Retail Clinics
Thursday, June 5, 2008The Benefits of Retail Health ClinicsBy Gregory L. SchneiderCategories: Kansas, Retail ClinicsSarah McIntosh, my colleague at the Flint Hills Center for Public Policy, offers Kansans a review of retail health clinics, in a policy paper, Adding Health Care to Your Shopping List: The Emergency of In-Store Clinics (PDF). It discusses the origins of these clinics, their benefits, objections to them, and consumer responses.
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Wednesday, June 4, 2008Don't Get Ill in Illinois: State Medical Society Wants to Reduce Patients' ChoicesFederal Trade Commission rips bill to hobble retail clinics By John R. GrahamCategories: Illinois, Retail ClinicsAt the request of an Illinois state representative, the Federal Trade Commission has cast its eye over HB 5372, an appalling bill that threatens to reduce Illinois residents' choice of where, when, and how they seek out health services. Well aware of the benefits of convenient clinics, the FTC pulls no punches in its report criticizing this anti-competitive bill. The "Retail Health Care Facility Permit Act" sentences convenient clinics to "death by a thousand paperclips": regulations demanding that retail clinics have their own bathrooms (not shared with the host retail store), not be located in stores that sell tobacco or alcohol, and be forbidden from advertising their prices, are the most egregious. Call me crazy, but surely common sense demands that if health professionals choose to provide service where smokers and drinkers get their fixes, it should be encouraged, not outlawed! And banning advertising takes away the main reason why these convenient clinics are such a critical part of consumer-directed health care. Maybe clinics' price transparency will force the physicians to be more creative in how they negotiate payments with health plans, so they can become more transparent themselves. (Actually, I've previously expressed concern about convenient clinics joining health plans' networks, for fear that they will lose the incentive to be price transparent.) Who's behind this appalling legislation? The Illinois State Medical Society, that's who! How self-serving is this legislation? The bill exempts convenient clinics owned by physicians or hospitals from regulation. (It implies that they recognize it's a good business opportunity, at least.) The most galling of the Society's claims is that the retail clinics will treat patients and not inform their primary care physicians of what's happening. The hypothetical case cited is a clinic prescribing an antibiotic that conflicts with medications prescribed by the patient's primary care doc. Excuse me? It seems to me that the Society should be asking itself: "How are we failing to educate our patients, or coordinate their care, such that we are ignorant of treatment they get from other health providers?" I've said it before, and I'll say it again: by opposing the growth of convenient clinics, organized medicine dishonors its profession. HB 5372 deserves a speedy death in the Illinois legislature.
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Wednesday, May 7, 2008Retail Clinic Industry AdjustingBy John LaPlanteCategories: Retail ClinicsHere's a case where a headline can set up expectations. Today's Wall Street Journal says that Health Clinics Inside Stores Likely to Slow Their Growth (subscription required). The headline set me up to expect a gloom-and-doom piece about these businesses, which offer walk-in medical consultations inside Wal-Mart and other stores. Instead, what we learn is that clinic owners have gotten ahead of themselves, with some operators closing clinics and others pulling back on expansion plans. Given the relatively new status of these clinics, none of this is surprising. "In recent months," the Journal says, 69 clinics in 15 states have shut their doors. CVS, meanwhile, has scaled back its plan to open new clinics--from 200 new MinuteClinics to "only" 100 ones. On the other hand, Walgreens expects to stay on course to open over 100 Take Care clinics, doubling the number of retail clinics it operates.Marketing gets a bad wrap from the public in general, but this story is one example of how marketing can be useful: It introduces people to a new concept, or perhaps an old one rediscovered. The effort has been successful. Three years ago there were 125 retail health clinics. Today there are 963.
