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.