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Mayo Clinic Remedy for Health Care: It's The System, Stupid

By John Reichard, CQ HealthBeat Editor

March 21, 2008 -- The ideas advanced on Friday by the Mayo Clinic for overhauling health care may not be novel in many respects, but they are the Mayo Clinic's, after all—its sterling reputation means they'll get a look from policy analysts. A key tenet of the Mayo approach: there is no "system" now per se of U.S. health care, and the mere act of admitting that is liberating, because it frees policymakers to focus on designing one.

Outlined by Mayo Clinic CEO Denis Cortese in a speech to the National Press Club, the overhaul plan treats universal coverage almost as an afterthought—sure, Mayo regards it as an essential goal, but Cortese spent little time talking about it and said other goals to improve the value of health care will be tougher to accomplish.

An essential element of the Mayo vision, developed through consultations with some 800 "thought leaders" and 1,400 patients over the past year and a half, is the idea of teamwork. To be effective, care must be well coordinated and tailored to the particular patient and his or her particular condition and genetic makeup. Using a musical analogy, that means everything from a duet for simple health care needs to a chamber ensemble for less simple cases to a full orchestra of providers for complex cases, Cortese said.

Mayo envisions a new system of health care in which teams of hospitals, doctors, nurses, and others function as "learning organizations" that engineer and implement processes of care that reduce medical errors and increase quality and share successful approaches with patients and providers nationwide.

Cortese cited research showing so many preventable deaths of hospital patients occur every year that it's the equivalent of a Boeing 747 crashing every two or three days. "Would this country tolerate this in the airline industry?" he asked. "You know we don't even have a way to report near misses and reports errors in this country to a central body that systematically looks at it and reviews it and tries to get ahead of these problems and tries to distribute the learning throughout the whole organization—so if a hospital in Seattle finds a new way to eliminate a complication of a drug, every other hospital in the country should learn about it the same day. The click of a button. That should be a goal. That's what I mean by learning organizations."

The promise of information technology must be realized to share up-to-date medical records and medication lists and develop techniques of care based on the latest medical evidence; right now providers give the right treatment only about half the time, Cortese said.

Medical schools must train doctors "not to memorize stuff" so much but how to organize care, how to pull the right people together to deliver the right treatment.

Government and private health insurance plans should "pay for value", rewarding providers for safer care, better treatment outcomes, and greater patient satisfaction with health care services. Cortese contrasted that approach with the path Medicare is now on toward rewarding providers more if they practice certain processes of care and provide certain services—the emphasis, in other words, is on results, not techniques.

Each individual should be responsible for purchasing health insurance but government should assist those unable to pay for coverage themselves. Government should not set prices, but prices should be made public as part of a system in which consumers have a menu of insurance plans from which to choose, and insurers should not be permitted to deny coverage.

Cortese also suggested that some sort of independent entity like the Federal Reserve Board that is shielded from political pressure should be established to oversee health care.

"Congress interferes with Medicare's ability to do what it needs to do," Cortese added. The current system leads to Medicare paying more in parts of the country that have the worst treatment outcomes, the opposite of what it should do, he said.

"Congress does not allow Medicare to make decisions based on comparative effectiveness" of treatments. "Something has to be done to have Medicare become insulated from political pressure. In other words, Congress has to get out of the business." he said. Medicare "is just spending money it shouldn't be spending."

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