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Service Discrepancies

Typically, successful franchises meet consumers’ expectations by providing a standard product or service mix in every location. Retail clinics share some operational characteristics with franchises: The “look and feel” of the facilities, immediate access to services, posted menus with prices, etc.

Feed-back.com’s visits to selected retail clinics in 2008 (so far) suggest there may be inconsistencies in the way services are delivered in different locations — even in facilities that are operated by a single company. As noted in the August 27th, 2007 blog, a senior citizen was unable to have diagnostic testing done at a California-based retail clinic. A follow-up visit (March 2008) at the same facility and another one indicates the policy hasn’t changed. The signs that cite Medicaid and Medicare restrictions are still present. According to one receptionist, if a patient lies and receives treatment, the clinic and patient are both at risk for penalty. At another facility, the receptionist stated that elderly patients are not treated, but a service provider at the same location said elderly patients who are not covered by Medicare can receive treatment.

Recently, another odd discovery was made at the same group of retail clinics regarding a specific type of diabetes test — glycosylated hemoglobin (A1c). A survey conducted with eleven clinics operated by the same company revealed that four facilities require an office visit for patients to receive the test. No visit is required for testing at the other seven clinics. When asked, clinic personnel could not explain why such a discrepancy exists. In addition to requiring extra time, it costs more. The final result is a service that’s not as convenient, quick, or cost-effective as patients might otherwise expect.

Comments From VelociDoc About The August 27th, 2007 Posting:

In reference to: “… A visit to a retail clinic in California made earlier this month by an 84-year-old acquaintance did not provide the services she sought. According to a posted notice, federal law excludes Medicare and Medicaid patients from receiving services from retail clinics.”

This is interesting information. At Practice Velocity (www.practicevelocity.com), we provide software solutions for over 500 urgent care clinics, of which some are retail clinics. This is the first that I have heard of a Medicare ban on these clinics. I believe that the clinic may have confused non-participation with legal issues. I do not believe that there is any Federal law that prohibits retail clinics from seeing Medicare patients. Retail clinics that serve Medicare patients may have to deal with several complicating issues:

1) coding would have to use CMS-standard codes

2) incident-to standards would have to be followed

3) compliance issues are more rigorous with CMS

Note: I believe that all providers (even those who have opted out of Medicare) are required by Federal law to treat any Medicare beneficiary who presents with an emergency situation and to bill Medicare for these services.

Distant Rumblings Of A Shakeout…

Announcing its “soon to be released” new study, a brief blurb issued by Corporate Research Group (CRG; New Rochelle NY) suggests there’s going to be a shakeout in the retail clinic market in the next two years. The CRG article is entitled “Retail and Onsite Clinics: Fad or Future?” The news appears be mixed. The industry is “burgeoning” on the one hand and “losing money” on the other.

Clearly, any new business must pay substantial overhead expenses whether customers come through the door or not. Most emerging markets start strong, riding the wave of enthusiasm for a new product or service. Initially, the driving force may be a technological breakthrough or a unique way of doing business. Over time, emerging markets mature, economic and regulatory conditions change, new competitors enter the market, or someone comes up with another innovation. In the case of retail clinics, tighter regulations are likely to be imposed. However, employers and insurers are welcoming the chance to pay less for routine health care services.

One might argue that consolidation is happening already. Monthly tallies compiled by Feedback Research Services’ staff show slight fluctuations in retail clinic numbers and locations. A reasonable conclusion is that managers and owners are paying attention to consumer demand (or lack of it) and revising operations accordingly.

Turf Wars…

An article attributed to The Associated Press made the rounds last month, via various news outlets. As the public embraces retail clinics for quick convenient health care services, physicians and their associations continue to try to stem the tide. There’s been some give-and-take over the years. For example, the American Medical Association and the American Academy of Family Physicians have offered policy guidelines that set quality of care goals for retail clinics. In reality, the underlying issue may be competition. AMA officials indicate that an increasing number of practices are extending hours of operation in response to the rise in retail clinics.

Right now, it may seem like a tempest in a teapot. There is increasing competition, but companies clearly state the types of testing and treatment that are provided at retail clinics — most of which are quite limited and very similar among the various outlets currently in operation.

The business model is expanding, however, which may explain recent concerns about both continuity of care for patients on a long-term basis and the potential for retail clinic providers to miss underlying medical problems. Initial success often leads to further innovation. With the right mix of access and professionalism, availability of a wider range of health and medical services in the retail space could have a favorable impact on the U.S. health care system.

Taking “Convenience” One Step Further…

Retail clinics typically provide services in a store setting, but proponents suggest that the current business model is flexible and likely to expand with more innovative services yet to come. An example of such a service was reported in the Post-Tribune (8/18/07). Staff from a Corner Care retail clinic visited residents of Gary Manor Apartments (Gary IN). General health topics and clinic services were discussed with residents, who are mostly senior citizens. [1]

Going out into the community to deliver health information is a great idea. Starting with a facility that largely serves senior citizens is an interesting choice because…. A visit to a retail clinic in California made earlier this month by an 84-year-old acquaintance did not provide the services she sought. According to a posted notice, federal law excludes Medicare and Medicaid patients from receiving services from retail clinics. That must be why most clinic companies clearly state age limitations on their web sites — typically from two years of age to 65. It’s surprising, though, that the senior who was unable to use the retail clinic sometimes pays out-of-pocket for doctor’s visits when she wants a second opinion. There don’t appear to be restrictions regarding those services. Is it possible that retail clinics are being held to a different standard?

[1] For more information about the retail clinic cited above, visit: Corner Care Clinics.