THIS WEEK IN U.S. DOMESTIC MEDICAL TRAVEL

Volume 2, Issue 3

Dear Colleagues,

When discussing the voluntary benefit space, a medical travel offering seems to be the missing puzzle piece. Employers are looking for answers that the medical travel industry provides, i.e. high-quality, cost-effective healthcare, so, why has medical travel not yet become a mainstream benefit?

Jim Ouimet, president, US Marketing & Sales, Afinium, Ltd., who plays an active role in both the voluntary benefit and medical travel spaces, says, "In my experience, it can be difficult to get people, including brokers, to expand professionally beyond their comfort zone or core competencies. I think this has been the case with medical travel."

In this issue, Ouimet hones in on the relationship between voluntary benefits and medical travel, and shares his thoughts on the likelihood of a voluntary medical travel benefit in the future.

We're starting to hear from many hospitals, independent surgi-centers and provider groups that want to be better positioned to serve self-funded employers offering medical/surgical travel options.  If you have a good story to tell us, please be in touch!  We want to boost opportunities for Centers of Excellence nationwide. 

Tell us:
What distinguishes your service offering in terms of cost, patient experience and satisfaction, outcomes, or other quality indicators. 

Send us your descriptor, including photos or charts, and we will evaluate for publication in this newsletter.

"Rising health insurance premiums, lack of transparency and increased awareness of how varied medical costs and quality vary dramatically between hospitals and across regions, have pushed consumers right into the arms of international and domestic medical travel. The growing industry provides the perfect solution for patients to receive the high-quality, cost-effective care that they need AND rightfully deserve!" - Laura Carabello, Executive Editor& Publisher, Medical Travel Today & U.S. Domestic Medical Travel.

READERS: I invite you to send quotes relevant to domestic medical travel to editor@usdomesticmedicaltravel.com to be featured in upcoming issues of U.S. Domestic Medical Travel.

 

Thank you for your interest in this exciting, growing market space. Please be in touch with your comments and editorial contributions, which can be sent directly to: editor@USDomesticMedicalTravel.com.

Laura Carabello
Editor and Publisher

 

SPOTLIGHT: Jim Ouimet, President, US Marketing & Sales, Afinium, Ltd.

www.afinium.com

About Jim Ouimet
Jim Ouimet is president, US Marketing & Sales, for Afinium, Ltd., a customer-centric enterprise enrollment and marketing platform using self-learning algorithms and configurable rules to support automated sales and marketing. He is also founder of JCG consulting, a thought leadership firm dedicated to advancing ideas and strategies focused on staying ahead of the curve and maintaining a competitive advantage in the benefits market place.

Jim began his career with MetLife where he was instrumental in the development of Met's individual voluntary benefits program. He subsequently served as vice president of Broker Sales for BCBS of Kentucky, and was president and CEO of Kentucky Home Mutual and Kentucky Life Insurance Companies. Jim co-founded the Workplace Benefits Association, the industry's foremost association focused on workplace benefits, and served for three years as its first president. He has served on the association's board since its inception. He has addressed many groups in insurance and financial services, and has been published in a number of prominent industry magazines. He authored a book on the discipline of selling entitled The True Basics of Successful Selling, and eBooks, Becoming Customer Centric in a Product Centric Industry, and Big Data Big Sales, which are available on Amazon. In 2000, Jim was inducted into The International Worksite Marketing Hall of Fame. He is a graduate of Dominican College and received his MBA from the University of Notre Dame.

About Afinium, Ltd.
Afinium has 15 years of data-driven marketing and enrollment experience within the insurance and financial services markets in Europe and the United States. Afinium delivers a smarter way to sell insurance and other financial products and services, empowering consumers and improving product distribution through multi-channel sales platforms. Afinium combines cutting-edge technology with years of sales and marketing expertise to bring its customers a set of innovative tools absolutely crucial to successful marketing, distribution and sales. www.afinium.com

U.S. Domestic Medical Travel (USDMT): Tell us about your interest in voluntary benefits.

Jim Ouimet (JO): While my voluntary benefits experience began in 1980 at MetLife, I became even more intimately involved with the inception of the Workplace Benefits Association in 1997.

