Clinics Without Doctors

In Washington state, an experiment in accessible health care has been launched. Multicare Express has opened two clinics in the back of local Rite Aid stores, an approach that seems to have legs despite the absence of actual medical doctors in those clinics.

Via Rob Carson of The News-Tribune:

For a flat fee of $59, an advanced registered nurse practitioner will usher you into a 9-by-14-foot exam room (immediately, in most cases) and conduct a routine exam. Lab equipment is limited but adequate for diagnosing common illnesses such as strep throat, earaches, flu and urinary tract infections. The clinics can handle pregnancy tests, adult immunizations and sports physicals.

No appointments. No waiting rooms. No insurance requirements.

No doctors, either, but the ARNPs are fully equipped to diagnose most basic problems and write most prescriptions.

“It’s a new way for patients to enter our system, and it’s a convenience for consumers,” said Kristopher Kitz, a MultiCare business strategist. “Primary care facilities in Pierce County are at capacity, and this is a way to ease that burden.”

Clinics in retail outlets have been opened before -- there are close to a thousand of them across the country -- but despite many advantages, their numbers are actually experiencing a slight drop over this past year. Analysts within the health care industry have stated that the worsening economy combined with the fact that investors did not truly understand the commitment of finances needed to make it work have caused the recent reduction.

Enter MultiCare, an established hospital system that is bringing electronic medical records among other advances to the equation. The fact that they will accept most forms of insurance including Medicare and Medicaid is a major point in their favor especially considering the already reduced pricing.

MultiCare will be holding grand openings at the clinics on August 15 and 16 with free espresso, sodas and an appearance by Tacoma Rainiers’ mascot, Rhubarb.

SOURCE: "CLINICS OPENED AT TWO TACOMA-AREA RITE AIDS- Multicare Express an experiment in health care" 07/30/08
photo courtesy of dpade1337, used under its Creative Commons license

Doctors Reviewed Online

One of the growing trends online that has been spreading like a virus is that of sites that allow people to provide feedback on goods or services they have received. The ability to have an independent platform for both praise and complaints is refreshing to many. After all, most people trust "word of mouth," and the relation of personal experience far more than any sales pitch. It is the trend du jour, as sites across the net will demonstrate. There are websites for rating and reviewing all kinds of products and services ranging from cars to college professors, and now there are a whole new generation that focus on health care providers.

Via Shari Roan of The Atlanta Journal-Constitution:

They're saying what they think about the state of health care and, more specifically, the doctors who provide it. Dozens of Web sites that permit people to rate, review, spin or flame their doctors have sprung up in the past year, operating in much the same way as online services that help people find hotels or plumbers.

Patients and site operators say the trend is good for consumers and good for health care. Thoughtful doctors, they say, will provide better customer service because of the feedback, and the bad ones will no longer be able to hide. Many physicians say the reviews on RateMDs.com, Vitals.com, DrScore.com and other sites are skewed by disgruntled patients and are unfair, pushing some doctors to near-ruin after a single post.

Ms. Roan provides a lot of solid background and quotes from authorities that are both pro and con. She also includes a bullet list of the six top sites for the rating and reviewing of health care professionals.

Since legally a doctor cannot publicly discuss a patient's health care, they are at a bit of a disadvantage as far as dealing with detractors on the Internet, to say the least. It remains to be seen how much impact reviews like these will have on bad doctors, and likewise how much damage might be done to the good ones. In the past, I have worked in the service and retail industries, and in both it was very much a truism that 99% of people will never comment unless they have a complaint. This tendency has potential to skew these sites, so it will be interesting to watch the evolution of checks and balances develop as they evolve.

SOURCE: "Doctors are 'in' for online evaluation" 07/30/08
photo courtesy of Geishaboy500 used under its Creative Commons license

Health Care In The Mall?!?!

One way of accessing health care in Prince George's County, MD, in the near future will be by emulating the tradition of suburban youth in America: going to the mall.

Oveta Wiggins at The Washington Post reports:

Under the plan, the county would partner with private retail owners to renovate or build spaces where customers could, for example, buy a pair of shoes in one end of the mall and get a mammogram or a physical in another. The partnership would be paid for with public and private dollars.

A feasibility report presented to the County Council a month ago looked at four different malls in the Beltway chosen due to their size, vacancy rates and unstable tenant base. After reviewing the report, some county officials have stated that they see this sort of development serving multiple purposes. On one side of the equation, adding medical services to malls would generate jobs and tax revenues for the county. On the other, access to medical services could be brought within reach of people in under served areas. The perception of a win-win scenario seems quite likely to be accurate. The funny thing is, this is not a new idea:

Hunter Interests, which was commissioned by the Maryland-National Capital Park and Planning Commission to do the report, noted that hospitals introduced the "medical mall" concept about 20 years ago to bring health care closer to residential neighborhoods. Groups of doctors followed, opening clusters of medical services in abandoned retail spaces.

