Who owns the patient? In terms of health care delivery, where does the spectrum of care begin and end? Retailization and convenient care (store-based clinics) bring this question to the forefront.
The American Medical Association (AMA) believes that if convenient care clinics exist, there are certain guidelines that should be followed that are beneficial to the patient. The AMA issued a 9 page report entitled Store-Based Clinics that offers guidelines for convenient care.
The AMA Council on Medical Services (CMS) issued Report #7 dealing with Retail Health Clinics. This report outlined the development of store-based clinics and their use of medical protocols. This report highlighted the activities of the AAFP in this area and outlined the AAFP’s desired attributes for store-based health clinics. The recommendations adopted by the House of Delegates are the following:
a. Store-based health clinics must have a well-defined and limited scope of clinical services consistent with state scope of practice laws.
b. Store-based health clinics must use standardized medical protocols derived from evidence-based
practice guidelines to insure patient safety and quality of care. (Some may disagree with this statement because they think it replaces physician judgment).
c. Store-based health clinics must establish arrangements by which their health care practitioners
have direct access to and supervision by MDs/DOs as consistent with state laws.
d. Store-based health clinics must establish protocols for ensuring continuity of care with practicing
physicians within the local community.
e. Store-based health clinics must establish a referral system with physician practices or other
facilities for appropriate treatment if the patient’s conditions or symptoms are beyond the scope of
services provided by the clinic.
f. Store-based health clinics must clearly inform patients in advance of the qualifications of the
health care practitioners who hare providing care, as well as the limitation in the types of illnesses
that can be diagnosed and treated.
g. Store-based health clinics must establish appropriate sanitation and hygienic guidelines and
facilities to insure the safety of patients.
h. Store-based health clinics should be encouraged to use electronic health records as a means of
communicating patient information and facilitating continuity of care.
i. Store-based health clinics should encourage patients to establish care with a primary care physician to ensure continuity of care. There should be a mechanism to ensure continuity of care if the convenience center is not going to do the follow-up care.
When physicians make a decision to get involved and supervise care, the AMA urges them to follow these guidelines.
The American Academy of Family Physicians believes, in addition to the AMA’s guidelines, that the most valuable commodity that anyone can have in health care is a medical home, where their medical history resides, and where they can get most of their primary care, that coordinates their care, and where they can always come back to.
Part of provinding a medical home is a team-based approach to care – physicians, nurse practitioners, dieticians, physical therapists, etc. Everybody has a role in patient care. There has to be an electronically coordinated center of care to effectively take care of the patient and coordinate the activities of all the providers.
The American College of Nurse Practitioners supports the concept of convenient care clinics. The system is broken, and retail clinics think that they can provide a service. The retail clinics are filling a need that wasn’t filled before. There are not enough family care physicians graduating each year to meet demand. It can take a long time to see a family practice physician. How do we solve it? Look at the numbers. 2.5 family nurse practitioners are graduating for every one family practice physician. They can play a role.
There are a number of reports that show that the quality of care that nurse practioners provide is equivalent to that provided by family physicians. They can do about 70% of what MDs can do. Unlock the regulations and restrictions to allow NPs to do what they are capable of doing. Retail clinics are using nurse practitioners as a primary care provider. The primary care provider is the person seeing the patient at that point in time.
Minute Clinic thinks there is patient value to retail clinics. The retail clinic model is to provide services as an adjunct to the medical home. The medical home relationship is a critical one, and retail clinics should facilitate that relationship. Most patients don’t currently have a medical home. Retail clinics cannot provide the full breadth of services because of the businesss model. Retail clinics are there to be supplements to the medical home. Can they help in, for example, disease monitoring, not necessarily disease management.
How do you measure and demonstrate the quality of retail clinics? Minute Clinic has been working with the Joint Commission on Accreditation of Healthcare Organizations to set these standards of measurement.
Little Clinic also sees itself as a compliment to the family practice. But the question we should ask is what do consumers want? How do they want to deal with their daily medical needs? Do they always need to see their family practitioner, who might not always be available? Maybe not. The primary care physician is responsible for integrating all the patients health care information, but PCPs are in decline. There are less of them than in the past. They can’t keep up with demand. So convenient care clinics can serve as a compliment to help ease the burdon on the system. Let the retail clinics deal with the low risk issues if the consumer so desires. If it brings value to the consumers, this model will be successful. If not, it will fail.
Teladoc believes that when people move, it is difficult to drag the doctor with us. More likely, our medical record will go with us in the form of an electronic medical record. When a continuity of care record is working, a patient can bring their record to anyone providing their care. Patients, at 2am, can access their medical record and deliver it anywhere. CCRs will be a huge part of the solution.
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