Chapter 16: Patients: from the Wealthiest to the Indigent
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Description
Dr. Mendelsohn begins this Chapter with a brief description of a gift of 150 million dollars from Abu Dhabi designed to invest in making cancer care even better. He turns to the subject of MD Anderson’s international patients, noting that there have been fewer since 9/11 and represent only 3% of patients. He MD Anderson could do better in this area. International patients need a concierge service, for example. They pay in cash as they go out the door and billing needs to work differently for them. However, he stresses that despite some special accommodations, it is important to MD Anderson’s mission that all patients receive the same level of care. He recalls the rules the Executive Committee adopted to help decide how to make institutional change: Is this something we do for the sake of our mission; can it be done in a way we can be proud of; can we avoid losing money doing it; and do we have the resources and skills to do it. Dr. Mendelsohn explains that he has not looked at the changes made under his leadership as corporatization, but as responsible management. He then speaks about the indigent patients MD Anderson serves (about 8%) and the difficult cases of individuals who are not technically indigent, but who are very economically stressed. (Patient Services works out payment plans for them.) He states that the U.S. has to work out a system in which everyone is covered.
Identifier
MendelsohnJ_02_20120928_C16
Publication Date
9-28-2012
City
Houston, Texas
Interview Session
John Mendelsohn, MD, Oral History Interview, September 28, 2012
Topics Covered
The University of Texas MD Anderson Cancer Center - OverviewPhilanthropy, Fundraising, Donations, Volunteers The Business of MD Anderson Patients The Healthcare Industry
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey Ann Rosolowski, PhD:
There was another important gift that you were able to secure in 2011, which was the $150 million gift for the Institute for Personalized Care.
John Mendelsohn, MD:
Well, no. It was a gift for $100 million for the new facility and $25 million for the Institute for Personalized Care and $25 million for pancreas research and other things.
Tacey Ann Rosolowski, PhD:
Talk to me about getting the largest gift ever made toward cancer research in history.
John Mendelsohn, MD:
It was the largest gift we’ve ever received and the largest single gift I think the University of Texas has ever received. Because it involved patient care, it’s confidential, but let’s just say that the people in Abu Dhabi were very satisfied with their care and felt that they wanted to invest in making that care even better. They developed very close-working relationships first with physicians here, who gave marvelous care, and then with myself and some of the research leaders and the administrative people here. This was a very complicated and long negotiation.
Tacey Ann Rosolowski, PhD:
When did it begin?
John Mendelsohn, MD:
I think it was signed probably in 2010. I probably began in 2008, so maybe 2007 or 2008.
Tacey Ann Rosolowski, PhD:
Cultivating those connections.
John Mendelsohn, MD:
Yes, growing out of care for a number of people who were quite ill with cancer.
Tacey Ann Rosolowski, PhD:
What was the process of reaching out to individuals or tapping into those networks of patients that would create that international clientele?
John Mendelsohn, MD:
We had more international patients here before I came than we have now. The number went down substantially after 9/11. This is true for the Cleveland Clinic. This is true for all American institutions. The people in the Middle East who were the main users got used to going to England and Germany instead of coming to the States, although it’s coming back. This is an area I think we could do better. The international patients need a concierge service. They need very special treatment. Many of them like to pay in cash. The best time to get them to pay is on the way out the door, not a bill sent a month later. Our routines here are very different. I think we’re getting better at it than we were, but I think this is an area we could expand on. It’s going to take effort. We’re so busy taking care of all the patients that are crowding our floors we don’t give “VIP” care here. We give everybody some level of VIP care, so there isn’t any separate VIP group. If we want to get more of those international patients, we’re going to have to spend a little more time figuring out how to triage them in ways where they get the amenities they want, but that we’re not compromising the time and effort of our great doctors, so that we can continue to implement this idea that a Fortune 500 CEO and a gardener can be in a room next door to each other and get the same level of care. We have to work that out still.
Tacey Ann Rosolowski, PhD:
What do those patients represent for MD Anderson?
John Mendelsohn, MD:
I think it’s about 3% of our patients.
Tacey Ann Rosolowski, PhD:
Why are they so important to MD Anderson?
