Mayo model praised, but can it last?

| June 25, 2009

By Jeff Kiger Post-Bulletin, Rochester MN 

Recent weeks have cemented the Mayo Clinic's reputation as a health care superstar but raised the ominous question of how long that can continue under the present U.S. health care system.

Time Magazine excerpt:

"The Mayo clinic attracts Kings and Presidents, injured athletes and ailing billionaires. … But Rochester's costs are well below the national average because Mayo also provides tremendous value for ordinary care …"

With the health reform debate heating up, Mayo Clinic has been praised on the national stage as a model for offering quality health care at a low price. Those patting Mayo on the back include President Obama, Time magazine and The New Yorker magazine.

But the question has been raised: Can even Mayo continue to use the Mayo model?

Dr. Atul Gawande's article in The New Yorker magazine June 1 showed that Mayo's per-person Medicare costs in Rochester were low even though it provided a high level of care. He contrasted that with McAllen, Texas, which has some of the high costs but poor quality.

The system of paying for medicine doesn't reward Mayo's quality, and instead drives up costs by encouraging doctors to order pricey scans and surgeries, as they do in McAllen, Gawande concluded,

In his article, "The Cost Conundrum," Gawande wrote, "In the war over the culture of medicine the war over whether our country's anchor model will be Mayo or McAllen the Mayo model is losing."

That was echoed in a June 29 Time magazine article on the Mayo model, which details Mayo's "institutional obsession with evidence-based medicine" it keeps track of what works and does it. Also, Mayo pays doctors fixed salaries so they don't make more if they do more to patients and they don't make less if they take more time to talk to them, the article said.

Mayo Dr. Dawn Milliner was quoted as saying, "We've been able to buffer our staff from the harsh realities of the system, so they can concentrate on patient needs, But it's not clear how long we can keep doing that."

Gawande explained his conclusion this week.

"Their (Mayo's) practice model is closer to the quality and cost we want, though we have a financing system that doesn't make it sustainable," wrote Gawande in an e-mail. "My conclusion is that it's the financing system that has to change, not the medical system."

Mayo Clinic, which lost $840 million on $1.7 billion in Medicare treatment last year, agrees.

"That's the underlying reason we are involved in health care reform," says Josh Derr of the Mayo Clinic Health Policy Center. "The Medicare system is a fee for care system. We want to that shifted to value."

Derr says the short-term fix would factor value into Medicare reimbursement. The longterm fix tosses out the pay-per-service plan, to be replaced with something like a bundled care method. That means a heart attack would be covered with one fee for all related treatment and that encourages a hospital "to do things right the first time," he said.

Of course, change may take a long time, even if Obama admires Mayo's methods.

"Mayo will still find way to stick with its model of care going forward," Derr says. "We'll just have to find different ways to do that."

Category: General Healthcare News

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