Tuesday, May 13, 2008

Specialty Urgent Care Centers

I learned today about the first example I'm aware of (outside of pediatrics) that is a specialized urgent care center - one that only sees orthopaedic injuries. Somewhat like a specialty hospital, but this center is open the traditional extended hours, does not require an appointment, is staffed by physicians, and has x-ray on site - all of the traditional "requirements" to call oneself an urgent care. But they do not do any other kind of illness outside of orthopaedics. Very interesting. A trend?

Wednesday, May 07, 2008

WSJ Article notes some retail clinics slowing growth

Health Clinics Inside Stores Likely to Slow Their Growth
By DAVID ARMSTRONG
May 7, 2008

The boom in walk-in health clinics located inside pharmacies, supermarkets and big-box retailers is showing signs of slowing.

Hailed as an inexpensive option for treating minor health ailments like sore throats and rashes, the retail clinics have grown in number to 963 as of May 1 from just 125 three years ago. The clinics typically feature nurse practitioners who can prescribe basic drugs, and the price for a visit ranges from $50 to $75.

But in recent months, retail health-clinic operators based in New York, Nevada, Indiana and Alabama have closed their doors, shuttering 69 clinics in 15 states, including ones operating inside outlets of Shopko Stores, Meijer Inc., Bi-Lo LLC, Wal-Mart Stores Inc. and the Medicine Shoppe unit of Cardinal Health Inc.

Now, the biggest retail-clinic operator, CVS Caremark Corp., says it is scaling back expansion plans for its MinuteClinic brand.

"We have seen fallout in this industry, on a smaller scale, that is not unlike the dot-com bubble," says Tom Charland, the owner of industry consultant Merchant Medicine LLC and a former vice president for strategy at MinuteClinic. "The big mistake was for people to think they could reach break-even in six months," he says. "People are learning this is an 18-to-24-month process to get to break-even."

Mr. Charland says the venture capitalists and private-equity firms that backed many of the retail clinic operators failed to appreciate how complicated and expensive the clinics are to operate. Research shows that patients are enthusiastic about the clinics' convenience and quality of care, but acceptance has been slow.

CVS, which operates more than 500 MinuteClinic facilities, says its plan to scale back expansion is part of a change in strategy. David Rickard, chief financial officer, told analysts last week that the company expects to add 100 clinics this year, down from a prior estimate of 200 openings. He said the company may also close some MinuteClinic locations that aren't in CVS outlets. He said that CVS will focus on "enriching" services at MinuteClinic facilities rather than expansion, and that the company believes MinuteClinic will be a "terrific, successful little business."

Some operators are finding that the clinics are complex to manage. Earlier this year, CheckUps, a clinic operator based in New York, abruptly closed 23 clinics that it operated inside Wal-Marts in Florida, Mississippi, Alabama and Louisiana. It was stretched thin by operations in multiple states, says company spokesman William Armstrong.

"You have to have a critical mass of stores seeing a high number of patients to get somewhere," he says. He adds that new clinics need to spend a lot of money on marketing to build public awareness and that the clinics become expensive quickly. "We ran out of operating funds," he says.

Not everyone is trimming sails. Walgreen Co. says it still plans to more than double the number of its Take Care health clinics this year by adding about 240 locations between now and the end of the year, bringing it closer to the number operated by rival CVS. The expansion will cause a drag on earnings in fiscal 2008 of five cents a share, the company says.

Tina Galasso, an analyst who follows the retail clinic industry for Verispan LLC, says the cost of setting up an in-store clinic runs about $500,000. That is one reason why much of the future growth in walk-in health centers is expected to come from big companies with deep pockets and from hospital systems that are already well-known within a community and don't have to spend so much on marketing.

In a strategy that combines both elements, Wal-Mart plans to partner with hospital systems to open as many as 400 co-branded store clinics by the end of 2010, up from about 50 sites in operation now. That approach is a departure from an earlier strategy under which Wal-Mart leased space to operators like CheckUps that weren't associated with hospital systems.

from the Wall Street Journal May 7, 2008

Monday, April 21, 2008

Retail Clinics, Service, Volume and Paperwork

I've just finished reading the Spring 2008 issue of Frontiers of Health Services Management, a quarterly publication of the American College of Healthcare Executives entitled "The Retail Clinic Strategy - Learn from the Innovators."

I could not help but notice several items that have given me pause:
1. Regularly in the articles they discuss the low volumes currently being seen in the clinics, and how those are projected to increase, etc. with breakeven figures and expected time frames for that (2 years) and so on and so forth.

