By Mathew Keller, RN JD
Regulatory and Policy Nursing Specialist
A recent statement by the Mayo Clinic’s CEO John Noseworthy, as reported in the Star Tribune, speaks volumes as to the true status of healthcare in America: those with the money get the care they need, those without, get something else. As Noseworthy put it, “if [a] patient has commercial insurance, or they’re Medicaid or Medicare patients and they’re equal…we prioritize the commercial insured patients enough so … we can be financially strong at the end of the year.”
A Mayo spokesman went on to say, “We can provide the care they require for complex medical issues. However, we need to balance requests from these patients with their specific needs — if it’s necessary for them to come to Mayo — as well as the needs of commercial paying patients.”
There’s something fundamentally wrong with a healthcare system, especially one as vaunted as the Mayo clinic, that bases the care patients receive on their ability to pay. Unfettered capitalism simply has no place in healthcare—is there any limit to the amount you would pay to stay alive? To keep your spouse or children alive? When it comes to healthcare, the patient seldom enters into the hospital room as an equal partner to the transaction, able to shop around for the best prices, negotiate, and otherwise operate as a wise consumer. The average patient typically has zero leverage. In healthcare, it’s take it or leave it, and leaving it often leads to horrendous consequences.
The Mayo Clinic and other healthcare institutions would have you believe that they’ve been forced to such measures due to the expansion of Medicaid under the Affordable Care Act. The numbers show otherwise: hospitals are saving enormous sums of money on reduced need for charity care as well as lowered bad-debt write offs, to the tune of $43 million in Minnesota between 2013-2015 alone. The patients who are now covered by Medicaid were the patients who formerly needed charity care, or who simply could not afford to pay the bill. The Mayo Clinic itself “saw charity care costs decline by 14 percent, or $11.4 million, between 2013 and 2015.”
Even as Mayo’s charity care costs declined due to the Medicaid expansion, it pulled in eye-popping sums in excess revenues: $579 million in net income over the last two years for which financial disclosures are available. This is a corporation that holds nearly $10 billion dollars in assets. Indeed, Mayo is doing quite well on the financial front, and so is Noseworthy. He pulled in a cool $2.3 million in reportable compensation in 2014, a 42 percent increase from 2010.
And yet, Mayo would have you believe that it can’t afford to treat Medicare/Medicaid patients equally to private insurance patients. But the vaunted clinic might be in for a reckoning—under 42 CFR 489.53 (a)(2), discriminating against Medicare patients is grounds for termination of participation in the Medicare program. That would be a big hit for the Clinic, which receives about 50 percent of its annual $3.2 billion in revenue from the Medicare and Medicaid programs.
It also stands to reason that an institution that receives hundreds of millions in tax breaks as a non-profit institution deserves to have that status scrutinized if it turns its back on its charitable origins and the community of patients who need care the most.
As the brothers who founded the clinic roll in their graves, Mayo would do well to remember that its mission, “providing the best care to every patient,” and its primary value, “the needs of the patient come first,” have no caveats for “only if they can pay.”
At the very least, the Minnesota legislature should consider taking a second look at the $585 million in public funds it earmarked for Mayo’s destination medical center. Perhaps those funds ought to be contingent on Mayo serving publicly insured patients on an equal basis to privately insured patients.