3 trends driving retail health clinic expansion -AND- Doctors' Medicare payment data finally set for release

Mon Apr 21 20:01:46 PDT 2014

April 7, 2014

3 trends driving retail health clinic expansion

Fierce Healthcare

By Zack Budryk

Retail health clinics are a new healthcare delivery trend quickly picking up steam across the country, the Washington Post reports.

Walk-in retail clinics only date back about 14 years, according to the article, but after slow growth, management consulting firm Accenture predicts retail clinic numbers will almost double to nearly 3,000 by 2015. Several industry trends will drive the increase, according to the article, including:

• The doctor shortage, which industry experts expect will create a 45,000 primary care provider deficit by 2020. The increasing number of insured people under the Affordable Care Act will add to the problem, according to the Post. "[The shortage is] a strong driver of retail clinics," Ateev Mehrotra, M.D., of the RAND Corporation, told the Post. "If your primary care provider says you can have an appointment in three days, and you're worried about a urinary tract infection or your daughter has an ear infection, the retail clinics are going to benefit from that."

• Quality care at lower prices. A study by Mehrotra and colleagues in 2009 found treatment for three common conditions--pharyngitis, urinary tract infections and middle-ear inflammations--was similar at retail clinics, physicians' offices and urgent care centers. Patient cost per episode averaged $110 at retail clinics, compared to $156 at urgent care centers, $166 at doctors' offices and $570 in the emergency room, according to the article.

• Clinics are ahead of the curve on price transparency. Unlike a primary-care doctor, if consumers want to comparison shop at retail clinics, "the price is just out there on a giant board," Ceci Connolly, managing director of PricewaterhouseCoopers (PwC) Health Research Institute, told the Post. Since many consumers buy higher-deductible insurance, she said, "they are looking for those alternatives to hospital or physician's office visits that are going to be more cost-effective and convenient.

A recent PwC survey found retail clinics are increasingly popular in the United States due to a combination of cost and convenience, FierceHealthcare previously reported.

April 2, 2014

Doctors' Medicare payment data finally set for release

Modern Healthcare

By Joe Carlson

Despite 30 years of opposition from physicians, the public will soon learn how 880,000 doctors and other healthcare practitioners billed Medicare for the services they provided and what the government paid them. The data are expected to spotlight doctors with suspicious billing patterns. 

Covering $77 billion worth of Medicare Part B payments in 2012, the data will be released as soon as next Wednesday, according to an announcement from CMS Principal Deputy Administrator Jonathan Blum. The information will include physicians' provider IDs, their charges, their patient volumes and what Medicare actually paid.

Blum said the data will allow the public to compare 6,000 different types of services and procedures, allowing data analysts to pinpoint outliers in charges and volume. 

“Release of physician-identifiable payment information will serve a significant public interest by increasing transparency of Medicare payments to physicians … and shed light on Medicare fraud, waste and abuse,” Blum wrote in an April 2 letter (PDF) to the American Medical Association.

In response, the AMA issued a statement late Tuesday expressing concern "that CMS' broad approach to releasing physician payment data will mislead the public into making inappropriate and potentially harmful treatment decisions and will result in unwarranted bias against physicians that can destroy careers." The association is asking the agency to allow physicians to review and correct their information before the database is released. 

The AMA has strongly protested the release of any Medicare payment data that identifies individual doctors, saying it would be a violation of physicians' personal privacy rights. 

The AMA and the Florida Medical Association successfully convinced a federal judge in Jacksonville, Fla., in 1979 to permanently bar Medicare from publishing the data because of privacy concerns.

A lot has changed since then. The public interest in Medicare transparency has increased, Blum said, specifically citing a series of stories published by the Wall Street Journal that used a similar, but smaller, data set to identify waste, fraud and abuse in Medicare payments to doctors. The data will also help inform consumers and insurance companies about which doctors have adequate patient volume to be considered safe practitioners for complex procedures, patient advocates say.

The Florida injunction barring release of the data was scrapped last year by another Jacksonville judge, after Wall Street Journal parent company Dow Jones & Co. sued to overturn it. That cleared the way for the CMS to consider releasing the information.

Initially the information was slated for release only through specially tailored requests under the Freedom of Information Act. But after scores of media outlets including Modern Healthcare filed FOIA requests, the agency said it had to follow a federal law that requires it to publish “frequently requested” materials.

A report from HHS' Office of the Inspector General last year concluded that a group of 303 high-earning Medicare physicians were reimbursed an average of $4.2 million each—a high amount that the office concluded merited further scrutiny. Three of those doctors have had their licenses suspended, and two others were indicted. The remaining 880,000 or so doctors analyzed in the report were paid an average of $78,000 each.

The data will not identify patients, and CMS will redact any “data element” that pertains to fewer than 11 Medicare beneficiaries.

Correction: An earlier version of this story incorrectly identified Medicare reimbursement to physicians and physician offices as earnings or take-home pay.

Bryan Sloane
Deputy Editor, CAL/AAEM News Service

Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

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