Volume 1, Issue 2

by Laura Carabello, Editor


Response to the launch of this newsletter has been overwhelming - from letters of congratulations to validated off-the-charts media results to our debut. Thanks to all who have responded so favorably.

Healthcare Transparency: This edition focuses on the need for Centers of Excellence (COE) to implement pricing transparency and how the marketplace is responding. 

An exclusive interview with David B. Nash, M.D., M.B.A., the founding dean and the Dr. Raymond C. and Doris N. Grandon professor of Health Policy at the Jefferson School of Population Health (JSPH) of Thomas Jefferson University, hits home on the pressing need for quality reporting with the question: Who will take charge of data collection, maintenance, and dissemination?  Dr. Nash looks forward to also hearing from the employers about their experiences with domestic medical travel.

If you have any comments or feedback, please be in touch.

We appreciate your support and interest in this growing sector.

Laura Carabello
Editor and Publisher

Healthcare Pricing Secrecy: The End May be Near
Pricing transparency gives medical travel destinations and hospitals a definitive EDGE

By Laura Carabello
Executive Editor and Publisher

Medical Travel Today

US Domestic Medical Travel


  1. (of a material or article) Allowing light to pass through so that objects behind can be distinctly seen.
  2. Easy to perceive or detect.

Synonyms: clear - pellucid - limpid - diaphanous - plain - lucid

Could it be that healthcare pricing transparency in the U.S. is finally becoming reality?

The answer is, “perhaps.”

It is widely known that in the U.S., patients rarely know what they'll pay for services until they've received them. Furthermore, healthcare providers bill differently for the same services, depending on the payer, with privately insured patients paying more to subsidize the shortfalls left by uninsured patients. All this, hopefully, is about to change.

John Santa from Consumer’s Union characterizes the U.S. healthcare market as one shrouded by obscurity around costs, prices and quality. Santa suggests that even though the healthcare system depends on market forces to allocate care services, it falls short and places patients and consumers at a distinct disadvantage.

In what is regarded as a move in the right direction, the Centers for Medicare & Medicaid Services (CMS) recently made public pricing by hospitals across the nation for treating the 100 most common Medicare inpatient stays. Average inpatient hospital charges for services that may be provided to treat heart failure range from $21,000 to $46,000 in Denver, and from $9,000 to $51,000 in Jackson, Miss., according to CMS. Nationally, a joint replacement costs $5,300 at a hospital in Ada, Okla., with the same replacement costing $223,000 at a hospital in Monterey Park, Calif.

The data released on May 8, 2013, shows how widely pricing can vary across the nation and within a single city:

While information about quality has become more transparent, meaningful price information is still difficult to obtain. So there was a lot of positive nodding when one hospital CEO in South Florida vowed to make public what private insurance companies pay his institution for individual services.

Speaking in May 2013 at a local public radio affiliate, WLRN, Steve Sonenreich, CEO of the Mount Sinai Medical Center in Miami Beach, Fla., said, “We’d be willing to put our prices to all the insurance companies out in public, and we would welcome that kind of transparency of everyone in the marketplace.”

But Baptist Health CEO Brian Keeley hedged making this type of promise, saying, “We’d welcome transparency -- we’ve always been strong advocates for transparency.” Nevertheless, he stopped short of saying his institution would publicly release price data.

With this type of pushback from providers, and limitations on data-sharing by the health plans, system stakeholders need to do more to advance price transparency and to marry price and quality data together to help consumers assess their treatment options.

The good news is that there are some private sector initiatives underway to promote transparency, notably Castlight and Change Healthcare, both founded within the past five years and using proprietary software to analyze claims data to estimate the costs of common medical procedures.

Their reports also include performance data on various providers, enabling users to take into account both cost and quality. They sell these healthcare "shopping" tools to self-insured companies and, in the case of Change Healthcare, health plans, which in turn encourage their employees and health plan members to use them to choose providers based on their quality and costs.

Furthermore, anesthesiologist Keith Smith, managing partner of the Surgery Center of Oklahoma, started posting his prices online when he saw he could beat rates in India, Costa Rica and other popular medical destinations outside the U.S. He said his center's rates for surgeries are up to 90 percent cheaper than nearby nonprofit hospitals, and his center performs as many as 700 procedures a month in Oklahoma City. Smith does a lot of business with Canadians, and even more business with Americans, who he thinks are getting a rotten deal.

