It all comes down to sustainability.
Most people in the feverish national debate about the cost of health care, from the president of the United States to experts and pundits in magazines and on television, agree that Mayo Clinic offers “fantastically high levels of technological capability and quality.”
But can even Mayo continue to use the Mayo model?
Dr. Atul Gawande wrote recent article in The New Yorker comparing health care at Mayo Clinic to that provided by hospitals in the community of McAllen, Texas. He pointed out the level of quality at Mayo with its payment method that does not rely on how many surgeries a doctor performs.
He compared that to how the pay-per-service McAllen model has apparently driven up costs with pricey scans, and surgeries without improving care.
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 Time magazine article on the Mayo model that was written soon after Gawande’s.
Dr. Dawn Milliner of Mayo Clinic 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.”
In an interview this week, Gawande explained his conclusion about how to provide Mayo Clinic-like care.
“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.”
With the Baby Boomer wave aging fast, Derr says a “perfect storm” is coming.
How should the shift from per service to payment for value be done?
Derr says the health policy center sees a short term fix and a long term one.
The short term one stays with the per service model, but it adds a “value index” calculation to different Medicare reimbursement level for each region.
The long-term proposal, tosses out the pay-per-service plan completely 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, it will the politicians in Washington, D.C. to make any sort of change and Mayo Clinic knows that might take a long while, even if Barack Obama admires Mayo’s methods.
Does that mean Mayo might need to change its focus to more profitable actions, since its current model is “unsustainable.”?
“Mayo will still find way to stick with its model of care going forward,” he says “We’ll just have find different ways to do that.”
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