[Vampyr]

Cthulhu D, on 2013-November-23, 18:23, said:

Mayo is very, very expensive, often for no discernible benefits (in terms of healthcare outcomes compared to other leading US hospitals). It is a pragmatic decision to cut it.

On what basis do they charge higher prices? Maybe this is something that needs sorting along the path to a single-payer system. I think that Obama-Care is an improvement on the staus quo, but the varied charges are not conducive to an everyone-covered system.

Here, if your condition is serious, you will be sent to a hospital that has a specialist unit. Otherwise you will go to another, more convenient, hospital. It seems to work.

You cannot get boob-jobs on the NHS, unless you can demonstrate that the size (or lack thereof) of your bust is causing you psychological distress (well, yes, it could be physical distress if they are too large.) The same applies, I think, to sex-change operations.

[PassedOut]

Cthulhu D, on 2013-November-23, 18:23, said:

Mayo is very, very expensive, often for no discernible benefits (in terms of healthcare outcomes compared to other leading US hospitals). It is a pragmatic decision to cut it.

You are wrong.

Mayo charges are comparable to those of other hospitals, most of them very inferior to Mayo. There are not many "leading hospitals" around the US, and the goal is (or should be) to get good quality healthcare to everyone. A key factor in Mayo's success is that Mayo is very well managed -- a fact that anyone who has used their services can attest -- and those management techniques can be applied generally.

This post has been edited by PassedOut: 2013-November-24, 08:08

[kenberg]

Putting aside all the arguments for a moment, I enjoyed reading the article below:
http://www.washingto...ry.html?hpid=z3
There are descriptions of interviews with potential participants, for example (Courtney Lively is the interviewer):

Quote

"You smoke?” Lively asked, going through a few routine questions.

“Right- and left-handed,” he quipped as she typed.

“All right,” Lively said after a while. “You are covered.”

“I’m covered?” Fletcher said. He slapped the table. He clapped twice.

“Woo-hoo! I can go to the doctor now?” he asked Lively. “I’m serious. I need to go.”

I found the following numbers interesting:

Quote

In a state where 15 percent of the population, about 640,000 people, are uninsured, 56,422 have signed up for new health-care coverage, with 45,622 of them enrolled in Medicaid and the rest in private health plans, according to figures released by the governor’s office Friday.

So far at least, some 80% of the sign-ups are for Medicaid. This is for one state, of course. I was wondering how those numbers were going to go.

[y66]

From The Cost Conundrum -- What a Texas town can teach us about health care by Atul Gawande.

Quote

The real puzzle of American health care, I realized on the airplane home, is not why McAllen is different from El Paso. It’s why El Paso isn’t like McAllen. Every incentive in the system is an invitation to go the way McAllen has gone. Yet, across the country, large numbers of communities have managed to control their health costs rather than ratchet them up.

I talked to Denis Cortese, the C.E.O. of the Mayo Clinic, which is among the highest-quality, lowest-cost health-care systems in the country. A couple of years ago, I spent several days there as a visiting surgeon. Among the things that stand out from that visit was how much time the doctors spent with patients. There was no churn—no shuttling patients in and out of rooms while the doctor bounces from one to the other. I accompanied a colleague while he saw patients. Most of the patients, like those in my clinic, required about twenty minutes. But one patient had colon cancer and a number of other complex issues, including heart disease. The physician spent an hour with her, sorting things out. He phoned a cardiologist with a question.

“I’ll be there,” the cardiologist said.

Fifteen minutes later, he was. They mulled over everything together. The cardiologist adjusted a medication, and said that no further testing was needed. He cleared the patient for surgery, and the operating room gave her a slot the next day.

The whole interaction was astonishing to me. Just having the cardiologist pop down to see the patient with the surgeon would be unimaginable at my hospital. The time required wouldn’t pay. The time required just to organize the system wouldn’t pay.

The core tenet of the Mayo Clinic is “The needs of the patient come first”—not the convenience of the doctors, not their revenues. The doctors and nurses, and even the janitors, sat in meetings almost weekly, working on ideas to make the service and the care better, not to get more money out of patients. I asked Cortese how the Mayo Clinic made this possible.

“It’s not easy,” he said. But decades ago Mayo recognized that the first thing it needed to do was eliminate the financial barriers. It pooled all the money the doctors and the hospital system received and began paying everyone a salary, so that the doctors’ goal in patient care couldn’t be increasing their income. Mayo promoted leaders who focussed first on what was best for patients, and then on how to make this financially possible.

