OP-ED

Op-Ed: Healthcare Reform Lessons From Mayo Clinic

Mayo_MN_Gonda_3884cp Three goals underscore our nation’s ongoing healthcare reform debate:1) insurance for the uninsured, 2) improved quality, and 3) reduced cost.  Mayo Clinic serves as a model for higher quality healthcare at a lower cost.President Obama, after referencing Mayo Clinic and Cleveland Clinic, advised, “We should learn from their successes and promote the best practices, not the most expensive ones.”

Atul Gawande writes in The New Yorker, “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.”Two pivotal lessons from our recent in-depth study of Mayo Clinic demonstrate cost efficiency and clinical effectiveness.

1. Patient-first medicine.  Throughout its 140-year history, Mayo Clinic has never put money first but lives its primary value:  the needs of the patient come first.  Mayo doctors, as all employees, are on salary.  No doctor earns more by ordering an extra test or procedure.  No doctor earns less by referring a patient to another Mayo physician with more expertise.

Core values guide organizational behavior, and Mayo Clinic’s patient-first core value guides the more than 43,000 employees.

For instance, the head of transfusion medicine noticed a day-shift technician working at 2:00 a.m. as he dealt with an emergency.  The technician explained that she was redoing a test to correct an earlier mistake.  “Why not repeat it the next day?” she was asked. She replied, “I can’t have patients at Mayo Clinic waiting an extra day in the hospital because I fouled up a test.”  Dr. Robert Waller, who retired as Mayo Clinic CEO in 1999, remembers a conversation with a cardiologist whose patient needed a pacemaker.

Option A: a Medicare-approved model requiring relatively involved surgery and several days of postoperative hospitalization.  Option B: a new model that could be implanted more simply with only one day of hospitalization.

Option B was not yet Medicare-approved and meant noreimbursement to Mayo.  Dr. Waller recalls:  “This was a no-brainer – use the pacemaker that is best for the patient.”Healthcare is a sacred service.  The patient’s quality of life – and life itself – is at stake.  The needs of the patient must be at the center of healthcare reform. This will require, among other steps, revamping doctors’ compensation to encourage efficient and effective care that truly serves patients.  Until we pay doctors for better care, rather than for more care, we cannot successfully reform healthcare.

2. Team medicine.  Mayo Clinic does not have a monopoly on highly capable doctors and nurses, but it has a competitive advantage because its highly capable clinicians pool their knowledge.  When clinicians truly work together, as at Mayo, the result is more efficiency, less duplication of effort, and a greater likelihood of correctly diagnosing and effectively treating a patient earlier in the process.Medical care in America is highly fragmented, impeding both efficiency and effectiveness.  Patients with multiple or complex illnesses are often treated by physicians from different medical practices who may not communicate with one another.  Not so at Mayo Clinic, which functions like a medical department store with staff experts for each medical specialty.  Working in an organizational culture that demands teamwork and using tools such as an electronic medical record and a sophisticated communication system, Mayo clinicians collaborate to provide the specific expertise needed by the individual patient.Consider the case of “Don,” who endured an undiagnosed tumor on the base of his tongue for two years.  Both his dentist and an ENT physician told him the discomfort in his mouth was not clinically significant.  When another ENT doctor diagnosed cancer and recommended immediate surgery (that would end Don’s ability to speak), Don contacted Mayo Clinic.  Two weeks later he met his Mayo team of three physicians (ENT, medical oncology, and radiation oncology specialists).  The team dismissed surgery and recommended radiation and chemotherapy instead.  Today, five years after Don’s initial cancer diagnosis, he is cancer-free and living a normal life.  He still sees his initial physician team at six-month’s check-ups. Don’s story illustrates Mayo Clinic at its best.  Teamwork is vital to improving medical efficiency and effectiveness, and health reform must include bold investments that encourage and enable it.  Encouraging medical practices, financially and otherwise, to coordinate a patient’s healthcare over time (called “patient-centered medical homes”) should be in the health reform blueprint.  So should the transformation from proprietary paper medical records to universal electronic records available as needed by treating clinicians.

A time to learn.  Few organizations survive for more than 100 years, much less thrive like Mayo Clinic. Mayo Clinic is not perfect.  Its integrated, multispecialty medical model works wonderfully — most of the time.  Stories like Don’s occur each day at Mayo, but the Clinic cannot help every patient.  Nor is Mayo Clinic the only medical institution that merits consideration in healthcare reform discussions.Yet, the way Mayo conducts its business, governs itself, and sustains focus on its core values of patient-first needs and collaborative medicine is deeply instructive.  Never have such lessons been more important to our nation’s healthcare.

Leonard L. Berry and Kent D. Seltman, authors of Management Lessons from Mayo Clinic (McGraw Hill, 2008).  Berry holds the M.B. Zale Chair in Retailing and Marketing Leadership in the Mays Business School, Texas A&M University.  Seltman retired from Mayo Clinic in 2008 after serving as director of marketing from 1992 through 2006.

