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Is 'Quick' Enough? (Store Clinics Tap a Public Need, but Many Doctors Call the Care Inferior)
Washington Post ^ | 16 January 2007 | Ranit Mishori

Posted on 01/16/2007 1:35:06 PM PST by shrinkermd

Some of the newest players in health care are rubbing doctors the wrong way.

You may know them: those small clinics at your neighborhood Wal-Mart, Target or CVS that promise quick attention for routine visits -- sore throats, minor aches and pains, flu shots -- with no appointments needed. The clinics, which go by such names as MinuteClinic, RediClinic, QuickClinic, Medpoint Express, Curaquick and MediMin, offer convenience and low price -- scarce commodities in today's medical marketplace. But while consumers are taking to the concept, physician resistance is building.

...Not that many are convinced this trend is good for patients. Within the past six months, the American Medical Association and the American Academy of Pediatrics have both decried it.

(Excerpt) Read more at washingtonpost.com ...


TOPICS: Business/Economy; Culture/Society; Extended News
KEYWORDS: clinics; enough; store
The AMA is making a big mistake. These clinics are helpful in both providing immediate, necessary services and in keeping health costs down.

Almost everyone I know received their "flu shot" from a store clinic. This is a service whose time has come and professional groups will be unsuccessful in stopping it.

1 posted on 01/16/2007 1:35:10 PM PST by shrinkermd
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My mom was just sick and I took her to one of these. They did a strep test, a flu test, and diagnosed it as viral, which you can't do anything about.
Unless these quick clinics hand out antibiotics for viral illnesses or miss warning signs, they're much better than bothering another doctor with minor problems.


2 posted on 01/16/2007 1:40:28 PM PST by Libertarianchick
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To: shrinkermd

Yeah, interesting. I visit urgent care facilities from time to time, but I also have a PCP that I'll go to for more serious things. I've generally had good experiences, and it just doesn't make too much sense to me to go to my PCP when all I need is a guy to write me a prescription.

I think a line from the article is telling: "Van Vleck agrees: 'When I see a kid for a sore throat, I get to go through their chart. If they have a little bit of scoliosis I might check their spine. I will check their immunization record. We go over the record, and we try to go over what's going on besides the sore throat, or besides the ear infection.'"

Translation: I add on a bunch of services that the patient hasn't requested, and then I charge them for those services.


3 posted on 01/16/2007 1:41:08 PM PST by Publius Valerius
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To: Publius Valerius
Translation: I add on a bunch of services that the patient hasn't requested, and then I charge them for those services.

You got that right. The AMA and APA are picking up where the unionnn goons leave off in attacking free enterprise.

4 posted on 01/16/2007 1:44:13 PM PST by Gabz (If we weren't crazy, we'd just all go insane.)
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To: shrinkermd

These clinics will continue to prosper as long as it takes up to a week to make a sick visit....and 3 months to make an appt for a well visit to a physician.


5 posted on 01/16/2007 1:47:10 PM PST by TASMANIANRED
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To: shrinkermd
As traditional medicine sees it, when a young patient gets hurry-up treatment for a single symptom at a retail-based clinic (RBC), also known as a convenient care clinic (CCC), the process leads to "fragmentation of care."

Heck this is what we're getting anyway with our primary care physicians. Every time I visit, I'm in and out in under five minutes with a prescription, and this is presuming that an appointment is available when I need it. My wife had some kind of bug last week, and she couldn't even get in to see her doc period, and she ended up just treating herself with Thera-flu.

As this article strongly implies, I just think that the regular docs feel threatened and that they don't want to adjust their hours or fees to compete. Go clinics!

6 posted on 01/16/2007 1:51:50 PM PST by Virginia Ridgerunner ("Si vis pacem para bellum")
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To: TASMANIANRED
These clinics will continue to prosper as long as it takes up to a week to make a sick visit....and 3 months to make an appt for a well visit to a physician.