Additionally, in 1998, I joined Afinium, a company that serves the affinity and workplace voluntary benefits space with enrollment software that is highly customer-centric and data-driven - gathering and analyzing customer information in real-time, turning it into actionable insights, and changing the tone and content of the presentation in real-time as well. The software becomes familiar with the customer and enables outbound marketing going forward based on prior information. This way you are always reaching out to each individual customer, in worksite, to each employee, with information that you know is relevant to them.

USDMT: Are you familiar with medical travel?

JO: Absolutely. In fact, I wrote an article a few years ago entitled: "Converting Medical Tourism into Customers - What Every Broker Needs to Know."

As a former broker, I believe that insurance professionals must be able to serve their clients' needs - and if you are a professional in the health insurance space, you should be at least somewhat knowledgeable on the growing medical travel industry.

A lot of people have doubted the future of medical travel and even based their business model on that assumption. However, after the implementation of the Affordable Care Act (ACA), consumers are searching for the highest quality medical care at the most affordable price - no matter where the location.

USDMT: Is there a higher interest in international or domestic medical travel among employers?

JO: Right now, employers are primarily interested in domestic medical travel, but I think that may change.

At conferences, I tend to ask individuals, "If you could receive a surgical procedure for X number of dollars in, let's say Mexico as opposed to the U.S. - or any other country for that matter - would you be willing to do it?"

Right off the bat, most people will say, "Absolutely not." But when they hear that a procedure could be performed at a foreign facility affiliated with a major Center of Excellence (COE) in the U.S., they will change their answer.

As the U.S. becomes more global in its approach to medical care, international medical travel will expand.

USDMT: Where does medical travel fit into the voluntary space?

JO: In relation to the voluntary benefit space, medical travel is a clear fit, but we're not there yet.

Years ago, I worked for a health insurance company that hired me to introduce voluntary benefits to their brokers. From my experience, it can be difficult to get people, and brokers are no exception, to expand professionally beyond their comfort zone or core competencies. I cite this story because I think that will be the case with medical travel.

I think it will certainly be a challenge to introduce medical travel as a voluntary benefit, but the fact is employers are going to be looking for the solutions medical travel provides, and that will lend itself to medical travel becoming a more mainstream voluntary benefit over time.

USDMT: What should employees look for in terms of voluntary benefits?

JO: It's always been sort of a gap analysis - depending on where the gaps are in an employer's current benefit program, to help us determine where we can fill in with voluntary benefits.

Generally, the rule of thumb has been to only offer one or two benefits at a time. This is because offering more than that at one time may tend to confuse employees and minimize participation.

Today, there is a general understanding that one size no longer fits all - each employee has his or her own unique set of needs that should be recognized and fulfilled.

Now that technology is making its way into the insurance industry in a way that can benefit brokers and their clients, i.e. employers and employees, a full range of voluntary benefits will be available to satisfy the specific needs of each individual. As a result, we should see dramatic change and growth in the enrollment process and the voluntary benefit space.

USDMT: How would facilities get involved in offering a medical travel benefit?

JO: That's a really tough question.

I'm a broker by trade, and would suggest that facilities that are interested in offering a medical travel benefit should reach out to the broker that handles their core or voluntary benefits packages. If brokers take the time to educate themselves in medical travel and how it can play into benefits programs, they will be able to provide appropriate counsel to their clients.

USDMT: Do you think having a medical travel benefit would be attractive?

JO: I do think a medical travel benefit would be attractive.

I've been in this business for almost 40 years. Good brokers want to serve their customers fully, and be, or become, the valuable, trusted advisor that employer groups are looking for. To do this going forward, they must know about medical travel and provide the opportunity for their clients to understand how and where they can get high-quality, cost-effective care.

USDMT: Do you see value in a voluntary benefit exchange?

JO: I'm not sure there's a role for a voluntary exchange on a standalone basis at the moment, but I think voluntary products are going to become a critical component of the healthcare exchanges currently in place.

Choosing the Right Hospital: Helping Employees Avoid Potential Harm 
by Spencer Whipple and Benjamin Tabah

Introduction

Fifteen years ago, the Institute of Medicine published a 223-page report called To Err is Human: Building a Safer Health System. The report alleged that up to 98,000 people die in hospitals every year due to preventable medical errors, which represents up to four percent of all deaths in the U.S. The result of this report was a national uproar from the public and the medical community, and was featured on major news outlets including NBC, ABC, the New York Times, the Washington Post, and USA Today; it is estimated that over 100 million Americans were exposed to coverage about the epidemic of medical errors.

