Rosalie Barnes (right) traveled from England with her son, Alex, who suffers from a brain tumor, to get treatment at the University of Florida Proton Therapy Institute at Shands in Jacksonville. The 5-year-old opened Christmas presents there with Dr. Sameer Keole, a radiation oncologist. [Photo: Rosalie Barnes]

Alex Barnes, a 5-year-old English boy from the country’s Midlands region, has battled a brain tumor for more than 14 months. When the tumor returned last year, his doctors in England said he had few options other than traditional radiation therapy — treatment that could have left him deaf, partially blind and unable to walk. Appalled by the potential side effects, Alex’s mother, Rosalie Barnes, surfed the internet looking for alternatives.

Barnes’ research introduced her to proton beam therapy, a form of radiation that can be precisely targeted to spare the healthy tissue around a tumor. There are 26 proton beam machines in the world — five are in the U.S., but none in England. In September, Alex and his mother packed their bags and flew 4,200 miles from their Leicester home to Jacksonville, where Alex was treated at the University of Florida Proton Therapy Institute at Shands.

“I was hoping for great things when I got there,” says Barnes.

Alex was just one of an estimated 400,000 foreign residents who sought medical care in the U.S. last year, according to a 2008 study by the Deloitte Center for Health Solutions. Collectively, those patients spent almost $5 billion here to get treatment that was either unavailable or required too long a wait at home.

Florida medical facilities actively, if quietly, market to attract that overseas business. Many offer special services geared toward foreign customers: Staffs at most major Florida hospitals now include international services divisions that help patients with everything from applying for tourist visas to scheduling airline reservations and hotel stays. Miami Children’s Hospital, for example, has negotiated special hotel rates for its international patients and their families; upon request, it will arrange for limousines, baby-sitting, special meals and tours.

Some facilities are able to capitalize on brands and reputations that are already recognized internationally. In Jacksonville, Mayo Clinic Florida draws between 1,400 to 1,500 international patients each year with very little marketing.

“In other countries, particularly in Latin America, La Clinica Mayo is very well known,” says Nancy Skaran, who leads the clinic’s international services group. Much of the international patient traffic, she explains, results from relationships that Mayo cultivates with physicians around the globe. Once a month, Mayo’s Spanish-speaking physicians conduct “grand rounds” in Spanish and broadcast them to five or six hospitals and universities in Latin America.

Other Florida facilities without Mayo’s profile try to take advantage of the state’s identity as a vacation destination. On its website, NCH Healthcare in Naples promises patients a “unique combination of top-quality surgery with a luxurious Floridian paradise holiday-recovery.”

Some facilities, including Baptist Health South Florida, market well-patient services such as executive physical packages to executives overseas. But the bulk of the 12,000 foreigners the hospital treats each year are people seeking treatment from specialists in cardiology, oncology, orthopedics and gastroenterology.

“Many times it’s because services are not available in their home countries — particularly in the Caribbean,” says Larry Cole, assistant vice president of business development for international services for Baptist Health South Florida.

Healthy income

The biggest reason to woo foreign customers, of course, is that they provide a reliable revenue stream in an era of reduced Medicaid payments and hassles with insurance providers. “Many of the international patients who travel (to the U.S. for care) fall into the top 5% or so economically in their country, so they’re not as impacted by economic downturns or trends with the currency,” says Skaran.

Most of the affluent foreigners fall into the “self-pay” category, and many providers, such as Cleveland Clinic Florida, get their money upfront by requiring advance payment for services. Aventura Hospital consolidates its hospital charges for international self-payers so patients can make one payment for services at a “package” price. Maria Lawhorn, patient coordinator for international services at Florida Hospital, says that even after offering foreign patients a discount, Florida Hospital can get a better rate than it would receive from most HMOs and managed care plans. She says Florida Hospital took in about $3 million last year caring for international patients.

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Alex’s mother made a special point of taking him to the beach, the park or the zoo after his treatments each day at the University of Florida Proton Therapy Institute in Jacksonville.

Administrators say an increasing number of patients from overseas have health insurance coverage. Some of the more frequently seen foreign providers include Bupa UK, Grupo Nacional Provincial SAB (GNP), the Canadian Medical Network, Generali Worldwide, Amedex Insurance Group and British Caymanian Insurance. In Alex’s case, an insurance “settlement” and more than $75,000 in donations from the public helped defray the costs of his $150,000 proton treatment at Shands.