Competing hospitals "are not going to publish their prices online because it would be meaningless," he said. “Hospitals offer discounts to insured patients so the uninsured patient is going to wonder why they're not getting the same price. Hospitals don't want to publish these prices because then everybody knows how ridiculous it is."

This should be music to the ears of U.S. employers who are paying the bills. Greg Walters, president of the Piedmont Health Coalition, stresses the need for transparency, saying, “Pricing is still a quagmire despite certain arrangements with discounted fee-for-service arrangements or caps. Negotiated arrangements still prevail.”

International Hospitals Tout Pricing Transparency

Overseas hospitals, including those in medical tourism destinations, appear to be much more transparent in their pricing plans. In Singapore, the number one destination for medical travel according to a new Bloomberg report, hospitals are legally obligated to display a list of medical procedures and medical fees for foreign patients.

Taiwan says that patients are always provided with an itemized bill - which includes every single item the patient is expected to pay for, including medication, food, surgeon fees and ward fees. The price quoted in the initial estimate is almost always the price paid after care is administered - except in cases where further treatment is required.

The risk of turning a less expensive medical travel experience into a highly expensive journey seems to plague the medical travel industry, with some employers being wary of high costs associated with extended treatment and care beyond the initial procedure.

But one group is putting a halt to any of this concern. SpheraGlobal is an international healthcare company that now guarantees the best quality healthcare, the follow-up of each case in destinations participating in its international medical network and, most important, a competitive fixed price for the medical procedure, regardless of whether or not follow-on treatment is necessary. See pricing here:

Pricing Transparency: Ideal Complement to Value-Based Insurance Design
During a recent hearing on price transparency before the U.S. Senate Committee on Finance, Paul Ginsburg, president of the Center for Studying Health System Change, testified that the key to leveraging transparency into lower prices was to employ programs with value-based insurance design (VBID) principles.

Ginsburg told the committee, "Without changes in insurance benefit designs that steer patients to high-value providers--those that provide high-quality care efficiently--price transparency initiatives are likely to continue to have limited impact."

Some innovative employers are seeking to use VBID to engage their employees in making high-value purchases.

Delhaize Group, the parent company of more than 1,000 supermarkets on the East Coast, including the Food Lion chain, reduces co-insurance from 40 percent to 20 percent for employees willing to undergo minimally invasive procedures in place of more invasive alternatives.

The company also offers to eliminate copayments, and pay travel expenses for employees willing to get hip and knee replacements (and soon cardiac and back procedures) in certain facilities in other markets where costs are lower and quality higher.

The program works well until patients meet their deductible for the health plan.

"Once you get to your co-insurance level and it's paid at 100 percent, we seem to see a slowdown in the uptake of medical tourism," says Joanne Abate, director of Health and Wellness Strategy for the company. 

Last year the Commonwealth Fund released “Health Care Price Transparency: Can It Promote High-Value Care?” The report included state and federal policies promoting price transparency.

Legislators in more than 30 states have proposed or are pursuing legislation to promote price transparency, with most efforts focused around publishing average or median prices for hospital services.1 Some states have already established price transparency policies.2 For example, using its all-payer claims database, New Hampshire publishes information about total and out-of-pocket costs.

California requires hospitals to give patients cost estimates for the 25 most common outpatient procedures. The state's Office of Statewide Health Planning and Development also runs a "Common Surgeries and Charges Comparison" site, which posts median charges per hospital stay for common, elective inpatient procedures-searchable by year, procedure, county and city. Pending legislation would require California hospitals to publicly disclose all charges, including physician and laboratory fees, for certain procedures.

Texas requires providers to disclose price information to patients upon request.

Florida's enables consumers to view the range of prices charged for various procedures, alongside quality-of-care ratings, mortality rates, infection rates, and other measures for hospitals, surgery centers, nursing homes and hospice centers in the state.

Massachusetts' Health Care Quality and Cost Council is developing strategies to promote consumer engagement in seeking high-value care through promotion of medical homes and shared decision-making.

On a federal level, the Affordable Care Act requires hospitals to publish and annually update a list of standard charges for their services. Starting in 2014, the health insurance exchanges will require participating health plans to create websites or other communication tools to enable consumers to look up their expected out-of-pocket costs for specific services under the plans.

