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Study Gives High Marks To Retailers' Clinics

23 points by FleursDuMal 17y ago

baran 17y ago
This is the healthcare of the future. The basic care that you receive will come from a physician assistant/nurse practitioner. This dramatically cuts down on cost while mantaining an adequate level of care. Physicians are going to continue to become more and more specialized. Which leads to physicians only providing specialized/unique treatments.
- TomOfTTB 17y ago
  What I'm wondering is how much these clinics use technology and how much better they could be if they used it more. I wonder if having a small number of doctors available to these nurses could improve treatment by allowing more patients to get a doctors opinion (somewhat in the same way e-mail and IM tech support allows each technician to server more people than phone support). Could they treat even more conditions that way? It seems a setup like this with some technology checks and balances (to make sure the right questions get asked) could make health care a lot more efficient.
  - Radix 17y ago
    Walmart has a deal with RediClinic. The Walmart RediClinics are apparently using eClinicalWorks, the rest might be Athena Health. I expect these clinics use technology as much as possible. I don't think they can lower cost much more by using more, and if they did I expect any profits would be kept with no change in price. http://ecwblog.blogspot.com/2008/02/walmart-rediclinic-eclinicalworks.html http://ecwblog.blogspot.com/2008/02/walmart-rediclinic-eclin... http://www.redorbit.com/news/health/1501613/rediclinic_to_leverage_athenahealths_emr_and_practice_management_services_for/index.html http://www.redorbit.com/news/health/1501613/rediclinic_to_le...
  - kgrin 17y ago
    Generally speaking, PAs and NPs must technically be "supervised" by a physician. I think the degree of supervision varies by state, but it's typically not case-by-case supervision - rather more of a general sign-off sort of thing, with availability for the "tough cases". That sort of sounds like what you're describing, though obviously there's a wide spectrum of how involved the doctor can get.
- Dove 17y ago
  I agree. This is a sign that health care is in the process of fixing itself. If you have 45 minutes to kill, you can listen here (http://dpcare.org/wa_health_underwriters http://dpcare.org/wa_health_underwriters) to a Seattle doctor talk about the issues, his company's approach, and why direct primary care is such a good thing. He advocates concierge care as opposed to the Walmart care discussed in the article, and I find the approach to be more sound. His approach is like Performace Based Logistics for medicine--the doctor that keeps you healthier makes more money, and I like that incentive. Nonetheless, both his solution and the Walmart solution are attempts at taking advantage of the same idea: paying directly for primary care can both lower costs and improve quality because the time and money required to pay for routine things with insurance is so terribly high. I am convinced we are witnessing the birth of a revolution in medical care. I pay out of pocket for primary care, even though my insurance would cover everything if I went to a traditional provider. The new way is that much better than the old way -- and that cheap.
  - Radix 17y ago
    Great, thank you for that link. I look forward to listening to him during breakfast tomorrow. I agree that concierge practices sound like a better approach, at least as a primary source for health care. It would be the same as insurance for the smaller things. Leaving insurance to cover larger things. As far as I can tell the worst of the problem is caused by insurances and the related need for medical billers. Another interesting group are the Ideal Medical Practice Doctors. They work with minimal staff and use cheaper technology so they can lower the cost per patient and spend more time with the patients. One doctor I have heard has zero staff.
  - litewulf 17y ago
    (If the doctor that keeps you healthier makes you more money, will that not drive doctors to less risky specializations? I'd imagine that a brain surgeon for example sees many more people who are likely to die than say a dermatologist.)
    - billswift 17y ago
      There was a study a long while back, I think I read it in the mid 90s, that the best doctors and hospitals had lower recovery rates, because they took the worst, most difficult, cases. I saw it as part of a discussion of the difficulty of rating health care service providers.
deleted 17y ago
[deleted]
- TomOfTTB 17y ago
  "In order to delicately preempt any political trolling, this article is about medical care, and that is an entirely separate issue from insurance." I hate political trolling as much as the next guy but I disagree with your point. If health care is absolutely free to everyone than why choose a clinic with nurse practitioners over a hospital with doctors? The questions surrounding the health care debate are ones of efficiency and cost and these types of clinics are very relevant in that debate (though I could see both sides using this to support their point)