Bingo. And half the time you don't even see the doctor, just the PA

7 posted on 01/16/2007 1:54:43 PM PST by Harmless Teddy Bear (We must have faith For when it is all said and done, Faith manages. And the impossible is achieved)
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To: Harmless Teddy Bear
half the time you don't even see the doctor, just the PA

We have some very good PAs. It takes a long time to get an appointment with our Primary Care Physician, but we can get to see our PA in the same office right away. If all I need is antibiotic and cough syrup scripts to ward of a bout of bronchitis, why not? If I need to go over CT scan results, I see the Doc.

8 posted on 01/16/2007 1:58:36 PM PST by Jeff Chandler (Romney si! Rudy no!)
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To: TASMANIANRED

These clinics will continue to prosper as long as it takes up to a week to make a sick visit....and 3 months to make an appt for a well visit to a physician.

Exactly. These clinics are filling a need that consumers want- quick, convenient and reasonably priced care. MD's will not be successful in fighting these unless they are willing to provide some of those same services themselves- and that is highly unlikely.


9 posted on 01/16/2007 2:02:21 PM PST by usmom
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To: Jeff Chandler

There is nothing wrong with seeing a PA. My mom is one. But far too many offices you make a doctors appointment and you don't see the doctor. They need to say up front that you will be seeing a PA.


10 posted on 01/16/2007 2:04:53 PM PST by Harmless Teddy Bear (We must have faith For when it is all said and done, Faith manages. And the impossible is achieved)
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To: shrinkermd
Some folks sure do hate capitalism, don't they?

If a little clinic messes up, they'll get sued, just like a big clinic.

Meanwhile, a lot of people get at least some kind of care right away that they would otherwise have to wait for.

11 posted on 01/16/2007 2:07:11 PM PST by rbookward (When 900 years old you are, type as well you will not!)
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To: Gabz

In the military, we saw a nurse or a physician's assistant for just about everything. Heck, a paramedic can do much of what civilians have to see a doctor for.


12 posted on 01/16/2007 2:07:18 PM PST by Tax-chick ("I don't know you, but I love who you seem to be.")
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To: Tax-chick

Heck, I barely get past the Corpsmen when I go to our clinic. We don't have a full-srevice clinic here at our base. I understand the stresses on military medicine, really I do, but if I call and say I know my daughter must have strep, being the mother of three and experiencing it before, and I get told that I can't get in to see ANYONE at all for 3 or 4 days...forget it.

On this particular occasion, I just waited until 4 PM, called the clinic duty medic and then got a referral for the out in town urgent care clinic. We were in and out of that clinic in 20 minutes, whereas on base I have to schedule an entire day for appointments.

I'd go to these clinics if they were near me.


13 posted on 01/16/2007 2:13:52 PM PST by USMCWife6869
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To: rbookward
Meanwhile, a lot of people get at least some kind of care right away that they would otherwise have to wait for.

OR for which they will tie up the local Emergency Room, as they do now.

14 posted on 01/16/2007 2:19:20 PM PST by Gorzaloon (Global Warming: A New Kind Of Scientology for the Rest Of Us.)
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To: Tax-chick

I see absolutely nothing wrong with these clinics.


15 posted on 01/16/2007 2:19:30 PM PST by Gabz (If we weren't crazy, we'd just all go insane.)
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To: Gorzaloon
OR for which they will tie up the local Emergency Room, as they do now.

Sounds like a win-win.

Folks get quick care for little problems, emergency rooms get a lighter load, and somebody makes money.

Now, if we can just keep the lawyers out of the loop!

16 posted on 01/16/2007 2:24:25 PM PST by rbookward (When 900 years old you are, type as well you will not!)
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To: shrinkermd
Yep. The MD trade groups have been whining for years about how there isn't enough reimbursement in primary medicine.

So here's an outfit that puts the lie to that by making it work profitably. More power to them say I.

17 posted on 01/16/2007 2:36:35 PM PST by Doghouse Riley (No war unless it's total war for total victory.)
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To: Tax-chick
If you are over 65 on Medicare and live in a big city you will seldom see a physician unless necessary. You will receive excellent followup and other care from a physician's assistant or other non-MD professional provider.

