International Health Train Express

Quote of the day:

There will always be a part, and always a very large part of every community, that have no care but for themselves, and whose care for themselves reaches little further than impatience of immediate pain, and eagerness for the nearest good. - Samuel Johnson

Who needs ICE (Immigration and Customs Enforcement? According to today's New York Times,  hospitals do not.

Many hospitals resort to this "cost-effective' means to hold expenses in check in regard to the care of undocumented immigrants.

" JOLOMCÚ, Guatemala — High in the hills of Guatemala, shut inside the one-room house where he spends day and night on a twin bed beneath a seriously outdated calendar, Luis Alberto Jiménez has no idea of the legal battle that swirls around him in the lowlands of Florida. "

Mr. Jiménez was deported — not by the federal government but by the hospital, Martin Memorial. After winning a state court order that would later be declared invalid, Martin Memorial leased an air ambulance for $30,000 and “forcibly returned him to his home country,” as one hospital administrator described it.

Unable to find a chronic care facility to care for him, the hospital solved it's "problem" by leasing an air ambulance to ship Mr Jiminez back to Guatemala...  A much less expensive option than the 1.5 million dollar charges that were accumulating.  Even with attendant legal battles, this was a 'bargan" for the hospital.

Martin Memorial Hospital is not a unique hospital to resort to this "ploy'.  Hospitals will do what our federal government either will not or cannot do. 

"A few hospitals and consulates offered statistics that provide snapshots of the phenomenon: some 96 immigrants a year repatriated by St. Joseph’s Hospital in Phoenix; 6 to 8 patients a year flown to their homelands from Broward General Medical Center in Fort Lauderdale, Fla.; 10 returned to Honduras from Chicago hospitals since early 2007; some 87 medical cases involving Mexican immigrants — and 265 involving people injured crossing the border — handled by the Mexican consulate in San Diego last year, most but not all of which ended in repatriation. " reports the New York Times.

It also serves as a potent reminder what the 'free market system' of entrepeneurial motivation can accomplish when our governments are frozen with inaction, and indecision.

Over all, there is enough traffic to sustain at least one repatriation company, founded six years ago to service this niche — MexCare, based in California but operating nationwide with a “network of 28 hospitals and treatment centers” in Latin America. It bills itself as “an alternative choice for the care of the unfunded Latin American nationals,” promising “significant saving to U.S. hospitals” seeking “to alleviate the financial burden of unpaid services.”

God bless "American know how".  It did not take a committee to accomplish this.

Your comments are welcome..

MORE ON P4P

Quote of the day:
The squeaking wheel doesn't always get the grease. Sometimes it gets replaced. - Vic Gold

Greg Scandlen (Consumers for Health Care Choices) extracted some facts from Health Affairs that bears some scrutiny.

Pay for Performance is a buzz word that has CMS and other payors  brainwashing and extorting providers with either incentives or negative rewards for implementing a largely unproven scheme.

Health Affairs elaborates:

Pay for Performance Doesn't Work

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Health Affairs has published an important new study on Pay For Performance (P4P) that concludes it has had virtually no impact on physician practice. That is not to say physician practice isn't improving with time, but P4P programs have little to do with it.

The study looks at 5,350 physicians in 154 physician groups in Massachusetts from 2001 through 2003. Overall about half of these physicians were in P4P programs established by five health plans that cover four million enrollees in that state. The plans reported information about physician compliance with thirteen measures of performance established by the National Committee for Quality Assurance known as HEDIS measures. It compared physicians who were "highly incentivized" by P4P bonuses to physicians who were not involved in P4P programs.

