ACA- is this what the gov. wants? Maybe?

[Tabrett]

I posted this in the other post, but I thought it might deserve a post of it's own.

 

Has anyone noticed the minute clinics that Walgreens, CVS, Wal-mart, Target, Kroger+ more are setting up? Google it, it is quite interesting how many big box store are going to provide walk clinics.

 

I think this is what the ACA is wanting to take over regular 'sick' doctor visits. Then you would only see a doctor for speciality care. The minute clinics charge about $90 a vist and you are seen by a Physicians assistant or a nurse practitioner. I'm in NC and these clinics are popping up.

 

Here is an article about SC Medicaid being accepted at the clinics:

 

http://www.postandco...ssues-out-of-er

 

Here is a list of what you can be seen for at the CVS minute clinic:

 

http://www.minutecli...s/minorillness/

 

Honestly, I think, after people discover these clinics, they aren't going to go to a doctor unless it is a true ER emergence or they have a special need.

 

This type of care will prevent people from using the ER for minor sickness. It will be convenient for people to get to the nearest CVS or Wal-mart or where ever. It will be a one-stop-shop for your sick-visit and your meds. It is a win win situation for these big box stores. All they have to do is hire a PA or a NP. They will be no doctor trying to pay rent, the store is guaranteed that the patient buys thier med form them and probably the patient will buy something while waiting on their meds to be filled. How convenient!

 

I may be a tin foil hat wearer, but I truly believe this is what the government is wanting to see happen. I don't think the government wants to tell people this is what they want, but they want people to discover the clinics themselves and think it was their idea for them to go there for care! If it is the people's idea, they will be happy. Problem solved!

 

This would make regular sick care affordable. Unfortunatly, this is bad news for general practitioners.... maybe.......or maybe people who have good insurance will keep seeing their regular doctor and low income people will have care too.

[Slartibartfast]

These are just after hours clinics. I don't believe those clinics could truly offer preventative care and that is what the ACA is encouraging.

 

I have been to after hours clinics a few times and it was because either my Drs office was closed or they were too booked and couldn't get me in. I can't imagine people would want them to fulfill the role of primary caregiver if they have the choice.

 

I am sure some people will do that, but that is not what they are set up to provide.

[QueenCat]

They have those around here. We've only used them for getting flu shots. I'd rather see my family doctor for pretty much anything else.

[Annie G]

If I call our doctor's office and describe an illness such as strep or sinus infection, they direct me to the minute clinic at our local ShopKo. They won't even consider giving me an appointment with our regular doctor.  I find that annoying because I rarely see our doctor and if I am ill, I'd rather see him and have at least a little bit of continuity of care.  Dd had a sinus infection three times one winter- the walk in clinic didn't notice that and didn't listen when she mentioned it to them. They just kept prescribing a Z-pack. On the 4th infection, I insisted on seeing our regular doctor, who of course realized that the z pack wasn't enough to completely fix the sinus infection, which is why it kept recurring. I believe if we'd seen him from the beginning he would have caught it on the 2nd infection. 

 

 

[nmoira]

Locally we have two chains of same-day clinics (you can make appointments for that day and only that day) staffed by PAs and FNPs. 

 

Rates and services are posted and are straightforward: http://www.zoomcare.com/info/services-prices

 

We have one within walking distance, and even though we've got good insurance, we use it for some basic services because of the convenience. One of our kids had a plantars wart removed; I had an abscess drained (TMI :p ), DH and I get flu shots there... that kind of stuff. ZoomCare has also relatively recently started offering chronic care treatment. 

[Mrs Mungo]

The ACA offers free preventative care. BUT, I will say that care (in my experience) often comes from a PA or Nurse Practitioner. The only General Practitioners I have seen are in hospital-based clinics. The Primary Care Provider for me and my daughters is a Nurse Practitioner. But, we see him in a more traditional care setting.

 

It is easy to get referrals from him for specialty care. He has done any tests I requested and referred me to any specialists that I requested. I do think you might need to be a little more proactive than with a traditional GP.

 

The only time we have used an after hours clinic is when we were traveling and had a baby with an ear infection.

[momto10blessings]

I doubt that is what the gov wants.