2. They also cite great satisfaction rates from patients, which is terrific.

3. They also note how, although it wasn't the original model, most are now setting up to take insurance. An additional comment to this is that while the NPs who are staffing the clinics need very little clinical preparation, the training for dealing with all of the financial aspects (including all of the insurance issues) have been a bit of a learning curve.

All this has made me consider - with few patients coming in, it is no wonder the attention levels are high and the wait times are low - and satisfaction levels are great.

What happens when utilization starts to creep up - when they get as popular as they are predicted to be? When the NP is having to deal with lines of patients and paperwork ten times the current levels - will their challenges not be the same challenges we are seeing in urgent care (and all other health care outlets) now?

While I believe that retail clinics have their place in the healthcare system, and look forward to a good, integrated continuum of care that will put patients in the right place for the right conditions - I have concerns that over time the retail clinics will suffer the same burdens as the rest of us, regardless of the nationally-recognized volume-based delivery system concepts that are behind them. The majority of complaints we see about urgent care now are not about cost, but about wait times. They cannot meet demand. Retail clinics will help divert some of that traffic, but if no-wait non-urgent care gets pushed down yet another level (no disparaging of clinical care meant, but access point related) will that level not eventually suffer the same fate?

Friday, April 18, 2008

Hospital posting ER wait times

Scottsdale Healthcare has started posting its ER wait times on its web site. It's an interesting move, and one to consider if your urgent care has PR issues in this area. It almost has to be driven by an EMR - so if you have one, check with your vendor to see if this is a possibility for you.

I have seen a few stories in the news about people choosing retail health over urgent care because of the wait times expected - so if you can give them a place to look at least they will be making a judgment based in reality.

Monday, April 14, 2008

New Study on Causes of ER clogging - it's not non-emergency patients

According to a new article in the Annals of Emergency Medicine, many of the assumptions about ER overcrowding increases may be incorrect. There has not been an increase of uninsured or of inappropriate care seekers (who are better off in urgent care - this has held steady at 15% -still high) - it's the fact that there are no hospital beds to put people in when they are ready to leave the ER.

This article covers the study briefly - if you have access to the Annals the full study is available there: http://www.thenewstribune.com/news/nationworld/story/333924.html

Monday, March 24, 2008

Angie's List adding health care reviews

If you aren't familiar with Angie's List, it's an online evaluation systems of service providers across the country. They have over 600,000 users.

Angie's List has just decided to open categories for practitioners and facilities and insurance companies.

Here's the story http://www.insideindianabusiness.com/newsitem.asp?ID=28504

Monday, March 17, 2008

Triaging Joint Pain - free CME webcasts for all clinical staff

An organization has developed several CME programs targeting patient presentations that may be seen in an urgent care center. This is part of a larger initiative to educate the primary care/urgent care community on specific diagnoses and treatments. See below for details and to register:

Primary Cares: Triaging Joint Pain Through a Quality Improvement Approach

A chief complaint of joint pain accounts for a large percentage of office visits each year. The reasons behind the pain are numerous and often hidden. Time and other resources spent recognizing and diagnosing the etiologies add to the burden already faced by the primary care community.
Successful recognition and diagnosis of the underlying cause of joint pain is initially associated with better patient outcomes, and ultimately in savings of both clinic time and resources.

Join us for a unique Quality Improvement initiative where you will be guided along a process designed to increase the efficiency of the practice flow when faced with these patients. Regsiter today at www.Qicme.org/jointpain or call Qicme, LLC, at 800-777-5790.

Webconference dates: Tuesday, March 18 at 1pm ET, Thursday, March 20 at 2pm ET, and Monday, March 24 at 12pm ET

Learning Objectives At the completion of this educational activity, physicians and nurses who care for patients with joint pain will be able to:
Conduct a self assessment to contrast their own clinical management of joint pain with best practice guidelines
Identify perceived or real barriers to improving the management of joint pain patients in their clinical setting
Enumerate strategies to improve coordination between interdisciplinary members of the care team within their clinic
Understand criteria and timeline for enrolling in the site-based QI initiative to improve the care of joint pain patients.

Accreditation
The Peer•Point Medical Education Institute, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CME Credit Designation
The Peer•Point Medical Education Institute, LLC, designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Nursing Accreditation
The Peer•Point Medical Education Institute, LLC, is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.
This program is accredited for 1.0 contact hours and contains 0.1 hours of pharmacology (Rx) content.