“Doc-in-a-Box” Care Models Demand a Cautious Approach

The popularity of retail and walk-in clinics for health care delivery has been growing among patients for years and accelerated exponentially during the COVID-19 pandemic.

Convenient and generally quite accessible, these “doc-in-a-box” practices are now an accepted part of the healthcare landscape, and many hospital systems and physician practices are acquiring or developing them in a growing effort to bolster their reach into local communities.

The expansion of outpatient delivery systems and its resulting influx of new practitioners also presents potential risks. Providers must be positioned to address these to reduce liability exposures, manage claim and loss activity, and successfully fulfill healthcare missions.

Professional Oversight is a Must

Diagnosis and treatment at these clinics are often performed by ancillary paraprofessionals in the medical field, often physician assistants (PAs), nurse practitioners (NPs), or registered nurses (RNs). While all possess the basic certifications and qualifications necessary to treat most simple medical concerns, patients may not be aware that they are not receiving treatment from a fully licensed physician.

As the number of clinics grows, so does the number of non-MD practitioners in the field. It becomes imperative for providers—whether a stand-alone clinic or a clinic operated by a hospital or physician group—to ensure rigorous oversight of the licensing, credentials, and daily protocols of these paraprofessionals to avoid potentially disastrous malpractice exposures.

Monitoring Quality of Care

The scope of services offered at most walk-in clinics has, so far, been limited to routine testing (COVID screening, strep throat cultures, etc.) and non-emergency treatments. However, as the number of clinics and practitioners grows, the risk of a provider overstepping these boundaries or creating a failure or delay in diagnosing a truly serious condition rises.

From an insurer’s standpoint, this creates significant risk for both the provider and the patient, leading to potentially high-cost claims on both sides of the equation. Implementing, monitoring, and maintaining stringent quality of care standards, including addressing when care should be elevated to the next level, is essential to mitigate these potential risks.

Preparing for Future Growth

Consumer appetites for new models of health care are growing, and the industry is taking notice. Delivery systems are expanding to encompass a wider variety of outpatient models than ever before. Existing providers, as well as private equity firms, are looking for ways to tap into this market and integrate them into existing healthcare ecosystems.

Insurers have taken a cautious approach to underwriting these risks, asking more questions, and carefully reviewing and monitoring internal protocols. Claim or loss activity directly attributable to these new models is being stringently monitored, and many insureds are seeing an increase in deductibles and premiums to offset the heightened risk to insurers.

These new models offer healthcare systems exciting ways to grow their patient base and provide a broader range of services in alternative settings. For many, this is the true future of health care. Working closely with specialized brokers to carefully consider potential insurance liability and risk is a critical consideration before diving headlong into this new world.

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Connect with Risk Strategies Health Care team at healthcare@risk-strategies.com