Cath Lab Digest

Pilot Project Excludes Medicare Payments for Primary Care

Capping off a year of hard-fought debate over reforming healthcare, and specifically health insurance, the Mayo Clinic made holiday-season headlines with the initiation of a 2-year pilot project involving a 5-physician family practice clinic in Glendale, Arizona, that has opted out of accepting Medicare payments for primary care starting January 1. Initially announced in October, the decision to temporarily stop accepting Medicare reimbursement for primary care office visits followed an earlier announcement that some Medicaid patients would not be accepted at a Minnesota facility. Mayo attributes these policy changes to low reimbursement rates and is asking legislators to remedy the situation as part of the comprehensive healthcare reform proposals being debated by Congress.

A statement from the Mayo Clinic clarified terms of the
time-limited trial, which will be reviewed at its conclusion. “Some recent
media reports have inaccurately stated that the Mayo Clinic in Arizona is no
longer seeing any Medicare patients. This is not true.” The decision will
result in changes for about 3000 patients receiving care at the Mayo Clinic
Family Medicine–Arrowhead facility. These patients will not be able to transfer
their primary care to another Mayo facility.

Current Medicare patients may continue receiving primary
care at the Glendale clinic but will be required to pay out of their own pocket
for office visits or to seek care from another physician. Normal fee rates for
office visits are expected to range from $175 to $400 per visit, depending on
the type of service provided. There will also be an annual administrative fee
of $250.

Mayo Clinic is currently one of the largest Medicare
providers in the country. The project affects only primary care office visits
for the 5 Mayo family practice physicians at the Arizona site. For the duration
of the trial, the Glendale location will still accept Medicare for specialty
care, laboratory services, imaging studies, and ancillary services. Primary
care reimbursement will not change at the Mayo Clinic in Arizona overall.

The Mayo Clinic loses a substantial amount of money every
year due to the reimbursement schedule under Medicare. Last year, Mayo provided
approximately $275 million in uncompensated care, due in large part to
underfunding from Medicare.

 “The
discrepancy between what Medicare pays and our cost of providing services is
particularly acute for our clinics that provide primary care,” said a statement
provided to First Report–Managed Care 
(FR-MC). “Due to these ongoing financial challenges, the 5 physicians at
Arizona’s Mayo Clinic Family Medicine–Arrowhead in Glendale will no longer
accept Medicare payments for primary care office visits. This is one of several
options we are exploring to address the Medicare shortfall situation. Mayo
Clinic remains committed to serving Medicare beneficiaries, but we struggle to
afford it.”

In October 2009, Mayo also announced that Medicaid patients
from Nebraska and Montana would no longer be accepted in its Rochester, Minnesota, facility. Only Medicaid patients from Minnesota and
its 4 bordering states would be accepted there.

Physician Shortage