|
|
Mayo in Rochester Unlikely to Limit Medicare Patients
By Jeff Hansel, Rochester Post-Bulletin
January 24, 2008
The move to limit care for Medicare patients by Mayo Clinic in Arizona could loom large to aging baby boomers if other major health providers follow suit.
Mayo Clinic officials say they decided to start limiting the number of Medicare patients who get primary-care physicians because Arizona has different priorities than the ones of Mayo in Rochester.
It's unlikely Mayo in Rochester will start managing the flow of new Medicare patients locally, said Jeff Korsmo, Mayo's chief administrative officer in Rochester.
But, he said, it's important to recognize that "no matter how big we are, we don't have the capacity to serve every patient."
Korsmo and national CAO Shirley Weis say, as always, the needs of the patient come first.
In Arizona, the biggest patient need is specialty care, they say.
Conversely, in Rochester, Mayo is a main provider of primary health care.
That's why there's a greater focus here on serving patients who need a family physician.
"We have a real responsibility for this community and this immediate region," Korsmo said, noting Olmsted Medical Center is a partner in that shared responsibility.
Snowbirds have big impact
For most providers, Medicare doesn't pay for the cost of providing the medical care, said Korsmo. But the number of new Medicare beneficiaries is sure to rise, as baby boomers begin retiring in 2011.
Mayo's method of offering access to Medicare patients has been "really blind to the issue of payer," Korsmo said. The clinic looked at local communities and decided what was required, based on patient need and Mayo's service capacity.
"We always, always want to see the patient based on their need. We don't care if they can't pay a penny," Weis said.
Many people, including southeast Minnesota residents and Mayo retirees, follow warmth to Arizona each winter. About 80,000 flood the Phoenix area each year, Weis said, and Mayo can't serve them all.
"There's no way we could build enough capacity -- nor the valley as a whole, I think," Weis said.
"They go to Arizona and they don't have primary care down there. That's also an issue that we have to think about, but we don't have that kind of capacity," Korsmo added.
At the three campuses in Minnesota, Arizona and Florida, Mayo has "very high numbers of Medicare patients that we care for," Korsmo said. "If you add us together, we take care of several times more Medicare patients than the next largest provider in the country."
Medicare beneficiaries have more access at Mayo in Scottsdale, Ariz., or Jacksonville, Fla., than they do at other providers in those states, Weis said.
"We're one of the largest providers period in those areas," she said. "What they'll find as they call around the communities, it's harder yet."
Mayo continues to monitor the metrics of both patients and employees seeking primary care providers, Korsmo said.
"The care of patients, that is who we are, and we can't provide every answer for every patient, and we're doing our best -- I'm sure we could do better," Korsmo said.
Other providers
Other facilities also are facing a surge of Medicare patients, but they're not limiting who gets care yet.
"Despite the drastic reduction in Medicare reimbursement, Olmsted Medical Center, as the community provider of primary and secondary medical services, does not intend on reducing any health care access for its Medicare patients," said Tim Weir, chief administrative officer of OMC in Rochester.
A spokeswoman for Cleveland Clinic in Ohio said her organization, which frequently rivals Mayo in many national health rankings, does not limit access for Medicare patients.
"Nor do we have plans to," she said.
Currently, she said, about 37 percent of Cleveland Clinic's patients are Medicare beneficiaries.
At the University of Iowa, Medicare patients represent 30 percent of gross patient charges but only 23 percent of reimbursement, said Stacey Cyphert, assistant vice president for health policy at U of I.
"So this implies that Medicare is not as good a payer as some other third parties. That being said, our preference with respect to Medicare is to try to encourage Congress to make Medicare a better payer and not necessarily restrict access to the Medicare beneficiary," he said.
Will the University of Iowa restrict Medicare patients?
"I'm not aware of any conversations that have occurred here about doing that," he said.
Medicare patients to remain at steady percentage
Existing Medicare patients already make up 48 to 49 percent of Mayo's patients in Arizona, so new ones will only get new primary-care doctors when openings become available.
Mayo in Arizona plans to stay steady at that percentage, said Michael Yardley, chairman of public affairs. "We don't have the ability to grow the practice at this time," Yardley said.
Instead, medical-surgical fields will remain the focus. "That's a niche we filled basically since we've been here," Yardley said.
Access to specialists gets first billing at Mayo in Arizona.
"All requests for Mayo Clinic appointments are prioritized so that patients with complex medical problems, those who can most benefit from the specialized expertise of the Mayo Clinic team, are seen," Yardley said.
MAPs patients also affected
Mayo in Arizona also stopped taking new Medicare Advantage Plan patients Jan. 1, Yardley said, although it will continue seeing established MAP patients.
"Medicare Advantage Programs were an initial step toward reforming the traditional Medicare program. But they are still government-regulated, price-controlled insurance programs," said Mayo Rochester spokeswoman Shelly Plutowski. "MAPs themselves have created some serious administrative and financial challenges for both patients and providers. As a result, Mayo Clinic does see some patients who are covered by Medicare Advantage Plans (MAPs) but limits its participation in these plans based upon local market conditions. MAP patients currently can be seen at Mayo Clinic in Rochester."
Many major medical systems, including Johns Hopkins and Sloan Kettering, either limit patients in Medicare Advantage plans or do not accept them at all, said Vicki Gottlich, senior policy Attorney for the Center for Medicare Advocacy.
The future
They key question for Mayo's Medicare patients in Arizona, Cyphert said, is where do those patients go if they can't get physicians at Mayo?
That's the same question asked by patient Bob Withers, who has many connections to Rochester, Mayo Clinic and even the Mayo brothers who laid the groundwork for the health organization's eventual success.
"My clinic number starts with zero," Withers said. "I grew up down the street from Dr. Will. I used to ski down his hill."
Withers, a former Post-Bulletin publisher, wants a primary-care doctor in Arizona. Even though he has a family physician at Mayo in Rochester, he hasn't gotten one at Mayo in Arizona.
For many years, health providers have been fretting about the nation's health-care system and the way medical providers get reimbursed for care of elderly patients who qualify for Medicare.
Mayo officials hope to drive fundamental change in the nation's health-care system that will prevent a Medicare meltdown of health care.
Yardley said Mayo has taken the issue national through the clinic's Health Policy Center.
It's important as an organization to do the best thing for patients, while at the same time raising the issue on a national level, he said.
"As we try to shape policy through our Health Policy Center, we're also doing a lot of things internally to meet the needs of the future," Korsmo said.
More Information on US Health Issues
|
|
