Tuesday, December 04, 2012

Mayo as Model 

In response to one of my postings about doctors becoming hospital employees, a reader who prefers to remain anonymous called my attention to the Mayo Clinic as a possible model for the delivery of health care.  Specific reference was made to a Commonwealth Foundation study called “Organizing the U.S. Health Care Delivery System for High Performance”  Mayo was one of 15 institutions studied and the report on that organization was titled  “Mayo Clinic: Multidisciplinary Teamwork, Physician-Led Governance, and Patient-Centered Culture Drive World-Class Health Care.” 

Under the heading “Lessons Learned,” the report included this statement:  “The success of Mayo Clinic’s model of integrated care flows from three primary and interrelated influences, according to Dr. Schwenk [a Mayo physician]. First, multidisciplinary practice with salary-based compensation fosters team-oriented patient care and peer accountability. Second, the supportive organizational and technologic infra­structure permits physicians and other caregivers to excel at the clinical work they were trained to do. And third, a physician-led governance structure inculcates a culture that filters all decisions through the lens of patients’ interests.” 

Mayo is one of several multi-specialty group practices that were formed early in the 20th century and which have become large, integrated, healthcare institutions consisting of group practices that operate their own hospitals.  Others that come to mind are Leahy, Ochsner, Geisinger, and Cleveland Clinic.   The question is whether they ought to serve as a model for the health care delivery system of the future. 

They very well might except for one thing:  they can’t be replicated.   

As a general rule, medical partnerships find it impossible to accumulate capital.  If the group is fortunate enough to accumulate cash in the bank, the desire of the partners to take it out for themselves proves too strong to resist.   

Mayo and the other groups like it were each founded by an entrepreneurial physician who ruled the group with an iron hand during its formative years.  They may have had some legal form of partnership but the founders retained enough power to hang onto the profits and use them to grow. 

That was possible in the culture of the time, but not in the culture of today.  There has been no repetition of these large, integrated groups in recent times and there is not likely to be in the future.

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