Indian Doctor Tagged 'Henry Ford of Heart Surgery' Drives Down Costs
By Susie Madrak Monday Nov 23, 2009 7:00pm
Since this is going to be a healthcare-themed kind of week, this is an interesting look at an Indian surgeon and entrepreneur who's making heart surgery affordable for even India's poorest - and whose facilities will be coming to us via a short plane ride. This very well may be the U.S. health care model of the future:
BANGALORE -- Hair tucked into a surgical cap, eyes hidden behind thick-framed magnifying glasses, Devi Shetty leans over the sawed open chest of an 11-year-old boy, using bright blue thread to sew an artificial aorta onto his stopped heart.
As Dr. Shetty pulls the thread tight with scissors, an assistant reads aloud a proposed agreement for him to build a new hospital in the Cayman Islands that would primarily serve Americans in search of lower-cost medical care. The agreement is inked a few days later, pending approval of the Cayman parliament.
Dr. Shetty, who entered the limelight in the early 1990s as Mother Teresa's cardiac surgeon, offers cutting-edge medical care in India at a fraction of what it costs elsewhere in the world. His flagship heart hospital charges $2,000, on average, for open-heart surgery, compared with hospitals in the U.S. that are paid between $20,000 and $100,000, depending on the complexity of the surgery.
The approach has transformed health care in India through a simple premise that works in other industries: economies of scale. By driving huge volumes, even of procedures as sophisticated, delicate and dangerous as heart surgery, Dr. Shetty has managed to drive down the cost of health care in his nation of one billion.
His model offers insights for countries worldwide that are struggling with soaring medical costs, including the U.S. as it debates major health-care overhaul.
"Japanese companies reinvented the process of making cars. That's what we're doing in health care," Dr. Shetty says. "What health care needs is process innovation, not product innovation."
At his flagship, 1,000-bed Narayana Hrudayalaya Hospital, surgeons operate at a capacity virtually unheard of in the U.S., where the average hospital has 160 beds, according to the American Hospital Association.
Narayana's 42 cardiac surgeons performed 3,174 cardiac bypass surgeries in 2008, more than double the 1,367 the Cleveland Clinic, a U.S. leader, did in the same year. His surgeons operated on 2,777 pediatric patients, more than double the 1,026 surgeries performed at Children's Hospital Boston.
Next door to Narayana, Dr. Shetty built a 1,400-bed cancer hospital and a 300-bed eye hospital, which share the same laboratories and blood bank as the heart institute. His family-owned business group, Narayana Hrudayalaya Private Ltd., reports a 7.7% profit after taxes, or slightly above the 6.9% average for a U.S. hospital, according to American Hospital Association data.
The group is fueling its expansion plans through private equity, having raised $90 million last year. The money is funding four more "health cities" under construction around India. Over the next five years, Dr. Shetty's company plans to take the number of total hospital beds to 30,000 from about 3,000, which would make it by far the largest private-hospital group in India.
At that volume, he says, he would be able to cut costs significantly more by bypassing medical equipment sellers and buying directly from suppliers.
Go read the whole thing. (And don't miss the "farmer's insurance" he offers poor farmers.) Obviously, you need to have impeccable quality control when you have that kind of volume - but we already know that the more often a surgeon performs a specific procedure, the better he gets. So maybe these specialized treatment centers will be the wave of the future.
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He sends money to the Nazi party?
I do believe they're referring to how Henry Ford made his money, i.e. making something previously unattainable for all but the richest (a car) something most people could afford.
Probably a lot better than your temper. Maybe before you show your bigoted side you could find out and report back here. Scoot now.
[Deleted. No one flagged you. I caught it right after it went up. And this post is off topic-Sitemonitor]
n/t
[No worries. We do prefer you flag comments like that. It saves the site team work when a full blown flame war is averted :) Sitemonitor]
the US congress is going to make us buy insurance from insurance companies that keep their anti-trust exemption?
the dementia of our "representatives" has moved to a new level.
If you don't buy healthcare...the IRS will audit you to see if you can "afford" it.
If so ...the IRS will penalize you...
and if you don't pay the extra tax penalty (assuming you DON'T have a bank account that they can confiscate it from)
you can be sentenced to jail time.
...however (I hear) there may be a religious exemption form that one can fill out...(but I still have 1,732 pages left to read still, so don't quote me on it!
