Tag: medical direction

Portland, OR U.S.A—In an ongoing effort to provide full service medical services to the worldwide shipping industry, SphereMD now has a network of medical professionals who provide routine as well as complex medical and dental care in Panama. SphereMD has compiled a summary of the unique aspects of Panama’s medical market, the Company’s service goals in Panama, and recommendations for ship owners, managers, and operators in the region.

Understanding Panama’s Medical Market

Compared to the U.S. medical market, Panama’s government does not provide oversight to control prices. However, Panama’s physicians are generally well trained. Additionally, many Panamanian hospitals are internationally certified and receive U.S. level hospital certification from bodies such as The Joint Commission on Accreditation of Hospitals (JCAH). However, the smaller hospitals may not meet the rigid standards of such certification. Panama’s medical market differs in key ways for hospital services, physician’s fees, commissions, and the use of medical brokers and intermediaries. Here’s a quick rundown:

• Hospital services: Compared to U.S. hospital services, Panamanian hospital fee schedules and prices are generally lower. However, significant savings may result by managing hospital services by insisting on medical management with any hospitalized patient to decrease utilization.
• Physicians’ fees: In the United States, laws require each doctor to charge all patients the same price, and doctors use standardized codes and medical notes to justify charges. In Panama and in most of Central and South America, there are no laws that require physicians use insurance codes or provide detailed medical records.
• Commissions: Documented cases show medical brokers and intermediaries receive up to 20% or more of medical charges. This type of commission drives up costs for ship owners and may be a conflict of interest.
• Third parties: Third parties in Panama may add additional costs to some of the issues mentioned. For instance, a third party may increase medical costs by receiving discounts from hospitals and doctors and then overcharging for those services.

As you can see, working with medical staff and facilities in Panama requires a slightly different approach than in the United States or Europe. Therefore, while markets differ from country to country, the key is to control medical costs before any care is rendered, and to start with your P&I Club or medical manager who knows the market firsthand.Meeting Service Goals in Panama

Based on firsthand experiences, SphereMD identified the following actionable goals for managing medical services in Panama. Ship owners can follow these goals, as well:

• Keep routine care routine by using P&I Clubs and medical managers who have a network of trusted Panamanian
• Avoid elective care in Panama to reduce medical services costs.
• Opt for repatriation for treatment when medically appropriate.
• Decrease the length of hospitalizations by insisting on medical management with any hospitalized patient.
• Require providers to deliver clear legible records and reports in a timely manner.

By choosing SphereMD as a medical partner, you are choosing to use trusted physicians and certified hospitals, and to control costs while ensuring the best medical care while in Panama.

Taking Precautions

If a crew member needs medical services in Panama, you can help keep costs under control by being proactive:

• Insist on a proof of payment settlement to the hospital before paying a hospital bill.
• Insist on paying individual providers and hospitals directly—don’t pay third parties in Panama who provide doctor and hospital services on one invoice without first vetting the invoice with your P&I Club.
• Contact your P&I Club or a trusted medical manager—don’t ask your agent to arrange for medical care because it could cause a conflict of interest.

Learning More

Like all medical markets, understanding the system is key. SphereMD has cultivated a strong understanding of medical markets through firsthand experiences, which we are happy to share. Contact us at operations@spheremd.com if you have any questions or would like more information, including summaries of real case experiences that support our findings.

SphereMD specializes in coordinating, managing, and reviewing medical cases in an ethical, transparent, and cost-effective manner. We yield tangible and significant financial benefits to our clients while ensuring that your crew members receive the highest quality of care possible, every day of the week, 24 hours a day, 365 days a year.

Having all the right information at the right time makes all the difference in the world. To make that vision a reality for maritime medical claims, we need to understand what’s actually happening in our world.

