This document discusses the potential for using medical tourism to lower costs for workers' compensation cases in the United States. It notes that medical costs make up a large portion of workers' compensation claims and can be significantly lower when procedures are obtained overseas. While some legal barriers around state licensing laws and regulations exist, the document reviews case law that suggests courts have allowed limited medical tourism for workers' compensation claims when it provides cost savings. The author concludes there is reason to further implement medical tourism for workers' compensation given evidence of quality care and lower prices abroad.
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Receiving a cancer diagnosis can be one of life's most frightening events. Unfortunately, statistics show you probably know someone who has been int his situation.
You can't predict the future, but you can plan for it. We invite you to put yourself in Good Hands with Critical Illness insurance from Allstate Benefits.
Learn how to qualify for extra help, about the Affordable Care Act, and much more....we hold events at public libraries in Columbus OH and Atlanta GA....
VisitorSecure Insurance is a low-cost plan for relatives or parents visiting USA or for travel abroad. More info: http://www.atlasamericainsurance.net/visitor-secure-insurance/
Visitor Secure Insurance that provides cheap and affordable scheduled or fixed benefit travel medical protection coverage for immigrants or travelers to the U.S., or for visiting any foreign destination outside home country. VisitorSecure plan is available from a minimum of 14 days up to a maximum of one year. Visitor Secure Insurance is designed to protect the visitors health across borders with coverage benefits such as both inpatient and outpatient hospital medical expenses, emergency medical evacuation, and common carrier accidental death and dismemberment. and emergency travel features, and is suitable for a single individual or a group of family members or travelers to any nation. Individuals on one application must fall into one of these categories: below age 69, ages 70 to 79, and age 80 and above. If you will be traveling to the US and are age 65 or above, your date of arrival in the US must be no more than 30 days after your effective date. Visitor Secure Insurance is extendable and renewable up to 12 months of continuous coverage.
COBRAhealth.com - The Patient Protection and Affordable Care Act, PPACA. The government cannot create doctors, nurses and facilities to service the masses of people. ObamaCare cuts payments to the private health insurance companies that provide coverage to the 20 percent of Medicare enrollees who participate in the Medicare Advantage program.ObamaCare cuts the prices Medicare uses to pay hospitals and many other health care providers. ObamaCare could force one in six hospitals to stop accepting Medicare patients. we will ration with our eyes open.You can't get medications. You are left waiting on life saving procedures. You must wait for quality of life procedures that are medically needed. 5 million Canadians have no health insurance and the wait is 5 years for a primary care physician.
This chapter examines the U.S. health care system—specifically, the organization of medical services; key governmental health programs such as Medicare and Medicaid; the crisis in health care, including attempts to curb health care costs; the large numbers of uninsured people; the impact of the American Medical Association on health care; and that of managed care in the American health care system. The chapter also surveys various proposals designed to ameliorate the problems in U.S. health care and considers how medical services are organized in Great Britain, Canada, and Australia.
Over the last twenty years, medical costs associated with lost time workers’ compensation claims has risen dramatically, despite efforts to reform the system. Medical tourism, a popular option for many seeking lower cost health care, is one option that has yet to catch on. Issues of quality of health care in other countries is no different for workers’ compensation patients, as it is for health care patients, and with accreditation from the Joint Commission International (JCI), hospitals that cater to medical tourists offer better care at lower cost than most U.S. hospitals offer. Certain procedures, common to workers’ compensation claims, such as knee replacement, hip replacement and spinal fusion in countries such as India, Thailand and Singapore, are considerably lower cost than those performed in the U.S.
However, legal barriers currently exist not only for medical tourism, but for its implementation for workers’ compensation. Medical malpractice, liability laws, patient privacy and medical records (HIPAA), ERISA, and the PPACA, all present significant obstacles that need to be addressed before such implementation are possible. Case law in the US has recognized limited use of medical tourism, both domestic and international, and opens the door a little for further development in this direction. The globalization of healthcare as evidenced by the tremendous growth of medical tourism in the health care arena, will lead to the implementation of international medical providers into the medical provider network for workers’ compensation.
