Modern healthcare is beginning to follow the example of the Borzoi Foundation. In fact, the greatest changes in the healthcare industry are being formulated now according to the same principle: Specialized care to patients will be allowed only in institution with proven records of knowledge and experience. It is called Operation Leapfrog and it is destined to dramatically change medical care. Operation Leapfrog is a health initiative of The Business Roundtable (BRT) which is an association of the chief executive officers of leading corporations with a combined workforce of more than 10 million employees in the United States. In a effort to improve healthcare outcomes, reduce medical complications, and reduce costs, Operation Leapfrog has begun to work with major insurance companies to direct patients to hospitals and doctors with proven records of high volume and best outcomes. For example, the Operation seeks to have coronary by-pass surgery done at hospitals that perform at least 500 such operations annually. Similarly your aortic aneurysm repair should be done at a hospital that does at least thirty such operations per year. For cancer surgery, Operation Leapfrog has not spoken yet but the data is in. In a report published this year, the risks of a surgical death for cancers of the colon, lung, and stomach are significantly less in hospitals that perform such operations at least 36 times per year for colon cancer, 28 times for lung cancer, and 8 times for stomach cancer. For the surgeon, your risks are reduced if your surgeon does at least 5 colon operations, 12 lung cancer operations, or even a single stomach cancer operation each year. In a city like Savannah, our hospitals make the cut. St. Joseph’s-Candler and Memorial Health each performed over a 100 colon cancer operations in 2000. Regarding the surgeons, the patient must ask the hard question, “Doctor, how many operations like the one you recommend for me have you done this year?” You can be sure that in the very near future, the insurance company will ask the question. The concept that “practice makes perfect” may seem unfair to small, quality, rural hospitals at which the volumes of cancer surgery do not come close to these numbers. The public and payors, however, demand and deserve the lowest risks and costs for superior care. The Governor’s plan to define cancer centers for special care is driven in part by the concepts of Operation Leapfrog and the newest medical reports regarding the linkage between experience, outcomes, and therefore cost. These changes will be hard for many good hospitals and quality physicians. I advise hospitals to look at their records and offer only those services they do well and often. For doctors, get yourselves a dog. They are loyal, kind, and don’t ask questions.