Kansas City hospitals said they are prepared for the influx of international patients expected this summer during the World Cup. But they worry that the patients may not be ready for America’s labyrinthine healthcare system.

In addition to bulking up translation services and scheduling more doctors and nurses for shifts during the monthlong tournament, hospitals said they’re focused on communication to help international visitors understand that getting care here isn’t as simple as it may be back home.

“All of our health systems have been working together to share information about how to best work with and take care of patients coming from single-payer countries,” said Dr. Bryan Beaver, an emergency medicine physician at the University of Kansas Health System who is leading the city’s medical coordination for the event.

In countries where healthcare is provided through the government, it is free to patients and, unlike the United States, there is no menu of care options with varying price tags. That’s why, hospital leaders said, visitors need information, so they’ll know where to go and what it may cost if they get sick.

“Look at our market,” said Christine Hamele, a spokesperson for HCA Midwest Health. “We have free-standing emergency rooms, surgery centers, urgent care and big physician offices. In their home countries, they may be used to having just one hospital.”

Choosing where to go for care

Although World Cup visitors are encouraged to purchase travel insurance that covers medical expenses, those who don’t follow that advice and end up as an uninsured patient in the U.S. health system will get a bill for their care. 

The bill could be drastically different if they wander into a hospital emergency room rather than finding an urgent care clinic, but many won’t understand the distinction. Urgent care, where people with mild or moderate symptoms can walk in and get care on the spot, is far more affordable than an emergency hospital visit.

Dr. Mike Main, senior vice president and chief clinical officer of St. Luke’s, the West Region of BJC Health, said the system is doubling its medical staff at four urgent care locations, hoping patients who can get care there will. That will save patients money and leave capacity for more serious cases at the system’s hospitals.

The health system can offer urgent care as a cash service, Main said.

“That is an affordable service,” he said, “and it is also a service that is very timely. People can walk in and be seen immediately and have a disposition and plan in a short period of time.”

Despite efforts to provide information about care options, area health leaders worry there is still plenty of room for confusion.

In addition to cost considerations when deciding where to get care, international visitors also need to understand that not all health facilities in the United States are open for emergency care. A surgery center, for example, may look like a hospital, but it isn’t the right place to show up on a weekend with a health emergency.

HCA had considered installing signs outside facilities to inform visitors in multiple languages when they’ve arrived someplace that isn’t a hospital — despite what it looks like.

“We are trying to get ahead of it,” said Angie Giegerich, HCA Midwest’s assistant vice president for emergency planning, preparedness and trauma services. “We recognize this is not familiar. We are trying to make sure we communicate effectively.”

Planning for more patients

Since FIFA, the international organizing committee behind the World Cup, announced that Kansas City would be one of 16 host cities, the local medical community has been planning for the impact.

Organizers have said as many as 650,000 visitors could make their way to the area in June and early July.  For local health providers, that could mean an increase in patient traffic of between 6% and 8% over the course of the event.

Health system leaders have spent 18 months preparing for that added traffic. Among other measures, they have increased staffing and expanded patient care space. Because of that planning, leaders said local residents’ care should not be affected by the added number of patients in town.

“Our concern,” Beaver said, “was ensuring that we could fulfill our two primary missions, which were to take care of all the visitors and continue to ensure that we provide excellent care to residents who live here.”

Hospital leaders have been meeting regularly for a year to plan. Beginning this week, they launched a daily call, which will continue throughout the World Cup, so leaders can share what they’re seeing and coordinate any necessary response.

“We got rolling this week so we’d be a well-oiled machine by the time our first match gets here,” Beaver said.

The first World Cup match is on June 16 when Argentina is set to play Algeria. The final match, a quarterfinal, will take place on July 11. 

Hospitals said they have tried to anticipate as much as possible any situations that may come during the tournament. They expect to see an influx in minor injuries and illnesses and likely a rise in heat-related illness. But hospitals are also closely monitoring infectious disease spread around the world and have already begun closely screening patients for symptoms and risk factors. 

An ongoing Ebola outbreak in the Democratic Republic of Congo and Uganda is unlikely to make its way here, health officials said. But they are watching it carefully, as well as monitoring other potential diseases, including measles, which has been spreading more widely, and hantavirus, which this spring infected travelers on a cruise ship.

Health leaders said they are also prepared for a mass casualty event, like the shooting after the 2024 Super Bowl parade in Kansas City. Plans are in place so emergency responders and hospitals across the region know exactly how to respond for such an event.

But even if that situation does not unfold during the World Cup, having thousands of extra people on the roads and in the city’s public spaces comes with its own risks. Getting around the city may be more difficult, which could be problematic if someone has a medical emergency.

“There’s a lot of impact that just comes by having an increased population in the city,” said Dr. Jennifer Watts, chief emergency management medical officer at Children’s Mercy. “That includes the visitors that are coming, as well as our local population. … It’s going to be an impact that will be felt across our entire region.”

Staffing plans

For all of the potential scenarios hospitals may face, they said plenty of medical staff will be available. Hospitals have scheduled extra doctors and nurses already for certain shifts when they know a match or another event is taking place. And throughout the month, they said, they have plans in place to quickly scale up staff if necessary.

HCA, which has hospital facilities in seven host cities around the country, including Research, Centerpoint and Menorah medical centers in the Kansas City area, is running a systemwide command center in Nashville where the for-profit hospital chain is based. Staff at the center are constantly monitoring events throughout their markets to anticipate potential problems before they happen. 

HCA’s command center is focused on gathering intelligence, including about each country’s fan base, how they celebrate and what spontaneous events they are planning.

“We know we have sanctioned events that are already going on and unsanctioned events that will have risks around them,” Giegerich said. “Where are those and how do we prepare? It’s about anticipation and about being prepared.”

In addition, Kansas City area hospitals said they have ordered extra supplies, including stocking up on personal protective equipment (PPE) in case of an infectious disease outbreak. They also are adding language translation services in hospitals and in the field, so medical providers can communicate with patients in a variety of languages.

Hospitals also are looking closely at nailing down as many other details as they can before the events begin. 

At HCA hospitals, for example, pharmacists have given providers the different names used for common medications in various countries. University Health has added capacity for more ice storage in the emergency department, so patients with heat-related illness can be immediately treated. And hospitals are translating signage and patient information into more languages.

“We have put measures in place to expand our capacity throughout the entire metro,” Beaver said. 

Extra cost

Ultimately, the extra staff and supplies will come at a price for hospitals, and already has, although officials could not offer specific figures since the final cost will depend on how many fans show up. Potentially caring for uninsured patients during the tournament will be part of that final number.

“In any emergency department, we will always treat the patient that walks in the door,” said  Watts of Children’s Mercy. “That is hands down emergency medicine. … Will we end up getting reimbursed for that? Maybe, maybe not. It is unclear, unknown.”

She added that there are “a lot of conversations around awareness” about the cost and whether some of Kansas City’s World Cup funding should be shared with hospitals to help cover that care. The local organizing committee did not reply to a question about whether those plans are being considered.

“The ask would always be there,” Watts said. “There are a lot of needs during the World Cup for healthcare across the board, and so the funds have to be allocated appropriately for what the city and FIFA feel to be most appropriate.”

Charlie Shields, CEO of University Health, the city’s safety-net hospital and the hospital located closest to the World Cup Fan Fest at Liberty Memorial, said he’s not particularly concerned about the one-time cases of international visitors who come in for emergency care and end up not being able to pay. It’s much less burdensome than the number of uninsured patients the hospital cares for on a regular basis, he said.

Shields said that added costs associated with the World Cup are “probably not something that we realistically would go out and seek reimbursement for.”