That was my mission on a recent trip to the Philippines. While in Manila, I met many talented and dedicated manning agents, doctors, claims managers, and correspondents. Each person I encountered plays a valuable role in managing illness and injury claims for crew members repatriated to the Philippines. I gained a great deal of valuable insight through our conversations. For instance, I now have a better understanding of issues related to post-repatriation claims concerning injuries and accidents that happen abroad, and a more thorough understanding of the pre-employment medication examination (PEME) process and clinics in the Philippines.

As far as the claims issues, one key takeaway I found is that claims professionals are looking for clear, sufficient, accurate information by which to fairly adjudicate claims. Currently, the information they receive ranges from non-existent to vague or unclear.

• Vacuum of Information: Almost all claims handlers expressed concern over the poor information they receive from doctors in the United States and around the world. In some cases, no documentation is received whatsoever, especially for crew members treated in the United States. To compound matters, claims handlers said subsequent requests for documentation are often ignored, and privacy laws in many countries present a barrier to accessing medical records.
• Inadequate Documentation: Another common concern is that when medical records are available, the documentation is often inadequate. Some records are illegible or incomplete, and others contain little information that can be used to accurately adjudicate a claim. In addition, vessels’ medical forms are often missing, and when included, they are also incomplete or illegible. Furthermore, language barriers can add an extra level of complication in understanding records, reports, and forms.
• Poor History: Missing medical history information presents yet another challenge for claims handlers. Even in the presence of legible medical notes, insufficient information is often provided concerning the history of the illness, patient’s medical history, the prescriptions the patient was on pre-examination, and so forth. Most claims handlers I spoke with cited this as a primary concern. Without an accurate medical history, they cannot determine preexisting conditions.
• Unclear Documentation: Universally, claims handlers said medical providers rarely sufficiently indicated if an illness or injury is a work-related illness or injury. Most claims professionals agree that this is a critical piece of information. Without this documentation, claims determination and adjudication are far more difficult than necessary. This issue may be rooted in perspective. From a medical provider’s perspective, at least in the United States, claims issues are not the concern. Instead, the medical issue is the main concern, and the documentation addresses patient wellness and serves to avoid medical legal liability. Claims handlers view the situation from an entirely different perspective.

While the claims complications can occasionally be individually identified, in many cases all factors are present to some degree. Understandably, this makes adjudicating claims excessively difficult. It doesn’t have to be this way. We can take steps to help claims handlers obtain the information they need from the outset.

The first step to creating a better process is awareness. Certainly, most medical providers have never been asked to provide documentation in a different way up front. Instead, medical providers respond to queries for clarification, questions about workplace illnesses and injuries, medical history, and more- information they often provide after the fact. Theoretically, medical providers could document these data points up front if they are aware of the need for the information. For people who provide and coordinate maritime care, we need to ensure that this awareness exists and create a process that meets the unique needs of claims handlers.

The challenge is making hundreds of individual providers aware of this need across the United States (and possibly thousands of providers around the world). This daunting thought is one reason many ship owners have Fit for Duty forms that attempt to answer medical questions of history, occupational cause or relation of injuries and illnesses, and so forth. But as noted earlier, these forms are rarely completed accurately, if at all.

While tackling awareness and response on a global basis will be a work-in-progress for many years, SphereMD has the awareness and capabilities to begin to collect this type of information with all our medical cases. In doing so, we will be able to provide complete, accurate, and clear information for a few thousand medical cases per year. While this is a relatively small number of cases compared to the tens of thousands of maritime illness and injury claims that occur every year, we feel this will make a difference.

After considering these issues, I have a final thought and a question. In managing maritime claims from a medical perspective, I firmly believe that claims and medical care can be managed with a greater deal of control and precision. I believe this because in the United States, insurance companies have been achieving this for decades. Better control is possible, and I wonder, would you, as a claims professional, doctor, correspondent, or P&I Club stakeholder, be interested in collaborating on a project with SphereMD to collect an idealized set of data to help claims managers effectively, fairly, and efficiently adjudicate medical claims? If so, we would love to collaborate with you. In a future article, I will share some of the perspectives I gathered concerning PEMEs performed in the Philippines.

