Thursday, July 24, 2008

Retail Health Care Clinic Updates

1. One of the nation's leading retail health clinics, Take Care Health Systems, recently informed the American Academy of Family Physicians that it would not renew its commitment to the Academy's list of Desired Attributes of Retail Health Clinics. The action fueled AAFP's already heightened concerns about retail health clinics expanding their scope of practice beyond the treatment of simple acute health concerns. Link.

Translation: The family doc cartel is worried about increased competition.

2. Boston Globe -- Some of the state's largest health insurers say they will cover visits to the retail health clinics expected to open in CVS and Walgreens drugstores later this year, making the clinics attractive options for the treatment of everyday ailments.

The endorsement by insurers is likely to turn retail clinics into major healthcare providers in the state because, for many patients, they will be less expensive than hospital emergency rooms, with less waiting time. Under the contracts signed and being negotiated, retail clinic copayments range from $10 to $25, compared with the $50 to $150 copays most insurers assess for emergency room care.

The state's powerful physicians' group, the Massachusetts Medical Society, opposed the clinics when they were proposed by CVS last year, saying they raised concerns about safety, oversight of caregivers, and spread of germs.

Translation: The MMS cartel was actually most concerned about competition.

20 Comments:

At 7/24/2008 12:40 PM, Anonymous Anonymous said...

Are you suggesting that "safety, oversight of caregivers, and spread of germs" are irrelevant concerns?

Are we to imagine that someone who has chosen a profession which requires years of training and thousands of dollars in tuition fees, exposes them to disease pathogens on a daily basis, and is renowned for its gruelingly protracted shifts is motivated primarily by self-interest? There are many fields that are far less demanding and highly remunerative, like investment banking.

Your post has failed to address the safety concerns raised by physicians. There is more to medicine than a few rudimentary cost estimates. Not up to your usual standard.

 
At 7/24/2008 12:42 PM, Blogger Matt S said...

The "Doc in a box" concept takes its next step. My dad I think was one of the first doctors to open a practice off the highway, bringing medical care closer to non- big city folk. I guess now they don't want city folks to even have to trek to the hospital in the city.
There is a danger here, though. Discount clinics at places like Walgreens strike me as an idea that would require a very stringent guidelines and enforcement. You would probably
-hire the doctors willing to work for less than at other clinics
-have lots of people coming in trying to score narcotics
-have people coming in and being misdiagnosed, due to 'discount' doctors and the fact that you're getting a checkup at Walgreens.
-There would be a very tight limit on what kinds of medicines will be available, due to space concerns and regulatory concerns.

I'm all for competition, but in the medical world, there's a lot of concerns you have to keep in mind.

 
At 7/24/2008 12:43 PM, Blogger Matt S said...

Also, let me reiterate from before:

As far as my folks know (and they're docs from different disciplines), most docs seem to favor universal healthcare.

 
At 7/24/2008 12:59 PM, Blogger Walt G. said...

Any business that puts its own needs ahead of the customer/patient will always fail eventually.

Is that what doctors are doing with these clinics? I personally don't know. If they are, they better read my statement above and figure out how it is illogial. If they can't do that, they better change before it is too late.

 
At 7/24/2008 2:57 PM, Anonymous rvturnage said...

Anon @ 12:40 said:"Your post has failed to address the safety concerns raised by physicians. There is more to medicine than a few rudimentary cost estimates."

The patient should have the freedom to decide if a retail clinic is the best choice for them based on their own "rudimentary cost estimates" and not have the decision forced on them by a third party who has a vested interest in seeing retail clinics close down or change business models to be less competitive.

If the patient felt that the care from a retail clinic was unsafe or not a wise use of their money, they wouldn't go to the retail clinic.

 
At 7/24/2008 4:13 PM, Anonymous Anonymous said...

Well, anon 12:40, if you had read the article at the link you would have read: "The oversight and safety issues raised by the medical society have been addressed by new state regulations that govern how the clinics are run."

I agree that it appears someone is afraid to compete.

We could use a half dozen of these clinics in our area. It's pretty ridiculous to be told to wait two weeks to see the doctor when one is sick. Maybe it just a cold, maybe it isn't. But, if it is something more pressing, how does it help the patient, and the public, to make them wait (and spread those "germs")?

