What do foreign medical facility operators need to know in order to meet the American Medical Association(AMA)'s recommended guidelines? The AMA has developed recommendations for patients seeking care Internationally.
(Reference: Medical care outside the United States, AMA Council on Medical Service Report 1 (Resolutions 711 and 732, A-07).
Available at http://www.ama-assn.org/ama1/pub/upload/mm/372/a-08cms1.pdf).

The recommendations discuss 9 major points.

• Medical Care Outside U.S should be voluntary.
• Financial Incentives to go outside US for care should not inappropriately limit diagnostic and therapeutic alternatives or restrict treatment referral options.
• Financial incentives should be used for care only for care at institutions accredited by recognized international accrediting bodies.
• Local follow up care should be coordinated and financing arranged to ensure continuity of care.
• Coverage for Travel outside US for care must include costs of follow up upon return
• Patients should be informed of rights and legal recourse before traveling outside the US for care.
• Patients should have access to physician outcome data, as well as facility accreditation and outcomes data.
• Transfer of patient medical records should be consistent with HIPAA guidelines.
• Patients should be provided with information about the potential risks of combining surgical procedures with long flights and vacation activity.

Properly disclose all information to patients by providing options:
The AMA discusses four areas of disclosure of information to occur for patients: financial incentives, legal issues such as patient rights and legal recourse, Quality data on the provide and the facility, and patient specific information to optimize outcomes.

Provide aftercare
The AMA guidelines for Medical Travel outside the US state discuss that after care should be planned and financed prior to departure. A new system of billing for private payers is not necessary and they are encouraged to recognize existing CPT codes and with modifier codes.

Provide international alternative legal dispute Resolution system. An International alternative legal dispute resolution system is consistent with the AMA's Recommendations above. A system is under development and will be a focus on MediTour Expo's conference Pioneering the Future of Global Healthcare.

Currently existing systems of quality accreditation exist such as Joint Commission International(www.jointcommissioninternational.org), International Society for Quality in Healthcare(ISQUA), and the British QHA Trent International Accreditation Scheme. IntHealthCert will incorporate JCI accreditation into its standards along with some additional standards specific to the International Medical Tourist Zones. IntHealthCert is developing focused Certification Programs in which the standards are under development.

Changing Policy:
IntHealthCert currently has developed preliminary accreditation standards which will be revised as the organizational develops. Certification will be granted based on the standards evaluated at the time the facility was evaluated. The certification status would not change for the facility once it was issued. IntHealthCert may evolve as an organization to provide time limited certification.

Future directions of IntHealthCert:
IntHealthCert is a new organization which is currently focused on phase one development of its organization and educational events. Phase II development will focus on development of its program services and establishment of a foreign office.

What are the best countries for International Accreditation?
A list of accredited organizations can be obtained from the JCI website at
www.jointcommissioninternational.org/JCI-Accredited-Organizations/.

What are the Initial costs in applying for JCI accreditation?
The JCI website has a PowerPoint presentation available on its website to educate potential candidates on the process of accreditation www.jointcommissioninternational.org/Journey-to-JCI-Accreditation/.

The process for accreditation is 7 steps: 1) Obtain copy of JCI standards, 2) Submit an application and schedule survey, 3) Complete JCI Survey contract, 4) JCI survey team leader delivers survey agenda, 5) Survey occurs 6) Survey Decision, 7) Resurvey(www.jointcommissioninternational.org/Accreditation-and-Certification/JCI-Accreditation-Process-Timeline).

The initial costs can vary based on the survey to be performed and the size, complexity and services of the hospital. The estimate provided on JCI's website is the initial full hospital survey is $46,000 US. More detailed questions can be obtained from the JCI website(www.jointcommissioninternational.org/Cost-of-Accreditation/).
Additional questions can be obtained through e-mail at jciaccreditation@jcrinc.com.

News & Info - New Directions:
Events: JCI is participating in sharing best practices and has listed upcoming events for an International Practicum in Doha, Qatar November 7-11, 2010 and in Miami, Florida January 24th-25th.
Resources: JCI Published new 2011 Hospital Standards in July 2010.
Publications: JCI has two publications JCI Insight a newsletter and a Journal The Joint Commission Journal Quality and Patient Safety.