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Monday, April 7, 2008Retail Clinics Mean Quicker ServiceBy Grace-Marie TurnerCategories: Retail ClinicsThe Houston Chronicle reports that the rise of walk-in clinics at retail outlets and expanded government prescription drug coverage to seniors may be responsible for the shrinking number of patients at the Harris County Hospital District in Texas, which serves as the health care safety net for nearly a third of the county's 3.8 million uninsured residents. District officials pointed to the increasing popularity of in-store clinics that have sprouted at Wal-Marts, CVS stores and retail outlets across the city and nation as a possible source of patient drain. The in-store clinics allow patients to get treated, without an appointment, by physician's assistants and nurse practitioners for minor ailments. Patients who use the district's community health clinics do not receive same-day service, often waiting two weeks to be seen. Another possible cause of the shrinking patient load may be the changes in Medicare prescription drug coverage that took effect two years ago. Before Medicare Part D began, senior citizens without prescription coverage could get medicines when they were treated at district facilities. Now, senior citizens who can get medications at any drug store through Medicare Part D are choosing other health care providers over the district's doctors.
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Tuesday, March 18, 2008What if My Wife Suggests I Whiten my Teeth?NC lets mall kiosks survive to brighten another day By Joseph D. ColettiCategories: North Carolina, Retail ClinicsYou may have seen the teeth whitening kiosks in the mall. You may have even used them. The North Carolina Dental Society raised questions about their safety and the state board of dental examiners wondered whether workers at these kiosks were practicing dentistry. The verdict for now: the state board will handle things on a case-by-case basis.
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Saturday, March 15, 2008Convenient Clinics: Becoming Part of the Problem?Disturbing News: Retail Health Clinics Buying into the Status Quo By John R. GrahamCategories: Retail ClinicsI hate to write this, but there are increasing signs that one of the most significant disruptive forces in American health care today is slowly being sucked into the same old way of doing business. I speak of the convenient clinics. I'm not saying the news is all bad. The Convenient Clinic Association still reports good stories about patients with high-deductible health plans who appreciate the lower costs and higher prices of convenient clinics. However, now that the health plans, a.k.a. the 3rd party payers, are horning in, things are changing. And changing, I fear, for the worse. See CIGNA's recent announcement about expanding its network to include more convenient clinics: "retail clinic claims are processed at the same benefit level as an office visit to a primary care physician. For example, if a CIGNA member's co-insurance for a physician visit is 20 percent and the cost of the service is $60, the member's out-of-pocket cost for a typical visit would be $12." Well, that's just not the way it's supposed to work. In fact, it's horrible because it threatens to turn the convenient clinics into just another cost driver for the 3rd party payers. I suppose CIGNA thinks it can fool people into believing that CIGNA pays the remaining $48, but I hope we all understand that the cost of convenient clinics will now be rolled, opaquely, into our premiums. And that the clinics, like the doctors and hospitals, will start working for the health plans instead of the patients. And what about the uninsured patient? What will he do when the convenient clinic's costs go into an upward spiral, after adding on the costs of bureaucratic complance implicit in belonging to CIGNA's network? And the list price at the convenient clinic starts to look like the hospital's chargemaster? When CIGNA decides the co-pay should be $15, and the convenient clinic increases its list price to $75? And, I contemplate with horror, convenient clinics contracting with the carriers to serve Medicare, with all the lobbying, logrolling, and corruption in that program! Pretty soon, prices at convenient clinics will be as opaque and meaningless as they are elsewhere in American health care. Oh well, maybe this is indiosyncratic and all will be well..... ......but my confidence is shaken. (Nota bene: Lest you think this is an anti-CIGNA rant, I defended the health plan against John Edwards' contemptible accusations that CIGNA caused a young woman's death by denying her a liver transplant).
