Transcript for the Piece Audio version of Urgent Care Clinics -- Taking on the Primary Care Overflow in Health Care
DENISE GAGNIER HAS FELT MISERABLE FOR DAYS. SHE CAN'T KEEP FOOD DOWN, SHE HAS A FEVER. SO THIS MORNING SHE DECIDED IT WAS TIME TO GET CHECKED OUT BY HER REGULAR DOCTOR.
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Time: 6s
Title: urgent ax - primary care didn't
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AX (DENISE) My primary care doctor didn’t have any urgent care appointments open, and they sent me here.
HERE -- BEING THE FAMILY CARE MEDICAL CENTER -- A STAND-ALONE URGENT-CARE CLINIC IN SPRINGFIELD'S FOREST PARK NEIGHBORHOOD. GAGNIER IS WEARING A MEDICAL GOWN AND SITTING ON AN EXAM TABLE, WHEN DOCTOR IRA HELFAND WALKS IN, AND STARTS TO ASK ABOUT HER RECENT HISTORY.
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Time: 20s
Title: urgent amb - got sick1
Description: urgent amb - got sick1
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Amb: ‘ok, so you got sick when?” ‘on Monday..’ ‘and you’re still nauseated?’
THIS IS GAGNIER'S FIRST VISIT TO THE CLINIC, WHICH IS SET UP FOR MINOR BUT URGENT PROBLEMS -- ACUTE ILLNESSES OR INFECTIONS, SPRAINED ANKLES, STREP THROAT -- PROBLEMS THAT PEOPLE WANT TREATED QUICKLY AND WHICH DON'T NEED A HOSPITAL SETTING.
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Time: 34s
Title: urgent amb - press on stomach1
Description: urgent amb - press on stomach1
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“If I press on your stomach, is it sore? Yah. How about over here? Yeah. Lower part? It’s tender.
AFTER A BRIEF BUT THOROUGH EXAM, HELFAND DIAGNOSES GAGNIER WITH A STOMACH VIRUS....WRITES HER A NOTE FOR WORK.....AND SENDS HER ON HER WAY. (CUT OUT AX)
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Time: 31s
Title: urgent amb - clear liquids
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‘I will be giving you a sheet with some diet instructions…. We want you to limit yourself to clear liquids…’
IRA HELFAND BOUGHT THIS URGENT CARE CLINIC THREE YEARS AGO. HELFAND -- WHO FOUNDED THE GROUP PHYSICIANS FOR SOCIAL RESPONSIBILITY -- HAD WORKED FOR TWO DECADES AS AN EMERGENCY ROOM DOCTOR AT COOLEY DICKINSON HOSPITAL IN NORTHAMPTON. HE SAYS RUNNING AN URGENT CARE CLINIC ALLOWS HIM A SOMEWHAT SLOWER PACE THAN A HOSPITAL E.R....AND MORE FOLLOW-UP WITH PATIENTS.
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Time: 10s
Title: urgent ax - back injury
Description: urgent ax - back injury
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so if somebody comes in here w/ a back injury that's going to need several visits, we'll see them for the several visits & get some sense of how they're doing.
BUT FOR THE MOST PART, WHAT HELFAND'S CLINIC DOES IS FILL IN THE GAPS LEFT BY THE PRIMARY CARE SHORTAGE. MOST OF HIS WALK-IN PATIENTS EITHER DON'T HAVE A PRIMARY CARE DOCTOR, OR CAN'T GET IN TO SEE THEIR DOCTOR BECAUSE OF THE OVERWHELMING DEMAND ON GENERAL PRACTICES.
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Time: 18s
Title: urgent ax - escape valve
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AX: we have a number of primary care physicians in the community who regularly use us as an escape valve for their practice. they get a call from a patient who has a problem they clearly need to be seen, but they don't have time to see them that day, so they refer them here.
HELFAND SAYS THERE AREN'T MANY OF THESE WALK-IN CENTERS IN THE NORTHEAST, ALTHOUGH ONE RECENTLY OPENED IN NORTHAMPTON. BUT THE NEED FOR ALTERNATIVES TO THE PRIMARY CARE PRACTICE IS LIKELY TO GROW..... THAT’S BECAUSE THE SUPPLY OF PRIMARY CARE DOCTORS HAS NOT KEPT UP WITH THE DEMAND OF PATIENTS. DOCTORS SAY THEY'RE LEAVING PRIMARY CARE BECAUSE OF OVERWHELMING PAPERWORK, LONGER HOURS, AND LOWER PAY THAN MOST SPECIALTIES. AS A RESULT, THE MASSACHUSETTS MEDICAL SOCIETY FOUND THAT 40 PERCENT OF THE REMAINING PRIMARY CARE PRACTICES ARE CLOSED TO NEW PATIENTS -- THE HIGHEST PERCENTAGE EVER -- AND THE WAIT FOR A FIRST APPOINTMENT AVERAGES 45 DAYS. SO WHEN SOMEONE NEEDS HELP RIGHT AWAY, HELFAND SAYS THERE ARE FEW OPTIONS.
