Beyond the Bricks and Mortar Doctor's Office

As the New York Times noted in its December 15 editorial, When the Physician is Not Needed, health-care reform will propel millions of newly insured Americans into a system with far too few primary-care physicians.

That shortfall will have to be filled by other qualified providers, including nurse practitioners (NPs) operating in retail-based clinics. As I noted in a 2011 New York State Health Foundation-sponsored report, Easy Access, Quality Care: The Role for Retail Clinics in New York, retail clinics offer high-quality care for routine ailments at a fraction of the cost of physician's offices or emergency rooms. Today, about 1,400 retail clinics operate nationwide.

Unfortunately, in New York, retail clinics are often hindered by outdated regulations. Fewer than 20 retail clinics operate in New York today, compared with 106 in Florida (which licenses corporate owned retail clinics, although it does not license provider-owned clinics). Albany policymakers should rescind laws that prohibit companies from directly employing NPs and allow NPs to practice independently - making routine care more affordable and accessible.

This not to say that all traditional hospital or physician-based services are outmoded, just that every provider should be allowed to practice at the top of their license and utilize emerging technologies and new business strategies to reduce costs and increase efficiency. Providers that deliver enhanced quality, improved convenience, and lower costs to consumers - whatever license they happen to have - will win in the emerging cost- and data-driven health care market place.

Take another evolving consumer-oriented health care innovation, telemedicine. Telemedicine (via companies like Teledoc) offers a way for consumers to access physician services using phone or web-based platforms like Skype or Facetime.

Telemedicine allows consumer to conveniently consult with expert physicians or specialists when they can't get an appointment with their regular physician, in rural areas where specialists aren't available, or for business travelers who can't access their regular physicians - avoiding an expensive and onerous trip to the emergency room. In New York, Beth Israel Medical Center offers telemedicine services for just $38 - including prescriptions, if necessary - compared to $75 or $100 for a traditional "bricks and mortar" office visit.

An even more promising evolution is the expansion of app-based health care services through on your smart phone. My colleague Mark Mills has penned a terrific Forbes blog series on the app- and supercomputer-driven future of medicine, enabled by massive increases in computing power and ubiquitous Web access. The real life Star Trek tricorder may not be far off, and it will eventually revolutionize medicine - with sophisticated analytics that can match or better the diagnosing skills of all but the best physicians.


Back to the New York Times editorial. Bravo to them for thinking about health care from the consumer's perspective, where cost, quality, and convenience are key. The irony is that the Affordable Care Act is building out mid-century American medicine - subsidizing high cost traditional insurance and physician access - when technology is poised to make the old paradigms obsolete.

Health care's labor problem won't be solved without massive increases in technology driven productivity, espeically given the double whammy of the Affordable Care Act and a rapidly aging population that is going to require much more care and care management. The resulting logjam of patients demanding doctors to "see them" will have to spur a revolution in how care is delivered, and by whom (or what).

In other words, paging Dr. Watson.

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