The walk-in clinic boom is betting big on the uninsured

Which is not a bad strategy, sad to say:

At least six retail clinic chains have emerged in the past few years – all betting there are millions more like Mui, who either don’t have insurance, don’t have a provider, or don’t have the time to spend in a doctor’s office for a minor health problem.

Comments

Anonymous
“Still, he worries that the walk-in clinics may be tempted to expand the range of their services as they grow. “They may want a bigger piece of the market and that’s a concern,” he says. “In today’s complex world of healthcare, patients really need to have a medical home.” For most Americans, that’s still a doctor’s office—for now, at least.”
A concern… god forbid that the MDieties have actual competition instead of a monopoly based on legislative feat. We need more of these clinics with more services offered.
Anonymous
so why don’t you go to the wallmart clinic instead of your internist/urologist/cardiologist/pulmonologist/rheumatologist? That’s what I though, jag-off…
Anonymous
Being un-insured I am tempted to consider this a good thing. I wonder how they will deal with the inevitable wrong diagnosis (really, everyone makes mistakes). How will they deal with the litigation given their price baseline? Would quantity really make up for it? I also wonder if, given that they expect mundane problems in their patients, they would recognize serious problems when it was required of them.
Anonymous
I don’t get why people feel so threatened by this. It’s another choice for patients, and I like knowing that walk-in clinics are available. I don’t have a chronic illness, so when I’m sick it’s not realistic for me to be able to make an appointment a week in advance to be seen. I can’t exactly say okay on August 10th I’m going to have a high fever, so I better go ahead and make that appointment now. Going to a walk-in clinic and being seen when I need to be seen is a good option, and one I’ve exercised.
Anonymous
We are insured and use a walk-in clinic regularly. It is just much more convenient for us, since we go usually only for things like sinus infections and poison ivy outbreaks. It is better for us since it is a week before you can get into a Dr’s office and by then you are so miserable you can’t move or you’re over it. I think it is a good option for people who don’t have serious or chronic illnesses.
Anonymous
I think most people at one time or another, have used a walk-in clinic. I see no problem with that. What I have a small problem with, is the fact that they are merging a medical, walk-in clinic with a huge conglomerate, like Wal-mart. “Faster service, less wait time, more convenient” doesn’t equal good service, or adequate time spent with a patient. I work for Wal-mart in one of their pharmacy’s, and patients are run in and out of there like cattle, and that’s the same thing that would eventually happen in a medical care clinic setting, if it was set up inside a retail store.
I do think there is a need for more walk-in clinics, but not clinics that are run by drugstores, or superchains. Either keep clinics affiliated with a nearby hospital, or incorporate themselves to be independent.
Anonymous
The real question is are you willing to sacrifice your quality of care? These are Nurse Practitioners functioning in a provider role. Few are as competent as physicians. They are qualified to diagnose and treat MINOR health problems & most have to function under a physican’s supervision. Many patients see their doctor for something they consider minor…finding out from their doctor it is something much more serious. What if it is misdiagnosed? Is Walmart going to be represented in a malpractice suit when there is a medical catastrophe? Do yourselves a favor and stay with the experts. They’ve gone to medical school for a reason & that expertise may save your life! Medicaine does not belong in the fast food world.
Rachel
Anonymous (uh, the last one) – Are you suggesting that nurse practitioners are incompetent to deal with sore throats and earaches? Should those people be in the ER on Saturday night instead?
Why assume that the NPs practicing in these clinics are less qualified than those practicing in other walk-in clinics or even in doctor’s offices? I’m sure many patients feel like cattle when their MD makes them wait 30 minutes in the exam room only to have someone without even NP training take a 2 second throat swab and send them on their way. Misdiagnosis can happen anywhere, and I get the impression from what I’ve read that these NPs are being specifically advised on referring people on if the problem seems more serious.
I’m taking a wait and see approach to these clinics. I think if it frees up ERs to focus on real emergencies, that’s a good thing.
Anonymous
Anon. 2:34 said, “The real question is are you willing to sacrifice your quality of care?…Few are as competent as physicians…” It really doesn’t matter how competent the physician is if I need to be seen and can’t get in for a week. If a person has a UTI or something else that needs prompt treatment a week long wait is going to compromise a patient’s health more than if they could get in and be seen by a nurse practioner.
Josh
As a medical student and aspiring FP, I appreciate the medical concern of quality of care/missed dx/lack of a ‘medical home. However as a pt (and entrepreneur) I appreciate the convience factor and the drive to encourage dr’s to compete/adapt/change. However, I think as doc’s begin to compete w/ these clinics, the need for them will fade significantly reminiscent of the dot.com bubbble. As doctors compete, the equation will change and thus decress the need for these clinics to some signficant degree.
For example, in my future clinic, I will provide the convience the customer requires (same day appts, low cost @ $20/visit, fast service, email visits, online access etc) while providing physician level quality (a medical home, preventative care, health screening). Often, the supports of nurse-clinics argue that doctors need to have some competition w/o realizing that–IF done right–dr’s will run them out of business. Sadly though, if I was a nurse in these clinics, i wouldn’t be too nervous for a while. We docs are awfully slow to adopt sound business practices.
Now let the doubters comment, drs and rns alike,
Anonymous
Anon 6:20
Talking to the voices in your head again? One might suspect that such is the case given that you are exhibiting a propensity for answering your own questions. I can only hope to see the day when the MDs have to compete in a market for customers just like every other business.
