Volume 2, Issue 7

Dear Colleagues,

Employers and plan sponsors increasingly recognize the cost-savings and quality that result from utilization of ambulatory surgery centers (ASCs) - which are often physician-owned. ASCs are now offering a wide range of surgeries well beyond the traditional orthopedic procedures. Read on to see what is now available in gynecologic surgery. .

Hugo D. Ribot Jr., M.D., founder and co-owner, Georgia Advanced Surgery for Women, discusses his outpatient model, where he performs major gynecological procedures - done by 99 percent of all U.S. gynecologists in a hospital setting -- at unbelievably low rates.

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 and Publisher, Medical Travel Today and U.S. Domestic Medical Travel.

READERS: I invite you to send quotes relevant to domestic medical travel to 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:

Laura Carabello
Editor and Publisher

SPOTLIGHT: Hugo D. Ribot Jr., M.D., Founder and Co-owner, Cartersville Ob/Gyn Associates

Cartersville Ob/Gyn Associates
958-A Joe Frank Harris Parkway
Suite 102
Cartersville, GA 30121

About Dr. Hugo D. Ribot Jr., M.D.
Dr. Ribot is a board certified physician in the specialties of obstetrics and gynecology, and advanced operative laparoscopy, and the managing partner of Cartersville Ob/Gyn Associates. A 1981 graduate of Dartmouth College, Dr. Ribot received his medical degree from the University Of Miami School Of Medicine in 1986. He completed his residency in obstetrics and gynecology at Emory University Affiliated Hospitals in 1990, receiving its first-ever annual "Best Laparoscopic Surgical Resident Award." Since joining Cartersville Ob/Gyn in 1990, he has introduced to the northwest Georgia region numerous advancements in the specialty. Dr. Ribot is also the founder and medical director of the practice's onsite outpatient surgical facility, the Georgia Advanced Surgery Center for Women.

About Cartersville Ob/Gyn Associates
Cartersville Ob/Gyn Associates is a full-service Ob/Gyn practice, delivering women the exceptional care, medical expertise, compassion and support they deserve through every life cycle - from menstruation and childbirth to menopause and beyond.

Cartersville Ob/Gyn Associates has been a leader in women's healthcare for over 30 years, introducing many innovations and advancements that have become the gold standard of treatment and care for our specialty. Cartersville Ob/Gyn Associates was the first practice in the Cartersville/northwest Georgia area to: offer obstetric patients collaborative midwifery/physician care; provide non-invasive sterilization; and introduce minimally invasive surgical procedures for hysterectomy, incontinence, infertility and other common gynecological and pelvic conditions, as well as an outpatient surgical protocol for these procedures.

In addition, Cartersville Ob/Gyn Associates is the only Ob/Gyn practice in Georgia with an onsite, fully accredited, state-of-the-art outpatient surgery center for performing all major and minor gynecological surgeries. This-state-of-the-art facility, the Georgia Advanced Surgery Center for Women (GASC), is among only a few facilities in the entire country awarded special Center of Excellence designation by the American Association of Gynecologic Laparoscopists (AAGL), the premier standards-setting organization for the specialty of minimally invasive gynecologic surgery.

The Cartersville Ob/Gyn Associates practice, surgery center and board certified physicians and midwives offer the highest level of ob/gyn care available today.

U.S. Domestic Medical Travel (USDMT): Give our readers some background on your professional experience.

Dr. Hugo Ribot (HR): I am a practicing Ob/Gyn physician, as well as founder and co-owner of the Georgia Advanced Surgery for Women - an ambulatory surgery center that is part of our Ob/Gyn practice.

Georgia Advanced Surgery for Women is conveniently located in Cartersville, Georgia - a quick 30-40 minute drive from Atlanta, Georgia.

I finished my residency in 1990 and have been practicing medicine in the same location ever since. We've been very fortunate to have a wonderful, growing practice.

Since the early 1990's, I have made it my mission to specialize in delivering babies, as well as minimally invasive gynecological surgery.

Do patients travel to your center?

HR: Yes, we have been hosting travel patients for some time now - some from North Carolina, Texas, Florida, and even as far as the U.S. Virgin Islands. We are one of two gynecology-only surgery centers in the entire country.

A colleague of mine connected me with Bridge Health and Pro Health Partners, and I was able to establish a great relationship with this high performance network.

USDMT: What are the reasons that patients travel to your center?

