Posted on 10/05/2023 1:03:22 PM PDT by Responsibility2nd
CLARKSVILLE, Tenn. — On a hot July morning, customers at the Dollar General along a two-lane highway northwest of Nashville didn’t seem to notice signs of the chain store’s foray into mobile health care, particularly in rural America.
A woman lifted a child from the back of an SUV and walked into the store. A dog barked from a black pickup truck before its owner returned with cases of soda. Another woman checked her hair in a convertible’s rearview mirror before shopping.
Each went right by a sign exclaiming “Quick, Easy Health Visits,” with an image of a mobile clinic.
Just after 10 a.m., registered nurse Kimberly French arrived to work at the DocGo mobile clinic parked in the store’s lot. She checked her schedule.
“We don’t have any appointments so far today, but that could change,” French said. “Last night we didn’t have any appointments and three or four people showed up all at one time.”
Dollar General, the nation’s largest retailer by number of stores, with more than 19,000, partnered with New York-based mobile medical services company DocGo to test whether they could draw more customers and tackle persistent health inequities.
Deploying mobile clinics to fill care gaps in underserved areas isn’t a new idea. But pairing them with Dollar General’s ubiquitous small-town presence has been heralded by investment analysts and some rural health experts as a way to ease the health care drought in rural America.
Dollar General’s latest annual report notes that about 80% of the company’s stores are in towns with populations of fewer than 20,000 — precisely where medical professionals are scarce.
Catering to those who want urgent or primary care, the mobile clinics take private insurance as well as Medicaid and Medicare. The company’s website says DocGo’s self-pay rates start at $69 for patients without insurance or who are out of network. DocGo officials said Tennessee patients may be charged different rates but declined to provide details.
On the ground in Tennessee, primary care doctors and patients are skeptical.
“Honestly, they don’t really grasp, I don’t think, what they’re getting into,” said Brent Staton, a family medicine doctor and the leader of the Cumberland Center for Healthcare Innovation, a statewide organization that helps small-town family care doctors coordinate care and negotiate with insurers, including Medicare.
Michelle Green manages the popular Sweet Charlotte grill about 10 miles south of Dollar General’s most rural test site. Green, who was handing out hamburgers and hand-cut fries during a Saturday rush, said she hadn’t heard of the mobile clinic. She said with a shrug that Dollar General and health care clinics “don’t go together.”
“I wouldn’t want to go to a health care clinic in a parking lot; that’s just me,” Green said, adding that someone might go if “you’re sick and you can’t go anywhere else.”
Bumps in the Road
The Clarksville-area pilot, which launched last fall, is in a federally designated primary care shortage area for low-income residents.
About 1,000 patients have been seen in the company’s clinics, either at Dollar General sites or community pop-up events, and some became repeat visitors, according to DocGo. Payment is taken outside on a mobile device and, once inside, patients meet with an on-site staff member, like French, and connect via telehealth on an iPad screen with a physician assistant or nurse practitioner.
A photo of a nurse standing inside of a mobile health clinic.
The clinic rotates between three Dollar General pilot sites each week. The stores are in the Clarksville area and, early this summer, the van stopped going to the most rural site, near Cumberland Furnace, because of low utilization, according to company leaders. DocGo moved that location’s time slot to busy Fort Campbell Boulevard in Clarksville.
“We do try for months in a given area to see where it makes sense and where it doesn’t,” former DocGo CEO Anthony Capone said in a July interview. “Our goal is to align the supply we have with the demand of the local community.”
Capone, though, said he thought the pilot would work in rural areas when insurers are signed on to refer their members to the mobile clinic. DocGo recently announced a deal with Blue Cross Blue Shield of Tennessee.
Capone abruptly resigned on Sept. 15 after the Albany Times Union reported he lied about having a graduate degree.
Dollar General stores have a “tremendous opportunity” to have “a major impact on health there and really bond themselves as a member of the community,” said Tom Campanella, the healthcare executive-in-residence at Baldwin Wallace University, who has managed mobile clinics in rural places.
Near tiny Cumberland Furnace, south of Clarksville, William “Bubba” Murphy stopped on his way into a Dollar General, paused to wave and holler hello to friends getting out of their cars, and shared that multiple family members — his sister-in-law, nephew, and niece’s boyfriend — used and liked “the little clinic on wheels.”
“We don’t have to go to town and fight all that traffic,” he said. “They come to us. That’s a wonderful thing. It helps a lot of people.”
