Fruit Selection Etiquette

Here’s a contradiction of social norms for you to ponder…

If you are standing behind someone in the produce section of the grocery store, it is perfectly normal for them to closely examine the pile of cantaloupes, sniffing and squeezing away, taking the best ones and putting any sub-par melons back for the next sucker – you.

But if you’re in line for the catered lunch at your meeting and the dude in front of you stops at the fruit salad to pick out the best strawberries, leaving you only honeydew and pineapple chunks, you will think he is a bit rude.

‘Cherry-picking’ turns out to be more OK in some situations than others.  I am relatively confident I am the only person who woke up today pondering the implications of this inconsistency, but join me for a moment.

The CEO of the Mayo Clinic made a little news by acknowledging this practice, maybe a little too directly. Actually, it was in a speech to his staff last year when Dr. John Noseworthy said that Mayo would ‘prioritize’ commercial insurance patients over Medicare and Medicaid patients.  It was just recently reported by the Minneapolis Star Tribune when the paper got ahold of a transcript of the talk.

Dr. Noseworthy said that while the system would, of course, continue to provide care to all patient, when there was discretion and all other things being equal, Mayo would give preference to those patients with better paying commercial insurance over those covered by a lowering paying government program.

He was clear on the reason behind this policy – the organization must take steps to remain financially strong if it is to continue its mission.  Mayo made $475 million on $11 billion in revenue in 2016, a 4.3% operating margin. Besides what it spends on research and education, Mayo provided $630 million in charity care and invested $600 million on capital expenditures for the future.

No margin, no mission.

That a provider would do this is not news per se (No!  Really?), but that the top dog at a place with the Clinic’s reputation said it so matter-of-factly seemed a little shocking.

Depending on your point of view, Mayo is either wise and prudent, just looking for the best apples, or they are downright unethical, selfishly plucking the fresh kiwi from the fruit salad.

Fortunately, this story is about the esteemed Mayo Clinic because it raises a legitimate decision making conundrum in a way that allows us to actually talk about it.  If your practice has not worked through this issue and made an intentional decision on where you stand, you should – is it OK to selectively search for good fruit, or should you just stick the spoon in the fruit salad and take what you get?


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Tim Coan, ALN’s CEO, writes an insightful and witty blog three times a week about a variety of topics relevant to independent physician practices.

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