Reports, white papers, studies, presentations

Clinics and location-based services / Clinics in pictures / Dr. Ateev Mehrotra / Driving forces / Reports, white papers, studies, presentations / Retail clinics / Strategic initiatives / Walk-in clinics — Comments Off
14
Jan 13

New Evidence That Retail Clinics Are a Prime Example of High Value Health Care Innovation

You’ll find it on page 4 of Rand’s Research Brief: Flattening the Trajectory of Health Care Spending:
Facilitate High-Value Innovation (Rand, 2012)

Retail clinics: evidence for high value health care (Rand 2012)

Retail clinics: evidence for high value health care (Rand 2012)

(Note that the graph is found, incongruously, under the heading Further Expand Use of Health Information Technology; while HIT does figure in retail clinics’ delivery of high-value health care, it is not principally an HIT “play”)

It’s fair, and important, to note that Rand employs – or maybe it’s merely contracts with – Ateev Mehrotra MD, probably the most authoritative observer/researcher of the retail clinics phenomenon to date. Rand has published a number of Dr. Mehrotra’s studies. What’s most important is that retail clinics ARE embematic of high-value health innovation in the US – and that the chart deftly conveys the evidence for it in a ‘tri-fold’ chart: charts indicating comparable clinical quality bookend a chart indicating retail clinics cost markedly less than treatment source alternatives.

Clinics and location-based services / Data and clinics / Dr. Ateev Mehrotra / Driving forces / Health care practitioners / Health care venues / Reports, white papers, studies, presentations / Retail clinics / Walk-in clinics — Comments Off
19
Nov 12

Recent Clinics News: The Sublime and The Ridiculous

Prominent articles on retail clinics published in the past 3 weeks range from the sublime to the ridiculous.

The Sublime: Retail Clinic Visits and Receipt of Primary Care, Rachel O. Reid, J. Scott Ashwood, Mark W. Friedberg, Ellerie S. Weber, Claude M. Setodji and Ateev Mehrotra, Journal of General Internal Medicine, 11/1/12), Ateev Mehrotra’s latest report on retail clinics, which examines retail clinics’ impact on individuals’ relationships with primary care physicians. While the study did produce some empirical evidence that retail clinic usage might diminish an individual’s engagement with a primary care doc, Mehrotra et al take pains to examine the tenuous nature of that evidence at present. For instance, the research team urges that “[f]uture studies should assess the impact [of retail clinic usage on primary care MD relationships] over the longer term” given that the study only looked at subjects’ treatment visits to clinics and/or primary care doctors over a 12 month span.

We feel too many of the articles on the Mehrotra report belong on the Ridiculous end of the Sublime/Ridiculous spectrum, inasmuch as they zoom in so eagerly on the “clinics are probably bad for your health!” angle, while ignoring evidence that, for instance, clinic usage does not derail patients’ receipt of care from primary care physicians for preventive care or diabetes management.

Articles in this vein from leading news outlets are particularly egregious: Retail Clinics May Cut Into Primary Care: Study, Chicago Tribune/Reuters, 11/1/12).

The Ridiculous: 10 things walk-in clinics won’t tell you, Jen Wieczner, MarketWatch/Wall Street Journal, 11/2/12)

Purposefully ‘controversial’ at a 10th-grade level of comprehension of that term, this “top 10″ style article, which draws on the Mehrotra study, features ‘alarming’ assertions of this kind throughout:

“1. “We might put your family doctor out of business…””, and even MORE ridiculously, “6. “We practically self-regulate.”"

Ms Wieczner seems like an earnest, industrious individual – she’s apparently written a number of articles for various publications – but she cannot be legitimately described as an authority on health care topics generally or clinic-based care specifically. Her profile confirms this. However, we are prepared to wager her observations on parties in the Hamptons or horseracing are nonpareil.

Clinic openings and closings / Data and clinics / Driving forces / Opinion/commentary/analysis / Reports, white papers, studies, presentations — Comments Off
12
Apr 12

Retail Clinics: Status Update

If you’re looking for a no-nonsense digest of where retail clinics are today, we dont’ know why you haven’t already clicked through to acquire this new KnowledgeSource report: Retail Clinic Growth Has Resumed (Knowledge Source, April 2012)

No, really – what are you doing still here?

Health care practitioners / Health care venues / MinuteClinic / Onsite clinics / Reports, white papers, studies, presentations / Take Care Health / Telehealth and clinics / Walmart — Comments Off
22
Mar 12

Mobile + Retail = Convenient Care Future?