No one there actually intends to do fewer expensive scans and procedures than is done elsewhere in the country. The aim is to raise quality and to help doctors and other staff members work as a team. But, almost by happenstance, the result has been lower costs.

“When doctors put their heads together in a room, when they share expertise, you get more thinking and less testing,” Cortese told me.

Skeptics saw the Mayo model as a local phenomenon that wouldn’t carry beyond the hay fields of northern Minnesota. But in 1986 the Mayo Clinic opened a campus in Florida, one of our most expensive states for health care, and, in 1987, another one in Arizona. It was difficult to recruit staff members who would accept a salary and the Mayo’s collaborative way of practicing. Leaders were working against the dominant medical culture and incentives. The expansion sites took at least a decade to get properly established. But eventually they achieved the same high-quality, low-cost results as Rochester. Indeed, Cortese says that the Florida site has become, in some respects, the most efficient one in the system.

The Mayo Clinic is not an aberration. One of the lowest-cost markets in the country is Grand Junction, Colorado, a community of a hundred and twenty thousand that nonetheless has achieved some of Medicare’s highest quality-of-care scores. Michael Pramenko is a family physician and a local medical leader there. Unlike doctors at the Mayo Clinic, he told me, those in Grand Junction get piecework fees from insurers. But years ago the doctors agreed among themselves to a system that paid them a similar fee whether they saw Medicare, Medicaid, or private-insurance patients, so that there would be little incentive to cherry-pick patients. They also agreed, at the behest of the main health plan in town, an H.M.O., to meet regularly on small peer-review committees to go over their patient charts together. They focussed on rooting out problems like poor prevention practices, unnecessary back operations, and unusual hospital-complication rates. Problems went down. Quality went up. Then, in 2004, the doctors’ group and the local H.M.O. jointly created a regional information network—a community-wide electronic-record system that shared office notes, test results, and hospital data for patients across the area. Again, problems went down. Quality went up. And costs ended up lower than just about anywhere else in the United States.

Grand Junction’s medical community was not following anyone else’s recipe. But, like Mayo, it created what Elliott Fisher, of Dartmouth, calls an accountable-care organization. The leading doctors and the hospital system adopted measures to blunt harmful financial incentives, and they took collective responsibility for improving the sum total of patient care.

This approach has been adopted in other places, too: the Geisinger Health System, in Danville, Pennsylvania; the Marshfield Clinic, in Marshfield, Wisconsin; Intermountain Healthcare, in Salt Lake City; Kaiser Permanente, in Northern California. All of them function on similar principles. All are not-for-profit institutions. And all have produced enviably higher quality and lower costs than the average American town enjoys.

[Winstonm]

If Kansas can change course, there is hope for us all.

Quote

To her credit, Senate President Susan Wagle, R-Wichita, has expressed a willingness to keep the state’s options open on Medicaid expansion, showing particular interest in the “Arkansas model” of using expansion funds to help people buy private insurance

[y66]

From Fortune Mag's October 31, 2013 interview with Mayo Clinic CEO John Noseworthy:

Quote

Q: How will the advent of the Affordable Care Act affect Mayo Clinic?

A: In a number of ways. Most particularly, we expect that it will reduce how well we're reimbursed for the work we do. But the Affordable Care Act, on which we're all putting so much attention at the moment, is in the context of an anemic recovery in our economy and a marked shift in the demographics of the American people, with the aging population, plus the prevalence of chronic disease, the rising costs of health care, the rising costs of research. All of that contributes to an unsustainable health care system. It's too costly -- we're spending too much on health care. This is an effort [by elected officials] to try to get their arms around the cost, and we will need to deal with that.

Q: America's health care spending is still growing faster than GDP. That trend cannot go on forever. What will cause it to stop, since something must?

A: One approach is to pay less for the unit of work. I'm not sure that's anywhere near the whole answer. We're spending too much on health care because it's fragmented and the quality is so uneven in our country. There are pockets of outstanding health care, and there are other places not at that level. There are highly efficient, high-quality health care groups, and others that are expensive and don't deliver that quality.

At Mayo Clinic we're focusing on the fragmented health care part and on delivering higher quality. We believe that if we can get health care to be more integrated and that if we drive quality through the system, it will actually save money and provide what patients need, which is trusted, affordable, safe health care. Mayo's focused like a laser on those two aspects: integration of care and providing safer, more efficient care.

Q: Mayo consistently achieves better-than-average outcomes at lower-than-average cost. Is what you have just described a part of the secret?

