THIS WEEK IN U.S. DOMESTIC MEDICAL TRAVEL™
Volume 1, Issue 21
Editor's Note: Emerging Industries Can Learn From One Another
Medical Travel Meets Solar
When leaders in medical travel scratch their heads to figure out what will jump-start widespread adoption, they might want to look at other emerging industries - like the renewable energy sector -- that have mastered the art of disruptive innovation.
While the comparison between medical travel and solar seems unlikely, consider the fact that both are regarded as emerging industries: generally defined as a group of companies in a line of business formed around a new product or idea that is in the early stages of development. Typically, it consists of just a few companies and is often centered around a new technology.
Barriers to entry in emerging industries can be low because of limited competition, but it may be difficult to secure financing to grow the company. Entirely new or restructured industrial sectors, however, are growing at a rate faster than the overall economy. Such industries usually come into being when customers need change, new technologies replace older ones, or when new socio-economic conditions emerge.
This sounds like medical travel.
In December 2014, research and advisory firm Frost & Sullivan looked at 10 emerging industries and rated them on the four operating categories of market attractiveness, their ability to disrupt their industry, level of certainty of future business, and degree of innovation. After scoring each of 10 industries across those four categories, they gave the highest overall score to the industry of business-to-business and retail e-commerce, which it calls B2B Online Retail.
Perhaps the medical travel industry fits this category. But how can it mature, and where can it turn for guidance?
Let's look at solar and the renewable energy category. While solar and wind companies in this emerging sector historically struggled for market positioning, they successfully shed the term "alternative" and transitioned to mainstream. In other words, they gained credibility and public trust by documenting value - and this is paying off.
Today, companies in this sector are capturing business, as well as the attention of investors. How did they make this transformation? They became adept at tackling some of the greatest skeptics who doubted that their industry would survive without government subsidies.
Now, even the most ardent objectors can't help but feel bullish about these new energy sources and their unending ability to generate power without harmful emissions. Solar, in particular, represents a limitless source of sunshine and has attracted some of the most attractive IPOs and stock offerings.
Take a look at Principal Solar www.principalsolar.com which just announced it will be building the largest solar generating facility east of the Rockies. One must immediately ask how an early stage company can secure the rights to such a significant project. The answer goes back to disruptive innovation as explained earlier. In traditional industries, it is almost never the infrastructure companies that introduce the innovation and game-changing methodologies, but instead the fast-footed innovators.
What did they do right, and where is the parallel to medical travel?
- Emerging alternative energy companies addressed some big problems: finite fossil fuel sources, dangerous emissions, bloated and volatile pricing, and a growing reluctance to rely upon foreign oil.
The medical travel industry is already positioned to effectively address big global problems - cost, quality and access to healthcare. But we have not yet successfully convinced purchasers that in order to achieve cost savings without sacrificing quality, patients are advised to travel to a Center of Excellence... wherever it is located.
- Solar farm development companies like Principal Solar went on to document the cost, efficiency and clean benefits of solar power. As they forecasted, Grid Parity became a reality and the cost of solar power is now equal to - or in some locations cheaper than - traditional sources. Solar is not only recognized as a greener option, but it is also good business.
The medical travel industry continually boasts lower prices for dental and surgical care - with some locations touting savings of up to 80 percent on certain procedures. Even in the US, certain hospitals and free-standing surgi-centers broadcast significant savings. If the decision was simply based upon price, these destinations would be inundated with business, and the appetite of the investment community would be heightened... but it's not yet there.
- Several companies, including Principal Solar, developed and advanced a sound and sustainable business model, creating utility-scale operations that attracted high-profile partnerships: First Solar announced in February 2015 that Apple Inc invested $848M to build a solar farm with the Company. Also in early 2015, Principal Solar announced two major projects in North Carolina: one in Hope Mills, NC and the second - the largest solar project east of the Rockies -- in Cumberland County. Duke Energy Progress signed power purchase agreements (PPA) to buy energy from the projects. http://www.principalsolar.com/newsroom.html#mar92015
The medical travel sector has witnessed several business models: Online shopping portals, surgery benefit management, direct-to-consumer marketing and others. There's been a slight blip in the investment market, but we've yet to see a big break in the market - stay tuned! We need more fire-power and financial backing to make the industry attractive to investors.
- One of the best moves that Principal Solar made was to recruit a stellar Board of Directors and Board of Advisors - with high-profile names like Astronaut Buzz Aldrin, Energy-guru Earl Nye, Hunter Hunt, Hunt Consolidated Energy and others. Check out http://www.principalsolar.com/aboutus_advisorteam.html. You'll recognize some familiar names from other business sectors.
The medical travel industry needs to learn from this example. To date, we simply haven't done a good job in attracting all the right people as our champions and advisors.
- Principal Solar also deployed a campaign to become an industry thought-leader: they established the Principal Solar Institute, published White Papers, conducted Webinars, and tackled serious issues. They built a credible platform, earned the respect of stakeholders, and developed a channel for industry support.
The medical travel industry has some amazing thought-leaders. In the US alone, we can point to David Boucher (Companion Healthcare), Josef Woodman (Patients Beyond Borders), Ruth Coleman, (HealthDesign Plus), Olivia Ross (Pacific Business Group on Health) and others. Keith Pollard at IMTJ in the UK is also a great industry advocate. What we are lacking is a credible resource center that has the confidence of industry stakeholders and can command attention on a global level.
In a nutshell: this industry is not yet mainstream.
We have not yet figured out the "secret sauce" to engaging the financial and investor communities. But we seem to be undaunted in our pursuit of success, and there is clearly an entrepreneurial spirit that never wanes.
The question often arises as to why the entrepreneurs frequently lead and win in an environment where the established well-funded companies should prevail. Long time entrepreneur Michael Gorton, Founder and CEO of Principal Solar, says it best: "Entrepreneurs do not believe in barriers or obstacles. They work with relentless and creative persistence. Most importantly, they are willing to take risks where established companies feel they must protect their assets."
We need to keep studying and learning from other industries and market sectors, and institute a new set of behaviors that will catapult us to the next level.
Editor and Publisher
Following the implementation of the Affordable Care Act (ACA), many consumers are scrambling to keep up with the tremendous health care reform - and the high costs that trail along.