Three bills have been introduced in Congress to promote price transparency, including H.R. 4700: Transparency in All Health Care Pricing Act of 2010, which would require physicians, pharmacies and insurers to publicly disclose the prices of the services and products they provide.

SPOTLIGHT: David B. Nash, M.D., M.B.A.

David B. Nash, M.D., M.B.A.
Dean, Jefferson School of Population Health


About Dr. David B. Nash
Dr. Nash was named the founding dean of the Jefferson School of Population Health (JSPH) in 2008. This appointment caps a 20-year tenure on the faculty of Thomas Jefferson University. He is also the Dr. Raymond C. and Doris N. Grandon professor of Health Policy. JSPH provides innovative educational programming designed to develop healthcare leaders for the future. Its offerings include master’s Programs in Public Health, Healthcare Quality and Safety, Health Policy and Applied Health Economics. JSPH also offers a doctoral program in Population Health Science.

Dr. Nash is a board-certified internist who is internationally recognized for his work in outcomes management, medical staff development and quality-of-care improvement. In 1995 he received the top recognition award from the Academy of Managed Care Pharmacy. He received the Philadelphia Business Journal Healthcare Heroes Award in October 1997, and was named an honorary distinguished fellow of the American College of Physician Executives in 1998. In 2006 he received the Elliot Stone Award for leadership in public accountability for health data from NAHDO. In 2009 Dr. Nash received the Wharton Healthcare Alumni Achievement Award. In 2012, he received the Joseph Wharton award in recognition of his “social impact.”

Repeatedly named to Modern Healthcare’s list of Most Powerful Persons in Healthcare, his national activities cover a wide scope. He is on the VHA Center for Applied Healthcare Studies Advisory Board and he is a member of the Board of Directors of The Care Continuum Alliance (formerly DMAA). Dr. Nash is a principal faculty member for quality of care programming for the American College of Physician Executives in Tampa, Fla., and is the developer of the ACPE Capstone Course on Quality. He also leads the academic joint venture between ACPE and the JSPH.

Dr. Nash is a consultant to organizations in both the public and private sectors. He has chaired the Technical Advisory Group of the Pennsylvania Health Care Cost Containment Council for more than a decade and he is widely recognized as a pioneer in public reporting of outcomes. In December 2009 he was named to the Board of Directors for Humana Inc., one of the nation’s largest publicly traded healthcare companies. In March 2011 he joined the Board of Directors of Endo Health Solutions, a publicly traded pharmaceutical company headquartered in Malvern, Penn. He is on the Board of Main Line Health - a four-hospital system in suburban Philadelphia, Penn. From 1998-2008, he served on the Board of Trustees of Catholic Healthcare Partners in Cincinnati, Ohio, where he chaired the Board Committee on Quality and Safety.

Through publications, public appearances, his blog and an online column on MedPage Today, Dr. Nash reaches more than 100,000 persons every month. He has authored more than 100 articles in major journals. He has edited 22 books, including Connecting with the New Healthcare Consumer, The Quality Solution, Governance for Healthcare Providers Population Health: Creating a Culture of Wellness, and most recently, Demand Better. From 1984 to 1989 he was deputy editor of Annals of Internal Medicine. Currently, he is editor-in-chief of four major national journals, including American Journal of Medical Quality, Population Health Management, P&T, and American Health and Drug Benefits.

Dr. Nash received his B.A. in Economics (Phi Beta Kappa) from Vassar College, his M.D. from the University of Rochester School of Medicine and Dentistry, and his M.B.A. in Health Administration (with honors) from the Wharton School at the University of Pennsylvania. While at Penn, he was a former Robert Wood Johnson Foundation clinical scholar and medical director of a nine-physician faculty group practice in general internal medicine.

Dr. Nash lives in Lafayette Hill, Penn., with his wife of more than 30 years, Esther J. Nash, M.D. They have fraternal twins, 26-year-old daughters, and a 21-year-old son.

Please visit: and his blog at

U.S. Domestic Medical Travel (USDMT): Please share your perspectives on this fast-growth phenomenon.

Dr. David Nash (DN): Major national firms that are self-insured want to play a greater role in maximizing the value of dollars spent on healthcare. This is a strategic objective for fiscal years 2014 and 2015.

How to achieve a greater value for healthcare spends is not just a technical issue, it is a strategic objective that CEOs are focused upon.

My second reflection is that the federal deficit is all about healthcare spending, and that connection hasn’t been adequately publicized and described.

