Minn. state department questions whether Mayo Clinic policy violates civil, human rights laws

The Minnesota Department of Human Services has launched a review of Rochester, Minn.-based Mayo Clinic for possible violations of civil and human rights laws. The review comes after news surfaced of an internal video memo from Mayo Clinic CEO John Noseworthy, MD, in which he told staff to prioritize care for patients with commercial insurance over those who are publicly insured, according to MPR News.

"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," Dr. Noseworthy said in the videotaped speech, which was recorded in late 2016, according to the Minneapolis Star Tribune.

DHS Commissioner Emily Piper confirmed the review Thursday, according to the report. The department is also evaluating its contracts with the Mayo Clinic, which served more than 150,000 people covered by Medicare and Medicaid in 2016.

Ms. Piper told MPR she will be working over the upcoming days to learn more about the policy from Mayo Clinic's senior leadership.

Mayo Clinic provided Becker's with the following statement from Dr. Noseworthy:

"Patient medical need will always be the primary factor in determining and setting an appointment. 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.

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 Clinic also published a news release on its website March 15 that aims to clarify the policy Dr. Noseworthy discussed in his video:

"Mayo Clinic has always been committed to serving patients who need us the most, regardless of insurance coverage. Across Mayo, beneficiaries of government programs, including Medicare and Medicaid, make up about 50 percent of the total services we provide. Medical need is the top factor in the decision making process for appointment scheduling. 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.

"Mayo 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. The estimated unpaid portion of Medicare services across the organization was an additional $1.8 billion. 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. 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.

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. 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."

Editor's note: This article was updated to include the statement from Dr. Noseworthy. 

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