A New Doorway to Opportunities with Medical Tourism

Pandemic?

Endemic?

Here on LinkedIn, people have been reaching out almost daily to ask me for help with new and established but languishing medical tourism business concerns. Rapid changes in the medical tourism and health travel business environment have triggered massive shifts across the world. Health travel companies need to rethink business strategies, and the business essence of what they offer to patients. They must be able to forecast market acceptance of health (medical, dental, pharmacy, and wellness) travel to their partnered destinations. They must also embrace online platform technology, fintech, and other innovations embedding it in their differentiated value proposition to achieve sustainable growth.

Moreover, globally, experts believe the virus that causes COVID-19 will never be eradicated, the world must at some point transition away from “pandemic” and toward an “endemic” phase.

That's a new reality for medical tourism and health travel businesses. And it isn't likely to reverse course anytime soon. How does one pivot to start a successful new business or sustain an existing health travel and medical tourism business under these new realities? If you have the answer for this, the travel, hospitality, airline, restaurant, and other tourism sector businesses want to know.

With reasonable expert certainty, I can tell you what is not a viable pathway:

1. Seeking numerous accreditations, designations, and other assorted "window dressings" as a differentiator.
2. Targeting a source market to attract patients without knowing enough about that unique source market, its local competition, consumer behaviors, beliefs, fears, financial constraints, and apprehensions.
3. Assuming that the pre-Covid market for health travel and medical tourism is anything like it is now or will be in the future.

Medical tourism and health travel is not new.

I began coordinating patient travel to domestic and foreign destinations in 1976. My clients traveled for surgery, checkups, dentures, pharmaceuticals, and consultations with renowned specialists.

At that time, I had already completed my training and was working full time as a travel agent with full airline, hotel, cruise ship, and rail credentials through IATA. that enables bookings and commissions for travel and accommodations. Most medical tourism facilitators are not travel agents with IATA credentials. Therefore, by industry regulation, they are prohibited from earning commissions on travel-related bookings of any type. So they begin at a disadvantage. And providers have no interest in making up those shortfalls by paying the commissions on the airfare and accommodation and other sundry commissionable expenditures of health tourism and medical travel. Plus, it's ludicrous to ask them to do so.

At the time I was coordinating patient transfers, I was also in the middle of my undergraduate healthcare formal education. I went on to become an OR nurse working in surgery. That made it possible for me to understand the language of medicine, the procedures, the anatomy and physiology, and altitude physiology, the surgery procedures, the aftercare, the pre-operative testing, diagnoses, precautions, medication implications, and comorbidities. Untrained medical tourism facilitators who lack this knowledge can get it, but most don't invest in themselves and their craft to this extent, at their disadvantage. One error that causes patient harm or physician brand tarnish or hospital brand tarnish or a negative experience and it's game over. Let alone, one could be sued for damages.

Later, I continued my post-graduate training and education to become a health administration executive. I managed hospitals, ambulatory surgery centers, medical clinics and groups of surgeons. I personally managed accreditation preparation, quality management system implementation, patient safety, outcomes measurement, and contracting with insurers and TPAs. That enabled me to "walk" hospitals in real life, and observe operations, safety policies and procedures, cultural and language fluency, the hospital setting in a community, its nearby infrastructure, and separate the difference between photoshop images and reality. Most medical tourism facilitators lack this knowledge and can be sold any propaganda (including various accreditations that are "valueless" in terms of operations, patient safety, or patient recognition of what the accreditation means.) After all, break down the word "valu-able", which means "having desirable or esteemed characteristics or qualities." Who desires these dubious accreditations? Before one can place a "value" on them as a facilitator, one must understand what the accreditation signifies. One must then transfer this knowledge to the client in order for the client to appreciate its "value".

In summary, medical travel has been a routine medical access necessity for many people who reside in remote areas, where healthcare is not accessible locally.

Solving for the anxiety and apprehension of international medical tourism.

Self driving and autonomy of local ground transfers is very different than boarding a flight to a foreign country, with a foreign culture, language, and food when one requires surgery.

Post-Covid, solutions for patients and clients are now vastly different in terms of frequency of utilization and acceptance of telehealth. For a consultation with a renowned specialist, telehealth (synchronous and asynchronous) is now available to anywhere, including a specialist in Antarctica, Australia, New Zealand, Argentina, South Africa, North or South America, Europe, the Caribbean, or Asia. Whether the need is cancer treatment staging, second surgical opinion, or a treatment plan clinical pathway, telehealth is easily coordinated if one can locate the appropriate specialist, connect, arrange payment and fix an appointment at a mutually convenient time. That cuts out a lot of what was once only a face-to-face option. Ergo, it eliminates the need for many former medical travel journeys, and the health travel business opportunities therein. And it cuts the cost to the patient to a far more affordable option.