International Accreditation
International Accreditation is a system established to continuously improve the
quality and safety of healthcare organizations. It establishes standards,
a quality system, and a mechanism for providing feedback.

International Accreditation does not participate in patient malpractice or
facility licensing decisions. The information from accreditation can be used to
analyze the system by other parties and determine the system's strengths or
weaknesses.

International accreditation means a system of standards exists with the common goal to promote the development and maintenance of a high quality and safe healthcare facilities.

Will international standards really meet the demands of the international healthcare consumer or will it be just another rubber stamp?
International standards is a step in the direction where quality information about healthcare facilities and the care received can be made available to the administrator, provider and consumer to promote better outcomes. Consumer empowerment is important part of the quality initiative where consumers are using quality information to participate as active partner in their care for shared decision making. The goal is to share quality information with the consumer so they utilize it for improving their own self-care.

Will international standards for foreign medical facility operators become increasingly harder to obtain?
No, International standards already exist for many types of facilities: ambulatory care, hospitals, Clinical care, Care Continuum, Medical transport, Clinical Lab, and primary care. The initial accreditation with International standards for a facility is the hardest step as it means a system of continuous quality improvement needs to be established. Once the system is in place for initial accreditation and a leadership team exists to implement, the process is ongoing with new goals.

How will physicians worldwide see the direction international accreditation has taken?
Physicians world wide will welcome quality initiatives as it drives a higher standard for practice allowing for efficiency in patient care and new opportunities such as involvement in special projects, research and clinical trials etc. Physicians are increasingly being required to have a knowledge in quality improvement as part of their training and certification requirements in some countries. There also are a lot of quality campaigns being developed which require the participation of physician leaders as a physician champions for a facility to achieve accreditation. International accreditation for facilities is currently growing with more and more countries participating. The sites who have received JCI accreditation are listed on JCI's websites (www.jointcommissioninternational.org). Individual healthcare provider certification is currently offered as a membership benefit by the International Board of Medicine and Surgery(internationalboardofmedicineandsurgery.org/index.php)

Will there be rivalry?
No, International accreditation is a system for developing
standardization in healthcare organizations from different countries. There are International organizations and country specific organizations who are promoting the goal of a minimum standard to achieve the development of safe and high quality facilities. The goal for all healthcare organizations should be to participate in this continuous improvement process which includes a team approach of healthcare providers. Competition amongst hospitals and providers can be designed to be amicable, if the information for accreditation is presented in aggregate in the form of benchmarking and sharing of best practices.

International Certification will enhance overall business plans and operations as it establishes a system of leadership and quality improvement.  An organization does have to make a financial commitment to implement this process.

The way I can market my business?
International Accreditation does not have any standards relevant to marketing.

The terms & conditions on how much I charge?
International Accreditation does not have any standards relevant to cost. Cost is usually determined by market competition in a geographic area for a country and prices established by public or private insurance companies.

The type of liability insurance I am covered by?
International Accreditation does not address liability issues. International Accreditation should improve an organizations ability in obtaining liability coverage.

How much I spent on aftercare post op. etc...?
International Accreditation does not outline how much money an organization needs to invest in developing its programs. Consulting services are available by JCI to provide an evaluation of the current system and suggestions to meeting the JCI standards.

North American healthcare consumers expect high quality standards which would be consistent with the JCI standards available at URL:
Http//www.jointcommissioninternational.org/Engineering-Safety-and-Health- Design/

How to determine your particular needs and requirements?
JCI offers consulting services which can be accessed at JCIconsulting@jcrinc.com.

Advice when revamping existing hospitals to attract medical travelers
JCI has standards in the category of Engineering Safety & Health Design.
It would be helpful to review these standards and incorporate in development
To promote a safe and high quality environment.

Types of liability issues:
There are two categories of liability issues which are of concern to medical facility operators, facility liability issues and professional liability issues. More information on the legal issues associated with Global Healthcare will be presented at the Second International Conference, Pioneering the Future of Global Healthcare, May 23rd and 24th in 2011.

International Legal Dispute Resolution System. How will it impact foreign facility operators?
An International Legal Dispute Resolution System is under development as a program service for Phase II Organizational development of IntHealthCert. An International Legal Dispute Resolution System will be a focus of some of the Presentations at the Second International Conference: Pioneering the Future of Global Healthcare May 23rd and 24th in 2011.