News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups
Hosted by Robert Michel

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Clinical Laboratories and Pathology Groups
Hosted by Robert Michel
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Consumer Trend to Use Walk-In and Urgent Care Clinics Instead of Traditional Primary Care Offices Could Impact Clinical Laboratory Test Ordering/Revenue

May 25, 2018 | Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Testing, Management & Operations

Primary care is shifting from traditional office visits to urgent care and walk-in clinics even as large hospital groups continue to buy up independent physician practices, altering where and from whom clinical laboratories receive referrals and test orders

Medical test ordering and referrals from office-based physicians are the financial foundation of the clinical laboratory industry. Thus, recent trends reshaping how and where physicians practice medicine, and the ownership of their medical groups, could have both beneficial and adverse implications for medical laboratories and anatomic pathology groups.

Primary care doctors who own their own medical practices are disappearing from the healthcare landscape at an impressive rate, as large hospital groups expand their share of the primary care market. According to the New York Times (NYT), in 2010, large hospital groups employed 23% of the nation’s primary care physicians. By 2016, that number had increased to 43%.

However, office visits to primary care physicians fell by 18% between 2012 and 2016, according to a report by Health Care Cost Institute (HCCI). During the same period, visits to specialists rose 31%.

Walk-In and Urgent Care Clinics Replacing Traditional Office Visits

An increasing number of patients are selecting different types of providers when seeking medical care. Convenience, low cost, and shorter wait times have many patients choosing urgent care and retail or walk-in clinics instead of traditional office visits. Dark Daily reported on this growing trend last fall in “Five Reasons Why Retail Clinics Are a ‘Game-Changing’ Threat to Traditional Healthcare Providers That Could Strain Clinical Laboratories and Pathologists.”

The number of retail or walk-in clinics in the United States has increased by 14 times over the past decade, according to Statista, a provider of market and consumer data. In 2008, there were only 200 retail clinics in the country. Current projections indicate there will be 2,800 walk-in clinics located throughout the country by the end of this year.

In 2010, retail clinic sales totaled $518 million. By the end of 2016, retail clinic sales were more than $1.4 billion representing an increase of 20.3% per year during that time period, according to the Kalorama report, “Retail Clinics 2017: The Game-Changer in Healthcare.”

Jeffrey D. Le Benger, MD, FACS

“There is huge consolidation in the market right now,” Jeffrey D. Le Benger, MD, FACS (above), Chief Executive Officer of Summit Medical Group in New Jersey, told the NYT. “Everyone is fighting for the primary care patient.” (Photo copyright: Gannett.)

Retail or walk-in health clinics were originally intended for uninsured and underinsured individuals who sought an affordable option for medical services. These clinics are designed to treat non-emergency situations, such as burns, sprains, and minor infections or illnesses. Services at these clinics are usually administered by a nurse practitioner.

Retail walk-in clinics often are located inside larger, popular stores. Examples include:

Providing 24/7 Healthcare Services at Lower Costs

In contrast, urgent care clinics are equipped to handle more serious, non-emergency injuries and conditions and are generally staffed by physicians. The Urgent Care Association of America states that there are more than 7,500 urgent care centers in the US with an annual revenue of $18 billion. This industry is expected to grow by 5.8% in 2018. The largest urgent care group in the country—MedExpress Urgent Care in Morgantown, W.Va.—has 252 locations in 22 states.

Another growing urgent care center—ZoomCare of Portland, Ore.—has 36 locations in Oregon and Washington State. Services offered include: urgent care, primary care, pediatrics, gynecology, orthopedics, dermatology, dental care, ear nose and throat, chiropractic, podiatry, physical therapy, mental health, immunity, imaging, internal medicine, clinical laboratory, and prescriptions. They offer convenient, extended hours and some locations are open seven days a week.

“Our customers are looking for world-class conveniences,” Albert DiPiero, MD, co-founder and Chief Medical Officer at ZoomCare, told Portland Monthly.

ZoomCare lists its menu of services/cost for both insured and self-pay patients on its website. Basic medical laboratory tests include:

  • Strep-$50;
  • Urine-$20;
  • Mononucleosis test-$20;
  • Pregnancy-$20; and,
  • Influenza A/B-$40.

The website states that half of ZoomCare’s medications cost less than $10, and five out of six of the medicines are less than $20.

With such low costs and easy accessibility, it’s understandable why the number of patients seeking care in non-traditional office settings is growing. Clinical laboratories must accept and support these new sites of healthcare delivery to ensure continued procurement of lab test referrals. Staying on top of these trends and adjusting to consumer demand will help labs thrive and survive in healthcare’s ever-changing landscape.

