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Hospitals will continue to merge and buy each other out because larger groups can run more efficiently and provide cheaper care.
Mayo Clinic CEO John Noseworthy says that by taking advantage of an increasingly hyperconnected world, there's an alternative that's better for patients.
In the future — indeed right now if you live in certain areas — your doctor could have access to 100 plus years of experience treating the hardest cases in the world, and you could get a second opinion from a doctor at the Mayo Clinic, which is perhaps the best known and respected brand in medicine ... at no additional cost to you.
Noseworthy's goal is to bring the Mayo Clinic's expertise to 200 million people around the world by 2020.
Sharing the best medical practices and
Mayo isn't immune to cost and economic pressures but its advantage is that it's been at this longer than anyone else. They're the oldest and largest physician led practice out there.
"For well over 100 years everything we do every day is continually retooling how we work to provide safer care, better care, more efficient care, for our patients," Noseworthy said. "The Affordable Care Act and everything else that's happening in the industry is putting a sharper pencil on that, but we're not really reacting to the law."
Others, like Cleveland Clinic CEO Dr. Delos Cosgrove, argue that cost pressures and the increasing complexity of medicine make consolidation inevitable, and smaller practices increasingly unworkable in the long run.
Noseworthy understands the trend towards consolidation, but it wasn't right for Mayo because it could dilute a unique patient experience. Putting the clinic's name on a sign out front isn't enough, Noseworthy argues. "Unless we change the whole culture, which takes decades, it won't feel like the Mayo Clinic.
Instead, Mayo is doing something entirely different. They're giving patients around the country access to best practices from more than 100 years of experience, and consultations with the best doctors in the country.
Members of the Mayo Clinic Care network, a group of carefully vetted medical groups around the country, subscribe to a online database (called Ask Mayo Expert) on the way the hospital does things. If offers a level of information and expertise that doctors have never had access to before. It lets them, in Noseworthy's words, "provide better care to their patients and their community."
Not every case can be covered by that tool. In complicated cases, there's an option to have an electronic consultation with a physician at Mayo, at no cost to the patient. Around 10 percent of cases are sent on to one of the Mayo Clinic's campuses.
The first group signed on in 2011, and the network's grown rapidly since then.
"This is a model of integration that will be good for patients, reduce the cost of care, and be much more efficient," Noseworthy said. "We're very excited about that. It's not a consolidation
It's not about bringing new patients to Mayo, but rather keeping them home whenever possible.
"[We can] stay connected to patients at a distance either before we see them or after we see them, to keep them at home and reduce the cost of their care, yet retain the connection with the Mayo clinic," Noseworthy said. "We don't want to take patients away from other doctors, we want to help these doctors and nurses provide better care in their own communities."
Saving small and community hospitals from being swallowed up
A separate program that's been around for longer proves that a remote digital model can have impressive results, even for emergency care, and may make it possible for small medical practices and local hospitals to survive and stay independent.
There are drugs that can break up the clots that cause thrombotic strokes in the brain, and save lives. However, a patient's eligibility for the drug is determined by how quickly they get to care. That determination takes a degree of expertise. The Mayo Clinic pioneered a telestroke program in Arizona 4 years ago that helps patients in rural hospitals quickly get this drug, in their own community.
"We have put robots in the emergency departments of 12 to 15 rural hospitals in the Southwest part of the country," Noseworthy revealed. "24/7, these medium and small size remote hospitals have an immediate connection to a neurologist at the Mayo Clinic in Scottsdale. If a patient comes in to the ER with a stroke, they can hook up the robot, and within 20 minutes or so our neurologist is examining the patient remotely, looking at the CAT scan, interviewing the family and the patient, and making a decision whether that patient should receive the clot busting drug."
Speed is essential because there's an extremely short time frame in which the drug can work. It's made a real difference. The program has increased the number of patients who are eligible for TPA treatment 20-fold. "Eighty percent of these patients don't need to leave their own community," Noseworthy adds.
Dr. Noseworthy's a neurologist himself, so he knows what a huge change this is. "In the old days, five or six years ago, all those patients would have either been left alone, not gotten treatment, or in a sense almost worse, would have been transported at great cost and risk and time to a tertiary hospital in a major urban setting, he said. "That's an example where Mayo can reach out and supplement and support the patient in a rural setting."
That's just one part of how they can help keep the sorts of small hospitals and practices that serve millions of Americans from being swallowed up. It makes the doctors better at their jobs. They can treat cases they might have otherwise had to send away because the Mayo Clinic has seen thousands of these cases, and can walk them through the treatment.
It also lets small hospitals and practices attract better people. "Having access to the Mayo Clinic through the Mayo Clinic Care Network allows them to thrive to grow and, as we're hearing from them, to recruit better staff. Young doctors and nurses want to have access to academic medicine, and these practices are not connected with a medical school or university," Dr. Noseworthy said. "They're thriving in their local communities, they're remaining independent, and they'll say it, not having to be bought out by some large hospital group that's trying to consolidate them."
An incredibly ambitious plan to reach 200 million people by 2020
This program is relatively recent, and has been enabled by better technology and an increasingly hyperconnected world. It's growing rapidly, and Noseworthy expects that to continue. They signed their first group in late 2011, they have 14 now, and plan to have 20-25 of these — 2 or 3 of them international — by the end of the year.
Twenty to 25 groups are only the very beginning. "Its a demonstration project for the Mayo Clinic being able to do this globally," Noseworthy said. "How can we help patients everywhere? One day, we're wondering, why wouldn't the Mayo Clinic be available to people everywhere to help them live healthier lives, to help them understand their risks of serious illnesses?"
By the end of the decade, they plan to take this worldwide. "Our board has approved our plan that by 2020 we will have a meaningful interaction with 200 million people a year through this mechanism," Noseworthy said. "That's a few years away, but ultimately, why wouldn't we at Mayo share what we know with people everywhere remotely? That's our grand plan."
There are still bugs to be worked out — for example, how to make consultations become part of the workflow so it's not an extra duty after hours, and how the Mayo Clinic can do the right thing for patients while remaining successful financially.
Scaling it up is going to take work, and possibly more staff. Consultations usually take from 30 minutes to an hour, depending on the complexity of the case. Some are visual or phone conversations while the patient is at the remote doctor's office, and others are medical record review. Both take time out of doctor's already busy days.
Still, it's an appealing alternative to a future where small providers can't survive, and a way to bring a higher standard of care to people who previously haven't had access.