Hospitals

Obama in Ohio: A lot of health-care sell, but not a lot of substance — MedCity Morning Read, July 23, 2009

Obama’s trip to Shaker Heights allows him to continue a public campaign to sell the country on health-care reform, with the backdrop of Cleveland Clinic: a model hospital that won’t hinder his speech today but is also being careful to be neutral and wait as rickety reform efforts continue to gather into a substantive shape.

By Chris Seper on July 23, 2009

CLEVELAND, Ohio — President Obama said he won’t be seeking an endorsement from Cleveland Clinic when he tours the facility and talks with Chief Executive Toby Cosgrove. And when the president says that, we should take it to mean the Clinic must have already intimated he wouldn’t get one.

Obama will meet with Cosgrove and get a private tour of Cleveland Clinic, which will include an up-close look at the health system’s electronic medical records and a spin through its top-ranked heart center. He’ll follow that up with a very public town-hall meeting in suburban Shaker Heights to continue to sell health-care reform (MedCity News’ Mary Vanac will be live-tweeting from the event, and will also discuss the Obama appearance at 9 a.m. today on Sound of Ideas).

An endorsement would actually be a good thing for Cleveland Clinic. While it matches the care and innovation of the Mayos and Hopkins of the world, it trails them in national brand and name recognition. Obama’s appearance today helps that cause, but breaking from the pack and endorsing the plan would vault them further into the public spotlight.

But a neutral stance would be the best endorsement Obama would hope for. It is unlikely that Cosgrove would do the opposite of Denis Cortese, his longtime friend and ally who is the current CEO of Mayo. Cortese has come out strongly against health-care legislation proposed in the House of Representatives (it’s cheered some potential changes, though).

Cortese and Cosgrove have regularly worked together on efforts including health-care reform. And in substance, the hospitals share similar characteristics — like its own staff of salaried doctors — that make it unlikely an Obama plan that bothers Mayo helpful to Cleveland.

And, as the Wall Street Journal points out, it will be extremely difficult to replicate the Clinic model of health care. For all the red-tape it eliminates it also breaks from a broader medical culture in which institutions are staffed largely by private practioners.

If anything, American doctors seem to be migrating away from multispecialty clinics.

Multispecialty clinics such as Mayo have complained that the health-overhaul bill unveiled by the House last week doesn’t use Medicare enough as a lever to change how medicine is practiced. The House bill does include a provision to reward doctors who join “accountable care organizations” when they provide quality care at lower cost, but only as a pilot. It also includes an experiment in bundling payments to providers, with a fixed fee for caring for a given patient.

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So Obama’s trip to Shaker Heights allows him to continue a public campaign to sell the country on health-care reform, with the backdrop of a model hospital that won’t hinder his speech today — but is also being careful to be neutral and wait as rickety reform efforts continue to gather into a substantive shape.

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