PERSPECTIVES:
Joseph M. Heyman, M.D., Immediate Past Chair,
Board of Trustees, American Medical Association
Editor's Note:When
President Obama delivered his remarks on
healthcare reform at the American Medical
Association (AMA) meeting in June, he began by
thanking Dr. Joseph Heyman, then Chair of the
AMA's Board of Trustees.
Dr. Heyman has been involved in organized
medicine since joining the Massachusetts Medical
Society (MMS) in 1973. He joined the AMA in 1980
and has been a member of the Massachusetts
delegation to the AMA since 1987.He was a member
of the AMA Council on Medical Service, serving
on its executive committee (1997–2000) and as
its Chair (2000–2001). During his tenure on the
council,Dr. Heyman helped develop AMA policy on
health insurance reform, pharmaceutical industry
spending in the United States, and hospital
mergers.
Medical Travel Today recently put some
questions to Dr. Heyman regarding the up- and
downsides of medical travel and his thoughts on
how the proposed reform measures might impact
the industry.
Medical Travel Today (MTT):
Can you share with us your thoughts
on the up- and downsides of medical travel for
both consumers and physicians?
Paul Heyman (PH): We believe
patients should have choice in healthcare. That
includes being able to choose medical travel. We
want our patients to take an active role in
their healthcare decision-making, and we believe
that choosing from whom and where to receive
healthcare is not a decision that should be
arrived at lightly. Whether care is provided in
the United States or abroad, it's important for
patients to be confident in the qualifications
of the physician providing their care, as well
as the safety standards of the hospital or
clinic where the care will be given.
The risks of seeking care outside the United
States can be significant. Fewer international
hospitals meet the same quality
standards imposed by accrediting organizations
like Joint Commission International, as opposed
to those in the United States. Patients may have
a hard time trying to assess the qualifications
of the physician and facility providing the
care. In some countries there may be no legal
recourse for poor outcomes. Seeking healthcare
overseas, particularly with long flights
following surgery, carries an increased risk of
developing complications, such as blood clots,
swelling, and infection.
MTT: Pre- and
post-op care is one of the biggest concerns
physicians have about medical travel. What
advice might you share with physicians regarding
addressing the issue with patients?
PH: It’s essential that
patients going abroad for care have a physician
and follow-up care plan in place prior to
treatment to ensure that they receive the proper
follow-up and lessen the risk for complications
when they return home.
MTT: What can U.S.
physicians do in order to be more competitive
with non-domestic providers?
PH: A strong patient-physician
relationship is incredibly important, and we
want our patients to be comfortable talking to
us about their medical concerns and decisions.
While a cheaper price has often been sighted as
one of the main reasons Americans go overseas
for care, it is important that price not be the
only factor in determining where and from whom
to receive medical treatment.
MTT: Clearly the goal of the
proposed reform measures is to make healthcare
more affordable and accessible to all Americans.
As one in the field, what do you think is a
realistic timeline for seeing meaningful change
and how dramatic might it truly be? That is,
will the cost of a hip replacement in the United
States be competitive with the cost of one in
India?
PH: We expect health reform to
happen this year. We are committed to achieving
reform that ensures all Americans have
affordable, high-quality health coverage and can
get the best value from healthcare spending.
The American Medical Association has guidelines
for choosing international travel. They are as
follows:
H-450.937 Medical Care Outside the
United States
Our AMA advocates that employers, insurance
companies, and other entities that facilitate or
incentivize medical care outside the United
States adhere to the following principles:
-
Medical care outside of the United States
must be voluntary.
-
Financial incentives to travel outside the
United States for medical care should not
inappropriately limit the diagnostic and
therapeutic alternatives that are offered to
patients or restrict treatment or referral
options.
-
Patients should only be referred for medical
care to institutions that have been
accredited by recognized international
accrediting bodies (e.g., the Joint
Commission International or the
International Society for Quality in Health
Care).
-
Prior to travel, local follow-up care should
be coordinated and financing should be
arranged to ensure continuity of care when
patients return from medical care outside
the United States.
-
Coverage for travel outside the United
States for medical care must include the
costs of necessary follow-up care upon
return to the United States.
-
Patients should be informed of their rights
and legal recourse prior to agreeing to
travel outside the United States for medical
care.
-
Access to physician licensing and outcome
data, as well as facility accreditation and
outcomes data, should be arranged for
patients seeking medical care outside the
United States.
-
The transfer of patient medical records to
and from facilities outside the United
States should be consistent with the
Health Insurance Portability and
Accountability Act (HIPAA)
guidelines.
-
Patients choosing to travel outside the
United States for medical care should be
provided with information about the
potential risks of combining surgical
procedures with long flights and vacation
activities (CMS Rep. 1, A-08)
About Joseph M. Heyman, M.D.
Joseph M. Heyman, M.D., an
obstetrician-gynecologist with a private
practice in Amesbury, Mass., has been a member
of the American Medical Association (AMA) Board
of Trustees (BOT) since 2002. He served as its
secretary (2005–2006) and was chair of the
finance committee. In June 2008 he began serving
as chair of the AMA-BOT for 2008–2009.
Dr. Heyman serves on the board of commissioners
of the Joint Commission, the board of directors
of Joint Commission Resources and the steering
committee of the Markle Foundation’s Connecting
for Health. He has served as president of the
Essex North District Medical Society and on the
U.S. Department of Health and Human Services
Practicing Advisory Council. He has served MMS
as president, vice president, trustee, and
speaker of its House of Delegates.
