After Care

Comment

Comment by Zoumanan Debe on November 8, 2009 at 11:32pm

Yes Dr Collins. The best aftercare start during the preoperative period. We are also a Canadian based organization ( debsonmedicaltourism) and our main focus is to motivate and raise awareness on patient management. Christina, your definition of aftercare is potentially right, however from experience , the better the risk assessment is done before surgery the better the aftercare will have a positive outcome when the patient return home with a clear guideline. This is where our company comes in with the use of telehealth by nurses to provide support pre and post operative. Dr Collins, I would like to discuss more with you. You could email me at zdebe@debsonmedicaltourism.com

Comment by Christina deMoraes on October 19, 2009 at 3:51pm

Hello Dr Collins! Yes, the Aftercare must be set up before they leave AND an integrated part of their experience. Maybe to clarify here, there seems to be a little confusion, my understanding is AFTERCARE is the care they receive in the post op period of their stay, between being discharged from the hospital and awaiting clearance to return home to their country. CONTINUUM of CARE is the care that should also be waiting for them on their return home, whether that is understood to be via their PCP or some other set up care. BOTH should be recognized by MTF's and included as part of their patient's care without room for discussion! Again, my experience is that when the patient is explained to that the DOCTOR is mandating this and helping structure it uniquely for the patient, in their best interest, I have never had a patient refuse. And the one or 2 that might balk, well, trust me, you don't want them anyways. =)

Comment by T. Rand Collins PhD MD on October 19, 2009 at 3:35pm

I have just joined the group, and think that this discussion is highly relevant. I have just joined International Health Care Providers, a highly successful Ontario-based company linking Canadians with US facilities. One of the things that attracted me to Kelly Meloche, IHCP's CEO, is her insistence that aftercare be set up before the the patient leaves Canada. I have talked with one facilitator in this business who seems to view patients as commodities to be packaged and sold; this is upsetting to contemplate.

Comment by Christina deMoraes on October 13, 2009 at 7:11pm

Hello Again Kevin,
My, ahem, speech (LOL!) was directed at everyone here and to give less experienced MTF's the "courage" if you will that these types of services need to be integrated into the value of the package and that patients WILL accept it, but it DOES have to become more standard practice! YOU are obviously on the right track and I fully encourage those MTF's that feel the calling to provide the most complete and medically appropriate care to their patients, absolutely begin to TELL THEM WHAT THEY NEED. Because, as you said, they really have NO idea until they're in it! And we don't want it to be too late by then....

My Email is cmd@MedNetBrazil.com my Skype is MedNetBrazil
Blessings,
Christi deMoraes
www.MedNetBrazil.com

Comment by Dr. Kevin Huffman on October 13, 2009 at 6:37pm

Hello Christina,

Thank you for taking time to draft your informational response. I would like to arrange a conference call with you and my partner Michael DiFranco. Please email him at mdifranco@ibarihealth.com in order to set up a brief conference call to get acquinted. He will be able to talk about your suggestions below and provide you more program information that you potentially could integrate into your service packages. Thanks again. Also, what is your email address?

Dr. Huffman

Comment by Christina deMoraes on October 13, 2009 at 5:14pm

Hello Dr Kuffman,
I agree with you! Many of my patients came for bariatric procedures as well, and I am a successful post op WLS patient myself, so I knew first hand what my patients would face immediate post op and returning home, but I also knew they needed and wanted a procedure that they could not make happen in the USA. MY passion in implementing IN COUNTRY aftercare services as well as providing a way to "enlist the support" via my protocol, of the home PCP to assist with FOLLOW UP care once home, has been exactly that, raising the bar that doesn't even truly exist stateside. Long term outcomes are always given a better chance at success if short term care, instruction and support is available.

I think a FOLLOW UP or CONTINUUM OF CARE package such as your company is offering is WONDERFUL and I have done this from day ONE. I felt it medically and ethically appropriate in making it KNOWN to my patients (and providers) that AFTERCARE services are EXTRA, they are a specialized service APART from the surgery costs and an absolutely essential PART of their surgical procedure. When their individualized Treatment Plan is created for them upon their inquiry, the surgeon tells me exactly what kind of therapies, treatment, support, etc they will need based on his evaluation of them and this is passed to the patient with a separate price (every patient has different needs and post op issues). Let me tell you that I have NEVER had a patient refuse ANY post op treatment or service that was recommended to them by the surgeon!!

