Does the Federal Government support medical tourism?

The federal government is an enormous organization. There has not been a position transmitted by the Administration to our knowledge. However there is an arm of an important healthcare agency that has at its core, a mission to ensure patient safety for those seeking healthcare abroad.

Previous posts have discussed this in more detail, but the Joint Commission, previously JCAHO, has an affiliate arm, The Joint Commission International. It is this second body's role to review facilities and organizations abroad.

The Joint Commission International is invited to facilities in order to review their safety procedures, quality procedures, licensing and providers credentialling processes and other key organizational issues. They will render a determination that the facility is on par with US requirements or deficient in certain areas. They do not certify that the care is better or worse. Only that the safety features in quality programs and patient care problem resolution are effective and have an equivalence to those found here.

This is an important distinction. Our healthcare system is certified periodically by the former organization, The Joint Commission. They do not state that the healthcare at one facility is better than another, rather they certify that the same features described before exist and are effectively used. Loss of this certification is a death blow to a facility.

Be Well, Travel Safe,

Jim McCormick, MD
Premiere Medical Travel Company
818.917.6189

Is the medical care equal to, or better than the US?

As my business professors would answer...that depends.

What metrics and outcomes are you comparing and how are you comparing them? If you are comparing the World Health Organization's statistics on healthcare monitors we, in the US are doing a terrible job. If you are asking for the ability to go to a cutting edge tertiary care hospital and receive the latest greatest and hopefully best options we have more than you can imagine. They are however very expensive and not cost effective solutions to large scale healthcare issues.

Now mentally go to a community hospital or an inner city hospital faced with significant budget issues and concerns. There are less choices and less cutting edge (read more expensive) options available. Some places must transfer out heart attack patients for cardiac catheterizations. Other hospitals must transfer patients out for brain surgery emergencies and others for trauma patients. So if you had one of these conditions and the facility you wound up at does not treat that condition than you are at an potentially inferior hospital for that specific condition.

Some hospitals only specialize in a specific disease class or age groups. Examples would include cancer specialty hospital, eye institutes, orthopedics facilities and geriatric or pediatric hospitals. So arguably if you are in one of these hospitals and develop a condition outside their scope of practice you may receive inferior care or need to be transferred to receive adequate care.

Now move to a nitty gritty facility with many poor people who are very ill consuming many precious resources. They should have access to their needed medical care. But can the facility or the government spend endlessly to provide the latest, greatest and most expensive care?

Given the scenarios, I think we can agree that in the US there are different levels of care available which create a significant impact on the care received by our citizens.

Now let us move outside the US and examine this question again. Is it possible that there are hospitals outside the US who exist in countries that provide the latest, greatest care for those who can afford it? The clear answer is Yes. Then move to areas similar in capability to the US and the same gradients of care options appear.

As a medical traveler, you want to be helped in identifying the best facilities and the best providers for your condition in these locations. Then you can comfortably say that the care is comparable. On a more granular level you can say that the care is better than or equal to the US. But the question at that point is more a matter of all the amenities that you can afford when you select medical travel. These options are not even considerations when in the US seeking medical care.

Be Well, Travel Safe

Jim McCormick MD
Premiere Medical Travel Company
818.917.6189

What do the AMA guidelines for Medical Tourism mean?

They are a set of principles that are a balance between the acknowledgment that this industry exists, is here to stay and a need to meet their member's concerns. Medical Travel and tourism are future competitors with general US medical practice. The industry is not large enough to be a business concern, but it is predicted to grow to that point.

The guidelines are available at the AMA website. It is worthwhile to discuss them. The first one: Medical Tourism must be voluntary. Yes I agree voluntary, but who or what company would force this option upon an unwilling client? Forced care overseas is a recipe for a medical and public relations disaster. So I agree voluntary, but the Medical Tourism industry has ethical participants.