This e-mail program doesn't allow for complex tables, so it is hard to show the information graphically, but here are some highlights -

Breast Cancer Screening: "Highly Incentivized" Physicians (we'll call them HIP below) complied with HEDIS measures 82% of the time in 2001 and 82% in 2003, while the comparison group (call them non-HIP) complied 83% in 2001 and 84% in 2003.
Cervical Cancer Screening: HIP -- 84% in 2001, 86% in 2003; Non-HIP -- 84% in 2001, 86% in 2003.
Chlamydia Screening ages 16 - 20: HIP -- 31% in 2001, 41% in 2003; Non-HIP -- 30% in 2001, 39% in 2003.
Chlamydia Screening ages 21 - 26: HIP -- 31% in 2001, 36% in 2003; Non-HIP - 34% in 2001, 39% in 2003.
Diabetes Care, eye exams: HIP -- 51% in 2001, 54% in 2003; Non-HIP - 52% 9in 2001, 56% in 2003.
Diabetes Care, HbA1c tests: HIP - 81% in 2001, 85% in 2003; Non-HIP - 81% in 2001, 87% in 2003.
Diabetes Care, LDL-C screen: HIP - 79% in 2001, 88% in 2003; Non-HIP - 80% in 2001, 89% in 2003.
Well-Child, age 3 - 6: HIP - 81% in 2001, 86% in 2003; Non-HIP - 87% in 2001, 90% in 2003.
Well-Child, adolescents: HIP - 34% in 2001, 40% in 2003; Non-HIP - 57% in 2001, 62% in 2003.

Leaving aside the question about whether any of this measures anything meaningful - other than marking off boxes on a check list (notice there is nothing here about actually listening to your patient, or finding and treating anything that might be wrong, or persuading the patient to change behavior), what else does it show us?

Many athletes are paid for performance, and their are also amateurs who are not

 

It shows us that the much-vaunted pay-for-performance system is useless, not withstanding the fact that private payers, Medicare, and the presidential candidates all promise that such programs will save the health care system. In fact, on many measures the "non-incentivized" physicians improved more than those who were "highly incentivized." Golly, is it possible that physicians actually pay attention to the emerging literature and freely change their practices in the interests of good patient care? Oh, no, that can't be it.

SOURCE:
Health Affairs P4P Study.

An interesting take from a  consumer advocate, that is very pro-physician.

Special Edition XTRA XTRA!

While I  was gone, my feeds have updated. Lots of interesting news, and opinions.

Let's start with iHealthbeat

150 Billion dollars !! to implement Health IT, says Dr Robert Miller from UC San Francisco

Dr Miller quoted these figures at a recent meeting of The Institute of Medicine

Dr. Miller is a Professor of Economics at UCSF.

Government Health IT  elaborates further on the Feud that is breaking out regarding the ultimate costs of implementing Health IT.

Ladies and Gentlemen.....the ship is sinking, let's not fight over which side of the ship to jump off.

 

I am going back to my sleep number bed

Another Post with No Title

I need to find another title. One that is catchy and is tagged well so that the search engines rank me up there with The Health Care Blog. How does Matt do it? My ratings have never crashed,, largely because I have never soared into a  gleaming takeover possibility.  I was hoping to become  " a cult blog". Perhaps I need a better research department.  I secretly dream that readers are so enthralled with my writings, and meanderings that they are struck by 'shock and awe' and are dumbfounded into silence. Now and then I find snippets or complete ideas on other blogs several days or weeks after I post the same opinion. Are they reading my blog, and not admitting it?  Is there such a thing as mental telepathy?  I will have my legal department investigate.

Besides I have notice my reimbursement rate has declined much llike my fees for seeing patients. Perhaps a new business model is necessary, such  as:

Besides I started blogging to relax and freely associate with my writings.  Now I have to get up and first thing is read my  'prayer for the day' check the weather forecast to see if it will be 95 or 105 degrees, sunny or more sunny, and read the ozone levels, followed by reading all my relevant blogs.

I am up too early this A.M. The  blog feeds are not in, and this is getting to be too much like med school, and residency. It reminds me of morning rounds at 5:30 am walking around seeing sleeping patients (and nurses), cruising empty hallways.

I am going back to my sleep number bed, I may be back today again.

