Health Reform: Hold The Mayo

29 Sep

Alec MacGillis and Rob Stein had an interesting article in the September 20, Washington Post. The pair take a look at popular appeals to the renowned Mayo Clinic as the gold standard in health care–some from none other than President Obama–and ask: Is the Mayo Clinic really all that?

Sure, we’re all familiar with Mayo, and for good reason: The folks from Minnesota do a great job of providing high quality care, achieving stellar health outcomes, and doing all of this for much less than you might expect. Yet, if there’s anything that I’ve learned from my doctoral training, it’s that if something looks too good to be true, it probably is. (Look at that, I just saved you thousands of dollars and years of your life.)

But, seriously, we in research talk often about confounders–things that work behind the scenes and make us see things differently than they actually are. For example, imagine one did a study and discovered that people who lived in large houses smoked fewer cigarettes. It could be that somehow smoking and house size are related, or more likely, the relationship could be spurious. That is, perhaps something like income is involved. Those with higher incomes tend to buy bigger houses, but also tend to be better educated and therefore less likely to smoke. Here, income and education would both be considered confounders.

It looks like Mayo may be a bit confounded as well. As the Washington Post authors write:

“Mayo’s patients are wealthier, healthier, and less racially diverse than those elsewhere in the country. It has few poor patients. It limits the number of procedures it performs per patient, but the rates it charges private insurers and self-paying patients is higher than average, allowing it to thrive despite the lower Medicare spending cited by its supporters.”

So the relationship between low Medicare spending and the above average health outcomes seen at Mayo may simply be confounded by the nature of the patient population, which is healthier, and a bit of a shell game–making less from Medicare, but more from other sources. At the upper margin, money chases after quality after all, which explains why those from all over the world who can afford to pay almost anything for the best care in the world just happen to catch a flight to Rochester, Minnesota.

Of course, that doesn’t mean that we can’t take some lessons from what they’re doing in Rochester. It just means we should be a little bit more skeptical of such fantastic results, rather than expecting them to be easily replicated nationwide. After all, when it comes to health care, we are a nation comprised of islands of excellence in a sea of mediocrity.

Let’s be honest. If it were feasible–and profitable–to achieve Mayo’s success all across the country, don’t you think that we’d have seen more than just the two additional clinics in Jacksonville, Florida and Phoenix, Arizona spring up in the last few decades?

The fact that we haven’t witnessed that tells me one thing: Until you can replicate the Mayo Clinic’s upper-midwestern patient population nationwide, you will find it daunting to base reform on the Mayo model. So for now, when it comes to health reform, let’s hold the Mayo.

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Posted by on September 29, 2009 in Uncategorized


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