It boggles my mind that people don’t understand that the deficit and sequestration equal Medicare spending. If we tackle retirees and current employees, all self-insured organizations -- especially national ones that have national contracts with multiple payers -- are in a position to demand price transparency and outcomes accountability, and that is where the world is headed.

Given that background, I predict that travel to domestic Centers of Excellence (COEs) will be a booming business, especially in the next two to five years, as we implement the Affordable Care Act.

Who are these COEs and are they really excellent? I think that is a critically important concern.

What are the measures used to promote transparency? For example, in orthopedic surgery is it patient satisfaction scores, functional status? Is it unexpected return to the operating room? Is it physician-specific infection rate? Is it all of those? Is it none of those? Is it just price?

It is not a trivial issue to say that the Cleveland Clinic is ranked first in cardiac care. This is great, but what are the measures? Or that the Rothman Institute at Jefferson is the best orthopedic group. Another great conclusion, but what are the measures that we are looking at?

USDMT: Who will make these determinations regarding the COEs?

David Nash (DN): We have a saying in our business: In God we trust, all others bring their outcomes data.

And that is the theme of this entire work. Now, I do believe that many of these COEs do a great job, but I would want to know this: What are the measures that they are using? Who maintains the dataset? Is there external scrutiny of the data? What measures are they considering for the future?

There’s a bona fide science of outcomes and measurement, and I feel that they are pretty sophisticated today and becoming increasingly more sophisticated every day. So how do we organize this information?

We could go online to and find out a lot about a hospital, but I am not sure that that is the sufficient information on which to base a COE program. We need additional data and that is where the challenges are.

USDMT: So are you indicating that these measurements should be somehow established, maintained and judged?

DN: Let’s talk about the future.

Moving forward, I think you are going to see a great expansion in domestic medical travel to COEs for high-cost procedures, and I think you outlined it pretty well: cardiac procedures, transplantation, orthopedic, bone marrow or solid organ transplants -- procedures that are dreadfully complicated and expensive, and remain highly variable across the country, even at the best COEs.

What I am advocating and have been writing about for two decades is determining what measures are important? Who maintains and updates these measures? Where and how do we disseminate the measures and the results? These are very important questions.

USDMT: Should that be done by a third party? Joint Commission or Leapfrog Group? Who should be the arbiter?

DN: That is a great question, so let me give you the options that are out there.

Peter Pronovost (Peter J. Pronovost, M.D., Ph.D., F.C.C.M.; Sr. Vice President for Patient Safety and Quality, Director of the Armstrong Institute for Patient Safety and Quality Johns Hopkins Medicine) has called for a SEC-type independent, federally funded organization to promote transparency and accountability - which is certainly a great idea.

Others have said, “No,” that the market should determine what the measures should be based upon feedback from customers.

Others have also said, “No,” the states should maintain statewide databases like in Pennsylvania, where the Pennsylvania Healthcare Cost Containment Council really provides a tremendous example of how to do this from the state perspective.

I’m not sure who is right, but it is probably going to be some quirky American solution with some semi-independent, non-governmental organization.

I think we ought to have some kind of NGO (non-governmental organization) that maintains a national database that is open access to everyone -- one that is constantly updated under scrutiny from scholars in the field and others.

I think Peter Pronovost has a pretty good idea, but I don’t think there’s a political appetite for another alphabet soup federal agency in healthcare.

USDMT: What is your opinion on physician-owned hospitals and surgi-centers that are grandfathered in from the new regulations, and their contention that they can deliver better care at 70, 80, even 90 percent less than the community or general hospitals?

DN: This is a very complicated issue.

There is some interesting data in the marketplace, especially from cardiac and orthopedic freestanding institutions.

Their assertion that they deliver “greater value” is probably true because they are not caring for uncompensated care patients, and are not taking anyone who walks in off the street who hasn’t seen a doctor in 15 years and is on 20 different medications.

They are not set up to care for the complex chronically ill or uncompensated care patients that all hospitals are burdened with - and they don’t take Medicare.

They are at a great economic advantage in the marketplace, which is one challenge.

The second challenge is the quality of the data that they are broadcasting. Again, without third party scrutiny, how do we know that that outcomes data is reliable and reproducible? We really do not know that.

I do believe that there is some merit to the previously submitted volume-outcome hypothesis, which is the fancy way of saying that if you practice the piano, you’ll get better.

