The Rochester clinic says it already is accountable to patients without the government's proposed oversight system.
The Mayo Clinic says it will not be part of a critical piece of national health care reform under the government's proposed rules.
The prestigious Rochester clinic is raising questions about accountable care organizations, or ACOs, which are supposed to be updated -- and better -- versions of health maintenance organizations. Approved as part of the 2010 health care law, they are designed to improve care and cuts costs by over half a billion dollars a year.
But Mayo says the proposed regulations from the federal Centers for Medicare and Medicaid Services (CMS) conflict with the way it runs its Medicare operations, which treat about 400,000 patients a year.
Dr. Douglas Wood, Mayo's chairman of health care policy and research, said Mayo does not want to significantly change what it believes is an efficient, patient-friendly program. Wood said Mayo "is not going to participate in a Medicare accountable care organization under the circumstances proposed."
At this point, Mayo's reluctance to be part of a crucial piece of health care reform is predictable, said Elliott Fisher, director of population health and policy at Dartmouth Institute in New Hampshire.
"Every affected stakeholder said it's not good enough yet," Fisher said. "This is how the process is supposed to work."
Even if Mayo holds to its position, other experts say it may not matter to the success of the health care law. "Mayo is obviously a well-respected place," Harvard Medical School professor Michael Chernew said. "But I don't think the success or failure hinges on one participant."
Mayo sent CMS a nine-page letter this week outlining problems with the accountable care organization rules, along with suggested fixes. But in an interview Friday, Wood suggested that the gap between Mayo's way of staying accountable and the government's regulations may prove too wide to bridge.
Among the clinic's biggest concerns is the government's demand that patients be included on oversight boards that judge performance. Mayo doesn't do that now and is not eager to change.
"You don't have to have a [patient] on the board to make [treatment] patient-centered," Wood said.
A bigger sticking point could be antitrust rules that are part of the ACO proposal. Mayo already provides most or all of the health care in many of Minnesota's rural counties, and Wood believes it could not operate ACOs in those areas without violating the proposed regulations.
Another issue is the way the government plans to measure effectiveness and its way of assigning patients to ACOs. The effectiveness measures proposed by the government are such things as 30-day mortality statistics and the number of diabetes treatments, Wood said.
"They don't get you close to measuring health," he maintained. "The simplest measure for consumers is: How effectively did the organization keep me functioning. People feel strongly that they want to be able to do what they need to do so that people who depend on them can continue to depend on them."
Mayo is confident enough in its current approach to accountable care that it has asked CMS "to take an entirely different approach to implementation of ACOs in the country." Mayo would like the government to contract directly with groups that are already providing programs.
CMS declined to comment on Mayo's concerns.
"This is a proposed rule," a spokeswoman said. "We will review the comments [provided by all organizations] and issue a final rule. We're confident providers will decide to participate based on the final rule, not the proposed rule."
Wood said Mayo is only interested in working in ways that are proven.
"We're not looking to intentionally give [health care reform] a black eye," Wood said. "We're working to implement accountable care."
Jim Spencer • 202-408-2752 • firstname.lastname@example.org