VisitorSecure Insurance is a low-cost plan for relatives or parents visiting USA or for travel abroad. More info: http://www.atlasamericainsurance.net/visitor-secure-insurance/
Visitor Secure Insurance that provides cheap and affordable scheduled or fixed benefit travel medical protection coverage for immigrants or travelers to the U.S., or for visiting any foreign destination outside home country. VisitorSecure plan is available from a minimum of 14 days up to a maximum of one year. Visitor Secure Insurance is designed to protect the visitors health across borders with coverage benefits such as both inpatient and outpatient hospital medical expenses, emergency medical evacuation, and common carrier accidental death and dismemberment. and emergency travel features, and is suitable for a single individual or a group of family members or travelers to any nation. Individuals on one application must fall into one of these categories: below age 69, ages 70 to 79, and age 80 and above. If you will be traveling to the US and are age 65 or above, your date of arrival in the US must be no more than 30 days after your effective date. Visitor Secure Insurance is extendable and renewable up to 12 months of continuous coverage.
COBRAhealth.com - The Patient Protection and Affordable Care Act, PPACA. The government cannot create doctors, nurses and facilities to service the masses of people. ObamaCare cuts payments to the private health insurance companies that provide coverage to the 20 percent of Medicare enrollees who participate in the Medicare Advantage program.ObamaCare cuts the prices Medicare uses to pay hospitals and many other health care providers. ObamaCare could force one in six hospitals to stop accepting Medicare patients. we will ration with our eyes open.You can't get medications. You are left waiting on life saving procedures. You must wait for quality of life procedures that are medically needed. 5 million Canadians have no health insurance and the wait is 5 years for a primary care physician.
This chapter examines the U.S. health care system—specifically, the organization of medical services; key governmental health programs such as Medicare and Medicaid; the crisis in health care, including attempts to curb health care costs; the large numbers of uninsured people; the impact of the American Medical Association on health care; and that of managed care in the American health care system. The chapter also surveys various proposals designed to ameliorate the problems in U.S. health care and considers how medical services are organized in Great Britain, Canada, and Australia.
Over the last twenty years, medical costs associated with lost time workers’ compensation claims has risen dramatically, despite efforts to reform the system. Medical tourism, a popular option for many seeking lower cost health care, is one option that has yet to catch on. Issues of quality of health care in other countries is no different for workers’ compensation patients, as it is for health care patients, and with accreditation from the Joint Commission International (JCI), hospitals that cater to medical tourists offer better care at lower cost than most U.S. hospitals offer. Certain procedures, common to workers’ compensation claims, such as knee replacement, hip replacement and spinal fusion in countries such as India, Thailand and Singapore, are considerably lower cost than those performed in the U.S.
However, legal barriers currently exist not only for medical tourism, but for its implementation for workers’ compensation. Medical malpractice, liability laws, patient privacy and medical records (HIPAA), ERISA, and the PPACA, all present significant obstacles that need to be addressed before such implementation are possible. Case law in the US has recognized limited use of medical tourism, both domestic and international, and opens the door a little for further development in this direction. The globalization of healthcare as evidenced by the tremendous growth of medical tourism in the health care arena, will lead to the implementation of international medical providers into the medical provider network for workers’ compensation.
Chapter 2Fraud and Abuse StarkPhysician Self-Referral and EstelaJeffery653
Chapter 2
Fraud and Abuse: Stark/Physician Self-Referral and Anti-Kickback
Learning Objectives
Physician Self-Referral (Stark) Law and Anti-Kickback Statute (AKS)
Services, individuals, organizations, and transactions affected by these laws.
Specific behaviors prohibited.
Exceptions and “safe harbors” for avoiding liability.
Anticipating and preventing violations.
Physician Self-Referral Law (Stark)
Initial law (Stark I) sponsored by Congressman Pete Stark enacted in 1989 and applied only to clinical laboratory services.
Omnibus Budget Reconciliation Act of 1993 (Stark II) expanded law to additional 10 types of clinical services.
Patient Protection and Affordable Care Act of 2010 added restrictions on physician-owned hospitals and required the issuance of a self-referral disclosure protocol.
Stark Prohibition
“... If a physician (or an immediate family member of such physician) has a financial relationship with an entity ..., then the physician may not make a referral to the entity for the furnishing of designated health services for which payment otherwise may be made” under Medicare (also applicable to Medicaid). (underlining added).
“Physician”
The person making the referral may be a(n)
MD
Osteopath
Dentist
Podiatrist
Optometrist, or
Chiropractor
“Immediate family member”
Besides the referring physician herself, this person may be a
spouse;
parent, child, or sibling (by birth or adoption);
stepparent, stepchild, step-brother, or step-sister;
father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, or sister-in-law;
grandparent or grandchild; or
spouse of a grandparent or grandchild.