HR: Two of the main reasons females consider traveling for gynecological surgery are quality and cost. We have studied every single gynecological procedure outside of oncology, ranging from hysterectomies and bladder tacks to removal of endometriosis, prolapse procedures, rectal seal or uterine prolapse. We have successfully been able to perform all of these procedures within our ambulatory surgery center.

USDMT: What are the advantages of undergoing these procedures in an outpatient setting versus the hospital?

HR: Georgia Advanced Surgery for Women opened in May of 2010, so we are coming up on our sixth year, and we have been able to develop techniques that have allowed every one of our patients to stay out of a hospital setting. We perform major procedures that over 99 percent of all gynecologists in this country do in a hospital setting, and not only have we been performing these procedures outside of a hospital, but we have also been providing absolutely untouchable low rates.

USDMT: Can you share your outcomes or incidence of complications?

HR: Complications in surgery are easy to track through re-operation rates, transfusion rates, complication rates such as organ injury like bladder, bowel, blood vessel injuries, and of course, readmission rates.

We began tracking quality and outcomes before individuals started ordering us to do so. As a result, we can provide comprehensive statistics at any given point in time. We believe in total transparency.

USDMT: Are you also transparent about pricing?
HR: Yes. For example, in a U.S. hospital a hysterectomy may cost upwards of $30,000-45,000. At our facility, we offer bundled rates for travel patients, which includes the surgeon's fee, the ambulatory surgery center facility fee, anesthesia fee, pathology fee, plus any other disposable fees. A hysterectomy at our facility costs well under $10,000.

Often times, patients traveling from places like Bridge Health are given a choice: have a surgery performed by their local doctor at an astronomical fee, or they can travel to a preferred facility where their deductibles and co-pays are waived, and hotel and travel fees are paid for (for both the patient and a companion).

USDMT: How do you market your center?

HR: To be honest, we haven't employed a marketing campaign yet - we need to!

There are pioneers out there that have strictly posted their pricing online and have drawn in a huge clientele that way.

We have not posted all of our pricing online just yet, I am trying to decide who would benefit most from access.

It is challenging to develop relationships with certain groups and convince them that our center offers unbeatable deals, both in quality and cost.

USDMT: Do you have a hospital standing ready if you have emergencies?

HR: Yes, in fact, we are a small thorn in the hospital's side because our medical office building, including our ambulatory surgery center, is located right on the hospital's campus.

When we built the center, the hospital tried to challenge us by saying there were deed restrictions that precluded us from offering anything other than medical office services. You couldn't do physical therapy, pharmacy, radiology, imaging...nothing! But, in the state of Georgia, deed restrictions on commercial property expire after 20 years. And, guess what, we built our surgery center 20 years after the initial sale of the property.

USDMT: And here you are!

HR: Yes, here we are. And, because we are on staff at this hospital and have been for 25 years, I've been chief of staff at the hospital, chairman of the Ob/Gyn department many times, and served on multiple quality committees.

We have full blown admitting privileges at the hospital, so if that day ever comes where we have to transfer somebody from the surgery center to the hospital it wouldn't be an issue.

Like I said, in the six years we've been established, we have not had to transfer a single patient.

Medical Tourism: Why Employers and Health Insurers are Choosing Medical Travel for their Employees
by Patrick Goodness, CEO, The Goodness Company

Due to the rising costs in healthcare and medical insurance, with deductibles and co-pays so high that they often prevent people from benefiting from the insurance they pay for, it's not a surprise that many Americans are seeking medical and dental care options abroad. Even when taking into account the costs for travel, most medical procedures are less expensive in popular medical tourism destinations, such as Mexico, Costa Rica, Singapore and India.

Now many employers and business owners also realize that there is cost-saving potential in offering healthcare employee healthcare options that include medical travel. Just like individuals, companies are also affected by the rising costs of health insurance in the U.S. Corporations are interested in less costly healthcare options. This is particularly true for the growing number of companies that are self-insured and do not purchase a private health insurance policy with a third party. (In fact, medical tourism options can make self-insurance a more realistic option for many companies.)

Should Your Company Consider Medical Tourism as an Employee Benefit?
Unlike individuals, companies aren't just affected by the rising costs of health insurance, but also by the increasing number of employees they hire as they grow. This is why in 1998, the percentage of employees who were covered by self-insurance plans was 40.9 percent, but by 2011 it had risen to 58.5 percent, according to a report by the Employee Benefit Research institute.

Lower healthcare costs allow companies looking for talented people to offer more benefits or higher salaries. Alternatively, they can offer their products or services at a lower price, making them more competitive in their respective markets.

