By Dr. Ron Johnson, Chief Medical Officer at Satori World Medical

World Heart Day is globally held on the last Sunday of September each year to inform people about cardiovascular diseases, which are the biggest cause of death worldwide. Over 17 million people have died from cardiovascular diseases in 2005, representing 30 percent of all global deaths.

Compelling evidence indicates that the following strategies are effective in preventing cardiovascular diseases:

1. Do not smoke
2. Eat a heart-healthy diet, that limits fat and salt intake
3. Have an active lifestyle and keep a healthy weight
4. Limit alcohol intake to one to two drinks a day
5. Get your blood pressure and cholesterol levels checked regularly
6. Encourage stress-free moments at home and at work

Read further about how to reduce your risk of heart problems and about World Heart Day here.

By Dr. Ron Johnson, Chief Medical Officer at Satori World Medical

This Sunday, September 26, is the 10 year anniversary of World Heart Day. World Heart Day was created to promote heart health and inform people around the world that heart disease and stroke are the world’s leading cause of death, claiming more than 17 million lives each year. In partnership with the World Health Organization (WHO), the World Heart Federation organizes events in 100 countries to spread awareness through health checkups, organized walks, and lectures.

Although major risk factors of heart disease such as family history and age are beyond control, there are a few key healthy steps you can adopt today to reduce your risk of heart problems.

1.  Do not smoke – Smoking greatly increases the risk of developing coronary artery disease by 50 percent or more.
2. Eat a heart-healthy diet – Watch your fat and salt intake. Saturated and trans fat elevates the risk of coronary heart disease by raising blood cholesterol levels. Main sources of saturated fat include dairy products, animal fats, and oils. Sources of trans fat include deep-fried fast foods and packaged snack foods. High-sodium diets are also linked to an increase in blood pressure and a higher risk for heart disease and stroke. It is recommended to eat less than 1,500 mg of sodium a day.
3. Have an active lifestyle and keep a healthy weight – 30-60 minutes of physical activity a day can control weight and reduce blood pressure levels.
4. Limit alcohol intake – Excessive alcohol consumption can lead to weight gain and higher blood pressure. Limit yourself to one to two drinks a day.
5. Get regular checkups – Get your blood pressure and cholesterol levels checked regularly. High blood pressure and high cholesterol can damage your heart and blood vessels. Optimal blood pressure is less than 120/80 millimeters of mercury.
6. Encourage stress-free moments – High levels of stress can elevate blood pressure and cholesterol levels. Establish a regular sleep schedule, engage in relaxing activities, and take regular breaks during work hours.

Or as Dr. Jeffrey Williams says, “If you take care of your heart, it will take care of you.” Happy World Heart Day!

Dr. Jeffrey Williams specializes in Invasive/Interventional Cardiology and is a member of Satori’s Medical Quality Advisory Board, a team of expert board certified physicians who are recognized leaders in their sub-specialty field. Satori’s Medical Quality Advisory Board continuously monitors and evaluates clinical procedures and guidelines to ensure that Satori Global Network™ hospitals and physicians follow our established Standards of Excellence.

By Dr. Ron Johnson, Chief Medical Officer at Satori World Medical

An estimated 46 million people in the United States have arthritis of some form. By the year 2020, this number is expected to reach 60 million. Osteoarthritis, the most common form of arthritis, is caused by the breakdown and eventual loss of the cartilage of one or more joints. Here are a few tips to maintain healthy joints and protect against injury and disease.

1.       Maintain a healthy weight

Carrying less weight will help reduce pressure on your knees, hips, and back and can help prevent joint injury.

2.       Be active

Sitting or standing for extended periods can cause joint stiffness. Engage in low impact exercises that raise your heart rate and reduce joint swelling – try yoga, swimming, walking, or bicycling. 

3.       Eat right

A diet that is high in omega-3 fatty acids, Vitamin D and Vitamin C can promote healthy joints and reduce pain and swelling. A good source of Omega-3 fatty acids can be found in foods such as salmon, flaxseed oil and walnuts. Many experts recommend taking supplemental Omega-3 for joint health. Vitamin C is necessary for the formation of collagen that supports joint tissue and can slow the progression of osteoarthritis. Excellent sources of Vitamin C are papayas, oranges, and brussel sprouts. Vitamin D helps build strong bones, which reduces stress on joints. Vitamin D-rich foods include pure cod liver oil, salmon and milk.

