The Federal Trade Commission public workshop “Examining Health Care Competition” held in Washington D.C. March 20-12, examined trends that may affect competition in the evolving healthcare industry. Current developments were discussed related to professional regulations, innovations in healthcare delivery, advancements in healthcare technology, measuring and assessing healthcare quality, and price transparency.
The panelists taking part in the “Innovations in Health Care Delivery” session concentrated on how the new models for healthcare delivery including retail clinics and telemedicine can offer significant cost savings, improve the quality of care, and expand healthcare services to consumers.
Panelist Ateev Mehrota MD, Associate Professor, Department of Health Care Policy at the Harvard Medical School described how the medical landscape today enables consumers to receive care conveniently in terms of locations and hours.
According to Dr. Mehrota, “These new healthcare delivery models are able to reach many more patients including underserved populations, however, there are a number of issues to take into consideration. These issues can relate to whether quality of care improves, whether the patient’s relationship with their primary care physician can be damaged, and whether it is essential to have prior contact with a healthcare provider before treatment.”
Karen S. Rheuban, MD, Professor of Pediatrics, Senior Associate Dean for Continuing Medical Education and Director of the Telehealth Center at the University of Virginia (UVA) discussed how the Center provides video conferencing, store and forward technology, remote patient monitoring, and health related distance learning.
Currently, the Center currently operates 126 telemedicine partner network sites, has performed 38,400 patient encounters in Virginia, helped 30,000 patients with teleradiology, provides services in more than 40 different sub-specialties, and performs telestroke consultations.
However, even with program’s success, Dr. Rheuban brought up several issues and concerns that need to be addressed. These issues involve reimbursements, funding, credentialing, licensure, malpractice, technology standards, costs, determining what is rural, and how to effectively integrate data into EMRs and HIEs.
Margaret Laws, MPP, Director for Innovations for the Underserved, at the California HealthCare Foundation (CHCF), said that CHCF uses store and forward, live video, and remote patient monitoring. For example, a program connecting safety net clinics across the state with specialists at the University of California, is able to provide consultations in dermatology, endocrinology, neurology, orthopedics and psychiatry.
A major problem in California’s rural areas is the lack of local intensive care units. To meet the need for more ICU units, the state is using tele-ICUs, a new concept using a communication network with electronic vital sign monitors that allows clinicians in one center to remotely monitor, consult, and care for ICU patients in multiple distant satellite centers.
Explaining how retail clinics are in a growth mode, Nancy J. Gagliano MD, CMO, for MinuteClinic, and Senior Vice President for CVS Caremark, reports that there are 825 MinuteClinics in 28 states and the District of Columbia with 2,500 licensed nurse practitioners treating 19 million patients. In 2017, the clinics are expected to climb to 1,500 MinuteClinics in 35 states.
The retail clinics are located in supermarkets, pharmacies, and in high traffic retail outlets such as CVS. They are open seven days a week for extended hours and staffed primarily by nurse practitioners or by a small number by physician assistants.
Appointments aren’t necessary, 83 percent use third party coverage, most visits take 15 minutes provide care for only minor illnesses, administer vaccinations, and screen for diabetes, high blood pressure, and high cholesterol. The clinics use EMRs in all locations so that the information can be shared with the patient’s primary care physician.
Fifty percent of current MinuteClinic patients don’t have a primary care physician so that when they leave a clinic, unaffiliated patients are given a list of doctors willing to accept new patients.
According to Dr. Gagliano, “The retail clinic concept will only increase as the use of telehealth and remote monitoring technologies navigated by nurse practitioners will take place at a distant site from the retail clinic within the same state. The result will be that more and more patients all over the country will be able to receive treatment using the retail clinic concept.”
The tele-ICU program described by Lee B. Sacks MD, Executive Vice President and CMO for Advocate Health Care cares for ICU patients in multiple distant locations. However as Dr. Sacks explained there are still barriers concerning tele-ICUs in terms of state licensing requirements, interoperability of monitoring systems and EMRs, and the need to provide behavioral health teams 24/7.