THIS WEEK IN U.S. DOMESTIC MEDICAL TRAVEL™
Volume 2, Issue 6
As healthcare costs continue to rise, employers are looking for solutions to maximize value and obtain the highest return on investment.
Bill Lacy, president, Association for Corporate Health Risk Management (ACHRM), communicates ACHRM's goal to help organizations control healthcare costs, aggregate and manage health risks, and boost employee health-related productivity and well-being.
The medical travel industry learned that Satori World Medical, Inc. has filed for bankruptcy. There may be some lessons here that we can all learn from - and build a business model that generates confidence. I have been receiving emails from many stakeholders in the medical travel community, and while they are reticent to be identified, their comments are worth repeating:
"It is a mess and a shame. They had made some headway but the ghosts of prior employees and over-spending got the better of them..."
"The former CEO and founder of Satori was a convicted felon who served time for fraud. His ‘patents' -- which he seems to have filed while in prison -- have perhaps done the most harm to our medical travel industry, on the corporate side. People, and organizations founded on lies and deceit, eventually get their due, but it sometimes takes time for the market to heal the wounds."
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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.
"Rising health insurance premiums, lack of transparency and increased awareness of how varied medical costs and quality vary dramatically between hospitals and across regions, have pushed consumers right into the arms of international and domestic medical travel. The growing industry provides the perfect solution for patients to receive the high-quality, cost-effective care that they need AND rightfully deserve!" - Laura Carabello, Executive Editor and Publisher, Medical Travel Today and U.S. Domestic Medical Travel.
READERS: I invite you to send quotes relevant to domestic medical travel to email@example.com to be featured in upcoming issues of U.S. Domestic Medical Travel.
Thank you for your interest in this exciting, growing market space. Please be in touch with your comments and editorial contributions, which can be sent directly to: editor@USDomesticMedicalTravel.com.
Editor and Publisher
SPOTLIGHT: Bill Lacy, President and CEO, Association for Corporate Health Risk Management (ACHRM)
President & CEO
The Association for Corporate Health Risk Management (ACHRM) is a national membership-based organization comprised of progressive employers ranging in size up to 30,000 employees and Best-In-Class Sponsor Partners seeking education, a venue to collaborate, innovative methodologies, disruptive technologies and other resources to more effectively contain their organization's healthcare costs, aggregate and manage health risks, and boost employee health-related productivity and well-being.
U.S. Domestic Medical Travel (USDMT): Describe the activities of the Association for Corporate Health Risk Management (ACHRM).
Bill Lacy (BL): To better define our mission, let me break it down into pillars.
The first pillar of ACHRM is built on price transparency and quality metrics for healthcare services, and within that pillar is where direct contracting comes into play - domestic medical travel, international medical travel, pharmacy benefit management, etc.
The second pillar consists of how to optimize a self-funded strategy, accessing, analyzing and interpreting data, and integrating employee health management strategies - which include wellness, disease management, safety and workers' comp.
The third pillar comprises developing, advancing and sustaining the employee health management strategies that are implemented, as well as addressing data analytics that measure return on investment.
The fourth pillar, where my professional background comes in, focuses on the education and engagement of the CFO, as well as the financial community.
In the past, when I was a CFO for a small, mid-sized or large company, my advisors were the investment bank, the commercial bank, the auditor, the attorney, etc. Truth be told, we need to engage these groups with healthcare cost containment. Unfortunately, while these professionals realize the importance of cost containment, most are disconnected from it. ACHRM runs a variety of different programs to educate and engage these professionals, but the most effective one to date is the CFO roundtable.
The fifth pillar consists of professional certificates for the working individual. I am not going to spend a great deal of time on this last component, because this element is still in incubation. We've developed a curricula, but are still trying to find a strong academic partner to drive this initiative forward.
USDMT: How can employers get involved in direct contracting?
BL: Right now, we are targeting the small to mid-size employers - around 30-35,000 employees or less. The reason we are sticking to this market is because these are the firms that are hemorrhaging and don't have the resources to support the same initiatives pursued by larger employers.
