Maria Todd writes this candid, “from the trenches” response to the daily stream of daily emails she receives from new medical tourism facilitators
Starting a medical tourism facilitator business requires capital, know how, and consummate documentation for operating quality and safety standards, practices, policies, and protocols. Only then can a marketing and business plan and branding strategy be drafted to explain the business rationale, model and value of its existence and revenue potential. Most don’t realize how much of each is required to succeed, but I can tell you from experience that it is far more than I (and others) ever anticipated.
Almost daily, I receive emails from people located around the world who are convinced that there’s big money to be made in medical tourism. After all, Dr Paul Keckely of Deloitte published some really “aggressive” projections in 2008 and 2009 upon which the media, thousands bloggers and business plan authors have used for syndicated references and projections of their own with the Deloitte report dutifully cited as a footnote. Every time I see them, I laugh out of pity…and seethe, because I too believed in them once upon a time – just like I once believed in Santa and the Easter Bunny and the reliances I made on what he wrote cost me a fortune for which there is no recourse or accountability.
These hopefuls believe the Field of Dreams slogan: “Build it and they will come”. Some of these new medical tourism startups write to me with the hopes that I will take time from getting paid as a consultant to spend a few hours with them on the phone consulting and giving advice and feedback as a courtesy to them. (Since this is what I do for a living, rendering advice, recommendations, and transferring knowledge – I am mystified why they believe I will do it for them and every other startup without compensation.) Others offer me a barter stake in their future business. They want me to provide advice for equity in a company that has no existing business, experience, track record, or product to sell. They would take advice from someone daft enough to agree to this? And then, from what revenues would I eventually be compensated as a shareholder?
I often wonder if the latter group realizes that if they get sued for failure to comply with regulations or patient endangerment or some other reason that businesses get sued (like stealing copyrighted photos and content from other websites, for example) that I will get sued with them as a deep pockets shareholder/partner of the business. For anyone to agrees to this arrangement makes me wonder how experienced they are in that which they are being asked to give advice! Most of these startups have no existing shareholder agreement that states that the corporation will indemnify me for legal expenses and damages awards in the event the corporation or its shareholders are sued. Even if they did, without an in-force insurance policy that covers a shareholder, such a provision in the written Agreement is worthless and is an unreliable provision.
Stock photos and stock documents? Not hardly!
Some write to ask if I can supply an off the shelf organization chart or organogram for their new medical tourism facilitator business, but they don’t have an organization. I am told repeatedly that they need this to complete a business plan. But wait…. they want an organogram for an organism that does not exist, and for which they don’t know what should be listed with regard to roles, responsibilities and staffing, but they want to use this for a business plan to approach investors and the bank to loan them money? Really? Do they honestly believe that this graphic depiction of a business infrastructure that does not yet exist, that they cannot even outline, will help them ti get startup capital for a business operation that they can’t even describe? Heck if they could at least outline the roles, responsibilities, and staffing plans and management structure, some graphics person on FIVERR could draw it for them in AI or InDesign or PowerPoint and render it for a cut and paste into a business plan! That’s the surface, not the substance!
Next, the ask me for and off the shelf daily checklist. What is it that the checklist but a list of items required, things to be done, or points to be considered, used as a reminder. A reminder of what? If they don’t know what they will be doing in their business, how will a checklist serve as a reminder or failsafe that when used as intended guides their actions in the event of something going wrong or that is there to prevent such an occurrence?
The org chart and the daily operations checklists are not things that are stock items. They are both is dependent on what the daily operations will be. I believe that determination of the work flow at all stages of selling, marketing, operations and logistics coordination is where the value lies in the consultation; especially if they don’t know how to be a medical tourism facilitator. If the startup owner feels they need some been there; done that experience and guidance, I can provide that. Typically that kind of guidance is ongoing and done through weekly meetings that break their business development project into “chunks” of activities and deliverables. The graphic depiction of the organization is an hour’s worth of work by a graphics person on my team. The words in the checklist can come only after the proprietary policies, standards and procedures are developed and refined. That’s called copy-editing. The development of the proprietary policies, standards and procedures are where the consulting expertise brings value.
What it takes to form and operate a medical tourism facilitator business
In 2003, when we began development of Mercury Healthcare International, I spent nearly 24 months of pre-launch effort and tens of thousands of dollars to formulate our medical tourism facilitator business by myself. This came after having a master’s degree and doctorate in health administration, years in organizational development and process design, strategic planning, and consulting in healthcare operations management. I had education and training and work experience as a surgical scrub nurse. Along with this, I was equipped with decades of healthcare marketing, reimbursement contracting, TPA and insurance network operations, and training and experience working with accreditation programs preparing for Joint Commission surveys and inspections by other accrediting bodies. I also had several years working in travel, tourism, ticketing, and tour design and operations, as well as hotel inspection procedures with huge branded tourism accreditors before reinventing my career to healthcare at the age of 26. Never in the 1970s and 80s did I expect that this eclectic mix of skills, education and experience would lead me to where I am now. I designed MHI’s operating standards, policies, procedures, and checklists from this body of knowledge, training and experience. Then, I still had to purchase advice (using real cash money, not equity promises and coffee dates) from other experts (mostly lawyers and physician advisors). Afterward to go from paper to reality, I spent 2 more years of post launch testing and business activity to prove the processes I documented and planned and improve them. Along the way, I had to adapt the strategy and business processes to changing market conditions.
