Health Travel Providers & Suppliers Face Different Challenges as Borders Reopen

Each health facility, facilitator, clinic, and clinician will experience restarting on a case-by-case basis.

As the old saying goes, "Prescription without diagnosis is malpractice."

As the old saying goes, "Prescription without diagnosis is malpractice." Now is not the time to follow opportunistic novices selling and hawking mass webinars, mass marketing, mass certifications and accreditations, or misguided advice that comes from thin air. Standards and protocols for reopening health and surgical facilities in the USA and abroad have been a moving target, and likely won’t be a one-size-fits-all approach.

The ongoing COVID-19 pandemic, its treat of relapse, political attitudes and weighing health risks against economic damage have created a city-by-city, cluster-by-cluster patchwork of reopening dates, forcing health tourism suppliers and facilitators, airlines and hotel operators to approach their reopenings and resumption of health tourism and medical travel services on a case-by-case basis.

There is great disparity in jurisdictional approach across the world. Few of the many opportunistic medical tourism consultants who lack health administration experience and training fail to appreciate all the sophisticated moving parts, city-by-city, facility-by-facility.

The reopening approach of some smaller facilities in remote destinations with an heavy reliance on natural tourism attractions nearby has been criticized by some as too stringent. Some of the quarantine and shelter-in-place mandates for visitors (for example, Hawaii) that require visitors to be there for 14 days before they can venture out from a hotel or risk jail time are simply a non-starter.

Many full services hospitals will not be ready to open to health travelers for non-urgent, elective services for months to come. They owe their local patients a chance to clear the list of postponed cases before opening their doors to foreigners. If they proceed in any other order, they risk alienating and causing resentment from the locals who can make or break the welcoming spirit that is so necessary for health travel patients to come for an extended time and support their economy.

When a health tourism destination with 150,000 residents or 1.5 million residents had a pre-COVID tourism footfall of 40 million visitors, tourism is critical to its economy. Many small health facilities don't have a specific medical tourism market strategy deployed. This is true for a number of reasons. But ask the CFO if they are interested in caring for patients from outside their local area who bring cash to pay for a surgery or treatment if they'll turn it down. Strategically, there may be no official position, but no hospital administrator turns down cash under normal circumstances...

But are we working under "normal" circumstances right now? Not really.

Many Americans surveyed are afraid to travel and afraid of being admitted to or having tests at "hospitals"

In many foreign countries the word "hospital" is used as a synonym for "clinic". In Greece, for example a "clinic" denotes private ownership while a "hospital" denotes public health ownership. Patients don't care what you call it. They care about their safety and risks and hazards. In the USA, clinic refers to a small place that houses a medical group's private practice. So if you start by confusing them with semantics, you won't inspire much trust.

• In a recent survey of US patients, 36% of respondents said going to the hospital was a risky behavior, compared to going to the beach (16 percent) or a hair salon (27 percent).
• More than 60% of respondents said they thought it was either "somewhat likely" or "very likely" that they'd contract COVID-19 in a hospital.
• Fifty-two percent of respondents over age 60 said they were more afraid of contracting the virus than experiencing a stroke (25 percent) or heart attack (23 percent).

For medical tourism businesses, these numbers represent an alarming rate of people are avoiding care for medical emergencies because of COVID. That's not likely to change overnight or over the next several months, especially if a rebound occurs in a few months.

And the safeguards being touted as a solution are pretty insufficient in terms of safeguarding against COVID. Hospitals have processes and safety measures in place to keep you separate from COVID-19 patients, including:

• Checking temperatures
• Requiring masks
• Limiting number of visitors
• Practicing social distancing in waiting rooms, exam rooms and emergency rooms

But once COVID is in the door, the game changes drastically. And unless you are going to convert some certification or accreditation seal into an N95 mask, those aren't going to help you much.

Traveler origin and county-level regulations are additional wildcards

So many webinars, certifications and accreditations of "COVID FREE" status are only as good as a facility, clinic or staff is actually COVID free. One nurse or other worker or contract laborer or subcontractor or vendor who brings COVID into a healthcare environment from home or community contact disrupts that strategy in a matter of seconds. It need not emanate from a patient contact.

One contamination from a transient guest defiles the hotel, hospital, clinic, medical practice, lab, imaging center, restaurant, taxi, rental car, of shared car service. The daily housekeeping service of a hotel or hospital inpatient room is not a terminal cleaning. That patient or companion can carry the infection to the healthcare environment, to nurses, to physicians, to receptionists, registrars, admissions coordinators, discharge coordinators, and others and spread the risk for a full week before development of symptoms and cause for testing.

What's more confusing is that none of the rules and precautions are identical from place to place. Most facilitators are unprepared to cope with these rules. Many represent healthcare providers in a number of different destinations. But with the number of medical tourism facilitators diminishing by the hour, the referral potential and lead sourcing diminishes with their demise. The hospitals, clinics, and medical and dental practices don't have internal trained workers to manage this. That's actually why they contract with facilitators and lead sourcers in the first place...because they cannot manage on their own without outside subcontracted assistance. And this knowledge is not picked up in a mass webinar, few day certification training or some write a check accreditation scheme that results in a pretty wall plaque or framed notice to the public on the facility wall.

The lack of continuity in reopening road maps and guidelines has forced hoteliers, hospital executives, airport managers, airlines, and other stakeholders to interpret and execute on multiple reopening timelines amid a medical tourism industry environment that has been the most challenging in our lifetime.