It is part of the secret of how Mayo has been successful. But that piece is missing in the Affordable Care Act. The Affordable Care Act is really insurance reform. It gets people covered with insurance, but nothing in the Affordable Care Act really addresses the varying complexity of illness and certainly not the varying quality of the work that's done. That's why we're working with the Senate and House to reform the SGR [sustainable growth rate -- the method used by Medicare to control spending] and put these elements in it. We think it's the right thing to do, and we think it'll help the health system move to more team-based care, sharing of information, and trying for better outcomes.

Q: The Mayo model of salaried physicians and team-based care is used at a few other institutions, but not many. In light of its effectiveness, why isn't it used more widely?

That's a tough question to answer. The model comes down to the mission of Mayo Clinic. Our primary value is the needs of the patient come first. Every decision we've ever made at the Mayo Clinic over the past century and a half is based on what's right for the patient. That involves a culture of teamwork centered on the patient. That's hard for other groups that are heavily fragmented -- and the whole health care system basically is heavily fragmented.

A culture of what centered on who? Indeed.

[Winstonm]

Here is the heart of the Mayo Miracle:

Quote

“It’s not easy,” he said. But decades ago Mayo recognized that the first thing it needed to do was eliminate the financial barriers. It pooled all the money the doctors and the hospital system received and began paying everyone a salary, so that the doctors’ goal in patient care couldn’t be increasing their income. Mayo promoted leaders who focussed first on what was best for patients, and then on how to make this financially possible.

Pooled resources and salaries - what a concept.

[PassedOut]

y66, on 2013-November-24, 10:04, said:

A culture of what centered on who? Indeed.

I've mentioned before that my middle son, Daniel, needed parathyroid surgery when he was a freshman in college. Instead of the surgery that was strongly advised by his doctor there (and that would have laid him up for weeks in the middle of his first semester), we took him to Mayo for a minimally invasive surgery during his winter break.

All went well and we needed to take him home to the Upper Peninsula the next day. Realizing that we had a long drive in the winter, the Mayo folks had scheduled us for our release consultation first thing in the morning. Going over the schedule with them the afternoon before this was to take place, the scheduler asked if we'd like to come in an hour before they ordinarily opened so that we could avoid night driving at the end of our trip.

We did, and the doctors came in early to go over the results with us and to explain what we needed to look out for in the days and months ahead. That was only one of many positive interactions we've had with Mayo and their service.

[kenberg]

The Dr. Noseworthy interview is fascinating, and the episode with PassedOut's son is a strong demonstration that the Doctor is not just talking to hear himself talk.

This is very interesting to me.

[Trinidad]

Winstonm, on 2013-November-24, 10:11, said:

Here is the heart of the Mayo Miracle:

Pooled resources and salaries - what a concept.

They're probably just a bunch of communists...

Rik

[kenberg]

Trinidad, on 2013-November-24, 12:14, said:

They're probably just a bunch of communists...

Rik

No, that's not possible. In Minnesota we toss communists into the Mississippi and let them float downstream to Memphis.

[kenberg]

This thread has helped me focus some.

From the story about rural Kentucky, it seems clear that some needed help is getting to people. This is useful information. As I mentioned, I also hope to hear more about how the help that is provided breaks down between Medicare and other forms. of help. The discussion about the Mayo Clinic still astounds me.

We need, as a country, to think about where we are headed with how ordinary people are going to cope. Two things: When people are down and out, I feel it is our national obligation to help. I also strongly believe that when people accept he.[ they are obligated to think a bit about how they can handle their lives so as to need less help in the future. The first view is often associated with liberals, the second with conservatives, but I regard it as a false dichotomy. We can effectively help people only if we remain economically strong enough to do so, and everyone, including those of lesser means, has an obligation to bring this about.

How to do it? That's the rub. I think we could start by realizing that neither conservatives nor liberals have a corner on creative thinking. Nor on wishful thinking, for that matter.

[Winstonm]

Ken,

I agree with your assessment. One of the big disappointments of the ACA to me is that it really doesn't attempt to solve healthcare cost problems - as the Mayo CEO said, the ACA is insurance reform rather than healthcare reform.

[PassedOut]

kenberg, on 2013-November-24, 12:09, said:

The Dr. Noseworthy interview is fascinating, and the episode with PassedOut's son is a strong demonstration that the Doctor is not just talking to hear himself talk.

Yes. All kinds of organizations promise this and promise that, but most of those promises are bullshit because the managers have no mechanism to make sure that the promises are actually kept (if, indeed, they even meant for the promises to be kept). That's one reason that folks get cynical after awhile.

