My Personal Experience with Dr. Shetty’s Healthcare Mission: An $800 Heart Surgery

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Heart SurgeryWhen I was a little kid, I wanted to be a motivational speaker, then a nuclear physicist. But now I dream that my next career might be in heart surgery … and I’m not kidding, although my wife hopes I’m teasing.

Driving this radical departure from my current day job is a renewed appreciation for the generations of life that can be realized when just one life is saved. You see, I spent several weeks this summer working with Ethan Vincent and Nathaniel Hansen to create a video documentary of the work of Dr. Devi Shetty, a world-renowned cardiothoracic surgeon. Among the scenes seared into my memory is the photograph included – it’s a snapshot of a small 18-month-old child whose tiny body lay on the surgery table, his chest cavity open and his heart in the hands of Dr. Shetty and his team of super specialists. I was there when the photo was taken.

Dr. Shetty invited me to talk to him openly during the surgery – all the while his hands were busy sewing shut the hole in this boy’s heart. What I learned only after the procedure was how risky the operation was. Dr. Julian, a heart surgeon also working on this boy, explained that there is no second chance if the “fix” is not done right. My jaw dropped. Why would Dr. Shetty allow me to be there? And how could he talk to me with such ease while at the same time doing something so risky?

Dr. Julian smiled as if this was a new question, although I’m pretty sure he had answered it a thousand times over. He explained that Dr. Shetty had performed that procedure 100 times, if not more, and it was this volume that dramatically reduced the risk. Therein lay two keys to Dr. Shetty’s success — huge procedural volumes and sub-specialty expertise, the latter of which Dr. Shetty demonstrated during those 10 minutes that he spent on the procedure. All Dr. Shetty did was the expert sewing; the rest of the procedure was performed by Dr. Julian and his team of specialists.

Called the Henry Ford of healthcare by the WSJ, Dr. Shetty is deserving of the title. While Henry Ford revolutionized auto manufacturing by perfecting the assembly line, profit was never a prime motive – access and affordability were. In 1908, Henry Ford produced 19,000 model Ts that sold for $950 each. Within four years, Ford had increased production to more than 150,000 units and had reduced the vehicle price to $575. That was the first time a vehicle had dropped below a wage worker’s average annual salary. At its lowest point, the model T dipped to $280.

Similarly, Dr. Shetty set out in 2001 to build his own hospital – which today is a 26 hospital system. Why build his own hospital? Because to fix healthcare, Dr. Shetty knew he needed to control each component of the cost structure. He had spent the first half of his career trying to transform care in other people’s health systems to no avail. Having been trained in England’s finest school, if profit were his primary objective, he could have immigrated to the U.S. and made his fortune. Instead, he methodically set out to reduce the cost of heart surgery from $3,000 to today’s cost of $1,400 by torturing every cost component.

What was Dr. Shetty’s driving motivation? Well part of it surely came from the four years he spent caring for Mother Teresa as her heart surgeon and personal physician. He shared with us what he learned from “Mother,” as he called her; the hands that serve are greater than the lips that pray. That one-line description suggests how much Dr. Shetty’s life changed while serving this woman who dedicated her own life to the service of the world’s poorest.

Dr. Shetty seemed to me to embody the mission of saving humanity, similar to Mother Teresa’s mission to care for the poor, although Dr. Shetty chose life-saving medicine as his means. He explained that he would, day-in and day-out, diagnose patients who needed heart surgery to save their lives. And, day-in and day-out, those patients would not return to the hospital for their procedures. To someone like me who works in the U.S. healthcare system, it seems absurd. Why wouldn’t they have a procedure that would save their life? Because they couldn’t afford it. Dr. Shetty explained that even today at $1,400 (USD) for a heart surgery in his Indian hospitals, only 20 percent of the world’s population who needed that heart surgery would be able to afford it.

By the way, Dr. Shetty isn’t satisfied with a $1,400 heart surgery. His goal is to get the number down to $800 – the point at which he has calculated that 50 percent of the world’s needy heart surgery patients could afford the procedure (still, he insists, even 50 percent is a travesty). Until he reaches $800, he won’t stop examining every component of his cost structure.

Dr. Shetty’s Narayana Health System has become a laboratory of sorts testing process and its impact on prices. But his two latest projects also have the attention of those keen enough to be watching. The first is the system he helped develop with Ascension Health in the U.S. and the Cayman Islands Health Authority — Health City, a hospital in the Cayman Islands. That facility is a 108-bed facility that’s less than two hours by plane from 22 million Americans – any of whom could save some $100,000 per heart surgery there.

Why does Health City matter in Dr. Shetty’s mission to provide life-saving healthcare to the world? He explained that there are several reasons including technology innovation and volumes. The U.S. economy creates many of the components critical to healthcare supply chains. Secondly, the U.S. volumes are important to further reduce costs in an assembly line model.

And, on the other end of the economic spectrum, Mysore is Dr. Shetty’s newest facility in India. Designed to deliver top quality medicine, this hospital has absolutely zero lavish amenities. Its goal is to extract every unnecessary cost from healthcare to achieve that $800 heart surgery. That model, once perfected, may be the solution to healthcare in poor communities within Asia, and Africa.

Could these models of care work in the U.S? Not with the current costs to do business in the U.S. However, the learnings from Health City in the Cayman Islands could potentially lead to a U.S. version of Dr. Shetty’s model. It’s a wonderful thing to hope for – that a $1,400 Indian heart surgery could somehow lead to the transformation of U.S. healthcare. What do you think?

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