Quote of the day:
To achieve the impossible dream, try going to sleep. - Joan Klempner

A Post with No Title

Quote of the day:
I was born not knowing and have had only a little time to change that here and there. - Richard Feynman

 

Several comments and studies regarding the National Effort for Health Information Technology.  The Heartland Institute and the Center for Consumer Directed Health Care published an opinion piece regarding how government is failing and will establish a non working and instantly obsolete health IT network.

"Any system that is imposed today will be obsolete in five years," Greg Scandlen, director of the Heartland Institute's Consumers for Health Care Choices, said, adding, "Yet the federal government is woefully incapable of changing or eliminating outdated rules and regulations. So we will be stuck for all time with whatever they come up with today."

The Heartland Institute describes itself as a national not-for-profit research and education group that is unaffiliated with any political party, business or foundation (Monegain

  Many feel the government should perhaps set an interoperability standard, and then butt out.  They and I feel private companies would be better suited in our market to accomplish this task

It remains my opinion from the onset of the furor over EMRs, RHIOs that the best route is to go to those who already know more about networking than anyone else....the telecommunications industry.  The solution is to contract with these entities to set up this network..

Some things are better left to those who specialize in telecommunications.   There have only been a few health entities that have developed regional HIEs that are operating successfully.

Much of the work thus far has been local with "boots on the ground", with voluntary workers. 

They do this as a "love" effort for health care, knowing this is necessary.  At the end of the day there are few stakeholders.  Yes there are some isolated, disconnected  demonstration projects.

There are also false illusions about making this a patient centric network.  That sounds alluring, and does peak the public interest and involvement.

Let's distill that idea down to the idea of the public setting up and operating there own  ATM network.

Patients do need transparency, should be running the business of your office or your hospital?

If anyone believes the government can or will fund these 'mandates' then I have this bridge I will sell to you for $1.00.

 

We do need system changes, perhaps EMR and/or RHIOs will play a part.

Health Train Engines

Today's New York Times carries an article by Natasha Singer, "The Price of Beauty".  It points out how this has become the 'Engine for Success" in many dermatology, ophthalmology, and ENT practices. It however failed to point out that this is ocurring in non surgical practices such as family medicine, and yes, even OB/GYN.  Reader's comments range from understanding and commiseration to outright condemnation of these practices.

Cosmetic laser treatments, botox injections, collagen filling procedures, vein removal procedures, ophthalmologic procedures such as laser refractive surgery, premium multifocal intraocular lense cataract procedures offer the opportunity to stay afloat or drown in a sea of rising cost, and reductions in reimbursement.

For most physicians who practice without these cosmetic procedures, it is an easy step into this realm, at first noting that the economic pressure is reduced, then gradually it begins to take over the practice....It is not an admirable occurence, and those who do it cringe at what they have become.

There is no doubt that the 'engine for health care' should and must be caring for those who are ill.  When and if money is removed from the equation is a very doubtful prospect....communism tried it.....and failed.  Would socialized medicine, or universal payor solve the problem? 

Sights, Sounds and ......

Quote of the day:
That which has always been accepted by everyone, everywhere, is almost certain to be false. - Paul Valery

Today I discovered while editing my blog that my list of blog links over to the left sidebar was totally missing. 

I spent part of today re-posting it, and it looks a bit ragged, but I will clean it up later this week. 

You may note I have a new link on the left sidebar  http://www.healthpolcom.com/blog/

Mike Miller M.D. contacted me via Sermo.  After reading several of his posts I can recomend  him without hesitation for quick and pithy observations that are not verbose and to the point.

Mike, thank you for contacting me.

My brain is tired tonite. It's been a long week.  I have added some video and sound links to the site as well.  Let me know if you experience problems.

Toot-Toot on the Health Train Express

embargoed until  July 24,2008
Quote of the day:
My definition of an expert in any field is a person who knows enough about what's really going on to be scared. - P. J. Plauger

The horns are blowing at the health train express hurtles down the track, first leaning to the right, then the left travelling along tracks laid in 1960 or even further back than that.

