The American Association of Family Practitioners has revised it’s position on retail health clinics from mildly concerned to oppositional. This is in response to what the association sees as expanding scope of services offered by the clinics, which are small health care outlets typically located in pharmacies, grocery stores, and other retail locations that have historically focused on treating a handful of very standard illnesses like strep throat, bronchitis, ear infections, and pink eye.
These clinics have always represented a threat to the AAFP, since they primarily staff physicians assistants and nurse practitioners and are an obvious substitute for their members. This is not the first organization of health professionals to object to the retail clinic model. The American Academy of Pediatrics has previously issued a policy statement listing their concerns about quality of care and safety and officially opposing the use of retail health clinics for infants, children, and adolescents. The AMA, and the American Academy of Family Physicians have called for increased regulation.
A symposium last year in Health Affairs on retail clinics included articles showing that 90.3% of visits to retail clinics were for clinics typically served 10 common and simple illnesses. Furthermore, clinics treated these patients at lower cost than traditional health providers, specifically, $50-$60 cheaper per treatment, and they serve a population that is currently underserved by primary care providers. Other studies, which I can’t find right now, have shown no difference in treatment quality between retail clinics and traditional caregivers. So if retail clinics are treating common illnesses, at lower cost, with the same quality, what is the problem?
The AAFP is worried that clinics are expanding the scope of services they offer. According to a 2008 interview with an industry expert by the AAFP, clinics have the following expansion of scope in mind:
You can see the expansion with things like camp physicals, screenings and preventive care. Consumers need a health care provider; they want something done quickly, simply and conveniently. That core brand promise is now being applied to a whole new range of services, including injections, vaccinations and weight loss counseling….
This is supported by a recent study from Health-Leaders InterStudy, which confirms that in some markets retail clinics are expanding the services they offer. The more services these clinics provide the more they are competing with the AAFP’s members, so this move represents an increasing threat to them.
The expansion of scope is not surprising either, while retail clinics are popular and growing in numbers, there have long been concerns about clinics profitability. In recent years have been several incidents where large retailers, including Wal-Mart and CVS, will close several clinics at once. The issue appears to be that clinics have to serve a lot of customers a day in order to be profitable, and one easy way to overcome this would be to expand the scope of services.
Entrenched industry groups have been successful in the past in getting states to impose burdensome regulations on retail clinics, and this increasingly oppositional stance by the AAFP may add to that.
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Tuesday ~ March 2nd, 2010 at 5:32 pm
Apex
Isn’t this kind of self protectionist model within members of the AMA community a classic example of how the cost problem with health care exists on the provider side? Until we do something about that there will be no bending of the cost curve or reduction in the cost of medical care.
Insurance companies are surely no saints but they aren’t driving costs, they are just passing them along. And while they have their own inefficiencies, those are a small portion of the overall cost in the health care system.
This case is an example of having lower skilled individuals provide care that obviously requires lower skill and yet that whole model is opposed by the AMA community. I mean do I really need an MD to do a swab for strep?
Someone needs to have the courage to attack the real problem rather than the boogie man.
Tuesday ~ March 2nd, 2010 at 9:19 pm
Adam Ozimek
Apex,
I have never seen a quantification of the impact of the AMA and other supply constraints on the cost of medicine, but I think it would be incorrect to attribute too much of health care cost inflation to it. As an example, some studies tie an increase in supply of doctors to an increase in spending, which is known as supplier induced demand. Also, supply constraints like the AMA are usually statewide, yet huge cost differentials exist between counties within the same state. So I am skeptical that it would go very far in explaining cost growth. But I would be interested in seeing some quantification of this issue.
Wednesday ~ March 3rd, 2010 at 3:12 pm
Apex
Adam
You may very well be correct. I suspect cost inflation is complicated and varied. I suspect having insurance plans where the cost-service link is mostly removed from the consumer is also a considerable contributor. I just don’t see how things like having more people get insurance, making insurers take people who already have conditions and pay for the costs, etc can address the cost side of the equation.
I have tried to ask various people in medicine (providers, auditors, hospital accountants, etc) where they think the cost increases come from, and I get many various different answers but they are all kind of guessing too I think. But I never hear that they think insurance companies are driving cost. They may hate dealing with them but they don’t point at them from a cost driver stand point.
Wednesday ~ May 5th, 2010 at 7:18 am
Bringing Retail Competition to Chronic Illnesses « Modeled Behavior
[...] who do. At least the American Association of Family Practitioners seems to think so, as they have recently begun opposing retail clinics because of expansions into other services just like [...]