Dr. ThomasParisi, who spent less than 24 hours in Cancun, was paid $2,700, orthree times what he would get from Medicare. (Photo:Shutterstock)

CANCUN, Mexico — Donna Ferguson awoke in the resort city ofCancun before sunrise on a sweltering Saturday in July.

She wasn’t headed to the beach. Instead, she walked down a shorthallway from her Sheraton hotel and into Galenia Hospital.

A little later that morning, a surgeon, Dr. Thomas Parisi, whohad flown in from Wisconsin the day before, stood by Ferguson’shospital bed and used a black marker to note which knee neededrepair. “I’m ready,” Ferguson, 56, told him just before being takento the operating room for her total knee replacement. For thissurgery, she would not only receive free care but would receive acheck when she got home.

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The hospital costs of the American medical system are so highthat it made financial sense for both a highly trained orthopedistfrom Milwaukee and a patient from Mississippi to leave the countryand meet at an upscale private Mexican hospital for thesurgery.

Ferguson gets her health coverage through her husband’semployer, Ashley Furniture Industries. The cost to Ashley was lessthan half of what a knee replacement in the United States wouldhave been. That’s why its employees and dependents who use thisoption have no out-of-pocket copayments or deductibles for theprocedure; in fact, they receive a $5,000 payment from the company,and all their travel costs are covered.

Parisi, who spent less than 24 hours in Cancun, was paid $2,700,or three times what he would get from Medicare, the largest singlepayer of hospital costs in the United States. Private health plansand hospitals often negotiate payment schedules using the Medicarereimbursement rate as a floor.

Ferguson is one of hundreds of thousands of Americans who seeklower-cost care outside the United States each year, with manygoing to Caribbean and Central American countries. A keyconsideration for them is whether the facility offers qualitycare.

In a new twist on medical tourism, North American SpecialtyHospital, known as NASH and based in Denver, has organizedtreatment for a couple of dozen American patients at GaleniaHospital since 2017.

Parisi, a graduate of the Mayo Clinic, is one of about 40orthopedic surgeons in the United States who have signed up withNASH to travel to Cancun on their days off to treat Americanpatients. NASH is betting that having an American surgeon willalleviate concerns some people have about going outside thecountry, and persuade self-insured American employers to offer thisoption to their workers to save money and still providehigh-quality care.

NASH, a for-profit company that charges a fixed amount for eachcase, is paid by the employer or an intermediary that arranged thetreatment.

“It was a big selling point, having an American doctor,”Ferguson said.

The American surgeons work closely with a Mexican counterpartand local nurses. NASH buys additional malpractice coverage for theAmerican physicians, who could be sued in the United States bypatients unhappy with their results.

“In the past, medical tourism has been mostly a blind leap to acountry far away, to unknown hospitals and unknown doctors withunknown supplies, to a place without U.S. medical malpracticeinsurance,” said James Polsfut, the chief executive of NASH. “Weare making the experience completely different and removing as muchuncertainty as we can.”

Medical tourism has been around for decades but has become morecommon in the past 20 years as more countries and hospitals aroundthe world market themselves to foreigners.

There are, of course, risks to going outside the country,including the headache of travel and the possibility that thestandards of care may be lower than at home. If something goeswrong, patients will be far from family and friends who can help —and it might be more difficult to sue providers in othercountries.

Chasing lower costs

The high prices charged at American hospitals make it relativelyeasy to offer surgical bargains in Mexico: In the United States,knee replacement surgery costs an average of about $30,000 — sometimes double or triple that —but at Galenia, it is only $12,000, said Dr. Gabriela Flores Teón,medical director of the facility.

The standard charge for a night in the hospital is $300 atGalenia, Flores said, compared with $2,000 on average at hospitals in the United States.

The other big savings is the cost of the medical device — madeby a subsidiary of the New Jersey-based Johnson & Johnson —used in Ferguson’s knee replacement surgery. The very same implantshe would have received at home costs $3,500 at Galenia, comparedwith nearly $8,000 in the United States, Flores said.

Galenia is accredited by the internationalaffiliation of the Joint Commission, which sets hospitalstandards in the U.S. But to help doctors and patients feelcomfortable with surgery here, NASH and Galenia worked to go beyondthose standards.

That included adding an extra autoclave to sterilize instrumentsmore quickly, using spacesuit-like gowns for doctors to reduceinfection risk and having patients start physical therapy justhours after knee- or hip-replacement surgery.

