The secret to fixing healthcare in the United States is to focus on value, a measure that takes into account both quality and cost, says Dr. Denis Cortese, president of the Mayo Clinic.

The Rochester, Minnesota-based network of clinics is being held up by President Barack Obama and health policy experts as a potential model for healthcare reform, in part because it offers good care at a fair price.

In a commentary on Wednesday in the New England Journal of Medicine, Cortese says under the U.S. healthcare system the country spends more than any other but the results are uneven at best.

Costs vary drastically, with some centers spending $10,000 on tests to arrive at a diagnosis, while others may spend $15,000 to get to the same result.

To get healthcare moving in the right direction, Cortese argues for using currently available measurements to devise a value score that takes into account patient satisfaction, safety, cost and outcomes -- Did the patient get better?

We could thus create a value score for each medical institution and make it publicly available, Cortese and colleague Jeffrey Korsmo wrote.

Armed with that information, patients could choose hospitals that represent the best value, forcing doctors and caregivers to compete on cost, service, safety and results.

Those with poor track records would lose out among healthcare value shoppers.

They also said care among different medical and surgical specialists should be coordinated, giving patients access to teams of doctors who share the same electronic medical records.

And to remove the temptation to order too many tests or procedures, they think doctors should be paid a salary -- something that distinguishes Mayo.

The goal is to reduce conflict of interest, they wrote. Instead, they can focus on providing the right level of coordinated care for each patient -- no more and no less.

Doctors should be offered a bonus when patients are happy with their care, they said.

Cortese and Korsmo said lawmakers looking to reform healthcare should be willing to pay for high-quality, low-cost care instead of making across-the-board cuts to Medicare, the government health program for the elderly.

GROUP PRACTICE

In a separate commentary, Dr. Francis Crosson of Kaiser Permanente in California said fixing healthcare will require a change in the way physicians are paid to foster the formation of group practices, such as Kaiser, Mayo, and Geisinger Health System in Pennsylvania.

Crosson favors payment up front for care. That way, the physician is generally not in a position where they have to say, 'If I don't do this, I don't make that money,' Crosson said in a telephone interview.

Instead, like the Mayo model, Crosson said doctors should be paid a salary, with modest incentives for good quality work. And physician groups should work together with hospitals in a partnership.

The result, he said, is doctors get to focus on patients.

The quiet secret is that we have an environment in these group practices where physicians love to practice medicine. They are not telling their children, 'don't go into medicine,' Crosson said.

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