While we’re not completely convinced that we’ll soon see evidence its conclusions are timely, we are big fans of MobiHealth News’ recent report on the intersection of mobile health devices and applications and retail clinics (Mobile health at the clinic, Brian Dolan, MobiHealthNews, March 22, 2012).

….As new entrants like Walmart step up to build out retail clinics that provide primary care services, large employers continue to roll out on-site clinics, and existing retail clinic chains ink deals with local hospital groups to form collaborative care systems, mobile health services will have an increasing presence at the clinic….

For our money, Brian Dolan is the Nate Silver of mobile health, and mobile health is as convenient a bellwether of health innovation as you’re going to find.

What’s that you say? You haven’t read the report yet, even though it’s free? What on earth are you waiting for?

Data and clinics / Dr. Ateev Mehrotra / Driving forces / Health care venues / Reports, white papers, studies, presentations / Retail clinics / Walk-in clinics — Comments Off
21
Nov 11

Retail Clinics Usage: Trending (And We Mean ^^^TRENDING^^^)

Several primary health innovations obsessives like ourselves have noted with interest the appearance of Trends in Retail Clinic Use Among the Commercially Insured (free registration/subscription required to download the 6-page report), the latest analysis of the field by the industrious Dr. Ateev Mehrotra & colleagues*.

The Robert Wood Johnson Foundation/American Journal of Managed Care report documents changes in usage of retail clinics by a subset of over 13 million people whose health benefits are administered by Aetna.

Other commentaries note that the report documents retail clinics growth rates that sound impressive, but provide you, dear reader, with no context for those rates – no way to determine what if anything they might mean.

We may wind up making several observations about the report’s findings, but – hey! – this is the internet, so we we’ll make just one for now. We feel it’s a doozy.

The report notes prominently, yet almost in passing, that “Retail clinic use increased 10-fold from 2007 to 2009.”

Wow, “tenfold growth in usage” you say. “Sounds like a lot. But later, you tell me that just 7% of the conditions treatable by retail clinics, that were in fact treated by SOMEbody in 2009, were actually treated in retail clinics. That doesn’t sound so special.”

Well – is it special, or isn’t it?

We’re here to tell you it is. And we’ll tell you in pictures. Specifically, this one (Click on the chart to enlarge):

Visual Economics: Adoption Rates of Popular US Consumer Goods & Services

Adoption Rates of Popular US Consumer Goods & Services

Team Mehrotra’s report tells us that retail clinics usage among people who could use them, for purposes they’re intended for, grew TEN TIMES in 2 years, to SEVEN PERCENT of potential users in the population studied.

Now examine the chart above closely. Not many of those thoroughly familiar consumer goods & services show SEVEN PERCENT ADOPTION in their second year of existence. Or even (since the study isn’t looking at adoption from the “absolute” start of the retail clinics concept) in their third, fifth, or tenth.

Several DO show TENFOLD increases in usage during 2-year segments of the life cycles shown in the chart. Note that in most such instances, that kind of growth happens in the steep parts of the curves-where similar growth happens in the 2-year increments before and after.

If you’re thinking “wow- that suggests retail clinic usage growth is poised to really take off!”, well, you’re thinking what I’m thinking.

*Make no mistake, he’s listed as if he were just another contributor, but it is highly unlikely that he was not the point man on the report.

Health care practitioners / Physicians' perspective / Regulatory activity / Reports, white papers, studies, presentations / Scheduling treatment visits — Comments Off
29
Jun 11

HHS’s MD Appointment-Scheduling Survey: Hold, Please

Practically as soon as HHS announced plans to get data on the ease of scheduling appointments with physicians, they have called them off (Administration Halts Survey of Making Doctor Visits, Robert Pear, NY Times, 6/28/11). (Is it quibbling to note that no actual visits were ever going to come of the department’s survey activities?)

Opponents noted there already is considerable reputable evidence on the ease or difficulty of obtaining timely appointments with physicians, and Administration officials could certainly have managed planning and execution of the survey with greater transparency.

On the other hand, the letter from Republican Senator Mark Kirk to HHS Secretary Kathleen Sibelious requesting information on details of the survey plan contain howlers like this one:

…we request details of how this survey would be conducted, how investigators would be punished for misconduct or extortion and how patient/physician confidentiality would be maintained….How will patient and doctor confidentiality be maintained? If your researchers report bad information or use this survey for extortion, bribery or other bad acts, how will they be disciplined?

“Or extortion“? Senator, they’re calling to arrange a doctor’s appointment.

“Bad acts”, indeed; Senator your feigned outrage is leaving teeth marks on the stage props.