 

I took my kids to 2 different minute clinics and waited 1 hr at one and 2 hours at the other just to be seen. Don't think I will go back

[Jann in TX]

Our family uses these clinics when we have a minor illness.  It is getting harder to get into our GP unless we want to wait a day or two (and you don't when you are sick!). 

 

I think with the ACA getting into a GP for something other than preventative care will be harder initially (hopefully we will have new Drs who will go into family care to fill in the gap and the wait will level out-- but I'm not too optimistic).

[Tabrett]

Mon – Fri 8:30am to 7:30pm

Sat 9am to 5:30pm

Sun 10am to 5:30pm

 

I pasted this from my local CVS clinic hours, so they are not just after hour clinics.

 

I have had 10k deductible for the past several years. I do not have a primary doctor because I don't go unless it is an emergency. This causes me to end up at Fast-Med which cost about $250 a visit. Being able to walk in and be seen for $90 makes me very happy. I really don't care who I see as long as I can get the proper meds for my sickness. This will be a very good option for young adults and people, who in general, have been skipping seeing the doctor when sick because of the cost.

 

I think it is a good option.

[Mama Geek]

We travel for dh's work and have used these clinics for years and have been happy with the service.  Usually the wait times are not long, I have never waited an hour like the previous poster said they had.  Usually I either go right in or just have to wait on 1 person.

[Annie G]

Those might be in abundance in larger towns, but the closest one here is 65 miles away over a pretty major mountain pass and it closes at 5:00 pm!

 

 

Do you have a hospital in your town? Our town is pretty small- well under 20,000 people, but we have a hospital. When our doc-in-a-box opened, the newspaper did a pretty big article about how the clinic was going to help those who were using the ER for minor illnesses- and that would save the hospital a lot of money because they wouldn't be writing off as many charges for people who couldn't pay.  But the people who couldn't afford to pay at the ER can't pay at the doc-in-a-box and they require payment before you see the doctor.   So...I think we have the clinic because the hospital pulled strings and helped it get started. 

 

 

I cannot imagine driving 65 miles over a mountain pass to a clinic! And to have it close at 5 pm? Yeah, not convenient. 

[NotSoObvious]

I saw a clinic like that, complete with sick kids, in a Target this summer while we were visiting the Midwest. Target doesn't have them everywhere- yet. Honestly? I think it's awful. It was right near the checkout lines, not in some secluded corner of the building. 

 

I realize there are sick people everywhere and sick people still shop at Target for medicine, but I will tell you that I will stop going to our Target if they put in a clinic. 

 

I don't want to shop in a doctor's waiting room. 

 

(But no, I don't think it's some conspiracy.)

[Tabrett]

Do you have a hospital in your town? Our town is pretty small- well under 20,000 people, but we have a hospital. When our doc-in-a-box opened, the newspaper did a pretty big article about how the clinic was going to help those who were using the ER for minor illnesses- and that would save the hospital a lot of money because they wouldn't be writing off as many charges for people who couldn't pay. But the people who couldn't afford to pay at the ER can't pay at the doc-in-a-box and they require payment before you see the doctor. So...I think we have the clinic because the hospital pulled strings and helped it get started.

 

 

I cannot imagine driving 65 miles over a mountain pass to a clinic! And to have it close at 5 pm? Yeah, not convenient.

But Medicaid patients don't pay anyway. So if the Medicaid patents went to the clinics instead of the ER, it would save the gov. $$$,

[Annie G]

I saw a clinic like that, complete with sick kids, in a Target this summer while we were visiting the Midwest. Target doesn't have them everywhere- yet. Honestly? I think it's awful. It was right near the checkout lines, not in some secluded corner of the building. 

 

I realize there are sick people everywhere and sick people still shop at Target for medicine, but I will tell you that I will stop going to our Target if they put in a clinic. 

 

I don't want to shop in a doctor's waiting room. 

 

(But no, I don't think it's some conspiracy.)

Our clinic is in a ShopKo, which is like a Target.  While you're waiting, they offer to give you a beeper so you can SHOP while you wait to see the doctor. I cringe when I see mothers dragging their sick kids though the store- kids with their germy hands on the carts, and kids who look like they're going to barf at any second. 

Yeah, I know people bring sick kids in every store, it just drives me nuts that the clinic encourages them to shop while they wait.

