AMA House of Delegates
AMA meeting: Guidelines target safety of medical tourists
■ With patients increasingly considering overseas trips for care, new principles outline how they should be protected.
By Karen Caffarini — Posted July 7, 2008
Chicago -- Acknowledging that lower costs are luring a growing number of patients abroad for medical treatment, the AMA's House of Delegates adopted nine new guiding principles at its Annual Meeting to ensure the safety of those medical tourists.
The principles -- which the AMA said were the first of their kind -- provide steps that the organization said should be considered by patients, employers, insurers and others when coordinating medical travel.
"Medical tourism is in its infancy, although it is growing very fast. It is still too early to determine whether the risks outweigh the advantages. We need to address this issue in its initial stage," said W.J. Terry, MD, a Mobile, Ala., urologist and member of the AMA Council on Medical Service.
In 2006, an estimated 150,000 Americans received medical care overseas, nearly half of which was for necessary surgeries, according to Josef Woodman, author of a book on medical tourism. Overseas procedures can cost 20% less than the price of the same procedure in the U.S. It also was pointed out in the council's report that a growing number of foreign hospitals and clinics are owned, managed or affiliated with American universities or health care systems, including the Cleveland and Mayo clinics.
The principles state that medical travel should be a choice, not a requirement, for patients and that patients need to be informed of the medical and legal risks of travel. The principles also state that financial incentives for medical travel should not restrict care given to patients, and be used only for facilities accredited by internationally recognized bodies such as the Joint Commission International or the International Society for Quality in Health Care.
In addition, follow-up care for patients back in the United States should be arranged prior to travel and patient information transferred between overseas and the U.S. should conform to HIPAA guidelines.
AMA President-elect J. James Rohack, MD, said the cost of care in the U.S. needs to be addressed and the uninsured need to get coverage so that every American can get the health care he or she needs at home.
But, "until there is significant action at home, patients with limited resources may turn elsewhere for care. It is important that U.S. patients have access to credible information and resources so that the care they receive abroad is safe and effective," Dr. Rohack said.
The new policy also encourages private payers to recognize and follow CPT codes and modifiers to describe the segments of care provided when more than one physician delivers a specific segment of that global care.
Michael Rosenberg, MD, a cosmetic surgeon and delegate from New York, pointed out that some companies entice medical tourists with five-star hotels and other perks. He asked that the AMA seek legislation or regulations that would prevent insurance companies, employers or other entities from providing such incentives to their subscribers.
"The fact that insurance companies are incentivizing patients with beaches, five-star hotels, even cash kickbacks, I find distasteful," added Michael Simon, MD, an alternate delegate for the American Society of Anesthesiologists.
Their appeal that the resolution be amended to include this regulation was denied.
"We need to address the safety aspect for the patient. But the AMA feels patients should be able to go to the doctor they want where they want," Dr. Terry said.
To ensure that insurers and others that facilitate medical tourism adhere to the nine new principles, the AMA will introduce model legislation for consideration by state lawmakers.
