Thursday, February 21, 2008

medical clinic checklist

Drugstore Medical Clinics Scorecard Americans spend double what residents of many other industrialized countries do on health care, yet we still have a hard time getting appointments with our doctors and so we often go without treatment for illnesses and injuries. A new solution available in many states is retail-based medical clinics, making walk-in clinics even more convenient by locating them in drugstores, supermarkets and other convenient facilities. These may not be the solution to the health care crisis at large -- but I believe walk-in clinics can fill a void by providing very basic care in a far more accessible way.

SO MUCH MORE CONVENIENT... With the elite concierge medical practices (for more on concierge medicine, see Daily Health News, October 3, 2005) on one end of the spectrum, these are at the other, with care that is down-to-earth and convenient to all. Medical professionals are on staff to treat simple-to-diagnose problems, such as a strep test for a sore throat or a case of poison ivy. They also offer flu shots. Some are operated by independent organizations or hospitals. And, of course, they offer convenient one-stop shopping in that you can even fill your prescription right there, if medication is required. It's all good for the consumer, but no surprise -- some physicians are up in arms complaining that store-based and walk-in clinics pose a threat to patient safety, not to mention their own profit margins. For an unbiased consumer perspective on the matter, I spoke with patient advocate Trisha Torrey, about.com's expert on patient empowerment and a syndicated newspaper columnist. She agrees that walk-in clinics offer real benefits for consumers, as long as they are used with appropriate caution.

EASY ACCESS, LOWER FEES In addition to the fact that many retail clinics are open weekends, evenings and holidays, the average visit, including waiting time, at retail clinics takes just 15 to 25 minutes, according to the Convenient Care Association (www.convenientcareassociation.org, an organization made up of convenient care clinics across the nation). This is quite a bargain in terms of time, especially when I think of my last doctor's visit. Even with an appointment, I waited two hours... and I know that's not an unusual experience nowadays. Torrey says prices are lower at walk-in clinics, and therefore it's not just time but also money you save by using walk-in clinics for medical care. This is especially important for people who are uninsured or under-insured and must pay out-of-pocket for their care. Many insurance plans allow treatment at retail clinics and, in fact, the CCA estimates that 70% of people who visit store-based clinics have health insurance and are using the clinics primarily for convenience. In those cases, the same insurance co-payments apply as with doctors' offices. Insurance plans vary so Torrey advises confirming your company's policy in advance. For example, some plans require you to call for preapproval if you go to any office other than your own provider (e.g., on a weekend). Otherwise, unless it is a bona fide emergency such as a car accident -- not a Sunday morning sore throat -- they won't cover it.

SAFETY CONCERNS PERSIST Still it is valid to raise questions about safety. Some states require a physician on the premises at all times, while others merely mandate that one is on call. Among the concerns doctors list are no continuity of care, the lack of familiarity with patients' medical histories and "less-than-expert treatment" delivered by nurse practitioners and physician assistants, rather than primary care physicians, though in truth, these professionals often do the same work in private physician practices as well. Symptoms can be difficult to interpret, Torrey notes. A seemingly innocuous problem, like a bad cough, may be a sign of something more serious than a cold. While there's no guarantee your physician would diagnose this correctly either, the fact that he/she has more training and immediate access to your medical history makes it likelier a more complicated illness would be correctly identified and treated before serious problems arise. The American Medical Association (AMA) is calling on state and federal governments to investigate how clinics are run and place regulations on what they do. A major reason for this is that many walk-in medical clinics are joint ventures with store-based pharmacies. This opens the door to a potential conflict of interest, since drugstores clearly stand to make money from the prescriptions written in their clinics.

THE DOS AND DON'TS OF DRUGSTORE CLINICS Torrey offered tips on how to use walk-in retail clinics safely and to your best advantage:
Don't go to a drugstore clinic for serious medical problems. If you have chest pain or trouble breathing, for example, call 911. Likewise, walk-in clinics may not be a good idea for people with other health issues, like cancer or even diabetes. You may be better off seeing your primary care physician.
Research options in advance. As noted above, depending on your particular state's regulations, you may be seen by a nurse practitioner, physician assistant or other "physician extender," says Torrey, while others have doctors in attendance at all times. It's a really good idea to call around before you need to visit such a clinic -- so you know in advance where to go for the best care when you are sick.
Ask about the clinic's policy on prescriptions. Also best done in advance, Torrey recommends that you ask staff what they would do if you wanted to fill your prescription elsewhere. How they respond offers insight into how the clinic operates. If prescriptions written by their medical practitioners can only be filled in their facilities, you may want to seek care elsewhere.

