Thursday, February 7, 2008

Access - It's All About Access

Recently I met with a group concerned about innovation themes to help doctors succeed. We discussed medical homes, patient-doctor connectivity, productivity approaches, innovation itself, and other august matters.

In the meeting’s aftermath, the thought came to me: from the patient’s point of view, medical innovation is often all about access. How can I get medical care quickly, conveniently, affordably, reliably, at a predictable price, at any hour of the day or night, without endless waiting? Providing answers to this multipronged question isn’t as saimple as A (All), B (aBout), C (aCcess).

But, if you give the matter any thought at all, there are multiple developments out there that indicate access is much of what the medical markets and opportunities for doctors are all about.

• Foremost among these developments are outlets in retail outlets open for long hours and manned )if you’ll pardon the expression) by nurse practitioners. These are growing like topsy nationwide, especially in states like Massachusetts and Florida. Doctors may think of these outlets are either a threat or an opportunity. The opportunities are to serve as backups to these clinics, to own them yourself, to prolong your hours to counter them, or to set up and organize competing entities.

• Another development, little noticed but growing, are worksite clinics, set up by employers with over 1600 employees, in which primary care physicians are salaried at $200, 000 or so to run practices with embedded EMRs, practice protocols, preventive programs, and prescribed drugs at no or little cost and no co-pays. Again this approach may be regarded as a threat or opportunity, depending on ownership, but physician might think of setting up their own model.

• Yet another sign on the access horizon is the setting-up of specialty clinics for treating minor ailments. A leader in this sphere are the Jewett clinics, run by an orthopedic group in Winter Park and Orlando, Florida. These clinics are staffed by orthopedic surgeons who the skills and diagnostic wherewithal to differentiate strains and pains from fractures, ligament tears, and disc ruptures.

• Then, of course, there is the flowering of urgiclinics nationwide, which may be open 24/7 and offer on-site doctors and the skills and equipment to back them up. These offer an alternative to hospital emergency rooms. ERs tend to be overcrowded, expensive, and rushed. Futhermore, they too often feature long-waiting lines – the bane of the modern, time-strapped, consumer.

• Finally, there’s home access – going to homes to provide care for the chronically ill or overseeing nurses and others to provide care in homes. National chronic are companies have seized the initiative here. But there’s no reason these services could be part of the medical home concept.

For many physicians, these access approaches represent a wrenching departure from the time-honored single office. They entail going to the patient rather than having the patient come to you. But no one ever said innovation was easy.

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