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.
What was revelatory about his statement was not what he said, but the mere fact that he said it. The Minneapolis Star Tribune first reported the news after obtaining a transcript of the speech and verifying it with the Mayo Clinic. Now, it's raising concerns about medical ethics and the broader repercussions of a highly regarded health system's willingness to boldly spell out its preference for wealthier patients.
“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 told staff.
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.
More than 1.3 million patients a year visit the Mayo Clinic. The Rochester, Minn.-based health system operates in five states, including campuses in Arizona and Florida. In 2016, it reported $11 billion in revenue and $475 million in income. That year, U.S. News & World Report ranked it as the top hospital in the country.
“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. “A wealthy leader like Mayo is sending a grim message not only to other hospitals but to those who rely on Medicare and Medicaid.”
While it may be unseemly or unethical, it is not illegal for Mayo Clinic, a private entity, to prefer patients on the basis of their insurance coverage. Discriminating against patients is illegal only in the emergency room. Some physicians already choose not to accept Medicare or Medicaid, Caplan pointed out.
Mayo Clinic's nondiscrimination policy statement states, “As a recipient of federal financial assistance, Mayo Clinic does not exclude, deny benefits to, or otherwise discriminate against any person” based on race, gender, religion and other characteristics, including “status with regard to public assistance.” This statement applies to “admission to, participation in, or receipt of the services and benefits under any of its programs and activities,” through Mayo itself or any contractors.
The system also states on its website that it “appropriately serves patients in difficult financial circumstances and offers financial assistance to those who have an established need to receive medically necessary services and meet criteria for assistance.”