If I asked you to name five hospitals in the US that provide the highest quality health care, what would you come up with? Would the Mayo Clinic be on your list? It would be on mine, and probably a lot of other people’s as well. A new report is out that compares Medicare expenses in the last two years of life at the top five US teaching hospitals. The UCLA medical center averaged $93,000 per patient, and Johns Hopkins spent $85,000 per patient. But the Mayo Clinic averaged just $53,000 per patient, in those same last two years of life.
The Mayo Clinic is not providing sub-standard care. But they also are not doing unnecessary tests and procedures – they stick with the basics, which is reflected in their costs. Mayo Clinic doctors are paid a salary. They earn the same amount of money regardless of how many tests they run. In contrast, doctors at many hospitals across the country are paid on a per-procedure basis, which provides a nice financial incentive to run every test in the book – jacking up the overall cost of care as they go.
In such a high-cost, high-stakes industry as health care, it only makes sense to pay providers on an hourly or salaried basis. If a doctor knows that an additional MRI will result in a higher pay check that week, where is the incentive to pause and determine if the MRI is really necessary? Especially if the patient is insured and the doc knows that the insurance company will just foot the bill – no harm done in just getting it done, right? Except that all the over-treatment all across the country adds up to an out of control health care system that spends more money per capita than any other country in the world, without anything in particular to show for it.
None of the hospitals in the Dartmouth study are in Colorado, but I’m curious now to see how the major Colorado hospitals pay their doctors. Given a choice, I would be more inclined to use a hospital that pays physicians a salary, rather than using a per-procedure compensation structure. Seems like the latter would be likely to result in not only over-treatment, but also overly hurried treatment, as it behooves the doctors to fit in as many patients and procedures as possible in a day, rather than focusing on quality of care.