An article in today’s Washington Post, entitled “Is the Mayo Clinic a Model or a Mirage? Jury is Still Out” highlights Mayo Clinic and similar institutions as part of the national health reform debate.

ROCHESTER, Minn. — The Mayo Clinic looms out of the prairie here like the mecca it has become, a world-renowned medical complex that is often cited by President Obama as his model for national heath-care reform.

“Look at what the Mayo Clinic is able to do. It’s got the best quality and the lowest cost of just about any system in the country,” Obama said in Minneapolis this month. “So what we want to do is we want to help the whole country learn from what Mayo is doing. . . . That will save everybody money.”

Read the rest of the article here.

Mayo Clinic CEO Denis Cortese, M.D., was a guest on the Charlie Rose show earlier this week, discussing health care reform. Here is an excerpt of the interview:

You can see the interview in its entirety on the Charlie Rose site.

Given the attention Mayo Clinic has received from President Obama and from the recent article in The New Yorker for its cost-effective care delivery, I took the opportunity yesterday to interview a member of Mayo Clinic’s health reform team, Raymond Gibbons, M.D. Dr. Gibbons is a national cardiology leader, having served as president of the American Heart Association. He discussed some of the localized Medicare spending disparities (e.g. Miami spending more than $16,000 per beneficiary, 65 percent more than neighborhing Fort Lauderdale) that must be addressed as part of health care reform, if the goal is to improve quality for all Americans:

Dr. Gibbons, as a cardiologist, went on to give one example from his field of how more treatments don’t always lead to better patient outcomes:

Dr. Gibbons highly recommends you visit the Dartmouth Atlas site to see the interactive map, which shows the spending per Medicare beneficiary in various local Medicare referral regions. Please note that high-cost areas are often immediately adjacent to lower-cost areas, within the same state. This suggests that patient populations and geography aren’t the real causes, but instead medical practice differences.

A featured article in the current issue of The New Yorker compares the health care costs and quality in McAllen, Texas with that of Mayo Clinic, and finds important lessons for health care reform. Here is a sampling:

Americans like to believe that, with most things, more is better. But research suggests that where medicine is concerned it may actually be worse. For example, Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country—$6,688 per enrollee in 2006, which is eight thousand dollars less than the figure for McAllen. Two economists working at Dartmouth, Katherine Baicker and Amitabh Chandra, found that the more money Medicare spent per person in a given state the lower that state’s quality ranking tended to be.

The author describes his experience in having visited Mayo Clinic:

I talked to Denis Cortese, the C.E.O. of the Mayo Clinic, which is among the highest-quality, lowest-cost health-care systems in the country. A couple of years ago, I spent several days there as a visiting surgeon. Among the things that stand out from that visit was how much time the doctors spent with patients. There was no churn—no shuttling patients in and out of rooms while the doctor bounces from one to the other. I accompanied a colleague while he saw patients. Most of the patients, like those in my clinic, required about twenty minutes. But one patient had colon cancer and a number of other complex issues, including heart disease. The physician spent an hour with her, sorting things out. He phoned a cardiologist with a question.

“I’ll be there,” the cardiologist said.

Fifteen minutes later, he was. They mulled over everything together. The cardiologist adjusted a medication, and said that no further testing was needed. He cleared the patient for surgery, and the operating room gave her a slot the next day.
The whole interaction was astonishing to me. Just having the cardiologist pop down to see the patient with the surgeon would be unimaginable at my hospital. The time required wouldn’t pay. The time required just to organize the system wouldn’t pay.

The article concludes:

As America struggles to extend health-care coverage while curbing health-care costs, we face a decision that is more important than whether we have a public-insurance option, more important than whether we will have a single-payer system in the long run or a mixture of public and private insurance, as we do now. The decision is whether we are going to reward the leaders who are trying to build a new generation of Mayos and Grand Junctions. If we don’t, McAllen won’t be an outlier. It will be our future.

Read the entire article here.

The Mayo Clinic Health Policy Center is joining with M.D. Connector, a student-run Web portal that connects premedical students, medical students, and medical doctors, to launch a national competition on health education reform. This unique competition offers student in all health care fields the opportunity to present their ideas on health education reform to nationally recognized health education experts.

For information on prizes and how to register, see M.D. Connector.

Share the news about this contest with your friends using the toolbar below!

