Rather than try to limit the scope of walk-in clinics, hospitals and health systems can join with them to provide more comprehensive care.
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| Scott MacStravic, Ph.D. |
The concept of “convenience clinics,” where patients can get quick and inexpensive care for routine problems without an appointment, in an accessible location and at an affordable price, has been around for decades. These clinics have recently started hiring less expensive nurse practitioners (NPs) rather than physicians, and by doing so, have run into some strong opposition from organized medicine.
But these clinics need not be enemies of hospitals and health care systems. In fact, the two groups can form a mutually beneficial partnership. Clinics can inexpensively handle cases that don’t require a physician’s expertise, including those patients who inappropriately head to an emergency room. They can also provide routine care such as immunizations and blood pressure checks. Finally, they can refer patients to health systems or hospitals, helping build patient trust with an organization.
Opposition
While physicians have at least recognized that many patients may obtain services they might otherwise miss through convenience clinics, particularly immunizations and simple, routine care, they fear that patients may be choosing convenience over quality.
In Texas, for some reason, physicians seem particularly against the idea of convenience clinics. Local and state medical associations in Texas have taken stances opposing them, and made their positions public. The Texas Medical Association, reacting to the growth of NP-staffed RediClinics in that state, along with the Texas Patient Safety Alliance, have expressed concerns over patients using such sources of care, particularly as their medical homes. They argue that such clinics are not equipped to diagnose or treat serious medical conditions, and do not offer the kind of continuity of care that is essential to good quality [W.S. Bailey, “Texas Docs Raise Concerns about Supermarket Clinics,” San Antonio Business Journal, Jan. 16, 2006 (www.bizjournals.com )].
A Wall Street Journal/Harris Interactive survey had found echoes of such concerns among consumers. While the vast majority of respondents strongly or somewhat agreed that such clinics are a fast and easy way to get basic medical services, 75 percent also agreed that serious medical problems might not be accurately diagnosed there [“Clinics in Retail Chains Draw Mixed Reviews,” Strategic Health Care Marketing, January 2006].
Of course, the CEO of Interfit, which operates Texas RediClinics, does not claim that they should be used for serious medical problems. Most of the care is of a strictly routine nature, and charges are usually only $45, with preventive services starting at $11. When patients’ needs fall outside the clinics’ scope of practice, the NPs refer them to a physician, though a large portion of their patients have no regular source of care.
Potential Partners
Public criticism is unlikely to endear physicians to either the clinics’ owners or the NPs practicing in them. If physicians sat down with the operators of such clinics and the NPs staffing them, they might find a host of symbiotic opportunities.
For example, primary physicians could refer patients seeking immediate routine care to these clinics, rather than routing them to ERs. And since continuity of care is a concern, physicians could easily share information with such clinics and their patients, and obtain referrals from them when patients need more advanced follow-up care.
One of the most significant opportunities lies in the proactive side of primary care. Under current insurance payment systems, physicians are poorly paid for even minimal annual physicals and screening tests. And they are likely to be paid nothing for “cognitive services,” such as counseling patients on ways to better manage their chronic conditions or reduce their health risks. Convenience clinics could easily offer these kinds of proactive services that physicians cannot afford to deliver.
Patients have already shown the willingness to pay out of pocket for the services offered by such clinics, given the low costs involved. In fact, many employers and insurers have agreed to cover the costs, given the savings.
Moreover, some physicians already sponsor their own NP-staffed clinics, coordinating referrals to and from them to promote quality, access and affordable care for patients. The Physicians Organization of Western Michigan, for example, operates convenience clinics in a local store chain, where NPs can refer interested patients to member physicians for additional services, and to its HealthCare Coach program, offering proactive health coaching for $99 a year.
An Array of Services
The RediClinics (www.rediclinics.com ) are among a growing number of convenience clinic chains that offer significant, formal proactive care programs along with traditional routine primary care. They include an array of screenings, immunizations and routine physicals, but go well beyond these to disease counseling and monitoring for chronic conditions such as asthma and diabetes, as well as for risk conditions such as high cholesterol and blood pressure, overweight and obesity. They create an overall health profile for patients wishing to manage their health, rather than merely be treated for existing problems.
Some NP proactive care centers offer combinations of CAM and traditional medical care. One is in Conshohocken, Pa., scheduled to open this spring. It will offer comprehensive preventive services, along with specialized programs for integrative weight management, bone health and smoking cessation. It combines medicine with yoga and other alternative therapies, and will be called the Rivertown Yoga and Health Center.
The America’s Family Doctors Walk-in Clinics (www.afdclinics.com ) in Brentwood and Smyrna, Tenn., offer screenings and physical exams, but go beyond these to include CAM services such as massage therapy and acupuncture. They also offer proactive health management, including weight management, diet/nutrition services, antismoking and career counseling, along with an online newsletter and nutritional supplements for sale.
And Bridges to Health in Green Bay, Wis., uses integrative medicine for a variety of proactive health development challenges, including weight/nutrition and stress reduction, as well as massage and aroma therapy, guided imagery, hypnosis, biofeedback, nutriceuticals and reiki healing.
Mutual Benefit
Hospitals and physicians could partner with convenient, low-cost clinics for any combination of reactive and proactive care with employers as well as providers. When Wal-Mart hosts the convenience clinics located in its stores, for example, it uses them for its own employees, saving lost time from work. Hospitals might host such clinics to reduce inappropriate use of their ERs, thereby reducing overcrowding and the potential for poor service. Hospitals might also host such clinics simply to provide another community service that offers the public a chance to get a pleasant first impression of the facility, an impression that might help bring patients in later for more serious needs.
By sitting down on the “same side of the table” and treating the availability of convenience clinics as an opportunity, rather than as an enemy, hospitals and physicians may find ways to achieve mutual advantage from their presence. And since both convenience clinics and proactive care are growing dramatically, and seem likely to continue doing so, hospitals and physicians might lose out on even greater opportunities for mutual benefits in the future if they sound and behave like enemies in the present.
Scott MacStravic, Ph.D., is a consultant, writer and former chief marketing and strategy officer at two multihospital systems. He has published 10 books, including Creating Customer Loyalty in Health Care (Health Administration Press). He lives in Golden, Colo.
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This article 1st appeared on May 23, 2006 in HHN Magazine online site.
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