Interesting comments on WSJ's post on retail clinics

I recently wrote about retail clinics regarding Illinois considering tightening regulation of them. Here's a WSJ Health Blog post about these clinics in general, and the comments I found most interesting were:

My prediction is that after a certain amount of time and the certain demise of many of the ckinics, the remainder will actually begin to have physicians as the staff. Prices will rise but will still remain relatively affordable. And doctors offices will respond by offering similar services since there is no barrier to competition.

Makes sense. After all, the supply of willing NPs are limited versus the number of primary care docs.

My wife and I have both used the medical service Target provides for our flu shots. There were no lines and the cost was half of what our phycian would have charged. Perhaps these services are similar to those provided by stores like 7 - 11. We still shop at Safeway, but 7 - 11 is more convenient on occasion. I think we should encourage service differentiation well matched to service needs.

A recogonition that retail clinics offer a better value than doctors' offices for services like vaccines.

While the quality of care and physician-patient relationship may be compromised or non-existent in this type of setting, these retail clinics may be a great solution for keeping non-emergency healthcare needs out of the ER during evenings and the weekend.

Don't know if I agree with this one, but being in the ER and seeing a few common complaints not belonging in the ER every day I certainly hope it comes true.

Another problem with these quick in-store clinics is many patients with apparently simple problems, the kinds the clinics treat, actually are not so simple.

Quite true! I see many cases in the ER, such as cuts that actually are abscesses tied to a person's unmanaged diabetes that also aren't ER cases per se but require a more advanced look at the person's health.

I believe that web based communication between doctor and patient will be more useful than Minute Clinics.

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I believe that innovations in IT will make Minute Clinics obsolete. If a doctor knows his patient, he can do more in less time and at lower cost via communication with the patient over web site or telephone than the Minute Clinic can.

Oncoming generations of doctors and other healthcare workers will definitely make better use of Internet technologies to improve patient care.

The reality is anyone who has looked closely at this model will quickly determine that they cannot even break even (and one malpractice lawsuit and they are history). The rush to open these centers is the “dot com” of the healthcare. The real draw is the traffic these stores get after the visit.

Are they breaking even already?

Of course they [retail clinic nurses] are going to miss some diagnoses. Of course they’re going to overprescribe antibiotics. However, doesn’t that happen in the ER anyway? The complaint from hospitals, hospital based physicians is the prices are high because they see non emergencies in the ER. Wouldn’t it be nice if there was a place you could go after 5 in the evening or on the weekend, that you didn’t have to wait 4 hours, that didn’t cost a few hundred dollars and get at least seen and/or treatment? I’ve been seen by NPs and PAs and receive the same level of care, maybe even better as they tend to spend a little more time with patients.

A good point to consider if you're torn between visiting the ER, where I have seen most patients wait 8+ hours to see us, and a retail clinic where for cheaper you can see a nurse almost immediately in comparison.

What these clinics will not do is exert any real downward pressure on the medical cost trend in the US. 80% of our costs are driven by the 20% of Americans with chronic complex medical conditions. Treating these efficiently and effectively is a long term commitment requiring continuity between patients and providers, not well suited for drive-in/drive-out episodic care delivery models.

This is a good point to those who believe retail clinics will drive down the cost of overall healthcare. It won't, although I could see it dropping down the costs of basic healthcare (flu vaccines, treatment for minor infections and bites, getting your stitches out, get refills on prescriptions, yearly physical exams, etc.).

Try No. 3: Entrepreneurism fills in the gaps

In the title above, I refer to Atul Gawande's essay where he concludes at the end that there are two possibilities to the future of the US healthcare system.

Ventures such as retail clinics (e.g., MinuteClinic, RediClinic), clinics focused on managing one disease (Diabetes America), online comparison sites mandated by states and founded as private enterprise (PricePoint, HealthGrades.com), and a host of others are filling in gaps between what people want and what the healthcare system currently provides.

And as long as there are gaps in healthcare, I have faith that social and capital entreprenuers, as it is said about Nature when it is hemmed in or temporarily tamed, will continue to always find a way.

Illinois docs feel threatened by retail clinics

The Financial Times article "Wal-Mart health clinics divide US medics" describes how the state of Illinois is considering to enhance the regulation of retail clinics. This is due to pressure from its medical association, which no doubt feels that primary care doctors' livelihood is threatened.

[But a]dvocates say the clinics will improve access to healthcare and reduce costs; that they will reduce more expensive visits to hospital emergency rooms; and that they will catch some illnesses before they become serious and costly. As a result, physicians will have more time for complex cases.

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Dr Rodney Osborn, president of the Illinois State Medical Society, said: “This is a brand new animal. That’s why we believe legislation is important to guarantee patient safety ... They’re not putting these things in to provide healthcare; these people are businessmen.”

If retail clinics make better sense to patients and their long-term health and will even save a part of the healthcare system (the ER) money, doesn't the complaints of these doctors appear more self-interested and less patient-centered? And aren't doctor practices businesses too?

Dr Arnold Milstein, chief physician at Mercer health consultancy, says doctors are playing on patient fears to thwart change.

“[Doctors] wrap themselves in the holy garb of quality ... completely ignoring the facts that all the research shows current care stinks,” Dr Milstein says. “The weaknesses that are endemic in the current healthcare system are being trotted out to block innovation and change.”

Nature's healing touch

I only write because in the space of a few days there were articles regarding health and three natural substances (though processed into products): dark chocolate, honey and coffee.

The Reuters piece on dark chocoloate was more about the boom in sales but mentioned the antioxidant flavonols found in cocoa and their cardioprotective effect (here is a recent study supporting the claim).

The AFP piece on honey's ability to kill bacteria and thus prevent, in this case, the amputation of an ulcerated foot belonging to a diabetic person. A physician using so-called honey therapy has launched a study to gather more support for the claim. (This study concludes that honey inhibited growth of several bacteria species.)

(Aside: Unfortunately honey bees have been dying off rather mysteriously.)

The Reuters piece on coffee's health benefits touts its ability to ward off type 2 diabetes (according to this 2002 Lancet article) and perhaps some cancers, according to a panel including a public health professor at Harvard. This was tempered by evidence that coffee can increase incidence of leukemia and stomach cancer. So, like most things in life, moderation is key.