- baran 17y ago
  I have to disagree with this. I think this is an industry that is ready for hackers to make a difference. Many of you are very familiar with the technology that is in place in medical record systems, actually you will find the technology laughable. A technology upgrade would create a major improvement for healthcare systems. The healthcare system in this country HAS to change. It is not a question or else it will bankrupt our country. If healthcare is not in need of quality hackers I don't know what is.
  - idm 17y ago
    werd - this is a great opportunity for hackers, and the amount of money at stake here is huge. Of course, that's not what the article is about, but I completely agree.
  - deleted 17y ago
    [deleted]
motoko 17y ago
I know the primary care outpatient business, and I support "Walmart medical care." (We call them "counter clinics.") People who don't want expert medical advice go to the counter clinic, we don't have to serve resentful patients, and we can spend our time thinking about medicine with patients who appreciate our service. Further, patients sometimes visit a counter clinic, but they have issues beyond what the counter clinic can handle. So, the counter clinic will refer the patient to us ---the medical doctors. One of our most regular patient referrals is corner CVS because the local medical doctors introduced themselves respectfully to the CVS clinic staff. However, don't be fooled by the "cost cutting" nonsense. My estimation is that counter clinics increase total medical spending in the same way that shopping at Wal-Mart increases total consumer spending. Yes, each individual purchase of "health care" is moderately cheaper. However, given the lower prices, omnipresent availability, and cross-marketing of other products in the store, people do not simply buy the same things at a lower cost, they impulsively buy many smaller purchases of dubious value. So, rather than visit an outpatient medical doctor for an hour for $500 (that is what we bill, though we usually only collect about $300 of that from insurance), one visits the Wal-Mart counter clinic for $70. That's a savings of $430, right? Maybe. Assume the counter clinic treated your sore throat, but you also had another issue, and later visited the medical doctor. Both issues could have been treated by the medical doctor for $500 now rather than $570 over several weeks. Oh, and you also bought "health supplements." Add another $30 recurring cost. Well, actually, you don't go to the doctor at all because you only have $500 for health care, and the doctor costs $500, but you only have $400 because you've already spend $100 on the counter clinic and supplements ---oops, actually, that $400 is already spent by your employer for health insurance. So, you still pay, but you never visit a doctor, chronic heath conditions continue to exasperate, and in addition to suffering from chronic health problems, you eventually get very sick, progressively lose your ability to function, and are hospitalized sooner at a much higher cost. Even a single day of missed work at $5 minimum wage due to illness not addressed by a counter clinic is quantitatively worth more than the $37 best case savings at the counter clinic. Primary and preventative care alternatives are almost never "cost savings" unless you know precisely otherwise. By the way: there is some ludicrous cultural myth that exasperated health problems can be "fixed," or if you can just avoid "having a a serious problem" and "keep natural," you will be OK ---or at least, you can "fix" health "issues" "later." No, you don't. You die. Also, jeez, you spend so much time and money making your face and buying clothes, but when you have a disease, you're thinking about saving a few dozen dollars? Bleh.
_ck_ 17y ago
Given the trend and lack of care about suffering in this country, in a decade all we'll be able to afford is health care "vending machines". Instead of talking to people, you'll stick your arm in one machine socket and spit into another and it will take your blood and analyze your fluids for the flu, a dozen diseases and genetic defects. Then it will print out a prescription with a credit for the store it's located in. You'll be force-fed advertising while the process happens and then they will sell the results to various other corporations which will then market you cures. They'll be able to do this because they will flash an EULA on the screen waving all your rights, which you have to agree to so you can get help. Then the medical vending machine corporations will have a massive lobby for their rights in Congress which cannot be defeated because they will get the loons on their side to defend their massive profits as "American Values".
dspeyer 17y ago
It's worth noting that all the pro-retail-clinic claims in this article come from a study done by the RAND Corporation. This is not an entity known for single-minded pursuit of truth. It is closely (though informally) tied to the republican party.