Driving forces / Health care practitioners / Nurse practitioners' perspective / Reports, white papers, studies, presentations — Comments Off
29
Jun 11

Who’s More Consumer-Friendly: MDs, or NPs?

NPs in a walk, suggests a small study by University of Michigan researchers* which was referenced by FierceHealthcare (Sara Jackson, Study: Patients prefer NPs over physicians, FierceHealthcare 6/28/11).

Patient satisfaction, a major indicator of quality healthcare, was higher among low-income primary care patients treated by nurse practitioners than among those treated by physicians, according to researchers at the American Academy of Nurse Practitioners 26th Annual NP meeting.

We feel the results are attention-worthy, with two important caveats:

The study was very small – the survey results reflect analysis of fewer than 200 patients’ responses;

The researcher’s assertion that “this is just more proof NPs can operate effectively independently without supervision by physicians” does not appear to coincide with the purposes of the study, and is not supported by the results.

We found it surprising – almost as noteworthy as the study itself – that this was the first time the federal Agency for Healthcare Research and Quality’s well-known Consumer Assessment of Healthcare Providers and Systems patient satisfaction survey included NPs. What took them so long?

* Shoutout to Clinical Advisor, which on a brief scan looks to be a great resource for nurse practitioners

Driving forces / Health care practitioners / Health care venues / National/regional/local TV coverage / Public policy / Reports, white papers, studies, presentations / Scheduling treatment visits — Comments Off
28
Jun 11

Access Matters – So How Much IS There?

We struggle to imagine a more auspicious foundation for conveying messages about the potential benefits of a robust health reform role for the convenient care sphere:

NY Times coverage of the emerging story here: US Plans Stealth Survey on Access To Doctors (Robert Pear, NY Times, 6/27/11)

Pre-publication edit: apparently, the drumbeat of “outrage” amongst physicians about the mystery shopper exercise is already gaining volume. Kent Bottles has captured some quotes (posts to other blogs, or replies to the cited NY Times article, presumably*) in an entry in his blog this morning that depict a physician community in utter denial of a fundamental problem with their practice model – which is that they imagine it is THEIR time that is the driving factor in peoples’ assessment of a physician’s accessibility.

*at 10:50 ET, there were already 349 comments to the NYTimes article

Driving forces / Reports, white papers, studies, presentations — Comments Off
07
Sep 10

The Geocomplexity of US Primary Care

What to say about the popular press accounts (such as this one, in the 9/7/10 New York Times) of a new study of acute care treatment published in the current issue of Health Affairs (Stephen R. Pitts, et al, Where Americans Get Acute Care: Increasingly, It’s Not At Their Doctor’s Office. Health Affairs, September 2010) ?

The options are numerous:

  • Primary care is broken, and the study simply quantifies what has been known for years;
  • Primary care is broken, and the study highlights looming challenges for the implementation of effective health system reform in accord with new Federal legislation;
  • Primary care is broken, and the study provides a needed platform for outlining effective primary care delivery alternatives

You may discern a theme here, dear reader… ;-)

The difficulty is that appropriate conclusions are not self-evident. Is educating ER users about more-appropriate treatment venues the best fix? Perhaps hospitals could solve the problem with relatively simple adjustments to their EMTALA obligations? Surely the nation’s policies regarding EMR/PHR adoption can play a positive role in channeling individuals to the most appropriate care settings for their health conditions? And of course we can’t forget the possibility that a combination of these and other approaches might yield valuable improvements….

Our initial feeling is that close examination of decisions about where to obtain acute care treatment would be well worth the time and trouble. People get care where they get care for reasons, and we imagine those reasons are at once practical, malleable. and deeply affected by both ingrained habits and available information about alternatives.

When we undertake to make people’s care-consumption decisions better for them and for our health care system, we’lll do better by looking at what people actually do rather than go by practitioner beliefs/desires regarding what people should do.

Dr. Ateev Mehrotra / Driving forces / Opinion/commentary/analysis / Public policy / Reports, white papers, studies, presentations — Comments Off
19
Aug 10

Retail clinics and public policy

It’s been a relatively slow summer, newswise, for retail clinics, and our vigilance for news items has undoubtedly flagged a bit. So imagine our delight to have news of this report show up in our mail this morning:

Policy Implications of the Use of Retail Clinics. August 2010. Authors: Robin M. Weinick, Craig Evan Pollack, Michael P. Fisher, Emily M. Gillen, Ateev Mehrotra.

We haven’t yet seen any media releases for it, and thought you’d like to know about it.

Dr. Mehrotra can lay claim to being the most recognizable retail clinics expert among clinicians and academics.

We’re poring over the report as you read this. Watch for our review in the next few days.

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