Editor’s Note: MyHealthGuide is an online newsletter for the self-funded community that “promotes and advances healthcare management, financing and compliance for the self-funded community.” To subscribe to MyHealthGuide at no cost, visit myhealthguide.com Medical tourism provides Americans international access to medical procedures at a fraction of the cost when the procedure is performed stateside.  This article excerpts and comments on recent articles reviewing the pros and cons of international and domestic medical facilities along with excerpts from the American Medical Association policy on international care. “Recent SIIA conferences have presented international medical travel,” says Allison Repke, Director of Operations for Global Medical Conexions, an International Select Provider Organization that facilitates medical travel for the group health market. “The interest level in medical travel continues to increase as US health cost rises. “A group can analyze experience data to understand which high-dollar claims have the greatest impact on the plan. While it is not advisable to travel for all major medical procedures, there are some high-cost procedures that could be outsourced to an international provider for a fraction of the US retail cost.” Repke recommends the following procedures as medical travel candidates:

Orthopedic

Gastrointestinal (such as Bariatric surgery)

Cardiovascular

Dental

Vision

Hearing

Cosmetic surgery

  Medical travel features:

Lower stop-loss premiums and aggregate factors can be significant

No waiting times or referrals required

Access to desired care that might otherwise require a long wait time

One of the fastest growing emerging markets

  5 Most Critical Considerations for Medical Travel In his white paper, “Increase Profitability by Offering a Medical Travel Benefit”, Jeff Carter, CEO, HealthGlobe International, LLC, provides the five most critical considerations for implementing a medical travel benefit.

1. Use a Medical Travel Facilitator: Medical travel facilitators have established working relationships with many hospitals. They can help narrow the choice of hospitals and locations in order to create the most compelling benefit, as well as which procedures to cover.

2. Offer Accredited Hospitals: There are many hospital accreditation programs in use around the world. All stakeholders should be involved in this discussion to be sure the plan hospitals are accredited by a respected accreditation organization.

3. Optimize Plan Design: Take the extra time to make sure the medical travel benefit is well-designed. Offer procedures that will create substantial cost savings and provide members with equal or better outcomes than they get at home. Analyzing utilization history can help target the best procedure categories to cover.

4. Incentivize Utilization: Utilization of a medical travel benefit is highly dependent on incentive programs. The most successful plans have crafted innovative incentives that strongly encourage members to consider the medical travel option, not just on the basis of cost but also on the basis of educating themselves on their provider choices and seeking out the best result.

5. Educate Members: Even more important than utilization is a well-articulated educational program to make members aware of the medical travel benefit. Experience clearly shows that when a thorough educational component is included in a medical travel benefit, utilization rates increase dramatically.

“Our goal is to identify the highest quality medical care worldwide and make that care available to individuals and businesses in the United States, at globally-competitive rates,” says Carter.  “Our policies and procedures are centered on patient advocacy and quality outcomes, and our practices are driven by Standard Operating Procedures (SOPs) that ensure a consistent and positive patient experience for each of our individual clients.”   Domestic Medical Travel Leading healthcare providers in the US have responded to growth in international medical travel by positioning themselves as viable domestic travel destinations.  In her article, “Domestic Medical Tourism”, American Medical News, Victoria Stagg Elliott argues that international medical travel “never took off.”  As a result, “Some employers are looking closer to home as a means of controlling health care costs and improving outcomes. “Although there is no exact recorded number of patients traveling elsewhere for care, the percentage of employees doing so appears to be very small,” says Elliott. Out of $2.5 trillion spent annually on healthcare, only $600 million is spent on medical travel. Lowe’s had 38 medical travel participants out of 234,000 employees. (That’s less than two per 10,000.) “In 2011, self-funded Lowe’s Companies paid for 38 employees or their dependents, including three children, to travel to Cleveland Clinic for heart surgery that was fully covered by health insurance with no co-pays or deductibles. PepsiCo announced on Dec. 8, 2011, that a similar arrangement will be available for their employees to travel to Johns Hopkins Medicine in Baltimore for care,” says Elliott.   Lowe’s and PepsiCo Introduce Domestic Tourism Options  Lowe’s has 234,000 employees and many more dependents covered by its self-funded health insurance plan, according to the 2010 annual report. The company announced Feb. 16, 2010, that heart surgeries at Cleveland Clinic will be an employee benefit. PepsiCo’s US employees will have the option of traveling to Johns Hopkins for cardiac and joint-replacement surgeries. The program covers about 250,000 employees and dependents. Both companies may expand their domestic medical tourism programs to cover other procedures. “We want people to have choices,” said Kyle Wendt, Lowe’s Director of Benefits. “That’s really what the goal of this program is.” Lowe’s considered hospitals in Mexico, but went for Cleveland Clinic when it became clear that domestic travel would get more buy-in from workers. “A lot of our employees live in rural areas,” Wendt said. “Going to Cleveland is a big decision for them, but much more compelling.”??Bruce Monte, Senior Director of PepsiCo’s Health and Welfare Benefits, said: “In providing access to surgical excellence, we expect the best outcomes in terms of care and recovery. For employees, we want to make what can be a challenging experience go as well as possible. The arrangement also offers predictability of cost for PepsiCo as procedures are part of a bundled rate — an all-inclusive rate for hospital and physician charges and certain preoperative testing. We’re not intently focused on cost savings, but rather clinical outcomes.” “Everybody thinks their physician is above average, but they are not,” said Terry White, President of BridgeHealth Medical, a healthcare tourism company based in Denver. “We’re going to have a lot more emphasis on quality. Before, patients went where their referring doctor said they should go. Now, you have companies cutting these kinds of deals. Companies want to save money, and there’s a recognition that some places are consistently doing better than others.”   AMA Policy on International Medical Service?? American Medical Association policy was presented in its June 2008 report from the AMA Council on Medical Service.  Policy excerpt: “That our AMA advocates that employers, insurance companies, and other entities that facilitate or incentivize medical care outside the US adhere to the following principles:

(a) Medical care outside of the US must be voluntary.

(b) Financial incentives to travel outside the US for medical care should not inappropriately limit the diagnostic and therapeutic alternatives that are offered to patients, or restrict treatment or referral options.

(c) Patients should only be referred for medical care to institutions that have been accredited by recognized international accrediting bodies (e.g., the Joint Commission International or 36 the International Society for Quality in Health Care).

(d) Prior to travel, local follow-up care should be coordinated and financing should be arranged to ensure continuity of care when patients return from medical care outside the US.

(e) Coverage for travel outside the US for medical care must include the costs of necessary follow-up care upon return to the US.

(f) Patients should be informed of their rights and legal recourse prior to agreeing to travel outside the US for medical care.

(g) Access to physician licensing and outcome data, as well as facility accreditation and outcomes data, should be arranged for patients seeking medical care outside the US.

(h) The transfer of patient medical records to and from facilities outside the US should be consistent with HIPAA guidelines.

(i) Patients choosing to travel outside the US for medical care should be provided with information about the potential risks of combining surgical procedures with long flights and vacation activities.

  MyHealthGuide Sources: Allison Repke, Director of Operations, Global Medical Conexions, “How International Medical Travel Can Work for You”, January 2012, The Self-Insurer Article, 1/2012 Jeff Carter, CEO, HealthGlobe International, LLC, White Paper Victoria Stagg Elliott, “Domestic Medical Tourism”, American Medical News, 1/9/2012, AMN Article