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VOL. 7 | NO. 14 | Saturday, March 29, 2014

Walk-In Clinics Rising as Response to ACA

By Don Wade

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When the Affordable Care Act became law in 2010, medical providers were not sure what to expect.

But four years down the road, it’s evident the ACA has presented some opportunities – not just for patients, but for how care is delivered and, yes, marketed. And that has meant a rise in walk-in clinics nationally and locally.

Walk-in clinics such as Baptist Medical Group’s new Minor Medical Center at 2087 Union Ave. are increasing throughout Memphis as health care providers respond to the  Affordable Care Act.

(Memphis News/Andrew J. Breig)

“Here’s what I look at,” said Baptist Medical Group CEO Jim Boswell. “With the Affordable Care Act, one of the biggest issues is to provide access to patients for preventive care in an outpatient clinic setting as opposed to emergency room or, worst-case, in in-patient care.

“From a business perspective, access points are extremely important. So is good geographical presence convenient to patients. As we look at demand, we have been strategically locating primary clinics that have a walk-in side to it.”

For example, a BMG Memphis Primary Care and Walk-in Clinic recently opened in Midtown on Union Avenue; the very name – primary and walk-in – describes the model.

“We can accept walk-ins and integrate them into our practice,” said Dr. Mark Castellaw of BMG.

Big picture, the more hospitals and physician groups that go to this model the less often emergency rooms will be flooded with uninsured patients walking in for minor medical problems.

“It’s a good alternative to the emergency department,” said Mitch Graves, president and CEO of Health Choice LLC, a physician hospital organization (PHO) that is a joint venture between Methodist Le Bonheur Healthcare and MetroCare. “That’s something the whole health industry hasn’t done well – getting the person to the appropriate provider for care.”

Many of the people buying insurance through the ACA marketplace exchanges never have had health insurance before, and never before had a primary care physician. So, many of those people are more comfortable in a walk-in setting. Which makes combining the walk-in and primary clinics a smart business move, in addition to being a good way to bring health care to people.

“You’ve hit on our strategy,” Boswell said, adding that BMG believes this is a “proven concept” based on the success of having several such clinics in the Jonesboro, Ark., area. BMG also has primary/walk-in clinics on Poplar Avenue in the Carrefour at Kirby Woods Shopping Center and at 8970 Winchester Road.

BMG also is partnering with Walgreens and their 11 pharmacy walk-in clinics in metro Memphis. The medical providers – typically nurse practitioners – in those clinics have operated as independent contractors supervised by doctors who were independent contractors, Castellaw said. Now, BMG doctors will have oversight.

“One of the challenges mini-clinics or retail clinics have is they traditionally are not connected to a group of physicians,” Boswell said.

Referrals can be made from both BMG’s own clinics and the ones in Walgreens.

“This streamlines the process,” Castellaw said, adding that people can be matched with primary care physicians. “They have a go-to-doctor, a point guard to run the show, and the outcomes are so much better.”

Boswell says they’ve already discovered it’s not that unusual for, say, a 45-year-old to come into a walk-in clinic and basically have no medical trail because they’ve yet to have a major health problem and they’ve never had a “work-up” and learned whether their blood pressure, blood sugar and cholesterol readings are within healthy ranges or danger zones.

But with the walk-in and primary clinics together, it’s easy to direct the patient to where he or she next needs to go. And Baptist also has a new electronic health records system powered by Epic software to track the patient.

“With the ACA it’s important we don’t duplicate tests,” said Dr. Steve Gubin, president of Stern Cardiovascular Foundation, which is part of BMG.

The ACA provides financial incentives for lowering Medicare costs and Gubin says Stern Cardiovascular has lowered Medicare costs enough to receive the so-called bonus payments in two years. But there is also a great opportunity to get people to undergo preventive tests that previously went against their deductible, but won’t under the ACA, Castellaw says, adding, “That will encourage people to get colonoscopies and mammograms done.”

As a specialist, Gubin is used to seeing patients late in the medical process.

“Most of the time, we see patients after they’ve had a heart attack, a stroke or high blood pressure a long time,” he said. “Getting patients early prevents long-term problems. Heart disease is the No. 1 cause of death for men and women. In Memphis right now we’re (known) for obesity, diabetes and heart disease. We want to try and change that.”

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