Now, as the majority of consumers are given full reign of their health care decision-making, it is important to note that not only are individuals interested in quality and pricing, but also outcomes and safety information.
Betsy Imholz, Special Projects Director, Consumers Union, details the organization's full commitment to consumers and its mission to assist individuals receive optimal care, and assure universal access to care, where possible.
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.
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.
Please be in touch and let me know how you are surviving and thriving in this emerging marketplace.
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.
Editor and Publisher
SPOTLIGHT: Betsy Imholz, Special Projects Director, Consumers Union
1535 Mission Street
San Francisco, CA 94103
About Betsy Imholz
Betsy began at Consumers Union's (CU) West Coast office in San Francisco in 1994. She focused on advocating in the California legislature and before State agencies on policy issues related to insurance, healthcare and general consumer protection. From 1999 to 2006, she was director of the West Coast office, overseeing core work and grant-funded projects. She has been Special Projects director for CU since 2006, and has focused intensively on healthcare reform since then.
Before coming to CU, Betsy was the Consumer Law coordinator of Legal Services for New York City, and represented low-income clients at the esteemed South Brooklyn Legal Services. Betsy graduated from Rutgers School of Law-Newark, and received her undergraduate degree from Columbia University.
About Consumers Union
Consumers Union is the policy and action division of the nonprofit Consumer Reports. We work with our million+ activists to pass consumer protection laws in states and in Congress. We hammer corporations that do wrong by their customers, and encourage companies that are heading in the right direction.
Our campaigns have already helped reduce hospital infections, lower credit card rates and improve card services, expand access to health insurance, improve the security of your financial information and much more.
U.S. Domestic Medical Travel (USDMT): Most people are familiar with Consumer Reports - but what is Consumers Union and its position in the healthcare space?
Betsy Imholz (BI): Consumers Union is the advocacy and policy division of Consumer Reports. Our healthcare work strives to bring about public policies that improve access to affordable, safe, high-quality care for all consumers.
Right now, rising costs in the healthcare system are a great concern to us. We know that we can't sustain the reforms that we worked so hard to attain unless costs can be contained. In developing policy positions, we research the available evidence. To my knowledge, however, consumers have not been surveyed on this topic of traveling within the U.S. for medical care, so there is not substantial research available on consumer reactions.
We know that for some procedures, facilities and physicians that perform a higher volume tend to have the best outcomes. Of course, it is important to note that, when it comes to medical care, consumers are not only interested in price, but even more so in safety and high quality results.
USDMT: Do you think that there is a real basis for reference pricing?
BI: Experience based on reference pricing continues to unfold, but reference pricing has mostly been in the employer context to date. In that particular circumstance, it has shown promise, but there has to be a number of consumer protections in place.
While reference pricing does seem to effectuate some cost-savings for purchasers and consumers, we do not know its overall potential. It is certainly not the "silver bullet" for all cost concerns.
The best way to implement reference pricing would be to start with a pilot project and limit it to specific procedures. For example, it should be aimed at procedures with high cost variation and elective procedures only.
Another major component that must be ensured is full understanding by both referring providers and consumers.
Of course, consumer support is especially important to us. When a patient undergoes a traumatic surgery, they need to have funding for a family member or close friend to be with them for assistance, and afterwards. Continuity of care and follow-up, such as physical therapy, must be in place when they go home.
Needless to say, there are many steps that must be in place first to test reference pricing - and to make it mandatory is an even bigger step.
USDMT: Is it feasible for the public exchanges to look outside of their particular state, or region, to find a more appropriate destination for care?
BI: It's not up to the public exchanges to look outside of their realm for care. Rather, they contract with plans that arrange for care. That said, contract terms between the public exchanges and the plans could affect whether that opportunity is, or is not, available.
Two of the worries that we have about out-of-state travel are, first, whether the strong consumer support I mentioned before is available, and second, the different regulatory schemes in each state.
I would want to know, "Does the other state have sufficient regulatory safeguards for people, and do they carry over? Do they maintain consumer protections from the state of residence or the state of the contract?"
USDMT: Who brings this type of healthcare education to the consumer?
BI: Information needs to be provided to the consumer by a trusted source where there is ongoing communication - and not simply a one shot deal. Medical travel options must be fully explained, and full information provided about the cost, safety, quality and track-record of the facility and physician.
I think multiple touch points are needed on the education front for both consumers and providers to make this kind of opportunity welcome and effective, as opposed to being viewed with suspicion.
USDMT: What can be done to help consumers view a medical travel opportunity as a quality option?
BI: As I mentioned, information must be provided by a trusted source. We know that consumers are skeptical, and rightfully so. These days consumers are being asked to share increasingly more of healthcare costs, facing limits on the number of providers in plan networks, and subjected to a constant deluge of health information, from new types of health plans to drug advertising and the latest medical study.
Medical travel is yet one more new concept. To be accepted as credible, it must be seen as a choice, not a requirement, with clear, credible information on cost, safety and quality. And additional support for accompanying family travel should be available. Frequent, clear communication amongst all providers involved-at home and away, from referral to surgery to follow-up-is essential. Misunderstandings and miscommunication between providers, and between patients and providers, are so common in our fragmented healthcare system. Out-of-area procedures could compound this unless communication and record-sharing systems are well coordinated in advance.
Charting a positive track-record of patient experiences is the best approach for creating positive perceptions about medical travel. Missteps, on the other hand, will become the "poster child" for how not to do it and chip away at public trust.
USDMT: Is there a role for Consumers Union to dig into this space and ensure that the consumer is protected?
BI: We have already written consumer principles on reference pricing, so we have begun to think through the protections needed from the consumer perspective, which can be viewed here.
As with all new health trends, we will monitor its prevalence, as well as practices involving domestic medical travel, and try to gather evidence about its impact on the health policy landscape, safety and consumer responses.
INTERVIEW: Hannah Alphs Jackson, M.D.
Program Director for Value-Based Delivery
Northwestern Memorial HealthCare
About Hannah Alphs Jackson, M.D.
