Washington Post’s Mayo Clinic critique should run in local papers

[Note: updates below]

It was like two hospital ships passing in the night.

On Sunday, the Star Tribune published reporter Chen May Yee’s 1,300-word examination of Massachusetts’ health insurance mandate, similar to a proposal President Obama supports and Gov. Tim Pawlenty attacks.

The same day, the Washington Post ran a 2,300-word demystification of Minnesota’s holiest of medical holies, headlined “Is the Mayo Clinic a Model Or a Mirage? Jury Is Still Out.”

Both stories demonstrated ambition — the financially troubled Strib unleashing its travel budget for a national story, and the Post pointedly questioning an institution that has taken a forceful health care reform lobbying role.

But why did it take an out-of-town paper to weigh our sacred cow?

Here’s the basic boildown of the Post’s take on Mayo’s integrated-care model:

Few dispute the prowess of Mayo, which brings in $9 billion in revenue a year and hosts 250 surgeries a day. But a battle is underway among health-care experts and lawmakers over whether its success can be so easily replicated. Before embracing a fundamentally new approach to health care, dissenting experts and lawmakers say, Congress should scrutinize the assumption that a Mayo-type model is the answer.

They point out that 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.

Armed with their new stature, officials from Mayo and a handful of similar facilities have become determined lobbyists in their own right. They are pushing for an overhaul of Medicare that would reward cost-effective hospitals and doctors, while punishing others.

But if the Mayo model is, in fact, difficult for even the most dutiful hospitals elsewhere to mimic, such an overhaul could set up many providers nationwide for failure — and a big loss of funds.

It’s sometimes easier to criticize from a thousand miles away. And readers who think the Strib has been a Mayo cheerleader are right — though the record is more complicated than that.

Surprisingly (at least to me), the Strib’s health team hasn’t really covered the clinic’s political efforts, an assessment health team editor Dave Hage confirms.

[Update: Hage and I talked this afternoon, and he asked me to reprint verbatim the first paragraph of the two-paragraph email he sent. It read: “The short answer is that, in my team’s coverage of the health care debate, we haven’t done a story on Mayo — favorable or skeptical.” The second paragraph is from the original story.]

“We’ve written about HealthPartners (is it the model for a ‘health care co-op’’?) and UnitedHealth (what’s the role for private insurers in an overhauled system?) but we haven’t done a Mayo story,” Hage says. “We’re trying to pick off stories that illuminate specific items in the House and Senate bills — e.g., the public option, the individual mandate, savings in Medicare.”

It’s a real missed opportunity that the Strib hasn’t done extensive reportage on Mayo’s ultra-high-profile advocacy. [Update #2: Hage notes that Yee wrote about the clinic’s financial difficulties in March, and about its then-nascent lobbying push in 2007.] Neither has the rival Pioneer Press, which has focused on east-metro health systems likely to fly below national reporters’ radar.

(My guess is local providers don’t mind Mayo being the nail that sticks up nationally.)

Mayo’s real cheerleader at the Strib is editorial writer Jill Burcum, who has written several pieces praising the clinic’s “advocacy for payment reform and individual mandates, as well as its staunch opposition to a public plan based on a government-run, price-controlled, Medicare-like insurance model.”

Burcum’s advocacy is hardly beyond the pale. She writes for the editorial page, after all, where you get to have opinions. Plenty of health care journalists have praised Mayo’s system of salaried docs and fully coordinated care, including New Yorker surgeon-writer Atul Gawande, currently being touted as Ted Kennedy’s interim U.S. Senate replacement.

Mayo’s — and Burcum’s — advocacy for “payment reform” is broadly embraced in Minnesota, where, parochially, it favors lower-reimbursement areas like ours and could deflate costly national misincentives. And while I personally favor a public option (you can’t mandate insurance without real administrative-cost competition), it shouldn’t surprise anyone that the Strib editorialists don’t bang that particular drum.

To her credit, Burcum referenced the Washington Post story Monday, at least online, noting it raised fair questions, though I think she mischaracterizes critics as primarily single-payer believers. The Post’s sources are broader than that.

Given Mayo’s political influence, the Post check-and-balance deserves wider local play than a link from startribune.com. At the very least, Strib (and PiPress) should republish it in their national sections, and perhaps some local reporter can give us her or his take soon.

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Comments (10)

  1. Submitted by David Thompson on 09/22/2009 - 12:09 pm.

    Why do you care what the strib prints? I thought you guys were trying to be an (electronic) newspaper in your own right.

