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Mayo Clinic leery of public health plans

By Heather J. Carlson

hcarlson@postbulletin.com

ST. PAUL — Concern about how a public health care plan might affect Minnesota’s health care system dominated a public forum on Friday sponsored by Mayo Clinic.

Dr. Douglas Wood, who chairs the clinic’s division of Health Care Policy & Research, said a public plan modeled after the Medicare system has the potential to do serious harm to health care in states like Minnesota where quality is high and costs are low.

"If it’s a government-run plan with government price controls, that could be highly detrimental to states like Minnesota, Iowa, Wisconsin and all across the northern tier of the United States," Wood said.

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About 200 people gathered at the Minnesota History Center for the forum, including lawmakers, business leaders and health care company officials.

As Congress works on overhauling the nation’s health care system, Mayo Clinic has been highlighted repeatedly by President Obama for its efficient and quality care.

As the health care debate ramps up, so have the efforts of the Mayo Clinic’s Health Care Policy Center to get out its message that value must be part of the health care equation. Launched about four years ago, the center has consulted with 1,200 "thought leaders," as it calls them, and 1,400 patients to draft what it calls the four cornerstones for health care reform. They are: creating value to improve patient care, coordinating patient care, reforming the payment system to consider value and providing health insurance for all.

House Health Committee Chair Tom Huntley, DFL-Duluth, told the audience he is concerned that Minnesota’s health system will suffer if proposals to cut Medicare reimbursements and redistribute them go through — especially if value is not taken into account.

Obama’s proposal includes a public plan. That has proven to be a divisive issue on Capitol Hill, where some economically conservative Democrats and Republicans have opposed the cost.

Mayo Clinic supports providing subsidies based on a sliding scale to help make sure that all patients are covered regardless of income level. The clinic contends that health care should be portable instead of tied to a job, and that everyone should be required to have it, Wood said. It also backs prohibiting people from being excluded from coverage because of pre-existing conditions.

The clinic has also put forward the idea of "value indexing" to determine how providers get paid. Wood said that the system would take into account patient outcomes and cost over a period of time. He added that the current bills in Congress contain "very little that reflects payment for value."

DFL Sen. Amy Klobuchar, who flew in Friday morning for the meeting, is sponsoring the Medicare Payment Improvement Act. It would require that Medicare payments be based on quality, not quantity, of care. Klobuchar said figuring out how to cut health care costs has to be part of the health reform effort. She said Medicare spending is projected to increase by 114 percent over the next 10 years.

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"If we just simply change who is paying for something and do nothing to make the system more efficient, we are really not going to get where we want to go," she said.

She cited a 2008 study that found Medicare could save more than $50 billion per year over five years if health care providers are as efficient as Mayo Clinic in caring for patient with chronic diseases in the last five years of life.

Klobuchar said it is also critical that providers be rewarded for preventive care efforts, adding, "right now, doctors are paid to treat disease not prevent them."

Minnesota Medical Association representative Dr. Noel Peterson, a urologist at Olmsted Medical Center, agreed that it is critical that national health reform include provisions that reward providers who do a good job.

He added, "There is a real risk with this process in Washington that somehow what will happen, which has already happened in Medicare, is that we will get paid less than other areas do."

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