Archive for August, 2007
August 23rd, 2007 by Trisha Torrey
Do you have a quick health clinic in a drug or big box store near you? They are called Quick Clinics, Redi-Clinics, Minute Clinics or other names, and you can drop in at any time for basic needs such as a bad cough, a sprained ankle, or whatever other “simple” ailments you or your children might have.
They are reviewed in today’s NY Times. Are they a good idea?
I blogged about them a few months ago…. and yes…. for the most part I think they ARE a good idea — but with a few cautions.
But my cautions aren’t those of the NY Times, nor are they the cautions of the American Academy of Family Physicians, or the various State Regulators or the pediatrican groups.
What are the differences?
My cautions are about the patient’s health, and theirs are about money.
I know, I know — if you read this article, or any of a dozen others written on the subject (cited in my previous blog post), the spokespeople for these various organizations will tell you just how concerned they are about the health of the person who gets treated there.
But if you read between the lines? Yeah. They’re worried about money. These clinics cut into their income, pure and simple. A patient has a choice between walking-in (no appointment necessary), waiting 15-20 minutes (instead of who-knows-how-long), being handed his/her prescription on the spot (instead of having to travel to the pharmacy), and paying an average of $18 less than a visit to a traditional doctor’s office. And $18 is $18.
The AMA calls it “sacrificing quality.” Pediatricians cite the need to understand a child’s history. And state authorities are concerned about licensing. But they are really worried about money. Because in the case of these quick clinics, patients are bypassing those died-in-the-wool establishments that justify charging way too much money for way too little service.
All that said — there are some real cautions for patients that have to do with their health — so if you are tempted to use one of these quick clinics, please take note:
- Remember that these clinics (and therefore the doctor or nurse practitioner who sees you) do not have your records or your history. If you are someone who has had challenges, allergies, or reactions to treatments or symptoms in the past, you’ll want to continue seeing your primary care physician. The clinic provider can’t know what your past history is and could recommend something that makes you even sicker.
- Remember that these clinics are just as interested in selling you the drugs they have on their shelves as they are making sure you get the right medicine. Your physician will prescribe based on what s/he knows is right. The clinics will prescribe based on the deals they’ve made with pharmaceutical distributors. That may not matter — it might still be the right drug — but it might not.
- Drug interactions and contra-indications are a real concern. With a pharmacist right there, you should be OK, but make sure you take a master list of everything — EVERYTHING — you take on a regular basis, long or short term, and share it with the practitioner you see. Prescription drugs, yes, but also any pain relievers, vitamins, herbals, etc.
- Some quick clinics do not accept Medicare or Medicaid, and not all insurance companies will work with them, so ask that question before you see the quick clinic doctor.
- If, in fact, you are really sicker or hurt beyond what you realize, you don’t want one of these quick clinics recommending the next steps — you want that to come from your primary care doctor — or — your specialist. If you question your situation at all, don’t fool with these quick clinics. You could end up sicker.
A cautionary tale? Yes, but no less enthusiasm for a good idea whose time has come.
August 22nd, 2007 by Trisha Torrey
I have but a few minutes today to provide more info, compliments of Bob, who I mentioned yesterday….
Bob alerted us to this scenario: going in for a check up, he was asked to return the next day for a blood test. When he returned the next day, he was charged another co-pay (and of course, the office will bill insurance again.) Thing is — there is no reason the test could not have been done the first day — the day he was there for a checkup! It was not a fasting blood test (meaning he would have to refrain from eating anything for many hours before hand…)
I wrote back to Bob and asked him why he thought it was a scam (thinking perhaps there was a reason he had to be there a second day? argh. sometimes I can be so naive!)…. Here is Bob’s reply:
I confronted the doctor because the day I returned, they did NOT do a fasting blood sugar — only a HA1C. As an informed diabetic, I know that a Hemoglobin A1C measures over time the results of the hA1c represent average blood sugar for the previous 2-3 months).
There was absolutely no legitimate medical reason to schedule blood work the following day. All the other tests were routine and not time sensitive. I use a PHR (personal health record) and get copies of ALL documents - including labs - and can prove every statement I’ve made here.
I no longer will use that doctor. However, I have reason to believe this scam is taught by management consultants as a sure fire revenue builder.
Recycle 10 patients a day for blood work tomorrow. Do that five days a week with 4.3 weeks in the month and it is NOT small change. Do the math on a $25.00 co-pay like mine if you want to see the dollars. 10 * 5 * 4.3 * $25.00… That tidy sum makes the payments on a very nice car.”
And my note — the doctor gets the co-pay AND bills insurance again….. ha!
This is an excellent heads up for those of us watching our health care dollars (who doesn’t?) And I can only imagine a few other ways this is happening, too. Any tests or procedures that can be handled in your doctor’s office — but put off for another day so they can charge again and again.
If your doctor suggests one of these tests or procedures for another day, or even suggests you simply return for no apparent reason, then ask — no — insist — the test or procedure take place before you leave. If they say it can’t be done, tell them you’ll be happy to return, but you aren’t willing to cough up another co-pay.
Explained a different way — your mechanic charges a basic fee for working on your car, no matter what gets done to it — in addition to the work that gets done to it. You take your car in for repair, and he only does part of the job — and insists you bring your car back tomorrow for the rest — and charges you that basic fee again. Would you stand for that?
