Aravind model - Possible in the USA?

[grilledcheese]

Hello,
I saw some interesting articles on the Aravind Eye hospital in India and their "McDonaldization" of cataract surgery. The costs of ocular surgery have been brought to light a few months back with the Mr. Beast video. What's holding people back from adopting a similar model here in the US? Is it the liability?

I am curious as to hear what your thoughts are.

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[docdoc2012]

Medical malpractice insurance.

 

[TheLesPaul]

US patients and JCAHO are not tolerant of the cost-saving measures necessary to run an operation like Aravind. Not to say that they are unsafe --- simply that medical waste is extreme in the US.

 

[LightBox]

For better or worse, there are so many regulations here in the U.S. compared to abroad contributing to extreme waste. One prime example:

• Throwing away an entire bottle of Betadine after using just a few drops of it for the ocular surface. Yes, 99.5% of the bottle is wasted because ASC regulations dictate that we use a new bottle for every patient.

 

[eyeeye_captain]

I’ve worked in surgery centers where post-op drops and ointment that a patient could use at home would be thrown away because JCAHO. That the patient already paid for and were sterile. Somehow they may have wound up in the patient’s pocket when they were in the PACU.

 

[Slide]

One of my former residents performed cataract surgery in India, so I don't know if what she worked in was the same model, but the process she described was similar to what's done at Aravind.

What happens there would never fly in the US. Patients are shuttled through almost like cattle (though not unlike some high volume cataract mills). It’s truly an assembly line ; if the original surgeon breaks the bag, another surgeon around takes over (likely retina). A lot of surgeries are done I believe SICS-style.

There’s nothing wrong with this approach, but in the US patients would likely not like this approach. I mean, think about a good portion of your patients with demanding needs, do you really think they would want this experience? Also, the expectations for good outcomes have only increased. It’s my understanding that the visual improvement from these assembly line cases are improving it in a general sense - it’s not close to the 20/15 outcomes that are becoming more and more expected. If patients in the US were ok with just some improvement, then yes, this model could work (if you can avoid JHACO’s radar). Else, it’s a pipe dream

 

[Dusn]

I remember being surprise when I first learned that the ABO (and the boards of other specialties) is just some private company that suckered us into giving them our money.

So I decided to look up JCAHO. Sure enough, as far as I can tell, they’re some independent organization that is not the US government. Their revenue is reported to be $96 million online (I’d guess that it’s really much higher). It just seems crazy to me how these organizations convinced everyone to let them run the show.

 

[solitude]

I remember being surprise when I first learned that the ABO (and the boards of other specialties) is just some private company that suckered us into giving them our money.

So I decided to look up JCAHO. Sure enough, as far as I can tell, they’re some independent organization that is not the US government. Their revenue is reported to be $96 million online (I’d guess that it’s really much higher). It just seems crazy to me how these organizations convinced everyone to let them run the show.

AFAIK, there are no regulations that mandate hospitals adhere to JCAHO. It's completely voluntary. Does not affect CMS eligibility etc. Absolutely insane that the administrators are paid gobs of money (that we produce) to do this, all while increasing cost and decreasing quality of care.

 

[grilledcheese]

The consensus seems to be red tape, then. Unfortunate, since their model seems to work really well for reducing healthcare costs and have low complications (they say half the complication rate of the UK). Thanks for all the responses!

 

[TheLesPaul]

It is extremely frustrating when you waste an entire bottle of lidocaine, betadine, whatever else, when you consider:

1) how much energy was expended to make the product -- the oil used to make the plastics, the oil used to drive the trucks to deliver the raw materials, the energy needed to produce and QC the product,

2) how many items are on backorder (lidocaine with epi - we use 10mL of a 50mL bottle and discard 40mL at the ASC -- could get 5 times as many uses out of a single bottle,

3) the physical waste the piles up on the planet because we are using 5-10 times as much material as is truly necessary.

In India, if you are rich you get a fresh balloon during your heart catherization, if you are poor you get a re-sterilized one. Both work fine. Everyone gets taken care of and the population is so high and wealth inequality so extreme that people understand you have to make that choice. It is only a matter of time before that scenario becomes widespread.

 

[Dusn]

The consensus seems to be red tape, then. Unfortunate, since their model seems to work really well for reducing healthcare costs and have low complications (they say half the complication rate of the UK). Thanks for all the responses!

Aravind seems like an impressive system. But I’d also take what they report with some skepticism. I’m somewhat familiar with Indian healthcare and complication doesn’t mean the same thing there as it does here. Patient expectations are entirely different. I suspect that even those of us who think that most American patients have unrealistic expectations would not find Indian healthcare acceptable.

They don’t usually have the money to order tests or the time to think about whether they’ve made the correct diagnosis (not that we always do), they usually seem to just throw a possible treatment at the patient without any testing and hope the patient doesn’t come back.

Luckily cataracts are an easy diagnosis. But in the US if you get your cataract taken out but still can’t see because of your undiagnosed macular degeneration, patients get upset.