As anyone who has been observing recent goings-on in the Senate Finance Committee knows, moving toward universal coverage is no easy matter. No sooner did Finance Chair Max Baucus (D-MT) release his long-awaited Chairman’s mark of health reform legislation than he was pushed to increase the subsidies available to low- and middle-income Americans to purchase insurance.
But as hard as health insurance reform is, compared to health care delivery reform, that’s the easy part, Mayo Clinic CEO Denis Cortese said at the National Press Club on Friday. Cortese has been a key player in health reform discussions. Mayo has been frequently cited as a model for health care delivery reform by President Obama and others, but the question of Mayo’s value as a model for overall reform has also generated controversy.
Cortese cited the significant regional variation in medical practice documented by researchers at Dartmouth and elsewhere, and he listed several factors common to institutions and regions that produce what he called “high-value care”: patient-centric cultures; high levels of physician engagement in leadership and change; much higher levels of teamwork, collaboration, and coordinated care; more “connectivity” and sharing of electronic medical records and information; and much greater use of “the science of health care delivery,” meaning systematically looking at how patients flow through an organization in order to reduce waste and standardize processes to reduce errors.
As Cortese illustrated with a personal story about his own mother’s care, high value care has the potential to keep patients healthier and out of the hospital. After years of frequent hospitalizations, his chronically ill mother moved to Jacksonville and was cared for by the Mayo Clinic. “For the last six years of her lifetime, she was hospitalized once, the month before she died, he said. “She rarely came to our clinic,” instead communicating with nurses and other providers from home.
“It Doesn’t Pay To Be Good”
The problem, Cortese emphasized, is that there is currently no business model to support this type of care in a fee-for-service environment such as Medicare: “Do you know how much we got paid for all that home care my mother was getting? Zero. Medicare doesn’t pay unless you go into the hospital or see the doctor in the office,” he pointed out. “It doesn’t pay to be good.”
Cortese said that all of the Congressional health reform bills contain some good suggestions for moving from FFS to payment for value, and he outlined Mayo’s recommendation to use Medicare to start moving the health care system toward paying for value. “Let’s set a goal that in three years Medicare is paying for value. In those three years, let’s create a process where we define what we mean by value. We start setting up the metrics — the outcomes, safety, and service compared to the cost – and let’s start being transparent about where everybody is on that scorecard.”
That task may seem overwhelming, but it’s not if Medicare starts with the three to five most expensive medical conditions, such as high blood press and stroke, and perhaps the three to five most expensive procedures, such as hip and knee surgeries, Cortese argued.