Medical tourism is a growing industry, and so far most patients traveling for surgery have gone out of the country. However, there is a significant opportunity for ambulatory surgery centers to capitalize on this market by offering high quality, low cost services to patients and companies willing to pay out-of-pocket for their care.
"According to the experts, there are 1.5 million people leaving the country for treatment every year," says James Spearman, MD, an orthopedic surgeon with Lowcountry Orthopedics, owner in Lowcountry Outpatient Surgery Center and founder of TravelSurgeryUSA, a medical tourism facilitating company. "We estimate the range of orthopedic surgeries is 200,000 to 300,000 patients each year. I'm sure there's a big market of people who are willing to pay cash, and they are who we're targeting. Once patients have an experience at an outpatient surgery center, they aren't likely to go back to the hospital for an outpatient procedure. That's our experience and I think it's the experience of other people nationwide."
Dr. Spearman discusses how ASCs can prepare for and attract medical tourism patients within the Untied States.
1. Implement global payments. For cash-pay patients, ASCs can offer global payments that cover anesthesia, surgery and facility fees so the patients aren't negotiating all the different components of surgery. However, in some states this may create a unique challenge as the provider must prove they aren't an insurance company.
"I had to get a written statement from the state saying I wasn't an insurance company since I took payment for all three different components of care," says Dr. Spearman. "The statement says I'm not an insurance company because I'm not taking payment for a possible risk."
2. Offer significant cost savings. As more self-insured businesses and cash-pay patients will be looking for the best price for the best value for surgical procedures, ambulatory surgery centers are in a unique position to cater their services to these patients. "Surgery centers, especially the ones owned by physicians, are able to regulate their efficiencies so they can keep cost down," says Dr. Spearman. "Therefore, they can offer the services at a lower price than a hospital."
Beyond just efficiencies, surgeons can work on standardizing equipment and supplies to keep inventory and supply costs down. If people are paying high deductibles or out-of-pocket expenses for their surgery at hospitals, they will be looking elsewhere for cost savings without skipping on quality.
"Efficiency allows us to offer a better value and our infection rate is extremely low," says Dr. Spearman. "For the past year, we have been at 0.2 percent, compared to a hospital that might be 3 to 4 percent."
3. Patients can relax in a non-medical setting. Surgery centers can attract medical tourism patients not only with better value but also through unique accommodations. South Carolina, where Dr. Spearman's surgery center is located, is ranked number one in the country by Conde Nast Traveler Magazine as a tourist destination.
"South Carolina has always been a popular place to go," says Dr. Spearman. "When I looked at people going overseas to India, Thailand or Turkey for surgery, I thought we could do it here just as well or better — and cheaper — then patients can still have the medical tourism experience without traveling to a different country."
There are several options for patients traveling to Charleston, S.C., for surgery; Dr. Spearman's group has a partnership with local hotels as well as beachside houses so patients can enjoy discounted stays while recovering from their procedure.
"We have a whole company that could set them up in a house or on the beach and there are several hotel and resort area options," says Dr. Spearman. "If they want to go inexpensively, we partner with inexpensive hotels as well as five-star facilities."
4. Screen patients before they travel. It's important to screen patients before they make an appointment so you know they are medically good candidates for the procedure. If patients have previously undergone an MRI, the images can be screened or reviewed beforehand as well. Dr. Spearman also offers traveling patients a discounted MRI if necessary. A nurse practitioner reviews patient records and assigns them to the appropriate physician who is most experienced with their condition.
"We can also do phone consults prior to booking surgery," says Dr. Spearman. "Finally, we have a face-to-face meeting one or two days prior to surgery to ensure the patient is okay for the procedure."
5. Patients don't have to worry about the risks of going overseas for surgery. While traveling overseas for vacation sounds attractive, there could be several risks involved when undergoing surgery in another country. The facility may not be kept to the same standards as facilities in the United States and the surgeons may not be as technically skilled as the surgeons you'll find domestically. Patients aren't able to have follow-up visits with their surgeons and complications after returning to the United States could be hazardous.
Patients undergoing several types of procedures, especially orthopedic surgeries, should also be weary of long plane rides home. "Patients could suffer blood clots if they are on the plane for a long time in the same position," says Dr. Spearman. "Traveling within the United States avoids all that. I think that ASCs are really well positioned to take advantage of those patients in the future."
To offer global payment, Dr. Spearman contracted with physicians in the group, the facilities involved with care and the anesthesia group to negotiate rates. The contracts should be written by a healthcare lawyer, who can also work with you on patient waivers. The contracts and patient waivers are in place in case a patient decides to file a suite.