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Tuesday, March 11, 2008California's Convenient Clinics: Some Win, Some Lose, All ChangeReally, should the state allow such "fragmented" care?!?! By John R. GrahamCategories: California, Retail ClinicsThe Sacramento Business Journal (subscribers only) has surveyed the "drop-in" clinics that have sprouted up around the state's capital city in the last three years or so. It's amazing what a diverse group they are! Sutter Express Care, owned by a large non-profit, hospital chain, has been hoping to use its convenient clinics as a "feeder" for more value-added, hospital-based services. It's not an approach favored by the founder of QuickHealth, a stand-alone chain of clinics located in Wal-Mart, Long's Drugs, and Farmacia Remedios, who believes that people are more loyal to retailers than health-care providers. The entrepreneur in question, Dave Mandelkern, is a businessman who engages physicians, not nurse practitioners, in QuickHealth clinics. Another clinic, Medi-Stop, is owned by two physicians but care is given by nurse practitioners. And it's not in a drugstore, but an office park, to attract workers who want to take a short break (not half a day) from their jobs to get health care. And guess what? Some are succeeding, some are not doing so well, and all are facing conditions a little different than they had expected. Despite California's over-regulated scope of professional practice codes (as discussed in the U.S. Index of Health Ownership) a number of different business models are competing to gain a foothold. How distressing this must be for the central planners of American health care! No Center for Medicare & Medicaid Services regulations & guidance for providers (cash payment only, please); no co-ordinating with the U.S. Secretary of Health & Human Services' 500 (or 5,000) day plan to "transform the health care system"; no compliance with the Office of Statewide Health Planning & Development (OSHPD) Facilities Development Division (FDD) such as burdens hospitals; et cetera. Just entrepreneurs and health care professionals trying to figure out how to deliver care in their communities. How dare they!
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Monday, January 21, 2008Mayo Clinic Enters Convenience Clinic BusinessBy John LaPlanteCategories: Retail ClinicsHere's another sign that convenience clinics are here to stay as a part of the health care industry: the Mayo Clinic will open a shopping center-based clinic in its home town of Rochester, Minnesota. It plans to open similar clinics in the neighboring state of Wisconsin.
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Friday, January 11, 2008Retail Clinics AdvanceBy John LaPlanteCategories: Retail ClinicsNow for something good coming out of Massachusetts: Retail clinics can set up shop, says the Health Blog. Critics complain that these clinics, which offer low-cost, convenient care, offer limited services (that the point) and disrupt the continuity of patient care. But that's exactly the father/Big HMO/Uncle Sam-knows best attitude that we would be well to dispose of. No, these clinics aren't the only way to make health care widespread and affordable. They are, however, a useful element. Kudos for Massachusetts for ignoring the self-serving pleas of those people who would restrict the freedom of consumers to have another option in health care.
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Wednesday, September 12, 2007Gadzooks! A Clever Counter to Convenient ClinicsA doctor responds by changing his practice instead of whining to the state By John R. GrahamCategories: Retail ClinicsSo, there is at least one light in the darkness of organized medicine’s frantic attacks on convenient clinics – those storefront operations, often staffed by nurse practitioners and paid directly by patients, that offer some diagnoses and treatments, .....umm.....conveniently. The Wall Street Journal’s Dr. Benjamin Brewer is rebelling against colleagues in his rural Illinois town by opening up his own clinic, and hiring nurse practitioners to staff it. “Beat the clinics or join them,” writes the good doctor. Dr. Brewer realizes how ridiculous it is for his patients with earaches to go to the hospital ER at $600 a pop because they have no other option after hours. Imagine his patients knowing that if his office is closed, they can go to a clinic run by their own family doctor, where the nurse practitioners will have access to the medical records, and even a professional relationship with Dr. Brewer himself! And if the situation requires follow-up treatment by the doctor during regular hours, he’ll be able to pick up the case right where the nurse practitioner left off. One of the tests of whether you’re on the side of the angels in public policy is how you address competition. Will our friends at the Convenient Care Association lobby the state to prevent Dr. Brewer from opening up his own clinic? I don’t think so. So, convenient clinics are already prompting innovation in primary care practice. What’s next? Somewhere down the line I think we’ll see the end of $600 earaches in ERs, or $1,400 colds (as reported in the Atlanta Journal-Constitution). People talk about the ER as the most expensive place to treat minor ailments, but that’s not quite right. Hospitals have high fixed costs relative to marginal costs, and they have to allocate their overheads. The marginal cost of treating these ailments is not so high. However, the Medicare Prospective Payment System and other government regulations demand an esoteric and Byzantine approach to pricing and billing for procedures and supplies. Once the $600 earaches disappear from the ERs, the hospitals lose an input to their algorithms for determining the prices they charge everyone else. So, they might become a little more creative (a.k.a. free-market oriented) with their public policy goals. Of course, if I held my breath waiting for hospitals to break free of their government dependency I’d turn blue and pass out first – in which case I’m sure I’d get great treatment at Dr. Brewer’s new clinic!
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