Académique Documents
Professionnel Documents
Culture Documents
Kelly Thompson, JD
Law and Policy Manager,
National Nurse-Led Care Consortium
August 2017
Table of Contents
____________________________________________________________
Introduction…………………………………....………………………...... 3
Recommendations…………………………………………………………10
Conclusion…………………………………………………………………... 13
Convenient Care Association | Report: Retail Health Workforce Strategy Think Tank | P. 2
Introduction
____________________________________________________________
On July 20, 2017, the Convenient Care Association (CCA) and its Provider Workforce Committee
convened expert stakeholders in Orlando, Florida for the “Retail Health Workforce Strategy
Think Tank” (“Think Tank”), a facilitated group discussion designed to identify methods to
strengthen the partnership between advanced practice nursing and physician assistant
programs and retail health, and ultimately to develop and strengthen the provider workforce.
The Think Tank featured a panel of experts representing the National Organization of Nurse
Practitioner Faculties (NONPF), American Association of Nurse Practitioners (AANP), American
Academy of Physician Assistants (AAPA), the National Nurse-Led Care Consortium (NNCC), and
CCA. Think Tank participants included providers, educators and stakeholders throughout the
retail-based convenient care industry. The overall objectives of the Think Tank were to
collectively identify methods to foster growth and opportunity for providers and the convenient
care industry, including innovative ways to educate advanced practice nurses and physician
assistants about retail-based health care, and to use retail-based convenient care clinics as both
clinical training sites and venues for employment.
The Think Tank built upon the conversation and recommendations arising from a Think Tank
convened a year prior, also hosted by CCA. The 2016 Think Tank brought together international
nursing experts, graduate nursing faculty, and clinic operators to commence important dialogue
about effectively preparing students to practice in retail health and advancing the retail health
industry. The objectives from that discussion were to explore core clinical competencies,
understand the gaps in education and preparedness of graduates, and identify collaborative
opportunities to expand awareness of the industry among clinical educators. As a key
takeaway, schools of nursing were encouraged to develop clinical opportunities in retail health,
and to encourage clinics to develop post-graduate programs to improve onboarding. Building
on the 2016 conversation, the 2017 Think Tank broadened its reach to obtain input from
physician assistant programs. The updated discussion focused on needs for improvement in
new graduate readiness to practice in retail health, partnering educators and clinicians, and
industry policy priorities and strategies.
Convenient Care Association | Report: Retail Health Workforce Strategy Think Tank | P. 3
healthcare patient visits to date.1 As of 2015, there are more than 234,000 practicing NPs and
101,000 practicing PAs, with over 5,000 NPs and PAs working in the retail health industry. It is
expected that the need for more practitioners will grow as the industry evolves and expands.2
Research has identified retail clinics as the lowest cost unsubsidized provider of healthcare.
Retail clinics prove to be remarkably geographically accessible, as nearly 40 percent of the
urban U.S. population lives within ten minutes of a clinic.3 Notably, an estimated 50 to 60
percent of retail clinic patients report that they do not have a primary care provider.4 In that
sense, clinics often serve as a point of entry to health systems for patients.
Currently, many retail clinics provide a variety of services and patient education opportunities.
Clinics have increased their education offerings and wellness services beyond acute ailments,
including screenings, tobacco cessation support, mental health treatment, and chronic disease
management, as well as preventative services such as flu shots and immunizations. For
example, retail health is credited with increasing rates of patients receiving flu shots from
32.2% in 2003 to 40.3% in 2013.5 The ability of clinics to reach previously uninvolved patients
and the increasing breadth of provided services has attracted healthcare system partners.
Today, more than 240 health systems are actively involved with retail clinics.
Define clinical and administrative competencies, standards and best practices of retail
health providers.
Explore ways to improve identified educational gaps and to ensure new graduate
readiness for the retail health industry.
Identify opportunities for retail health workforce experts to help schools prepare
students for successful retail healthcare careers.
1
“Convenient Care Clinics: Addressing Unmet Need.” http://www.ccaclinics.org/.
2
Riff J, Ryan S, Hansen-Turton T. Convenient Care Clinics: The Essential Guide to Retail Clinics for Clinicians,
Managers and Educators. Springer Publishing; 2013.
3
Pollack CE, Armstrong K. The geographic accessibility of retail clinics for underserved populations. Arch Intern
Med 2009;169:945–9.
4
Mehrotra, A., & Lave, J. (2012). Visits to Retail Clinics Grew Fourfold From 2007 To
2009, Although Their Share of Overall Outpatient Visits Remain Low. Health Affairs, 31.
