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Store-based health clinics fast becoming big industry
Express approach can be quicker, cheaper, but the quality of care is questioned
BY ANNE D’INNOCENZIO The Associated Press

   NEW YORK — Increasingly, American consumers are shopping for health care the way they buy a hamburger or milk shake at a fast-food chain: By standing in line at a local store under a menu.
   Store-based health clinics — which are staffed mostly by nurse practitioners and offer quick services for routine conditions from colds and bladder infections to sunburn — aren’t just a health care fad anymore, but fast becoming a serious industry.
   About 7 percent of Americans have tried a clinic at least once, according to an estimate by the Convenient Care Association, an industry trade group formed last year. That number is expected to increase dramatically, as major pharmacy operators like Wal-Mart Stores Inc., CVS Corp., Target Corp. and Walgreen Co. partner with miniclinic providers like RediClinic and MinuteClinic to expand operations. The trade group estimated there will be more than 700 by year-end, up from the more than 400 now, and 2,000 by the end of 2008.
   With the nation’s $2 trillion health care system in need of repair, such an express approach to health care — which offers a wait time averaging about 15 minutes and evening and weekend hours — is being heralded as serving up a cheaper and quicker alternative than a doctor’s office or an emergency room. A physical exam costs on average $60, while a flu shot typically costs about $20. A strep throat test has a price tag of about $15.
   “I was frankly very impressed with how thorough [the examination] was,” said Susan Anthony, who visited a clinic at a Phoenix, Md., Target for a dry cough. “And it was fast. I walked in at 10:30 a.m. and was in my car a little after 11:00 a.m.”
   The American Medical Association said a growing number of medical practices are extending their office hours or forming their own clinics to compete. But concerns about quality of care are rising among physicians and some industry experts say the clinics’ services need to be more comprehensive if they are going to have a big impact on reducing overall health care costs.
   The competition is already spawning expanded services as well as new spinoffs. Consumer Health Services Inc. — founded by a former investor of MinuteClinic, considered the pioneer in the industry — just started rolling out walk-in doctor’s offices at Duane Reade Inc. drugstores in the New York City area. The clinics offer broader services that include wart removal and treatment for sprained ankles.
   The ventures are promising enough that big-shot investors are jumping into the game. RediClinic got an undisclosed cash infusion from Revolution LLC, the investment house launched by AOL founder Steve Case.
   Support among health insurance companies is also growing; about 40 percent to 50 percent of clinics accept insurance from providers like Humana Inc., UnitedHealth Group Inc. and Aetna Inc., according to CCA.
   But concerns are rising in the medical industry that these operations remain largely unregulated and are prone to conflicts of interest. Some physicians are also concerned that the clinics could disrupt the continuity of care and result in serious underlying health conditions going undetected.
   In June, the American Medical Association urged state and federal agencies to look into whether pharmacy chain-owned clinics urge patients to get their prescriptions filled on site. That followed buyouts of miniclinics by two big-name pharmacy operators: Walgreen bought Conshohocken, Pa.-based Take Care Health Systems in June, and CVS acquired Minneapolisbased MinuteClinic last year.
   A growing number of states have passed legislation to better defi ne the role of the nurse practitioner at these clinics, but store-based clinic executives say some of the state rules are too burdensome and hinder growth. According to the American College of Nurse Practitioners, approximately 23 states allow nurse practitioners to treat patients on their own. The remainder requires some formal relationship with a physician, which varies from supervision to collaboration. In Texas, for example, the physician is required to be at the site for 20 percent of the time a clinic is open.
   Store-based health clinics are held to the same high standards as doctors’ offices, said Tine Hansen-Turten, executive director of the Convenient Care Association. She pointed out that store clinics are either monitored by a state board of nursing or board of medicine, and sometimes by both.
   AMA also wants to ban the practice of health insurance companies waiving or lowering co-payments for clinic patients, which it calls a conflict of interest.
   Dr. David Plocher, the senior medical officer at Blue Cross Blue Shield of Minnesota, said that “the normal market forces should determine such things.” His company has reduced or waived co-payments for 25 member companies who use MinuteClinics and several other store-based clinics.
   The savings can be significant.
   A visit to a store-based clinic averages about $60, but a doctor’s visit costs twice as much, particularly in urban markets, according to Barry Barnett, a health care consultant for PricewaterhouseCoopers. That compares to about $300 for an emergency room visit, according to Barnett.
   About 40 percent to 50 percent of clinics take insurance. Hansen-Turten estimated 50 percent of clinic customers pay cash, but she noted that the majority have insurance.
CONCERNS OVERBLOWN?
   Like many of his industry peers, Michael Howe, president and CEO of MinuteClinic, said the concerns about quality are overblown.
   “I wouldn’t call it express care. I would call it efficient care,” added Howe.
   The AMA denies that its criticism of these clinics is being driven by economic interests, though there’s no doubt that primary physicians could lose some business as their insured patients go elsewhere for minor ailments.
   But health care consultants say that while the clinics may help save customers money and time, their ability to reduce overall health care costs will probably be limited given that they are really tackling the most minor of health problems.
   A bigger effect lies in increased worker availability as employees don’t have to take as much time out of their work schedules to go to a doctor’s office, according to Dr. Tim Newman, senior medical consultant for Watson Wyatt Worldwide.
   The growing number of onsite clinics at workplaces, staffed by physicians, actually have more of a potential to reduce overall health care costs since they focus on disease management, not episodic illnesses. The onsite clinics are not part of the Convenient Care Association’s total count, since they are not store-based clinics and have a different model.
   Store clinics are proving to be good business; they take about 12 to 18 months to break even. For retailers, the highest-margin products continue to be pharmaceutical, and clinics average about one drug prescription per patient.

