Mayo's prowess indisputable, but can it be replicated

ROCHESTER -- The Mayo Clinic looms out of the prairie here like the mecca it has become, a world-renowned medical complex that is often cited by President Obama as his model for national heath-care reform.

"Look at what the Mayo Clinic is able to do. It's got the best quality and the lowest cost of just about any system in the country," Obama said in Minneapolis this month. "So what we want to do is we want to help the whole country learn from what Mayo is doing. ... That will save everybody money."

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 under way 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.

They point out that Mayo's patients are wealthier, healthier and less racially diverse than those elsewhere in the country. It has few poor patients. It limits the number of procedures it performs per patient, but the rates it charges private insurers and self-paying patients is higher than average, allowing it to thrive despite the lower Medicare spending cited by its supporters.

Armed with their new stature, officials from Mayo and a handful of similar facilities have become determined lobbyists in their own right. They are pushing for an overhaul of Medicare that would reward cost-effective hospitals and doctors, while punishing others.

But if the Mayo model is, in fact, difficult for even the most dutiful hospitals elsewhere to mimic, such an overhaul could set up many providers nationwide for failure -- and a big loss of funds.

"It's not (Mayo's) model. It's their patients and money. If you have the money, you can attract good staff, good doctors, good nurses," said Richard A. Cooper, a professor of medicine at the University of Pennsylvania. "You are going to force hospitals to find ways to avoid taking care of poor people just because they are going to be penalized because poor people cost more."

Mayo and other oft-cited model facilities also are lobbying against one of Obama's favored provisions: a government-run insurance plan, or public option, which would work against these hospitals' financial position.

"What they want to do is leverage their high-quality delivery systems to keep as much of a private delivery system as possible," said Gerry Shea, the AFL-CIO's chief health-care negotiator.

Mayo and the other model centers -- which tend to be in the Upper Midwest, Mountain West and Pacific Northwest -- have gained their current stature because of Dartmouth University research showing that they spend less per Medicare patient than their counterparts elsewhere, including in Miami, Los Angeles, New York and much of Texas and the South. Many experts have seized on the data to conclude that the key to reining in health-care spending is to emulate Mayo -- a large group practice in which physicians are on salary and have less incentive to perform unnecessary procedures than physicians paid on a "fee for service" basis.

"These communities are able to control utilization [of health care] without harming patients," said Don Berwick, head of the Institute for Healthcare Improvement.

Mayo officials say their model dates to the clinic's founding in the late 19th century by brothers Charles and William Mayo, still known around the campus simply as "Charlie and Will." As their clinic grew, it became known for its quality and the brothers' insistence that doctors work on salary.

That, Mayo physicians said, has drawn doctors more committed to their professional obligations than to making high salaries by racking up procedures. "I didn't go to medical school to be the hardest-working guy in the room. I went to medical school to take care of patients," said cardiac surgeon Thoralf Sundt.


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Doctors group donates $10,000 to medical college

A group of local doctors wants to cultivate the next generation of physicians to fill one of the area's most pressing needs — access to health care.

"We know there's a physician shortage in this area," Dr. Natale Falanga, a doctor of internal medicine and geriatrics, said in a telephone interview. "The goal is to recruit students in the area, get them training and hopefully they'll stay in this area."

Falanga is president of the Monroe County Medical Society, which next month will give $10,000 to The Commonwealth Medical College in Scranton.

The new college, which is focused on developing local talent and researching the health needs of the northeast region of the state, welcomed its first crop of 65 medical students and master's candidates in biomedical science last month.

The aim of the college is to bolster the region's depleted supply of doctors.

Northeast Pennsylvania suffers from a shortage of approximately 100 doctors, and the situation could grow worse without new doctors coming to the region. Nearly one-half of the physicians practicing in northeast Pennsylvania are over the age of 50, according to Pocono Medical Center.

The region's shortage of doctors is compounded by gaps in insurance coverage in the county.

Monroe County's share of uninsured adults exceeds the state average. More than 16,500, or nearly 16 percent, of the county's residents between 18 and 64 have no health insurance, according to the U.S. Census Bureau's American Community Survey for 2008. This outpaces the state average for this age group by more than 3 points.

It is hoped that bringing medical residents to the area will lead to new clinics for the uninsured and under-insured.

"This can lead to so many things down the road," Falanga said. "But you have to start somewhere."

PMC and Sanofi Pasteur have also pledged their aid to the college. Sanofi has given $1.5 million — one of the largest financial donations ever made by the company in the United States — to help build research labs at the medical school.

PMC has awarded money for a scholarship. Its staff also serves on the faculty of the college.


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