by Richard Krasner
About Richard Krasner
Richard Krasner has worked in the Insurance and Risk Management industry for more than 30 years in New York, Florida and Texas in the Claims and Risk Management spheres, primarily in Workers’ Compensation Claims, Auto No-Fault and Property & Casualty Claims Administration and Claims Management. In addition, he has experience in Risk and Insurance Business Analysis, Risk Management Information Systems, and Insurance Data Processing and Data Management.
Krasner is available for speaking engagements and consulting.
Phone: 561-738-0458 Cell: 561-603-1685
Merrell: “…Can you see a role of medical tourism in workers’ compensation injury?”
Ludwick: “I could, if it were a long-term issue. Many workers’ comp issues are emergent,
so that would take out the medical tourism aspect. However, if it was a long-range issue,
I could see us involving workmen’s comp issues into that, or problems.”
Lazzaro: “I would support that. I don’t know the incidence, for example, of some of the orthopedic procedures that are non-emergent, such as knee or hip replacement, which would fall under workmen’s comp. But theoretically, a case could be made for that…”
Merrell: “I was thinking about it in terms of the chronic back injury and the repetitive action injuries and hernia that are in the workers’ compensation area. An acute injury on the job would probably not be at issue, but a work-associated problem with a potentially surgical solution might be a matter for medical tourism.”
When I was doing research for a term paper for my Health Law class, which later became my white paper, Legal Barriers to Implementing International Medical Providers into Medical Provider Networks for Workers’ Compensation , I came across the above discussion, and had a proverbial “light bulb” moment. It was the first time that I actually believed that what I was attempting to write about was actually possible, because of the expert commentary cited. But in the six months since I began this blog, I have been finding that what I so strongly believed at the time was possible, and still do believe is possible, is not possible, according to some other experts in the field of medical tourism.
Yet, in going over in my mind what Dr. Merrell, Ms. Ludwick and Mr. Lazzaro said back in 2008, and weighing the skeptical comments I have encountered about my ideas, it occurred to me that these three distinguished individuals cannot possibly be wrong. Dr. Merrell was at the time, the editor-in-chief of Telemedicine and e-Health, and the chairman of the Department of Surgery at Virginia Commonwealth University’s School of Medicine. Ms. Ludwick is the president of the Health Care Compliance Association, the leading trade association for third-party administrators, and someone intimately knowledgeable about the workers’ compensation claims process from the point of view of third-party administrators. Mr. Lazzaro is the managing director of Tivis Capital and CEO of Bridge Health international, and an expert on surgical and other medical services in China.
In the confusion and frustration that accompanied my doubt and anguish over this realization, I determined to press ahead anyway and write this post in the firm conviction of my faith that such an integration of medical tourism into workers’ compensation is not only possible, but it is also an imperative, not only for the sake of the injured worker’s treatment, the employer or the insurance company’s savings, but for the global medical community. . Integration is the only way forward for the human race if we are to survive. But it won’t be easy. It will take courage, vision, hard work, and a lot of idealistic dreaming, but it will become a reality. Medical care will be global, just as everything else will be, and the time to begin the process is now, not a hundred or two hundred years from now.
One way that integration can be achieved was presented this week in an article on Insurance Thought Leadership.com.
The Integrated Care Management Model
An integrated care management model for workers’ compensation will be a game-changing phenomenon that will improve results throughout the entire system, says Don Duford, chairman of the Board of One Call Care Management, in an article forInsurance Thought Leadership.com . The article, Game-Changing Strategies To Transform Workers’ Compensation , describes how the workers’ compensation system faces three major challenges, and offers a solution to these challenges.
Duford identifies the three challenges:
·Reducing the spiral of rising costs for claims
·Improving outcomes for medical care, and
·Streamlining efficiencies that impact both care and cost
As I mentioned in my recent post, Average Medical Claim Costs Still Rising for Workers’ Compensation , and in my white paper , Duford cites statistics from the National Council on Compensation Insurance (NCCI) that states that workers’ compensation medical costs continue to rise, and now constitute 60 percent of total claims costs, as opposed to the 58 percent I originally mentioned in my white paper two years ago. In addition, the average medical cost of lost-time claims has more than tripled since 1991, as indicated in the table below, and nearly doubled since 2001, ten years later.
The Workers’ Compensation Research Institute (WCRI) reported that outpatient hospital average payments per claim rose 31 percent from 2006 to 2010, and inpatient hospital payments per episode rose 36 percent in the same period.
Some of the drivers of these costs, Duford points out, are:
·The growing opioid epidemic, which I have written about in past posts on this blog and elsewhere.
