April 13, 2017
Health Systems Walk-In Clinic Strategy Threatens Private Practice Primary Care Health systems are a major player in the urgent care market. In fact 37% of urgent care centers nationally are either hospital owned or are a joint venture with a hospital. (1) While under the banner of broadening access and keeping patients out of the ER that don’t belong in the ER, the reality is that this appears to be a strategy to siphon patients to their medical groups and emergency departments, at the expense of community-based independent primary care providers. While urgent care is a low margin, high volume proposition, this hub and spoke model is attractive to health systems as a way to capture greater market share, gain new patients and reap the benefits of downstream referrals to their hospitals, specialty providers, labs, imaging services and other ancillaries.
To add to the disruption of the Medical Home (Read Here), an emerging hospital strategy is the ownership of or partnership in retail clinics. Viewed previously as competitive threats, hospitals and health systems now see retail clinics as a way to extend their geographic reach and get new patients into their system.
Consider what’s happening in the Atlanta market which is a snapshot of a growing trend occurring across the country that threatens private practice primary care medicine.
Emory Healthcare recently announced that they had partnered with two urgent care companies with a combined total of twenty facilities in the metro Atlanta area. The urgent care providers will become part of the Emory Healthcare Network, a clinically-integrated network of employed and private practice physicians. The urgent care centers will be linked to the Emory EHR. If needed, patients who are referred to specialists within the network for more complex treatment will have a health record in the system. (2) Additionally, Emory Healthcare expanded it’s relationship with CVS MinuteClinics to include 38 retail locations. Under the agreement, Emory Healthcare physicians will serve as medical directors for the MinuteClinic locations in the metro Atlanta area and both organizations will collaborate on patient education, disease management initiatives and will begin to work toward fully integrating their electronic medical record systems to streamline communication around all aspects of each individual’s care. (3)
And in February, rival health system Piedmont Healthcare in Atlanta reached agreement to take over and operate 27 Walgreens in-store retail clinics in the metropolitan area. The clinics will be re-branded as Piedmont QuickCare at Walgreens. The clinics will be staffed with Piedmont clinicians and will utilize Piedmont’s EHR. Piedmont also operates 19 urgent care centers. (4)
Care coordination between Emory Healthcare and MinuteClinics and Piedmont Healthcare and Walgreens clinics will likely be vastly better than what exists generally today between walk-in clinics and primary care providers. That’s a good thing. But the model also has a downside for unaffiliated, independent PCPs. What happens when their patient walks into one of these clinics and then gets referred by the clinic into their respective health system? That patient probably becomes a former patient of the private practice PCP.
Being in private practice can feel pretty lonely. Independent primary care physicians today are faced with competitive forces from multiple directions, not to mention greater administrative demands and confusing reimbursement systems that have led to longer hours, declining income, less job satisfaction and more stress. To succeed while remaining independent, they need help navigating all the changes and administrative demands they’re faced with. By affiliating with a fully integrated Independent Practice Association (IPA) with a care management infrastructure and experience managing risk-sharing contracts, independent physicians gain the benefits and competitive strength of being part of a larger organization along with the resources and support they need to thrive in the new healthcare environment.
Chief Operating Officer
Northwest Physicians Network
- 2015 UCAOA Benchmark Survey
- “Emory Healthcare Network Partners With Urgent Care Companies, Expands MinuteClinic Affiliation To Broaden Access”, October, 2016
- “MinuteClinic and Emory Healthcare Announce Clinical Affiliation”, November, 2011
- “Atlanta Hospital System To Take Over Walgreens Clinics”, Crane’s Chicago Business, February, 2017