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Is the Mayo Clinic a Model Or a Mirage? Jury Is Still Out.

The White House was not happy, as Cortese found when he went to meet with the administration's health reform czar, Nancy-Ann DeParle, shortly after the letter was sent. "I guess they got the feeling we undercut" them, he said.

But instead of freezing Mayo out, Cortese recalled, "They said, 'Tell us exactly what you want.' I said, 'You really want me to tell you exactly what we ought to be doing?' And they said yes."

Since then, the legislation has been heading in Mayo's direction. The White House has sent signals that a public option is expendable. In the House, lawmakers agreed to add to the bill a three-year study, with a requirement that its findings be implemented, of shifting Medicare payments to a "value index," under which cost-efficient hospitals would be paid the most. And last week, Senate Finance Committee Chairman Max Baucus (D-Mont.) released a health-care reform bill that includes many of Mayo's ideas for high-value incentives.

Mayo's momentum has the skeptics worried. Cooper and others say the better way to reform Medicare is to pay for outcomes in a way that takes socioeconomic factors fully into account and to improve the health of the poor before they get on Medicare.

Still others question whether mandating the Mayo model will result in savings for the taxpayer if the money cut in some areas is simply used to reward others. "These cuts will NOT go to tax or cost reductions," wrote Rep. Michael E. Capuano (D-Mass.) to his colleagues. "Every penny of these cuts will be sent to OTHER states."

Mayo officials, however, recoil at the suggestion that their lobbying is solely driven by self-interest.

"Our focus is on the needs of our patients," said Jeff Korsmo, the clinic's policy director. "There are people trying to position us as anti-reform, but we wouldn't be doing this if we weren't for reform."

Stein reported from Washington.


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