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Time: 24s
Title: urgent ax - emergency rooms
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That is a role which ER’s often fill as well, and they are much less well set up to do that in an ER, because they’re trying to deal with the really sick people….
IN FACT, EMERGENCY ROOMS STATEWIDE ARE REPORTING MORE TRAFFIC FROM PEOPLE WITH ROUTINE, NON-EMERGENCY PROBLEMS -- SEVERAL HOSPITAL ADMINISTRATORS IN WESTERN MASSACHUSETTS ATTRIBUTE THAT, IN PART, TO THE RISING NUMBER OF NEWLY INSURED RESIDENTS WHO EXPECT SAME-DAY TREATMENT. WHILE DOCTOR HELFAND SAYS HIS CLINIC HELPS RELIEVES THAT PRESSURE – HE SAYS NEITHER URGENT CARE CENTERS NOR EMERGENCY ROOMS CAN REPLACE PRIMARY CARE. AND IN FACT, FOR A TIME, HE TOOK ON SOME OF HIS WALK-IN CLIENTS AS PRIMARY CARE PATIENTS – HE FELT THEY NEEDED MORE CONSISTENCY.
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Time: 24s
Title: urgent ax - need for primary
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someone would come in … and they have a blood pressure of 160 or 90 and they don’t have a primary care doctor and they were trying to get one for six months. so we'd start them on medication and find they also have high cholesterol and other problems, so I started taking on primary care patients as well….
BUT ABOUT SIX MONTHS AGO, HELFAND STOPPED AGREEING TO ANY NEW PRIMARY CARE PATIENTS. HE NEEDED MORE TIME FOR ACUTE CARE, WHICH IS THE PRACTICE’S BREAD AND BUTTER. BUT HE SAYS HE’S FRUSTRATED THAT HEALTH CARE ECONOMICS HAS COME DOWN TO THOSE CHOICES. LIKE MANY DOCTORS, HELFAND LAYS MUCH OF THE BLAME ON HOW INSURERS, FROM PRIVATE COMPANIES TO MEDICARE, PAY FOR HEALTHCARE FOR EXAMPLE, HELFAND SAYS, MINOR PROCEDURES GET REIMBURSED MUCH BETTER THAN IN-DEPTH MEDICAL EXAMS.
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Time: 23s
Title: urgent ax - facial laceration1
Description: urgent ax - facial laceration
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Say someone comes in here and they have a facial laceration… a little one, an inch and a half… I’ll get paid a couple hundred bucks to stitch it up…. It’ll take me about 5 minutes. If I do a complete history and physical on a patient….make a plan with them about medications…. If i do this well, it will take me over an hour, I get paid $120. [TIGHTEN]
THE MASSACHUSETTS COMMISSION ON PAYMENT REFORM CAME TO THE SAME CONCLUSION THIS SUMMER -- AND RECOMMENDED MAJOR CHANGES TO HEALTHCARE REIMBURSEMENT SO THAT PRIMARY CARE IS REWARDED MORE FAIRLY. BUT THAT WON'T HAPPEN QUICKLY. IN THE MEANTIME, POLICY MAKERS ARE LOOKING TO URGENT CARE CLINICS AS ONE STOP-GAP MEASURE FOR THE DOCTOR SHORTAGE. ANOTHER, SIMILAR TREND.... IS THE RETAIL CLINIC – A CONTROVERSIAL TYPE OF WALK-IN CENTER, HOUSED IN PHARMACIES LIKE CVS AND WALGREENS AND MOSTLY STAFFED BY NURSES. SO FAR, SEVERAL CVS MINUTE-CLINICS HAVE OPENED IN EASTERN MASSACHUSETTS AND OTHER PARTS OF NEW ENGLAND. HELFAND -- WHO'S NOT A FAN OF RETAIL CLINICS -- SAYS HE'S HEARD ONE MIGHT COME TO HIS NEIGBHORHOOD, AND HE'S EXPECTING DEMAND FOR BOTH OF THEM WILL CONTINUE TO BE HIGH. I’M KAREN BROWN IN SPRINGFIELD.
