The Korean government has started a program to train medical interpreters to help hospitals avoid language barriers when providing services to foreign patients. The Korea Human Resource Development Institute, a subordinate of the Ministry for Health, Welfare and Family Affairs, selected 65 trainees for its 200-hour program to develop medical interpreters in English, Chinese, Japanese, Russian, and Arabic. The KHRDI expects the Council for Korea Medicine Overseas Promotion, which includes 30 hospitals nationwide, to recruit the interpreters.
Editor's Note: This is the third of three contributed features submitted by members of the International Medical Travel Association's Board of Directors. The IMTA is a not-for-profit global organization of stakeholders in the international medical travel industry.
The time has come for leadership in the medical travel industry to focus on one of the most important issues facing all stakeholders: continuity of care. It is a major concern, and rightfully so. Everyone wants to know how patients will access follow-up care after they have undergone a procedure, surgery or other treatment outside of the United States.
Today, there are some major challenges, primarily centered on a lack of communication between caregivers, liability concerns, and sharing patient records.
Some physicians may reluctantly provide follow-up care to their patients who decided to access high quality, low cost surgery in a foreign country. These physicians may find it challenging to communicate with doctors outside the country as easily as they would with a U.S. colleague, the result of language barriers and time zones differences.
If the patient is uninsured or does not have a U.S. physician, it may be necessary for this patient to pay for copies of their medical records in the foreign country—including x-ray films. They will also need to transport these records back home in order to provide them to a new U.S.-based physician that is handling follow-up care. This is recommended, particularly when foreign providers do not have electronic medical records or the digital capabilities to transmit written records. Conversely, when patients need to send their medical records to a foreign physician, there are HIPAA challenges that must be addressed by the U.S. physician.
Additionally, there may be malpractice risks for U.S. physicians, a factor that has generated considerable attention. However, there is limited available evidence of any prevalence of malpractice regarding follow-up care, and few studies have been conducted.
While these challenges may be of concern, they can and should be overcome. The opportunity is to take the long view approach and understand that the globalization of healthcare will ultimately lead to more choice and options.
Defining the problem
While government officials and voters debate the politics of the U.S. healthcare system or the injustice of one of the wealthiest nations on Earth having nearly fifty million of its people uninsured or underinsured, thought leaders in medical travel must address the reasons why U.S.-based physicians are reluctant to treat individuals returning to this country following medical care or treatment outside U.S. borders.
Today, many studies show a growing number of highly-complex procedures being performed abroad, including neurology, orthopedics, bariatrics, and cardiology. The list of diagnoses and procedures for which U.S. citizens go elsewhere for care is growing. According to a 2008 Deloitte Study, most are elective procedures that require follow-up care for a period of weeks and involve a surgical intervention. Common medical tourism procedures that consumers choose are dental, cosmetic, orthopedic, and cardiovascular.
Furthermore, last year the AMA published a set of guidelines for medical tourism and stated that "coverage for travel outside the U.S. for medical care must include the costs of necessary follow-up care upon return to the US."
Strategic partnerships and alliances to ensure continuity of care
As the quality of care and improved patient safety level the playing field between the United States and international providers, and as the size of the medical travel market increases, there will undoubtedly be a number of progressive physicians, large insurance providers and other healthcare businesses leading the way. It's not difficult to imagine that by working in partnership with leading accredited foreign hospitals, these U.S. providers will be able to offer a complete uninterrupted continuum of care for a reasonable price.
Beyond the partnerships of top U.S. healthcare providers with management responsibilities in foreign hospitals that we see today, there are the yet unseen service partnerships that may take many forms:
U.S. cancer centers that provide several portions of specific and otherwise very expensive therapy regimens can done in combination in the US and done abroad
Large U.S.-based specialty centers that offer value to their clients by performing high cost procedures abroad—and then returning to the US for further follow up care
U.S. based specialty clinical laboratories that ship specimens abroad to clinical laboratories for testing
Insurance companies that extend their physician and hospital networks to other countries.
We may also see the use of low-cost, in-home monitoring devices and online tools that would reduce the need for return visits to foreign countries, allowing individuals to be more active in their care while being monitored remotely by their physician abroad. We may also witness foreign providers partnering with U.S.-based home health agencies to monitor patients after their return home. The potential of foreign partnerships is endless.