Today’s New York Times has a thought-provoking editorial column from Billy Beane, Newt Gingrich and John Kerry. It’s about how the data revolution that has led to low-budget baseball teams competing effectively with the Yankees, Mets and Red Sox could be applied to providing better health care at lower costs. Here’s an excerpt:

Similarly, a health care system that is driven by robust comparative clinical evidence will save lives and money. One success story is Cochrane Collaboration, a nonprofit group that evaluates medical research. Cochrane performs systematic, evidence-based reviews of medical literature. In 1992, a Cochrane review found that many women at risk of premature delivery were not getting corticosteroids, which improve the lung function of premature babies.

Based on this evidence, the use of corticosteroids tripled. The result? A nearly 10 percentage point drop in the deaths of low-birth-weight babies and millions of dollars in savings by avoiding the costs of treating complications.

Another example is Intermountain Healthcare, a nonprofit health-care system in Utah, where 80 percent of the care is based on evidence. Treatment data is collected by electronic medical records. The data is analyzed by researchers, and the best practices are then incorporated into the clinical process, resulting in far better quality care at a cost that is one-third less than the national average. (Disclosure: Intermountain Healthcare is a member of Mr. Gingrich’s organization.)

Intermountain Healthcare also has been among the participants in the Mayo Clinic Health Policy Center’s discussions on health reform, and has been cited by Dartmouth along with Mayo Clinic as an example of high-quality, cost-effective care.

A report issued today by the Commonwealth Fund further bolsters the case for fundamental health care reform.

The report, the second national scorecard prepared by an influential health policy research group, provides evidence of just how frequently the country falls short of its own standards of care and those of its global peers. While the United States spends more than twice as much per capita on health care as most other industrialized countries, including France, it has fallen to last place among those countries in being able to prevent deaths with timely and effective medical care, according the report by the Commonwealth Fund, a not-for-profit research group in New York.

Denis Cortese, M.D., Mayo Clinic’s CEO, was quoted in the International Herald Tribune article, saying “We need to generate better value in this country.” For more information about Mayo’s perspective on producing high-value health care through payment reform, see this post about a related New York Times editorial.

Recent health reform news highlights:

The Wall Street Journal’s Health Blog covered the story of Wisconsin Congressman Steve Kagen (D), the only member of the U.S. House to refuse health insurance coverage. He introduced a bill this year, says the WSJ, that “would bar insurers from denying coverage or raising rates because of pre-existing conditions. He’d also require companies to disclose all of their rates.” Jacob Goldstein also wrote about IBM’s consumer-driven health care project in Georgia.

The Associated Press ran a background piece yesterday comparing the leading presidential candidates’ proposals with the systems in Great Britain and Canada.

The Kaiser Family Foundation also issued a Background Brief on Health Care as a 2008 Election Issue.

The Pittsburgh Post-Gazette ran an article on employer-sponsored wellness programs aimed at cutting insurance costs.

On HealthPopuli, Jane Sarasohn-Kohn analyzes reports from Watson Wyatt on factors that will influence retirement timing and a Zogby poll for the American System for Advancing Senior Health. Here are some of the most relevant statistics:

One in 3 older Americans said they need more help with their health decisions, and 71% said they want to be able to find more information about their own health care. 9 in 10 older Americans want to be in control of their health decisions.

One-half of older people believe they themselves are in the best position to help improve the quality of their health.

Read the rest of Jane’s post for additional background and her analysis.

Denis Cortese, M.D., the president and CEO of Mayo Clinic, and Mayo Clinic Health Policy Center director Jeff Korsmo, who also is chief administrative officer for Mayo Clinic Rochester, began the LaCrosse Leadership Luncheon on Health Care Reform with a presentation that highlighted Mayo Clinic’s health reform efforts.

Their slides are embedded below, and you can read more about the presentation here, or you can view the webcast of the entire event

Here are the questions and comments, submitted via laptops at each table, from the LaCrosse, Wisc. community leaders who attended the Leadership Luncheon on Health Care Reform on Monday, Apr. 28. Please feel free to add your input and contribute to the discussion in the comments below:

Questions and Comments
LaCrosse Leadership Luncheon, April 28, 2008

Dr. Cortese asked us whether we would want to be a patient tomorrow or go to a hospital, and we all answered no.  This is because we see receiving medical care as being a negative thing.  We only seek medical care when we are sick.  However, if the healthcare system put as much emphasis on proactive, preventive, wellness-based care, I would be happy to go to a hospital tomorrow and be their patient in an effort to live a healthier life.

How can a new system integrate a wellness, prevention component and still meet the public’s healthcare needs?

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I’ve read that commercialization (markets, investors, profits, etc.)  of medicine is driving the problem with health care. Please comment.