What we touch connects us to so many other contact points that we know and don't know.

While branding experts talk of enhancing touchpoints, COVID has us reducing them in both the literal and figurative sense. Touch has been something we just "do" in healthcare. It's a challenge to imagine interacting with a healthcare brand without touching. Without contact. Without close proximity. Social distancing is antithetical to all we've experienced in healthcare for decades.

We "lean in" as a means of body language to show we are listening. We touch, feel for heat, cold, swelling, fluid in places where it shouldn't be. We press, squeeze, stretch, and move body parts to elicit and reproduce and compare symptoms one side to the other. How do we "unlearn" those things in a matter of weeks to continue physical exams?

Guest confidence and trust are now all about cleanliness and safety. But how many of your medical tourism patients may have irrational germaphobic tendencies that, no matter how clean something is, they'll find something else to "fear"?

All the medical tourism price messaging platitudes are no longer as relevant.

Price advantage was a key strategy for many of the misguided medical tourism providers. Now that rug has been pulled out from under them. What platitude will they advertise now? No one will believe that something 90% cheaper than something else can be of high quality and safety? Will the pre-COVID marketing strategy flaws come back to haunt them going forward?

Expect to see some new discussion threads on Appropriate Utilization Criteria (AUCs) for health tourism and medical travel

Something I've noticed that's a common denominator of the many "me too" consultants hoping to hook into medical tourism marketing and business development is their lack of clinical experience, training, and knowledge.

Expect to read new discussion threads about AUCs that these novices and opportunists cannot manage. Appropriate use criteria (AUC), sometimes referred to as appropriateness criteria (AC), specify when it is appropriate to approve or accept a patient who intends to travel to access a medical procedure or service. An "appropriate" procedure is one for which the expected health benefits exceed the expected health risks by a wide margin.

With COVID, all the AUCs for my SurgeryShopper.com domestic medical travel brand and my other international health tourism brands are currently being redesigned. The reason: It would be unethical and unconscionable to help someone travel to a destination if doing so would expose them to preventable risks to their health unrelated to the condition for which they are seeking treatment. This requires an interview about their health status, health history, current conditions, medications, and that of their companion traveler to act as a preliminary filter before accepting their case.

It is my professional opinion that without a starter set of AUCs and a CDSM, no medical tourism program should restart in a post COVID era

Many medical tourism facilitators lack this knowledge and are so desperate for business and income right now that they will likely skip this interview out of ignorance. It isn't something that can be trained in a 2-3 day or a week long or a month long training program. It takes years to develop these skills and this rudimentary knowledge. And it isn't something so simple that a checklist sold by some marketing firm will suffice.

We use to think in terms of appropriate use criteria and appropriateness criteria in terms of the treatment and the travel. Now we must update them to reflect the risk of COVID on those who may want cosmetic or orthopedic surgery as to their pulmonary or metabolic comorbidities - something totally unrelated to the reason for their surgery or consultation or other treatment.

And appropriateness criteria isn't just about the destination they select for their medical treatment. It also impacts where they go around their hometown for diagnostic pre-operative testing and post operative follow-up care and monitoring.

At SurgeryShopper.com and for my other medical tourism brands, we are building out the AUCs that can be accessed from a proprietary portal specific to medical travel services. Our coordinators will be required to consult a newly developed qualified Clinical Decision Support Mechanisms (CDSMs). The CDSM is an electronic portal through which appropriate use criteria (AUC) is accessed. It provides a guidance about patient selection, destination and provider selection and whether the episode of care adheres to AUC, or if the AUC consulted was not applicable (e.g., no AUC is available to address the patient’s clinical condition). 

These are not built overnight, so by my order as CEO, we will start with the most frequently requested procedures for medical travel and health tourism services. This wasn't my brilliance that initiated this. As an experienced healthcare business development consultant, I must keep my ear to the ground for what's happening in my domain. In the USA, the Medicare and Medicaid programs have initiated similar programs slated to take effect for non-medical travel patients as of January 1, 2021.

The program being initiated by CMS impacts all physicians and practitioners (as defined in 1861(r) or described in 1842(b)(18)(C)), that order advanced diagnostic imaging services and physicians, practitioners and facilities that furnish advanced diagnostic imaging services in a physician’s office, hospital outpatient department (including the emergency department), an ambulatory surgical center or an independent diagnostic testing facility (IDTF) and whose claims are paid under the physician fee schedule, hospital outpatient prospective payment system or ambulatory surgical center payment system.

In my role as a director of business development at an ambulatory surgical center and in my role as a consultant to health systems, ASCs, and medical groups in the USA and 117 countries, I'll be expected to be competent with this.

Many of the generalist consultants in medical tourism are not healthcare business administration experts. As generalists, they lack the training and experience and have no other need to remain informed and competent to guide others along these pathways. There's no business case for them to learn all this on the off chance that someone will actually hire them to plan, build and launch a medical tourism program in the next two to three years. And even if they copied the CDSMs from Medicare publicly accessible use files, the medical travel specific components won't be included.

AUC present information in a manner that links: A specific clinical condition or presentation, one or more services and, an assessment of the appropriateness of the service(s). For purposes of this program AUC is a set or library of individual appropriate use criteria. Each individual criterion is an evidence-based guideline for a particular clinical scenario. It is my professional opinion that without a starter set of AUCs and a CDSM, no medical tourism program should restart in a post COVID era. I believe most ethical physicians and facility administrators will agree with me without equivocation.