Feed-back.com: Blog

“Resource Utilization”

One of the driving forces for emergent health care technologies such as telemedicine and telephone triage is to optimize utilization of limited medical resources. Access to care is a major issue for many Americans. The health care reform debate focuses on the uninsured, but others are under-served by the current system. For example, residents in remote rural areas typically have to travel to a large city to receive specialty care (e.g., cardiology or oncology).  In Oregon, telemedicine enables patients and physicians in a distant community like Lakeview to consult with specialists at a tertiary care center in Bend or Portland.

Optimal use of resources apparently wasn’t a top priority for the “Cash for Clunkers” program. The economic benefit was revenue generation for the automobile industry, while the favorable environmental impact was to replace old gas-guzzling vehicles with more efficient models.

An article published by the Associated Press in August observed that clunkers turned in at a dealership near Chicago on the day the journalist visited were all driven there.[1]  In fact, drivability was a qualifying requirement — despite the fact that being “cubed” into scrap metal by a salvage company and sold to steel mills was the final destination for every clunker, whether it was in great shape with low mileage or a wreck.[2]

Is scrapping old vehicles the only option? How can we reuse the things we manufacture over time?

Some people (and companies) are seriously thinking about resource utilization for cars, from the big concept (”design for disassembly”) to simpler measures (e.g., retreading tires). While metal parts have a long history of reuse, others can also be recycled (bumpers, filters, oil, etc.), especially if car designs make disassembling parts easier.[3]  In 2008, Shanghai GM announced plans to incorporate recycling in the design process, with the goal of having 95% of materials and energy used in vehicle manufacturing to “be able to be recycled” by 2012.[4]

Discussion Questions:

It’s always easier to critique something than to generate it in the first place. So, if Cash for Clunkers is resumed in the future, what kinds of changes would you implement?  More stringent criteria for clunker trade-ins? Offer alternatives to scrap metal processing?

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[1] “What do they do with all the Clunkers?” The Associated Press, August 7, 2009 (www.reporternews.com).

[2] “Cash for Clunkers more Trouble than Worth for Salvage Businesses,” Report-News, August 6, 2009 (www.reporternews.com).

[3] “3 Strategies For Green Design”, SlideShare.net.

[4] “Shanghai GM Launches ‘Drive to Green’ Strategy,” Green Car Congress, January 22, 2008.

“Keeping The Doors Open In Hard Economic Times”

Recent news articles suggest that retail clinics continue to do well, despite hard economic times. Two companies, CVS and Walgreens, currently operate approximately 800 clinics nationwide, providing consumers with convenient access to affordable health care. Industry participants suggest that the rapid rise of retail clinics meets consumer /patient needs and also demonstrates inadequacies within U.S. health care system.

A new software product recognizes the value of retail clinics to consumers. In mid-April, Healthagen added retail clinics and urgent care centers to its iTriage™ application to expand facility choices for iPhone® users who seek health care services.

In other news, Walgreen’s Take Care Health Systems is reaching out to consumers who have recently become unemployed, offering free care from 11 a.m. to 3 p.m. during the week. Services will be free, but prescription costs will not be waived.

Cynics suggest the new service is really a marketing ploy to bring consumers into Take Care’s clinics during slow periods and to build the customer base. The on-demand nature of the retail clinic business means there are busy and slow periods, neither of which is predictable. Low patient volumes are the cited reason for MinuteClinic’s closure of 89 locations this summer.

Discussion Questions:

Would you be adversely impacted if retail clinics were no longer available in your community?

Do you ever choose to not patronize a company because of its business philosophy, marketing tactics, or any other reasons?

“Diapering Options: Convenience, Costs, & Impacts “

Many of the changes we implement for greener living are relatively cost-free: Reducing consumption, recycling, using items many times before disposal, etc. Other lifestyle choices involve high initial investments, such as making our homes more energy efficient or installing an alternative energy system. Choosing to use cloth diapers also requires a significant purchasing commitment.

An article published earlier this year in the Wall Street Journal challenged some moms to test reusable diapers as an alternative to disposables. Ultimately, moms who regularly used disposables weren’t interested in switching, citing convenience as the main reason. Not surprisingly, most parents (90% or more) prefer disposables. There’s an ongoing debate about which option is greener: Disposables add to landfills, while reusables consume energy and water.[1]

High-end reusable diapers are often very expensive — $25 to $30 each (with or without covers). The good news is you purchase and unpack each diaper once, but it lasts for two to three years.

Disposable diapers are not inexpensive over the long-run. The cheapest brands seem affordable, but there are hidden costs: Byproducts from disposal (methane gas), raw material / resource use, packaging material production and disposal, transportation (shopping trips and product distribution to retail stores), etc.

