August 13, 2007

The Medicine Machine

Bathers at Kamahole Beach Maui Hawaii. Nearly one in five persons not insured by employers have state supported health insurance. Hawaii has a good catastrophic insurance program for the indegent and has a good VA system in place for veterans. Still we saw huge inequities in health care, with many people doing without basic services. There was only one emergency room on our side of the island where there were 100,000 people living and the conditions were in many ways primative and desparate. Often times the only doctor that could see you was in ER as it took months to get an appointment to see a doctor that flew in from another island because there were so few medical professionals living there.

"Hoku, Im calling you to tell you that you were right on in sending me to that Redi Clinic at the Walmart...they were great!"
"So, what happened?"
"The nurse took a few notes on my issues then gave me a once over, I didnt have to get undressed. They took blood and said that they would give me tests for all of the usual stuff like blood sugar, cholesterol, and even a test for prostate trouble..."
"So, how much was it?"
"Sixty bucks...isnt that great? It would have cost a lot more if I had just walked in to see a doctor. I will get my results over the internet and I can print them out and take them to my doctor if there is a problem. If something is really wrong they will call me personally."

"That is great, imagine if you were a mom with kids and no insurance that would beat going to the ER..." I thought

Two days later we got a phone call...The nurse was kind and had a referal to a Physician in her hands. Woody's blood sugar was over 500, his colesterol was 320 and his blood pressure was through the roof. They faxed over the report to his doctor, not the one that they had for him... but they were ready with the referal to a doctor if he didnt have one, and it was a great thing...Dr Ludens, his GP was very impressed and got Woody on meds and he is doing better and is back to work... but there was fall out

Woody had an eye exam today and his vision has deteriorated massively and will need a strong corrective percription. It was likely due to the diabetes going untreated for so long because he had no insurance... By the way all of those tests would have cost 400.00 if he had them done in Dr. Ludens office, which is a part of a major medical group in our area

Photo Courtesy of AP- The Redi Clinic inside the Walmart in the Pleasent Grove Shopping Center Lowell/Rogers Arkansas.

I had seen this Redi Clinic newly opened in the Wal mart near my work, and sent Woody over there. Thank God I did, because he was going blind, and could have died from the high blood sugar. I have heard similar stories in the past few weeks of sick babies, and inexpensive school shots and a single mother between insurance programs that needed a doctor but had little money. The "in between" people need help with their medical care. Seinors not quite old enough for MediCare but uninsured otherwise really need help. Woody falls into this catagory. My Mother became too disabled to work full time and lost her medical insurance at 59. Because she was indegent she went to the county medical center and spent many hours in the now infamous emergency room lobby where the woman was left on the floor to die a few weeks ago.By the way..what the news didnt say about that woman and that situation was that she was a meth head that came and went and the place was full to the rafters with gun shot victims...as Mom would say when she went there..."gunshot wounds, and babies go first". There were times when that would mean she would spend the night sleeping in her wheel chair so that others could get help but eventually the doctors would get to Mom and they always gave her what she needed and she had good care there. Sad they closed it. Those folks needed the help those medical heros provided

But I digress. The Medical establishment is hell bent on preserving their hegmony over the health care industry and the Walmart bashers are moving to regulate these clinics. Read the article below

Concerns rise over care at retail health clinics
AMA warns of conflict of interest, docs worry health probs may be missed

AP NEW YORK - Increasingly, American consumers are shopping for health care the way they buy a hamburger or milk shake at a fast-food chain: By standing in line at a local store under a menu.

Store-based health clinics — which are staffed mostly by nurse practitioners and offer quick services for routine conditions from colds and bladder infections to sunburn — aren't just a health care fad anymore, but fast becoming a serious industry.

About 7 percent of Americans have tried a clinic at least once, according to an estimate by the Convenient Care Association, an industry trade group formed last year. That number is expected to increase dramatically, as major pharmacy operators like Wal-Mart Stores Inc., CVS Corp., Target Corp. and Walgreen Co., partner with miniclinic providers like RediClinic and MinuteClinic to expand operations. The trade group estimated there will be more than 700 by year-end, up from the more than 400 now, and 2,000 by the end of 2008.

With the nation's $2 trillion health care system in need of repair, such an express approach to health care — which offers a wait time averaging about 15 minutes and evening and weekend hours — is being heralded as serving up a cheaper and quicker alternative than a doctor's office or an emergency room. A physical exam costs on average $60, while a flu shot typically costs about $20. A strep throat test has a price tag of about $15.

"I was frankly very impressed with how thorough (the examination) was," said Susan Anthony, who visited a clinic at a Phoenix, Md., Target for a dry cough. "And it was fast. I walked in at 10:30 a.m. and was in my car a little after 11:00 a.m."

Some doctors expanding hours to compete
The American Medical Association said a growing number of medical practices are extending their office hours or forming their own clinics to compete. But concerns about quality of care are rising among physicians and some industry experts say the clinics' services need to be more comprehensive if they are going to have a big impact on reducing overall health care costs.

The competition is already spawning expanded services as well as new spinoffs. Consumer Health Services Inc. — founded by a former investor of MinuteClinic, considered the pioneer in the industry — just started rolling out walk-in doctor's offices at Duane Reade Inc. drugstores in the New York City area. The clinics offer broader services that include wart removal and treatment for sprained ankles.

Support among health insurance companies is growing; about 40 percent to 50 percent of clinics accept insurance from providers like Humana Inc., UnitedHealth Group Inc. and Aetna Inc., according to CCA.

"(Store-based clinics) provide another access point for our members," said Allen Karp, vice president of health care delivery for Aetna.