Even those MTA's out there that aren't so new (and I say new because I started 8 years ago!) I see are #1 AFRAID to be FIRM with their patient and tell them this is what they need and WHY, thinking they won't appreciate that. (They DO, believe me!). #2 as you say, they are looking to quote the lowest price to get them on that plane and don't really concern themselves or are even conscious of what these additional costs will be for the patient post op once there.
Again, I reiterate, you must sell the whole package and you MUST be responsible for their entire experience. Patients just need explanation as to WHY this is the protocol with your company and your surgeons. When they see you are setting yourselves apart and holding firm to your ethics for THEIR ultimate benefit AND you get the support of your surgeon/provider to help INSIST on these extra services, THEN you are performing a true service. Otherwise, we become just a bunch of glorified travel agents. =(
I constantly have to explain to my patients that MY quote is a COMPREHENSIVE one and it includes ALL of their care that the Doctor mandates including hotel stay because HE determines recovery period before issuing a travel release! MTF's must NOT be afraid to be firm and you MUST make sure they are comparing apples to apples!
Everyone will benefit this way, your patients FEEL attended to and that their care will be medically thorough and complete (something they don't get in their own country!). Your surgeons will thank you because you are taking this aftercare load off of them and their staff AND you are actually insuring his results in caring for the patient post op to avoid complications! You will look good because you show you KNOW what that patient will go thru and have thought of things not even THEY could think of. And, of course, the bottom line... if "sold" properly and made clear that it is separate but not independent of the procedures, it can actually be another small stream of income.
Kevin, I would be most interested in getting information on your package and NO trepidation whatsoever in selling it as part of MY patient's package. =)
Blessings,
Christi deMoraes
MedNetBrazil Concierge Services
www.MedNetBrazil.com

Comment by Dr. Kevin Huffman on October 13, 2009 at 10:52am

Hello to All My Fellow Members,

It is very encouraging to hear these hearty discussions about aftercare and the obvious gap in care once the patient returns home from the host country. We all agree that the primary care doctor should play an active role and for patients who receive bariartic surgery, the follow up and professional support required is even more intensive to make the surgerical tool work for life. We have seen how patients relapse and regain weight due to unaddressed habits or experience complications etc.

I am a member of the MTA's aftercare committee who is stirving to develop new standards and guidelines for aftercare that will raise the bar on patient safety, reducing risk, and improving long term outcomes.

However, while we all echo one another on the need for better aftercare protocols and standards, it does seem to boil down to a 'cost added' discussion. My company iBariHealth does provide a comprehensive aftercare program solution for US traveling bariatric patients that includes a home based team of registered nurses, dieticians, and exercise specialists who work with the bariatric patient once they return home to the US. While program like ours fit perfectly to meet all of the gaps in care, it comes down to MTFs ability to either upsell the aftercare package or find other creative methods to market/sell the medical necessity of aftercare to a cash strapped patient who can barely afford the core surgery. Not to mention most Americans underestimate the work required after surgery and just want the quick fix and don't think about aftercare/follow up and the vital role it plays.

SO, this is the dilemma that we all face. An obvious need/outcry for better continuity of care, an available high quality aftercare solution, but push back from MTFs on intergrating aftercare into the surgical package price for fear of a higher package price putting them out of competative range and losing the sale. The big influx of new MTFs has created more supply and in turn price deflation has almost squeezed out the viablity of any program improvements.

