Friday, October 07, 2005

Doc in the Box at Wally World?

I caught a reference to this at Symtym, and have not been able to find much else about it; the original article was in the Wall Street Journal, but has been fanned out since to other papers:

In a development that has broad implications for the nation's primary-care system, a rising number of major pharmacy and retail chains -- including CVS Corp., Wal-Mart Stores Inc. and Target Corp. -- are opening in-store health clinics. They offer patients fast access to routine medical services such as strep-throat tests, sports physicals and flu shots. The clinics, which typically charge between $25 and $60 per visit, don't require an appointment and are open during pharmacy hours including evenings and weekends. To keep costs down, they are staffed by nurse practitioners, who can legally treat patients and write prescriptions in most states.

The trend is rapidly spreading in pharmacy chains as they look for ways to stem losses to mail-order pharmacies and big-box stores. Three of the nation's largest drugstore chains -- Rite Aid Corp., Brooks Eckerd Pharmacy and Osco Drug -- have announced plans to open health clinics in the coming months. All three have partnered with a Pennsylvania-based health-care start-up called Take Care Health Systems LLC that will lease space inside the pharmacies and operate the clinics.
Interesting, n'est ce pas? Wearing my "specialist" hat, I can say that many of my colleagues have been predicting this for the past few years. Many primary care practices employ a variety of "physician extenders," nurse practitioners or PAs who provide a large amount of the routine care for the patients in the practice. So, that means that many patients, while nominally patients of a family practitioner or internist, never see said physician, and receive all of their care from the NP or PA.....and many of these patients (unfortunately) don't really see much of a difference. This MinuteClinic service, quite frankly, may serve these patients just as well, with a whole lot of convenience thrown in to boot.

Wearing my "doctor" hat, I find a few things about this that are troubling. Will there be a true caregiver-patient relationship established, or will visits simply devolve into a series of one-time transactions? While the clinics will limit themselves to a relatively small number of problems, all physicians know that patients frequently come in with one problem, only to really want to discuss several others. What type of patients will be referred out, and to whom? This is particularly important for the patient who arrives with, say, severe hypertension, and has no physician --- does the local ED then become the treating facility? And, of course, do the deep Wal-Mart pockets become fertile soil for malpractice attorneys?

Health insurers don't seem to have many questions. I am no great fan of health insurance companies and their methods of operation (i.e., denial, denial, obfuscation, and denial), but I will grant them this -- they know a good business deal when they see one:
Health insurers have embraced the concept because the clinics promise considerable savings. While a typical doctor visit for a basic illness costs an insurer about $110, a visit to one of the clinics usually costs under $60. In addition, the clinic services are far cheaper than the emergency room, which is where patients often wind up when they need medical care outside business hours. (A strep throat test at the emergency room can cost over $300.)

Some insurers are actively encouraging patients to use the clinics by lowering the co-pay. In Minnesota, companies including Blue Cross Blue Shield of Minnesota and Graco Inc., have reduced or eliminated co-pays for employees who opt to use a MinuteClinic instead of a doctor. Take Care has deals in place with several insurers in Portland.

In all honesty, I think that we in the medical profession have to recognize this for what it is -- businessmen with customer service experience (the CEO previously ran Arby's; the chairman of the board ran a travel company) recognizing a business opportunity, and exploiting it. We have seen the same sort of thing with so-called "specialty" hospitals, boutique practices, etc. In response, we need to do borrow a phrase from Clint Eastwood in "Heartbreak Ridge:" we need to adapt, improvise, and overcome!