Retail Health Clinics: Should you treat your sore throat at the supermarket?

By Denise Mann, MS
WebMD Guest Blogger

Nov. 2, 2009 – Buy groceries. Check. Pick up prescription. Check. Get blood sugar levels tested. Check. Get flu shot. Check.

Health care is increasingly becoming part of our one-stop shopping culture as retail health clinics pop up across the map. Retail health clinics are free-standing, walk-in medical kiosks in drugstores, shopping malls, and grocery chains that offer acute care for throat infections and earaches as well as diabetes and cholesterol screenings, routine checkups, and vaccinations. The fees are low, and care is often provided by a nurse practitioner rather than a physician.

The latest study shows that such care tends to be on par with that received in a doctor’s office or urgent care center and may even be better than the care received in emergency rooms for some conditions. The study appears in the Sept. 1 issue of the Annals of Internal Medicine.

In this study, retail clinics charged significantly less for services commonly offered for several hundreds of dollars by doctors in private settings. “The cost of care was much lower than compared to doctor’s offices and about 80% less than in the emergency room, and the uninsured save even more than insured,” explains lead author Ateev Mehrotra, MD, a professor of medicine at University of Pittsburgh School of Medicine and policy analyst at the Rand Corporation, a public policy think tank in Pittsburgh.

Not everyone is on board. The American Academy of Family Physicians does not endorse retail health clinics and believes that such health care delivery could interfere with the medical home, and other medical associations are concerned that the quality of care received care at these clinics may be sub-standard.

Acute care for simple issues is one thing, but some clinics may be branching out into treating more complicate health issues, and that is where things get dodgy. The jury is out on how well these clinics could treat more serious conditions, Mehrotra says.

If you build it, will they come?

The retail health clinic philosophy is ala Field of Dreams with a twist: If you build it they will come (as long as it is conveniently located and open late). “If we provide health care access where people live, work and play and they can go after work, on weekends, and when it is convenient, then people are more likely to avail themselves to it,” explains urgent care physician Matt Mesnick, MD, chief medical officer of Minute Clinic, a subsidiary of CVS pharmacy. “Tripping over a clinic is a nice solution to the health care access problem, and being open when it is convenient is a huge leveraging point,” he says.

As of now, there are more than 1,200 such clinics located throughout the U.S., according to the industry’s trade group, the Convenient Care Association.

“We are at the point where we are still trying to fine-tune the model and we will see a steady growth of these clinics,” Mesnick predicts. He discussed the growth and potential of retail health clinics at the General Electric Healthymagination conference in New York City, a two-week-long conference designed to introduce doctors, thought leaders, and patients to the next generation of medical care.

Mesnick sees these retail clinics as the ‘front porch’ of the medical home, a concept that refers to comprehensive primary care. In this scenario, the primary care doctor is on the first floor, and the retail health clinic ushers people into their lair.

Here’s how it works: Someone with diabetes goes to a drugstore or mall with a health clinic. He or she picks up their medication and gets a coupon for a blood sugar and diabetic foot ulcer check right next door. The results of these tests are input into an electronic medical record system and sent to their primary care doctor, so care is coordinated as well as convenient, Mesnick explains. Any issues are flagged and addressed by the primary care doctor.

Access still an issue

Such an approach could save lives, he says. As it stands, just 2% of people with diabetes are hitting their blood sugar targets. “Is it the fault of training, education, or is access an issue?” Mesnick asks. If access is part of the problem, getting more people with diabetes screened more frequently can help a greater number of people achieve their blood sugar goals and minimize the risk of diabetes complications and related hospitalizations.

For these clinics to really take off, coordination is needed, he says. Consider this: “If you bring Johnny in to pick up medication for an ear infection, then we can see when his last measles mump rubella (MMR) vaccine was or if he is due for any other vaccines,” Mesnick says. “If you have this access but don’t have the patient’s immunization records, it doesn’t work."

Access to health care is still an issue for the masses, Mehrotra says. Most of the clinics are in dense, urban areas. One-third of people in cities live within a 10-minute drive from a retail health clinic.

“We did find that people who go these clinics are young adults who don’t have a primary care doctor, so retail clinics are serving a population that aren’t that well plugged in to the health care system, but these clinics are located in wealthier neighborhoods,” he says. “Some had hoped that clinics would serve the underserved, and that’s not happening."