Dr. Alphs Jackson is currently program director for Value-Based Delivery at Northwestern Memorial HealthCare. Prior to this role, she completed an Administrative Fellowship at Northwestern Memorial HealthCare after earning a master's in Health Services Administration at the University of Michigan's School of Public Health. Dr. Alphs Jackson received her medical degree from Johns Hopkins University School of Medicine in 2008 after achieving a Howard Hughes Medical Institute Medical Research Fellowship and being elected to the Alpha Omega Alpha Medical Honor Society. She subsequently spent three years as a Urology resident at Northwestern University's Feinberg School of Medicine in the Physician Scientist Training Program. It was at Johns Hopkins and Northwestern, navigating the healthcare system, where Dr. Alphs Jackson observed the formidable challenges of our contemporary healthcare landscape. From these experiences, she discovered her desire to become a physician leader to help transform the delivery of healthcare. Throughout her academic and administrative career, Dr. Alphs Jackson has maintained a passion for high-quality patient care, and hopes to use this passion and experience as a tool to shape the next generation of medicine. She currently holds a patent, has edited two book chapters and has authored 17 peer-reviewed journal articles, two book chapters and over two dozen abstracts.
About Northwestern Memorial Hospital
Northwestern Memorial is an academic medical center hospital where the patient comes first. We are an organization of caregivers who aspire to consistently high standards of quality, cost-effectiveness and patient satisfaction.
We seek to improve the health of the communities we serve by delivering a broad range of services with sensitivity to the individual needs of our patients and their families.
We are bonded in an essential academic and service relationship with Northwestern University Feinberg School of Medicine. The quality of our services is enhanced through their integration with education and research in an environment that encourages excellence of practice, critical inquiry and learning.
USDMT: You are an M.D. - do you practice medicine and run the program?
Hannah Alphs Jackson (HAJ): I am a urologist by training, but do not practice medicine anymore.
I am currently employed as the program director for Value-Based Delivery at Northwestern Memorial HealthCare.
The Value-Based Delivery team is part of our Managed Care department. We are tasked with examining how our organization might strategically transition from fee-for-service models to fee-for-value care delivery.
USDMT: Is your role an unusual position in today's market?
HAJ: A position with responsibilities similar to mine seems to becoming a much more relevant job in today's market. However, there is a wide range of scope, qualifications and governance for these roles depending on the individual organization.
USDMT: Tell us more about Northwestern Memorial Hospital.
HAJ: Located in the heart of downtown Chicago, Northwestern Memorial Hospital is one of the country's premier academic medical center hospitals, and the primary teaching hospital of the Northwestern University Feinberg School of Medicine. Northwestern Memorial ranks tenth in the nation in the U.S. News & World Report 2014-15 Honor Roll of America's Best Hospitals.
I should note that as of September 1, 2014, Northwestern Memorial HealthCare, the corporate parent of Northwestern Memorial Hospital, Northwestern Lake Forest Hospital, Northwestern Memorial Foundation and Northwestern Medical Group, merged with Cadence Health in Chicago's western suburbs, which greatly expanded our delivery system to include Central Dupage Hospital, Delnor Hospital, Cadence Medical Group, Cadence Foundation and Cadence Medical Partners. Together, we are striving to create a national model of a premier integrated academic health system that will serve a broad community and bring the best in medicine to a growing number of patients close to where they live and work. As an integrated academic health system, we are poised to take advantage of opportunities like bundled payments. It's an intriguing strategy for organizations, especially academic medical centers like ours, to explore as it leverages the high-quality, high-value services we can offer employers and payers alike.
USDMT: Tell us about your recent collaboration with General Electric (GE).
H AJ: Initially, GE sent us a request for a proposal, which we responded to accordingly.
Once GE selected Northwestern Memorial as one of their Centers of Excellence, our project teams have worked together closely to implement the program. This has been a highly collaborative process.
We participate in weekly team meetings to solidify our program progress and ensure success of the overall implementation.
Thus far, it has been a fantastic learning experience, and we are really grateful for their collaboration and partnership.
USDMT: What medical procedures or surgeries will be addressed with this contract?
HAJ: Our contract with GE is a national program that focuses specifically on total hip and total knee replacements.
USDMT: At this point, have any procedures been performed?
HAJ: GE introduced the program to their membership in November of 2014, and we are now in the process of signing up multiple patients for surgery in this new year.
USDMT: When patients arrive to your facility are they ever dismissed as unnecessary cases?
HAJ: That is something that we, GE, or our patients never want to happen - to have a patient show up and be deemed a non-surgical candidate. Often times, the patient will be deemed a candidate for a total hip or total knee replacement by either their primary care physician (PCP) or an orthopedic surgeon in their home location. GE has a process built in to ensure that patients are good candidates for surgery. We build in extra controls to ensure that before a patient even makes travel plans, our physicians on both the surgical and pre-operative clearance sides have had a chance to fully review their records.
I can say that this program is not necessarily optimal for every patient who needs a total hip or total knee replacement. In fact, the program is designed to be selective of which patients are good candidates.
For instance, evidence suggests that a patient with poorly controlled diabetes has a much higher chance of post-operative complications. As such, if a candidate is diabetic, we require that the patient have evidence that their disease is well-managed before they have surgery.
USDMT: What is the average length of stay for a patient in this program?
HAJ: The length of stay is different for hips and knees.
Typically, a patient undergoing a total knee replacement will stay here for roughly 48 hours, and a patient undergoing a total hip replacement will stay overnight.
However, I would add a caveat by saying that, while that might be the typical length of stay for each procedure, we very much individualize the care of every member in this program. Our care team works with each patient to appropriately position them based on the level of his or her pain, functional status and other relevant clinical factors related to overall recovery.
USDMT: Does your institution provide cost transparency - not only for GE, but for the general public, as well?
HAJ: Our organization is committed to sharing our performance on quality measures and outcomes on our website (http://nm.org/location/northwestern-memorial-hospital/quality-nmh/view-our-quality-ratings-nmh). We do not currently publish cost data on our website.
However, as part of the RFP process with GE, we were asked to be transparent about our costs in creating the bundled pricing. It makes a lot of sense to me that a partner like GE, who is investing time and money to create a great program with us for their members, needs that transparency to ensure that our pricing is not only competitive, but also financially viable.
USDMT: Does Northwestern plan to contract with additional employers in the future?
HAJ: If given the opportunity to contract with additional employers or expand our relationship with GE, it would certainly be something worth considering.
USDMT: Does your facility handle all of the travel and hotel accommodations for the patient?