Who is blowing the horns? Is it the government, health insurance plans, consumer advocacy groups, employers, or some hidden

Demonic Forces TRAILER - For more of the funniest videos, click here

demonic forces

 

Here are several relevant news articles in regard to health information technology.

iHealthbeat reports the following:

PHR Networks Better Model Than RHIOs To Exchange Health Data

Speakers at the Third Annual Leadership Summit on the Road to Interoperability in Boston on Tuesday said personal health record networks likely will provide a better model for health data exchange than regional health information organizations, Healthcare IT News reports.
R. Tim McNamar -- founder and CEO of e-certus, a software company, and former member of the Reagan administration -- said PHR platforms offer hope for the exchange of health data sooner than could be achieved through RHIOs. McNamar criticized President Bush for not pushing interoperability. He added, "There's no viable model for RHIOs."
David Kibbe, senior adviser to the American Academy of Family Physicians, said, "We can't expect government to build a network. Government didn't build the Internet. Government didn't build PCs."
Vince Kuraitis, a lawyer and principal of Better Health Technologies, predicted that companies would begin developing applications for PHR platforms such as Google Health, Microsoft's HealthVault and Dossia (Monegain, Healthcare IT News, 7/23

There actually are models for RHIOs, that will work. The technology is there, but the financing is not. I am not at all sure how consumers, or employers or whomever are going to build a PHR  that would work for providers, or hospitals.  PHRs as they now stand do not address the issue of P4P, management of chronic diseases and many other important issues. 

This is a little like asking the consumers to design their own ATM network for banking , or a computer inventory system for their local supermarket.

iHealthbeat goes on:

House Committee Passes Revised Health Care IT Legislation

Today, the House Energy and Commerce Committee approved health IT legislation (HR 6357) aimed at driving widespread adoption of electronic health records, Health IT Strategist Alert reports.
The legislation also is intended to strengthen federal patient security and privacy laws.
The bill would authorize more than $560 million in grants and loans for health care providers (Health IT Strategist Alert, 7/23).

Changes to Bill

On Tuesday, House Energy and Commerce Committee Chair John Dingell (D-Mich.) and ranking member Joe Barton (R-Texas) released a revised version of the bill.
According to CongressDaily, the lawmakers significantly changed the legislation's information-sharing and privacy provisions to address recent concerns from health care, high-tech and consumer advocacy stakeholders (Noyes, CongressDaily, 7/22).
Under the revised bill, patients would give their consent only once to health care companies that want to access health care records without identifying information for HHS-approved purposes, such as hospital audits or fraud and abuse allegations. The bill previously would have required patient consent each time the records were accessed.

Comments

Mary Grealy, president of the Healthcare Leadership Council -- who on Monday sent a letter to Dingell and Barton stating her concerns about the proposed bill's effect on the Confidentiality Coalition -- said, "They did make improvements in those provisions we had some concerns about, so I do feel like we're making progress." However, she added, "Do I think they have completely addressed all the issues? No" (Young, The Hill, 7/22).
A spokesperson for America's Health Insurance Plans said the provision that would allow patients to access their medical records and require them to provide consent for third-party access could restrict health care providers from developing wellness, disease management, quality assurance and other essential programs (CongressDaily, 7/22).
A spokesperson for Patient Privacy Rights said the revised bill is being reviewed and declined to comment (The Hill, 7/22).

It is apparent there are many hands in the cookie jar. Health data exchanges will undoubtedly be heterogeneous and probably never be fully integrated, nor should they be.

BEAM ME UP SCOTTY

 

This phrase from Star Trek, and others such as "More power to the warp engines, Scotty", might also be applicable to health care.

Although we can't quite de-materialize and rematerialize elsewhere, the advent of telemedicine, email, and some forms of HIT does allow us to be intellectually present in two places simultaneously...