“Entity”
The entity with which there is a financial relationship must be one that bills CMS for designated health services (DHS) or that furnishes all or most of the components of the DHS.
This includes the person or entity that actually performs the DHS, or presents a claim for DHS services to the Medicare program.
7
“Financial relationship”
Direct or indirect ownership of an entity:
Equity stock, interest in a limited liability company, holding debt in an entity.
Direct or indirect compensation from an entity:
Physician’s compensation from an entity, lease between physicians and health care facilities, medical director agreements, and independent contract with physicians.
“Designated health services” (I)
Clinical laboratory services.
Physical therapy services.
Occupational therapy services.
Outpatient speech-language pathology services.
Radiology and certain other imaging services.
Radiation therapy services and supplies.
“Designated health services” (II)
Durable medical equipment and supplies.
Parenteral and enteral nutrients, equipment, and supplies.
Prosthetics, orthotics, and prosthetic devices and supplies.
Home health services.
Outpatient prescription drugs.
Inpatient and outpatient hospital services.
Penalties for Stark Violations
Payment for services in response to prohibited referral must ...
Text of speech (associated PowerPoint is at http://www.slideshare.net/stevelevine/protecting-texas-medical-liability-reforms-piaa-2014) delivered to PIAA Medical Liability Conference in Toronto, May 14, 2014
11 minutes agoJessica Dunne RE Discussion - Week 3COLLAPS.docxdrennanmicah
11 minutes ago
Jessica Dunne
RE: Discussion - Week 3
COLLAPSE
Top of Form
NURS 6050C: Policy and Advocacy for Improving Population Health
INITIAL POST
Economic Challenges of Healthcare Policy
The economics of the healthcare system in the United States is complex and fragmented. Costs associated with care and the prices healthcare consumers pay are determined by a wide variety of factors making it extremely difficult to find a one size fits all solution. Knickman and Kovner (2015) argue that healthcare is neither a commodity or a service, because of the high variabilities in need, cost, and consumption. The United States spends 80% of all healthcare revenue on just 20% of the population. Health insurance can be provided by the government, the private sector, or an employer. Some citizens do not have any form of healthcare coverage. Regardless of type, insurance coverage generally only pays a portion of the total healthcare cost leaving the consumer to pay the remaining balance. Moreover, reimbursement standards differ for facilities and providers. The government reimburses healthcare facilities, such as hospitals a fixed amount per patient, which creates a higher incentive to work efficiently. Healthcare providers, on the other hand, are reimbursed based on a fee for service model, meaning the more services they provide, the more money they are reimbursed (Knickman & Kovner, 2015).
Reindart (2010) maintains the passage of the Affordable Care Act (ACA) created more strain on the system by adding approximately 30 million uninsured Americans to the market. The projected cost to provide such coverage is around 8 billion to 1 trillion dollars over the next decade. However, the estimated expense of healthcare with no legislative intervention is 35 trillion dollars over the next decade (Reindart, 2010). Laureate Education (2012) contends that the human resources required to provide healthcare to an additional 30 million people is another consideration the ACA does not address. The United States is already experiencing staff shortages for key healthcare jobs like nurses and physicians. Additionally, with baby boomers retiring from the workforce and simultaneously needing more healthcare resources as they age will inevitably exacerbate the shortage of providers (Laureate Education, 2012).
Ethical Considerations
It is important to recognize that the private sector often follows the public sector when deciding what services will be covered (Knickman & Kovner, 2015). Therefore, the implications of Medicare deciding not to pay for a drug or service will likely affect the entire population. Stein (2010) asserts that cost should not be a consideration in determining if medications or services will be paid for by Medicare. Nonetheless, that is what happened with Provenge, a vaccine indicated for late stage prostate cancer patients. The drug prolonged the lifespan of patients by about four months. Provenge costs around 93,000 dollars per p.
Health Care Reform Goes Live: The Affordable Care Act in 2014
Implementing International Providers
1. Implementing Medical Tourism
for
Workers’ Compensation
What are the Legal Barriers?
