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Really interesting article on Indian open hearts

Posted

Specializes in ICU, Informatics.

The Henry Ford of Heart Surgery

In India, a Factory Model for Hospitals Is Cutting Costs and Yielding Profits

http://online.wsj.com/article/SB125875892887958111.html?mod=WSJ_hpp_MIDDLETopStories

"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."

"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."

"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."

As an ICU Nurse who aspires to one day land open hearts I find this article amazing.

MedSurgeMess

Specializes in Med/Surg, ICU, educator.

WOW.....with healthcare reform, I see America heading this way. Let's just hope that it doesn't affect outcomes. If it works to the betterment of society, I have to say I'm all for it. Looking at the article, it looks like quality is not being sacrificed.

It's definitely an interesting article. But I'm not entirely sure if I like the assembly line premise. It seems like it would increase the chance of errors, he must be pretty damn talented to pull off those kind of success rates. If it turns out to be feasible to reproduce, that's going to be a pretty big slap in the face to the buisness models hospitals are currently employing.

greenbeanio

Specializes in mental health. Has 3 years experience.

Why is this amazing to you? Because it's happening in India, or because it is not resulting in a higher mortality rate? Given the population and poverty in India this is the only thing that makes sense.

And I think this is a very valid point:

"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.

In smaller U.S. and Indian hospitals, he says, there aren't enough patients for one surgeon to focus exclusively on one type of heart procedure.

Narayana surgeon Colin John, for example, has performed nearly 4,000 complex pediatric procedures known as Tetralogy of Fallot in his 30-year career. The procedure repairs four different heart abnormalities at once. Many surgeons in other countries would never reach that number of any type of cardiac surgery in their lifetimes."

If you had to have major surgery like this, would you rather have a doctor who has done that particular surgery 700 times or 25 times?

If you had to have major surgery like this, would you rather have a doctor who has done that particular surgery 700 times or 25 times?

700 times with 30 times that day? Or 25 times with you being their primary concern for the day? Tough call.

I'm not knocking the process. Although, I have concerns over whether or not it's something that any surgeon can reproduce, or if he's just gifted in his talents. We'll see how it translates to widespread use.

Not to discount any of the positive aspects here, but the original article failed to mention that the relative difference in economies dampens the apparent ten- to fifty-fold difference in cost. In plain English, $2000 buys a LOT more in India than it does in say, Beverly Hills, California.

Again, I don't mean to minimize the huge positives mentioned. I am simply compelled to keep as much in accurate perspective as possible.

...though it often gets me into trouble doing so.

Not to discount any of the positive aspects here, but the original article failed to mention that the relative difference in economies dampens the apparent ten- to fifty-fold difference in cost. In plain English, $2000 buys a LOT more in India than it does in say, Beverly Hills, California.

Again, I don't mean to minimize the huge positives mentioned. I am simply compelled to keep as much in accurate perspective as possible.

...though it often gets me into trouble doing so.

Noone begrudges you the truth.

stephenfnielsen

Specializes in ICU, Informatics.

"Why is this amazing to you? Because it's happening in India, or because it is not resulting in a higher mortality rate?"

It amazes me and frustrates me at the same time. First, I think it kind of knocks conventional wisdom that says big and cookie-cutteresque operations are bad things when compared to their traditional, personalized counterparts- think Walmart vs. ma and pa, Starbucks vs. the corner cafe, small vs. large class sizes, family doc vs. HMO, etc, etc, etc,. I'm not arguing the merits or demerits of Walmart, but as far as producing goods- economies of scale are hugely impressive.

It's frustrating to me because I don't think we can see anything like this in the US because we are so much more heterogeneous and spread out than a country like India.

K.P.A.

Specializes in mental health. Has 2 years experience.

It's frustrating to me because I don't think we can see anything like this in the US because we are so much more heterogeneous and spread out than a country like India.

A little more spread out maybe but we're pretty well homogenized in comparison to India.

greenbeanio

Specializes in mental health. Has 3 years experience.

stephenfnielsen, I'm curious - more hetereogenous in what way?

And I totally know where you're coming from re: big, cookie-cutter vs. small, personalized. I wonder if it feels different to me from Walmart because with that kind of big corporation, most of the benefit goes to the ultra-rich CEOs and upper management, whereas here there are extremely poor people getting life-saving surgery instead of just accepting an early death. And becasue the level of need is so different. People don't NEED the stuff they sell in Walmart (one can get almost all of one's basic necessities met thrift stores and yard sales), but they really desperately need this surgery.

jetfuel - you're absolutely right - thanks for pointing that out. And it's a point to bear in mind when people talk pityingly of third-world laborers working for "pennies an hour". For one thing, it's not pennies, and for another, $1 could feed a small family in a poor village for a day.

Silent night: If you divide Dr. Colin John's 4000 surgeries by his 30 years of practice it works out to about 11 surgeries a month, not 30 in a day. Would you consider 11 surgeries a month to be dangerous?

Silent night: If you divide Dr. Colin John's 4000 surgeries by his 30 years of practice it works out to about 11 surgeries a month, not 30 in a day. Would you consider 11 surgeries a month to be dangerous?

Somehow, I doubt they were spaced out evenly. I think they're more concentrated in recent years when he developed this plan. Anyways, I'm not saying its dangerous. Just something I'd want looked into a little more before we implement it with possibly less talented surgeons.

I wanna go there and learn.

You know doctors in the US are just looking out to protect their rediculous earnings. Hospitals profits. It's not about saving lives here. Dont be silly.

K.P.A.

Specializes in mental health. Has 2 years experience.

You know doctors in the US are just looking out to protect their rediculous earnings. Hospitals profits. It's not about saving lives here. Dont be silly.

Surely you jest. The only doctors making huge $ are taking advantage of quirks in government funded health care. Yes, there are podiatrists billing medicare big bux for trimming toe nails on 50 patients a day. The dude who did my bypasses got $510 for the first and $110 for the 2nd, 3rd, and 4th grafts. That's $840 BEFORE TAX dollars. The guy works his ass off and barely makes $200k/year. Considering the time in school and the limited number of years a surgeon can work...it's not much money.

erichRN

Specializes in geriatrics, telemetry, ICU, admin.

insurance and standards

A little more spread out maybe but we're pretty well homogenized in comparison to India.

I don't agree. While there are a VAST array of cultures within India itself (since each state and general region often practices its own culture) America is pretty diverse as well! I wouldn't call America homogenized...

In India the Sathya Sai Baba Hospital and Health Clinics are free to anyone that needs care. The Hospital was built in less then 2 years and has Vanguard Care. They do all types of Cardiac Procedures/Open Heart Surgeries for Free.There is actually a waiting list of Medical Staff who want to Volunteer their time working at this Hospital.

Also in NJ the Deborah Heart Hospital used to do Free Operations and it was not base on income at that time.( They may still do some).