I. Glenn Cohen, a law professor at Harvard and an expert onmedical tourism, called the model used by NASH and a few othersimilar operations a “clever strategy” to attack some of theperceived risks about medical tourism.

“It doesn’t answer all concerns, but I will say it’s a big stepforward,” he said. “It’s a very good marketing strategy.”

Still, he added, patients should be concerned with whether thehospital is equipped for all contingencies, the skills of othersurgical team members and how their care is handed off when theyreturn home.

Officials at Ashley Furniture, where Ferguson’s husband, Terry,is a longtime employee, said they had been impressed so far. Thecompany offers the option of overseas surgery through NASH at nocost — and with an incentive.

“We’ve had an overwhelming positive reaction from employees whohave gone,” said Marcus Gagnon, manager of global benefits andhealth at Ashley, a Wisconsin-based company with 17,000 employees.Ferguson was the company’s 10th insured person to go to Cancun.

Ashley also has sent about 140 employees or dependents fortreatments at a hospital in Costa Rica, and together the foreignmedical facilities have saved the firm $3.2 million in health costssince 2016, he said.

“Ever after the incentive payments and travel expenses, we stillsave about half the cost of paying for care in the United States,”Gagnon said. “It’s been a nice option — not a magic bullet — but anice option.”

NASH’s strategy has its skeptics.

“Building a familiar culture in a foreign destination may beappealing to some American consumers, but I do not see it as asustainable business,” said Irving Stackpole, a health consultantin Rhode Island. “It’s not unusual for people thinking about thisto have doctors, family and friends who will see this as ahigh-risk undertaking.”

Stackpole said only a limited number of Americans were willing —even with a financial incentive — to travel abroad because mostperceive the care won’t be as good.

‘You Are Nuts For Doing This’

Ferguson’s knee started causing her trouble two years ago, andlast fall a doctor recommended replacing it. She is on her feetmost of the day assembling furniture toolkits at her job atAmerican Furniture Manufacturing in Ecru, Miss. Terry Fergusonmentioned the Cancun option he had heard about at work. The couplepay $300 a month in premiums for family health coverage.

“I had a friend say, ‘You are nuts for doing this,’ but Dr.Parisi trained at Mayo, and you can’t do any better than that,”Ferguson said before the surgery. Also, having an American doctormeant that if something went wrong, she could file a malpracticesuit in the United States, she added.

IndusHealth, Ashley’smedical travel plan administrator, arranged for her to get aphysical exam, knee X-rays and heart tests near her home to makesure she was a good candidate for surgery. It even had her see a dentist to make sure she didn’t have an infection thatcould complicate her recovery. Parisi reviewed some of thoserecords before Ferguson headed to Cancun.

The company also coordinated her medical care and made travelarrangements, including obtaining passports, airline tickets, hoteland meals for the couple.

In Mexico, the day before surgery, Ferguson had more X-rays andhad her blood drawn. After lunch, the couple met with Noemi Osorio,a nurse, who reviewed Ferguson’s schedule and showed her thephysical therapy facilities. Later, they met Parisi and the rest ofthe medical team.

“My job is pretty easy,” Parisi told her. “How you do over thenext five or 10 years depends on how well you work with thephysical therapy.”

The surgery began at 8:20 the next morning. Dr. Daniel Rios, anorthopedic surgeon who practices full time in Cancun, worked withParisi. Rios, who had done a fellowship at Brigham and Women’sHospital in Boston, checked on Ferguson for several days after theoperation.

By 9:30 a.m., the operation was over, and at 11 a.m. she leftthe recovery area. Parisi checked on her there. “Everything wentgreat,” he told her before heading to the airport for his 2:30flight home.

Parisi said that the lack of English proficiency among somesurgical staff members created “momentary delays” but that thebilingual surgical assistant helped.

A little more than three hours after the surgery, Ferguson wasin her hospital room, and a physical therapist came and helped herout of bed. Using a walker, she gingerly took some steps to testout her new knee. By the next morning, she was on crutches walkingthe hallway and was discharged before noon. She stayed at her hotel10 additional days while having physical therapy twice a day at thehospital.

“It’s been a great experience,” she said two days after thesurgery. “Even if I had to pay, I would come back here because it’sjust a different level of care — they treat you like family.”

Kaiser HealthNews (KHN) is a national health policy news service. It is aneditorially independent program of the Henry J. Kaiser Family Foundation whichis not affiliated with Kaiser Permanente.

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