Idaho Falls is ripe for MinuteClinics
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I read about the so-called MinuteClinics in this week’s Time magazine, and immediately recognized that this health-care solution is perfect for Idaho Falls.
These places are run by nurse practitioners who can diagnose and prescribe medication for the most common ailments. They are faster and cheaper than doctor’s office visits. While these places can give you a receipt for insurance reimbursement, obviously their allure is to the many un- and under-insured in our fair city. Think of this concept as fast-food health care, and you see why it will be successful.
There are no name-brand MinuteClinics (or their main competitor RediClinic) in Idaho yet. It’s nice to think that little mini clinics could open up in small neighborhood spaces around town, which would truly serve sick people who don’t want to drive far or walk amongst the public. However, the trend looks like they will mostly open up in large retailers like Wal-Mart, Fred Meyer, or Shopko. Larger people areas like the INL, University Place, Melaleuca, high schools, call center row on International Way, or even on our greenbelt could be prime spots for these mini clinics.
What other life tasks are currently long or difficult but could be transformed by fast-food style service?
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Comments
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0 
0 I think these clinics sound like a great idea but I read one thing that got me thinking: Why are they opening these clinics in large retail stores? If someone is going to be treated for a possibly contagious disease it doesn’t seem like a good idea to locate the clinic where there are large numbers of people running around. Maybe they didn’t mean the clinics are inside the stores, but they are free-standing buildings in the parking lot or something like that. The overall concept is a good thing and something I believe is needed around here. I think it would be a mistake to put it in a shopping center. It’s not the type of business that needs traffic to generate more customers. People would be going there for a reason and would go wherever they build it.
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0 0 Based on my background, I see this article differently than any views expressed. To address what Archy wrote, I believe Archy is referring first to an Urgent Care clinic in Skyline, which is staffed with physicians, Nurse Practitioners (NPs) and Physician’s Assistants (PAs). All of the physicians have hospital privileges.
2. The physician who operates his office of a location near Pancheri primarily conducts his practice in the homes of patients. Yes, he does house calls. The Post Register did a nice feature on him about 18 months ago. He has his house call prices calculated on how far you are from his office, the complexity of the visit, measured in time. He also transports with him the supplies and equipment he’ll need to treat the patient. I believe he works on a cash basis and patients file their own claims with their insurances, but I might be wrong.
To the best of my knowledge, unless something has just changed, this physician does not have hospital privileges. This is also another way to keep his overhead costs down. He obviously has a limit of what conditions and types of patients that he can treat. If he’s added clinical hours in his office for more complex conditions, that is a new addition in his practice.
3. The Idaho Migrant Council received the three year grant, jump-starting The Community Clinic on 25th Street. It also has satellite offices in Blackfoot and Roberts. While geared with bilingual staff and providing other services for migrant workers at the 25th Street location, the medical part of the clinic is available to anyone. NPs and PAs have staffed the clinic, but the council certainly has recruited for at least two physicians for the Idaho Falls clinic. That doesn’t mean the demands for PAs and NPs will decrease, it simply means more patients can be served at the main and satellite sites with more providers.
Other Urgent Care Clinics and private medical offices accepting walk in patients exist in eastern Idaho.
The pros and cons of the Minute Clinics model have totally different meanings in the State of Idaho, compared to other states. Idaho has too few physicians. Conversely, a state like Missouri has too many physicians trained yearly to remain in that state to practice. A Minute Clinic like this gives patients more access to providers in ID. Yet, in most states, these clinics are merely for convenience, not providing an overall larger number of practitioners available to the population. I don’t remember if the Time article discussed that fact, as the Minute Clinic concept wasn’t really designed for ID.
Voice Of Reason makes one of the most basic arguments against clinics like this being in shopping malls or large grocery stores. From the Time article Joe mentions above the description of the clinic FOCUSES on infectious diseases. “For common illnesses, such as strep throat, bronchitis, ear infections, sinus infections, Minute Clinic provides quick, convenient care. Minute Clinic provides a consultation with a health care professional, a prescription when clinically appropriate and the choice of having it filled onsite.”
Certainly sunburns, immunizations and allergies, as well as other simple medical conditions could be assessed in this setting. Consequently, referrals to primary care or specialty physicians can be made - and always to the sponsoring healthcare facilities and doctors who work within that facility or chain (if more than one hospital is owned by the healthcare system).
With no x-rays machines, limited lab equipment and other diagnostic work can be done on-site. Voice of Reason suggests these clinics be in free-standing buildings, which I agree is a good idea. But, those clinics already exist - they are called Urgent Care and can do far more than a Minute Clinic. Besides, there may not be a pharmacy within 100-200 feet of the clinic, which is a key concept in this clinic’s design.
