August 13, 2019

To meet growing yet skeptical American interest in medical tourism, a Denver-based organization is arranging for American doctors to leave the States for quick trips to perform operations on American patients—who might even get paid for having the procedure abroad, Phil Galewitz reports for Kaiser Health News.

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A foreign hospital with an American doctor

Medical tourism has grown in popularity over the last two decades, and today, hundreds of thousands of Americans leave the United States to seek lower cost health care, Galewitz reports.

But a top concern for prospective medical tourists is quality, according to Galewitz.

That's where the North American Specialty Hospital (NASH) comes in.

Denver-based, for-profit NASH works with Galenia Hospital in Cancun to connect U.S. patients—and their payers—to cheaper care. The American surgeons at Galenia Hospital work closely with a local Mexican surgeon and with local nurses to perform the operation. NASH has organized operations for at least two dozen American patients since 2017.

Galenia is accredited by the international affiliation of the Joint Commission, and by working with NASH, it's adopted new quality standards. For instance, the hospital added an additional enclave to sterilize instruments more quickly and has patients begin physical therapy just hours after their operation, Galewitz reports.

A defining feature of NASH is that it connects Americans with American doctors to perform the procedure they receive abroad. According to Galewitz, "NASH is betting that having an American surgeon" on board will ease patients' concerns and convince employers who pay for health care to see medical tourism as a high-quality, lower cost option.

When it comes to payment, NASH charges a fixed amount for each case. For patients, the service isn't subject to deductibles or out-of-pocket copayments for their operations.

"In the past, medical tourism has been mostly a blind leap to a country far away, to unknown hospitals and unknown doctors with unknown supplies, to a place without U.S. medical malpractice insurance," said James Polsfut, CEO of NASH. "We are making the experience completely different and removing as much uncertainty as we can."

Nash buys additional malpractice insurance for the U.S. doctors, who can be sued by American patients whose surgeries don't go as planned, Galewitz reports.

A free operation and a $5,000 incentive

For Donna Ferguson, a NASH Galenia patient, having an American surgeon made her more open to the option.

Ferguson, who has health insurance through Ashley Furniture as a dependent, flew from Mississippi to Cancun to meet Thomas Parisi, an orthopedist from Milwaukee who trained at Mayo Clinic, for the operation. Parisi is one of roughly 40 U.S. orthopedic surgeons who've signed up to work with NASH, Galewitz reports. Ten days after the operation, Ferguson was discharged from the hospital.

The operation proved to be cost efficient for Ferguson, Parisi, and the furniture company, Galewitz reports.

Parisi spent less than 24 hours in Cancun and received $2,700 for performing the procedure, which Galewitz reports is three times the rate Medicare would have paid.

Ashley Furniture offered Ferguson an incentive payment of $5,000, in addition to covering the costs of travel, and the total cost to company was less than half of what it would have paid for the same procedure in the United States, according to Galewitz.

Ashley Furniture, which has sent about 140 employees abroad for treatments through operations like NASH, has saved about $3.2 million through the operations, Galewitz reports.

"Even after the incentive payments and travel expenses, we still save about half the cost of paying for care in the United States," Marcus Gagnon, manager of global benefits and health at Ashley, said.

The dangers of operating abroad

Glenn Cohen, a law professor at Harvard University and an expert on medical tourism, said the model used by NASH and other organizations is a "clever" marketing strategy. "[I]t's a big step forward," he said.

But, despite the financial incentives, Cohen said operations like NASH don't "answer all concerns." For instance, patients would still have to question whether the foreign hospitals are equipped to handle all possible surgical outcomes, the skills of the other medical staff, as well as the continuity of care after they're discharged.

For these reasons, "Building a familiar culture in a foreign destination may be appealing to some American consumers, but I do not see it as a sustainable business," according to Irving Stackpole, a health consultant in Rhode Island. "It's not unusual for people thinking about this to have doctors, family and friends who will see this as a high-risk undertaking" (Galewitz, Kaiser Health News, 8/12).

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