Re: Drugstore Clinics Spread, and Scrutiny Grows


"Evelyn Ruut" <evelyn.ruut@xxxxxxxxx> wrote in message
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"Jim Higgins" <gordian238@xxxxxxxxxxx> wrote in message
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Nixon.D wrote:
"Jim Higgins" <gordian238@xxxxxxxxxxx> wrote in message
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Drugstore Clinics Spread, and Scrutiny Grows
http://tinyurl.com/2ghwtm

The concept has been called urgent care ?lite?: Patients who are tired
of waiting days to see a doctor for bronchitis, pinkeye or a sprained
ankle can instead walk into a nearby drugstore and, at lower cost, with
brief waits, see a doctor or a nurse and then fill a prescription on
the spot.

With demand for primary care doctors surpassing the supply in many
parts of the country, the number of these retail clinics in drugstores
has exploded over the past two years, and several companies operating
them are now aggressively seeking to open clinics in New York City.

But with their increasing popularity, the clinics are drawing mounting
scrutiny. Several states including New York, New Jersey, Rhode Island,
Massachusetts and California are examining ways to more closely monitor
the clinics, which are overseen by a hodgepodge of state agencies
applying a wide and inconsistent range of regulations.

More than 700 clinics are operating across the country at chain stores
including Wal-Mart, CVS, Walgreens and Duane Reade.

New York State regulators are investigating the business relationships
between drugstore companies and medical providers to determine whether
the clinics are being used improperly to increase business or steer
patients to the pharmacies in which the clinics are located.

And doctors? groups, whose members stand to lose business from the
clinics, are citing concerns about standards of care, safety and
hygiene, and they have urged the federal and state governments to step
in to more rigorously regulate the new businesses.

?We?ve got big problems in health care, and this is not the answer,?
said Dr. Rick Kellerman, president of the American Academy of Family
Physicians. ?They are a response, they are a niche market and an
economic opportunity, but we still have an underlying primary care
crisis in this country.?

Patients, however, have flocked to the clinics, according to a new
industry group, the Convenient Care Association.

?I think it?s great you don?t have to make an appointment. That could
take weeks,? said Ezequiel Strachan, 33, who lives in Manhattan and
walked into the clinic at the Duane Reade store at 50th Street and
Broadway on a recent morning for treatment of a sore throat. ?People
here value their time a lot.?

The average waiting time for an exam at such clinics nationwide is 15
to 25 minutes, according to the Convenient Care Association.

The association estimated that 70 percent of clinic patients have
health insurance and are using the clinics because of convenience. For
them, costs may not be much different from those at doctors? offices,
because the same insurance co-payments apply. But uninsured patients
could reap substantial savings.

In New York City, one in five residents lacks a regular doctor and one
in six is uninsured, according to a recent survey by the city?s
Department of Health and Mental Hygiene, and overcrowded emergency
rooms are often their first resort for routine care.

State officials acknowledged the clinics? appeal. But they said they
were looking into possible violations of state law prohibiting
unauthorized corporations like pharmacies, which are licensed only to
provide pharmaceutical services, from delivering medical care.

?If we determine the business corporations are practicing medicine,
then they are illegally practicing the profession and we have the
authority to investigate,? said Frank Munoz, associate commissioner of
the State Education Department?s Office of the Professions.

MinuteClinic, a wholly owned subsidiary of CVS Caremark, the drug chain?s
formal name, and the largest of more than a dozen clinic operators
nationwide, manages seven clinics at drugstores in New York state,
including one on Staten Island, and 20 others in New Jersey and
Connecticut. The company said it hoped to open as many as 150 more
clinics in the New York area, which would be staffed by nurse
practitioners and physician assistants.

New York law requires that nurse practitioners work closely with a
physician, who oversees the practice but is not required to be at the
clinic, and that the clinics operate as independent practices or
professional corporations. In other states, the medical providers can
work directly for a drugstore company, a practice that has touched off
concern that the providers might place the interests of their employers
above those of patients.

MinuteClinic officials insisted that there was nothing improper in the
relationships between providers and the drugstores and that medical
care is not being compromised.

?We are transparent with regulators,? said Michael C. Howe, the chief
executive of MinuteClinic, which is based in Minneapolis and operates
more than 200 clinics nationwide. using the motto ?You?re Sick, We?re
Quick.?

Mr. Howe said the concerns of doctors? groups and other critics ?are
being raised by voices of people who have not really studied the
model.?

