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Retail Clinics: How Can Primary Care Docs Compete?
Featured in: Hippocrates
Medpundit's post on retail health clinics kicked off quite a discussion.
These "doc-in-a-box" outfits based in retail outlets seem to be a growing trend, California Healthline reports. Where exactly do they fit in the marketplace of healthcare services? To quote Medpundit:
For $39 they'll take care of colds, flu, minor injuries, pink eye, and the like. They'll also take out your sutures and clean your ears. They'll screen for diabetes, anemia, and cholesterol, among other things. And they'll give you your immunizations, too, but their brochure doesn't say how much those cost.
What does it mean for small primary care practices? To answer this question let's first look at what is driving demand:
- Under-Insured: People without insurance or on a high deductible plan are usually price-sensitive. They skimp on the quality of service until the going gets really tough. Emergency room has long been the forced choice of many for a long time.
- Impatient Patients: Let's face it, who likes the ritual of setting medical appointments, getting to the doctors's office, then waiting in line? Especially for routine things. Especially if office hours are during your work hours and you want to keep your job.
- Shopaholics: For some getting routine health services could be just a part of the "shopping experience". As a commenter puts it, you sign in, get a buzzer and shop until they call you. Clever way for retailers to subsidize the cost and cross-promote.
Physician practices still make a strong case for greater quality of service with better personnel, continuity of care and personal touch. But given the motivations of people targeted by these retail clinics, they may not be receptive. What else can docs do to compete?
Aside from locating your office in a mall (bad joke huh?), support for telemedicine may be the answer. Consider the issues:
- Costs: Online consults for routine matters could cost less than full office visits, but cannot compete with co-pays. Still the lower cost per incidence could actually net more per hour, because of less time and interruption required.
- Scope: No doubt, you cannot do everything without seeing patient face to face. Physical exam is still required by law to diagnose and prescribe in many jurisdictions. Getting to know your patients personally has no substitute too.
- Availability: Telemedicine does not have to be real-time. A busy professional can submit a request before or after work hours and the doctor can answer... whenever he or she feels like, perhaps within a certain time window.
- Location: Flexibility can be increased not only for time but place of care. Travel is a big issue for many people, especially in rural areas. For physicians this could mean being able to increase the "service radius" and attract more patients.
- Reimbursement: In most places, telemedicine still means "cash-only-please". But some health plans (e.g. in California) are starting to catch up and include coverage. Yet, it still may be too early to count on this in your planning.
These factors could bring back some "impatient patients" and perhaps "under-insureds", for routine interactions to supplement regular office visits. There is little hope for "shopaholics" though.
Medpundit notes from her experience that there was not much uptake for web visits in her practice. But the key may be in reaching out to the population who are not currently your patients. Internet presence could be the key here, if you play your cards right.
Will telemedicine take off? It has nowhere to go but up. Online access is increasingly seen as must-have in choosing a doctor.
UPDATE: On meeting the challenges of trust raised by e-medicine: Trust: Traditional or Electronic, A Doctor-Patient Relationship Starts There
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Comments (2)
Is being a consumer really worse than being a patient? We make patients wait for many hours in the waiting room, but a consumer can voice their frustration. We treat patients like they are lucky to see us, while we are more attentive to the needs of consumers. The past has been very paternalistic in attitude toward our patients - they were at the office so we could tell them what to do.
I don't object to looking at patients as consumers, I condone it. What I am against is viewing patients as commodities. A commodity is impersonal, it is something to profit off of. Truthfully, the way we treated patients in the past was also in many ways as commodities. I take far more interest in meeting the needs of my patients by being on time, having the latest evidence-based standards, etc.
This is where I think the retailers will get it right in some ways, wrong in others. They do understand convenience and will probably do a better job than we do as physicians. They do not understand, however, the relational aspect of medicine. It is better to go to a doctor who knows you, your parents, your kids, and can make decisions based on that knowledge. Yet many people are not interested in that, hence the high use of "Doc in a box" facilities. Do they get better care there? No. Do they get better service? Yes. So if the decision is between service and care, traditional doctors will win in the care category (although many still are practicing poor medicine - more on that in another post). Retailers will do much better in the service category - something doctors need to catch up on.
What do we need to do? It is far more likely for us to be able to become more service-oriented than it is for the retail clinics to become more personal. It was taught to me a long time ago that the first rule of marketing was to raise the cost of going anywhere else for service. In other words, do such a good job in terms of service and care that people will be dissatisfied anywhere else they go. We have a walk-in clinic from 7:30AM to 9:00 AM every day and also from 5:30 PM to 7 PM each evening. This makes it nearly impossible for our patients to say that they could not get in to see us for an urgent problem. This has produced very high loyalty among our patients and makes us fear the urgent clinics less.
What do I think about the "telemedicine" idea? If I am interacting with patients I have no information on, I am no better than the retail clinics. Certainly there are some problems that do not require an office visit and can be handled through cyberspace. I think as P4P ramps up, it will become economically advantageous to handle things without incurring an office visit. The problem remains that the present transaction of medicine is based on procedures - i.e. you get paid to see the patient. Unless we can be paid to do visits over the internet or for the overall health of the patients (P4P) we will still lean toward bringing patients in to be seen.
We have seriously looked at the possiblity of e-visits, where the patient is charged a certain amount to send us an e-mail with their complaints, questions, etc. If we can handle it over the internet, then they are spared an office visit (as are we). If they have to come in to be seen, the charge for the e-visit is put toward the office visit. I really think that this type of approach will become more normative as things progress. Truthfully, I don't get a lot out of seeing patients for URI's and Ringworm and would be happy to handle them over the web if the right safeguards were in place (if I could do the same quality of care). I get much more out of the long-term relationships I build with my patients and offer that as a major advantage they have in maintaining the relationship with me.
Again, I see this as an area where I am very much ready to move, due to the fact that I have been on EMR for 10 years, while others are not even close to doing this. I anticipate starting e-visits in the next 12-18 months. I will keep you up to date.
Rob
Augusta, GA
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This is really about looking at people as Consumers, not Patients...