But smaller employers have the ability to take action much more quickly: we have much better access to their decision-makers and can finalize a direct contract in weeks versus years, which is what happens frequently with some of the larger employers.
USDMT: Do employers have to wait for the benefit cycle to engage in direct contracting?
BL: No, employers do not have to wait for the benefit cycle.
Some of the more sophisticated employers recognize that they can enter into a direct contract at any point during the year, but we have found that there can be some hurdles along the way, such as, "Are you really self-funded?"
For example, if an employer is self-funded through a major insurance carrier, they may not have access to the data they need to move down the direct contracting pathway.
We can put together a great direct contract, but if the employee isn't fully educated, incented or ready for change - it may not be for them, regardless of how beneficial it is.
USDMT: I am aware of an addiction treatment center that wants to get involved in direct contracting with employers- how would that work?
BL: They would first join the organization, and from there a membership fee would be assigned based on a sliding scale depending upon the number of employees. For example, for less than 100 employees, it costs an employer $99 per year, and so on.
We then offer a select handful of insurance brokers and consultants the opportunity to join, on a chapter basis, and its costs roughly $2,000 per year for the firm to get involved.
We offer an application membership for facilitators - there are a lot of employers who have no idea what a facilitator is when it comes to medical travel. We also have what we call the vendors - the solution providers - who are selling services to the employer to help control cost containment.
We are very selective as to which vendors we work with because we are specifically looking for groups that are going to collaborate with the employer.
USDMT: Addiction treatment is a very sensitive area.
BL: Right now, we see a lot of employee assistance programs (EAP) that are engaging the addiction treatment centers - but how is this model executed? Is it through a direct contract? I'm not sure, but it is an area of clear sensitivity, and from the employer standpoint, addiction treatment is very expensive to the employer.
USDMT: Individuals are traveling all over the world to get prescription drugs cheap, too.
We had an event in Orlando, Florida, and a group based out of the U.K. was in attendance and working to identify the loophole in the U.S. law that enables an employee or a patient to order medicines - the same brand they could get in the U.S. but out of the U.K. - at about a 20 to 50 percent cost reduction.
At one of our recent round table discussions, we had groups from Pennsylvania, Michigan and New Jersey who were all interested in engaging directly with employers, and they wanted our group to help!
USDMT: If more employers got involved in medical travel, the industry would boom.
BL: I agree, and it proves to be a slow development cycle - there are a lot of breadcrumbs that have to be laid out. It's a process and at times it can be very frustrating.
I would love to find a way for more employers to take a stance in the industry, and listening to your take on medical travel tells me we've got some cross over.
Nueterra-Managed Hospitals Rank Among Nation's Best from CMS
Rothman Orthopaedic Specialty Hospital, Physicians Care Surgical Hospital Receive Five-Star
Nueterra, the largest privately held healthcare organization in the U.S. specializing in developing equity partnerships with health systems, governments, hospitals and physicians, is proud to announce that two of its partnering facilities have been designated as Five-Star hospitals by the Centers for Medicare & Medicaid Services (CMS). Rothman Orthopaedic Specialty Hospital and Physicians Care Surgical Hospital were chosen as Five-Star recipients from CMS as a result of their exemplary patient satisfaction scores, dedicated staff and best-in-class patient experience yielding favorable results.
"Nueterra is proud to be associated with these hospitals because of their unparalleled, patient-centric approach to healthcare," said Dan Tasset, chairman. "They exemplify what the patient experience should be by ensuring that every patient receives excellent care at all times."
Of the nearly 3,500 hospitals that were awarded a star rating from the CMS, only 207 were designated as Five-Star recipients. To constitute a hospital's rating, CMS ranks 11 categories from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), a survey ranking numerous sets of hospital criteria based off patients' perceptions of their hospital experience.
"We're honored to be distinguished as a Five-Star hospital by the CMS," said Kelly Doyle, CEO of Rothman Orthopaedic Specialty Hospital. "This rating speaks to our entire team and how we embrace each patient as individual and unique."
The results, compiled from the reporting period of January 1 to December 31 of 2014, assess every aspect of the patient experience. Additionally, a hospital must have at least 100 completed surveys in the designated four-quarter period and must be eligible for public reporting of HCAHPS measures in order to be called a Five-Star hospital.