HAJ: No, the members themselves are responsible for scheduling their own travel and hotel accommodations, but we do provide the patient a knowledgeable contact here at Northwestern who acts as a navigator for the patient throughout his or her participation in the program. In addition, we provide patients with a comprehensive list of resources in the local area, including hotels that provide special rates for Northwestern patients.
Medically-Assisted Therapy: An Outpatient Process for Affluent Individuals Who've Spent too Much Time on Pain Medications
Dr. Ricardo Borrego prepares for a naltrexone infusion procedure, part of EAI's patented ClarityTM process for treating opioid addiction.
Affluent individuals with busy careers and businesses wisely guard their time and their reputations. For those who develop dependency and addiction to painkillers - OxyContin, Vicodin and similar opioid-based medications - seeking treatment can feel like a Catch-22.
The cause of the current spike of opioid abuse in the U.S. is well documented and understood - two decades of increased prescription rates for painkillers has created a nationwide addiction epidemic. Healthcare providers wrote 259 million prescriptions for painkillers in 2012, enough for every American adult to have a bottle of pills. The people affected by this epidemic changed dramatically from the previous spikes in opioid dependency and addiction. Today, opioid addicts are 90 percent white, more than 50 percent female and often live in a well-manicured suburban neighborhood.
In many ways, typical healthcare for opioid addiction wasn't developed with the needs of an affluent population specifically in mind. First of all, most medically assisted treatment for opioid addiction involves replacing an addiction to one kind of painkiller with another opioid, just one that is safer. This may work for some, but for many people this kind of treatment is inconvenient or unrealistic. People with high profiles, such as senior executives, athletes, models and entertainment personalities, often will travel great distances for treatment that helps them become drug-free and suits their unique needs.
Over the past three years, our doctors at the Eagle Advancement Institute (EAI) have made substantial investments in research and development toward a breakthrough treatment for people who have become addicted to prescription painkillers or other opioids, such as heroin. The process consists of several steps, but includes a medically assisted detoxification procedure which requires our clients to visit one of our facilities. While the treatment, marketed as ClarityTM Intensive Outpatient Opioid Treatment (IOOT), is still fairly new, our company based in West Bloomfield, Michigan, is quickly gaining recognition within the medical community for its efficacy.
"People come to us because they don't have the time or the desire to suffer through a natural detoxification process. The CEO of a major company can't just take off for 30-days with no explanation and neither can a lot of other people with busy lives," notes Dr. Michael J. Michael, M.D., an anesthesiologist and medical director for Eagle Advancement Institute. "Clients compare our detoxification procedure, which is pain-free and completed in a matter of hours, to weeks of painful withdrawal symptoms and view our approach as more practical."
Patients have limited memory of the detoxification process. The hour-long procedure utilizes semi-conscious sedation, similar to that experienced in minor dental procedures, to eliminate the pain and suffering of withdrawal. During this time, doctors introduce medications into the patient's system that work to cleanse the body of opioids. If a patient were completely conscious this would result in immediate and very painful withdrawal symptoms. The naltrexone-based therapy aids in the reduction of post-procedural cravings. Naltrexone is a drug known as an opioid antagonist - it blocks the same receptors in the brain that painkillers and other opioids use to induce its euphoric and painkilling effects. The procedure is complete when the level of naltrexone present in the patient's body can prevent withdrawal symptoms for several days.
Importantly, our naltrexone-based therapy contributes heavily to the long-term success of the procedure by drastically reducing the potential for relapse. We prescribe the naltrexone regimen for a minimum of one year, which helps them to readjust to an opioid-free lifestyle at work and at home. The opioid-blocking effects of a long-lasting naltrexone pellet, injected monthly under the skin, helps to prevent the possibility of short-term psychological stress creating a relapse incident.
"A client would need to deliberately avoid their naltrexone dosing schedule for weeks at a time in order to achieve a high, which is a weakness of traditional naltrexone-based therapies where patients can cease taking pills for a day in order to experience the escape and euphoria of taking pain medication," added Kathy Row, licensed therapist for the Clarity Aftercare Program. "In most cases, the psychological stress that creates the temptation to return to opioid abuse passes before the naltrexone wears off."
Patients who elect for treatment are provided with instructions before and after they arrive for treatment. These include typical measurements of vital signs, average daily opioid consumption habits, and advice on how to prepare for the procedure and rehabilitation therapies.
"We understand that our clients are still trying to maintain very busy and hectic schedules, and we take measures to limit the disruption to their lives," added Jim Carpenter, managing director for Eagle Advancement Institute. "Most clients know little about the laws governing the transport of a schedule II drug for instance, but nobody wants them going into withdrawal while they're traveling for treatment, so we instruct them on what and how to pack."
People who have been taking opioids for long periods have depressed their emotional centers of their brains. The drug also influences other bodily systems, such as the digestive tract and respiratory systems. Following treatment, people often feel like they have the flu for a couple of days, so clients may travel with or ship certain items they find comforting during times of illness.
Clients with extraordinarily high public profiles or for those with professions where public knowledge of abuse behaviors could be career-ending, maintaining privacy is of even greater concern. People with these backgrounds often opt for greater levels of service provided by the Clarity program.
"For convenience and privacy concerns, we frequently handle hotel reservations, car service to and from the airport and arrange for other kinds of comfort accommodations that help make their post-procedural recovery less stressful," added Carpenter. "We've even worked with clients who travel with an entire staff where we've had to discretely reserve an entire floor of a hotel as part of their stay with us."
After the procedure, it is recommended that clients engage mental health support services that are close to their home or workplace. Our staff members help clients coordinate these connections whenever possible. However, our counselors run a weekly online support meeting for people in recovery that many clients take advantage of for its convenience and relatively higher degree of anonymity.
Addiction is as much a behavioral challenge as it is anything else, and 12 months is a key milestone in long-term recovery. We focus on helping patients achieve abstinence for a minimum of one year. We've seen great results - better than four out of five patients remain compliant and active for the entire year following detoxification in an outpatient-based program. Success in addiction medicine starts with fully understanding available practices and the environments our clients live in.
About the Authors:
Dr. Ricardo Borrego, M.D., a board-certified anesthesiologist and director for Eagle Advancement Institute (EAI) and EAI's addiction specialists and licensed counselors contributed to the development of the ClarityTM Intensive Outpatient Opioid Treatment (IOOT) - the process on which this article is based. Patients, families and referring parties, such as medical and insurance providers, schools and courts, can find more information at the ClarityTM website or by dialing 1 (888) 431-1502.