As someone keenly interested in management, I loved watching the Mayo organization in action. Mayo is not-for-profit, but the management is as good as you'll find in any business.

[Winstonm]

PassedOut, on 2013-November-25, 12:21, said:

Yes. All kinds of organizations promise this and promise that, but most of those promises are bullshit because the managers have no mechanism to make sure that the promises are actually kept (if, indeed, they even meant for the promises to be kept). That's one reason that folks get cynical after awhile.

As someone keenly interested in management, I loved watching the Mayo organization in action. Mayo is not-for-profit, but the management is as good as you'll find in any business.

How does not-for-profit management differ from for-profit management?

[PassedOut]

Winstonm, on 2013-November-26, 10:13, said:

How does not-for-profit management differ from for-profit management?

In any organization, good management requires a good plan and good execution. Between not-for-profits and for-profits, the nature of the plans differ, but good management principles apply equally.

If you are managing solely for profit, though, your overall results are easily and objectively measurable. This is especially true when your basic goal is to meet or exceed profit expectations each quarter. If you are managing a not-for-profit (or a business where short-term profit is not your basic goal), it is more difficult to define your goals in a measurable way. Your organization needs to give serious thought about how to do that and how to achieve its goals with a unified strategy.

That Mayo has succeeded in that -- especially given the size of its operation -- impressed me a lot. And, since I do not see maximizing short-term profits as a dominant goal in our family's businesses, I found Mayo inspiring as well.

[Winstonm]

PassedOut, on 2013-November-26, 10:45, said:

In any organization, good management requires a good plan and good execution. Between not-for-profits and for-profits, the nature of the plans differ, but good management principles apply equally.

If you are managing solely for profit, though, your overall results are easily and objectively measurable. This is especially true when your basic goal is to meet or exceed profit expectations each quarter. If you are managing a not-for-profit (or a business where short-term profit is not your basic goal), it is more difficult to define your goals in a measurable way. Your organization needs to give serious thought about how to do that and how to achieve its goals with a unified strategy.

That Mayo has succeeded in that -- especially given the size of its operation -- impressed me a lot. And, since I do not see maximizing short-term profits as a dominant goal in our family's businesses, I found Mayo inspiring as well.

Thank you.

[mike777]

Just for the record there are hundreds and hundreds of clinics cheaper than the mayo clinic.
The Mayo clinic is one of the most expensive clinics in the entire world.

In fact the vast majority of the world never goes there.....

A tiny few do


Most of them die.
-----------------------------------


I predict 6 billion people will die over the next 100 years.

I predict they will become ill/sick/ over and over again.

[WellSpyder]

mike777, on 2013-November-27, 00:23, said:

I predict 6 billion people will die over the next 100 years.

I predict it will be at least 50% more than that.

[kenberg]

mike777, on 2013-November-27, 00:23, said:

Just for the record there are hundreds and hundreds of clinics cheaper than the mayo clinic.
The Mayo clinic is one of the most expensive clinics in the entire world.

In fact the vast majority of the world never goes there.....

A tiny few do


Most of them die.
-----------------------------------


I predict 6 billion people will die over the next 100 years.

I predict they will become ill/sick/ over and over again.

What was it Daniel Bernolli said about an unsigned letter from Newton? Oh yes, "I recognize the lion by his claw". This post is in the Mike style, I would recognize it unsigned. . First the easy part:
Of course only a tiny fraction of people, in fact only a tiny fraction of sick Americans, even a tiny fraction of sick Minnesotans, visit the Mayo clinic. I have never been there, neither has my wife. But only a tiny fraction visit the X clinic, whatever X is. And yes, most all of us die regardless of the clinic we go to, although usually not because we visited the clinic, if that was the suggested explanation. Moving on to the more challenging.

So, the post perhaps asks implicitly, why talk about the Mayo at all? Probably this portion of the thread started with me. I linked to an article in the Washington Post:
http://www.washingto...ed81_story.html

and I quoted:

Quote

A number of the nation's top hospitals — including the Mayo Clinic in Minnesota, Cedars-Sinai in Los Angeles, and children's hospitals in Seattle, Houston and St. Louis — are cut out of most plans sold on the exchange.

This led to discussion of whether such an exclusion was reasonable based on cost. Subsequent discussion seems to indicate that excluding the Mayo is not a very good idea.
If, as appears to be the case, an institution that is widely regarded as exceptionally strong in both its medical practice and its management of costs finds itself excluded from the exchange, it is fair to ask how this happened. No reason, just policy, is the usual answer to such questions.

PSI am not saying that you are Newton or that I am Bernoulli.