How physician practices can compete with retail clinics

A reader recently wrote to me: “Brandon, in our area, we’ve seen a few retail clinics pop up. What can we do as a practice to let patients know that visiting retail clinics is not in their best interest?”

We had along discussion. So I put together a summary of our conversation. Below is a rundown, more of less, of what I told the doc.

Beat them at their game. One of the benefits that retail clinics promote, is their flexible hours and immediate access; so it makes sense for the practice to look for ways to offer extended hours and rearrange the schedule to give people immediate access. “This is low hanging fruit, so you should take advantage of it,” I told the doc.

Beat them at your game. The next thing one can do, I said to the physician, is look for ways to differentiate yourself from the retail clinics by finding things you do well, that they don’t. How so? he asked.

Peruse. I mentioned to take a moment to visit a retail clinic’s website and study their services. While perusing, I told the doc to think about the retail clinic’s limitations, where they fall short and some of the restrictions they have. As I was saying that, all I could see was a blank stare. “Let me guess,” I said, “you don’t have time to peruse do you?”  ”Well, you’re in luck.  I do have the time and this is what I found on the retail clinic’s site.” I listed a few things and the list looked something like this:

  • First doses, which are given at 2, 4 and 6 months of age, are not available.
  • Patients with a history of allergy or adverse reactions to the vaccine may be referred to another care setting.
  • Allergy patients must be 2 years of age or older.
  • Only female patients ages 12 to 65 will be treated for urinary tract infections.
  • We cannot refill prescriptions for conditions that are outside our scope of services. Patients should call their primary care provider to refill any needed prescription.
  • If specifically required by patient’s physical exam form, a urinalysis will be performed, which will result in an additional $15 lab charge.
  • Patients with moderate to severe asthma symptoms such as wheezing or shortness of breath will be referred to another care setting.

Differentiate. Next, I mentioned to the doc to think of services that the practice can offer that directly addresses these shortcomings.  I also made a point to say that just because he treated asthma all the time and he has  attended every single asthma lecture known to man, and is very comfortable treating it, don’t assume it is not a huge service. Clearly it is something that only an expert can handle; otherwise, retail clinics wouldn’t have a problem handling asthma patients.

After I went through all that, I got another blank stare. “OK, ok, I get it. You don’t have the time to differentiate.” So I shared with him what I would do if I were in his shoes. And this is what it looked like:

  • Our practice offers physical examinations provided by a Medical Doctor, not a mid-level provider.
  • We offer a personal relationship with the family and the child.
  • We take a proactive role in the health care of our patients (ie. making sure imm are up-to-date, yearly school physicals, vision screens, hearing screen, developmental screens, etc).
  • We have a detail knowledge of our patient’s history (ie PFSH, medication list, previous Dx’s. etc.) which enable us to provide better, comprehensive care.
  • Our office has an after hour emergency line for when things get difficult in the middle of the night.
  • We have certified lactation consultants available to new moms.
  • We also can provide a system of written management plans to manage asthma, ADHD, acne, or weight management issues.
  • Not to mention programs to empower parents to better manage illness at home and thus save money on emergency room visits and even copays.

 

So what now? Now that we’ve done this great exercise, and gathered all this great info and perspective, I told the doc he needed to start telling stories that address the value a pediatrician can offer over a retail clinic by playing up his strengths as a pediatrician, as well as highlighting the retail clinic’s shortcomings.

How so? Easiest way to start is on the practice’s Facebook page. There, one can write up relevant information pertaining to the benefits of breastfeeding for example and then talk about the lactation services the practice offers. Another place to share these differentiations is on the practice’s blog.

Another example is using a newsletter that has interesting and informative articles that highlights the practice’s comprehensive services. A newsletter is another great way to keep patient’s informed of the importance managing an illness like asthma closely and how managing chronic conditions save money in the long run. Or perhaps tell patients of the benefits of a healthy lifestyle and how pediatricians can tailor a plan to meet the needs of the patient that will help them lose weight.

Go head to head with advertising. I mentioned that outside of healthcare, companies go head to head in their advertising to highlight their strengths when compared to the competition or highlight the competitions weaknesses. For example, JetBlue recently started a new campaign called “You Above All” that takes direct aim at other airlines annoyances like baggage fees and terrible customer service.

JetBlue has an advertising agency; at the office, It’s just me. “Yeah, but you got me now” I said. So I took put together a few concepts to get the ball rolling. Below are a few mock ups.

