A couple of years ago we went elsewhere. We got recommendations from friends for primary care physicians, they referred us to specialists and, if we needed a hospital, it was whatever the doctor suggested. All in all we thought that was working pretty good.
But there were some annoyances. First, when we were referred to a specialist, it was pretty much start all over.
“Here, fill in this form with your medical history, allergies, etc.”
“And we need to make a copy of your medical insurance card for our records.”
And that was after calling to be sure that *this* doctor would take our insurance.
The statement, “We don’t take that insurance but will work with you,” means you’re going to be on the hook for a much larger fee than what the insurance has negotiated. Going “out of the system” is expensive. Very expensive.
So we got into the habit of not only carrying the card but also our complete medical history – at least as much as needed to be written down on the form for each new doctor – and a list of hospitals that were also covered.
And when one specialist referred us to another, there came the clipboard and pen again.
And if the “copy of the test results” didn’t make it to the new physician, we were on the hook to track down where things broke and, often, to be the delivery service.
So into this story now enters my favorite primary care physician. I’ll call him Dr. S (not his real initial).
Recommended by a friend, I really liked this guy. He was good, paid attention, told me what to expect when I was sick, worked well with my insurance and so forth.
But one day we got a letter saying he was leaving private practice and going to work at Mayo. If we wanted to continue seeing him, it would have to be through Mayo which, unfortunately, our insurance didn’t cover.
Good-bye, Dr. S.
After some looking around and asking friends, my wife and I both started seeing the same, new to us, primary care physician. At first, he was very good but, over time, I guess he just got too busy – that seems to happen with the good doctors – and we saw him less and less. Every visit we’d see one of his PAs for the essentials but, more and more frequently it seemed, that was it. No Doctor. Eventually, it was next to impossible to get to “the doctor”.
It was time for another change of physicians and, recognizing what was likely to happen should we find someone really good whose business would then grow and grow to see us less and less, we weren’t too thrilled at the prospects.
This “find a new doctor” routine looked like the new status quo.
Regardless, we had to make a change. I remembered Dr. S and thought, “Maybe he’s back in private practice again.”
I called his old number.
“Mayo Clinic. How may I help you?”
Rats, I thought, still at Mayo. I’m out’a luck.
The person on the phone confirmed that Dr. S was one of their physicians but she added, “But we now take many more insurance plans than we did in the past. Would you like me to check yours?”
And, surprise, Mayo takes our insurance!
So, you’re probably asking, what’s the point of the story?
It’s called the Mayo “system” for good reason.
First, Mayo keeps all the records centralized where all of their facilities, physicians and nurses can get to them. Each physician can see the results of the previous tests, the X-rays from an hour ago to three years ago. They can read what each specialist thought as well as what they recommended. All prescriptions as well as the list of vitamins we take – which are updated whenever we visit, that’s the one list we *do* fill out on most visits – are on the computer.
Second, Mayo has a very large network of physicians spanning a great many specialists. And they’re good, very good. Mayo is known as a teaching hospital and doctors who like learning – every doctor has to be continually learning or he’s gonna hurt you, you know – like Mayo. It’s the place to be. Mayo keeps them busy, they work with the best in the world, and they stay current and are up to date on what’s happening in health care.
Mayo is well known as one of the best of health care providers in the world, so much so that new doctors from around the world want do complete their training at Mayo. Not only do they want “Mayo” in their credentials, they also know they’ll be exposed to a “system” that has its act together.
So, because of the very high level of expertise that Mayo draws, when we need a referral to a specialist, while the doctors aren’t required to stay “in the system” in who they recommend, the fact is that some of the best are already there. That specialist is almost always a Mayo physician, too. He/she will have the same access and the same requirements to coordinate and consult.
Did I mention the consults?
Mayo physicians are required – this is one of the policies the Mayo brothers established – to consult with each other on every case on a regular basis. We don’t get one doctor at Mayo, we get a group. And it’s not a group only when we need it. It’s a group every time.
Oh, I suppose for mundane visits, the “group review” may happen a couple of days after the fact and we never hear anything from it, at least not so far. But the input, the review is there. The “group” helps make sure some important clue doesn’t fall through a crack.
And finally, Mayo works really good with the insurance companies, far better than any doctor’s office or other hospital we’ve ever encountered. And I mean a *lot* better.
Let me give you an example where all of this was put together.
A while back, Anita’s primary care physician at Mayo said that Anita needed to see a good liver guy.
“One of the best in the world is here, by the way, Dr. R.”
The “system” made the appointment and a couple of days later we saw him, had some tests and, shortly thereafter saw him for the follow-up and got the results.
Nothing too worrisome. Just something to watch.
“Thank you, Doctor.”
Some time later and with a different specialist for a totally unrelated problem, another blood test showed up something slightly out of kilter. This specialist was an ear and balance guy and he said, “Well, I don’t quite know what this means – it’s quite minor and has nothing to do with your balance. Nonetheless, it’s a liver enzyme and I see here you’ve been to Dr. R. He’s great. I’ll send him an email and ask him to take a look. We’ll let you know if it’s something to be concerned about or not.”