Finding high-quality medical and dental services is easy. There are websites that offer information about costs, availability, testimonials, etc. Popular medical tourism destinations are creating campaigns to reach out to individual patients and companies in order to offer them promotions and packages that make purchasing healthcare abroad an easy experience. Additionally, trusted local resources that have first-hand connections with reputable providers are helping hundreds of companies find medical and dental care for their employees.,, and other related sites can assist employers and employees alike with finding medical and dental specialists. These sites are often staffed by actual dentists and medical doctors to ensure quality guidance and high success ratios.

Private hospitals and clinics abroad are heavily investing in equipment, training and service in English. Governments are investing in infrastructure, promotions and security. American patients can now go abroad with the confidence that the quality of the healthcare they will receive will not be compromised, and the reassurance that they will be able to express all their needs in English.

Employees are sometimes offered free airfare and lodging, and even meals as added benefits that come with medical tourism options. It is not uncommon for patients to take extra days and enjoy a vacation, and even take their families with them, provided their condition allows them to travel for enjoyment. Even in cases when travel expenses are not included, the employee still ends up spending much less money than if he or she had paid for the treatment at home due to deductibles and co-pays, etc.

Companies can offer their employees access to highly desirable procedures that are not typically offered in the U.S. or Canada because they are not covered by insurance. An example would be dental implants. Frequently their cost makes them unaffordable. However, implants are affordable and offered by many dental clinics abroad. Costa Rica is becoming one of the leading global destinations for dental care. Dr. Adriana Barrantes, International Patient Coordinator with, reports that she assists hundreds of patients each month who are considering dental care in Costa Rica. "Most patients are seeking dental implants and full mouth reconstructions," says Dr. Barrantes. Many of these patients choose Costa Rica for the high quality of care and considerable savings over U.S. dental rates.

Medical travel eliminates bureaucratic delays. Sometimes, a procedure in the U.S. or Canada needs to be approved and the government agency or the insurer may delay or reject approval, leaving the employee in a state of uncertainty and maybe pain. By getting the procedure abroad, waiting time is often eliminated. This is a benefit for both the employee, and the employer who gets the employee back to work much sooner.

Some companies are not able to offer expanded coverage to their employees. Medical tourism can change that by making added coverage affordable. The most common is dental care, but a few employers are even offering cosmetic surgery or other non-insured procedures such as bariatric surgery to high-level employees.

If anything, this trend will continue, as companies naturally look for ways to reduce costs, attract better employees, and stay competitive.

To view the original article click here.

Leading US Companies Announce Plan to Transform the Corporate Health Care System
20 of America’s Major Employers, with Four Million Employees and Family Members, Come Together to Form the Health Transformation Alliance

-A Better Way-

Twenty of America’s largest corporations announced today they have joined together to improve the way health care benefits will be purchased for employees in an effort to create better health care outcomes. Their goal is to break with existing marketplace practices that are costly, wasteful and inefficient, all of which have resulted in employees paying higher premiums, copayments and deductibles every year.
“The current system is unsustainable and it costs our employees too much," said Kevin Cox, the Chief Human Resources Officer (CHRO) of American Express. “Even the most successful companies won’t be able to afford the rising costs of health care in the not too distant future." “Our priority in this coalition is supporting positive health outcomes for our strongest asset-our employees. Health care benefits are too important to our people for us to sit on the sidelines; the status quo needs to change, and we have to be part of the solution. We are creating a better way of getting workers what they want and need," said Kim Hauer, the CHRO at Caterpillar.

The initiative focuses on reforms to the supply chain that are designed to reduce redundancies and waste, all of which drive up the cost of health care coverage. By coming together to share expertise, the companies seek to make the current multilayered supply chain more efficient. Collectively, the 20 companies are responsible for health care benefits for four million people and spend more than $14 billion annually on health care for employees, their dependents and retirees. The effort to transform the system will be led by a not-for-profit entity known as the Health Transformation Alliance. The Alliance will serve as part of each company’s health strategy, bringing increased innovation, better analyses of the latest data and greater leverage into how corporations obtain coverage for their workers.

The HTA will be built and organized throughout 2016, and beginning as soon as 2017, a pilot project to help employees obtain more affordable prescription medications will be launched. The rest of the major initiatives are planned to begin in 2018 or later. “The American health care delivery system is a patchwork of complicated, expensive and wasteful systems," said Marc Reed, the chief administrative officer of Verizon. “We’ve done what we can as individual companies. By joining together, we can do more. We need to stop applying bandages to the system and address what’s fundamentally wrong."

