The Free Press, Mankato, MN

January 16, 2013

St. Peter hospital, clinic accuse Mayo of questionable business practices

By Robb Murray
Free Press Staff Writer

ST PETER — When it happened to her friend, Colleen Spike had had enough.

Spike, the CEO of River’s Edge Hospital and Clinic in St. Peter, says she and other staff for the past few years have been hearing stories about questionable businesses practices by Mayo Clinic Health System.

What kind of stories?

Patients being told by Mayo Clinic Health System staff that the city-owned River’s Edge is full and their only recourse is to use a Mayo hospital such as the one in Mankato or Waseca. Or patients being told River’s Edge isn’t certified to do certain procedures or that they don’t offer a specific type of test.

But Spike says that something her 88-year-old friend told her over lunch one day was among the final straws: The friend, a Mayo Clinic Health System in St. Peter patient, said she was told she needed an ultrasound. But when she said she wanted to have it done at River’s Edge, the scheduler told her River’s Edge doesn’t perform ultrasounds.

Spike says she told her friend the ultrasound could very well have been performed that day and that they do ultrasounds all the time.

“She said, ‘Colleen, did they lie to me?’” Spike said in an interview this week. “And the answer is yes.”

That story, and many more, prompted Spike to write a letter to Minnesota Attorney General Lori Swanson requesting an official investigation into Mayo Clinic Health System. She wants Swanson to look into allegations of MCHS staff falsely telling patients the St. Peter hospital was full, or telling patients that River’s Edge staff couldn’t do certain procedures such as ultrasounds, or weren’t certified to carry out certain tests such as mammograms and echocardiograms.

“We have now reached a point where someone has to listen to our concerns,” Spike’s letter to Swanson says. “The Mayo Clinic Health System has become very silently and swiftly a dangerous monopoly in rural southern Minnesota and we are seeking your assistance. … The communities of St. Peter, Fairmont and Springfield have been challenged and ravaged over the past several years by MCHS-Mankato’s predatory threats, restraint of trade practices, attempts to monopolize the market and deceptive trade practices.”

Since penning that letter, and going public with her concerns in an article published in the St. Peter Herald, the health care community in St. Peter has been abuzz with the flap between Mayo and River’s Edge, a community hospital owned by the city.

 Mayo Clinic Health System denies all allegations. They say they never made false claims about River’s Edge. An MCHS official has attended recent hospital commission meetings and refuted Spike’s claims.

This week Mayo Clinic Health System spokesman Kevin Burns released a statement about the Mayo/River’s Edge situation. He said they have not been contacted by the attorney general or her office.

“Our medical practice has been in place in St. Peter for over 80 years, and we have always supported the community’s hospital,” Burns said. “In fact, last year, 75 percent of all admissions to River’s Edge Hospital came from Mayo Clinic Health System providers. In this era of tremendous change in health care, we are committed to strengthening communication with all health care partners in St. Peter in order to deliver on our primary value — the needs of the patient come first.

“In short, we are proud of our record and will continue to work within the communities we serve, including with the hospital commission and others in St. Peter, to solve the problems of providing better health care at lower costs.”

Spike said she understands that health care is a business. And she concedes that each example, on its own, can be chalked up to honest mistakes or sloppiness.

But after collecting example after example of similar “mistakes,” she says, she’s convinced they aren’t mistakes at all but are the manifestation of a concerted effort by Mayo Clinic Health System to crush the competition.

Spike, who has been in St. Peter for 15 years and in health care for 40, said the relationship between St. Peter’s hospital and Mayo had for years been a good one. She says it soured a few years ago when a Mayo executive told her flat out its plans.

“We had refused to become part of Mayo,” Spike said. “And he said ‘We will take you down.’”

The Free Press was unable to contact that executive.

When asked why she didn’t seek redress at that time, Spike said she didn’t want to make waves.

“I never really wanted to bring this into the public. To me it was kind of like airing your dirty laundry in the public,” Spike said. “And you learn early on, it’s difficult to say no to Mayo.”

Ever since that conversation with the executive, Spike says, the working relationship with Mayo has grown rocky.

One of the biggest issues surrounds the concept of so-called “swing beds,” a term that refers to the legal ability of small rural hospitals to offer hospital beds to people who need a three to five days of rehabilitation following surgery or hospitalization in a larger hospital. Swing beds are covered by Medicare and Medicaid.

The swing-bed concept is very important to River’s Edge. Spike says the same doctor who vowed to “take them down” also told her they’d no longer be referring patients to River’s Edge for swing-bed care.

Mayo Clinic Health System, as Burns said, is responsible for 75 percent of all admissions to River’s Edge. But the number of swing-bed admissions has dropped somewhat, from a height of 140 in 2008 to a low of a little over 100 in 2010.

Other figures have dropped, as well.

Acute admissions have gone from more than 600 in 2004 to about 250 in 2012. The number of echocardiograms performed at River’s Edge has gone from about 800 in 2004 to about 100 in 2012. Ultrasounds, nearly 1,600 in 2004, about 550 in 2012.

Financially, the hospital is struggling overall.

St. Peter City Administrator Todd Prafke said that it’s operating at a deficit of about $1 million, although Spike put that figure at closer to $1.6 million.

Several years ago, Prafke said, it was a different story. The hospital was running year-to-year surpluses. But the hospital business, like any other, has ebbs and flows. Right now, it’s in an ebb.

Prafke said that last summer when Spike announced her retirement at the end of fiscal year 2013 (which will be at the end of June,) they revisited the issue of potentially selling River’s Edge to a larger provider. Prafke himself analyzed the issue and recommended to the hospital commission — of which neither he nor Spike are voting members — to stick with the current situation … for now.

“That could change in two years,” he said.

If they did sell, they wouldn’t be the first. In fact, a lot of smaller community hospitals have opted to sell to larger entities. In Waseca, formerly a community hospital, their governing board opted to sell to Mayo Clinic Health System, as did hospitals in Springfield, New Prague and Madelia. In New Ulm, the hospital opted to sell to Allina, another health care giant.

In addition to full-scale sell off, there are other, smaller levels of partnering that Prafke says go on all the time, including granting physicians privileges to work there. He cited one example of a North Mankato physician who performs bariatric surgeries, but isn’t a member of the hospital’s medical staff. They also partner with the Orthopaedic and Fracture Clinic in Mankato.

In the aftermath of the situation between Mayo and River’s Edge, a new effort has been planned to come up with recommendations to strengthen communication between the two and address concerns that may come up.

An editorial published in the Herald said, “We appreciate the quick action of those on both sides of the issue as well as their willingness to step back and put patients’ needs first. A protracted argument and finger-pointing would have been in no one and no entity’s best interest — not the city of St. Peter, not MCHS, not River’s Edge Hospital and certainly not all of us who rely on their services.”

Spike says the most important part of health care is doing what’s right for patients. For the residents of St. Peter, she said, the best thing for them will be making sure they’re able to get the care they want where they want, and if they want it in St. Peter, they should have that chance.

When the hospital was built in 2004, it was done with the help of a referendum in which 82 percent of voters said yes to it. That is evidence, Spike says, that people want to use it.

As for the attorney general and an investigation, Swanson’s office did not return phone calls from The Free Press for this report. Spike, however, says they’ve responded to her and have called her back twice to request more information.

She says it all makes her nervous, but it’s worth it.

“When I put my signature on that letter, my heart was pounding. We are a 17-bed hospital taking Mayo Clinic Health System to task,” she said. “I knew that organization when it was good. It does good things, it does wonderful things for health care. But that doesn’t mean that it doesn’t go astray. And it has gone astray.”