To read more about a healthcare system that has added a few of these clinics to high volume grocery stories, here is a link to IHC’s version of a Minute Clinic:
http://intermountainexpresscare.org/
However, for me, a major concept about Minute Clinics in Idaho has not been addressed to date, in this thread. In Idaho, Nurse Practitioners and Physicians Assistants, due to the shortage of physicians, are licensed to independently practice on their own. How many other states allow that freedom as routine medical care? Currently, at least three NPs have their own offices in Idaho Falls. The idea of the “Minute Clinic” isn’t such breaking news in ID compared to other states where NPs and PAs, MUST have a physician on-site when he/she sees patients.
In those states, this is a major change to see a mid-level, receive a prescription if appropriate and have it filled, all within 90 minutes.
This is just my view of what Minute Clinics are and how they would or wouldn’t vary in Idaho compared to the Time article
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0 0 OK4now, thanks for putting some skin on that skeleton. You are clearly well informed on the subject. VOR has a good point. I also think that location in places where people spend a lot of money isn’t going to attract the people who need help most. I realize that is not the point of the clinics, but maybe it should be. 5 mins to give some homeless person some athlete’s foot help (or whatever)could be priceless to them . And they aren’t going to be shopping Macy’s.
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0 0 Now Wal-Mart has announced $4 generic prescription drugs! That’s cheaper than my insurance benefit co-pay!
Can American general healthcare do better without insurance?
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0 0 Yes and No, Joe. A lot of the responsibility depends on how much the consumer is willing to pay for healthcare and the specific need. If you have a family member that needs a specific blood pressure medication NOT on the list because he/she has blown threw others on the list, then do you have the person take the $4.00 generic just because it’s $4.00 and not receive the benefits of another drug (more than $4.00 co-pay), but that manages more symptoms and side effects? Is having a stroke and the expenses of an ICU stay, plus extensive rehab, let alone the human “cost” to all the people involved, worth the $4.00/month, so a more expensive pill that provided a different type of blood pressure regulation via a different mechanism or release, or for a longer period of time, wasn’t used? What if it is something simple like an antibiotic? Could the answer be different? Maybe.
Some people see it as a given that all should reach a “x” level of healthcare, regardless of what he/she contributes toward the cost. Some opt for low option health care coveage as nothing could ever happen to them. Some are not educated when it comes to being wise healthcare consumers. It’s great to have WalMart’s $4.00 generic rx drugs for those eligible in this pilot program. Pharmacies have made a LOT of $ for years with generics. I don’t claim to know why Wal-Mart did this, but am happy it has the potential to help many. From what I read, this is a test market pilot in FL. and 291 generics will be available at $4.00 co-pay.
Some generics are not without their problems and can actually end up causing more dollas spent in the overall healthcare picture than brand names. People with certain chronic diseases in particular, have to be very careful about generics.
A really simplified way to think about pharmacodynamics, or one major problem some generic drugs are known to have, is how much medication is delivered over what amount of time. Another way to look at that would be say you are pouring a new cement pad at your houe. Do you have the cement mixer dump all of the cement at one time? Or does the mixer continue to turn on the truck as one wheelbarrel is dumped, leveled and finished as one section of the overall new pad and then a new wheelbarrel of freshly turned cement is wheeled to the area so the next section may be com-
pleted to perfection. If the goal is smoothness and the right finish over the entire area, does it work to have the cement truck come in and dump the entire load at one time? Usually not.
So it takes an educated consumer to learn more about their medications and how they work, and obviously why the reason the medicaton is being prescribed. Is every consumer willing to be that educated? In my experience, no. It is far easier to not to have to learn, for many, more about their illness (or that of a loved one) and what role medication may or may not play in overall recovery or normal daily activities.
So while I think it is a novel approach Wal-Mart is trying and I say good for trying something new and different, I for one will have to learn more about the 291 generics available for $4.00, and what conditions they treat. If a generic drug at $4.00/month requires a patient with impaired memory or less than perfect compliance to take a pill four times/day vs. a different medication not on the list that might be taken once or twice a day (under supervision at home), who are the winners and who are the losers if the individual patient cannot remember to take his/her medication four times/day, instead of twice of day? That is just one simple example of many questions that will arise from this program.
For me, any solution to healthcare concerns and costs start with educated consumers who take responsibility for their healthcare. What good are generics at $4.00/prescription, if the person doesn’t see his/her health care provider for ongoing care?