Online sources come to different conclusions when comparing total costs for disposable and reusable diapers. The assumptions and methodologies are similar, but diapering habits may vary significantly from one household to the next (number of changes per day, laundering temperatures, electricity costs, line versus machine drying, etc.).

A conservative analysis offered by a Canadian organization suggests that diapering for a one-year period may require nearly 2,550 disposables, at an estimated cost of approximately $1,150.[3] For comparison, if high-end cloth diapers are $27.50 each, 36 diapers would require an immediate investment of $972. At $0.50 per wash-and-dry load using energy-efficient machines, home laundering of two diaper loads a week could cost as little as $52 a year. In the second year, disposable diaper purchases continue, doubling the total cost. Laundering costs for cloth diapers seem negligible in comparison.

Discussion Questions:

Convenience is often a deciding factor in choosing between normal habits and green ones. Have you been able to switch a convenient habit for a greener one? Is it a struggle or part of your normal routine now?

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[1] “Can We Swap Our Pampers®?”, The Wall Street Journal, February 5, 2009.

[2] 2005 PIRA Biodegradables Conference (www.nonwoven.co.uk).

[3] http://www.thenewparentsguide.com/diapers.htm

“Recent Trends”

Despite tough economic times, many consumers continue to spend a portion of their discretionary income on skin care products. Results of an online survey conducted with more than 1,000 women for Obagi Medical Products earlier this month revealed that women who receive in-office treatments currently spend about $500 a year on facial procedures. Half also indicated a willingness to pay as much as $300 a year on a customized skin care regimen.

Competitors are aware of ongoing demand and responding with some attractive new offerings. Mintel Beauty Innovation notes that approximately 25% of new skin care products introduced in 2009 highlighted “convenience” in promotional descriptions. The target audience is consumers who seek stylish, cost-effective solutions at a budget price. One example would be a single product that combines two or more functions, such as moisturizing and sun protection.

Dermatologists are also addressing patients’ skin care issues by authoring articles that are available online at the Beauty-Doctors web site. Content is divided into four categories: Beauty science, cosmetic concerns, cosmetic procedures, and skin care products.

Finally, global issues are driving growth of fair trade and organic cosmetics. Consumers can use their purchasing power to support ethical values such as social injustice or sustainability. ["Skincare Shopping on a Budget" is available for download as a PDF document at: PRWeb.]

Discussion Questions:

How much do you usually spend on skin care each year? Have you cut back on anything in 2009? Do you consider fair trade or green issues when purchasing a skin care product?

The often-stated mission of retail clinics is straightforward, according to the descriptions posted on clinic operators’ web sites: Provide convenient, fast, affordable routine health care services (e.g., diagnosis /treatment of common ailments, exams, screenings, and vaccinations) to patients who walk in the door during business hours. Theoretically, retail clinics offer an additional option for medical care that supplements rather than supplants clinics, doctors’ offices, group practices, urgent care centers, etc.

Recently, a colleague and I received calls from a retail clinic we’d used earlier in the year for routine diagnostic monitoring purposes. One call reminded the “patient” to schedule a follow up screening. The other announced closure of one clinic and the location of an alternate site.

In order to receive health care services, patients routinely provide confidential medical and personal information to providers. Continuity of care is the reason for doing so at a doctors’ office or urgent care center. By design, retail clinic visits are informal and limited in scope. While such visits are not anonymous, services are provided on demand. My colleague and I pay out-of-pocket for retail health care services and rightfully expect visits, diagnoses, and test results to be “unofficial.”

Have you received a reminder call from a retail clinic? If so, were you surprised? If not, how would you feel about it?

“Shopping To Support Charitable Causes”

Combining skin care product sales with donations for breast cancer research offers women a win-win opportunity to support a cause they believe in. The mid-October 2008 issue of TV Guide presented a full page of products (from lipstick and soap to bracelets and pens), along with the amount of proceeds (10% – 20%) each purchase would contribute to various organizations (e.g., Breast Cancer Research Foundation and Susan G. Komen for the Cure),

In the December 2007 issue of The Atlantic, “Scents & Sensibility” highlights the author’s efforts using a similar approach. The Arghand Cooperative was developed by Sarah Chayes as a business that would enable Afghan farmers to grow native crops as alternatives to poppy cultivation for opium production. Essential oils and soaps are produced locally and sold in North American boutiques. Online product prices range from $8.00 to $22.00. For more information, visit: Arghand Cooperative.

