The Mayo Clinic now has two family medicine clinics in Arizona. Beginning January 1, primary physicians at one of those clinics will no longer see Medicare patients unless they are able and willing to pay an annual $250 administrative fee, plus $175 to $400 per visit . They will also have to agree to“an appropriate number of visits each year, including physicals.
The total annual costs for the physical and three office visits would be about $1500, according to the letter that Mayo sent to the 3,000 patients who receive care at the clinic. The letter also informs those patients that they will not be able to transfer their primary care to another Mayo facility.
Michael Yardley, chairman of public affairs of the Mayo Clinic in Arizona, said the changes are necessary because Medicare’s reimbursement rates for primary care are so low. "It has been difficult for us to be able to sustain our own medical practice in a way to provide the best care to patients and for us," he told a local news outlet, youwestvalley.com. “For some the $1500 annual fee- will be cost-prohibitive, and that’s why it’s so painful," Yardley acknowledged. "We have a list of physicians for them that are accepting new Medicare patients. We have done homework in that area, and we have customer service representatives for folks who we are encouraging them to talk to about it."
Keep in mind that the median income for U.S. seniors is $20,000—and that includes Social Security, investment income, pensions, income from part-time work—every penny that comes into the house. This means that half of all seniors rely on less than $20,000 a year—in some cases, far less. This is why $1500 for primary care, in addition to whatever Medicare co-pays and deductibles they face for drugs and other services, could easily be more than many can afford.
In the letter, Mayo said it will continue to accept Medicare for critical care and specialty services as well as lab services and physical therapy—but not routine primary care. (So much for the idea of a “medical home.”)
Mayo warned earlier this year that its operations were struggling. In a March statement, hospital administrators said income from patient care dropped to $205 million in 2008, down from $293 million in 2007. The hospital also estimated unpaid portions of Medicare and other senior programs at $765 million for the year.
Under health care reform, primary care physicians are likely to receive higher fees. The House bill promises increases of 5 to 10 percent (depending on whether there is a shortage of primary care physicians in a given area), plus bonuses for physicians who deliver higher quality care.
But this Mayo Clinic isn’t going to wait for reform. According to hospital officials “this is a two-year-pilot program.”
It’s not entirely clear what the program is piloting.
When I called Mayo headquarters in Rochester Minnesota a source told me that Mayo CEO Denis Cortese is “not available this week.” I’m still waiting for a Mayo official from Arizona to return my call, as promised. When he does, I’ll update this story.
In the meantime, I can only wonder: if one of the Mayo Clinics family practices is going to dump its Medicare patients will other physicians around the country soon follow its example?
Yardley indicates that an increase at that level wouldn’t be “sustainable.” Medicare would go broke.
In the end, all that Yardley can tell me is this: “We are experimenting to see whether we can sustain our primary care practice with this new model of payment.” In other words, it seems that they are trying to find out how many seniors in their area can afford the $1500 for a physical plus three office visits. (Of course if a patient has the misfortune to need more than three office visits in the year, he will need to ante up more than $1500.)
If patients have the money, the clinic will continue to take them. Isn’t this rationing by ability to pay? “We can’t provide primary care to everyone who wants care,” Yardley replies.
This reminds me of something Rick Scott, the former head of HCA/Columbia once said, explaining why hospitals just can’t throw their doors open to one and all. In Money-Driven Medicine, I quote him: “Do we have an obligation to provide health care for everybody? Where do we draw the line? Is any fast-food restaurant obligated to feed everyone who shows up?” (HCA/Columbia is the hospital chain that bilked Medicare, paid kickbacks to doctors, and wound up pleading guilty to no fewer than 14 felonies, while paying $1.7 billion in criminal and civil fines. Scott walked away, “Scott-free” and now runs “Conservatives for Patients Rights,” a group dedicated to blocking healthcare reform. (I wrote about Scott on HealthBeat earlier this year–March 3, 2009
Clearly, this is not what Yardley meant to say. He is hardly Rick Scott. He is the spokesperson for Mayo in Arizona, and Mayo has failed to give him a good explanation of why they are doing what they are doing there.. I truly am sorry that he has the misfortune to be the subject of this post. To his credit, throughout the interview, he was polite and patient. He did not make the policy. No one should blame him for being the messenger.
I wish I could direct my questions to Dr. Denis Cortese, Mayo’s CEO. I know that both physicians and some at the higher administrative levels at Mayo read HealthBeat. I’m hopeful that Cortese may see these queries—questions that anyone might ask– and somehow, explain what is going on here.The responses I’m hearing just don’t square with Mayo’s philosophy that “the patient always come first.”
I still believe that Mayo’s Rochester, Minnesota medical center acts on that motto. I have spoken to doctors who have worked there for years. I have spoken to patients. I have seen research data.
But what on earth are they doing in Arizona? My guess is that, in the midst of the debate over health care reform, someone at Mayo decided to use an outlier clinic to make a strong political statement: “Medicare payments to family practitioners are far too low.” Agreed.
But for a Mayo clinic to ask doctors to abandon 3,000 elderly patients hardly seems the most professional way to make that statement. I wonder how primary care physicians working at that clinic feel about this. I’d like to hear from doctors and patients in Arizona. You can reach me at firstname.lastname@example.org.