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Anita Graves Pacific Surgical Center patient

Omaha, Neb., resident Anita Graves, front left, poses with staff at Longview's Pacific Surgical Center on Dec. 7 after her knee replacement surgery in late November. 

A year and a half ago, Anita Graves’ doctor told her her right knee needed to be replaced.

However, rather than undergoing the procedure near her home in Omaha, Neb., where the surgery would cost about $50,000, Graves saved $13,000 by having it at the Pacific Surgical Center in Longview.

“It was a miracle, because I wouldn’t have been able to do it if I didn’t get out there,” Graves said last week from Omaha, which is 1,700 miles from Longview.

Patients have traveled to other countries for low-cost procedures for years, but Graves’ surgery is part of a growing trend of medical travel within the United States. The Deloitte Center for Health Solutions predicts the number of patients travelling domestically for medical treatment will increase, though the trend is hard to quantify.

William Turner, Pacific Surgical co-founder, said the center began participating in a medical travel program in November and has seen eight patients from out of the area. Turner said as far as he knows, Pacific Surgical is the only provider in the region participating in a medical tourism program. He expects that number to grow as the industry expands.

Some patients discover Pacific Surgical online through their own searches, Turner said. The center also works with third-party administrators to spread the word, he said. Those administrators work with medical tourism companies to send patients out of the area for procedures to cut costs. Turner said companies will often incentivize employees to do this by reducing their co-payments or deductibles.

“Not very long ago… you went where luck guided you and usually got good care but paid three times as much,” Turner said. “We wanted to remove obstacles.”

Determining in advance what a specific procedure will cost at a hospital is challenging. Pacific Surgical, on the other hand, began setting flat fees for procedures and publishing them. Prices for cash-pay patients are listed on the center’s website but don’t apply to those who pay through insurance.

Pacific Surgical lists the cost for a total knee replacement at $20,500. The price doesn’t include any additional fees for implants or follow-up appointments. Through her insurance plan, Graves’ employer paid about $36,000 including all travel and appointments, she said.

The arrangement “worked out wonderfully,” Graves said. Her employer is self-insured and works with medical travel company Hostcare Resources to save money on procedures by sending employees to lower-cost facilities to get the work done. Hostcare covers all travel expenses, and the fee includes all pre-and post-operation appointments, she said.

Graves said the Hostcare agent proposed Texas, Oklahoma and Indiana as potential destinations for her surgery. But when Graves mentioned her hometown of Longview in passing, the agent suggested Pacific Surgical Center.

Hostcare set up all Graves’ appointments with Turner and booked her a first-class flight, she said. The company would’ve also paid for a travel companion, transportation and lodging, but Graves stayed with a friend.

After four weeks in Longview, Graves returned to Omaha on Dec. 13 and said she didn’t even need any additional physical therapy.

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“For a person to have to go through this major, expensive surgery, the savings they can hand down to patients is amazing to me,” Graves said.

According to Hostcare’s website, not all patients qualify for medical travel and those who do are not required to travel to a less costly alternative.

Turner said he learned about medical tourism from the Surgery Center of Oklahoma, which began displaying all-inclusive pricing on its website in 2009.

Before the Affordable Care Act, many people didn’t have insurance or had plans with high deductibles, Turner said. This created a market for outpatient surgeries offered at a lower and predictable cost. Even after the ACA, transparent and predictable pricing can help individuals and employers save money, he said.

Ron Kirkpatrick, president of Seattle-area benefit firm LBG Advisors, said medical tourism is more attractive to employers running their own health plans, like Graves’, rather than those fully insuring with a carrier because self-funded plans will see savings while less transparent carrier plans may not.

As healthcare costs continue to increase, Kirkpatrick said he expects more larger employers to use medical tourism to help cut costs.

Walmart, for example, will pay for medical costs and related travel expenses for patients, according to the International Medical Travel Journal. Walmart is self insured.

Besides drawing in patients from other areas of the country, Turner estimates there are about 7 million people within a three-hour drive of Longview that the center could attract.

“There’s a feeling in Longview and other places near a big city that the care in the big city is better,” Turner said. “But now we have real quality data patients can compare.”

Most surgery centers have pricing available, and a recent Medicare law requires hospitals to publish a list of their standard charges. Washington has required this since June.

Patients can find prices of standard procedures at hospitals as well as quality ratings at the HealthCareCompare website. The online tool launched in June as part of a 2015 state law in an effort to make health care costs and quality data more transparent.

Graves said her employer partnered with Hostcare in 2017 but that she was the first employee to use the medical travel services. She said she would recommend the experience to those needing a similar procedure and may even return for her other knee.

“I said (to Turner) if my knee goes out, I’ll be calling you.”

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