BETH HALL/THE ASSOCIATED PRESS Shoppers walk past a sign that lists the cost of medical treatments at RediClinic while shopping at a Wal-Mart in Rogers, Ark.

A shopper walks past the RediClinic inside Wal-Mart in Rogers, Ark.

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Cash-flow crisis hits Bellevue
Women’s hospital facing bankruptcy
BY MICHAEL LAMENDOLA
Gazette Reporter

   Bellevue Woman’s Hospital is quickly running out of cash to pay its obligations as a result of its pending takeover by Ellis Hospital, according to Bellevue Board Chairman Neil Golub.
   A lack of cash could force Bellevue to declare bankruptcy, further complicating plans by Ellis to take over Bellevue’s services Nov. 1.
   “We will likely run out of money before the takeover,” Golub said Monday at an event to recognize staff involved in efforts to keep the Niskayuna-based hospital open.
   Bellevue has been forced to pay overtime and for shift coverage beyond what it has budgeted because staff members are using up their accrued sick time benefits, Golub said.
   Ellis Hospital will not assume any liabilities belonging to Bellevue after the takeover, including sick time accruals and pension benefi t contributions, said Ellis CEO James Connolly.
   “We also can’t do it. Ellis is not prepared to assume any liabilities from Bellevue. We have said that to the Department of Health and the Department of Health has agreed,” Connolly said. “As a corporation, Bellevue is still responsible for all of its liabilities.”
   Connolly said Ellis is telling Bellevue staff that after Nov. 1, it will calculate their level of benefi ts with Ellis based on their current years of service at Bellevue and that Ellis will waive their waiting period for health, dental and life insurance benefi ts.
   State Department of Health spokeswoman Claudia Hutton said the state authorized a $1.1 million loan to Bellevue Monday to help them meet financial obligations.
   “We see that their urgent need is to pay their vendors,” Hutton said, urging Ellis and Bellevue to work out the cash-flow problem themselves.
   “The state does not have money sitting around that we can use to solve everyone’s transitional issues with. We recognize there are operational issues with this transition. Bellevue and Ellis realize that as well,” Hutton said.
   Golub said the state loan will only cover “a week or two of payroll.” He said, “The state and Ellis have put this place in jeopardy. They have pulled the rug out from under us and have told us to continue to operate. It is creating serious problems.”
   He said Bellevue’s problems are further complicated by the loss of 10 “key people.” The administrators left following the July 19 announcement that Ellis would take over Bellevue under a deal worked out with the state Department of Health.
   The Ellis-Bellevue agreement will satisfy the Berger Commission decision that Bellevue close. The law, which took effect Jan. 1, puts into effect proposals of a commission headed by Stephen Berger that called for health-care cuts statewide to make the system more efficient and save public money.
   The Berger law also requires Ellis and St. Clare’s hospitals, both in the city of Schenectady, to enter into a joint governance agreement. Those hospitals have jointly submitted plans to the DOH calling either for a new women’s and children’s center at Ellis or an entirely new hospital. DOH approval and financial aid would be required for either plan. Ellis is a nonsectarian hospital while St. Clare’s is a Catholic hospital subject to Roman Catholic canon law, which affects the women’s reproductive health services it offers.
