Fast-food medicine: retail health clinics and the licensing issues

Back in July, CVS bought MinuteClinic, thinking to get a jump on the coming retail health clinic boom. If you’re like me, and you oppose the fast-food medicine phenomenon, you’re probably against the whole idea.

What I can’t argue against is the convenience, and that’s what’s going to be the big thing. People aren’t going to utilize them for the management of chronic illness, they’re going to use it for the one-off things: Hey I’ve got an ear infection. Hey I’ve been hacking my lungs out for the last 3 days. Hey my sinuses are about to explode and I’m ready to go postal on anyone who f’n looks at me. That sort of thing. (“Zpak, next!” “Zpak, next!” “Amoxicillin, next!…” etc. etc. ad inifinitum) Anyways, what’s better than stopping by CVS, seeing the PA (or NP), doing some shopping, then stopping by the pharmacy to pick up your Zpak? One-stop shopping at it’s finest.

Anyway I spoke at some length with a CVS district manager two weeks ago about the MinuteClinic thing, asking for some details on how they’re run. Who are they staffed by? (An MD? Probably not.) He didn’t know, which sort of irritated me. He was thinking in terms of revenue, and I’m thinking in terms of what’s best for the patient. I guess my main question is how you’re going to have someone diagnosing and prescribing without an MD on staff. PAs and NPs, of course are able to prescribe, so long as they have a supervising physician. (In the two states I’m familiar with, anyway.) So where’s the incentive for the MD to “supervise” a clinician at a retail-based health clinic that’s taking revenue away from their own practice, regardless of whether they own their own shop, or are part of a bigger whole? From a pure business perspective, it doesn’t make sense to me, unless CVS plans to share part of the revenue from their health clinics with these practices. (Which I don’t see CVS doing.)

Maybe they’ll higher one supervising MD per district and have all their NPs or PAs report to him? That’s really the only way I could see a system like that working, but it would seem like a terribly kludgy system. Does anyone know?

In any event, retail health clinics will not be coming to New Hampshire or Massachusetts in 2007, according to aforementioned DM. There hasn’t been any money allocated to open clinics. They will be popping up in Maine, particularly in the uniquely urban-rural areas like Bangor. Apparently there’s more money to be made there than in southern NH and Massachusetts, which really isn’t terribly surprising given the relative density of clinicians to the general populace.

[tags]Medicine, pharmacy, CVS[/tags]

12 thoughts on “Fast-food medicine: retail health clinics and the licensing issues

  1. What do you want, someone with a cough to wait 2 weeks to get an appointment with their primary MD? By then they may be dead. Go to the ER and fill out pages of litigous documentation? What is the patient to do? With 15% of the US population uninsured or only having major medical, where do they get treatment for a sore throat? Do you have any idea the out-of-pocket cost an underinsured patient pays at an ER?
    Your indignent attitude toward the NP & PA is unbiasised, the reasurch I’ve done suggests the quality of care provided by these highly trained medical professionals equals that of MD. They work with MD’s not against them, they are an extention of a doctors scope of practice. NPs/PAs free up an already overcrowded medical system utilizing the Doctor’s full potential.
    Most states have limitation to the number of mid-levels that may be supervised by an MD (California it’s 2). Second of all they are quite qualified to diagnosis and treat these acute matters, if the situation needs a higher level of care then the patient can be sent to the ER or the PA/NP can call their primary and get a STAT appointment.
    Face it, the medical system in this country is a mess, with tort lawyers around ever corner, medicare reinbursments going down yearly and reduction of MD wanting to go into Primary Care this minute clinic has a VALUABLE place in society’s medical system. We cannot continue taxing a currently broken system.

    Food for thought; what’s the difference between Minute Clinic and Kaiser’s Fast-track? Location….

    Steven J. Schutz PA-C

  2. fast-food health
    + catastrophic insurance coverage (just expect to be treated like a sub-human at the ER and itll be a breeze)

    + overseas medicine (were u can expect to be treated as a human so itll be a breeze)

    = US middle class sln to health

    medical cartel:
    http://www.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm

    high quality ctrl:
    http://digg.com/world_news/Death_after_2_hour_ER_wait_ruled_Homicide

    overseas: (just dropped my mother at the airport yesterday for her now yearly overseas visit- beats being treated like a beggar at the local docs. she’ll be back next week- well-rested and honestly looking years younger everytime she comes back.)

    chow

  3. Patient outcomes are superior in patients treated by Nurse Practitioners. Nurse Practitioners practice independently in many states. If your idea of quality care is waiting 5 hours in an ER for an upper respiratory infection diagnosis and treatment then by all means, that is your choice.

  4. What do the following statements have in common?

    “Red is better than blue.”

    “Patient outcomes are superior in patients treated by Nurse Practitioners.”

    and finally:

    “People who wear black shoes are smarter than people who wear brown shoes.”

    ANSWER:

    There is absolutely NO DATA to back up any of these claims. Nor would it matter if there was.

    Thank you, have a nice day.

  5. RJS, you are obviously not well-read. Many studies have supported comparable to superior outcomes for Nurse Practitioners. Dig a little deeper before you insult an entire profession.

  6. You’re clearly unfamiliar with the rules of debate. Since you’ve made the assertion, the burden of proof lies on you to provide links to peer-reviewed studies which support your view.

    As for insulting an “entire” profession — I was up until recently considering becoming an NP. Why would I insult a group of professionals whose ranks I might’ve joined?

  7. The problem is the medical system in the USA is not working. More and more patients are being left behind. With the loss of non-profit hospitals, HMO CEOs giving themselves 1.2 billion dollar bonuses and the continuance of litigious assault; the health of the nation is failing. We need to think outside the realm of the current broken medical system and try to fix it. I believe this includes using Nurse Practitioners and Physician Assistants in as many places as possible. These “mid-levels” can provide high quality care to patients in a medical team approach.
    This bickering about insulted this and quality this is useless time consuming garbage. Focus on the patient, not one’s pride. If we in the field cannot care for the ill without putting aside our richeous indigenisation, then the health system is doomed, and our patients we swore to help will suffer.
    PA-C Steven

  8. These “mid-levels” can provide high quality care to patients in a medical team approach.

    i would extend this… to “competitive” teams- so that consumers are delivered options, increased services

  9. Let’s leave the debating to RJS and the health care to the Nurse practitioners. He questions an established fact and I make hundreds of people happy with my quality evidence based care. We both continue our lives, I make a huge difference in thousands of lives and he…ummm….well….continues to debate; and remains an expert on the rules of debating. Very nice.

    RS

  10. So far it’s your word against… well, not mine, because nowhere did I say that NP or PA care was inferior. In fact, my post is largely in favor of the MinuteClinic phenomenon. My comments, directed at the person who came out and made a completely ridiculous blanket statement, have nothing to do with you, or NPs in general. Please, point out where I’ve insulted the profession, or questioned the quality of care.

    Truly it’s amazing that you are a nurse practitioner yet basic skills like reading comprehension somehow elude you.

  11. RJS-

    You mean-spirited, unenlightened soul, here is info about the study:

    US Congress, Office of Technology and Assessment. Nurse Practitioners, Physician Assistants, and Certified Midwives: A Policy Analysis. Washington, DC: US Government Printing Office; 1986. Health Technology Case Study 37

    You’ll have to find your own link.

  12. RJS wasn’t intentionally insulting your profession. All he was doing was calling out the fact that people make broad statements without citing their sources.

    You people took that as a personal attack, when in fact all he was doing was pointing out the need to back up your assertions.

    It is also amusing to me that it took almost a year for someone to actually find a study to back up these broad statements. Now all we need is a link to it…

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