How physician practices can compete with retail clinics

How physician practices can compete with retail clinics

How physician practices can compete with retail clinics

How physician practices can compete with retail clinics

Note: I put these together to illustrate how one can use advertising and effective copy to drive certain points home. Naturally, a real advertising piece will have a doc’s telephone number address and any other pertinent information like a call to action.

What about the medical home concept. When do I talk about that? Unfortunately, medical home concept makes sense to doctors, but it doesn’t always resonate with parents. And the reason is, parents are not as interested in quality and continuity of care as much as they are with convenience.

However, that doesn’t mean one can’t push the advantages of a medical home. But I think it should be reinforced once they are in the office. So when little Timmy’s mom needs that med so Timmy can play tomorrow in that crucial game, and you were able to give mom a same day Saturday appointment, that is when you should suggest to put Timmy on a plan to control his asthma, ADHD or whatever and highlight the benefits of a medical home.

Final thoughts. I told the doc that I believe that the retail clinics down the road is  actually good for his business. Here’s why.  The retail clinic down the street gives the doc’s practice an opportunity to differentiate himself  by illustrating how his practice provides a different kind of value. Had the retail clinic not opened up, he’d continue to be a commodity. But the retail clinic’s presence allows pediatricians to demonstrate how a peds office delivers a “greater” service in a different kind of way.

Brandon Betancourt manages a pediatric practice and blogs at Pediatric Inc.

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  • http://natickpediatrics.net Rob Lindeman

    I disagree with the premise. Who says a visit to a retail clinic is NECESSARILY not in a person’s best interest? And in any case, the determination as to what is in a person’s best interest is theirs, not ours. We can use persuasion if we feel strongly about doing so, so long as we are clear and honest as to our motivations.

    For example, I caution against use of EDs (and ENCOURAGE use of retail clinics) because EDs in my community routinely over-test and over-treat and the retail clinics do not. I tell my families so.

    • Primary Care Internist

      overtest & overtreat???

      well, duh, they are an ER! and they don’t have the luxury of staying STAY AWAY to asthmatics and UTI patients 65.

      So by that logic, i would say retail clinics undertest and undertreat, and probably that 90%+ of visits to a retail clinic do not need to be seen at all. And if they are seen in their pediatrician’s office, that’s an opportunity to tie up the often many loose ends in a child’s continuous care e.g. vaccinations, anticipatory guidance, routine screenings etc.

      And what about the minute clinics giving flu shots for 5 months out of the year and then closing the rest of the year? what a bunch of BS. If i were to get a call from a patient who i hadn’t seen in a year but went to get his/her flu shot from minute clinics 2 months ago i’d tell ‘em to go back and see their “doctor” over there, or go to the ER.

    • http://kckidsdoc.com Natasha Burgert

      RL – I feel sorry for the kids in your community if they don’t have a reliable ER. In our area, the concern with retail clinics is the opposite of what you describe.

      We are having a real problem with poor care at retail clinics – that is our practice’s motivation to keep kids out of them. Antibiotics are given out like water (ie amox for rapid strep neg kids.) They take money from the patient and then refuse to see them if any “abnormal” lab is present (ie isolate 1+ protein on a UA.) I have even had an patient call from a retail clinic in a panic because the provider thought something was “wrong” with their tongue and needed urgent evaluation – yep, lingual tonsils.

      Our practice is making efforts to battle these clinics just as Mr. Betancourt has suggested. In our area, encouraging kids to see their docs and avoid these places is best for kids’ healthcare. And I tell my families so.

  • doc99

    Brandon,
    One scenario you didn’t consider is that in which the local “Hospital-Health System” opens and runs the Clinic. I foresee the same fate as befell the Mom & Pop grocery stores when the large Supermarkets opened in the neighborhood.

  • Leslie

    Advantages to retail clinics: convenient hours, upfront and affordable prices, prescriptions filled quickly onsite, you can shop or eat while you wait, health info stored electronically, located all over the country, insurance not required if you pay, multiple family members can be seen at the same time.

    Some people don’t want a relationship with a primary care doctor. Some people only go annually. Some people coordinate their own care. Some people travel a lot. Some people don’t have insurance.

