International Hospital Accreditation for Medical Tourism — Who pays?

International Hospital Accreditation for Medical Tourism - Who Pays?



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As Health Tourism is merely a service line within your overall business strategy, is aN EXPENSIVE & separate "accreditation" really necessary?

Maria Todd is frequently engaged as a consultant to prepare hospitals and ambulatory surgery facilities for accreditation surveys. In an accreditation survey, the entire hospital or facility is assessed. Accreditation is a form of quality control, ensuring that facilities and organizations that provide health delivery education satisfy certain standards. 

There isn’t an internationally designated standards setting body so just what are all these proprietary accreditors selling? And why would the hospital or ASC require a separate accreditation just for its medical tourism operations, quality and patient safety? 

Maria and her team of experts believe this redundant separate accreditation adds cost for the facility – and ultimately results in the insurer or patient paying more for care than is absolutely necessary. Learn why they argue that there isn’t a business case rationale for doing so.

This article was originally published in 2009 and has been reformatted for consistency with the current website design.

Who pays?

Maria Todd: While the hospital will usually be expected to cover the cost of the application and the survey itself, often, Maria and her team are often engaged by regional government authorities if the hospital in question happens to be a public-private partnership, or a public tertiary teaching hospital.  

What they usually do is create a grant to underwrite our travel, consulting time and accommodation hosting.  The grant amount may be a loan package or an outright sponsorship. One way that costs are reduced is it the primary airline for the region is a government-owned (e.g., Aeroflot, Croatia Airlines, China Airlines, Aerolineas Argentinas, LOT Polish Airlines, Malaysia Airlines, Thai Airways, South African Airways, and about 125 others). This is possible because they have special rates they can arrange from agency to agency. 

When we began, we agreed to fly economy for 16-30 hours in each direction. Then, over time, the team began experiencing deep venous thrombosis and pulmonary emboli. No one should risk their health for work. Now, by company policy, none of us will agree to travel longer than 3 hours in cramped economy class seats on any client project, so that’s a cost in addition to the consulting deliverable to which your organization or sponsors must agree or you’ll need to hire some other firm.  We aren’t willing to accept this health risk given the amount of travel required to work with clients. 

Approaching government agencies for partial or full accreditation expense support

Maria Todd: One way to convince the government to support you with a grant for assistance is if a health cluster is if several providers are ready at the same time. We often negotiate a fee reduction if we only have to travel once and serve many, than to spend so much time flying between engagements.  The same thing may happen with the accrediting body surveyors themselves. Always ask! No one will be offended.

Maria Todd: One thing to keep in mind, JCI and a few other accrediting bodies don’t permit surveyors to perform surveys in their own country. So always expect to budget for business class travel and hotel accommodation for surveyors and consultants. Teams are usually 3-5 individuals dependent on the size of the facility or organization.

What’s the incentive for the government to help a hospital achieve international hospital or ASC accreditation?

Better, safer, higher-quality assured care for all.

Michael Tarabay: The incentive for healthcare facilities and clinicians to embrace international accreditation is to help them to identify areas that require improvement and improve quality and patient safety. When we had our first JCI survey in Mexico, we passed with the highest score in history.

Maria Todd: Most accepted and recognized accrediting bodies provide benchmarks or standards in areas of clinical quality and management efficiency, safety, the Life Safety Code, cultural sensitivity, credentialing and privileging, and patients rights. Insurers and consumers may recognize these standards or they may conduct their own site and operational surveys.

Additional Benefits of Accreditation Preparation

Good consultants and accrediting bodies also provide continuing education and keep clients informed of latest developments in patient care and operational efficiency.

Maria Todd: While there’s been lots of rumor about insurance companies that allegedly “require” facilities to be accredited before they will pay for elective services, a review of more than 2000 managed care and other contracts proves that this is conjecture, and not stated in most contracts, per se.  This is especially true with regard to a specific “medical tourism” accreditation. 

In fact, payers who are fully aware of what accreditation is and isn’t are likely to object to paying more because your organization is accredited.  And if they don’t respect or recognize your accreditor you may not be offered a chance to contract with them by policy.  The payer or customer must first recognize and respect the accrediting body and what accreditation from that organization represents. Otherwise, they assign zero value to being accredited.

