Expanding The Retail Clinic Business Model
Written on August 27, 2007
Taking “Convenience” One Step Further…
Retail clinics typically provide services in a store setting, but proponents suggest that the current business model is flexible and likely to expand with more innovative services yet to come. An example of such a service was reported in the Post-Tribune (8/18/07). Staff from a Corner Care retail clinic visited residents of Gary Manor Apartments (Gary IN). General health topics and clinic services were discussed with residents, who are mostly senior citizens. [1]
Going out into the community to deliver health information is a great idea. Starting with a facility that largely serves senior citizens is an interesting choice because…. 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. That must be why most clinic companies clearly state age limitations on their web sites — typically from two years of age to 65. It’s surprising, though, that the senior who was unable to use the retail clinic sometimes pays out-of-pocket for doctor’s visits when she wants a second opinion. There don’t appear to be restrictions regarding those services. Is it possible that retail clinics are being held to a different standard?
[1] For more information about the retail clinic cited above, visit: Corner Care Clinics.
Filed in: Retail Clinic Market.
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.