 

Oh. Maybe that's their strategy. Spread the germs. 

[Dandelion]

I don't think the emergence of these clinics is tied to any ACA goals/plans.

 

These clinics are popping up because there's a need, and astute businesses see that need and come up with solutions they can market and sell.  I haven't used these types of clinics, but if there's a market and both consumers and businesses are benefiting, then I'm all for it. 

[Danestress]

I have been happy with them. I am someone who delays doctor visits and have to be in a pretty critical situation to go to an emergency room. Sore throat and a high fever would not do it. I take 'emergency' seriously.

 

So for a suspected UTI, strep, etc, I will visit the minute clinic. I am happy seeing a competent nurse rather than a doctor. The things I go for don't require a doctor.

[Annie G]

But Medicaid patients don't pay anyway. So if the Medicaid patents went to the clinics instead of the ER, it would save the gov. $$$,

True. But our town has been hit hard- many people are working - making too much to get medicaid but not enough to afford to visit a doctor.  These are the people I was talking about. They're caught- they make both too much AND too little. I'm not convinced ACA will fix that because high deductibles will not help when they need to visit a clinic.

 

I hadn't actually considered the savings to the government. I was thinking about the hospital who writes off bad debt when they know people cannot pay. I'm sure some is subsidized but much is not.   But yeah, I'm sure the government would save a lot if people used the clinics instead of the ER. In our town, a clinic visit is well under $100. 

[QueenCat]

If I call our doctor's office and describe an illness such as strep or sinus infection, they direct me to the minute clinic at our local ShopKo. They won't even consider giving me an appointment with our regular doctor.  I find that annoying because I rarely see our doctor and if I am ill, I'd rather see him and have at least a little bit of continuity of care.  Dd had a sinus infection three times one winter- the walk in clinic didn't notice that and didn't listen when she mentioned it to them. They just kept prescribing a Z-pack. On the 4th infection, I insisted on seeing our regular doctor, who of course realized that the z pack wasn't enough to completely fix the sinus infection, which is why it kept recurring. I believe if we'd seen him from the beginning he would have caught it on the 2nd infection. 

 

Wow! That would frustrate me to no ends. The practice we go to always has sick openings available. It might not be with my doctor but it will be with someone in the practice. Sometimes a PA but that's fine for minor issues.

[Pawz4me]

These are just after hours clinics. I don't believe those clinics could truly offer preventative care and that is what the ACA is encouraging.

 

No, they aren't after hours clinics.  They're staffed all day long.  Here they've been around for several years now, and they were originally advertised as being for relatively minor things -- strep throat, ear and sinus infections, bronchitis, UTIs, etc.  The kind of things for which most people believe they need or might need an antibiotic, but not something so complicated as to really require a doctor's attention.  I believe some of them offered sports physicals.  But they weren't originally meant to be for any type of preventative care.  I don't doubt that they've grown in response to the ACA, though.  More people insured means more people who will be quicker to seek medical attention rather than try to treat things at home.  So lots of opportunity for money making.

[MedicMom]

We don't have the minute clinics in the stores but urgent care centers are creeping up. I love them; as a patient, a paramedic and a parent. There is no reason for me to try to get into my GP for a sore throat/cough/minor illness, and I can take my kids for minor illnesses such as a fever. Getting into my doctor is hard and I don't usually want to wait three days to get in. As a paramedic, ER crowding is a huge issue here. Many many people use the ER as their only form of healthcare and so all sore throats and bronchitis and such gets handled there, instead of at a GP office. People are starting to take those issues to an urgent care office instead of an emergency room, thus leaving beds and staff to deal with patients who have more serious needs.

 

I don't think it has a thing to do with the government or ACA. Someone saw a need and a way to make money, and it works.

[zoobie]

There's already a *shortage* of general practitioners, and it's getting worse as the Baby Boomers age and as more people can go to the doctor. The ACA has some provisions in it for attracting doctors to general practice. The clinics won't hurt existing GPs, who already have an over-full roster of existing patients with insurance. The clinics are an example of corporations profiting from healthcare, not a government conspiracy. They're useful, sure.