Richard Krasner
HSA 6425
Health Law
April 14, 2011
2. Medical Tourism
A rapidly emerging segment of global healthcare
industry
Motivated by desire to seek lower cost health care, avoid
long wait times, or provide services not available in one’s
own country
Many foreign hospitals affiliated with U.S. medical
schools such as Harvard Medical School
Estimated 500,000 Americans traveled abroad for
treatment in 2005
3. Medical Tourism and Health Care
Trade-off for consumers, allows them to opt-out of increased
regulation in favor of looser restrictions and greater cost
savings
Cardiac surgery
India = $4,000; U.S. = $30,000
Partial hip replacement
Argentina, Singapore or Thailand = $8,000 - $12,000;
U.S. = $16,000 – $24,000
Knee replacement
Singapore and India = $18,000 and $12,000; U.S. = $30,000
4. Medical Tourism and Health Care,
continued
Cost savings more likely benefit those with inadequate
health coverage
Lower-middle-class will benefit from medical tourism
Disproportionately benefits uninsured or under-insured
Self-insured & private insurance companies have
integrated medical tourism
Large HMO’s and health insurance companies
established plans
5. Workers’ Compensation and the
legal barriers to Medical Tourism
Average WC medical cost per lost time claim was
$260,000 in 2008 (6% increase from 2007)
Medical costs in 2008 were 58% of all total claims
40% of WC costs are associated with medical and
rehabilitative treatment
In 1980’s & 1990’s, medical costs fluctuated, rose in
2000’s, and totaled $41.7 billion annually (as of 2002)
6. Comparison of Costs for Common
Workers’ Compensation Procedures
U.S. U.S.
Procedure Retail Price* Insurers’ Cost* India** Thailand** Singapore**
Hip Replacement $75,000 $31,485 $9,000 $12,000 $12,000
Knee Replacement $69,000 $30,358 $8,500 $10,000 $13,000
Spinal fusion $108,127 $43,576 $5,500 $7,000 $9,000
*Retail and insurer costs are mid-point between high and low ranges.
**U.S. rates include one day hospitalization; international rates include airfare, hospital and
hotel.
Source: (Herrick, 2007)
7. Legal Barriers
State WC laws – CA, FL, NY, TX – Medical providers
must be licensed in state to practice medicine
Federal & State laws intended to protect consumers,
instead increase costs and reduce convenience
Federal & State regulations restrict public providers
from outsourcing certain medical procedures
Federal STARK laws inhibit collaboration
State licensing laws prevent certain medical tasks
being performed by providers in other countries
8. Workers’ Compensation Case Law
& Medical Tourism
State Compensation Insurance Fund v. Workers’ Comp. Appeals
Bd. (1977)
Mexican worker fell from ladder; treated in Tijuana; WCAB
ordered reimbursement.
SCIF petitioned – MD’s not licensed under CA law.
CT of Appeals affirmed award of WCAB; CA Lab Code does
not exclude physicians licensed to practice in another
country.
9. Workers’ Compensation Case Law
& Medical Tourism
Braewood Convalescence Hospital et al. v. Workers’ Comp.
Appeals Bd. (1983)
Domestic Medical Tourism; cook slipped and fell; told to
lose weight; went to obesity clinic 3000 mi from home.
WCJ awarded temp disability prior to going to clinic
WCAB granted reconsideration, affirmed WCJ’s award
Employer appealed
Sup. Ct., CA affirmed award of WCJ for reimbursement for
all costs and future costs.
10. Workers’ Compensation Case Law
& Medical Tourism
AMS Staff Leasing, Inc. v. Arreola (2008)
Undocumented Mexican worker in FL struck in rt. leg; had 12
surgeries
Seen by Dallas orthopedist, recommended add’l surgery
Returned to Mexico, no documents to return to US
Had surgery in hometown of Jalisco
Employer claimed “no known orthopedic doctors in Mexico
qualified … according to FL WC statutes”
FL Ct of Appeal ruled state law did not preclude medical care in
Mexico, FL WC law contemplates coverage for non-citizens,
worker not prohibited from receiving treatment outside of state
11. Conclusion
Nothing of real substance to prevent WC cases from
benefitting from medical tourism.
Several legal barriers remain, but can be overcome.
Cost savings, quality of care matches and surpasses
that found in US is reason to implement medical
tourism.
Courts willing to allow limited medical tourism; how
future courts will rule is unclear; some precedent
exists for ruling in favor of medical tourism in WC.