Monday, April 07, 2008

5,000 Retail Clinics & The Threat to the MD Cartel

DETROIT--Retail health clinics have made their way into metro Detroit and are competing with doctors' offices for routine patient visits. Clinics contend that the quality of care is high and that when a patient requires urgent care or a visit to a physician's office, the process is seamless, said May Hang, manager of operations in Detroit for Minneapolis-based MinuteClinic, a subsidiary of CVS Pharmacy.

The latest numbers show that there are fewer than 1,000 U.S. retail clinics operating, but some expect the number of clinics to grow to 4,000 to 5,000 over the next five years.

Doctors and other groups, though, remain skeptical about how the clinics are operated and consider them a potential competitive threat.

Translation of the last paragraph: MDs are worried about competitive threats to their "medical cartel," and the potential erosion of their above-market, cartel wages.

15 Comments:

At 4/07/2008 4:10 PM, Blogger Walt G. said...

Alternative translation of the last paragraph:

Doctors are worried that patients having stroke symptoms of numbness in one hand and slurred speech will be misdiagnosed as having carpal tunnel syndrome and “one too many at lunch.” This was an actual misdiagnosis at one of the area auto factories by both a physician assistant and an RN. Luckily, the worker disobeyed a direct order against leaving work while being held by security for a taxi ride home to “sober up” and face a penalty the next day (this is standard procedure for drinking on-the-job) He broke away from security and drove himself to the hospital where he had a stroke in the emergency room and was admitted for two weeks.

There is a somewhat good ending to the story. Although not as healthy as before the stroke, the worker now is happily retired with a lodge on a popular lake up north paid for by winning his medical negligence lawsuit.

People who are sick are not always rational and can waste valuable time attempting to save money by going to a clinic even if the clinic will quickly and properly diagnose a serious problem and transport the patient to a hospital. That additional time kills cells in the heart and brain that cannot be replaced.

Saving money is cool, but being healthy and alive is much better.

 
At 4/07/2008 4:25 PM, Anonymous Is said...

Walt, real doctors at real hospitals make mistakes, too. There are lots of examples.

 
At 4/07/2008 4:36 PM, Blogger Walt G. said...

is,

You’re right. But you will always wonder "what if." Won't you? A nurse or physician assistant are simply not doctors. Who do you trust most with your life?

 
At 4/07/2008 4:48 PM, Anonymous Fred said...

Yeah, Walt, as Judy Tenuta used to say, "It could happen."

Of course, she said that as part of an over the top comedy routine.

 
At 4/07/2008 5:02 PM, Blogger Walt G. said...

Does Judy Tenuta carry a spare tire in her car?

 
At 4/07/2008 5:36 PM, Anonymous Fred said...

Did you know that the value of two plus two approaches five for large values of two?

I am reminded of that little bit of math whenever I read one of your way out there arguments.

 
At 4/07/2008 6:15 PM, Anonymous Victor said...

The Mayo Clinic has a policy where the doctors are paid a salary instead of a per patient model. I spent a great deal of time there. During that time, I found out that a five minute doctor's appointment is almost worthless. It is an extremely great feeling to have a doctor spend 90 minutes with you going in depth into the problems and giving real solutions.

To get an accurate diagnosis of a condition, I would not trust a five minute doctor's appointment any more that I would trust the nurse or the physician assistant.

I think that the last paragraph has a lot to say. Those clinics may not provide the care that you could get in a doctor's office. The problem is that you don't get the kind of care in a doctor's office that you should get in a doctor's office.

Why not pay less for the same sub-standard care?

 
At 4/08/2008 5:46 AM, Blogger Walt G. said...

Fred,
I'll give you four bucks if you'll give me a five.

 
At 4/08/2008 9:50 AM, Blogger Gregory said...

Walt, the alternative scenario I would expect to see is this:

After rushing to the emergency room the admitting nurse sees that he is neither dying nor bleeding so she says "take a number and sit over there." An hour later he has a stroke in the emergency room and is admitted for two weeks.