"By listening to our patients' feedback and establishing a positive rapport within our community, the entire team at Physicians Care is dedicated to providing the best healthcare experience possible to anyone that walks through our doors," said Chris Doyle, CEO of Physicians Care Surgical Hospital.
Both Rothman Orthopaedic Specialty Hospital and Physicians Care are multi-specialty surgical hospitals located in Pennsylvania, and the only two hospitals in Pennsylvania to receive this designation.
To learn more about Nueterra, visit Nueterra.com. For additional information on Rothman Orthopaedic Specialty Hospital and Physicians Care Surgical Hospital, visit RothmanSpecialtyHospital.com and PhyCareHospital.com.
Nueterra, the largest privately held organization in the U.S. specializing in developing equity partnerships with health systems, governments, hospitals and physicians, owns and manages focused community hospitals, surgical hospitals, ambulatory surgery centers, pathology labs, and physical therapy centers across more than 28 U.S. states.
Our mission is to integrate providers and connect them to consumers through our programs and services powered by our technologies and delivered in facilities and networks we partner or manage.
About Rothman Orthopaedic Specialty Hospital
Rothman Orthopaedic Specialty Hospital is a multiple-specialty surgical hospital located in Bensalem, Pennsylvania.
The facility is the only surgical specialty hospital in partnership with the highly respected Rothman Institute - known for its exceptional care and internationally recognized orthopaedic specialists. Our 65,000 sq. ft. facility features six fully equipped operating rooms with the latest medical instrumentation. The hospital is equipped for joint replacements, orthopaedic surgery, pain management, and spine surgery, as well as sports medicine, foot and ankle surgery, shoulder and elbow surgery, and hand and wrist procedures.
About Physicians Care Surgical Hospital
Physicians Care Surgical Hospital is a multiple-specialty surgical hospital located in Royersford, Pennsylvania.
Established in 2010 by local physicians and Nueterra, the 30,000 sq. ft. facility features five fully equipped operating rooms with the latest medical instrumentation and 12 inpatient beds for post-operative care. Physicians Care Surgical Hospital specializes in orthopaedic surgery, general surgery, ophthalmology, otolaryngology and pain management.
For more information about Physicians Care Surgical Hospital, please visit the hospital's website at www.phycarehospital.com.
For more information:
Amy Leiker, VP, Global Marketing
Lumpy Gravy: the Lack of Uniformity in Hospital Performance
by Shakil Haroon
Mpirica.com-Since we're embarking into the holiday season, let's talk about gravy!
I don't know about you, but when I think about gravy, I think of a golden liquid with smooth even consistency throughout. But as any cook knows, gravy is rarely uniform. While there are spots that are smooth and perfect, more often than not, there are plenty of lumps.
It's exactly the same with hospitals.
Perception is Not Reality
When we think about hospitals, we tend to think "oh, that's a good/bad hospital" based on the hospital's public image and reputation. The reality is that the performance of most hospitals, like gravy, is lumpy; the quality of different procedures in the same hospital is far from uniform.
Having analyzed outcomes across thousands of hospitals, MPIRICA has observed one simple fact: hospital performance can't be aggregated. Depending on the specific procedure or procedure class, a hospital might be a top, mediocre or bottom tier performer, and those performances are independent of its reputation.
Lumps in Your Gravy
To demonstrate this idea, we can walk through an example. Massachusetts General Hospital in Boston is consistently considered one of the best hospitals in the country. In fact, this year, US News and World Report named it THE top hospital in the nation. And looking at the hospital's quality scores across a number of procedures on the MPIRICA system, you can see they are generally fair to excellent across nearly all of their procedures.
However, if you are in need of knee, hip or carotid artery procedures, their quality scores should give you pause. Each of these procedures has a score below 400, which means they have demonstrated below-average performance, and you may be exposing yourself to unnecessary risks.
It's probably worth mentioning here that the MPIRICA Quality Score is backed by three decades of medical quality analysis expertise, and calculated using only actual clinical outcomes. If you like, you can find out more about how we score hospitals and surgeons.
