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Outsourcing surgery

Discussion in 'Topics in Healthcare' started by pathstudent, Jul 30, 2006.

  1. pathstudent

    pathstudent Sound Kapital
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    We have all heard about outsourcing radiology and pathology. But now it looks like even surgery is going abroad.

    U.S. Employers Look Offshore for Healthcare
    As costs rise, workers are being sent abroad to get operations that cost tens of thousands more in the U.S.
    By Daniel Yi, Times Staff Writer
    July 30, 2006

    After going overseas to outsource everything from manufacturing to customer services, American businesses — pressed by rising healthcare costs — are looking offshore for medical benefits as well.

    A growing number of employers that fund their own health insurance plans are looking into sending ailing employees abroad for surgeries that in the U.S. cost tens of thousands of dollars more.

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    Carl Garrett of Leicester, N.C., will fly to a state-of-the-art New Delhi hospital in September for surgeries to remove gallstones and to fix an overworn rotator cuff. His employer, Blue Ridge Paper Products Inc. of Canton, N.C., will pay for it all, including airfare for Garrett and his fiancee. The company also will give Garrett a share of the expected savings, up to $10,000, when he returns.

    Garrett chose to go abroad rather than have the operations locally, where he would have paid thousands of dollars in deductibles and co-pays.

    "I think it is a great thing," the 60-year-old technician said. "Maybe it will drive down prices [of surgeries] here in the U.S."

    Blue Ridge, which employs 2,000 and funds its own health plan, began studying the idea out of frustration with rising rates at local hospitals, company officials said. Blue Ridge's healthcare costs have doubled in the last five years, to about $9,500 a year per employee.

    "The hospitals have a monopoly. They don't care, because where else are patients going to go?" said benefits director Bonnie Blackley. "Well, we are going to go to India."

    Every year, tens of thousands of Americans travel abroad for cheaper tummy tucks and angioplasties. This "medical tourism" has typically been reserved for uninsured procedures or uninsured patients.

    No major insurer offers such travel, but several employers that fund their own benefit programs have expressed interest, according to consultants and medical tourism agencies. No statistics are readily available on how many companies or patients have undertaken such travel.

    Some medical tourism agencies are preparing to offer health insurance plans that outsource all major surgeries abroad. IndUSHealth — a medical tourism agency based in Raleigh, N.C., that Blue Ridge hired — said it was in negotiations with several companies.

    Earlier this year, United Group Programs Inc., a health plan manager in Boca Raton, Fla., added a Thai hospital to its network of preferred providers. A handful of plan members have traveled to Thailand for treatment in recent months.

    Arnold Milstein, chief physician at human resources consulting giant Mercer Health & Benefits, said he had been hired by three Fortune 500 companies interested in contracting with offshore hospitals. Milstein said the employers requested anonymity because they were not ready to unveil plans to their workers.

    "This could really open up the healthcare market to foreign medical travel," said Milstein, who is based in San Francisco. "It won't just be people without insurance anymore. It could be available to just about everybody."

    U.S. hospital operators say that doesn't bode well for them.

    "This is not the solution," said California Hospital Assn. spokeswoman Jan Emerson. "In fact, this could make problems worse."

    Hospitals must deal with rising costs just like other parts of the healthcare system, she said, and California hospitals lost $6.65 billion last year caring for the uninsured. Hospitals rely on paying, well-insured patients to keep them afloat in the face of costly government regulations and low-paying government programs like Medicare and Medicaid, she said.

    Exporting the best-paying patients, she said, "will only add to the woes of the entire healthcare system."

    But like other industries, healthcare is globalizing as costs rise. High drug prices have led some Americans to import prescription drugs from Canada and elsewhere. Some U.S. hospitals outsource radiology analyses to cheaper facilities in Australia and Europe.

    Industry observers say that expanding health plans' provider networks to include foreign hospitals is an economic necessity and a natural progression.

    But there are risks. Patients have little or no legal recourse in medical malpractice cases because of relatively weak patient-protection laws in such countries as India and Thailand, popular surgery destinations among Americans. And U.S. medical organizations and government agencies do not oversee foreign facilities.

    "Foremost, surgery is a serious business," Bruce Cunningham, a plastic surgeon from Minneapolis, testified at a recent Senate hearing on medical tourism. "Patients simply cannot make informed decisions about medical care, or establish a proper physician-patient relationship, from travel brochures."

    Milstein, of Mercer Health & Benefits, says hospital quality is not a major worry because over the years, the same agency that accredits most American hospitals for participation in Medicare — the federally funded health plan for the elderly and disabled — has accredited 88 foreign hospitals through a joint international commission.