More on the Mayo Clinic:

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Netflix
Guest

We must figure out a way to completely take away the opportunity of corruption! Nothing personal – but “We the People” must always come first and be protected!

glenn
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glenn

I am a huge fan of the Mayo Clinic and have attempted to become a patient. I live in NY but spend 5 months in st augustine. i went to the mayo clinic primary care office and asked if my medical coverage was accepted, fully expecting a positive response. i have empire gov’t from united heath care in new york. at one time what i thought was one of the best coverages out there. i was advised that they were not a participating provider. i was suprised that a highly touted medical center praised for there service and held out… Read more »

Acai
Guest

It seems like the Mayo clinic has taught us a lot of lessons over the years. I think we can all take something good from this.

Tom
Guest

President Obama, we are tired of the Whitehouse trying to sell us health care reform. You know, I know and the American people know this is really about more government power and control. Our biggest problem has become our government! Stop! Just stop all this nonsense! Do not treat U.S. like we are stupid, ignorant morons! Join U.S.! Do Not Sell Out “We the People” of the U.S.A.! We Trusted You! President Obama, great Presidents do Great things! They have great Honor and Integrity! We know you can do it! “We the People” know the truth! We want to hear… Read more »

Floyd Hunter
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Jo
Guest

Mayo treated my disabled daughter in Scottsdale, AZ. She is on medicare and medicaid. Her condition was complex. Her care was excellent and without it, she would have certainly lost her life, if not the quality of her life. There was not one question about how much Mayo would receive for her care. The bottom line is, in my most humble opinion, what if the great equalizer, illness, strikes your loved one? How do you want your loved one treated? With this in mind, we must work together to discover what works and carefully, thoughtfully apply it to all citizens.… Read more »

What do the people want?
Guest
What do the people want?

“When did the system get so upside down that a physician who used to be an average citizen holding a job like his fellow countrymen get elevated to million dollar salaries?” HA! Try a 250 thousand dollar… 14 year education rewarded with an 80 to 120 grand per year “salary” left over after paying all the usual expenses (not including student loans). That’s what most Doctors face. Keep in mind that the physician fee schedule has gotten cut every year since the 1970s. Surgeries that used to pay 2 grand, now pay about 500 dollars and include 3 months of… Read more »

What do the people want?
Guest
What do the people want?

The Mayo clinic primarily treats patients with the mental and financial resources to fly to Rochester. They don’t have to deal with patients pulled out of dumpsters who stagger from one E.R. to the next with the same pain and no useful memory. Whether miracle cure is realized or not, afer the razzle dazzle, Mayo just ships ’em back to poor community slob doctor to fish through the 100s of pages of tests and XRAYs and try to figure out what they were thinking and why it took 50 new tests to come to the same conclusion. Cleveland Clinic hid… Read more »

Bea
Guest

My husband was at Mayo last summer for 2 1/2 months. His bill came in at a little less than $1,000,000. They’re trying to protect costs? Who are they kidding? They promote themselves in various ways, supplying PR information about what they supposedly do. People believe their PR because of their name.

Health Plan Veteran
Guest
Health Plan Veteran

The Mayo and Cleveland Clinics are valuable not as role models or poster children for what the national health care system should look like, but rather because we need places where we can credibly assess what works and what doesn’t and evaluate new and emergent technologies and procedures. They are the thought leaders of the field, but I wouldn’t design a national system to mirror them. The much better model is to leverage them and apply what works to the rest of the system. At the same time, the focus and financial incentives of the US health care system need… Read more »

Red Dress Lady
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Red Dress Lady

I do not understand the Mayo Way, i.e. health first $$$ last. I wanted desperately to go to Mayo in Rochester for my heart but my insurance carrier would not cover any of the Mayo’s. Cleveland Clinic, John Hopkins, Mass General, Emory, Duke, etc. etc.etc. but no Mayo. Mayo had the doctor I wanted to see. I was also told by a Mayo doctor that Mayo is very expensive if your insurance does not cover them. 2 and 2 do not add up here.

Tom Leith
Guest

Ranae, your outcry is from the 20% who become seriously ill — mine is from the 80% who don’t, whether or not they manage to remain employed.
t

Wayne
Guest
Wayne

this should be sent to all the republican fear mongers around the country.

Barry Carol
Guest
Barry Carol

“Docs don’t make a million a year, but they have to make something for the risk. In 2009 dollars that is going to be close to half a million. If you pile on all those taxes, it will be 3/4 mill.”
MD as HELL – Are you talking before or after practice expenses, which, as I understand it, average about half of revenue collected?

MD as HELL
Guest
MD as HELL

The problems for the people with ailments and no coverage due to change in employment is that they were never the policy owner. The alternative compensation in the form of benefits is contructed badly; people should own the policy and be able to keep it with no increase in premium for change in condition or employment status. I believe that was the intent of HIPAA, which was hijacked into an AIDS privacy bill. The policy should be owned by the individual, regardless of who pays the premium. As for peiple like the lady above, this is what Medicare disability was… Read more »