In the second, third and fourth, there are important issues that are discussed. It is very important for many reasons to have Joint Commission International or International Society for Quality in Health Care certification. These two bodies ensure that facilities are using the right process and procedural mechanisms to ensure patient safety. The countries and facilities have the same quality assurance that we do or a different, but equivalent, process for assurance. This is important to the longevity of the industry. They are benchmarks that help us interpret important safeguards across cultural, political and language barriers.

The next two are intimately tied together. Follow-up care must be financed and coordinated prior to departure. A less well defined one: coverage for travel outside the US for medical care must include the costs of necessary follow-up care upon returning to the U.S. I am a strong proponent of aftercare. It is essential that this is available to the patient. Who should pay for the cost of after care is a more difficult question. Should the insurance company who receives the financial benefit of success care rendered abroad? Should the patient who is uninsured seeking the care overseas at a steep discount to the price a U.S. physician and hospital would charge? Should the destination facility be responsible for this fee? Should the facilitators? The premise is medically correct, aftercare should be available upon return. The business aspects of who pays for are open for discussion.

Physician outcome data and HIPAA Compliance issues are reasonable requests as goals. We do not have full transparency on specific physician outcomes and do not fully enforce HIPAA in the U.S. that is our goal, to move the country in that direction. It is the right goal for everyone. Our colleagues abroad may feel it is unreasonable to ask for a perform better than we do on our own metrics. But the goal is valid.

The last one we fully embrace at Premiere Medical Travel. First and foremost is the healthcare. We have taken a particular stance in calling ourselves medical travel and not medical tourism. We believe tourism highlights the tourism component too much. For simple procedure or health check ups, this is feasible, but to recover from major surgery while on safari is unreasonable. Health first, experience next and everything should follow properly.

In general the AMA has it right in our view. There are some gaps in expectation and performance domestically on the aftercare, payment, outcome measures and HIPAA issues that warrant further examination. We can only expect others to perform at the level we set, embrace and enforce for ourselves.

Travel Safe, Be Well.

Jim McCormick, MD
Premiere Medical Travel Company, LLC
818.917.6189

Does a Complication Always Have to be a Disaster?

Truthfully no.

Medicine is a scientific art practiced by human beings. These three components fail. Even machines and computers running perfectly and incessantly fail at times.

Perhaps the better questions are:
1) Was the mistake or complications foreseeable and preventable?
2) Did the provider(s) make the best of the situation to correct the complication for the patient?
3) Do the people and the organization learn from the error and work to prevent it from happening again?

These are essential process components to any quality system. JCI mandates their existence at a surveyed institution.
Recently, I interviewed a patient who underwent abdominal surgery. She felt quite abandoned by her country and insurance company. The insurer contradicted itself in her mind. It would not perform the corrective surgery until she lost weight. They would not perform weight loss surgery until she corrected her first condition.

At this facility she had her weight loss surgery. One of her pre-existing hernias became stuck unrelated to her weight loss surgery. She was rushed back in the OR and had the hernias corrected. All performed quickly and with as much safety as could be achieved. The problem was rapidly identified and corrected. A turn she had not expected, but it was managed masterfully by this institution and its personnel.

To say that she was simply glowing is an understatement. There was not enough time to hear how happy she was that someone, this facility, took the time to give her the needed services that would allow her to get back to a healthy life. It took a complication in a foreign country to give her the keys for her life. The hernias were no longer there to cause her pain and discomfort. It was an inspiring story to hear her tell the events. She clearly felt and had the impression that this facility and its staff were on her side and acting to improve her health. It was clear in her mind which party had served her poorly.

So complications can have good outcomes. Not all, but some do end up with favorable events.

Travel Safe, Be Well
Jim McCormick MD
Premiere Medical Travel Company
www.premieremedicaltravel.net

How would we promote Medical Travel from non-west coast states?

I was recently asked about how to move patients from a non-West coast location to receive medical travel related healthcare. This was the response. The original posting can be found at: http://fastcompany.com/blog/james-mccormick-md/medical-travel-tourism

There are many global destinations that can provide healthcare, besides asian locations. We can assist your patients in sourcing care that is medically appropriate, culturally relevant, geographically important, or for purely interest in a location for medical care. All that can be done at an attractive value proposition.

