How does a Baton Rouge physician go about establishing a full-service medical tourism program?

For Dr. Arnold Feldman, the first step was hurting his back 10 years ago.

Feldman, who does minimally invasive spine procedures, needed back surgery and obviously couldn’t work on himself. He started looking for a practice similar to his in a search that led him out-of-state.

“It was only by accident that I found a doctor, almost across the country, with a practice similar to mine,” Feldman said. “It was one-on-one, very personal service in his own surgical center.”

Feldman mailed his MRI to his new doctor in Phoenix. Two weeks later, Feldman limped onto a plane — Baton Rouge to Dallas to Phoenix — met with his doctor and had surgery the next day. Later the same day, Feldman took a pain-free walk in a mall.

“I went home the next day, and a terrible problem was fixed,” Feldman said.

The experience stayed with Feldman.

Traveling might have been a little inconvenient, but Feldman figured there were lots of patients like him who wanted the highly personalized service he sought: people who didn’t want to spend hours in a waiting room to spend five minutes with a doctor; who want treatment from a doctor they know and who knows them; and are willing to pay their travel expenses.

Thus, the Feldman Institute Travel Program.

The dollar value of this sort of medical tourism, as it is called, is unclear. But some employers have embraced domestic medical travel as a way to reduce hospital spending, which will reach an estimated $920.7 billion nationally this year, according to the federal Centers for Medicare and Medicaid Services.

By sending workers to high-quality, lower-cost facilities, some employers believe they can cut costs, according to a 2010 joint report by Kaiser Health News and USA Today.

Last year, Wal-Mart announced a domestic medical travel program with six centers of excellence. Workers who go to those centers for some heart and spine procedures won’t have out-of-pocket procedure or travel costs.

Iain D. Vasey, director of the Baton Rouge Area Chamber’s business development group, said it’s hard to estimate the local economic impact of medical tourism, which is still an emerging sector of health care.

But Baton Rouge has the foundation in place to become a medical hub in some fields, Vasey said. The area has Pennington Biomedical Research Center, with its obesity and diabetes research; Mary Bird Perkins Cancer Center and Pennington Cancer Center at Baton Rouge General Medical Center; Woman’s Hospital; and the Franciscan Missionaries of Our Lady, General and Ochsner health systems.

“In the specialty niches, a person isn’t just going to go to the closest hospital,” Vasey said. “On a national level, you look at the Mayo Clinic or the Cleveland Clinic …. People fly in from all over the country and all over the world to have their specific ailment treated.”

That’s what Royce Martin, Latin America operations manager for oilfield services company Brock, did with Feldman.

Martin, who is originally from Holden, had herniated a couple of discs while in South America, he said. Visits to physical therapists and chiropractors there brought no relief.

“I found Dr. Feldman, actually, on the Internet, called him, and he called me back over the weekend,” Martin said. “I made arrangements, flew in there on a Saturday evening. Sunday he opened up his facility, ran all the tests and Monday we did the procedure.”

Martin said the experience was wonderful.

Feldman said three members of his 40-person staff handle the travel program. Those workers will make all the travel arrangements for patients, including airline, hotel and rental car reservations, although most people prefer to book their own flights. The staff will even pick up patients at the airport and book visits at The Oaks at Goodwood Medical Spa, a partner facility.

Feldman said his staff didn’t need additional training to deal with insurance companies for out-of-state patients, even those from outside the country.

The pre-certification process is the same just about anywhere, Feldman said. Large companies with domestic and international locations sometimes use the same health insurance company.

Feldman said medical travel is now a small percentage of his practice, around 1 percent to 2 percent.

His normal practice is busy, Feldman said, and he doesn’t want to grow the travel practice too fast or service will suffer.

But his medical travel business is growing, he said, and an international ad campaign, with a tentative budget of $25,000 per month, should help.

Marcy Rogers, chief executive officer of SpineMark, is working with Feldman and about two dozen other spine centers on medical travel.

“Within the year, we hope to make medical tourism 10 percent to 20 percent of the practice,” Rogers said.

Spine patients are in so much pain they are willing to travel wherever it takes to get relief, Rogers said. Spine injuries are the No. 1 cause of disability worldwide.

Feldman said he has obtained a license to practice in the Cayman Islands, an international travel destination, and hopes to open a satellite clinic there.

He expects domestic medical travel will explode in the coming years.

The changes wrought by the Affordable Care Act — whether considered good or bad — along with physician and facility ratings on the Internet and increasing price transparency, will all contribute to the growth of domestic medical travel, he said.

Feldman said there aren’t enough physicians to handle the expected influx of new patients the federal legislation will generate.

The impersonal treatment the health-care system forces on patients and providers will only grow worse because of the worsening physician shortage, Feldman said.

“I just won’t tolerate it. I’d rather not have the medical care,” Feldman said. “I think everyone’s going to get that way … if they’re not there already.”

And that means patients will look for places that offer personalized care, Feldman said. Practices that have travel programs in place will be ready.

“I think you’re going to see these types of services grow and flourish,” Feldman said.