Not only can physicians treat patients in remote or underserved regions, but they can also tap into a market of international patients who want access to specialty care in the U.S. without getting on an airplane.
Children's Mercy Hospitals and Clinics, Kansas City, Mo., made the foray into international medicine nearly a decade ago when it forged a partnership with Guangzhou Women's and Children's Hospital in Guangdong province, China. Its first international collaboration was a way to provide educational and training opportunities for clinicians and administrators.
But during the past two years, Children's Mercy has sought to build on that relationship. In May, it signed two deals with Zhujiang (Pearl River) Hospital, also in Guangdong province—one that establishes a sister relationship with the medical center as well as another agreement to provide imaging consultation services.
Karen Cox, executive vice president and co-chief operating officer at Children's Mercy, notes that the partnership is not only a way for the organizations to share expertise, but also establish a formal business agreement in the country. “We feel like we need to be able to do both,” Cox says. “We want to be able to monetize the relationship in some way.”
Compared with 263-bed Children's Mercy, Pearl River is a mammoth 2,000-bed hospital, with 500 pediatric beds.
“They've got a lot of patients; they've got a lot of complex cases,” says Dr. James Brown, chairman of the radiology department at Children's Mercy. “It opens up discussion on interesting cases they send us.”
Children's Mercy has about 20 pediatric radiologists who read imaging scans from Pearl River. Brown acknowledges that there are financial drivers behind the partnership, but says, “My primary motivation for doing this is offering my expertise to other hospitals.”
Children's Mercy was already using SeeMyRadiology, a cloud-based program for medical image sharing. The technology allowed the medical center to quickly download scans from U.S. patients who were referred or transferred from other facilities, such as in cases of severe trauma, sometimes before the patient even arrived.
Expanding its use internationally, Cox says, was “such a win-win for everyone because you can share the fixed costs over many organizations.”
The increasing purchasing power of the middle class in countries such as China means that more patients have the means and opportunity to pursue treatment from Western medical centers. “They're paying readily to get the best healthcare in the world,” says David Jahns, managing partner at venture capital firm Galen Partners, which invests in telemedicine technology companies.
And that means U.S. medical centers, particularly large academic institutions, are making a concerted effort to build their brands abroad. “It's 100% financially motivated,” Jahns says. “This is a great way for the U.S. to export what we have an advantage in.”
Payment can be better than reimbursement in the U.S., as patients are either self-pay or have government health plans. Physicians can also bypass the additional licensing and paperwork they would need if they were going to expand their practices in another state.
“It's actually easier to do telemedicine internationally than across state lines,” Jahns says. In the U.S., “getting reimbursed for telemedicine—even if it is lower-cost—is very difficult to do.”
Among Galen Partners' investments is InTouch Health, Santa Barbara, Calif., which makes the robots used in the cardiology program at Shanghai East. The company launched in the international market about two years ago and has seen a “tremendous appetite” for Western expertise in fields including plastic surgery and trauma care, says Michael Chan, general manager, international, at InTouch.
While videoconferencing technology has been available for some time, the next frontier is clinical validation—the ability for physicians to take a full physical or even perform robotic surgery from thousands of miles away. The availability of technology also means that academic medical centers no longer have a first-mover advantage in emerging markets. “Healthcare today is unbounded,” Chan says.
Chan adds that “healthcare reform is a global phenomenon,” pointing to China's pledge to build 20,000 hospitals to meet its growing demand. The healthcare sector in China is undergoing “massive restructuring and growth,” Chan says. “I think that's creating opportunities.”
The UCLA Health System conceived the idea for its telepathology program in late 2010, and has performed nearly 900 cases since its launch in early 2011. UCLA partners with Zhejiang University, which operates a tertiary-care center in China with a network of smaller campuses, to read biopsies including prostate and gastrointestinal tract. It also has agreements in place with private laboratories in China.