Commentary:

So, if you’re thinking about buying something special with a charitable donation in mind, what do you look for? The type organization receiving the proceeds is one consideration (e.g., how it fits with your personal or political interests). Another is the percentage of funds that directly benefit the organization, as suggested above. It’s probably simpler to just write a check, but if you were able to choose a “charitable” product over the “retail” one, would you? – Fran

“Hope in a Tube”

At this year’s Face & Body Conference (2008), Karen Newman of Global Cosmetic Industry magazine summarized recent trends in her “From the Beauty Industry, With Love” presentation. One of two hot topics she covered used the catchy description of “Hope in a Tube,” which succinctly describes consumer expectations. Typing the phrase into Google generated 17,000 hits (10/01/08). [It's also the name of an eye/lip cream product sold by PHILOSOPHY.]

While many consumers are highly motivated to use skin care products, they may not know how to make wise choices. There are literally thousands of skin care products available through professional service provides (e.g., beauty salons, spas, etc.), retail stores, and the web. It’s surprising that consumers aren’t paralyzed by the choices.

Commentary:

Despite the massive number of products, some brands have gained significant market share over all the others. In surveys that Feedback Research Services / Feed-back.com conducted during the past three years, several manufacturers consistently dominated the “most popular skin care product” list, while others may do so one year and not even be mentioned the next. Several survey participants noted that the popularity of certain products reflects brand loyalty among their clientele. Are other successful brands reaching the top because they’re 1) better products or 2) marketed more aggressively by the manufacturers? — Fran

Service Discrepancies

Typically, successful franchises meet consumers’ expectations by providing a standard product or service mix in every location. Retail clinics share some operational characteristics with franchises: The “look and feel” of the facilities, immediate access to services, posted menus with prices, etc.

Feed-back.com’s visits to selected retail clinics in 2008 (so far) suggest there may be inconsistencies in the way services are delivered in different locations — even in facilities that are operated by a single company. As noted in the August 27th, 2007 blog, a senior citizen was unable to have diagnostic testing done at a California-based retail clinic. A follow-up visit (March 2008) at the same facility and another one indicates the policy hasn’t changed. The signs that cite Medicaid and Medicare restrictions are still present. According to one receptionist, if a patient lies and receives treatment, the clinic and patient are both at risk for penalty. At another facility, the receptionist stated that elderly patients are not treated, but a service provider at the same location said elderly patients who are not covered by Medicare can receive treatment.

Recently, another odd discovery was made at the same group of retail clinics regarding a specific type of diabetes test — glycosylated hemoglobin (A1c). A survey conducted with eleven clinics operated by the same company revealed that four facilities require an office visit for patients to receive the test. No visit is required for testing at the other seven clinics. When asked, clinic personnel could not explain why such a discrepancy exists. In addition to requiring extra time, it costs more. The final result is a service that’s not as convenient, quick, or cost-effective as patients might otherwise expect.

Comments From VelociDoc About The August 27th, 2007 Posting:

In reference to: “… A visit to a retail clinic in California made earlier this month by an 84-year-old acquaintance did not provide the services she sought. According to a posted notice, federal law excludes Medicare and Medicaid patients from receiving services from retail clinics.”

This is interesting information. At Practice Velocity (www.practicevelocity.com), we provide software solutions for over 500 urgent care clinics, of which some are retail clinics. This is the first that I have heard of a Medicare ban on these clinics. I believe that the clinic may have confused non-participation with legal issues. I do not believe that there is any Federal law that prohibits retail clinics from seeing Medicare patients. Retail clinics that serve Medicare patients may have to deal with several complicating issues:

1) coding would have to use CMS-standard codes

2) incident-to standards would have to be followed

3) compliance issues are more rigorous with CMS

Note: I believe that all providers (even those who have opted out of Medicare) are required by Federal law to treat any Medicare beneficiary who presents with an emergency situation and to bill Medicare for these services.

Distant Rumblings Of A Shakeout…

Announcing its “soon to be released” new study, a brief blurb issued by Corporate Research Group (CRG; New Rochelle NY) suggests there’s going to be a shakeout in the retail clinic market in the next two years. The CRG article is entitled “Retail and Onsite Clinics: Fad or Future?” The news appears be mixed. The industry is “burgeoning” on the one hand and “losing money” on the other.

Clearly, any new business must pay substantial overhead expenses whether customers come through the door or not. Most emerging markets start strong, riding the wave of enthusiasm for a new product or service. Initially, the driving force may be a technological breakthrough or a unique way of doing business. Over time, emerging markets mature, economic and regulatory conditions change, new competitors enter the market, or someone comes up with another innovation. In the case of retail clinics, tighter regulations are likely to be imposed. However, employers and insurers are welcoming the chance to pay less for routine health care services.

One might argue that consolidation is happening already. Monthly tallies compiled by Feedback Research Services’ staff show slight fluctuations in retail clinic numbers and locations. A reasonable conclusion is that managers and owners are paying attention to consumer demand (or lack of it) and revising operations accordingly.