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presentation

Measuring the impact on physician reimbursements with upsurge in retail clinics

March 12, 2012



“As medical service providers try to adapt themselves to these altering equations, their ability to manage clinical and operational functions would invariably involve the next level of efficiency. While there is ample scope for revenue augmentation amidst a booming health insurance scenario, there is also the issue of keeping the quality of medical services on par with the industry’s best practices. Left with such opportunity-responsibility bait, medical practices would do well to trust outsourced service providers that have the competence and credibility to maneuver them through effectively and efficiently.”

While there can be no substitute to full-fledged clinical settings as far as clinical management of chronic or acute medical conditions are concerned, retail clinics hold their own sway when it comes to managing trivial or superficial medical conditions. In fact, a study in the November 2011 American Journal of Managed Care, which analyzed the claims data of 13.3 million Aetna enrollees from 2007 to 2009, found a tenfold increase in patient traffic to clinics in grocery stores, pharmacies and big-box stores. Therefore, there is substantial truth in believing that patients are growing more comfortable with retail clinics, which offer them instant and easy access during times of medical exigency.

The growing fascination towards this retail model of clinical care can largely be attributed to the Federal Healthcare Reforms – which are going to accommodate health insurance for a substantial uninsured population, and promote accountable care organization model of healthcare and other aspects of health system reform – and the growing dearth of primary care centers which happen to be the connective clinical centers to major healthcare centers. While established clinical centers may feel the pinch of eroding patient base to these new-trend retail clinics, it could still be a blessing in the disguise as they concentrate on clinical management of far more critical medical conditions. And with the promise of a booming Medicare and private health insured population, there is every reason to remain optimistic.

The retail health clinics, on their part, should strive to be connective link in the clinical management of patients; retail clinics, rather than operating in isolation, should establish ways to ensure continuity of care with physicians and have processes for referring patients who require primary care. One of the major impediments to this integration, as noted by majority of specialist practices, is that retail clinics may not be able to share medical necessary reports that render collaborative clinical management possible. But, with proper coordination, retail clinics and specialist clinics or hospitals can both share the workload as well as promote clinical efficiency. In fact, many established hospital groups themselves are open to the idea of opening their own retail clinics that could become window advertisements for their specialist services.

As medical service providers try to adapt themselves to these altering equations, their ability to manage clinical and operational functions would invariably involve the next level of efficiency. While there is ample scope for revenue augmentation amidst a booming health insurance scenario, there is also the issue of keeping the quality of medical services on par with the industry’s best practices. Left with such opportunity-responsibility bait, medical practices would do well to trust outsourced service providers that have the competence and credibility to maneuver them effectively and efficiently. Medicalbillersandcoders.com – with long-standing reputation of being competent and a credible source for comprehensive medical billing and operational services – may well have the right answers to such opportunity-responsibility bait.

For more information visit: medical billing companies, medical billing services

 

Category : Revenue Cycle Management