Re: retail clinics and NPs

April 10, 2010

Thank you, I really enjoy your posts especially. I loved the "pay what you can" day, and have thought I might give that a try after I open this summer because it will give me a bit of free publicity. Free marketing is good!

You're so right that the retail clinics fracture care. Although we always print out notes and tell patients to give them to their providers, almost all the time the patient says, "I don't have a PCP." A lot of the people who use the clinics have the high-deductible HSA plans, and want to conserve those HSA savings, so they don't get any primary care to speak of. Or they don't have insurance at all because they're self-employed, unemployed, COBRA is so expensive they'd have to sell their children, or they just think they're so healthy they don't need it. Until they're in trouble.

I talked a lot to the corporate mucky-mucks at The Little Clinic about expanding services to these people so we could be an affordable option for primary care, but at the time, they said that didn't fit "their business model." So now they're going to expand to a few things -- but it still won't be full primary care. The clinics are so small, you really can't have the equipment you'd need, and the NPs work three 12-hour shifts a week, so it depends on the day you show up, whether you get to see the same provider or not -- still fractured.

And they're not doing very well economically because they have the same problem that insurance companies and hospitals have -- layer after layer of corporate people who DO NOT provide any health care, but who DO have to be paid!! With the buildings, computers, human resources, marketing, blah, blah, blah -- just another layer of expense between the provider and the patient.

That's why I love the IMP model -- it gets down to brass tacks. What do I really need to provide this care? How can I get that (space, supplies) at the best cost so I can pay myself a decent income (recognizing that we all have different ideas about the word 'decent') and still give excellent care to the patient?

It is interesting what our society values, isn't it? We have no problem paying celebrities and athletes multi-zillion dollar salaries, building huge entertainment complexes at the public's expense, but pay for excellent patient-centered health care? That's socialism.

Thank you for letting me be part of your group. I have this tendency to speak my mind even when no one really wants to hear it. You could ask my professors, classmates, and husband about that. I'll try to be sensitive! It's hard for me.

Deanna

retail clinics and NPs

welcome Deanna

Wondering who you were-saw you name somewhere

The list serv tends to be crabby becasue we are so beleaguered with crap Of course there is more than enough work for everyone and I think that acting threatened by someone else who takes care of people isn;t the best thing to do,Becasue we are so beaten down into the ground, becasue we see nurse anesthetists being paid more than we are and acting justifed about it, becasue the best of our good intentions get eroded by some bad event 4 times day every day ,new events, something that invades and slaps and robs us of money and time or causes us to make an error or not be able to get the med interactions or reminders things tuned up etc , becasue of allof these things many of us at just at our wit's ends We see our friends providing fabulous measured and documented quality at low cost but unable to send thier kid to a state college. Or unable to paint the hous ebuy a car save for retiremtn

We do not see NPs or nurse anesthetists or cardiologists etc supporting us. We stand out here alone and fed up

I read somewhere recently the retail clinics were not really doing very well e conomically so I think we end up back at square one- some people just need something immediately and will make use of such services and so, fine . NOT comprehensive continuity of care but the strep throat or uti needed treatment AND physicians in this country have not found a way to provide access

retail clinics are no different that the stamped out plastic shoes from china you f ind inside the same big box stores American shoe workers-I live in MAIne big industry here til recent yrs when all shoes went cheap coming from overseas in the same lesser quality as medicine in walmart so are shoes form walmart-- cheaper shoes cheaper medicine but accessible and good while it lasts,- american shoe workers were skilled sewers and zillions lost their jobs out of work becasue americans won;t buy quality they want instant and cheap)

Physicians have both hands tied behind their backs more in some regions than others IT is extraordinarily difficult not to be angry

Please understand that and remain and engage withus This lists erv tries to be forward thinking and patietn centerd but you can only hit people so much before even t he best of us get fed up SOme of the people who are still here had to close thier practices

so sometimes the bestw e do for each other is provide community

Jean

--

PATIENTS,please remember email may not be entirely secure and that Email is part of the medical record and is placed into the chart ( be careful what you say!)

