McCain has an idea!

Posted by The *Angriest* Pharmacist as --Not Pharmacy--, Insurance Companies, Politics

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Hey Angriest Pharm!

I came across this video about McCain wanting clinics in places like Walmart that has a doctor and pharmacist on site that would basically do Emergency room duties and prescription filling all in one stop. Thought you might enjoy. I’d love to hear your take on it. Could you deal with a clinic in your store? :-)

http://www.youtube.com/watch?v=xfxjL-YjT6U

-Ryan

I actually somewhat agree with McCain here (though his ‘idea’ is far from new or his own). As a taxpayer who pays $30k+ to our government each year, I’d much rather see my tax dollars pay for a person on medicaid to visit one of these clinics rather than the ER. Walgreens has opened some of these clinics around the country — called Take-Care clinics where they see coughs, colds, vaccinations, sprains, bumps, bruises, and even do sports physicals. They are manned by family nurse practitioners (FNP).

The fact is that most patients on medicaid do not have a primary care physician. They use the Emergency Room as their source of healthcare for the flu, bumps, and bruises. It’s just not economical or cost effective
in our current healthcare scheme in America.

These clinics McCain speaks of could be manned by Nurse Practitioners (rather than ALL doctors) — or even pharmacists in states where Pharm.Ds have prescriptive authority. They (FNPs and Pharm.Ds) get paid much less than MDs and can treat minor injuries and such and refer more serious problems to an ER or PCP. It makes sense because it’s much more cost effective for the taxpayers — the Medicaid patient never pays either way — so they don’t see the long term issues and related costs with the current way they are seeking healthcare.

ERs should be reserved for massive injuries, coronary events, and people that are dying or at risk of death — not infants that are pulling at their ear, running a fever and need a prescription for some amoxicillin and Tylenol. While the doctors will see them and provide great care in an ER — it’s overkill for what’s necessary.

It will also reduce the wait time the patients encounter while seeking that healthcare. ER wait times can reach 4-8 HOURS. Time to a nurse practitioner in one of these clinics would always be less than an hour (or two at most).

It would take massive changes in medicaid coupled with education of those milking the system (and those that need it legitimately) — it’s no surprise that our people on public aid and Medicaid are not our most educated citizens. They deserve the care — they just need to be educated on what’s proper and what’s overkill.

Or Print it...

Kate says October 1st, 2008 at 5:41 pm

What about staffing these clinics with PA’s?

Same difference. PAs can have DEA licenses in most states. Regardless, they have to be operating under a licensed physician in collaborative practice in every state (so far as I know).

sarah says October 1st, 2008 at 8:52 pm

It is bullshit how some people can take full advantage of Medicaid. It breaks my heart when a person can’t afford insurance, has a job, HAS to work and has his pockets drained over a injury or illness. Medical issues can empty your account in a heartbeat. But if you know how to work the system, you can pull up in your mercedes SUV, complain about the 1.00 copay and convince the doctor that you
” have horrible back pain” Get your script filled for $.50 and make a huge profit before hitting up your next doctor. And the best part is that Medicaide want’s to protect it’s patients and not give us any information on the patients prescription history. Thank god for pharmacists that will alert us to patients that doctor shop. I love to call patients and tell them they are fired. Sorry for such a long rant. You guys are hero’s in my eyes. I don’t know how I would handle drug seekers in my face day in and day out. At least I can hang up on them.

