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.).