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Archive for Tuesday, February 24, 2009

Walk-in clinics on rise

From left, Dermot Kerin, Lawrence, his two-year-old daughter Summyr and his wife Karen Kerin, wait in the lobby at First Med and Walk-In Center, 2323 Ridge Court, to see a doctor. Friends recommended the clinic to the Kerins, who moved from Wisconsin to Lawrence in November.

From left, Dermot Kerin, Lawrence, his two-year-old daughter Summyr and his wife Karen Kerin, wait in the lobby at First Med and Walk-In Center, 2323 Ridge Court, to see a doctor. Friends recommended the clinic to the Kerins, who moved from Wisconsin to Lawrence in November.

February 24, 2009

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On the street

Would you ever use a walk-in health clinic?

Yes I would, just for the convenience of it … as long insurance still covered it.

More responses

From left, KU freshmen Jen O'Hare and Abby Drogosz, both from Chicago, wait to see a doctor in the lobby of First Med and Walk-In Center, 2323 Ridge Court on Friday. Walk-in clinics are popping up across the nation to provide immediate care for people. Walk-In Center, 2323 Ridge Court, was one of the first walk-in  clinics in Lawrence.

From left, KU freshmen Jen O'Hare and Abby Drogosz, both from Chicago, wait to see a doctor in the lobby of First Med and Walk-In Center, 2323 Ridge Court on Friday. Walk-in clinics are popping up across the nation to provide immediate care for people. Walk-In Center, 2323 Ridge Court, was one of the first walk-in clinics in Lawrence.

Dr. David Dunlap has worked at First Med and Walk-In Center, 2323 Ridge Court, for five years and likes working there because he can provide care immediately.

Dr. David Dunlap has worked at First Med and Walk-In Center, 2323 Ridge Court, for five years and likes working there because he can provide care immediately.

Patient Jason Kelich, KU graduate student from Overland Park, visits with Dr. David Dunlap  at First Med and Walk-In Center, 2323 Ridge Court, on Friday. Dunlap has been at the clinic for five years and likes working there because he can provide care immediately. Walk-in clinics are popping up across the nation to provide immediate care for people.

Patient Jason Kelich, KU graduate student from Overland Park, visits with Dr. David Dunlap at First Med and Walk-In Center, 2323 Ridge Court, on Friday. Dunlap has been at the clinic for five years and likes working there because he can provide care immediately. Walk-in clinics are popping up across the nation to provide immediate care for people.

An explosion in the number of retail medical clinics is occurring nationwide.

From 2006 to 2007, the number of clinics grew 220 percent from 250 to more than 800, according to Deloitte Center for Health Solutions. The number is expected to reach 5,000 by 2010.

According the Kansas Health Policy Authority, Kansas has seen the fastest expansion of these clinics — 52 percent — between February 2008 and November 2008. The state has 25 clinics, including one that opened in September in Lawrence. Florida came in second with a 28 percent increase.

Why so popular?

The explosion has grabbed the attention of primary care providers. That’s because retail clinics are accessible and often cost less.

According to Deloitte, the cost of services provided at retail clinics ranges from $50 to $75, with the majority priced at $59, compared with a doctor’s office visit, which generally costs from $55 to $250. Another study found the average total cost for a retail clinic visit was $51 less than in the urgent care setting, $55 less than a doctor’s office and $279 less than in the emergency department.

Retail clinics often cost less because they are staffed by nurse practitioners — something most consumers don’t seem to mind.

Almost 50 percent of consumers report being receptive to retail clinics and are not concerned about safety issues.

“Consumers are looking for convenience primarily,” said Dr. Lori Heim, president-elect of the American Academy of Family Physicians. The retail clinics typically are open longer and see people on a first-come, first-serve basis.

She said the clinics serve two types of patients: those who don’t have a doctor and those who have a primary physician but can’t get a timely appointment.

Heim said the retail clinics are driving many doctors to expand hours and rearrange their schedules to allow for more same-day visits.

That is happening in Lawrence.

Two weeks ago, Mount Oread Family Practice extended its hours until 7 p.m. Monday through Thursday.

In November, Lawrence Family Practice Center opened its own walk-in clinic. Its hours are from 8 a.m. to 6 p.m. Monday through Friday and from 9 a.m. to noon Saturdays.

