If anyone thought 2015 at Health City Cayman Islands was a busy year, 2016 promises to be frenetic: New capital projects alone are budgeted for $25 million.
They involve apartment blocks, a commercial center, an expanded oncology wing, hotel design and inexorable progress toward a regional standard of affordable medical care.
The past year‘s most significant event was the hospital’s April accreditation by the Illinois-based Joint Commission International. While assessing HCCI in regard to American standards of care, cleanliness, reliability and efficiency, JCI approval means governments and healthcare facilities worldwide – as well as patients – can rely on a gold-standard benchmark assuring top-flight medical care, and a firm spot on the international roster for “medical tourism.”
JCI accredits more than 20,000 healthcare facilities in the U.S. and more than 800 in 63 countries. HCCI Marketing Director Shomari Scott says the East End hospital had prepared long in advance for the commission’s March visit and that accreditation had come quickly.
“It was just one year from our initial operation,” he says, pointing to HCCI’s February 2014 opening at 1283 Sea View Road in the High Rock section of the district.
“We are one of the fastest institutions to achieve this feat, which is a testament to the great team that has worked within these guidelines previously,” he says.
“We planned for accreditation from the inception,” planning “the right specificity” from the design stage. “[H]aving a quality manager who has gotten three other facilities JCI accredited, there was no guesswork in regards to the needs,” set out in 14 chapters of the JCI literature, covering 1,300 fields graded on a point system.
“For lack of a better example, what we have,” Scott says, “is the FDA’s [U.S. Federal Drug Administration] stamp of approval. It is third-party verification in regards to the quality of our services and facility. This is important in order to get potential patient bases/companies to try us.
“Just like the Cayman Islands in general, we know that once someone uses our service, they will definitely come back anytime we have a service which they need,” says Scott, the islands’ former director of tourism. “They will fall in love with us, with the medical solution we are offering … You are not a number; we care about you.”
HCCI was created to offer patients an alternative to the wildly escalating costs of healthcare, particularly in the United States. The hospital joins nearly 1,000 similar “medical tourism” facilities around the world – Thailand’s Bumrungrad International, accredited in 2002, is probably among the best known. Health City is also the first major Caribbean hospital to gain JCI accreditation, joining Nassau’s modest 72-bed Doctor’s Hospital and the Barbados Fertility Centre.
The facility’s 2014 opening laid to rest initial doubts about the viability of the project, which has incrementally carved out a niche, including in the local healthcare industry.
By statute, HCCI doctors are not permitted to practice privately in Cayman or in other local hospitals, nor can it offer services provided by either the Health Services Authority’s Cayman Islands Hospital or the private Chrissie Tomlinson Memorial Hospital.
Nonetheless, says Scott, in the past year, HCCI treated more than 9,000 patients, many of them local residents, specifically for “cardiac, orthopedics, medical oncology, neuro, etc.”
The greatest surprise, however, he says, has been HCCI’s “level-one sleep lab,” diagnosing a high incidence of sleep apnea, a disorder which has gained increasing attention as a cause of high blood pressure, heart attack, stroke, obesity and diabetes.
As of now, local clinics provide only minimal care for patients with a half-dozen afflictions, opening the door for treatment at HealthCity.
“We have found much acceptance and have cordial relationships with the local medical community,” Scott says. The tertiary facilities “fill a major gap” in regard to cardiac care and other services.
“We regularly receive referral patients from the Cayman Islands Health Services Authority and we appreciate the partnership … we have forged in the past 20 months,” he says. “We look forward to building a greater relationship with all parties in the medical field within the Cayman Islands.”
The hospital, however, was built to promote medical tourism, and appears to be gaining momentum with at least eight – and very likely twice that many – referral agencies throughout North America. Most work directly with particular companies with captive healthcare plans.
IndUShealth, Companion Global and Patients Beyond Borders are just three agencies that list HealthCity, which has drawn patients from the U.S., Canada and Central America, as well as the Bahamas, Jamaica, Barbados, Anguilla and St. Kitts and Nevis.
“We have seen continuous growth from the international market,” Scott says, but he cautions that hospitals are often reluctant to discuss their facilitators, fearing either economic or political repercussions.
“Many don’t publicize their medical tourism offerings,” he says, because the hospitals deal directly with companies versus individual patients.
In the partisan atmosphere of U.S. politics, for example, patients traveling abroad – and the companies sending them – for affordable treatment have faced criticism for so-called unpatriotic behavior.
“We have partnered with many facilitators and self-insured companies throughout the United States, Central America and the Caribbean,” Scott says.
