Mayo discriminates against Medicaid patients

Mayo to give preference to privately insured patients over Medicaid patients

By Jeremy Olson
StarTribune, March 15, 2017

Mayo Clinic’s chief executive made a startling announcement in a recent speech to employees: The Rochester-based health system will give preference to patients with private insurance over those with lower-paying Medicaid or Medicare coverage, if they seek care at the same time and have comparable conditions.

Mayo will always take patients, regardless of payer source, when it has medical expertise that they can’t find elsewhere, said Dr. John Noseworthy, Mayo’s CEO. But when two patients are referred with equivalent conditions, he said the health system should “prioritize” those with private insurance.

“We’re asking ... if the patient has commercial insurance, or they’re Medicaid or Medicare patients and they’re equal, that we prioritize the commercial insured patients enough so ... we can be financially strong at the end of the year to continue to advance, advance our mission,” Noseworthy said in a videotaped speech to staff late last year.

Mayo reported a sharp increase in the amount of unreimbursed costs related to Medicaid patients, from $321 million in 2012 to $548 million in 2016. The figures include its campuses in Arizona and Florida. Mayo nonetheless remained profitable in 2016, with income of $475 million.

(Allan Baumgarten, a Twin Cities health analyst) added that complaints about the rise in Medicaid patients should be tempered by the corresponding decline in uninsured patients. “Aren’t you better off having bad payment through Medicaid compared to next to nothing from a patient who is uninsured?” he asked.


Cherry-picking patients? Mayo Clinic aims to ‘prioritize’ privately insured

By Elizabeth Whitman
Modern Healthcare, March 20, 2017

Late last year, CEO John Noseworthy had a message for the staff of the Mayo Clinic: We want patients with commercial insurance over Medicare or Medicaid.

For the Mayo Clinic health system to articulate its preference for patients with commercial insurance, which pays better than government insurance, was disappointing and surprising, said Arthur Caplan, head of the bioethics division at NYU Langone Medical Center.

“A cornerstone of our ethical thinking is you get the same care whether you’re rich or you’re poor, and we don’t triage by the size of your wallet,” Caplan said.

Noseworthy’s statement was a rare articulation of a broader trend - trying to make up for losses from Medicare or Medicaid patients with commercially insured patients - that the industry tends to try to conceal.

“I’ve heard of hospitals trying to do this behind the scenes, but I’ve never heard anybody say it up front,” Caplan said. “This statement is taking that dirty secret and bringing it into the open.”



By Don McCanne, M.D.

The mission of our health care delivery system should be to provide everyone with the highest quality care possible within the limits of the finite resources available. That is an opinion not shared by all. The fact is that the mission of some sectors of our health care delivery system is to maximize revenues, and that may mean that patients of limited resources without generous public or private insurance coverage would be avoided by them.

This is a view not often expressed in public. In fact, Mayo’s CEO expressed it only in private to Mayo employees. But from decades of my exposure to conversations in physician dining rooms and locker rooms and in confidential board meetings, you can be assured that it is an exceptionally prevalent view, particularly regarding Medicaid, uninsured, and undocumented patients. This reality drives many of us to carry on the fight for an equitable system that serves everyone well.

Under a well designed single payer system in which payment is the same for all and capital improvements are distributed efficiently and equitably, everyone would have access to the highest quality care available within the limitations of our resources. We must intensify our advocacy efforts because we are a long, long way from that ideal.