A study conducted by the Workers' Compensation Research Institute (WCRI), and reviewed in a session entitled “Crossing State Lines for Medical Care” at their annual convention in Boston recently, showed that New York based injured workers who engaged in medical travel to New Jersey experienced orthopedic surgery costs at more than twice the allowable rates permissible in New York. This is apparently because, while New York maintains a fee schedule that dictates what surgeons may charge, there is not a statutory provision dictating or limiting what out of state providers may charge New York employers. This means that an outpatient knee surgery costing $5,000 in the Big Apple may be as much as $11,000 if performed in the Garden State.

This, of course, is unequivocal proof that Medical Travel is just a sham and a hoax that simply drives costs up around the world.

Now, I really don't believe that, but, believe me, for personal reasons that prior statement is funnier than you think.

According to McGraw-Hill, Medical Travel, or Medical Tourism, is “The combination of medical care–usually of a type–eg, pediatric neurosurgery or experimental cancer therapy, that is not available to a [patient] near his/her home–with pleasure–eg, visit to a theme park, Disneyworld, MGM studios”. This really helps clarify things. Most people think of medical tourism as flying to some far off land like Turkishmaninacanstan to have a medical procedure performed. Now we learn the destination just has to have a Disneyworld or MGM Studios. Of course, New Jersey has neither, but on the plus side, many people in New York do treat it as though it is a foreign third world nation.

Lately discussions around the topic have postulated that “Medical travel” could indeed represent travel from one jurisdiction to another for the sole purpose of obtaining medical treatment. Under that broader description (eliminating the requirement for foreign status or a Disneyworld) then traveling from New York to New Jersey to obtain medical care could qualify. Still, medical tourism is supposed to be the cheap option; it is supposed to drive costs down, not up.

So what went wrong here?

The study conducted by WCRI really did not delve into causation. It was more focused on the what, rather than the why. Therefore, it is left to intellectual sleuths like myself to expand upon the subject with our own fantastical spin and wild ass speculation. Fortunately, I am more than prepared for that task.

I pondered during the WCRI presentation (I am prone to daydreaming, after all) about what might drive injured workers to New Jersey for orthopedic surgery. It is not like they intentionally choose that destination simply because it will cost more. I wondered if there was heavy advertising that might influence decisions within New York, where medical care is not employer directed. Then a comment from lead researcher Dr. Bogdan Savych made this come brightly into focus for me. In response to a question from an audience member, he indicated he thought some of these physicians had offices in both states.

Ding! It was clear to me now. I could even hear the dialogue between these multi-state physicians and their patients; “We are terribly backed up here, and can't schedule your knee surgery for another 2 months, but if you are willing to have us drive you to New Jersey, we have an opening tomorrow in our facility there”.

Bazinga. Treating patients for fun and profit. All for the cost of a short limo ride.

I of course cannot prove that theory, but it is one of the few that makes any sense. Humans are a creative lot, and if they find a loophole that will allow them to double their money and double their fun, some are likely to take it. For New York, this is a legislative issue that should be addressed. For the folks promoting medical tourism as the solution for all of workers' comp's ills, this is not the example to support their cause.

To be fair, it is really not an example of medical travel at all. It is more likely an example of greed inconveniencing patients for monetary gain. But there is a lesson to be learned here.

Many of us do not believe that workers' comp will ever send our injured workers' to Turkishmaninacanstan just because it will save us a lot of money. We now know, however, that until Turkishmaninacanstan gets a Disneyworld, we couldn't consider the option if we wanted to.

Rules is rules, don'tcha know. Who am I to argue with McGraw-Hill?

 

 

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