[redsquirrel]

I don't know about the gov't but I do know that stores are in the business of making money. Do you think they wouldn't do it if it didn't bring in money?

[Tabrett]

True. But our town has been hit hard- many people are working - making too much to get medicaid but not enough to afford to visit a doctor. These are the people I was talking about. They're caught- they make both too much AND too little. I'm not convinced ACA will fix that because high deductibles will not help when they need to visit a clinic.

 

I hadn't actually considered the savings to the government. I was thinking about the hospital who writes off bad debt when they know people cannot pay. I'm sure some is subsidized but much is not. But yeah, I'm sure the government would save a lot if people used the clinics instead of the ER. In our town, a clinic visit is well under $100.

But if a family is low income, but not low enough to qualify for Medicaid, they would qualify for the 60/40 Bronze Plan (which would possibly be free if their income is low enough). 40% of the $90 clinics fee is $36. I would find a way to borrow money to pay the clinic rather than have the ER hounding me for $$$$.

Maybe most people don't feel this way, I don't know.

[TechWife]

I prefer to go to a provider where there is a physician on site. I am honestly not comfortable with the doc-in-the-box model. I have a hard time believing that Target and drugstores are willing to pay top-dollar for quality professionals. The urgent care I go to is owned & operated by a hospital system and is staffed by a combination of MD, RN, & NP's. There is always a physician there (yes, the prices are urgent care prices, not hospital prices). 

[Amy in NH]

I wish we had those around here.  If you need after hours care the only thing available is the emergency room.  There is a small local hospital where you can go to a walk-in clinic on weekends between certain hours and they will decide if they charge you for an emergency room visit or a walk-in clinic visit.  Either way it's super expensive.  I don't see why I shouldn't be able to go to a walk-in for a quick-strep and antibiotic prescription instead of wasting the time of my doctor (who is really a nurse practitioner).

 

I doubt the government wants us to be able to income eligible for the expanded Medicaid program, except our state hasn't expanded it, so we won't be eligible for subsidies either.

 

I hate people who begrudge others basic medical care.

[Tabrett]

Has anyone heard of this?

 

http://www.teladoc.com

 

I was with Christian Medi-share. They were doing a pilot program allowing their customers to use it for free. I never tried to use it, but it is ...... ummm.....interesting. I would rather go to a clinic than call and video conference a doctor.

[Annie G]

But if a family is low income, but not low enough to qualify for Medicaid, they would qualify for the 60/40 Bronze Plan (which would possibly be free if their income is low enough). 40% of the $90 clinics fee is $36. I would find a way to borrow money to pay the clinic rather than have the ER hounding me for $$$$.

Maybe most people don't feel this way, I don't know.

 

Agreed- $36 is way better than having a hospital hound you for money you don't have! That's clearly a good choice. 

What I have been reading is that the plans have high deductibles before the benefits kick in. If that's not true, great! There are so many who need insurance, and I hope this works.  It's quite possible that I'm wrong about the policies having high deductibles- there seems to be so much conflicting information that we probably won't really know how it will all work until January. 

 

 It has to be frustrating for uninsured people to know that the antibiotic they need is available at Walmart for $4, but they have to afford to pay a doctor to prescribe it for them. I'm thrilled that so many pharmacies have programs to provide low cost medications- it's been wonderful! We've saved SO much money on prescriptions.  Hope the ACA can make visiting a doctor affordable, also.   

[T'smom]

I love the idea of walk-in clinics, but our co-pay is $35, so I wouldn't go somewhere that I had to pay $90.

[In The Great White North]

There are no doctors at these mini-clinics?  How come they get to prescribe antibiotics?

[NicksMama-Zack's Mama Too]

There are no doctors at these mini-clinics?  How come they get to prescribe antibiotics?

 

I believe they are staffed with Nurse Practitioners and PA's that have "Prescriptive Authority"  -- they can prescribe medications with some limits, based on which state they are practicing in.

 

http://allnurses.com/advanced-practice-nursing/prescriptive-authority-nurse-805523.html

[Tabrett]

There are no doctors at these mini-clinics? How come they get to prescribe antibiotics?

I don't know. When I used a nurse-midwife, there was not doctor there either, but they did have a supervising doctor who came in to do circumcisions once a month. You would also see that doctor if there was a medical emergency during delivery. I never saw him while pregnant.