Don’t stand for this scam either…. and if there seems to be no way around it, you might want to do what Bob did — find another doctor.
Thanks for the heads up, Bob. We’ve got enough problems with healthcare these days without having to worry about being robbed by our providers, too!
August 22nd, 2007 by Trisha Torrey
I have but a few minutes today to provide more info, compliments of Bob, who I mentioned yesterday….
Bob alerted us to this scenario: going in for a check up, he was asked to return the next day for a blood test. When he returned the next day, he was charged another co-pay (and of course, the office will bill insurance again.) Thing is — there is no reason the test could not have been done the first day — the day he was there for a checkup! It was not a fasting blood test (meaning he would have to refrain from eating anything for many hours before hand…)
I wrote back to Bob and asked him why he thought it was a scam (thinking perhaps there was a reason he had to be there a second day? argh. sometimes I can be so naive!)…. Here is Bob’s reply:
I confronted the doctor because the day I returned, they did NOT do a fasting blood sugar — only a HA1C. As an informed diabetic, I know that a Hemoglobin A1C measures over time the results of the hA1c represent average blood sugar for the previous 2-3 months).
There was absolutely no legitimate medical reason to schedule blood work the following day. All the other tests were routine and not time sensitive. I use a PHR (personal health record) and get copies of ALL documents - including labs - and can prove every statement I’ve made here.
I no longer will use that doctor. However, I have reason to believe this scam is taught by management consultants as a sure fire revenue builder.
Recycle 10 patients a day for blood work tomorrow. Do that five days a week with 4.3 weeks in the month and it is NOT small change. Do the math on a $25.00 co-pay like mine if you want to see the dollars. 10 * 5 * 4.3 * $25.00… That tidy sum makes the payments on a very nice car.”
And my note — the doctor gets the co-pay AND bills insurance again….. ha!
This is an excellent heads up for those of us watching our health care dollars (who doesn’t?) And I can only imagine a few other ways this is happening, too. Any tests or procedures that can be handled in your doctor’s office — but put off for another day so they can charge again and again.
If your doctor suggests one of these tests or procedures for another day, or even suggests you simply return for no apparent reason, then ask — no — insist — the test or procedure take place before you leave. If they say it can’t be done, tell them you’ll be happy to return, but you aren’t willing to cough up another co-pay.
Explained a different way — your mechanic charges a basic fee for working on your car, no matter what gets done to it — in addition to the work that gets done to it. You take your car in for repair, and he only does part of the job — and insists you bring your car back tomorrow for the rest — and charges you that basic fee again. Would you stand for that?
Don’t stand for this scam either…. and if there seems to be no way around it, you might want to do what Bob did — find another doctor.
Thanks for the heads up, Bob. We’ve got enough problems with healthcare these days without having to worry about being robbed by our providers, too!
August 21st, 2007 by Trisha Torrey
Some misc pieces for a chilly Tuesday morning in the Northeast (at least we don’t have a hurricane coming through!)….
I heard from Bob, a reader who alerted us all to a scam-of-sorts — meant to increase revenue for the doctor while draining a patient’s pocket for no apparent reason…. it’s unclear from his email whether it happened to him — but — here’s the takeaway:
You go to the doctor for a check-up. At the end of the exam, you are scheduled for bloodwork and told to return the next day. So — now you have to make a second trip AND pay a second co-pay. Why? Why can’t they draw the blood while you are there?
Granted — it could be a fasting blood-sugar test — which should be explained to you. But if it was a check up, then they knew that’s why you were there to begin with, and it should have taken place just prior to your exam, fasting the night before — right?
Bob’s point is a good one, in two ways: first, don’t let them schedule you for a return visit, which you’ll need to pay for, unless it’s absolutely necessary. Ask if whatever they need to do then can’t be done while you are already there. And second, when you make an apopintment for a check up, ask whether you should fast beforehand, if that would help move the process along.
Good points, Bob. Thanks.
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Then I heard from a woman who blogs under the pseudonym of N=1 about healthcare politics, policies, trends, and all those big picture things that mostly get in the way of healthcare. You know — my statement that American healthcare is not about health or care –> it’s about sickness and money. It seems she was part of the healthcare landscape, in a highly responsible position, for many many years — and blew the whistle and got fired — and is now persona-non-grata when it comes to being hired elsewhere.
Talk about a trust violation! The very person who sticks her stake in the ground to HELP is now left out of the helping field all together.
She’s taken her skills, anger and vision to her blog and other writing. While I don’t agree with everything she writes, I admire her chutzpah to go out on such a long limb…. And the points she makes are certainly based on our lack of trust for “the system” that is so out of control.
……………………………….
I really hate not trusting. Just want to make that clear. It’s not in my nature. Last week in a conversation with an advocate I was “meeting” for the first time (who I’ll blog about in a day or two — some really good stuff!) I explained to her that the ONLY part of this work I do that I dislike is that edge of cynicism I have had to develop. It’s just not who I’ve been in my entire life. In fact, I’ve been dubbed Pollyanna too many times! That gives you some idea of how far outside my comfort level this new edge is for me.
But I also know it’s necessary to fulfill my mission of helping patients help themselves. Asking the right questions at the right time, looking at the inside from the outside, trying to play devil’s advocate — it’s all worth it if the result is a better outcome for just one person.
