Health care practitioners

Driving forces / Health care practitioners / Opinion/commentary/analysis / Physicians' perspective — No Comments
12
Jul 10

Retail clinics: good enough, enough?

Colorado-based Dr. Marc Ringel avers that they just may be in this public radio interview (7/10/2010, station KUNC, Colorado).

Audio clip is available at the top of the article.

Dr. Ringel sums things up this way:

As we proceed into the brave new world of post-healthcare reform, where there will be lots more people with health insurance but no more primary care doctors to attend to them, we’re no doubt going to have to receive a greater share of outpatient medical services outside the traditional setting of the doctor’s office. Retail clinics will certainly be in the mix.

We should be no worse for this change of venue, if we can keep our eye on what’s good enough care.

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4
May 10

Where Do Doctors Learn The Price of Care?

Turns out more than a handful have become well-acquainted with the role of cost in clinical decisions at the East Harlem Health Outreach Partnership, which is a free (for patients) clinic run by students of Mount Sinai School of Medicine, according to this 5/3/10 New York Times story: Teaching Physicians The Price of Care (5/3/10.

Medical students evaluate patients, choose which drugs are prescribed, arrange care for patients who need to see a surgeon or other specialist and collaborate with a social worker to help those who need social services or assistance paying for medicine. They also sit on the steering committee and are in charge of researching and updating the clinic’s formulary, a stock of inexpensive, cost-effective drugs that are purchased from the hospital pharmacy.

Surely similar models might emerge for providing teaching hospitals’ students about real world health costs via immersion in hospital-supported clinic operations…?

Driving forces / Health care practitioners / Opinion/commentary/analysis / Physicians' perspective / Strategic initiatives — 1 Comment
29
Apr 10

Primary Care Busy-ness: NEJM Article Has Major Media Hotness

So Dr. Richard Baron’s What’s Keeping Us So Busy in Primary Care? A Snapshot from One Practice shows up in the Occasional Notes section of the New England Journal of Medicine on 4/27/10, and the watchful editors at the New York Times and USA Today are already busily turning it into News Of More Than Occasional Note.

And rightly so.

So what’s being said?

The NY Times’ Steve Lohr, a health journalist who “gets it”, doesn’t seem to get this one – at least not in his opening lines:

A new study detailing the uncompensated work burden on family doctors points to the need to change how they are paid, medical experts say — particularly as the new health care law promises to add millions more patients to the system.

Really Steve? The thrust of the piece is that doctors need to be paid differently? Or is it rather that they have to practice differently, so there is justification for paying them differently?

You can probably guess what we think, but here’s a passage directly from Dr. Baron’s post that bolsters our confidence in thinking so (with our emphasis):

The work we describe arises from the needs of patients in a society that assigns many roles to physicians — from making diagnoses and providing treatment to ordering tests and filling out forms — and the practice must be organized to respond reliably. How and by whom the work is done is a continuing project of primary care redesign, dependent on both the skills of available nonphysician staff and the extent of information-technology support.

Meanwhile, correspondent Lohr only gets to this concept indirectly, at the very end of his brief report, and then thanks to a quote from Obama administration HIT point man Dr. David Blumenthal (again, we’ve provided the emphasis):

….Dr. Blumenthal said the study showed “the enormous strain” on family doctors, but also “a pathway toward escaping at least some of those burdens: the electronic health record combined with changes in workflow and payment.”

USA Today’s Rita Rubin gives greater emphasis to the “what are primary care doctors actually doing?” aspect of the story – taking it less for granted that what primary care doctors are doing is what everyone thinks they’re doing, and what they ought to be doing – but she still does not delve into the trickier, thornier, more sensitive matter: what if, once what’s going on there is fully sorted out, everyone discovers that other health care practitioners are better situated to do some of those things, in league with a “re-purposed” contemporary primary care physician?

Now there you would have a platform for disruptive innovation.

EXTRA CREDIT: It may seem unrelated at first, but we feel The Data-Driven Life (New York Times, 4/26/10) supplies valuable commentary on the vital issue of applying data to the information-driven business of deciding “what am I doing, is it what I fully intend to be doing, and what might I do differently to do what I intend to do better?”