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    Bumrungrad Hospital in Bangkok, Thailand, and Apollo Hospitals in India, for example, are internationally recognized institutions. Despite the Third World conditions outside, the hospitals resemble five-star hotels and are equipped with the latest technology, American patients have reported. Many of the doctors are trained in the U.S., and visiting Americans are pampered around the clock, they have said.

    Still, traveling far from home to undergo a serious surgery may not appeal to everybody.

    "Some of our employees have never even been on a plane," said Blackley, Blue Ridge's benefits director.

    The company has not fully implemented the plan to all employees but hopes to do so in coming months, she said. Employees will be offered incentives such as waived co-pays to travel abroad for certain types of surgeries, but they will not be required to do so. Garrett will be a Blue Ridge test case, and company officials are expected to visit the facilities in India soon.

    "It sounds crazy," Blackley said, "but desperate times call for desperate measures."

    As more companies join the ranks, the concept may not sound that extreme, Milstein said: "The perception will change gradually, as more patients go through the experience."

    The savings can be sizable.

    A coronary artery bypass surgery costs about $6,500 at Apollo Hospitals in India, Milstein estimated.

    The average price in California is $60,400.

    Some health plans in California, such as Blue Cross of California and Health Net, have insurance plans with approved providers in Mexico. The plans offer lower premiums but are limited to those living near the border.

    United Group, the health insurance manager that recently added Bangkok's Bumrungrad Hospital to its provider network, offers low-premium insurance called a Mini-Med plan that covers basic medical treatment but only a few major procedures.

    Surgery coverage for Mini-Med's 20,000 subscribers is capped at about $3,000, said Jonathan Edelheit, United Group's vice president of sales. By going to Bangkok, subscribers may be able to afford a surgery that would have been prohibitively expensive in the U.S.

    Along similar lines, a Malibu-based start-up, PlanetHospital, hopes to create a health insurance plan that covers primary care in the U.S. but major procedures in foreign hospitals.

    "America has the best medical treatment," said founder Rupak Acharya. "Problem is, much of it is inaccessible."
     
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  3. Wallachia

    Wallachia Member
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    good opportunity to invest in airlines?
     
  4. fab4fan

    fab4fan TiredRetiredRN
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    <shudder>
     
  5. Llenroc

    Llenroc Bandidos Motorcycle Club
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    Sucks for surgeons, I guess.

    I can't stand surgery, what do I care. :sleep:
     
  6. NonTradMed

    NonTradMed Perpetual Student
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    Well, I'm pretty supportive of free markets, even in this case. If people can find a better deal, why stop them? If people start dying....well, that means it's not a better deal, is it? I guess it's just one more step in globalization. Sucks to be a surgeon in 20 years perhaps, but that's life.
     
  7. docB

    docB Chronically painful
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    I already see lots of patients who come to my ER with complications of surgeries they went to Mexico to have done. Usually it was cosmetic stuff and gastric stuff. I've got a woman I'm working up right now who came complaining of abd pain and no bm x 2 weeks since she had her breasts enlarged south of the border. Sucks for her but with the CT scan and the blood work, meds, fluids, etc., etc. her ER visit will probably be about $6000. That's probably about $4000 more than she paid for her new breasts.

    The biggest problem I see for these folks is that when they have problems there's no one to take care of them. You can imagine how reluctant any surgeon is to step into a case that's already screwed up by someone else. Getting anyone to deal with these folks is a real ordeal.
     
  8. dawg44

    dawg44 Senior Member
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    Mr. Jones: Yeah doc I had my total knee done in India now its infected and killing me. What should I do?
    Doctor: Well, hopefully you can get a flight in the next day or two and the guy that put it in can take care of you. Good Luck and ask him if can take care of the DVT you're probably going to get as well. Hey nurse, How may more patients do I have to see?
    Nurse: 50
    Doctor: Well, nice knowing you smart guy.
     
  9. Vox Animo

    Vox Animo Runs with Scissors
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    Just move to one of those countries, and blow off the loan payments.
     
  10. Llenroc

    Llenroc Bandidos Motorcycle Club
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    There's a difference between these top hospitals in India, staffed with American and British trained doctors, and some **** back alley plastic surgeon in Mexico. The quality of surgery you get at one of these top Indian institutions (which are built specifically to cater to medical tourists) is as good as or better than what you get at the typical U.S. hospital.

    There was an ariticle about this in one of the big 3 news magazines some time ago. Major companies offer these medical tourism surgeries on their health plans now. Typically the deal is that if you agree to it, you get to pocket 25% of the savings, which can be a lot of money for a $40,000 surgery that's done for $5,000 in India. The companies save money. The sick get excellent quality healthcare. India earns some foreign exchange money. The only losers are overpaid, blowhard American surgeons and lazy anesthesiologists who fall asleep during surgery.
     