Medical Tourism Facilitator Certification – Schmertification
Did I seek out MTA certification for this? The MTA didn’t come into existence until May of 2007! Did I seek out TEMOS or MTQua for this? They were twinkles in their respective founders’ eyes when I started my business activity for medical tourism (Pre-MHI) in 1983. To be a professional medical tourism facilitator that will work to coordinate patient care on behalf of others, or to decide which brands of healthcare providers are worthy for one to agree to promote, is to commit to the documentation level of an ISO 9001:2008 or equivalent, even if you don’t apply for the ISO certification. However, I would recommend this if you plan to approach investors, you must seriously consider this level of commitment in business startup infrastructure because it will differentiate you from all the other “facilitators with a website and a cell phone”. Having ISO 9001:2008 certification will represent to your hospital partners and insurers and others that you are serious and meticulous about documented policies, procedures and preparedness to enter this market.
Doing so will give you a branded advantage because ISO 9001:2008 is a recognized standard for quality management unlike any of these other certifications, especially for medical tourism facilitators. You can safely assume that with proper marketing, brand messaging and the right medical tourism doctors, hospitals, clinics, spas, and other suppliers (the “product vendors”) as well as a unique branded product that is properly advertised, you should realize higher value-added commission rates and fees for your services that others with the just the website and cell phone and unsubstantiated organograms and checklists cannot justify.
A number of international insurers require their suppliers to hold ISO 9001 certification (not just the healthcare facilities). In addition to several stakeholders’ benefits, a number of studies have identified significant financial benefits for organizations certified to ISO 9001, with a 2011 survey from the British Assessment Bureau showing 44% of their certified clients had won new business1. Corbett et al. showed that certified organizations achieved superior return on assets compared to otherwise similar organizations without certification.2
ISO 9001:2008 specifies requirements for a quality management system where an organization needs to demonstrate its ability to consistently provide product that meets customer, professional, industry, and applicable statutory and regulatory requirements, and aims to enhance customer satisfaction through the effective application of the system, including processes for continual improvement of the system and the assurance of conformity to customer and applicable statutory and regulatory requirements.
All requirements of ISO 9001:2008 are generic and are intended to be applicable to all organizations, regardless of type, size and product provided.
Examples of these standards, policies and procedures include, but are not limited to: credentialing, privileging, site inspections, marketing, new patient intake, disaster recovery, records management, standards of practice, standards of care, facility minimum criteria to perform certain procedures (regardless of what they want to sell) payment transactions, website updates.
Developing checklists for daily operational quality and patient safety
Once the processes are created and tested, then (and only then) can you standardize the process to a daily checklist. For example, you can’t have a checklist that references carrying out a facility inspection without the standards for what to evaluate and check and how to evaluate the findings and categorize them as acceptable or unacceptable or in need of improvement. You can’t have a checklist that says “contract negotiated and executed” if you don’t have a draft contract agreement for hospitals, clinics, drivers, hotels, etc.)
Readiness for network development
Until you have such an inspection protocol, credentialing and privileging standards, and a facilities grading standard, you should not be investing startup capital in fam tours, travel costs to conduct site visits and other network development and provider contracting activities.
The price of admission and basis of consideration for you to be invited as a hosted buyer should be a copy of your inspection and grading standards, documented and protected by a non-disclosure agreement so that hosts that invite you can be sure you are prepared to do business when you arrive and not just take advantage of their goodwill and free trips to cool medical tourism destinations, simply because you have a website and a cell phone.
Certifiers’ Competency to Certify
This begs yet another question: Certifiers’ competency. Where are the certifiers’ competencies and standards documented? Lately, every organization wants to sell their medical tourism facilitator certification for $1000 to $5000 for a one or two-day class. ISO 17024 is the standard for quality documentation of an ac creditor or certifier. This is where I give a limited number of certifying bodies credit. Angela Katsapi in Greece, is one of these experts. A fellow former nurse, she holds a Master of Science degree in Health Informatics and is an IRCA certified lead auditor and auditors’ trainer for ISO 9001:2008 Quality Management System. I know her, I endorse her methods. I don’t endorse TEMOS, MTQua, MTA and most other medical tourism facilitation certifiers though I respect what they say they are trying to do. This is for one reason: the value proposition of their certification brands to the consumer market is not proven to me. On the other hand, the value of the knowledge transfer in learning how to prepare for ISO 9001:2008 for medical tourism is an entirely different matter. Instead of buying a medical tourism facilitator certification from an unaccredited body or certifier that the consumer market doesn’t easily recognize, why not go the route of achieving certification of the business process used in your medical tourism facilitation business? ISO is internationally recognized and the cost is in the preparation for the certification itself, not for the wall plaque and the logo license.