“It’s really just a convenience factor for all patients whether they are ours or someone else’s,” said Susan Hall, office manager.

The walk-in clinic is staffed by a nurse practitioner, but doctors are available for on-site consultations if needed. As of Jan. 15, the new clinic had provided care for about 250 people.

Fragmented care

Heim, of American Academy of Family Physicians, recommends using a primary care physician first and then a walk-in clinic at a physician’s practice as a second option if appointments aren’t available. She said retail clinics should be used only as a last resort to avoid going to a hospital emergency room.

That’s because the academy believes clinics are contributing to the nation’s problem of fragmented care. For example, there may be no follow-up appointment. Also, a patient may get an immunization, but his or her primary doctor never finds out.

“When a patient has one usual source of care from a primary care physician, they will have a better outcome and higher quality of care,” Heim said.

For example, Heim said if one of her diabetic patients made an appointment for a cold, she might remind that patient to get her glucose levels checked. She also might ask if the patient has had a mammogram and maybe even schedule an appointment.

“There’s continuity,” she said. “If you are a patient, you already are going to a doctor that has your medical records, they know your medical history and they will be able to follow up with you.”

Filling a void

But, Gabriel Weissman, Take Care Health Systems spokesman, said the company’s Take Care Clinics, which are located in Walgreen Drug Stores, go the extra mile to provide continuity of care.

He said all patients receive a follow-up phone call from the nurse practitioner who provided treatment. All patients receive a copy of their visit record and, if consent is given, a copy also is faxed to their primary care provider’s office. If a patient doesn’t have a primary care provider, the clinic provides a list of doctors who are accepting new patients in the area.

“We are really focused on providing high-quality, affordable and convenient health care,” Weissman said. “We are absolutely an advocate for our patients.”

The clinics operate under the same state guidelines as other health facilities, Weissman said. Take Care Clinics also have met additional guidelines set by the Convenient Care Association. On Feb. 10, the clinics passed an official certification process by the Jefferson School of Population Health, a premier academic health center. Take Care Clinics were noted for their exceptional performance in quality monitoring, quality of care, patient referrals to primary care providers and usage of electronic medical records.

The first Take Care Clinic opened in November 2005 and since then has expanded to 330 clinics in 19 states and has served 1 million patients. It owns at least half of the retail clinics in Kansas, including the one in Lawrence.

Take Care Health Systems says it is filling a gap in the country’s health system. Here’s why:

• Nearly 30 percent of patients would have gone to the emergency room if a clinic didn’t exist. Eleven percent would not have sought treatment.

• About 20 percent of patients are either uninsured or pay cash for these services, suggesting they may be uninsured or underinsured.

• Roughly 30 percent of patients who visit the clinics do not have a primary care provider.

Olathe Health Care System and CVS Pharmacy own the other retail medical clinics in Kansas. A CVS Pharmacy spokesman said there are no plans to add a clinic in Lawrence.

Lawrence’s first walk-in clinic

Dr. Ronald Burt is a pioneer when it comes to providing convenient health care in Lawrence. Burt and his wife, Nancy, opened First Med Family & Walk-in Care Clinic on Aug. 2, 1993.

“We were new to town and we had seen that there was no walk-in medical care available,” Burt said. “We thought we should try and fill that need.”

On that first day, he provided care for 14 patients who walked into the clinic. The clinic still serves two of those patients, but is much different today. Now there are five doctors and one nurse practitioner, and their business is about 40 percent walk-in patients and 60 percent ongoing patients.

Burt said his job is gratifying because he works in acute and chronic care. Priority is given to the clinic’s regular patients who have appointments, he said, and the system has worked well.

Dr. David Dunlap said working in a walk-in clinic is what attracted him to Lawrence.

“I like the idea of being able to provide same-day care. When people are sick, I don’t think they should have to wait three or four days to get treated,” Dunlap said.

When he practiced in Hutchinson, he left time open for same-day appointments and generally filled them. It’s something he thinks many doctors don’t do because they fear they won’t be busy.

Dunlap said Lawrence’s new walk-in clinics haven’t slowed business, and he noted differences. At First Med, clients will see a doctor, not a nurse.

“If those places can provide quality care, then great,” Dunlap said. “But I think sometimes they’re limited in what they can see. We don’t have too many limitations.”