Preliminary data from a two-year study of claims from MinuteClinic by a
Minnesota health maintenance organization, HealthPartners, which was
released to The Minneapolis Star Tribune in July, showed that each
visit to the retail clinic cost an average of $18 less than a visit to
other primary-care clinics, but that pharmacy costs were $4 higher per
patient.

Duane Reade, New York City?s largest drugstore chain, which opened four
clinics in Manhattan in May, plans to open as many as 60 more across
the city in the next 18 months. A key difference at the Duane Reade
clinics is that they use doctors, while nurse practitioners and
physician assistants typically provide the care at most retail clinics.

The American Medical Association, contending that patients might be
sacrificing quality for convenience or seeking help at drugstore
clinics for problems that should be addressed by their doctors or a
hospital, has proposed a series of guidelines, including a requirement
that the clinics have a ?well-defined and limited scope.? The
association has also urged federal and state governments to investigate
how the clinics operate.

Pediatrician groups have strongly opposed reliance on the clinics
because of the importance of having doctors who are familiar with a
child?s medical history.

After doctors? groups in Massachusetts protested MinuteClinic?s plans
to open the state?s first retail clinic, the Health Department issued
guidelines for what the state is calling ?limited service clinics,? and
has scheduled two public hearings next month.

New Jersey health officials said they were looking at what
Massachusetts and other states were doing to regulate the clinics and
were considering whether they should propose new regulations to oversee
them.

In New York, the company operating the Duane Reade clinics, Consumer
Health Services, announced last week that it had entered into a
partnership with several New York City hospitals that will work closely
with the Duane Reade doctors.

?We are in the embryonic stage of a new era in New York City health
care,? said Adam Henick, senior vice president for ambulatory care and
medical enterprise at Continuum Health Partners, the parent company of
St. Luke?s-Roosevelt Hospital Center and Beth Israel Medical Center,
which are working with the Duane Reade doctors. ?The traditional place
that we deliver care is no longer in the traditional location.?

Under the partnership agreement, the doctors at Duane Reade will have
admitting privileges at the Continuum hospitals and the drugstore
clinics can streamline a patient?s journey to a specialist or through
the emergency room, when that is necessary, because of the
relationship, company officials said.

The Duane Reade retail clinics, advertised at the stores as ?Duane
Reade Walk-In Medical Care,? function as private medical practices that
lease space from Duane Reade. Despite the name, doctors own the
clinics, which have low overhead costs in a city where setting up a
practice can be wildly prohibitive.

Doctors? groups said they had fewer objections to doctor-run retail
clinics, because the doctors are accountable to a state licensing
board.

But New York State officials are still looking at these ?physician
based models,? Mr. Munoz said, to determine whether there were any
inappropriate connections between the prescribing doctors at the
clinics and the pharmacy?s bottom line.

The pharmacy companies and the operators of the clinics insisted that
customers are not told where to fill their prescriptions. But the
proximity of the pharmacy is part of the appeal for consumers, and
Duane Reade officials said they would undoubtedly see increased sales
at pharmacies with clinics.

The clinics accept most health insurance plans, although the Duane
Reade ones do not yet accept Medicare and Medicaid. At Duane Reade,
prices for services are posted on a large board near the check-in
counter ? from a basic exam at $95 to more complicated procedures for
wart removal, abscess drainage or treatment of a sprained ankle for
$199.
========================

Seems to me as if it just might be an idea whose time is NOW.
Interesting. But, I'd still prefer to have a single doctor (an
internist) to oversee my health care.
(With me overseeing his decisions of course; after all I celebrate life
within this body 24/7)

McDave of Merryland
========================================================================



I too would prefer a single Doc overseeing my healthcare but considering
the "on the go" society we live in its right for current times.

Just imagine the "Blue Light Specials" ads :-)


The way I see it, for something really minor it might be OK (pinkeye was
mentioned) because it seems silly to take up time in a doctors office,
waiting time, expense, etc. for something so minor.

But an untrained person may not be smart enough to realize what is "minor"
and what might be more serious. I could see lawsuits coming of this, and
also serious situations that masqueraded as some little problem, but were
really a serious thing starting up, unrecognized. I can also see people
going to a druggist for help with a medical problem and neglecting more
serious other health issues that might come up in the course of a proper
routine medical exam.

--
Best Regards,

Evelyn
==========================================

Oh. . . In my previous post I forgot that there is at least one among us
that does get more than one time around. Nevertheless, my statement
remains applicable.

McDave
============================================



.

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