When I consult in the startup and development of a medical tourism facilitation business, or a medical tourism destination launch, I bring 30 years of experience and medical tourism business know-how and subject matter expertise. From 2003 to 2013, my company coordinated more than 10,000 medical tourism patient referrals to providers in 115 countries. I am not an expert like Ms Katsapi in the documentation of the process, but instead I bring the recommendations for the processes, practices, and standards criteria themselves. You actually need both kinds of consultants. No one can be a master of both and do them well.
Marketing the Medical Tourism Facilitator Business
Once you create the business and its brand, then comes the marketing, advertising and selling. This takes tools, technology platforms, and far more than a website to be done correctly. These tools cost money, and have recurring expenses of time and effort to create content and a distribution plan to publish the content in the form of articles, videos, and advertising collateral. To produce these takes cash for graphic and creative design, copyediting, translation to target consumer languages and the time to post these assets across the various marketing and social media channels. The software and technical management platforms are necessary to do reputation management and monitoring, respond to comments and posts about your business, and ensure that all the places you can be listed on the Internet list your business information accurately. At MHI, we offer this service to clients, and the cost of a basic package to use our private label technology solution is about $600 per month just for the monitoring services. We’ve seen it sold for far more.
To assign an account manager that will manage your social media content distribution across your social media channels is an additional weekly fee to cover the time and services of the account manager. This is an outsourced service that takes the place of a staff member on the medical tourism facilitator’s organizational chart, along with the desk space, telephone service and communications hardware, computer and software licenses, social media know-how, and discipline to distribute content according to an editorial calendar and perform the SEO and SEM treatments necessary to generate leads and visits to your website.
We provide this on a shared use basis for our clients, meaning that our account managers actually work on 5-6 other accounts each day, but that is all they do. Many medical tourism facilitation companies believe they can do all this in-house and skip this expense. They believe that they can do this in-house, do it effectively, and still manage patient quotes and logistics, provider network development, fam tours, site inspections, and the day-to-day activities of accounting and business development and network face time. This tells me straight away that they either have no business or they have a clock with more than 40 hours in a day on it, or they are in denial. 10 years of experience in the business of medical tourism facilitation is how I know this. We tried.
A small medical tourism facilitator company can rarely do all this to avoid having big purchased advertising and media budgets. Even if you have the budgets and the content, professional graphics and creative design (artwork, logos, editing, etc.) add thousands of dollars to properly capitalized an annual marketing and advertising budget. If you attempt to do this in-house, salaries, taxes, and benefits must be added to the budget in order to retain talent.
Your Business Image
Aside from developing a functional and responsive website that makes it to the top of organic searches, you’ll need a commercial address and telephone service. While it is rare that businesses need a fax machine anymore, a commercial telephone service that answers at all hours of the day or night will cost you a minimum of about $8-10 per day to answer 24/7/365. This gives callers a professional brand impression when callers call at night or from other time zones and countries. Many calls and leads are lost because people want information immediately and don’t want to leave voice mail or give up email addresses. But with Google maps, they can (and do) check out your business address to see if you are a real business or working from your house. You can lose lots of brand confidence points working from a residential address. A commercial address will cost you between $75 and $150 per month to rent, even it you work from home behind the scenes. Thinking of adding “Suite XYZ” to your home address for appearances sake? Think again. That photo on Google Maps Street View blows your lame disguise out of the water. If you lose consumer confidence at that level, you have no chance to regain it in order for them to entrust you with plans and guidance or advice for their personal health and safety.
Once you have these things nailed down, you can start writing your executive summary of a business plan that highlights a projected revenue and operating budget, product description, differentiation, marketing and branding strategy, and describe your competency to grow such a business. Only then will somebody risk investing in your business.
So next time you think to write me an email to cooperate or collaborate with you to help you build your medical tourism facilitator business, or you decide to ask me to sell you an organizational chart or checklist to get started, do us both a favor and save both of us time. Perhaps now you will understand why they aren’t available, or why you wouldn’t want them if they were available. And if you were planning to buy me a cup of coffee to trade you business advice, keep in mind I have George Clooney (Nespresso) in my kitchen any time I want it.
1. http://www.british-assessment.co.uk/news/iso-9001-proven-to-help-win-new-business. doi: May 25, 2015
2. Corbett, Charles J.; Montes-Sancho, María J.; Kirsch, David A. (2005). “The Financial Impact of ISO 9000 Certification in the United States: An Empirical Analysis”. Management Science 51 (7): 1607–16. doi:10.1287/mnsc.1040.0358