This led to numerous legislative changes and the creation of organizations (both public and private) focused on patient safety and quality of care, including:

  • the Healthcare Research and Quality Act of 1999 (which authorized the Agency for Healthcare Research and Quality, or AHRQ, as the lead agency);
  • the Leapfrog Group, officially launched in November 2000 (citing To Err is Human as a focal point for their founding) ;
  • the Patient Safety and Quality Improvement Act of 2005;
  • the AHRQ program Voluntary Reporting of Adverse Events; and
  • in 2004, the launch of the "100,000 Lives Campaign" by the Institute for Healthcare Improvement (IHI), with the goal to extend or save 100,000 lives from January 2005 through June 2006 by getting hospitals to adopt targeted best practices. This program was meant to be recurrent.

The problem was serious but optimism was high to fix the system, and the IHI aptly summed up the spirit of the age: "Some Is Not a Number. Soon Is Not a Time. The number is 100,000. The time is NOW."

Fifteen years later, although important strides have been made and millions of private and tax dollars spent, the results are objectively underwhelming. In fact, some have suggested that the situation has actually gotten worse. At a minimum, it appears that initial projections of 98,000 deaths were not accurate. According to a 2013 study, the actual number is likely two to four times higher, representing 210,000 to 440,000 preventable deaths occurring in hospitals per year. Leah Binder, president and CEO of the Leapfrog Group, captured the situation in this way:

"...Hospitals are killing off the equivalent of the entire population of Atlanta one year, Miami the next, then moving to Oakland, and on and on."

All told, Americans will have an average of 9.2 medical procedures in their lifetime, and according to studies, in 25 percent of these procedures they will be harmed by medical errors. It is time to acknowledge that at best, the healthcare system as we know it is incapable of repairing itself; at worst, it has only a passive interest in doing so due to conflicting financial considerations. The fee-for-service structure has the potential to reward these types of medical errors, as hospitals charge for treatment required to manage the consequences of medical errors -- something we see regularly at Global Excel Management (GEM).

The future is not entirely bleak, however; as we shall see, many hospitals offer quality care at reasonable prices for specific conditions - the key is finding them.

How Hospitals Do Harm

Hospital Overtreatment

The U.S. spends over three trillion dollars per year on healthcare, and hospitals take 35 percent of that (or over one trillion dollars), representing the single largest source of spending. Many studies support that 30 percent ($300-$350 billion) or more of these funds are compensation for unnecessary and inefficient care.

High-quality facilities offer the right care at the right time; nothing more, nothing less. This results in better outcomes and lower costs. However, many facilities overuse key resources, which is both expensive and harmful.

Diagnostic imaging such as MRI and CT scans, for example, are often used in a hospital setting but many, possibly up to a third, of these tests are not necessary. While some would say that it is better to be safe than sorry, the fact is that these tests expose patients to large doses of radiation, and new studies have found that up to 29,000 deaths can be attributed to overexposure to radiation in the clinical setting.

Another example is the overuse of blood tests on patients scheduled for heart surgery. A study from the Annals of Thoracic Surgery found that there was an average of 116 tests per patient and that many patients required transfusions to offset their blood losses. This in turn led to more post-operative infections, more time on a ventilator, and more deaths. Diagnostic testing is big business for hospitals but, unfortunately, there are unintended consequences as it relates to patient safety.

Patient-Centered Care

Hospital systems are notorious for buying up new technologies and marketing the fact that the care they render is superior to that of the competition. However, not all technologies actually represent advancements in quality of care. Take, for example, robotic surgical technologies, which have great promise for certain types of surgery, but overall have not been proven to provide an additional benefit to most patients.

This can be a concern as these large pieces of equipment, in the case of a patient "crashing" during surgery, can actually get in the way of a surgical team that needs to intervene. Furthermore, robotic surgical technologies are very expensive to purchase and maintain, and lead to a surcharge on hospital bills. For certain procedures, it is estimated that these robotic technologies add an average of 11 percent to the total cost of the surgery, but rarely add a tangible benefit to the patient. GEM recently reviewed a claim where use of the Da Vinci Robot increased the billed charges by over $120,000 (in this case 70 percent of the total bill), with no supporting documentation demonstrating its necessity. Through discussions the provider wrote off all charges associated with the use of the robotic device.