  2. Submitted by Susan Herridge on 09/22/2009 - 12:30 pm.

    He’s the media critic/media reporter. Its his job to analyze what other local media is doing and oh so gently hold their feet to the fire. This used to be much more prevalent and its a good thing. Despite their emaciated financial state, local print and tv news should be held to high standards. And I’m sure that MinnPost would welcome the same analysis of their work.

  3. Submitted by Nick Coleman on 09/22/2009 - 01:29 pm.

    Easier to criticize a beloved institution from 1,000 miles away? You bet your life.
    In 1980, while I was stationed in Rochester as the southern Minnesota correspondent for the Tribune (which merged w/ the Star to make the Strib two years later), I wrote a week-long front page series examining the political, cultural and social impact on Rochester and the region of the 800-lb Gorilla in a doctor’s smock known as the Mayo Clinic. I was ably assisted in this effort by Lew Cope, the Tribune’s excellent medical/science writer who — I don’t blame him for this — was not completely enthusiastic about being involved in a project that was certain to displease the notoriously tightly-wound public info managers of the clinic. We discussed everything from the Clinic’s no-divorce policy (which disappeared when the Clinic’s head divorced his wife, triggering an avalanche of divorces and marriages)to the male-dominated culture that left many women employees feeling second class, the clinic’s appeal to wealthy Saudis and foreign potentates, and the willingness of city officials to be dictated to on many policies. A day after the series ended, the wife of a prominent Mayo surgeon told me: “The clinic has placed a giant fart over your house. It’s been nice knowing you.”
    I left Rochester a few months later.
    I don’t think anyone has tackled Mayo since.

  4. Submitted by Paul Scott on 09/22/2009 - 04:25 pm.

    My wife works at Mayo, so, there’s that.

    That said, I don’t think I need to tie my brain behind my back to say that this WP article kind of seems under-sourced in places that matter, and very likely highly functional in support of a home team of its own — the doctors on the coast who stand to lose if their profession becomes increasingly salaried, and if their decisions are folded into an integrated care value system that requires cooperation and evidence-based practices. (Did you notice, by the way, the utter lack of mention in the piece about whether Medicare payment reforms would, you know, make people healthier?)

    Start with this idea, not backed up with data, that Mayo treats exclusively wealthy healthy people. Yes, the clinic is a fly-in destination for a lot of wealthy people. (Although chances are that was the first expense that got removed from their budgets last fall.) But take a look at the demographics of rural Minnesota sometime — a population treated here by virtue of its serving local people as well as its own 30,000 employees and their families. You have everything you have in the city — drugs, poverty, environmental and diet-induced illness.

    I was struck by the subtle digs in the piece — Cortese’s office “high above Rochester.” Please! Clinic buildings top out here at heights not even a third of those in midtown Manhattan. There’s taller buidlings ringing the south metro. The idea that Mayo pays for all the all-stars of every medical specialty is another laugher. My guess is it’s harder to recruit talent to Rochester than to Mpls, let alone the coasts — then there is the salary thing. MY guess is you get people here who like to be academic and medical at the same time, and that screens out a lot of those dermatologists on the Upper East side who want to sell you their wonder cream.

    There seemed to be a strange irritation at work in the WP piece that Mayo isn’t a dump like so many other big working medical centers around the country. Yeah, let’s fix that problem. I would argue that people try harder to do a good job at Mayo because it feels like any other corporate campus — a well tended professional home.

    Then there is this sense that local media goes too easy on Mayo specifically. I was sorry to read Nick Coleman, whose work I like so very much, relieve himself all over a pretty nice place that he will surely think differently of should his health take a turn for the worse, god forbid. I wasn’t here at the time, but the charge that Mayo was at one time a patriarchal old school big dog can be applied to pretty much any large employer in this state, and the same goes for the easy-off press coverage. You try to pitch a story in this town critical of, say, 3M, Medtronic, Cargill, Carlson, MPR, Target, etc etc etc…There is no interest, and there’s nothing Mayo-specific about that one!

  5. Anonymous Submitted by Anonymous on 09/23/2009 - 07:29 am.

    People who are up in arms about the death of the Strib should read this post carefully – here is the most important issue in the country, with the most important player in our own backyard, and they can’t even cover that. Why should anyone care when they can’t even cover the Mayo clinic, and when they do, they get it wrong? I for one will shed no tears when the presses stop.

