Ophthalmology Business

MAY 2013

Ophthalmology Business is focused on business topics relevant to the entrepreneurial ophthalmologist. It offers editorial, opinion, and practical tips for physicians running an ophthalmic practice. It is a companion publication of EyeWorld.

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For surgeons, medical tourism can be a way of adding revenue to a practice, but can also be a means of improving surgeons' "brand," Mr. Edelheit said, by noting people from around the world seek out their particular services. One clinic in Cuba performs more than 30,000 procedures yearly on Russian travelers; Mr. Edelheit said some travel agencies now specialize in putting together vacation-surgery trips. Smaller but growing demographic A third contingency comprise people who are returning to their home country for surgery. "That's a particularly common situation for our patients in south Florida," said William Trattler, MD, in private practice, Miami, whose patient base is surprisingly "comfortable" leaving the U.S. to have an elective procedure in their home country—including laser vision correction. "There are a number of outstanding surgeons in central and South America who have advanced laser technologies that are similar to what is available in the U.S.," he said, and for patients who travel it may be because "they have more family support during and after their procedure." Likewise, the Wellington Eye Clinic (Ireland) has patients who opt for surgery "back home," and those patients have mostly been referred by friends or family, said Arthur Cummings, MD. "They have a backup at home while recovering from their surgery; once they've returned here we treat them like we do our own except that we bill them for their visits. Our own patients who had LASIK with us don't have follow-up costs for one year following the surgery." Those details should be considered and patients need to be educat- ed about those topics, Mr. Edelheit said. Bilateral LASIK costs about $4,400 in the U.S., $2,000 in Colombia, $500 in India, but $5,000 in Jordan and $6,000 in Korea. Making medical decisions based on price (or destination) alone is illadvised, Mr. Edelheit said. His group encourages its clients "against going overseas on a whim. We tell patients to get the right diagnosis—both by the domestic and the foreign physician—and ensure the local doctor will continue follow-up upon their return." If those criteria cannot be met, Mr. Edelheit advises against the surgery. Complication management Both Drs. Trattler and Cummings noted that as with any ocular surgery, there may be complications. Dr. Cummings is a bit less sympathetic when problems crop up if the patient has opted for surgery elsewhere simply based on price. That said, however, "if we manage the problem and treat them well at the same time, they are very likely to advise their friends to come and see us instead of travelling after the apparently cheaper deal elsewhere," he said. A good percentage of Dr. Trattler's practice involves providing second opinions, so while his approach to evaluating and treating the patient remains the same regardless of where the surgery occurred, obtaining records from foreign colleagues has proven difficult unless Dr. Trattler has a personal relationship with the treating surgeon. When patients "end up off target, they need to schedule a return international trip for an enhancement procedure with their home country physician," however, when issues such as epithelial ingrowth or ectasia develop, patients have to decide whether to return home or have their condition treated locally, Dr. Trattler said. "We have an approach that any patient who sees us for a second opinion or in a similar scenario to that outlined before is a golden opportunity to show off our skill sets and technology but also our caring and service side, and that's far more likely to generate business for us" than berating the patient for seeking surgical expertise elsewhere, Dr. Cummings said. Dr. Cummings also suggests patients' return to the original surgeon where possible for enhancements. His main concern is that he often has no idea "what I might encounter—previous flap size, flap thickness, bed quality, residual bed thickness, etc.—so the surgery is in fact a little more challenging" in those kinds of enhancement cases, he said. For physicians interested in becoming a "go-to" source for medical tourism patients, Mr. Edelheit suggested contacting some of the larger brokers who work with networks of hospitals, clinics, and other providers in dozens of countries as well as hundreds of employers. OB References 1. National Travel Health Network and Centre. Medical Tourism. August 2011. www.nathnac.org/pro/factsheets/medicaltourism_010911.htm. Accessed Oct. 11, 2012. 2. YourSurgeryAbroad.com. Medial Tourism Report: United States of America. July 2009. www.yoursurgeryabroad.com/research. Accessed Oct. 11, 2012. Contact information Cummings: abc@wellingtoneyeclinic.com Edelheit: jon@medicaltourismassociation.com Trattler: wtrattler@gmail.com May 2013 • Ophthalmology Business eZine 13

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