Walk-in Clinics
NEWS FLASH: Led by Pete Stark (D-CA) and Henry Waxman (D-CA), House Democrats today announced a plan to provide low-cost, high-quality, easy-access primary care to millions of low- and moderate-income Americans, including millions of the uninsured. The plan: override a slew of anachronistic, bureaucratic, anti-entrepreneurial regulations that are thwarting the spread of walk-in clinics in drug stores, shopping malls and big box retail outlets and keeping them from realizing their full potential. Among the regulations to be set aside is legislation authored by Stark himself.
Oops. I was just day dreaming.
The more walk-in clinics are studied, the better they look. And the better they look, the stranger the silence from people who are rarely at loss for words on matters of health policy.
Anyway, this brief experiment in private, for-profit, free enterprise, entrepreneurial, capitalistic medical care is bearing fruit:
- A state of Minnesota study finds walk-ins match the average quality of care found in traditional practice with considerably less variation.
- A HealthPartners study finds that walk-ins reduce overall medical costs by substituting for higher priced emergency-room and primary-care physician visits.
- A RAND study [gated but with abstract] finds that 60% of walk-in patients have no regular physician, making the clinics a potential medical home.
For a review of legal barriers these unsung Florence Nightingales face, see Devon Herrick’s study. Among the opportunities squelched by Stark: (a) The ability of clinics to electronically prescribe at their store’s own pharmacy and (b) the ability of doctors to own clinics and generate self-referrals.
For a survey of the clinics – where they are, who owns them, etc. – see this Merchant Medicine report [gated].
Consider this insanity. Anyone can set up a walk-in clinic that handles easy problems and refers patients to doctors for serious problems.
Anyone, that is, except a doctor who refers patients to himself.
Put another way, everyone can practice drug store medicine except doctors.
That restriction is courtesy of Pete Stark.
Reply to Joe: well, we seem to have a way to accomplish that goal and remain compliant with Czar Stark’s regulations. We operate a walk-in Urgent Care center that shares a waiting room with our regular clinic. We operate at a higher level than most retail clinics, but less than a regular ER. We capture overflow from our own clinics and neighboring ones who are too busy to see their own patients for acute care problems. Patients without doctors are referred for follow up to our regular providers, some of whom have special interests in areas like sports medicine and stress testing. I used to work in the traditional clinic until the burden of meeting capricious P4P goals drove me over the edge. Now I can see acutely ill patients and get home by 5:30 every night.
Glad to find this resource – fascinating reading. Thanks.
Have been practicing family and occupational medicine for a few years and recently started a “professional” MPH program. I’ve been horrified at the apparent willingness of my school mates to continue our national slouch into socialism by nationalizing our health care system.
I guess I must seem like a real dinosaur to them – I seem to be utterly alone in my beliefs about personal responsibility and the impotence of government to solve the problems in health care.
Anyway, it’s nice to know I’m not fighting alone. Please continue your great work. I’ll be stopping by often for a recharge. It’s not easy fighting this battle – the liberals have had about a 40-year head start.
[…] “Health Policy Blog,” National Center for Policy Analysis, September 30, 2008, at http://www.john-goodman-blog.com/walk-in-clinics (October 13, […]
[…] allowed to do so, walk-in clinics manned by nurses fill the void and the potential for handing off routine activities to physician […]
Never trust a politician named “Fortney”.
I’ve often wondered about the high cost of treating walk-in patients in emergency rooms. How much of this is accounting fiction? Are they using billed costs, or actual incremental costs? It seems to me that if the emergency room is open 24/7 anyway, and if true emergency patients always have priority, then non-emergent patients are basically consuming otherwise unused capacity.
Bart… have you ever been to an emergency room? Have you ever seen waiting rooms? There is no unused capacity.
And yes, the guy with the bone sticking out of his leg is rushed through, but the woman with internal bleeding who is not symptomatic except for some abdominal pain (that could be gas, appendicitis, a bowel obstruction, she won’t know until she is examined) still waits hours for all the people coming it for chronic injuries, colds, etc take up time.
Ask an ER Doc or Nurse sometime the kinds of ridiculous patients they get showing up.
[…] care, he could make a huge leap forward with a single decision: let Medicare cover the services of walk-in clinics and encourage states to do the same with Medicaid. In principle, these clinics could meet all kinds […]
I wish we could have more of these clinics. What I don’t understand is why the providers that are creating/offering them do not seem to be doing much in my community. We had a local hospital close one of its two urgent care clinics a while back. The one that’s left is constantly overburdened with patients, as are the two hospital ERs in town. Recently, a privately owned medical group opened up their urgent care clinic (which used to only serve existing patients of this group) to walk-in care for “all” patients. So maybe things are turning around. But none of the CVS or Walgreens, nor any of the Kroger, Walmart, etc stores in my community have urgent care clinics, despite what would seem to be an overwhelming demand. It is possible this is due to the fact that until about the last two years, the rate of uninsured was much lower in this area due to steady union work with good benefits. However most of those jobs have gone, and what is left has “basic” benefits but no “Cadillac” plan at all.
While some of the regulations may be preventing doctors from opening these clinics, they surely aren’t preventing hospitals, retailers, etc. who seem to have plenty of these clinics in other areas.
Also, for the record, I would agree with requiring Medicare/Medicaid plans to reimburse for services at these clinics.
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