  6. Submitted by Nick Coleman on 09/23/2009 - 08:16 am.

    In reply to Paul Scott, I was not defending the WashPo story on Mayo, nor did I “relieve” myself on the Mayo Clinic, which I firmly believe to be a shining light in the health care debate and an important model for reform. (Does a person have to stand up and sing, “Hail, Mayo!” as a caveat every time the clinic comes up in conversation?) Inadvertently, however, Mr Scott illustrates the prevailing attitude of many large and important institutions: Any criticism or close examination of an institution’s culture, organizational structure or impact on a community is taken as an attack. Mr Scott wasn’t in Rochester at the time of the 1980 series I wrote, so he has little if any idea what Mayo was like at that time — not in terms of the medicine it practiced, but in terms of the politics and social influences it practiced. My series wasn’t an assault on Mayo. It was an unusual — and still too rare –attempt to take a look at an important and powerful institution in our own backyard. That’s the kind of scrutiny the news media should do far more often, as Rob Levine suggests. The Mayo deserves scrutiny because of its very greatness. So do many other institutions even closer to 425 Portland Ave. So. in Minneapolis. This kind of journalism doesn’t get done nearly enough, or well enough.
    Lastly, I want to thank Mr Scott for his concerns about my future health needs. I return the sentiment, and hope he and his family receive quality, affordable care when they need it. From wherever they can get it.

  7. Submitted by Paul Scott on 09/23/2009 - 09:34 am.

    I would have liked to read Nick’s piece from 1980. I’m sure it was a great read and all very true. (Though I do wonder about that ban on divorces bit — it just plays too closely into the stereotype.) Mayo is by no means perfect, and is on the receiving end of any number of grievances in our local paper on a weekly basis. My concern wasn’t that he was attacking Mayo — only that he was emphasizing a list of very likely outdated characteristics, all negative, albeit in service of a larger point about the state of journalism. I would welcome more stories about the culture of different big institutions, but just don’t believe these are going unwritten specific to Mayo.

    Getting back to the Post article, because that was the point, and because I am not going to survive another round with a much better writer, the idea that Mayo just treats rich people and healthy farmers is just really incredibly lazy. I saw that seeded throughout the piece and couldn’t believe the paper of Woodward and Bernstein couldn’t do any better. The Mayo model deserves a hard look, especially if its chief has the ear of those planning new health care policy. But I just remained convinced that this is one of those cases where what’s good for Mayo would prove good for health care nationally, given the billions of dollars currently being spent on treatments with little evidence of their efficacy. You have a much harder time providing those treatments in an integrated care model.

  8. Submitted by Jay Furst on 09/23/2009 - 12:23 pm.

    Breaking news for Nick and David: There’s a daily newspaper in Rochester — ours — and to imply that Mayo has gotten a free ride since Nick’s memorable expose 29 years ago is pretty funny.

    Regarding the Washington Post story, we considered buying the rights to reprint but decided to get Mayo and other reaction and do that type of piece instead…might still reprint the original. I’d like to see it in Thursday’s paper but will take another day or two.

    I tend to agree with Scott, by the way — and not because I’m a Mayo homer. The story raises more questions than it answers; through word choice and framing of the material, it clearly portrays Mayo (and Cortese) as elite and unrepresentative, even disinterested in less well-off, less-healthy patients. Check my blog, Furst Draft, at Postbulletin.com on that point.

    Full disclosure: I was Burcum’s boss for a few years, and Scott writes occasional freelance columns for us.

  9. Submitted by Jay Furst on 09/23/2009 - 12:41 pm.

    I’m the Post-Bulletin managing editor, FYI.

    And our story likely will run Thursday, with the Post story.

  10. Submitted by Nick Coleman on 09/23/2009 - 05:12 pm.

    Dear Mr Managing Editor of the Good Old P-B: As a former subscriber to the Good Old P-B, let me say that no one covers Rochester better than its daily newspaper. But that hardly makes the Good Old P-B a media outlet that sets the tone or shapes the coverage of stories outside the Zumbro River basin. We were talking about the Washington Post and the Strib and such. Without any disrespect whatsoever aimed at the Good Old P-B. And without ANY INFERENCE that the Good Old P-B hasn’t been up to snuff in covering its circulation area. Please forgive us for not knowing enough about what the Good Old P-B has done in the last 29 years.
    I’m afraid my subscription has lapsed.

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