Jefferies lead equity analyst Corey Tarlowe, who follows discount retailers, said the clinics will help “democratize” access to health care and simultaneously boost traffic to Dollar General stores.
With its rapid growth in recent years, Dollar General has faced accusations that its stores kill off local grocery stores and other businesses, reduce employment, and contribute to the creation of food deserts. More recently, the U.S. Labor Department said the chain “continues to discount safety” for employees as it has piled up more than $21 million in federal fines.
Crystal Luce, senior director of public relations for Dollar General, said the company believes each new store provides “positive economic benefits,” including new jobs, low-cost products, and its literacy foundation. On the federal fines, Luce said Dollar General is “committed to providing a safe work environment for its associates and shopping experience for its customers.” The company declined to provide an interview.
The DocGo pilot, she wrote, is intended to “complement” the DG Wellbeing initiative, which is a corporatewide push. Dollar General wants to increase “access to basic health care products and, ultimately, services over time, particularly in rural America,” Luce wrote.
States away, DocGo is under fire for a no-bid contract to provide housing, busing, and other services for asylum-seekers in New York. State Attorney General Letitia James is investigating complaints levied by migrants under the company’s care. In August, DocGo officials said claims aired by sources in a New York Times article that first reported the problems were “not reflective of the overall scope and quality” of the services the company has provided.
The company’s pilot with Dollar General is “supported with funding from the state of Tennessee,” DocGo’s Capone said during the company’s first-quarter earnings call. The Dollar General partnership is cited in quarterly grant reports DocGo’s Rapid Reliable Testing LLC submitted to the state, according to records KFF Health News obtained through public information requests.
In the grant filing, DocGo listed Dollar General along with other organizations as “trusted messengers” in building vaccine awareness.
Dollar General declined to respond to a question about its involvement in the grant. Instead, Luce stated, “We continue to test and learn through the DocGo pilot.”
‘Relational Care’
The goal of the $2.4 million grant, funded by the Centers for Disease Control and Prevention and distributed by the Tennessee Department of Health, is to administer covid-19 vaccines. In a written response provided by DocGo’s marketing director, Amanda Shell Jennings, the company said, “Dollar General has no involvement with the TN Department of Health grant funding or allocations.”
The grant covers storage and maintenance of covid-19 vaccines on the DocGo mobile clinics, Jennings’ statement said, adding that, as of September, DocGo has held 41 vaccine events and provided 66 vaccines to rural Tennesseans.
Lulu West, 72, was visiting a friend at the Historic Cumberland Furnace Iron Museum when she stopped to consider the mobile clinic. West said she would rather go to her primary care doctor.
“When you say mobile clinic outside a Dollar General it just kind of has a connotation that you may not be comfortable with. You know what I mean?” she said.
That kind of response doesn’t surprise Carlo Pike, a doctor who for years has practiced family medicine in Clarksville. He said he’s not worried about the competition because providing primary care is about developing relationships.
“If I can do this relationship right,” Pike said, “maybe we can keep you from getting a [blood] sugar of 500 [mg/dL] or from Grandpa climbing up a ladder and trying to fix something he has no business with and falling off and breaking his leg.”
Staton said the Cumberland Center for Healthcare Innovation, his accountable care organization, has saved Medicare and Medicare Advantage companies more than $100 million by focusing on preventive care and reducing hospitalizations and emergency visits for patients.
“We’re just small rural primary care docs doing our jobs with a process that works,” Staton said. In another interview, Staton called it “relational care.”
DocGo surveyed its patients and found that 19% of them did not have a primary care physician or hadn’t seen theirs in more than a year. In the written responses Jennings provided, DocGo said it follows up with every patient after the initial visit, offers telemedicine support between visits, and provides ongoing preventive care on a regular schedule.
But despite its outreach, DocGo struggled to get a foothold in rural Cumberland Furnace.
Lottie Stokes, the president of the community center in Cumberland Furnace, said DocGo’s team had “called and asked to come down here.” Stokes said she would rather use the local emergency medical technicians and firefighters, who she knows are “legit.”
Her father-in-law, Bobby Stokes, who’s nearly 80 years old, said he used the mobile clinic before it moved locations.
His wife couldn’t breathe. They pulled into the parking lot and climbed onto the van.
“We wasn’t in there five minutes,” he said. “They done the blood pressure test and what they need to do and put her in the car and said, ‘Get her to the hospital, to the emergency room.’”
