7 ms·

I see this as a move towards providing cheap basic medical care. This is timely now that it's possible that the individual mandate will be repealed. Millions of

by allenz 9y ago

I see this as a move towards providing cheap basic medical care. This is timely now that it's possible that the individual mandate will be repealed. Millions of uninsured people could be treated for rashes or flus by nurses at CVS cheaper and faster than at doctor's offices. More competition in healthcare could be a good thing--many say it's bloated and overpriced. The risk is that poor people get basic care while rich people get full care, widening health disparities. It's unclear what the new healthcare economics will look like. Currently, minor procedures are profit centers for doctor's offices and hospitals. They subsidize complicated patients (often elderly with multiple chronic diseases like diabetes or COPD) who are riskier and take more time to treat. If CVS is taking that money, then hospitals may need to do some cost-cutting.

deleted 9y ago
[deleted]
jrnichols 9y ago
> treated for rashes or flus by nurses I sometimes think that's one of the things that's kept health care so expensive. Nursing salaries aren't cheap. A lot of the home health and basic clinic stuff could be handled by an LPN/LVN or even a Paramedic in many cases. Not everything needs an RN. There are plenty of available telemedicine options to put a provider in touch with a higher level of care if necessary.
- afpx 9y ago
  Or, the high price may be from administrative costs: http://www.nejm.org/doi/full/10.1056/NEJMp1209711 http://www.nejm.org/doi/full/10.1056/NEJMp1209711
  - refurb 9y ago
    Do a search for "McKinsey health costs" and browse the report. It breaks down category spending in the US vs. other western countries. Yes, admin cost more in the US, but it doesn't add much to the overall costs. The biggest driver of US healthcare spending are out-patient care. The US just does a shit-ton more of it then most countries.
    - ericd 9y ago
      I've seen at least one healthcare economist claim that admin costs account for roughly 25% of spending. Is this in line with what you see there?
- maxerickson 9y ago
  The Minute Clinics are staffed by nurse practitioners and physician assistants https://www.cvs.com/minuteclinic/why-choose-us/our-practitioners https://www.cvs.com/minuteclinic/why-choose-us/our-practitio... To expand their services to all of their stores, they'd be looking at hiring 5 or 10 percent of the NPs and PAs in the country.
  - remarkEon 9y ago
    Or...the publically signaled demand for those relatively high paying jobs would encourage more people to seek training for those opportunities.
    - mywittyname 9y ago
      These aren't easy roles to get into. The educational requirements are pretty high (MS or PhD) and the courses are rigorous. The educational requirements are close enough to an MD that I'm sure most people considering being an NP from the onset also debate just getting an MD. The minimum requirements of a RN is an Associates degree and successful completion of the NCLEX -- though, many hospitals require a person to also obtain a BSN after a few years to continue being employed. That's a big educational jump to make. I don't think pay is a big motivator for nurses. There are so many better paying jobs out there that are easier to get, and don't involve dealing with the figurative and literal shit nurses deal with daily.
- just1nn 9y ago
  "Professional Extenders" are everywhere, and it hasn't caused anything to become cheaper. If you show up at an urgent care, just expect that you will be treated by a LPN and a PA or a NP. A Family Practice physician's salary is about comparable to a Sr. Engineer at many tech companies (~160k), and they can have significant malpractice insurance overhead and insane hours. A PA or NP still makes 6 figures, so the "savings" just aren't there. If you've ever had to attend something like Physical Therapy, you'll see the actual PT (a MS/Doctorate level professional aka DPT) about twice. Once for an eval, and once for a discharge. An "aide" will guide you through all the other exercises, and they make very significantly less than a PT. The savings are mysteriously gone, even adding lower-salaried professional extenders.
  - psergeant 9y ago
    > “Professional Extenders" are everywhere, and it hasn't caused anything to become cheaper. This needs the caveat of “to American consumers”. The NHS seem to be heavily moving in that direction, and I suspect “cheaper” is no small part of that
  - aaavl2821 9y ago
