1. Stacy Brethauer, MD Bariatric and Metabolic Institute

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. 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 Medical Tourism

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

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. 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 ASMBS Recommendations

20. Thanks