SOURCES:
General Electric Healthymagination conference. New York.
Matt Mesnick, MD, chief medical officer, Minute Clinic.
Ateev Mehrotra, MD, professor of medicine, University of Pittsburgh School of Medicine; policy analyst, Rand Corporation.
Mehrotra, A. Annals of Internal Medicine, Sept. 1, 2009; vol 151: pp 321-328.
Rudavsky, R. Annals of Internal Medicine, Sept. 1, 2009; vol 151: pp 315-320.

Is Your Doctor’s Office Fat-Free?

By Denise Mann, MS
WebMD Guest Blogger

Oct. 27, 2009 -- You leave your house at 6:30 a.m. so you are sure to be the first person in line at the lab to have your blood work done. This way, you won’t be late for work, and with any luck, you will have the results of the tests by day’s end.

No such luck. You ended up sitting in the waiting room reading an outdated issue of People magazine and a few brochures on disease prevention for more than two hours before your name was even called, and didn’t get to the office until after lunch. Obviously, the results of your lab work were also delayed.

Sound familiar? Maybe not for long. Growing numbers of health care institutions are trimming the fat, and going lean. This doesn’t mean lay-offs, it means de-cluttering, reprioritizing, shifting resources, and striving to avoid bottlenecking in waiting rooms.

Lean can mean different things in different industries. For example, in the technology arena, lean means getting material through the factory, assembled, to the customer, installed, and ready to use faster than anybody else -- defect free, says Gary Reiner, senior vice president and chief information officer at General Electric.

Reiner spoke about the "leaning" of health care at the General Electric Healthymagination conference in New York City, a two-week-long exhibit designed to introduce doctors, thought leaders, and patients to the role that technology can play in improving health care.

Fat-free health care means less frustration

In health care, getting lean means improving patient satisfaction by cutting down length of stays or wait times without sacrificing care. It also means reducing costs. It’s about the bottom line -- but that doesn’t have to mean staff lay-offs or sub-standard care.

And many hospitals and health care systems are adopting this new mode of thinking by hiring consultants to put them on diets, so to speak. Brigham and Women’s Hospital in Boston, for example, got lean and cut average waiting time from 14-17 minutes to about 4-5 minutes. They also improved the lab turnaround time, and boosted patient satisfaction by 80%.

Lean is not mean

Tejas Gandhi, assistant vice president of management engineering and center for lean at Virtua Health, Marlton, N.J., is a believer. Going lean saved $14 million for the four health care systems that make up Virtua.

“Lean is about creating value from a customer prospective, and the customer is the patient who wants to know ‘how quick can I get home after a procedure or exam?’” he says.

In some cases, lean may involve some redesign. “Nurses and doctors walk miles and miles each day within their hospital hunting for equipment, looking for medication, charts, and supplies, but if they had the right tools in the right place at the right time, they would be able to spend more time by the bedside,” he says.

This strategy added 600 hours of doctor-patient face time -- and that is win-win.
“Patient satisfaction and employee satisfaction jumps the more time that the clinicians spend by the bed side because that is what they both want,” he says.
Lean is not mean, he says. “Many people may think lean is about job cuts, but we have not had a single layoff,” he says.

SOURCES:
Gary Reiner, senior vice president and chief information officer at General Electric.
Tejas Gandhi, assistant vice president of management engineering and center for lean at Virtua Health, Marlton, N.J.
General Electric Healthymagination conference in New York City.

Is the Health Care System Ready for Aging Baby Boomers?

By Denise Mann, MS
WebMD Guest Blogger

Oct. 28, 2009 -- There’s a silver tsunami gaining strength, and the health care system may not be able to weather the storm.

“As the tidal wave comes, are we prepared?” asks Margaret Scott, chief investment officer of Belmont Village Senior Living in Houston. “Do we have health care providers, doctors, nurses’ aides, or systems in place to keep people at home.”

The answer is a resounding “no”, but many in the health care field are furiously working on developing innovative, multi-pronged solutions to these problems. Improved disease prevention efforts and technology are two important parts of any potential solution, but the clock is ticking.

“It’s very scary to all of us in terms of solving this,” says geriatrician Mark Leenay, MD, MS, senior vice president of medical management and physician services at UnitedHealth Group-Ovations, based in Minnetonka, Minn. Scott and Leenay took part in a sobering panel discussion on the challenges of providing quality care to the elderly and chronically ill at the General Electric Healthymagination conference in New York City.