I was reading several blogs yesterday and came across several eponyms, EBM (Evidence Based Medicine) and Ix.  Ix really threw me.  I thought I was fairly current on my blogging CME but apparently I am lagging.  I think we should all received CME credits for our work in the blogosphere.  I wonder what Edwin Leap or Kevin MD think about that one.  They have been off at summer camp, hiking or some other non-productive activity while I have been chained to my keyboard. At least Dr Reece at Medinnovation has been at work.....but then who can call it work when one lives in Old Saybrook, CT.

If I remember correctly from a far distant place Old Saybrook is where the movie  " was filmed.

This epic cult film from the early 1960s portrays a young Sandra Dee playing the role of the weekend or summer fraternity party, frolicking at the beach and other pursuits of the androgenous and estrogenic late adolescent phase of life in college.  During my more youthful days I made several attempts to duplicate "Summerplace" one week when I was in charge of social activities for my  fraternity.  I was quite successful from what I can remember.

Anyway, back to Ix....This eponym coined by Josh Seidman stands for Information Therapy, not to be confused with IT.

Josh Seidman and his Center for Information Therapy  (Center for Ix) form a focus group 

"  The Center for Information Therapy (IxCenter) is an independent, 501(c)(3) tax-exempt, not-for-profit that aims to advance the practice and science of information therapy to improve health, consumer decision making and healthy behaviors.

The Ix Center acts as a catalyst for health care delivery innovation by diffusing Ix strategies through research, education and collaboration. A core function of the IxCenter is engaging with Ix proponents and industry leaders through its IxAction Alliance. "

Well, if you have followed my "drift", then set a course at warp 9  for Omicron 9 and make it so.

That being said, and also that it is quite a mouthful I would recommend clicking on my link to the source.

Congressional Health IT Legislation

 

from:  iHealthbeat

Prospects for Passing House Health IT Legislation Unclear

The House Energy and Commerce Committee is expected to vote this week on legislation aimed at creating a nationwide system of electronic health records and protecting patient privacy, but the bill's fate remains unclear, CongressDaily reports.
In June, the House Energy and Commerce Health Subcommittee approved the bill, sponsored by Energy and Commerce Chair John Dingell (D-Mich.) and ranking member Joe Barton (R-Texas), by voice vote. Since then, staffers have been negotiating language with industry and consumer advocates, but some individuals involved in those talks say the chances of passing the bill get slimmer as more time passes.
Barton and Energy and Commerce Health Subcommittee Chair Frank Pallone (D-N.J.) say the negotiations largely are related to privacy.

Comments

Rep. Henry Waxman (D-Calif.) wants the bill to include language that would allow state attorneys general to sue on behalf of residents over security breaches because thousands of complaints about HIPAA violations have been ignored, he said.
Rep. Mike Rogers (R-Mich.) has said the bill's patient consent provision is too broad and would impose regulations on top of what is already required by HIPAA.
Pallone said, "This bill, unlike others, still has the potential of being passed in both houses and getting to the president's desk." He said he still hopes to move the legislation through the House and Senate and to the White House this year.

However, Dave Roberts, a lobbyist for the Healthcare Information and Management Systems Society, said he believes the House has "achieved what it's going to achieve" this session in regards to health care IT. He said a provision aimed at encouraging doctors to use electronic prescriptions that was included in the recently passed Medicare physician payment bill was a good first step (Noyes, CongressDaily, 7/21).

FUTURE OF HEALTH CARE

A DISMAL OUTLOOK?

The American Economist web site offers this pessimistic view on what is happening to our health care system.

My response is at the end.

"If you haven’t read Alvin Toffler’s book, Powershift, you probably have no idea what has happened to us in the last decade with regards to the information era. In this historic book, Toffler talks about the “Powershift” which is the information era and how knowledge and information will be the most valuable currency in the world. While traditional economic transformation progressed from agrarian to industrialized societies, the next wave was the information era. “Third World” economies could actually leapfrog the industrialized economy from a rural/agrarian one to an informational society with the advent of computer networks and the internet.

