Word: patients
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...visit to Rochester last month, I watched a hospice team of nurses, social workers, a chaplain and just one doctor talk about dying patients in ways that might have baffled the white coats on Emanuel's cancer ward: platelets were discussed, but so were spiritual needs, family tensions, hobbies and anything else relevant to quality of life. It sounds squishy, but Mayo patients who request palliative care have 84% lower hospital costs, 53% lower overall costs and higher satisfaction. Mayo has computerized medical records that provide instant access to patient histories, improving information-sharing, reducing pharmacy errors and eliminating...
...Mayo also has an institutional obsession with evidence-based medicine, using electronic records for in-house effectiveness research, constantly monitoring its doctors on everything from infection rates to operating times to patient outcomes, minimizing the art of medicine and maximizing the science. "We try to drive out variation wherever we can," says Charles (Mike) Harper, a neurologist who oversees Mayo's clinical practice in Rochester. "Practicing medicine is not the same as building Toyotas, but you can still standardize. Uncertainty shouldn't be an excuse to ignore data." Mayo has teams working on evidence-based protocols to reduce...
...Mayo doctors are also shielded from the incentives that discourage evidence-based medicine, because they all receive fixed salaries. They don't make more if they do more to patients, and they don't make less if they take more time to talk to them - even if they use the time to explain why a CT scan or a wonder drug advertised on TV might not be advisable. They don't have to worry about reimbursements that overvalue radiological tests and invasive prostate treatments, undervalue preventive care and watchful waiting and put zero value on returning a phone call...
...That's the bad news about Mayo's success: it's not sustainable. The harsh reality is that smart, conservative, data-driven, patient-focused medicine is not necessarily profitable medicine. Last year, Mayo lost $840 million on $1.7 billion in Medicare work. It compensated by charging private insurers a premium for the Mayo name, but they're starting to balk. "The system pays more money for worse care," says Mayo CEO Denis Cortese. "If it doesn't start paying for value instead of volume, it will destroy the culture of the organizations with the best care. We might have...
...Helping organize the pushback against the drive for data has been former House whip and legendary Democratic operator Tony Coelho, an epileptic who helped write the Americans with Disabilities Act and now leads the Partnership to Improve Patient Care. The partnership is an odd coalition of the drug companies, devicemakers and medical specialists who stand to lose the most from evidence-based medicine, joined by a variety of patient groups (some of whom also receive industry funding) concerned about access to care. Coelho says he welcomes effectiveness research if it can help doctors and patients make more informed decisions...