Repatriation vs. Subacute Care

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To treat or repat?  That is the question


In the article below, written for the October Cost Containment Supplement of the International Travel Insurance Journal (ITIJ), Cindy Lubiarz, RN, BSN, former national director of business development for CareMeridian, asks whether international insurers are considering all their options if they have a client ill or injured in the US.  (You can also read the full version of this article with quotes from other industry experts as it appears in the October Cost Containment Supplement of the ITIJ. )

De-complicating patients prior to repatriation by using a sub-acute healthcare and specialty rehabilitation facility can significantly reduce medical and related costs in an environment that is also conducive to a better recovery, with less stress and a more comfortable return home for the insured.

The Choice Is Yours

Travelers suffering a traumatic injury or acute illness while visiting the US are faced with a multitude of challenges while they recover, and most will have the goal of returning home as quickly as possible. Sending them back to their country prematurely, though, could result in added expense and health risks. How do you assure these patients quality care, reduced stress, and the best possible recovery, while containing the inevitable associated medical costs?

There is an alternative to an extremely expensive air ambulance repatriation: discharge the patient from the hospital as soon as possible and then transfer the patient to a sub-acute healthcare and specialty rehabilitation facility. There are significant advantages, including the cost savings; an opportunity to simplify and stabilize a patient’s clinical status; faster functional gains; and repatriation without an air ambulance transfer. Ordinary costs for air ambulance flights can run to as much as $50,000, depending on the state of the patient and their needs, as well as their final destination. Too often, travelers who are seriously hurt abroad are sent home prematurely directly from the hospital, thus creating the need for intense in-flight care and increasing the odds of suffering added complications related to their illness or injury. The cost to the insurer quickly adds up, particularly if there is a need for a specialist physician and/or equipment onboard the aircraft.

Consider this: the average daily bed rate in a short-term acute hospital in the US can be over $2,500 per day for room and board, and this figure is not including physician costs, labs and pharmacy, all of which serve to substantially increase overall expenses for a traveler hurt abroad. The transfer home can take extra time, effectively elongating the hospital stay. Add that to the cost of the air ambulance and it’s easy to see how a catastrophic case could easily add up to $100,000 in excess of the ER and surgical procedures.

Now, as an insurer, imagine sending this same patient from the hospital to a sub-acute facility after only a few days. The average sub-acute facility will charge around $900 per day, which is inclusive of room and board, nursing, therapy and many of the other ancillary costs. And then, after a short stay there, the insurer would be able to send that traveller home by commercial flight because they were more medically stable and on the path to functional recovery. This approach could save thousands of dollars, as well as resulting in a much-improved prognosis for long-term recovery.

At smaller non-institutional sub-acute and specialty rehabilitation facilities, patients are offered specialized care from a highly trained rehabilitation team, comprised of physical, occupational, respiratory and speech therapists, as well as neuropsychological specialists. Many medical teams at the larger facilities do not understand the unique complications and preventative measures that need to be undertaken in order for a TBI (traumatic brain injury) or SCI (spinal cord injury) patient to reach their highest potential. Because the high nursing staff to patient ratio at these higher end sub-acute facilities is 1:4, patients receive personalized clinical attention and are up on a daily basis – imperative in preventing pneumonia, increasing circulation and preventing skin breakdown. Whirlpool bath therapy is also utilized for increasing circulation and reducing stress. In the end, care in a sub-acute facility prior to repatriation could be a win-win for patients, their families and their insurers.

In summary, sub-acute and specialty rehabilitation facilities offer not only significant cost savings (less than half), but also the highest possible opportunity for recovery in non-institutional-like community-based settings. Patients can be moved to these facilities directly from the hospital emergency room or within the first 24 to 48 hours of a patient’s stay and will receive care from an expert healthcare and rehabilitation team in an environment comparable to a five-star hotel.

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