·Co-morbidities and obesity
·An aging workforce
·Variations in care by provider and by state
·The fragmentation of care management, and
·The impact of providers, which can vary widely, especially if they are not experienced in workers’ compensation cases that use an assertive “sports medicine” approach that deploys and manages treatment from the beginning to achieve rapid recovery and return to work.
Duford’s solution calls for finding and using superior practitioners, which is the key to getting the best care for injured workers, and reducing overall costs. Such outcomes-based networks with superior providers, Duford says, can reduce total claim costs by 20 to 40 percent. Also, rapid interventions, with the right therapies, means that the worker is more likely to recover faster and have a better outcome.
He cites three capabilities currently in today’s marketplace that will enable this change:
·The ability to develop strong networks of specialty “best-in-class” providers who contribute to all elements of care in workers’ compensation, and who receive scrupulous credentialing and consistent quality oversight to ensure an aggressive focus on evidenced-based medicine and fast return-to-work.
·Advanced analytics of claims data that can determine the providers who generate the best outcomes.
·Technology that is easy-to-use and that connects a broad range of providers with claims professionals, leading to the expediting of fast referrals and treatments, overall care coordination and prompt reporting or test and care results.
How medical tourism can be integrated into workers’ compensation
Naturally, Duford does not include medical tourism into this model, but by using this model as a guide we can, and should, include medical tourism into this model by recognizing that like most other processes a workers’ compensation claim has a beginning, middle and end point. The providers in Duford’s model represent links in the supply chain we call a workers’ compensation claim.
If the goal of the process is to get an injured worker back to work faster, with a greater outcome of care, then as the worker moves from one point of the supply chain to another, a decision tree is formed that answers the question: “Is the worker able to return to work, yes or no?” If yes, then there is nothing more that can be done, and the process stops. But if the question is answered with a no, the next step in the chain takes over, until you come to the point at which surgery is required. Then the question is not “Is the worker able to return to work?”, but “Where can the worker get the best medical care, at the lowest cost and highest quality that will save the employer and or the insurance carrier money?”
Duford’s model does not include medical tourism destinations but, if it did, that last question would certainly be part of the model, because to leave out the possibility of lower cost medical care at the same or better quality than what is available in the U.S., is shortchanging the worker, employer and insurer.
Medical tourism can be integrated as part of the end point of the supply chain, but will be dependent upon all the other activities that preceded it, much in the same way that the store that sells a certain product is dependent upon the manufacturers who made the parts that went into making the final product that they sell.
Which brings me back the quotation at the beginning of this article: Dr. Merrell, Ms. Ludwick and Mr. Lazzaro all agree that there is a place for medical tourism in workers’ compensation, and they all agree that non-emergent care, i.e., those injuries that do not require a worker to be rushed to an emergency room or operating room immediately after an injury, are good candidates for medical tourism. And if they are correct, then adding medical tourism to Duford’s model will not only improve the outcomes for patients, but will improve the bottom line of their employers and the insurance companies that pay for medical tourism.
Afterword and Conclusion
I mentioned earlier that I have been receiving skeptical comments about my ideas on medical tourism and workers’ compensation that fly in the face of what Dr. Merrell, Ms. Ludwick and Mr. Lazzaro said previously. As part of these and other comments, the issue of standards and regulations and laws came up that I was told will prevent this integration from ever taking place. I was told that it would take 100 years or so to get international standards, that it was a pipe dream, or that because of politics, custom, culture, etc., these laws are difficult to change. But change they must, because to not change will only lead to stagnation – or worse.
I have even been told that I should cite market research to bolster my argument, which of course is true in certain circumstances, but not here when I am staking my firm faith and conviction on the future course of global medical care for all people, not just those who have money to travel or who have great insurance. Yet, relying here and now on market research reminds me of the three kinds of lies: lies, damned lies, and statistics, so the reader will have to excuse me for not citing the latest market research that says such integration cannot be done or will not be done.
I then realized that behind the comments was something bigger, something that had until then escaped me. It was not who these people were, because I respect them and their accomplishments and their expertise, but rather a form of protectionism that is going on between countries, hospitals and other facilities and providers that, like all other forms of protectionism, not only hinder progress, but also run counter to basic economic truths that goods and services will migrate to those areas where goods and services will be cheaper to produce. Such is the case that, no matter what we personally think of it, with the globalization of jobs and services outside of healthcare today, why should healthcare be any different?
It shouldn’t, and like all visionaries, I take it as a matter of faith, that this will happen in healthcare too. It may take 100 years to do so, but when will we take the first steps towards that goal, now or 100 years from now? The Chinese say that a journey of a thousand miles begins with the first step. Do we in healthcare wait until we take our thousandth step, or do we begin right here, right now? The answer is right in front of us. All we need is vision, courage, faith and hard work — qualities that are desperately lacking in so many people.
I call it as I see it — with no apologies to anyone.