August 19, 2019 | Modern Healthcare 35
“Like other rural healthcare providers, we’ve had to become pretty
resourceful in finding ways to make (challenging) situations work.”
expectant mothers and
delivering babies, or being
part of that labor and delivery
process. Then the hospital or
the place where you practice
announces that in the future,
the service is going to be
discontinued. You probably
will start looking for another
place to practice that will
give you more longevity. It’s a
natural occurrence.
MH: Are you saying you saw
people transferring to the
Austin, Minn., hospital because
they knew that the Albert Lea
labor and delivery unit was
closing?
Dahlen: There was perhaps a
little bit of that, but they were
also looking at our other
campuses, in Rochester and
elsewhere, as well as non-
Mayo hospitals.
MH: When you take that more
broadly, how does Mayo
determine whether a specific
service line is still viable?
Dahlen: I’d first say this
is done very carefully.
Foremost, we consider
whether we can clinically
provide the service safely
and reliably. And the
ingredients to safe and
reliable care include
trained human resources,
in appropriate numbers
and across multiple
professions. Nurses,
anesthetists, social workers,
lab techs, physicians, all
of those contribute to the
multidisciplinary team.
Then you need a level
of clinical volume that
maintains those skill levels.
And of course with hospitals,
and not all of our rural care
settings are hospitals, they
have the additional burden
of delivering care reliably
and safely 24/7. So that’s
even a little bit more difficult.
Obviously we’ve had
some challenges in southern
Minnesota as we attempt
to rationalize care between
the two hospitals in Albert
Lea and Austin. I grew up
in a small rural town, so I
really do understand, and
many others in Mayo do as
well, the emotions of closing
a service. We take it very
seriously and consider every
and all options. And we try to
communicate clearly.MH: Are there other regions
within Mayo, or other specific
service lines you can talk
about, that are experiencing
similar pressures to what you
were seeing with labor and
delivery in Albert Lea?Dahlen: All rural healthcare
sites are experiencing similar
pressures. Austin and Albert
Lea are small cities and
population centers. But we
serve population centers
that are even smaller. And
like other rural healthcare
providers, we’ve had to
become pretty resourceful in
finding ways to make these
situations work.
I want to call out our
staff who work in these
clinics and hospitals.
They’re really “athletes”
who perform multiple tasks
to meet our patient needs
and our service delivery
requirements. They’re just
amazingly committed to
that mission.
That said, it’s pretty
difficult when you’re in a
smaller care setting and
you’re reliant on minimal
staffing, and somebody issick that day, or somebody
decides to take another job,
and you’re recruiting for a
replacement. It’s really very
hard to be, for instance, a
single physician in a smaller
town, handle the 24/7 call
burden, and then be able to
do it reliably and safely every
single time. You just can’t
sustain that over a period of
months or years.MH: I am interested in
the subject of risk-based
contracting. Something I’ve
been hearing from health
systems is that commercial
payers in some markets
aren’t offering those kinds of
contracts.Dahlen: There’s no
comparison looking at our
commercial payer partners
and the CMS. The CMS
is more enthusiastic and
moving faster. Our largest
business relationship is
with Blue Cross and Blue
Shield of Minnesota, and we
announced about a year ago
a new five-year contract.
Over that period, we do
plan to introduce value-
based aspects to it, upside
and downside, plus and
minus risk. And I would just
say we’re fortunate to have
a business partner that’s
willing to work with us on a
trajectory, as opposed to an
immediate implementation
that aligns our interest
as we both get better at
implementing value-based
contracts.
In general, we are seeing
interest from the commercial
payers we deal with in
implementing value-based
solutions, but it’s not on a
wholesale basis; it’s on more
of a pilot basis or for certaincase types, or incentives for
overall cost of care.MH: Are there any updates you
can provide on the Destination
Medical Center campus?Dahlen: We’re very pleased
that our first Destination
Medical Center building—
One Discovery Square—is
essentially rented out. And
we’re contemplating the
second building, ahead of
schedule. There’s quite a
bit of momentum here in
Rochester on the Destination
Medical Center.MH: How do you see Motion
Medical, the med-tech
accelerator, factoring into the
equation? Is part of the plan to
spin that off into startups?Dahlen: I can’t comment
on an informed basis on
what the ultimate goal of
the relationship is, but the
hope is that by putting
(Motion Medical partner)
Boston Scientific engineers
in close proximity with
our Mayo clinicians at a
site of care where there’s
a very strong patient flow
... that will synergize and
accelerate discovery of new
technology. If that results in
new ventures and startups,
that would be terrific.MH: Lastly, how’s the transition
been to the new CEO?Dahlen: Like anything, it is a
change in personality. Every
human being is different.
A CEO at the end of their
tenure, as John Noseworthy
was—a tremendously
successful tenure—to a new
CEO who was selected in
part because of his ideas for
moving Mayo Clinic forward
... those are two vastly
different paces, and so I’m
enjoying the change in pace,
but it is a change in pace. l