In the healthcare system, such a “powershift” is occurring within the walls of hospitals. Archaic hospital systems are using paper charts and paper prescriptions. Physicians must hand sign an order book which then gets faxed to the pharmacy. A courier then runs up the medicine to the patient’s room. All charting is done on paper and record keeping rooms are enormous. Medical transcriptions are done on a typewriter and placed in the patient’s paper chart.

In the second wave of medical informatics, the electronic network came about. Orders were allowed to be filled electronically. Medical transcriptions of dictations were outsourced to transcription companies who typed these out and they appeared electronically. Physicians could edit, verify, and sign electronic records and transcriptions. Computerized vending machines on the hospital floors could electronically document the use of supplies for the indicated patient. The second wave of medical informatics cuts costs and dramatically improved things and brought us out of the dark ages.

It appears that we are starting the third wave of medical informatics. “Going Live” is the concept where the electronic record is completely “live” and “online” and always being edited. Laboratory and diagnostic results appear real-time; doctors dictations, nurses notes, medical orders, and prescriptions are all done online and appear real-time. Transcription software allows the physician to dictate his note which uses voice recognition and speech transcriptions software to transcribe the note instantaneously where the physician can edit. If he so desires the doctor can electronically type his notes if he likes. There is no paper chart.

“Going Live” is the third wave of medical informations. Gone are the outsourced medical transcription companies. Gone are the paper charts. Gone are the electronic notes that indicate that a dictated note is “pending.” There are no gaps in the care or documentation of the care of the patient. The laptop or PDA-toting physician is here to stay.

As in the global powershift, hospitals and healthcare systems who “Go Live” early on will win more business and thrive. They will be more profitable and be more efficient and thus more effective in the delivery of healthcare.

If you’re interested in other works by Alvin Toffler, read Greg Beatty’s review of Revolutionary Wealth: How It Will Be Created and How It Will Change Our Lives by Alvin and Heidi Toffler.

medical informatics, health care economics, health care, alvin toffler, powershift, electronic medical records, electronic health records, medical IT, health care IT, health care informatics

Tags: electronic health records, medical industry, medical informatics

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One Response to “The Future of Healthcare Is Here”

1. 1 Gary Levin M.D., on July 21, 2008 at 10:00 am, said:

   Alvin Toffler also authored “Futureshock”, the story of how human beings and society can only absorb certain rates of change, then become overwhelmed and dysfunctional leading to deterioration of coping mechanisms.

   We see this occuring in health care for the past 20 years, some of it driven by technology innovations, but much of it from outside bureaucracy in it’s mis-directed attempts to control cost escalation. Managed care has been a misnomer for managed costs, and control of health care by non medical personell (ie, physicians). Physicians have been wrongly held accountable for ordering too many tests, too many treatments,while paradigm shifts occured without benefit of careful evaluation by physicians of their net effect, other than to reduce reimbursements, decrease access,, increase administrative paperwork and overhead.

   Health information technology is the next “Pandora’s Box” currently being promulgated by political leaders, insurance companies and the massive bureaucracy now surrounding your visit to the provider’s office (used to be called..doctor’s office)….Patient’s are now called “consumers”.

   Most physicians remain highly skeptical of Health IT.
   Most younger providers look forward to adapting it to their practices, because they have grown up in a school system that now promotes IT for everything, examinations, applications, research, The word processor has replaced script. Email and the web are replacing the telphone call to make an appointment at the office. Economics and time factors are credited with this new shift.

    

   Economic change is driven by these evolutionary and revolutionary sea-changes..

