The renowned Mayo Clinic is no longer accepting some Medicare and Medicaid patients, raising new questions about whether it is too selective to serve as a model for health-care reform.
The White House has repeatedly praised Mayo and other medical centers, many of which are in the Upper Midwest, that perform well in Dartmouth College rankings showing wide disparities in how much hospitals spend on Medicare patients.
The centers have capitalized on their status to insert into healthcare legislation provisions that would result in higher Medicare payments for hospitals that do well on the rankings, while punishing those elsewhere -- mostly in big cities and the South -- that spend the most per Medicare patient.
But some skeptics -- healthcare analysts as well as politicians and medical officials in states that would be hurt by Mayo's proposals -- argue that low Medicare spending by Mayo and others is driven by the lack of diversity and poverty in their patient population.
"If your institutions are located in the Bronx or South Central L.A. or other parts of the country with dense poverty, it's hard to compare those patients…with places like Mayo," said Atul Grover of the Association of American Medical Colleges. "It's not like they can just stop seeing Medicaid patients, because they live right in their area, and are not coming from hundreds of miles away. They're located right in areas with dense poverty."
Mayo spokeswoman Jane Jacobs rejected this, saying that poverty rates can explain only a fraction of the Medicare spending disparities. "To use your patient demographics as an excuse for not getting better is outrageous," she said.
Washington Post, by Alec McGillis, 10/13/09
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