Although there are some positive provisions in the current House Tri-Committee bill – including insurance for all and payment reform demonstration projects – the proposed legislation misses the opportunity to help create higher-quality, more affordable health care for patients. In fact, it will do the opposite.

In general, the proposals under discussion are not patient focused or results oriented. Lawmakers have failed to use a fundamental lever – a change in Medicare payment policy – to help drive necessary improvements in American health care. Unless legislators create payment systems that pay for good patient results at reasonable costs, the promise of transformation in American health care will wither. The real losers will be the citizens of the United States.

Bloomberg TV correspondent Lizzie O’Leary is at Mayo Clinic this morning to interview Dr. Denis Cortese, CEO and President, and Dr. Thoralf Sundt, cardiac surgeon, about why Mayo Clinic is used as an example of high quality, efficient health care by President Obama. The focus of the story is on the fact that Mayo Clinic physicians receive a fixed salary. See the story.

Minnesota Public Radio reporter Lorna Benson recently spent a day at Mayo Clinic to learn why President Obama touts Mayo Clinic as a model for high quality, efficent health care. Benson got examples of both low tech and high tech methods Mayo uses to improve quality and efficiency, as well as a chance to talk values and principles with a Mayo Clinic physician. Read the Web version of the story; an audio link should become available shortly.

In case you missed the June 24 broadcast, President Obama was on ABC News Primetime discussing health care reform.   In a question-and-answer format, the president spent an hour and a half describing his vision for health care in the US.  Yet again, he mentioned Mayo Clinic (about twelve minutes in to the program) as a great existing model of how health care can be delivered much more effectively in this country.

In an exclusive interview with Diane Sawyer on ABC’s Good Morning America President Obama continued to point to Mayo Clinic as an example of health care that delivers better outcomes at lower cost. The interview precedes a town hall meeting on health care reform being held at the White House on June 24, 2009. Responding to a question about whether Americans will need to make do with fewer tests and procedures in the future, President Obama commented, “I think what’s important is to say to the American People that you should get the best possible care to make you well. And that the measure of the quality of care is not quantity, but whether or not it is making you better. Now, what we’ve seen is that there’s some communities and some health systems that do this very well. Mayo Clinic, a classic example. In Rochester, Minnesota. People go there. They– spend about 20-30 percent less than some other parts of the country, and yet have better outcomes.”

Read the complete transcript of the interview.

Mayo Clinic is featured in the June 29 issue of Time Magazine in an article called “More Data + Less Care = Lower Cost + Better Health.” Senior Correspondent Mike Grunwald visited Mayo Clinic in late May and spent two days interviewing several Mayo physician leaders, observing a Hospice meeting and visiting a patient.

Grunwald says “…Mayo also provides tremendous value for ordinary care; its flagship hospital spent just more than half as much per patient in the last two years of life as did the UCLA Medical Center.”

Read the full article and see the print edition.

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.

President Obama, in a public letter addressed to Senators Edward Kennedy and Max Baucus, referred to Mayo Clinic as offering “the highest quality care at costs well below the national norm.” He went on to write “We need to learn from their successes and replicate those best practices across our country.”

Read the Obama HCR Letter to Kennedy and Baucus 6-3-09.

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.

President Obama today, in a speech to Senate Democrats, cited Mayo Clinic as an example of high value, low cost health care. Read the President’s remarks.