Clinics in pictures / Driving forces / Employers and retail clinics / Health care practitioners / Public policy / Retail clinics: field reports / Strategic initiatives / Tactical innovation — 1 Comment
29
Apr 10

Community Health Centers and Retail Clinics: Are You Thinking What I’m Thinking?

I mean, when I look at the map of community health center locations provided in this New England Journal of Medicine article: (Health Care Reform and Primary Care — The Growing Importance of the Community Health Center, 4/28/10), I say to myself “imagine if that many locations were served by retail clinics”.

And then I occasionally reply to myself, “well, why couldn’t the retail clinic operators do for some – and maybe many – community health centers what they have begun to do for employer-sponsored onsite clinics?” which is namely to supply operating expertise with special attention to the particular needs of the location’s clientele.

And then I frequently go “hmmmm….”

For the time-pressed, here is the map in question – though I strongly urge anyone following retail clinics to check out the entire article:

Nationwide Distribution of Community Health Center Sites, 2008.</p> <p>Data are from the 2008 Uniform Data System, prepared by the Robert Graham Center, April 2010

Nationwide Distribution of Community Health Center Sites, 2008.
Data are from the 2008 Uniform Data System, prepared by the Robert Graham Center, April 2010.

The accompanying map of the share of each state’s population that frequents CHCs is also information-rich:

Percentage of the Population of Each State Served by Community Health Centers, 2008

Percentage of the Population of Each State Served by Community Health Centers, 2008

Clinic openings and closings / Driving forces / Health care practitioners / Retail clinics: field reports / Tactical innovation — Comments Off
20
Apr 10

New Clinics Locator – And Clinic Treatment Is (Often) Free!

Or at least this is what the Partnership for Prescription Assistance says at their web pages for the Partnership for Prescription Assistance’s new Blackberry and iPhone clinic locator apps:

With this application, patients can scroll through the medicines offered by PPA member programs or locate one of 10,000 free health care clinics across the United States…..Many patients will get their medications at no cost or at discounted prices….The Partnership for Prescription Assistance can help you find free or low-cost health clinics near your home.

Here’s a link to the online version of the locator itself: Partnership for Prescription Assistance Low-Cost Health Clinic Finder.

Hat tip to MedGadget for posting this info.

Driving forces / Health care practitioners / Regulatory activity / Retail clinics — Comments Off
14
Apr 10

Real Life in Retail Health: Frustrated NPs

As if on cue, this post appears at Real Life in Retail Health:

What Frustrates NPs in Convenient Care?

You aren’t be getting this kind of reportage in other resources, friends.

Dr. Ateev Mehrotra / Driving forces / Health care practitioners / Opinion/commentary/analysis / Physicians' perspective / Retail clinics / Strategic initiatives — Comments Off
9
Apr 10

Is Physician Resistance a Real Barrier to Retail Clinics’ Success?

A 4/8/10 story by Healthleaders Media‘s Cheryl Clark asks the timely question Will Retail Clinics Be a Key Player in Post-Health Reform World? – then proceeds to address a quite different, though related, question.

That question is, how ‘real’ is physician resistance to the growth of retail clinics?

On cursory examination, the positions taken by physician organizations seem real. The Healthleaders Media article notes the AMA’s recommendation that store-based clinics have “appropriate physician oversight on-site”. The California Medical Association offers 3 reasons why retail clinics are not in patients’ best interest, which can be summarized as 1) retail clinicians do not have the requisite competence 2) they aren’t built to share care information with the patient’s primary care doctor 3) their primary purpose is to sell “beef jerky and Gatorade”, not health care, in the words of the CMA’s CEO that the article quotes.

We can leave questions of clinical purpose & competence to more authoritative analysts like RAND’s Dr. Ateev Mehrotra, whose research to date has largely refuted the essentially unsubstantiated assertions of the physician organizations. What we CAN do is ask whether the AMA, the CMA, and their kindred clinician associations are prepared to deal with the issue as people of science rather than politics – that is, to weigh their concerns on the scales of data, of evidence, rather than resort primarily to dismissive remarks in press releases?