If you are interested in collaboration, please contact David Shubin at shubin@spheremd.com.

Quicker Return to Fit for Duty Status

Crew members spend more time than necessary dealing with shore side medical care. Many things can be done to improve the efficiency of shore side care. This article provides specific recommendations to expedite U.S. shore side care and quickly return a crewmember to fit for duty status.

Communicate While at Sea

Even before a ship arrives at its intended or nearest port-of-call, a key step can be taken to increase the likelihood that an injured or ill crew-member can return to fit for duty status relatively quickly. Specifically, it is important to seek medical advice via e-mail or radio with a medical provider – e.g. a physician or nurse. Medical providers will describe the best course of treatment that can be achieved while the crew-member is still at sea. Such treatment will typically be relatively easy to implement, such as crew-member immobilization, ice treatments, use of anti-inflammatory medications, and adequate rest.

Make Medical Appointments Prior to Arriving in Port

If, two days in advance of port arrival the crew-member is still being adversely impacted by their injuries, or still has illness symptoms, it is important to schedule a land-based medical appointment to take place as soon as possible. Such medical appointments can be made by making requests to a medical manager. With up-to-date information about the crew-member’s medical condition and the ship’s arrival schedule, the medical manager will schedule an appointment with the appropriate medical facility, physician, or medical specialist. Keep in mind that if the crew-member’s condition improves before the ship arrives in port, the medical appointment can be easily canceled.

Waiting until the vessel arrives to make medical arrangements can result in the use of hospital emergency rooms, which (as will be described below) are expensive and problematic for quick return to fit for duty status.

Share Work & Schedule Information with Physicians and Medical Managers

Before the crew-member’s medical examination and treatment, it is important to provide U.S. physicians with information about the crew-member’s responsibilities. In particular, such information should focus on flexibility in the crew-member’s work duties. The more that U.S. physicians understand about flexibility in crew-member’s duties, the more options they have in terms of granting fit for duty status. Examples of such flexibility include:

• Indicating that the crew-member’s responsibilities allow for light duty restrictions or modifications (e.g. 2-hour work shifts with intermittent work breaks).
• Explaining that the crew-member’s responsibilities mainly consist of bridge duty, for which remaining seated is acceptable.
• Indicating if bedrest can be accommodated by vessel

Additionally, it is important to share the ship’s port-of-call schedule with U.S. physicians. As U.S. physicians typically do not have confidence in other countries’ medical infrastructures, it is beneficial to share with them any near-term visits to U.S. ports of call. With such information, U.S. physicians will gain confidence that adequate follow-up medical care can be provided, and will more likely approve fit for duty status. Even if the crew-member is not fit for duty, U.S. physicians may grant a “fit to sail” status. In this case the crewman is able to return to the ship, keeping it in compliance with its crewing certificate. Fit to sail status provides time for owners to locate and onboard replacement crew, often reducing costs surrounding immediate repatriation.

Choose the Right Medical Provider

It is well accepted that emergency rooms are an expensive, inefficient venue to receive non-emergent care, and therefore should be avoided for routine cases. Further, emergency rooms in the U.S. tend to issue more restrictive fit for duty statuses, and require follow-up that doesn’t consider the movement of ship. Emergency rooms are often unwilling to complete ship medical paperwork, as they are not required by U.S. law to do so. Sometimes, emergency room physicians omit any mention of fit for duty status, which means that those physicians must be re-visited (requiring extra time, paperwork, and costs to request fit for duty status).

The best way to avoid emergency rooms and find the right medical provider in each port is to work with a medical manager. Medical managers will ensure that the crewmember is taken to the right physician (e.g. an eye doctor for an eye injury) or to a clinic if a specialist is not required. Not only can clinics cover the majority (90%) of emergent or non-urgent care, they also provide quick service and are willing to fill out ship medical paperwork. By being proactive with care and utilizing medical management services, you can have better control over crew member medical care in the U.S. You will decrease costs, protect vessel schedules, and enjoy more effective medical care.