Mayo Clinic faces questions after CEO comments on insurance

MINNEAPOLIS (AP) — Mayo Clinic is facing questions from the state of Minnesota after its CEO told employees that if patient conditions are equal, its hospitals should prioritize privately insured patients over those under government-subsidized programs such as Medicaid.

John Noseworthy's comments were made late last year in a videotaped speech to staff but surfaced only this week after a transcript of his speech was obtained by the Star Tribune newspaper. The Mayo Clinic has verified the transcript is accurate.

Noseworthy said in a statement Friday that medical need will always be the top factor in scheduling 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," he said, adding that the hospital is committed to serving patients with government insurance.

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

Minnesota Department of Human Services Commissioner Emily Piper said she was surprised and concerned by Noseworthy's earlier comments, and has questions about what they really mean and how Noseworthy's directive would be carried out. The department is looking into whether there are possible violations of civil and human rights laws.

The agency also is reviewing its contracts with Mayo Clinic to ensure the hospital is meeting its obligations to serve patients in public programs.

Last year, Noseworthy told staff that when Mayo Clinic has expertise that can't be found elsewhere, it will always take patients, regardless of how they are paying for care.

"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 our mission," Noseworthy said in the transcript.

Mayo Clinic spokeswoman Duska Anastasijevic said Friday the speech stressed the need to increase privately insured patients, but not at the expense of government insured patients.

Mayo Clinic said about half of the services it provides go toward those enrolled in government programs. The clinic said it provided $629.7 million in care to people in need in 2016, including $546.4 million that wasn't covered by Medicaid or other programs for the uninsured or underinsured.

The statement said that as Mayo's percentage of publicly funded patients has grown, to now roughly 50 percent, the health system is working to increase commercially insured patients.

"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," the statement said.

Piper said Noseworthy's statements do not reflect routine hospital practices, and she found them to be troubling.

As Human Services commissioner, Piper is focused on ensuring access to health care for those enrolled in public programs. She said providers have to follow the law and uphold agreements to provide such care. She said that in her view, nothing that is happening with the health care law on the federal level changes those requirements.

"Health insurance coverage for health insurance coverage's sake is not the end goal," she said. "It's access — that's what's important."

Anastasijevic said Minnesota Medicaid patients are and will continue to be scheduled the same as patients with commercial insurance.

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