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Fam Pract Manag. 2006;13(10):22-24

Take Care clinics in Portland close quickly

Anyone predicting a quick demise for retail health clinics received a glimmer of hope recently out of Portland. That's where Take Care Health Clinics in September closed the last of its 10 clinics, less than one year after opening them in Portland-area Rite Aid stores.

The closures were brought about by “high turnover, low patient volumes, poor clinic locations and a troubled electronic health record system,” according to a Sept. 22 report in the Portland Business Journal.

Before their critics read too much into the closings, Take Care officials were quick to say that their other locations in the Kansas City, Pittsburgh and St. Louis areas have been successful.

“We are committed to our model of care,” Take Care spokeswoman Lauren Tierney said in a Sept. 25 DSN Retailing Today article. “We have firm confidence in our ability to execute this in other markets.”

Confidence runs high among the major retail clinic chains, which have all announced aggressive nationwide expansions in the next few years. Take Care told FPM in May that it plans to open 1,400 clinics by the end of 2008.

For its part, Rite Aid was undaunted by Take Care's departure from Portland.

“We are in serious discussions with a widely recognized in-store health provider to open clinics in the same Portland pharmacies as soon as possible,” Rite Aid spokeswoman Jody Cook told the Portland Business Journal.

Another flu season, another vaccine delay

Although an estimated 75 million doses of flu vaccine were distributed as of October, according to the Centers for Disease Control and Prevention (CDC), many physician offices are still awaiting their full supply. The CDC reports that because manufacturers are producing vaccine at or near full capacity, orders are being distributed in phases. Most physicians should receive their entire vaccine order by late November. The CDC is urging physician offices to vaccinate patients even in December, January and beyond, as influenza season typically peaks in February.

Physician offices experiencing a vaccine shortage may want to consider using the live attenuated influenza vaccine, which reportedly has had no supply problems to date. The product is indicated for use by most adult patients and health care workers. For more information, visit

Study examines surveys of EHR usage

A recent study of high- or medium-quality surveys on electronic health records (EHRs) published in Health Affairs estimated that about 24 percent of physicians use EHRs in the ambulatory setting. When the study was narrowed to those EHRs that include at least four core features (including electronic documentation of providers' notes, electronic viewing of lab and radiology results, and electronic prescribing, as identified by the Institute of Medicine), the adoption rate dropped to 9 percent of physicians.

IOM issues report on pay for performance in Medicare

A recent report from the Institute of Medicine (IOM) suggests that Medicare pay-for-performance incentives have the potential to encourage higher levels of quality and should be implemented, but they should be monitored closely for adverse consequences.

The IOM report offered 10 recommendations, including the following:

  1. Medicare should implement pay for performance using a phased approach: “rewarding performance in selected settings, with a small level of funding, on specific measures, moving eventually to include all provider settings, with a larger level of funding, on more measures.”

  2. Initial funding (over the next three to five years) should come from existing funds via a reduction in the base Medicare payments for each class of providers, including physicians.

  3. The program should initially reward both those who achieve high levels of performance and those who improve significantly.

  4. The program should pay for and reward successful coordination of care.

The complete report is available online at

Physicians clash with United over contracts, payments, policies

While United Health Group isn't the only company clashing with physicians over contracts and payment issues, it recently has had its fair share of controversies.

Contracting battle. In California, United has been aggressively rebuilding its provider network during the past year after acquiring PacifiCare and being told by the U.S. Department of Justice that it could no longer lease much of its network from Blue Shield of California.

According to an Oct. 13 report by the San Francisco Business Times, the process of recontracting with the state's physicians has not gone smoothly. A consultant at Physician Focus Inc., which handles negotiations for medical practices, was quoted as saying that United is paying some groups at rates “well below Medicare on what they say are existing PacifiCare contracts.” The source predicts that as more physicians catch on, “more terminations of [United/PacifiCare] contracts are on the horizon.”

Class-action lawsuit. In New York, a group of 11 doctors and the state medical society have filed a class-action lawsuit against United and several of its affiliates, including Oxford Health Plans, alleging that the health plans are “using the combined economic muscle created by their recent affiliation … to extract significant financial concessions from physicians and to impose Herculean administrative burdens upon them.” The plans are reportedly terminating contracts with any physician who does not agree to become a provider for both United and Oxford.

A similar lawsuit was filed by a group of Connecticut doctors in August 2005.

Radiology notification. To “promote appropriate and rational use of imaging services,” United has launched the Radiology Notification Program, which requires “prior notification” (as opposed to prior authorization) for CT scans, MRIs, MRAs, PET scans and nuclear medicine studies. Under the program, physicians do not have to obtain United's approval for the services, but they do have to contact United prior to ordering or performing the services and must receive a notification number. Failure to do so will result in the claim being denied. The program is currently being pilot tested in six states.

Physicians who have received United's “Premium” designation for reaching quality and efficiency performance measures are exempt from the Radiology Notification Program. The designation is awarded annually, usually during the summer or fall.

Stock-options inquiry. In October, United's CEO William McGuire resigned amid a stock-options controversy. Under the terms of his resignation, McGuire reportedly agreed to reprice a portion of his $1.6 billion in stock options. An independent review recently found that some backdated stock options had been inappropriately accounted for and United may be required to revise its past earnings reports.

The Securities and Exchange Commission, the Minnesota Attorney General, a New York federal prosecutor and the Internal Revenue Service are also reportedly investigating the company's stock options.

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