Dr. John Noseworthy was named president and CEO of Mayo Clinic in 2009. In a recent interview, he discussed Mayo's strategy for an era of health reform that is placing new cost and quality pressures on the nation's medical system.

Q: Does cost even matter when you have the reputation of the Mayo Clinic?

Noseworthy: To be relevant to patients, you have to be trusted but you have to be affordable. Mayo can be famous, and we can talk about patients coming from all over the world, but candidly, individual patients and families in this country are going to be making decisions about their health care and about their insurance. If Mayo is perceived as being irrelevant to them because they are not sick enough, or it's too far away or it's too expensive, that would put us at a disadvantage. We plan to be relevant to all Americans, at least in their decisions, because we do believe we can provide them outstanding care at affordable cost.

Q: But then why do public measures tend to show Mayo on the high cost side of care?

N: We have, sort of, two types of patients. [There are] those who have complex but easily managed and standardized care, and that's about somewhere between 60 and 80 percent of the people that we see. And we can standardize their care, provide them outstanding service, and be really quite affordable and comparable with other groups. But there are somewhere between 25 and 35 percent of the patients we see who only can get care here — who have very, very expensive care needs. And when you mix those together, it tends to shift the average to much higher than other hospitals that don't see those extraordinarily complex cases … We hope that those [who] look at us will understand those differences and see that we're really not more expensive for most of the patients, and we're the only place that really manages all of the others.

Q: Research is a major expenditure for you. Given the increasing pressures to keep health care affordable, is that a cost you would consider curbing?

N: Our budget for research and education is close to $800 million a year. It's a lot of money. Some of that comes from the National Institutes of Health, a lot of it is our own. But that investment drives new models of care, which drives up quality and drives down cost. So we will never defund our research programs. We just can't do that. That's who we are. That's what the world expects — that they'll get cutting edge care at Mayo Clinic.

Literally every week, we are coming up with innovations that provide new ways of caring for patients that are safer and lower cost … So that's an important investment. If we just hunkered down and defunded research, we wouldn't be adding value to the community and we would have lost what is so essentially Mayo Clinic.

Q: Is Mayo Clinic in position to be one of the destination medical centers in the United States for the foreseeable future?

N: We have the reputation and the market awareness to be a destination center for hope and solutions for patients with any kind of problem, from birth to death. We have that now and we intend to strengthen it.

Jeremy Olson