It doesn’t work for everybody. I never got beyond second seat clarinet no matter how much I practiced. It has everything to do with innate skill, the team that surrounds you, the culture of the place you are working in and experience.

I believe that a focused specialty hospital that just does three procedures is going to do a better job because they have advantages that community hospitals simply don’t have.

USDMT: Plus there is growing market suspicion from the Office of Inspector General and others that some doctors are fraudulent and generating enormous profits.

DN: Well, that is more than suspicion.

There is solid evidence that there was economic duplicity in a lot of these places, and you do have to worry about an inherent conflict of interest in some doctor-owned facilities.

USDMT: Can you comment on the international market and the opportunity for domestic COEs to attract patients from other countries? Could this type of patient volume be used to offset some of the costs of uncompensated care?

DN: That’s a great question and I would say, “Yes and yes,” but this only applies to about 20 organizations in the country, which makes it an interesting issue.

In other words, in my view, there are two dozen or so major national COEs that could draw international business at a sufficient volume to support this kind of work.

USDMT: And they are?

DN: The U.S. News and World Report Top 20 is probably the closest you are going to get to that list.

Your second question, “Is the margin sufficient to cross subsidize other activities?” I don’t know. I would have to really understand what we are talking about here.

Would there always be place for Cleveland Clinic to do super high-end work for sheiks and moguls? I would again say, “Yes.”

But is there a global market? Yes - absolutely -- but I think this is a tiny part of the story about healthcare in our country.

Will this work to help these institutions to cross subsidize? Well, you have to assume the answer to that is also, “Yes.” Why else would they be doing it?

USDMT: There are hospitals, particularly in Florida, that are serving the Caribbean, South America and Central America.

DN: I think that is a different flavor and I think that is a separate marketplace. Here’s why:

Florida is readily accessible from Central and South America where the infrastructure for healthcare is nothing like the rest of the developed world. There are a handful-literally-of western-style, super well-trained staff physicians in very few leading hospitals in Brazil and Argentina.

The infrastructure, like we have, just doesn’t exist to a great extent. So wealthy persons of Central and South America will go to Florida - I think that is probably a unique case.

USDMT: We are also hearing about a lot of people traveling to the U.S. from third world countries where there is a lot of cash but no healthcare infrastructure. And it’s not just the high-profile institutions that are attracting these patients.

DN: I think they are also going to go and get care where there is a cultural sensitivity to their needs. For example, they might choose hospitals in New York City where there is a large Russian-speaking staff, which makes sense.

I think there’s one other area that we haven’t talked about on the domestic front. Here’s what I hope will happen in the future.

I would really like to see the major retailers such as Wal-Mart, Boeing and Pepsi benchmark their self-funded employer and employee experience -- and have it be transparent.

In other words, what can we all learn from the experience of all these companies and are those lessons exportable to the rest of the nation?

USDMT: Agreed there is little to no information available. What do you suggest?

DN: I think the issue is this: What can we learn from the experience from these nationally prominent companies? I think there is a lot to learn.

USDMT: There is a lot to learn, but I think it is early in the game.

DN: Yes, but I think they should be tracking this now so this information can be shared moving forward.

SPOTLIGHT: Jeffrey J. Rice, M.D., J.D.

Jeff Rice MD picturelogo_hcbb

About Jeffrey J. Rice, M.D., J.D., CEO, The Healthcare Blue Book
Dr. Rice has over 20 years of clinical, information technology and executive management experience within academic medical institutions, national health plans, disease management organizations and healthcare IT solution consulting firms.

Currently, Dr. Rice is CEO for the Healthcare Blue Book which provides fair pricing to consumers, employers and providers. Previously, Dr. Rice served as executive vice president of Medical Leadership and Business Development, for Healthways where he was responsible for leading strategic alliances, and mergers and acquisitions. Prior to that position, Dr. Rice served as CEO of CareSteps, which was successfully merged with Healthways.

Dr. Rice led the development and implementation of market leading technologies in consumer-oriented evidence-based medicine and advanced predictive modeling for CareSteps. In addition, Dr. Rice has extensive managed care operational experience having served in executive roles with NYLCare (New York Life Insurance Company's managed health care subsidiary) and as director of the Managed Care Organization at Duke University. Dr. Rice has served as an independent director of Source Medical Solutions and nTelagent, and as an advisory board member of Seneca Health Partners Venture Capital Fund. 

