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by, Satori World Medical

Last week, Satori World Medical’s President & CEO Steven Lash and Chief Medical Officer Dr. Ron Johnson, as well as Jessica, a patient who underwent a surgical procedure through the Satori Global Network™ in February, were featured in a Newsweek article on medical tourism, entitled “Medical Tourism Appeals to 60 Percent of Americans. Are You One of Them?”

The article written by Johannah Cornblatt discusses why global healthcare is continuing to gain appeal among a larger population of Americans in search of high-quality, affordable healthcare options. It also offers expert opinions on some of the key considerations Americans have when exploring this option for their healthcare.

Jessica, a 26-year-old woman from San Diego, spoke about her experience of traveling to Costa Rica through the Satori World Medical program to undergo a procedure related to weight loss. She explained that even with health insurance, the procedure would have cost her thousands of dollars out of her own pocket had she gone to a hospital in San Diego. Alternatively, by choosing to undergo her surgery through the Satori Global Network™ in Sán Jose, Costa Rica, Jessica said she was able to save $7,500 on her procedure, including all hospital fees, travel and hotel expenses for both herself and her mother, who accompanied her.

Dr. Johnson also then commented on how significant the cost savings of global healthcare really are, particularly for common, high-cost surgical procedures that often require a patient to stay in a hospital for at least 7-10 days. For example, he said, “the average cost of heart surgery is $50,000 in the U.S., versus $10,000 to $20,000 in other countries.”

But beyond the cost savings, what are other reasons why more Americans are participating in medical travel programs and what are the common reservations that some authorities and patients still have about global healthcare?

One of factors the industry is seeing is the growing number of employers offering a medical travel benefit package to their employees. Karen Timmons, President and CEO of Joint Commission International (JCI), a nonprofit that has accredited more than 250 hospitals in 36 countries, told Newsweek readers that Americans who are underinsured are more likely to go abroad for surgery than those who are not insured at all. “That’s because insurance companies will typically cover some portion of the cost for underinsured patients while uninsured patients, who also tend to make less money, have a harder time coming up with enough cash to cover the procedure, the flights, and a hotel room on their own,” she explained.

Of course, there are certain risks that patients need to consider when choosing to undergo surgery in a foreign hospital. Dr. T. Forcht Dagi, co-chair of the American College of Surgeons Committee on Perioperative Care, commented that Americans should not confuse cost with value.

In response to Dagi’s point, it’s important to recognize that the quality of care available internationally rivals some of the most, well-respected U.S. hospitals. In fact, many international hospitals are affiliated with top medical universities and hospitals, such as Johns Hopkins and Harvard Medical.

That is why it is highly recommended, as well, for employers that do offer global healthcare benefit plans to their employees to only contract with a reputable medical travel company, such as Satori World Medical, which offer an integrated medical benefit program that ensures the highest-quality care for its patients.

Dagi also emphasized the importance of follow-up care. In general, patients should think about follow-up care before they cross borders, he said. “Find out what your responsibility will be in the U.S. afterwards. Who is going to take care of a complication if God forbid, there is one?” Satori World Medical ensures that all follow-up care is arranged for the patient before he or she even leaves the country, and its all-inclusive benefit program includes a Personal Accident Insurance Policy for the patient.

Finally, Cornblatt asked Nethersole, who is quoted in the article, if American interest in medical tourism will dwindle if national health care becomes a reality in this country? She said no. Industry experts share the consensus that medical travel is here to stay.

A recent op-ed by Arnold Milstein, Mark D. Smith and Jerome P. Kassirer (Overseas, Under the Knife, June 9, 2009) sheds light on the increasing popularity of medical tourism, as well as the advantages and concerns of choosing to undergo a surgical procedure outside the U.S.

Below is Satori World Medical’s Chief Medical Officer, Dr. Johnson’s response to the New York Times Op-Ed Piece, “Overseas, Under the Knife”

By Ronald Johnson, M.D., F.A.C.S., Satori World Medical

The article was very timely, both with the increased interest in medical travel (a recent Gallup Poll showed a sizable minority of Americans view the health care diagnosis and treatment available beyond national borders as something they would consider using) and with the national discussions now taking place on health care reform and costs.