23 points by FleursDuMal 17y ago

baran 17y ago

This is the healthcare of the future. The basic care that you receive will come from a physician assistant/nurse practitioner. This dramatically cuts down on cost while mantaining an adequate level of care. Physicians are going to continue to become more and more specialized. Which leads to physicians only providing specialized/unique treatments.

TomOfTTB 17y ago
What I'm wondering is how much these clinics use technology and how much better they could be if they used it more. I wonder if having a small number of doctors available to these nurses could improve treatment by allowing more patients to get a doctors opinion (somewhat in the same way e-mail and IM tech support allows each technician to server more people than phone support). Could they treat even more conditions that way? It seems a setup like this with some technology checks and balances (to make sure the right questions get asked) could make health care a lot more efficient.
- Radix 17y ago
  Walmart has a deal with RediClinic. The Walmart RediClinics are apparently using eClinicalWorks, the rest might be Athena Health. I expect these clinics use technology as much as possible. I don't think they can lower cost much more by using more, and if they did I expect any profits would be kept with no change in price. http://ecwblog.blogspot.com/2008/02/walmart-rediclinic-eclinicalworks.html http://ecwblog.blogspot.com/2008/02/walmart-rediclinic-eclin... http://www.redorbit.com/news/health/1501613/rediclinic_to_leverage_athenahealths_emr_and_practice_management_services_for/index.html http://www.redorbit.com/news/health/1501613/rediclinic_to_le...
- kgrin 17y ago
  Generally speaking, PAs and NPs must technically be "supervised" by a physician. I think the degree of supervision varies by state, but it's typically not case-by-case supervision - rather more of a general sign-off sort of thing, with availability for the "tough cases". That sort of sounds like what you're describing, though obviously there's a wide spectrum of how involved the doctor can get.
Dove 17y ago
I agree. This is a sign that health care is in the process of fixing itself. If you have 45 minutes to kill, you can listen here (http://dpcare.org/wa_health_underwriters http://dpcare.org/wa_health_underwriters) to a Seattle doctor talk about the issues, his company's approach, and why direct primary care is such a good thing. He advocates concierge care as opposed to the Walmart care discussed in the article, and I find the approach to be more sound. His approach is like Performace Based Logistics for medicine--the doctor that keeps you healthier makes more money, and I like that incentive. Nonetheless, both his solution and the Walmart solution are attempts at taking advantage of the same idea: paying directly for primary care can both lower costs and improve quality because the time and money required to pay for routine things with insurance is so terribly high. I am convinced we are witnessing the birth of a revolution in medical care. I pay out of pocket for primary care, even though my insurance would cover everything if I went to a traditional provider. The new way is that much better than the old way -- and that cheap.
- Radix 17y ago
  Great, thank you for that link. I look forward to listening to him during breakfast tomorrow. I agree that concierge practices sound like a better approach, at least as a primary source for health care. It would be the same as insurance for the smaller things. Leaving insurance to cover larger things. As far as I can tell the worst of the problem is caused by insurances and the related need for medical billers. Another interesting group are the Ideal Medical Practice Doctors. They work with minimal staff and use cheaper technology so they can lower the cost per patient and spend more time with the patients. One doctor I have heard has zero staff.
- litewulf 17y ago
  (If the doctor that keeps you healthier makes you more money, will that not drive doctors to less risky specializations? I'd imagine that a brain surgeon for example sees many more people who are likely to die than say a dermatologist.)
  - billswift 17y ago
    There was a study a long while back, I think I read it in the mid 90s, that the best doctors and hospitals had lower recovery rates, because they took the worst, most difficult, cases. I saw it as part of a discussion of the difficulty of rating health care service providers.

deleted 17y ago

[deleted]