Here in the USA, a telehealth consultation can range from $125 to $400 and from $1500 to upwards of $2500 for a renowned authority specialist at a designated and proven Center of Excellence. In many cases, some or all of the fee paid for the consultation may be applied to additional surgical or diagnostic services. This is especially true with many outlets offering transparently-priced surgical and diagnostic package fees. Many of the package fees include the facility fee, surgeon fee, anesthetist fee, and implants and hardware, plus an overnight stay after surgery, if medically warranted.

Here in the USA, one can find knee replacement with a globally-accepted, leading robotic technology, that uses a 30-year service life-rated implant for under $18,000. Unfortunately, many medical tourism facilitators who are not aware of these proliferating deals that are easily accessed. They mistakenly believe they are competing with a hospital fee of close to $80,000. Such false data without deep market research and with reliance on it for marketing and business strategy and source market targeting is to their detriment. What they offer in terms of travel to a faraway land is not competitive.

One can find a bariatric surgery in the USA and in Mexico at proximate border crossings that are driveable distance in the patient's own vehicle for under $8,000. Why would a large person who doesn't easily fit in a coach seat fly to a destination more than 30 hours in one direction, and fly back needing an airline ticket that costs more than the surgery itself?

And cardiovascular surgery that can now be performed in an outpatient setting is far less costly and more accessible locally where the outpatient surgery center exists. What many don't realize is that some countries do not license ambulatory surgery centers at all.

In the USA, we are blessed with an abundance of these outlets for "safe-er" surgical procedures. The reality is they legitimately boast lower hospital-acquired infection rates because there is less guest and visitor traffic, people stay only as long as their surgery and recovery requires, so there are fewer risks of hospital-acquired patient-to-patient transmitted infections.

Ambulatory (same day) surgery centers: The hidden weapon that unbalances the hospital price equation for health travel and medical tourism

ASC costs (costs; not prices) are lower than typical hospitals, because operating, staffing and overheads are lower. As a result, ASCs can be far more competitive than their hospital counterparts.

• For instance, ambulatory surgery centers (ASCs) are not open nights and weekends, so they can attract nurses and surgical staff who don't want to work on rotating shifts or rotating departments.
• The gas and electric bills and water bills are lower. They operate using smaller autoclaves and washers than the typical hospital.
• They can outsource lab and imaging other than a C-arm, so the regulatory costs associated with licensing and operating these departments in a full-service hospital are eliminated. These days, surgical instruments are shipped in to the ASC a few days prior to surgery so they need not invest capital to purchase them.

All these little efficiencies and advantages make for a compelling argument and enable lower than hospital pricing. But foreign facilitators often overlook this market reality and then wonder why their marketing and advertising falls on deaf ears and an unwillingness to travel afar for care. Why risk the risks associated with unnecessary travel for healthcare when one can drive to an ASC that solves their needs at a lower price and better outcome?

Patient "redirection" vs medical tourism

In the USA and other countries, patient redirection is a phrase used to describe where insurance plans and employers and unions and/or their TPAs "redirect" and incentivize plan members to agree to travel to designated high-quality providers with published outcomes on metrics that the insurance plans and employers and unions and/or their TPAs respect and relate. The contracts are direct between the surgeon or the ASC (or the hospital in some rare instances) and the insurance plans and employers and unions and/or their TPAs.

In the USA, foreign providers are not invited to this redirection program in most cases. But that's not the case worldwide. When I've worked with health systems and government funded health programmes in the Middle East and Northern Africa, those countries often lack health access. As a result, they pay to send their plan participants to the USA, Germany, and Australia. With those groups, I function as a medical attaché', paid by the insurer, state-funded public health system, or the patient.

I don't seek referral commissions from providers, That is because in several countries (USA, Canada, UK, Germany, Australia and others) payment of steerage commissions for referrals is illegal and breaks several federal laws.

If the practice is illegal, then the contracts signed by and between facilitators and providers are not for a lawful purpose and are thus unenforceable. So if you do all the work and then don't get paid your commission, you lose. That's not how one starts and operates a sustainable business.

