Northwestern Medical Center sheds Medicaid-heavy pediatric clinic

Northwestern Medical Center in St. Albans on June 21, 2021. File photo by Glenn Russell/VTDigger

Northwestern Medical Center has ended its affiliation with a pediatric clinic it bought just five years ago. The hospital in St. Albans absorbed the struggling independent clinic in 2016 to keep it afloat financially.

But last month, the rural hospital quietly separated from the practice. 

Northwestern Pediatrics became Monarch Maples Pediatrics, and hospital officials published a short statement celebrating the change, which they said would serve the community well.

The reasons for the transition are in dispute. The five pediatricians who now own the clinic say the hospital pushed them out because the clinic was losing money. Northwestern’s chief executive disputes that assertion.

“This isn’t a contraction of pediatric services,” CEO Dean French said. “It’s an expansion.” 

No one disputes, however, that keeping the fledgling independent clinic afloat would be an uphill battle. Tracy Tyson, a pediatrician co-owner at Monarch, said the clinic cares for more than 8,000 children and adolescents in St. Albans and Enosburg, both areas with very high Medicaid enrollment.  

With the change in ownership, Monarch is essentially at the mercy of the same economic tides that put the clinic under in 2016. Without the financial backing of a larger institution, the pediatricians would have to see many patients each day to keep the clinic solvent. Even so, the physicians had to take a pay cut in the transition, according to Tyson.

The clinic’s payer mix could also be a problem. Medicaid pays doctors less than private insurance, and private practices that have a lot of Medicaid patients tend to struggle financially. 

“I don’t know what this community would do without this practice,” Tyson said. “There’s so many families that would be really, really significantly harmed if we were not able to stay successful.” 

In its notice to regulators at the Green Mountain Care Board, Northwestern said Monarch’s independence would allow for “a financially sustainable model that will ensure long-term access to high quality pediatric services” in rural Franklin County. 

Northwestern bought the clinic, then called Mousetrap Pediatrics, in 2016. The move was hailed as a major win at the time, because it kept a valuable service in the community. But sometime last year, Tyson said, hospital administrators told staff the clinic was losing money. 

However, French said the physicians chose to leave because they disliked dividing their time between primary care and hospital work. He said the physicians chose to become independent over affiliating with another organization. 

French wouldn’t speculate on the pediatric clinic’s long-term survival. 

“I can’t answer that question. They made that decision to go back,” he added. “We were looking at a different solution to set out a different structure that we thought was sustainable. That’s not the solution they chose.”

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