Mayo Clinic updates its model for the modern age

ROCHESTER, Minn. – Milestone anniversaries can be useful things. Take this season's 150th anniversary of the cold January 1864 day when Dr. W.W. Mayo placed an ad in area newspapers announcing that his medical practice was open for business in downtown Rochester and the Mayo Clinic was born.

A burst of high-risk, high-opportunity change is hard upon the health care industry in general and Mayo Clinic in particular. That makes this a fine time for Mayo folk to reflect on how their mammoth enterprise became famous for the best in medical care, and how that story might guide what comes next.

They know it, too, judging from the "150 Years Serving Humanity" emblems and lovingly curated exhibits in evidence at the high-rising, fast-growing Mayo campus. History matters here, a visitor deduces.

Mayo CEO John Noseworthy amended that observation. Patients are what really matter at Mayo, Noseworthy said. That's the emphasis that the "Little Doctor" brought to Rochester from England and Indiana by way of St. Paul and Le Sueur, and that his surgically gifted sons "Dr. Will" and "Dr. Charlie" hammered as they led their practice through a period of rapid change in health care every bit as challenging as today.

"Mayo's success, over a long time, is rooted in the purpose of our work, and that's meeting the needs of our patients," Noseworthy said. "That's our secret — knowing that's what matters. Being deeply rooted in that primary value allows us to be successful. Once you put the patient in the center of any discussion, you can't make bad decisions."

It was striking to hear that credo voiced moments after I'd read an excerpt of a speech Dr. Will Mayo made at Rush Medical College in Chicago in 1910: "The best interest of the patient is the only interest to be considered." At Mayo Clinic, some things don't change.

William James Mayo, the elder of the two Mayo brothers, was making the case that day for sick people to be treated by teams of doctors functioning in coordination as a multiple-­specialty group practice. Those physicians would be salaried, so that they would have no financial incentive to strive for volume at the expense of quality. Genuine teamwork, "uniting for the good of the patient," was the goal.

The Mayo brothers were a genuine team, able to spell each other so that they could travel to learn the latest surgical techniques and to engage in some self-promotion along the way. That helped them attract partners skilled at other aspects of medical care. Those specialists were deployed in what Dr. Will called "a union of forces," because in his view, patients "could not be treated in parts, but only as a whole."

Given Mayo's success with that formula, one might think that the Mayo Clinic Model of Care would have become the American norm by now. It has had much influence in Minnesota, helping give this state high marks for health care quality and value.

But medicine has always been a business, too, with a bottom-line imperative that challenges the Mayo model. Dr. Will and Dr. Charlie met that challenge — and prospered — by building their reputation, then charging rich patients a premium price for surgical procedures, explained cardiologist/historian W. Bruce Fye. A version of that kind of cost-shifting from one category of patients to another has been a staple of American medical business models into the modern era.

It may not be much longer. The Affordable Care Act strengthens the ability of both government and insurers to ratchet down reimbursements to providers. Around the country, some providers are responding with efforts to increase their volume through mergers and acquisitions. What will happen to the quality of patient care as providers scramble for financial security is anyone's guess.

A push for more patients — and more patients able to pay — is also the latest chapter in Mayo's history. It explains the $6 billion Destination Medical Center expansion that's on tap not only for Mayo Clinic, but for all of downtown Rochester, in the next 20 years. (State taxpayers will pick up a portion of the city of Rochester's improvement costs, the 2013 Legislature decided.) It's also clearly an ingredient in Mayo's move into Block E in downtown Minneapolis, announced this month, with a sports medicine/orthopedics clinic that connects its brand with that of the basketball Timberwolves and Lynx.

For all of last year's legislative talk about Destination Medical Center, the hot topic at Mayo headquarters last week wasn't glitzy new attractions in downtown Rochester. It was about Mayo's new online network of smaller clinics throughout North America and the prospect of improving diagnoses and treatment regimens for many times more than the 1.1 million patients the clinic served in 2012. The "Ask Mayo Expert" interactive online service, offered to the Mayo Clinic Care Network of providers who meet Mayo's standards, will make Mayo advice available in real time. An online second opinion or consultation will be available within 24 to 36 hours at no direct charge to patients.

Twenty-five medium-to-large health care provider organizations around the country have subscribed to the network in the two years since it was launched; 16 more have applied to participate and are under review.

That service might keep some patients at home who otherwise would have come to Rochester. But if that service catches on as Mayo predicts, it's also likely to bring more of the world's toughest cases to meet in person with the Mayo doctors who have been helping their doctors at home.

"We only want people to come here if they absolutely need to," Noseworthy said. "That's a win for us and a win for Minnesota, but most importantly, it's a win for the patients. The more we can drive out the waste, drive up the quality of at-home care, and improve the outcomes, the better off the patients will be."

Mayo leaders know they are taking a risk with that response to the economic, demographic, legal and technological changes that are rattling American health care providers. But they don't seem nervous. Maybe that's because they have 150 years of institutional history reassuring them that if they make care better for patients, they're on the right path.