6. The market for self-insured and cash-pay patients is growing. The target audience for medical tourism is companies that are self-insured and uninsured individuals who are able to pay for high-quality care. "Even though companies are self-insured, payment for care comes out of their bottom line," says Dr. Spearman. "They might have an insurance company that administers funds, but they might be finding them the best deals."
For example, a company without a local ASC might find it's cheaper to send patients away for the weekend for their service like a colonoscopy than to have the procedure done at the local hospital. "There's a market out there for companies looking for the best deals," says Dr. Spearman.
There are a few big companies that recently contracted with big hospitals for their service, but Dr. Spearman sees more partnerships with surgery centers down the road. "Hospitals can never match the efficiency, price savings, patient satisfaction rate or infection rate we have," says Dr. Spearman. "Surgery centers are in a better position to offer the same thing for a lower cost. We offer better services, and once industry realizes that they will be partnering with their local facility or groups like mine."
7. Bring bigger cases into the ASC. As a result of advances in surgical technology and pain management, surgeons are able to perform bigger and more complex procedures in ambulatory surgery centers than ever before. As an orthopedic surgeon, Dr. Spearman has seen the evolution of orthopedic surgeries into the outpatient setting and been an advocate of this transition.
"I've been doing this for 25 years and I've been promoting outpatient surgery as opposed to in-hospital surgery," says Dr. Spearman. "I've been doing bigger orthopedic cases like ACL reconstruction and rotator cuff surgeries on an outpatient basis for almost 20 years now. There was a time about 15 years ago that 75 percent of orthopedic surgeries that could have been done outpatient were still done as inpatient procedures; it raises the cost of healthcare unnecessarily. A goal of mine is to push more orthopedic care into the outpatient setting, which would benefit society as a whole."
However, there are some procedures that will not do well in the outpatient setting. Therefore, physicians may benefit from partnering with a hospital as well in order to accommodate for these patients.
8. Work with a healthcare lawyer. It's important to have a lawyer focused on healthcare working with you to make sure all of your legal paperwork is in order. Beyond the legal logistics, you also want to make sure everyone knows their role with the medical tourism patients before launching the program.
"Have your contracts, agreements and insurance coverage in order," says Dr. Spearman. "You should also know who is assigned to all tasks; someone should be responsible for marketing and the legal aspects of the program. There is a lot of work involved in setting it up."
Learn more about TravelSurgeryUSA.
More Articles on Surgery Centers:
12 Steps to More Robust Reimbursement in a Surgery Center
8 Steps to Elevate Profitability at Surgery Centers
40 Benchmarks About Orthopedics in Surgery Centers
"According to the experts, there are 1.5 million people leaving the country for treatment every year," says James Spearman, MD, an orthopedic surgeon with Lowcountry Orthopedics, owner in Lowcountry Outpatient Surgery Center and founder of TravelSurgeryUSA, a medical tourism facilitating company. "We estimate the range of orthopedic surgeries is 200,000 to 300,000 patients each year. I'm sure there's a big market of people who are willing to pay cash, and they are who we're targeting. Once patients have an experience at an outpatient surgery center, they aren't likely to go back to the hospital for an outpatient procedure. That's our experience and I think it's the experience of other people nationwide."
Dr. Spearman discusses how ASCs can prepare for and attract medical tourism patients within the Untied States.
1. Implement global payments. For cash-pay patients, ASCs can offer global payments that cover anesthesia, surgery and facility fees so the patients aren't negotiating all the different components of surgery. However, in some states this may create a unique challenge as the provider must prove they aren't an insurance company.
"I had to get a written statement from the state saying I wasn't an insurance company since I took payment for all three different components of care," says Dr. Spearman. "The statement says I'm not an insurance company because I'm not taking payment for a possible risk."
2. Offer significant cost savings. As more self-insured businesses and cash-pay patients will be looking for the best price for the best value for surgical procedures, ambulatory surgery centers are in a unique position to cater their services to these patients. "Surgery centers, especially the ones owned by physicians, are able to regulate their efficiencies so they can keep cost down," says Dr. Spearman. "Therefore, they can offer the services at a lower price than a hospital."
Beyond just efficiencies, surgeons can work on standardizing equipment and supplies to keep inventory and supply costs down. If people are paying high deductibles or out-of-pocket expenses for their surgery at hospitals, they will be looking elsewhere for cost savings without skipping on quality.
"Efficiency allows us to offer a better value and our infection rate is extremely low," says Dr. Spearman. "For the past year, we have been at 0.2 percent, compared to a hospital that might be 3 to 4 percent."
3. Patients can relax in a non-medical setting. Surgery centers can attract medical tourism patients not only with better value but also through unique accommodations. South Carolina, where Dr. Spearman's surgery center is located, is ranked number one in the country by Conde Nast Traveler Magazine as a tourist destination.
