Editor’s Note: We’re pleased to present the conclusion of our interview with Gregory Ciottone. To view Part I, click here. Medical Travel Today (MTT): Why do you think that U.S. employers are still so reticent to adopt an international medical travel benefit? Gregory Ciottone (GC): I’m not sure they have been slow to adopt. If you look at any major paradigm accepting any change in any industry, I don’t think it happens overnight. When you look at the numbers of medical tourists — people going to other destinations to take advantage of quality care at lower costs — those numbers are higher than I ever thought they would be, and they are growing. I think it’s just a reflection of a typical type of paradigm shift in how companies and people think about this new kind of provision of healthcare. I also believe that as the industry grows, we are going to see the involvement of more companies seeking to utilize this option. MTT: When your hospitals recruit staff, do they rely upon local doctors and nurses or do they recruit from elsewhere? Do they look to those who have been trained in Western medicine? GC: The composition of the medical staff in each hospital does vary. Some of them have been driven by projects, but many are funded by private investors.  Frequently, whoever is driving the project will dictate the make-up of the staff. In some regions, they’re very specific that they want a local medical staff, while in other regions and areas they are more insistent that we bring as many outside medical staff as possible. It varies. The other thing to understand is that these facilities are not simply dedicated to medical tourism. In fact, the first populations that these facilities serve are the local populations. Quite frankly, that’s what’s most appealing to me, given the knowledge and understanding that I have of these local citizens. When we come into an area and establish one of our hospitals and, perhaps, place the first MRI or CT scanner in that city – or even in that country — we are not only improving the healthcare that is being provided by that one facility, but also raising the standard of care around the region. Then you start seeing other entities with higher quality care and more advanced technologies popping up around you. What’s really appealing to me is that we can go into an area and raise an overall standard of healthcare by doing the work that we are doing. MTT: Does AHMC compete head-to-head in certain areas outside the United States with other companies or hospital management groups? GC: Yes, certainly. There are hospital management groups out there that do exactly what we do on any given project. Whomever is driving the project has looked at these companies and compared the services, and maybe received proposals from a number of groups, ours being one of them. MTT: Do you ever get involved in marketing the hospital’s services? GC: No. Our role is to manage the hospital. The hospital groups that hire us on or whomever they designate as their key stakeholders may do so, but our job really does not include that. We specifically manage the hospital to the highest levels of quality achievable and that’s our role. The facilities certainly conduct marketing – both locally and probably outside of the local area.  But that’s not really something that falls under what we do. MTT: What are the key quality metrics that you would look at to communicate? Do you look at outcomes? Do you look at infection rates?  GC: We measure all of these things. The way these hospitals manage quality assurance is comparable to any western hospital.  We use metrics, such as you stated — infection rates, patient satisfaction — and we have a number of metrics that are in place to keep our finger on the pulse of the quality. At the same time, and as the need arises, we change policies, change practices, implement patient safety guidelines and clinical guidelines. It’s much like any other Western hospital would do — the main thing is quality. MTT: Do your hospitals offer procedures that you can’t access in the USA? GC: That’s not really our area. We don’t dictate which direction this is going for any given hospital. If they want to go into some of these areas and as long as they work within the rules and regulations of the country that they are in, we obviously support that and we’ll help them from a managerial standpoint. For instance, a few years ago, the hospital in Panama performed its first transplant — and that was a neat and novel thing. As long as it’s a sanctioned practice in the country, we’ll support it. Again, that’s not really what we do. We don’t dictate in which direction the hospital might like to go as far as what procedures to do or not do. MTT: How do you see your role going forward – personally and within the company? GC: My role will continue to focus upon making sure that the standards are as high as possible in our facilities. We’ll also make sure that the medicine that we practice is evidence-based and cutting edge. We’ll ensure that all facilities are keeping current with their policies procedures and up to date with medical guidelines. As far as the company is concerned, it is growing. We received more Request for Proposals in the last few years than we had in a long time. It’s hard to say what the future holds, given the current economic trends and investment climate, but the demand for our services does seem to be on the rise. We are being sought after more and more and I anticipate that this will continue. MTT: Is there an international association of chief medical officers at facilities like yours? GC: No – not that I am aware of.   About Gregory Ciottone, M.D., FACEP Dr. Ciottone is a practicing emergency physician with more than 20 years experience in academic, clinical and global medicine. He is internationally recognized in disaster medicine and emergency management, healthcare policy and infrastructure-building. Dr. Ciottone is a U.S. Board-Certified Emergency Physician and is an assistant professor of medicine at Harvard Medical School, where he currently is the chair of the Disaster Medicine Section and director of the Division of Disaster Resilience at Harvard Medical Faculty Physicians. He has also served as the chair of the International Emergency Medicine Section at Harvard Medical School, as well as director of the Division of International Disaster and Emergency Medicine and medical director for emergency management at Beth Israel Deaconess Medical Center, where he works clinically in the Department of Emergency Medicine. Dr. Ciottone is founder and director of the first Disaster Medicine Fellowship Program at Harvard Medical School. In addition to these appointments, Dr. Ciottone holds a visiting professorship at Vrije Universiteit Brussels in Belgium and the Universita del Piemonte Orientale in Italy, and has served as the medical director for the Office of Security and Investigations, United States Citizenship and Immigration Service, U.S. Department of Homeland Security, Washington, D.C. He is the editor-in-chief of the textbook “Disaster Medicine,” published by Elsevier/Mosby in 2006, and has extensive field experience including 10 years as a flight physician for a LifeFlight rescue helicopter system. In 2007, he was named “EMS Physician of the Year” by Central Massachusetts Emergency Medical Services, and, in 2008, he was the “Spotlight” for the Phi Beta Kappa national publication keynote reporter. Also in 2008, the World Champion Boston Red Sox honored Dr. Ciottone by having him throw out the Ceremonial First Pitch as part of the 9/11 remembrance ceremonies at Fenway Park. In 2010, Dr. Ciottone was named by the Russian Federation Ministries of Education and Science as an approved evaluation expert for the New Eurasia Foundation, as defined within the framework of Resolution No. 220 of the Russian Federation Government. In 2011, Dr. Ciottone was selected by USAID as one of two U.S. experts for consultation to the Russian and Tajikistan Ministries of Health on the epidemic of polio in the Central Asian Region, and infectious disease epidemic threat preparedness and disaster response planning. About American Hospital Management Company American Hospital Management Company (AHMC), is a diversified international healthcare management and consulting firm, based in Washington, D.C., whose focus is on the administration, management and development of world-class hospitals and healthcare systems all over the world. AHMC is the premier consultant for hospitals seeking to elevate their healthcare services to internationally recognized standards and position themselves to compete effectively in the medical tourism industry. Aside from promoting the tourism destination and available healthcare services, providers must effectively differentiate themselves from potential competitors. This is accomplished by providing prospective patients and payers with the relevant information needed for them to make an informed and educated decision regarding the healthcare service options available to them.