Not only do hospitals over-invest in some technologies, they can under-invest in new approaches or technologies that do have proven benefits for patients. For example, large and well-funded university-based hospitals are actually slower to adopt new methodologies as the teachers follow an "old guard" mindset, whereas smaller and lesser-known community hospitals can be much more progressive and eager to adopt new and improved methods.

Hospital Errors

Though certainly not intentional, many serious and preventable errors can occur in the hospital. The worst of such errors are called "never events":

  • Foreign object retained after surgery (e.g. scalpels, sponges, retractors)
  • Air embolism
  • Pressure ulcers, Stage 3 and 4
  • Trauma and falls
  • Collapsed lung due to medical treatment
  • Breathing failure after surgery
  • Postoperative PE/DVT (a deadly blood clot)
  • Wound split open post-surgery
  • Accidental cuts or tears linked to medical treatment

Not all errors are so extreme. Other examples include post-surgical infections due to suboptimal cleanliness, or preventable readmissions (a.k.a. revolving door syndrome or "bouncebacks") within 30 days of discharge due to poor communication, coordination of care, etc. Some hospitals, even after adjusting for severity, have twice the rate of readmissions as that of other similar hospitals.

To make matters worse, a recently published article actually quantified that hospitals with higher rates of complications had higher profit margins as compared to hospitals with lower complication rates. In contrast, lower cost hospitals that are less likely to over-utilize healthcare services had better quality than higher charging facilities.

Hospital Quality Performance is Disease-Specific

All hospitals must be licensed to provide care, which means that they meet the minimum safety guidelines and have the proper infrastructure to provide care. Many consumers assume this means a facility must also provide high-quality care, and this is simply not the case.

The Joint Commission offers both hospital accreditations and disease-specific certifications. Whereas the former deal with the entire organization, the latter deal with establishing best practices for certain types of care for a specific disease. Hospitals may get a passing grade overall, but that doesn't mean every department functions at a high level. For this reason, quality of care data is collected on a disease-specific basis so that high hospital performers can be duly recognized for their excellence in certain types of care.

Hospitals are required by the government to submit information on outcomes, which can be used to determine which hospitals are better at providing disease-specific care. Unfortunately, this data is rarely considered or presented to consumers.

Many consumers assume that if a hospital is "in-network," it provides high quality care for their specific disease. However most, if not all, preferred provider organizations (PPOs) end their review of quality of care at the minimum hospital accreditation level, not assessing differences in patient outcomes of care on a disease-specific basis, and they assign a percentage discount for the aggregate of all the services provided at the hospital.

What if a facility's quality for neurosurgery is high, but the quality on orthopedics is very low? Why would one pay the same ‘discounted' rate for both? And shouldn't the patient be made aware of these stark differences in quality at a facility they are told is "in-network" and therefore high-quality? Is there another in-network facility that could do better for the orthopedic procedure and possibly for less cost? Perhaps the best option for both cost and quality is out-of-network?

How Consumers Choose Hospitals: Looking for a Better Way

As shown above, there is a lot of misinformation about hospital care, attitudes such as "more is better" or "the most expensive care is the best care." This is simply not factual. And yet consideration for quality and efficient care (i.e. lower cost) in hospital selection is virtually non-existent in today's market.

Today's consumers often choose the hospital based on physician recommendation, network status, the one with the most billboards, the easiest parking, the nicest lobby, the best reputation with friends and family, etc. In other words, consumers (and in most cases, physicians) do not consult hospital quality of care data.

Hospital Quality of Care Data Options

There is a host of available resources to help determine a hospital's quality for a variety of care types. Here are a few examples along with the data they consider for their findings:

  • The US News & World Report is derived from three measures weighted equally: hospital infrastructure, hospital reputation with subspecialists, and 30-day mortality rates.
  • HealthGrades' proprietary rating system predominantly uses mortality for most of their ratings, with select procedures assessed for post-surgical complications.
  • Leapfrog focuses primarily on structure, process and best practices for patient safety.
  • Comparion Medical Analytics considers mortality, complications, inpatient quality, core process, patient safety, and patient satisfaction. Data is subdivided by clinical categories (such as cardiology, orthopedics, etc.), and adjusted for age and severity.

