Mayo Clinic Health System — where it all started

DECORAH, IOWA — Way down in northeast Iowa 20 years ago, Winneshiek Medical Center in Decorah was looking to collaborate and approached Mayo Clinic leaders in Rochester, proposing a first-ever partnership.

"It was a big decision for Mayo, when we first joined (Mayo Clinic Health System), whether they wanted to do that type of thing," said family physician Dr. Kevin Sand.

What started with Decorah has now grown to Health System sites in 72 communities in Minnesota, Wisconsin, Iowa and, now, Georgia. The Health System first proposed by providers in Decorah now handles half of Mayo Clinic's overall 1 million patients annually nationwide. 

"Back in the day, we'd just talk about pros and cons of what we should do and we'd just decide what we should do," Sand said. "That was it."

Anyone who knows Mayo knows that's no longer the case. Consensus decision-making is similar to the way it was back then, but now includes several administrative levels within the medical center in Decorah, Mayo Clinic Health System and, sometimes, Mayo Clinic's home base in Rochester.

But benefits of the Health System far outweigh the added layers decisions must break through, Decorah staff are quick to point out.

Sand said a young adult male patient was suffering from bad headaches, muscle aches and sore joints. 

Might be early Lyme disease. But hard to know without the classic target-like rash radiating out from a bite mark.

"I wasn't quite sure if I felt comfortable treating him for Lyme disease or not," Sand said. He consulted with a Mayo Clinic specialist and prescribed the treatment.

"It turned out he developed the rash…after I saw him," Sand said. 

A quick specialist consult is just a telephone call away. In the old days, Sand said, he might call and get a secretary. Being part of the Health System provides direct connections to experts in the field.

Specialists available

Decorah also gets services from visiting Mayo cardiologists.

"We've always found them to be superb and very helpful," Sand said. "And they really like coming down to our small town."

Other specialties available include rheumatology, oncology, kidney and neurology.

Patient Arlene Soltow said she has used just about every specialist offered at the Health System site in Decorah.

"We know that's right in our back yard," she said. "…It's very, very easy to get here to Decorah, and parking is never an issue." Soltow's smile spreads — that's a good-natured jab at Mayo Clinic Rochester, where the staff waiting list exceeds a decade in order to get a parking space.

Mayo increasingly works to offer care as close to patients' homes as possible, with patient convenience in mind.

In Decorah, "some of the patients are seen remotely in front of the screen; telemedicine," Sand said. When needed, he can also remotely access patient records from Mayo in Rochester. And, specialists in Rochester can digitally view X-ray films taken in Decorah without ever leaving Rochester.

As the Affordable Care Act gives millions more Americans access to health insurance, health providers are expecting an influx of patients who otherwise skipped care.

It's possible insurers will "bundle" payments so that a single fee pays for everything related to a specific diagnosis, such as a hip replacement. Medical centers will need to handle many more patients with an increased focus on patient outcomes so that patients don't get re-admitted to the hospital (they won't get extra money to take care of those patients because the bundled payment is supposed to cover it all).

"We are poised and ready to do that," Sand said.

Growing network size helps

As Mayo Clinic Health System increases in membership, increased network size helps free up resources for clinics and hospitals throughout the system. State-of-the-art equipment, education and continuity of care became easier as the system grew.

Key, Sand said, is the way Mayo Clinic approached formation of the Health System. Rather than sending in outside managers to take over, the clinic "recognized Decorah was a rural site (and) let us continue to make the decisions locally — and that was huge for us."

Decorah serves a radius of about 25 miles around Decorah. It sends ear-nose-throat specialists to New Hampton, Iowa and urologists to Oelwein, Iowa, thus spreading Mayo's model of care widely. If needed, patients can be quickly transferred to Franciscan Skemp in Wisconsin or Mayo Clinic Rochester.

Providers in Decorah, while allowed to make local decisions, also take in much of the Mayo care model.

"The knowledge base just continues to grow," said Laurie Bulman, Decorah Health System director of human resources and community relations. 

Soltow says, with the Health System name in Decorah, "you know you'll get good medical care."

Decorah Health System Chief Administrative Officer Dave Rooney said the goal for Health System sites is to deliver the right care "to the right people in the right location."

That takes collaboration between the Health System, Mayo in Rochester, health providers regionally and patients — a so-called "union of forces."

"It all comes back to 'the needs of the patient come first,'" Sand said.

Or, in the words often quoted of Dr. Will Mayo of the Mayo brothers, "the best interest of the patient is the only interest to be considered, and in order that the sick may have the benefit of advancing knowledge, union of forces is necessary."