   Golub said Bellevue has been unable to recruit replacements for the positions, which may not exist after the Ellis takeover. “They are allowing Bellevue to dissolve,” he said. “We could have worked out a transition over six to eight months that would not have disturbed the quality of professionalism that exists at this hospital.”
   Bellevue CEO Anne Saile, who is leaving the hospital Oct. 31, said the deal with Ellis “happened quite suddenly.”
   Saile said Bellevue had sought a resolution with the health department prior to renewing the hospital’s malpractice insurance coverage. “We didn’t feel it was good conduct to have an insurance company insure us with the Berger Commission proposal over our heads,” she said.
   Bellevue officials asked the state either to postpone closure of the hospital, to have Ellis take Bellevue over and assume $35 million in debt and consolidation costs, or to close Bellevue down immediately.
   The state expects Ellis to maintain a full range of women’s health services following the transition. Connolly said abortions will continue to be provided on the Bellevue campus, but Planned Parenthood may take over the services in the future.
   “It is a matter of sitting down with Planned Parenthood and working with them,” Connolly said. “Ellis would be a medical backup for Planned Parenthood. They are meeting a need in the community.”
   He said having Planned Parenthood perform abortions and offer other reproductive services would satisfy canon law in regard to Catholic Church prohibitions against these services.
   The cost of a new hospital is estimated at more than $500 million, and a women’s and children’s center at least $25 million. Either facility would take years to design and build.
   Hutton said the state has $550 million available to help healthcare facilities put Berger Commission mandates into effect. The facilities have submitted requests totaling more than $2.5 billion.
   Connolly said the $550 million represents the first of four rounds of awards the state will make. The state is expected to announce awards in September.
   “If time and money are not available, then we have suggested a scaled-back version, which means building something on the Ellis campus. There should be some money to build a women’s and children’s center and expand our operating rooms and emergency room to meet community needs,” Connolly said.
   The money is coming from the Health Efficiency and Affordability Law for New Yorkers, also known as HEAL. The state expects to spend $1 billion over four years. The money comes through bond sales and is being allocated through the New York State Dormitory Authority.
   The federal government is also expected to provide the state with up to $1.5 billion as it meets goals to reduce hospital beds. The federal government wants to control Medicaid and Medicare costs by reducing hospital beds.
   “The federal government supported the idea of a Berger Commission to help move us in that direction,” Hutton said.

Is there anything in this town Neil and Co. don't run?

I am not a fan of Bellevue Maturnity and could care less if they sell it or not. But I do know that Neil Golub and his wife have sunk a ton of money into this hospital because they believed in it. And for that I give them a lot of credit. I would be somewhat dismayed if I were them, in just thinking of the money alone that they have invested. Not to mention their time and energy. They did a great community service by supporting Bellevue. They should be commended for their admirable efforts.