    "professional extenders" are often "profit extenders", as the supervising physician can enable his / her practice to see more volume and better match revenues and costs (ie have lower cost labor do lower revenue / acuity work). the "savings" from this often end up accruing to the owner of the practice. increasingly this owner is a large hospital system, but they take this delegation a step further, using lower cost primary care as a way to increase volume to higher acuity / reimbursed hospital procedures.
- JshWright 9y ago
  'Even' a paramedic? While we might cost about the same, our scope of practice is a lot broader than an LPN's... Nursing unions and trade groups are generally very opposed to the 'paramedic practicioner' or 'community paramedicine' model.
untog 9y ago
How does CVS buying Aetna allow for "more competition"? I'm a lot more concerned that before we know it non-Aetna insurance customers will have difficultly or increased cost fulfilling a prescription at CVS stores. I'm not sure what Aetna brings to the table in regard to a future where nurses fill CVSes, either. That seems like it would be a far bigger operation than buying Aetna, and the two would be only tangentially related.
- allenz 9y ago
  I agree that CVS wants to stave off Amazon and mail order pharmacies. But a buyout is an expensive way to secure a fraction of the market. Buying Aetna makes it easier to expand the new Minute Clinic business model. CVS no longer has to worry about getting paid less than a hospital for treating a cough or fever. Aetna could even charge zero copay for nurse visits. It's more competition in the "basic healthcare" space (if it happens).
  - just1nn 9y ago
    The "Caremark/CVS" insurance that I have for prescriptions allows me to go to Target/CVS for covered medications, but I also have the option to mail-order (from them, of course). I also have Aetna Health Insurance just by chance (we have a choice of 3 companies @work). Amazon is going to buy drugs in major bulk (Walmart, or Mail-order-pharmacy style), and likely will charge low "dispensing fees" (because robots will do most thigs). CVS is looking to be the "other other Walmart" of pharmacies. I have worked (as an intern) in many pharmacies, and I've seen several buyouts. At this point in time, I'm very happy that I made the leap from PharmD to SRE/DevOps about 11 years ago. Pharmacists will be robots in <5 years IMHO.
    - jdmichal 9y ago
      Is it even legal to dispense drugs without a pharmacist? The same way that a nurse practitioner is only legally permitted to do so much before a doctor is required.
      - 9y ago
Spooky23 9y ago
Sounds more like building a moat by aligning formularies with insurance requirements.
guelo 9y ago
There's no reason to believe that a return to pre-ACA will make the market behave differently than it did pre-ACA.
- allenz 9y ago
  ACA without the individual mandate is not the same as no ACA. Plus, lots has changed in the meantime: a growing shortage in physicians, even higher healthcare costs, an expanding role for nurses. The healthcare market is not static.
  - guelo 9y ago
    ACA without the individual mandate means that the insurers can't make the exchanges work causing their collapse. One benefit for the insured of millions fewer insured is that it will aliviate the shortage of doctors and nurses, probably to near pre-ACA levels.
code_duck 9y ago
>The risk is that poor people get basic care while rich people get full care, widening health disparities. In my experience, that's already the situation. Actually, reality is worse. The rich (meaning, upper middle class and not sick) get full care and even excessive care, while the poor get basic or no care, often emergency only. If you go to a hospital for an emergency procedure, the level of care and follow up care depends on your insurance. When the hospital thinks they probably won't be paid for services they choose to not offer them. So, the poor get basic care... while rich people get full care.
- hiram112 9y ago
  This may have been true pre-ACA, but it isn't the reality now. It's now a system where wealthy, government employees, and the poor (i.e. subsidized) have access to full care, and most of the middle class just goes without. In the past 5 years, I've gone from a decent $20 copay to a employer-sponsored high deductible to currently a fully out of pocket deductible of $2k before insurance pays a cent. I've begun rationing my prescriptions and simply skip the doctor unless it's a true life-or-death situation. The deductible for co-workers with a kid or two is something like $5k. That's on top of probably $10k in premiums a year.
  - code_duck 9y ago
    Right, it is worse to have some money then none. But still, if you are super poor receiving free care, you do not get anywhere the same level of care as people with good insurance. But at least you're not paying tons of money for it or getting none (massive deductibles) like the middle class.