TomOfTTB 17y ago
"In order to delicately preempt any political trolling, this article is about medical care, and that is an entirely separate issue from insurance." I hate political trolling as much as the next guy but I disagree with your point. If health care is absolutely free to everyone than why choose a clinic with nurse practitioners over a hospital with doctors? The questions surrounding the health care debate are ones of efficiency and cost and these types of clinics are very relevant in that debate (though I could see both sides using this to support their point)
baran 17y ago
I have to disagree with this. I think this is an industry that is ready for hackers to make a difference. Many of you are very familiar with the technology that is in place in medical record systems, actually you will find the technology laughable. A technology upgrade would create a major improvement for healthcare systems. The healthcare system in this country HAS to change. It is not a question or else it will bankrupt our country. If healthcare is not in need of quality hackers I don't know what is.
- idm 17y ago
  werd - this is a great opportunity for hackers, and the amount of money at stake here is huge. Of course, that's not what the article is about, but I completely agree.
- deleted 17y ago
  [deleted]

motoko 17y ago

I know the primary care outpatient business, and I support "Walmart medical care." (We call them "counter clinics.") People who don't want expert medical advice go to the counter clinic, we don't have to serve resentful patients, and we can spend our time thinking about medicine with patients who appreciate our service. Further, patients sometimes visit a counter clinic, but they have issues beyond what the counter clinic can handle. So, the counter clinic will refer the patient to us ---the medical doctors. One of our most regular patient referrals is corner CVS because the local medical doctors introduced themselves respectfully to the CVS clinic staff. However, don't be fooled by the "cost cutting" nonsense. My estimation is that counter clinics increase total medical spending in the same way that shopping at Wal-Mart increases total consumer spending. Yes, each individual purchase of "health care" is moderately cheaper. However, given the lower prices, omnipresent availability, and cross-marketing of other products in the store, people do not simply buy the same things at a lower cost, they impulsively buy many smaller purchases of dubious value. So, rather than visit an outpatient medical doctor for an hour for $500 (that is what we bill, though we usually only collect about $300 of that from insurance), one visits the Wal-Mart counter clinic for $70. That's a savings of $430, right? Maybe. Assume the counter clinic treated your sore throat, but you also had another issue, and later visited the medical doctor. Both issues could have been treated by the medical doctor for $500 now rather than $570 over several weeks. Oh, and you also bought "health supplements." Add another $30 recurring cost. Well, actually, you don't go to the doctor at all because you only have $500 for health care, and the doctor costs $500, but you only have $400 because you've already spend $100 on the counter clinic and supplements ---oops, actually, that $400 is already spent by your employer for health insurance. So, you still pay, but you never visit a doctor, chronic heath conditions continue to exasperate, and in addition to suffering from chronic health problems, you eventually get very sick, progressively lose your ability to function, and are hospitalized sooner at a much higher cost. Even a single day of missed work at $5 minimum wage due to illness not addressed by a counter clinic is quantitatively worth more than the $37 best case savings at the counter clinic. Primary and preventative care alternatives are almost never "cost savings" unless you know precisely otherwise. By the way: there is some ludicrous cultural myth that exasperated health problems can be "fixed," or if you can just avoid "having a a serious problem" and "keep natural," you will be OK ---or at least, you can "fix" health "issues" "later." No, you don't. You die. Also, jeez, you spend so much time and money making your face and buying clothes, but when you have a disease, you're thinking about saving a few dozen dollars? Bleh.

_ck_ 17y ago

Given the trend and lack of care about suffering in this country, in a decade all we'll be able to afford is health care "vending machines". Instead of talking to people, you'll stick your arm in one machine socket and spit into another and it will take your blood and analyze your fluids for the flu, a dozen diseases and genetic defects. Then it will print out a prescription with a credit for the store it's located in. You'll be force-fed advertising while the process happens and then they will sell the results to various other corporations which will then market you cures. They'll be able to do this because they will flash an EULA on the screen waving all your rights, which you have to agree to so you can get help. Then the medical vending machine corporations will have a massive lobby for their rights in Congress which cannot be defeated because they will get the loons on their side to defend their massive profits as "American Values".

dspeyer 17y ago

It's worth noting that all the pro-retail-clinic claims in this article come from a study done by the RAND Corporation. This is not an entity known for single-minded pursuit of truth. It is closely (though informally) tied to the republican party.