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Attorney general wants insurers to explain physician-ranking systems
BY CAROLYN THOMPSON The Associated Press

   BUFFALO — Attorney General Andrew Cuomo asked Aetna Inc. and Cigna Corp. on Thursday to explain how they recommend doctors to patients after finding the insurers’ physician-ranking programs to be confusing or even deceiving.
   “Ratings can be a very good thing if these ratings are accurate and fair and transparent. The more information to the consumer the better,” Cuomo said during a conference call with reporters. “But we want information that is helpful to the consumer and in the consumer’s best interest.”
   In letters to the Connecticut-based insurers, Cuomo took issue with their use of claims data, which is provided to the companies by physicians seeking payment, in ranking specialists such endocrinologists, neurologists and cardiologists.
   The reliance on claims data, which does not contain complete clinical information, can skew rankings, Cuomo said. He also took issue with the insurers’ failure to disclose the accuracy rate of their rankings, noting that insurers “have a profit motive” to recommend doctors who cost less but are not necessarily the most qualified.
   For example, a diligent doctor who orders an additional test may, using claims data, be branded as expensive and fall in the company’s rankings.
   “Absent review of relevant clinical data, you are unlikely to know why the additional test was ordered,” the letter from Cuomo’s office said.
   Insurers were asked to detail the criteria used to rank physicians and explain how they measure a doctor’s performance and cost-effectiveness and what incentives are used to steer patients toward or away from certain providers.
   “We will cooperate fully. Aetna is fully committed to transparency,” Aetna spokeswoman Cynthia Michener said.
   She said the company’s “Aetna Aexcel” network is limited to specialists in 12 areas and does not include primary care doctors.
   “Doctors are designated if they meet certain thresholds first for clinical performance and, only then, cost efficiency,” Michener said. The criteria is published on Aetna’s member and provider Web sites, she said.
   A spokesman for Cigna said the company was reviewing the attorney general’s letter.
   “We take the attorney general’s concerns seriously and will respond to his request for information,” spokesman Wendell Potter said.
   Last month, Cuomo instructed United HealthCare not to introduce a physicianranking program in New York state without his approval.
   Paul Macielak, president of the New York Health Plan Association, defended ranking physicians within a plan’s network as a “natural evolution” of the annual ranking of plans themselves. He said the doctor rankings also are meant to help health care companies meet government, employer and consumer demands to improve the quality of care and reduce costs.
   “The design of these programs, including the use of claims data, also helps plans identify potential fraud and abuse,” said Macielak, whose organization represents 30 managed care health plans.
   “The health care companies have an economic interest in seeing the customer go to the doctor or institution that charges the least amount of money,” Cuomo said. “Cheaper is not necessarily better and we don’t want a health care system where we enter a race to the bottom.”
   He compared insurers’ rankings of doctors to the practice of colleges recommending certain lenders to students while accepting gifts from the lenders, a practice he condemned earlier this year.  

  
  
  

That is what happens when it is no longer patient/doctor priviledge....not to mention medicine is only a small percentage of science.....NO ONE knows our body better than our Maker.....Hitler and his goons tried to learn that kind of stuff and have given us some of the things we know now....but, it is only 1 rain drop.....

we are holding an umbrella, the umbrella represents the insurance companies and the rain represents our doctor......

if we think the umbrella will go away when universal healthcare comes into play we are sadly mistaken......it just means that there are a bunch of people holding the same umbrella----we all know how well that works out when there are 5 people all trying to fit under AND CONTROL that SINGLE umbrella......

So united health care is all about the money and nothing what so ever about the quality of medical care. Okay folks, we better start getting use to trying to understand the foreigners in the medical profession. Cause that will be the only ones there will be to go to. Which is about the way it is right now. Just look in the phone book and see if you can even pronounce their names.

Quoted from bumblethru

So united health care is all about the money and nothing what so ever about the quality of medical care. Okay folks, we better start getting use to trying to understand the foreigners in the medical profession. Cause that will be the only ones there will be to go to. Which is about the way it is right now. Just look in the phone book and see if you can even pronounce their names.

This is the way I've always remembered it to be honest.  I grew up going to what is now known as Schenectady Pediatrics, with Drs. Mele, Lee, and Surani.  I don't remember who was who, I think Mele was the oldest.  I'm glad I was young when I was going there and had my mother with me because even though they were speaking English, I would still need a translator.  Maybe that's why I grew up trying to read doctor's writing on prescriptions.  Needed to at least know SOMETHING about my visit.