Wait-and-see approach

The National Academy for State Health Policy released a report this month regarding the operation and licensure of retail clinics. Despite the rapid growth, it found few states have developed regulations to govern retail clinics’ organization and operations. Many states are just letting market forces decide the fate of retail clinics. Only Massachusetts has written regulations specific to retail clinics.

The Kansas Department of Health and Environment and the Kansas Health Policy Authority had no comment on the growth or regulations concerning retail clinics.

For a majority of states, the care provided in retail clinics is not subject to oversight by health departments, according the national report. Instead, oversight is provided by the applicable licensing authority — for example, the Board of Nursing.

Kristi Pankratz, public information officer of the Kansas State Board of Healing Arts, said Kansas is no different. She said individual practitioners are licensed and regulated, meaning if there is a clinic that involves a chiropractor, a cosmetologist and a licensed nurse practitioner, one agency wouldn’t have complete oversight over all licensees and services provided. It would involve multiple agencies.

“When it comes to walk-in clinics, there are numerous overlapping regulators as well as gaps in the regulatory framework and that does concern us,” Pankratz said.

Comments

Ryan Neuhofel 5 years, 5 months ago

I think there are several reasons "urgent/walk-in clinics" are succeeding:

1) Pricing is transparent (upfront) and people appreciate knowing where their money is going. "Traditional" medicine is currently dominated by third-party payers - even for minor/routine primary care. 2) The patient-physician relationship has been destroyed by the third-party system (public and private). The multiple layers of office staff/insurance that are meant to "protect" the patient financially (poorly so) have created a large disconnect. 3) Most primary care offices are a poor value: the average visit (indirectly, mostly hidden in premiums) costs 100-200 bucks for 5-10 minutes of face time with the actually doctor (after waiting for 2 hrs). What other service-industry would this be tolerated?

The true future of primary care (family medicine, pediatrics, GPs, etc.) is direct-medical practices (without insurance). Insurance should be reserved for unexpected/catastrophic costs - by it's very definition! We have been convinced in America that we must utilize health insurance EVERY time we see a doctor - this makes no economic sense! We don't use car insurance to change oil and gas, or home insurance to paint our walls or sweep our porch!

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classclown 5 years, 5 months ago

So how long until HMO's start making people go to these clinics?

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cowboy 5 years, 5 months ago

First Med is a money machine , $100 to walk in the door then they push tests on you , just give me some antibiotics and get me outta here. What we need is a good Mexican pharmacy in town where you can go get what you need without a $100 office visit.

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transform 5 years, 5 months ago

Nurse Practitioners are often considered a vital component of the health care system for the indigent, underserved, and rural populations, offering comprehensive care for patients throughout their lifespan without a lot of complaint or interference (or help) from doctors and the AMA (American Medical Association). Once they operate out of a fully reimbursed urban or suburban clinic, however, they apparently become a dangerous agent of substandard "fragmented medical care."

Retail clinics provide a service that fills a niche. A long term relationship with a health care provider is important, but there are many folks, insured and not, who rarely go to a clinic, and just need an occasional visit. This is also an option for patients who need off-hour, but not emergent, care. This frees up the ER to do more important work.

As with any profession, there are going to be good practitioners and bad, good business models and bad. But the issue here is really turf, not quality of care. Studies have shown repeatedly that Nurse Practitioners have good outcomes and high levels of patient satisfaction. They can't do everything a doctor does, nor do they want to, or they would have gone to med school. But they can do a good job within their scope of practice, and should know their limits and make appropriate referrals.

I found it interesting that in the initial ad I saw in LJWorld for the new Lawrence Family Practice walk in clinic, all the "consulting" doctors were listed, but the name of the NP heading up the clinic was absent. I take it they trust the NP to do the job well, but the are making the NP invisible, and therefore, less important to the public. These are the ways, conscious or not, that physicians can undermine what should be a cooperative, mutually beneficial collegial relationship. (If this has been corrected in their later ads, kudos.)

There is a huge shortage of primary care physicians today. If NPs are willing to step into the gap, that seems to me to be a good thing.