Changing the rules of engagement

Fully 75% of today’s health care dollars are spent on treating chronic illness, Leenay says, and half of that is used to treat illnesses caused by poor diet, poor exercise, and tobacco use -- i.e. preventable causes of illness.

“The focus needs to be on preventing them from getting sick,” he says. That is easier said than done, but making risks very specific to the patient, rewarding them for positive behaviors, and motivating doctors to prevent diseases can help.

Technology and prevention can go hand in hand, he says. A diabetes pump can be programmed to monitor a person’s blood sugar and adjust insulin levels accordingly. This technology will lead to tighter control of diabetes, and a lower risk of complications and hospitalization down the road.

“Technology allows the caregiver or physician or registered nurse to do what they are there to do -- not fill out charts for four hours a day,” says John Cobb, CEO of Senior Lifestyles, a Chicago-based corporation that owns and manages 54 retirement communities across the map.

He is referring to things like electronic medical records that can put needed information at a doctor’s fingertips instead of having to sift through mounds of paper files located miles away from the patient.

This paves the way for more face time between doctors and patients and can help compensate for the shortfall of doctors by allowing them more time to practice medicine.

Telemedicine can also play a role in caring for baby boomers, says Lynn Townshend, executive aide to the Commissioner of the Connecticut Department of Public Health in Hartford. Video conferencing and other technologies can allow doctors to reach out to patients in their homes, and can allow specialists to have a presence in communities that they would not otherwise have access to.

All this works to improve care and keep people home longer, she says.
Preparing for the silver tsunami is an uphill battle, Scott says. “They will not come simply, but we will find solutions.”


SOURCES:
Margaret Scott, chief investment officer of Belmont Village Senior Living in Houston.
Mark Leenay, MD, MS, senior vice president of medical management and physician services at UnitedHealth Group-Ovations.
John Cobb, CEO of Senior Lifestyles, a Chicago-based corporation.
General Electric Healthymagination conference in New York City.

View From ASPS: Plastic Surgeons Like It Hot

By Denise Mann
WebMD Guest Blogger

Oct. 29, 2009 (Seattle) -- Botox breast lifts, cleavage rejuvenation, fat injections in your butts, and breast and penis enlargement surgery.

No, this is not a rundown of hot topics discussed by the ladies of The View, it’s a mere snippet of the equally edgy -- and at times, bawdy -- subjects broached by leading plastic surgeons at the aptly titled topics “hot topics” session of the annual meeting of the American Society of Plastic Surgeons (ASPS) in Seattle.

And just like on The View, very little was off limits for this esteemed panel. Mark P. Solomon, MD, a Philadelphia-based plastic surgeon wowed the crowd by discussing a surgery that can add width and length to a man’s penis. Seeing is believing. And if before-and-after pictures can be believed, it really works. I kid you not.

And that was just the tip of the hot topics. Overall, there was less talk, and more action at this year’s ASPS meeting as new treatments moved to the breast and body. I’m talking about fat-melting injections with Lipodissolve -- a once controversial therapy that involves injecting a cocktail of chemicals into muffin tops, saddle bags, love handles, or other trouble spots to dissolve fat cells.

Several years back, V. Leroy Young, MD, a plastic surgeon in St. Louis known as a savvy clinical trialist and scion of surgical safety, began investigating this therapy. He was a skeptic at the time, but now Young is a believer. While the final results are not tallied, Lipodissolve may actually melt away fat.

What’s more, plastic surgeons have been talking about taking fat from thighs, butts, and other areas where it is plentiful and injecting it into the breast for cosmetic reasons for years. Some say it has merits, while detractors fear that it may mar mammograms, be mistaken for early breast cancer or even worse, cause cancer. But these fears are being dismissed by studies, and fat injections to the breast may be here to stay.

Plastic surgery is not all about nipping, tucking, and sucking or zapping away fat. There is another side to plastic surgery and plastic surgeons. The reconstructive side of the biz may not garner as many tabloid headlines as the sexy, celebrity-driven procedures like fat injections to the breast or cleavage rejuvenation, but reconstructive plastic surgery holds the power to save and changes lives every day.

