Lessons from Cleveland

The Visit:
When President Obama visits the Cleveland Clinic today he will no doubt trumpet the Dartmouth Atlas finding that chronically ill patients in the last two years of life cost Medicare tens of thousands of dollars less at the clinic than similar patients at many other highly ranked academic medical centers.
The Question:
Then the President will ask a question that he has asked before: Why can't other medical centers be just like Cleveland?

Where to Find the Answer:

The answer to that question is not to be found in Cleveland. The answer is to be found back in Washington, D.C. in the Health and Human Services building, only a few blocks away from the Capitol.

The Answer Found:

Like other medical centers, the Cleveland Clinic gets paid less than private payers for everything it does under Medicare. But on top of that, the clinic is sacrificing tens of thousands of dollars per patient because it is a high-quality, efficient provider of care. As the Wall Street Journal explains, the clinic makes up for these losses by charging list prices to foreign patients and even some US patients (a revenue source that most other medical centers don't have). Basically, other centers can't afford to be as good as the Cleveland Clinic — even if they were so inclined.
Assigning Blame:
The culprits in all this are the people at both ends of Pennsylvania Avenue and the agency that carries out their wishes. These are the people who designed and enforce the way Medicare pays for health care.
Lesson No. 1:
When you reward mediocrity and punish excellence you get a lot of mediocrity and not very much excellence.
Lesson No. 2:
To avoid making matters worse, don't let the culprits who created this state of affairs have more control over the health care system.

Comments (6)

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  1. Tom H. says:

    John, you are exactly right. Obama visited the wrong city.

  2. Joe S. says:

    Obviously Obama has not mastered Lesson No. 2.

  3. Audrey I Prefer, MD says:

    When will “comrad” Obama understand that without tort reform, there will be no way of decreasing healthcare costs, save denying care?
    More importantly, when will the Obamanites get it?

  4. Larry C. says:

    Joe, he hasn’t mastered Lesson No 2 either.

  5. Michael Kirsch, M.D. says:

    I’m from Cleveland and I know the Cleveland Clinic first hand. I trained there. Sure, they remove the profit motive from their physician staff, but they make up for it with excessive high technology care and a gaggle of consultants on every patient. When one of my own patients return from a medical evaluation from the Clinic, I am awestruck at how much diagnostic testing and specialty consultations have occurred. The culture is not one of judicious thought, but of diagnostic and therapeutic excess. If this is really the model that Obama wants the rest of us to emulate, then the rising deficit will shoot to another galaxy. More physician thoughts on health reform and medical quality at http://www.MDWhistleblower.blogspot.com

  6. Vicki says:

    Dr. Kirsch, what you have to say is very interesting. Sounds like the “model” for everybody else is actually quite wasteful.