Stanley Feld M.D., FACP,MACE
Convienent Clinic Association’sCCA’s press release challenges the AMA to join them in providing convenient care that is affordable and high quality and not fight them.
The AMA is put in the position of being reactionary. More precisely the AMA has been portrayed as being protective of turf. In reality the AMA is not protective. They are challenging the claim for quality care. A claim for which CCA and the in-store clinics have no evidence for.
On CCA’s web site they claim:
“At most Convenient Care Clinics (CCCs), standardized protocols and guidelines assist nurse practitioners (NP), physician assistants (PA) and physicians (MD or DO) in clinical decision making. (These protocols are not intended to replace the critical thinking or the clinical judgment of the providers, but to enhance the decision making process.) The leading CCAs’ protocols are grounded in evidence-based medicine and guidelines published by major medical bodies such as the American Academy of Pediatrics and American Academy of Family Physicians.”
“Most Convenient Care Clinics are incorporating rigorous quality assessments into their practice, such as:
• Formal chart review by collaborating physicians
• Peer-review by NPs and PAs
• Medical diagnosis and treatment code auditing
• Processes to ensure that all providers possess an adequate experience level to work in this new independent setting
In addition, most NPs are Master’s prepared and nationally certified in their specialty. Furthermore, all Convenient Care Clinics comply with all state regulations regarding the practice of physicians, NPs and PAs.”
The reader should notice the frequent use of the word most. What does most mean in this press release. Is this disinformation? If it is it is disinformation that is readily acceptable to the healthcare insurance industry. The real question is how many clinics adhere to the standards they say they set.
“One of the primary goals of the CCA is to establish common clinical guidelines and standards of operation to ensure the highest quality of care throughout all Convenient Care Clinics. To achieve this goal, the CCA has assembled a Clinical Advisory Board. The purpose of this advisory board is to provide input and guidance in the development of industry-wide quality standards and clinical guidelines.”
It sounds as if standards have not yet been developed. We are lead to believe that they have been developed because they provide high quality care with a 98% approval rating. There is no evidence for a 98% approval rating except CCA saying so.
Who is not looking? The consumer, patients, doctors and hospitals are not looking. Some day they will all wake up. It is important to see right now what is happening in front of everyone’s eyes. The devaluation of medical care as a way of lowering the price of medical care is happening right now.
The real problem to solve with medical care costs is the cost of the treatment if complications of chronic disease. The complications of chronic disease cost the healthcare system 90% of the healthcare dollar. Effective treatment can lower the cost by at least 50%.
Unholy alliances are formed by the smell of money. The healthcare insurance companies would love the in store clinics because they serve to devalue the physician driven medical care services even further. Innovative cutting edge ideas for medical care should be developed by physicians. After all, who are the experts in the delivery of medical care? However, many physician groups are dysfunctional because of the pressures of overhead, reduction in reimbursement and malpractice concerns. They are fighting for their lives as reimbursement continually decreases. Physician practices must become more innovative, more efficient and more effective. If not I believe the delivery of quality medical care in a dysfunctional healthcare system with decrease even further.
Business executives are developing in store clinics because they perceive a business opportunity. If the in store clinics succeed it will be the fault of organized medicine’s inability to help physician practices achieve a new efficiency. It will be because state licensing boards buckled to pressures and permitted various healthcare practitioners to practice medicine and bill without supervision.
The frustration of patients to get appropriate, timely medical attention, and the inability of physicians to adjust to the changing medical environment could drive the in-store clinics to succeed. However, I believe Americans are smart. When they own their own healthcare dollar and see the clinical outcomes of these clinics they will not support them. In the present insurance environment there is little evidence that the public is supporting these clinics.