 

Maybe there is a supervising doctor at a different location.

[Caitilin]

They are staffed by PAs or CNPs, both of whom can prescribe that type of medicine. I've been to the ones local to me a couple of times for sinus infections, etc. and I was very happy with the cost, which was about $70 for the visit, plus the cost of the meds. As a person without insurance, these are a good quick option for me for reasonably priced care for simple issues.

[Murphy101]

I saw a clinic like that, complete with sick kids, in a Target this summer while we were visiting the Midwest. Target doesn't have them everywhere- yet. Honestly? I think it's awful. It was right near the checkout lines, not in some secluded corner of the building. 

 

I realize there are sick people everywhere and sick people still shop at Target for medicine, but I will tell you that I will stop going to our Target if they put in a clinic. 

 

I don't want to shop in a doctor's waiting room. 

 

(But no, I don't think it's some conspiracy.)

 

 

That was my first thought too! Ack!! I'd never shop that place again. There's not enough hand sanitizer to convince me to ever do that. I wouldn't even want to take my sick kid there. The last thing a sick kid needs is the extra germ infested toy aisle at anywhere.

 

And to be fair, I feel the same about my drs office. Our pediatrician keeps the offices extremely clean. Which I know doesn't prevent everything, especially the age old virus, but at least they are trying to reduce spread. A drs office in the middle of a target would make me want to shower in bleach when I got home.

 

Seriously. I think that is way way way worse than the diapers at a restaurant thing a while back. I'd rather a person change a diaper discretely and quickly on the floor or on a booth seat at a restaurant than see a clinic in a Target.

 

*shudder*

 

 

But if a family is low income, but not low enough to qualify for Medicaid, they would qualify for the 60/40 Bronze Plan (which would possibly be free if their income is low enough). 40% of the $90 clinics fee is $36. I would find a way to borrow money to pay the clinic rather than have the ER hounding me for $$$$.

Maybe most people don't feel this way, I don't know.

Borrow from who? Many times people who are living paycheck to paycheck are surrounded by everyone else living paycheck to paycheck. Not everyone has family to bum off of either. And "borrow" implies paying it back. If they couldn't afford it to begin with, how can they afford to have it for debt?

[mommymilkies]

They've had these for ages-waaaaaaay before Obama was even president. I'm glad.  It's a pain getting doctor appointments, and I don't really want to have to go to the ER just because I have a UTI and my doc is closed for the holiday weekend.  BTDT.  Unfortunately, these haven't popped up where I live now, but for low risk care (abx needs, etc.) they can be extremely helpful.  I wish we even had a Convenient Care around here!

[Serenade]

These clinics suck.  One at CVS refused to treat me for Strep because I have rheumatoid arthritis and was on medication.  Not even hardcore RA medication -- just an anti-inflammatory and sulfasalazine.  Nothing I've ever been denied treatment for before, or even questioned about. When the one clinic refused to treat me, I went to a different branch -- that one agreed to "see" me, but would only give me a culture test -- not an instant one.  Finally, my third visit of the day was to an Urgent Care clinic, where they promptly diagnosed my Strep, put me on medication, and I felt better the next day.  Meanwhile, two days later I get a call from the CVS minute clinic confirming that my culture was positive, and that they'd prescribe medication.  I told them I'd already been on medication for two days and I had no further need of their services.  I'll never go to one again.

[Joker]

I've stopped at them once - and they sent me to the ER. It was something my doctor could have handled in office but it was a holiday weekend. The clinic didn't want to handle it, so I had to pay them and the ER fee.

 

I don't like the idea of them for regular care because there have been many things our regular doctor has caught because they know our history.

 

That said, the way our insurance is right now we can barely afford to actually see the doctor. This year the out of pocket expense and deductible has sky rocketed. Our premiums are cheap but we still can't afford to actually use the insurance we're paying for anymore.

