Hold the Mayo?

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.

7 thoughts on “Hold the Mayo?

  1. All I know is that my mother had Stage 3 cancer and would not have survived in many treatment environments. But after having been treated at Mayo, she can now say she was cured-going on 8 years cancer-free. From the receptionists to the oncologists, they are icons of professionalism in my book.

  2. Another outstanding blog, Anne. Thanks! I do think Mayo is a mirage for all of the reasons in your blog. It is unique in so many ways – too unique. In healthcare, it has some very strong strengths and is also quite average in some areas. Finacially, it’s being held up by some as a model but it’s really struggling right now during the downturn in the economy and cuts in reimbursments. I’m just not convinced it is the right model. However I’m not sure what is. You are so well informed. I’d love to see you have even MORE of a platform to share your insights & knowledge… :)

  3. Mayo is the heart of an integrated system of hospitals, clinics of various sizes, and small physician practices spanning several states. Like other such systems in the area, like HealthPartners in the Twin Cities, Duluth Clinic, and Gunderson in Wisconsin, it offers comprehensive services to all patients who participate in the system, in addition to those who come from farther away.

    Patricia Gibbons
    Rochester, MN

  4. I would go to Mayo in a heartbeat if the need ever arose. I think it can be hard, however, to pin down what makes them uniquely successful. Is is the salary structure? Is it their culture? Is it geography? Does it have something to do with their history and values? Some of these things are intangible, and they are not easy to export to other organizations.

    GrandForksWolf, it’s good to hear your mother is doing well. I hope she enjoys many more healthy years to come.

  5. There is no question Mayo is an outstanding medical facility. I have personal connections in that my wife and brother-in-law trained there and also did research there. My brother-in-law currently practices there as a specialist and my father-in-law is a retired Mayo specialist. My wife is a general practitioner. We know the perspective as Mayo doctors and patients. Our family has had general health care and experimental cancer care at Mayo. Mayo is unique and has strengths in certain areas but often the perspective people have is that Mayo does everything in an outstanding way. In reality, general healthcare at clinics around the state is comparable to Mayo. Mayo is very willing to acknowledge this fact, just ask. Currently, their financial situation is struggling and salaried physicians can no longer work in the same way they used to. That means physicans are told to see even more patients in a day, work longer days with no increase in salary. Not sure that that is a model to emulate. Or if it is emulated how does it affect patient care? I’m not sure. At least I would imagine it will affect physician satisfaction and interest in practicing medicine there. To essentially be told by administration “we need to make more money so you have to see more patients – you don’t get any of the money” sounds like a model to question.

  6. Anne, I have Mayo connections as well. It’s hard to compare Mayo to anywhere else. My spouse’s family lives there and are physicians there. My husband also did some residency training there. It is a very different place to work because of the academic and research environments. My family loves Mayo. My family member in Willmar has gone there for late stage cancer and was put into a study with experimental meds. She is a survivor!!! We have had good experiences there and a few that weren’t great. Mayo isn’t perfect – how could they be? My sister has been there and was referred along to three different Mayo specialists who all disagreed with each other and then she was sent back at square one to sort things out. When she returned to the clinic for the appt to the original doc she’d seen, they said he wasn’t there anymore…so they had her see a fourth doc who told her there was nothing he anyone could do to help her. She didn’t give up and went back to the third doc and went with his plan. 12 months after pursuing treatment, she got it and is doing great!!! It’s huge place, it’s a training facility AND Physicians are people! But they have physicians from all over the world who go there to train and do research. That means they have some top docs and along with doc learners working on you. It is a UNIQUE place that would be great to recreate in so many ways I just don’t know if it’s possible…but what do I know!?!? :) My family members have always been fine with the salary situation…as far as I’ve heard. It’s secure. Mayo docs also seem to have lots of time to spend with patients….That’s a real plus! I think we can be proud of the medical care around the state and feel secure knowing we have the incredible Mayo Medical Center nearby! That is a blessing!!!I think the reason Mayo can be held up as an example is thanks to the many unique factors we all have discussed. Just my opinion! :)

  7. We’ve went to Mayo lots of times from living in the cities. Frankly they don’t do nothing different then at Healthpartners clinics for run of the mill problems. That has dispointed us. Unless a problem is wierd. Then they know what to do with you when others don’t. Don’t know about financal dealings.

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