I've been a trusted research and advisory partner to clients operating medical travel and health tourism businesses, and their governments in 120 countries. I've assisted more than 6000 hospitals and more than 80,000 physicians and surgeons.

Here in the USA, the list continues to grow as the market proliferates with domestic medical travel and patient redirection. I help the providers analyze the market, set the pricing algorithms, and strategize the go-to-market pathways and advertising. they don't need "facilitators" when I am done with my work. They are capable of marketing and managing logistics internally. And they have contracts with marketing platforms, shopper platforms, financing companies, insurers, and TPAs before I conclude my services. Foreign facilitators should realize these realities before targeting US and Canadian patients. The facilitators may be able to convince Diaspora to return home if the patients are uninsured. However, in the USA, many ASCs offer bundled, transparent, cash pay surgery discounts as long as the patient is able to pay up front, in full. To do that may require financing, so I introduce a partnership between Smart Health Pay Card which almost instantly approves patients shopping surgery to be approved for up to $30,000 in about 3 minutes, online so that they can afford their surgery, imaging, labs, physical therapy and aftercare. One snag for foreign facilitators: Smart Health Pay Card is a MasterCard product, but it does not pay outside the USA.

So how will your patients pay for the foreign travel, hotel, ground support, surgery package and aftercare?

Many medical tourism businesses quote surgery prices that are not firm, fixed prices. They use the word "from" instead of publishing a "write a check for this amount" price. As such, on further scrutiny, the U.S. patients have to quit and look elsewhere as the savings don't turn out to be as compelling when they evaluate the entire episode of care. On the contrary, most of the U.S. quotes are far more transparent and reliable, so they don't have to fly. But if they choose a location within a 900 mile radius, we can fly them to their destination and return without cost.

Tourism during recovery

Medical tourism is a "misnomer." People who are facing surgery rarely want to sightsee or visit attractions on their medically-oriented journey. We all thought that in the early days, and then some of us wised up.

Pre-operatively, they are anxious and distracted. Post-operatively, they are on medication, possibly nauseous, swollen, and advised to take it easy. Pairing true "tourism" with surgery travel is pure fantasy. Those packaging up the two show their ignorance, lack of experience, and waste their time on other more lucrative efforts. A little area drive is even too much for many patients. In all honesty, I too tried that route, thinking that there was merit to the approach. It was a confabulation fabricated by the now nearly extinct Medical Tourism Association. They got hotel and hospital associations, government agencies, destination companies, chambers of commerce, and others to buy in to their conferences and certifications. None of those entities found sustainability with that tactical plan and strategy, and few survived COVID unscathed. Many complained openly that the only people walking around were competitors, not prospective customers. Will they buy again? Who knows? I know I won't.

Those gold, silver, bronze and platinum sponsors paid hundreds of thousands to entice facilitators, without vetting them first, to come for "fam" trips to see hospitals, hotels, attractions, cultural centers, museums, golf resorts and more. In the end, nothing came of these foreign investments and they called them a failed attempt. I know this from first-hand accounts because I worked with many of them, paid by grants from various foreign investment and government grants.

One of the smartest things one government in Europe did was to start to certify the hotels that were prepared to host medical patients. Once the standards were promulgated and released for use, they found another dirty little secret: Posh hotels and 5-7 star hotels don't want a bunch of post-operative patients in the lobbies of their hotels and restaurants. The wounds, urine bags, potential smell of pus in infected wounds, and other bodily fluid drains, walkers, and wheelchairs are unsightly. Not to mention, bleeding and vomiting in the guest rooms were unwelcome. So the countries had the standards, the lesser properties did not measure up, and the elite brands didn't want the business.

So what's the new doorway?

I can help you analyze the market ecosystem that influences your opportunity, growth and business strategies. Researching end-markets, demand-supply dynamics, competitors, customers, health services access and supply-chains, health logistics technologies, social / innovation trends and industry disruptions are my forte. I am one of the rare people in the world who has 45 years of experience in the health travel sector. What makes me more rare is my health administration, insurance and payor contracting and travel agent acumens.

The fact that I don't work for a big firm that requires its consultants to generate big billings and lots of hours, enables me to be more affordable than others who don't have as much experience.

The fact that I've successfully launched, operated and sold several medical tourism companies also differentiates me. I speak from experience, the results of trial and error, the mind of an entrepreneur, and one who has put boots on the ground in 120 countries and 50 states and several territories of the USA makes me far more knowledgeable than my competitors. I sustained through 45 years?and?COVID. My rate limiting factors: I am a human and I am one person who is supported by a team of administrative support personnel. My other rate limiting factor is that I am direct, brutally honest and educated in my domain area of expertise. When I tell you that there are new doorways, believe it. There is no one right or wrong answer. The answer and the doorways lie in your ability to execute swiftly, decisively, and sustainably. No certification or accreditation delivers this, so I don't offer them.