Quality is Key, and as Dr. Milstein, et al note, there are insurers, employers and patients favorably impressed with the quality at many foreign hospitals. At Satori World Medical we use Joint Commission International accreditation as a gating issue, and use other evaluations such as affiliation with U.S. institutions such as Johns Hopkins, Harvard Medical International, Cleveland Clinic and Methodist International to name a few, comparable quality measurements such as Healthgrades, Leapfrog, American Society of Bariatric Surgery, and extensive on-site visits. As a Board Certified general surgeon and now Chief Medical Officer of Satori World Medical I have visited and evaluated all of our Centers of Excellence and I would not hesitate to have surgery at any of these facilities. We would welcome further comparative performance reporting systems for both short- term complications and long-term outcomes here and abroad.

While the cost savings are significant on these elective procedures that Americans have overseas, there is a potential for even larger savings. In a recent article in Health Affairs (Volume 27, Number 5, September/October 2008), authors from the Duke University schools of law, business and medicine describe how organizational innovation has made Indian heart hospitals a low cost, high quality success story. The article is sub-titled “How organizational innovation can reform health care, and (more important), why it hasn’t.” Lessons from the globalization of health care may help us understand why the U.S. spends twice as much per capita on health care than the rest of the world with no apparent benefit – and perhaps how global competition may change that.

By Ron Johnson, M.D., F.A.C.S., Chief Medical Officer, Satori World Medical

It has been almost a year since the American Medical Association addressed the issue of “medical tourism,” travel for medical care outside of the US. The AMA supports patient choice, wants it to be informed choice, sees many advantages in medical care outside the US and an opportunity to learn from international competition and recommends principles to provide the best care possible. Now the American College of Surgeons has issued a statement on medical and surgical tourism.

The American College of Surgeons (ACS) is a scientific and educational association of surgeons that was founded in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice. The ACS currently has over 76,000 members, referred to as “Fellows,” including more than 4,000 Fellows in other countries, making it the largest organization of surgeons in the world. The ACS Committee on Perioperative Care developed a statement on medical and surgical tourism that was approved by the Board of Regents, the ACS governing body, at its February 2009 meeting. (To read the full statement, go to the Bulletin of the American College of Surgeons, Volume 94, Number 4, pp. 18-27.)

The American College of Surgeons’ statement, along with the AMA guidelines, together provide an important set of principles for consideration by patients, employers, insurers, and other third-party groups responsible for coordinating such travel outside of the country. The ACS has adopted the following position with respect to medical tourism.

1. The ACS encourages patients to seek care of the highest quality and supports their rights to select their surgeons and health care institutions without restriction.
2. The ACS encourages its Fellows to assist all patients in reaching informed decisions concerning medical care, whether at home or abroad.
3. The ACS advises patients to consider the medical, social, cultural and legal implications of seeking medical treatment abroad prior to deciding on a venue of care.
4. The ACS encourages patients electing to receive treatment abroad to seek care at health care institutions that have met the standards for accreditation established by recognized accrediting organizations, i.e. Joint Commission International (JCI), Trent International.
5. The ACS encourages patients electing treatment abroad to seek care from surgeons and anesthesiologists certified in their specialties through a process equivalent to that established by the member boards of the American Board of Medical Specialties.
6. The ACS encourages patients receiving treatment abroad to obtain a complete set of medical records prior to returning home, and follow-up care at home should be organized prior to travel whenever possible.
7. The ACS encourages patients contemplating medical tourism to understand the special risks of combining long international flights and certain vacation activities with anesthesia and surgical procedures.
8. The ACS opposes the imposition of provisions for mandatory referral of patients by insurers to health care institutions outside the US, unless such provisions are clearly and explicitly stated in the insurance contract and accepted by the subscriber.
9. The ACS supports the view that payors referring patients for mandatory treatment abroad should be responsible for the coordination and reimbursement of follow-up care in the US, including the management of postoperative complications, readmissions, rehabilitation and long-term care.

