In July, US News and World Report ranked the Mayo Clinic in Rochester, Minn., as the nation’s best hospital for the seventh consecutive year.
Looking more closely at how US News assessed hospitals, reporters at Rochester’s daily newspaper, the Post Bulletin, noticed that on the issue of health equity, the Mayo Clinic was ranked significantly lower than other hospitals. The editors at US News defined charity care as, “How well hospital spending on free and discounted care for uninsured patients aligns with the proportion of uninsured in the surrounding community.”
Since September, Molly Castle Work, an award-winning investigative journalist (@mollycastlework), for the Post Bulletin, has published at least six articles about the Mayo Clinic and charity care.
After the Post Bulletin broke the story, Minnesota Attorney General Keith Ellison said the staff in his office would investigate Mayo’s aggressive billing and collection practices. And the state legislature has begun work on making hospital financial assistance accessible to more patients this year.
For this “How I did it” Work explains her efforts and the results she’s seen to date. This conversation has been edited for clarity and brevity.
After reading the court records showing that the Mayo Clinic had sued patients and interviewing one such patient, your editor encouraged you to pursue the story. What happened next?
After that first call, I wanted to interview more Mayo patients to see if these suits were part of a pattern. The court records showed that Mayo sued more than 100 patients for unpaid bills last year. I called each one who had a phone number listed in the lawsuit files. I had to call most of them two or three times because I got a lot of voicemails and wrong numbers. But some were willing to talk and share their experiences.
Several patients spoke to me for over an hour, despite the sensitive nature of getting sued for being unable to pay medical bills. One of the most difficult conversations was with a mother whose daughter had died and was later sued by Mayo Clinic for her unpaid medical debt.
I had data on the average lawsuit amount and the variety of claims filed. From October 2021 through October 2022, the total amount Mayo sought to recover totaled 0.01% of its annual revenue.
Over a little less than two months, I interviewed 20 patients. Then, I started calling experts who could provide context. Also, of course, I contacted the Mayo Clinic.
What strategies do you suggest for journalists doing similar work?
First, I recommend using public records. Minnesota’s court records allowed me to gather all sorts of data easily. Second, choose lead characters for the story who are memorable and who allow you to see patterns in your interviews. Whenever possible, use data to support the narrative.
Third, I learned not to be afraid to ask difficult questions. Initially, I was nervous about calling patients because I assumed incorrectly that they wouldn’t want to share personal details. These patients wanted to share their stories and surprised me with the depth of our conversations.
Do you have any advice for reporters investigating prestigious hospitals such as the Mayo Clinic?
Don’t be intimidated. Our job is to hold the powerful accountable. As a resident of Rochester, I’m in awe of the incredible work Mayo Clinic does every day for its patients and the many reasons Mayo has earned the best hospital rank for seven years running. At the same time, it’s important to show there’s room for improvement.
It also helps to be as detail-oriented as possible in your reporting and to provide context whenever possible. Find out, for example, if the institution is the only one taking aggressive collection action and if the hospital is worse or better than others. Can you compare them fairly to their peers? When answering these questions, use data whenever possible.
And of course, have a colleague and editor fact-check your work. Before publication, my editor and our in-house lawyer reviewed my articles.
Why did you contact state Attorney General Ellison and how did he respond?
After the first story was published, a source recommended I share it with Ellison’s office. When I did, I asked what the Attorney General’s office would do about financial assistance and hospital billing. Ellison said, “We are thinking about ways to do more to highlight the existence of charity care.”
How did readers and Mayo react after your stories were published?
Mostly, readers have reacted positively. Usually, I hear from a few readers after a big story, but dozens reached out this time. Hospital billing practices are a personal topic, which makes sense since four in 10 U.S. adults have medical debt.
Also, the coverage was featured in two articles the Lown Institute published, “Medical bills can be crippling. Mayo Clinic’s charity care? Arguably lacking,” and “How some hospitals put up barriers to financial assistance,” and it was included in the Local Matters weekly newsletter from Investigative Reporters and Editors.
One of the most interesting developments was that a Mayo Clinic doctor reached out to me via Twitter to say he’d followed my reporting and had formed a workgroup inside Mayo to address the issue. Also, a source told me recently that Mayo revised its policies for a period when she could have qualified for financial assistance and refunded her more than $700.