Mayo Clinic and more than a dozen co-signers took a more conciliatory tone in a statement issued on Wednesday than its previous letter about healthcare reform, but still underscores Mayo's continued concern: Reform legislation needs to include methods that reflect pay for value and quality—not quantity.
As he has done numerous times, President Obama held up the Mayo Clinic, headquartered in Rochester, MN, as an example of an organization focusing on quality care in his Wednesday evening press conference. "Part of what we want do is to free doctors, patients, hospitals to make decisions based on what's best for patient care. And that's the whole idea behind Mayo," the President said.
In the initial Mayo letter, concern centered around the continued use of Medicare rates and how old and "flawed" government-set payment methodologies were still being used to pay hospitals and physicians. Mayo called for inclusion of a "value index" that would define, measure, and pay for value while holding down costs.
"There are many examples around the country of areas that have very high quality of care and much lower overall costs. And, the key to achieving that seems to be basically better coordination of care," said Bruce Kelly, the Mayo Clinic's Washington-based director of government relations.
"[These are] incentives that we're trying to build into the reimbursement system," said Kelly. And so, "the better your quality—the lower your total costs."
In the July 22 letter, the healthcare organizations, while saying they "wholeheartedly support" the president's call for reform, also urged that any legislation still under consideration "include a method that pays for quality and value, rather than the quantity of medical procedures." This includes the Senate Finance Committee, which is expected to unveil its measure any day, and the House Energy and Commerce Committee, which is continuing to mark up the Tri-Committee health reform bill this week.
In particularly, Mayo noted that "Medicare pays more to 10 states that often provide poorer outcomes, safety and service at higher cost," and much less to other parts of the country where the organizations show better outcomes, safety and service as lower cost. These latter parts of the country include Minnesota, Wisconsin, Iowa, Oregon, and Washington State, according to Kelly, where many of the letter signers are located.
With lower reimbursement under Medicare, many providers—both hospitals and physicians—are reaching a point where they cannot afford to see Medicare patients, according to the letter. Expanding any "Medicare-type plan without a method to define, measure and pay for healthy outcomes for patients" will move providers over a threshold where they cannot provide care, which would "ultimately hurt the patients who seek our care."
The healthcare letter-writers did note that they "were encouraged" by other ideas that move toward paying for value"—such as a expanding the powers of the Medicare Payment Advisory Commission at the federal level—to develop "value-based payment methodologies for Medicare." During the past few days, the White House has put more emphasis on creating this independent board of physicians and hospitals.
In addition to the Mayo Clinic, the letter was signed by leaders from the following organizations: Altru Health System, Dartmouth Hitchcock Health, The Dartmouth Institute for Health Policy and Clinical Practice, Group Health Cooperative, Gunderson Lutheran Health System, HealthPartners (MN), Lahey Clinic, Marshfield Clinic, McFarland Clinic, Northwest Physicians Network, North Texas Specialty Physicians, Scott & White Healthcare, Sutter Independent Physicians, College of Medicine Health Science Center, Texas A&M University, and Virginia Mason Health System.