Dr. Rice is a long-time champion of advancing the science of medical outcomes and quality measurement. He serves on the editorial board for the American Journal of Medical Quality and is a member of the editorial board for the Population Health Management journal. 

About The Healthcare Blue Book (HCBB)
The Healthcare Blue Book has a single mission: fair, upfront pricing in healthcare.

Healthcare Blue book, headquartered in Nashville, Tenn., provides a healthcare transparency solution that helps consumers and companies determine what fair prices are for healthcare services and treatments in their markets.

Healthcare Blue Book‘s analytic tools help employers identify unnecessary in-network price variability for common, high-volume procedures. We focus on the top opportunities to save by making better use of high value providers in the existing network. Healthcare Blue Book’s price transparency tools enable employees to shop for and compare in-network providers on cost and quality, and even earn rewards when they make value-based choices on care.

U.S. Domestic Medical Travel (USDMT): How did you get involved with The Healthcare Blue Book (HCBB) and can you explain how the company functions?

Dr. Jeffrey J. Rice (JR): I founded HCBB when I personally was charged $200 for a $20 lab test.

I knew that even though I was both a physician and a health insurance executive, I had been grossly over charged.  I realized that if I was able to share my knowledge about healthcare pricing with patients, they too would be able to find affordable, quality healthcare services.

HCBB’s business consists of two parts.  

At the HCBB website, consumers can use our free tool to help individuals understand fair healthcare prices and often to find local providers that also offer fair prices.

The second part of our business is providing customized transparency solutions to employers and insurance companies/third party administrators (TPAs). These organizations use our tool to allow employees and members to see the local in-network price variations that exist and to find local providers that offer the best value.

USDMT: What audience does The Healthcare Blue Book market its services to? The uninsured? The working class?

JR: HCBB assists individuals that have insurance, as well as those that must pay for their own care.

Our primary clientele generally consists of employers, insurance companies and TPAs.

USDMT: Do you have a set network of providers you work with nationwide? Any centers of excellence (COE)?

JR: We work with all providers and do not limit our review to any particular providers.  

The providers that offer the best value are the ones most likely to promote their services with HCBB, which often includes online appointment scheduling.

We do collaborate with COEs. Often we promote the COE that the employer or health plan recommends. Examples of the COE programs include Cleveland Clinic for cardiac surgery and Mayo Clinic for organ transplants.

USDMT: In terms of the COE-is this where you see domestic medical travel come into play with The Healthcare Blue Book’s services? 

JR: Absolutely, we see patients traveling domestically to COEs.

We also have patients who will travel to find fair prices for their surgeries or other procedures.

HCBB can help patients locate providers that offer both high quality care and fair prices. Patients appreciate the ability to know in advance exactly how much their care is going to cost.  

USDMT: Have you witnessed a large percentage of individuals traveling for lower cost and better quality treatment? 

JR: Currently, I would say the majority of patients still receive their care locally.

However, when local providers won’t offer satisfactory arrangements, we do see increasing interest in domestic medical travel from patients in search of affordable, high quality/specialized services.

News in Review

Part II of III: Traveling for Healthcare - What Should You Do?
Stewart M. Hamilton, M.D., C.M.O., The Medical Travel Commission

Note that patient satisfaction is as an outcome! Satisfaction, in a general sense, is achieved when expectations are met. What are your expectations when you visit a physician, clinic or hospital? I am sure that high among your expectations is a successful operation or procedure. Incidentally, physicians rarely assume a successful operation, procedure or diagnostic work-up. They expect that it will be the case, but it is rarely assumed.

In light of the fact that a successful procedure, operation or work-up is presumed by most patients, for many the "softer" side of medical care is what drives satisfaction, as long as the procedure/treatment goes as planned.

Ask yourself what would be your expectations beyond a successful intervention away from home. Were arrangements made for you to get from the airport to comfortable accommodations? Were your dietary needs met? Were you able to speak with your principal physician before you left home? Were your concerns and questions answered? Do you feel that you were listened to and treated with respect? Post-surgery or procedure, were you able to contact your caregivers? How were your traveling companions treated?  Were your doctors prompt? Did they examine you? Did the hospital or clinic make sure that you were able to communicate with them when away from home? Were you provided with a summary of your hospital stay and any tests as you were discharged? Were arrangements made to ensure your safe trip home? Were you given enough medication to ensure you a pain-free recovery period including the journey? As a prospective patient looking at websites and brochures it can be difficult to assess whether such expectations are likely to be met.