No new appointment. No new tests. Just an email and, “Here, look at this test. What do you think?”
A couple of days later we got a call from the ear physician’s office.
They said, “Dr. R and his associates looked at the test and they’re agreed it is nothing anyone needs to do anything about. It is noted in your records along with their observations, and it’s nothing to be concerned about.”
Mayo physicians consult, and they do it a lot. They “huddle” on each case and in a time frame commensurate with the needs of the situation.
For example, Anita was hospitalized a while back and, as part of that stay, she ended up with several specialists stopping in from time to time. Before Mayo, this meant not only lots of bills from “who the hell is this doctor?” but also the discovery that we needed to have someone with her, in the room full-time to write down and cross-check what the different doctors were ordering.
“No water,” one doctor would order.
But ten minutes later a different one would order, “Lots of water.”
And, trust me, if they can’t agree – or even know what the previous guy said – about water, do you trust them on the medications?
Not us. So before Mayo, a hospital stay meant a family member, appropriately briefed and armed with pencil, paper and a good ear and sharp mind, would be in attendance full-time.
I suppose we got quite a reputation for that but, with the appalling number of contradictory orders, it was the only way to keep the doctors and nurses on track for *this* patient. (God help those alone and unconscious in their rooms!)
But at Mayo, you’ll see the specialists huddled in the hall looking over the reports and talking. They come to consensus, they “get their act together” before prescribing the care. If one wants no water and another wants to drown the patient, they reach a collaborative decision.
How do we know they don’t disagree? Well, we don’t. In fact, all we know is that, by the time they choose an action or a medication, they’ve discussed it and have agreed on a strategy. It may not be perfect, but it’s the best *they* can find.
For Anita’s hospitalization at Mayo, one of us, our daughter or our son or myself, sat in the room and wrote down what they decided to do and what they did. We monitored everything as nurses and physicians carried out the plan. And at Mayo, without fail, there was no deviation from the plan. Not one. And when her condition changed, as long as it wasn’t in the emergency category, there was always a meeting and a consensus on the treatment plan, and communication to us about what that was to be – and that it was the group’s consensus.
The only exception, of course, are emergencies.
Or it seems they are the exception.
But are they?
In all hospitals, not just Mayo, that is also when you’re going to see a team in action. Yes, there will be a hierarchy, there is likely to be one person making most of the decisions, but that “team” will be checking and monitoring what’s happening and everyone in that team will be participating, more or less, in what course of action is taken.
That’s what Mayo does, but they do it all the time, not just for emergencies.
We love this coordination, this communication. When we see *anyone* at Mayo, we know they’ve got all of our Mayo-history right there, and that we’re not getting one physician, we’re getting several, and that they’ll discuss our case and have more than one mind figuring “us” out.
And finally, there’s how they work with our insurance.
After a visit, a procedure or a test, we’ll get a statement from Mayo within a couple of weeks listing the particulars and their fees. But that statement will also say, “We’ve submitted this to your insurance. Do not pay anything now.”
A couple of weeks later, we’ll get a statement from the insurance company that says, “Here’s what Mayo usually charges, here’s what they’ve discounted the fee to since you’re with us, here’s what we’ve paid and here’s what left over for you to pay to Mayo. Wait for a billing from Mayo before paying anything.”
And a couple more weeks will pass before the real bill from Mayo finally arrives.
Then, we pay.
Anita’s hospitalization last year pushed well into six digits. It was life-threatening and required several hospital stays, a couple of surgeries and emergency room visits. Fortunately, we were able to do all of this with Mayo facilities here in the Phoenix and Scottsdale area.
So, Mayo did the insurance. All of it.
I have a two-inch thick pile of statements, counter-statements, list of payments and so forth, and never had to do one thing about any of what was going back and forth between Mayo and our insurance.
They did it all.
Our part, after all the dickering between Mayo and our insurance – none of which we saw – came down to a four digit amount of which the most significant (left-most) digit wasn’t really all that big.
We didn’t have to make a single phone call, challenge a single treatment or suffer the surprise or have to do the follow-up for, “the insurance doesn’t know who Dr. Y is and so they’re refusing to pay his fees for three visits in Intensive Care on the 21st. Do you remember, while you were plugged-up with hoses and electrodes, someone with that name?”
Mayo does it right. The Mayo brothers knew what they were doing and what they founded and the system they put in place is the best in the world.
We focus on our health, not the bills, not the insurance, not what one doctor says versus another’s evaluation.
My Dad was a surgeon. He says he interviewed with one of the Mayo brothers early in his career but, for whatever reason, they didn’t link up. Regardless, whenever Mayo would come up in conversation, Dad always gave them the very highest of praises.
“Best in the world,” he would say with possibly a distant note of regret in his voice.
“Physicians from all over apply to train at Mayo. Only a few get in. Only a very small number. And patients travel across the country and sometimes halfway around the world to get to Mayo.”
We’re in, Dad. And you were right.