Wednesday, December 20, 2006

RediClinic? Huh? Where did this come from?

I understand where they're coming from, but when non-doctors start producing cheap-care clinics staffed by NP's to take care of the supposed "uncomplicated" issues in medicine, it makes me wonder where healthcare is going in this country? That's a problem and a lawsuit waiting to happen.

RediClinic is opening walk-in clinics staffed by NPs in WalMarts and Duane Reades around the country. Their biggest investor is the Revolution Health Group, a company founded by AOL Co-founder Steve Case. Their CEO's message on the website starts by saying that, "Healthcare is one of the largest and fastest growing industries in our country, accounting for more than $3 trillion in sales..." Ok, great, this is the first line from a clinic that is supposed to be about "high-quality, low cost routine healthcare." Oh, but they don't want a bite of this, because they're producing so-called "'convenient care'" centers through their RediClinics. They're calling it "consumer-driven healthcare," but it actually comes down to retail healthcare. Yes, ladies and gents, you are witnessing the retailization of medical care. Would you like some hair gel and shampoo with your flu shot? How about some toothpaste with your health assessment?

But seriously, let's analyze this. These clinics are staffed by NPs. They don't mention where the supervising physician is. In fact, some state laws use the word supervising loosely to mean -- easily accessible via telephone. So the physician doesn't have to be in the clinic to examine a questionable case. Ok, fine, you can say that this is only routine simple care. What about headaches? Will these NPs know who to send to the ER? What if it's a subarachnoid hemorrhage? Or a brain tumor? Will they know? Maybe routine care is fine. But they've gone beyond that. They talk about providing "stay well services," marketed as Men's and Women's Health Assessments and Diagnostic Screening. Wait a second, should I be hanging up my stethoscope and retiring from medicine? They apparently are going to do everything I do, and for a cheaper cost, because NPs cost less than MDs. I'm curious to know how quality will be maintained?
Peeved!? Yes, I am. They're infringing on my territory, and falsely marketing an ability to take care of more complex issues in medicine by promising health assessments.

What if a patient has a neurological issue? Will they be ordering MRI's? What neurologist will they be referring their patients to? And how about continuity of care? I find a company delving into healthcare, run by mostly corporate types, to be a dangerous thing, for corporations care about numbers -- the bottom line is cost, no matter how much they may say they care about quality. What quality is there in marketing drive-by, quick-fix healthcare. I truly believe this is dangerous. It's almost like a health insurance plan now also becoming a medical provider. Where is the RediClinic's greatest interest -- cost or standard of care? I understand the American public has been accustomed to quick, drive-through consumerism, but this is a dangerous mentality to pass on to medical care. Ever since HMOs tried to rear their ugly face in this country the quality of care has suffered. What looks too good on the surface cannot be that good. I don't think this is my Trojan Horse, nor that for the rest of primary care physicians in this country, but I ask, "Should we be standing by idly watching this happen?"

Apparently, we're already involved. Can you hear the the dark side of the force calling? Now this is frightening to me -- the American Academy of Family Physicians (AAFP) has signed an official agreement with the RediClinic for adhering with its "desired attributes of retail health clinics." Et tu, Brutus? That the AAFP is encouraging the formation of these clinics is disheartening. That this is going to be sold to the American public as good care is disgusting. One thing is treating a simple sore throat, another thing is having an NP do a routine health screening. What if the cholesterol is elevated? What if there are EKG abnormalities? Will they recognize them? Again, who will they refer to? And how do they know the specialist they may refer to takes good care of patients when you are literally popping into the neighborhood without any established relationships and opening the equivalent of the McDonald's of healthcare down the corner.

I hope some good will come of this for the uninsured. Or maybe we can learn from what Dr. Vic Wood is doing. Read: Crisis in Healthcare: Does Vic Wood have the answer?

The RediClinic has signed agreements with Aetna and Humana. Apparently, UnitedHealthcare is also joining the bunch. It's disturbing. Will they use this as an excuse to further lower our
reimbursements? Is the PCP being slowly squeezed out of medicine? Will we be facing a slow death of 1000 years in the belly of the insurance giants?

"Ho, ho, ho....ha, ha, ha....Goodbye PCP's....Your measly mind tricks won't work on the mighty Jabba, the RediClinic CEO"

16 Comments:

Anonymous Bonnie said...

I find this a frightening concept. Although my practice is complementary care, I think anything that further streamlines the mainstream medical process is scary. Doctors are already expected to spend too little time for the reimbursement with patients.

I guess what's really scary, is that many of the people who will use those services don't understand the limits of an NP and the limits of this type of care.

12:32 PM EST  
Blogger Bottlerocket said...