But can this data be used to improve hospital selection and if so, what are the tangible benefits of doing so? Consider the following real example of a coronary bypass in an urban center in Illinois using a primary PPO:

Facility 1 (a university hospital), rated at the 48th percentile of quality for DRG 234 (Comparion), charges on average $201,000, and the in-network rate is $129,000.

Facility 2, rated at the 98th percentile in quality for DRG 234 (Comparion), charges on average $147,000, and the in-network rate is $89,000.

By simply choosing Facility 2, the member receives higher quality services (and is more likely to avoid overutilization and harm) and the payer (an employer in this case) saves approximately $40,000 for this episode of care. In a real world example GEM was asked to secure a case rate for a specialized neck surgery in New York. After reviewing cost and quality metrics and the treating doctor's admitting rights, GEM was able to have the surgery moved to a facility less than 10 miles away to a hospital with higher quality of care and saved over $100,000 by accessing a more favorable discount.   

Arming Patients with Knowledge

Patients want to know that they are receiving the best care available, and at the lowest out-of-pocket expense for themselves. This is aligned with the goals of insurers and self-funded employers, who want to obtain affordable quality care for their members.

The key is finding a bridge between this knowledge and the member that allows them to make informed decisions about their healthcare and finances. GEM recently launched FairChexTM, a simple and low cost program that supports all stakeholders in comparing value when shopping for elective surgery. FairChex consolidates cost-quality data to a simplified letter score, which is communicated to the member through a trusted source.

With proper plan language and incentives, members can be engaged to choose high-value care.
By factoring costs, quality and discount information, substantial savings can be achieved for payers and patients through the strategic selection of high quality and lower cost facilities. Most importantly, the member may be spared from needless and expensive harm. 

Conclusion

Dr. Marty Makary, Surgical director at Johns Hopkins and New York Times best-selling author of Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care, offers this suggestion: "Businesses may find it in their best interests to actively assist people to find the best medical care." Employers can use cost-quality tools to help protect their employees in a tangible and realistic way while drastically reducing hospital costs. By educating employees, and providing rewards to encourage usage (adoption is a critical component to these programs), employers can truly reform healthcare one admission at a time.

About the Authors
Spencer Whipple is Large Loss specialist at Global Excel Management. He advises clients, including self-funded TPAs, stop loss carriers and international travel insurers, on cost containment strategy for catastrophic claims. Spencer works closely with GEM's team of claims resolution specialists to align resources and approaches with clients' needs on their most difficult claims.

Benjamin Tabah manages GEM's Product Development and Marketing team. His focus on developing different approaches to cost management has led to a commitment to developing healthcare literacy tools designed to provide self-funded groups with the knowledge required to make informed decisions about their healthcare needs.

Susan Dentzer, Media Mistakes in Coverage of the Institute of Medicine's Error Report, http://ecp.acponline.org/novdec00/dentzer.htm, December 2000.
Retrieved from http://www.leapfroggroup.org/about_leapfrog.
John T. James, PhD. "A new, evidence-based estimate of patient harms associated with hospital care", www.journalpatientsafety.com, Lippincott Williams & Wilkins, 2013.
Leah Binder, "Stunning News on Preventable Deaths in Hospitals", http://www.forbes.com/sites/leahbinder/2013/09/03/the-shocking-truth-about-medication-errors/, September 3, 2013.
New England Journal of Medicine, "Temporal trends in rates of patient harm resulting from medical care"; 363, no. 22 (2010): 2124-34, as quoted in Marty Makary, Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care (Bloomsbury USA, 2013), introduction.
Institute of Medicine, Transformation of Health System Needed to Improve Care and Reduce Cost, http://www.iom.edu/Reports/2012/Best-Care-at-Lower-Cost-The-Path-to-Continuously-Learning-Health-Care-in-America/Press-Release.aspx, press release, September 6, 2012.
Leana Wen, MD and Josh Kosowky, MD. When Doctors Don't Listen: How to avoid misdiagnoses and unnecessary tests (St. Martin's Press), January 2013, 81.
The Annals of Thoracic Surgery, March Issue News Release, March 2015, as cited by Robert Preidt, "Do Heart Surgery Patients Get Too Many Blood Tests?" http://consumer.healthday.com/circulatory-system-information-7/blood-disorder-news-68/do-heart-surgery-patients-get-too-many-blood-tests-696852.html, March 2, 2015. http://www.medicinenet.com/script/main/art.asp?articlekey=187195
This section is largely indebted to research from Makary, Unaccountable, chapter 12, "All American Robot".
Eva Kiesler, PhD. "Study Shows Robotic Surgery Holds No Major Advantages for Bladder Cancer Patients", http://www.mskcc.org/blog/study-shows-robotic-surgery-holds-no-advantages-bladder-patients, July 24, 2014.
Makary, Unaccountable, chapter 12.
The Dartmouth Institute for Health Policy and Clinical Practice, "U.S. Hospitals, Facing New Medicare Penalties, Show Wide Room for Improvement at Reducing Readmission Rates", http://www.dartmouthatlas.org/downloads/press/Post_Acute_Care_Release_092811.pdf, September 28, 2011.
Sunil Eappen, MD; Bennett H. Lane, MS; Barry Rosenberg, MD, MBA; Stuart A. Lipsitz, ScD; David Sadoff, BA; Dave Matheson, JD, MBA; William R. Berry, MD, MPA, MPH; Mark Lester, MD, MBA; Atul A. Gawande, MD, MPH. "Relationship Between Occurrence of Surgical Complications and Hospital Finances", Journal of the American Medical Association (JAMA), April 17, 2013.
Makary, Unaccountable, 77.