As the trade grows, however, incoming patients are increasingly arriving by private and chartered carrier, often funded by the savings gained on medical procedures. HCCI expects additional transport in 2016.
“Due to our cost savings … patients have been utilizing connections to get to HealthCity. [Through] Jamaica or … Miami is the most typical route from those located in the Caribbean trying to reach us,” Scott says.
“We have good connectivity in the USA and Canada, so that isn’t an issue, and we have two countries presently that are looking at the possibility to charter and pool patients. This option won’t start before March, however, and the cost would be borne by the payer.”
The coming year presents several challenges, he says.
“The challenge Health City will face [in 2016] is keeping up with the increased demand in areas that we originally didn’t anticipate,” Scott says. “This is a good challenge to have, so we are properly planning and streamlining operations to offer the best service possible.
“An example is that we didn’t expect to have as many outpatient services (consultations, etc.) as we are currently receiving. So now we are planning to get as efficient as possible and still keep a high level of customer service.”
He enumerates a list of nearly $25 million in expansion projects. Some – such as assisted-living facilities, apartment blocks, a hotel and medical college – have long been planned, while others – an expanded outpatient wing and affiliated, new oncology unit – have only recently been approved.
“The outpatient expansion is an increase of about 6,000 square feet,” approximately 75 percent bigger than the present facility, made necessary by “integration of the oncology wing and the increase in outpatients it brings. We will have increased outpatient services for modalities we have added,” he says.
The new 5,000-square-foot oncology wing will be an addition to the “medical oncology” facility.
Cancer treatment is broadly separated into three areas: medical treatment with chemotherapy; surgical treatment in the operating theater; and radiation, employing high-energy X-rays and other particles to kill diseased cells.
He expects expansion of the oncology and outpatient units to start in the second quarter of 2016, finishing by the last quarter of the year or the first quarter of 2017.
Also in the 2016 pipeline are what he calls “non-hospital” projects: Phase one of the 59-unit Parrot Ridge Apartments, comprising one-, two- and three-bedroom units between 450 square feet and 1,000 square feet, designed for staff and patients. Work will start in the first quarter of 2016 and finish in the last quarter of the year.
At the same time, design and enabling works will start next year on Parrot Ridge’s second phase, another 59 units similar to phase one.
In the second quarter, HCCI will start work on the 24,000-square-foot Heron Landing Commercial Centre, scheduled for opening in the final quarter.
Finally, designers will start planning a 185-room hotel, the first of two at HCCI, intended to accommodate patients and families, visitors to the site and even tourists.
Scott says he cannot enumerate costs for individual projects, relying instead on the $25 million “rough order of magnitude” for everything.
The most significant development in the new year, however, and one that has already taken nascent shape, is HCCI’s medical college and its affiliated school of nursing.
Scott says a “market analysis” for the medical college will take place in 2016. The nursing program started in November, after an October agreement with the University College of the Cayman Islands.
In 2013, a group of 17 Caymanians formed the first class in UCCI’s four-year bachelor of science nursing course, a partnership between the college, the ministries of Health and Education, and the Health Services Authority.
Numbering 31 students today, the program qualifies graduates for the Nursing Council of Jamaica’s regional examination, gaining certification as registered nurses qualified to work anywhere in the Caribbean.
The Cayman Islands Hospital offers apprenticeships to UCCI’s third-year and fourth-year nursing students. On Oct. 13, 2015, hospital CEO Dr. Chandy Abraham signed a pact with UCCI for similar slots in East End, telling students he hoped it was the “first step” in a “partnership” to supply the Bangalore, India-originated hospital with Caymanian medical staff.
“Our dream is to have a 2,000-bed facility,” Abraham told the group in October. “The nursing component of that is not going to continue to come from India. We have got to have well-trained, well-equipped staff, and the first place to look is Cayman. This is an investment in our future as well.”
Scott said 10 third-year UCCI students entered the four-week training program on Nov. 15. “The students work alongside Health City’s nursing team for hands-on experience. This is an example of working with our local education arm to help wherever possible with the local pool of healthcare professionals,” he said.
“All students are from the Cayman Islands branch of the University of the West Indies” on the UCCI campus, he points out. Student intake is likely to expand as the partnership becomes established.
“Upon graduation students are free to choose where they would like to apply for employment. The ultimate goal, however, would be in the future to have more Caymanian professionals within our organization across all medical fields, noting that we have specialist nurses, so additional training would be needed in that area,” Scott said.