by allenz 9y ago

deleted 9y ago

[deleted]

jrnichols 9y ago

> treated for rashes or flus by nurses I sometimes think that's one of the things that's kept health care so expensive. Nursing salaries aren't cheap. A lot of the home health and basic clinic stuff could be handled by an LPN/LVN or even a Paramedic in many cases. Not everything needs an RN. There are plenty of available telemedicine options to put a provider in touch with a higher level of care if necessary.

afpx 9y ago
Or, the high price may be from administrative costs: http://www.nejm.org/doi/full/10.1056/NEJMp1209711 http://www.nejm.org/doi/full/10.1056/NEJMp1209711
- refurb 9y ago
  Do a search for "McKinsey health costs" and browse the report. It breaks down category spending in the US vs. other western countries. Yes, admin cost more in the US, but it doesn't add much to the overall costs. The biggest driver of US healthcare spending are out-patient care. The US just does a shit-ton more of it then most countries.
  - ericd 9y ago
    I've seen at least one healthcare economist claim that admin costs account for roughly 25% of spending. Is this in line with what you see there?
maxerickson 9y ago
The Minute Clinics are staffed by nurse practitioners and physician assistants https://www.cvs.com/minuteclinic/why-choose-us/our-practitioners https://www.cvs.com/minuteclinic/why-choose-us/our-practitio... To expand their services to all of their stores, they'd be looking at hiring 5 or 10 percent of the NPs and PAs in the country.
- remarkEon 9y ago
  Or...the publically signaled demand for those relatively high paying jobs would encourage more people to seek training for those opportunities.
  - mywittyname 9y ago
    These aren't easy roles to get into. The educational requirements are pretty high (MS or PhD) and the courses are rigorous. The educational requirements are close enough to an MD that I'm sure most people considering being an NP from the onset also debate just getting an MD. The minimum requirements of a RN is an Associates degree and successful completion of the NCLEX -- though, many hospitals require a person to also obtain a BSN after a few years to continue being employed. That's a big educational jump to make. I don't think pay is a big motivator for nurses. There are so many better paying jobs out there that are easier to get, and don't involve dealing with the figurative and literal shit nurses deal with daily.
just1nn 9y ago
"Professional Extenders" are everywhere, and it hasn't caused anything to become cheaper. If you show up at an urgent care, just expect that you will be treated by a LPN and a PA or a NP. A Family Practice physician's salary is about comparable to a Sr. Engineer at many tech companies (~160k), and they can have significant malpractice insurance overhead and insane hours. A PA or NP still makes 6 figures, so the "savings" just aren't there. If you've ever had to attend something like Physical Therapy, you'll see the actual PT (a MS/Doctorate level professional aka DPT) about twice. Once for an eval, and once for a discharge. An "aide" will guide you through all the other exercises, and they make very significantly less than a PT. The savings are mysteriously gone, even adding lower-salaried professional extenders.
- psergeant 9y ago
  > “Professional Extenders" are everywhere, and it hasn't caused anything to become cheaper. This needs the caveat of “to American consumers”. The NHS seem to be heavily moving in that direction, and I suspect “cheaper” is no small part of that
- aaavl2821 9y ago
  "professional extenders" are often "profit extenders", as the supervising physician can enable his / her practice to see more volume and better match revenues and costs (ie have lower cost labor do lower revenue / acuity work). the "savings" from this often end up accruing to the owner of the practice. increasingly this owner is a large hospital system, but they take this delegation a step further, using lower cost primary care as a way to increase volume to higher acuity / reimbursed hospital procedures.
JshWright 9y ago
'Even' a paramedic? While we might cost about the same, our scope of practice is a lot broader than an LPN's... Nursing unions and trade groups are generally very opposed to the 'paramedic practicioner' or 'community paramedicine' model.