Medical tourism is a rapidly growing, world –wide industry, and its continued expansion could have significant implications for health care delivery in the US. The Statement on Medical and Surgical Tourism drafted by the American College of Surgeons was developed with the patient’s interest in mind.

By Ron Johnson, M.D., F.A.C.S., Chief Medical Officer, Satori World Medical

Travel for medical care outside of the US for the purpose of medical treatment (“medical tourism”) is a rapidly growing trend and is gaining a lot of attention by patients, employers and insurance companies. The American Medical Association (AMA) is the largest association of physicians in the United States and works to promote the art and science of medicine for the betterment of the public health. So what does the AMA have to say about this growing trend of medical tourism?

The AMA is a voluntary association of physicians in the US which sets standards for the medical profession and advocates on behalf of physicians and patients. After several years of study and discussion and many proposals and resolutions, the AMA addressed the issue of medical care outside the US at its 2008 Annual Meeting and issued a report and recommendations. The report noted long-standing AMA policy on pluralism supports the ability of patients to choose their treatment settings and providers. It also stated that medical care outside the US provides many advantages and the opportunity to learn from international competition.

The AMA adopted the Council on Medical Service Recommendations that “our AMA advocate that employers, insurance companies, and other entities that facilitate or incentivize medical care outside the US adhere to the following principles.”

1. Medical care outside the US must be voluntary.

2. The financial incentives to travel outside the US for medical care should not limit or restrict diagnostic, treatment or referral options.

3. Medical care should be limited to institutions that have been accredited by recognized international accrediting bodies (i.e. the Joint Commission International).

4. Prior to travel, local follow-up care should be arranged to ensure continuity of care when patients return from medical care outside the US.

5. Coverage should include the costs of necessary follow-up care in the US.

6. Patients should be informed of their rights and legal recourse prior to agreeing to travel.

7. Access to physician licensing and outcome data, as well as facility accreditation and outcomes data should be arranged.

8. Transfer of patient medical records to and from facilities outside the US should be consistent with HIPAA guidelines.

9. 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.

The AMA supports patient choice, wants it to be informed choice, sees many advantages in medical care outside the US and an opportunity to learn from international competition and recommends principles to provide the best care possible.

Ron Johnson, M.D., F.A.C.S., Chief Medical Officer of Satori World Medical 

The new Administration has placed high priority on healthcare reform, to lower costs and improve quality.  Maybe a recent article in Health Affairs (Lessons from India in Organizational Innovation:  A Tale of Two Heart Hospitals, Sept. 08) can help.  Authors from the Duke University schools of law, business and medicine describe how organizational innovation has made Indian heart hospitals a low cost, high quality success story.  Can the US do the same? 

The Indian market is different – with over a billion people and a large middle class, only 14% has health insurance, so Indian hospitals understand that their services have to meet the middle-class family budget.  Lower labor costs are important, but much of their success is due to developing and improving innovative organizational structures to provide care.

• Hospital Management Structure.  Many leading healthcare organizations in India are led by dynamic physician-executives, and there is much more collaboration between physicians and senior administrators than in the US.  Hospital management teams come with experience in the hotel industry to give a more focused customer/patient approach.
• Pricing.  Hospitals are competing on both price and quality – they have developed differential pricing, to target different income sectors and maintain volume and efficiency.  Fixed or capitated pricing is offered, to allow patients and payers to “shop” for procedures and compare prices.  This also shifts financial risk to the service providers, and makes them continually evaluate cost drivers and develop new, innovative approaches to care delivery.
• Drive for efficiency in supply and delivery chains.  The competitive market and fixed costs demand efficiency, increased production volumes, with reengineering service delivery models to maximize use of capital equipment.  Some develop and manufacture routine equipment to reduce costs.  There is considerable investment in information technology.
• Competing on quality, paying for mistakes.  Because Indian hospitals compete on both quality and price, hospital managers have instituted quality assurance and improvement as integral to the business models.  As one physician said, in this business model, “we can’t afford to have complications.”

