If you think mere compliance with the Patient Protection Affordable Care Act and meaningful use is enough to survive in the future, wait until you find out about what Dr. Devi Shetty is up to in the Cayman Islands.
Those in the industry who are resisting the movement to the delivery of high-value, lower-cost services through clinically integrated systems of care ought to read a recent article in Forbes by Robert Pearl, MD, CEO of The Permanente Medical Group. If you think mere compliance with the Patient Protection Affordable Care Act and meaningful use is enough to survive in the future, wait until you find out about what Dr. Devi Shetty is up to in the Cayman Islands. Let me put it this way: He's bringing a hyper-sophisticated brand of medical tourism a lot closer to our shores, and many healthcare providers in our country may not be ready for the challenge he presents.
Dr. Pearl recently flew to the Caymans to moderate an afternoon-long panel on delivering high-quality, affordable healthcare. There were about 2,000 attendees from around the world at the meeting. He writes that the reason there was so much excitement about the conference was because it was hosted by Dr. Shetty, the chairman of India's Narayana Health and widely regarded as India's most renowned heart surgeon. Narayana is internationally known as a low-cost, high-quality healthcare provider that is laser-focused on doing cardiac care really well and achieving great cost efficiencies that keep prices ridiculously low.
Narayana has been operating 18 cardiac-care hospitals across 14 cities in India. The average Narayana cardiac hospital performs 40 heart surgeries a day for less than $1,600 a case. That's about 2 percent of the average heart surgery cost in the U.S., with outcomes that rival the best American facilities'. The Harvard Business Review has done a widely cited case study on its success.
Now Dr. Shetty and his team have built a new hospital called Health City Cayman Islands, the organization's first development outside of India. Just 430 miles off of Miami, it brings its highly focused care to residents and, importantly, visitors to the beautiful Caymans resort area. With a new 5-star hotel right next door (built by Narayana), the new hospital is clearly set on attracting foreign (read: American) patients.
In the United States, there is about 1 hospital bed per 333 people. Grand Cayman Island has about 50,000 residents. When Dr. Shetty completes his expansion plans, his newest hospital will feature 1 bed per 25 Grand Cayman residents. Today Health City Cayman focuses on cardiac and total joint surgery. It will add cancer care and transplant services in the near future. Plans are under way to construct an international medical school and a variety of high-quality residency training programs. He expects his facility to become a global academic medical center and a destination for the best medical school graduates.
Dr. Shetty makes it clear that he will charge less than half the average U.S. price for surgical procedures. Despite those prices, Narayana buys only the best heart valves and orthopedic implants.
Dr. Shetty had a lot to say as he addressed the 2,000 attendees at the opening of the new hospital. He said that human life should not be determined by a price. "One hundred years after the first heart procedure was performed, only 10 percent of the world can afford to have one. We can and must do better. The future cannot just be an extension of the past. It must embrace new technology, implement innovative approaches and aim higher than people thought possible before." He concluded his remarks by saying, "The day we turn anyone away from this place of healing for an inability to pay is the day we have failed as an institution and betrayed God's commandment."
So how will he achieve his promised prices and results in a place where wages and living standards rival those in the U.S.?
Patient care at Health City Cayman Islands is supported by state-of-the-art information technology. Every patient admitted to the hospital receives a low-cost mobile tablet containing medical information collected throughout his or her stay. Doctors and nurses access the encrypted information through Google Glass devices and Bluetooth-enabled watches as they make their rounds. There is a central care area with four large wall-mounted computer screens that allows physicians to continually monitor patients. One screen shows real-time performance metrics across the medical center, paying particular attention to medical care delays.
Dr. Shetty believes that time is the true enemy of quality and cost savings. "When patients have potentially life-threatening problems such as a low blood-oxygen level, diminished blood pressure or an untreated infection, their health deteriorates with every passing minute." Physicians can minimize the deterioration by responding rapidly when unexpected clinical findings surface. This allows the patient to recover much faster and reduces the total cost of care.
The most dangerous time for a patient in a hospital is after midnight, Dr. Shetty says, as that is when the least experienced nurses work and there are the fewest number of physicians available. His stated goal is the provide quality care 24 hours a day. He believes it can be accomplished by staffing the central-monitoring area with experienced physicians who closely monitor patients, not just those in the Caymans, but patients and medical information half way around the world. For instance, when it is daytime in the Caymans, it nighttime in India. Consequently, during the day, the Health City Cayman physicians help monitor video feeds of post-operative patients in India and quickly alert their Indian colleagues at the slightest sign of a problem. At nighttime in the Caymans, physicians in India return the favor.
Those who would scoff at Dr. Shetty's attempt to give patients a better deal they are denied in U.S. hospitals ought to think twice at a time when more patients are footing more and more of the total costs of their care. When we read about inconsistent performance on metrics of quality, outcomes and re-admissions, a patient needing a cardiac procedure may find it easy to travel to a resort area for surgery and recuperation, knowing the outcomes and patient experience are better.
If I were a CEO of a hospital in Florida I would buy a plane ticket to the Cayman Islands so I could see first what Health City is all about. It may be a lesson in what American healthcare must become, at least for those providers that want to survive when consumers call the shots.