Saturday, June 06, 2009

Retail Clinics Expand: Almost Everybody is Happy

LA TIMES -- Amid the economic downturn and slow growth for retail and outpatient medical care services, pharmacy giants Walgreen and CVS are rolling out new specialized services at their in-store clinics, going beyond treatment of routine maladies. Launched over the last four years to care for such simple ailments as ear and sinus infections, strep throat or pinkeye, retail clinic operators now are training nurses to do specialized injections for such chronic conditions as osteoporosis and asthma.

Retail clinics not only market themselves as a convenience, they also can be less expensive, providing a competitive threat to primary-care doctors and even specialists. Costs for services for those paying out of pocket at retail clinics generally run $55 to $75 compared with $100 or more for a visit to a primary-care physician.

Typically staffed by advanced-degree nurses known as practitioners, most of the nation's more than 1,100 retail health clinics are open seven days a week, with no appointment needed. The model has been greeted by health insurers, employers and consumer groups as one way to address the rising number of uninsured Americans, estimated at more than 46 million.

MP: There's only one group who is apparently not so happy about the expansion of retail clinics and the services they offer. Can you guess who? (Hint: Check the 8th paragraph of the story.)


At 6/06/2009 10:13 AM, Blogger Joe Lais said...

MP wrote: There's only one group who is not happy about the expansion of retail clinics and the services they offer. Can you guess who?

I think there are two groups.
1. Doctors and clinics losing the easy money from simple procedures are not happy.
2. Advocates of single payer/ socialized medicine are threatened by anything that leaves the economic decision with the individual.

Friedman's advocacy of the ending of mandatory licensing for doctors has often been used to ridicule his free market principles. Friedman was right.

At 6/06/2009 12:18 PM, Blogger Steamboat Lion said...

The best way to disarm the self-serving opposition of the medical establishment would be to turn their own well-accepted practices back on them. Rename these "medical clinics" as "triage clinics" and then ask the doctors the following question:

"What do you mean you're opposed to highly trained nurse practicioners performing triage so that you only see the cases requiring a fully qualified doctor?"

At 6/06/2009 12:37 PM, Blogger Robert Miller said...

I'm mostly in agreement with you here Mark.

Clearly, doctors and nurses consider retail clinics as rubbing their rhubarb. Their plausible but fallacious argument is that they are most skilled in diagnosing medical conditions and serious conditions could be overlooked otherwise.

Perhaps they're right. But even in the absence of retail clinics people with serious illnesses take OTC medicines or ignore the problem until it's too late. A practitioner at a retail clinic might actually recognize a serious condition and recommend doctor treatment.

Doctors, lawyers, nurses and other "professionals" always use the fear of lower quality as their excuse to restrict labor supply. Indeed, increasing the number of doctors will lower average doctor quality, but that needn't mean the doctor who graduates last in his class is incompetent. In fact, I'd say that some of the people who graduate now are incompetent despite higher standards.

In olden days there were only doctors and nurses, and nurses did all the dirty work. Now there are specialists, general practitioners, physician's assistants, nurse practitioners, registered nurses, licensed practical nurses, nurses assistants and medical assistants. Care has indeed been rationed along quality lines and the various wages reflect the quality. A proper and efficient triage methodology would channel a patient to the correct level of care.

But with this more efficient provision of medical care, the rationale for limiting labor supply has evaporated.

We need more nurses and doctors, and if that lowers their wages it will also lower our costs.

At 6/06/2009 2:29 PM, Anonymous Αμάτι Nώνυμος said...

We need more nurses and doctors, and if that lowers their wages it will also lower our costs.

6/06/2009 12:37 PM

I once heard some guys near me in a bar telling that in England there are half the number of surgeons for group of people as there are for same size group in USA. As I remember it USA had twice the number of surgeons and did exactly twice the number of operations. The idea was that more surgeons you have the more unnecessary procedures are done. Would you guess that getting second opinion before operation might be impractical in some areas or with some medical conditions? Might it be dangerous to have more starving cutters slashing around the hospital?

Do we have too many expensive medical trials, or do we have a dearth of lawyers busy at hitting up careless doctors? These are hard answers to question.

One thing for sure -- we are finding more and more that the only thing we can do to improve the medical system is lot of exercise, sensible limitations on food and whiskey, and better planning to avoid accidents.