John Mendelsohn, MD:
The main reason they’re important is many of them have complicated cancer, and we hone our skills and learn and do better by taking care of complicated cases. We’re not getting a typical, easily curable case here. They are a potential source of revenue when the per-patient reimbursement in Medicare is below our cost. The per-patient reimbursement in the private sector here has been above our cost by I’m guessing in the area of 20%, but this figure is decreasing. Individual wealthy foreign patients are reimbursing at a higher rate, although they’re negotiating tougher now. I don’t think the finances alone drive it. This is something very important, actually. Everything we do, all these ventures we’ve been talking about, we have a set of rules that Mr. Leach actually put on the blackboard one day to summarize our priorities. First, it has to be something that we want to do for our mission. Second, it has to be doable by MD Anderson, and we must be proud of it. That’s another way of saying you want to be number 1 or number 2. Third, we don’t have to make money on it, but we should avoid losing money on it. I guess those are the 3 main rules. The other one is the fit: do we have the skills and the resources to do it? Proud of it, can we do it, won’t lose money, and does it fit?
Tacey Ann Rosolowski, PhD:
What do you do when you take a medical institution and begin to ask business questions about how it functions? You raise the issue of patients who can pay more than others, and do we treat them differently, or do we think about them as sources of cash rather than points to receive a lot of care? How do we speak about money and care in the same way? I can see that this set of rules is creating a set of guidelines in which you can at least begin to address those issues. What’s your reaction to that corporatization of care?
John Mendelsohn, MD:
I don’t call it corporatization. You can’t do anything unless you can pay for it. It’s that simple. If you’re running a symphony, if you’re running a soup kitchen, if you’re running General Motors, if you’re running a hospital, you need a budget. You need what you’d call a business plan. You’re looking at revenues, and you’re looking at expenditures, and it has to foot out. I don’t think this is a corporatization. This is just responsible management. One of the chief questions that comes up is what do you do for poor people? When I first came here and was in charge, I think about 10% of our care was with indigent patients. Now I think it’s about 8%. We have a wonderful program we worked out with LBJ Hospital, 1 of the 2 county hospitals, where, at our expense, we put doctors and nurses and trainees there to take care of cancer patients. If they need a bone marrow transplant or something that can’t be done there, we’ll bring them over here. It’s a win-win deal. They get staff, and we get to free up a bed for a patient that Medicare or the insurance company will pay for instead of having to give the bed away to unreimbursed care. Now, we won’t give free medical care to everyone. We give free medical care to indigent Texans. We’ll work very hard to try to find a way to get them on Medicaid or find another way to pay for it. We’ll work with them. But, as a last resort, we’ll give free cancer care to indigent Texans. If you’re indigent from out of Texas, we just can’t do it. We’d break the bank. The person that’s the toughest is somebody who is poor but not indigent. Our formula goes up to, I think,3 times the indigent level. Suppose you’re making $55,000 a year (above the national average), and you’re a young person. You didn’t buy an insurance policy, and you’ve got 3 kids, and you’re paying off a car, and you get leukemia, which is going to cost $150,000 to treat, and you don’t have any insurance. You’ve got a job, and your wife’s got a job, but the family income couldn’t possibly cover this. That’s the person, to me, I feel most sorry for. That’s the one that is the hardest. Somebody here has to deal with that person, try to get a 20-year payment plan. You have to ask personal questions. They don’t want to give up their car. They can’t get to work. This is painful. This is something that is unique to America. Every other Western country has nationalized healthcare. It may not be as good, in some cases, but at least it’s there. It may not be as prompt. You may have to wait 6 months to get a hip replaced, but it’s eventually fully paid for by the government, in most of Europe and Canada and Australia. So part of what has to happen in the United States is not only covering and insuring the 30 or 40 million people that are uninsured but providing backup insurance for a catastrophic illness - like acute leukemia. It’s going to be challenging, and the American health system has to figure out how to handle all these challenges.
Tacey Ann Rosolowski, PhD:
Who is it that works with a patient, such as the one you described who makes $55,000 a year?
John Mendelsohn, MD:
We have intake people that are specialists in this. It’s Patient Services personnel and business office personnel who have training and oversight from business and from the clinical program. It’s a tough job.
Tacey Ann Rosolowski, PhD:
Yes. It’s just the realities of people’s lives and the choices they have to make.
John Mendelsohn, MD:
If you’re from Harris County, now we’ve worked it out so that we can get you quickly admitted to the county system and manage you at that institution. That works out well.
Recommended Citation
Mendelsohn, John MD and Rosolowski, Tacey A. PhD, "Chapter 16: Patients: from the Wealthiest to the Indigent" (2012). Interview Chapters. 1432.
https://openworks.mdanderson.org/mchv_interviewchapters/1432
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