Some clinics sell vitamins. Others hawk headscarves and bras fitted with prosthetic breasts. Still others sell wigs, swimwear, and shirts with detachable breast pockets (for easy port access). Whether the practice is large, with a boutique staffed by a full-time employee, or small, with an unmanned rack in the waiting room, it isn’t uncommon for a clinic to try selling nonmedical products to patients.
Although the sales bring in a nominal amount of revenue at best, clinic administrators say patients appreciate the convenience of “1-stop shopping,” and administrators appreciate satisfied patients. Oncology management consultant Teri Guidi said rural clinics could benefit the most from selling items. Patients would appreciate the convenience and practices could use the additional revenue; however, clinical retailing has its limitations, she said.
“I don’t know that it’s becoming any more popular—at least not drastically so—than it has been over the years, and that’s in part just because it isn’t generating a whole lot of revenue for anybody,” Guidi said. “It’s creating some headaches—whether it’s inventory control, or additional purchasing—that weren’t there before. That may be part of the reason we don’t see more of them: these headaches.”
Staff from 2 clinics interviewed by Oncology Business Management™ agreed that Guidi is correct about the value proposition. Retailing items directly from the clinic isn’t a moneymaker, they said. Rather, the sales add to what PJ Sidhu, the administrator of Joliet Oncology-Hematology Associates in Illinois, calls the “intangible value” of patient satisfaction.
Having products on site that complement the treatment process can improve patient satisfaction, which is important for meeting the goals of the Merit-Based Incentive Program, notes Kathy Oubre, chief operating officer of Pontchartrain Cancer Center in Louisiana, referring to the CMS payment modification program launched this year. Private payers have put similar pressure on practices, she said. “As insurance companies entertain the idea of more value-based care, patient satisfaction surveys, which weren’t super present years ago, have been gaining traction.”
From the practice’s own perspective, in an age when many patients shop around for their provider, “from front to end,” it’s important to find new ways to meet patients’ needs and expectations, and offering helpful nonmedical products can boost satisfaction, Oubre said.
Careful selection of what to sell is key. Assessing a product’s usefulness is a good way to determine whether its presence in the clinic would be helpful or exploitative. The American Medical Association Code of Medical Ethics offers some guidance on this front. Opinion 8.063 addresses the sale of nonprescription products that ostensibly benefit a patient’s health, while Opinion 8.062 tackles the sale of nonhealth-related goods.
“In general, physicians should limit sales to products that serve the immediate and pressing needs of their patients,” the AMA writes in Opinion 8.063. “For example, if traveling to the closest pharmacy would in some way jeopardize the welfare of the patient (eg, forcing a patient with a broken leg to travel to a local pharmacy for crutches), then it may be appropriate to provide the product from the physician’s office.”
The AMA discourages practices from selling products that provide no benefit to a patient’s health. “This activity risks placing undue pressure on the patient and risks demeaning the practice of medicine,” the AMA writes in Opinion 8.062, echoing a segment of another opinion in which it says marketing any unnecessary product to a patient poses a “risk of patient exploitation.”
Physicians should only sell nonhealth-related goods from their offices for the benefit of community organizations, the AMA writes. The goods should be low-cost, the physician should not profit from their sale, sales should not be a “regular part” of the clinic’s business, and sales should be conducted in a dignified manner, ensuring patients are never pressured into making purchases.
Oubre keeps the guidelines in mind when selecting what items to sell, she said. Two years ago, when there was a push for oncology practices enter the vitamin market, Oubre considered bringing vitamins into the clinic, she said. But the physicians advised against it, saying there was no data to back up the vitamins’ usefulness for cancer patients, so she decided not to pursue it. “It’s a marriage of what’s good for the patient and what the physicians deem appropriate,” Oubre said.