Frankly, we do not see how the physician organizations CAN take the high road here, even if they want to, because the data they have, that they can access and evaluate, is simply not likely to be as good – as timely, as auditable, as thorough – as the data and analyses that retail clinics can deliver. In support of their position, physician groups have anecdotes, rather than evidence. Until they have evidence, it is difficult to understand how their resistance can be regarded as a “real” barrier to retail clinics growth.

Driving forces / Health care practitioners / Physicians' perspective — Comments Off
30
Mar 10

The 70-Year Timeline of “Too Few Primary Care Docs” Warnings

You’ll find it here, in this concise March 29, 2010 Kaiser Health News summary: Primary Care Crisis Has Been a Long Time Coming

Driving forces / Health care practitioners / Reports, white papers, studies, presentations / Retail clinics / Walk-in clinics — Comments Off
11
Mar 10

Retail Care Convenience Has a Price

…and consumers readily name it, according to a study published Monday in the Annals of Family Medicine.

Physician Office vs Retail Clinic: Patient Preferences in Care Seeking for Minor Illnesses (Ahmed and Fincham, Annals of Family Medicine, 2010;8:117-123. Immediate access) finds:

Willingness-to-pay estimates suggest that, all else being equal, a cost savings of $31.42 would be required for the respondents to seek care from a nurse practitioner at a retail clinic. Similarly, a cost savings of $82.12 would be required for them to choose to wait 1 day or more.

It would be easy to infer from this that, as long as the bill for a retail clinic’s services is $31.42 or more lower than an available physician’s charge for the same treatment visit, a consumer is likely to pick the retail clinic over Dr. Welby.

The authors are careful to note, however, that

It cannot be determined from our study…whether the relative importance of the time and cost attributes would remain the same when the choice is between seeking care from a nurse practitioner or physician assistant in a physician-led primary care practice and seeking care from a nurse practitioner or physician assistant at a retail clinic.

We find this a particularly important qualifier, and a great opportunity for any enterprising health care researchers looking for a valuable follow-up study to undertake.

Not surprisingly, the report concludes:

Time and cost savings offered by retail clinics are attractive to patients, and they are likely to seek care there given sufficient cost savings. Appointment wait time is the most important factor in care-seeking decisions and should be considered carefully in setting appointment policies in primary care practices.

The report’s release was news in the Los Angeles Times, on UPI, and Bioscience Technology on Tuesday and Wednesday – though it must be noted that the Times filed it under a section of the paper whose tagline is “Oddities, Musings, and News from the Health World”.

Driving forces / Health care practitioners / Onsite clinics / Physicians' perspective / Public policy / Reports, white papers, studies, presentations / Retail clinics / Strategic initiatives / Tactical innovation — Comments Off
9
Mar 10

Macy’s Floats Recommendations for “Primary Care Expansion”

The newly released primary care advancement recommendations from the Josiah H Macy Foundation include a number of recommendations for further investment and action. While the 49 participants and the event leaders produced numerous recommendations concerning primary care organization, financing, education, and leadership worthy of closer inspection, we have quoted our favorites below:

  • ….state and national legal, regulatory, and reimbursement policies should be changed to remove barriers that make it difficult for nurse practitioners and physician assistants to serve as primary care providers and leaders of patient-centered medical homes or other models of primary care delivery. [Conclusion I, Recommendation 2]

  • ….Invest in primary care health information technologies that support data sharing, quality improvement, patient engagement, and clinical care, with the aim of continuously improving the health and productivity of individuals and populations. [Conclusion I, Recommendation 4]

  • ….implement all-payor payment reforms that more appropriately recognize the value contributed by primary care through such mechanisms as global payments linked to patient complexity and accountability for the provision of healthcare services, including preventive services, care coordination across settings, chronic disease management, and 24/7 accessibility. [Conclusion I, Recommendation 5]

Can anyone help me square these proposals with AAFP’s turnabout with respect to its qualified support for retail clinics?

Tip of the cap to Healthleaders Media‘s Janice Simmons for her story on the release of the JHMacy Foundation report.

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