This year’s meeting showed all of us how. An injured Iraqi citizen, a port wine stain patient, a breast reconstruction patient, and a patient who had skin cancer on her nose received the Patients of Courage: Triumph Over Adversity awards. Listening to these award winners tell their stories and talk about the doctors who treated them will forever change how you think about plastic surgery and plastic surgeons.

Design Thinking May Change Your Hospital Experience

By Denise Mann, MS
WebMD Guest Blogger

Oct. 28, 2009 – Doctor. Nurse. Physican assistant. Lab technician. Interior designer?
Yes, you read that last one correctly. Designers are increasingly becoming important members of your health care team, and they are helping to change the way that you receive medical care in some very innovative and creative ways.

It’s called “design thinking,” and it is aimed at changing your health care experience by changing the environment where you receive care. It helps take the fear and anxiety out of the hospital environment by making things friendlier, brighter, and easier to navigate.

“The health care team of the future has to involve designers,” says Nicholas F. LaRusso, MD, director of the Center for Innovation & SPARC lab at the Mayo Clinic in Rochester, Minn. The SPARC lab is working to re-create and reshape the entire patient experience with the help of a cadre of designers. LaRusso discussed his experiences at a General Electric Healthymagination conference in New York City.

In Rochester, where the Mayo Clinic is based, designers are ingratiating themselves into the community to learn what members need in terms of their health care and how they feel about their own health. Armed with this type of information, the designers seek to break down barriers by changing and softening the environment, redesigning exam rooms, simplifying the appointment check-in process, and increasing patient education.

“Designers and design thinking are a critical component of our team,” LaRusso says. “The value of design and design thinking has been fully embraced by our institution and the demand for the designers services are exceeding capacity,” he says.
It’s a marriage made in heaven, LaRusso adds.

“Physicians are evidence-based and solution-driven thinkers and this has pluses and minuses,” he says. “We often move to solutions before considering all potential approaches, but designers slow us down and help us think more broadly about framing the question and exploring a wide array of potential approaches.”

The result of this union? Improved communication between doctors and their patients and better health care delivery, he says.

Gary Kalkut, MD, MPG, the senior vice president and chief medical officer at Montefiore Medical Center in the Bronx, agrees. The design thinking approach starts with seeing things through the patient’s eyes and going from there, he says. “At our hospital, I tell staff to physically walk patients to where they need to go as maps and directions can be confusing.” Such efforts humanize health care and help take fear and anxiety out of the hospital experience, he says.

SOURCES:
Gary Kalkut, MD, MPG, senior vice president and chief medical officer, Montefiore Medical Center, Bronx.
Nicholas F. LaRusso, MD, director, Center for Innovation & SPARC lab, Mayo Clinic, Rochester, Minn.
General Electric Healthymagination conference, New York.

Virtual Stethoscopes: Coming Soon to a Doctor’s Office Near You

By Denise Mann, MS
WebMD Guest Blogger

Oct. 27, 2009 – It’s slim, it’s slick, it’s shiny, and it’s smart. It is also about the size of a cell phone, and the Vscan may help save lives in developing nations as well as rural parts of the United States.

The Vscan, developed by General Electric, is referred to as a virtual stethoscope and can be used to quickly and accurately make a diagnosis without relying on the more traditional and cumbersome ultrasound machinery. There is no pricing information available yet, but the product was unveiled at General Electric Healthymagination conference in New York City, a two-week-long exhibit designed to introduce doctors, thought leaders, and patients to the next generation of medical technology.

And that’s not the only high-tech product that may help save lives while cutting health care costs. Portable ECG machines that are about the size and weight of a laptop computer may allow doctors in small clinics and developing nations to quickly and efficiently assess the cause of heart problems. Electrocardiograms (ECGs) measure and record the electrical activity of the heart.

Former Sen. Bill Frist, R-Tenn., a former heart-lung transplant surgeon, is a fan of the Vscan. “If I had something like this, it would save what I had to do in the middle of the civil war in the Sudan when five patients showed up with abdominal masses that could have been caused by a number of things,’ says Frist, who is a member of a new advisory panel created by General Electric that aims to help use technology to provide access to affordable health care. With VScan, “instead of operating on all five, I might have only operated on one of them.”

