A family physician colleague, Aaron Segal M. D., told me a story that reminded me of some of the poor quality care that we hear about a retail clinics. He overheard the following conversation:
Person A, “well, good luck at Minute Clinic…”
Person B, “Yeah, I think it will work out. I have a doctor who doesn’t write a lot of prescriptions. Minute Clinic usually takes care of what I need.”
The recent article in an online publication called Health Leaders Media explored the growth retail clinics. It acknowledged the growth of these facilities across the country, including even receiving support from organizations that historically supported primary care such as Kaiser Permanente. It quotes an expert from the RAND Corporation, Ateev Mehrotra, MD, who says that the development of quality measures is tough for these facilities, because most of the conditions that patients seek help at retail clinics for will get better on their own.
We all know antibiotics are overprescribed in many healthcare settings. But I see no indication that there is any pushback in the retail clinic or urgent care industries. The only thing that matters to them, besides some generic sense of a good reputation, is that the patients leave the facilities feeling like they got what they ordered. And if that means an unnecessary antibiotic, so be it.
And it’s all comes at a time when the Choosing Wisely Campaign is actively resisting the growth of unnecessary antibiotic prescribing, led in part by the AAFP.
I have grown more sour over the years about the role of quality improvement in primary care. I still believe it has merit, but the way it’s practiced is a travesty. The quality improvement movement simply does not understand the complexity of the work that we do family medicine. Sometimes doing the right thing means upsetting a patient. Family physicians and other front-line providers should be rewarded for making sound medical decisions, not marginalized in the name of pleasing customers who make demands on the healthcare system that they should not.
Regulations may prove the death knell of the small practice. I work as a solo family doctor in a micro practice setting- no nurse, no secretary, no biller. Because I have a small panel I can not qualify for PQRS money although my quality numbers are good. I decided to get Patient Centered Medical Home status. Four hundred uncompensated hours later I am 3/4 of the way through that mind numbing process. This type of regulation is skewed in favor of the large practices, who hire someone to check the boxes with little effect on the practitioners. I ask a friend who works at a large health center what the effect of obtaining PCMH status had on him. His reply- “No effect whatsoever.” More and more regs require time, money and energy that small practices lack. I fear for the survival of small practices.
P.S. Our local Mom and Pop hardware store went out of business.
Serious question:
why in the world are you bothering with PCMH? Why not cut your losses and abandon it?