A call-to-action for U.S. providers
The question remains: Why should US healthcare providers partner with high quality foreign counterparts? In response, consider the following: the Deloitte study as cited above asserts that U.S. healthcare providers lost billions in 2007; if their predictions fall true, these providers will lose almost $70 billion to outbound medical tourism by the year 2010. The number and rate of foreigners coming to America for healthcare services is not growing as fast as it once did.
Currently, many U.S. hospitals use the high priced fees paid by foreigners to help offset their operating deficits. It's not difficult to predict that this windfall is likely to decrease if foreigners choose high quality, accredited hospitals in their home country rather than traveling to the United States for medical care. The United States also benefited for years from an influx of foreign-born physicians, who chose to practice in the here instead of in their homeland. If more of these physicians either stay home or return home because the healthcare facilities are comparable to the U.S., there may be staffing constraints for U.S. providers.
History has shown that when there is a need, solutions always present themselves to meet those needs. Although these solutions may take several different forms, each will fill a niche in the continuity of care of an international patient.
Joseph S. Barcie, MD, PhD, MBA, is the President of Centralized Services for the Dallas-based International Hospital Corporation. He may be reached atjbarcie@intlhosp.com.
Wichita, KS-based Galichia Heart Hospital has reached an agreement with Mobile Surgery International for Galichia to host MSI-coordinated, urologic surgical teams at its facilities.
Mobile Surgery International coordinates the union of patients from all over the world with surgeons and facilities in an effort to provide the patients with high quality, affordable choices for their treatment, says CEO Arnon Krongrad, MD. The agreement expands Galichia's capabilities as a center of excellence for selected types of surgical care and expands MSI's ability to offer patients surgical choice in high-quality facilities in the U.S., say representatives from the two organizations.
"Through this partnership within the medical tourism concept, we are able to treat patients within the United States who might normally have otherwise chosen to seek treatment overseas," says Alisa Crawford, VP of business development at Galichia. "The partnership allows a blend of Galichia Heart Hospital's dedication to patient care and Dr. Krongrad's specialized expertise in minimally invasive prostate surgery."
Galichia already actively seeks potential medical tourists to its facilities by offering discounted fees in an effort to lure business. The partnership with MSI is an excellent compliment to Galichia's current service lines of cardiac, orthopedic and general surgery, Crawford says.
"Dr. Krongrad heard of Galichia Heart Hospital's medical tourism initiative and appreciated our forward thinking approach to providing services," Crawford says. "He will be using our facility for his patients who wish to stay within the United States."
MSI forms relationships that allow payers to fill gaps in coverage and offer choice, quality and cost containment to their patient base. Some of these relationships will specifically include referrals of patients to MSI for certain urological procedures at Galichia, Krongrad says.
Patients find MSI through medical tourism facilitators, as well as through agreements with employer representatives, third party administrators, and domestic and foreign insurance companies. The partnership with Galichia Heart Hospital allows MSI to more easily overcome barriers to choice and quality for many patients, Krongrad added.
"Because it is situated in the middle of the country, it helps Mobile Surgery International serve a very large number of Americans and Canadians who face barriers to choice and quality," Krongrad says. "It may be that others will also take interest: We recently got interest in our Galichia option from a Turk living in Norway."
Some patients also seek help from MSI on their own. Last week alone, MSI was directly contacted by patients in Wichita, Phoenix, Kansas City, Toronto, Calgary, and Kingston, Jamaica, Krongrad says.
"Each of these patients may ultimately choose to have surgery with us in Wichita," Krongrad says. "For many of them, Wichita offers geographic and/or cultural convenience. For others, including the man from Kingston, Wichita represents not geographical or cultural convenience but economic convenience."
Given the state of the Global economy, partnerships such as the one between MSI and Galichia are more important than ever, Krongrad says. For some non-emergency surgeries, the partnerships can better align demand and supply, and in turn reduce costs while preserving quality, he adds.
"The world is in a state of economic crisis," Krongrad says. "The pressures we face are causing an intense focus on cost containment everywhere, including in healthcare. Our subject expertise and service model can be used to overcome economic, geographic, and cultural barriers to choice and quality."
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Nurses cure the sick, heal the wounded, and comfort the dying, but are they doing so at their own cost?
Jenny Watts, researcher and psychology PhD student at the University of Leicester in Leicester, England aims to find out in a new project examining the emotional toll of nursing. The project, which follows a large scale methodical review of published literature Watts conducted last year, will explore how exposure to patient suffering and empathizing with patients influence nurses' experiences of distress.
