American healthcare has gone global. Several top U.S. health systems have opened institutions beyond their borders and committed themselves to treating international patients.
Cleveland Clinic is one of those systems that takes patients from across the globe. To learn more about how its international treatment program works, Becker's reached out to Maan Fares, MD, chair of global patient services at Cleveland Clinic.
Question: How did Cleveland Clinic's international patient treatment program begin?
Dr. Maan Fares: This is an organic growth for the Cleveland Clinic. The Cleveland Clinic is a little over 100 years old right now. We just celebrated our centennial. Since the inception of the Cleveland Clinic, we have had international patients come to us for a second opinion, patients from Canada, all walks of Earth, and patients that lived within the vicinity of the Cleveland Clinic.
The wisdom of our archive kept those documents, and we are really proud of them. But really, this did not take off until the 1950s and 1960s, when the Cleveland Clinic started to be very innovative in cardiac care, renal care and other surgical specialties. At that point, the board took notice, and we started to have dignitaries and other people come to us, specifically targeting the Cleveland Clinic, from the Middle East, Europe and Latin America.
The department itself, called Global Patient Services, really did not come into fruition until the 1970s. It started with a philanthropic donation meant for helping international patients and education. Essentially, this really came out of the need to recognize interpreters and for people that are dedicated professionals that will help international patients through their journey. So this has been an organic growth of international patients. We are very proud of it. It is not a large part of our operation. It is probably in the single-digit percent of our operation. However, it is extremely meaningful to us because of the attention that we get from other places; other people are noticing that people come to the Cleveland Clinic for a second opinion — therefore it must be the best place to get care.
Q: How do you estimate the cost of treating an international patient?
MF: This is 70-plus caregivers that are professionals and dedicated to helping international patients. The majority are dedicated to interpretation and the coordination of care. So what happens if a patient decides to come to the Cleveland Clinic, is the patient could potentially have international insurance or be sponsored by a government, or is self-paying. As they decide to come to the Cleveland Clinic, there are multiple ways to reach out to us either through our website, dedicated phone lines, an email or through referrals from physicians that have worked at the Cleveland Clinic or work with physicians and the Cleveland Clinic.
So once the patient arrives or gets identified at the Cleveland Clinic, what we do is we try to do everything to make the journey identical to a domestic patient. Essentially, we register them, we give them an electronic medical records file, and we upload all their digital images and copies of the records so that all of our experts will have instant access to those records. It helps us triage the patient with the appropriate physician or team of physicians. At that point, after triaging the patient and putting together the plan of care, this is when we are better able to estimate the cost.
Let's say for instance, this is a self-pay patient. They would want to know what the cost is going to be, we are able with very high accuracy … to give them an estimated cost of care based on their journey. We audit this to make sure that we are accurate. This is a very important part of patient satisfaction and quality measures that we do in our department. Thankfully we've been successful with this for the most part.
Q: Are there innovations or ways you estimate patient costs in your department that you could see expanding throughout the whole Cleveland Clinic system?
MF: It depends on how you look at it. I always say that international patients are probably our window toward the future, as patients deal with an increasing proportion of out-of-pocket costs, whether it be domestic patients or international patients. What we do in the global patient services department is really work very closely with our colleagues from revenue cycle management, in other words with finance, to become more sophisticated in estimating cost at bundling cost in many cases or using preexisting bundles so that there is more accuracy and certainty for distinction. We try as much as humanly possible to eliminate the element of surprise.
Q: What makes an international patient's care journey unique?
MF: We feel very strongly that all patients are equal. Where international patients may need a little bit of extra attention is if they can't afford to stay here for a prolonged period of time. There's usually a lot of associated costs of flying here and staying here. So we try again as much as humanly possible without affecting our larger operation to make sure that their journey is compact and is not extended, if at all possible. However, the clinical component is really what determines this. We never take shortcuts from that standpoint.
We make sure that whenever it's appropriate, we have pre-scheduled them with anticipation that they will need potential surgery, so we have a definitive surgical appointment. If that gets canceled, then somebody else will get that opportunity, as opposed to giving special treatment to international patients. This process and journey are well outlined from the get-go. We know that patient satisfaction is utmost, but it's not only the patient that needs to be satisfied. We need to be mindful of our colleagues, our caregivers that we're not adding an additional burden on them. People are in this post-COVID-19 environment. There's strain. We're very mindful of physician and nursing and caregiver burnout.
Q: How did COVID-19 impact the international patient program?
MF: Actually, I was one of the physicians that got COVID-19 early in 2020. So there was no doubt that the ward was closing for a moment at the beginning of COVID-19. However, people still need to be cared for and by 2021, we saw a renewed interest of patients to come back. By 2022, we were almost at pre-pandemic level in terms of patient volumes. What helped us enormously is being innovative. Any patients that had been preexisting or had been a patient at the Cleveland Clinic, whenever it was legally possible, we allowed them to get distance health, in other words, reach out to their physicians and follow up via virtual health, either synchronous or asynchronous. So that has been extremely helpful for us.
Q: Do you plan on keeping those virtual treatment tools as we move into a post-COVID-19 environment?
MF: Percentage-wise now not as much as early in 2020 or during the pandemic. However, I'll tell you that the rules and regulations internationally are shifting; some countries are more permissive, some countries are not; we tend to be extremely by the book. We practice very safe medicine for both our caregivers and patients. So we're very careful about following the international rules and regulations when it comes to distance health. This is obviously a little more complicated for international patients compared to domestic.
Q: Where do you see the global patient care program going in the next decade?
MF: Our purpose from this is to personalize. Our CEO and our leadership feel very strongly about the growing footprint of the Cleveland Clinic. We have a hospital in Abu Dhabi. We have a new hospital in London. We exist in Florida, Nevada, Canada and obviously in Northeast Ohio.
For us, international patient care is part of this continuum. It's very important for us to reach more lives to help more patients heal. The priority for this program is really not revenue — it's touching lives. There will always be patients who need to come to Cleveland Clinic for very complex care, such as the growing need for cancer treatment. Whenever there's chemotherapy, it becomes a lot more complicated to do those estimations, but I see that this program will continue to grow. The global footprint will continue to grow, and we will adapt to the patient's needs all the time. I'm very enthusiastic about this program. I think this is what makes places like the Cleveland Clinic unique today in the global healthcare market.