If we wait too long to go back on exercise then we might hear our joints cracking and be afraid to do that particular exercise that we had skipped for a long time. Best thing to do is never break the chain of exercise. Do some of each exercise every week
Never break the chain

At 6/06/2009 3:53 PM, Blogger B said...

In June of last year, my two high school aged boys needed physicals for sports. The bill for each son was $208. Since I had not met my deductible, I paid 80% or $165.

A month later, my two girls needed physicals for school. Walgreen's had a sign "Physicals 50% OFF only $25!"

What do you think we did?

At 6/06/2009 6:12 PM, Anonymous Dr. T said...

Note: I'm a pathologist, so I don't have an oar in this row boat.

Nurse Practitioners have the training to treat simple, common medical problems. They don't have the training to deal with complications or less common diseases. A good nurse practitioner will recognize those cases and refer them to a physician. A bad one will misdiagnose, treat incorrectly, and cause harm. (I personally know of a fatal case.)

Now, the flip side. Although physicians are trained to deal with all types of medical problems, the training doesn't always stick. I have known a number of family practice physicians with less diagnostic and treatment skills than the average nurse practitioner.

Given the above, I favor clinics staffed by nurse practitioners or physician assistants as long as they have a good physician available (but not necessarily on-site) for the tougher cases.

At 6/06/2009 7:39 PM, Blogger marketdoc said...

As the demand for physicians increases, and so does the need for services, (and most other healthcare professionals) we will continue to see more of this type of treatment arrangement. Of course, the quality of care needs to be very high. Of course, some will not be happy. It sure beats a nationalized healthcare plan. Yes, the free markets are at work... even in healthcare.

At 6/07/2009 2:49 PM, Anonymous benny "reargas" cole said...

You want less expensive health care?

1. All patients agree to binding arbitration of any disputes. No lawyers.

2. The elderly and terminally ill get morphine and a quick exit.

3. A single player plays tough with providors, and directs patients to low-cost options regularly.

Do these three things, and your health care bill gets cut in half. No more waa-waa. Problem solved.

At 6/07/2009 4:55 PM, Blogger QT said...

Aren't we forgetting another happy group...lawyers?

Imagine the potential spoils from lawsuits naming Wallmart or Wallgreens.

At 6/07/2009 7:56 PM, Anonymous Αμάτι Nώνυμος said...

Dr. T said...

Note: I'm a pathologist, so I don't have an oar in this row boat.

Nurse Practitioners

Hold on thar, Dr. T.

You are saying that there is an interface between nurse and physician, and that the nurse should decide when the distraught should cross over that interface towards the physician. The nurse should be the gatekeeper raising the draw-bridge until she recognizes the truly complex physician requiring situation.

Although difficult for an economist to understand the interface you have described, we can understand an interface between a clinic staffed by parents who act as gatekeepers to the interface between parent and nurse. How we as parent can determine when child is ready to cross the interface towards echelon of nurse? Armed with a book of definitions we can check for those defining properties, but what if some conditions are more easily defined than recognized by someone who has never before been there?

Tell me Dr. T, if former fed chairman knew of definition to Ponzi Scheme but was unable to recognize it within its more complex brand new guise,
then how can parent recognize
some brand new skinned knee guise?

Just wondering

At 6/20/2009 8:19 AM, Blogger Kathy said...

Nurse Practitioners are not trained in the art of business savy, though some may have business backgrounds. They do however get a lot of training in advanced physical assessment and recognition of disease and abnormal physical presentations. Quality of Care and high standards does refer to the higher level of expertise that Nurse Practitioners have in assessing and treating simple and complex illnesses. In fact studies have proven that Nurse Practitioners can provide up to 95% or more of the care that the physician provides. Should this be reassuring? I think it indicates that NP's are capable of recognizing and treating illness on a broad scale of health issues. It also indicated that a well prepared nurse practitioner can take very good care of the public who presents to retail clinics. As with all medicine/nursing, there is risk. Errors of any kind are never acceptable, but errors do happen in both physician and nurse practitioner clinical practice due to the human element. Can NPs provide safe, excellent care within a retail clinic. Absolutely. The rest is a matter of business success, left up to the sponsoring company, and how they are willing to work with the high standards that NPs require for safe and legal practice.


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