Friday, September 21, 2007

Physician Business Ideas, worksite clinics - Some Doctors Now Practicing at Worksites and in Stores

Innovation for doctors comes in many forms. One form is simply moving elsewhere to practice. If the move for primary care physicians results in greater income, less hassle, no malpractice premiums, primary care physicians may be attracted and tempted to make the move. If they treasure their autonomy, they may not be interested.

At the risk of being repetitive, here’s what I said in my Sept. 5 blog about the move to worksite clinics.

More than 100 of the nation’s 1,000 largest employers now offer on-site primary care or preventive health services — forecast to exceed 250 by the end of 2007. Companies opening or expanding these clinics include Toyota, Sprint Nextel, Florida Power and Light, Credit Suisse and Pepsi Bottling, and a small company in Florida called MyCareTLC, which plans to franchise these clinics across multiple corporate settings.

According to MyCareTLC, these clinics are projected to save as much as 45% to 50% in health care expenses for employers.

How? Well, it’s claimed company doctors onsite can conveniently assess the situation, prescribe generic drugs on site, follow best practice guidelines, and refer to pre-selected specialists, judged by data mining to be the best performers, the most quality oriented, and the most economical.

Furthermore, employees need not travel to see a doctor for routine care, pay no co-pay, receive generics at cost, and they and their families can be coached on healthy living and preventive care.

The clinics have an EHR integrated with an online editing and publishing service containing best practice information and evidence-based data on 200 clinical conditions, updated daily. In addition, the clinic and its doctors have access to information from a data-mining company which identifies high risk individuals, high performance physicians to whom to refer, and offers clinical advice and strategies to employers, purchasers, and patients.

Why would these clinics attract primary care doctors?

• First, they’re hassle-free. No worries about billing and collection and arguing with health plans.

• Two, the company will be pay 30% more than what MGMA reports as the mean income for primary care physicians.

• Three, an EHR system integrated with best practice guidelines and diagnostic support information is in place.

• Four, patients are on site, so no practice marketing is necessary.

• Five, a bevy of free-generic drugs are available on site, so drug costs drop to zero for most patients.

At least, that’s what MyCare clinic backers envision, and we’ll have to wait and see what happens as this innovation is rolled out across the country.

Doctors in Retail Outlets

Now we have another new wrinkle on the practice site block. It’s called Medical Marts, and it puts primary care doctors inside stores, as reported by Bruce Japsen in the September 20 Chicago Tribune ( “Medical Marts' Retail Clinics Putting Doctors inside Stores.”)

The physician-staffed retail clinic model has officially opened its doors in the Chicago area.

Medical Marts opened physician-staffed retail clinics in the Chicago suburbs this month in Aurora and St. Charles, with plans to open a third in Algonquin by the end of the month. All are located in Meijer supercenter stores, but Medical Marts is working with other retailers and plans to open two clinics in Kmart stores in Rockford before Nov. 1.

Medical Marts staffs its clinics with two full-time primary-care physicians, and two full-time medical assistants or licensed practical nurses. Las Vegas-based Medical Marts has avoided the criticism of retail clinics opened by the likes of Wal-Mart Stores Inc. and Walgreen Co. staffed by nurse practitioners. Medical groups such as the American Medical Association say clinics' nurse practitioners should have direct access to a physician and referral systems so patients with severe medical issues can be treated elsewhere.

"Our clinics are as one would find in any newly constructed, state-of-the-art medical facility, generally with three exam rooms, a procedure room, nurses station, reception area, physicians office and washroom," said Dr. Kenneth Richmond, a Wilmette physician and vice president and chief medical officer of Medical Marts. "The reception areas are purposely small, as patients are seen upon arrival. Should the physician be occupied, patients are given a pager, given time to shop, and paged when the physician is ready to see them."

Medical Marts clinics are open seven days a week, from 8:30 a.m to 8:30 p.m Monday through Friday, 8:30 a.m. to 6:30 p.m. Saturday and 9:30 a.m. to 5:30 p.m. Sunday.

Three year old Medical Marts hopes to open 400 clinics in retail outlets across the country by the end of 2009. The company has opened seven in Utah in Shopko stores, with four under construction in St. Louis and Virginia.

There are at least 600 retail medical clinics staffed by nurse-practitioners in the U.S., according to Merchant Medicine, a Minneapolis-based research and consulting firm. CVS/Caremark Corp. subsidiary, MinuteClinic, leads the pack, with more than 250 retail clinics, followed by Walgreens' subsidiary Take Care Health Systems, with 55 clinics. Sixteen separate companies now operate retail health clinics, and the number of clinics may reach 10,000 by 2011 or 2012,

What’s the significance of moveable primary care practices?

• One, innovation is alive and well in America’s employer-driven and consumer-directed health system and bears watching and responding to.

• Two, corporate employees and health care consumers are receptive to receiving care outside the traditional office settings.

• Three, when it comes to cutting costs and offering convenience, employers and entrepreneurs can be very innovative and effective in transforming the health care practice landscape.


Corporate worksites and retail stores are now employing primary care physicians on salaries to manage clinics in their facilities. For some primary care physicians, these new practice settings are attractive because of lack of hassles in billing and collections, relief from dealing with managed care carriers, regular hours and fringe benefits, availability of electronic medical records and access to diagnostic support services. But these types of practices may not be for doctors who wish to retain their autonomy and to be free of corporate fetters. For most physicians, practicing at worksites and in stores will remain a fringe phenomenon, and the overwhelming number of physicians will choose and prefer independent practice.
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