Medical Tourism Facilitators: What's Next?

In the aftermath of the COVID-19 pandemic, the stalled travel and tourism industry will decimate most undercapitalized, fledgling medical and dental tourism startups.

Many of the medical and dental tourism facilitators who raced to startup by setting up a website, printing business cards, and registering a Google Voice telephone number without proper business plan development and strategy will have failed outright and will be licking their wounds and shaking their heads as if someone hit them in the head with a piece of lumber.

Health Tourism Facilitator Brand Sustainability "Secret Recipe"

1. Sufficient Capitalization
2. Proper Business Planning & Risks Mitigation
3. Specialized Skills Competency
4. Market's Demand for your Product(s)

Those coming from the travel agency world or destination management firms will likely retrench into 100% general travel agency operations and general tourism DMC operations. Tour operators will retrench into general and spa and thermal waters tourism package sales. They have well-developed skills in their respective crafts and won't miss the struggles they didn't expect when they expanded into health tourism and medical or dental travel.

Hotels and resorts will still be hotels and resorts, assuming they survive. Airlines will still be airlines, assuming they survive. The same for airports, attractions, taxis, pharmacies, hospitals, clinics that were in their respective businesses prior to COVID-19.

But for many of the worlds' medical tourism facilitators, the ones who didn't start out as professionally-trained nurses, medical and disease management case managers, and insurance-plan or medical assistance company care coordinators - what will become of their little medical or dental tourism business?

• Some will turn off the computer and the lights in the spare bedroom or their basement home office and just walk away and give up. They may go get a part time or full time "job" earning some income in or outside of the realm of health tourism and medical travel.
• Some will roll down the business, go through the formalities of retiring any corporation they founded and try to find something else to do. When the website comes up for renewal, they will let it lapse into the oblivion in the mystifying sombreness of a post-COVID-19 earth. They may decide that self-employment and entrepreneurism was more challenging and complicated than they initially assumed.
• Some will continue. They have the combination of the four ingredients in the secret recipe mentioned above coupled with brand differentiation, market awareness of their brands, and established clientele who are and will forever be grateful and loyal to their brand for past services rendered. These facilitators know how to remain top of mind in health tourism. After the dust has settled, they will continue to update their websites and answer their phones. Call their number or email them and you'll find that they are "on call", responsive, and ready to serve.

The job market may be different for everyone than it was pre-COVID-19. The world's economies will take the time they need to recover. Many savings and investment accounts will have taken a hit and will take time to bounce back.

Many employers will reassess business risks, recuperate, rehabilitate, and rebuild. The birds will sing, the bees will buzz, and the tides will continue to ebb and flow.

In the healthcare industry, healthcare facilities and organizations will sadly mourn and memorialize their heroic but dead doctors and nurses, technicians, and clean up the aftermath of the "rode hard and put away wet" hospital wards. They'll replenish supplies and maybe even re-evaluate their "just in time" supply chain and staffing strategies and modify to correct what went wrong. Elective surgery cases and diagnostic services will eventually resume.

In the travel industry, losses are predicted to the tune of about $820 billion dollars. Layoffs are already starting to occur. Virgin Atlantic asked employees to take 8 weeks of unpaid leave. Who will pay their health insurance premiums in the interim?

For marketers in all sectors, not just health tourism, organic traffic is down and event marketing... will be suspended for 2-3 months, if not longer. All those medical tourism events and conferences will face challenges of attendance, finding delegates, hosted buyers, and sponsorship buyers. But overall, the conference businesses like the medical tourism associations and conference organizers that dot the map around the world are going to struggle for well several years because those who buy tickets and sponsorships will have to try to make up for their losses as a first priority.

Not only is organic traffic down, but conversions are still sinking as well. People will read your emails and then stop and think - "No, my savings and investments tanked. I need to conserve cash." Travel, for any reason is viewed as a luxury -- even for healthcare or wellness, and especially for cosmetic surgery procedures, hair transplants, infertility treatments, and spa travel escapes. Even checkups will see a temporary decline. With a 2.7 trillion dollar hit, you can expect we will go into a recession.