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

 In 2008 and 2009 the American Medical Association (AMA) and American College of Surgeons (ACS) issued guidelines on medical tourism, the rapidly growing trend of traveling outside the US for medical care.  These guidelines were in favor of patient choice and focused on quality of care and patient safety.  Now the American Society of Anesthesiologist (ASA) is advising patients who are seeking surgical care internationally to help them make informed decisions.

The American Society of Anesthesiologists is an educational, research and scientific association of physicians organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.

Below are a few of the questions the ASA suggests asking before traveling abroad for surgical care and how Satori World Medical meets or exceeds these criteria.  For the complete list of questions, click here.

Are the physicians who will be performing the procedure licensed specifically for the procedure, and is the facility accredited by a reputable organization such as the Joint Commission International (JCI)?

Find out what professional memberships, training and qualifications the physicians hold (e.g., surgeon, anesthesiologist, etc.).  Choosing an accredited facility ensures that the hospital proved it met certain standards of care intended to keep patients safe.  While most hospitals feature this information on their Web sites, you can find those accredited by JCI at www.jointcommissioninternational.org.  You should also make sure to research mortality rates, infection rates and other performance measurements.

As a quality baseline or “gating” issue, Satori World Medical only contracts with international hospitals accredited by the Joint Commission International (JCI), the international arm of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) that accredits all US hospitals and healthcare organizations.  JCI sets over 350 standards of excellence for international hospitals to meet that ensure the quality and safety of patient care.  Moreover, our network of International Centers of Excellence have leading-edge technology, departments designed to cater specifically to international patients, and teams of US/UK or equivalently trained and board certified physicians that are English speaking.

Have I considered working with a medical tourism company?

Medical tourism service providers can guide you through the process by doing everything from transferring your medical records, to coordinating your travel logistics.  It is critical that you research them carefully because, as is the case with hospitals, they can vary in quality of service.  As a first step, you should check with the hospital where you are having the procedure, as it likely has a dedicated medical tourism group.

While high-quality care is available at many hospitals around the world, not all medical travel programs offer the same level of quality.  Satori World Medical has a robust quality assurance program and a strong patient advocacy and support program in place.  Satori’s primary focus is providing access to the highest quality patient care.  Our company has developed a proprietary quality management system which includes ongoing quality audits as well as a Nurse Patient Advocacy Program.

Who will be traveling with me for this procedure?

A support group can play a significant role in the overall outcome and experience associated with having a medical procedure abroad. If possible, patients should identify a family member or friend who can accompany them.  In addition to ensuring patients are receiving the best care possible, they can also play a motivational role, which can make the experience more comfortable and decrease recovery times.

Fundamental to Satori’s Business & Care Model is the belief that a companion should accompany the patient while traveling internationally for medical care, enhancing the ease of their trip, comfort, and quality of life while abroad.  Satori’s innovative model includes the cost of hotel and travel accommodations for the patient’s companion.

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

David G. Jaimovich, M.D. is the President and Founder of Quality Resources International, the former Chief Medical Officer and Vice President for International Accreditation Services for Joint Commission Resources (JCR) and Joint Commission International (JCI), and a member of the Medical Quality Advisory Board of Satori World Medical.  I recently interviewed Dr. Jaimovich about his role at JCI, his new company and international quality in general.

Satori:  How is your role at Quality Resources International different from your work at JCI?

Dr. Jaimovich:  At JCI I was in charge of International Accreditation: surveying against standards of quality and patient safety.  JCI Standards address key issues relevant to medical travel, including evidence of quality and professional competence, and accreditation provides objective validation and serves as a benchmark, assisting patients in medical travel decision-making.  I am now involved in consulting, developing quality and performance improvement programs and patient safety initiatives as they relate to accreditation and improving the safety of patients in the hospital setting.  It is a more creative role, going beyond meeting standards to continuous improvement in quality and safety.

Satori:  Tell us about Quality Resources International.

