Trade group's "accreditation" could confuse medical tourists

The proposed benchmarks are designed to reward best practices, but health care accrediting bodies worry that the terminology could mislead patients.

By Kevin B. O’Reilly — Posted Oct. 6, 2008

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The Medical Tourism Assn. in July launched a program to identify medical travel agencies that follow industry best practices.

But the West Palm Beach, Fla.-based trade group's initiative has drawn fire from hospital accreditation and physician certification organizations who say it could confuse patients seeking reassurance when considering surgery outside the United States.

In a news release, the group initially described its effort as an "accreditation program" to "help patients, employers and insurance companies identify which hospitals have the highest quality of care and the right processes and procedures in place to ensure patient safety during their entire patient experience."

But experts said accreditation is a term with a particular meaning in the world of international health care quality and should not be used lightly. Accreditation organizations say their goal is to address international medical travelers' quality concerns by holding hospitals to standards that transcend national boundaries.

Established bodies offering international health care accreditation, such as Joint Commission International, are in turn accredited by the Dublin, Ireland-based International Society for Quality in Health Care Inc. About 750,000 Americans traveled abroad for medical care last year, and that figure is expected to jump to 6 million by 2010, according to a recent report from the consulting firm Deloitte Center for Health Solutions. Renee-Marie Stephano, chief operating officer of the Medical Tourism Assn., said the group hoped to make its standards publicly available on the group's Web site, but a mid-September check of the site found no such information listed. The group plans to hire a firm to evaluate medical travel agencies on everything from informed-consent procedures to postoperative care arrangements.

According to an outline of the standards that Stephano provided to AMNews, agencies applying for certification will be judged partly on how they select surgeons and surgical facilities, what kind of network of practitioners and procedures they offer to patients, and whether they validate surgeons' credentials and outcomes.

Joint Commission International CEO Karen Timmons resigned from the MTA's advisory board after the accreditation program was launched. Timmons said she was "caught off guard" by the move and believes MTA "got a little bit ahead of itself" in announcing a program without being transparent about its standards, how the program would be field-tested and how the trade group would manage conflicts of interest.

About 175 hospitals in 30 countries are JCI accredited, Timmons said. The average survey fee is $30,000, and hospitals require 18 months to two years to qualify for accreditation.

MTA officials say their program is intended only to complement existing accreditation efforts and not to certify the quality of care in hospitals. But the group will offer its seal of approval to overseas hospitals' "international patient departments," which are in-house medical travel facilitators.

Timmons said that could be problematic.

"If you accredit a piece of an organization, it could be confusing to patients or other stakeholders not as knowledgeable about hospital accreditation," she said.

"Certification" also draws objections

In August, MTA changed its terminology from "accreditation" to "certification," which Timmons said is less troublesome.

But Kevin B. Weiss, MD, MPH, CEO of the American Board of Medical Specialties, was not so sanguine about the change.

"The use of 'certification' for the American public is very closely aligned with the idea of their doctors being board certified," Dr. Weiss said. "This will falsely assure potential users of the type of doctor they are getting without any standards comparable to the American certification system."

The MTA is not alone in looking to set medical-tourism standards. Another nonprofit, Los Angeles-based HealthCare Tourism International Inc., launched an accreditation system for medical travel agencies in June 2007. In July, it was relaunched as a "compliance program."

On its Web site, HTI says its mission is to "become the international authority on health tourism governance through the administration of a comprehensive accreditation system."

Another trade group, the Singapore-based International Medical Travel Assn., said it objects to such ad hoc efforts.

"The emergence of trade groups and others declaring themselves as quality accreditors or certification authorities not only threatens the integrity of existing organizations, but also creates market confusion at a time when global outsourcing of medical care is a growing phenomenon," IMTA President Steven Tucker, MD, said in a statement.

The American Medical Association House of Delegates adopted guidelines on medical tourism in June. The new policy says third-party payers should offer financial incentives for patients to receive care abroad only at institutions accredited by recognized international accrediting bodies such as JCI.

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Guidelines for care abroad

The AMA House of Delegates has spelled out guidelines for U.S. patients who receive medical care abroad. The new policy, adopted at the Annual Meeting in June, says third-party payers and medical travel agencies should follow these principles:

  • Medical care outside the U.S. should be voluntary.
  • Financial incentives to go outside the U.S. for care should not inappropriately limit diagnostic or therapeutic alternatives, or restrict treatment or referral options.
  • Financial incentives should be used only for care at institutions accredited by recognized international accrediting bodies (e.g., Joint Commission International or the International Society for Quality in Health Care Inc.).
  • Local follow-up care should be coordinated and financing arranged to ensure continuity of care.
  • Coverage for travel outside the U.S. for care must include the costs of follow-up care upon return.
  • Patients should be informed of rights and legal recourse before traveling outside the U.S.
  • Patients should have access to physician licensing and outcomes data, as well as facility accreditation and outcomes data.
  • Transfer of patient medical records should be consistent with HIPAA guidelines.
  • Patients should be provided with information about the potential risks of combining surgical procedures with long flights and vacation activities.

Source: "Medical Care Outside the United States," AMA Council on Medical Service Report 1 (A-08), as adopted (link)

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External links

Medical Tourism Assn. (link)

"Medical Care Outside the United States," AMA Council on Medical Service Report 1 (A-08), in pdf (link)

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