5
Heath, Sara. PatientEngagementHIT. “Retail Clinic Access Bumps Patients Receiving Flu Shots Rate.” August 15,
2017. https://patientengagementhit.com/news/retail-clinic-access-bumps-patients-receiving-flu-shots-rate
Convenient Care Association | Report: Retail Health Workforce Strategy Think Tank | P. 4
Key Areas of Discussion
____________________________________________________________
The following topics were the focus of this year’s Think Tank discussion, and expand upon
central themes of the preceding Think Tank.
Convenient Care Association | Report: Retail Health Workforce Strategy Think Tank | P. 5
having prior roles such as charge nurse/house supervisor that demonstrate ability to
lead a team and work independently.
Participants agreed that these five competencies are widely applicable to all retail settings and
levels of practice. The ability to provide high-quality customer service distinguishes retail clinics
from most other health care settings. Likewise, unlike in most other settings, clinic providers
are often solely responsible for managing the healthcare environment of the clinic without
depending on a broader system for administrative tasks and ensuring safety. It was
acknowledged that this requisite self-sufficiency marks a clear overlap in the core competencies
of healthcare environment and autonomy, and educators are encouraged to cultivate those
skills in tandem.
Think Tank participants noted a need to develop well-devised programs that simultaneously
meet needs of young, unseasoned new hires and the needs of the current retail model. Faculty
and industry leaders identified various opportunities and strategies to build out more
sustainable, widespread clinical opportunities to meet these coinciding needs, including
establishing retail health practices run by faculty that could serve as clinical training sites.
Although clinics partially struggle with employee retention because some individuals are simply
ill-suited for the unique competencies required by the retail health industry, other losses are
traceable to a lack of mentorship and adequate training. Mentoring providers is an effective
way to strengthen the workforce while improving quality of care and patient outcomes.6
Participants shared the onboarding strategies of their organizations, ranging from two-week
intensive training programs for new employees, to six-month transition periods into
independent practice. The group explored the possibility of implementing more fellowships and
post-graduate mentoring programs for recent graduates who wish to make the transition to the
retail health industry, but are not immediately ready-for-hire.
Relying upon observations of new graduate providers in the field, seasoned retail health
providers and executives noted that many students are lacking thorough preparation on
business acumen. To decrease the common discomfort of students with topics such as finances
and profit-making in the provision of healthcare, retail health experts encouraged educators to
foster organic conversations with students about the fundamentals of running and growing a
business.
6
Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Retrieved from
http://books.nap.edu/openbook.php?record_id=12956&page=R1
Convenient Care Association | Report: Retail Health Workforce Strategy Think Tank | P. 6
Build a Knowledge Base for Educators
Faculty in advanced practice nursing and physician assistant programs have expressed an
interest in understanding the composition of retail clinics, the scope of healthcare services
provided, availability of clinical sites and preceptors, nuances of clinic management, and
desired level of education and experience for new hires. Educators are also interested in
knowing how to incorporate the needs of the retail health industry and convenient care model
into their respective curriculums.
Convenient Care Association | Report: Retail Health Workforce Strategy Think Tank | P. 7
o Enforce existing scope of practice authorizations: In some cases, a provider’s scope of
practice may be limited by policies of retail health companies, networks, or individual
clinics to a further extent than is mandated by applicable state laws (e.g., requiring
nurse practitioners to collaborate with a physician in order to write prescriptions in a
state that does not statutorily mandate collaboration). Stakeholders should ensure
that retail health company policies are as permissive as applicable laws.
o Reduce regulatory barriers creating logistical/administrative strain: As with scope of
practice limitations, outdated or unnecessary state laws and regulations that cause
strain on retail health companies, clinics and/or providers should be dissolved or
amended. Participants agreed that a primary regulatory burden on retail health
companies are “corporate practice of medicine” (CPM) restrictions, which generally
prohibit corporations from practicing medicine or employing a physician to provide
medical services. Due to CPM laws, many companies must establish separate legal
entities in order for their clinics to contract with physicians in states that require
physician collaboration with non-physician providers. These separate legal entities are
expensive to establish and maintain, and do not add value to the clinics.
o Establish dual Medicaid and Medicare credentialing: State Medicaid enrollment has
increased by 16.7 million since 2013. Retail clinics are well positioned to serve as
access points for these enrollees; however, the process each state has established to
enroll new Medicaid providers can be lengthy, sometimes taking up to eight months to
complete. Stakeholders should work with legislators to draft language that would test
the effectiveness of a dual Medicare/Medicaid provider credentialing process. Under a
dual process, states would voluntarily agree to waive the credentialing requirements
for their state Medicaid programs for providers that have already met the
credentialing requirements for Medicare – eliminating the need to submit duplicate
documentation, reducing administrative burdens, shorting credentialing times, and
lowering costs. The dual credentialing process would also be open to all types of
primary care providers, creating the potential for wider partnerships.