Paralysis by Analysis: Or the Only Thing We Have to Fear Is, Fear Itself
By Richard Krasner

Having now written this blog for more than two and a half years, I find that when I discuss the issue of medical travel, either for workers' comp or for general healthcare, there are dozens of reasons (or maybe they are excuses) given by various individuals I have conversations with about why medical travel is not feasible or even profitable.

Being an intelligent, well-educated person, I know that this country has put men and women into orbit, landed on the Moon, and have sent unmanned spacecrafts to every single planet and planetoid in our system, as well two probes out of the solar system and into deep space.

And yet, as complicated as these space missions were, no one ever said it was impossible. No one ever said it would never work. No one ever said it was not profitable. And no one ever said there was no incentive in it for this one or that one, etc., ad infinitum.

However, that is not the case with medical travel. There always seems to be some kind of reason, some kind of caveat, and some kind of negative excuse given against this idea. And mostly, it concerns what some lawyer would do to an employer, or other entity that puts the fear of a lawsuit or economic ruin if this were to be attempted.

But it is not just lawyers who are at fault here for the fear that I am sensing. Laws and regulations designed to deal with all aspects of the healthcare and benefits fields, not to mention the statutes and regs in workers' comp, are to blame for what a career counselor I knew years ago here in Florida, used to tell unemployed people at the weekly workshop.

He was a retired engineer, and in his field, they talked a lot about "paralysis by analysis", and how we stop doing things once we analyze it to death. This was true in the engineering field, and is true in doing a job search, and even implementing medical travel into either healthcare or workmans' comp.
We are so used to being afraid of doing new things, we are so afraid of doing something different and out of the norm, that one has to wonder why any of us get out of bed in the morning, or leave the house for that matter, fearing that something terrible is going to happen.

As pertains to medical care, of course bad things can happen. They can happen in the hospital across town, or on the way to the hospital, but we don't avoid it because of what might happen. The same is true for medical travel. The same complications and negative outcomes can occur here that they are afraid of might happen over there.

Then there is the legal liability excuse. Damn, if I had to worry about legal liability, I would not take my car out of the garage.

And here again, we come back to the issue of lawyers and lawsuits, etc. As many of you may know, my father died last September, and since then, and earlier that year, we had to deal with lawyers to handle family matters in the event one or both of my parents passed away.

The first lawyer we used is the best friend of my first cousin, and was the person who drew up several legal documents for my parents in the past. The second lawyer was referred to me by the first lawyer after my father died, and I was using him up until April, when my brother decided to go with someone who was referred to him by a fourth lawyer he sat next to on the plane to Miami when my brother came for a short visit.

I have known many lawyers in my life, as no doubt many of you have, and on the whole, they are not a bad lot. But some of them are just out for the money and to prevent progress on a whole range of fronts, including healthcare and workers' comp.

