Hospital system pulls out of retail clinic deal

A St. Louis-based health system says it will terminate a contract to provide doctors to oversee retail-based health clinics in the area.

SSM Health Care has announced that it will end the deal in which its doctors supervise nurse practitioners working at in-store clinics operating out of nine Walgreens stores in St. Louis. The contract, which started in July, is with Take Care Health Systems. SSM will stop providing those services to the Conshohocken, Pa.-based company effective Feb. 1, 2007.

"Our decision is about listening to, and respecting, the concerns of our physicians," according to a letter dated Oct. 10 that SSM CEO Ronald J. Levy sent to the health system's medical staff. "We continue to believe that retail-based health clinics like Take Care Health are being developed in response to the growing consumer demand for convenient and accessible health care services, particularly for those who don't have a primary medical home."

Despite that sentiment, SSM reconsidered its partnership with Take Care because "an increasing number of physicians, particularly pediatricians, have voiced concerns about retail-based health clinics," Levy wrote.

SSM declined to elaborate on the nature of those concerns, referring AMNews to the letter.

But SSM spokeswoman Stacey Thomson said the doctors who complained were not employed by SSM and weren't asked to help out with the in-store clinics. "It was a different group of physicians who referred patients to our network who opposed the [in-store clinic] model. SSM as a whole still very much believes in this model. It's a great thing for the environment in and of itself, but we have to listen to our physicians and that's what we did."

The St. Louis Metropolitan Medical Society welcomed SSM's decision. It says it has concerns about continuity-of-care and quality-of-care issues related to in-store clinics.

"We were glad to see it happen," said Ravi S. Johar, MD, the medical society's president. Dr. Johar is an ob-gyn at a 32-doctor multispecialty group owned by SSM. Some doctors in his group had signed agreements earlier this year to supervise Take Care's nurse practitioners. Missouri is among several states that require nurse practitioners to have such agreements in place before they can treat patients.

"The opposition came from physicians in general," said Dr. Johar, who did not supervise Take Care staff, and said he was speaking for the medical society. "The most vocal and organized were the pediatricians both within the group as well as outside the group. ... They felt kids were targeted a lot in this model."

Take Care, which recently pulled out of a half-dozen Rite Aid drug stores in Oregon because it was unable to make money there, blamed a "small vocal minority" of physicians for SSM's decision.

"It's just unfortunate that SSM felt the need, based on listening to their physicians, to end their formal collaborative practice arrangement with us," said Peter Miller, CEO of Take Care. "Every market we have entered, there is a small vocal minority that frankly, largely for economic reasons, feels threatened by us."

Dr. Johar, however, said that physicians' opposition wasn't rooted in economics. "I think that they opposed this from more than just a business standpoint," he said. "They feel like this is just not good medicine. ... They feel this is not good continuity of care; it's not good patient-physician relationship; and I think they had a lot of concerns from that standpoint more so than anything else."

During its Annual Meeting in June, the AMA's House of Delegates set policy on in-store clinics. The policy does not come out directly against the facilities but states the AMA's belief that in-store clinics are no substitute for a long-term relationship with a doctor. The policy also sets guidelines for clinic operation -- including having well-defined limits of what they will treat and opportunities for them to refer patients to physicians -- and asks the AMA to monitor clinics' effect on the health marketplace and report its findings back to the House.

SSM's decision will not cause any disruption in Take Care's ability to operate in St. Louis, comply with Missouri regulations and deliver care, Miller said. Take Care plans to work with SSM doctors who have been supervising its staff as well as other community physicians, some of whom have already inquired about filling in for SSM, he said.

Doctors employed by SSM are free to decide whether to continue their relationship with Take Care on an independent basis, Thomson said.