While accreditation by the Joint Commission International (JCI) and other such bodies affirms a commitment by a hospital or clinic to quality and safety, accreditation by the Medical Travel Commission (MTC) assures that a hospital or clinic addresses each of the above "softer" aspects of care (and more). The MTC, founded and led by highly experienced international healthcare professionals, began accreditation activities in the U.S. in hospitals that provide care to international and intra-national patients in 2012, and is now expanding internationally.

The MTC standards are rigorous and have all to be met to be accredited. The Rehabilitation Institute of Chicago, the Texas Medical Center - Memorial Hermann Hospital, the Moffitt Cancer Center in Tampa and the Mount Sinai Hospital in New York are prime examples of world-class institutions that have departments totally dedicated to the medical traveler.  They are also examples of hospitals that have met all of the rigorous standards of the MTC and, as such, provide the very best of care to their patients who have travelled for care.

Any institution that attains the MTC accreditation joins a group of world-class hospitals providing world-class care specifically tailored to the needs of those patients who travel for their medical care. A comparable award might be that of a Michelin Star or Zagat rating.

Passing inspection by the local Health Department by the local Health Department implies a certain degree of cleanliness and safety but a Michelin Star or Zagat rating implies a great deal and particularly includes a superior ambiance, trained staff, and customer satisfaction, along with great food. An MTC rating of a hospital that has been accredited by JCI brings the same implication of quality, safety, ambiance, communication and cooperation and, most important, a dedicated department focused on the well-being and safety of the travelling patient.

Read Part III in the next issue of US Domestic Medical Travel Today

ProCure’s Involvement in Treating the Hearts, Minds and Souls of Medical Travelers
Carmen Sapara, ProCure Proton Therapy Center, Somerset, NJ
Nycke White, ProCure Proton Therapy Center, Oklahoma City, OK

As managers of patient services in facilities where many patients travel long distances to seek critical cancer treatments, we take our roles as partners with the physician team very seriously. While the clinicians’ primary focus is on the physical well-being of patients, we focus on treating hearts, minds and souls.

Many patients who arrive at our proton therapy centers travel great distances to receive treatment. Proton therapy is a very targeted form of radiation that treats tumors often located near critical organs such as the brain, spinal cord, head, neck, GI tract, lung and prostate. Sarcomas and pediatric cancers can also be treated with protons. When faced with the challenge of managing your own or a loved one’s illness, the extra burden of travel can pose an added layer of stress to an already overwhelming list of pressures and responsibilities.

It is our job to help alleviate this stress and to ensure that patients and their loved ones receive a very high level of service at every point in their treatment journey. Advance meetings with patients prior to their treatment enable us to best determine the type of accommodations that would optimally suit them and allow us time to reach out to community partners to assist in the process.

Such outreach often includes lengthy conversations with local hotels and extended-stay facilities, arrangements with airlines to waive baggage fees, coordination with rental car companies and relationships with community leaders and local businesses to help provide recreational activities. These meticulous efforts yield a rewarding result for everyone involved. ProCure’s team and the surrounding community often become a second family for our patients.

From the design of our centers that feature a “living room”-like lobby, to the patient graduation luncheons, weekly “dine-arounds” and new patient orientations, our team’s extensive thought and preparation aim to ensure that patients minimize time spent isolated in hotel rooms. While surrounding patients with an abundance of love, care and attention, we encourage them to maximize their time getting acclimated to the surrounding neighborhood. We take special care to ensure that children feel like children during this challenging time by occupying them with outings such as trips to the zoo, science museum and local fire station. Much to our delight, some patients end up knowing more about our community than we do!

Since actual treatment time each day is short, we feel it is critical to patients’ morale that they spend their free time engaging with others and enjoying quality time with loved ones that they might not take advantage of during their daily routines back home.

Our patients seem to agree.

It is not uncommon for those who have completed treatment and returned home to schedule follow-up visits to coincide with dine-arounds and other patient activities and to reach out to former patients who live locally to let them know they will be in town. The friendships we witness between patients who understand what the other is going through, and particularly between travelers and local patients, who extend their homes and hearts to patients far from home, are among the strongest bonds we have ever seen.