I welcome the change. And isn't that important today? Change?! ;-)

 
At 7/24/2008 4:14 PM, Anonymous Anonymous said...

I have no problem with freedom of choice, the development of retail clinics, private clinics or the forces of market competition. I object to concerns of physicians being dismissed as evidence of a cartel rather than seriously considered.

MP has suggested that the alternative to clinics in retail outlets is a hospital emergency ward with a 6 hour wait. Any physician can tell you that the last place that needs a patient with a minor ailment is a hospital emergency dept. These patients should be going to see their family doctor or visiting one of the thousands of walk-in and after hours clinics. Many walk-in clinics also offer family care.

A patient can put themselves at risk by going to a myriad of sources for treatment, ie. adverse drug interactions. The value of a family physician is that he coordinates and tracks the patient's medical treatment. By contrast, the patient will seldom see the same doctor at a retail clinic and each physician will have to take a medical history.

While a retail clinic offers convenience, economy and accessibility, one must also consider that patient tracking is a very important part of delivering high quality care especially with patients who suffer from conditions that require monitoring like diabetes.

 
At 7/24/2008 4:19 PM, Anonymous bob wright said...

I recently had an appointment at a surgeon's office - to see his PA.

She examined me and determined if face time with the doc was necessary. As it turned out, I did not see the doctor. The PA took care of me.

I see no reason this can't work inside a Retail Health Clinic at Wal Greens.

 
At 7/24/2008 5:26 PM, Blogger Shawn said...

matt: your concerns are utterly unfounded.

-hire the doctors willing to work for less than at other clinics
no, they hire nurse practitioners
-have lots of people coming in trying to score narcotics
umm...what?
-have people coming in and being misdiagnosed, due to 'discount' doctors and the fact that you're getting a checkup at Walgreens.
as their scope is limited, and the possible areas of treatment detailed rather thoroughly by a 'treatment book', and NP's are very highly trained, the possibility of misdiagnosis seems slight, and certainly within the realm of tort liability, and therefore very enforcable and easily monitored
-There would be a very tight limit on what kinds of medicines will be available, due to space concerns and regulatory concerns.
this is true. the purpose is not to replace doctors, but to replace the minor issues that doctors have to treat, thereby enabling them to be focused on larger issues

I gleaned this information after a recent visit to a retail clinic for treatment of lyme's disease. I had waited too long to seek treatment, and the rash was too large for them to be involved. I was sent on my way without having to pay a cent. Had I visited earlier, I could have obtained the dose of doxycycline that I needed with no problems, and saved myself some money (my next options were either express-care in the ER or urgent care facility, both of which are noticeably more expensive.)

And, let me reiterate: the fact that many doctors favor universal healthcare/single-payer is utterly irrelevant. This is primarily an economics question, not a healthcare question. If 9 out of 10 baseball players recommend AIM toothpaste, that is merely interesting, not helpful information as I stand in the toothpaste aisle.

 
At 7/24/2008 5:30 PM, Blogger Shawn said...

bob: at a walgreens, you're getting even better than a PA, you're getting a NP. And, usually, on shorter notice than you can get in to see your doc.

At least, that is, until these take off, and doctors don't have to see as many menial items.

then we'll see what the real equilibrium of doctors is....how many GP's do we REALLY need, given this new opportunity for specialization?

 
At 7/24/2008 6:56 PM, Blogger juandos said...

Hey matt s, your comment: "As far as my folks know (and they're docs from different disciplines), most docs seem to favor universal healthcare"...

Do they actually favor universal health care (do they REALLY know what it is?) or do they want to be sure they get paid and they think the government can do it?

Are your parents willing to shell out of their pockets the extra money this expanded medicare/medicaid as envisioned by libs and other uninformed folks?

BTW what part of the country are you from if I may be so nosey?

Hey walt g, the clinics that are open in various Walgreen pharmacies here in the St. Louis, Mo area aren't normally staffed by M.D.s but by a nurse or a nurse practitioner...

The manager of the Walgreen's near me says that most folks don't know if they really need to see a doctor or not and the clinic is a good place to find out...

