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Head of US Mayo Clinic reconsiders comments that privately insured patients should have priority

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j1406 (Published 20 March 2017) Cite this as: BMJ 2017;356:j1406
  1. Michael McCarthy
  1. Seattle

The head of the prestigious Mayo Clinic in Minnesota, USA, has tried to distance himself from his remarks that patients with private insurance should have priority over those with government cover, by reassuring the public that a patient’s medical need is the center’s “top priority.”

John Noseworthy, president and CEO of the Mayo Clinic, had told staff that, when patients with similar problems seek care at the clinic, patients with commercial insurance should be given priority over those covered by Medicaid or Medicare—government run programs for poor, elderly, and disabled people.

Noseworthy was quoted as saying, “We’re asking . . . that we prioritize the commercial insured patients enough so . . . we can be financially strong at the end of the year.” State officials plan to investigate the comments, which were reported 15 March by Minneapolis’s Star Tribune after the newspaper obtained a transcript of Noseworthy’s speech. The clinic has not contested the accuracy of the quotes.

Medicare and Medicaid often pay significantly less than commercial insurers, so US hospitals commonly depend on higher payments from private insurance companies to help offset the losses they incur in providing care to patients covered by lower paying government plans and those with meager cover or none at all who cannot pay their medical bills.

As the number of people covered by Medicare and Medicaid has grown in recent years, hospitals have seen the percentage of their patients covered by these programs swell, straining their finances.

In his speech, Noseworthy told his staff that the Mayo Clinic had reached a “tipping point,” with a recent 3.7% increase in Medicaid patients. “If we don’t grow the commercially insured patients, we won’t have income at the end of the year to pay our staff, pay the pensions, and so on,” he reportedly said. “So we’re looking for a really mild or modest change of a couple percentage points to shift that balance.”

State health officials said that Noseworthy’s proposal seemed to violate laws requiring health systems to provide equal treatment for all patients. Emily Piper, commissioner of the Minnesota Department of Human Services, told Minnesota Public Radio that her department would investigate the clinic.

“I was really surprised and disturbed by Noseworthy’s comments,” Piper told the radio network. “We need to understand directly from Mayo Clinic how and if this directive is being implemented and whether it’s had actual negative impacts.”

After the announcement of the state’s investigation the clinic released a statement in which Noseworthy seemed to take back his earlier comments: “In an internal discussion I used the word ‘prioritized’ and I regret this has caused concerns that Mayo Clinic will not serve patients with government insurance. Nothing could be further from the truth. In fact, about half of the total services we provide are for patients who have government insurance, and we’re committed to serving those patients.”

He said that, in 2016, the clinic had provided $629.7m (£507m; €586m) in unpaid care to people and had absorbed an additional $1.8bn in losses for care provided to patients covered by Medicare.

“As our percentage of government pay patients has grown, we are working in turn to grow the number of commercially insured patients we are seeing,” Noseworthy said. “To fund its research and education mission, Mayo needs to support its commercial insurance patient numbers in order to continue to subsidize the care of patients whose insurance does not cover the cost of their care.”

He added, “Balancing payer mix is complex and isn’t unique to Mayo Clinic. It affects much of the industry, but it’s often not talked about.”

A patient’s medical need would remain the “top factor” in the decision making process for scheduling appointments, Noseworthy said, adding, “After medical need, we consider if the patient can access the care they need closer to home and often work with their local provider to provide the highest level of care locally.”

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