Public policy

Driving forces / Public policy / Strategic initiatives / Tactical innovation — No Comments
20
Aug 10

Policy May Shape Clinics – and Clinics May Shape Policy

This concise summary of the emerging retail clinics business:

McMedical Care |The rise of health clinics in retail stores could affect both health policy and regulation

http://www.governing.com/topics/health-human-services/McMedical-Care.html

was published in Governing in 2006, so it could not have been informed by the recent white paper on clinics and public policy released by Rand, & written by Dr. Ateev Mehrotra and colleagues which we posted about yesterday. We did not see it in 2006 – a link to the article showed up in our mail just yesterday – so we took heed of the serendipity & decided to reference it here.

At very least it makes a nice complement to that more recent publication, providing a historical point of reference for the early & modest research findings summarized in the Rand paper.

Dr. Ateev Mehrotra / Driving forces / Opinion/commentary/analysis / Public policy / Reports, white papers, studies, presentations — 1 Comment
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.

Convenient Care Association / Driving forces / Public policy / Retail clinics — 1 Comment
2
Aug 10

National Convenient Care Week

August 2 – 8 has been declared National Convenient Care Clinic Week in “recognition of the critical role retail clinics play in our very fractured healthcare system, and a nod to the indispensable role the clinics, and the practitioners in them, will play as healthcare reform plays out over the next several years.”

Hawaii Senator Daniel Inouye and Massachusetts Senator Thad Cochran led Congressional declaration of the week of recognition. There are few retail clinics in either state – none in Hawaii, as far as we know.

Driving forces / Opinion/commentary/analysis / Public policy — No Comments
29
Jul 10

Doctor visits: down

A gaggle of Wall Street Journal reporters has examined recent data of a dip in doctor visits – and prescription fills, and lab work – and adjudged it evidence of the market working its magic to reduce use of care.

They inform Journal readers of their findings in this article: Americans Cut Back Visits to Doctor (July 28, 2010; paid subscription required for access).

The reporters make an elementary, and incorrect, conclusion from the information they have in hand:

Continued weak demand could eventually put downward pressure on spiralling health-care costs, a long-sought goal of policy makers. It could also force insurers to lower premiums.

Somewhat surprisingly, this mistake is made even by people who should know better – people who spend lots of time looking at patterns of health care data.

The essence of these reporters’ confusion is that they’re treating all doctor visits as of equal value. Most of the foregone visits are probably indeed of little value – but some of those visits would have revealed conditions that benefit from ongoing, relatively inexpensive care that, having gone untreated, produce results both clinically and financially catastrophic.

In other words, that immediate reduction in total costs wrought by foregone primary care results, in relatively short order (15-24 months) in a spike in the costs driven by a surge in “rescue care” provided to people whose conditions went undertreated or unidentified. Everyone from Rand to individual self-insuring employers like Pitney Bowes have seen and reported on the hard data that demonstrates the effect.

It’s probably too much to expect Wall Street Journal health care reporters to be aware of this sort of research, but we have taken the time to peruse a third of the comments on this article, and not a one has referenced the body of research refuting their cockeyed predictions.

Driving forces / Opinion/commentary/analysis / Public policy / Retail clinics: field reports — No Comments
6
Jul 10

MA ER: Up

And the increase in ER patients is not due to the advent of universal coverage in Massachusetts, according to this Boston Globe article: Emergency Room Visits Grow in Mass. (7/4/2010)

These observations do not surprise us:

David Morales, commissioner of the division [of Health Care Finance and Policy], said several national and statewide studies have shown that expanding insurance coverage does not reduce emergency room visits. This is because the uninsured “are not really responsible for significant ER use’’ he said.

The growth in emergency room use predates the health insurance law and mirrors national trends, according to Nancy Turnbull, a senior lecturer at the Harvard School of Public Health.

“I don’t think the increase has anything to do with health care reform,’’ she said. “It’s much more reflective of [primary care] access problems.’’

But we feel these two surmises are on shakier ground:

  • “Morales said the state needs “to change our payment system to encourage the use of primary care.’’ Better payment for primary care physicians would encourage more doctors to enter the field, he said.”
  • Andrew Dreyfuss, EVP health care services at MA Blue Cross, the state’s largest insurer, suggests that the slight decrease in ER use among MA BC subscribers “could be related to growing use of limited-service clinics, such as CVS MinuteClinics.”

Changing payments is one part of changing health care usage, but simply raising pay presumes that what primary care is, is what it should be. Do we really know that?

And there are roughly a dozen MinuteClinics in all of Massachusetts. We’re pretty sure they alone did not account for BC MA’s contrasting ER usage trend.

Driving forces / Opinion/commentary/analysis / Public policy / Reports, white papers, studies, presentations — No Comments
26
May 10

Unnecessary ER Visits – And Results of Efforts to Cut Down On Them

A new report on potentially unnecessary emergency room visits in upstate NY, released 5/25 by Rochester, NY-based Excellus Blue Cross Blue Shield, notes that close to half of all such visits may be unnecessary, and that reducing the number of such visits by as little as five percent could save between $6 & $9 million.

The report notes

The Indianapolis Medical Society Foundation’s Project Health18 provides care and service free of charge to low income, uninsured adults. Members must “make all reasonable attempts to avoid using the ER for non-urgent care.” Unnecessary ER visits among members dropped from 77 percent to less than 1 percent.[Our emphasis]

(Story in the Rochester Democrat-Chronicle)

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

Driving forces / Opinion/commentary/analysis / Public policy / Retail clinics — 1 Comment
22
Apr 10

Health Reform Is Retail Clinics’ Road To Success: Drug Store News

So sayeth Drug Store News’ Antoinette Alexander, in this 4/16/10 article: Healthcare Reform Paves the Way for Success of Retail Clinics

Drug Store News has a two-word answer for why retail clinics will continue to grow for a very long time: health reform. And there are 32 million reasons why that growth will be quite dramatic.

Our feeling? The new federal health law doesn’t, on balance, hurt retail clinics’ chances – but “major catalyst”? That seems doubtful to us, for a few reasons. Here’s just one; legislation – whether federal, state, or local – tends to encapsulate social trends rather than galvanize them.

Another, more tactical (so more subject to emerging changes): we haven’t looked at the data, but we would gather from work by Ateev Mehrotra and others that many of the 30 million uninsured live, work, and seek their care most often in places other than those served by retail clinics.

As longtime employee benefits grinds, we’re pulling for The Little Clinic’s new chief, Michael Stoll, a successful employee benefits executive of long standing. That said we’re not convinced his appointment is so much a harbinger of TLC triumph than an acknowledgement that clinics’ success may well be reliant on some retail clinic/onsite clinic hybrid, a la Take Care Health, and significantly dependent on strong, rapid employer adoption.

Finally, the little-noted Sec. 10104(3) of the Patient Protection and Affordable Care Act of 2010 (yes, that’s the new health law, and Section 10104(3) just a paragraph of the act), with its support for the development of qualified direct primary care medical homes, does offer some paving materials to retail clinics as well as concierge practices, but is not in itself a retail clinics traffic-ready superhighway.

Clinic openings and closings / Driving forces / Public policy / Regulatory activity / Retail clinics: field reports / Strategic initiatives — Comments Off
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.

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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