Natasha says October 1st, 2008 at 10:56 pm

Amen.

dumbmedicine says October 1st, 2008 at 11:07 pm

I really want to put a FNP or PA in my independent pharmacy but being in a small town means I may create some bad blood between the other 3 doctors offices and I. Since there are 2 other pharmacies, I guess I’ll hold out and see what happens. I think the idea means well, but I think you’d run into a lot of problems with maintaining these clinics. Places like Walmart would milk it for what it’s worth. For instance, Walmart makes $12.50 for each 15 minutes it makes customers wait. This was a study completed by Walmart, so it’s no surprise that the wait times at Walmart are ridiculous. I could only see this being turned into a similar profit machine.
I say put them in independents, but I’m probably a bit biased
DM

Dave says October 1st, 2008 at 11:33 pm

We have one of these clinics in the same building as the pharmacy I work in. They are staffed by a APRN and handle the run of the mill stuff that shouldn’t be dealt with at the ER. Also, it is convienent for if you get sick on the weekends and can’t make an appointment with your PCP. Lastly, the pharmacy is located right next to the clinic so we end up getting 90% or so of the scripts. Why people would leave and drive elsewhere is beyond me. The only thing I hate about these clinics is the APRN’s get in a habit of writing for the SAME SHIT for every person and we have a tendency to run out of things on the weekend.

thetwitchytechnician says October 2nd, 2008 at 5:28 pm

Anything that would get more patients in semi-preventative care I’m behind. My store doesn’t have one, but others do. What I like the best about them is that they don’t owe the company anything, even information.

However, I am not for anything controlled being prescribed by the nurses, regardless if they have a DEA or not. I can’t submit a nurses DEA for controlled substances, but instead I have to create a new file for him/her and link them to their supervising MD. As well, I have a lot of Vicodin/Adderall mommies and I’m for preventing that…

Odd point of view and reasoning for such. Most states don’t allow FNP’s DEA licenses or authority to prescribe CII-CV. If your state does, keeping people from getting medicine they need is not the point of pharmacy or pharmaceutical care. Whether or not you have to do an extra three minutes of work or not, you do it if the prescription is legit.

It’s unlikely that the clinics McCain (and I) speak about would EVER write Adderall or any CII for that matter — those would require intervention outside of the scope of most acute care clinics of this sort.

Even if — here’s how you make your problems go away. We know that the FNP is working with a licensed MD. Tell this nurse to either get the doctor to sign several blank scripts for their use to write controls for patients. They would have the MD name on it, but technically coming from the FNP. [This is outside of collaborative practice as well, but almost every 'duo' does it] Or, merely have the FNPs call in the controlled meds if their authorizing doctor allows the FNP to prescribe controlled drugs without the MD intervention. As an agent of the doctor, they can call in an Rx under his name just as a receptionist sitting in his office…even if they are not in the office. MD name still goes on Rx bottle.

jax says October 3rd, 2008 at 1:26 pm

Man, I like the content of your blog, but white font on black background is really painful to the eyes.

Might wanna try a new design

First complaint in 18 months of this theme. I’d switch, but it’s a lot of work. You help me find it and I’ll change. I want want with TWO sidebars on one side (left or right). I want the header to be slim and not have a lot of wasted space — since I don’t know CSS or how to edit them very well. I also prefer it to feature one main color — like orange in this theme. I would like it to have more room for ‘Pages’ — those permanent links across the top. That way I can cater all my content/links/featured text to one color. Just email me the link to the new theme, I’ll DL it and install it.

BTW, why would you submit something like this as a reply to a post rather than using the CONTACT link at the top of the page? Just curious.

chip says October 3rd, 2008 at 11:26 pm

I think that this is a great idea, and I don’t know why it’s taking so long to roll out. It’s an obvious cost saver for both the payers and the insured. My wife is a clinical pharmacy resident with Veterans Affairs, and as such has prescribing rights for all maintenance meds through the VA. I think the VA figured out that they can punt difficult to manage patients to the Pharm.Ds, and get better disease state management and outcomes at reduced cost for providers. I hope it won’t be long before community pharmacists have more rights, if nothing else but for dose adjustments. I am a first-year Pharm.D student, and I think the future is bright.

Carol says October 28th, 2008 at 1:10 am

A-men

Unfortunately my health insurance will not pay for a clinic like that, they will pay for an ER visit though. I’m stuck. If there is no opening at my nearest Military Medical facility I can go to their ER or the local ER. I sure wish I could plan when my kids get sick.