Still, there are only about 50 medical malls nationwide, Hunter said.

In my opinion, this is a highly logical move. In addition to the reasons that Ms. Wiggins presents in her report, I also think it is indicative of the ongoing consolidation of services I see occurring in many of the "big box" stores. Now you can often find notaries, banking and other services in these sort of venues. It makes perfect sense to integrate health services into the overall trend. After all, accessibility is one of the huge and looming issues in the current debate.

Transportation imposes limits on many people's access to health care, as well as a variety of other services. Bringing medical care to malls, which are usually easily accessible via public transit, vastly increases the array of people who can make use of said facilities.

SOURCE: "One-Stop Spot for Health-Care Needs - Officials Say 'Medical Malls' Could Make Services More Accessible, Convenient" 07/27/08
photo courtesy of Joe Shlabotnik, used under its Creative Commons license

Slate Brings US The Health Care Slugfest!

Slate Magazine, an online daily owned by The Washington Post that has attracted numerous awards brings us a really useful collection of links to information from all sides of the health care debate.

As Slate's writer, Timothy Noah, puts it:

If you want to learn the current parameters of the political debate over health care reform, scrutinizing the plans proposed by presidential candidates Barack Obama and John McCain will get you only so far. A sharper picture of where the battle lines are drawn is starting to emerge from two new lobby campaigns recently created by two key opposing groups.

He then goes on to provide capsule descriptions of the Insurance Industry's Campaign for an American Solution and the liberal movement's Health Care For America NOW!

It is, as blog posts often are, a quick read. A plethora of hyperlinks will take the online investigator to a variety of pertinent source material on both sides of the issue, and does so with the usual patented Slate cheekiness.

SOURCE: "Health Care Reform: The Slugfest Begins - Meet the interest groups that will decide the fate of medical insurance." 07/22/08
photo courtesy of d. billy, used under its Creative Commons license

Checkup: Reducing Costs By Paying More

You've all been there. Sitting in a sterile waiting room while you fidget. Finally hearing your name called, allowing you a few precious moments with the man in the white coat. While you are waiting, time seems to drag, but once ushered into the presence of a physician it suddenly seems to kick into overdrive. You can hardly believe that you were in and out so quickly.

It begs the question: can adequate care really be given in the rushed format in which most doctors see their patients?

One answer offered also claims to be a route towards decreasing medical spending. In short, the idea of paying doctors more to take time with their patients (a permutation of the Medical Home concept) to prevent massive costs down the line. It is a grand experiment on the part of a group of state and federal government agencies in conjunction with a number of insurers.

Milt Feudenheim at The New York Times gives us two pages of analysis and commentary on the idea. Here is an illustration of the difference taken from that article:

For want of a careful examination by a primary-care doctor, Mr. Williamson became one of countless Americans each year whose unidentified or under-treated illnesses escalate into medical conditions with catastrophic personal and economic costs. Besides incurring $30,000 in hospital bills paid by his employer’s insurer, Mr. Williamson had to stop working as a customer service representative at Philadelphia Gas Works and go on Social Security disability, at a current cost to taxpayers of $1,900 a month.

With Mr. Williamson’s new doctor, such an outcome would be much less likely.

“I give him my heart and diabetes readings by e-mail and phone, without getting up out of my chair,” Mr. Williamson said. “I can get better directions, at the very moment I need them. It’s life-saving.”

His current internist, Richard Baron, is one of more than 100 physicians in metropolitan Philadelphia taking part in the experiment, which is being conducted jointly by some of the region’s largest insurers. Dr. Baron still gets a fee of only about $64 for each office visit. But his five-doctor group will also receive $200,000 to $300,000 this year beyond their regular fees to keep better track of their 8,400 patients.

“We are trying to do more e-mail care and telephone care, which we haven’t been paid for in the past,” Dr. Baron said.

Insurers are conducting similar pilot projects in at least a half-dozen states, in experiments involving thousands of doctors and nearly 2 million patients. Many more are in the planning stages, at the urging of health policy experts and employers that provide medical benefits.

The big government health care programs, Medicaid and Medicare, are also studying the concept. A Medicaid experiment already under way in North Carolina saved the government program in that state about $162 million in 2006. That was 11 percent less than the state would have spent under the old system of reimbursement, according to an audit by Mercer, a consulting firm.

