A Mexican Hospital, an American Surgeon, and a $5,000 Check (Yes, a Check)

By Phil Galewitz – New York Times

CANCÚN, Mexico — Donna Ferguson awoke in the resort city of Cancún before sunrise on a sweltering Saturday in July.

She wasn’t headed to the beach. Instead, she walked down a short hallway from her Sheraton hotel and into Galenia Hospital.

A little later that morning, a surgeon, Dr. Thomas Parisi, who had flown in from Wisconsin the day before, stood by Ms. Ferguson’s hospital bed and used a black marker to note which knee needed repair. “I’m ready,” Ms. Ferguson, 56, told him just before being taken to the operating room for her total knee replacement. For this surgery, she would not only receive free care, but would receive a check when she got home.

The hospital costs of the American medical system are so high that it made financial sense for both a highly trained orthopedist from Milwaukee and a patient from Mississippi to leave the country and meet at an upscale private Mexican hospital for the surgery.
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Ms. Ferguson gets her health coverage through her husband’s employer, Ashley Furniture Industries. The cost to Ashley was less than half of what a knee replacement in the United States would have been. That’s why its employees and dependents who use this option have no out-of-pocket co-pays or deductibles for the procedure; in fact, they receive a $5,000 payment from the company, and all their travel costs are covered.

Dr. Parisi, who spent less than 24 hours in Cancún, was paid $2,700, or three times what he would have received from Medicare, the largest single payer of hospital costs in the United States. Private insurers often base their reimbursement rates on what Medicare pays.
ImageMs. Ferguson’s surgery was Dr. Thomas Parisi’s first one in Cancún. He spent less than 24 hours there and was paid triple what Medicare would reimburse in the United States.
Ms. Ferguson’s surgery was Dr. Thomas Parisi’s first one in Cancún. He spent less than 24 hours there and was paid triple what Medicare would reimburse in the United States.CreditRocco Saint-Mleux for Kaiser Health News

Ms. Ferguson is one of hundreds of thousands of Americans who seek lower-cost care outside the United States each year, with many going to Caribbean and Central American countries. For many, a key question is whether the facility offers quality care.

In a new twist on medical tourism, a Denver company is tapping into this market. The company, North American Specialty Hospital, known as NASH, has organized treatment for a couple of dozen Americans at Galenia since 2017.

Dr. Parisi, a graduate of the Mayo Clinic, is one of about 40 orthopedic surgeons in the United States who have signed up with NASH, to travel to Cancún on their days off to treat American patients. NASH is betting that having an American surgeon will alleviate concerns some people have about going outside the country, and persuade self-insured American employers to offer this option to their workers to save money and still provide high-quality care. NASH, a for-profit company that charges a fixed amount for each case, is paid by the employer or an intermediary that arranged the treatment.

“It was a big selling point, having an American doctor,” Ms. Ferguson said.

The American surgeons work closely with a Mexican counterpart and local nurses. NASH buys additional malpractice coverage for the American physicians, who could be sued in the United States by patients unhappy with their results.

“In the past, medical tourism has been mostly a blind leap to a country far away, to unknown hospitals and unknown doctors with unknown supplies, to a place without U.S. medical malpractice insurance,” said James Polsfut, the chief executive of NASH. “We are making the experience completely different and removing as much uncertainty as we can.”

Medical tourism has been around for decades but has become more common in the past 20 years as more countries and hospitals around the world market themselves to foreigners.

There are, of course, risks to going outside the country, including the headache of travel and the possibility that the standards of care may be lower than at home. If something goes wrong, patients will be far from family and friends who can help — and it might be more difficult to sue providers in other countries.
Chasing Lower Costs

The high prices charged at American hospitals make it relatively easy to offer surgical bargains in Mexico: In the United States, knee replacement surgery costs an average of about $30,000 — sometimes double or triple that — but at Galenia, it is only $12,000, said Dr. Gabriela Flores Teón, medical director of the facility.

The standard charge for a night in the hospital is $300 at Galenia, Dr. Flores said, compared with $2,000 on average at United States hospitals.
https://www.nytimes.com/2019/08/09/business/medical-tourism-mexico.html?utm_source=pocket-newtab for the rest of the story