The U.S. government defines health care as “affordable" if it costs 9.5 percent or less of a household’s income. According to a study by the American Health Policy Institute, which developed the concept of the Alliance, by 2020 over 37 percent of private sector employees who are heads of families will face an average family premium and deductible above affordable levels. In less than 10 years, 53 percent of employees are projected to face unaffordable health care costs, creating a significant problem for employees and employers alike.

The Alliance seeks to fundamentally transform the corporate health care benefit marketplace by first focusing on four areas:

1. Greater Marketplace Efficiencies: Today, employers rely on a broad range of organizations to procure health care services, and often these organizations serve interests not aligned with the interests of employers and the people they employ. The Alliance will pool the resources and expertise of its member companies to gain leverage and create an organization whose sole focus will be to ensure the health care needs of employees are being met more effectively and efficiently.

2. Learning from Data: Employers have become experts in studying data and trends to make wise business decisions in a variety of areas. The health care marketplace lags behind other sectors in using data to identify best treatments, good outcomes and cost reductions. By pooling aggregated data that doesn’t identify individual patient information and using it to improve the effectiveness of the health care supply chain, the Alliance anticipates delivering better health care while reducing costs.

3. Educating Employees: Employers have considerable experience working directly with their employees to explain companywide benefits, but the complexities of health care are difficult and costly to explain. By pooling their knowledge and resources, members of the Alliance will develop better and more helpful tools to educate employees about their health care choices. Helping employees to better navigate these choices will result in better outcomes, increased savings and more satisfied employees.

4. Breaking Bad Habits: Patients, along with the health care system, too often pay for prescription drugs that are not the most cost effective for their care. Doctors, along with patients, aren’t always armed with a full range of facts concerning best outcomes and pricing for pharmaceuticals. This happens in part because incentives currently built into the delivery system have made it habitual to merely pass costs along. The Alliance will seek to change costly and inefficient purchasing and contracting systems that don’t deliver better health care results, but do drive up health care costs. “We have considerable work to do, and we expect this will take years to fully implement," said Bill Allen, the CHRO of Macy’s Inc. “This is a major undertaking for each of us, but if we don’t do it now, the growth in health care costs will overwhelm all of us. We are proud to be pioneers who seek to transform and improve the way health care benefits are provided for millions of working Americans." The members of the Alliance are:

1. American Express Company
2. American Water
3. BNSF Railway Company
4. Brunswick Corporation
5. Caterpillar Inc.
6. The Coca-Cola Company
7. E.I. du Pont de Nemours & Company
8. HCA Inc.
9. The Hartford Financial Services Group Inc.
10. IBM Corporation
11. Ingersoll Rand
12. International Paper Company
13. Lincoln Financial Group
14. Macy’s Inc.
15. Marriott International Inc.
16. NextEra Energy Inc.
17. Pitney Bowes Inc.
18. Shell Oil Company
19. Verizon Communications Inc.
20. Weyerhaeuser Company

Tevi D. Troy
(202) 315-5582

To view the original release click here.

U.S. Will Remain Hernia Repair Market Leader by 2021 Thanks to Higher Treatment Rates, Says GlobalData
  • U.S. set to hold on to its domination of hernia repair market through to 2021, as treatment rates in the country continue to rise
  • However, various smaller markets, such as Brazil, will expand more rapidly than the U.S. during the forecast period, says analyst

Although there will be substantial changes across the global hernia repair space by 2021 as the new laparoscopic technique grows in popularity, the U.S. will sustain its steady domination of the market due to its superior treatment rates, says research and consulting firm GlobalData.

According to the company's report*, the overall U.S. hernia repair market was valued at approximately $875 million in 2014, and is expected to rise to approximately $1.2 billion by 2021, at a moderate Compound Annual Growth Rate (CAGR) of four percent.

Yizhe Xu, GlobalData's analyst covering medical devices, says that while developing economies are growing rapidly across the incisional, umbilical, femoral and inguinal hernia repair markets due to their large population bases, it may take some time for these countries to catch up with the U.S. in treatment rates.

Xu explains: "The U.S. has a higher adoption of expensive meshes in general, and procedure volume will go up by one percent annually. For example, the majority of umbilical hernia repairs are performed with composite meshes, which contribute to a higher market valuation.