Medicare has reduced benefits to such a degree this is the only way a cognitive specialist or outpatient physician can survive. In doing so they have proved the value of the physician's assistants and registered nurses.

I look forward to my registered nurse far more than to my physician. She is more contactful, patient and interested than my highly trained specialty physician. She also, like any professional, knows what she doesn'g know. Many have similar experiences and that is why I am optimistic about the trend in medical care.
18 posted on 01/16/2007 2:49:39 PM PST by shrinkermd
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To: Libertarianchick

A viral infection can quickly become a bacterial infection which should be treated with antibiotics, particularly in the elderly. So for many people it is better to go to the same doc who has your medical record and knows if you are prone to certain complications from an illness (e.g., bacterial sinus infections accompanying a viral cold) or even complications to the treatment to an illness (e.g., allergies to certain meds). The Walmart-style clinic serves a purpose, but it doesn't replace having your own personal doctor who knows your history.


19 posted on 01/16/2007 3:07:47 PM PST by Kirkwood
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To: Kirkwood

Excellant.


20 posted on 01/16/2007 3:19:00 PM PST by Recovering Ex-hippie (There are no moderate Mooslims !)
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To: Kirkwood

That is a valid concern, however, my mom is not elderly (I'm 22, she's 48 the reason I go with her is because she's deaf).
Even though she has been very prone to needing antibiotics in the past, I carefully watched her and gave her vitamins and good care and she did not end up needing them.
She also carries a full list of her meds and allergies and we make sure to inform the doctor.
Due to her insurance, her specialists and general doctor are 30 miles away and are extremely hard to get in to see, otherwise we might use her doctor more often.
Under the circumstances, with precautions, these clinics are the best many people can do.


21 posted on 01/16/2007 3:24:24 PM PST by Libertarianchick
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To: Kirkwood

Our local hospital complex has an Ergent Care unit in-hospital, and also an Emergency Room. If your doc is not in or it's after hours and you can't wait, you go to Urgent Care. If you are sicker than you thought Urgent Care will admit you or tell you to see your doctor the next day. If it's something that requires an anti-biotic or something like that, then they take care of it. I imagine most hospitals will do this in order to compete with the store clinics.


22 posted on 01/16/2007 3:28:57 PM PST by WVNan
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To: usmom

You don't need a physician to lecture you about your weight, your b/p, your cholesterol or your last mammogram when you have strep throat.


23 posted on 01/16/2007 3:32:43 PM PST by TASMANIANRED
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To: USMCWife6869
We were in and out of that clinic in 20 minutes, whereas on base I have to schedule an entire day for appointments.

BTDT! The first time I made an appointment at a civilian pediatric practice, saw the doctor in 15 minutes, wrote a check for $35 (it was a while ago ...), and got the prescription filled at the grocery store, I thought I'd died and gone to heaven.

24 posted on 01/16/2007 4:22:09 PM PST by Tax-chick ("I don't know you, but I love who you seem to be.")
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To: shrinkermd
If you are over 65 on Medicare and live in a big city you will seldom see a physician unless necessary.

I'm not any of those things, but I don't mind seeing a nurse or P.A. for our usual needs.

25 posted on 01/16/2007 4:23:47 PM PST by Tax-chick ("I don't know you, but I love who you seem to be.")
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To: Publius Valerius
re: Translation: I add on a bunch of services that the patient hasn't requested, and then I charge them for those services. )))

Is that so? You mean you regularly get charged for two office visits when you've only had one?

The Van Vleck quote is about continuity of care--treating a patient instead of an illness. Family medicine. Opportunity to screen a patient for other problems, like, why does this patient catch so many colds?

These clinics are good mostly for minor acuity, which is great. I'm glad they exist.

But if your doc charges by the question--I'd sure like to see how he gets paid for that with the rules the way they are. Bills are not coded that way.

26 posted on 01/16/2007 5:20:11 PM PST by Mamzelle
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To: Libertarianchick
Exactly. There has been times in my life that I've been without health insurance. A visit to a Pharmacist is sometimes helpful if the remedy is an OTC drug. Otherwise, a quick diagnosis for a minor aliment is necessary.

