Today capitation, tomorrow the world.
While most providers are preoccupied with the rigors of managed care, network formation and declining reimbursement, a growing number are turning their atte ntion to international ports of call.
The same goes for consultants, insurers, pharmaceutical companies and others looking for some relief from an American healthcare system that's choking on cost containment.
About 65 of the curiou s and the committed met earlier this month in San Diego to discuss the hows and whys of exporting managed care and healthcare services. The Institute for International Research-sponsored event brought together an odd mix of healthc are executives, including:
Lisa Finkelstein, newly appointed international marketing director for the University of Pennsylvania Health System. The system has a excellent worldwide reputation for medical research but has done litt le to formally recruit patients from overseas.
"We need to examine the links that our institution has with foreign physicians and build a patient referral program," she said.
Deloitte & Touche consultant Susan Bolles, who took time off from an assignment for Kaiser Southern California to investigate international opportunities for the firm.
"I'm on an international task force, but right now all of us are so busy on domestic assignments that we volunteer our time," said Bolles, who is based in Seattle. "All I know is that many of our foreign offices are receiving healthcare assignments and are pleading for assistance from the U.S."
Lawrence S. Brewster, chief executive officer of Health Resource and Technology. The Boston-based company offers a PPO network for international companies and insurers that send patients to healthcare facilities in the United States.
A pair of home boys: Russell Bennett, Sharp HealthCare's international services director, and Steven Goe, ScrippsHealth's vice president of international business. Both San Diego-based systems are pioneers in attracting affluent, private-pay patients from south of the bor der. Each also offers consulting and management services to Latin American providers and government-run healthcare programs.
When looking at Mexico, Bennett sees opportunities in building or managing specialty services (like diagnos tic imaging), hospital hotel services, outpatient centers, urgent care in resort areas, continuing-care retirement communities, telemedicine networks and medical equipment distribution.
ScrippsHealth tries to stick with selection cr iteria before entering an international market. Some of the rules of the road include a medically underserved population, a high density of expatriate U.S. executives, close relationships with ScrippsHealth physicians or board memb ers, convenient transportation and a stable political/economic climate.
Despite the strategic map, Goe admits "it is hard to say no when you are approached by investors with deep pockets." He candidly cited a hospital development deal in strife-torn Guatemala that remains stalled after a year of civil turmoil and government foot-dragging.
"We broke most of our own rules," Goe said. "Discipline must drive your international decisions. Despite our many suc cesses, we've also had to learn from our mistakes."
Charlie Floto, international relations director of St. Luke's Episcopal/Texas Heart Institute. The Houston hospital's relationship with noted cardiac surgeon Denton Cooley, M.D. , has helped attract a steady flow of international patients. Floto estimated they generate 5% of the inpatient volume and 9% of the hospital's annual revenues. Profit margins of 25% or more are expected from each foreign patient.
H e said simplified billing, superb customer service and strong commitment from staff physicians drive the program.
"Physicians took 65 trips overseas last year on our behalf and at our expense," Floto said. "But these are not vaca tions. The physicians visit colleagues and former patients. They are expected to file reports. The success of our program is based on relationship marketing and accurate, timely billing."