Anon 2:34
Is Walmart going to be represented in a malpractice suit when there is a medical catastrophe? Do yourselves a favor and stay with the experts. They’ve gone to medical school for a reason & that expertise may save your life!
You must be kidding… trying to use the malpractice scare? Who is it that whines the most about being held responsible for professional malpractice? Who is it that demands special legal protections from professional malpractice litigations? Hint: It isn’t Wal-mart.
Dr. Steve
Josh – $20 is far too little. You can and should get $50. Seriously co-pays for insured people are often over $20.
And I assume you will not be taking insurance since you flat fee would then be considered “two-cycle billing” and thus fraud unless you were to accept the same fee from insured patients (when the insurer is offering you a lot more).
My advice: avoid primary care like the plague – if I had I might still be practicing.
Anonymous
It is neither a threat nor a significant concern for quality. Walk-in clinics have their own concerns regarding liability and practice limits. The last thing they will want is to have hostile relations with the community providers. If I were an internist, I would stop by when the nurse was on duty, leave some of my cards and offer to help where I could. I would want them around, because they are a source of referral, which is something primary care physicians should be cultivating. (They also should be cultivating referral from specialists; believe it or not that kind of referral works too.)
This is a good thing, not a bad thing.
Josh
Oh Dr. Steve, thanks for writing, you’re just the kind of doctor I love talking to.
I agree $20 is too cheap and I definitely agree I deserve $50, but (and its a big but), that’s the brilliance of any business. Competitive pricing is what will make pts be willing to pay cash and what will attract ins companies. If they’ll wave the co-pay for the nurse clinics at $60, they’ll love me. Yes, I’ll be cash only and the pt can work it out w/ their ins company (or even better, have an HSA)
In all actuality, $20 isn’t too little b/c at $20/15 minutes x 50 hr/wk x 50 wk/yr I’ll avg 200K which is 60k > than the avg FP (ROUGH ESTIMATES). Now for the “oh you can work that much” or “you’re overhead will be huge” arguments. I’ve heard them and I can explain them away w/ good business sense. I won’t go into it all here (that’s what my blog is for) but by reducing staff & maximizing technology I plan to have 50k in expenses and 50K in additional revenue (lab tests, email visits, group visits).
It’ll work, just watch. Once someone decides to run Primary Care like a business (a win:win for all), then I forsee see FP rising to one of the top sought-after residencies.
now for the rebuttal. . . .
Anonymous
What is to rebut? It probably would work. But the only way it would work is to demand cash up front with no exceptions. No four-pocket checkout shuffle, No Medicare or Medicaid cards, no insurance cards or anything that defers payment or leaves to persons not present the payment to the provider. Those who can’t/won’t pay can take a hike.
Anonymous
Josh, I would also say charge more. I went without insurance for a while (thankfully those days are over) and went to a walk-in clinic where I paid $70 cash (I was given lots of samples so I didn’t have to fill a prescription). I think most people, even those without insurance, could cough up more than $20. I didn’t feel $70 for a general office visit.
Anonymous
Oops, I meant to say I didn’t feel $70 for a general office visit was unfair – I thought I got a pretty good deal.
Josh
“the only way it would work is if you demanded cash upfront” — Yep. Just like any other business, talk about pay for performance. Cash/Check/Credit Of course, depending on your pt population, you maybe able to set up automatic withdrawal from CC or bank accounts to speed up the process. But for those who say its too harsh to turn people away if they can’t pay (and its not) I still plan on giving away some free care to those “I” deem worthy. Sidebar: docs who accept medicare/caid can’t give out free care b/c its considered fraud. . .go figure.
“I think $70 is fair. . .” Personally, I’m such a tigh-ass, I wouldn’t pay $70 for anything short of stitches. If we want to encourage preventative care, we have to recognize how cost changes pts willingness to visit the dr. More importantly, you have to realize that the major critisim (unfounded) of cash based practices is that they’re “for the rich”. For the trend to really take hold, it will have to prove itself as a win:win:win for pts:drs:ins co.’s
Anonymous
“I think $70 is fair. . .” Personally, I’m such a tigh-ass, I wouldn’t pay $70 for anything short of stitches. If we want to encourage preventative care, we have to recognize how cost changes pts willingness to visit the dr. More importantly, you have to realize that the major critisim (unfounded) of cash based practices is that they’re “for the rich”.
You have a point, I didn’t go for preventative care – I was already sick and so $70 with no extra cost for prescription RX seemed like a good deal, but would I have spent it on preventative care with my income at that time- probably not. I would love to talk to people who believe cash based practices are for the rich, because at the time I used this walk-in clinic I was working retail and making barely enough to survive. Taking a look around the waiting room I could tell that the people there were in a similar situation to my own – far from rich. Not saying this as a sob story but just to point out that people can in many cases find the money to pay for things they value. If I had had a chronic illness, though, the situation would have been very different. I would not have been able to continue to pay that $70 fee on a regular basis.
Josh
Yeah, by the time you add in labs, blood draw, radiology etc $20 can grow quickly. Plus, if my plan works i’ll already be making nearly 50% more than the avg FP.
Wanna hear something crazy. . .the internal med program at my med school has a residents clinic for the underserved. . .but charges $350/visit. . .and they call me crazy?!?
Brooke
Why not? Clinics are meant to be convenient and help the customer as well as the company. The drug stores are getting into the walk-in clinic business. By operating a clinic out of a drug store, like Walgreens and CVS, you will be able to get the treatment you need and the medication as well. These clinics are operated by Take Care Health Clinic.
http://www.WalgreensClinic.org