DANVILLE, Pa. - President Obama's and Nancy Pelosi's people have made the pilgrimage to this little town in middle-of-nowhere north-central Pennsylvania to see the Geisinger Health System.
So have staffers from the Mayo Clinic, Kaiser Permanente, and the Cedars-Sinai Medical Center.
In fact, Geisinger, touted by Obama as a health system that offers "high-quality care at costs below average," has gotten so popular that it started offering group tours. It expects more than 70 visitors from insurance companies and health systems this week.
"We were consuming ourselves with entertaining," said Howard Grant, a former Temple University Health System chief medical officer who became Geisinger's chief medical officer in 2008.
"People from all reaches of the country are trying to understand how what we do translates to their world."
What visitors find in the wooded hills of Danville, population 4,450, is a seriously wired health system that has made saving money and improving quality a priority. It has been aided by a relative lack of competition, its stable patient base, and the fact that its 800 doctors are on salary. It owns its own health-insurance plan and pharmacy.
That's a rare combination of factors that makes outsiders question how much of Geisinger's success can apply to the rest of the country.
"I really wish President Obama would stop holding them up as a model, because it's just not readily, broadly applicable," said David Nash, dean of the Jefferson School of Population Health at Thomas Jefferson University and a longtime proponent of basing medical care on proven science.
Nash said Washington reformers should focus on ideas that would work for the vast majority of hospitals, not unusual systems like Geisinger. "We don't have time for Penn and Jefferson and Temple to turn into Geisinger," he said. "We just don't."
Others say that Philadelphia's poorer patients need more care and support, that the city's focus on medical research is more expensive, and that Geisinger's cooperative approach draws doctors with a mind-set different from that of doctors attracted to the rarefied research at Philadelphia's top hospitals.
Medical care is more fragmented in most hospitals, with many doctors self-employed or working for independent groups, and insurance provided by separate companies. That pits those groups against one another economically. In a fully integrated system, like Geisinger's, everyone benefits more easily from holding costs down and improving care, experts said.
"Because we are completely integrated, it doesn't matter to us which component of our organization sees the revenue or sees the expense," Grant said.
The Obama administration did not respond to a reporter's request for elaboration on why the president used Geisinger as a positive example, but it's likely that the health system's strong performance in the Dartmouth Atlas played a role.
For more than 20 years, the Dartmouth Atlas Project has analyzed Medicare spending, producing maps that show huge regional variation in spending that it attributes primarily to differences in the amount of care. Though it has not evaluated Geisinger's quality, its researchers have consistently found that higher spending does not correlate with higher quality.
Elliott Fisher, director of the Center for Health Policy Research at Dartmouth College, said the nation could cut health spending by 20 percent to 30 percent by making everyone behave like low-cost regions.
Medicare costs in Geisinger's region averaged $6,790 per patient in 2006, placing it in the nation's lowest fifth. At $9,665 per patient, Philadelphia's spending was in the top fifth. Geisinger leaders say pay for their medical staff is comparable to pay here.
Fisher is impressed with Geisinger. "They have made a very firm commitment to both improving care and reducing costs," he said.
Geisinger Medical Center opened in 1915 as a 70-bed hospital funded by Abigail Geisinger, daughter of a wagon-maker. Its first surgeon and leader had trained at Mayo, another center lauded for its integrated practice and salaried physicians.
The system now includes three hospitals, serves 2.6 million people, and spans 43 counties. In its core, 31-county market, it captures 30 percent of patients. Thirty percent of its patients belong to the Geisinger Health Plan, its own insurance company, but it also treats patients with other plans. Its doctors provide care in 15 hospitals not owned by Geisinger.
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