Email is best used for appointment making and brief questions

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MD

ph fax

impcenter.org

April 10, 2010

I dont know where that thread veered so off track.. not even going there

it was more a comment on how corporations are picking the low hanging fruit of more easily managed diagnoses where there is a vast body of knowledge to fall back on( yes " protocols " ), and leaving the toughter stuff that require more work to ...who?

and yes probably the reason retail clinics are looking at disease management is because their model is not quite working as well as they thought.

welcome Deanna

Wondering who you were-saw you name somewhere The list serv tends to be crabby becasue we are so beleaguered with crap Of course there is more than enough work for everyone and I think that acting threatened by someone else who takes care of people isn;t the best thing to do,Becasue we are so beaten down into the ground, becasue we see nurse anesthetists being paid more than we are and acting justifed about it, becasue the best of our good intentions get eroded by some bad event 4 times day every day ,new events, something that invades and slaps and robs us of money and time or causes us to make an error or not be able to get the med interactions or reminders things tuned up etc , becasue of allof these things many of us at just at our wit's ends We see our friends providing fabulous measured and documented quality at low cost but unable to send thier kid to a state college. Or unable to paint the hous ebuy a car save for retiremtn

We do not see NPs or nurse anesthetists or cardiologists etc supporting us. We stand out here alone and fed up I read somewhere recently the retail clinics were not really doing very well e conomically so I think we end up back at square one- some people just need something immediately and will make use of such services and so, fine . NOT comprehensive continuity of care but the strep throat or uti needed treatment AND physicians in this country have not found a way to provide access

retail clinics are no different that the stamped out plastic shoes from china you f ind inside the same big box stores American shoe workers-I live in MAIne big industry here til recent yrs when all shoes went cheap coming from overseas in the same lesser quality as medicine in walmart so are shoes form walmart-- cheaper shoes cheaper medicine but accessible and good while it lasts,- american shoe workers were skilled sewers and zillions lost their jobs out of work becasue americans won;t buy quality they want instant and cheap)

Physicians have both hands tied behind their backs more in some regions than others IT is extraordinarily difficult not to be angryPlease understand that and remain and engage withus This lists erv tries to be forward thinking and patietn centerd but you can only hit people so much before even t he best of us get fed up SOme of the people who are still here had to close thier practices

so sometimes the bestw e do for each other is provide communityJean

-- PATIENTS,please remember email may not be entirely secure and that Email is part of the medical record and is placed into the chart ( be careful what you say!)Email is best used for appointment making and brief questions

Email replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org

-- Sangeetha Murthy M.D

April 10, 2010

more from the same articlehttp://www.kevinmd.com/blog/2010/04/retail-clinics-starting-primary-care.html

In another study still in press, Mehrotra and colleagues interviewed retail clinic patients to find out more about why they went to the clinics. For the uninsured patients, “one of the things that was a key driver . . . was the transparent pricing,” he said.

One woman taking her son to the clinic told the researchers, “I could take him to a doctor but I would not know how much things would cost. But here the cost is up front.” Retail clinics typically post their pricing, often on large signs. "

I dont know where that thread veered so off track.. not even going there

it was more a comment on how corporations are picking the low hanging fruit of more easily managed diagnoses where there is a vast body of knowledge to fall back on( yes " protocols " ), and leaving the toughter stuff that require more work to ...who?

and yes probably the reason retail clinics are looking at disease management is because their model is not quite working as well as they thought.

welcome Deanna

Wondering who you were-saw you name somewhere The list serv tends to be crabby becasue we are so beleaguered with crap Of course there is more than enough work for everyone and I think that acting threatened by someone else who takes care of people isn;t the best thing to do,Becasue we are so beaten down into the ground, becasue we see nurse anesthetists being paid more than we are and acting justifed about it, becasue the best of our good intentions get eroded by some bad event 4 times day every day ,new events, something that invades and slaps and robs us of money and time or causes us to make an error or not be able to get the med interactions or reminders things tuned up etc , becasue of allof these things many of us at just at our wit's ends We see our friends providing fabulous measured and documented quality at low cost but unable to send thier kid to a state college. Or unable to paint the hous ebuy a car save for retiremtn