In our efforts to create a strong sense of family for patients, we are keenly aware that when they return home, they may not be surrounded with the same intense level of support that they experienced during their treatment period. We therefore work to help transition patients back to their former life, or their “new normal” and help to recreate the environment that surrounded them at ProCure. An important component to this effort includes helping patients connect with support groups in their home town, as well as coordinating patient reunions.

Witnessing and extending such an intense level of friendship and love on a daily basis is truly an inspiring experience. The patients that we meet from across the country -- and even the globe -- continue to inspire us and make us grateful to work where we do.

About Carmen Sapara
 She looks forward to celebrating every milestone that patients reach in the recovery process and seeks to empower them on a daily basis.

About Nycke White
Nycke White works as manager, Patient Services at ProCure Proton Therapy Center in Oklahoma City, Okla. The wife of a prostate cancer survivor, Nycke was inspired to work at ProCure as soon as the center was built in her neighborhood.  Motivated by the strength and determination of the patients who cross her path, she finds great fulfillment in enabling patients to relieve some of the pressures they face during the diagnosis and treatment process.

About ProCure Proton Therapy Center
ProCure Treatment Centers, Inc. ( was founded in 2005 and is the first to develop a network of proton centers across the country, including facilities in Oklahoma City, Chicago, New Jersey and Seattle.


Medical Tourism in the U.S.? This New Tool Makes It Possible
by Bruce Watson - Medical tourism is nothing new: For years, ailing Americans have been traveling around the world to get lower rates on hundreds of medical procedures, from hip replacements to root canals. But patients hoping to save money on healthcare may not need to travel across the globe. As a new tool from consumer comparison site demonstrates, lower rates for healthcare could be as close as the next state.

Take knee and hip replacements, for example, two of the more than 100 procedures the tool compares. On the low end, Chickasaw Nation Medical Center in Ada, Okla., charges $5,304 for a knee replacement. The next most expensive hospital, Medina Memorial in Medina, N.Y., charges $14,788. On the opposite end, Monterey Park Hospital in Monterey Park, Calif., charges $223,373 -- 42 times as much as Chickasaw and 15 times as much as Medina Memorial. Even factoring in the cost of traveling cross-country, the difference is stunning.

The economics of knee and hip replacements is especially shocking, but there are major differences in price for most big procedures. When it comes to angioplasty, for example, prices range from $13,314 to $203,522. Pacemaker placements run from $15,128 to $167,628, and removal of a gall bladder ranges from $6,750 to $140,449.

Admittedly, not all hospitals are the same. Some may have more experience with certain operations, which can improve patient outcomes. (The tool, which compares more than 3,000 hospitals, also indicates patient volumes for various procedures.) Others may have a higher average Medicare reimbursement, which could help keep costs low. All things being equal, however, it's clear that it doesn't take an overseas plane ticket to find medical bargains. With that in mind, before you plan your trip to Mumbai for a new hip, you may want to take a peek -- and see if there's a better bet just around the corner.

Medical tourism draws 450,000 visitors a year to Baja California
by K. Mennem estimated 450,000 people a year visit the Mexican state of Baja California for medical tourism. The numbers were recently stated by Juan Tintos Funcke, the state tourism secretary. Tintos Funcke went on to claim that the medical tourism industry brings in an estimated $89 million U.S. dollars per year to the state.

The state offers a cheaper alternative to many medical procedures in the U.S., from dental work to extensive surgeries. Passes are even available, by participating facilities, to shorten the wait at some of California’s ports of entry.

The Domestic Medical Tourist

An increasing number of individuals are opting to travel for medical treatment nationwide in search of quality medical care at lower costs. Delta Sky Magazine featured a story in July 2013 entitled, “The Domestic Medical Tourist” by Eric Lucas, showcasing the benefits of traveling for treatment. To view the story in its entirety, click here.


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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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From the Editor

Healthcare Pricing Secrecy: The End May be Near

International Hospitals Tout Pricing Transparency

Pricing Transparency: Ideal Complement to Value-Based Insurance Design

Spotlight Interview

David B. Nash, M.D., M.B.A.

Jeffrey J. Rice, M.D., J.D.

News in Review

Part II of III: Traveling for Healthcare - What Should You Do?

ProCure’s Involvement in Treating the Hearts, Minds and Souls of Medical Travelers

Medical Tourism in the U.S.? This New Tool Makes It Possible

Medical tourism draws 450,000 visitors a year to Baja California

The Domestic Medical Tourist