 

 

Fueling the Health Train Express

Quote of the day:
Where all think alike, no one thinks very much. - Walter Lippmann

Home health agencies, hospice services are feeling the effects of rising fuel prices, and in some cases workers and agencies are considering withdrawing from far flung rural locations that requiring long drives.  In some cases companies issue pre paid gas cards to employees as a perk.  Mileage allowances by the IRS now are far outdated, and medicare reimbursements for home health care do not consider regional differences nor the expense of transportation for home health care workers.

ALBANY, N.Y. (AP) — Stethoscope? Check. Bandages and medications? Check. Money for fuel? Uh-oh.

U.S. home health care workers, particularly those in rural areas, are suffering from financial headaches caused by the escalating cost of transportation, forcing some to borrow cash from co-workers in between paychecks and others to consider leaving the industry altogether.

Providers of home care in New York, California and other states are doling out prepaid gas cards, rental cars and other perks in an effort to retain their workers, who care for roughly 12 million elderly and disabled patients nationwide and drive an estimated 5 billion miles a year, according to a recent study by the National Association for Home Care and Hospice.

The industry is also contemplating abandoning uneconomical home visits in far-flung locations, and increasingly checking patients' blood pressures, heart rates, blood-sugar levels and other vital signs via remote monitoring systems, which many companies previously deemed too expensive.

Industry officials said they had not heard of any instances where a patient's care was compromised by the high cost of getting a health care professional to their home, though they are worried it could happen. After some home health providers threatened earlier this year to cease operations in rural parts of South Dakota, Democratic Sen. Tim Johnson said he would push Congress to revamp the Medicare payment system to account for the industry's rising fuel prices.

Donald Wagoner, a nurse who travels up to 100 miles a day traversing New York's Adirondack region, said his newest professional challenge these days is simply not running out of fuel. "I've come close a couple of times," said Wagoner, who drives a Saturn Vue SUV that gets around 25 miles to the gallon

These new economic pressures may allow remote monitoring information technology a more competitive edge.

For its part, the Home Care Technology Association of America is lobbying Congress for changes in Medicare to allow companies that use remote monitoring systems to get reimbursed for it — a major reason more companies haven't embraced the technology

Home Health Care figures

Each year, U.S. home care workers...
• Care for about 12 million patients.
• Make 428 million visits.
• Drive nearly 5 billion miles, a distance about the same as going 192,920 times around the Earth

Too many Cars on the Health Train??

Quote of the Day:
Injustice is relatively easy to bear; what stings is justice.
--H.L. Mencken

I go to my CVS pharmacy quite often because my wife, myself and one of children have chronic medical conditions. My son has cystic fibrosis, and that is another story in itself.

About 8 months ago several aisles were cleared near the pharmacy and a sign went up.  "Minute Clinic coming to serve you, soon."  The space remained vacant for several months.

Eventually construction crews arrived, taking about two months to build the clinic, with two rooms and a computer kiosk at the entrance for patients to register, and enter a brief intake history.

Several months later it opened for business.  In the interim there were multiple newpaper ads, cable news ads, and mailers sent to the neighborhood.  There were even five or six chairs set up in the pharmacy as a waiting area.

I will give them this....my CVS is located in an area with plenty of doctors (in Southern California).

I observed their operations from a distance and noted that 90% of the time there were no patients in the clinic, and a lone NP,, usually reading the computer.  On three occassions there were two NPs present, with no patients, and one time one NP was examining the other one.

After about six months on one day it seemed unusuallly busy. As I walked by there were five people in one room.  All of them had laptops, PDAs and/or cell phones.  One had an obsolete yellow legal pad and a yellow number 2 pencil. Three of them were "suits".  This was obviously their semi-annual review and performance reports. 

My estimate is that they perhaps saw two patients a week. Not a bad investment of at least 100,000 dollars in tenant improvements, computers, equipment and personell costs. I guess CVS needed a write off.

Perhaps in some rural communities this new paradigm might have something useful to offer, but not in a typical urban or suburban area. 

Maybe I could open a lipo or vein and tattoo removal service. I hear the space is up for rent.

What's your opinion??