Medical Tourism Growing up to 25 Percent Annually: Stratus Video Interpreting Urges Florida Healthcare Organizations to Standardize Interpretation Services
Amid increased promotion and investment in Florida medical tourism, Stratus emphasizes the critical need for standardized medical interpretation services to support foreign patients with limited English proficiency (LEP).
After receiving $5 million from the state legislature to promote medical tourism, the Visit Florida tourism marketing association recently launched a $2.5 million grant program to help businesses promote Florida as a medical tourism destination (1). In light of these initiatives to capitalize on the burgeoning medical tourism market, Stratus Video Interpreting advises Florida healthcare organizations to standardize their medical interpretation services for foreign visitors with limited English proficiency (LEP). Stratus, which specializes in video remote interpreting (VRI), cautions that a lack of formal interpretation services for LEP patients can have legal and financial consequences.
According to Patients Beyond Borders, today's global medical tourism market is worth between $38.5 and $55 billion, growing at a rate of 15 to 25 percent annually, and draws 11 million cross-border patients worldwide (2). While much of America's medical tourism is outbound, with approximately 1.2 million citizens traveling outside the country for medical treatments (2), the United States is reportedly the second largest inbound medical tourism destination, with an estimated 850,000 to 1.25 million medical tourists annually (3). Florida's beaches, theme parks and cruise ports have made it a popular destination for overseas visitors, and evidence suggests that many medical tourists are among them. One Florida healthcare organization-Miami's Jackson Health System-estimates that it serves approximately 2,500 international patients each year and grosses an average of $78.3 million from international payments (4).
Financial incentives, such as the Visit Florida grants and potential income from foreign medical tourists, have led numerous healthcare organizations to begin marketing their services internationally. However, since foreign-born patients often have limited English proficiency, healthcare providers need to be mindful of the LEP compliance requirements established under Title VI of the Civil Rights Act. Title VI mandates that any program receiving federal funding-including hospitals and other healthcare facilities that accept Medicare or Medicaid payments-must ensure that people with limited English proficiency have meaningful access to programs and services (5).
Despite these federal requirements, some healthcare organizations have not yet implemented standardized medical interpretation services. Those facilities may rely on unofficial interpreters that have not completed standardized training or certification, such as a patient's family members or friends, or they may assume that a patient's limited English skills are sufficient to understand health-related conversations. However, any organization or healthcare provider that does not comply with Title VI requirements can be investigated for discrimination against LEP patients, and may be subject to fines and other noncompliance penalties.
In addition, organizations that do not provide access to qualified healthcare interpreters risk jeopardizing their patients' health and safety. Numerous studies have shown that professional interpretation services resulted in a significantly lower percentage of medical errors than ad-hoc interpreters or no interpreters (6), thereby helping to avoid potentially life-threatening mistakes and malpractice lawsuits.
"The medical tourism industry is clearly growing in popularity and financial potential. As a Florida-based business, we recognize the value it offers to patients and our state economy," said Sean Belanger, CEO of Stratus Video Interpreting. "While we fully support the promotion of Florida medical tourism, I think it's important for healthcare organizations to first ensure that they have standardized medical interpretation services in place. This not only protects LEP patients, but it also protects the facility from potential discrimination complaints and noncompliance penalties."
Belanger notes that budgetary and staffing limitations are no longer a barrier to providing equal language access, since on-demand video interpretation services allow organizations to connect to qualified medical interpreters as and when needed. Stratus offers video remote interpreting (VRI) services in more than 175 spoken and signed languages, and clients only pay for the actual minutes used.
To learn more about Stratus and its medical interpretation services for patients with limited English proficiency, visit http://www.stratusvideo.com.
About Stratus Video Interpreting:
Stratus Video Interpreting provides on-demand interpreter services by using technology to connect clients with interpreters in over 175 spoken and signed languages in less than 30 seconds. Stratus' cloud-based video solution delivers an array of unique features to virtually any Internet-enabled PC, Mac, smartphone or tablet. Stratus clients use the technology to connect with their own staff interpreters, as well as with Stratus interpreters, who have years of healthcare and courtroom experience and hold multiple certifications. With Stratus, state-of-the-art video remote interpreting is made available with virtually no capital investment. Stratus averages 65,000 video calls a day, up from 40,000 in mid-2013. Stratus Video is the sister company of The Z® (CSDVRS, LLC, dba ZVRS), which was established in 2006 and developed by and for deaf and hard-of-hearing individuals, setting the industry standard as the nation's premier Video Relay Service Provider and the first VRS Provider to receive a five-year certification from the FCC. In 2014, Stratus was recognized as one of the fastest-growing privately held companies, ranking #3,827 on Inc. magazine's Inc. 5000 list. For more information, visit http://www.stratusvideo.com.
1. Satchell, Arlene. "Visit Florida Offers $2.5M in Medical Tourism Grants"; Sun Sentinel; November 11, 2014. sun-sentinel.com/business/tourism/fl-florida-medical-tourism-grant-20141111-story.html
2. Mitchell, John W. "Medical Tourism: Healthcare Disrupter or Fringe Service?"; DOTmed HealthCare Business News; January 2015. dotmed.com/news/story/24812
3. "Medical Tourism Statistics & Facts"; Patients Beyond Borders website; last updated July 6, 2014. patientsbeyondborders.com/medical-tourism-statistics-facts
4. McGrory, Kathleen. "Lawmakers Seek to Draw Medical Tourists to Florida"; Miami Herald; April 6, 2014. miamiherald.com/news/business/article1962450.html
5. National Health Law Program. Federal Laws and Policies to Ensure Access to Healthcare Services for People With Limited English Proficiency; July 1, 2009; PDF file. healthlaw.org/publications/federal-laws-and-policies-to-ensure-access-to-health-care-services-for-people-with-limited-english-proficiency
6. Flores, Glenn; Abreu, Milagros; et al. "Errors of Medical Interpretation and Their Potential Clinical Consequences: A Comparison of Professional Versus Ad Hoc Versus No Interpreters"; Annals of Emergency Medicine; November 2012. ncbi.nlm.nih.gov/pubmed/22424655
To view the original release click here.
