Mayo Clinic facing state review for prioritizing privately insured patients

Mayo Clinic is being reviewed by the Minnesota Department of Human Services (DHS) for possibly breaking civil and human rights laws after comments from CEO John Noseworthy, MD, encouraging employees to prioritize commercially insured patients over Medicare and Medicaid beneficiaries.

The probe was first reported by Minnesota Public Radio, with Minnesota DHS Commissioner Emily Piper saying it will include reviewing contracts with Mayo covering about 150,000 public program enrollees every year for services like lab work.

“We need to understand directly from Mayo Clinic how and if this directive is being implemented and whether it has had actual negative impacts,” Piper said.

Noseworthy had told employees to give preference to privately insured patients for similar conditions for Mayo to be “financially strong” after a 3.7 percent increase in the number of Medicaid patients served by the system.

Emphasizing that his words came in an “internal discussion,” Noseworthy’s statement after the comments were reported said he regretted causing concerns about Mayo not treating patients covered by Medicaid or Medicare.

“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. “Changing demographics, aging of Americans and budgetary pressures at state and federal government pose challenges to the fiscal sustainability in healthcare today. While these discussions are uncomfortable, they are critical for us to be able to meet the needs of all of our patients.”

Mayo’s press release said the system provided “$629.7 million in care to people in need in 2016 alone, including $546.4 million in unpaid portions of Medicaid and other indigent care programs for people who are uninsured or underinsured,” along with an additional $1.8 billion in unpaid Medicare services. Seeking growth in commercially insured patient services, it said, would help sustain its research and education priorities and subsidize the other patients.

“Balancing payor mix is complex and isn’t unique to Mayo Clinic,” it concluded in the press release. “It affects much of the industry, but it’s often not talked about. That’s why we feel it is important to talk transparently about these complex issues with our staff. We will continue to discuss these complicated issues and work to find solutions that benefit our patients.”