Manhattan Institute studies state of clinics

NEW YORK — The Manhattan Institute has come up with a novel idea to help New York state slash its healthcare costs by a hefty $350 million by 2020: Expand access to retail health clinics.

Sounds simple enough, right? Think again.

To discuss the potential costs and benefits of such a move, several experts gathered for a policy forum on Feb. 16 in Albany, N.Y., hosted by the Manhattan Institute and the Empire Center for New York State Policy. Serving as the foundation of the lively discussion: Manhattan Institute’s new research report, “Easy Access, Quality Care: The Role for Retail Health Clinics in New York.”

Under the Patient Protection and Affordable Care Act, nearly half of New York state’s 2.6 million uninsured residents will acquire coverage by 2014, an influx of newly insured that will come amid an already critical primary care physician shortage and an overusage of emergency rooms.

According to the research, citing a 2010 report from Excellus BlueCross BlueShield, there were more than 640,000 unnecessary emergency room visits in 2008 in the 43 counties constituting upstate New York — or 44% of all ER visits in that region. This included more than 20,000 visits for sore throats and more than 22,000 visits for ear infections, two ailments that retail clinics routinely treat.

Despite the dense population and the clear need for easier access to affordable health care, the state has fewer than 20 retail health clinics (all physician-owned facilities) because opening in the state is extremely difficult with the existing regulatory structure.

“The impact that retail clinics have from a cost standpoint are pretty well-documented: 40% less than the cost of primary care or urgent care, and 80% less than the cost of an ER visit. I think the challenge now becomes finding a pathway to allow retail clinics to open and operate on a level playing field,” Lisa Loscalzo, managing director at Solera Capital and president of Solera Clinics, told Drug Store News following her participation in the policy forum.
The solutions to overcome the state’s burdened system, as suggested by the Manhattan Institute, are:

  • Repeal the costly regulatory structure for retail health clinics;

  • Create a licensure process to streamline regulation of one or more existing retail health clinic models; and

  • Allow nurse practitioners to practice outside of the state-required collaborate-practice agreement.

However, New York is not an isolated case. In looking at the retail clinic presence in the 30 largest metropolitan statistical areas, or MSAs, it comes as little surprise to find that seven of the top 10 MSAs with the lowest concentration of clinics by population are located in states with some of the most difficult regulatory hurdles: Texas, California and, of course, New York.

The challenges facing clinics in these states, as well as within Florida and Kentucky, vary — whether it’s constraints on scope of practice, a prohibition of corporate practice of medicine or stringent physician oversight regulations.

“We need to re-adapt our system and recognize places where the reality is patients will consume care in very different ways, find new ways to fit quality care into those places and encourage integration between care providers to raise the quality of care,” said Paul Howard, director and senior fellow for the Center For Medical Progress at the Manhattan Institute.

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