On the other end of the spectrum is University of Toledo Medical Center, which was highlighted by The Atlantic Magazine in April as one of the "worst performers in the state, if not the country" based on their rates of infections and complication. While MPIRICA's quality scores indicate UTMC is a bottom tier of demonstrated performance in coronary artery bypass graft (CABG) as well as knee replacement (the latter of which was specifically called out in the Atlantic Magazine article), the hospital is actually a top tier performer for balloon angioplasty.
This is the level of quality transparency that will inform healthcare decisions for both consumers and employers, and is something that has not been widely available until recently. Being able to access easy-to-understand, outcomes-based, procedure-level data is what will help everyone make smarter healthcare decisions.
To view the original article click here.
Employer Choice States See Lower Claim Costs
by Richard Krasner
When I started this blog three years ago, one of the first topics I covered was the issue of employee/employer choice of treating physician (see "Employee vs Employer Choice of Physician: How best to Incorporate Medical Tourism into Workers' Compensation" and "Employee vs. Employer Choice of Physician Revisited: Additional Commentary on How Best to Incorporate Medical Tourism into Workers' Compensation").
Then in March of this year, ProPublica's Michael Grabell and NPR's Howard Berkes, wrote an article called, "The Demolition of Workers' Compensation," which was a first in a series about the workers' compensation system.
In the article, Grabell said that in 37 states, the worker cannot choose his doctor, or they are restricted to a list provided by their employer. This statement generated some concern from the industry.
My fellow blogger, Joe Paduda tried to get them to see both sides, but gave up the effort when it did not result in any discussion between them, as he wrote about the following day, calling the reporting a "public disservice."
The next day, I wrote to Mr. Grabell, and told him that his facts were wrong. He told me in his response that he relied on data from the U.S. Chamber of Commerce.
I told him that the WCRI and the state statutes were a more accurate source of information. My email thread covered eight messages that day. I provided him with the data I used in the articles cited above, and in the presentation I gave the previous November in Mexico.
Lower Costs When Doctor is Chosen By Employer
Business Insurance's Stephanie Goldberg today reported on a study published in the latest issue of the Journal of Occupational and Environmental Medicine that found that the average medical cost per work comp claim is lower in states where the employer chooses the worker's initial treating physician.
Average medical costs were $308 lower in those states where the employer can choose the treating doctor for employees with low back pain, than in states where the workers were allowed to choose, Goldberg reported.
The study, sponsored by the Liberty Mutual Research Institute for Safety, said that states limiting treating provider change had higher medical costs than states that allow a one-time change.
There was however, the study found, no significant difference in average medical costs between cases in states that limit initial change and states that don't, according to Goldberg.
Employers participating in a managed care organization, preferred provider organization or coordinated care organization in states like California and Florida are allowed to direct care. States like Arizona and Massachusetts allow workers to choose their providers.
The study also found that the average medical costs ranges from $1,211 in New York to $4,514 in Texas, and length of disability ranged from 19 days in Missouri to 69 days in Texas.
The study was compiled using more than 59,000 low back pain claims between 2002 and 2009 from 49 jurisdictions, including Washington, D.C., and did not include North Dakota and Wyoming.
To view the original article click here.
Novaseek Research and Massachusetts Hospital Association (MHA) Partner to Help Hospitals and Patients Contribute to Biomedical Research
Novaseekresearch.com-Massachusetts Hospital Association (MHA) and Novaseek Research today announced a novel collaboration that will enable Massachusetts-based hospitals and patients to contribute broadly to the advancement of biomedical research. Through this collaboration, MHA member hospitals will leverage Novaseek's state-of-the art platform to provide researchers in industry and academia with biospecimens and associated clinical data from consenting patients, accelerating research into the diagnosis and treatment of human disease.
Breakthroughs in medicine require the support of patients and healthcare organizations of all sizes. However, many institutions struggle to balance research engagement with their core mission of providing patient care. The Novaseek platform makes contributing to biomedical research easier than ever before by plugging into health information systems at hospitals and labs, and matching data and specimens from consenting patients directly to research needs.