ChartWise 2.0 Helps Southeastern Ohio Regional Medical Center Prep for ICD-10 Implementation
With the ICD-10 conversion deadline right around the corner, healthcare professionals are doing all they can to make sure they are prepared for the transition. Computer-Assisted Coding (CAC) solutions alone will not be able to meet the specificity of documentation required under ICD-10. The need for a comprehensive Computer-Assisted Clinical Documentation Improvement (CACDI) solution to ensure accurate records, improve outcomes and ensure equitable reimbursement is in high demand. ChartWise Medical Systems' ChartWise 2.0 software provides a proactive, high quality and easy-to-use method for streamlining and improving the clinical documentation process.
Southeastern Ohio Regional Medical Center opened its doors in 1952 as Guernsey Memorial Hospital, named after the county it serves. Since then, Southeastern Med has served as Guernsey County's only general acute healthcare center and largest employer. A true community hospital, Southeastern Med is affiliated with approximately 180 physicians and licensed for 99 beds. It has a coding staff of seven, along with four clinical documentation specialists. When Denise Stephens, director of documentation integrity/utilization management, started as a documentation specialist four years ago, all documentation at Southeastern Med was on paper and over the years she developed an Excel spreadsheet to track queries and create monthly graphs for her director and vice president. While it worked fine, the documentation team was also aware of the opportunities they were missing out on and the information they were unable to provide.
Search and Action:
Amidst her search to find an application to assist the clinical documentation specialists at Southeastern Med, Stephens attended the 2012 Northern Ohio Documentation Specialist meeting. The speaker for the day was ChartWise Medical Systems Founder and CEO Dr. Jon Elion. Stephens took notice and later called for a demonstration of his company's software. For Stephens and her team, ChartWise was the clear choice. Their willingness to work with a small community hospital, the affordability and the ability to import data via HL7 feeds helped them stand out from other vendors.
Stephens took the ChartWise software to the medical center's Purchase Analyst Support Team and pitched them on the software's return on investment, ease of use, ability to toggle from ICD-9 to ICD-10, and the minimal internal support needed from the medical center's IT team. Important to Stephens was the ability to demonstrate to the CEO that ChartWise could help the staff accomplish more, improve the quality of care and supplement the hospital's needs.
"In our case, the addition of the documentation system promotes the quality and integrity of care received, a decrease in medical necessity denials, and more accurate coding," said Stephens. "These do not necessitate reimbursement figures but assist in our HVBP, APU and validation with CMS."
Once ChartWise was selected, implementation went quite smoothly. The ChartWise implementation team and trainers worked closely with Stephens and her team, preparing them for their go-live. When asked about the training, transition, and support from ChartWise, Stephens has nothing but praise. "ChartWise is fabulous! They treat their clientele like family," said Stephens. "They want you and your team to succeed."
Southeastern Med implemented the ChartWise software in September of 2014, and in the first three months, the medical center's query impact captured more than the previous three quarters of the year combined. Other victories reported by Southeastern Med are ease of use, time saved, superb support, and being able to test and easily transition from ICD-9 to 10.
"We are proud to be able to partner with Southeastern Ohio Regional Medical Center," said Mary Cooper, executive vice president of ChartWise. "It's exciting to see the success this wonderful community medical center has achieved in such a short amount of time. ChartWise is humbled to have been able to play a part."
When asked about her favorite ChartWise 2.0 features, Stephens explains, "We love the program's Sophie built-in intelligence feature which helps guide the staff through queries and consideration of other diagnoses. Then, there's the baseline to working DRG and the ease of review thanks to features like color coded notes. In the past, we would use an encoder and each time we received a new or additional diagnosis we would have to start over. Now, new information is simply added to the list, which saves a tremendous amount of time. Finally, the customer service is phenomenal. You can't undervalue fast response times and a personalized touch. From top to bottom, Southeastern Med is reaping the benefits of implementing the ChartWise 2.0 software."
Simple Steps for Physicians to Minimize Malpractice Risk
For many physicians, it's no longer a matter of if they will face a lawsuit from a patient, but when.
According to Physicians Practice's 2014 Great American Physician Survey, three in 10 physicians said they have been a defendant in a lawsuit, and another four in 10 said they've been threatened with legal action regarding their services. While providing excellent clinical care can of course reduce the likelihood of a medical error, there are other ways medical practices can minimize their malpractice risk.
The cover story for the March 2015 issue of Physicians Practice explores several of these non-clinical ways physicians can decrease the likelihood of facing a malpractice lawsuit, featuring insight and advice from practice management and malpractice experts. From prioritizing physician communication and improving staff interactions with patients to having strong policies and documentation in place, medical practices can work to be proactive vs. reactive in addressing patient dissatisfaction with a treatment outcome.
"Physicians and medical practices are busier than ever and everyone is trying to see all the patients they can in a set amount of hours -- and that's not counting emergency and last-minute visits. So, sometimes, in the bustle of a busy practice day, the patient doesn't feel heard or understood, and when they are troubled or have a bad outcome, those feelings can manifest into a lawsuit," said Keith L. Martin, Physician Practice's group editorial director. "But from improving staff training to making sure documentation is thorough and organized, there are ways to handle the business of medicine and the emotions of patients."
For example, Jeffrey D. Brunken, president of physician insurer MGIS, recommends four simple communication strategies for physicians during a patient visit:
- Don't dismiss (or appear to dismiss) patient concerns.
- Listen carefully.
- Set realistic expectations.
- Provide clear answers.
In addition to expert recommendations, this month's cover story also features:
- Tips on how to handle a confrontation with angry patients;
- Advice on how to properly apologize to a patient following a treatment error;
- Insight on four key communication problems that increase the likelihood of a lawsuit (and how to avoid making them; and
- Guidance on the top 10 things physicians should never say to patients.
About UBM Medica US
Addressing today's healthcare information needs, UBM Medica US, delivers strategic, integrated communications solutions and comprehensive reach -- online, in print, via custom programs and live events. Improving the effectiveness of healthcare through information and education, UBM Medica US provides unbiased clinical, practical and business information for physicians, providers and payers resulting in improved quality of care for patients around the world. Through journals, magazines, online communities, live and digital events and other valuable resources, UBM Medica US also delivers comprehensive communication solutions for the pharmaceutical and related industries. Online communities include CancerNetwork.com, ConsultantLive.com, DiagnosticImaging.com, RheumatologyNetwork.com, OBGYN.net, PhysiciansPractice.com, PsychiatricTimes.com and SearchMedica.com. UBM Medica US is part of UBM Connect which, through a range of aligned interactive environments, both physical and digital, increases business effectiveness for both customers and audiences through meaningful experiences, knowledge and connections. Headquartered in New York, UBM Connect brings together UBM's healthcare business, UBM Medica US; UBM Canon's advanced design and manufacturing event, online and print brands; UBM Connect New York's catering, cruise shipping, customer management, and fine, specialty and custom chemical communities; and UBM Mexico's concrete show. For more information, visit www.UBMMedicaUS.com.