If the Physician Assistant and a RN fail to recognize stroke then why do you think the admittance personnel in the emergency room will do any better? they are at best just a RN, same as the RN he saw in the clinic.

What, do you think they have doctors admitting patients?

It seems to me that seeing a Physician Assistant immediately is better than seeing the admittance personnel at the emergency room in 20 minutes then maybe a doctor an hour later if your symptoms are not obvious.

 
At 4/08/2008 10:25 AM, Blogger Walt G. said...

This comment has been removed by the author.

 
At 4/08/2008 10:28 AM, Blogger Walt G. said...

Gregory,

You're right, but where else would you want to be when you have a stroke or heart attack?

I realize that clinics can save money; however, you have to count everything when you want to prove that.

Le’s say 99 people save money by visiting a clinic with no problems, and the 100 th person drives himself to a clinic because he is having what he thinks is heartburn. The heartburn is actually an oncoming heart attack. The patient is promptly diagnosed and transported to the hospital, but because of the amount of time elapsed he spends the next 10 years on life support paid for by the taxpayers.

Will the amount of money saved by the 99 people be more than the amount of money spent on 1 person for 10 years?

You can't ignore the outliers when doing this type of cost/benefit analysis because they are very expensive, and the odds are they will be there. Without further research, what appears to be a simple solution really may not be a cost-saving approach to the health care problem. Even having said all that, I do agree with the concept that the problem should be solved by addressing the cost, and not by socialized medicine.

 
At 4/08/2008 10:36 AM, Blogger Mark J. Perry said...

One issue: If you are covered by insurance and are spending SOMEBODY ELSE'S MONEY, you'll always choose the higher quality option: an MD over a nurse practictioner, a specialist over a regular MD, a hospital over a clinic at Wal-Mart, etc. But when you are spending your own money, you would more carefully weigh the trade-offs in cost, quality, convenience, etc. Sure, if somebody else pays my medical bills, I'll always go to an MD, but if I am paying out-of-pocket, I would usually choose a nurse over an MD, at least for routine healthcare (poison ivy, ear infection, flu shot, etc.)

 
At 4/08/2008 11:02 AM, Blogger Walt G. said...

OK. But how about if you spend your own money and go to a clinic to save a few dollars, but end up on life support spending someone else's money as a result? Taxpayers’ money is spent by someone else's poor decision. I like the idea of clinics; however, just a few mistakes will eat up all the savings.

A lot of people with insurance will go to clinics because they are not sure their insurance will cover the emergency room fee until after they are diagnosed. Our people have to pay for the visit if it turns out not to be an emergency.

Would I go to a clinic for heartburn even though I have good insurance and a history of heart problems? Quite possibly. I squeeze dollars for exercise.

 
At 4/08/2008 11:20 AM, Blogger Marko said...

Don't forget the argument that Doctor's are actually way over qualified for most routine tasks they now perform. This is part of the reason for the recent rise of the PA and that nursing is growing. Many argue that PAs and certain nurses are actually better at many levels of treatement. Mark is right, when spending other people's money, people often chose the most expensive option, that may well not be the best option.

There is also the "all you can eat buffet" affect - if it is free or low cost, you want to get as much as you can.

And don't forget that flooding ERs with hearburns, colds and such has a cost too - it keeps people with serious problems from getting emergency care. Better they go to a clinic than the ER.

 
At 4/08/2008 1:31 PM, Blogger Walt G. said...

In my job, I only see the extremes, so I'm biased without a representative sample of all health care cases.

We see the guy who took his child to the emergency room for asthma, and the insurance company won’t pay the $500, or $1500 if an ambulance is involved, because the asthma, at that time, was not life-threatening. The neighbor’s kid died from an asthma attack, so he felt it was a life-threatening event. Should he go to a clinic next time? On the other end, people delay treatment until their cancer is in the late stages even though they have good insurance.

I hate to be a pessimist; however, oftentimes a lot of many is spent on just a few cases. There are a lot of efficient ways to cut costs. Some simple ways might not be cost efficient.

 

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