Monday, March 2, 2009

Mayo Clinic, interviews - Chat with Retiring Mayo Clinic CEO

I assiduously follow three other blogs – The Health Care Blog, the WSJ’s Health Blog, and KevinMD – in search of material and chances to comment.

Here is my latest comment on a February 27 WSJ blog, Health Blog Q&A: Mayo Clinic CEO Cortese, in which Cortese, a pulmonologist, chats about the changes he’s like to see in American health care.

There once was a Mayo doctor named Cortese,
Who about his future was breezy and hazy,
When his health turns for the worse,
He will email a nurse to relieve the strain on his purse
Careful, Dr.Cortese, lest you end by pushing up a daisy

This is tongue-in-cheek, but many of more than 60 comments on what Dr. Cortese had to say were acid in their comments.

This shows to go you, what a tangled web you weave when you try the health care crisis to relieve. As for myself, I admire the Mayo Model. But given the fact that 75% of doctors practice in groups of ten less and cherish their independence, I just cannot foresee a system run a series of Mayo-like physician organizations.

Health Blog Q&A: Mayo Clinic CEO Denis Cortese
Posted by Jacob Goldstein

Denis Cortese is stepping down later this year from his job as Mayo Clinic CEO, as the clinic’s hometown paper reported this week. Cortese has had the job since 2002, and he’s become more involved in national health policy in the past few years. We were interested to hear what he’ll be doing next, and we got him on the phone today (which happens to be his 65th birthday).

Here are the highlights of our conversation.

Why are you leaving now?

I’d like to get out of day-to-day stuff. I want to have a job trying to foster discussion at the national level. How do we design a health-care delivery system in the United States? It’s not just getting everybody insured — that’s the easy part.

What’s the hard part?

Everybody’s got to lose something here. Physicians may have to have lower salaries. They may have to shift their thinking away from just doing things for patients when they’re sick. Shift over to, ‘I’m in the business of finding ways to keep people healthy so I do fewer procedures.’

Insurance companies may have to insure everybody and quit worrying about pre-existing conditions.

Hospitals are going to have to think that they’re no longer the center of the universe. The center of the universe should be patients. Hospitals should be viewed as the symptom of failure of the health system. I’ve never met a patient who wanted to go to the hospital.

What’s an example of the kind of systems you’d want to create?

I’ve got five chronic medical medical problems.

Wait — are you speaking hypothetically?

No. I have some atrial fibrillation, a little high blood pressure. I don’t need to see a doctor for that. When I’m having a little problem, why can’t I just call the nurse or send an email and ask them what I should do? Or even better, that person hounds me once in a while and makes sure I’m doing what I should do.

Where are you headed next?

There’s an option in Seattle, there’s an option in Arizona. There are academic centers that are interested in having health-policy centers started. [Or maybe] some kind of a social business that’s taking a systems-engineering approach to health care.

What about a job in the Obama administration?

Nobody’s approached me. If the job were right, it would be an option. I’ve not seen anybody yet ready to go the level I’m talking about, which is the design of the delivery system.

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