Robert W. Morrow, M.D.
A couple of weeks ago, the New York Times took a stab at documenting one of the radical transformations that is happening in the delivering of healthcare in the US, i.e. the advent of the store-front urgent care facilities. This is how they introduce the topic:
“Is the doctor in?
“In this new medical age of urgent care centers and retail clinics, that’s not a simple question. Nor does it have a simple answer, as primary care doctors become increasingly scarce.”
In the sub-head to the article, the authors announce that:
“Big corporations — giant retailers and health insurance companies — are teaming up to become your doctor.”
Are they really? And why? The story behind the story is a bit involved, but it is not complicated to see that it has less to do with doing any doctoring, than with having your name on a list that allows them to claim you as a patient. Here’s how it works…
A Family Practitioner in the Bronx
My patient Paolo’s wife had diabetes. Together, with some guidance from me, they lived together happily and managed her diabetes for years. One day, however, she had a small stroke and was admitted to the hospital where the doctors did not know her or her history. Soon, she was moved to a rehab facility where, no surprises here, no one knew her either. Worse, none paid attention to her and her complicating factor, i.e. diabetes. Thanks to cutbacks and profit taking, the rehab facility had only a skeleton staff.Early in the morning after a few day in the facility, Paolo’s wife entered insulin shock and died. No staff was watching, there was no appropriate monitoring, nothing. Just another dead patient.
I had worked with the two of them on their various medical problems over the years, and this outcome could have been avoided. After she died, her husband also became ill with multiple major, but preventable problems. I was able to work closely with subspecialists and see him frequently. He has survived many complications, and we meet regularly to tweak his medicines and lifestyle.
I don’t do miracles, but I work with my patients and community, which is complex and challenging, but also great fun and rewarding. Even after many years, however, I get a little bit of my heart taken when one of my patients dies, especially unnecessarily.
But as the New York Times article correctly reports, I’m part of a dying breed. My practice is squeezed from every direction. The payments I receive for my work are so restricted, and the administrative work so complex, that I gross far less than I did 15 years ago. My net income from this business is kissing zero.
The Urgent Care Center “Fix?”
If you live in NY State and have diabetes, then the risk that you will end up with an amputated foot increased from 2016 to 2017. Expect with the lack of solid primary care those numbers will get worse. More feet in buckets, when not one should need amputation.
That’s in spite of the blossoming of urgent care facilities around the State heralded by the Times article.
An urgent care center is not an effective replacement for effective primary care. Sure, a primary care physician like myself gets a fair number of patients with coughs and colds and various other types of conditions that do not require long-term monitoring. Nor does every patient visit require giving eating and lifestyle guidance based on a long-term view of the patient.
But, we have substantial evidence, not only from around the world but also from experiments in the US, that independent primary care, like my practice, slashes costs and improves outcomes.
Follow the Money
So what are urgent care centers doing, and how do they make money for investors, which a primary care practice like mine is being financially squeezed out?
The ideal scenario for an urgent care facility is to attract relatively healthy, relatively young people that they can treat, bill and send home in a very short period of time. When they do this successfully, they are actually stealing those patients from the traditional primary care physicians.
And that leaves us with the the relatively less health, relatively older population to deal with. That’s a challenge because treating their complaints takes more time and is more poorly reimbursed.
If the problem here sounds familiar, it is because you have heard this before in the debate about Obamacare. The reason for the personal mandate that everyone needed insurance is to spread the costs across the entire population, including the young and healthy who rely much less on the system.
Once an urgent care facility has established itself with a population of mostly young and otherwise healthy people, it become a valuable property that can be packaged up and sold on to other investors. They, in turn, can squeeze out more profit for less care, something which will make my practice suffer even more.