I've heard the figure "$700" floated around for the penalty. For that, screw American insurance and get the $2000 operation.
In practice, however, the problem would be getting you to the Caymans if you have a heart attack, so the opportunities are limited to operations that can be scheduled. But, in general, I approve. I've seen the same thing done in other areas. Oracle database servers, for instance, are very expensive, but the free, open source PostgreSQL database server is a _very_ competent db server. So what did Oracle do but release a free Oracle server suitable for departments and small business with the hope that they retain market profile in doing so. This sort of cheap competition has more potential to change American health care than we can accomplish trying to get our voices heard through the shield of lobbyists that surround every congressman.
the Pinto once the medical Henry Ford brings his factory to our shores?
they will be building ...pintos, edsels, and fairmonts...
they are all crummy cars (and FORD stands for)
Found
On
Road
Dead
or
Fix
Or
Repair
Daily
First
On
Race
Day
lol
Ford has fixed many of their historical problems with quality, and their current cars are pretty good. Notice that they're the only major US car maker that has not been in or near bankruptcy recently. That was not by accident.
a type of process-based medical service? Our family belonged to Kaiser most of my childhood and early adulthood. I was often irritated by their "assembly line" attitude, and determination to give one every single test available.
It wasn't till going on Aetna and other 'private' insurers that I realized how expensive these tests can be, and how incredibly costly to me! Not to mention confusing and contradictory billing, and threats from collection agencies for a $6.99 charge.
I didn't know when I was well off!
The more often he performs, the better he gets. But look at those numbers. 42 surgeons performed over 3,000 in one year? That's an average of 3 a day, without days off. Considering that open-heart surgery is not a simple half-hour procedure, I'd say that is FAR too many surgeries for each doctor. I'd be very wary of a place that pumped out surgeries like that, for the simple reason of doctor fatigue. How much rest are these guys getting? How much time off? Hell, how many COFFEE BREAKS are they getting?
The more you do, the better you get. But if you're cramming those surgeries in one after the other, the more you do, the more TIRED and likely to commit error you get. Fatigue is one of the major problems facing surgeons and nurses in U.S. hospitals. I can't imagine this kind of pace would do anything to alleviate the problem; it probably exacerbates it.
It's complex. An uncomplicated CABG takes about 4 hours, skin to skin. Complex pediatric cases can take much longer (Tetralogies are not that long). I've been in tough cases that went 24 hours. The primary surgeon does not have to be there the entire four hours. There are assistant MD's and PA's who, in some US states, can open and close the chest. I do wonder how much they pay their nurses and ancillary staff. The $110K to $224K for the surgeons in India is like half a million here, based upon cost of living.
I've seen primary surgeons do 3 to 5 operations per day using a well oiled machine of staggering rooms and having assistants to open and close.
I also noted that they can negotiate prices for suture and equipment, and can buy second hand equipment for the cath labs and echo labs. Neither of those practices are permitted in the US.
And their mortality rate is not age adjusted. I wonder how many octegenarians they operate on? In the US we operate on people who in other countries would be a week away from wearing toe tags.
In the larger centers, the primary surgeon may be completing the grafts on a patient, while a Fellow surgeon is opening a patient in another room, the primary walks into the other room as soon as the patient is safely off pump, and then starts the next one's grafts immediately. I am sure that is what happens in India, as well.
We could, however, have Open Heart Centers of Excellence for larger areas and population centers and concentrate the use of equipment and staff and other factors and use the Cath Labs sixteen hours a day, instead of eight, and the surgical suites the same way, and rotate teams for days for two weeks and then evenings for two weeks, thus permitting more surgeons to use the same equipment and save tremendous amounts of money.
Proliferation of all these small programs in the U.S. drives up costs and drives down results in many situations. Close half the programs, concentrate and enlarge others and SAVE THE COUNTRY billions of dollars.
Cardiovascular services are big moneymakers for hospitlas. That is why we have so many programs. If certain hopitals are to become centers fo excellence, then other hospitals would suffer financially. It's a side effect of the for profit medical system.
Actually, 3,174 cardiac bypasses for 42 surgeouns is about 80 per surgeon per year. Even if the same 42 surgeons were also responsible for the 2,777 pediatric cases mentioned in the article, that would still come to under 4 cases per surgeon per week.