Getting access to clinical data and biospecimens is a chronic problem that continues to delay or derail vital research projects. Novaseek integrates clinical data from multiple healthcare organizations, ensuring that the data is HIPAA-compliant and easy to use in R&D. Novaseek's platform realizes the potential of the electronic medical record (EMR) by accessing streams of data on thousands of specimens from consenting patients that flow through hospital laboratories each day and that would otherwise be discarded.
It provides researchers with powerful analytics, based on real-world real-time data, and supports project planning and biospecimen accrual projections. Furthermore, the platform enables researchers to specify criteria such as lab values, gender, diagnosis and medication history, and then match these search criteria to biospecimens in the hospitals. Novaseek and its healthcare partners use IRB-approved protocols and patient consents to ensure the ethical conduct of research and respect for all participants.
"We are excited to collaborate with the Massachusetts Hospital Association," said Dr. Kate Torchilin, CEO, Novaseek Research. "Novaseek was born from the need to bridge the world of life sciences research and the hospital world. Our collaboration with MHA is also strategically aligned with the objectives of the NIH's Precision Medicine Initiative announced earlier this year."
"Novaseek Research is a key technology leader that will enable more patients at more hospitals to participate in vital biomedical research," said Lynn Nicholas, president and CEO of MHA. "As the first hospitals in Massachusetts begin to adopt Novaseek's platform, we are proud to promote getting consented patient data and samples into the hands of researchers who are developing new treatments and cures, and further strengthening Massachusetts' preeminent position in life sciences research."
The Massachusetts Hospital Association (MHA) is a voluntary, not-for-profit organization comprised of hospitals and health systems, related organizations, and other members with a common interest in promoting the good health of the people of the Commonwealth. Through leadership in public advocacy, education, and information, MHA represents and advocates for the collective interests of its members and supports their efforts to provide high quality, cost effective and accessible care. While Massachusetts hospitals and other care providers are facing an era of unprecedented change, MHA members remain committed to their most basic mission: caring for people. To continue to fulfill this mission, the hospitals and health systems of Massachusetts support a set of fundamental values.
We believe that the healthcare system must:
- focus on the needs of patients and the health status of the community;
- provide access to care for all members of society;
- use resources wisely and support incentives for high quality, cost-effective care;
- work continuously to improve the quality of care;
- be accountable for its performance to the community;
- fulfill healthcare needs through collaboration and partnerships;
- support innovation and leadership in advancing the clinical process, new delivery models, and ways to lower cost and reconfigure capacity.
Novaseek connects researchers from industry and academia with healthcare organizations, and enables broad patient participation in medical advances. The Novaseek Clinical Data Network for Research (CDNR) is the industry's first HIPAA compliant comprehensive platform that enables researchers to access real-world, real-time clinical data and large quantities of high quality biospecimens. Incorporating Novaseek's CDNR platform across all phases of research and development helps to generate powerful new insights, increases R&D productivity, and decrease risk in the pursuit of new cures. The CDNR platform was developed by experts in drug development, hospital operations and health IT to create a win-win for industry, academia, healthcare providers and patients. For more information, please visit www.novaseekresearch.com.
To view the original release click here.
One In 6 Massachusetts Residents Put Off Healthcare This Year To Avoid Costs, Survey Finds
Commonhealth.wbur.org-A new survey of Massachusetts residents finds that about one in six did not get healthcare they said they needed in 2015 because of the cost.
To view the original article click here.
With Aetna's Exit, AHIP Takes Another Hit
Insurer joins UnitedHealth Group in parting ways with trade association
by Leslie Small
Fiercehealthpayer.com-Aetna has decided to leave America's Health Insurance Plans (AHIP), becoming the second major insurer to part ways with the industry's largest trade association.
To view the original article click here.
Passage Nears in N.J. Legislature on Hospitals-Towns Tax Deal
by Lindy Washburn
Northjersey.com-Last-minute negotiations on Wednesday set the stage for passage of a bill requiring New Jersey's non-profit hospitals to contribute financially to their host towns, a measure crafted after a landmark state Tax Court decision raised doubts about their century-old property tax exemptions.
To view the original article click here.
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