While the health care reform debate focuses on expanding coverage and finding a way to pay for coverage for millions of new Americans, some think Washington is losing sight of the real problem -- the built-in inefficiencies within the health care system that are driving up costs. The problem, they say, is in the way hospitals organize care and the way Medicare reimburses doctors.
But while the hospital system may be seen as wasteful, some clinics do stand as models of efficiency.
President Obama has long been fond of the Cleveland Clinic and in a June letter to Sens. Edward Kennedy, D-Mass., and Max Baucus, D-Mont., he praised Cleveland and the Mayo Clinic for providing "the highest quality care at costs well below the national norm." At a town hall in Green Bay later that month, he picked out two more models of efficiency: Geisinger Health System in Pennsylvania and Intermountain Healthcare in Utah. "If they can do it, there is no reason why all of America shouldn't do that," he said.
NationalJournal.com spoke to representatives from those four model clinics and identified four lessons the hospitals can offer for giving efficient care -- and ways Congress has tried to incorporate them into health care legislation.
• Lesson 1: Put The Patient First
Paying doctors for quality, not volume, means more efficient care at a better value to the patient.
• Lesson 2: Emphasize Wellness Instead Of Treating Sickness
Investing in healthy habits now can stop diseases later.
• Lesson 3: Standardize Care
Computerizing records and making practices routine can cut costs while reducing mistakes.
• Lesson 4: Integrate Care
Doctors need incentives to work together and offer complete care.
Meet The Hospitals
The Cleveland Clinic has been offering group practice medicine since 1921 and is consistently rated among the best hospitals in the nation. In 2009, U.S. News and World Report named it the country's fourth-best hospital overall and, for the 15th year straight, the best for cardiac care. It is noted for keeping its doctors on salary and encouraging integration and communication across specialties. With branches in Florida, Canada and Abu Dhabi, the clinic sees more than 3.3 million patients every year. It is headed by CEO and President Delos "Toby" Cosgrove.
Geisinger Health System
Founded in 1915 on the Mayo Clinic model, Geisinger Health System is a physician-led system that serves northeastern and central Pennsylvania. Geisinger, frequently listed among the nation's best hospitals, is noted for its leadership in electronic health records. The group also offers innovative payment systems, including ProvenCare payment for certain procedures that uses a flat fee to cover 90 days of treatment and follow-up care. Geisinger operates four hospitals and several clinics in the area, serving more than 2 million patients annually. It is headed by its president, Dr. Glenn Steele Jr.
With hospitals across Utah and Idaho, Intermountain Healthcare is the largest health care provider in the region. Having taken over its hospitals from the Church of Jesus Christ of Latter-Day Saints, Intermountain has made its mission to provide "extraordinary care in all its dimensions" to the community while remaining a nonprofit group. Intermountain has been ranked in the top two integrated care systems by Modern Healthcare magazine eight times since 2000 and is consistently recognized for providing high-quality integrated care. The system is led by an all-volunteer board.
The second-best hospital in the nation this year, according to U.S. News and World Report, Mayo Clinic has been operating as a nonprofit private institution for more than 100 years. Mayo was the first private integrated system and is still the largest integrated nonprofit. The Mayo Clinic Model of Care states that the practice is based on the core value that "the needs of the patient come first" and encourages a team approach headed by one primary physician. The Mayo Clinic is based in Rochester, Minn., and has branches in Arizona and Florida that treat millions of patients from all 50 states and more than 150 countries. Mayo is led by Dr. Denis Cortese.