A quick scan of the affected area with the lightweight device could have helped rule in or out causes of the pain that warrant surgery, he explains. And it’s not just the Sudan; this technology can also help doctors in rural areas of the U.S. such as Eastern Tennessee and Memphis, Frist says.

The smart ECG talks and gives feedback on the placement of the leads. While it has not received clearance from the FDA yet, some preliminary research shows that doctors dig its portability. The machine has a long-lasting battery life and allows users to transfer the information using a memory card.

Putting technology like the VScan or portable ECG into doctors’ hands will allow more people to be diagnosed sooner, says Michael J. Barber, a vice president of General Electric in Fairfield, Conn., who is head of Healthymagination.

“Health care reform is about providing access to more patients,” he says.

Sources:
Former Sen. Bill Frist, R-Tenn.
Michael J. Barber, a vice president of General Electric, Fairfield, Conn.
General Electric Healthymagination, New York.

GI Docs Talk Science, Find Time for Stress Relief

By Kathleen Doheny
WebMD Guest Blogger

Oct. 27, 2009 (San Diego) -- Mention “gastroenterologist” and some people will ask, “Which doc is that, again?” Others will literally back away, wary of their upcoming (or recent) colonoscopy.

Suffice it to say, gastroenterologists -- charged with the health of our entire digestive tract and liver --don’t have the fun-and-games image of, say, pediatricians who wear clown noses to amuse their young patients.

But another side of GI docs emerged when about 5,000 of them gathered in San Diego this week for the annual meeting of the American College of Gastroenterologists. The fun side!

In between serious research sessions, some shot hoops in the exhibit hall at the booth of PLUS Diagnostics, a diagnostic laboratory. Spokesperson Char Schraibman admitted it was a shameless (and effective) attempt to attract docs.

Over at the booth of Shire Pharmaceuticals doctors tried their hands at a video game to deliver the medicine to the little man on the screen before the bugs got him.

And at a press briefing Monday, David A. Greenwald, MD, a gastroenterologist at Montefiore Medical Center in New York, excitedly unveiled what he calls “Facebook for GI docs.” It’s a secure social network, hosted by the American College of Gastroenterologists and called the GI Circle, designed to help gastroenterologists communicate and view breaking news on research.

Whatever your score at fun and games -- or your friend tally on Facebook -- the stress relief might be good for your GI tract, research presented at the meeting suggests. At a press briefing Tuesday, researchers warned that workplace stress can wreak havoc on your GI system.

Other research focused on improvements in colonoscopy, considered the gold standard for detecting colorectal cancer, which kills about 49,000 people annually in the U.S. High-definition colonoscopy is being phased in, with new machines replacing older ones.

A tiny camera device, called the Third Eye Retroscope or TER, gives doctors a better look at the colon as they withdraw the scope, helping them find growths hiding behind the many folds of the intestines.

There was news about old diseases, such as P. Patrick Basu, MD, of Columbia University College of Physicians and Surgeons’ report that a four-drug regimen, including antibiotics and a medicine to reduce stomach acid, works better to wipe out the ulcer-causing bacteria Helicobacter pylori than a three-drug regimen often prescribed.

It got a thumbs-up (over the phone) from Emmet Keeffe, MD, professor emeritus of medicine at Stanford University in Palo Alto, Calif., a gastroenterologist who reviewed the findings for WebMD. “This is a relatively convenient regimen and has a high success rate,” he says.

As for patients who suffer from inflammatory bowel disease or IBD, they should be extra wary of too much sun exposure, Millie Long, MD, of the University of North Carolina Chapel Hill cautioned.

In her research, she found that IBD patients were more likely to get nonmelanoma skin cancers, especially if they are on certain medications.

Her findings, she cautions, are no reason to abandon treatment, especially if IBD patients get relief. Rather, it’s a wakeup call, she says, to pay close attention to sun safety practices such as wearing sunscreen.

Despite the advances in technology, the GI doctors stressed that patients play a big role in their own GI health. Compliance with medications for IBD and other problems is always an issue, they say. And those about to undergo colonoscopy need to know preparation is crucial.

For those looking for a bowel prep alternative to that traditional pre-procedure cocktail, researchers from Wyckoff Heights Medical Center in New York reported that a pre-colonoscopy regimen of lukewarm salt water and exercise works as well as traditional measures.

Stay tuned, they’re studying the approach further before it is ready for prime time.