Does Travel Health fit into your primary care practice?

Despite the current state of the economy, many people are traveling. Immigrants return home to visit friends and relatives. Students travel abroad to study and do humanitarian work. Church groups offer tours that combine missionary work and vacations. People, who can’t find work here, travel to find jobs. People who can’t afford certain medical procedures in the U.S. are traveling abroad for what is now called medical tourism. And of course, those who can are taking advantage of worldwide discounts in vacation travel.

As a primary care provider, you will be asked for health advice for travel. You will need to decide which patients you can advise and which you will want to refer to a travel health specialist.
So, how do you decide? First, evaluate your level of expertise in travel health. Do you understand the destinations and types of itineraries your patients are taking? Do you have the knowledge to evaluate when malaria chemoprophylaxis is warranted and which drug to choose? Do you understand all of the travel vaccines and drug and other vaccination interactions? Are you current with the latest evidence based recommendations for self treatment for traveler’s diarrhea ?

Do you have the time in your practice to devote to travel health? A typical travel health visit in my practice involves about one and half hours for the preparation, research, visit, charting and follow up. Medicare and Medicaid will not reimburse you for travel health visits or most vaccines. Medicare B covers pneumonia and flu vaccines and hepatitis B in very high risk patients only. Medicare D covers herpes zoster vaccines in varying degrees. Most private third party insurers do not cover travel visits, most vaccines or malaria medications if used for prophylaxis. Third party payers typically reimburse at cost or less than your cost for immunizations. Only certified yellow fever centers can administer yellow fever vaccine. If your patient is traveling to an area where yellow fever is required or recommended, you will need to refer to a certified yellow fever centers.

After gaining expertise in this field, I choose to set up a travel health clinic as a separate entity from my primary care practice. Travel Health of NH, PLLC is a fee for service practice that does not bill or accept any insurance. As a family nurse practitioner in the state of New Hampshire, I am able to operate my own practice and prescribe independently. You will need to check with your state’s laws to determine your legal scope of practice.

So, you can refer all your travel patients or offer some travel health services within your level of expertise in your primary care practice. Or you could add to your education and start a travel health practice separate from your primary care practice. No matter what level of involvement you choose, the most important thing you can do for all your patients is make sure all their routine adult immunizations are current and documented.

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