Come on now. There is no data that physicians provide better care than NPs. I understand that NPs are not neurosurgeons, oncologists, cardiologists, etc. But the fact is that most problems are benign. Thirty years ago, when Mao's "barefoot doctors" roamed the Chinese countryside, there was a great improvement in population health. I don't know that I would go to a Wal-Mart clinic, I'm insured; you can't that healthcare has priced itself out of reach for many of the people who shop or work at WalMart. This is not a shot at primary care physicians, for whom it is well established that their practices improve overall health. Perhaps you've seen the papers by Dr. Elliot Fisher, who found that as the concentration of specialists go up, population health goes down. I do agree with the limits this type of care; but from what I've seen, they spell this out quite carefully. Unfortunately, malpractice attorneys are probably watching this quite carefully.

8:49 PM EDT  
Anonymous Anonymous said...

NP's provide an essential service to the community. They provide services in communities were doctor's are overloaded or few doctor's are available. Health maitenance seems to have been placed on the "back burner" of health care these days an most would agree that the ER is not the place to have your cardiac function monitored every month or refill blood pressure medications. With that said, what is a community to do? Many of the clinics I have seen are health screening clinics. Blood pressure, BMI and cholesterol are measured and the results given to the patient. Numerous studies have shown the benefit of health screening events, such as identifying chronic problems and refering these patients to an M.D. As for in-store facilities that are open on a day to day basis, I'm still on the fence, although, NP's are highly skilled and do not overstep their bounds. They are trained in health regulations, diagnosis and treatments within their scope of practice. In general, you will see most NP's working in a community health, health maitenance or urgent care capacity. The impression your blog implies, is that NP's are not trained as MD's, correct but skewed since the focus on health is in a different perspective.

11:58 AM EDT  
Anonymous Anonymous said...

It is quite funny that the initial commentator of the blog looks at the financial end of the stick and not the medical care that the RediClinic and others like it iare providing to patients in both metropolis and rural areas where some physicians aren't or whose hours are limited to 9-5 or closed on Tuesday due to surgery or other commitments. RediClinics are open as per www.rediclinic.com from 8-8M-F as well as open on Saturday and Sunday.

Where would someone find care other than the ER for a co payment of 100 dollars or more when they do not have the funds? RediClinic, Minute Clinic and others, like those that have started in Mr. Manhattan's area.

Frigthening concept, or is it just that it is hitting you in the pocket??

Let's go back a few years and look at what happened with HealthCare Reform in the early 1990s that has forced the hand of many. This is the end result of this. Patients are tired of the $140 dollar visits for colds and the 2 hour waits. The change of healthcare billing has created the madness in the offices where doctors are triple booking patients into one 15 minute slot because of the likelihood they will not show up; but what if they do. Then you have 3 people waiting for the same time and someone is angry.

Minute Clinic and many others like it have a certain scope of practice that will not and cannot invade in Neurosurgeon's or other specialty types of practice. There are no appointments. Take a look at the site and stop creating a mountain out of a molehill.

Knowledgeable Practitioner, MAG

8:56 PM EST  
Anonymous Anonymous said...

Hey doc, cool your jets. These NP's are overseen by a local board of doctors, and are quite competent. I'm a contractor for RediClinic, doing health screening fairs, and we are quite adequately trained, and well supervised. We will not serve anyone who, in our judgment, appears ill. "First Do No Harm" That goes triple for flu shot drives.

You need not lay down your Littmann, but do realize that these mini-clinics are mainly for those who have a little ache here or need a quick physical there. Anything that even appears serious gets referred-out, or at worst, an ambulance called.

The NP's I've known while I've been with RediClinic have always impressed me as knowing their stuff, but they're just as quick to urge someone to see their regular doctor, or see a specialist. And they really DO watch their limits, and they'll tell a patient so.

We can all appreciate a MD's greater expertise, and none here will deny that, but if my PCP is booked for up to two weeks, I'm sometimes not able to wait that long, and as long as my needs are relatively minor, an NP is a great alternative. I'll usually follow up with my PCP at a later time.

As for RediClinic coming to Wal-Mart, I think that's a great thing, for those whose needs are minor, and for those who have no insurance coverage, but could afford $50 to be seen without a long wait time. SO WHAT if I can get my flu shot, motor oil, milk & bread, and underwear all under the same roof !!!

Just my $0.02

3:37 PM EST  
Anonymous Anonymous said...

We've developed a way to prevent kidney failure in patients with diabetes or hypertension. We've also published a remarkably effective treatment for COPD. My only interest is getting it into the clinic. If there are any PCPs out there who want to use cutting-edge medicine to get superior outcomes, please contact me. For the moment, the NPs are staying away from chronic care, but that won't last long.

For the participating PCP, we can double your income while seeing the same number of patients.

