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    Sunday, January 29, 2006

    The Competition: My local grocery store is opening a QuickClinic. For $39 they'll take care of colds, flu, minor injuries, pink eye, and the like. They'll also take out your sutures and clean your ears. They'll screen for diabetes, anemia, and cholesterol, among other things. And they'll give you your immunizations, too, but their brochure doesn't say how much those cost.

    I know my office can't compete with $39 visits. I'd go bankrupt. But then, I'm not just a walk-in clinic. I'm expected to do a lot more than just "treat and street," and rightly so. I know quite a few doctors who are more than a little upset about the competition. There's no sense fighting it, though. They exist because there's a perceived demand for them. They're also a natural outgrowth of the influenza vaccine clinics that have been held these past several years in drug stores and grocery stores throughout the country.

    It should be interesting to see how they pan out, though. They're still more expensive than most people's co-pays. And I'm not entirely convinced that the volume of uninsured patients (or HSA plans, for that matter) is high enough to sustain a practice based solely on cash payment. I know one doctor who tried it here, and ended up closing his practice after a year. (He had other personal issues, though, so he might not be a good example.) Then, too, these aren't standard practices. They're subsidized by the retailers who think of them as a means to bring customers to their store (and pharmacy). They're like an interactive advertisement.

    Perhaps this will be the new model of American healthcare as the number of doctors declines. Primary care by nurses and pharmacists and specialty care at hospitals. I don't necessarily think that's the best model, but it sometimes feels as if that's where we're heading.

    posted by Sydney on 1/29/2006 06:02:00 PM 11 comments


    I'm sure you've run the numbers for your clinic, but imagine the low overhead. Especially if the store provides the space for free.

    Imagine giving the patient a pager when they sign in, sort of like what you get at a restaurant. They can shop while they wait and just come back when the pager goes off. Then the provider transmits the prescription electronically to the in-house pharmacy.

    Of course, you do "screening" for diabetes, but punt the long term, time consuming, detail care.

    By Blogger DrTony, at 7:59 PM  

    Have you thought of moving some of the routine services to a telemedicine format?

    Consider email consults where the volume could be greater and the price lower.

    Better than retail clinic as the patient does not even have to leave home.


    By Anonymous The Medical Blog Network, at 10:35 PM  

    There's only one hope for the future of primary care solo practice as I see it. But I fear it's not in us to achieve.

    All practitioners need to go completely non-par.

    Then bill for time spent. The same as for architects, lawyers, and accountants.

    They're professionals. Are we not?

    By Blogger Jim Hubbard, M.D., at 12:34 AM  

    Let's see. I spend one hour in the waiting room and anothr hour dealing with everything so that I can get my Flonase scrip renewed.

    This is not new. The number of ER and Doc In The Box visits by insured patients has been rising due to convience and hours open.

    MD's have a lot to offer but the bulk of people are just trying to deal with everyday things and being busy is one thing everyone has in common.

    By Anonymous Anonymous, at 9:08 AM  

    Medical Blog Network,

    I have experimented a little with Web Visits, although I don't encourage them. (i.e. promote them.) My experience is that my patients only use them when they are out of town. The cost of a Web Visit is higher than the average co-pay, and the insurers in my area don't reimburse for them. I still have reservations about them myself. Mostly because I feel better examining a patient before treating them. I like to have all the data and the physical exam is often an important piece of the puzzle.

    By Blogger sydney, at 12:34 PM  

    Patients at these quick clinics are going to get antibiotics for every respiratory infection, unnecessary specialty referrals for common medical conditions, and erroneous and outdated advice from practitioners who have no background in evaluating medical evidence. I fear that this won't make any difference for most people who just want attention to their complaints and have no concept of the quality of the treatment they are getting.

    By Anonymous Anonymous, at 1:40 PM  

    Might be a good thing if it takes a load off hospital emergency rooms.

    By Anonymous Anonymous, at 2:08 PM  

    RE: Web Visits

    No doubt, telemedicine has long way to go before it can really enter mainstream. Here are some points to ponder (or "pundit" if you will) :-)

    1) Web visits vs. retail clinics stack up about the same from the co-pay perspective compared to regular office visits

    2) If cash-based primary care increases in popularity, web visits could give PCPs (especially small practice) a fighting chance against retailers. What else can, besides promoting full-service approach?

    3) Yes, there is no replacement for a physical exam. Diagnosing and treating online may be impersonal (even illegal in many places). But routine things like patient education, Q&A, referrals and visit prep work could move to remote, high-volume, low cost cash model.

    4) Use of web visits while traveling only. I wonder if that is your current patient population that strongly prefers face-to-face in the office (especially when insurance pays anyways). What about busy tech-savvy professional types who may not be your patients today?

    5) Reimbursement for new delivery models always lags, but often catches up - eventually. This could be the real tipping point. Until then, the service itself has to justify the out-of-pocket cash.

    I wonder if there are studies that looked into the economic viability of telemedicine models in the real world primary care practice.

    By Anonymous The Medical Blog Network, at 7:24 PM  

    Medical Blog Network,

    I do use a secure messaging service to communicate with patients via the internet. A little over ten percent of my patients use it. These are not necessarily the tech savvy patients.

    I've been surprised at the number of tech savvy patients who decline to use it. These are people with internet businesses, for example, or retired people who tell me they text message each other all the time. Some people are just not comfortable having their personal health information floating around in cyberspace.

    It does free up some phone time. I've been able to get rid of the auto-attendant ( Press 1 for scheduling, 2 for referrals, etc.) and have a real person answer the phone which has increased my daily patient volume.

    But, I think to have a high usage of Web Visits for minor problems, you would probably need a large population of very busy people who are comfortable with the internet - not just on a technological level, but on a personal level. Those privacy concerns do have some validity.

    By Blogger sydney, at 12:00 PM  

    The issue inspired me to summarize all sides of the argument and post them here: "Retail Clinics: How Can Primary Care Docs Compete?"

    Further feedback is very much invited.

    By Anonymous The Medical Blog Network, at 12:31 AM  

    Refer to Diabetes for
    useful information

    By Anonymous Anonymous, at 3:16 AM  

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