Even now that I do have medical insurance, making the appointment and taking the time off work can be a real bother. These are places to take care of hangnail type ailments, not to get a heart bypass.

Of course, I suppose I could learn Spanish, pretend to be an illegal (I'm dark enough) and just show up to the friendly freebie taxpayer supported ER.

27 posted on 01/16/2007 8:50:46 PM PST by Vigilanteman (Are there any men left in Washington? Or are there only cowards? Ahmad Shah Massoud)
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To: shrinkermd

I am a physician and have no problem if patients want to go to these type of clinics for minor things. But do not go for routine care. As a matter of fact if we get Hiliary care I plan on doing something like this. I do not want to have to directly work for the government and have made up my mind I will quit or do something like this. I have even seriously though of writing a letter to Wal-Mart headuarters and letting them know if they want to open one up in the town I live in I would be glad to work for Wal-Mart. I have about had it with .gov interference and poor pay by .gov and after today I am tired of running off all the drug abusers who try to get me to prescribe the two favorites--Vicoden and Xanax. Had a patient drive 3/4 across the state hoping I would be his doctor cause no one between here and there would prescribe him the meds he wanted. I said no and did not charge the guy.


28 posted on 01/16/2007 9:32:57 PM PST by therut
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To: shrinkermd

I went to the Wal Mart clinic...they cut the price of everything. What I love about PAs and the other techs is that they actually listen carefully. If they feel it's out of their hands they tell you to go to a specialist.

OTOH, there are "some" Gen Practice doctors that are horrible in everyway. And when they can't answer the problem, they want to go further instead of admitting their clinic of specialists can't help.


29 posted on 01/16/2007 9:39:47 PM PST by sully777 (You have flies in your eyes--Catch-22)
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To: Tax-chick

The first time I made an appointment at a civilian pediatric practice, saw the doctor in 15 minutes, wrote a check for $35 (it was a while ago ...), and got the prescription filled at the grocery store, I thought I'd died and gone to heaven.



It's about $75 now. If it's the cold and flu season expect an overbooking or a two day wait. My general time in - time out is approx. 2 hours or more.

First time visit is between $110 to $175 depending on the physician's practice/specialty.

PA at Walmart charged $45--first time visit was a total of 45 minutes with all the filling out forms garbage. Tests are grouped and they have special prices for screenings, blood work, etc. which is sent off to the same lab the local doc uses. Results are given to you and you are directed to the proper specialist(s) rather than to a mega-clinic's Dr. Nick (Simpson's Dr. Nick) wanna-be.

I swear by it.


30 posted on 01/16/2007 9:51:10 PM PST by sully777 (You have flies in your eyes--Catch-22)
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To: Gabz

That's because you're not losing business to them.


31 posted on 01/16/2007 9:55:42 PM PST by Richard Kimball
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To: sully777

Sounds great!


32 posted on 01/17/2007 4:43:27 AM PST by Tax-chick ("I don't know you, but I love who you seem to be.")
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To: Mamzelle

Doctors, like most professionals, charge for their time on an hourly basis. Most doctors, though, set up their bills so you are just charged a flat rate for an office visit; however, that fee is based on an estimated time that he'll spend with each patient and then calculated out to determine what he wants (or needs) to earn.

Thus, when the doctor is spending more time with each patient (performing services that the patient doesn't request), then the fee for the visit needs to be higher so the doctor can continue to cover his nut.

Don't think your time with the doctor is free. It's not.


33 posted on 01/17/2007 6:57:58 AM PST by Publius Valerius
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To: Mamzelle
The Van Vleck quote is about continuity of care--treating a patient instead of an illness. Family medicine. Opportunity to screen a patient for other problems, like, why does this patient catch so many colds?

P.S.: That's not really what this doctor is saying. Read what he says again:

"'When I see a kid for a sore throat, I get to go through their chart. If they have a little bit of scoliosis I might check their spine. I will check their immunization record. We go over the record, and we try to go over what's going on besides the sore throat, or besides the ear infection.'"