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How do we deal with people not wanting to get preventative care because of the costs associated with copays, coinsurance, and deductibles?

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Can you describe how this model will impact schools and local governments, that have good health care benefits for employees, but face increased costs each year that far outpace the ability of these organizations to pay?

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What are the suggestions that will reduce paperwork (insurance, federal program related, etc)

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Why are reimbursement rates lower in the Midwest?

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What can be done to reduce prescription costs in this country?  Why do Canadians pay so much less than we do?

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The discussion and model focuses on reforming health care delivery.  How do we move the value proposition to focus on improving health, as opposed to the delivery of medical care?

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The majority of us either started with, or will aquire a disability.  Please describe the policy direction we should take regarding disabilities as we work towards health care reform.

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Will caps on medical care measures be applied to all care measures to control costs?
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It seems Mayo has identified Information Technology as a key component to health care reform.  When HIPAA was enacted several years ago I seem to recall that one of the “benefits” of the initiative was to enable sharing of information.  Is this (HIPAA) an avenue of shared information?  It seems the HIPAA initiative has only resulted in emphasis on confidentiality/privacy.

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In an individual owning insurance environment, how does an individual of one determine value of one’s care?

What is your vision of the entity that will provide the care coordination activity?

In 1948 the United Nations, including the United States signed the Declaration of Human rights.  Article 26 declares that all have the right to healthcare.  All other industrial nations have universal health care for all.  The US currently has made healthcare a privilege for those who can afford. It would seem that the country needs to address this issue prior to entering into ideological discussions over economic considerations.

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If our system here in the Upper Mid-West works so well (as you all seem to agree) why can’t it be duplicated and exported elsewhere?

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How does the current physician salary/payment model (RVU’s) reconcile itself against paying for value versus volume, particularly in light of the concerns that a physician may have relative to failing to order sufficient tests (oftentimes redundant) to avoid potential litigation?

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How do you envision enforcing mandated insurance?  My understanding is that many young people voluntarily forego insurance and in most cases they will win that bet?  This is particularly true of healthy males.

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Where does “access to healthcare” fit into your idea of measuring value? Universal insurance could lead to extended waiting times for the patient.

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Please comment on the national movement to bring mental health benefits to parity with other illnesses across the treatment spectrum.

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Part of the budget discussion in Madison is a 1% tax on hospital revenue. Is throwing more money at the problem, part of the solution for Wisconsin’s health care?

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How do we convince the rest of the country to adopt a value-based health care system, particularly if it means lower reimbursement for providers in those areas?

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We hear from Health insurance representatives that the “new system” would put health insurance companies out of business.

Since the Health Insurance business spends the 2nd largest amount of lobby dollars in Washington DC (second to the drug companies) – how can we get past the barriers both the insurance industry and the drug companies will set down if they fear a threat to their business income??

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If we pay for good performance/outcomes, won’t providers be leery about taking the most serious, complicated cases where success is less likely?

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what can providers and consumers do to get drug manufacuters and insurance companies to stop influencing the political process and candidates?  Increasingly they are making political contributions that have to influence the likelihood that their profits will be affected or reduced.

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How have you addressed pay for performance on care for persons with more critical prognosis who will not be fiscally attractive to providers?

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How have your discussions addressed the unique needs of persons with mental illness who may not be able to adequately contribute to their own care (i.e. smoking, weight reduction, etc.)?

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No one trusts Congress, lowest confidence rate in history… no one trusts the drug companies…no one trusts the insurance companies…most, if not all in this room are covered.  What can the average person, not here,…one of the 47 million uninsured, retirees who are going broke because of this broken system, families…what can they do?  How are you going to reach them?  What will you do for their frustration now, since nothing has been done for the past 20 years.

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Medical Research and Medical Education are two fundamental underpinnings of our current system…and judging by where we are they obviously need to be looked to usher in change.  Does the panel have thoughts on improving the medical education of our physicians, or in enhancing research to be more focus on causes of diseases rather than symptoms (many times driven by the pharmaceutical industry)?

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Where do the Health insurance companies fit into this equation or vision?  We sometimes hear of patients being restricted because of the insurance limitations.  Also we hear of the aggressive lobbyists in Washington serving the interests of the health insurance companies.

Who do you see leading and developing the timeline for this project and keeping it on track? Hospital leaders?  Washington?

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Do the equations change at all when we talk about comprehensive health care – not just acute and primary but mental health, dental, eye care, etc.

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How does your proposal address the issues of custodial care (example: long term care)  Would this type of care be included in the coverage?

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Are there any short term initiatives?  Baby steps to impact change?