Dr. Jaimovich:  Our mission is to collaborate with the healthcare community around the world, to help public and private entities improve the quality and safety of health services through education, consultation, technical assistance, practical tools and guidance.  We provide advisory services to Ministries of Health, we prepare organizations for accreditation, and we provide quality management information systems to evaluate the success of interventional changes, to show continuous improvement.  That is a big issue: sustainability of improvements.  We are also developing a fundamental framework for healthcare quality: this is a distillation of the fundamental elements of the standards from JCI and other national accrediting organizations, such as Trent, Accreditation Canada and the Australian Council on Healthcare Standards.

Satori:  You have travelled widely, been involved with the evaluation of many hospitals and other healthcare organizations worldwide.  What is your view of the level of patient care – quality and safety – at the best international healthcare facilities, such as Satori World Medical’s International Centers of Excellence – and would you be comfortable receiving care at these facilities yourself? 

Dr. Jaimovich:  Quality and safety are now front and center for many hospitals and healthcare systems around the world.  There is a tremendous drive, a “tsunami” of quality and safety.  US hospitals have been doing this for a long time, there has been a plateau for some.  International facilities are on a steep curve, a big push coming from the World Health Organization, Ministries of Health – and Tourism -, payers, and multinational companies.  For myself, I would have no reservations about having surgery or other care at international facilities that meet high quality and safety standards, have transparent validated results and who have been accredited by an international accrediting organization.

Satori:  Thank you Dr. Jaimovich.  More information about Dr. Jaimovich and Quality Resources International is available at www.qrintl.com  More about Satori World Medical is available at www.satoriworldmedical.com.

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

Recent news reports show increasing interest in medical tourism, or medical travel – but not just for uninsured patients seeking lower-cost care abroad. Several major US health insurance companies have started pilot projects offering medical travel, and others are considering it. Skyrocketing health care costs in the US has driven some of this interest. But is that the only reason?

I talked with Dr. Charles Cutler, who recently retired as the Chief Medical Director of National Accounts at Aetna, who developed a pilot international medical tourism program for Aetna, and who has joined the Medical Quality Advisory Board of Satori World Medical, the leader in Global Health Care Networks.

“The main reason is cost-savings for self-insured customers, such as Maine-based Hannaford Co. The benefits department of this multi-national corporation became aware of the cost differences in international care and a program was launched to send patients overseas for major elective surgery,” explained Dr. Cutler. Another reason is “disruptive market force” – as with the Hannaford program, faced with international prices, local hospitals lowered their prices. Dr. Cutler mentions a third reason: cultural issues. A large part of the US workforce is from a Mexican background; there are also large Asian Indian, Filipino and other nationalities. When faced with major elective surgery, they may wish to travel to their “home” country for care.

What are the challenges for US insurers going global? Just as with US providers, due diligence around the quality of the international institutions and physicians is important. Dr. Cutler says that “with something new, with financial incentives, there needs to be quality that is equal or better than the US. It’s just not feasible for health plans to do that due diligence, with the costs, extensive site visits, coordination of all the travel and other arrangements. It’s more cost-effective to have an organization perform those tasks, like Satori World Medical. It is more cost-effective to have Satori negotiate contracts, make travel arrangements, perform the due diligence to rigorous quality standards – including extensive site visits, to see that international hospitals meet or surpass US standards.

“It is important to see the facilities and experience the overall process if you are sending someone there” says Dr. Cutler. “The facilities need to meet US standards, have English-speaking staff and meet the expectations of US patients and companions.” Also, Satori is able to offer unique financial benefits through its Health and Shared Wealth Program.

Aside from the operational and logistical challenges – site visits, getting quality data from the hospitals, etc. – what are Satori’s challenges? Dr. Cutler: “There are some regulatory and legal issues, particularly with fully-insured plans. But the real challenge is working with the plans to overcome their objections: selling the concept.” That is becoming less of a challenge, as health care is commoditized, part of the global economy and everyone, including insurers, is becoming more comfortable with international health care.

The benefits are there: quality, service, cost-savings, “disruptive” competition, increased patient choice, cultural affinity – so interest in medical travel by US insurers will continue. And Satori World Medical is here to help.

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.

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.”