I recently had the pleasure of visiting Health City Cayman Islands (HCCI), a medical facility founded by Dr. Devi Shetty in a relationship between Narayana Health and Ascension. A group of individuals from the United States toured the hospital and had an opportunity to meet with and ask questions of the staff including the senior physicians for the surgical areas.
Although I was on the island for less than 20 hours, it goes without saying that Grand Cayman is beautiful and the ocean was oh so inviting. Next time I’ll have to spend a bit more time and enjoy the amenities including what the locals refer to as CaymanKind, but back to the purpose of the trip.

Dr. Devi Shetty, a world-renowned Heart Surgeon (who was Mother Teresa’s personal physician for several years and has been called The Henry Ford of Heart Surgery by the Wall Street Journal) welcomed us via teleconference, and we learned of his vision as he explained his purpose for building the facility and his overall goals which relates to providing high quality services at a cost that allows anyone to get access.  He has driven down the costs of cardiac surgery in India to $1,400 and is shooting to get them to $800. Also part of his mission is charity care and the local charity Have A Heart Cayman, has provided 46 free surgeries (as of this posting) for children throughout the Caribbean, Central and South America.
The Cayman’s were selected due to the environment and beauty of the island. HCCI is a Medical Tourist destination targeting not only the islands and Central and South America, but the United States. The facility is accredited by the Joint Commission International. Some of the major differences of their 104 bed hospital as compared to those in the United States are:

1. The functionality of the facility. Built according to specifications from Dr. Shetty, the facilities while very nice were not opulent and there was no expensive art work hanging on the walls, statues in the courtyard or large expanses of space. The hospital has windows everywhere to let in light and although we did not tour the area, they even have windows in the surgical suites. The hospital cost, at about $430,000 per bed is substantially less than the $1 million or more price tag in the US. Their philosophy is to “start every project as if broke” and figure out how to get it done efficiently.
2. The building is constructed to withstand a Category 5 hurricane, has its own water supply and can provide its own power. They can be completely self-sufficient for up to 10 days.
3. Instead of paying to bring in oxygen in tanks, a substantial cost due to the additional price of shipping, they have a triple redundant oxygen generation system.
4. The standard ICU in the US is 4 times larger than their’s.
5. They collect waste water and reuse it on their lawns.
6. They collect, autoclave and incinerate waste on site.
7. They are constructing a 1.2 megawatt solar facility to handle 70% of their current needs.
8. The next hospital will have no phones, all patients will use a tablet and have full communications internally and externally.
9. Their patient bathrooms were built in a box and shipped to the facility for installation.
10. The facility uses 15% less cooling than projected.
11. The administration is all in one room with cubicles, and obviously billing, which is a single line item, requires but a few staff.

The hospital offers a full range of medical and surgical services including:

1. Onsite lab 24/7 including pathology, the lab is directly linked to their IT and EMR system.
2. 1.5T MRI, CT, Gamma Camera and Nuclear medicine.
3. 5 operating rooms, of which 2 are hybrid cath labs.
4. 17 bed open ICU with 3 private rooms, 2 to Ebola standards.
5. Blood bank with apheresis.
6. Surgical Service’s:
   1. Bariatric.
   2. Cardiac.
   3. Cardiothoracic.
   4. Orthopedic.
   5. Neurosurgery and Spinal.

They are planning to offer services associated with certain high cost specialty medications such as those for HIV and Hepatitis C.
On the cost side:

1. All services are offered at a fixed, all-inclusive price with single line billing.
2. All doctors are employees.
3. They import their medications from India at between 1/10 and 1/20 of the cost in the US and bring in sutures at considerably less than paid in the US.

Here is a link to their proposed pricing
Quality:

1. Last year they performed 200 surgeries.
2. They have had 3 surgical site infections since opening (1 in 2015) and have a robust QI program.
3. Since they opened they have had to fly out 1 patient to the US for services they could not provide.
4. The OR’s have 22 air changes per day versus an industry standard 18.
5. They use a real-time proprietary algorithm system to monitor patients.
6. They have an aggressive hand washing monitoring system.

The future goals of HCCI are to expand to 2,000 beds, create an academic institution and a biomedical research facility. Next on their construction roadmap is the building of a cancer facility.
Speaking with the physicians provided good insights into their thinking and areas of focus. Each of the physicians was selected from the teams in India and they all had a large number of surgeries under their belts. They are contracted for a several years in the Cayman’s and have the option of extending their contracts. You can see their physicians and backgrounds here.
Overall I came away impressed and thought that Health City Cayman Island could be an interesting solution for employers and health plans, perhaps even provider groups going at risk. They claim to be in discussions with a couple of large US insurers. The bottom line is, would I go there for a procedure, the answer is yes.
As an FYI, I paid for my flights and hotel in Grand Cayman, the trip was not sponsored by HCCI. They did provide a nice reception, lunch and rides to and from the hotel, hospital and airport.
The sunrise from my room: