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Clinical Laboratories and Pathology Groups

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

Research conducted by Kalorama suggests the popularity of retail clinics represents a trend towards newer healthcare models that challenge existing models of care, and which could severely impact hospitals, clinical laboratories, and pathology groups

In recent years, pathologists and medical laboratory managers have watched as retail clinics housed in drug and grocery stores became a go-to service for healthcare customers seeking relief from minor illnesses. However, to market research company Kalorama, retail clinics also are a “game-changer” that could pose a threat to healthcare providers if their growth remains unchecked.

At risk are health systems and office-based physicians, along with the clinical laboratories and pathology groups that serve them. This would happen if patients shy away from primary care doctors in favor of cheaper, faster, medical care. However, as retail clinics expand the services they provide, they also could become an important source of orders for certain types of medical laboratory tests.

Kalorama defines retail clinics as, “healthcare centers that provide basic and preventative care in a retail setting; excluded are crisis and acute care centers; urgent care centers; emergency facilities; and wellness centers.” According to Kalorama’s data, “in 2016, total US retail clinic sales are estimated at more than $1.4 billion, an increase of 20.3% per year from $518 million in 2010.”

This increased use of retail clinics is a mixed blessing. On one hand, easy accessibility, low-wait times, and flexibility combined with lower costs for basic care is a boon for certain patients. On the other hand, this emergent healthcare model requires that traditional healthcare facilities address the impact of retail clinics on traditional practices, patient care, and regulatory standards.

Here are five reasons why retail clinics could threaten traditional healthcare models:

Retail Clinics Disrupt the Normal Healthcare Delivery Environment

Retail clinics are designed for immediate treatment of symptoms and vaccinations, not in-depth examination or long-term healthcare relationships between physician and patient. However, because retail clinics are a convenient low-cost option for patients, they become direct competition for full-service. Why visit a primary care physician (PCP) when you can receive off-hour care at lower prices and with faster wait times?

Based on data from peer-reviewed journal Mayo Clinic Proceedings, the graph above illustrates the huge growth of retail clinics over just the past 10 years, which is expected to continue. (Image copyright: Accenture Consulting.)

There is a rising fear among PCPs that the quick fix of retail clinic services will translate into poorer overall health for patients who fail to establish permanent long-term healthcare connections. This fear is validated by an American Medical Association (AMA) report that states, “only 39% of retail clinic users report having an established relationship with a primary care physician, which contrasts to about 80% of the general population reporting such a relationship.”

Retail Clinics Increase Competition for Primary Care Practices

Rather than competing with emergency departments, retail clinics directly compete with primary care clinics, according to Kalorama and the AMA. Staffed primarily by nurse practitioners and physician assistants, retail clinics treat symptoms of acute and easily identifiable health issues. There is growing concern that this limits opportunity for patients to receive more comprehensive healthcare that includes identification and treatment of chronic diseases.

And though competition in the healthcare market is good, physicians worry that retail clinics may push smaller stand-alone clinics out of business. The Kalorama report explains that “ultimately, medical practices are businesses that rely upon a steady flow of [patients] for their success.” When primary care facilities close due to loss of patients, it can create immediate healthcare gaps in communities.

Retail Clinics Could Increase Strain on Medical Laboratories and Pathology Groups

Kalorama’s data shows that retail clinics could place strain on medical laboratories and pathology practices. The study notes, “retail clinics are becoming relatively large users of point-of-care (POC) tests, clinical chemistry, and immunoassay laboratory tests and vaccines.” Kalorama’s report states, “the combined sales of these three types of products to retail clinics reached $240 million” in 2015, reflecting a 26% per year growth in testing since 2010. Projections from Kalorama suggest further increases in retail clinic test ordering in years to come.

The Clinical Laboratory Improvement Amendments (CLIA) advisory boards, the US Food and Drug Administration (FDA), and the Commission on Office Laboratory Accreditation (COLA) all have expressed concerns about the rise of retail clinic testing. COLA’s 2017 Spring Newsletter states that the increased use of retail clinics could lead to unnecessary testing, and increasing use of “non-laboratory personnel for laboratory testing.”

The COLA newsletter also warns that pathologists and clinical laboratory managers “should expect to see, over time, a steady increase in the menu of diagnostic testing offered by retail clinics.” COLA suggests that pathologists and laboratory scientists will experience increased demand from retail clinics for their services and expertise, but that because retail clinics often require high-volume, fast-paced testing without the benefit of full clinical laboratories (both in terms of staff and equipment) there is potential for retail clinic testing to fall short of industry standards.

Retail Clinics Fragment Health Records

According to an article in AMA Wire, the AMA House of Delegates (HOD) established guidelines for retail clinics that focus on continuity of medical records and the safeguarding of patient care. The guidelines state that retail clinics “must produce patient visit summaries that are transferred to the appropriate physicians and other healthcare providers in a meaningful format that prominently highlights salient patient information.” The fear, according to the AMA, is that the fragmenting of medical records may bring harm to patients via miscommunication that undermines patient-physician relationships and complicates oversight in treatment plans.

The Kalorama report echoes this sentiment. It states that physicians often take a negative view of retail clinics because of the lack of communication between retail clinics and primary care practices, citing a lack of cooperation or “unwillingness or inability on the part of convenience clinics to share medical information about patients with primary care providers.”

Retail Clinics Are Expanding Their Reach

Despite the fact that the AMA Council on Medical Services 2017 report on delivery reform recommends that retail clinics limit the scope of their care, expansion of retail clinic services has gone unchecked in many areas according to the Kalorama report. AMA policy states that retail clinics must have a “well-defined and limited scope of clinical services,” and the AMA’s 2017 guidelines state that “retail health clinics should neither expand their scope of services beyond minor acute illnesses … nor expand their scope of services to include infusions or injections.”

As retail clinics open around the country and expand their offerings there is a call for increased regulation of retail clinics to check that growth. COLA states that retail clinics are positioning themselves to play a major role in the delivery of primary care services. And the Kalorama report suggests that the trend towards retail clinic use will continue to rise, creating both challenges and opportunities for providers, clinical laboratories, pathologists, and healthcare policy makers who will be required to address the disruption to their businesses.

-Amanda Warren

Related Information:

Retail Clinics 2017: The Game-Changer in Healthcare

Report 7 of The Council on Medical Service: Retail Health Clinics

COLA’s Insights Spring 2017: The Rise of Retail Medicine

The Advance of the Retail Health Clinic Market: The Liability Risk Physicians May Potentially Face When Supervising or Collaborating with Other Professionals

Primary Care Practice Response to Retail Clinics

Retail Clinics are Poised to Offer More Health Services, Participate in ACOS, and Offer Expanded Menu of Clinical Pathology Laboratory Tests

Retail Clinics Continue to Shape Local Healthcare Markets

More Medical Laboratory Testing Expected as Retail Clinics Change Delivery of Routine Healthcare Services

Top-5 Diagnostics Trends Identified by Kalorama Will Impact In Vitro Diagnostics Manufacturers, Medical Laboratories in 2017

UnitedHealth’s Plans to Build More MedExpress Urgent Care Centers Is a Sign of Strong Consumer Demand and Could Be an Opportunity for Clinical Laboratories

Study Shows Too Many Electronic Alerts Cause 30% of Primary Care Physicians to Overlook Essential Clinical Laboratory Test Results

Missed results in EHRs were related to information overload, electronic handoffs from one provider to another, and perceptions of poor usability of the EHR

Physicians often overlook important clinical laboratory test results when they get too many alerts in a day. This was one of several findings from a study designed to see how physicians responded to alerts delivered through an electronic health record system (EHR).

These findings will not surprise most pathologists and medical laboratory managers. Daily and weekly, they see how frequently “out of normal” test results can be reported to a referring physician. (more…)

Statewide Medical Home Programs Launched in Rhode Island and North Dakota

Patient-Centered Medical Home (PCMH) is the latest concept in managed care. Primary care physicians, relegated to gatekeeper status in the HMO model of the 1990s, are elevated to the status of healthcare guru, taking the role of coordinating care, counseling, and educating patients. Launching the first statewide Patient-Centered Medical Home (PCMH), programs are Rhode Island and North Dakota.