Concerns that clinics may have conflict of interest
But concerns are rising in the medical industry that these operations remain largely unregulated and are prone to conflicts of interest. Some physicians are also concerned that the clinics could disrupt the continuity of care and result in serious underlying health conditions going undetected.

In June, the American Medical Association urged state and federal agencies to look into whether pharmacy chain-owned clinics urge patients to get their prescriptions filled on site. That followed buyouts of miniclinics by two big-name pharmacy operators: Walgreen bought Conshohocken, Pa.-based Take Care Health Systems in June, and CVS acquired Minneapolis-based MinuteClinic last year.

Dr. Peter Carmel, a trustee on the AMA board, said "the path of abuse is wide open," and the clinics need to be better regulated.

Some states try to regulate nurses' role
A growing number of states have passed legislation to better define the role of the nurse practitioner at these clinics, but store-based clinic executives say some of the state rules are too burdensome and hinder growth. According to the American College of Nurse Practitioners, approximately 23 states allow nurse practitioners to treat patients on their own. The remainder requires some formal relationship with a physician, which varies from supervision to collaboration. In Texas, for example, the physician is required to be at the site for 20 percent of the time a clinic is open.

Store-based health clinics are held to the same high standards as doctors' offices, said Tine Hansen-Turten, executive director of the Convenient Care Association. She pointed out that store clinics are either monitored by a state board of nursing or board of medicine, and sometimes by both.

AMA also wants to ban the practice of health insurance companies waiving or lowering co-payments for clinic patients, which it calls a conflict of interest.

Photo Courtesy of the AP. Lady getting an initial screening at the Redi Clinic inside the Walmart at Pleasent Grove Lowell AR


Dr. David Plocher, the senior medical officer at Blue Cross Blue Shield of Minnesota, said that "the normal market forces should determine such things." His company has reduced or waived co-payments for 25 member companies who use MinuteClinics and several other store-based clinics.

Much cheaper than ER visit
The savings can be significant.

A visit to a store-based clinic averages about $60, but a doctor's visit costs twice as much, particularly in urban markets, according to Barry Barnett, a health care consultant for PricewaterhouseCoopers. That compares to about $300 for an emergency room visit, according to Barnett.

About 40 percent to 50 percent of clinics take insurance. Hansen-Turten estimated 50 percent of clinic customers pay cash, but she noted that the majority have insurance.

Like many of his industry peers, Michael Howe, president and CEO of MinuteClinic, said the concerns about quality are overblown.

"I wouldn't call it express care. I would call it efficient care," added Howe.

The AMA denies that its criticism of these clinics is being driven by economic interests, though there's no doubt that primary physicians could lose some business as their insured patients go elsewhere for minor ailments.

But health care consultants say that while the clinics may help save customers money and time, their ability to reduce overall health care costs will probably be limited given that they are really tackling the most minor of health problems.

A bigger effect lies in increased worker availability as employees don't have to take as much time out of their work schedules to go to a doctor's office, according to Dr. Tim Newman, senior medical consultant for Watson Wyatt Worldwide.

The growing number of onsite clinics at workplaces, staffed by physicians, actually have more of a potential to reduce overall health care costs since they focus on disease management, not episodic illnesses. The onsite clinics are not part of the Convenient Care Association's total count, since they are not store-based clinics and have a different model.

Some patients skeptical
Store clinics are proving to be good business; they take about 12 to 18 months to break even. For retailers, the highest-margin products continue to be pharmaceutical, and clinics average about one drug prescription per patient, according to clinic providers. Also, stores can enjoy additional sales when sick customers pick up other items.

But it's still big challenge to gain trust among consumers wary about being treated at a local drug store. Dr. Susan Bowers-Johnson, the medical director for the current four clinic locations at Duane Reade, said that a father recently brought in his 4-year-old child who had a sore on his hand. He said if she was going to prescribe antibiotics, he would rather get them through his family physician.

"Many people are skeptical," she acknowledged.

Im skeptical of the greedy medical establishment.

I am a political conservative and you can pretty much tell by my faith and values where I am going to stand on something, but here I stand with liberals and whoever. I think that it is flat out wrong that people die for want of basic healthcare in this country. Im not sure what the answer is or how you actually accomplish it but somehow there has to be a better way to deliver quality healthcare in this country. Tying healthcare to employment or marital status is crazy. Life is not one size fits all.

I personally know a couple that were uninsured and had a baby, $20,000 they were charged and they were told they couldnt take the baby home until they had made some arrangement to pay the bill... Can you imagine? She had to stay a week in the hospital and had issues sure but 20,000 dollars? Last December you remember that Woody had a overnight stay in the hospital, he didnt even have a room was in the annex of the ER where they observe paitents, had two meals and some tests saw a doctor or two $10,000 they billed the insurance company who have said "no way" to a lot of the charges... Now they want us to pay them. Woody told them to sue him they have gotten the Lion's share of their money. He wasnt paying anymore.

People go bankrupt, lose a life's savings, allow small problems to get out of control for want of insurance. Doctors charge whatever at the end of the visit and you are stuck. The Redi Clinic posts its rates upfront, no surprises. They do a pretty through exam. One of my work friends' sons had his Football exam last week, and she was shocked at how complete it was... so was the young man...

No, its not a free clinic, you have to pay and upfront for the services. No its not all inclusive, its a stopgap for minor issues. What it is is a choice, proof that the minor everyday services that we all need from time to time can be provided at a low cost on a cash basis. Its also proof that if we are willing, we can change a venerable institution that needs to update its self in order to meet the needs of our society. If we can simplify care delivery more of us can get the care we need afordably. It is one way to move towards a solution to this problem and it needs to be allowed to florish in the marketplace

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