I welcome your thoughts on this topic as it will take a united voice to raise the standards of care in the face of commercial pressures.

thanks everyone

Dr. Huffman
440-610-2030
drkdhuffman@earthlink.net

Comment by Christina deMoraes on October 12, 2009 at 11:16am

I would also like to comment on Cherie's comment about physicians denying care once the patient returns and needs some type of accompaniment. I saw the huge necessity of this when building my services. I created a protocol that included a very detailed Treatment Plan that described every medical aspect of their procedures AND aftercare therapies. I did this for many reasons: make the patient AND their PCP realize we were being extremely thorough and medically appropriate, affording my foreign providers the respect of their colleagues who have to "sign off" on this plan AND provide pre-op tests and surgical risk letter for their patient. Now the PCP knows the excellent care and protocol their patient will be subjected to, they "sign off" on it and provide their own assessment of the patient's ability to undergo surgery with pre-op tests we request AND, I feel, are now somewhat ethically bound to provide follow up for the patient in realizing that all precautions were taken to provide the best medical care and attention to the patient. Let's face it, complications can happen anywhere and we always went above and beyond to try to minimize the risk and earn respect in the medical field.

Christi deMoraes
www.MedNetBrazil.com

Comment by Christina deMoraes on October 12, 2009 at 11:06am

Hello, I am responding to the request for those of us that are offering medically complete and thorough Aftercare Services in destinations come forward and make ourselves known. Hopefully this will stimulate some discussion too as this group has been quiet for a while!

First of all, allow me to introduce myself, I am an American, my name is Christi deMoraes and I have been operating my Medical Concierge Services out of Brazil (based and living there) for almost 8 years now. My company has been offering medically complete and thorough Aftercare and in-country Support Services in Brazil for almost 8 years with USA and Brazil based companies. My US website is www.MedNetBrazil.com. I consult for and can offer Aftercare and in-country services to my fellow MTFs from a unique perspective because

#1 – I have personally built BOTH sides of my services. I DO what YOU do as an MTF AND I operate in the country to accompany the patient. I know we must control the entire experience for our patients to assure their satisfaction with their results and US as MTFs.
#2 – In hand-holding 200+ patients thru this journey, I have seen first hand the importance of thorough and complete Aftercare and support services as well as what happens without it.
#3 – I have spent 8 years as a cultural, social, business, economic and medical liaison and consultant between my patients, my company and my Latin/Brazilian providers, linking very different mentalities and providing tools to each for the ultimate benefit of all parties involved.

I began sharing my experiences in creating specialized Aftercare services with Renee here and other people in the industry, including the book authors on MT years ago, trying to get the industry to understand that the in-country part of the patient's journey is what makes or breaks their experience. Unfortunately I became very ill last year and I missed the immense honor of presenting on this topic at the MTA conference in San Francisco last year. Now that I am back and getting active here, I am pleased that MTA and others are recognizing the importance and forums like this are available.

In my 8 years experience I can unequivocally state that it is the period of time between being discharged from the hospital back to their hotel and the time they get back on the plane to come home, that MAKES or BREAKS their experience. Forgive me but, the accreditation, membership or reputation of the hospital or doctor no longer matters. This is the time when truly 98% of most complications will arise, however they can be managed; seromas, wound infections, popped stitches, etc. Psychological factors also complicate the recovery; depression can set in, they are in an unfamiliar and foreign place, lonely, in pain or discomfort, insecure, questioning themselves, their wings are clipped, they want to go home so they push themselves and end up compromising their return. Now they either go home with a complication (and their PCP saying, "I told you so!") or they have to stay longer, increasing their expenses (they were going to SAVE $ by going abroad!) and dissatisfaction.

Realizing that what happens once they are in the host country is OUR responsibility and being an active participant IN the country WITH your patient and accompanying them medically, socially, culturally and logistically, controlling as much as possible of their ENTIRE stay is key to running a successful operation with integrity and transparency. Since most of us cannot, we MUST as MTFs work with a team of reliable in-country service providers that we TRUST and can train to take care of OUR client as they would their own. They must have proper training to care for the patient we send them but ALSO to act as OUR advocate and our representative, because, “if they don’t look good, we don’t look good!” And it is the patient's ultimate satisfaction with their TOTAL care that will determine the success of Medical Tourism.

Comment by Cherie Bright on September 29, 2009 at 4:16am

I think it is medical malpractice to deny care. Very few physicians care for a patientt through all of their medical needs. When someone is disatisfied with one physician, patients go to other physicians. I don't think patients should be accepted or denied care based on who the previous physician was or who last saw them. This practice also dicourages patients from providing correct history which can create major problems.

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