Today’s solutions are tomorrow’s problems
Stanley Feld M.D.,FACP,MACE
Occasionally a media article will precipitate at response from me in this blog because I feel it is urgent to respond.
A New York Times May 14, 2006 front page story covered the development of free standing clinics in Wal-Mart, Target, CVS pharmacies. Several entrepreneurs including Steve Case former CEO of AOL and Rick Scott former CEO of the former Columbia Hospital System have gone into the business of “DOC in the Boxes” except without the use of DOCs (physicians). The plan seems to be to use Healthcare Providers. Physicians, in my opinion, should not be categorized as health care providers. They are Medical Care Providers. This is an important distinction in my mind and will carry over into my discussion for the Repair of the Healthcare System. All other Healthcare Providers should be called Physician extenders.
David Scull for The New York Times
“The MinuteClinic in a CVS store in Bethesda, Md., offers its customers a
number of vaccines.
That is the basic idea behind a retail approach to routine medical care
now catching on among consumers and entrepreneurs. At Wal-Mart
CVS and other chain stores, walk-in health clinics are springing up as an
antidote to the expense and inconvenience of full-service doctors'
offices or the high-cost and impersonal last resort of emergency rooms.
For a $30 flu shot, a $45 treatment for an ear infection or other routine services
from a posted price list, patients can visit nurse practitioners in
independently operated clinics set up within the stores whose own
pharmacies can fill prescriptions.
"It was a lot easier to know you can just drive up the block to a
clinic, rather than spend time in the pediatrician's waiting room," said
Liz Lyons, who recently took her 9-year-old son to have a sore throat
swabbed in a clinic at a CVS drugstore in Bethesda, Md.
She made a $10 co-payment, with her husband's insurance picking up the
rest of the $59 tab.
About 100 of these clinics, which typically lease space from the host
stores, are now operating around the nation. Hundreds more are in the
works, bankrolled by a range of competing entrepreneurs who include
Stephen M. Case the former AOL chairman; Richard L. Scott, who once ran the nation's
largest hospital chain; and Michael Howe, a former chief executive of
the Arby's restaurants group.
Despite their diverse backgrounds, those executives and others share a
concept of "consumer-directed health care" a marketing and political
term that usually means higher out-of-pocket medical costs as a
In response to an email about this article I replied;
"the creations of free standing “DOC in the Boxes” is one of the complicated mistakes that business people make to distort the healthcare systems even further. Both Steve Case and Rick Scott are very smart guys, when it comes to picking the cherries off the trees, and making some money. I am sure they will make some money at this. They will also bale out just before it crashes.
I think Wal-Mart and CVS are indeed putting their reputation and good will on the line and are going to get a nose bleed.
These are again today's solution to yesterday's problems which in turn will case tomorrow’s problems.
Our health is our most valuable asset. I think it would be worthwhile if entrepreneurs used their intelligence to figure out how to fix the system and not break it even further. Medicine should not be viewed by the entrepreneur as a "money making space". It should be approached from the view point of setting up systems to preserve our most valuable asset our health."
An effective healthcare system should have three qualities. Those qualities are access to effective care, affordable care, and high quality care.
These clinics answer none of these qualities. When and if the clinics get busy, the wait time will be the same as emergency rooms and “Pediatric clinics”. The access to care problem will not be solved. Are these clinics going to be open 24 hours a day? I would doubt it. These clinics also do not solve the problem the 45 million uninsured who can not obtain affordable insurance coverage for significant illness.
The price structure for acute minor illness seems to be the same as the price structure negotiated and contracted by the insurance industry for physician and emergency room visits regardless of the retail fee charged by the physician and emergency room. These clinics do not solve the problem that 80% of the healthcare dollar is spent treating the complications’ of chronic disease. The key to Repairing the Healthcare System is decreasing the complication rate of chronic disease.
Non physician directed care for acute illness does not address the issue of high quality care at all. I assume if a patient was really very sick that patient would be sent to an emergency room from the clinic.
To me these clinics address a very minor part of the healthcare problem. This is not what “Consumer Driven Healthcare” is about. It is true these clinics give that patient a choice. Is it a wise option?
Clearly, the developers of these clinics are trying to pick the low hanging fruit and make some money. However, I believe the will find that these clinic do not satisfy the patients, nor the healthcare community’s needs, nor their economic goals. It could in fact intensify turf wars and be harmful to the large retail stores mission to provide good quality merchandise at an affordable price.