Stanley Feld M.D., FACP, MACE Menu


Look What Happens When You Are Not Looking. Part 2

Stanley Feld M.D.,FACP,MACE

The AMA House of Delegates met and developed policy recommendations concerning the In Store Clinics. They stated they were not opposed to the in store clinics. However they wanted certain quality criteria met. I do not believe that the healthcare insurance industry relies on the AMA policy making meetings to help them determine who and what they will pay for what services these in store clinics provide. Its only concern is that the patient gets treated at the lowest price and permits the healthcare insurance industry to retain its control of the healthcare system
The AMA press release contained the following statements;

“Patients want quick and easy access to health care services, but they shouldn’t have to worry about the safety and quality of care provided in these clinics, said Rebecca J. Patchin, MD, AMA Board Member.”

Implicit in the AMA’s statement is that the in-store clinics have the ability to provide quick and easy access to healthcare services, while the practicing physician’s office can not. The only objection the AMA has is that the treatment might not be safe and the quality might be poor.

“Physicians deliberating the new principles at the AMA’s policy-making meeting agreed with the public’s concerns, noting that intensive diagnosis and care should not be carried out at clinics staffed by less-qualified health professionals and equipped for basic services. Physicians added that health care safety could be negatively affected if in-store clinics lead to fragmentation of patient care, inadequate follow-up and missed opportunities for preventive care of patients.”

“To enhance public confidence in the quality of care provided by store-based clinics, the AMA adopted the following principles to help promote their safe and effective operation.”

• Store-based health clinics must have a well-defined and limited scope of clinical services, consistent with state scope of practice laws.
• Store-based health clinics must use standardized medical protocols derived from evidence-based practice guidelines to insure patient safety and quality of care.
• Store-based health clinics must establish arrangements by which their health care practitioners have direct access to and supervision by those with medical degrees (MD and DO) as consistent with state laws.
• Store-based health clinics must establish protocols for ensuring continuity of care with practicing physicians within the local community.
• 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.
• Store-based health clinics must clearly inform patients in advance of the qualifications of the health care practitioners who are providing care, as well as any limitation in the types of illnesses that can be diagnosed and treated.
• Store-based health clinics must establish appropriate sanitation and hygienic guidelines and facilities to insure the safety of patients.
• Store-based health clinics should be encouraged to use electronic health records as a means of communicating patient information and facilitating continuity of care.
• Store-based health clinics should encourage patients to establish care with a primary care physician to ensure continuity of care.
Who is going to administer and enforce these rules? No one. Who cares about these rules? No one. The patients using these in store clinics should care about the rules and demand that the local governments administer and enforces these rules.

“There are clear incentives for employers, health insurers, and retailers to participate in the implementation and operation of store-based health clinics. Employers and insurers report being able to contain health care costs by using in-store clinics, while retailers state that the clinics help increase store traffic and drive sales.”
“The new AMA principles will help ensure these incentives do not override the basic obligation of store-based clinics to provide patients with quality care, said Dr. Patchin an AMA board member .”

The CCA responded to the AMA’s principles to promote in store clinic safe and effective operation with the following press releases.

“Responding to an American Medical Association resolution regarding retail pharmacy-based clinics, Tine Hansen-Turton, executive director of the Convenient Care Association, released a simple statement: “If it’s broken, fix it.”

Everyone agrees the healthcare system is broken. The CCA and the in store clinics are marching to the front of the line to fix it. Did the AMA march to the front of the line to fix the healthcare system? No. The Convenient Care Association has captured the healthcare repair initiative. The AMA has been idle and then reactive.

Hansen-Burton continued, “Convenient care clinics have proliferated in retail settings throughout the country due to a widespread lack of access to high-quality, affordable health care in America.
There has been a perception among consumers that there is a widespread lack of access to high quality, affordable health care in America.”

Americans love people and companies that are innovative and visionary. Americans certainly agree that we need an innovative and visionary model of healthcare to repair the broken system. Has medical practices or organized medicine provided them? It is the perception of most Americans that American medicine has not provided an innovative and visionary model.

“ Convenient care clinics collectively boast a 98 percent patient satisfaction rate, which indicates that Americans have embraced this innovative and visionary model of health care.”

I would like to see CCA’s evidence for a 98% approval rating for their care. I would also like to see how Americans have embraced the services of CCA members. It sounds like hype to me and a well crafted public relations campaign.

The AMA quotes a Harris Interactive poll that had a different conclusion.
“According to a Harris Interactive poll, while 78 percent of the public believes that store-based health clinics could provide a fast and easy way to receive basic medical services, 75 percent raised concerns about the quality of care these clinics provide. The vast majority of respondents were also apprehensive about staff qualifications in a clinic not run by medical doctors.”

CCA’s press release goes on to say;

“While the AMA convened its annual meeting this week to discuss ways to prevent patient access to convenient health care, the CCA held an annual retreat to promote accessible, affordable, price-transparent health care to all Americans.”

The above causes one to think the CCA is proactive and innovative while the AMA is defensive and reactive. In our sound bite society the CCA would win even though the organization is only eight months old and represents only sixteen corporate companys’ interests. In reality these corporate interests true concern is to profit from the 2 trillion dollars spent in the healthcare system.

The big question remains. Is the care provided good medical care by people capable and qualified to provide good medical care?
Who should be the judge of good safe medical care?

Walgreen Co. spokesman Michael Polzin stated in response that AMA members were more likely to find out “that that legislators and constituents have been demanding accessible, affordable and high-quality health care for years and that’s what retail clinics are delivering.”
The in-store clinics claim they are simply responding to what legislators and constituents were demanding for years. The assumption that they would be providing high quality health care is simply an assumption. No one has adequately defined high quality health care and CCA has not proven that the in store clinics deliver quality care. CCA simply declares that they deliver quality care.

“The CCA partners with all health care providers, including physicians,” Hansen-Turton said. “We are surprised that the AMA would take the position that it has because so many physicians and other health care professionals have accepted this new model and see it as part of the solution to our broken health care system.

Where is the evidence that physicians and other healthcare professionals have accepted this new model and see it as part of the solution to our broken health care system? I have not been able to find the evidence for this statement. Physicians who participate in the in-store clinics by signing off on the nurse practitioners and physician assistants work as figureheads. They do not know the patient or the patient’s illness. The physician’s actions cannot be interpreted as confirmation of quality medical care.

Carl Sandburg said in the Prairie Years “If you tell a lie enough times it becomes the truth.
The problem is a liar has to have a good memory.”

The executive director of CCA then goes on to scold the AMA for its position on the in store clinics.
“The AMA and CCA should be working together on solutions to improve our health care system’s efficiency and effectiveness. America has embraced the services that CCA members are providing as part of the solution, and we invite the AMA to recognize the role clinics provide in offering access to affordable, high-quality, basic health care services to all individuals.”

Carl Sandburg is right. The goal is to keep repeating the same unsubstantiated statement over and over again until it becomes the truth. In 2007 this tactic is called spin.

I believe these clinics will fail because they will not be able to generate a positive cash flow from these clinics. Perhaps the pharmacies and big box store want them as loss leaders. Rite Aid closed their in store clinics in Portland after one year.

I believe it is organized medicine’s responsibility to develop programs to teach physicians to service patients in need of basic health care services more efficiently. Physician practices must provide affordable, high quality, medical care services to patients. The medical profession must change the publics perception of physicians’ practices.
The only thing I can say to patients at the moment about in store clinics is
Let the buyer beware!!

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