Apr
27
2019

Mayo Clinic Could Become A Health Care Model

I watched the movie “Mayo Clinic: Faith-Hope-Science”, which suggested that the Mayo Clinic could become a health care model. The movie aired originally on Sept. 25, 2018. It is a fascinating presentation of the history of the Mayo Clinic.

Historical facts

The Mayo Clinic is well known for its surgeries. In the beginning there were only 3 surgeons, Dr. William Worrall Mayo and his two sons, Dr. Will and Dr. Charlie. In 1904 alone they performed more than 3000 surgeries at St. Mary’s Hospital. Today 255 Mayo Clinic surgeons do more than 76,000 surgical procedures for patients.

The original Mayo Clinic was built in Rochester (Minnesota). Later two more Mayo Clinics were added, in Jacksonville (Florida) and Phoenix (Arizona). Here is a link that shows more historic facts.

Involvement in Wars

The Mayo Clinic provided medical care during WWI, WWII and during the Korean War. Management of the Mayo Clinic decided to erect portable clinics close to the battlefields. Treatments for the injured soldiers were free.

Mayo Clinic Involved in Research

From early on in the development of the Mayo Clinic research played an important part. Now there are three Mayo Clinics, each with their own research facilities. There is a campus of a Medical School connected with the Rochester Mayo Clinic. The Medical School puts emphasis on medical research.

Organization of the Mayo Clinic

The organization of the Mayo clinic was initially based on a handshake between the Sisters of Saint Francis who provided nursing skills and the medical staff that provided diagnoses, surgeries and investigations. The movie reported that the handshake philosophy lasted for over 100 years, but eventually the administration came up with a formalized agreement.

A few peculiarities are worth noting.

Doctors on salaries

All doctors working for the Mayo Clinic are on salary. This is in stark contrast to the rest of the medical system in the US. The US medical system is a fee-for-service system. The problem is that fee-for-service clinics rush patients through their appointments. In the past one patient was seen on average every 15 minutes, then every 10 minutes, and now often there are only 7 minute time slots. The more patients a doctor sees in an hour, the more money he/she makes. With a complicated patient at the Mayo Clinic a doctor may take 2 yours to see such a patient. It makes no difference in term of salary to the doctor, but the quality of care and thoroughness of examining a patient can make a huge difference.

Proton therapy made affordable

When proton therapy was first introduced in the Mayo Clinic for cancer therapy, patients could not afford the higher costs of proton therapy versus conventional radio beam therapy. The Mayo Clinic resolved this problem simply by charging the same cost for both procedures. This way the doctor decided, which approach was more appropriate for a particular patient, but there was no financial hardship as a result of this decision.

When poor people cannot afford health care

Another peculiarity evolved when it became apparent that some very poor people could not afford the treatment. The nurses and the doctors consulted about this problem and decided that nobody should suffer diseases because of financial hardship. The minority of these patients received free treatments from the Mayo Clinic. To correct for the difference the administration was charging the well-to-do people a little bit more. Over the years the Mayo Clinic had made enough profit that they could expand and build bigger clinics. There are now three Mayo Clinics, namely in Arizona, Florida and Minnesota.

Other health care jurisdictions

I have worked in the Canadian health care system for 16 years as a general practitioner. Like in the US this is based on a fee-for-service system. Subsequently I worked as a Medical Advisor for the Workers’ Compensation Board of British Columbia (“WorkSafeBC”). This was a salaried position. The advantage of being in general practice is that you are in charge of your practice. You can decide how many hours in a day you work and how many patients you will see on average in an hour. Because of the fee-for-service remuneration from the government this determines your annual income. It also determines your income tax status, so that the take-home pay may not be that much larger than the take-home pay as a salaried physician.

The system in Germany is similar. Most patients have coverage by the regular insurance company (AOK patients). But there is a two tier system, where private patients have insurance coverage by a private insurance carrier, called DKV. They experience a different treatment. Unlike the AOK patients (fee-for-service) there is no rush when the doctor examines a private patient. The doctor takes a lot more time to see a private patient and is more thorough with the examination. The remuneration for the private DKV patients is 3 to 4-times as much as for an AOK patient.

Mayo Clinic could become a health care model for the US

The Mayo Clinic has been in existence for 150 years. It has achieved the highest level of care in the US and many physicians refer their difficult to diagnose patients to this clinic. It seems that financially the clinic is also on solid grounds.

Could this system be transferred to the US health care system at large? Several points have to be considered regarding this.

Health care should be administered by each state separately

Health care is administered by each of the separate states. But federally the United States Department of Health & Human Services (HHS), also known as the Health Department should be responsible for health care in the US. This means that there has to be consultation between the Federal and the state level.

Biggest problem to convince all practicing physicians to be on salary

The biggest problem would be to convince that all of the practicing physicians should be on salary. For centuries patients paid for physicians’ services by using a “fee for service” payment schedule. For physicians this is the gold standard. They perceive the payment for their services as independent from the government. They have a deep distrust whether the government will treat them fairly. Another complicating factor are very high liability insurance payments, and medical lawsuits are common. How can a physician afford sky-high insurance rates? It is only possible with an agreement that pays a fair salary to all physicians. This will stabilize the healthcare system.

Escalating drug costs curtailed by generic drugs

Regarding the escalating costs of brand name medicines a solution is to allow generic drugs. They are chemically identical to brand name drugs. They are often 1/3 or ½ the cost of brand name drugs. Many non-US countries have used generic drugs for many years with no problems. But in the US pharmaceutical companies that produce brand name drugs have maligned generic drugs. They call generic drugs to be inferior.

Provisions need to be made to cover poorer people

Provisions for poorer people allow them to not have to suffer from untreated illnesses. The Healthcare Plan can take care of this in a similar fashion as the Mayo Clinic did. The health care premiums to be paid by every citizen in the US would be dependent on what your annual income is. People in higher income groups would pay a slightly higher premium than low- income people or middle-income people. Special provisions would apply to cover healthcare costs for people in training who do not yet have an adequate income. But essentially everybody would pay something into the health care plan. This way there would be enough funding for the health care system.

Will all the players accept that the Mayo Clinic could become a health care model?

Whether or not the US public at large would ever accept this proposal, all of the physicians and all of the major players of the health care industry remains to be seen. It would contain the healthcare costs and would cover every US citizen for healthcare expenses.

Mayo Clinic Could Become A Health Care Model

Mayo Clinic Could Become A Health Care Model

Conclusion

The Mayo Clinic has provided 150 years of healthcare coverage and provided excellent medical service. There is no reason why this type of system would not work for the general public. Healthcare coverage would be provided for everyone, regardless of their income. The high-income group would pay more than the middle income and those with low incomes. But everybody would receive the same healthcare service. Physicians would be on salary. Drugs would be largely generic drugs, but would also be trademark drugs, if no generic drugs are yet available.

100% enrolment ensures full funding of healthcare plan

By having 100% enrolment into the healthcare plan there would be no shortage of funding as healthcare costs average out when everybody -young and old people, rich and poor -are all included. It would require negotiations of the United States Department of Health & Human Services (HHS), backed up by the president and including the health departments of all of the states in the US. The Mayo Clinic succeeded achieving all of this within the US. Why should the US at large not be able to copy that system in all of the states?

About Ray Schilling

Dr. Ray Schilling born in Tübingen, Germany and Graduated from Eberhard-Karls-University Medical School, Tuebingen in 1971. Once Post-doctoral cancer research position holder at the Ontario Cancer Institute in Toronto, is now a member of the American Academy of Anti-Aging Medicine (A4M).

Speak Your Mind

*