About UBM plc
UBM plc is a global events-led marketing services and communications company. We help businesses do business, bringing the world's buyers and sellers together at events and online, as well as producing and distributing news and specialist content. Our 5,500 staff members in more than 30 countries are organized into expert teams which serve commercial and professional communities, helping them to do business and their markets to work effectively and efficiently.
For more information, go to www.ubm.com; follow us on Twitter at @UBM_plc to get the latest UBM corporate news.
Jason J. Golden
Content Marketing Manager
To view the original article click here.
Healthcare Cost Institute (HCCI) Launches Guroo - To Provide Consumers With Free Access To A Healthcare Transparency Tool
New website, guroo.com, provides consumers with information to facilitate more informed healthcare decisions
The Healthcare Cost Institute (HCCI), an independent, non-partisan, non-profit organization, announced today the introduction of guroo.com, a consumer-focused website that provides national, state and local cost information for common health conditions and services using claims from multiple insurers for more than 40 million insured individuals - numbers that no one else has. The new website is free and accessible to everyone, regardless of whether they have insurance or who their insurer is. Guroo was created with the goal of giving consumers information on the costs and quality of healthcare so they can make more informed choices about how they spend their healthcare dollars.
The introduction of guroo.com sets the stage for more to come in 2015. HCCI envisions additional enhancements to the website, such as more healthcare price information, quality information, a Spanish-language version and prescription costs. For consumers whose insurers partner with HCCI (which is open to all insurers on equal terms), more detailed information, including expected out-of-pocket expenses and provider quality measures, are being planned for the future.
"For many consumers, shopping for healthcare doesn't feel like an option - it's simply too complicated. Guroo intends to change this by showing consumers they can shop for healthcare and elect where they spend their healthcare dollars," said David Newman, executive director of HCCI. "With rising prices and more consumers enrolled in high-deductible health plans, consumers are eager to get the best value out of every dollar they spend on healthcare."
In recent years, healthcare costs have increased faster than wages, and health spending is projected to continue to grow - estimated at six percent per year through 2023. Consumers need clear and accurate information now more than ever, as out-of-pocket spending also continues to rise. Through HCCI's transparency initiative, consumers will have access to health information that they can use when choosing a doctor or a seeking treatment. Consumers can learn about conditions, including the common progression or likely steps of their care, what to expect, and how to prepare for their doctor visit. The information guroo.com provides is based on data that allows reporting at the national, state and local level for a variety of procedures and tests relevant to consumers' healthcare needs.
Cost estimates are calculated from HCCI's comprehensive health insurance claims dataset, which includes anonymous claims data on more than 40 million people nationwide, making it one of the largest public consumer datasets. The claims data are from some of the nation's leading health insurance companies. Currently, Aetna, Assurant Health, Humana and UnitedHealthcare are involved in the initiative. All healthcare payers are invited to join the initiative and other insurers are expected to join in 2015. Broad stakeholder participation will encourage greater consumer engagement. HCCI also anticipates partnering with states engaged in all payer claims databases (APCD) initiatives as they work to provide price and quality transparency information.
What Can Guroo Do for Consumers?
Using health insurance claims data, guroo.com will launch with estimated costs for more than 70 common health services such as childbirth, knee pain, an MRI or a physician office visit. Future releases will significantly increase the set of schedulable, discretionary, shoppable services consumers can research. Similarly, consumers and healthcare stakeholders can compare costs across different locations to identify geographic areas where services are most affordable. These estimates are based on actual amounts paid to providers by insurers and consumers.
A search reveals the national cost estimate for one type of knee MRI is $681 compared to the statewide average cost in Wisconsin of $1,912 and the local cost of $2,511 in Madison, Wisconsin.
Guroo.com is consumer-friendly and presents cost information in a unique manner using care bundles and steps rather than difficult-to-understand procedure codes. The website summarizes the steps of care when appropriate and shows the cost of each step. Guroo.com also provides consumers with questions they can use when talking with their healthcare provider to better understand their choices and help achieve a quality health outcome.
Although guroo.com was designed specifically for consumers, HCCI recognizes that this website will also be valuable to employers, policy makers and regulators who can now assess prices and how costs compare nationally and locally. HCCI is currently not aware of any other resource that contains this much data and offers this service.
About the Healthcare Cost Institute
The Healthcare Cost Institute (HCCI) is an independent, non-profit organization with a public-interest mission. Launched in 2011, HCCI is now a leader in research and reporting on healthcare expenditures and utilization. HCCI holds data for over 50 million covered lives from the privately insured population and Medicare Advantage resulting in one of the most comprehensive claims datasets in the country. In addition, HCCI is the first national Qualified Entity (QE) entitled to hold Medicare data for the 50 million individuals covered by the program. For more information, visit www.healthcostinstitute.org or follow us on Twitter @healthcostinst.
Janet Firshein, 301-280-5701, firstname.lastname@example.org
Bethanne Fox, 301-448-7411, email@example.com
Brandon Skop, 212-885-0462, firstname.lastname@example.org
To view the original release click here.
Discontinuity of Care
by Arlen Meyers, M.D., MBA
The old notion of continuity of care, i.e. the quality and integration of care over time, has become another casualty of the changes taking place in both sick care and healthcare services. The expectation used to be that you would see the same doctor for all your needs. No more. It used to be that you would see the doctor you saw in the office if and when you were admitted to the hospital. No more. It used to be the same doctor would take care of you in the ICU, as well as on the inpatient floor.
No more. It used to be that you would see the same surgeon preoperatively, in the OR and postoperatively. No more. Now, in fact, you might be seeing no doctor preoperatively, have surgery in another country, then see someone postoperatively in your hometown...if they are willing to see you, that is.
