Be warned!!! It is happening now in
by Maggie Mahar
October 21, 2008
After working at the Mayo Clinic in
for nine years, Dr. Marc Patterson decided to change his life. In 2001, he moved to Rochester, Minnesota to take a job as chief of pediatric neurology at New York-Presbyterian Hospital (NYPH). New York City
This year, Patterson returned to the Big House on the Prairie. "Sometimes I miss New York,” he acknowledges, “but working in a system that actually functions is worth it."
Nevertheless, Patterson says: “There is a fundamental systemic difference between
Columbia and the Mayo Clinic: is a traditional academic medical center; [research] that came through the med school provided the money to pay us. The hospital is a separate entity. By contrast, at Mayo, the hospital and the medical school are one. It’s an integrated organization.” Columbia
What difference does that make?
Patients Trump Research
“At Mayo the focus is on the patient. The needs of the patient come first. I think one of the Mayo brothers originally said it—and here, that really is the case,” says Patterson. “We also do high quality research at Mayo, and we have a graduate school of medicine. But research is not the primary focus.
At Mayo, on the other hand, stardom is frowned up. “Mayo has been, from the beginning, a group practice,” says Patterson. “You really have to be a team player. People in administrative positions understand that everyone is an important member of the team.”
An Egalitarian Culture
You may have heard that at Mayo, doctors collaborate. But did you know that after their first five years all physicians within a single department are paid the same salary? During those first years, physicians receive "step raises" each year. After that, they top out ,and "he or she is paid just the same as someone who is internationally known and has been there for thirty years," says Patterson. ("Most could earn substantially more in private fee-for-service practice." he adds.)
“It doesn’t matter how much revenue you bring in,” Patterson explains, “or how many procedures you do. We’re all salaried staff—paid equally.
“Turnover is very low. It’s unusual for people to leave here, and when they do, many like me, wind up coming back. You would be surprised—we celebrate many 35 and 40 year anniversaries. That fact that people stay so long is important to the success of the organization.”
Patterson does not sound as if he’s boasting. He didn’t found Mayo. He didn’t create the culture. He merely works there—and he is telling me why he likes it.
Yet I believe that there is much that health care reformers can learn by studying how Mayo operates.
There is, after all, a difference between healthcare and hamburgers. Healthcare is not a commodity.
A “Firewall” between the Money and the Doctors
Yet—and this is key—although Mayo’s doctors are not worrying about the dollar value of what they do, they are not more extravagant than other doctors in dispensing care. Quite the opposite: Extensive analysis of Medicare records done by researchers at
Dartmouth University reveals that treatment at the Mayo Clinic in costs Medicare far less than when very similar patients are treated at other prestigious medical centers. Rochester, Minnesota
Yet no one would suggest that Mayo scrimps when treating patients. The Clinic received stellar marks on established measures of the quality of care, and both patient satisfaction and doctor satisfaction were higher than at UCLA.
…………when it comes to healthcare, lower costs and higher quality often go hand in hand. Mayo’s patients are not hospitalized as long as patients at other medical centers—and don’t see as many specialists—because resources are used efficiently, and diagnoses are made quickly.
A Fully Integrated System
“Here at Mayo, we can do things in a week that take several weeks to organize in
,” says Patterson. This is because Mayo is an integrated medical center. New York
For example, “In New York, each division has its own staff to make appointments. If I wanted several specialists to see a patient, I had to go through each of those divisions. At Mayo, we have a pediatric appointment office that makes all of the appointments for pediatric patients.”
Meanwhile, at Mayo, “We have a unitary medical record and a very effective IT department,” says Patterson. “We developed our own software, and we can we dictate notes—we don’t have to type.” (This is a boon because, believe it or not, many doctors don’t know how to type.)
“In the hospital, what we dictate can be transcribed within about an hour.” Patterson adds. “In the clinic, it’s done by the next half-day. In the meantime, if someone needs to access your notes, they can dial in and listen to the dictation.”
Patients, Like Doctor, are Equal –and Many Need Charity Care
The Mayo Clinic in
sees many local patients. “And like Minnesota , we have minorities—just different minorities.” New York
Like most academic medical centers, Mayo treats a fair number of patients who cannot afford to pay their bills. In 2007 it spent $182 million providing charity care and covering the unpaid portion of Medicaid bills—plus another $352 million on “quantifiable benefits to the larger community” which included “non-billed services, in-kind donations and education.”
That year, 100,000 benefactors gave the Clinic a record $373 million—enough to pay for the benefits the Clinic provided for the community, but far from the amount that would be needed cover the charity care Mayo provided.
When it comes to serving Medicaid patients, Mayo is generous with its time and talent. “Here, there is no distinction between Medicaid patients and other patients,” says Patterson. “I wouldn’t know whether they are on Medicaid, or have insurance from their employer. The business office knows that.”
At many academic medical centers, Medicaid patients are seen mainly by residents in a separate clinic. “At Mayo no one is seen only by residents. And we routinely spend 90 minutes with a new patent —going through X-rays, and a complete examination,” says Patterson.
It also is important to keep in mind that, “contrary to popular assumptions, it’s the volume of services, not the price per service, that accounts for most of the variation in Medicare spending” observes Dr. Jack Wennberg, the founder of what is now known simply as “the Dartmouth research.” And as more than two decades of
research have shown, it is the supply of hospital beds and doctors that drives volume—not patient demand. When more resources are available, as they are at UCLA, patients spend more time in the hospital and undergo more procedures. Yet outcomes are no better; often they are worse. Dartmouth
“UCLA knows it has a problem,” Wennberg confided in an interview last year. “But what are they going to do—close down beds and fire doctors? They need that stream of revenue that comes from the beds and doctors to service their debt.” So Medicare spends more at UCLA—and some patients are over-treated.
But Not All Mayo Clinics Are Created Equal
Mayo offers lessons for reformers. Still, it’s not easy to replicate the success Mayo enjoys in
. Not even Mayo can do it. Minnesota
Over the years, the Mayo Foundation system has grown beyond its original
Rochester, Minnesota site, establishing group practices in Phoenix, Arizona; Jacksonville, Florida; Eau Claire and La Crosse, Wisconsin as well as in several other communities in Minnesota and . Iowa
These are values that can be traced directly back to William Mayo and Charles Mayo, who, together with their father, William Worrall Mayo, founded
’s Mayo Clinic in 1903. The Clinic was one of the first examples of group practice in the Minnesota . As Doctor William Mayo explained in 1905: “The best interest of the patient is the only interest to be considered, and in order that the sick may have the benefit of advancing knowledge, union of forces is necessary…it has become necessary to develop medicine as a cooperative science.” United States
The Mayos also made it clear that patients’ interests were not well served if doctors competed with each other. Late in life William emphasized that in addition to making a commitment to the patient, doctors must make a commitment to each other: “Continuing interest by every member of the staff in the professional progress of every other member,” would be essential to sustaining the organization’s future.
More than one hundred years later, building a health care system that adheres to such a collective vision of its mission may be difficult. Perhaps it can only be done in
In the end, Mayo offers proof that when a like-minded group of doctors practice medicine to the very best of their ability—without worrying about the revenues they are bringing in for the hospital, the fees they are accumulating for themselves, or even whether the patient can pay—patients satisfaction is higher, physicians are happier, and the medical bills are lower. Isn’t this what we want?
Read the full article: What Makes the Mayo Clinic Different?
See also: Leadership Lessons from Mayo Clinic