A potentially important consideration in the analysis is the delay for a client to return to an active productive life.  A 6 t0 12 hour flight and recovery time next week is potentially more attractive, than a several month wait for a procedure appointment slot in a hospital bed, OR, day surgery or conscious sedation suite etc.

There are some important obstacles for some clients that will prevent their opting for this type of care plan. We can incentivize clients to move past their internal biases and concerns. We need to help them move from a place of hesitancy and uncertainty about medical travel to a zone of comfort and excitement. We must lead that campaign. That is where a physician led organization has a role. I understand patients, their needs and how to communicate to them.

Our perspective looks at the price issue from a different angle. It is and always will be, a avalue proposition. How much does a potential patient value their time hampered by a quality of life condition that can be corrected in an expeditious manner? What value does a patient place on waiting to return to an active, productive and involved life? 

Price cutting implies (in patient's minds) quality shortcuts. While the assumption may not be valid, it is likely at the forefront of any healthcare consumers mindset when we discuss price cuts.

The size of the destination facility can be less important than the capability, skill and expertise of the providers. Many of the existing facilities have designated areas in the hospital for medical travels to cater to their needs. Some are specializing in specific types of care.

We both know that complete solutions are never simple. There are important initiatives that the industry is currently building to implement in order to strengthen confidence for consumers of non-acute healthcare.

This industry can not solve our problems entirely. Rather it will be a important contributor to the solutions of the the US healthcare dilemma we face now and going forward for several years.

We, as an industry, are working to ensure that US standards are incorporated into the processes and practices abroad. JCI, an international arm of JCAHO, inspects facilities abroad. They certify that these standards are in place. I believe this certification is essential to ensure confidence and growth.

In my opinion, facilitators should play a role beyond booking flights etc. They should ensure seamless travel, privacy, and bidirectional transfer of medical information. This promotes the conditions for the best possible outcome for all involved.

There will be an important role for expert physicians and teams that can ensure the care and process are at a level acceptable to US payers, facilities and patient needs.

I would enjoy speaking to you and your group about this subject.

Jim McCormick, III M.D.

General Manager and President 

Premiere Medical Travel

818 / 917- 6189

http://premiere-medical-travel-blogspot.com/

Is the Philippines moving forward at a faster pace?

Recent conversations with a well placed individual in Manilla's healthcare system would clearly say "YES!"

More and more facilities are coming to understand the importance of JCI certification in order to have US clients feel more comfortable about medical care abroad. The government bodies that oversee this field are encouraging a broader embracing of participation in this important program.

There was a fair degree of certainty that the new air line terminal will open in the very foreseeable future. A welcome addition to the experience. It is an important improvement to the first impression that clients will experience.

As I stated in a previous blog post, there is tremendous investment in infrastructure here that will bear fruit. Perhaps sooner than I had expected. It is a welcome change in the schedule. The quicker the infrastructure and capacity is built the faster the market can mature here.

Are there agencies that oversee the standards of care in countries providing medical travel?

The answers depends on the interpretation of the word oversee.

In the US, the Joint Commission International (JCI) that reviews international hospitals on an invitation basis. If the facility meets preset standards for patient care and safety, quality controls, lab and radiology processes, and other important benchmarks to ensure your care is comparable to the United States; then it is a certified. 

The Council of Trent Accreditation Scheme is a UK based not-for-profit organization that serves a similar function to the JCI. It appears to play a similar role in certifying a hospital or organization outside the UK has comparable care.

There is no enforcement ability per se, except removal of the certification. This can mean significant loss in patient volume. The impact of a loss of certification may not be as powerful an indicator to medical travelers who arrive from countries other than the United States. It is important to understand that these organizations can not impose their standards on destination hospitals. 

These organizations are working to ensure that quality is the lead benchmark indicator. The presence of their certification should be reassuring, but not a guarantee of perfection. They are essential and contribute tremendously to the global growth of the industry. 

Jim McCormick, MD

Premiere Medical Travel