"South Carolina has always been a popular place to go," says Dr. Spearman. "When I looked at people going overseas to India, Thailand or Turkey for surgery, I thought we could do it here just as well or better — and cheaper — then patients can still have the medical tourism experience without traveling to a different country."
There are several options for patients traveling to Charleston, S.C., for surgery; Dr. Spearman's group has a partnership with local hotels as well as beachside houses so patients can enjoy discounted stays while recovering from their procedure.
"We have a whole company that could set them up in a house or on the beach and there are several hotel and resort area options," says Dr. Spearman. "If they want to go inexpensively, we partner with inexpensive hotels as well as five-star facilities."
4. Screen patients before they travel. It's important to screen patients before they make an appointment so you know they are medically good candidates for the procedure. If patients have previously undergone an MRI, the images can be screened or reviewed beforehand as well. Dr. Spearman also offers traveling patients a discounted MRI if necessary. A nurse practitioner reviews patient records and assigns them to the appropriate physician who is most experienced with their condition.
"We can also do phone consults prior to booking surgery," says Dr. Spearman. "Finally, we have a face-to-face meeting one or two days prior to surgery to ensure the patient is okay for the procedure."
5. Patients don't have to worry about the risks of going overseas for surgery. While traveling overseas for vacation sounds attractive, there could be several risks involved when undergoing surgery in another country. The facility may not be kept to the same standards as facilities in the United States and the surgeons may not be as technically skilled as the surgeons you'll find domestically. Patients aren't able to have follow-up visits with their surgeons and complications after returning to the United States could be hazardous.
Patients undergoing several types of procedures, especially orthopedic surgeries, should also be weary of long plane rides home. "Patients could suffer blood clots if they are on the plane for a long time in the same position," says Dr. Spearman. "Traveling within the United States avoids all that. I think that ASCs are really well positioned to take advantage of those patients in the future."
To offer global payment, Dr. Spearman contracted with physicians in the group, the facilities involved with care and the anesthesia group to negotiate rates. The contracts should be written by a healthcare lawyer, who can also work with you on patient waivers. The contracts and patient waivers are in place in case a patient decides to file a suite.
6. The market for self-insured and cash-pay patients is growing. The target audience for medical tourism is companies that are self-insured and uninsured individuals who are able to pay for high-quality care. "Even though companies are self-insured, payment for care comes out of their bottom line," says Dr. Spearman. "They might have an insurance company that administers funds, but they might be finding them the best deals."
For example, a company without a local ASC might find it's cheaper to send patients away for the weekend for their service like a colonoscopy than to have the procedure done at the local hospital. "There's a market out there for companies looking for the best deals," says Dr. Spearman.
There are a few big companies that recently contracted with big hospitals for their service, but Dr. Spearman sees more partnerships with surgery centers down the road. "Hospitals can never match the efficiency, price savings, patient satisfaction rate or infection rate we have," says Dr. Spearman. "Surgery centers are in a better position to offer the same thing for a lower cost. We offer better services, and once industry realizes that they will be partnering with their local facility or groups like mine."
7. Bring bigger cases into the ASC. As a result of advances in surgical technology and pain management, surgeons are able to perform bigger and more complex procedures in ambulatory surgery centers than ever before. As an orthopedic surgeon, Dr. Spearman has seen the evolution of orthopedic surgeries into the outpatient setting and been an advocate of this transition.
"I've been doing this for 25 years and I've been promoting outpatient surgery as opposed to in-hospital surgery," says Dr. Spearman. "I've been doing bigger orthopedic cases like ACL reconstruction and rotator cuff surgeries on an outpatient basis for almost 20 years now. There was a time about 15 years ago that 75 percent of orthopedic surgeries that could have been done outpatient were still done as inpatient procedures; it raises the cost of healthcare unnecessarily. A goal of mine is to push more orthopedic care into the outpatient setting, which would benefit society as a whole."
However, there are some procedures that will not do well in the outpatient setting. Therefore, physicians may benefit from partnering with a hospital as well in order to accommodate for these patients.
8. Work with a healthcare lawyer. It's important to have a lawyer focused on healthcare working with you to make sure all of your legal paperwork is in order. Beyond the legal logistics, you also want to make sure everyone knows their role with the medical tourism patients before launching the program.
"Have your contracts, agreements and insurance coverage in order," says Dr. Spearman. "You should also know who is assigned to all tasks; someone should be responsible for marketing and the legal aspects of the program. There is a lot of work involved in setting it up."
Learn more about TravelSurgeryUSA.
More Articles on Surgery Centers:
12 Steps to More Robust Reimbursement in a Surgery Center
8 Steps to Elevate Profitability at Surgery Centers
40 Benchmarks About Orthopedics in Surgery Centers