The PCMH concept, which has been endorsed by the AMA, is a care delivery model that provides patients continuous access to a personal physician for the majority of their healthcare needs. There are 22 medical home pilots underway throughout the nation, but Rhode Island and North Dakota are first to take the concept statewide.

The leading advocate for the PCMH is the Patient Centered Primary Care Collaborative, a 200-member group that includes major employers, consumer groups, labor unions and healthcare providers and payers. It contends this healthcare model could improve the health of patients, while ensuring viability of the healthcare delivery system through reduced costs associated with shorter hospital stays, fewer hospital readmissions, and emergency department visits.

A statewide pilot of the Rhode Island Chronic Care Sustainability Initiative was launched last October on the heals of a 2004 state law mandating that health plans work to improve accountability in healthcare affordability, accessibility and quality. The pilot includes the state’s three biggest health plans, including the state’s Medicaid plan, Neighborhood Health Plan of Rhode Island’s Rhody Health Partners; Blue Cross and Blue Shield; and United Healthcare. These plans will pay the five participating primary care practices a fee of $3 per member, per month to cover the services of a care-management nurse.

Rhode Island insurers are optimistic about the model’s potential for reducing healthcare costs and improving outcomes. They also suggest that the new care model, which provides compensation for extra time spent caring for patients, will improve physician satisfaction. Not only with this be due to increased reimbursement, but also because the physicians will have the ability to provide consistent care across the board, regardless of the patient’s health plan.

North Dakota has already completed a two-year pilot of its MediQHome Quality Project, a PCMH pilot focused on diabetes care. The pilot demonstrated an estimated $102,000 savings in the care provided to 192 diabetes patients. The state launched its full-fledged, statewide PCMH program on January 1, 2009.

Under the North Dakota program, Blue Cross Blue Shield of North Dakota, the state’s largest health plan, has agreed to pay primary care physicians a semiannual $50 care-management fee for Blues members treated for coronary artery disease, diabetes or hypertension. However, according to a report from Modern Healthcare,  Jon Rice, North Dakota Blues CEO/senior vice president, questions the need for a “medical home infrastructure” to achieve better outcomes and cost savings. He points out that the pilot focused on a single health issue, but has yet to prove its mettle as a broad-based quality improvement program.

This mirrors the position of TransforMed, a nonprofit subsidiary of the American Academy of Family Physicians that is concerned with creating a financially sustainable healthcare model through a nationwide medical home system. TransforMed urges that an effective medical home program must address all patients in a primary care practice, not just certain diseases.

If there is a downside to the medical home trend, it is that it adds to the workload for doctors, even as the pool of primary care physicians dwindles. Practicing primary care physicians are leaving the field to enter higher-paying specialties. Fewer medical school students are opting to enter primary care.

Dark Daily expects that one consequence of the medical home movement will be for physicians to shift their lab test utilization patterns toward greater use of predictive testing and risk assessment testing. That’s because a major goal of the medical home arrangement is to encourage early diagnosis and active intervention to help the patient maintain optimal health.

Related Information:
The Dangers of the Decrease In Primary Care Physicians

Survey of EMR Adoption by Doctors Provides “Best Data There’s Ever Been!”

It’s tough to get an accurate picture of EMR (electronic medical record) adoption by office-based physicians. That’s important information for clinical laboratories because they must often provide an electronic gateway interface with physicians’ EMR systems for laboratory test ordering and results reporting.

Now comes help for clinical laboratories and pathology groups seeking to understand the pace of EMR adoption by physicians. This summer, The Institute for Health Policy published the results of a six-month study on the use of electronic health records (EHRs) in physicians’ offices in the New England Journal of Medicine. “This is the best data that there has ever been on the adoption of electronic health records by physicians,” said William Jessee, M.D., the physician president and chief executive officer of the Medical Group Management Association.

