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Cleveland Clinic Chief: Lower Care Costs Must Be Focus in Reform Efforts

In the first in a series of health reform conversations, Judy Woodruff speaks with the head of the Cleveland Clinic about his ideas for health care reform.

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    And now the first in a new series of conversations about health care reform. We'll be getting the views of some leading players and thinkers about what kind of changes they would like to see in the health care system.

    We begin by picking up on some of the very ideas raised in Betty Ann's piece just now about costs and care. Judy Woodruff has our conversation.


    And for that, we turn to Dr. Toby Cosgrove, the CEO of the Cleveland Clinic. The president visited the center last month as part of his health reform efforts.

    Dr. Cosgrove, thank you very much for talking with us.

  • DR. TOBY COSGROVE, Cleveland Clinic:

    It's a pleasure to be here. Thank you.


    We just heard at the end of that piece by Betty Ann Bowser, in essence, an agreement that if you had more collaboration by doctors, as we've seen at these clinics, including yours, overall quality would improve, costs would go down. You agree with that?


    I absolutely agree with that. And what we really have got to put into the health care discussion is how we drive quality and how we bring the total bill for health care down.

    And one of the very important ways to do that is to integrate the health care system and make it more efficient. And that means integrating not only the doctor with the hospital, which you saw a great example of here, but also integrating hospitals, so not all hospitals are expected to be all things to all people, but rather to serve the community in a way that the community needs to be served, and then have the high specialty things located in places where you can get maximum practice and maximum efficiency.


    Do you think it's realistic to expand the model to the entire country, to take what Billings, Montana, is doing, to take what the Cleveland Clinic is doing, and expand it to over 300 million people?


    I think it's perfectly possible to expand that. It's not going to happen instantly. One of the things we're seeing is we're seeing an increasing number of doctors wanting to be in multi-specialty practices and in big group practices.

    Very few physicians — in fact, only 10 percent of people who are less than 40 — are going in to practice by themselves or with one other individual. They're being driven in that direction by the difficulty in setting up and running a practice, the expectation about electronic medical records, about the economics of running a practice, and by the fact that the knowledge has expanded hugely and it's very difficult for one individual to surround an entire field by themselves, and so they want to have colleagues.

    And, finally, they're being driven there because doctors are not so interested any more in being on call 24 hours a day, seven days a week. They want to have some sort of personal balance in their lives.


    So you think this worry is overblown that doctors are still more interested in their independence and in keeping their pay scale high?


    I think that we now pay physicians well, but they're not — they do not have an incentive just to drive volume. And they get paid for a year's salary. They get paid in conjunction with what a specialty would be paid on average across the country, but they don't have the obligation to drive more volume or do more tests. I think that is the difference.