This looks like an idea that might have legs. It is axiomatic that more careful and comprehensive care should drastically reduce the longterm costs of health care. Whether this approach will yield a solution or not is something only time will tell, but the logic is sound.

Certainly a set of initiatives to watch!

SOURCE: "Trying to Save by Increasing Doctors' Fees" 07/21/08
photo courtesy of Papalar, used under its Creative Commons license

Mr. Halvorson Goes To Washington, Recap

Last Friday I wrote about George C. Halvorson's trip to Washington to give testimony to the Senate Finance Committee. Today, I would like to do a small follow up on that post.

Commentary and reporting on Mr. Halvorson's Senate testimony provided by Andrew Noyes on NextGov:

Kaiser Permanente CEO George Halvorson's testimony came as several legislative proposals intended to create a national system of electronic medical records are moving through Congress. Achieving such an overhaul would be daunting, and electronic medical records alone are not sufficient to provide optimal care, Halvorson said.

He called for a special support system that would analyze data from interconnected networks and give physicians prompts to support consistent care delivery and a stand-alone care registry for those Americans who will not have immediate access to integrated health IT. Once a fully computer-supported system is in place, the nation should aim to reduce asthma, congestive heart failure and kidney failure by 50 percent, he said.

Mr. Noyes then proceeds to provide capsule reviews of the responses from the Senate. From the cautious skepticism of Finance Chairman Max Baucus to additional testimony by CBO Director Peter Orszag, he provides a nice summarization of events.

Under Mr. Halvorson's guidance, Kaiser Permanente has become recognized as being at Leading Edge of Health IT, at least according to a piece in U.S. Insurance News a few weeks ago. His focus on the billions in savings, as well as the improvements in treatment it would usher in provide the impetus for his quest to implement IT solutions.

This is far from a new position for Mr. Halvorson. This interview in the San Francisco Chronicle back in 2003 show an almost prescient awareness of the direction we, as a country, have been going as the health care crisis gets worse with each passing month.

What we need is health care reform, and we need it now!

SOURCE: "Panel weighs challenges of adopting health IT overhaul " 07/17/08
SOURCE: " Kaiser Permanente on Leading Edge of Health IT" 06/23/08
SOURCE: "On the record: George Halvorson Kaiser CEO looks at the high cost of health care" 11/16/03
photo courtesy of mdu2boy, used under its Creative Commons license

Community Prevention For $10 a Year

For $10 annually per person we, as a country, could invest in community-based disease prevention programs could save the U.S. $2.8 billion each year in health care costs. The savings could take effect in as little as a year or two according to a study released Thursday by the Trust for America's Health.

I first discovered this in the Baltimore Business Journal, where they point out:

The U.S. could save more than $16 billion annually within five years, or a return of $5.60 for every $1 invested. In that five-year time frame, D.C. could save $57.2 million, Virginia could save $385.1 million and Maryland could save $332.2 million.

The report focuses on disease prevention initiatives that do not require medical care, such as increased access to affordable, nutritious foods, increasing sidewalks and parks in communities, and raising tobacco tax rates.

The study found that reducing Type 2 diabetes and high blood pressure rates by 5 percent through such programs could result in $5 billion saved in heath care costs in five years.

Prevention is a loud chorus in the song of health care. While some things may not at first seem to be health care issues, I think we can all follow the logic of needing access to healthy food in order to properly nourish our children. Personally, as a smoker, I'm in favor of the higher tobacco tax. It might help me finally quit.

The study itself is well worth a look, and includes a breakdown of projected returns on a program of this nature broken down on a state by state basis. This excerpt from the report itself helps illustrate why this sort of strategy is important and can produce results that can alleviate the financial stresses that are crippling our system and bankrupting our citizenry:

"Health care costs are crippling the U.S. economy. Keeping Americans healthier is one of the most important, but overlooked ways we could reduce these costs," said Jeff Levi, PhD, Executive Director of TFAH. "This study shows that with a strategic investment in effective, evidence-based disease prevention programs, we could see tremendous returns in less than five years -- sparing millions of people from serious diseases and saving billions of dollars."

In Health Care Reform Now!, George C. Halvorson lays out the numbers on just how much chronic conditions and preventable health issues comprise of our overall health picture. I'll give you a hint. The number is well over half.

SOURCE: "Prevention for a Healthier America
Investments in Disease Prevention Yield Significant Savings, Stronger Communities" 00/00/00
photo courtesy of PublicResource.org, used under its Creative Commons license