I have worked for and under two lawyers in my career in claims. Both of them did not leave me with a good feeling for insurance lawyers, so when I hear that employers are afraid to consider medical travel to save money on expensive surgeries, or that some large organization in the labor world might sue an employer or a union because benefits are negotiated in collective bargaining agreements, then it tells me that people are afraid that it might work.

Instead, the lawyers force employers and insurers to spend more money because it is in a contract, or they want to use American medical providers, etc. even though it has been clearly proven that ours is the most expensive healthcare system in the world.

FDR said in his first inaugural address that the only thing we have to fear is, fear itself. It would seem that in the case of medical travel, it is not fear itself we fear. We fear lawyers and lawsuits. We fear what others might say or do. We fear that employees will like to go abroad because the care is better. We fear that employers will save money, which rightfully belongs to those who are profiting from the status quo, and most importantly, we fear that we aren't the best in everything, except in self-delusion and in paralysis by analysis.
We can do better.
I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client's employees.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com. Ask me any questions you may have on how to save money on expensive surgeries under workers' comp. Connect with me on LinkedIn and follow my blog at: richardkrasner.wordpress.com. Share this article, or leave a comment below.

To read the original article click here.

Follow-up Visits After Surgery: Telehealth, Medical Travel and Workers' Comp
by Richard Krasner

One of the questions posed to me when I have discussed the idea of medical travel in workers' comp is what to do with follow-up care.

In an article this week from Reuters, Andrew Seaman wrote that people may happily, and safely, forgo in-person doctors' visits after surgery by opting instead for talking with their surgeons by phone or video. Seaman said this was the result of a small study of U.S. veterans.

The study, conducted by researchers in JAMA Surgery, said most patients preferred the virtual visits and that the doctors didn't miss any infections that popped up after surgery.

Lead author Dr. Michael Vella, of Vanderbilt University Medical Center in Nashville, said, "These kinds of methods are really important in the climate we're in now...So I think anything you can do to save money, see more patients and improve access to care is really important."

Vella and his colleagues also wrote that there is interest in so-called telehealth to increase access to healthcare while also decreasing the costs associated with traveling to office visits.

Past research has found that telehealth visits may be useful in the treatment of chronic conditions and after surgery, but less is known about patients' preferences for these types of visits, they added.

The study team evaluated data collected over several months in 2014 from 23 veterans, Seaman reported, and all but one of them were men, who were seen three times after a simple operation that would require only a night or so in the hospital. One visit was via video, the second was via telephone and the third was an in-person office visit.

The researchers found that no post-operation infections were missed during the video or telephone visits.

Dr. Vella said, "The veterans were very good at describing their wounds...There was one patient who thought they were having problems, so we brought them into clinic and there was an infection."

Overall, the study found that 69 percent of the participants said they preferred a telehealth visit over the traditional in-office visit. Those who preferred the telehealth visit tended to live farther away from the hospital than those who would rather come into the office.

"I think (the study) challenges the paradigm that we need to see all patients back for visits," Vella said.

Dr. Vella cautioned that the study was small, and they could not say that telehealth visits won't miss problems. The study also cannot assess how telehealth visits would work for patients who have undergone more complex surgeries, according to Dr. Vella.

An alternative opinion was given by Dr. Sherry Wren, who was not involved in the new study, and also cautioned that not all patient preferences will align with the telehealth model.

"There will be patients who want to be seen, be reassured and want a doctor to check something out," said Wren, a professor of surgery at the Palo Alto Veterans Affairs Health Care System in California.

Still, she said, many patients will like the option.

"There is a subset of patient that it's not going to be appropriate for, but I think it's a great alternative for the vast majority of patients."

Dr. Vella said future research showing the results of the real-world implementation of telehealth will provide more information on its safety.

"I think it's just really important that people continue to look at it," he said.

What does this mean?
It means that when medical travel is ever implemented into workers comp -- and that day grows ever closer -- after a patient goes home to his/her country, they will still be able to get follow-up care from the surgeon who performed the surgery, without having to fly back to the medical travel destination several times.

Will it work for everyone? Both Drs. Vella and Wren indicated that there are people who will not want it, and subsets of patients for whom it will would not be appropriate, but overall they were both very positive about the future of telehealth visits after surgery.

