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
Showing posts with label quality improvement. Show all posts
Showing posts with label quality improvement. Show all posts
Wednesday, August 20, 2008
Monday, August 11, 2008
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
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
Friday, July 25, 2008
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
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
Monday, June 30, 2008
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
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