Southeastern Retina Associates stopped treating babies at JCMC after several months of negotiations with Mountain States Health Alliance officials. Citing rising premiums, the group had demanded that the hospital help pay for their doctors' malpractice costs or else risk losing its services.
"That was an aberrant request that we'd never seen before," said Lisa Smithgall, vice president of women's and children's services for MSHA.
Hospital officials argued that they could not legally pay for the doctors' insurance outright, and even if they could, the agreement would set a dangerous precedent that would encourage other subspecialists to make the same demands.
An agreement between MSHA and Southeastern Retina was never reached, so the group withdrew its services from JCMC, forcing the hospital to send babies to Nashville for eye exams for nearly three months while they worked on a new solution.
Eye exams are important for babies born at 32 weeks gestation or less, or weighing less than 1,500 grams. These babies need to be watched carefully for a potentially blinding eye disease known as retinopathy of prematurity. Many babies meet the criteria for regular exams, especially at a hospital like JCMC, which cares for many of the region's premature babies. A few of those babies will require a surgery to prevent blindness, which can only be done by a specially trained eye surgeon.
In September, JCMC officials reached an agreement with Vanderbilt to send doctors to Johnson City every other week to perform the exams, allowing the often-delicate preemies to stay where they are.
"They come here and do the in-hospital exam for all of the babies that are due (for an exam)," said Smithgall. "Sometimes it's one baby, but as of last week there were seven babies that were being seen."
"We're thrilled to be able to come and help," said Dr. David Morrison, assistant professor of ophthalmology and pediatrics at Vanderbilt Children's Hospital.
"We've been well-received by the folks at the Johnson City Medical Center."
The doctors are reimbursed by the hospital for their travel and time away from their home practice. Hospital officials would not disclose the exact dollar amount in the agreement, but Smithgall said the money spent by the hospital is worth the benefit for Johnson City patients.
"It's a dollar amount we have to pay because it's a critical service for our babies," she said.
About four to six babies at JCMC will require eye surgery each year, Smithgall said, and according to the terms of the current arrangement with Vanderbilt, those babies will still have to travel to Nashville for the actual procedure.
"We have the equipment and we have the staff to do it, but that's (the Vanderbilt doctors') preference. And because they're doing us this huge favor, we're willing to concede that at this time," Smithgall said.
Babies who need follow-up eye exams after being discharged from JCMC will also need to travel to Nashville, Smithgall said. After discharge, however, it will be up to the parents to make sure the babies get exams on time.
While the new agreement with Vanderbilt is much better than the situation the hospital was faced with last summer, Smithgall agreed that the arrangement is not 100 percent ideal.
"Would we rather have a physician in this area perform the service and bill for his own services? Yes, we would. ... Our goal is that we would eventually have someone in our region that will provide this service so we wouldn't have to do this."
Smithgall said East Tennessee State University is currently working to recruit a pediatric ophthalmologist who would practice locally and provide services at JCMC.