For hospitals and clinics, medical tourism business will be assigned a lower priority as people "catch up" on healthcare that was deferred during the height of the COVID-19 pandemic.

What this means for medical tourism facilitators

The best time to double down on marketing is when others are not. But that assumes you have sufficient capital to continue operations and to market. Full stack marketing (advertising, branding and public relations) cost money.

During an economic downturn, you’ll find that you will have less competition, which means it is easier and faster to get results, and in some cases, you’ll be able to get deals... as long as you have cash to pay for your campaigns, creative, print, events, and a marketing specialist (internal or contracted freelancer). The more eyeballs and share of voice you control, the more power you will hold in the future. So when you see your competitors closing down or slowing down on their marketing, the goal is to double down. You may not see the biggest return right away, but in the long term, you will.

Every time the market goes down by 20% or more it roughly takes 536 days to recover.

If you went in with an established and recognizable "brand", you may have an easier time on the other side of the COVID-19 "tunnel". If you stop marketing and your fledgling brand presence fades into the abyss, you'll have a much tougher time to restart, even if you have some cash. As recovery occurs, those who were able to continue marketing will see their ROI and revenues increase dramatically. The challenge is, for the moment, being able to continue marketing while everyone else is not marketing and maintaining their brand presence.

I get it. I am not "just the marketing or business consultant". I am actively involved in marketing, advertising and branding at several healthcare organizations around the world. So I am not just writing to have a blog article, or writing to show off. I am in the trenches. Sure, I consult to some businesses, but I also work hands on for a healthcare facility in my community part time. I love the work I do there.

But for many of my client hospitals, treating COVID-19 patients is expensive and unpredictable in terms of resources. If hospitals are not adequately compensated for the care they deliver during the crisis, their situation will be immensely worse because they will have given up elective surgeries and diagnostic testing for several months. Many COVID-19 patients are homeless, destitute, uninsured or unable to self-isolate and not able to pay for the care they need.

Many hospitals will have deployed a misguided blanket strategy and delayed all scheduled procedures - out of an over-abundance of caution. They may delay scheduled cancer surgeries, heart valve repairs, and other urgent surgeries that could be performed as outpatient procedures in ambulatory surgery centers. Many market strategists and health system executives believe that if they postpone or push back surgeries, it will simply be a "muted impact" of the canceled procedures, viewing them as "simply pushed back a few weeks." Not so fast.......

The elective procedures that were scheduled on the books may be pushed back 2-3 months in some cases. But that pushback alone will mean that the system will be backlogged for other newly arisen medical and dental problems that require surgery. For how long will the backlog continue? We don't know. In each market it will be different.

People in pain or in fear of a cancer or heart problem that's spreading will substitute providers if they have to. They will learn about other brands of healthcare in doing so. And they may like what they find.

• They may determine that they don't need to wait for the big, expensive hospital in town to fit them into the schedule. That their doctors are on staff with surgical privileges at multiple health facilities. Substitution may be preferable to waiting.
• They may determine they don't need to travel to India, Thailand or Mexico to find lower priced care. Prudent shoppers may find it is less expensive to remain closer to home once travel, accommodation and other expenses is calculated into the equations. After all, most advertised prices are limited only to what is listed in the second (blue) colored cell in the graphic below:

• They may determine they don't want to travel to Italy, Iran, and other parts of Asia or Europe for medical and dental procedures.
• And for some time, they may also be prohibited or restricted from traveling to medical and dental tourism destinations in your existing portfolio.

One patients figure out the "real cost" of medical travel they may be more emboldened to ask the local health facilities for the "cash price" for the services they need. When the answers total up to a better advantage closer to home, "cross border healthcare" may no longer be "as attractive" as the propagandists who own medical tourism associations, published industry report sellers and conference organizers led you to believe.

Can you pivot on your own?

As a medical tourism facilitator who depended on hosted buyer events and conferences to enjoy free trips to exotic medical and dental tourism wannabe locations and build your portfolio of medical and dental tourism provider options, you may suddenly find that you built a product nobody wants to buy or for some reason cannot buy what you sell. That's a flaw of an ineffective branding strategy and brand research. You didn't really read your prospective ideal customers sufficiently, effectively or at all.

