Sure You Want Your Network This Narrow? by Pat Conrad MD

It get’s confusing, but I have never been sold on the rationale of anti-trust legislation and court rulings.  I mean, if someone can do a better job, and pairs with someone else who thinks they can as well, what is the logic to override this free association of individuals?  At any rate, a federal court had blocked Aetna gobbling up Humana on anti-trust grounds, leaving the former as a tempting meal for pharmacy chain CVS in a $69 billion cash-and-stock deal. 

“CVS plans to use its low-cost clinics to provide medical services to Aetna’s roughly 23 million medical members. In addition to health clinics and medical equipment, CVS could provide assistance with vision, hearing and nutrition.”  And come on, who could be against vision, hearing, and eating right?  Of course this is CVS creating a captive population, Aetna-funded and blessed, to move right into their McHealth clinics for lower negotiated fees, government wink-and-nod quality assurances, and happy, smiling flu shot recipients.  And yes, honestly, any nurse practitioner or PA that can take vitals and dial 911 can keep a little CVS kiosk cranking along at a decent profit.  But will this be actual health care?

“CVS wants to be more than just a retail outlet,” says Craig Garthwaite, a professor at Northwestern’s Kellogg School of Management. “They’re expanding the retail clinics so they won’t be quite urgent care, but they’ll resemble a direct primary care facility.”

Whoa Nelly, hold up … a direct primary care facility?  “CVS operates more than 1,100 MinuteClinics at locations in its drugstores and within Target stores. CVS says its pharmacists and nurse practitioners can provide ongoing health care for people with chronic conditions like diabetes, high blood pressure or asthma.”  Pharmacists, nurse practitioners…no physicians?

Walid Gellad, a doctor and professor of health policy and management at the University of Pittsburgh says, “‘This is a different angle because the delivery part is focused on pharmacies, not hospitals or doctor’s offices.  Many are pushing for more health care services to happen in pharmacies, and this is one mechanism to make that happen.’

He says Aetna could help drive patients into the CVS clinics by making it cheaper to go there than to a primary care doctor. ‘The real potential here is for changing how healthcare is delivered in primary care settings,’ he says.”

To me this is an important fight over rhetoric and definitions.  I am all for the free market, and if you want to go to the gas station to have your piles treated by a snake charmer, then be my guest, seriously.  I no longer have the patience or desire to save people from themselves.  But I am damn tired of flimflammery, and calling these minute clinics “primary care” is just that.  Even associating them with Direct Primary Care is a stinking damn lie.  The CVS McClinics will feature pill-and-shot health techs that will smile, get discounts, and give you copious customer satisfaction cards to fill out.  The DPC physician – meaning a real doctor – will have the training, and attendant judgment to evaluate you more thoroughly and correctly, in the odd event that that raspy month-long cough might be something worse, and less quality-adherent.  The DPC physician will already provide all the apparent benefits of the McClinics and much more, with at least equal ease of access.

I do understand that this is the ongoing quest for better economies-of-scale, and that CVS is hoping to provide simultaneous reduced drug cost outlays and discounted sales, cheaper purchasing and better margins for consumables and insurance billings on a baked-in population.  Really, I can’t blame them.  But how does a local doctor’s office compete with this, when the CVS-Aetna axis is bragging about saving costs by not involving the expensive physician?

“This is a different angle because the delivery part is focused on pharmacies, not hospitals or doctor’s offices,” Gellad says. “Many are pushing for more health care services to happen in pharmacies, and this is one mechanism to make that happen.”

And what if Aetna doesn’t authorize you to see an actual physician, or get those fancy lab tests he ordered, when a Minute Clinic right around the corner can perform flu swabs in under 20 minutes, and write and dispense the Amoxicillin for your virus all under one roof?

Got it?

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  3 comments for “Sure You Want Your Network This Narrow? by Pat Conrad MD

  1. Steve O'
    December 8, 2017 at 8:55 am

    It’s called “quality harvesting.” Find a process with ‘excess quality,’ tear it out and harvest the savings. So what if you replace chicken salad with chickens**t. Lunch is lunch.

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  2. Perry
    December 5, 2017 at 8:01 am

    As the Titanic slowly sank into the icy sea, the band played “Nearer My God to Thee”.
    And so, the profession our mentors trained us in, becomes a mere farce of what it used to be. And health care goes down with the ship.

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  3. Martha Clark
    December 5, 2017 at 7:27 am

    “And what if Aetna doesn’t authorize you to see an actual physician, or get those fancy lab tests he ordered, when a Minute Clinic right around the corner can perform flu swabs in under 20 minutes, and write and dispense the Amoxicillin for your virus all under one roof?”

    There’s my fear right now. Right now I can’t get Aetna to pay for my much-needed medications, now I can look forward to being denied seeing a PHYSICIAN or getting labs!? Oh, and my taxes will continue subsidizing the whole mess.

    My personal experience at CVS has been a visit there during an Orlando vacation. Hotel concierge recommended it. I ended up being sent to ER by the helpful nurse practitioner…for a bladder infection! How is this decreasing healthcare costs?

    I write to my useless representatives in Congress about all kinds of issues, guess I’ll add this one to the list (*rolls eyes*).

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