SPOTLIGHT: Maria Todd, Ph.D., Mercury Advisory Group

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Editor’s Note: A recent and steady stream of press releases from Mercury Advisory Group including news of developing a cancer center in Mexico, plans to build a hospital in Nigeria, and presentations in Peru caught my attention. I decided to give Maria K. Todd, Ph.D., founder and CEO of The Mercury Healthcare Companies, a call and find out what exactly they’ve been doing to create such a diverse flurry of news. Despite having been up since 3:30 a.m., Maria graciously agreed to fill me in on her latest undertakings and what she thinks the future of medical travel may look like globally. Medical Travel Today (MTT): The nature of the work you’re doing in medical travel now versus what you were doing five years ago seems very different. To what do you contribute the shift? Maria K. Todd (MKT): I think many people have come to view the potential of medical travel quite differently. The notion that you can build or operate a facility just for medical tourists just isn’t valid. We’ve worked with and inspected hospitals in 95 different countries other than the US. The data shows that medical tourism represents only two percent of the average daily in-patient revenue. You can’t build a business off that. Investors are coming to an awakening. If they want the money to come back they need to consider where the actual money is coming from…that other 98 percent. What’s happening now is a move to build facilities to serve local populations. The idea is to get it up and open and then share it with others who need the services. This works for a number of reasons. First, medical travel creates jobs. The majority of hospitals we see offering medical travel services have a 4:1 nurse-patient ratio. In the ICU the ratio is more like1:1. That means that for every four patients you bring in you employ three additional nurses…plus a whole gaggle of support staff. Beyond the hospital, medical travelers need everything from food and lodging to transportation and guides. That’s jobs, jobs, jobs, jobs, and that’s all very good for the economy. MTT: Let me stop you there. How much real impact does that create on an economy? MKT: For a developing country every arrival, every penny counts. But honestly, it doesn’t matter if it’s Williamsburg or Johannesburg, tourism creates an economic spend impact. Adventure tourism, gastronomy, fishing, massage or medical, it all has an impact. Medical tourism has the added appeal to ministries and governments as it helps to mitigate the brain drain of physicians. It bolsters the local economy as those same doctors are now available to the local population that keeps people from going elsewhere for care…i.e. more money stays local. I can actually point to Nigeria as an example of how medical travel can play out. Right now Nigeria doesn’t have enough doctors or hospitals. People, very sick people, are signing themselves out of hospitals AMA and going to Germany, India and other places for care. I’m talking 300 cases a month going to India. And they’re leaving so sick and unfit to travel that many are dying en route or upon arrival. I don’t need to tell you the adverse affect that has on all medical tourism provider outcomes. Right now we’re engaged to do a feasibility study and develop a concept document and business plan for a private hospital to be built in the capital city of the Anambra State. The aim is to build a hospital to serve people from all over Nigeria and other local countries so that there’s no need to go to India or Germany or anywhere else for care. The potential economic impact of the project begins well before we even break ground and extends for many, many years to come. MTT: How did you actually become involved in the project? MKT: A colleague of mine who does medical practice consulting actually got the first call. A Nigerian doctor in Dallas found her on LinkedIn and called her to say they wanted to build a 100-bed hospital in Nigeria. Recognizing that this was well beyond her realm of expertise she passed along my name and number. I’m not one to say to an opportunity that hasn’t actually been offered so I took the call. Actually it was a Skype call involving five members of the Mercury team and seven Nigerians, plus the doctor in Dallas. It began with me saying something like, “I understand you want to build a 100-bed hospital.” They said, “No, 200.” Long story short, we presented a proposal and secured the agreement. Very shortly we’ll be traveling to Nigeria to do a pre-design phase which includes site location, research hospital commission and regulation, looking at the existing infrastructure and available raw goods…everything. It’s going to be a big undertaking. MTT: You nervous? MKT: Yes and no. On one hand, any time you take on something this big you should be nervous. You just don’t know what’s going to come your way. On the other hand, this is what the Mercury team does and does so well. Our team is uniquely poised to address virtually every issue. The team includes medical architects, an urban planner – who is also a medical architect and sustainability expert – a hospital administrator, a nurse, a communications and marketing person, and another former hospital administrator who to the hospital in Monterrey through the Joint Commission International (JCI)-accreditation process and achieved the highest scores ever in the history of the JCI. We’ve also got JCI-accreditation coaches who have a 100 percent success rate helping hospital achieve accreditation in 15 different countries. With this team we can undertake a construction project from the ground up and build JCI accreditation requirements into its very fabric. There’s no learning curve or missed turns. And it’s important to note that I’m talking JCI standards. There are lots of US architects who know JC requirements but not JCI. There’s a vast difference between requirements and it’s key to know that. In addition, we bring in a certified internet systems security professional (CISSP) who knows both the Health Insurance Portability and Accountability Act (HIPAA) and internet data security protocols. HIPAA is not relevant outside the US unless you’re bringing in US patients. We look to address any potential security issues like that upfront and do. Specialty things like this allow us to serve the market to an extent I’m not sure anyone else does. MTT: I know you’ve also been doing a lot of work with healthcare clusters. How does your expertise apply in that area? MKT: The breadth of knowledge and expertise the team has is helpful to any organization at any stage of the game. For developing clusters and even those that have stalled, we’re able to provide meaningful strategies that take into consideration not just how they’re going to promote themselves, but also how they are going to operate as a cohesive unit and actually deliver on the promises made. One tool we have that’s very helpful for assessing all the factors that play into operating a successful cluster is our audit tool. It’s actually now based on an iPad. Recently we used it in Guadalajara to do a series of audits. The audit itself takes about three hours and when it’s finished all the data dumps into one large database. We actually did ten hospitals in five days. At the end we were to look at all the data in a comprehensive manner. We found things like, ‘you have 17,000 healthcare jobs in Guadalajara. If each of the facilities gets four medical tourists the financial impact is this, the impact on hotels and restaurants will be this, your philanthropic contribution to the community is this’ and so on. It’s a way to present the opportunity in measurable and meaningful terms. From that we begin to shape the infrastructure based on the goals they want to achieve. That’s where it gets really exciting. Without an infrastructure an organization really has no idea what their potential is or how to achieve it. We provide that. Plus, our auditor is completely versed in JCI and 15 other accreditation schemes. So it’s about more than just numbers – it’s about compliance, as well. For those clusters that aren’t thriving for whatever reason, this is a great way to look at how to retrofit what’s there to deliver better results…turn what’s lackluster into something vibrant and thriving. About Maria K. Todd, Ph.D. Maria Todd, MHA, Ph.D., is a frequently invited speaker at international conferences on health tourism development, capacity building and health tourism infrastructure. She is the author of The Handbook of Medical Tourism Program Development and the Medical Tourism Facilitator’s Handbook. You can follow her and the rest of the Mercury Advisory Group’s articles and commentary on Twitter @HlthTourismJedi Mercury Advisory Group is a consultancy that supplies technical assistance and know-how to clients seeking to add health tourism to their overall regional or national tourism strategy. Health tourism creates jobs at every educational level, increases sustainable trade, improves surrounding infrastructure and access to specialized care and high technology for local citizens, and develops national recognition for excellence in health services. Our project engagements have taken us all over Asia, Europe, the US, Africa, and Central and South America. More than 65 technical assistants and consulting experts, along with project managers and support staff, are positioned worldwide to meet client needs.

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