Primary care is changing, and where it’s headed is honestly a mystery even to me, a veteran in the field for almost two decades.
With the marriage of pharmacy and insurance giants in the recently announced CVS/Aetna merger, the way that people access health care might just change dramatically in the near future.
What does CVS’s MinuteClinics offer that worries me?
First of all, it’s transparency. Looking at its website, there is a clear list of what services are provided and how much it costs for each one. Acute care visit, about $100. TB test, $35. Even labs are included. Cholesterol testing, $37. Diabetes screening, hepatitis C testing, and many more, all with direct prices right on the website.
MinuteClinics like this one in Waikiki at Long Drugs (its parent company is CVC) are getting more convenient — at least for certain services.
Cory Lum/Civil Beat
I still don’t know how much someone pays to do a cholesterol test when I order it. If they go to a lab at a hospital, there is a different charge than at a free-standing lab. If the test is for diagnosis versus screening, it’s covered at a different rate. There might be a copay for labs. Total cost? I have no idea.
Insurance may cover many of these tests, and in that case the cost may be covered for the visits in either location, but for those who pay cash, knowing up front how much they need is invaluable.
Access is another main advantage of MinuteClinics and other urgent care facilities.
I have set office hours, as many other doctors do. Granted, I have tried to expand access with two full Saturday clinics every month, but that means I have to give my staff a day off during the week, and some patients might still find these hours inconvenient. People get sick 24/7, and outside of the ER, there aren’t as many options for care after-hours in a private office.
Walk-in clinics do not have the current capability to manage complicated patients who see multiple specialty providers.
MinuteClinics are available on a walk-in basis. No appointment necessary. Want to check your A1C for diabetes? They can do it. Results in 10 minutes. Although I can do that test in my office, you need a scheduled appointment, and might have to wait. If you need to be seen after work when you are just starting to get sick, it’s easy to do at a walk-in location.
One-stop shopping is another huge plus for these types of retail clinics. Prescriptions come from the same place, the pharmacy. There’s no driving around to find parking, there is not even a need to leave the building. For those clinics in pharmacies attached to a shopping center, there are unlimited options for what to do while waiting.
I send my prescriptions to pharmacies, so patients need to first come to my office, and then go to the pharmacy and wait in line. Convenience would put both in the same place, but for most doctors’ offices, this is not the case.
So, why even visit a primary care provider?
Well, here’s why I firmly believe PCPs like me will always be in business, at least into the foreseeable future.
• Continuity: Most of the patients I see I have known for the past decade or longer. After moving here in 1999, I started seeing patients and we’ve both aged together over the past 18 years. I know their families, I know their health history, and I know what they’re worried about, and how to help figure out what’s going on when they have symptoms or concerns.
It’s often not the obvious conditions that are causing the back pain, but something that requires a bit more time and more than one visit to diagnose. That’s not to say that everyone will have a serious medical illness that requires frequent visits, but if they do, I will be the same person evaluating their condition until we get an answer. I’ll know what tests we did already and what else needs to be done to figure it out.
Although staffed by some of the same nurse practitioners regularly, there is not the same level of continuity in most walk-in clinics or urgent care settings.
• Experience: Complicated situations are best handled by those with the most experience. That is only acquired through years of training and years of medical practice, handling the sickest of patients, and knowing when a situation is dire, versus when it can be handled easily.
Walk-in clinics might be good at simple care, but for more advanced testing and diagnostics, even they don’t advertise that they want this type of business at their facilities.
• Collaboration: Most providers have their own network of colleagues with which they can easily consult for a quick question or an urgent surgery. If I know someone needs to see a cardiologist in the next week, I have plenty of options from which to choose, physicians who know me and make themselves available to take care of urgent patient concerns because I asked.
I am one doctor backed by every other specialty that can handle the complete range of needs a patient may have. No walk-in clinics currently have that capacity.
The model of health care may change in the next few years. In order to expand care options, particularly to the many patients who don’t have access to a primary care provider, MinuteClinics offer immediate care for simple concerns that require one-time prescriptions or easy screening with testing that can help identify a health condition that is otherwise unknown.
But walk-in clinics do not have the current capability to manage complicated patients who see multiple specialty providers.
There is plenty of room in health care for walk-in clinics and well-established primary care providers.
However, the advantages of transparency, easy access, and convenience can no longer be overlooked by providers if they want to stay relevant.
The post Health Beat: Are Primary Care Providers Becoming Obsolete? appeared first on Honolulu Civil Beat.