Monday, July 16, 2012

Parts of Health System  That  Matter to the Mayo Clinic
Control of medicine will never again belong completely to physicians. If that is the case, physicians should decide what parts of the system are important to them, what parts they would prefer to control in the future.  They should look around to determine where doctors have been particularly successful  in working out viable arrangements with management.  A good example of successful  accommodation – where physicians have remained in charge of what is important to them – is the Mayo Clinic in Rochester, Minnesota.  ..Mayo physicians still believe they command what is important to them.  They don’t feel that someone is trying to tell them how to practice medicine.
Victor Fuchs, “The Battle for Control of Health Care," Health Affairs, 1982
July 16, 2012 -  There is no longer any doubt about it.  Physician consolidation into large organizations is growing explosively and exponentially.  The only question remaining is: who is in charge – the doctors, hospital admininstrators,  government experts, or health plan managers?
When I was editor of Minnesota Medicine from 1975 to 1990,  I wrote a book And Who Shall Care for the Sick? The Corporate Transformation of Medicine in Minnesota.   The book contained a chapter “Mayo Diversifies into a National System: An Interview with W. Eugene Mayberry, Chairman of the Board of Directors at Mayo.” Mayberry instructed me on the principles of the Mayo culture.
Ever since,  I have asked myself: What makes Mayo tick?  It is not an idle question.    Mayo may be a good example of how doctors can remain in control of the practice of medicine on their terms.
In my 2009 book Obama, Doctors, and Health Reform, I wrote:
"The Mayo model consists of a large group of patient-centered, salaried physicians, specialists and primary care doctors alike, making similar incomes, gathered in one place, with hospitals and doctors under one roof, practicing conservatively , concentrating on outpatient care, working in teams, communicating electronically, keeping hospital care at a minimum,  at 20% less than the outside world."

What I wrote in 2009 was not completely accurate. Mayo does not practice in “one place” but in three major locations – Rochester, Minnesota, Jacksonville, Florida, and Scottsdale, Arizona – and in 135 counties in 70 communities serving 1 million patients in Minnesota, Iowa, and Wisconsin.
Now Mayo is expanding through something called “The Mayo Clinic Care Network, " launched in September 2011, which offers eConsults, Mayo clinic expertise, and business process and consulting expertise  to affiliated organizations.  These organizations include Sparrow Health Systems in Lansing, Michigan,  ASU Health Systems in Tucson,  Kingman Regional Network in Kingman Arizona,  Altru Health System in Grand Forks, North Dakota,  and Heartland Health Systems in St. Joseph,  Missouri.
To return to my question, what makes Mayo  tick?
Here is my list.
1)      Disciplined, consensus  physician leadership, with a physician serving as CEO

2)     Intense collaboration with the administrators within the Mayo system

3)     Heavy concentration on outpatient care, with primary care physicians on the frontlines coodinatiing care with specialists

4)     Patient and community-centered care with assiduous  training of physicians and paraprofessionals in the “Mayo-Way”

5)     Careful selection of physicians amenable to the Mayo corporate mentality of everyone singing from the same page.

6)     Payment of physicians by salary with corporate perks with lesser payment gaps between primary care physicians and specialists than in the outside world.

7)     A comprehensive electronic medical record available to all throughout the Mayo system.

8)     Close attention to patient loyalty with a vast fundraising effort from current and past Mayo patients.

9)     A coordinated, scrupulously controlled  communication effort aimed at the outside world -  Mayo patient newsletter, Mayo website, and editorial team effort – and at the insider world through frequent electronic  conferences.

10)   A rapt attention to details of care and innovation – with testing, retesting, re-retesting of new ideas

11)    A healthy skepticism of federal reform and outside managed  efforts and of the bureaucracy required to implement them

12)  A conscious effort to cultivate the Mayo image in all of its dimensions  which has resulted in Mayo usually  beening  rated #1 or #2 in national surveys such as the U.S News and Report.
 I should quickly add that the Mayo Model is not for all physicians.  Some find stifling the uninformity and corporate mindset.  Others simply feel uncomfortable in large organization settings. Still others prefer their way, not the Mayo way.
Tweet:   The Mayo Clinic is riding a wave of expansion and consolidation with like-minded organizations near and far from its main clinics. 

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