It is an interesting idea and hopefully one that will encourage other large retailers to think of what they may or may not be able to offer consumers.
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0 0 In reference to Walmart’s big generic pricing scheme:
“Among these are widely used drugs for blood pressure, diabetes, asthma, Parkinson’s disease or thyroid problems. Though the list includes 291 drugs, many of them are different doses of popular drugs. For example, there are 12 choices of amoxicillin and four of ibuprofen. When the dose differences are shaken out, the list is pared to 90 drugs”
90 drugs out of thousands. This is just another PR campaign that is not as good as it seems. What’s even sadder is you can buy more ibuprofen off the shelf for $4 than you will get from 30 day prescription.
As far as the nurses go, they pushed the state legislature to give them prescriptive authority by arguing that the lack of quality health care in rural Idaho would improve. Thye said they wanted it so they could go to po-dunk Idaho and give quality care to patients without being bogged down by laws that limited their abilty to prescribe medications. It worked and the law was changed. Right after that the nurses moved into the big cities where the money is. Rural health in Idaho never really recieved the benifit it was supposed too. This is just another way to make bigger bucks in the city. Let them fullfill thier original ideals of caring for our rural communities first with these clinics before they open in major metropolitan areas.
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0 0 Joe brought up this subject several months ago. I saw this article in the Salt Lake Trb. and thought it might be interesting to read.
I do agree with Archy and Voice-of-Reason about what good could come from these clinics - medically underserved. But, I’m still cautious given how small these clinics are what really can be done other than infectious diseases diagnosis, insect bites, pregnancy tests and a few other things.
And Speakout is right on about the stated goal of nurses becoming mid-levesl in ID to improve rural care, vs. the reality of where most practice.
See what you think.
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0 0 It’s been a year now since I wrote this. I read that these minute clinics have sprouted up all over America.
Unfortunately, we do not have any in Idaho Falls yet. Unless I missed it?
Why has this phenomenon not gotten a foothold in Idaho Falls?
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0 0 Because Idaho is not a highly capitated state and can’t recruit physicians fast enough to keep up with the growth. Consequently, mid-levels, such as NPs and PAs are being utilized in sub-specialty practices probably most never thought possible.
When a mid-level can work in a Cardiology practice, for example, that has nuclear Cardiology on site, along with a cath lab in the office, why would a mid-level want to work seeing patients with allergies, front line viral and bacterial infectous disease and the other limited illnesses they can treat in the very restrictive setting?
Minute Clinics are also driven by large populations with very capitated health care and visited by patients who have high co-pays, such as $45.00+ per visit. And very competitive, and different, hospital chains.
Minute Clinics are limited in what they can cover, again with infectious disease being their main focus. If you need a tetanus shot, do you want to sit next to someone who has pneumonia?
As for the mid-levels who would staff them, the PAs and NPs, in Idaho can work in so many settings, including their own private practices. The same is not true in every other state. Why work at a Minute Clinic when a patient could see you in your own office?
As someone who has to shop at a store monthly, that has a minute clinic, I’ve seen them first hand. My view is they are a marketing entrance into a specific healthcare system. And, I think they are a waste of money.
I’ve never seen the Minute Clinic, to which I’m referring, ever full. Of course “full” means all 4 chairs are occupied. Healthy patrons of the stores and pharmacies don’t really want exposed to infectious diseases that Minute Clinics focus on treating.
I enjoyed earlier comments by some we don’t seem to hear from much anymore. Archy, where are you?
It was pointed out Minute Clinics could do some good for the disadvantaged. And while I see the merit in that discussion, the reality is the large hospital chains that sponsor them know exactly which stores they are targeting for business. And I’ve not seen a Minute Clinic focus on the underserved to date.
They may be viable in CA, TX, NY, PA and FL, among other states with large populations. But, I believe for all the reasons listed in previous posts, by myself and others, they aren’t for ID, WY, or MT, given their respective populations.
Just my view. What do you think? What would make them work in Idaho?
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0 0 Oh, good points. Another case of the concept sounding better than the actual practice.
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0 0 Capitated. Now there’s a word you don’t hear as often as you would like. Thanks to M-W.com, I know what it means now.
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0 0 Brian,
With all due respect, I believe the word capitated is all too familiar in four western states (who rank #1-#4 for highest capitation rates nationally). Consequently, I believe anyone who has lived or worked in those states, or other states who are becoming more capitated each year, are too familiar with the term.
Having worked p/t for a MAJOR national health insurnce company for several years, I can tell you third party payers prefer the term “Managed Care.” Call it what you want…. it restricts patient access to certain hospitals and practitioners. Overall, it’s bad for patients and practitioners, IMHO.
