The Value of Future Care’s Medical Case Management

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Published Feb 6, 2020 3:30 PM by Lawrence Jacobson

The quality of medical resources available for seafarers onboard the major cruise lines is unsurpassed in the maritime industry. Ship’s crew typically have access to a 24 hour infirmary, staffed with at least one physician and several nurses. Larger ships sail with a greater medical complement.  

Of course, in serious cases requiring hospitalization or emergency treatment the crewmember is transferred ashore and often subsequently repatriated for convalescent treatment until a return to Fit for Duty status or Maximum Medical Improvement (MMI). 

Once the crewmember is relocated ashore the employer’s responsibility for medical care continues, but the ability to provide that care is shifted to more remote providers. Without professional medical management this can result in inefficient or delayed treatment, hindering  recovery and increasing medical and related costs. It can also create anxiety or worse for the ailing crewmember, with prolonged medical treatment and reduced employment income while ashore.    

When repatriation is contemplated Future Care’s medical case managers (MCM) add immediate value, even before the decision is made. Repatriation can be expensive and disruptive, to both the crewmember and the cruise line operator. The right decision requires weighing a variety of factors, including:  

• Treating physician’s medical opinion
• Anticipated recovery time
• Crewmember’s and/or family’s preferences
• Medical condition and stability during estimated travel time
• Costs of travel including attendant medical travel requirements / personnel
• Alternatives and timing for repatriation
• Costs of treatment away from home.

Once the decision to repatriate is made, Future Care’s MCM team coordinates and oversees the various preparations required, including: 

• Clear all visa / airline and related legal / travel requirements
• Identify and communicate with appropriate receiving facility 
• Identify appropriate out-patient rehabilitative facility, if necessary
• Forward all relevant medical records to receiving facility 
• Identify and procure all travel medications
• Establish communication channels with family, medical facility and port or manning agent.

Future Care’s physician and nurse case managers provide the knowledgeable oversight necessary to ensure continuity of care for the crewmember during extended convalescence. Our MCM can coordinate treatment from onboard ship to shoreside transfer, steering to approved facilities, thereafter engaging the facility’s medical team to oversee quality and costs of treatment.  

When repatriation is required our MCM identify qualified facilities, physicians and other medical providers in the crewmember’s home country and coordinate transfer of records and relevant data. Future Care’s experienced team works with cruise personnel, the crewmember and family, shoreside medical staff and qualified vendors to arrange flights, medical escorts and/or medications during the return home.

Once the crewmember has returned home our MCM ensure a smooth transition with the receiving treatment team, including transmission of all medical records; maintain active communication with the new treatment team and crewmember / family; monitor and manage hospital treatment and out-patient therapies, monitoring the crewmember’s compliance with medications and  follow-up consultations.  

Dr. Arthur Diskin, Future Care’s Global Medical Director, states: “Continued medical case management for the crew member while convalescing ashore is an indispensable element in returning the patient to Fit for Duty status.  Otherwise, the end result is left to chance, potentially delaying recovery and increasing treatment costs.” Arthur Diskin, M.D., F.A.C.E.P., Board Certified by the American Board of Emergency Medicine, former Chair of the Section on Cruise Ship and Maritime Medicine of the American College of Emergency Physicians, has extensive experience in managing mariner health care in the cruise industry.

The maritime medical case manager’s professional interaction and oversight of the treatment team fosters efficiency of treatment, reduces hospital length of stay avoids unnecessary medical procedures, thereby greatly reducing cost.

In addition to the many medical benefits to the crewmember, the presence of a licensed physician or nurse maritime medical case manager acts to personalize the medical care being provided by the shipowner to the injured or ill seafarer. The MCM’s knowledgeable attendance throughout hospitalization and convalescence is a reminder of the shipowner’s concern and creates goodwill between employer and employee, reducing the likelihood of claims and litigation. Also, the MCM often is able to identify litigation risks including any dissatisfaction with care received.

Future Care’s program for the cruise industry includes oversight of the medical treatment for the cruise line client’s crewmembers while convalescing in their respective home countries. Our network of hospitals and medical facilities enables Future Care to arrange medical appointments without delay; place the necessary payment guarantees when required; secure usual and customary and/or reduced billing; schedule follow up and specialist consultations, and other benefits.  

Not only does this management improve the quality of medical treatment, it reduces the employer’s costs. Future Care’s management has proved to be greatly appreciated by the crewmembers and undoubtedly has resulted in greatly improved crew retention.

To learn more please contact Future Care at [email protected].

Lawrence Jacobson is General Counsel and Managing Director of Future Care Inc.

The opinions expressed herein are the author's and not necessarily those of The Maritime Executive.