The Obamacare Report (#9)/Providers may expand through retail medical clinics

September 3, 2013

health-care-lawThis is #9 in a series of Obamacare Reports. (See also postings by Mitchell Law Office

Over the past decade, there has been continuing interest in the idea of setting up medical clinics that are located in retail facilities.

There have often been exploratory efforts to expand the roles of pharmacies to include additional health care services, as a means of customer growth and to achieve a competitive edge.

A variety of commitments were made in the past to develop such retail clinics, but actual growth has been modest.

Due to the Affordable Care Act (ACA) this movement may be poised for an expansion in the near future. This situation has been explored in detail in a recent analysis by Accenture.

Such an expansion may raise a variety of legal issues.

Experiences to date with this concept have been mixed. In the past, most retail clinics have found that “patient volumes were low for all but the narrowest range of services….” And there was often a failure by clinics to form partnerships with organized delivery systems, hospitals, and large group practices.

Retail clinics have often been seen as competitors instead of potential adjuncts.

As noted by Accenture, steady growth in the numbers of such clinics was experienced during 2001 to 2004, followed by a period of rapid growth during 2005 to 2007. Expansion then almost stopped from 2008 to 2012. As stated, the number of such clinics totaled about 1,175 in 2008.

However, the situation may change in 2014 and future years, as many individuals obtain new subsidized health insurance coverage or Medicaid eligibility through the ACA. Existing clinics and medical practices may be unable to accommodate the increased demand for services.

The result may place access pressures on existing providers and lead to the expanded use of retail clinics.

Better relations with insurance companies may also develop.

If the number of clinics begins to expand rapidly, new legal issues may emerge.

Federal requirements for services under the ACA may need to be adjusted. State licensing requirements may also need to be adapted to expanded retail settings.

Retail companies that introduce more clinics may need to revise their policies and procedures—and their liability insurance coverage.

Large provider organizations that form linkages with retail clinics will have to modify supervision and billing strategies. Such moves may support efforts by hospitals to shift from episodic care for presenting patients to a concern with population health in the community, and from fee-for-service volume-based payments for services rendered to “value payment” strategies that link to the health value of services rendered.

Individuals as health consumers may need legal assistance in deciding how and when to seek care through retail clinics, how to deal with related provider and insurance company problems, and how to cope with care issues that arise.

There may also be problems created by the “mixing of brands” associated with large retail businesses and expanded on-site clinics, which may in turn lead to consumer confusion and the need for legal advice.

More on these and related topics may be found in a recent book by the authors that describes implementation of the ACA and its impact on legal practices.

Previous installments of “Obamacare Reports” address the various ways in which implementation of the ACA is affecting legal practices:

Report #1   Report #2   Report #3   Report #4   Report #5  Report #6  Report #7  Report #8