Medical Tourism Provider Safety & Quality Criteria: Mobility programs

In my visits to healthcare facilities interested in medical tourism startup, I use several proprietary checklists to objectively assess a provider’s readiness and propensity for success with medical tourism.

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This is one reason why we don’t take seriously any emails we receive from hospitals or medical tourism agencies (in the USA or abroad) that say, and I quote:

Dear sir/madam,

This is —— from XYZ country. We deal in international patients. We provide them their medical services. If you have some patient who wanna to come to XYZ for their  treatment we can arrange that. I hope to get your revert.   Then we can arrange something for you.

When I evaluate a medical tourism provider, one thing I focus heavily on is patient safety and quality. I come at it from a different perspective than an accreditation surveyor, because the accreditation survey is designed to focus on a higher likelihood of local patients, not patients that will ultimately require a flight in an aircraft to get them home.

As a part of their course of care, patients may be transferred to the intensive care unit (ICU). When they leave the ICU, many patients experience weakness from the bed rest and immobility. The old formula I was taught was that for every day flat in the bed, one requires 2-3 days to bounce back. That means that fit-to-fly staging is going to take longer, the longer one is confined to complete bed rest (CBR) to be prepared to safely fly home.

Some patients also develop complications from the immobility, including pneumonia and deep vein thrombosis, atelectasis, and other complications. (If you don’t know what these words are, you probably aren’t properly qualified to be involved in medical tourism at any level — not even the revenue cycle and pricing activities.)  Early mobility is essential to preventing these potential complications and enhancing quality of life after discharge.

From a protocol perspective, I ask the Director of Nursing and the physicians who want to treat medical tourism patients about established protocols for patient mobility planning when determining “if” a patient should be mobilized – including respiratory, cardiovascular, neurologic, and other considerations. If the medical team cannot communicate these to me and how they approach this, show me their written and established protocols, and what they will do if things go wrong, I cannot approve them as “ready” to enter medical tourism service.

Another part of this evaluation has to do with nursing staffing. Many nurses are concerned that mobilizing patients will increase their workload. And rightfully so! Addressing patient mobilization, repositioning, transferring to a bedside chair, or ambulating in the hallways may hinge on staffing limitations, patient acuity, resources and patient assignments. Additionally, I ask about how the protocols are shared with staff, how orders are conveyed, and what guidelines are in place for patient activities.  I want to see them with my own eyes and determine if I can ethically endorse what they are doing to assert that on my inspection, I felt they were ready for safe and high-quality patient care for medical tourism patients that will not return to a local home upon discharge.

This also implicates the staffing ratios for the nurses. If the nurses are working with a 10:1 ratio as in most public hospitals at medical tourism destinations, thee is no way that they can consistently mobilize patients, and then I have to assume that the protocol is a paper policy and rarely adhered to. That’s because it simply can’t be done when nurses are overwhelmed. It is also why I look for no higher than a 4:1 ratio at medical tourism facilities.

Whether it is my background as a nurse, my decades in healthcare administration and clinical management, or just my predilection for being thorough when it comes to clinical evaluation and management of vulnerable medical tourism patients, the attention I pay to these details is the difference between how I evaluate a medical tourism provider for approval or pend them for corrective action and remediation.

If you are new to medical tourism as a facilitator, or a provider thinking of entering medical tourism service, I hope that my sharing of the above criteria will help you to improve your own process and preparation for site inspections and provider readiness.  If you have any questions, please call on me and I will try to help.

Maria K Todd, MHA PhD
CEO, Mercury Advisory Group


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