FORT LAUDERDALE _ Naples health-care leaders face many challenges if they decide to pursue a piece of the medical tourism market to bolster the local economy.
The headwinds include established programs at South Florida hospitals with Latin American connections, besides big-name hospitals in the United States and globally that began cornering the market years ago. They also rely on basic tourism appeal as a secondary draw.
"It's a pretty daunting task to do it well," said Dr. Aurora Estevez, chief medical officer for the NCH Healthcare System in Collier County. "For us, it's going to be about strategy. What differentiates us so people come (to us)?"
She estimates it could take two years of preparation for NCH and a support network to launch a medical tourism program locally.
This past week, Estevez attended the West Palm Beach-headquartered Medical Tourism Association's annual conference in the Fort Lauderdale area. It was the fifth year of domestic and international hospital representatives, insurance companies, travel and concierge groups coming together to network and eye the competition.
For some time, Dr. Allen Weiss, NCH's president and chief executive officer, has talked about broadening NCH's market scope, given that one in eight patients now come from outside the immediate region for elective medical care at the hospital system.
This past summer, NCH became the first Florida hospital to join the Mayo Clinic Care Network for consultations with some marketing opportunities using Mayo's name for a fee. Weiss and Naples Mayor John Sorey said that could help, along with what comes from a medical tourism committee set up by the Collier Convention and Visitors Bureau.
Estevez sees NCH focusing on orthopedics and open heart surgery as specialties to market to medical tourists. That's due to recognition by health-care ranking organizations for its top-notch quality and outcomes.
"It's going to be incremental," she said. "It's going to be engaging physicians. A lot of this has to do with networking and insurance companies."
She sees NCH having opportunities with patients from the Caribbean and Canada.
"There's an 18-week wait in Canada for an MRI," she said.
The east coast
The 400-bed Boca Raton Regional Hospital in Palm Beach County decided in July 2011 to start a medical tourism program. That's due in part from seeing how HCA East Florida, with hospitals from Palm Beach to Miami, and Cleveland Clinic Florida in Weston, have developed extensive programs, said Mindy Shikiar, vice president of business development for Boca Raton Regional.
"It really is a process. You have to take a look at your internal resources and what relationships you have with payers outside of the country," she said. "We didn't have any formal payer contracts to receive patients from outside the U.S."
One key is focusing on a couple of specialty areas to market, having physicians on board, and the staff to work with international patients from the first phone inquiry all the way through discharge, she said.
Boca Raton Regional hired a consultant to help with planning, and has since hired a full-time coordinator for international patient services, she said. In contrast, Cleveland Clinic has a whole department devoted to medical tourists.
Shikiar said marketing to date for Boca Raton Regional has been online only.
Also key is deciding which countries to target for patients.
"We picked Costa Rica and we are working with an air evacuation company in Cancun," she said. "You break into (a market) by being consistent. It is a lot of work. We're still getting off the ground. The first year was infrastructure and establishing contracts with different payers. Year two, we are now branding outside the country."
The 559-bed Holy Cross Hospital in Fort Lauderdale launched a medical tourism program a year ago; being in South Florida meant having visiting patients already, said Margarita Bazze, hospitality concierge for international services.
Canadians are important to Holy Cross, in part because of their Catholicism.
"We are Catholic and it makes them feel comfortable," she said. "If you want something, you have to invest in it and you have to have the personnel."
It's vital to have staff members who can speak the language and understand the cultures of international patients, along with addressing family members' needs. Medically, she said, patients from Latin American countries come for robotic surgery.
"That is why they are coming here (the U.S.). We have the technology," she said.
Outbound medical tourism
Hospital officials from some Central and South American countries take exception to assertions that their doctors, hospitals and quality aren't comparable to what's in the U.S.
"All our doctors in our hospitals, they came to the United States and studied," said Benjamin Romero, marketing director for the Institute of Cardiology in Bogota, Colombia. "So we have very good quality and we have the same technology. We have a special alliance with Cleveland Clinic. (It) started about 10 years ago."
His hospital started marketing to American patients five or six years ago, and now gets 20 to 30 patients from the U.S. a year.
The cost of open-heart surgery at his hospital is $15,000; hotel expenses and air fare from Florida could mean another $5,000, he said. About 80 percent of the patients coming from the U.S. are uninsured and pay out-of-pocket for their treatment.
"Colombia is 60 percent cheaper than the United States and 40 percent cheaper than Mexico and Brazil," he said. "Brazil is more expensive and too far from the United States. Everybody wants to sell their services and sometimes they don't have enough quality."
Puerto Rico is able to brand its medical tourism with U.S. accreditation standards and physician specialty board certifications because it's a U.S. territory, said Josephine Vidal, manager of HIMA Health, which has four hospitals and 1,100 beds. "The cost is 50 percent to 70 percent. A knee replacement in Puerto Rico costs $12,000."
The hospital system has seven contracts so far with self-insured companies in the U.S., so employees come to Puerto Rico for less-expensive care.
"We have very low costs but we can promise the quality," she said.
Nicaragua hopes to break into medical tourism with Americans and Nicaraguans who live in the U.S., but who may return to their native country for services, said Arlen Perez, medical tourism manager for the 42-bed Hospital Metropolitan Vivian Pellas in Managua.
"We have excellent prices and we are so close to the United States," Perez said.
Her focus is on Florida and California because of their Latin American populations. A knee replacement surgery is around $10,000, not including travel to Nicaragua.
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Marketing to the U.S. is limited to websites. She plans to have testimonials from patients to help convince people the country is safe, she said.
"You will find drugs and crime in every country," she said. "We are the safest country in Latin America."
It's all in the marketing
Josef Woodman, president of Patients Beyond Borders, a Chapel Hill, N.C.-based consumer resource group for international medical care, acknowledges marketers with international hospitals say their medical care is high quality at the best prices.
"Around 30 hospitals compete for inbound medical tourism. How can Naples strut its stuff? Las Vegas is trying to get into the game. How does Vegas tell its story? The first thing you have to have is great care and specialty care. If you have that, you have the beginnings of a story to tell."
Cleveland Clinic in Ohio branded itself with its open heart program, M.D. Anderson Cancer Center in Houston did the same for cancer treatment and Duke Medical Center is about sports medicine, he said.
His group estimates that one million Americans travel outside of the country for medical care and about 600,000 international patients come to the U.S. for medical care.
"To get started, you've got to have a song to sing so you get a lot of international visitors," he said. "So what is it about Naples?"