If he really is bringing "mass production" to the operating room, I would expect the number to be higher than that. I wonder if there aren't more surgeries performed by the unit in question beyond those listed in the article.
Per Trantorian, it is possible for one surgeon to perform multiple surgeries per day, though I doubt it would be possible to maintain the pace Trantorian described every day.
Where else can we cut costs? Do we need to sterilize instruments? How about if Dr. Shitty hires some medical interns to work free for the summer, sort of like hair-cutting schools do?
Or we could cut doctors' salaries to a quarter of what they are. We've already got airline pilots who have to work at McDonalds to make ends meet, why not chance our surgeries with doctors who have two or three jobs?
May as well send in the Robots now. Hey, what are a few "civilian casualties" so long as the profit machine is being served?
You want robots? We got 'em!
http://www.dmc-modesto.com/en-US/ourServices/...
More my cup o'grog:
http://www.youtube.com/watch?v=GzINI3au9q0
I do not want universal health gov run health care to mess with my Medicare and social security. I worked hard for these benefits and they should not be available to all that want them. and I don’t want any of the Indian health care for Americans that will take away out profits of our insurance companies. Profits are the engine that runs this country and makes this country the best in the world at everything.
This is America and gov is the problem not the solution. We need more tax cuts for the rich or no taxes at all for them. They are the selected few and should be treated as such. Reagan was a god and knew the ill effects of gov. Reagan balanced the budget and brought down the Berlin wall. Now if we just can do something about those terrorists.
Now our church puts together a food basket once a month for a family that lost their home due to his losing his job and health insurance and his wife has preexisting conditions; this is America and profits come first. What would America be like without capitalism. I.e. communism or socialism that is ungodly.
We also had a bake sale for that family of four children and raised 300 dollars. It was the Christian thing to do. I know their hospital bill was over 100 thousand and they lost their home but the bank let them keep their old car. Banks are like that very caring. They had to sell that old car for food but at least they had some food that month thanks to their bank.
I know they live under a bridge now and it takes me some time to drive that food basket to them but being a Christian it is the right thing to do. We Christians are like that.
I can only say I hope palin wins in 2012 as she makes sense to me. We must uphold the constitution and not let gov interfere with this family’s right to live under that bridge. That is their god given right to do that. It is there freedom of speech right.
God bless America and we republicans are truly god’s childrens.
Signed
Just your average wing nut Reagan loving repub,
That the demos are in fear of!
God is good all the time like the demos are in fear all the time of the repubs.
That is the way it should be as we repubs are godly people unlike the demos.
Got to go and take my new BMW for a ride and deliver that food basket to those folks under the bridge. At least I know they will be home to accept our food basket. We are a loving church and almost everyone there is a repub. God bless them.
Nice Poe.
I would be concerned that here, like in the US, demand is chasing supply.
mass production is a shitty model of health care. The opportunity for abuse, unnecessary treatment and human suffering are enormous. Quantities of procedures performed, like profits for investors are THE WRONG MEASURES OF SUCCESS in health care.
The correct model for health care is one that rewards caregivers when people are well, and PENALIZES them when they are ill, misdiagnosed, or mistreated.
I would drop the ill since that is inevitably a part of the human condition.
What they don't tell you is the success rate by objective and well documented standards. The last bit: "you need to have impeccable quality control when you have that kind of volume" is just wishful thinking. Go ahead, just try to sue your provider in India for leaving a sponge in your chest. See where that takes you.
You really should take Susie's advice and read the whole article.
You might have found that, "But Jack Lewin, chief executive of the American College of Cardiology, who visited Dr. Shetty's hospital earlier this year as a guest lecturer, says Dr. Shetty has done just the opposite -- used high volumes to improve quality. For one thing, some studies show quality rises at hospitals that perform more surgeries for the simple reason that doctors are getting more experience. And at Narayana, says Dr. Lewin, the large number of patients allows individual doctors to focus on one or two specific types of cardiac surgeries."
"Dr. Shetty's success rates appear to be as good as those of many hospitals abroad. Narayana Hrudayalaya reports a 1.4% mortality rate within 30 days of coronary artery bypass graft surgery, one of the most common procedures, compared with an average of 1.9% in the U.S. in 2008, according to data gathered by the Chicago-based Society of Thoracic Surgeons."