Not everyone who comes to Florida for medical treatment is a foreign citizen. Ever since a bout with colon cancer, Brenda Yager, who lives in the Washington, D.C., area, comes to Mayo in Jacksonville for all her medical needs. The doctors, she says, “actually talk to each other. They’ve looked at the notes. Everyone’s notes follow you.”

Regardless where they’re from, patients and their families who come to Florida spend money on more than healthcare. In addition to paying for her airfare, a hotel stay and a car rental, Yager likes to try out new restaurants when she’s in Jacksonville to see her doctors. Sometimes she’ll drive to Ponte Vedra or St. Augustine for a bit of sightseeing. Rosalie Barnes made a point of taking Alex to the beach, the park or the zoo after his treatments each day. They also made a special trip to the Magic Kingdom.

“He has come away from this thinking he was on a vacation,” says Barnes.

Providers expect revenues from medical tourism to hold up if only because people are willing to pay to get well. Despite the cost and distance, Barnes said she didn’t think twice about crossing the ocean to get care for Alex, who shows no physical signs of his proton therapy treatments save for a small bald patch on the back of his head.

“I felt I didn’t have much choice,” says Barnes. “My little boy’s worth it.”

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The Next Level

Barney Bishop, president and CEO of the lobbying group Associated Industries of Florida, says healthcare facilities in the state are doing a good job of attracting wealthy foreigners for medical care. Now, he’d like to see them begin competing for more middle-class customers. AIF is asking state lawmakers to allocate funds to create a domestic and international marketing program to better promote Florida’s medical facilities.

Cleveland Clinic surgeon Doug Boyd operates the da Vinci robotic surgical system.

Marketing — with Laser Precision

The Laser Spine Institute, an ambulatory care center in Tampa that offers minimally invasive laser surgery as an alternative to conventional back surgery to correct neck and spine problems, has conducted information seminars as far away as Canada to attract patients. The rapidly expanding company also operates a 30,000-sq.-ft. call center adjacent to its medical facility and has an aggressive internet marketing campaign. Bill Horne, CEO of the Laser Spine Institute, says the company gets about 450,000 hits on its website per month. Around 9,000 of those visitors fill out an electronic contact sheet.

The aggressive marketing has paid off. Ultimately, about 70% of the facility’s customers come either from foreign countries or other U.S. states, and LSI has grown from nine employees when it opened in March 2005 to around 350 today. The company, on track to perform around 5,500 surgical procedures in 2009 at an average cost of about $30,000, just opened its second center in Scottsdale, Ariz.

Horne says his international patients’ spending benefits more than the Spine Institute. “The Hyatt, the Holiday Inn, the Radisson and the Chase Suites hotel right next to us — we’ve got to be their biggest client by far. There’s just thousands of room nights that we’re doing every year there.”

About 70% of the Laser Spine Institute’s patients are from other states and countries.

Marketing and Services

Aventura Hospital and Medical Center capitalizes on its location on Florida’s east coast.

» Last October, the Mayo Clinic opened an information office in a large medical office building in Guatemala, a country from which it receives a large number of patient referrals. Patients who are unable to travel to the U.S. can get virtual second opinions on their case from Mayo.

» Aventura Hospital and Medical Center, located between Miami and Fort Lauderdale, markets a “Weekend at Aventura” package to international executives. The package includes a complete physical as well as three nights’ deluxe accommodations, limousine transport to and from the airport and store discounts at the nearby Aventura Mall.

» Orlando Health, a 1,780-bed system that serves more than 6,000 international patients each year, has an electronic database of staff translators who are fluent in 20 languages. For less common languages, the facility relies on a telephone translation service. Orlando Health also requires many of its staff members to take part in a cross-cultural training program so that the hospital personnel are sensitive to and can more easily accommodate a patient’s religious requirements or food requests. Orlando Health employees also help patients get tickets to Walt Disney World, Sea World and Universal Studios.

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Medical Meetings

Burnham Institute

As hospitals court patients from abroad, Florida cities are also looking to increase their share of the lucrative medical meetings market. Orlando, the nation’s top-ranked medical meeting hub for the past decade, played host to more than 215 medical meetings with 170,000 attendees in 2008. Local tourism officials hope a new medical city at Lake Nona — which will include the Burnham Institute, the University of Central Florida medical school, a new veterans hospital and Nemours Children’s Hospital — will generate even more interest in the area as a site for medical meetings. Jacksonville tourism officials, meanwhile, have created a website — VisitJacksonville.com/medical — and are working closely with local medical facilities to try to expand their reach into both the health tourism and medical meeting market.