Stacy Brethauer , MD Bariatric and Metabolic Institute

1. Stacy Brethauer, MD Bariatric and Metabolic Institute Medical Tourism for Bariatric Surgery

4. The Issue • Large number of patients who travel long distances for medical care • International • Across states or regions • Over 1.1 million Americans traveled abroad for medical care in 2009 • Interest has spurred a medical tourism industry • Match patient, procedure, destination

7. Motivations for Medical Tourism • $$$ • Can offer medical care and surgical procedures at prices 40-80% less than in patient’s home region • Long wait times at home • Lack of surgical expertise at home • Procedure/device not available at home due to regulatory issues

10. Medical Tourism • Some employers and insurance company offer incentives to patients who are willing to travel for medical care • Developed healthcare systems haven’t dealt with this yet • Prior to ASMBS position statement, no formal guidelines regarding medical tourism for bariatric surgery

11. Other Medical Societies • American Medical Society • American College of Surgeons • Emphasize accreditation of facilities • Board certification of physicians • Documentation available for physician providing follow-up • Proper informed consent policies • Protecting privacy and confidentiality • Insurance coverage for f/u and complications • Recognize risks of traveling for surgical procedures

12. International Accreditation Bodies • Joint Commission International (JCI) • Trent International Accreditation Scheme (UK) • International Society for Quality in Healthcare • International Organization for Standardization (ISO • International Bariatric Surgical Review Committee (IBSRC)

13. International Accreditation Bodies • 1000% increase in JCI accredited hospitals in last 5 years • 250 JCI hospitals in 36 countries, up from 25 hospitals in 2004

14. Bariatric Surgery • Treating a chronic disease • Preoperative education • Medical optimization prior to surgery • Continuity of care • Long-term follow-up • Procedure-specific risks • Need for revisional procedures

15. Medical Tourism and Bariatric Surgery • Who pays for the complications?

17. ASMBS Recommendations • Medical tourism/extensive travel for bariatric surgery should be discouraged unless appropriate f/u and transfer of information arranged • Opposes mandatory referral over long distances if expertise available locally • Opposes creation of financial incentives that make this the only viable option for the patient

18. ASMBS Recommendations • If patients choose to travel long distance for bariatric surgery • JCI or bariatric surgery COE • Board certified or equivalent surgeon • Investigate surgeon outcomes • f/u care covered by insurance or supplemental plan • Ensure transfer of medical records • Establish plan for f/u care and nutritional monitoring • Recognize increased risk for VTE • Recognize risk of endemic infectious diseases • Recognize limitations in preoperative education, preparation • Recognize legal redress for medical errors across international boundaries is very difficult

20. Thanks