Posted tagged ‘retail based clinics’

Inscos want to own your health care provider

May 23, 2011

The Pediatric Insider

© 2011 Roy Benaroch, MD

 We cut out the middleman to SAVE YOU MONEY!

It works with jewelers, car dealerships, discount chains—cut out that greedy middleman, and the buyer gets the goods, cheap!

Will it work for health care?

Here’s a new trend: insurance companies owning their own retail-based clinics. I’ve raised some red flags about retail clinics in drug stores and big box outlets before. One objection I have is the conflict-of-interest: if the drugstore will also make a profit when it sells you the drug, could it be that their salaried employee will want to prescribe the medicine that makes the most money for the drug store?

Take it one step further—what if the insurance company itself actually employs the health care provider? Every dollar spent on you is one less dollar of profit for the company. Do you think their provider is likely to order the best medicine, or the cheapest medicine? How about those blood tests or x-rays–you’d like to be sure that the person deciding whether to order them cares only for your well-being. What if the person who decides whether to order the test works for the company that has to pay for it?

Drug-store owned clinics are a huge conflict of interest, but at least the impact of their decisions is really limited only to medication choices. With insurance company-owned clinics, decisions aren’t just about who makes profit on the medicines. It’s about everything: how many specialist referrals there are, whether you’re told to go to the ER, whether you get an MRI on a knee or your brain. Every decision to offer anything past rudimentary, inexpensive care is less profit. Who do you want making these decisions?

The way health care is financed, “the middleman” is your doctor. Physicians are not beholden to the insurance company—we can pretty much order what we think is appropriate, without affecting how we’re paid for the encounter. (There are ill-defined “bonuses” to reward what’s considered “good care,” but those payments are minimal and unpredictable. And sometimes we have to jump through hoops to expensive things pre-approved, but whether they’re “approved” or not, we doctors still get paid.) Furthermore, I don’t actually make money on the stuff I order. You go get your MRI somewhere else, you go buy your medicine down the street. I decide what you need based on what I know about you and my best medical judgment. That’s the kind of middleman you need: a person squarely in your corner, looking out for only your interests.

Insurance companies are there to make money for their shareholders. Period. Who do you think will win when they alone decide what services you get?

Want the best pediatric care? Stay away from the retail-based clinics

March 31, 2011

The Pediatric Insider

© 2011 Roy Benaroch, MD

They’re everywhere, all of a sudden: little medical kiosks tucked into the back of drug stores, grocery stores, and big box outlets. With names like “Minute Clinic” or “RediClinic,” they stress speedy, in-and-out service. And of course, you’re already there in the store, ready to buy whatever has been prescribed. A win-win, no?

No.

Everyone knows that if you’re looking for good, wholesome food, you ought to stay away from McWendyKing. If you want good pediatric care, you ought to stay away from these quickie retail clinics, too. They’re the “fast food” of health care providers, offering exactly what your children don’t need.

What’s “good pediatric care”? Care that looks at the whole child, the whole history, and the whole story. To do a good job I have to review the history, the growth charts, the prior blood pressures, the immunization records, and more. Good care means I’m available for every concern—not just the sore throat, but the “Oh, by the way…” worries that are often more significant than the current illness. Things like “He’s not doing so well in school,” or “I think he looks clumsy when he runs,” or “What am I going to do about these headaches every day?” Every encounter is a catch-up on problems and concerns from before, to be reviewed and updated. Children are growing and developing, and every encounter is a snapshot of their over all well-being that can only make sense if it can be placed into a continuous album. At the retail-based clinic, the encounters are just a quick toss-off: an opportunity for genuinely improving health that’s thrown away.

Good pediatric care requires good training. The retail clinics are staffed by midlevel providers who may have minimal pediatric experience. Children are not the same as adults, and without specific, ongoing, significant training in taking care of kids, those well-meaning nurses at the local QuickieCare may not have the skills to adequately assess your child.

Good health care also means keeping up with recommendations and community standards. I recently reviewed two cases of children seen from my practice who were clearly mishandled by the local ZippityDoClinic. One was a child given a vaccine he didn’t need (mom said she brought the records; and even if she didn’t, my state maintains a complete vaccine registry. If they looked, they would have seen that he didn’t need another dose of that vaccine. Did they not look, or do they not know the recommendations?) Another involved treating a urinary tract infection without doing the appropriate testing beforehand (The clinic acknowledged to me that they don’t have the facilities to do the correct test. If they can’t do it right, why are they doing it at all? Are they telling parents that they’re delivering substandard care?)

This week I spoke with the Medical Director of one of the large retail-based chains, a doctor of internal medicine without any particular pediatric experience. She made the following points:

  • “There is a shortage of 40,000 primary care physicians in the USA, and we can fill in the gaps.” While it’s true that there is a shortage of PCPs, that’s primarily a problem in medically underserved areas in rural America and inner cities. Are these retail-based clinics being built where there is the strongest need? Of course not—they’re mostly in affluent suburbs where there’s money to be made. The proliferation of these McSpeedySick places in wealthier neighborhoods will make the imbalance of health resource availability worse, not better.
  • “We are committed to the concept of the medical home.” Right now her chain of clinics is offering special cut-rate sports and camp physicals, dangling cheap rates to lure patients away from their primary care docs for their well-checks. The heart of the well-check is to review all current issues, to look at the big picture, to make sure all health-maintenance tests and immunizations are up-to-date. They can’t possibly offer that service without a thorough review of the past records. A quick physical is cheap, but it is not a fair substitute for a thorough health maintenance visit at a child’s pediatrician.

The existence of a clinic-within-a-store may have another, more underhanded dark side. When I see a patient in my office, I can make whatever suggestions I feel are in the best interest of the child—I don’t make any money off of prescriptions, or medical devices, or anything else I recommend. You can be assured that your doctor isn’t suggesting something or prescribing a medication just because he’s selling it at a profit. At the retail QuickityClinic, families get their prescriptions, march over to the pharmacy, and pay for their white baggie of pills. There’s certainly at least the potential for an odious conflict-of-interest, with increasing profits tied to prescribing more medicines, more expensive medicines, or medicines with a more-favorable markup. Do you want medical decisions being made based on profit?

There’s an old saying: you can have it good, you can have it fast, or you can have it cheap—but you can’t have all three. Retail-based clinics may offer fast care, but you can’t depend on them to offer good care for children. Your kids deserve better.