Monday, March 25, 2019

Receiving healthcare in alternative settings

February 25, 2019 By Michael D. Shaw @ HealthNetDaily.com
 
Those of a certain age can remember what healthcare was like in the days before Medicare, private insurance companies, diagnostic related groups, and current procedure terminology codes changed things forever. Back then, “health insurance” was known as “medical insurance,” and was usually reserved for large in-hospital expenses.

As such, there was no need for a billing or coding specialist in a doctor’s office. All employees of the practice were principally devoted to providing patient health care. (Of course, there was always someone in charge of the front office.) In contrast, it was estimated in 2011 that physician practices in the US spend nearly $83,000 annually per physician on administrative costs. These include interacting with multiple health plans on claims and billing, obtaining prior authorization for patient services, and dealing with pharmaceutical formularies.

Here’s a sweet anecdote from the past (mid-1950s), courtesy of my late father-in-law, who was a psychiatrist:

He was practicing in a suburb of Detroit, and had just finished seeing a patient. She walked up to the front desk to find out how much she owed for the office visit. “Fifteen,” replied the administrator. The patient handed her a dime and a nickel. Whereupon the administrator got more specific. “Dollars,” she said.

But even now, charges for a primary care office visit are relatively modest, when compared to what procedures cost. And, don’t even get me started on how the system drastically favors procedural over cognitive medicine.

In the ideal embodiment, your primary care physician responds to your questions, watches for overall trends in your health—including the possibilities of chronic ailments such as diabetes and hypertension—as well as beginning the diagnosis of serious conditions such as cancer and heart disease. You will be referred out for various tests, and possibly to a specialist.

Sometimes, though, you just need a prescription for an upper respiratory infection, some stitches for a laceration, or quick therapy for a muscle strain. These conditions do not lend themselves to scheduling an office visit, as you want relief right now. What are your options?
  1. You can visit an hospital emergency department, bearing in mind that you will be triaged behind patients with life-threatening conditions. Still, the wait should not be too long.
  2. You can go to an urgent care or walk-in clinic. The advantage here is that these establishments are not burdened with severe cases. On the other hand, if you end up becoming a severe case, you must be transferred to a hospital. Reviews of this sort of facility indicate a wide range of customer satisfaction. Some are affiliated with hospitals, and others are part of a larger chain. Millennials seem to favor these clinics.
In 2006, MinuteClinic was acquired by CVS. In that same year, MinuteClinic became the first retail clinic provider to earn accreditation from the Joint Commission. As of 2017, there were more than 1,100 MinuteClinics. Services have been expanded to include diagnosis and treatment of minor illnesses, injuries and skin conditions; administration of vaccinations, injections, health screenings and physicals; and monitoring for chronic conditions.

In August of 2018, JD Power released its Pharmacy Study, which indicated—among other things—that customers have high satisfaction with health and wellness services they receive at retail pharmacy settings under current models. Fair enough, but how do patients feel about getting higher-acuity services in these same settings? The implication being that full primary care might be offered.
In December, 2018, JD Power ran a pulse survey, to determine how consumers feel about receiving primary care at a CVS MinuteClinic ®. 1,000 responses were received.
  • Here are some key findings…
  • 45% of respondents would consider receiving primary care at a CVS Clinic
  • Younger patients and the privately insured are most receptive to this model
  • Cost and convenience are growing in importance
  • Views diverge on coordinated care, with respondents about evenly split on whether a CVS healthcare option would provide a more coordinated approach than they are currently receiving
  • About half of respondents are open to using a CVS-based clinic for healthcare, about half can be persuaded by lower costs or greater convenience, and about half believe CVS can improve in the coordination of their care.
If the CVS model brings more accessibility and outreach into primary care, then count me as a big supporter.

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