 

 

[sunnyday]

The US pays disproportionately a LOT of money to get relatively mediocre outcomes from our healthcare system. Part of the point of the ACA is to redress that balance, permitting us to pay less for better care as is enjoyed in other countries. Since mid-level providers cost less than physicians, utilizing them effectively should have the net effect of reducing our overall healthcare costs while giving us just as good of outcomes if not better (people better able to access non-emergency care less expensively, seeking that care earlier, not getting as sick). This doesn't mean we don't still need primary care docs to manage our overall health, especially in cases of chronic illnesses, or in situations where multiple referrals need to be coordinated. And it certainly doesn't mean we don't need emergency departments! But if emergency departments were reserved for medical emergencies, and if the people who used them could afford their services rather than turning to them in desperation because they can't be turned away, the EDs would operate more efficiently, and that would be good for doctors and patients alike.

 

So yes, I do think that it's an anticipated effect of the ACA that we'd see easier access to more mid-level providers. But I don't feel like that observation means my tinfoil hat is needed. :)

[happypamama]

I haven't seen them at big box stores, but we do have a couple of walk-in clinics here, and I'm grateful for them. We've used them a couple of times on weekends for things that really didn't need to wait but which weren't ER-worthy. I have no problem with using PAs or NPs; I think that's a good thing, because generally, I think you should go for the lowest-level option that meets your needs. I really like our family doctor and will request to see her for checkups, but for other stuff, it depends. I happily saw the PA in her office when two kids had pink eye recently, although I did insist upon seeing our doctor when my asthma flared up this summer, but only because she's treated it before, so I felt like it was more of a continuation of preventive care than an infrequent illness. I don't know if this is what the government is intending, but there are times and places for everything: walk-in clinics, ERs, primary physicians, and specialists.

[MomtoCandJ]

Our family sees a NP who charges $35.00 if you pay at time of being seen and $45.00 if you need it billed to you. They also try to go for the cheapest medication that will help you. I just wish there was weekend hours and a day where they are open later than 5. But oh well, I'm just happy to have an affordable option. We live in an area where a majority of the population is uninsured.

[Murphy101]

We have after hours and urgent care places here but they are a total waste of money. They aren't any cheaper than seeing a primary dr and half the time you end up paying to see them AND the ER when the urgent care can't do anything for you. I never even bother to go to them. If it's truly urgent, I use the ER, otherwise, I wait to see our dr the next day. I always pay out of pocket to see our drs. None of them accept Medicaid and have said point blank they will retire and sell their practice rather than start accepting it. Two of them don't accept any insurance and one is transitioning to that.

[Lolly]

We have had them for several years. We do use them. They are much faster and cheaper than visiting a doctor. I generally know exactly what we have and need when we are going. I am 99% correct in my diagnoses. Sometimes, I think it may be strep and want a quick test run. (That is my 1% wrong.) What frustrates me is that when these places opened several years ago, the charge for a basic visit was $25. Now, the fees are much higher. I see no reason for that huge an increase in such a short amount of time. The only thing that has really changed has been demand for them has gone up. In a situation like this, demand should be equalling more dollars in their pockets from increased patient load.  It should not mean more than a 350% price increase. Personally, I wish they would just make antibiotics over the counter. Basic medical tests for common illnesses should be over the counter also. Honestly, I really don't need a doctor's opinion most of the time. Just their ability to access a test and a prescription. They could even limit the amount of antibiotic per year/month/whatever like they do with pseudoephedrine. 

[Big Buckin' Longhorn]

Fortunately we have a great local doctor who charges based on how much time you need with him. Usually I already know what's wrong and just go to him to get the prescription. A couple of times I've been able to hustle all three of my granddaughters in and out and have only paid $50 total. He is amazing. I hope he never retires.

[kbutton]

Well, my hubby is a PA in an emergency department. These clinics aren't going to run family practice and GPs out of business. We have a huge shortage of family practice/general practitioners in this country as well as a shortage of emergency physicians. That's one reason the PA profession is growing. These clinics are a response to that as well as a money maker for pharmacies. There is no reason to think that quality is low just because it's from a pharmacy. Many experienced practitioners staff these clinics as well as urgent care facilities, but I'm sure it depends on your location.

 

Regarding any visit to an urgent care or a clinic like this, you might want to call ahead and find out what they can or will treat so that you aren't sent to more than one place. For instance, our urgent care will do some suturing, but it depends on who's on duty. They even have some radiology services. Also realize that you might not be treated at the ED for some things either. If you break a bone, and it's not life-threatening in some way, you'll get pain meds, some radiology, and maybe a splint, but they won't patch you up there. You'll be told to follow up with an orthopod. That's not what you want to hear on a Friday night (especially after a 2 hour wait and a big bill/co-pay) because orthopods don't usually work weekends.