  • soloFP

    I find that very few seniors/geriatric patients go to retail clinics. For urgent conditions, they go to the ER. Otherwise they see me in the office within 24 hours of their call, meaning often the same day.
    The younger patients, meaning those under 40, look at insurance as a $20-$30 service that can be had most places. When the Walgreens clinic advertises two for one school phsyicals for $50, I can’t compete with those prices. The $25 a person does not include immunizations. The retail clinics in my area also offer $20 flu shot specials to bring people into the store, where money often is spent on store goods to make up the low $20 flu shot price.
    We have three retail clinics in my area. One of them is almost bankrupt, as it has a physician instead of a PA or NP. The other one is run by Walgreens, and another one is run by a state group of doctors and NPs. It is a convenient source for urgent care on Sundays, but UTIs/sinus infections/bronchits etc often can wait until normal business hours. Docs who don’t offer same day appointments are losing out to the retail clinics. There is some talk that the retail clinics may start treating chronic illnesses, such as HTN, T2DM, and chol. None of the retail clinics mid levels will see you currently for follow up in the outpatient world or in the hospital. Continuity of care is missing at most retail clinics, and I have noticed that they overprescribe meds, such as antibiotics, steroids, and inhalers for 2 days of bronchitis that magically are filled at the pharmacy that surrounds the retail clinic.

    • Primary Care Internist

      yes i have seen this too. and i have seen young healthy people with a mild asthma exacerbation seen by a PA in an ER and be discharged with whopping doses of prednisone and big-gun antibiotics.

      as the system gets more strained and anyone can play doctor this phenomenon of little/no supervision of mid-levels will grow.

  • ninguem

    Retail clinics are great if you’re not sick.

    Maybe that should be a tag line for one of Brandon’s ads.

  • http://natickpediatrics.net Rob Lindeman

    Primary Care Internist is quite right that 90%+ of urgent care visits to a retail clinic do not require medical attention at all. The same goes for 90%+ of the urgent care visits in my office. I’m not seeing the “logic” that suggests that retail clinics under-treat. If acute otitis media and acute pharyngitis can be managed (at home) without prescription drugs, then “under-treatment” must mean “not giving antibiotics”. If so, I plead guilty to under-treatment, but I prefer to call it “appropriate level of care”. Both conditions can be managed over the phone or via email, free of charge. What offends my colleagues more, the telephone/email part or the free-of-charge part?

    • Primary Care Internist

      Sorry if i wasn’t clear – by undertreat, i am referring to the hypocrisy of discouraging ER care on one hand, but refusing to see patients that fall outside specific parameters on the other. For example, asthmatics and UTI patients that are either very young or very old. ERs and doctor’s offices don’t have this luxury.

      And yes, acute OM and pharyngitis do not necessarily need to be seen by a “provider” as many are viral and will resolve on their own.

      Retail clinics primarily target the “worried well”. In terms of long-term stability of our nation’s health system, they will not serve the interests of the costliest segment, our frail elderly growing medicare population. Even ERs have trouble juggling patients with 4 diagnoses and 8 meds who come in with dyspnea.

  • soloFP

    You are still legally responsible for telephone and email advice. Telephone and email advice is documented in the chart. Giving meds and advice over the phone for free and documenting the discussion means free visits by phone and email.

    • Solomd

      Yeah, so how did we get to the point that other “providers” are able to pick the low-hanging fruit and then not be available for after-care, like you and I? If you want to practice medicine then shouldn’t you be available at 2:30 in the morning to field the calls of “my son is getting worse – what should I do” or “how much Tylenol can I give Suzy” or “Johnny seems to be breaking out in a rash after taking the amoxicillin”.

      Oh, wait. That’s what you and I are available for.

      • ninguem

        Turn it around. Dispense medicines from your office.

        I’ve already heard the criticisms “You can’t stock everything in your office”. I agree. So…….just stock the medicines that are profitable. Drugs used frequently, urgent care stuff. Let the patient go to the pharmacy for more complex meds that also have lower markup for the pharmacy.

        Pick the “low-hanging” PHARMACY “fruit” and leave the difficult and less profitable stuff to the pharmacies. They’re professionals, after all.

        Actually, it’s done, and the pharmacies scream about it.

  • http://natickpediatrics.net Rob Lindeman

    Should doctors be paid for services that incur liability? Absolutely. I wish I lived in that world.

  • http://www.BocaConciergeDoc.com Steven Reznick MD

    The reality is that there is a shortage of family practitioners, general internists and pediatricians. It is difficult to get a same day appointment in many practices for an acute illness. I agree that many of these illnesses are self limited and will get better with time, fluids and common sense. The patients want and are entitled to reassurance, compassion and understanding as well. The worried well have just as much right to be examined and reassured as the next patient. The retail clinic has arisen to prosper on that immediate care minor medical market. I personally think it is a travesty that Walgreens and CVS and Target are able to do this. It is a shame they receive vaccines because they buy them in bulk before i do for my patients. This is all part of the reason why primary care is disappearing . As time goes on the ABIM and ACP will destroy it even further by dumbing down the process and training either outpatient internists or in patient hospitalists so the concept of longitudinal care doesnt even exist in these heavily procedurally oriented medical societies that claim to represent primary care.

