A clinical conspiracy? Or just plain stupidity?

Rob Eder

It’s not like I’m not one of those conspiracy theorists. But I’m also not stupid enough to think that Lee Harvey Oswald was a good enough shot to have acted alone, either.

That’s kind of the way I have felt these past few weeks since the American Academy of Family Physicians suddenly reversed its official policy on retail clinics. The AAFP no longer will enter into agreements like the ones it previously held with Minute Clinic, Rediclinic, The Little Clinic and BellinHealth Fast Care, the group announced Feb. 24.

The following Monday, the American Medical News, a trade journal for doctors published by the American Medical Association, printed the article, “Retail clinics: Struggling to find their place,” which examined the slowdown in clinic growth.

While the article correctly noted that of the 1,200 retail clinics in operation today, about 1,000 of them have opened since 2006, it fails to factor in the time it takes a clinic to achieve profitability. If it takes two years for a new drug store that benefits from the marketing and promotional spend of the big, well-known chain it is a part of, how long should it take a retail clinic, which has traditionally grown via word-of-mouth and the sweat of nurse practitioners? It has only been in the last year that retail clinics—and only the biggest clinics—have begun to do big, splashy media campaigns. Walmart won’t even put the names of the clinics on the buildings that house them.

Looking at patient counts across the entire enterprise will distort the picture for many of these operators. To focus primarily on the patient counts of two of the smallest operators—FastCare and CoxHealth—distorts the picture even more. Drug Store News knows from talking to the NPs in the stores that patient counts continue to rise—last summer, roughly 20% of Retail Clinician readers said their clinics were at or above the 20-patient-a-day profitability threshold. At Take Care Clinics, comparable patient counts at clinics opened more than a year are up more than 60%, CEO Peter Miller told Drug Store News in February.

But beyond patient counts, there is another important measure of profitability to consider, and that’s the impact a clinic has on the host pharmacy. One retail pharmacy executive told Drug Store News that in stores where his company operates clinics, the OTC business is up more than 20% versus the average store in the chain. And that is by no means an isolated example. Drug Store News has heard similar reports from other retail pharmacy executives whose chains host clinics.

The reason clinic leaders and pharmacy executives alike have not been quick to share these numbers publicly is the lack of understanding in the media around the Stark Law and how it really works. The reality is that there has not been an example of any retail clinic steering a patient in the direction of the host pharmacy. They don’t have to—patients are voting with their feet.

And that’s what I believe has a certain, obviously very influential, group of physicians worried the most; that there just aren’t enough patients or dollars to go around, or that clinics will somehow commoditize health care to the point where none of them will be able to make a living anymore.

That’s just stupid given the massive gaps that exist in the U.S. healthcare system, and the massive amounts of money we are going to spend to fix that. The AAFP said it’s worried about clinics “interfering with the medical home.” More than 30% of clinic patients said they have no relationship with a primary care physician, and most of them have health insurance.

The AAFP’s decision is based primarily on the fact that some clinics are moving into chronic care management. Meanwhile, such manageable conditions as diabetes and heart disease continue to blow holes through the health and wealth of America, and there aren’t enough physicians to treat everybody.

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