For what it's worth, the AAFP had no interest in this program when I contacted them several years ago. So I'm not that surprised to see that they sold you out to retail clinics.

Preventive molecular medicine is here. Whoever wants to deliver it is welcome to. Obviously, effective prevention of disease is what patients want. I thought it was what PCPs wanted to. For the past 6 years, though, I must say I've been underwhelmed by PCPs' initiative.

Best regards,
Dave Moskowitz MD FACP
CEO & Chief Medical Officer
GenoMed, Inc.
www.genomed.com
dwmoskowitz@genomed.com

11:38 AM EST  
Anonymous Anonymous said...

Only 10% of Doctors graduate in the top 10% of their class and many doctors do not deserve the paper their degree is written on.

If doctors cared less about paying for their huge mortgages, lavish vacations, etc... and made health care more affordable, the rediclinics of the world would not be necessary.

I do not have health insurance and I have four children to care for. I was able to go to a NP office (not rediclinic) for a $35 visit. The great thing about the visit, I already new he had a sinus and ear infection, already knew what prescriptions he needed and I didn't have to sit in the waiting room for an hour and then in the exam room for another 30 minutes waiting for the "doctor" to come in to me see for 2 minutes with his haughty attitude, lack of people skills and patience to listen to me and a prescription already written out before he saw my child (which was probably referred to him by the nurse who took his vitals and did a basic pre-exam and questionaire before the "doctor" arrived).

Come on we both know the nurses do all of the work anyway so why not let them open and run their own offices. I think it is a great idea and I think medical care will go up exponentially.

I was so impressed with our NP that I asked for at least 10 of her business cards to hand out to my friends and associates and I have even begun exploring with an investor the idea to open more of these NP offices because of the great need the USA has for them.

You say that a nurse cannot diagnose something major, well what about something minor like asthma. For four years our Ped's doctor told us our two year old son had a running cough and he would grow out of it. After several sleepless nights over four years our doctors office got a new doctor from the childrens hospital in San Diego and and the first question she asked us was "what asthma medicine was he on? When we told her our history with the "best Ped doctors office in San Diego" she apologized and said we cannot change the past so lets look to cure him in the near future. Finally he got a good night sleep in four years.

Should you be worried, damn right you better be worried. 9 times out of 10 I would prefer a rediclinic over an overpriced doctors office.

Until you guys learn to get over yourself and start living the "medical code" you swore to. Instead of using your medical paycheck from your overcharged office visits and fees to fund your bad real estate investments or day trades that have gone sour.You guys do not have a chance.

Now with that said, over the last 12 years raising four children, there have been maybe 2-3 doctors that I would pay whatever fee they wanted to charge me but unfortunately they are the exception and not the norm compared to only one nurse we could not stand during that same time frame.

We also moved from San Diego to Austin and Dr. Pearson in San Marcos is one of those 2-3 doctors that we would visit, used to call in prescriptions for me over the phone for my overseas long distant flights. Well when I called a local Dr.s office in Austin and told him I have been taking these prescriptions for the last five years as needed for trips but the pharmicy would not take a faxed prescription request from my SD doctor, he charged me $185 to "get to know me" before he would write me a prescription, and he was the cheapest guy in town.

You rip on AOL and other investors trying to retailize the medical field via money motivation, I am sure it is not as hard to get into or stay in medical school as it was before and you can be sure it is based on the schools motivation for money.

So if you want to blame someone for the Rediclinics of the world, well dont blame AOL, get up off your lazy butt and go look in the mirror, or the rearview mirror of that fancy sports car/suv/etc...

Regards,
disgusted medical patient/father of four

1:43 AM EST  
Anonymous Anonymous said...

You doctors act like NP's are infringing on your business. As an NP, I feel, all the time, that people aren't being educated about what we are cabpable of doing. WE are not just limited to the very "easy or simple exams and treatment". We do work in critical care areas, and also work with more serious types of patients with chronic complicated diseases. It does depend on which specialty you were trained for. So, I don't appreciate being lumped into the category as the "cold and flu" practitioner. Second, it is this very type of public disparaging that causes people to misunderstand the role of NP's. So, doctors, Stop being so territorial, the world is big enough for all types of health care providers and people will benefit from this type of medicine.

2:23 PM EDT  
Blogger Dr. Mom said...