You may discover that this flawed assumption that the market for medical travel is so lucrative is no more than syndicated propaganda. And that it isn't as easy to establish a beachhead as a medical tourism business.

You may feel betrayed, taken advantage of, or foolish. It is an awful feeling. It is how I still feel when I see the names of Paul Keckley or Deloitte. In 2008, they got me good. I relied on the brand reputation and built a strategy on what they said. I went all in. I even relied on these reports to convince my publisher to contract for two books on medical tourism.

Deloitte didn't lose on the publication of their report titled Medical Tourism: Consumers in Search of Value, but I sure did for believing them and the U.S. Medical Tourism Association and acting on what they published. And I kept believing when they published their subsequent report a year later.

But I also learned from the disappointment, too.

• I learned to be more skeptical and dig deeper on analysis.
• I learned how to read market indicators and make my own observations.
• I learned how to trust my training (and practical experience) in travel and healthcare business administration.
• I learned about branding, marketing, advertising and the specialized niche that is healthcare marketing.
• I learned how to write compelling marketing and advertising copy and use imagery to my advantage. I developed a formula to convert features to benefits and advantages that my clients wanted or needed or believed they wanted or needed:

• I learned how to interpret data and develop strategies without reliance on big box consulting firms and their consultants and published reports; and
• I learned that the MTA was not my industry trade association, guild, certifier, or my business' advocate.

Your copy-paste strategy that mimics all the other commodity "certified" medical and dental tourism sellers may no longer have sustainable potential. And you may find that the abundance of medical tourism events, conferences, hosted buyer invitations, and other opportunities upon which you relied in the past that enabled you to build your portfolio of providers without investment cost doesn't exist to the extent it did pre COVID-19.

You may also find that post COVID-19 you don't have adequate capital to find new suppliers in other countries, visit their location, conduct due diligence site inspections.

Can you take advantage of new opportunities?

Warren Buffet says "take advantage of opportunities when others are fearful or simply can't execute." I still own a medical tourism company. It's not my first endeavor. I followed my own advice on business development and risk-based thinking and mitigation strategies. I tested my theories in the crisis of 2008, my Deloitte debacle, my trademark registration for a new term of art in 2010, and pivoted to a new strategy in 2013. And I continue to refine and execute on marketing and operating through this COVID-19 storm.

But mine is not a copy-paste strategy that imitates the crowd. I chose to march to a very different drum cadence. I chose a strategy that doesn't need India or Mexico or Thailand's healthcare outlets. I chose a strategy that doesn't rely solely on international flights and international transfer airports to get patients from point A to B. I don't rely on foreigners from other countries willing to cross borders to access care. And I laugh out loud when I read definitions of "medical tourism" that include the words "when people travel outside their home country to access cheaper healthcare." I laugh because these strategies and tactics are like copying someone else's term paper filled with flawed and incorrect information and inadequate research. Yes, you can turn in the term paper on time, but you'll fail too!

So, what now?

All is not lost.

If you learned new skills while attempting and failing at your launch of an independent medical tourism facilitator firm, no one can ever take those skills away from you.

Instead of reading all your emails and using this downtime to shop online and spend money you don't have, use the time to polish and update your resume/CV. So what if you don't have a college degree. Who cares if your degree was in liberal arts or underwater basketweaving.

You may not have all the skills and competency you need to succeed as an independent medical or dental tourism facilitator, but you can learn. Read my blog articles, listicles, white papers, and books. Take advantage of edX and Alexa courses to learn skills available at no charge.

You don't need to pay for their certificates of completion, but you do need to be able to apply your new skills and adapt. One way to adapt is to apply to work as an in-house facilitator at a hospital or health facility that is interested in attracting patients from outside your local community.

You can still be involved in medical travel and health tourism industry, but you won't be alone, self reliant, and traveling to conferences all over the world to participate in B2B meetings. Instead, for the next 2-3 years, you will cultivate a new revenue stream for your employer and coordinating care for patients to a specific hospital as a regular full time or part time employee.

You'll have employee benefits, colleagues, contacts, you'll be a team partner, and you won't have to pay for your own software, computer, and other business overhead expenses.