untog 9y ago

How does CVS buying Aetna allow for "more competition"? I'm a lot more concerned that before we know it non-Aetna insurance customers will have difficultly or increased cost fulfilling a prescription at CVS stores. I'm not sure what Aetna brings to the table in regard to a future where nurses fill CVSes, either. That seems like it would be a far bigger operation than buying Aetna, and the two would be only tangentially related.

allenz 9y ago
I agree that CVS wants to stave off Amazon and mail order pharmacies. But a buyout is an expensive way to secure a fraction of the market. Buying Aetna makes it easier to expand the new Minute Clinic business model. CVS no longer has to worry about getting paid less than a hospital for treating a cough or fever. Aetna could even charge zero copay for nurse visits. It's more competition in the "basic healthcare" space (if it happens).
- just1nn 9y ago
  The "Caremark/CVS" insurance that I have for prescriptions allows me to go to Target/CVS for covered medications, but I also have the option to mail-order (from them, of course). I also have Aetna Health Insurance just by chance (we have a choice of 3 companies @work). Amazon is going to buy drugs in major bulk (Walmart, or Mail-order-pharmacy style), and likely will charge low "dispensing fees" (because robots will do most thigs). CVS is looking to be the "other other Walmart" of pharmacies. I have worked (as an intern) in many pharmacies, and I've seen several buyouts. At this point in time, I'm very happy that I made the leap from PharmD to SRE/DevOps about 11 years ago. Pharmacists will be robots in <5 years IMHO.
  - jdmichal 9y ago
    Is it even legal to dispense drugs without a pharmacist? The same way that a nurse practitioner is only legally permitted to do so much before a doctor is required.
    - 9y ago

Spooky23 9y ago

Sounds more like building a moat by aligning formularies with insurance requirements.

guelo 9y ago

There's no reason to believe that a return to pre-ACA will make the market behave differently than it did pre-ACA.

allenz 9y ago
ACA without the individual mandate is not the same as no ACA. Plus, lots has changed in the meantime: a growing shortage in physicians, even higher healthcare costs, an expanding role for nurses. The healthcare market is not static.
- guelo 9y ago
  ACA without the individual mandate means that the insurers can't make the exchanges work causing their collapse. One benefit for the insured of millions fewer insured is that it will aliviate the shortage of doctors and nurses, probably to near pre-ACA levels.

code_duck 9y ago

>The risk is that poor people get basic care while rich people get full care, widening health disparities. In my experience, that's already the situation. Actually, reality is worse. The rich (meaning, upper middle class and not sick) get full care and even excessive care, while the poor get basic or no care, often emergency only. If you go to a hospital for an emergency procedure, the level of care and follow up care depends on your insurance. When the hospital thinks they probably won't be paid for services they choose to not offer them. So, the poor get basic care... while rich people get full care.

hiram112 9y ago
This may have been true pre-ACA, but it isn't the reality now. It's now a system where wealthy, government employees, and the poor (i.e. subsidized) have access to full care, and most of the middle class just goes without. In the past 5 years, I've gone from a decent $20 copay to a employer-sponsored high deductible to currently a fully out of pocket deductible of $2k before insurance pays a cent. I've begun rationing my prescriptions and simply skip the doctor unless it's a true life-or-death situation. The deductible for co-workers with a kid or two is something like $5k. That's on top of probably $10k in premiums a year.
- code_duck 9y ago
  Right, it is worse to have some money then none. But still, if you are super poor receiving free care, you do not get anywhere the same level of care as people with good insurance. But at least you're not paying tons of money for it or getting none (massive deductibles) like the middle class.