Sunday, February 11, 2007

Clinical innovationsm- Retail Clinics: Not the Perfect Storm

I pause before I say this, but retail health clinics may not be the perfect storm after all. I pause because in prediction #9 in my January 11 blog, I foresaw decentralization – devolving of health care into smaller, more affordable, more convenient, more flexible units – would take health markets by storm. Like global warming experts, I may not turn out to be a flawless weather forecaster.

The term “perfect storm” refers to sudden confluence of events, which, taken by themselves, have far less power than their combined force. When MinuteClinic and similar nurse-staffed clinics burst onto the scene over the last five years, they seemed to be the perfect storm for the new health care consumer-driven market.

After all, these clinics shared these traits:

• Convenience
• No appointments
• No waiting
• Open for long hours, including weekends
• Lower prices than emergency rooms or doctors’ offices
• Location next to prescription counters
• Close to other shopping needs
• Staffed by skilled nurse practitioners
• Care-guidance by clinical protocols

What more could you ask? For retailers, there was the promise of more foot traffic, more prescriptions being filled, more shoppers buying other things. For entrepreneurs, retail clinics were an unprecedented opportunity to expand outside doctors’ offices. How could such a phenomenon fail?

Yet, I keep running across early warning weather signals that the perfect storm may not be at hand.

• Dr. Don Copeland, a veteran family physician in Cornelius, North Carolina, warns, “ The first time a guy walks into a retail clinic for chest discomfort and is given antibiotics for a URI, then drops dead from an MI, the whole concept will come crashing to the ground.”

• Some hospitals and doctors are reacting by competing -- extending hours, setting up more convenient clinics, and, in some cases, spreading the word that these retail clinics are too commercial and not to be trusted.

• A leader of a large primary care organization who is setting up a half-dozen retail clinics for his physicians, informs me, “Things are not going nearly as well as we had planned.”

Finally, on February 9, came a feature article, “Retail –Based Clinics: Passing Fad or Here to Stay?” The authors, Eben Fetters and Ron Luke, of Research and Planning Consultants in Austin, Texas, warn, “To many healthcare is still a very personal need that may not be acceptable and met by a quick visit to an unknown person in a non-professional setting.”

Those who believe retail clinics will take markets by storm may be ignoring history – passing fads of urgent care clinics of the 1980s and of primary care offices in shopping malls in the 1990s.

Times may have changed, but not that much. Maybe the emergence of nurse clinicians, use of computer-based protocols, reducing costs, avoiding hassles of traditional care, growing numbers of uninsured and underinsured, backing of health plans, and halo-effects of hospitals and physician groups providing oversight and backup will not overcome the stigma of “commercialism ” – or of seeing an unknown person you will never see again at Walgreens, WalMart, or some other retail outlet.

Only time, consumer experience, and consumer response will tell. Meanwhile consumers are free to choose and will make the choice of what is of value (quality/price) to them.

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