Tuesday Sep 09, 2014
Changing Times, Changing Relationships?
One of the most important jobs the AAFP has is to analyze innovations in an effort to influence the future of health care delivery and its financing structure. Currently, there is not an issue more difficult to analyze than retail-based clinics.
The emergence of retail clinics can easily be viewed as innovative and responsive to consumer demand and, simultaneously, disruptive to a well-established health care market and the high quality of care that comes from longitudinal care models.
During the past few years, the AAFP has been engaged in meaningful conversations with the large companies that offer retail clinics about how family physicians and such clinics can, potentially, work together to improve access to health care for individuals in their communities.
To be clear, not all retail clinics are the same, and the AAFP does not view them as a homogenous industry. There are clear differences between the various business models. The challenge for each of us is to ensure we do not view every retail-based clinic through the same prism. The AAFP’s policy on retail clinics makes it clear that we do not support retail clinics providing continuous care to patients with chronic conditions. The policy also expresses, rightfully so, concerns that retail clinics may further fragment care delivery. However, our policy also expresses some belief that there is a potential role for retail clinics in the health care team or neighborhood, and this is what needs greater analysis.
Again, not all retail clinics are the same. There are clinics that are solely attempting to create a disruption in the marketplace and sell consumer products, but there also are companies that are serious about partnering with family physicians to create community delivery models. We need to identify the latter for collaboration and communicate with the former to better influence their business models.
Our motivations are multiple, but here are three primary reasons we are seeking potential collaborations:
- It is time that we acknowledge the existence, contributions and even the potential benefits of retail clinics to patients and family physicians. We can't pretend that retail clinics do not exist, nor can we legislate or regulate them out of business. According to the Convenient Care Association(ccaclinics.org) there are 1,500 retail clinics operating in 40 states and Washington, D.C. The impact of these clinics on the primary care system is unknown, but our observations are that the clinics are having a minimal impact on the family physicians in the communities where retail clinics are co-located. Additionally, there are several examples of collaboration that have expanded access for patients.
- Retail clinics may be complementary to family physicians through expanding community delivery partnerships that will enhance a practice's service to their patients and align retail clinics more closely with family physicians in their communities. The use of retail clinics as a part of the patient-centered medical home neighborhood holds great potential for patients and physicians. According to a 2012 RAND Special Feature: "Retail Clinics Play Growing Role in Health Care Marketplace,"(www.rand.org) 44 percent of care provided in a retail clinic takes place at a time when physician offices are typically closed (nights and weekends). Furthermore, RAND notes that 43 percent of individuals seeking care at a retail clinic are between the ages of 18 and 44 (young/healthy). These two data points alone clearly define the demographic factors driving expansion of retail clinics -- young people seeking expanded access that is convenient to them and their family’s personal and professional schedules.
- As fee-for-service becomes a less dominant payment model, the economic pressures of “who provides” will be replaced by “is provided.” An Accenture report entitled "Retail Medical Clinics: From Foe to Friend?"(www.accenture.com) notes the potential benefit of retails clinics to primary care physicians: “As the shortage of PCPs (primary care physicians) relative to demand continues to grow, one option for physicians will be to refer lower acuity cases to retail clinics. In addition to providing additional supply, the clinics would also leave PCPs free to deal with more complex cases, with correspondingly higher reimbursement.”
Although we can’t say with certainty that this scenario is achievable in all occasions, we do agree with Accenture that retail clinics, working with family physicians, can improve care delivery models in communities where they collaborate.
Since the concept first emerged onto the national scene in the late 1990s and early 2000s, retail clinics have been a source of controversy in many communities and a source of improved access and quality in others. Physician organizations were slow to acknowledge and analyze the economic and demographic drivers fueling the expansion of retail clinics. From a market perspective, retail clinics identified a gap in service and created a product to fill that gap. In blunt terms, they noticed that the delivery system was not always patient-centric and, in many cases, was unavailable to certain individuals.
The resistance to retail clinics expressed by the AAFP and other physician organizations during the past 15 years was appropriate. However, it has not impacted their rapid expansion. Is it time for a change? Can retail clinics contribute to the continuum of care for patients? These are important questions, and the AAFP is pursuing answers.
Posted at 09:00AM Sep 09, 2014