"The [previous] review revealed certain nurse characteristics may predict a specific form of distress," says Watts. "There appear to be many moderating variables, but the literature suggested more empathetic nurses showed greater vulnerability to what had been labeled as burnout and secondary traumatic stress."
Watts' findings indicate nurses who empathize and identify with their patients can share patients' emotional reactions, thus nurses with highly distressed patients can develop similar symptoms. In addition, dealing with patients' concerns can lead to draining of emotional resources.
Such distress can significantly affect nurses' personal and professional lives, resulting in flashbacks of traumatic events, sleeping difficulty, emotional detachment, and increased feelings of work-related dissatisfaction.
"There is evidence that caring for others can have negative implications for their career, in terms of physical health and professional functioning. However, we need to determine a more precise understanding of nurse distress to enable suitable interventions," Watts says.
According to Watts, one of the major findings of her review implicates age is a predictive factor of distress. For instance, younger, less experienced nurses report greater distress.
"This project aims to test these apparent relationships and determine how much variance in distress—in the form of burnout, for example—can be determined by factors, such as empathy and social support," Watts says.
Pending approval of the NHS Research Ethics Committee in the U.K., Watts will start the first stage of the project with the university's School of Psychology. A qualitative pilot study will involve nursing staff employed in long-term care facilities and hospital wards for older adults. Watts wants to study the nurses due to the U.K.'s aging population and adults older than 70 being the largest consumers of hospital care. Nurses witnessing death and deterioration in older adults have reported distress and may suffer from anxiety and depression as a result.
The project will include the use of qualitative tools to first gather nurses' experiences of patient care and then apply quantitative measures, such as questionnaires to assess the variables (i.e., social support or staff characteristics).
"Using the results, we aim to construct predictive models of the nurses' distress," Watts says. "These models may reveal sources of vulnerability, enabling education and training to be tailored more effectively."
She adds, "This strategy may also reveal sources of resilience, such as a negative relationship between social support and burnout, and these more positive findings could also be applied in strengthening occupational policy."
Fortunately, working in the profession doesn't and won't take a large emotional toll on every nurse. "Not all nurses will experience significant distress as a result of exposure to patients' suffering. However, for those that do, the consequences can be far-reaching."
It is because of this that more knowledge is needed and more measures be taken to prevent nurses and patients from suffering the effects of distress.
"It is increasingly important to maintain the health and wellbeing of healthcare providers," says Watts. "In addition, there is evidence within the literature that compassionate care can have a positive impact on patient outcomes."
Jason Gorevic, chief executive officer of TelaDoc Medical Services, discusses the role telehealth can play in health reform and how to get patients more engaged in managing their healthcare. [Sponsored by Emdeon]
Perot Systems Corporation's Fairfax, Virginia-based Government Services Business Unit won the re-compete for the performance-based contract with the Centers for Disease Control and Prevention valued at over $119 million. Under the contract, Perot Systems will provide infrastructure support to the CDC's Information Technology Services Office nationally and internationally, according to a release.
Columbia, SC-based Informatics Corporation of America has announced a strategic alliance with Companion Data Services, LLC in Nashville to develop a system that integrates with and builds upon existing clinical systems to create a unified electronic health record. ICA and CDS will offer healthcare consortiums and state agencies the capability to electronically move clinical information among disparate healthcare information systems and facilitate access to and retrieval of clinical data to provide higher quality, patient-centered care, according to a release.
Companies that make it easier for doctors to write prescriptions electronically would be eligible for a tax break under a bill being considered in Massachusetts. The bill, sponsored by state Rep. Peter Koutoujian, would give companies a tax break on the cost of purchasing and installing electronic medical record technology.
A Durham, NH, nurse has filed a civil suit against three officials of the Obama Administration alleging the American Recovery and Reinvestment Act's health information technology provisions unconstitutionally violate the HIPAA privacy rule, Privacy Act and Federal Common Law. In a complaint filed June 25 and seeking class action status, the nurse names as defendants Kathleen Sebelius, Secretary of the Department of Health and Human Services; Nancy-Ann DeParle, Director of the White House Office of Health Reform; and Charlene Frizzera, Acting Administrator of the Centers for Medicare and Medicaid Services.
David Blumenthal, MD, the National Coordinator for Health Information Technology, has announced he intends to "harmonize" certified electronic health records standards within the National Health Information Network. "We are working on continuing the momentum of the NHIN and Connect," the NHIN software, Blumenthal said. NHIN is a patient data exchange system developed under the Bush administration that is currently being used by the Veterans Administration and Social Security Administration, among others.
