The role of retail

MinuteClinic and its rivals in the in-store quick clinic market have generated a lot of interest on the part of traditional providers. Some providers are quick to poke holes in the clinics' quality. From the Washington Post (Is 'Quick" Enough?)

"Convenience is not enough," the AMA lamented in a recent editorial. Comparing the mini-clinic phenomenon to kudzu --the tree-strangling vine rampant in the South-- the AMA complined these new services are spreading too far, too fast. In a policy statement this fall, the [American Academy of Pediatrics] "opposes retail-based clinics as an appropriate source of medical care for children, and adolescents and strongly discourages their use."

There may be something to this skepticism, but it's a little bit funny to read the complaints, which include:

• Staffing by nurse practitioners rather than doctors. (That's funny because it's a strategy popularized  by physician offices.)
• Lack of continuity of care as the various practitioners who see a patient over time may not communicate with one another. (Now isn't that the pot calling the kettle black?)

I'm not rushing to seek care at retail, but I'm glad these clinics are keeping traditional providers on their toes and getting them to find ways to increase convenience and availability. A new article in NEJM by Richard Bohmer, MD evaluates the impact of the clinics and compliments them for developing a strong value proposition for patients with low complexity conditions. He also notes that patients manage to do a good job of segmenting themselves according to complexity;as a result only about 10% of patients have to be turned away from the clinics for presenting with something the clinic can't handle.One change I expect to see as a consequence of the rise of in-store clinics is physician offices becoming more willing to try open access scheduling, which often lets patients be seen on the same day. A HelthLeaders article, Nothing to Fear: The Myths of Same-Day Scheduling, shows providers they shouldn't worry about "insatiable demand," "fewer encounters," or "lower revenues." The article doesn't mention, but should, that not providing easy access could lead to an erosion of patients as more seek convenient, in-store visits.Another HealthLeaders article If You Can't Beat 'Em in the same edition, inadvertently demonstrated why the type of competition retail clinics offer is necessary.

"We were the first to open in New Jersey, so you could say it was a defensive measure to create a competitive barrier," says Donald Parker, president of AtlanticCare... "We have about a 65 percent market share in our region, so that presents a unique challenge for an outside provider who has no reputation in the market..."

I don't know AtlanticCare, but that attitude is typical of a monopolistic integrated delivery system that exists to exert power over health plans and employers rather than to ensure operational efficiency and high service levels. I actually think it should be relatively easy for a chain of quick clinics to establish a foothold in such an environment.