  11. Vox Animo

    Vox Animo Runs with Scissors
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    woah, i see the fire coming. What if the anesthesiolgists stay awake and the american surgeons are quietly arrogant, then is the extra thousands justified?
     
  12. Llenroc

    Llenroc Bandidos Motorcycle Club
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    That's for the market to decide. :sleep:
     
  13. docB

    docB Chronically painful
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    I don't know if anyone will be able to hear me over the sound of all those axes grinding but my point still stands that if you come back you will have no one to take care of any complications. You'll notice that I never implied that Mexican or other surgery centers have a higher complication rate (that's a totally seperate debate). Many of those Mexican surgeries are done by American surgeons who are fleeing JCAHO, CMS and the lawyers.
     
  14. Faebinder

    Faebinder Slow Wave Smurf
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    The trouble with surgery is split into 3 major issues:

    1) Supply and Demand. Too few surgeons because residency is too long + not enough funding by medicare/medicaid to get new residency positions out there to make surgery more specialized and thus shorter. Not to mention that older surgeons think that life style doesn't matter (even though life is harder in this day and age) and anyone who enters the field and complains is a whiner... Basically, just because they walked up hill bare-feet and learned every single procedure in the book then all their residents need to do so.. (regardless of the fact that they try and stick to 12-15 procedures themselves and yet want the residents to learn 40+ procedures.)

    2) Malpractice. You can write articles about this. Malpractice lawyers evilness vs malpractice insurance companies evilness. Both hike the stakes... Companies raise their premiums despite insane profits and lawyers keep busting surgeon's nuts cause surgeons make high income after their year and years of learning and practice (spending their twenties and thirties learning how to do procedures.)

    3) Finally, rising healthcare costs in general. Unlike regular medicine, surguries are more like to use instruments, medicines and not to mention spend OR time and utilize multiple healthcare workers like CRNAs, surgical techs, OR nurses etc etc etc on top of utilizing physicians... all this costs money.. and as the prices go up....all these go up and so surgeries end up going up at a faster rate.

    Is it wise to do surgeries outside the US? I'd do the minor ones outside but I don't know about major procedures outside..... (It's not the same as doing your teeth outside the US.... though for the price of root canal and a crown you can actually buy a ticket to anywhere in the world AND get the tooth done nad crowned.) You got a family of 4 that need root canals and crowns? Get some tickets and go visit china or india.. heh. I am just commenting so don't attack me but I know people who do this... then again root canals and crowning are not surgeries.. but they are procedures that utilize instruments, medicines and multiple healthworkers.
     
  15. footcramp

    footcramp Senior Member
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    even the best surgeons have complications. it's inevitable. current reimbursement mandates free return visits for 30-90 days post-op. do you think an american doctor will see someone for free for an operation someone else did overseas? think again.
     
  16. Blue Dog

    Blue Dog Fides et ratio.
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    It's not an insurance issue. Since the surgeon doing the follow-up care in the U.S. didn't perform the surgery, he/she wouldn't have billed a global surgery fee in the first place. They would be able to charge fee-for-service for office visits and procedures until the patient recovered.

    Jumping into the middle of an already-complicated case is certainly risky. After all, if the patient or surviving family is going to sue somebody, who's the easier target...the U.S. surgeon or some guy over in India?

    However, it's not like this doesn't happen already with U.S. surgeries. Lots of people have their surgery done at faraway academic medical centers and then return home after a few days. Any complications usually wind up being handled locally.
     
  17. SomeGuy

    SomeGuy Senior Member
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    Of course, her insurance coverage (if any) will probably cover the ED visit, while she gets to pocket the savings on the surgery.

    Externalities... gotta love 'em.
     
  18. dawg44

    dawg44 Senior Member
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    I tell you right now if someone has their surgery in another country electively and are here for a complication. I won't see them and will go on to the next patient. I bet 99% of other surgeons feel the same way. To put it bluntly have your staff tell them "Good Luck" and move on to the next appointment.
     
  19. docB

    docB Chronically painful
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    See, that's a luxery we don't have in the ED. We have to see them. If they do actually have a surgical emergency then the surgeon on call will get to take a bite of the s--t sandwich too. When I call them they yell at me even though I usually wasn't the one who told the patient to go get their surgery somewhere else and then show up here for their complication. Eventually they have to come in and deal with whatever's going on. It sucks but that's call.
     
  20. dawg44

    dawg44 Senior Member
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    Thus another good reason to opt out of call and only do outpatient surgery.
     
  21. Blue Dog

    Blue Dog Fides et ratio.
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    If you want hospital privileges, though, that's not always an option.
     

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