Scripps Clinic Reaches Contract Agreement With Its HMOs, Fails to Move Completely to Fee-For-Service Payments

Scripps Clinic has reached contract agreements with all six of its health maintenance organizations, ending the possibility of a disruption in services for 120,000 patients in San Diego, the San Diego Union-Tribune reports. Most recently, the clinic came to terms with Aetna and PacifiCare after "difficult negotiations" over the clinic's attempt to move from a capitation payment system to fee-for-service reimbursement. Scripps had wanted to switch reimbursement systems to improve its financial situation, officials said. Marc Reynolds, senior vice president for Scripps Health, the hospital system affiliated with the clinic, said, "We wanted to get out of risk in January 2002. In the middle of negotiations, we had to realize that the local employer community had made commitments" that prevented a "complete change-over." While clinic officials did not comment on the terms of the new contracts, Reynolds said that the clinic was not "completely successful" in moving to a fee-for-service system. Although Reynolds said that most of the clinic's HMO patients are in health plans that reimburse on a fee-for-service basis, the Union-Tribune reports that only Cigna has confirmed that it is making the switch to fee-for-service reimbursement. Of the six HMOs contracting with Scripps, Blue Cross and Aetna were the "most steadfast" in refusing to switch to fee-for-service payments (Fong, San Diego Union-Tribune, 12/18).