1. The first path through the doorway is education. Learn what you don't know you don't know.
2. The second pathway is to have startup and launch capital. Gather enough cash to invest in your education, travel for site inspections, and advertising through the necessary multi-channel marketing avenues.
3. The third pathway to sustainability is to research the markets, the laws, and regulations for your new business and build the correct strategy for what you want to achieve. Ignorance of the law and trying to work in gray areas depletes your energy, creativity and causes you to be hypervigilant where it serves no advantage. A quick buck in medical tourism doesn't happen - not ever!
4. The fourth pathway is strategy. Have a goal, a direction, metrics, benchmarks, and the means to execute. Financial and administrative means are necessary. This is a business; not a hobby.
5. The fifth pathway involve market intelligence. If what you read in this article was new to you about ASCs, consumer behavior and pricing, you need more market intelligence before you begin attempting to move patients.

Competitor Tracking

You'll need a comprehensive competitor tracking system that informs you of financials, product launches, innovations, disruptors, and other key initiatives to suit your specific requirements. I recently worked with a company that only wanted my name on the report, not my information. They have already failed.

Competitor Analysis

You must deep-dive the competitive landscape and be able to analyze the data about your competitors covering all aspects of their operations or specific functional areas such as dealing with foreign patients.

Market Forecasting

How will you conduct macro-economic modeling, bottom-up end-market analysis and headwind / tailwind trends to generate long term demand forecasts for your services and pivot points when you may need to change to something or adapt? Which methods will you use to create and perform semi-annual updates on the external parameters that could influence business direction, promotion, advertising and operations in different regions around the world?

How Will you Choose Suppliers?

Patients are anxious and they want to trust you to advocate for their interests. How will you establish metrics or strategic initiatives by key suppliers of health services? What will you include in your contracts? How will you enforce them?

All these things are differentiating elements that will enable "your" doorway to a future in medical tourism. There is no recipe or formula to success. Copying what one single other medical tourism business did may not be the right choice--- for your business.

I've been assisting domestic and international medical tourism and health travel business owners and government authorities for decades. In the past, I led the leading global research and advisory firm in medical travel. I empowered decision makers, entrepreneurial surgeons, health facilities, facilitators, travel agencies, hoteliers, and potential start ups with intelligence and insights to make better decisions for themselves. I tried to retire and became bored. Then came COVID. Now, business is returning, and new medical tourism startups are budding like flowers all over the world. I will help you bring to play the right mix of the best data, methodologies and experience so you can deliver value to your clients and partners.

My primary objective is to help you with decision making and problem solving based on information and education and expertise you cannot obtain on your own at any cost. It is tempered by experience, data and intuition.

I've walked in your shoes and survived and profited. I have focused on balancing bottom line results with direct patient care and safety. I excel in bespoke solutions that address specific issues and budgets and meeting or exceeding your business goals. I don't bring cookie cutter, one size fits most solutions that come from an n=(1) experience.

But unfortunately for you, I don't have lots of time for new clients. If you are willing to accept little bits of time for coaching in short spurts and are ready and committed to do your assigned homework, and meet after hours or on weekends with me, virtually or come to me in person, we can work together and get you the information, opinions, situational answers, opportunities and warn you of the time and money wasting pitfalls. I'll ask the questions and you'll provide the well- thought out answers. Together, we'll analyze the facts, draw conclusions and execute to enable or reanimate your medical tourism and health travel business.

Let's make your new medical tourism business possible! Let's simply and find efficient ways to achieve what you want, the way you want for your partners and patients.

I promise you professionalism. And if you need what I cannot deliver, I promise you I will be direct and honest and tell you so. I have more work than I can handle right now. But there are maybe five people on the planet who have my level of expertise and depth of experience. I don't need to take your money unethically. I do need to be paid for the value I deliver. I have an uncompromising work ethic. My global and domestic references will extoll this. Maybe the time is wrong or you aren't ready. If I believe that's the case, I'll tell you that too, and why I believe it, and what?can?be done in the meantime to prepare you to better utilize my expertise at a later date.

Feel free to reach out through LinkedIn as a private message or to call my office at +1.800. 727.4160.