SPOTLIGHT: Gregory Ciottone, MD, FACEP, Chief Medical Officer, American Hospital Management Company, Part One Medical Travel Today (MTT): You are a physician as well as an assistant professor at Harvard Medical School… so how did you get involved with international hospital management? Gregory Ciottone (GC): Upon graduation and after serving a residency, I began a career that actually had some international medicine as part of it. I am an emergency physician by training, board certified and practice clinically in Boston. I have been doing a lot of international work throughout my career and, in the early mid-1990s, I dedicated a lot of time to USAID and the American Health Alliance in the former Soviet Union. These projects included a great deal of educational training, and I set up 22 emergency medicine and disaster medical training centers throughout the Soviet Union. I am a disaster medicine specialist, have written a book on disaster medicine and do a lot of work around the disaster homestead including assignments for the former commander of Level I Federal Disaster Team. The first one was at Ground Zero, where we stayed for a few weeks. Case in point: after responding to the earthquake in Haiti and since that time, I have provided services in that country. The project is called “Child at Hand,” (www.childathand.org) and it assists orphans and children. So, that’s always been my area of expertise and involvement with international work. I first met the CEO of American Hospital Management Company (AHMC) back in 1999 when the company was about a year-or-so-old. We did a little bit of work together and kept in touch over the years. Three years ago, they asked me to be their chief medical officer. MTT: What does it mean to be the chief medical officer (CMO) at this particular company? Do you oversee the delivery of care at these hospitals or do you just help to plan? GC: AHMC does not manage any hospitals in the United States — all of them are outside the country. There are other companies and agencies that employ CMOs, but  it is relatively unusual for this industry to have management companies with a CMO. One of the reasons I joined them was because of their commitment to the quality of  healthcare provided. That’s reflected in the fact that they created the CMO position to demonstrate that they really understand what it takes to be successful in hospitals, medical centers and healthcare projects anywhere in the world — certainly overseas — and to also be financially sustainable,  top-notch high-quality healthcare is imperative. That’s the number one priority, the number one thing needed to provide for clients and patients – the best healthcare possible. So, that is why this position was created. I oversee the healthcare provided by our various hospitals including quality and quality assurance as well as continuing education. I introduce policies and different initiatives for patient safety and clinical guidelines, making sure that cutting edge medicine is practiced and evidence- based. I don’t micromanage — I don’t go into each hospital and talk or worry about how each physician is doing…or how this practice is being done. I macro-manage — sending down specific agency guidelines and protocols to use. MTT: Are all the hospitals JCI accredited? GC: They are either JCI accredited or pursuing JCI accreditation. That is one of the hallmarks of AHMC. When a facility becomes an AHMC hospital, it is automatically on the road to attaining JCI accreditation. Each hospital has a quality assurance department within the hospital. For instance, Mount St. John’s Medical Center, in Antigua, upper management of the hospital – CEO level – is involved in quality assurance, along with a full QA department and a quality manager in the hospital. Each hospital has its own executive infrastructure, which includes quality assurance that oversees the quality of patient safety, the education, credentialing and other activities MTT: What areas of the world are you targeting for involvement? GC: It’s interesting. The number of hospitals and regions we are getting involved with has really blossomed in the last several years. About 11-12 years ago, I managed a hospital project for AHMC in Panama City. That hospital is still running and under our management. Then, the company expanded its footprint in the Caribbean and Latin America. Now, hospitals in Ecuador, Honduras, Dominican Republic, and Antigua have joined our corporate community. We are expanding further with new hospital projects in Peru and Brazil. We are also active in the Middle East. We had two hospitals in Libya that were up and ready to start construction in March 2011. We had signed them on in January, one week before the turmoil in Libya began. So, we’ll see where those go, but we still have them as contracted hospitals that will hopefully get going at some point. We also have new hospitals in Egypt, and it looks like there’s one coming up in Jordan.  And there’s a new project hospital under construction, as we speak, in Russia. We also have a pending Management and Operations agreement with a state-of-the-art medical center in Tbilisi, in the Republic of Georgia. Plus, we have hospital projects in India, Bangladesh, Indonesia and in the Philippines that look very probable. MTT: I read your name in an article about hospital development on the island of St. Kitts. Do you think the Caribbean islands have greater appeal for American medical travelers? GC: Yes, I do for a couple of reasons. If you look at it from the perspective of medical tourism, it’s an ideal situation — especially for this hemisphere. The resort areas that are not too far away are most attractive because they are comfortable and known by many. MTT: From your perspective, how do you see this medical travel industry evolving — not only in terms of Americans leaving the country, but others coming from all over the world to these locations? GC:  Before beginning my current role, I  didn’t know a lot about medical tourism. I had a little information and knowledge, but now that I am working more in this area, I see medical tourism increasing in scale in the next few years; whether it’s the model we have now or a variation to be determined.  The cost of healthcare in developed countries is quickly driving up costs. Due to  the emergence of new technologies and its availability around the world, along with enhanced medical knowledge, information and infrastructure, the quality of healthcare on a global level has dramatically improved; particularly, in comparison to what otherwise might have historically been available in a developing country or at least not one of the traditional health countries. We knew that would happen, and we feel that in every place and every hospital where we build and manage a facility, we can bring first-world medicine. Today, this can be introduced anywhere in the world — whether it’s a third-world country, developing nation or otherwise. There’s no reason why you can’t bring first-world healthcare everywhere in the world and we are demonstrating that. I believe that concept is now accepted by the general population, and medical tourism is growing dramatically because of it. If someone could get the same quality healthcare in a place where cost is dramatically lower and the situation is better, they would opt for it. Plus, they could bring their family to a beach resort and some sort of vacation locale while recuperating. The patient could have their procedure done — whether it’s a hip replacement or bariatric procedure — and their family could take a vacation during the recovery process in a resort-like atmosphere. Of course, the number one thing is the quality. As we understand what drives our business — the quality of healthcare that we provide — hospitals will understand that their services can attract medical tourists who are seeking quality. Now that the quality is available in many of these places and the cost remains low, these other appealing attributes will continue to drive the industry’s growth. It is bound to accelerate over time. Part Two of this interview will be featured in our next issue.   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 an internationally recognized expert in disaster medicine and emergency management, healthcare policy, and infrastructure-building. Dr. Ciottone is U.S. board-certified  and an assistant professor of medicine at Harvard Medical School, where he currently is chair of the Disaster Medicine Section and director of the Division of Disaster Resilience at Harvard Medical Faculty Physicians. He also served as  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 the founder and director of the first Disaster Medicine Fellowship Program at Harvard Medical School. In addition to his many 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. About American Hospital Management Company Based in Washington, D.C., American Hospital Management Company (AHMC) is a diversified international healthcare management and consulting firm,  focusing on the administration, management and development of world-class hospitals and healthcare systems throughout 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.