When a visit to a doctor's office has an $40 to $80 co-pay one wants to be assured that actually going is necessary...

 
At 7/24/2008 8:56 PM, Anonymous Anonymous said...

Juandos,

Your point regarding public health care and getting paid is a valid concern. What doctors generally don't count on is salary caps.

At one point, specialists in Ontario were hitting the earning cap by April or May and any economist can tell you that no one works for free for the rest of the year. Fortunately, the government has finally lifted the cap.

 
At 7/24/2008 9:47 PM, Anonymous anonymous#2 said...

when you take care of patients ,over time a more indepth knowledge and trust develops.most people don' t understand how important continuity of care is till they find a good dr,they like and trust, then have to change because of their insurance.when my patients would end up in the er i usually had an idea what was wrong with them before the er dr did. plus the er dr might want to send the patient home, but i know this patient doesn't complain unless some thing serious is going on and over rule the er dr and keep the pt and find the diagnosis. medicine is complex ,not cookbook and care is becoming more and more fragmented. drs as well as patients are frustrated.remember big problems commonly start with minor symptoms and get worse. nurse practitioners may miss the constellation of that lead a dr to consider the severe sorethroat is really a peritonsillar abscess needing surgery.patient commonly don't realize how sick they are . some decisions are even difficult for competent drs to make ,can't wait till nurses try to make them !!

 
At 7/24/2008 10:18 PM, Anonymous Anonymous said...

Anon. 2,

Appreciate having your perspective. I was really trying to get to the issue of continuity of care. My doctor friends tell me that there are many young doctors that cannot even take a proper history and we somehow expect that they will do the right thing when they see a patient only once. In the case of retail clinics, it is nurse practitioners rather than doctors who will make these decisions.

It is important that we attempt to understand the complexity of this field. A government bureaucracy can be "satisfied" but they don't have to solve the problems of misdiagnosis and the resulting complications. It is very tempting for public policy makers to look access and cost above all other considerations.

Canada provides a textbook lesson in what happens when a government bureaucracy runs a health care system. Inadequate investment in diagnostic imagery, cuts to nursing and medical school enrollment, salary cuts, and long waiting lists for seeing a specialist or receiving treatment. The present problems will take years to solve. That is what doctors in the U.S. understand: the stakes

One can either interpret the actions of doctors as self-serving or as trying to ensure adequate protection of patients.

 
At 7/25/2008 6:18 AM, Blogger Walt G. said...

juandos,

I meant that doctors opposing the concept of retail clinics might be thinking more about themselves than the patients.

 
At 7/25/2008 11:23 AM, Blogger OBloodyHell said...

> Your post has failed to address the safety concerns raised by physicians.

So has yours. You haven't detailed how or why these clinics are supposed to be remiss in this manner.

> and is renowned for its gruelingly protracted shifts is motivated primarily by self-interest?

Look, I would not go so far as to say that all doctors are motivated by greed, but I have no doubt of any kind that many people in the medical field are in it for money and power. The returns for giving up about 20 years of your life are phenomenal. Not everyone can do it, but a good chunk of those who can, are people who can grasp that.

The "grueling hours" of which you speak are much more a matter of college and internship than of professional requirements.

And as to greed, why is it that they keep working to REDUCE the number of students trained as physicians each year (by further limiting class sizes and reducing the number of accredited medical training institutions, at least in terms of per capita), instead of expanding these things -- again, on a per-capita basis?

The AMA is nothing but a guild, something which was outlawed decades ago for every other trade in existence. Otherwise it would push for uniform standards and competency testing, have regular requirements for continued competency testing (not just "coursework requirements" which are often nothing but seminars in favor of a specific drug treatment regimen), and have a clear and straightforward mechanism for accessing the competency of foreign doctors in an encouragement to licensure (if Brit, French, and Canuck public health care is so damned good, why does it take the sacrifice of an arm and a leg for its licensed physicians to come HERE and practice? "Guatemalan" doctors I can see, but Canada? Britain? France? Gimme a break). As it is, it's often difficult to practice medicine in a different state of the USA than the one in which you were originally licensed.

Why are doctors not allowed to advertise their services? Their prices? Surely actually identifying, publicly, the cost of standardized procedures would not be a bad thing! Surely allowing a doctor to increase their business by openly stating that their prices will be as low as any other doctors would not be a bad thing?