"The usage levels of this mesh type will remain constant throughout the forecast period, so the rising market valuation will be driven solely by increases in procedure volume as the population grows."

While hernia repair markets in some other countries are much more modest in size, they will expand more rapidly than the U.S. during the forecast period. GlobalData states that the U.K. hernia repair market was valued at $85 million in 2014, and it will increase to $124 million by 2021, representing a CAGR of 5.5 percent. Furthermore, Brazil's overall hernia repair market was valued at $46 million in 2014, and will increase to $71 million by 2021, with a high CAGR of 6.5 percent.

Xu explains: "The increase in the Brazilian market value is being driven by the immense growth in the incisional hernia market and the increased use of 3D, composite, and biologic meshes will also play a part."

*MediPoint: Hernia Repair - Global Analysis and Market Forecasts


This report provides analysis of the hernia repair space across the 10 major markets of the U.S., France, Germany, Italy, Spain, U.K., Japan, Brazil, China and India, including annualized market data from 2014 and forecast until 2021. It discusses current and future trends towards different mesh types, procedure volumes for different hernia indications, and how the laparoscopic approach will grow in coming years.

This report was built using data and information sourced from proprietary databases, primary and secondary research, and in-house analysis conducted by GlobalData's team of industry experts.

For guidelines on how to cite GlobalData, please see:


GlobalData is a leading global research and consulting firm offering advanced analytics to help clients make better, more informed decisions every day. Our research and analysis is based on the expert knowledge of over 700 qualified business analysts and 25,000 interviews conducted with industry insiders every year, enabling us to offer the most relevant, reliable and actionable strategic business intelligence available for a wide range of industries.

For more information, please contact our Press Office on +44 (0)161 359 5822 or at

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CMS Proposes Changes to ACO Structure under Medicare Shared Savings Program
Would provide more flexibility in recalculating payments and renewing contracts
by Ron Shinkman Centers for Medicare & Medicaid Services (CMS) has proposed a variety of changes to the payments to providers who participate in accountable care organizations (ACOs) under the Medicare Share Savings Program.

To view the original article click here.

Lawmakers Slam Oversight of Failing CO-OPs
CMS' Andy Slavitt defends the startup insurers
by Leslie Small a Senate committee hearing Thursday, Congress members grilled Centers for Medicare & Medicaid Services acting administrator Andy Slavitt about what has gone wrong with the Affordable Care Act's flailing startup health insurers.

To view the original article click here.

New Cost-Cutting Strategy: Employer Plans with No Outpatient Surgery Coverage
Unclear how regulators will respond to emerging trend in benefit design
by Katherine Moody insurance sold to individuals and small businesses through online marketplaces, large employers are not required to offer a list of "essential health benefits," so some work-based health plans are starting to exclude outpatient surgeries to cut costs, according to an article from Kaiser Health News.

To view the original article click here.


Help Save a Life and Support MatchingDonors
100 percent of all donations on go to help people get organ transplants on

MatchingDonors is a 501c3 nonprofit organization and the nation's largest online living organ donor organization finding living organ donors for people needing organ transplants. In conjunction with various health organizations throughout the United States we have created a very successful Public Service Announcement campaign to help people recognize that they can save lives by being a living organ donor, to encourage them to register as an altruistic living organ donor, and to make them realize they can help save the lives of people needing organ transplants by donating other things. This MatchingDonors Living Organ Donor Initiative program has already saved thousands of lives.

Do you know of any available job openings relative to the U.S. domestic medical travel industry? We encourage readers to submit any available, relevant job opportunities along with its descriptions and requirements for fellow readers and industry professionals to consider. All submissions are appreciated.


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U.S. Domestic Medical Travel™

About U.S. Domestic Medical Travel
U.S. Domestic Medical Travel, a sister publication to Medical Travel Today, 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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Spotlight Interview

Hugo D. Ribot Jr., M.D., Founder and Co-owner, Cartersville Ob/Gyn Associates

News in Review

Medical Tourism: Why Employers and Health Insurers are Choosing Medical Travel for their Employees

Leading US Companies Announce Plan to Transform the Corporate Health Care System

U.S. Will Remain Hernia Repair Market Leader by 2021 Thanks to Higher Treatment Rates, Says GlobalData

CMS Proposes Changes to ACO Structure under Medicare Shared Savings Program

Lawmakers Slam Oversight of Failing CO-OPs

New Cost-Cutting Strategy: Employer Plans with No Outpatient Surgery Coverage