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New York Post


One Health-Care Answer

April 02, 2011

By Paul Howard

“Mommy, I don’t feel so good”: Those six words strike fear into the heart of every working parent. Find a doctor to see your kid on the same day you need an appointment? Fuhgeddaboudit.

ObamaCare won’t make it any easier. It spends billions to insure more Americans -- when primary-care doctors are in short supply. After Massachusetts passed its universal health-care law in 2006, wait times to see physicians increased, as did expensive emergency-room visits -- because all the newly insured patients couldn’t find doctors to treat them.

If New York is to avoid a similar fate, it should consider a promising option now hamstrung by state regulations: retail clinics.

The retail-clinic model is simple. Companies like Walgreens and CVS establish clinics inside their stores. Nurse-practitioners run the clinics; prices and services are clearly posted. Appointments are on a “walk-in” basis; most patients get seen in about 20 minutes.

My exhaustive review of the research shows that retail clinics can reduce the strain on doctors’ offices and prevent inappropriate use of emergency rooms.

Some physicians groups have raised concerns about the quality of care offered at retail clinics. But in a recent report for the Manhattan Institute, “Easy Access, Quality Care,” I found that these clinics provide high-quality care at very attractive rates. For instance, a 2009 RAND Corp. study found that retail clinics cost 30 to 40 percent less for the same services than doctors’ offices or urgent-care centers and 80 percent less than ERs. Other studies show that the retail clinics’ quality of care is equal to other providers’ -- sometimes even better. Patient satisfaction is over 90 percent.

States from Minnesota to Florida have taken advantage of retail clinics, but not New York -- even though we desperately need more affordable health-care options.

A spring 2010 report from Excellus BlueCross Blue Shield, an insurer, suggested that as many as 44 percent of emergency-room visits in Upstate New York may have been for inappropriate reasons (including 40,000 visits for sore throats and earaches). Similarly, a 2006 study estimated that about 40 percent of ER visits in New York City could’ve been prevented or treated in primary-care settings.

New York certainly could use more retail clinics. As of December 2010, retail-clinic locator Healthcare 311 ranked New York among the four states (along with Alabama, Mississippi and West Virginia) with the lowest number of retail clinics per capita, with just 0.1 clinics for every 100,000 residents.

A big part of the problem is heavy state regulation. Health-care providers (including retail clinics) in New York must obtain “certificate-of-need” approval before opening or expanding care facilities -- an expensive, uncertain and time-consuming process.

The state also prohibits corporations from operating clinics and employing cost-effective nurse-practitioners or physicians’ assistants; instead, New York-based clinics must be physician-owned and -operated.

New York should streamline the licensure process for retail clinics and let corporations operate clinics and employ providers, as dialysis-treatment centers in the state now do.

There’s some bipartisan support for reform: Assemblywoman Amy Paulin (D-Westchester) recently introduced a bill along these lines, explaining that “access and demand are increasing, and we need safe and accessible alternatives like retail clinics.” Her legislation would create a regulatory process for approving retail clinics in New York. And state Sen. Kemp Hannon (R-Nassau), chairman of the Senate Health Committee, introduced a companion bill on March 1.

Passing the legislation won’t be easy. Doctors groups remain wary of retail clinics. On the other hand, the nurse-practitioners have beaten them before: Last year, legislation passed that gives nurse midwives freedom from “collaborative-practice agreements” with docs.

With ObamaCare already phasing in, now is the time to act. By leveling the playing field for retail clinics, New York lawmakers can help avoid a crisis in care and offer consumers more high-quality, convenient and affordable health-care options -- as well as help keep minor health-care problems from turning into big headaches for New York’s already overstressed parents.

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