Open Heart surgical teams need to work together and do higher volumes to stay proficient. I gave Cardiac Anesthesia as a CRNA, and we did higher volumes and got to the point where we could watch the monitors and doe what was needed with hardly discussing it. It made the surgeries safer and we had better outcomes.
At smaller programs, their outcomes are often MUCH LESS in quality because they do not attain the numbers to stay proficient
Additionally, by concentrating surgeries in Centers of Excellence in this country, we could fully utilize the very expensive equipment, such as using a heart perfusion pump for four or five surgeries a day instead of one. That machine is tremendously expensive. Concentrate other things such as the blood banks, Cardiac Cath units and other things there and utilize them sixteen hours a day, instead of eight. Some patients and doctors would have to have them in the evening, rather than the morning, and the suites would need two shifts, but that expensive equipment would not be sitting idle. They could cut the price by 30 to 40% just by doing that.
We will never be able to attain the prices he does because their surgeons probably make $150 a surgery whereas I saw one make $63,000 recently for one surgery. That is obscene. I can see paying them $8,000, $10,000, or even $12,000 but $63,000....no way.
Couldn't find the story I wanted (mandatory off-shoring of surgeries) but did find this one, which may be the medicine of the future.
http://www.kiplinger.com/businessresource/for...
“Are costs of employee surgeries blowing your health care budget? Offer to send ailing workers to overseas hospitals for angioplasties, heart valve and hip replacements plus spinal fusions and other nonemergency surgeries. Many are far cheaper, at least as modern and high tech as U.S. hospitals and trying to draw business by pampering Western patients.”
duplicate comment deleted... see reply to Excelsior's comment above.
I was a Certified Registered Nurse Anesthetist and Advanced Nurse Practitioner for almost 25 years and administered almost 900 Open Heart Anesthetics. When one has a dedicated team where they do nothing but Open Hearts or thoracic surgery, then it speeds up the process, shortens the time involved, and improves outcomes.
Recently, my hairdressers' husband had Open Heart Bypass and his surgeons' fee was $84,000 but the insurance "negotiated" it down to $63,000. THAT IS OBSCENE. I know what they go through to become Cardiac Surgerons, but they should not make more than $12,000 to $15,000. They often do THREE A DAY at the larger centers. That is another thing, we have THREE times as many heart centers as we should and we have a three hundred bed and a two hundred and fifty bed hospital and a two hundred bed hospital all within ten miles of our home and all have an Open Heart program, which is ludicrous and DANGEROUS. Every team needs to do a certain number of procedures to stay proficient. Just equipping and keeping a program going can cost millions of dollars and they PERMIT TOO MANY DUPLICATIONS. We live near Houston, TX and they have three superior hospitals doing Open Heart procedures in the medical center and those should be enlarged and FULLY utilized and close the small ones. If one is going to have Open Heart go to a larger, better center. If the country would do that, we could cut the costs by 40%. Use that equipment and doctors to their fullness. They could do hearts sixteen hours a day utilizing the suites and keep the beds full and attain efficiencies and SUPERB RESULTS.
By having probably THREE HUNDRED TO FIVE HUNDRED unneeded and really, UNSAFE programs in small hospitals in this country we RUN UP COSTS, and lower outcomes. There should be center of excellence and patients should be flown to them, if needed and cut the costs.
We would never be able to attain the costs this man does, because their nurses and staff are paid one tenth ours and live well on that in India. But we could cut costs by 40% and the savings would be ENORMOUS were we to do what I suggest. People should realize that it is worth traveling a little distance to get better care and LOWER COSTS, and shouldn't think that they want to have their heart surgery ten miles from their home.
Additionally, India cuts their costs by not honoring patents on some drugs which are tremendously expensive and they make their own generics of them for pennies on the dollar.
There are ways we could provide quality and much less expensive care in the United States and we should do it. Go to Quality of Care centers, cut out duplication and make hospitals get Certificates of Need for very expensive centers such as Open Heart, Cardiac Cath Labs, Major Orthopedic, and other things. We could save enough money to finance quality care for the entrie population, were we to do that. Then, states should combine all the hospitals in their states into purchasing units to go directly to the suppliers and get tremendous discounts.
Could someone with medical experience comment on this?
The article said that if they did risk-adjust their numbers, they would look even better, because many of their patients had received very poor care before being their patients, and many were far along in the disease at the time of the surgery. That makes sense to me, but what do the healthcare workers think?
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