Mayo Clinic and the problems with primary care

This blog is primarily aimed at nurses in Texas, but if there are elements of the national health-care debate that pop up, I want to highlight those issues, too.  This post, on The New Republic’s The Treatment blog, presents one of the biggest problems in health-care – that low reimbursement rates for primary care , especially for Medicaid and Medicare patients.  The following quote is the clearest statement of the problem I have ever seen:

“First, by any sensible account, our medical care system must place greater emphasis on primary care. It’s not healthy that elite medical centers are moving the other way. Current reimbursement policies strike the wrong balance between specialty and primary care. This brings immediate tangible costs. Less tangibly, it sends a terrible signal about what is valued in the medical economy. Thousands of medical students and residents are being socialized to see primary care as a subordinate activity.”

This is exactly the opposite of what needs to happen.  Primary care should be the primary activity of all physicians, not just general practitioners.  While cardiothoracic surgeons and neurosurgeons are important, they are not intrinsically more valuable than a pediatrician or family practitioner.  I would even argue that the highly-paid specialists are intrinsically less valuable in terms of value added to society (even if I am approaching the age where I might need more specialists!), if you want to be really crass and put value on individual lives.

And it is really weak for one of our leading health-care organizations to use the lame “reality of the health-care business” excuse to justify not accepting medicare primary care patients in Arizona and significantly restricting medicaid patients in Minnesota.

Marc

4 Responses to Mayo Clinic and the problems with primary care
  1. Auriandra
    October 19, 2009 | 4:43 am

    A couple things you should no about Mayo. One is that they helped set up “the other hospital in the community” several decades ago so they could focus on multi-specialty care. They also have a collaborative relationship with the hospital, providing many specialty services (e.g. there is a Mayo Clinic van parked outside that clinic a couple times a week for imaging procedures), plus they take referrals of all complicated cases.

    Second, the cutbacks are are of about 1/2 of one per cent of Mayo’s Medicare patients. Mayo is still taking Medicaid pts from MN. IL, IA, WI, SD and ND, the states nearest to it. I personally think they should also take patients from NE and MT, but Medicaid is supposed to be a state program.

  2. Auriandra
    October 19, 2009 | 4:44 am

    I can’t believe I typed “no” in the last message instead of “know.” Sorry!

  3. Auriandra
    October 19, 2009 | 4:46 am

    Another correction: I meant “Medicaid” not “Medicare.” Dum Dum.

  4. Marc M. Meyer
    October 19, 2009 | 7:35 pm

    The point of the article is not that Mayo is a bad actor – they are not. In fact, they are extremely rational actors in our health-care drama (and extremely good to boot!). The problem is that the rules of the game are arguably not written to best leverage the limited pool of talent and money to pay for health-care. I only highlighted Mayo because they provide an example that Harold Pollack used. The limited point he makes is one of the insane absurdities of our health-care system, although an absurdity that has a rather large impact on several issues.

    Thank you for finding my blog and commenting!

    Marc