Dr. Edmundo Mesta Casavantes
Director General
Hospital Ángeles Valle Oriente
View from the Top

A New Vision for a Third Level Hospital

Sat, 09/05/2015 - 19:54

Q: Hospital Ángeles Valle Oriente is the result of the acquisition of Hospital CIMA – what is the new vision for the hospital?

A: Grupo Ángeles acquired Hospital CIMA at a time when the hospital had fallen into bankruptcy due to an overall lack of understanding about the complexities of the private sector. In Mexico there is a complicated interrelation between the public health sector, the private health sector, and private insurance companies, which private hospitals have to understand in order to thrive. The hospital had neglected to invest in the appropriate equipment and infrastructure, and it fell behind in these areas. It was also the only hospital in Mexico dedicated to pharmacovigilance, which is not a business model that can support a general hospital in this country and the appropriate investments to turn it from a pharmacovigilance hospital into a general hospital were not made. Grupo Ángeles is an investor in other successful CIMA hospitals and it wanted to establish a hospital in Monterrey, since hospitals are heavily dependent on private insurance companies and more than 20% of insurers in Mexico are based in Monterrey. What interested us about hospital CIMA particularly was its location and its employees. After acquiring Hospital CIMA we started a complete renovation of the infrastructure and equipment.

Q: As newcomers to Monterrey, how do you plan to compete with local hospitals?

A: First of all, we want to learn from the mistakes of the past. Grupo Ángeles therefore wants to become the best-equipped hospital group in Mexico, an ambition that we are already working to accomplish. For example we were aware that Doctors Hospital had a state-of-the-art 256-slice CT scanner, which was the best in Monterrey. We always aim to stay ahead of the competition, so we acquired a more advanced 384-slice CT scanner from Siemens. In the US there are no more than ten of these CT scanners, and there are probably only three of them in Latin America, and we are the first hospital to have this technology in Mexico. In order to be leaders in equipment and technology we are not just renovating, but orchestrating a complete reengineering of the hospital.

Q: What capacity are you aiming for the hospital to have?

A: At this point we have 75 beds and we are planning to expand to 150 beds with the anticipated final area comprising 42,000m2. We closed the ER as it did not comply with national norms and we started afresh with the construction of a new, appropriately equipped ER. Our goal is to expand the ICU and focus on critical medicine, meaning we had to build an imaging department to allow us to accommodate for emergencies. Currently, we have eight beds in the ICU with plans to expand to 18 but we also want to create a separate pediatrics ICU with eight beds. In fact, the restructuring of the hospital is so comprehensive that when completed, only the original chapel will remain. We expect the occupation level within the hospital to average at least 60%, since in the private sector when a hospital reaches 75% occupancy it indicates that the hospital must look at expansion. The situation is different from the public sector where it is possible to achieve 100% occupancy with ease. Such a feat is not desirable for private hospitals, as having such high occupancy makes logistics complicated and can place patients in unsafe conditions. Safety is one of our main concerns along with quality, so for that reason, 60% occupancy is the appropriate level to provide the best quality and safety to our patients. Another part of the project is a new 20-story tall building that we will start to construct in March once we have obtained all the necessary permits.

Q: Do you think hospitals in Mexico can compete with those in developed countries?

A: It is impossible to compare private hospitals in Mexico with those in the US or Europe, since the systems are unique to each country. Our goal is not to compete with hospitals in other countries but to become the best hospital in our specific area and to have the best equipment and the best technology. No hospital can excel in every area so we must choose fields in which to specialize. At Hospital Ángeles, we want to focus on clinical care, particularly radiology, neurology, orthopedics, and internal medicine. We chose these specialties by analyzing current statistics on morbidity and epidemiology for the area, and since obesity is among the main diseases currently affecting the health of Mexicans, we are focusing heavily on cardiovascular disease.

Q: How many of your patients have private insurance, how many pay out of pocket, and how closely do you work with insurance companies?