Can US hospitals learn from these Indian successes, where quality care is provided at a fraction of the cost in the US?  There are barriers to this experimentation, entrepreneurialism and technological progress.

• Medicare and insurance payment policies.  The Medicare DRG payment system does not reward innovation or efficiency or price flexibility.  Private insurance does little to stimulate price competition.  Innovation – new procedures or delivery models – is discouraged.
• Legal Barriers.  The Stark Amendment, the Medicare Prescription Drug, Improvement, and Modernization Act, and other laws stifle physician ownership and investment in new facilities and discourage their involvement in corporate strategy – both beneficial in the Indian heart hospitals. 
• Tort standards.  Even the US medical malpractice system discourages innovation – the “community standard” often locks in expensive and conventional practices.

The Duke University authors conclude that “although most innovation-intensive industries have enjoyed a history of producing new generations of industry leaders, offering dramatic improvements in both capability and affordability, the US health sector has not.  The US health sector, however, may soon resemble other innovation-intensive industries in one important respect: it may find its industry leaders displaced by Indian offerings.  If dramatic cost differences persist between procedures performed in Indian and US hospitals, it might not be long before employers and insurers begin sending patients to India for treatment.”

By Ron Johnson, M.D., F.A.C.S. –Chief Medical Officer, Satori World Medical

February is American Heart Month, and not just because of Valentine’s Day.  Cardiovascular disease (CVD), including heart disease, stroke and other vascular problems, is one of the deadliest and costliest health problems in the U.S.  The American Heart Association works with Congress to educate Americans about this epidemic and raise awareness throughout the month of February.  Today, I want to focus on three issues, prevention, treatment, and international options.

1.     The good news is that heart disease is preventable.  Some risk factors can’t be changed, such as family history of early heart disease, or your age.  But most risk factors can be controlled.  Here are a few tips for preventing heart disease.

• Don’t smoke – smoking reduces blood flow to the heart and can lead to a heart attack.
• Eat healthy – obesity increases the risk of heart disease, as well as stroke and other diseases; and a low calorie, heart healthy diet will also help lower your cholesterol.
• Be physically active – commit to at least 30 minutes of activity most days of the week, and if you have high blood pressure or diabetes (which are also key risk factors for heart disease), work with your physician to keep them under control.

2.     If you do get heart disease - and some forms, such as congenital CVD or viral cardiomyopathy (disease of the heart muscle), are not preventable – there are excellent treatments available, with medical therapy, angioplasty with stents and cardiac surgery offering dramatic results in many cases.  However, there is a cost.  An estimated 6.4 million cardiac procedures were performed in the U.S. in 2004, with nearly $438 BILLION spent on cardiac care in the U.S.  Needing heart surgery and not having health insurance (47 million Americans are currently uninsured) can be a disaster.  But even with health insurance, the high deductibles and co-pays may leave you facing $5,000 to $10,000, or more in out of pocket expense.

3.     Top quality healthcare for heart disease can be obtained internationally at a fraction of the cost than within the U.S.  One option Americans have which is becoming increasingly popular is medical travel, whereby Americans travel to international hospitals to receive quality medical care at a fraction of the cost than within the U.S. 

For instance, a patient in need of a heart valve replacement can travel to a hospital in Singapore, such as those within Satori’s Global Network™, to receive open heart surgery in a hospital that offers quality care and favorable clinical outcomes that are equivalent or superior to U.S. hospitals, yet for an average cost of 30 to 50 percent less. 

Satori World Medical’s international hospitals are accredited by the Joint Commission International (JCI), which is the international arm of the U.S. hospital-accrediting body, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).  These hospitals also boast leading-edge technology; have nurse-to-patient ratios exceeding U.S. standards; U.S./U.K. or equivalently trained and Board Certified physicians;  medical and nursing staff that is fluent in English; and many also have affiliations with prestigious U.S. medical universities, such as Harvard, Johns Hopkins, Cleveland Clinic, and others.

Heart Month is a good time to look at your risk factors, keep your heart healthy, and if you do have heart disease, know your treatment options!