I've got scoliosis. When I go to a doctor for a sore throat, I don't want him checking my back. I want a prescription for an antibiotic. Checking a patient for back trouble has NOTHING to do with why he has a sore throat--it's merely a way to run up the bill.

"Oh, so you've got a sore throat, huh? Great...say, I see you haven't had your Typhus fever immunization this year....Hmmm. What, you say you're not going to be aboard an 18th Century British sailing ship and don't need it? Well, you never know. Let's just get you set up with Typhus fever, huh? Great...that'll be $100. Thanks for stopping by!"

34 posted on 01/17/2007 7:04:23 AM PST by Publius Valerius
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To: Publius Valerius
re: Checking a patient for back trouble has NOTHING to do with why he has a sore throat--it's merely a way to run up the bill.)))

If you knew anything about the laws concerning billing and medical regulations, you'd know that he CAN'T run up the bill! An office visit is an office visit. Actually, I wish they'd OTC some antibiotics and have done with it, and let people medicate themselves.

re: Oh, so you've got a sore throat, huh? Great...say, I see you haven't had your Typhus fever immunization this year....

Something tells me that a doc recommended that you get current for tentanus, and you thought he was a greedy b@stard for suggesting such a thing.

35 posted on 01/17/2007 5:36:14 PM PST by Mamzelle
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To: Publius Valerius
re: Doctors, like most professionals, charge for their time on an hourly basis.))

LOL...they have to "code" their billings, unlike lawyers. Although it was lawyers who came up with the idea.

That's why surgeons make so much more (if you go by hourlies) than a subspecialty internist, but their yearly salaries work out very similar. Doctors can charge by procedures, like sewing up an idiot hunter who got drunk and fell out of his blind, but he can't charge extra for recommending that he get a tetanus shot if the hunter's going to be outdoors and stupid at the same time.

36 posted on 01/17/2007 5:40:46 PM PST by Mamzelle
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To: Mamzelle

An office visit IS an office visit, but a $50 office visit is a lot different than a $100 office visit. All office visit fees are not created equal.

Doctors see patients to make money. That's what they do. Extras are not free. The copy of People in the lobby--not free. The pen with the doctor's name on it--not free. The fancy building that your doctor practices in--not free. The "check of your records"--not free either. You (or your insurance company) pays for all of it. The cost of ALL of that is built into the office visit. If he is seeing fewer patients (because he is "giving" patients services that they don't want) the cost of the office visits will be higher than they otherwise would be because the doctor has to cover his nut. That's just how it is. Doctors are businessmen like anything else. If you don't believe me, just ask a prescription drug sales rep on how they sell prescription drugs to doctors. It's money. Doctors have boat payments, too.

But I'll give you a for instance on running up the bill with unnecessary services. I went to the doctor for a sprained ankle. He took some x-rays, told me it wasn't broken. That's good. All I needed to know.

But did my visit end there? No. The doctor told me that I needed an aircast for my ankle. This is one of those plastic bubble things you can buy at Wal-Mart for about $7.97. The nurse came into the office, opened the box, put the cast on my foot, and velcroed it. The entire procedure took about twenty seconds.

Several weeks later, I got the notice of payment from my insurance company. The doctor's bill for the cost of the cast and for the nurse putting it on my foot? $95. Fortunately for everyone (except the doctor), my insurance company refused to pay the charge, but it's these type of bills that encourage people to see doctors that will only treat them for what they've requested. If I didn't have insurance, I would have had a very difficult time getting that doctor to drop that $95 charge off his bill. This is precisely what spurs people to visit these immediate care clinics at Wal-mart. No surprises. You want a flu shot? Great, here you go. That's $8.

There is absolutely a market for doctors that won't give you a bunch of crap that you don't want, and the idea that doctors are just doing all this extra stuff "for the patient" is bogus. It's about money. Period. "What can I bill medicare for?"


37 posted on 01/18/2007 7:42:52 AM PST by Publius Valerius
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