o Bolster mental and behavioral health services and support: A number of participants
noted that despite increased attention on the need for improved mental health,
behavioral health, and substance abuse treatment options, regulations often limit the
ability of providers to adequately support and treat patients. For example,
buprenorphine prescriptions for medication-assisted treatment are highly regulated,
limiting the discretion of providers to prescribe buprenorphine to patients addicted to
opioids.
o Consider development of a multi-state provider licensing “compact”: In 25 Nurse
Licensure Compact (NLC) states, registered nurses can practice in any NLC state by
obtaining one compact, or multi-state, nursing license. Participants discussed the
value of an equivalent option for advanced practice retail health providers. A multi-
state license would allow providers the freedom to engage in telehealth practice
across state lines, as well as provide flexibility for providers to move to and work in
different states.
Convenient Care Association | Report: Retail Health Workforce Strategy Think Tank | P. 8
o Address telehealth practice restrictions and regulatory inconsistencies: Telehealth
continues to be a major priority for state legislatures around the county.
Approximately 200 telehealth bills have been introduced since January 2017.
Participants stressed the importance of monitoring new telehealth legislation and
regulations to ensure that additional restrictions are not placed on retail clinic
providers using telehealth. One concern is that in some cases, new telehealth
legislation mandates additional physician supervision requirements on nurse
practitioners that surpass supervision requirements in state nurse practice acts and
regulations. Participants discussed the need to ensure the language of new telehealth
legislation matches the state scope of practice language governing nurse practitioners,
physician assistants and other non-physician providers.
Convenient Care Association | Report: Retail Health Workforce Strategy Think Tank | P. 9
Recommendations
____________________________________________________________
The following key recommendations emerged from the Think Tank discussion, and further
develop propositions from the preceding Think Tank.
Convenient Care Association | Report: Retail Health Workforce Strategy Think Tank | P. 10
not typically feasible, clinics are encouraged to consider other methods of fostering
connections, such as facilitating relationships with providers at other clinic locations,
emphasizing the value of interdisciplinary team members, and maximizing use of
technology to make virtual connections.
Encourage standardization.
There is a logistical need to streamline the creation of partnerships between
educators and clinics. Formal agreements should be standardized to expedite
contracting, such as developing regionally applicable – not clinic-specific –
memoranda of understanding (MOUs). Academic institutions are also encouraged to
standardize clinical placement requirements (e.g., acceptable settings, preceptor
requirements, hourly/semester quota requirements). For scheduling ease, the retail
clinic student onboarding process should be aligned with the education timeline; for
instance, initiating the placement process earlier, permitting students to work in the
clinics as soon as the semester begins.
New graduate appeal: Retail health employers are encouraged to reconsider the
mindset that new graduates are generally less desirable hires, as the benefit of
hiring graduates without backgrounds in other healthcare settings may be less
influenced by non-transferrable prior practices and, wielding a contemporary
outlook, better equipped to handle the “clients of today.”
Convenient Care Association | Report: Retail Health Workforce Strategy Think Tank | P. 11
Higher education partners: Retail health representatives should emphasize the
willingness of the retail health industry to foster partnerships with higher
education. The industry should offer educational materials and resources about
the retail health setting to educators, including the variety of services provided
by retail clinics.
Convenient Care Association | Report: Retail Health Workforce Strategy Think Tank | P. 12
Conclusion
____________________________________________________________
CCA member clinic organizations have devised a successful business model for retail clinics that
has been brought to scale. A major opportunity of the retail health industry is the growth of
advanced practice providers to practice in the clinics. Similarly, the key to the future for
advanced practice nurses, physician assistants, and other providers is to engage in innovative
models of healthcare delivery, including retail health clinics. CCA is committed to forging the
connection by ensuring the readiness of recent graduates to thrive as retail health clinicians.
____________________________________________________________
Convenient Care Association | Report: Retail Health Workforce Strategy Think Tank | P. 13
Acknowledgements
____________________________________________________________
Ann Davis,
American Academy of Physician Assistants
David Hebert,
American Association of Nurse Practitioners
Shannon Idzik,
National Organization of Nurse Practitioner Faculties
Brian Valdez,
Convenient Care Association
Cheryl Fattibene,
National Nurse-Led Care Consortium
___________________________________________________________
Convenient Care Association | Report: Retail Health Workforce Strategy Think Tank | P. 14