Tuesday, September 11, 2007

An Almost Breakthrough

Have you heard of MinuteClinic?

MinuteClinic is a company that is creating and operating clinics staffed by nurse practitioners. According to its web page, it is now operating in 21 states with, I would judge, about an average of a dozen clinics in each state. Their standard operating hours are 8 a.m. to 8 p.m. Monday through Friday with 30 minutes off for lunch at 2:00 p.m., and 10:00 a.m. to 4:00 p.m. on weekends.

According to an Op-Ed piece by Michael Howe, CEO of MinuteClinic (The Boston Globe, September 10), the average charge for a visit is about $60, compared with six times that much in a hospital emergency room.

The medical profession seems to be going more or less bonkers over this, despite complaints all over the country about a shortage of primary care physicians. They raise questions about quality, but Howe’s piece said that for patients presenting with sore throats, MinuteClinic follows best practices 99 percent of the time, compared with 55 percent for the medical community nationwide.

I have suspected for some time that we really don’t need physicians to provide primary care any more. MinuteClinic seems to be based on that same opinion. If it is correct, that has important implications for the redesign of the health care system. The nursing profession does not share the medical profession’s sense of independence and as a rule is much more amenable to standardization and discipline. If primary care becomes recognized as a nursing function, progress in implementing evidence-based standard practice will become much easier.

But there is a problem with MinuteClinic. Its clinics seem all to be located in CVS pharmacies. The suspicion that they will be pressured to generate business for CVS is inevitable and can only reflect adversely on their credibility.

But their emergence is a breakthrough. Almost.

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