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.
Regulatory activity
23
Mar 10
Hospital System’s Retail Clinics Plan Sparks Lawsuit
Interesting story in Monday’s San Diego Union Tribune online about a legal dustup between two SoCal health districts, Palomar Pomerado Health and Tri-City Healthcare District, that has apparently been provoked by the former’s introduction of retail clinics (Hospital Clinics in North County Turf War, 3/22/10; immediate access).
Palomar has opened retail clinics in two Albertsons’ grocery stores, and wants to open three more – outside its operating district (gotta love California and its proliferation of special purpose political districts). A Palomar spokesperson has apparently noted that 20% of the patients at Palomar’s existing clinics live in Tri-City territory.
So Tri-City is fighting back in court.
There’s not much more to the story currently, but we plan to follow developments there.
PPH wouldn’t appear to be much of a retail health competitor: while they have a dedicated URL for their clinics: pphexpresscare.org – it redirects to a page at PPH’s main website, where they inexplicably provide the phone numbers, but NOT the addresses, of their current clinics (the addresses are provided as an afterthought in the media release PPH issued when the clinics were first opened – probably not the first place anyone would look to find the locations of their clinics).
Naturally, WE at Healthcare 311 provide their whereabouts, in Escondido and Rancho Penasquitos.
27
Feb 10
AAFP Hardens Line On Retail Clinics
From the American Academy of Family Practitioners website: AAFP Board Revises Retail Clinic Policy (2/24/10: immediate access)
The AAFP Board of Directors has revised its official policy on retail health clinics to reflect the Academy’s opposition to a growing expansion of scope of services provided by many such clinics. In addition, the Academy has discontinued its practice of entering into formal agreements with retail health clinics that support the AAFP’s desired attributes….
….The four retail health organizations that still hold signed agreements — MinuteClinic, RediClinic, The Little Clinic and BellinHealth Fast Care — have been notified that those agreements will be terminated.
In a letter sent to those companies, the Academy said its decision was not intended to reflect negatively on any retail health clinic company. Rather, it was made after observing the evolution of the retail health clinic model into expanded service lines….
without a trace of irony, the AAFP story continues:
The Academy’s policy urges all retail clinics to abide by the list of desired attributes, which, in addition to a limited scope of clinical services, should include
- evidence-based medicine,
- a team-based approach,
- a system of referrals to physician practices, and
- electronic health records.
Just to take the easiest point to pick off, we’d like a buck for every percentage point by which the share of retail clinics with EHR in place, and used, exceeds the share of AAFP docs with EHR in place, and used. We’d surely be able to buy the house a couple of rounds – and AAFP doctors are leaders in EHR adoption amongst physicians generally.
What we smell in this policy announcement is the acrid odor of fear. Instead of figuring a way to amplify on retail clinics’ simple, fundamental capabilities -take something as basic as routine identifiers information – and using them to their advantage, the AAFP’s public service solution is, to paraphrase a line from onetime Presidential candidate Sen. John Kerry, to vote against retail clinics after they voted for them.
That kind of health care reform we don’t need.
Modern Healthcare’s Andis Robeznieks reported the story, too, on Thursday (2/25).
15
Feb 10
Retail Clinics and the Uninsured
We are not big fans of quarrels about the health care needs of the uninsured.
This population is every politician’s favorite football: a population with neither well-defined leadership or easily specified needs that permits shifting discussion of one difficult topic – what sort of health reform would be best for everyone – to a more-easily-presented, less-easily -accounted-for zone in which politicians can claim they are doing more than their opposition to devise beneficial policies and programs for an underserved group.
When well-meaning observers overlay specific health care service innovations atop the elusive ‘debate’ about the uninsured, the results are predictable: politically-inspired proponents find the innovation addresses the ‘problem’, while their political opponents see movement in the opposite direction. Kristen Gerencher’s recent Wall Street Journal piece on retail clinics and the uninsured (Yes, The Uninsured Can Get Care, February 14, 2010; subscription required) falls in the former category.
The truth, no surprise, is more complex than the article suggests, and seldom if ever gets explicit attention in such narratives.
Here’s how that plays out in the realm of retail clinics: an observer will assert that retail clinics extend affordable access to basic health care to people who are uninsured, lessening their need for governmental intervention, and point to findings from clinical experts like Rand Health policy researcher and University of Pittsburgh assistant professor Dr. Ateev Mehrotra to support their case.
Meanwhile, those who caution that clinics may not be all that for the uninsured look to the same authority for evidence that clinics are not routinely sited in areas that are as accessible to the uninsured as they are to wealthier, more-likely-to-be insured customers.
It’s practically traditional of course for political adversaries to turn almost any cultural phenomenon into a rope for playing policy tug-of-war. We merely want to give voice to the observation that with respect to the emergence of retail clinics “they (retail clinics) are so not about all of that”.
20
Jan 10
WSJ Health Blog: New CA Law Limits MD Visit Wait Times
The Wall Street Journal’s Health Blog (1/20/10; subscription needed to access) posts today about the California law taking effect next year which will cap the maximum times by which MDs contracted with (and presumably also those working for) HMOs must see patients. The limits are based on the severity – presumably consumer-determined* – of the patient’s need for physician treatment.
Our entirely off-the-cuff observation is that this kind of legislation honors people’s perceptions of health care needs rather than their real clinical needs. People ‘need’ to see a physician, or they ‘feel’ they haven’t been cared for.
It represents a fundamental confusion of the person “needed” to do the job – a job which may not actually need to be done by anyone – vs the more pressing matter of the job the patient/consumer NEEDS to have done (that is, to have their condition evaluated and if necessary treated by a qualified health professional of some kind).
* we’re taking WSJ HB’s word for the specifics of the legislation: with luck, we’ll find time to dig deeper soon.
20
Nov 09
In Health Care, More (and Less) is Different
We’re big fans of taking hard-science aphorisms & applying them, often via the thinnest of justifiable analogies, to realms we deal in daily, like health care and information tech. We’ve gotten great mileage out of Heisenberg’s uncertainty principle and the lessons it holds for health economists & behavioral theorists (that’s all a story for another day).
So in trying to come to terms with the public reaction to the US Preventive Services Task Force‘s revision of its breast cancer screening recommendations, and the American College of Obstetricians and Gynecologists‘ kindred cervical cancer testing advisory, who can gainsay our murmuring “but more – and less – is different”?
“Less is different” is our little twist on a phrase which made one of its earliest appearances in a 1972 article written by 86-year-old Nobel-prizewinning condensed matter physicist Philip Anderson titled More is Different”. Anderson used the phrase “more is different” as a sort of summation of the perils of rote reductionism in the sciences. He cautioned against assuming, for example, that psychology is merely applied biology, or that biology is merely applied chemistry.
In the realm of health care, most people (certainly people in the US) instinctively assume that more is better. That’s the lesson we take away from the uproar about the cancer testing announcements this week.
Complicating that assessment is the fact that the socially sensible conclusion – that at some point it is arguable that the resources devoted to anticipating and avoiding one person’s death are better devoted to improving the wellbeing of many more lives – is certainly not the conclusion most individuals are prepared to live with.
A society is not merely more individuals. More is different. An individual is not merely one nth of society. Less is different, too.
Retail clinics’ critics frequently worry that retail clinic care is “less” health care; “less” care than a traditional primary care doctor can provide, of “lesser” quality. This ranking approach doesn’t hold up under close examination.
Why? Because less, too, is different.