Arnold Vision closing

This, they say, is the result of an anticompetitive medical community, dominated by CoxHealth and St. John’s Health System.

“Cox and St. John’s have kind of divided the medical community,” said Dr. Paul Arnold, an ophthalmologist who owns Arnold Vision, 1011 E. Montclair St., with his ophthalmologist wife, Dr. Priscilla Arnold. “We were cut off from all referrals from both health systems.”

The Arnolds weren’t novice clinic owners or doctors when they opened Arnold Vision in June 2004.

Both had both practiced ophthalmology for more than 25 years, and both had been named one of the Best Doctors in America by Boston-based Best Doctors Inc. Priscilla Arnold received the honor this year.

Paul Arnold even built his own facility in 1990 at 1265 E. Primrose St. before selling it in 1999 to four colleagues, who now operate Mattax Neu Prater Eye Center at that location.

Changes in the medical community during the last decade, however, spelled doom for Arnold Vision, he said.

Changing times

Arnold said he performed about 100 cataract surgeries – his bread-and-butter service – each month in the 1990s, when he also worked as an independent physician at his former practice, Arnold Eye Care Center. Now, he performs about 15 each month, a decline he attributes to the rise of managed care and consolidation of clinics.

Cox and St. John’s offer insurance products and contract with many employers in and around Springfield to offer exclusive, in-network managed care.

Nationally, managed care became the “predominant” form of health care during the last decade, according to National Conference of State Legislatures. The bipartisan organization estimates that more than 70 million Americans are enrolled in health maintenance organizations and almost 90 million are part of preferred provider organizations.

Arnold said businesses and insurance companies look for “large, integrated entities” that they believe will provide economy of scale. This hurts independent doctors, he said.

“I think that health care delivery has become more restricted in the past eight or nine years,” said Dr. Thomas Prater, co-owner of Mattax Neu Prater Eye Center, which also is independent from Cox and St. John’s.

While Prater said his practice receives referrals from Springfield’s two health systems, independent orthopedist Dr. Michael Clarke said his does not.

“It (is) pretty hard, because there are just so many people in town who can’t come to see you,” said Clarke, owner of Clarke Orthopedic Clinic and Clarke Surgical Center, 3150 S. National Ave.

“It’s getting to where new doctors who come to Springfield really can’t practice unless they’re in with the hospitals,” Clarke said. “It’s really nasty – nasty as it could be.”

Clarke said his practice is doing well, due to more than 25 years of building a patient base.

Clarke also gets patient referrals from out-of-town, independent doctors.

Arnold said doctors once acted like “free agents” who could practice at any of the hospitals in town. “They went wherever their patients wanted to go,” he said.

Now, Clarke said the health systems make scheduling surgical rooms difficult and don’t provide access to adequate equipment or support staff in an effort to stifle competition from independent doctors.

When asked about the state of market competition in Springfield health care, CoxHealth officials offered this statement: “Large or small, all health care providers continue to struggle in this market to remain competitive in an environment of poor reimbursement from Medicare and Medicaid.”

St. John’s has been an integrated health system since 1993, according to spokeswoman Cora Scott.

Scott said St. John’s has about 470 doctors on staff and about 500 more contracted in its network.

“We feel very strongly that an integrated system gives better benefits to patients,” said Scott, citing efficiency and better continuity of care.

She also said St. John’s doesn’t have a policy that restricts referrals to independent doctors, though out-of-network fees could apply.

“That decision is pretty much between a physician and a patient,” she said.

Arnold wants Missouri to enact an “any willing provider law,” which would prohibit health insurers from ostracizing independent physicians. About 20 states, including border states Illinois, Kentucky and Tennessee, have such laws.

“This would allow any physician who is qualified and accepts the terms of the insurance provider to participate on the provider panel,” Arnold said. “I think this may have helped prevent our demise, and (it would) provided patients with a greater selection of providers.”

Future plans

The Arnolds haven’t hired a real estate agent to sell their 10,500-square-foot building, but they are talking to interested doctors and physician groups. Arnold said they’re seeking $3 million for the facility, which was designed by Butler, Rosenbury & Partners and built by Wirt Construction Co.

They are asking another $700,000 for their equipment.

The Arnolds don’t plan to open another clinic. Instead, they’ll go to work at an existing clinic somewhere other than Springfield. They hope to have their building sold before they move, Arnold said.

“It’s just a shame we lost the Arnolds,” Clarke said. “They’re just first-class people and very good ophthalmologists.”[[In-content Ad]]