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0 0 I wasn’t making fun at all, so don’t get jumpy. I didn’t know the word, and looked it up. End of story.
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0 0 Brian,
I wasn’t getting jumpy; I’m glad to clarify that.
I don’t know how many people have really lived in highly capitated areas. So I don’t know how many assume what is allowed in ID is what is the standard everywhere, because it isn’t.
Hope that helps.
I was happy you looked the word up so you’ll have a better command of the situation as Managed Care seeps into ID.
No problem on my end, and I hope that clarifies it better for you. If not, please jot another post and I’ll see what I can do about posting something clearer.
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0 0 No problems here. I just wouldn’t assume people know what the word means. It’s highly specific to healthcare — a subject people like to groan about, but one not many are willing to research beyond “What’s it going to cost me?”
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0 0 Brian,
Thanks for your clarification. I’ve learned it benefits me to ask others to clarify, at times, if I’m not quite sure of a meaning, instead of just answering what I think the person meant.
Your statements are 100%.
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0 0 At least IF still seems to have decent services for medical care. I’ve heard many Poky residents are choosing to come to IF or Blackfoot for care. Why is this happening? I wonder if they would chose “minute clinics”? Although in Idaho I don’t see the difference b/w one of these and an urgent care facilty. I definately don’t like the idea of a an type of urgent clinic being located in the middle of a mall, unless it had it’s own outside door entrance.
http://www.pocatelloshops.com/blogs/Journal_Opinion.php?id=2358
http://www.pocatelloshops.com/blogs/Journal_Opinion.php?id=2443
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0 0 New in Town,
Minute Clinics can’t provide a fraction of the services an Urgent Care can. No onsite X-Ray, Lab, ability to set bones, sutues, set ups for special systems - ENT, eye, etc. that require a lot of equipment.
Minute Clinics are designed to be withint about 100 feet of a pharmacy. The thinking being it’s a one-stop shop.
Also, this isn’t about the Minute Clinics, but didn’t you and I have a discussion earlier about a certain physician that relocated from Poky to another area in eastern ID? If so, I’ve recently learned more info about who is leaving next (or at least is line to leave, but will be gone by 06/01/07).
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0 0 Does this physician primarily care for one’s skin and related problems? Yep, sorry to see this one go.
Thanks for the pharmacy clarification on a minute clinic. I don’t know much about them.
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0 0 Bingo. Ad just appeared to sell. I think you told me you knew one more who was planning to leave as soon as he could secure a job.
I don’t know if he was the one or not, but it seems all the good ones are hitting the trail, working locums (that’s what a couple of the gas folks did) or other.
Besides losing these players, does that make sense of why people are traveling north? Plus, new programs - tertiary level are drawing the crowd north. Not sure how much I can say about them right now.
Plus, that winner of a leader (you know I don’t think too highly of him), has really put people and “workers” in a fix. Will that business now have to go private, receiving the majority vote etc. What a mess!
If you have further questions/info, perhaps I should ask Joe to give you my e-mail addres I use for this site, so we can chat a bit more privately. While we have NOT mentioned names, I’d still feel better about it.
Anyway, it’s good to hear from you as I thought of you immediately when I saw that newly submitted ad.
As for the Minute Clinics, the IHC website I listed early in the discussion: IHC.com then click on “Facilities and Services,” then the listing is under “Express Care.”
Hope that helps!
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0 0 Thanks OK4now - we probably feel the same way about some things. Right now I’m going to kick back and watch the ISJ blogs, one writer is trying to uncover the problem. Let’s hope he gets feedback from all of those with complaints. I wish people would speak up when it matters most instead of quietly complaining to people who can’t do anything about the problem. Allegedly there will only be one MD on LG’s panel. Not sure on # of nurses. You’d think those fields would be more fairly represented, seeing as they have to live with the crap everyday.
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0 0 I definately wouldn’t call them “minute clinics”! You’re still going to sit there for an hour waiting to be seen! “convienent clinics” would be a better word for them.
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0 0 You are aboslutely correct, Chrisr67. That’s if there is a chair to sit on.
Of course, you could always go pick up a few groceries while waiting and get paged.
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OK Jumpstarting. Affordable health care is also an issue, here. On the West side, they have a nice little Family clinic on Skyline. Not the type you are talking, but neighborhood nonetheless. There is supposedly a Doctor near the Pancheri overpass who has opened a small office to help people who can’t afford expensive help. There is also an office on 25th that takes walk ins during specified hours. I think it is a migrant council effort.
I’m glad you brought up the subject - that’s how good things get started.