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Dementia patients seem to respond to Snoezelen therapy
BY KATHY RICKETTS Gazette Reporter

   ALBANY — When Bill Hodge used to go visit his mother, Phyllis Hodge, at St. Peter’s Nursing and Rehabilitation Center, she was often sleeping, and she did not always recognize him when he woke her up.
   Now when Hodge, 65, visits his 89-year-old mother, she is alert and smiling, and she seems to know that he is her son.
   The reason for the change may be Snoezelen (pronounced snoozlin) therapy, a treatment that started in the Netherlands some 20 years ago for people with Alzheimer’s and other forms of dementia. It’s named to evoke a sense of dozing and lazy relaxation that characterizes a visit to the room.
   The therapy uses colored lights projected on the wall, gentle music playing in the background, sounds of nature, a table filled with bubble tube lights, colorful fiber optic strands that residents can touch, large plastic eggs that change color that people can hold and aroma therapy.
   “I don’t know why, but she’s gotten a lot better in the last few months since she’s been having the Snoezelen therapy,” said Hodge, who lives in Nassau. “I would try to talk to her before, and when she’d try to talk back I couldn’t understand a word. Now, she’s not 100 percent, but she responds more appropriately.”
   While the therapy may not change the progress of the disease or make the resident recognize family members, Janette Albanese manager of the activity and volunteer services department at St. Peter’s Nursing & Rehabilitation Center, said it can make for a calmer, less stressful experience and bring the resident and family closer.
   “Alzheimer’s affects everyone differently,” said Albanese. “So depending on the resident, we can have fi ve people with Alzheimer’s in the room, and they all react to the therapy in different ways.”
   Between five and 10 residents spend an hour in the room with activity aides where they receive one-on-one therapy.
   “For some, it’s relaxing and calming, like going to a spa,” said Albanese. “For some people, it’s just a nice environment for them to be in. They enjoy it and have a nice experience. Others, like Mrs. Hodge, become more responsive. For others, it’s a slow progression.”
   Only a handful of trials have looked at whether the therapy provides true benefits for people suffering from Alzheimer’s, according to the Alzheimer’s Research Foundation. However, although the results were inconclusive, the trend was positive. After a Snoezelen session, people with dementia were less anxious, apathetic and restless. They also had fewer outbursts and created fewer disturbances. The therapy also has been shown to decrease the tendency to wander and to increase verbalization.
   Additional studies are in progress.
   Despite a lack of scientific proof, many experts remain convinced that the rooms are a useful addition to any facility.
   “Staff and residents alike seem to enjoy the relaxing and peaceful setting,” said Albanese.
   Hodge, a retired construction worker who works part time at Lombardo’s Auto Center in Albany, visits his mother every day except Sunday. Other family members also visit frequently.
   “She deserves it,” said Hodge. “She always stood by me no matter what. It’s only right that I stand by her.”
   Phyllis Hodge entered the nursing home three years after a fall when she began losing her memory.
   “She knows I’m her son, but not my name,” said Hodge. “But I notice a big improvement in the last few months. Her total awareness is better. She is much less confused. She used to cry for no reason. Now she doesn’t do that anymore, and she’s more aware of what’s going on. The quality of her life has improved.”
   Albanese said the equipment, which has been in use for the past four months, is intended to stimulate residents’ different senses.
   “Most of the things are very visual but calming,” she said. “So far we haven’t had any residents who don’t like the therapy.”
   Albanese said she was impressed with Snoezelen therapy when she read about it, and was pleased when St. Peter’s received a $2,500 grant from MVP Health Care’s Appleby Award to support the program last December.
   Orin Truss, activity aide, said Snoezelen therapy is currently offered on three units once a week for an hour each session.
   “We use different tactile sensations every week,” said Truss. “We don’t want to overwhelm them. Some residents look as though they are sleeping, but if you talk to them they respond. The brain is absorbing something, and we are seeing some slow progress in some residents.”
   Truss said many of the residents are more relaxed and want to nap after Snoezelen therapy.
   Truss said when he used to tell Mrs. Hodge that her son was here to visit, she would have no response. Now she looks at the door for him.
RESIDENTS REACT
   On a recent afternoon, five residents sat around a table in the activity room on the second floor. While a circular kaleidoscope of green and blue danced on the wall, residents seemed mesmerized by the fiber optic strands that changed color on the table.
   “Hello Mrs. Hodge. How are you?” asked Truss.
   “I’m well,” she responded, while she held a large plastic egg that changed colors.
   Later when Truss stood across the room and waved at her, Mrs. Hodge waved back.
   Staring at the egg, she motioned for her son to lean down. “I wish my mother was here to see this,” she whispered into his ear as Bill Hodge gave his mother a kiss.
   “I wish so, too, Ma,” he said. “I wish so, too.”