According to the abstract of the NEJM article, 4% of physicians reported having an extensive, fully-functional electronic-records system, and 13% reported having a basic system. Another finding was that the physicians most likely to be currently using EMRs were: 1) primary care physicians; 2) those physicians practicing in large groups, in hospitals or medical centers; and, 3) physicians practicing in the western region of the United States. Physicians reported positive effects of these systems on several dimensions of quality of care, as well as high levels of satisfaction in how their system performed. Financial barriers were viewed as having the greatest effect on decisions about the adoption of electronic health records.

The survey was conducted between September 2007 and March 2008 at the 902-bed Massachusetts General Hospital, Boston; the Harvard School of Public Health; George Washington University; and RTI International, working under a contract with the Office of the National Coordinator for Health Information Technology at HHS and grants from the Robert Wood Johnson Foundation.

Despite the fact that the survey revealed that 83% of physicians don’t have an EHR, the NEJM authors pointed out some good news. They noted that 16% of physicians with no EHR responded that their medical practice had purchased an EHR at the time of the survey, but it had yet to be implemented. Another 26 % of surveyed physicians said their practice was planning on implementing an EMR system in the next two years.

The conclusions of the report were that “Physicians who use electronic health records believe such systems improve the quality of care and are generally satisfied with the systems. However, as of early 2008, electronic systems had been adopted by only a small minority of U.S. physicians, who may differ from later adopters of these systems.”

The pace and nature of physician adoption and use of EHRs are important issues for medical laboratories and pathology labs. Lab managers and pathologists will want to be ahead of physician EHR adoption curve by preparing their laboratory information system (LIS) to interface with these EHRS to accept electronic test orders and directly download lab test results into the physician’s HER system.

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Doctors Promote “Medical Homes” as Way to Take Us Back to the Future

Many Dark Daily readers remember “Marcus Welby, M.D.” This popular TV show ran from 1969 to 1976 and starred actor Robert Young in the role of Marcus Welby, M.D. His sidekick was assistant Steven Kiley, M.D. (played by James Brolin). Dr. Welby was the dedicated family practice physician who treated patients as individuals in an age of specialized medicine and uncaring doctors.

Now, there is a movement among physicians to return to the caring compassion displayed by Marcus Welby, M.D. These physicians are endorsing a new model of patient care known as the “medical home.” The medical home is gaining momentum nationwide as an alternative to the current system of jumbled provider networks, says the Association of American Medical Colleges (AAMC). In addition to the AAMC, such organization as the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association, are promoting the concept of the medical home.

The AAMC defines the medical home as one that: 1) includes an ongoing relationship between a provider and patient; 2) provides around-the-clock access to medical consultation; 3) respects a patient’s cultural and religious beliefs; 4) provides a comprehensive approach to care; and, 4) coordinates care through providers and community services.

The medical home model puts the emphasis on primary care. It changes reimbursement to physicians so that they have an incentive to promote the early detection of illness and active intervention. This is similar to a major effort by the United Kingdom’s National Health Service (NHS). In recent years, the NHS has shifted funds away from acute and specialist care at the hospital trusts and transferred those funds to primary care trusts. In this way, the NHS has made primary care physicians responsible for early diagnosis, as well as pro-active management of patient care.

On July 21, USA Today reported that, here in the United States, individual states, the federal government, and private insurers are experimenting with ways to pay primary care physicians more money to oversee and coordinate patients’ care. The federal Centers for Medicare & Medicaid Services plans a demonstration project in 2010 to test whether paying primary care doctors more per month to treat patients with chronic illnesses in medical home settings results in better care and lower costs, compared with traditional clinical practices. The Tax Relief and Health Care Act of 2006 (TRHCA) mandates a demonstration in as many as eight states. This demonstration project will provide targeted, accessible, continuous, and coordinated family-centered care to Medicare beneficiaries who are deemed to be high need (that is, with multiple chronic or prolonged illnesses that require regular medical monitoring, advising or treatment.)

If the patient-centered medical home concept gains support, it could mean that clinical laboratories will see a greater demand for near-patient and point-of-care testing capabilities. That’s because, as caregivers visit patients in various settings, including patients’ homes, caregivers will want both fast access to lab test results and the ability to view those test results remotely.

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