We do not see NPs or nurse anesthetists or cardiologists etc supporting us. We stand out here alone and fed up I read somewhere recently the retail clinics were not really doing very well e conomically so I think we end up back at square one- some people just need something immediately and will make use of such services and so, fine . NOT comprehensive continuity of care but the strep throat or uti needed treatment AND physicians in this country have not found a way to provide access

retail clinics are no different that the stamped out plastic shoes from china you f ind inside the same big box stores American shoe workers-I live in MAIne big industry here til recent yrs when all shoes went cheap coming from overseas in the same lesser quality as medicine in walmart so are shoes form walmart-- cheaper shoes cheaper medicine but accessible and good while it lasts,- american shoe workers were skilled sewers and zillions lost their jobs out of work becasue americans won;t buy quality they want instant and cheap)

Physicians have both hands tied behind their backs more in some regions than others IT is extraordinarily difficult not to be angryPlease understand that and remain and engage withus This lists erv tries to be forward thinking and patietn centerd but you can only hit people so much before even t he best of us get fed up SOme of the people who are still here had to close thier practices

so sometimes the bestw e do for each other is provide communityJean

-- PATIENTS,please remember email may not be entirely secure and that Email is part of the medical record and is placed into the chart ( be careful what you say!)Email is best used for appointment making and brief questions

Email replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org

-- Sangeetha Murthy M.D

April 11, 2010

Which they hire NP’s to implement.

From:

[mailto: ] On Behalf Of Sangeetha

Murthy

Sent: Saturday, April 10, 2010 2:02 PM

To:

Subject: Re: retail clinics and NPs

I dont know where that thread veered so off track.. not even

going there

it was more a comment on how corporations are picking the

low hanging fruit of more easily managed diagnoses where there is a vast body

of knowledge to fall back on( yes " protocols " ), and leaving the

toughter stuff that require more work to ...who?

and yes probably the reason retail clinics are looking at

disease management is because their model is not quite working as well as they

thought.

welcome Deanna

Wondering who you

were-saw you name somewhere

The list serv tends to be crabby becasue we are so beleaguered with

crap Of course there is more than enough work for everyone and I

think that acting threatened by someone else who takes care of people isn;t the

best thing to do,Becasue we are so beaten down into the ground, becasue

we see nurse anesthetists being paid more than we are and acting

justifed about it, becasue the best of our good intentions

get eroded by some bad event 4 times day every day ,new events, something

that invades and slaps and robs us of money and time or causes us to make an

error or not be able to get the med interactions or reminders things

tuned up etc , becasue of allof these things many of us at just at our

wit's ends We see our friends providing fabulous measured and

documented quality at low cost but unable to send thier kid to a state

college. Or unable to paint the hous ebuy a car save for retiremtn

We do not see NPs or nurse anesthetists or cardiologists etc supporting us. We

stand out here alone and fed up

I read somewhere recently the retail clinics were not

really doing very well e conomically so I think

we end up back at square one- some people just need something immediately

and will make use of such services and so, fine . NOT

comprehensive continuity of care but the strep throat or uti needed

treatment AND physicians in this country have not found a

way to provide access

retail clinics are no different that the stamped out plastic shoes

from china you f ind inside the same big box stores

American shoe workers-I live in MAIne big industry here til recent

yrs when all shoes went cheap coming from overseas in the same lesser

quality as medicine in walmart so are shoes form walmart-- cheaper

shoes cheaper medicine but accessible and good while it lasts,-

american shoe workers were skilled sewers and zillions lost their

jobs out of work becasue americans won;t buy quality they want

instant and cheap)

Physicians have both hands tied behind their backs more in some

regions than others IT is extraordinarily difficult not to be angry

Please understand that and remain and engage withus This

lists erv tries to be forward thinking and patietn centerd but you

can only hit people so much before even t he best of us get fed

up SOme of the people who are still here had to close thier practices

so sometimes the bestw e do for each other is provide community

Jean

--

PATIENTS,please remember email may not be entirely secure and that Email is

part of the medical record and is placed into the chart ( be careful what

you say!)

Email is best used for appointment making and brief questions

Email replies can be expected within 24 hours-Please CALL if the

matter is more urgent .

MD

ph fax

impcenter.org

--

Sangeetha Murthy M.D

April 11, 2010

and Locke style -----a few numbers re the business model..I think though they must be treating the clinics as a loss leader rather than a profit center...