A: About 90% of our patients are insured and the remaining 10% pay out of pocket. We currently have several contracts with private insurers and we plan to work more closely with these companies to make the system more efficient. In Mexico, very few people would invest in medical insurance in the past as they were unaware of the benefits. Unlike the rest of Mexico, however, people in Monterrey tend to have greater awareness of the importance of medical insurance due to US influence. Since private hospitals are dependent on private insurers it is not possible to build these types of hospitals in areas that do not have the necessary population to support them.

Q: What is your perspective on the potential to develop Mexico’s medical tourism sector?

A: In my opinion there is no medical tourism industry in Mexico, only private and singular efforts for out of pocket services. Foreign patients come to Mexico for services that their own insurance companies and healthcare systems will not provide, such as cosmetic and bariatric surgery. It is unlikely that patients with health insurance in other countries will come to Mexico for medical care. It could be possible to develop a real medical tourism sector in Mexico, but several reforms would be required, such as an overhaul of policies of foreign insurance companies, which currently do not tend to cover medical expenses in Mexico. This move could save insurance companies money but may affect private interests, as Mexico’s image is not as prestigious as other countries in terms of healthcare. Patients may also need to return to Mexico for aftercare, which could be problematic. These changes will not take place in the short to medium term as Mexico needs to change its worldwide image to make patients feel safe. In this way, I do not believe that medical tourism is a real bankable approach, so while I would offer the services, I will not invest heavily in the practice.

Q: What current certifications does the hospital have?

A: We are accredited by the Joint Commission International (JCI) and we are working on obtaining the accreditation from Mexico’s General Health Council (GHC). The former has two different standards - process and structure - and the latter has stricter requirements than those of the JCI. To get the accreditation from GHC you have to comply 100% on structure and 80% on process, and, as a results, not all hospitals in Mexico are accredited by GHC.

Q: What are the biggest challenges that Hospital Ángeles Valle Oriente, and the hospital sector in general, is currently facing?

A: One of our largest problems is the recruitment of nurses. This problem is not exclusive to our hospital, as all hospitals in Mexico, and even in the US, are having trouble finding enough qualified nurses, even though a lot of universities and medical schools are investing in educating these professionals. The lack of interest in nursing as a profession is largely due to the fact that nurses are not compensated adequately. While government agencies pay nurses a determinate amount, private institutions cannot afford to pay the same levels as we do not receive money from the government to subsidize these costs. Currently, we are setting up education programs in collaboration with UDEM and Tec de Monterrey. We are only beginning to build the infrastructure for residents and interns, and plan to start the internship program and a residency in radiology this year.

Q: To what degree do you collaborate with the public sector?

A: We are currently collaborating with IMSS, ISSSTE, and PEMEX to provide treatments for specialties and sub-specialties. The public sector mostly approaches us for surgeries that require advanced equipment. We are planning to strengthen this collaboration with the public sector in the future when we have more of the necessary infrastructure. We provide the same high quality standards to all of our clients, but with some paying out of pocket and others insured, the amount they pay varies. Patients receive the same services with the only variation sometimes being the rooms allocated to them. We are limited by the fact that IMSS and ISSSTE are not always willing to send their patients to our hospital, so we can only provide support. At this point, it is more convenient to have one hospital providing services for the public sector and a different one for private sector patients. At the moment, we are focusing on the A and B+ sectors of the population.

Q: What specific goals does Hospital Ángeles have for 2015?

A: We have several goals. We must acquire all the necessary equipment and prepare our medical professionals by training them in different centers with a high patient volume, a project that will take about three years. Also, we plan to start the construction of the new building and to obtain the GHC certification. I have no doubt we are going to achieve these goals, as from my point of view we have many advantages. We buy larger volumes at more competitive prices than anyone else and Hospital Ángeles Valle Oriente is backed by the whole Grupo Ángeles. Doctors are aware of the many advantages we offer and experienced physicians prefer us over the competition. I am a firm believer in a free market where competition is based on a hospital’s statistics of mortality, morbidity, and results, and with this in mind physicians will prefer our hospital. In the long term we aim to build more hospitals in Monterrey.