MMI September 2010 - mmi home

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42 Seafarer Health Issues Medicare necessitate months of physiotherapy and even follow-up surgery. Should this scenario unfold, establishing an MSA for the claimant could prove highly useful in proving that the primary payer has done its best to protect Medicare from unnecessary liability. As Thomas Miller points out, ‘technically’ the CMS does not require disclosure of MSAs in liability settlements; the American Association for Justice has allegedly advised its members to dismiss the concept, for example. However, ship owners, of all the professions, will appreciate that the line between what is ‘technically’ meant to happen, and what happens in practice, can be blurry at the best of times. For instance, CMS guidelines specify that MSA agreements should be submitted for approval in every workers compensation settlement where the claimant is already a Medicare beneficiary, and where the settlement is likely to exceed US$10,000; and ditto if the claimant is ‘reasonably expected’ to qualify for Medicare benefits within 30 months of a settlement exceeding US$250,000. Yet, while the American Association for Justice has downplayed the importance of MSAs in liability settlements, Thomas Miller insists that adopting a hang-back strategy could prove “ill-conceived and short-sighted” – not least because it strips the primary payer of a key component in proving that it has done its best to protect Medicare’s interests. The mutual opines: “Waiting for guidance from CMS could mean that a shipowner or his insurer could effectively pay future medical expenses twice; once to the claimant in the settlement, and then to Medicare if the latter pays initially for treatment contemplated in the settlement.” On the other hand, an enormous amount Should Medicare recipients be involved in the chain at any stage, it is vital that ship owners do their utmost to guarantee as much transparency as possible when handling related claims. Failure to do so could result in losses of millions Should a US seafarer break his or her foot while on board, and Medicare pays this individual’s expenses for ongoing treatment in its capacity as secondary payer, CMS would be entitled to recover these expenses from the shipping company or insurer, should these latter primary payers have cover in place for said seafarer of cost and time is generated in creating a formal MSA agreement, and there is the very likely chance that the CMS will not even act on it. Putting together an MSA for each liability claim could also cause delays, leading to a time-consuming ritual that shipping companies can barely afford. In contrast, however, CMS may not find itself so inundated with work that it is unable to file a reimbursement suit against a tanker company deemed to have not taken enough steps to safeguard Medicare’s interests. Alternative solutions As a happy medium – or as happy as one can be when facing this vaguely defined system – shipping companies and underwriters would be better placed in creating a projection of future medical costs whenever a long-term injury claim arises, taking into account factors such as the claimant’s prior medical history, current condition, life expectancy and prescription expenses. The key is to demonstrate that measures have been proactively taken to identify these factors and to make a subsequent specific assessment confirming how future medical expenses will be administered. At the very least, Thomas Miller argues, this course of action would save shipping companies the risk of being slammed for extortionate reimbursement penalties, should they await a formal CMS announcement on MSAs, as well as saving them the time and effort involved in generating a MSA agreement that promptly ends up at the back of a filing cabinet. Fortunately, IMMA’s proposed Maritime Electronic Health Record database should go some way towards simplifying the process of accessing collated information on individual seafarers’ past medical records and most upto-date health assessments. Overall, it is clear that some course of pre-emptive action is better than none and that, should Medicare recipients be involved in the chain at any stage, it is vital that ship owners do their utmost to guarantee as much transparency as possible when handling related claims. Failure to do so could result in losses of millions. ❤ maritime medical international ________________________________________________________________________________________________________ september 2010
Skin Grafting Seafarer Health Issues 43 Grafting hard to set the right standard Panama has staked its claim to be one of the shipping industry’s most sought after areas for skin graft and burns treatment after it successfully treated an ‘oiler’ severely burned with oil onboard a ship off the country’s coastline. The seafarer was initially admitted to the Clinica Einstein and then transferred to the Centro Medico Paitilla where the intervention was performed. Clinica Einstein coordinates periodic medical examinations for employees of international agencies, cruise lines, several embassies and consulates accredited to the Government of Panama, foreign companies as well as local businesses such as hotels, shipping agencies, banks, pharmaceutical firms, insurance companies and airlines. A key role, as in this case, is the management of patient hospitalisation. In the past this has included barge crews or of cruise lines passengers and airline passengers in all major local hospitals. It undertakes the necessary checks, ensuring that the charges for the services offered are justified and in order. He suffered burns to around 20% of his body – mainly to his arms, legs, abdomen and face. The skin graft was predominantly carried out on his legs and arms by Dr Julio A. Molto and his team at the Centro Medico Paitilla. Dr Molto told MMI: “The burns were mainly on his face, arms and legs and the deepness of the burn was a priority because it was a little bit deep. They were classed as second grade burns.” The accident onboard ship happened on July 15th and the seafarer was admitted to hospital two days later. As Dr Molto added: “He has spent 26 days in the hospital and is likely to stay one more week. The skin graft operation was one day but the skin grafts need to be cleaned every two days under anaesthesia because it is so painful. So how is the patient doing now? Dr Molto again: “His recovery is very good. Without any skin graft he has recovered the skin on his face and his abdomen but he required skin graft on his arm and on his leg. The doctors who performed the operation are skilled in doing this type of operation in the clinic.” “He has spent 26 days in the hospital and is likely to stay one more week. The skin graft operation was one day but the skin grafts need to be cleaned every two days under anaesthesia because it is so painful” photographs coutesy of Joan David Molto, Panama september 2010 ________________________________________________________________________________________________________ maritime medical international
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Page 6: 4 Comment Welcome to Maritime Medic
Page 9 and 10: News & Views Heartbeat 7 Smile Plea
Page 12 and 13: 10 Diagnosis & Treatment Musculoske
Page 14 and 15: 12 Service Sector Tropical & Infect
Page 20 and 21: Directors & Officers The IMMA Board
Page 22 and 23: 20 Business Viewpoint Seafarer Scre
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Page 26 and 27: 24 Service Sector Medical Bags & Ki
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Page 32 and 33: 30 Service Sector First Aid & Medic
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Page 36 and 37: 34 Health, Fitness & Nutrition Onbo
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Page 40 and 41: 38 Service Sector Splintage & Traum
Page 42 and 43: 40 Seafarer Health Issues Medicare
Page 46 and 47: 44 Regional Focus Far East Putting
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Page 50: 48 Insight The Health Inspector Bea

MMI September 2010 - mmi home

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