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Chronically ill need better medical system  
First published: Saturday, August 18, 2007

I was heartened to read that the presidential candidates are making chronic illness a top campaign issue ("Shift in health care tactics," July 29.)
  
The current medical system, and its focus on acute, time-limited illnesses, poorly serves patients with chronic conditions, whose symptoms ebb and flow over time, making coping and symptom management a challenge. A better system would provide comprehensive, coordinated case management for people with chronic diseases. Comprehensive case management not only treats patients' medical conditions, but also provides interventions targeted to the patient's phase of illness, incorporating the entire universe of being chronically ill, including the social, psychological, financial, legal, disability and lifestyle implications of long-term illness.

Unless the medical system adapts itself to a chronic-care model, the increasing waves of baby boomers entering their twilight years in worse health threaten to overwhelm doctors' offices, hospitals and social service.

PATRICIA A. FENNELL CEO Albany Health Management Associate

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the increasing waves of baby boomers entering their twilight years in worse health threaten to overwhelm doctors' offices, hospitals and social service.

The boomers will be the largest retiring population in history. The entire health care system will be overwhelmed. Instead of trying to come up with new 'programs'....entice people to enter the health care field AND pay them well. You can have all of the programs and new theories, and new proceedures, but without people to carry thru with these, it just won't matter.

Since when is aging a chronic 'illness'???

Some mornings when I get up it feels like a cronic illness with the aches and pains.

When the changing occurs we have to make lifestyle changes....Medicine says that we shouldn't have too and here is this pill that pill this therapy that therapy and by the way dont forget to change your lifestyle.....

medicine is an art that is in the eye of the beholder and it is not an exact science with all the answers, just more questions...and the insurance companies and their rules and regs just get in between the artist(doctor) and the canvas(patient).....are there guidelines?,,sure....

if we get to national 'healthcare'....then we will be switching out the insurance companies(in a very small way, we still need the 'managers' and stock market generated funds for research) for the government.....

pay attention to the news...

a new government study finds drinking wine every day is good for your heart
a new government study finds drinking wine every day is not so good for your heart..
this list is endless.....

sometimes it is the US government or some other country,,sometimes it's a college, drug company etc etc.......

senders, I do agree with you, that not only do they treat 'old age' like a chronic disease, they portray old age as disgraceful.

Isn't growing old a part of the life cyle? Guess what? No matter what they 'think'they can do for this disease called old age, you can just bet the farm that if we are all blessed to live in our 80's or beyond, we will all be peeing our pants and wearing Depends, walking slightly stuped and somehwat slower, forget what we ate for breakfast, wear corrective shoes, will have to have cateract surgery, on blood pressure pills, on cholestral lowering pills, covered with age spots, thinning white hair or no hair at all, wearing dentures, full of wrinkles and if vain enough, the men will be taking viagra IF they can find a women who remembers what to do?  

Gee...and will our friends and family still love and respect us with this horrible 'chronic disease'? Sometimes I feel that I have this 'chronic disease' already! So I'm with ya on that one shadow!