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What a primary care, concierge medicine practice can learn from neighborhood retail clinics …

WHAT ABOUT THE IMPACT OF RETAIL MEDICINE in our local neighborhood and providing more convenient access to a primary care doctor?

By Michael Tetreault, Editor

AUGUST 23, 2013 – Retail medicine and price transparency are quite possibly the future of affordable health care in the U.S. Like most large pharmacies, the creators of ‘Retail Medicine’ understood years ago the need for affordable, convenient and price-driven access to healthcare.

“Until retail and concierge medicine came along, we would blindly walk into a doctor’s office or hospital and not know (or in many cases, care) about how much things cost,” says Catherine Sykes, Managing Director of Concierge Medicine Today. “We don’t purchase our homes, our vehicles or other services in this way. It’s time we stop using our health insurance card as a form of credit.”

A lot of modern health care medical centers and physicians across the U.S. are now starting to show their prices to their patients before they sit down for a visit. Dermatology offices and direct primary care clinics are a good example. Until recently, hospitals, primary care and other health care specialties were one of the only segments in the U.S. that rarely listed how much their fees were for their time, services and products.

“Maybe we should be examining why our patients would rather go to a retail clinic that see us (their primary care doctors),” said Dr. Rob Nelson, a direct primary care physician in Cumming, GA, a suburb of Atlanta, GA. “Here are just a few of the comments I hear from PCP [primary care physician] patients as to why they come to the retail care centers instead of their primary care physician: my PCP doctor couldn’t get me in; my PCP doesn’t do stitches anymore; my PCP doesn’t do x-rays in office; my PCP doesn’t take walk-in patients; my PCP usually refers me to specialist for everything anyway; and my won’t return my calls.”

As the healthcare system prepares to cope with an influx of 30 million Americans who will have health coverage as a result of the Affordable Care Act, a surging market of retail clinics is poised to take on a wider role to relieve the bottleneck. According to a recent article by Bill Malone in the AACC, he writes ‘Retail clinics are also adding new tests that go far beyond caring for scraped knees and scratchy throats. The growing list of tests includes lipid panels, HbA1c, microalbumin, HIV, fecal occult blood, influenza A and B, and even screening for methicillin-resistant Staphylococcus aureus. Clinics offer many of these tests as part of adult and child physicals, and more recently, Medicare wellness visits, and more.’

The article also notes that the expected influx of newly insured patients under the Affordable Care Act provides both opportunity and uncertainty for the retail clinic model, according to the lead author of the study, Ateev Mehrotra, MD.

“If more people are seeking primary care, and there is no dramatic increase in the number of primary care physicians, we could face a situation of increased demand and worsening access. Without an alternative, more patients may go to a retail clinic,” he said. “The flipside is that a significant segment of patients who go to a retail clinic don’t have a primary care physician. If under healthcare reform more people gain access to primary care physicians, it’s still possible they could choose the physician’s office over the retail clinic.” Mehrotra is a policy analyst at the RAND Corporation and an associate professor of medicine at the University of Pittsburgh School of Medicine.

According to Cain, family physicians have responded to the demand for greater flexibility by expanding access to appointments. “Family doctors have responded so that about 75 percent of their offices have open-access, same-day appointments and about half have evening or weekend office hours,” he said. Results from an AAFP physician survey also found that about 31% of respondents offered weekend appointments.  Both AMA and AAFP are urging insurers not to give patients an incentive to use retail clinics, warning of the potential for duplicative tests and treatments, higher costs, and lower quality.

As retail clinics have grown in number and ventured into the sphere of chronic disease management, they have also met with stern criticism from some physician groups, such as the American Medical Association (AMA) and the American Academy of Family Physicians (AAFP).  AAFP has been vocal in opposing any expansion of the scope of service in retail clinics that approaches managing chronic conditions. It believes that high quality and coordinated care depend on relationships with primary care physicians—a relationship with which retail clinics interfere. 

“AAFP believes that the best healthcare comes from a patient-centered medical home, where you have a strong primary care focus with comprehensive, coordinated, and continuing care,” said AAFP president Jeffrey Cain, MD. “When retail clinics start talking about managing chronic disease or performing well adult exams, that’s further fragmenting an already fragmented health system. We believe patients will have better care and better quality if they find that care within an ongoing relationship to a primary care physician who knows that person.” Cain is chief of family medicine at Children’s Hospital Colorado and associate professor in the Department of Family Medicine at the University of Colorado Health Sciences Center in Aurora.

Moving forward, the more doctors (not office managers, staff or nurses), communicate with patients face-to-face and provide other value-driven options, the more those patients will come back again and again and better yet, tell their friends and family to see you too. Afterall, what primary care of family medical practice do you know of today that spends more than forty five to ninety minutes with each patient on every visit?

In surveying thousands of physicians for the nonprofit Physicians Foundation, Merritt Hawkins, a national consulting and search firm in Irving, Texas, recently reported that about 7% of respondents said they were planning to transition to concierge or cash-only practices in the next one to three years.

“We believe the growth rate will be much higher in the coming years – possibly around 15% due to the Affordable Care Act (ACA). Although this is our opinion,” adds Sykes, “we have certainly seen an increase in physician interest to support it.”

Overall, concierge medicine and direct primary care is thriving in major metropolitan markets and prices are dropping dramatically due to increasing competition among physicians entering the marketplace, retail medicine pricing, price transparency demand from patients and uncertainty about the implications of the Affordable Care Act.

“Instead of viewing the status quo PCP model as the center of the universe,” notes Nelson, “maybe we should take some plays from the Retail Clinic playbook before we become obsolete.”

LOCATE A CONCIERGE MEDICINE DOCTOR or FIND a DIRECT PRIMARY CARE DOCTOR today …
direct primary care 1Until recently, people mostly based choosing a doctor on the personal recommendation of a trusted friend or relative. Now with the advent of social media, word of mouth marketing is changing from a spoken word referral to a social media link referral. To find a concierge medicine or direct care doctor near you, Concierge Medicine Today has created an iTunes and Android App, Concierge Doc, a free App and search engine resource to find and learn about concierge medicine and direct primary care in your area available at ConciergeMedicineToday.com.
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2 replies »

  1. Hi Michael,

    Good article and appreciate the reference. The quote is not accurate, though. It really changes the meaning and thrust of my point as published.

    Urgent Care Centers, by in large, DO provide all the services listed in the example you quoted. My intent was to point out that traditional primary care practice are getting away from these services; and that is why patients end up in the Urgent Care or ER for some of the more complex issues and it the Retail clinics for the more minor. More and more, they are skipping their PCP for the reasons presented.

    “Maybe we should be examining why our patients would rather go to a retail clinic that see us (their primary care doctors),” said Dr. Rob Nelson (no one knows me as Rob,please use Robert W. ) , a direct primary care physician in Cumming, GA, a suburb of Atlanta, GA. “Here are just a few of the comments I hear from urgent care patients as to why they come to the retail care centers instead of their primary care physician: my urgent care center couldn’t get me in; my urgent care center doesn’t do stitches anymore; my urgent care center doesn’t do x-rays in office; my urgent care center doesn’t take walk-in patients; my urgent care center usually refers me to specialist for everything anyway; and my urgent care center won’t return my calls.”

    All the highlighted areas should be PCP or primary doctor or family doctor

    Thanks,

    Bob

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