While I usually touch on emerging or existing legislation in my articles, I thought I’d pivot and write about something happening in the healthcare marketplace that has surprisingly little regulation or oversight at all.
That would be the growth of retail health – that is, clinical or healthcare services being offered in the retail setting, such as at clinics in pharmacies, grocery stores, or shopping centers.
Walmart, Walgreens, Amazon, and CVS are all jumping into the game, with significant investment and acquisitions happening in the past year.
Retail health’s appeal to consumers is that basically, healthcare is provided like any other retail commodity. Retail health clinics offers convenient hours, walk-in or last-minute appointments, less-expensive services, and transparency in pricing. Retail health clinics are mostly staffed with physician assistants and nurse practitioners who in turn are offered regular hours and strong administrative support.
The forecast for retail health in this post-pandemic era is bright and sunny. According to an analysis by Bain & Company, retail health has the potential to grab as much as a third of the U.S. primary-care market by 2030. Indeed, one survey says that about two-thirds of Americans believe that five years from now, most primary-care services will be provided at retail health clinics.
The potential for growth is in one part energized by brand familiarity and loyalty. For example, over 40 percent of Americans shop at Walmart on a weekly basis, and nearly two-thirds of American adults have an active Amazon Prime membership.
Now, while retail health is making a move into primary care, recent action seems to indicate that they also may be using relatively inexpensive primary-care services as a loss leader for them to enter the chronic care arena. CVS recently bought Oak Street, which, yes, is primary care, but it is primary care for the Medicare crowd, whereas reimbursement will be value-based, and 9 out of 10 patients have a chronic condition. CVS has also bought Signify, a home health company.
In order to successfully manage chronic care, a healthcare entity needs to be able to track and communicate with patients, and establish a network of providers for successful continuity of care. Does retail health have that? Maybe not yet, but retail health clinics are digitally connected to the consumer, and they appear to be well-poised to move patients seamlessly between in-person care and virtual care.
Most importantly, retail health can afford to experiment (and maybe fail) with some of those experiments. Why? Because they are well-bankrolled by huge corporations.
As I mentioned, the retail health sector is remarkably unregulated. Most states do not issue facility licenses to retail health clinics, avoiding oversight by state departments of health. Only Massachusetts has regulations designed specifically for retail health; Massachusetts limits the clinics to a specific set of services. And in fact, one service that retail health clinics cannot provide in Massachusetts is primary care.
Stepping back, if we use the language of retail and capitalism, it has become apparent that in the next few years, hospitals and physicians are going to have to compete for a decreasing number of paying customers (that is, for commercially insured patients). More of the population is aging in or becoming eligible for government programs. Utilization of healthcare services is down 6 percent from pre-pandemic levels, while emergency-room visits are down 30 percent – the only increase in usage among healthcare services was in urgent care and hospital outpatient services.
And in this competitive environment, retail health is throwing its hat into the ring. It’s the Walmart-ing of American Healthcare.
The Medicare Advantage (MA) program has grown significantly over the past two decades, becoming a popular alternative to traditional Medicare fee-for-service (FFS). As of 2023,
The Medicare and Medicaid provider auditing process is about to get a makeover in 2025. I am talking about artificial intelligence (AI), which may be
Please log in to your account to comment on this article.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
Copyright © 2024 RACmonitor. Powered by MedLearn Media.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
