NPs Ride the Convenient Care Clinic Wave
Monday June 30, 2008
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Marjorie Kozlowski, RN, MSN, APN-BC, and a patient.
(Photo by Andrew Campbell.)
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Quality Assured
Convenient Care Association member clinics incorporate rigorous quality assessments into their evaluative structures, including formal chart reviews by collaborating physicians and peer review by NPs, with additional standard coding auditing.
Overall, there is a 98% patient satisfaction rating among Convenient Care Association member clinics nationally.
State boards of nursing have not reported any complaints related to NP care at convenient care clinics to the American College of Nurse Practitioners, according to Susan Apold, RN, PhD, ANP, 2007 president of the organization.
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“NPs are the best kept secret in health care, but the healthcare system cannot afford these types of secrets. The CCC industry puts NPs front and center,” says Susan Apold, RN, PhD, ANP, immediate past president of the American College of Nurse Practitioners. The secret is officially out, and Convenient Care Association member clinics are employing NPs to staff 80% to 85% of clinics.
The first CCCs, also known as retail clinics, were established by MinuteClinic in 2000 in Minneapolis-St. Paul. Today, MinuteClinic has 500 clinics in 25 states, and the industry has expanded into more than a dozen companies that run more than 940 CCCs from coast to coast.
Despite the current success, getting the CCC concept off the ground has been a challenge. Resistance to the industry included a 2007 demand from some American Medical Association members for a complete ban on CCCs and a call for investigation into perceived conflicts of interest, such as requiring or encouraging patients to fill prescriptions at on-site pharmacies. Currently, the AMA has backed down on its proposal to ban CCCs, according to Jan Towers, RN, PhD, NP-C, CRNP, FAANP, director of health policy for the American Academy of Nurse Practitioners.
“CCCs are going to help patients and healthcare providers in the community rather than hinder them,” she says. The Convenient Care Association is confident of the benefits that its member clinics offer to the community. It has proactively addressed concerns about quality of care by adopting official standards and guidelines. In addition, member clinics encourage patients to fill prescriptions at any pharmacy they choose. CCCs have also addressed concerns of the National Association of Pediatric Nurse Practitioners.
“Infants under 2 years require specialists,” says Patricia Clinton, RN, PhD, CRNP, FAANP, immediate past-president of the National Association of Pediatric Nurse Practitioners. She says it takes a pediatric provider in a medical home to consistently evaluate growth progress and parenting skills.
The Convenient Care Association says that member CCCs generally do not care for children under the age of 18 months. In addition, the industry is working within the existing medical system to encourage both adults and children to establish a “medical home” — in other words, a central point for receiving primary care that provides continuity, coordination, and integration of health care, both preventive and curative.
About 30% of patients who present to CCCs don’t have a medical home. Patients without a primary care provider receive a local referral that accepts new patients and the patient’s form of payment or insurance. Electronic health records are used to coordinate care and ensure safety.
CCCs’ standardized and transparent pricing — that is, prior knowledge of costs — is a big advantage for patients. The basic visit fee for a Maryland or Virginia area RediClinic or MinuteClinic is only $59 — a boon for uninsured patients or those with fixed incomes. CCCs also accept most insurance plans, including Medicare, and sometimes Medicaid.
“Even if we are not in-network with a particular insurance company, the choice is there for a $59 out-of-pocket expense compared to a co-pay of $75 to $100 for an ED visit, where you may have to wait for hours to be seen for an ear infection,” says Anne Pohnert, RN, MSN, FNP, manager of operations for MinuteClinic in Northern Virginia and Washington, D.C.
The Convenient Care Association says that the affordability and convenience of CCCs also encourage patients to receive care early, which promotes early treatment and better outcomes. If a serious medical issue, such as hypertension or diabetes, is discovered during care for minor complaints, NPs are fully qualified to get patients access to the level of care they need, according to Towers.
“A physician-staffed model is more expensive to operate than an NP model, but there is strength in having some flexibility in model development, depending on community needs,” says Tine Hansen-Turton, MGA, JD, executive director of the Convenient Care Association. She notes that profitable physician-staffed models usually offer a broader scope of services than NP-staffed models, and they often function as urgent care or safety net providers.
Flexible models of CCCs are being courted in Massachusetts. In January 2008, the state approved regulations allowing for the establishment of NP-staffed CCCs, known there as limited service medical clinics. Massachusetts regulations open the door for retail-based companies but also encourage hospitals and community health centers to develop CCCs in alternative convenient settings, such as storefronts and homeless centers.
In the future, the CCC industry is also looking to develop models that partner with other healthcare professionals, such as pharmacists, to improve quality and access to care.
“Pharmacists will not replace NPs in clinics. The opportunity in this model is in marrying an expert in primary care with an expert in drug management,” says Hansen-Turton.
“That’s really putting NPs up there in the business world and with healthcare industry leaders,” says Sandra Festa Ryan, RN, MSN, CPNP, chief nurse practitioner officer for Take Care Health Systems and co-chair of the quality committee of the Convenient Care Association.
The NP-driven model also promotes the clinical contributions NPs make to healthcare, according to Karen Frye, RN, FNP, district manager for Richmond, Va., RediClinics, located in Wal-Mart. RediClinic NPs developed programs for smoking cessation and screenings for high cholesterol, diabetes, heart disease, liver and kidney function, thyroid disease, allergies, prostatic specific antigen, and osteoporosis.
“This is an excellent opportunity for NPs to do all those things they do so well,” says Frye. “It’s a unique place for NPs to stretch their wings.”
Catherine Spader, RN, is a contributing writer.
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