—JP Schlingman

Related Information:

How ZoomCare is Shaking up the Checkup

The Disappearing Doctor: How Mega-Mergers Are Changing the Business of Medical Care

Healthcare Mega Mergers Push Primary Care Clinics Closer to Extinction: Five Takeaways

AETNA and ZoomCare Announce New Accountable Care Collaboration in Oregon

Number of Retail Clinics in the United States from 2008 to 2018

Retail Clinics 2017: The Game-Changer in Healthcare

Urgent Care Industry Hits $18 Billion as Big Players Drive Growth

Five Reasons Why Retail Clinics Are a “Game-Changing” Threat to Traditional Healthcare Providers That Could Strain Clinical Laboratories and Pathologists

Studies Reveal Workers in HDHPs Pay Significantly Higher Annual Healthcare Costs than Employers and May Utilize Fewer Clinical Laboratory Tests

Mar 17, 2017 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Testing, Management & Operations

Consumers respond to high-deductible plans by using less healthcare services, which in turn leads to a decrease in doctor visits and clinical laboratory test orders

Are many Americans avoiding medical treatment because of the high-cost of their health plan deductibles? And if so, will such an underutilization of healthcare affect hospitals, independent medical practices such as pathology groups, and clinical laboratories?

Two separate studies: one a survey co-conducted by the Kaiser Family Foundation and the Healthcare Research and Educational Trust (KFF/HRET), and the other an analysis by the Health Care Cost Institute (HCCI), investigated the dynamics behind trends in the healthcare marketplace leading to these questions. (more…)

Higher Deductibles and Co-Insurance Costs Squeezing Healthcare Consumers’ Wallets; A Reasons for Clinical Labs to Make Lab Test Prices Easy to See

Sep 14, 2016 | Compliance, Legal, and Malpractice, Laboratory News, Laboratory Pathology, Laboratory Testing

Two new studies show patients are being increasingly burdened with a greater share of healthcare costs, which requires providers, including medical labs, to collect more money from patients at time of service

Although wage increases remain stagnant, consumers now pay a steadily increasing share of their healthcare costs. That’s because of rising deductibles, co-insurance, and other out-of-pocket costs. Not only will this cost-sharing trend continue to stretch patients’ budgets, it also will apply more pressure on clinical laboratories and pathology groups to increase price transparency for patients.

A recent study at the University of Michigan (UM), published in the Journal of the American Medical Association (JAMA), highlighted the growth in out-of-pocket insurance costs for hospitalized patients. For the average consumer with private health insurance, costs rose from $738 in 2009 to $1,013 in 2013—a 37% increase. During that same 4-year period, overall healthcare spending grew at 2.9% per year and health insurance premiums went up 5.1% annually.

Two types of health insurance plan charges were responsible for the biggest change in out-of-pocket spending: deductibles and co-insurance. During the same period, deductibles rose by 86%! Co-insurance costs increased 33% over the same period. Co-payments (a flat fee) were used in fewer hospitalizations. (more…)

Patient Healthcare Costs in High-cost States Can Be Double Those in Low-cost States; Clinical Laboratory Tests Are Among Procedures with Greatest Price Fluctuations

Aug 10, 2016 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Pathology, Laboratory Testing

Findings of this HCCI study, may increase pressure for more transparency in clinical laboratory and pathology test prices

Consumers in states with high healthcare costs may spend more than twice as much for common medical procedures as patients in other states. That’s a surprise finding in a milestone report from the Health Care Cost Institute (HCCI). The report also revealed that pathology and clinical laboratory tests are among the services with the widest price fluctuations. Prices also were shown to vary significantly within individual states.

The HCCI study is the latest salvo in the battle to provide consumers with healthcare price transparency and likely will increase demands on clinical laboratories and pathology groups to make lab test prices easy to find and understand.

HCCI Report Identifies Wide Variance in Prices of Clinical Laboratory Tests (more…)

2014’s Healthcare Price Transparency Report Card Reveals Few States Are Making It Easy and Fast for Consumers to See the Prices Charged by Hospitals, Physicians, and Medical Laboratories

Aug 20, 2014 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement

One reason is that the healthcare price websites operated by most states are inadequate, ‘poorly designed or poorly functioning’

Efforts to encourage price transparency at hospitals and other providers are making little progress. That’s one conclusion to be made from the second annual Report Card on State Price Transparency Laws, that gave a failing grade to 45 states.

This information is relevant because more consumers are now enrolled in high-deductible health plans. As a consequence, clinical laboratories and anatomic pathology groups must now handle requests from patients who want to know the cost of their medical laboratory testing in advance of service. As well, many of these consumers want to negotiate prices with their laboratory provider. (more…)

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