Bring a list of all drugs and supplements you take and the dosages. This is the single best way to avoid medical errors such as potentially dangerous drug interactions. Also, check beforehand whether you are up-to-date on immunizations, such as tetanus shots, as this can sometimes affect treatment.

Request copies of all medical records of your visit and make sure your regular physician receives these. While many say they do this automatically, Torrey cautions that they don't always follow through. The best advice on retail medical clinics is to use simple common sense. If you're in good health and have a minor medical issue, you may indeed find that walk-in medical clinics offer some advantages, including easy access, short waits and low prices. Those with chronic or serious health problems do better to seek conventional medical treatment.

These clinics are best used for treating illness and aren't targeted to achieving wellness.
( This is an opportunity area- Qj)

Monday, February 11, 2008

Can Web create shoppers' market for health care? - CNN.com

Can Web create shoppers' market for health care? - CNN.com: "Can Web create shoppers' market for health care?Story Highlights
New Web site allows consumers to search, compare medical services

'We want to let consumers define value,' says founder of Carol.com

Skeptical analyst: Users choices could be limited by their HMOs
Some may wish to pay out-of-pocket to get more care choices, founder says"

QJ What a great idea . Check it out This is a template for consumer choice options

Tuesday, February 05, 2008

Health myth busted

Fat people cheaper to treat, study says By MARIA CHENG, AP Medical Writer - Mon Feb 4, 11:58 PM PSTProvided by:

As adult obesity balloons in the United States, being overweight has become less of a health hazard and more of a lifestyle choice, the author of a new book argues.(AFP/File)
LONDON - Preventing obesity and smoking can save lives, but it doesn't save money, researchers reported Monday. It costs more to care for healthy people who live years longer, according to a Dutch study that counters the common perception that preventing obesity would save governments millions of dollars.
"It was a small surprise," said Pieter van Baal, an economist at the Netherlands' National Institute for Public Health and the Environment, who led the study. "But it also makes sense. If you live longer, then you cost the health system more."

lifetime cost per health type

healthy 84 years $ 417,000 from 20 on
obese 80 years $ 371,000
smoker 77 years $ 326,000

"This throws a bucket of cold water onto the idea that obesity is going to cost trillions of dollars," said Patrick Basham, a professor of health politics at Johns Hopkins University who was unconnected to the study. He said that government projections about obesity costs are frequently based on guesswork, political agendas, and changing science.

Saturday, February 02, 2008

medical benchmarking

Top-Rated Hospitals Continue to Deliver Better Care

THURSDAY, Jan. 31 (HealthDay News) -- Patients admitted to the top-rated hospitals in the United States have an average 27 percent lower risk of dying than patients admitted to other hospitals in the country, a new study shows.

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Released Thursday by HealthGrades, an independent health-care ratings organization, the analysis of 27 procedures and diagnoses also found that patients who have surgery at the top-rated hospitals have an average 5 percent lower risk of complications during their hospital stay.
For this study, researchers analyzed nearly 41 million hospitalizations in 2004, 2005 and 2006 at all 4,971 of the nation's non-federal hospitals. If all hospitals had the quality of care of the top 5 percent of those hospitals, 171,424 lives may have been saved, and 9,671 major complications may have been avoided during the three years studied.
The study also found that the top 5 percent of hospitals lowered their in-hospital risk-adjusted death rates over those three years by an average of 15 percent.
The procedures and diagnoses included in the analysis included: cardiac surgery; angioplasty and stenting; heart attack; heart failure; atrial fibrillation; chronic obstructive pulmonary disease; community-acquired pneumonia; stroke; abdominal aortic aneurysm repair; bowel obstruction; gastrointestinal bleeding; pancreatitis; diabetic acidosis and coma; pulmonary embolism; and sepsis.