Boo Hoo, sounds like Dr. Manhattan is being hit right in the pocket book, if Rediclinic is responsible for his loss maybe some self-evaluation is due. I personally don't focus on $$$$$ but focus on my patients. As a matter of fact the majority of patients prefer an NP because they state they seem to care more about me, they listen, and do a lot of teaching. I think Dr. manhattan is maybe jealous he didn't think of this venture first but I must say he should do a little research before attempting to describe NP education. I do believe NP are competent to know that when a patient presents with projectile vomiting, HA, mental status changes, and papilledema that the patient clearly has ICP and must be sent to the ER. NP's do know about subarachnoid hemorrhage and even subdural....hey. And did you know that a lot of NPs hold doctorates and may be called DR? I know that really chaps your hide....oh well. Did you also know that in California the Kaiser hospitals are staffed with NPs, you must see an NP first and if needed for referral purposes the doctors are available. Patients are happy and the care is good...live with it!

3:16 PM EDT  
Blogger Dr. Mom said...

Boo Hoo, sounds like Dr. Manhattan is being hit right in the pocket book, if Rediclinic is responsible for his loss maybe some self-evaluation is due. I personally don't focus on $$$$$ but focus on my patients. As a matter of fact the majority of patients prefer an NP because they state they seem to care more about me, they listen, and do a lot of teaching. I think Dr. manhattan is maybe jealous he didn't think of this venture first but I must say he should do a little research before attempting to describe NP education. I do believe NP are competent to know that when a patient presents with projectile vomiting, HA, mental status changes, and papilledema that the patient clearly has ICP and must be sent to the ER. NP's do know about subarachnoid hemorrhage and even subdural....hey. And did you know that a lot of NPs hold doctorates and may be called DR? I know that really chaps your hide....oh well. Did you also know that in California the Kaiser hospitals are staffed with NPs, you must see an NP first and if needed for referral purposes the doctors are available. Patients are happy and the care is good...live with it!

3:16 PM EDT  
Anonymous Anonymous said...

Dear Infringed upon MD,

Have you been living on another planet for the last few decades? PAs, of which I'm a well trained and experienced one, have been providing QUALITY healthcare in our ailing healthcare system for many years. You SHOULD BE WORRIED about your infringed upon territory 'cause something's got to give, perhaps one fewer BMWs parked in your garage, a couple fewer vacation homes. I have been a PA for over twenty-one years, working with an Army ENT surgeon, with pediatricians, family physicians, in renal transplant, organ and tissue recovery, convenient/urgent/ER fast track care, psychiatry at a state psych hospital, tropical medicine and radiation related medicine in the remote Marshall Islands, and I could go on and on and on. I bet I can diagnosis a cholesteatoma better than you, unless you are an EN. I bet I know more about immunosuppressant/antirejection transplant meds than you unless you are a transplant surgeon, and I know I KNOW more about long term radiation related diseases due to our hydrogen bomb testing in the 1950s. What's your come back for that? I am well trained and experienced and I spend more time with my patients than you and probably can prove that I know more than you in certain areas of medicine that I have seen in an urgent care setting. You would be lucky to work with me. And the funny thing is, is that patients can tell when someone may have unique experiences and knowledge that the average MD doesn't possess and I treat my patients as if they are family members, not just a morgage payment.

Melissa Pfitzer, PA-C
Southport, North Carolina

1:38 PM EDT  
Anonymous Anonymous said...

I work for a prominent convenience care clinic chain in Houston. If I was really sick, I would not seek treatment there. I would spend the extra money and see a physician. However, I do feel these types of clinics are good for those "soccer mom" types who like to take their children in (sometimes all at once) to the doctor every time they sneeze for high dose antibiotics.

7:23 AM EDT  
Anonymous DrMistyFunk said...

I personally love the RediClinic and think they provide great service to myself and the community. I get annual bloodwork, bimonthly B-12 shots, and visit them if I have a minor aliment such as a cold. All of these at a fraction of the cost to see a PCP.

I do believe that NPs are intelligent enough to know when to refer a patient out, so I will confidently go back for my minor healthcare needs. I also think I am intelligent enough to know when to seek more specialized treatment!

And to be honest...RediClinic is much more convenient, quick, and friendly than my busy PCP's office!

3:46 PM EST  
Anonymous Not a doc but not a dummy said...

Doc, you might want to do a little research before you start slamming another profession which you seem to know very little about. Numerous research has shown that NPs provide the same level of quality of care to patients (with perceived higher quality in pediatrics) as MDs do and our patients are generally more satisfied with our care vs the MD. Does that makes us better? Not at all but don't slam something you don't fully understand. For the record, NPs CAN recognize a SDH vs a general headache and lo-and-behold, I can read a 12 lead EKG with the best of them (thanks to cardiac CC). Will I get everything correct? No, but neither will you. NPs are here to fill in the gap because MDs are specializing, leaving a large percentage of the population without a general practitioner. Is a Rediclinic the solution? Maybe but I cannot say for sure. The best solution will always been good quality, afforable healthcare for our patients....especially with a team effort.

3:35 PM EDT  
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