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Sean Livingstone 5 years, 5 months ago

My medical insurance proposal: Insurance should not cover primary care or illness that are easy to deal with using a family doctor. Those that require specialists should be covered by insurance. It is such illness that bankrupted many. Anyone with minor alignment should be able to afford medical cares, because many alignments are the initial signs for the big illness. Detect early so that the more expensive treatment can be avoided. Also, annual body checkup should be made affordable, even at the expenses of the government. Again, early detection makes the whole difference. In this case, insurance premiums can be lowered since it will not cover the unnecessary flu and cold or whatever that are so cheap to cure.

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Fishman 5 years, 5 months ago

Cowboy is RIGHT. First Med is a definite MONEY MACHINE! After seeing Dr. Burt(male) for at least 8-10 years, and ALWAYS paying my bill before leaving I was harassed by his wife Dr. Nancy indirectly for not paying immediately. I was SOOOO sick that I honestly just forgot my wallet. I said I'd be back in the next day to pay, but the next day I was too sick to leave the house. Her help called to "remind" me that I said I'd be in that day to pay. They called to "remind" me again the next day. I was pissed after this and didn't pay, which wasn't right either. After maybe a month, not long I was summoned to court to pay. Funny thing is the lawyer in charge of my paperwork had Dr. Burt do the same thing to her! Terrible unfortunately as her husband seemed to be a pretty good guy, but because of her I WILL NEVER GO BACK! To take our three year old there as a new patient was about $175. At Prompt Care it was $75 for a new patient. After the first visit it would be $64. We only have $5,000.00 deductible because health insurance is suck a joke in this country so we pay for the office visits when we need them. Prompt Care gives a 25% disount when paying immediately which we do. I'd also never go to Lawrence Family Practice due to a so called doctor Dr. Brad Phipps there. There's always a doctor that finished last in their class! Just ask a few people. It won't take long to find out his reputation in town, and to say the least it isn't stellar.

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salad 5 years, 5 months ago

"Hey Cowboy, if you want Mexican healthcare, move to freakin Mexico bud. "

Ding, ding, ding!!! Annnnnd there it is! The first bone-head, knee-jerk, BS ideological response of the day! Hey there tard-master, ya know ya can't just "move" to another country? Even Canada or Mexico? They have immigration too. Maybe you should venture outside your whitebread tiny-treed suburb once in a while.

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jrlii 5 years, 5 months ago

I have to say I'm not favorably impressed by a lot of the local MDs I've dealt with. Of course, it seems to me the whole MD-Pharama-hospital system is organized to scam insurance companies.

Upwards of 40 years ago, my mom reports that her doctor prominently stamped her file with "Insurance." In those days MDs were professionals who made a middle to upper-middle class income. They drove Buicks and Mercuries not Cadillacs or, as is so often the case today, cars which make Caddys look cheap.

I do believe that Insurance should be for major losses, not routine care, though I have to admit I've collected on at least my fair share of claims for routine care. But at the same time, the price of routine care has become unsustainable. Something has to give, and the price of service has to be one of 'em.

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akt2 5 years, 5 months ago

You will likely see a nurse practioner or physician assistant in the ER if it isn't serious. Then you will still get to pay the ER price. It seems like insurance companies would get tired of paying these high costs for those that treat the ER as a walk-in clinic. Pretty pricey place to get your sore throat or your stubbed toe treated. If you have ever worked in an ER, between those patients and the Medicaid patients that abuse the system, you just have to shake your head at how stupid people really are.

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cowboy 5 years, 5 months ago

My whole opinion on health care problems is that the need is so large nowadays with some 40% of americans uninsured that the solution needs to be a big one to meet the daily needs in a cost effective manner. God love Health Care access but that feel good operation has no shot at delivering a large scale solution. find a way to deliver cost effective minor care , use insurance for major issues only.

Have a lot of elder family in Arizona and it's not unusual for them to get meds from Mexico or mail order from Canada for a lot less than US costs.

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Ryan Neuhofel 5 years, 5 months ago

Most health "insurance" (really just pre-payment) is analogous to a snake eating its own tail - it justifies it's own existence (sort of like politicians). You must use insurance to see a doctor because medical care its so expensive . . . because you are also paying for the costs associated with administering the insurance. If we could pay for the majority of our medical care (primary care) directly, in a true competitive market, the costs of most services would decrease by at least 50% overnight and the quality would improve.

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