Dr. Denis Cortese, in his own words
It’s always great to hear someone give their ideas in their own words.
Dr. Denis Cortese, national CEO of Mayo Clinic, offered his analysis of health-related comments made by Pres. Obama during the president's address to a joint session of Congress on Tuesday.
Cortese, who is expected to retire in November, appeared on C-SPAN from the Mayo Clinic campus in Rochester Minnesota. His comments were carried live from a studio inside the Plummer Building.
We join the C-SPAN conversation already in progress....
C-SPAN: What do you think about the will of this town to get at the problem of health care with the economy in the state that it’s in?
CORTESE: That’s a difficult one to answer about the will in Washington. But it certainly is a priority that needs to be addressed. I think the approach to thinkng about health care, and trying to reform it from top to bottom, is appropriate. And, certainly, getting people insured and beginning to look (at) the issue of how do we get better value for what we actually provide to our patients, how do we get better care, better outcomes, better safety is exactly the right approach, and this is the time to take it on. So I certainly would agree with people who want to address health-care reform now.
[Mayo Clinic Plummer Building. Photo by Jeff Hansel. Copyright.]
C-SPAN: On the issue of the goals, which is every American having coverage, the president said it could be paid for, in part, by efficiencies in the current system. You‘ve had a lot of experience with delivery of health care at the Mayo Clinic. Is the president right?
CORTESE: He’s exactly right. When you look at the ability to make the system more efficient, and you look throughout the United States at the different types of practices that take place, we can see wide ranges in efficiency and effectiveness in different regions of the country. And the ranges can go so far to the extent that we can predict that there’s at least 30 to maybe 40 percent efficiency that can be gained if we focus on finding the very best practice patterns, the very best care deliverers, and make sure we foster that other parts of the country practice the same way. And if we can do that, indeed there are efficiencies that can be attained over the next several years. It would take a while to get a return on that investment. But the statement that efficiencies are there is certainly true.
C-SPAN: Couple of other issues that he highlighted, and these are ones we’ve heard you talk about as well, is the need to convert medical-health records to electronic format.
CORTESE: Well yes, and that’s a significant issue because it raisies the question of: If we are going to electrify the practice, automate the practice, what is it that we want to attain out of that? What’s the real vision for the use of electronic medical records? And I think that if the vision is to just automate what we’re currently doing, we’re missing a huge opportunity. The vision should be, how do we turn the electronic environment into supporting the 'learning-organization' concept, where everbody can learn together? What is the the very best practice, the very best care — particularly for an individual patient? To do that, you have to have an information structure that connects to each other, 'plugs-and-plays' as we say; that it has to actually be interoperable so one system can communicate to the other, just like we can do on the Internet.
And then, finally, it has to be a tool that distributes knowledge — not just helps us pay bills and collect revenue — but much more importantly, it becomes an electronic environment that helps us make better decisions for patients, partcularly at the moment that we’re caring for the patients in that office. As your commentor who is the teacher said, it’s one person at a time. That is exactly true in health care. Health care is delivered one person at a time. And it’s delivered by the nurse or the physician that’s interacting with the patient, whether they’re together or whether they’re at a distance. That’s where the real magic takes place in health care. An electronic environment should be desigined with that vision in mind to support that kind of interaction.
C-SPAN: The president also called for a specific goal to find a cure for cancer, and I’m wondering if you had a chance to lobby for one particular disease that the country would focus on finding a cure for, would it be cancer?
CORTESE: I’ll answer your question two ways … First, cancer is not a disease. It’s not a single disease. it’s a coompliation of many, many different diseases. As a matter of fact, just in the one segment of let’s say, breast cancer. there are at least 120 to 130 types of breast cancer that we can identify based on gene markings and protein markings that make it quite different on how we design the treat for individual patients. So cancer is not a single dis. So the other question, though, you’ve got, is should we focus on cancer as a general domain that we should be treating and trying to improve care, absolutely — because there’s so much to learn with regard to approach to cancer that may be very helpful in the area of vaccine and vaccine development, small biologics, novel diagnostics, novel therapeutics, special imaging tests, immunology. there are many, many things that we can learn that would be transportable to other areas and other domains in medical care.
C-SPAN: The president, and this is in closing for you, mentioned the summit that’s taking place next week. Can you tell us more about what that is and what the outcomes are expected to be?
CORTESE: Well no. I do not know much more. there were no details that I heard during the presentation. But if it’s like his economic or fiscal-responsibility summit that I think occurred yesterday or the day before, it was like an open forum where there were some ideas exchanged.
I think it’s a great idea to have a summit, because it helps focus on health care as an issue, and reform, so that people can begin to focus on trying to develop better outcomes at lower costs, focusing on paying for those outcomes at lower costs, making sure we’re keeping the very best providers viable and healthy as we go forward, making sure we’re creating integrated and coordinated care as an approach to caring for people. He called it 'primary care,' but really it’s conducting the 'orchestra of care' for an individual patient and to make sure that everybody has insurance. The idea that insurance should be covering everybody is seomthing we certainly would support. So that summit will help emphasize the need to move forward. I don’t think we should expect a lot out of the summit because people have been debating these issues for many, many years and here’s where we are today. So one more summit won’t solve it.
But it certainly will show that the president is expecting to set standards and goals for the country to reach, and that’s dearly needed in this country right now.
C-SPAN: President Obama saying tonight we can no longer afford to put health care reform on hold. Dr. Denis Cortese who at the Mayo Clinic has been very involved in the national debate over health-care delivery. Thank you, sir, for being with C-SPAN this evening.
CORTESE: You’re welcome.
By Jeff Hansel, member Association of Health Care Journalists
Health Reporter for the Post-Bulletin newspaper, 18 1st Ave. S.E. in Rochester, Minnesota 55904
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