The DocGo staff, he said, did not ask for payment: “Nothing.”
“They were more concerned with her than they were with I guess getting their money,” he said, adding that his wife is doing well now. “They told me to get there, and I took them at their word. My car runs fast.”
My small town of 12,000 at least has a hospital, but the only reason it’s still open is that it’s only facility for the eastern half of the county, which has mountain vacationers and a large farming population.
All the Dollar stores specialize in being in remote / rural areas where they have a lock. Kind of like a micro Wal Mart.
They show up in the very smallest towns of just a few thousand people.
My entire county has a population of 21,565 and no hospitals or even an urgent care clinic.
But we do have 6 Dollar Generals.
So maybe…..
I wonder if DocGo uses PAs physician assistants and NPs nurse practitioners as mid level providers to increase their staffing ability to provide care?
Very practical
Medicine. I like it. Concierge.
Greatest health care system in the world!
Yeah, right.
Most expensive in the world more like it.
I’m a bit surprised that others like Walmart, etc haven’t done
the same. You wouldn’t want life or death situation but minor
things could be addressed. Once started I’m sure the wait time
may become an issue.
We now have a de facto NHS.
Ours works as well as the UK’s does.
For the same reason.
Access a variety of immunizations, from the COVID-19 vaccine to the to the flu shot & more.
Schedule a time that works best for you or stop in at your convenience.
Schedule a time that works best for you or stop in at your convenience.
Book up to three people under one appointment.
Book up to three people under one appointment.
*$0 copay with most insurances. State, age & health restrictions may apply.
Vaccines available at Walmart
COVID-19
Flu
Shingles
Respiratory Syncytial Virus (RSV)
Tetanus, Diphtheria, Pertussis (Tdap)
Pneumonia
Hepatitis A & B
Human Papillomavirus (HPV)
Meningitis
Measles, Mumps & Rubella (MMR)
Varicella (Chickenpox)
Insurance and pharmaceutical companies have figured out how to siphon every last dime out of US health care so we’re paying out the nose for rationed care. You almost can’t get in to see a doctor in a lot of places so something like this at least gets you to someone who can give you a prescription.
DocGo to test whether they could draw more customers and tackle persistent health inequities.
No one is addressing my health inequalities, ie my healthcare ain’t free.
I was in a Dollar General not long ago and it was amazing how much stuff they had in there, and at good prices also.
I formerly worked for a rural health system and advocated just such a program. At the time, it wasn’t technically and economically feasible (our EHR at the time wouldn’t have been able to handle it primarily, but the cost of the equipment was pretty high - if Starlink had existed, it would have cut the cost way down).
I advocated using church parking lots rather than Dollar General, but both have merit, I think.
There are a lot of people in rural areas who just can’t easily get across the county (or counties) to a clinic. Sometimes transportation is an issue (we explored getting a bus but in a big county that cost adds up and the time to collect a dozen or so people and then take them back could be enormous). Sometimes it’s just an unwillingness to leave their property for the whole day. Some people are too disabled. Some are remote and don’t have anyone close by to assist or watch their farm when they leave.
The thinking was to bring the clinic to them to at least get them basic evaluations and care, maybe prescriptions and even supplemental nutritional assistance. Even the most reclusive seemed to find a way to church at least occasionally, so we thought putting a mobile clinic at each church - maybe even on a Sunday - once or twice a year made a lot of sense. Then we figured we could arrange them to be picked up for follow up or outpatient if they had complications beyond the mobile clinic’s capacity and maybe get local social services to help with any other needs they have.
Other than x-rays, we could pretty much have duplicated one or two examination rooms in an RV or schoolbus-sized vehicle with enough supplies and staff to make it work. The terrain was another big stumbling point - you can’t always get a vehicle like that down the roads and getting stuck would mean a wrecker from several hours away. 4x4 on a vehicle of that size would up the cost significantly if even practical.
But a mobile clinic makes a lot of sense in a rural area.
Worked in the health care system administration. Had two really good physicians. One passed one retired. Only been once to Urgent care in 7 years. Decided it was time to get a physical. This was an “interview” no exam and they didn’t want to hear what I had to say. Scheduled series of tests but I don’t understand why. Some I may need and some I don’t. “See you next year!”
The worst. My doctor retired because he was not able to order tests he thought were necessary, he had to follow
“Protocol”.
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