In short, if doctors are NOT solely concerned with money, WHY IS IT THAT ALMOST EVERY POLICY IN PLACE HAS A TREMEDOUS EFFECT ON MINIMIZING COMPETITION?

When you can answer these questions, then you can make the statement that doctors do not have money as one of their chief aims in life. Until then, you're nothing but a shill for the medical Guild at best.

 
At 7/25/2008 11:33 AM, Blogger OBloodyHell said...

> A patient can put themselves at risk by going to a myriad of sources for treatment, ie. adverse drug interactions.

OK, so, what, they're going to Walgreens for the clinic, but NOT filling the prescription there? The chances of one of these clinics being unaware of the medicines taken by the customer is LOWER than that of the family physician.

Your claim, if anything, says that doctors should add to their own questionaires (if it's not already): "Do you regularly use a discount or walk-in clinic? Please identify any of them, especially if they have identified medications -- both prescription or over the counter, which you should take." And then, with that information, they can and should get the records from any applicable clinics for their own utilization.

Such centralization of basic services, if anything, will make such interactive issues LESS likely, since it reduces the probability that anyone not shopping for a high is going to go to random places, and the drug-use data will become a part of the basic service information. With modern record-keeping, even OTC meds like Benadryl, Ibuprophen (including heavy use, which has blood-thinning issues) could become a part of the client's records.

In short, your argument is of doubtful validity.

 
At 7/25/2008 4:39 PM, Blogger juandos said...

anon @ 8:56 PM says: "At one point, specialists in Ontario were hitting the earning cap by April or May and any economist can tell you that no one works for free for the rest of the year. Fortunately, the government has finally lifted the cap"...

Very interesting... Do you know if because of the lifting of that cap did tax rates also rise?

walt g corrects me with: " meant that doctors opposing the concept of retail clinics might be thinking more about themselves than the patients"...

Doh!... Should've thought of that walt g...

anon @ 10: 18 PM says: "Canada provides a textbook lesson in what happens when a government bureaucracy runs a health care system. Inadequate investment in diagnostic imagery, cuts to nursing and medical school enrollment, salary cuts, and long waiting lists for seeing a specialist or receiving treatment."...

You know anon you (and others) might be interested in economist John Lott's commentary from last year: John Lott: Moore's Myths

What struck me was this line in his commentary: "Myths aside, the vast majority of the uninsured were not only getting medical care, they were actually satisfied with their health care'...

How factual is his commentary, you be the judge...

 
At 7/25/2008 10:15 PM, Anonymous QT said...

Obloodyhell,

"The AMA is nothing but a guild, something which was outlawed decades ago for every other trade in existence."

Aside from the AMA, there are many professions that are self-regulated, ie. chartered accountants, certified general accountants, engineers, architects, air traffic controllers, airline pilots, lawyers, welders, etc.

Any profession which involves public safety or liability tends to have a governing body. Many of these organizations are mandated by mandated by legislation to protect the public interest.

 
At 7/27/2008 9:09 AM, Blogger OBloodyHell said...

> Aside from the AMA, there are many professions that are self-regulated

There is a major difference in power, because the AMA also constricts, substantially and by artificial and irrelevant means, the number of people entering their profession to keep the numbers artificially low -- well below the number of people actually able to do the work in question.

It also, as I noted, does things to strongly limit moving practice, which would allow doctors to move readily to where there were shortages. Other professional organizations also act, in the event of shortages, to increase the number of individuals trained in that profession.

When did you hear of the AMA pushing for Universities to open more Med Schools and/or expand the number of openings they had to increase the number of doctors (even assuming we don't lower or alter the standards to remove, say, "calculus", from the requirements to become a doctor [as a person with a strong background in math, I very much object to it being not encouraged for EVERY degree] -- but when the hell do doctors directly use the subject, for crying out loud? Why then, is it required to get into Med Schools? It's a weed-out course, and everyone knows it. It cuts out anyone who doesn't have a great deal of math ability, regardless of how little a doctor needs that professionally)

Further -- how many of the professions you listed prevent its members from advertising their services?

 

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