If you do well, you will prove yourself invaluable and have job and income security. You will influence branding, marketing, advertising as your skills become more robust by real experience. You will focus more intently on doing one thing well.

You will also make more income that you keep rather than continually reinvesting to try to make a go of being an independent facilitator. How much can you command as salary depends on your actual value proposition.

As a former hospital administrator let me share a secret with you: Once in your new role, track your contributions to margins and case volumes. If you can make $100 a month over what it costs to have you there, your employer will be satisfied and tend to keep you on the payroll. That's your initial goal. Make that your first objective. Learn the business, the brand culture, and the actual cost of your seat at the desk. Think like an administrator or a hospital CFO. Think like a business owner. Think about revenue accountability. Think about quality, safety, marketing, advertising. Think out of the box. Propose expenditures conservatively.

For each budget request, think ROI and be able to explain what you believe you can generate in ROI for every penny invested in your recommendations. When it happens, take credit with modesty and humility. Results don't really matter. What matters is the interpretation of the results by someone who is accountable to the board and who decides if keeping you on staff is "worth the expense".

Learn new skills. Keep adding to your skills and competencies and job knowledge. Don't ask for certifications. Certifications are not important. It's nice - but nobody really cares. They care about revenues and conversions. They care about branding, brand reputation, integrity and keeping with the brand culture they wish to portray.

Answer your phone. Respond to emails. Be quick on quote turnarounds. Take ownership of the entire episode of care planning and care coordination. Pilot your program. You can do this if you have the training and skills and the drive to be excellent at it. And enjoy the experience. In a world where uncertainty is the new norm, I believe it’s important to focus 100% of your attention instead on WHAT YOU CAN CONTROL.

I understand your situation more than you realize.

Unlike the other "consultants" out there who claim to be experts in medical tourism, I am "in the business" and working hands on every day. If all you need to do is learn a few new skills you can do this. If you need an hour of my time to help you or guide you, you can buy an hour, or a half hour, or even fifteen minutes and pay via PayPal or Venmo.

AskMariaTodd? if you need help: +1.800.727.4160

I am very busy these days. I don't work for free and I don't offer free advice beyond the articles and tools I publish without cost or obligation. I am not able to work without compensation, and I pay for my skills improvement and learning just like you. I have bills to pay just like you. We are all in this together. I'm just further along with lots of experience. I know what to do to survive in medical tourism after 40+ years.

Part of my time will also be spent creating new online courses to replace my income from in-person live seminars and Master Classes that are in suspended animation for months to come. I have 3 book contracts for which I must deliver manuscripts. To set aside these projects to take your call, I will trade my most precious commodity: time. But I won't do it for free. That's not how a successful business is operated. Harsh? Not at all. REAL.

If you want to stay in medical tourism, I will help you make the transition or sustain your business so that you’ll never again feel paralyzed by the fear and uncertainty that goes with losing your primary source of income. No one has a playbook for what comes next. Write your own with what you know you can achieve. You've been selling care at hospitals (or trying to). Certainly you can do this for one (or moe) worthy employer(s).

Use this transitional period as a time to pause, take stock, learn, and prepare. To lose your existing independent medical tourism business may not be the end of the world. It may be the window that opens with new opportunity.

A hospital that was paying out 20-30% per case with that commission rate loaded into the price may be able to hire you as a regular full time or part time employee for less than the 20-30% of the procedure fee and gain better control over its message, marketing, and growth. Make your case and present your well thought out value proposition.

I wish you all the best of luck!

About the author:

Maria K Todd, PhD MHA is a globally recognized expert in medical tourism business development. She consults to hospitals, clinics, ASCs, and other industry stakeholders. She also guides governments and public private partnership organizations, investors, and ancillary stakeholders. She has developed software for health tourism logistics and bundled price development applications for use by hospitals and ASCs and surgeons for use in value-based care and shared risk contracted opportunities with payers, employers, and PPO networks. She is the author of 23 book titles on healthcare business administration topics, several in 2nd and 3rd edition. Reach out to connect, follow her on LinkedIn and Facebook, or call on her for advice and guidance. +1.800.727.4160 or [email protected].