Study: Evidence mixed on clinic disruption of doctor-patient relationships
NEW YORK — A new Rand study examining the impact of retail medical clinics on the receipt of primary medical care found mixed evidence about whether the clinics may disrupt doctor-patient relationships. And, while the study found that people who visit retail medical clinics may be less likely to return to a primary care physician for future illnesses and have less continuity of care, one could argue that the study is fairly irresponsible and myopic in scope as it overlooks the physician shortage in this country and ignores the fact that clinics connect patients without a medical home back into the healthcare system.
The findings, published online by the Journal of General Internal Medicine, are the first to provide insight about how the growing number of retail medical clinics may affect doctor-patient relationships and use of primary care services, according to the authors of the study.
"There is concern whether retail clinics may disrupt the relationship between patients and their personal physicians, which may make it difficult to maintain the quality and continuity of medical care," stated senior author Ateev Mehrotra, an associate professor at the University of Pittsburgh School of Medicine and a researcher at Rand, a nonprofit research organization. "We found use of retail clinics did have a negative impact on some aspects of primary care."
The study, however, did not find evidence that retail medical clinics disrupted preventive medical care or management of diabetes — two important measures of quality of primary care.
Rand researchers have documented the rapid rise of retail clinics, which now number more than 1,300 nationally. Use of the clinics increased tenfold from 2007 to 2009 among those with commercial health insurance, with use projected to rise more in the future. The walk-in clinics typically are staffed by nurse practitioners and offer basic types of health care with clearly posted prices.
According to the study, researchers examined the link between retail clinics and use of primary care providers by examining the records of a large group of people with commercial health insurance who used a retail medical clinic for an acute medical condition during 2008. Researchers examined their medical care a year before the visit and a year afterward, comparing their patterns of care with those patients who visited a primary care physician for an acute health problem during the same period.
People who visited a retail medical clinic for 1-of-11 common ailments, such as a respiratory infection or urinary tract infection, were less likely over the next 12 months to visit a primary care physician the next time they needed similar care. Patients who visited retail clinics also had less continuity of care, such as seeing the same physician for their medical needs.
Mehrotra, however, said since the use of retail clinics was not associated with less preventive care or poorer management of diabetes, it’s hard to make an overall assessment about the impact that the use of retail clinics had on the quality primary care.
"The interpretation of our findings depends on one’s view about the relative importance of different aspects of primary care," stated study author Rachel Reid of the University of Pittsburgh School of Medicine. "Retail clinics are still in their infancy, and over time we may or may not observe a more negative impact of retail clinics on preventive care or continuity of medical care."
What the study didn’t mention is the critical physician shortage facing the nation. It is estimated that the primary care shortage will reach about 60,000 by 2015. As mentioned earlier, the study also fails to address the fact that clinics — some of which have clinical affiliations with healthcare systems — connect patients without a medical home back into the healthcare system.
Support for the study was provided by the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization Initiative.
Ms. Alexander's critique is quite appropriate, but more can be added. The greater disruption of continuity of care may be placed at the hands of: * employers and insurers, who change health plans and panels of providers every few years; * a traditional medical community that still believes all healthcare is local, despite the fact that people move every few years; and * the fact that the majority of physicians still practice in groups of three or less. Ron Hammerle Chairman and CEO Health Resources, Ltd. Tampa, Florida
What direction is preventive care utilization heading? http://www.healthcaretownhall.com/?p=5596
Giant Eagle introduces discount format Good Cents to Pittsburgh market
PITTSBURGH — Multiformat food and fuel retailer Giant Eagle will be introducing its first discount format Good Cents Grocery + More to the Pittsburgh market Nov. 4. The 46,000-sq.-ft. location will feature a 3,800-sq.-ft. produce section offering more than 230 conventional and organic produce items and a cheese department with more than 60 specialty items.
“This is the format people have been waiting for,” stated Good Cents SVP John Tedesco. “Think of it as the missing link between discount stores and supermarkets. Good Cents reflects the real fresh, not real fancy experience for customers who know how to recognize a great deal on high-quality products.”
To keep prices low, Good Cents focuses on lower operating costs. To that end, Good Cents does not accept checks as a form of tender and also encourages customers to bring their own traditional and reusable bags. Customers may also purchase grocery bags for a nominal fee.
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Survey: Health insurers show advances in NP credentialing, reimbursement
PHILADELPHIA — More health insurers are credentialing nurse practitioners as primary care providers, but there is room for improvement, according to a recent national survey of health insurers.
The survey of health insurers, specifically Health Maintenance Organizations — conducted by the National Nursing Centers Consortium, a support organization for nurse-led care — found that 75% of HMOs credential with nurse practitioners as primary care providers, an increase over previous years.
Data were collected from 258 health maintenance organizations managed by 98 insurance companies across 50 states and the District of Columbia in from June 2011 to May 2012.
“Compared with similar research we’ve done previously, this survey seems to indicate that more health insurers are credentialing nurse practitioners as primary care providers, which is an improvement. But it won’t be enough given the millions more Americans who will be insured after 2014 and a projected shortage of primary care physicians of about 60,000 by 2015. Unless we get to 100% credentialing, we should expect a repeat of the circumstances in Massachusetts in 2007, when the supply of primary care providers was far too low to meet new patient demand,” stated Tine Hansen-Turton, CEO of NNCC.
Out of 499 total attempted contacts, 258 HMOs participated and were included in the survey sample. Of these, 192 (74%) indicated that they credential nurse practitioners as primary care providers. Two of the plans (fewer than 1%) did not normally credential nurse practitioners as primary care providers but indicated they would occasionally make exceptions if nurse practitioners provided care in underserved rural areas.
"Increased credentialing of nurse practitioners as primary care providers is important, but it is not enough to ensure patients have the access to care they need and to alleviate the growing national shortage of primary care providers,” added Amy Bell, senior finance director at the Larry Combest Community Health and Wellness Center in Lubbock, Texas. “Sometimes insurers will credential us but will not reimburse us directly, will not list us on their websites as primary care providers or they will put stipulations in our contracts. For the healthcare system to be ready for the huge influx of new patients in 2014, all nurse practitioners must be able to practice to, and be compensated for, the full scope of their ability."
Hansen-Turton added, “This is the time to leverage our lower cost structure by combining with safety-net provider networks to offer new, low price-point, high quality, holistic options in state insurance exchanges’ targeted areas.”
Since HMOs may serve any combination of Medicaid, Medicare and commercial enrollees, the survey categorized the 258 responding HMOs by product line. The Medicaid group consisted of 119 HMOs, of which 90 (76%) credentialed nurse practitioners as primary care providers. Of the 89 HMOs in the Medicare group, 74 (83%) credentialed nurse practitioners as primary care providers. The commercial HMO plans, numbering 111 in this survey, credentialed nurse practitioners as primary care providers at the lowest credentialing rate, with 74 (67%) affirming that practice.
“As state health insurance exchanges add millions of newly insured lives, they also drive the need for more providers in the private insurance market,” stated Hansen-Turton, “the low number of commercial insurance plans that credential nurse practitioners will increasingly be a challenge.”
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