If it worked for American veterans, it can certainly work for injured workers covered under workers' comp, Veterans, especially those from our two ill-designed, ill-planned, and ill-conceived wars in Iraq and Afghanistan, certainly have wounds more serious than most injured workers would suffer as a result of a work-related injury.

The only thing that stands in the way of introducing telehealth into workers' comp, with or without medical travel, is what is between the ears of the leaders and "so-called" experts in the industry who have thus far gone and done the same things over and over again, and expect different results.

And you know what that is? Crazy, stupid, ridiculous, without any credibility, and without any traction in logic, which, I suspect is where the stuff between their ears are in.

To view the original article click here.

Kaiser Family Foundation Survey: Health Insurance Deductibles Outpacing Salaries

Nbchnewsletter.blogspot.com-This week the Kaiser Family Foundation/Health Research & Educational Trust (HRET) released its 2015 Employer Health Benefits Survey, an annual survey of employers that provides a detailed look at trends in employer-sponsored health coverage including premiums, employee contributions, cost-sharing provisions, and employer opinions.

To read the original article click here.

New Treatments For Congestive Heart Failure Could Be Too Costly
by Ron Shinkman

Fiercehealthfinance.com-Two new treatments have arrived to mitigate the effects of congestive heart failure (CHF), a growing problem in the United States. But their cost may be prohibitive, according to a new report by the Institute for Clinical and Economic Review (ICER) and the California Technology Assessment Forum.

To read the original article click here.

New Jersey Providers Mystified Over Blues Selection for New Network
by Ron Shinkman

Fiercehealthfinance.com-A big New Jersey insurer has created a tiered network from scratch that has excluded many of the state's biggest hospitals, leading executives to engage in behavior ranging from head-scratching to claims of religious discrimination.

To view the original article click here.

Lawmakers, Industry Leaders Clash Over Effects of Healthcare Consolidation
by Leslie Small

Fiercehealthpayer.com-While politicians and industry experts who spoke at a congressional hearing Thursday were divided about whether the Affordable Care Act is driving healthcare industry consolidation, nearly all agreed on one point: They are deeply concerned about the pending health insurance mergers.

To view the original article click here.

IV Drug Use Emerging as Top Risk Factor for MRSA Infections
by Julie Bird

Fiercehealthcare.com-With the rate of the most common form of methicillin-resistant Staphylococcus aureus (MRSA) infection falling in hospitals but remaining steady in the community, the biggest emerging risk factor for infection is intravenous drug use, a study published in Infection Control & Hospital Epidemiology found.

To view the original article click here.

California Launches Price Comparison Website But Procedure Costs Remain Unclear
by Ron Shinkman

Fiercehealthfinance.com- California is the latest state to get into the healthcare price transparency game, with one of its regulators launching a healthcare services comparison site in conjunction with Consumer Reports and the University of California at San Francisco.

To view the original article click here.

Short Pause After Patient Death Helps Medical Teams Recover Emotionally
by Julie Bird

Fiercehealthcare.com-Medical teams at the University of Virginia Medical Center find that pausing for a few moments after a patient dies helps them accept the loss and experience less emotional trauma.

To view the original article click here.


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U.S. Domestic Medical Travel, a sister publication to Medical Travel Today www.medicaltraveltoday.com, is a newsletter published by CPR Strategic Marketing Communications, an international marketing and public relations agency based near New York City that specializes in healthcare and life sciences. In the new era of health reforms, U.S. Domestic Medical Travel discusses the growth of domestic medical travel and its importance to hospitals, employers, insurers, health plans, government, TPAs, brokers and other intermediaries.

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News in Review

Choosing the Right Hospital: Helping Employees Avoid Potential Harm

Paralysis by Analysis: Or the Only Thing We Have to Fear Is, Fear Itself

Follow-up Visits After Surgery: Telehealth, Medical Travel and Workers' Comp

Kaiser Family Foundation Survey: Health Insurance Deductibles Outpacing Salaries

New Treatments For Congestive Heart Failure Could Be Too Costly

New Jersey Providers Mystified Over Blues Selection for New Network

Lawmakers, Industry Leaders Clash Over Effects of Healthcare Consolidation

IV Drug Use Emerging as Top Risk Factor for MRSA Infections

California Launches Price Comparison Website But Procedure Costs Remain Unclear

Short Pause After Patient Death Helps Medical Teams Recover Emotionally

NETWORKING JUST GOT EASIER