Healthcare is Complex
We have Leaders Conference coming up next week with Dr. Halee Fischer-Wright of MGMA as keynote speaker and many interesting sessions as I discussed last month. Leaders may be front of mind but the healthcare kerfuffle surrounding the proposed American Health Care Act (AHCA) is taking all of the air out of DC. It is so tempting to enter that debate and add my nickel to the noise. Happily, I concluded that there are already too many knowledgeable healthcare policy experts and experienced political analysts in that space along with even more less knowledgeable pundits and politicians. Difficult for me to join the former group and don’t want to be in the latter!
Instead, I want to focus on a recent article by Jeremy Olson from the Minnesota Star Tribune (http://www.startribune.com/mayo-to-pick-privately-insured-patients-amid-medicaid-pressures/416185134/) titled “Mayo to give preference to privately insured patients over Medicaid patients.” The article reports on statements made by Mayo CEO John Noseworthy to staff regarding their policy of giving preferences to insured patients over those with Medicaid or Medicare coverage. He was clear to qualify that this decision would be between patients that seek care at the same time and have comparable conditions. The article also indicated that patients needing emergency care would not be affected. Noseworthy further indicated that Mayo wanted patients needing services that could be obtained closer to home to get care locally. I am sure there has been a flurry of comment on this beyond what is in the article. Further, the Minnesota Department of Human Services has launched a review of the Mayo Clinic for possible violations of civil and human rights laws.
The message that Noseworthy’s statement to staff transmits is not consistent with core values of our profession in my opinion. While this policy does not represent anything clearly illegal, it does, however, demonstrate the complexity of healthcare. To be clear, none of us are so naïve as to think that leaders in the healthcare delivery system do not take the insurance status of patients into account when making service line, location, or operational policy decisions. For example, we are all aware of institutions debating the decision to locate a replacement facility in the suburbs or in the inner city. The issue on the table involves how to secure access to populations of well insured versus less well paying Medicaid or uninsured patients. We also all sympathize with the challenge that treating those less able to pay for care present to any provider or organization. If you treat too many low paying patients, you run the risk of not generating sufficient revenue to continue in operations. The position of Mayo in the current system makes leadership a major challenge.
At the core, this challenge is similar to our discussion in October last year of the EpiPen pricing. We asked the question, “How do these issues relate to us as health management educators?” The response was that our educational models blend what is best for the patient socially and clinically with an emphasis on the resources necessary to care for patients or on the business of healthcare. Our membership and the content of what we teach reflects widely diverse perspectives and we work diligently to find the appropriate blend of these two perspectives along with a strong dose of ethics and social responsibility. We have long had health and healthcare components to our education because our students are directly or indirectly in the caring professions. Our graduates are prepared to work closely with a wide variety of direct providers and enable treatment through their management and leadership. We also clearly recognize that much of the healthcare system consists of organizations that should be run as a business thus we also emphasize conventional finance, strategy, marketing, organizational theory, human resources, and information technology to name a few business themes. Both our curriculum and the composition of our typical faculty reflect that diversity. Our core faculty often includes individuals with clinical, business, public health, health administration, and other disciplines.
Over the years, we have found that too much emphasis on any one aspect of what we teach at the expense of the others can detract from the value of health management education. We carefully balance and benefit greatly from having a membership that includes programs and faculty with different perspectives. It makes our members unique. I would hope that our graduates would understand both the need to be financially sound but at the same time highly sensitive to that segment of the population less able to afford quality care. It is unfortunate that the photo leading the article was of Noseworthy exiting a meeting with then President-elect Trump and the transition team in Florida. I hope the meeting was intended to make a plea for the need to increase Medicaid payments so that Mayo would not have to be put in the position of preferring one type of payer over another. Our students can also manage the optics of their efforts as well!
Our graduates are equipped to manage the special responsibility we face on behalf of the populations they serve. We don’t know the full story yet regarding Mayo thus must be careful in reaching final conclusions. We are, however, cognizant of the competencies our graduates will need to become future leaders and are doing an outstanding job of getting them prepared.