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    Wednesday, May 23, 2007

    A Disruptive Innovation of Our Happy Little Empire: The happy little empire is the medical profession, the disruptive innovation is the retail clinic:

    Dr Arnold Milstein, chief physician at Mercer health consultancy, says doctors are playing on patient fears to thwart change.

    "[Doctors] wrap themselves in the holy garb of quality ... completely ignoring the facts that all the research shows current care stinks," Dr Milstein says. "The weaknesses that are endemic in the current healthcare system are being trotted out to block innovation and change."

    The clinics see themselves as advancing medical care, not diminishing its quality, with a retailer’s focus on service: the slogan of CVS's MinuteClinic, for instance, is "You’re sick, we're quick".

    Hal Rosenbluth, chairman of clinic company Take Care and head of the industry group Convenient Care Association, says any pushback against the clinics actually validates their existence, andadds that the concept is here to stay.

    "That’s what people are clamouring for - they want healthcare on their terms not the system’s," says Rosenbluth. Doctors’ quality concerns, he says, are merely anti-change "turf protection."

    Is it true that "all the research...shows current care stinks?" No. There is a perception, though, that quality means fast. It doesn't. You know what they say about fast, good, and cheap.

    posted by Sydney on 5/23/2007 08:58:00 PM 6 comments


    In the past month my family has made two visits to the ED at our local hospital. These were our first emergency visits in decades and we have primary care relationships with physicians. On the first visit, my own, I was seen and treated by a nurse practitioner, not an MD was in sight. I received excellent care, but it cost my insurance company a ton of money. On the second visit, my wife's, she was seen and treated by a physician's assistant, again with not an MD in sight. My wife also received excellent care at considerable cost to our insurance company. If we had the high-deductible coverage now on offer and there was a clinic nearby at a local Wal-Mart or CVS or RiteAid, would we have gone there? You betcha!

    Physicians and hospitals, wake up to these inconvenient truths: health care in the US costs a lot of money; third party coverage inures patients to cost and encourages inflation; those who pay for health insurance are trying to get out from under this treadmill of ever-rising costly health care by dumping the cost on to others; rising costs of health insurance with perceptively reduced benefits such as high deductibles encourages people to go without healht insurance; the rising numbers of uninsured encourages expansion of public programs like Medicaid and SCHIP; governments, as well as employers and insurance companies, will not much longer tolerate paying more and more for less and less; the bottom line is that you have to change your ways or wind up like dinosaurs. You are being warned.

    By Blogger cokaygne, at 8:10 AM  

    or you could try and emigrate to a country with a public health system?

    By Blogger Benedict 16th, at 9:37 AM  

    Cokaygne brings out a excellent point. If your going to see a midlevel anyway (and there is nothing wrong with that for minor complaints), why not do it for a fraction of the cost in a retail clinic rather than an ER. You might be seening the same midlevel since many moonlight between ER's and Urgent Care settings. Many of the ER's in my area have placed midlevels at Triage. This is done for two reasons, 1 - to claim a rapid door to provider time (used to be called door to doc time) and 2, rapidly dispo the minor stuff, much of which does not need to be there. Sicker patients are Triaged to the main ED. The problem I have seen with that (other than statistic buffing) is the midlevel will take longer in Triage than an experienced Nurse and sometimes gets in over their head by trying to see higher acuity stuff since they are with the patient anyway. The Nurses path is much shorter and not biased by the desire to see more patients.

    By Blogger ERMurse, at 11:21 AM  

    I'm not interested in picking on cokaygne, but there are two points he/she is missing- one is that ED costs are extremely high for a reason. They have to be staffed to handle anything from a splint to multiple trauma cases. No care rendered in the ED is cheap, which is why it is every hospital's goal to keep people OUT of it.

    The second is- if one's illness is can be handled by a nurse practioner, why go to the ED in the first place? What about the walk-in clinic, or the primary care doc's office? There must be only a few places left in this country that don't have a doc-in-the-box.

    cokaygne, I am afraid that you, too, are part of the problem. You even said it yourself- if you actually had to PAY for the care rendered, you would have gone elsewhere- but since you didn't, hey, why not do what's easiest for you?

    By Anonymous danie, at 1:44 PM  

    Danie, I'm guilty as charged. That is my point. Someone else is paying. At the point of sale, I don't care what the charge is. The provider will charge as much as the third party will let them get away with. This system is inherently inflationary.

    yes, ERmurse, EDs are staffed and equipped to handle major trauma, but charging hundreds of dollars for a few minutes of treatment by an NP or PA is inflationary. How would you like to buy a cup of coffee at your local restaurant and be charged for a seven-course dinner prepared by a three-star chef? How long would that restaurant remain in business?

    benedict 16th, we are moving inexorably towards a single (government) system as people are forced out of private group insurance due to its high cost. My point is that you providers should be the last ones to wish for this. When one payer becomes responsible for everything it will not be long before the hammer comes down.

    By Blogger cokaygne, at 6:06 AM  

    Rich people should be able to obtain the best health care from experienced MD's. Poor people should go to the local Wal-Mart clinic.

    By Anonymous Anonymous, at 9:31 PM  

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