Fixing a Broken Health Care System

April 9, 2009— -- Instead of consulting with their primary care doctors, many patients in this country who need medical care wind up in the emergency room.

Even the famed Mayo Clinic in Rochester, Minn., which provides quality health insurance to 130,000 employees and their families, was shocked to discover how many of them approached their own routine medical care.

"We just use the urgent care and the ER for whatever our needs were," said Cindy Hageman, a Mayo Clinic employee who works as a technician in the dialysis unit.

For some Mayo employees, the reason was simple: The ER was more convenient than going through the hassle of scheduling an appointment with a primary care doctor. But it came at a huge price -- both to Mayo, which was footing the bills -- and to patients, who were not getting the benefits of primary care, which include regular follow-ups and good preventive medicine.

"We consider if our patient goes to the emergency room, that's a failure of our system," said Dr. David Herman, Mayo Clinic medical director of employee health.

Mayo's problem, like that of many clinics around the country, was that it offered primary care using the old-fashioned model of office hours restricted to Monday through Friday, 9 a.m. to 5 p.m. Overhauling the system, the clinic took steps to make care more accessible and to control costs.

Mayo started by setting up one new department for the whole family -- combining pediatrics, family medicine and internal medicine under one primary care umbrella. They built six new family medicine centers, opened up an express care clinic in a shopping mall and started staffing physicians assistants and nurse practitioners on nights and weekends to see patients and field questions on a 24-hour phone service.

It's a model that other health care systems might want to follow.

"If we get the right person in the right office at the right time, we can help reduce the cost of care, provide quality and provide access and appropriately get referred to the right specialist," said Dr. Ted Epperly, primary care specialist and president of the American Academy of Family Physicians.