    • http://natickpediatrics.net Rob Lindeman

      Slight quibble. There is actually a glut of pediatricians. According to the AAP (Goodman DC et al Pediatrics July 1, 2005) there are between 1800 and 2000 children per pediatrician nation-wide. That is about enough to sustain a practice. However, in states like Massachusetts, the ratio is about 750 children per pediatrician. The closer you get to Boston, the more crowded the field.

      Pediatricians are competing not only with retail clinics, but with one another.

      • ninguem

        Steven Reznick MD – “….It is difficult to get a same day appointment in many practices for an acute illness……”

        You can get a same-day appointment in my office.

        BUT…….I won’t work with the really bad Medicaid plans

        As usual…..there’s not a shortage of physicians. There’s a shortage of physicians willing to be screwed. There’s a shortage of physicians willing to work for free.

  • http://healthblawg.typepad.com David Harlow

    In my opinion, PCPs ought to welcome retail clinics to the extent that PCPs can offload the “worried well” and entirely routine sorts of appointments. That’s what retail clinics can do, and they can provide those “commodity” services effectively and efficiently. In my state (Massachusetts), they are required to send a visit summary to the patient’s PCP, and if the patient doesn’t have one, to let them know how to find one (some very specific steps are mandated by regulation). Differentiation, as suggested by Brendan, is important (as there is some overlap with the services offered by a physician office) but not to the point of entirely undercutting the value of what retail clinics offer. In the not-too-distant future, at least 30 million uninsured Americans are going to become insured and they will be seeking PCPs. PCPs (including those who may be in local areas of oversupply, according to an earlier commenter) need to clear the decks in order to be ready to provide the physician-level services that this new influx of patients will require. The opportunity to leave the limited service market to the retail clinics should be seen as a boon to the profession.

    • ninguem

      Yeah, let’s set up free-standing paralegal and notary offices. They can handle the routine legal matters. They’ll send the reports to the lawyer’s office. The paralegals and the notaries can bill lawyer fees.The lawyers themselves will be glad to review that the nonlawyers did…..for free. Oh, and hold onto those records, so if that real estate purchase handled at the paralegal’s office impacts on a divorce the lawyer is handling, it’s the lawyer’s responsibility to know about it.

      Bar associations just love that.

  • http://www.bbmarketingplus.com Barbara Bix

    It seems like much of the debate here is about the pros and cons of retail clinics–which is ultimately up to the consumer. Unfortunately, competition is a fact of life in most professions and industries–especially as they mature and technologies enable less skilled providers to offer skilled services–and it always makes life harder.

    Common options include moving to a less competitive market, focusing in the areas that require specialized skills, playing to your strengths, promoting your strengths, or leaving the market altogether.

    Brandon offers some suggestions for addressing the competition. Niguem’s post, about “cream skimming” the market, reinforces the need for education as well as differentiation. Both are the sales and marketing that players in competitive markets need to perform.

    Loved the pictures of the kids!

  • http://www.head2toehc.com Deanna Tolman, DNP, FNP

    Change and innovation make many people nervous. The wise will embrace change and find a way to deal with it. Every retail clinic, which is essentially a “mini-urgent-care,” needs practices to refer patients to who need more complex care or follow-up. Go to your local retail clinic and provide your card and contact information as a referral site. You will be added to their list and patients will flow to your practice. About 1/3 of the patients in my new practice are coming to me from the referrals of several retail clinics.

  • Patient

    I much prefer my PCP’s office, however I like the upfront pricing of a retail clinic. It’s a factor. Doctors offices are hard to pin down on this and often the doctor doesn’t even know how much the test s/he ordered is going to cost. That’s stressful to people with no insurance or high deductible plans.

  • http://Www.twitter.com/alicearobertson Alice

    In the Weekly Standard this week they cover a doctor who sells start up kits for this premise at $3500 per kit. I think he sold 50 the first week, and is selling franchises. Employers like it because it meets the mandates and is extremely cost effective…yet, I could not see how it covers catastrophic care. The article is titled Cash for Doctors.

    As long as it stays an option, and not all encompassing it would serve a segment. It is run by a PCP, and duplicates Minute Clinic. But members get discounts for the annual fee.

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