Editor's note. This is adapted from the excellent blog of the Robert Powell Center for Medical Ethics.

The Mayo Clinic has long been an institution praised and emulated for its efficiency and forward-thinking policies. But now it has begun a pilot program that may set a highly undesirable precedent.

According to a story by David Olmos which ran at Bloomberg.com under the headline, "Mayo Clinic in Arizona to Stop Treating Some Medicare Patients," its clinic in Glendale, Arizona is launching a pilot program where it will no longer accept Medicare patients and which will force its existing Medicare patients to pay up to $2,000 out of pocket to continue to be seen by their Mayo doctor.

The reason? The Mayo Clinic says it is no longer able to afford the low reimbursement rates Medicare offers providers. A Mayo spokesman, Michael Yardley, told Olmos that "The program's payments cover about 50 percent of the cost of treating elderly primary-care patients at the Glendale clinic."

The Mayo organization "had 3,700 staff physicians and scientists and treated 526,000 patients in 2008," Olmos wrote in the December 30 story. "It lost $840 million last year on Medicare, the government's health program for the disabled and those 65 and older, Mayo spokeswoman Lynn Closway said."
(See www.bloomberg.com/apps/news?pid=newsarchive&sid=aHoYSI84VdL0)

According to the Medicare Payment Advisory Commission which makes recommendations to Congress, nationwide doctors receive around 20% less than the real cost of providing a service.

This move by the prestigious Mayo Clinic is very likely to have a ripple effect. Olmos writes, "Mayo's move to drop Medicare patients may be copied by family doctors, some of whom have stopped accepting new patients from the program, said Lori Heim, president of the American Academy of Family Physicians, in a telephone interview yesterday."

"Many physicians have said, 'I simply cannot afford to keep taking care of Medicare patients,'" said Heim, a family doctor who practices in Laurinburg, North Carolina. "If you truly know your business costs and you are losing money, it doesn't make sense to do more of it."

Citing surveys taken by her organization, Heim pointed out "While 92 percent of U.S. family doctors participate in Medicare, only 73 percent of those are accepting new patients under the program."

This problem will no doubt be exacerbated by the health care bills passed out of both houses of Congress. Both rely heavily on deep cuts to the Medicare program. In addition, the bills passed by Congress do not address the reoccurring problem of what is known as "doc fix."

Each year, the rates paid to Medicare providers are supposed to be cut in order to keep Medicare solvent. In truth Congress cobbles together expensive bills yearly to ensure those cuts do not take place.

National Right to Life has long recognized this dilemma of how underpayments in the Medicare program can lead to rationing. NRLC was instrumental in creating an option in the Medicare program known as private-fee-for-service. Seniors can add their own money on top of the government contribution, so that their plan could offer adequate reimbursement rates to secure insurance for senior citizens. However the Medicare private fee for service option is threatened by both the house and Senate version of health care reform. For more on this see www.nrlc.org/news/2007/NRL03/Rationing.html.

Although for now the Mayo Clinic is only rejecting Medicare patients at one primary-care clinic in Arizona, it will assess the financial effect of the decision in Glendale "to see if it could have implications beyond Arizona," according to Michael Yardley. This may be the start of a dangerous trend where seniors in the Medicare program will have very few options for the kind of care they deserve.

Please send your comments to daveandrusko@gmail.com.