Earlier in the business evolution of medical tourism, when only 400 organizations were accredited by international healthcare accreditors, having international accreditation was a rare phenomenon. Now it is simply a tick in a box on a checklist. The marketplace of accreditors has expanded and they all survey similar quality, safety and operational elements.

So what’s the point of having more than one? We don’t believe there is. What’s more, if they survey your entire operation, your medical tourism service line was already assessed. Why would you feel the need to underwrite the cost and time consumption and staff diversion necessary to pass and maintain yet another redundant accreditation or certification just for the medical tourism program?

Accreditation preparation and passage of your survey

Michael Tarabay: Accreditors ensure that the organization has sufficient resources, faculty, facilities and patient services. But, accreditation goes beyond walking around, asking questions and independently examining documentation and quality and safety policies and procedures.

Accreditors also evaluate the quality of the nursing care, cultural preparation and patient interaction with nurses and staff, continuing education, medical records documentation and handling, and credentials verification and medical staff privileges to determine whether the medical staff and allied health providers have sufficient expertise in their specialties and the procedures they perform.

Accreditation also involves peer reviews of the organization by qualified and experienced nurses, administrators and physicians. The best accrediting bodies train medical doctors, nurses and healthcare facility administrators to be surveyors. We’ve discovered that many of the more recent startup accreditors were launched and standards authored by individuals who are neither physicians, administrators or nurses. Others simply plagiarized existing standards further substantiating that having more than one is a waste of time, money and effort.

As former healthcare organization administrators working with experienced nurses and physicians, we first conduct a gap analysis to diagnose what needs attention at your organization. We then determine the pathway to fill the gaps discovered. Then other team members arrive to conduct a “mock” survey. This is your dress rehearsal. Any last minute corrections of deficiencies are addressed. A repeat mock survey is rarely needed. At that point, you pay your fees and schedule the actual survey. One of our two teams may return to accompany you through your actual survey – but that’s strictly up to you. By using a two team system, most of our clients are ready and confident to go through their survey without one of our teams being present. We’ve helped numerous providers and all of them passed on first survey without any significant deficiencies recorded that required any substantial corrective actions.

Additional Resources from AskMariaTodd™

Programmatic Accreditation

Programmatic accreditation, also known as specialized accreditation, is designed for specialized departments, programs, or services  within a healthcare organization that has already received accreditation.  Should medical tourism require its own programmatic accreditation?

Maria Todd: I can’t defend it.  If your organization has achieved accreditation overall, then each specialty program within the organization has already been surveyed and passed. I guess before I would offer an opinion on this, I would want to ask the reason for doing so. 

  • Does an insurer, employer or other third-party payor require this as a prerequisite to do business with you? If so, what will be the potential economic or brand impact of doing business with this payor? Will you earn more profit because of this investment? 
  • Does some entity willing to provide grants or funding require the programmatic accreditation to consider your application?  What will it cost to achieve the programmatic accreditation? Will the grant cover that amount plus the amount of money earmarked for whatever it is you want to use the grant money for?  Or will most or all the money from the grant be consumed by the prep and programmatic accreditation survey fees and maintenance? If so, again, what’s the market demand reason you want or need the programmatic accreditation?

Are there Accreditation Mills to be aware of?

Michael Tarabay:  There are all kinds of accreditations and certifications out there in the medical tourism industry. They grant accreditation or certifications or designations to organizations without requiring standard preparation for earning them. They provide accreditation status to hospitals, doctors, nurses, and facilitators without conducting an actual evaluation of competency. These mills can be difficult to identify, as their names often sound impressive and similar to those of authentic accrediting agencies.  Many charge a small fortune to purchase but don’t bring new business or trust or brand loyalty to those that spend the money. 

Programmatic accreditation for medical tourism is underdeveloped at this time. There isn’t yet an internationally accepted set of standards for medical tourism business operations.

Not all programs will have, or need, programmatic accreditation. We haven’t yet found a reason to add a redundant, voluntary, limited-scope medical tourism accreditation to an already accredited healthcare organization – just to have it.

Do you have questions about international accreditation or medical tourism marketing or branding strategies?

Would you like unbiased answers from experts who aren't in the business of selling any accreditation?

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