 

We haven't used a pharmacy clinic yet, but I imagine it will happen at some point. An ER visit may cost you a co-pay of varying amounts, but walking into an emergency room costs a minimum of $800 to your insurance company (or the taxpayers if you are on Medicare or Medicaid). Just a little perspective on cost. Many people use the ED like it's a primary care facility (and truthfully, they often use it like a Saturday night evening out--coming in on the squad for non-emergencies, asking for free meals, watching the free movies, asking for a bus pass to get home), and it's one of many factors driving up the cost of care.

[extendedforecast]

These clinics have been in existence for years. It has nothing to do with ACA.

[LucyStoner]

The prevalence of care provided by midlevels (either PAs or ARNPs) is a function of state law and the scope of practice/supervision requirements.  In states where midlevels have been able to work with less to no supervision from an MD or DO, small basic care clinics and options staffed by midlevels have been around for years and years.  More and more states are expanding what midlevels can do. So in some states it seems new but really it's been around for a long time.  

[Kathryn]

I've been using the clinic at CVS for years. I love my GP, but getting in for a sick visit can be days. If I know I have a UTI, an ear infection, or a sinus infection, it's much faster and cheaper to go to CVS than to wait for my doctor. I've never felt that the providers were idiots, but you don't need to be a genius to diagnose the kinds of issues they list as ones they deal with. I still take my kids to their regular pediatrician for illness, but I haven't had a problem getting seen quickly. If I did and they were in a lot of pain from a pretty obvious problem, I'd take them to CVS. The longest I've waited is 15 minutes. Usually, there's no wait at all.

[Pawz4me]

The prevalence of care provided by midlevels (either PAs or ARNPs) is a function of state law and the scope of practice/supervision requirements.  In states where midlevels have been able to work with less to no supervision from an MD or DO, small basic care clinics and options staffed by midlevels have been around for years and years.  More and more states are expanding what midlevels can do. So in some states it seems new but really it's been around for a long time.  

 

Yep.

 

Here there are more and more full-fledged practices springing up that are totally staffed by physician's assistants and nurse practitioners.  My cousin is a PA and has owned her own practice for many years.  She hires other PAs and NPs to work for her.  She also employs a doctor who technically supervises all of them, even though my cousin the PA is the one who signs his paycheck.

[Ravin]

I go to our family doc for preventative and chronic care. For urgent sick care I generally wind up at urgent care (and would use a minute clinic if available), since the wait time at the Dr. is usually longer than I want to wait in an acute situation (ear infection, possible strep, injury too much to handle at home but not enough to warrant emergency room, etc.). I could go to "whoever's available" at the doctor's practice, sometimes, but frankly the urgent care is closer and easier to get to. I've also had no problem or issue with the service--it's quick in and out, and the P.A.'s who see us are by all appearances competent.

 

I also use big box chain store pharmacies and optometrists who work independently out of box stores, and have no reason to think they are less competent than those who work at independent pharmacies or in independent storefronts. No reason why the same wouldn't be true for N.P.'s, nurse practitioners, etc. 

[Dahliarw]

I didn't read all the answers, but seeing my ND for an acute illness visit is less than the minute clinics.  And I think they bill separately for any testing (as a doctor would).  My ND also offers 20% off if you pay in full in cash day of (which is nice if you don't have insurance or your insurance does not cover naturopathic) as well as a sliding scale for those who need help paying for medical care.  I think not charging exorbitant amounts and having providers charge reasonable rates is more in line with ACA, but it's not happening on a large scale...

[Renee in NC]

Also realize that you might not be treated at the ED for some things either. If you break a bone, and it's not life-threatening in some way, you'll get pain meds, some radiology, and maybe a splint, but they won't patch you up there. You'll be told to follow up with an orthopod. That's not what you want to hear on a Friday night (especially after a 2 hour wait and a big bill/co-pay) because orthopods don't usually work weekends.

 

 

And then someone without insurance and no cash to pay up front won't get care.