The reality is that our old notion of continuity of care was and is a myth. The system provided little in the way of information integration, particularly when it came to getting services in non-traditional sick care locations, like alternative pharmacies or health clubs.
But things are changing. Teams are now taking care of teams. Health information systems, while not perfect by any means, are agonizingly inching towards interoperability and information exchange, making notes, information and data transparent.
The risk, however, is that one team will fumble when it comes to passing the baton to the next team, and that referral leaks and discontinuity of care will persist.
Continuity of care could be another casualty of the democratization, personalization and consumerization of care, and patients will have to assume more responsibility as a member of the team. On the other hand, technology might make it easier to securely take the ball between the numbers. Either way, fumbling the ball in the red zone can have fatal consequences.
Arlen Meyers, M.D., MBA, is the president and CEO of the Society of Physician Entrepeneurs at www.sopenet.org and linkedin group.
To view the original article click here.
Eight Health Plans Choose McKesson's Network Management Solutions
Payers go with McKesson's Provider Manager and Contract Manager to help ease complexity of transitioning to a value-based healthcare system
Today McKesson Health Solutions announced that eight health plans representing over 8.5 million lives began using new releases of McKesson Provider Manager™ and Contract Manager™ in 2014. These solutions are part of the Network Management suite that helps plans efficiently implement and scale provider networks and associated reimbursement models.
"Payers are under unprecedented pressure to bring new networks to market quickly to attract and retain members," says Carolyn Wukitch, senior vice president and general manager of Network and Financial Management at McKesson Health Solutions. "Our solutions provide the agility and process efficiency needed to rapidly develop new network models, contract for new care delivery and payment models, and price more complex reimbursement arrangements. Through automation, we can help reduce the time it takes to bring a new network or reimbursement model to market from years to just a few months, without adding headcount."
Developed in partnership with over 30 leading health plans, McKesson's Network Management solution suite helps payers nimbly create customized networks to appeal to today's healthcare consumer while facilitating better collaboration with providers. The suite helps payers transform network management to a strategic asset in a post-reform value-based healthcare world.
The McKesson Network Management solution suite includes:
- McKesson Contract Manager, a flexible contracting solution that helps health plans minimize the financial risk of new care delivery and reimbursement strategies, expedite the contracting process, and reduce administration costs. It creates a single, electronic repository of contract information coupled with workflow tools for automating and streamlining the entire contract management lifecycle.
- McKesson Provider Manager, an agile, scalable solution that centralizes complex provider information helps users manage relationships from a single source of truth for provider data. As part of the McKesson Network Management product suite, Provider Manager helps simplify design, management and servicing of provider networks and value-based reimbursement.
- McKesson Reimbursement Manager™, an advanced claims pricer that helps plans create, centralize and optimize complex reimbursement strategies. It helps identify the correct provider reimbursement rate based on the unique combination of member, product, provider, service and client-specific attributes. It also supports flexible policy design, allowing for complex mixes of reimbursement models and customized fee schedules.
For more information on McKesson Health Solutions, please visit our website, hear from our experts at MHSdialogue, and follow us on Twitter at @McKesson_MHS.
Related McKesson Health Solutions News
13 Health Plans Invest in McKesson's Latest ClaimsXten™ Solution for Accurate and Efficient Reimbursement
Over 600 Payers, Providers Chose McKesson InterQual® Criteria for Clinical Decision Support
New Reimbursement Models to Eclipse Fee-for-Service by 2020
About McKesson Corporation
McKesson Corporation, currently ranked fifteenth on the FORTUNE 500, is a healthcare services and information technology company dedicated to making the business of healthcare run better. McKesson partners with payers, hospitals, physician offices, pharmacies, pharmaceutical companies and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting. McKesson helps its customers improve their financial, operational and clinical performance with solutions that include pharmaceutical and medical-surgical supply management, healthcare information technology, and business and clinical services. For more information, visit www.mckesson.com.
McKesson Health Solutions
Amy Valli, 215-962-5531
To view the original release click here.
Medical Tourism Trend Domestic Travel Seen Trickling Down Market
by Bruce Shutan
Sipconline.net-When it comes to shopping for bargains on the so-called medical tourism market, self-insured employers might just be better off sending their infirmed employees to Peoria than Pretoria.
To view the article in its entirety click here.
Consumers Would Benefit from Transparency Tools on Exchange Websites
by Tracey Walker
Managedhealthcareexecutive.modernmedicine.com- Marketplace websites could be doing significantly more to help consumers make informed choices about their health plans, according to a new study.
To view the original article click here.
Providers Fall Short on Price Transparency
by Zack Budryk
Fiercehealthfinance.com-Only one-quarter of healthcare consumers get pre-treatment cost estimates from their providers, according to a new survey from TransUnion.
To view the original article click here.
Indiana Unveils Price Transparency Website
Hospital charges have wide range
by Ron Shinkman
Fiercehealthfinance.com-The Hoosier State is the latest to get into the price transparency game, with the Indiana Hospital Association launching a database that contains a variety of charges for common medical procedures, the Indianapolis Star reported.
To view the original article click here.
Best and Worst Hospital Rankings Often Conflict, Confuse Consumers
by Zack Budryk
Fiercehealthcare.com- Four of the most popular ratings systems for hospital quality are often at odds, potentially confusing patients, according to an analysis published in Health Affairs.
To view the original article click here.
Help Save a Life and Support MatchingDonors
100 percent of all donations on MatchingDonors.com go to help people get organ transplants on MatchingDonors.com.
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.
By subscribing to U.S. Domestic Medical Travel™ and using the website, you agree to the collection and use of your personal information as described in this policy. If we make any significant changes to this policy, we will notify you by posting a notice of such changes.
- We will never spam you or give your personal contact information to anyone without your express permission.
- You can unsubscribe from the newsletter at any time.
How we treat your information
We will not spam our subscribers. You will receive U.S. Domestic Medical Travel™ only, and you can choose to unsubscribe at any time. Subscribers may opt in to receive occasional messages from our partners or sponsors.
We will never disclose your personal information without your permission. We will never sell, rent or share your personal information with a 3rd party, especially your email addresses, without your express permission, unless:
- You specifically request us to do so (e.g. you are having technical difficulties).
- It is required by law.
- It is necessary to maintain our system.
We will protect your information from other users. We may sell, rent or share information about user habits in aggregate only.