Sunday, November 16, 2008

Financial meltdown, recession, mergers, affiliations, uninsured and retail clinics

With the financial market meltdown, worldwide recession I say look for new mergers and closings in the hospital industry. Even though many are profitable, well at least slightly, that will go by the way side with investment income losses, higher numbers of uninsured, rising bad debt and lengthening delays in Medicaid payments from the states, the picture is bleak. Declining utilization and tighter reimbursement from managed care doesn’t help either. Oh yea, those pesky retail clinics won’t help either. I am surprised more hospitals don’t go that route, partner with their doctors and drive those babies out of their markets.

Insuring the 45 million and growing uninsured is not in the cards fore the foreseeable future, not till 2010 at the earliest. President-elect Obama has his hands full. First priority is fixing the financial system, second is the economy, and third is healthcare. Without the first two, the third never happens.

Hospitals are cutting back, but it is in marketing as always. CEOs never did understand the value of marketing and what it can do, but then why do we need to be customer focused? Part of that blame goes to marketers who are unable to prove value; focus on the fluff stuff; and not holding themselves accountable for a bottom-line result. Could be too many newsletters, ads touting services people don’t need or want and not positioning on a quality and service perspective.

Answer this…. if you can’t say in 25 words or less about how you are different from everyone else, then you are adrift in your marketplace and your key customers can’t either. But then your competitors are in the same boat and they just may be as clueless as you are. Define and differentiate before someone else does it for you...

The hospital industry is undifferentiated and it’s becoming a commodity. Focus on satisfaction- employee and patient. You won’t have satisfied patients without satisfied employees. More to follow latter on that one

By the way I am hearing some not so flattering reports about the quality of primary care in those retail clinic settings. Wrong diagnoses, medication errors and faulty in site quick tests make we wonder how soon before the government step in and regulates. More direct physician oversight, certification and training are needed to prevent someone from dying. Hasn’t happened yet but it will. It’s just a matter of time. If you have a good or bad story about the retail clinics post it up.

The company I work for is going through a major reengineering. Look for big and I mean big reductions at the coporate staff level first quarter 09. Lots of uncessary layers and they could really benefit from a dose of lean management. Probably means I will be out of a job. Oh well, here we go again, that will be the seventh time in eight years. I have the nack for finding those companies.

1 comment:

TiredofWaitingfortheMD said...

Medication errors would be at fault of the Pharmacist, not the retail clinician.

Most convenient care clinics are staffed with Nurse Practitioners, advance-practice nurses with Master's level education, many of which live in states that allow them to operate their own practices completely independent of Physician oversight.

Study after study shows that consumers understand that retail clinics are to be utilized for acute care and/or screening purposes - not for chronic care management or family planning or anything else critics say the clinics will default to (though, NPs are MORE than capable of managing both - their scope of practice encompasses a much broader range of care than what they deliver in the retail setting).

Most of the time, criticism of convenient care is rooted in the fact that folks don't understand the capabilities and training of an NP. These clinics institute more rigorous quality standards than AMA, AAFP, and AAP, and yet are more highly regulated than any other provider setting.

Perhaps they should be, but to suggest that "more direct physician oversight, certification and training are needed to prevent someone from dying" tells me that a) you're unfamiliar with the capabilities of a nurse practitioner (indeed, you've probably received primary care from an NP at your own PCP, and yet you don't forewarn of people dying in the halls in that setting and b) you haven't followed the industry closely enough to know that more regulation and certification requirements have been placed on this model of care than that of urgent care centers, and convenient care clinics are only delivering a small proportion of the care delivered in urgent care centers.

The progression of expanding access for timely care (Emergency Care ---> Urgent Care ---> Convenient Care) combined with the traditional system's challenges to accommodate the needs of patients experiencing an acute illness has created the opportunity for consumer patients and convenient care clinic providers.

As you probably know, universal coverage isn't going to equal universal access, so while any plans the new administration has to cover those 45M uninsured Americans, most PCP offices are already at capacity and it's only going to make for longer waits in the short run, so to utilize a different provider for the same services one would receive in a crowded Physician's office is the kind of innovation that SHOULD be developing in the United States.

p.s. NPs own and operate many full-service primary care clinics thoughout the country. Nurse-managed health centers are one of the few places in the country where the traditional primary care system is actually working.

p.p.s. Everyone I know that has utilized a retail clinic has been positively astounded with the quality of care they have received.