The Mayo Clinic has reigned for many years as an example of health care that’s both high-quality and cost-effective. Many Minnesotans are proud that this facility, known the world over, is in their own back yard.
More recently, Mayo has been touted as the example to which the rest of the nation ought to aspire. But is this realistic or even desirable? The Washington Post took a critical look this past weekend and concludes that the jury is still out on whether Mayo is "a model or a mirage":
Few dispute the prowess of Mayo, which brings in $9 billion in revenue a year and hosts 250 surgeries a day. But a battle is underway among health-care experts and lawmakers over whether its success can be so easily replicated. Before embracing a fundamentally new approach to health care, dissenting experts and lawmakers say, Congress should scrutinize the assumption that a Mayo-type model is the answer.
Mayo’s patient demographics and payment structure are not typical, the article points out. Patients at Mayo are "wealthier, healthier and less racially diverse than those elsewhere in the country." Cost efficiencies at Mayo and at other well-known facilities in the Upper Midwest, such as Gundersen Lutheran and the Marshfield Clinic in Wisconsin, might be the result of a population that’s simply healthier and has lower rates of poverty and chronic disease.
Indeed, geography could be more important than we think. The Washington Post article notes that "Mayo’s other facilities, in Jacksonville, Fla., and Phoenix, have total spending rates that are roughly proportional to those in other hospitals in those areas. And across the Upper Midwest, per-patient spending is low, including at centers where doctors are not on salary." This suggests local or regional culture, attitudes and values surrounding health care might be among the critical determinants for how any given community uses its health care resources. It also incidentally calls into question the assertion that competition in health care leads to lower costs.
What is Mayo’s response to the Washington Post article? The Rochester Post-Bulletin talked to Josh Derr, manager of Mayo’s Health Policy Center. To read the full interview published today, you need access to the print edition, but there’s an online excerpt here, in which Derr discusses how other clinics might replicate Mayo’s model of care.
For what it’s worth, the attention being focused on Mayo as a paradigm of what health care should be seems a little misplaced. Yes, it provides specialty care and high-level procedures such as transplant surgery. It’s a center for research and teaching. For many Minnesotans, it’s the place to go if they receive a cancer diagnosis or need highly specialized care that’s not likely to be available at other facilities. It’s not necessarily the first place that comes to mind, though, for the vast majority of people whose main need is for routine care.
The real question is not what a single, rather rarefied institution such as Mayo is doing to provide high-quality, cost-effective health care. The real question is this: If health care in the Upper Midwest is measurably better at providing effective services at a reasonable cost, why is this so? What do the region’s hospitals and clinics have in common? What sets them apart from other regions of the United States? What makes them successful? What can we learn from them?
We can easily find examples right here in rural Minnesota that are worth studying. Maybe we should be asking why they can’t be the ones everyone else wants to emulate.
Update, Sept. 25: The Minneapolis Star Tribune takes a closer look at Mayo’s influence on how health care reform legislation is being shaped.
Photo: the Mayo and Gonda buildings, Rochester, Minn. Source: Wikimedia Commons.