Wal-Mart Health Care

Posted on May 30, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

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Healthcare’s New [Old] Innovative Disruption

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]dem2

So, the American Medical Association [AMA] couldn’t or wouldn’t do it; nor could/would the American Osteopathic Association, American Podiatric Medical Association, American Dental Association or any combination thereof.

Neither could/would Hillary Clinton in 1992, nor the US Congress, US Senate, Insurance Association of America [“Big I”], AARP, or plethora of other national organizations, medical trade unions and/or policy-makers.

One is not even sure the current crop of presidential candidates can “do it.”

What it is?

So, what am I talking about?

Why, free-market driven, non-universal [government sponsored] healthcare competitive reform; of course!

And maybe; just maybe; Wal-Mart can do-it?

The Wal-Mart Way

Look, clinics in giant wholesale stores are not new. The optometrists have been there for decades, nobly triaging and providing basic eye-care, but with a certain disdain from “real-doctors” and some patients.

But, all that is fading with the dearth of family practitioners, and rise of on-site and walk-in retail clinics staffed with nurse practitioners, Doctor-Nurse Practitioners [DNPs] and the like. The movement is both gaining traction as well as gravitas. And, the medical kiosks are increasingly being staffed by physicians.

Moreover, with the economy flagging, cheap generic drugs available, convenient hours and locations in many stores, electronic medical records, consumer directed health plans with high-deductibles and private paying patients; Wal-Mart may just have the marketing power to provide some modicum of basic healthcare for many of our nation’s uninsured, or under-insured.

And, imbued with the belief that capitalism always finds a way to wring out marketplace excesses in any industry – albeit slowly – I call the initiative “a perfect-storm of market-place reform.”

Vilfredo Pareto – ReDeux

Perhaps, by being so huge, Wal-Mart understands Pareto’s Law and realizes that many patients get better because-of, or in spite-of, the doctor’s intervention. This was the original promise of managed care that went awry; differentiating and treating the trivial many ills – from the vital few serious diseases.

The Pareto principle (also known as the 80-20 rule, the law of the vital few and the principle of factor scarcity) states that, for many events, 80% of the effects come from 20% of the causes. Business management thinker Joseph M. Juran suggested the principle and named it after Italian economist Vilfredo Pareto, who observed that 80% of income in Italy went to 20% of the population. It is a common benchmark in business; e.g., “80% of sales come from 20% of clients.”

Wal-Mart has studied the market and knows where the price and break-points are.

And, when 80% of healthcare expenditures are spent in the last 12 months of life, maybe there really is a better way; The Wal-Mart Way.    

Assessment

And Wal-Mart isn’t stopping here. In April, it opened the first of its walk-in health clinics in stores in Atlanta, Dallas and Little Rock, Ark. This joint venture with local hospitals will build up the almost 80 clinics already in place in Wal-Mart stores. The goal is 400 co-branded clinics by 2010.

Wouldn’t Sam, and I don’t mean “Uncle”, be proud of the above accomplishments?

Conclusion

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Medical Conflicts of Interest

Posted on May 30, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Emerging Ethical Issues of Trust

By Render S. Davis; MHA, CHE

Crawford Long Hospital at Emory University

Conflicts of interest are not a new phenomenon in medicine.

In the older fee-for-service system [FFS], physicians controlled access to medical facilities and technology, and they potentially benefited financially with every order, test, procedure, surgery or prescription they wrote.

Temptation to Over-Treat

Consequently, there was an inherent temptation to over-treat patients. Even marginal diagnostic or therapeutic procedures were justified on the grounds of both clinical necessity and legal protection against threats of negligence. And, this temptation remains a viable siren-call today. 

Managed Care’s Influence

In managed care, the potential conflicts between patients and physicians take on a completely different dimension. 

By design, in health plans where medical care is financed through prepayment arrangements, the physician’s income is enhanced not by doing more for his or her patients, but by doing less. This phenomenon is especially acute with some capitation reimbursement contracts and settings.

Assessment

Today, patients, confronted with the realization that their doctor will be rewarded for the use of fewer resources, might no longer rely with certainty on the motives underlying a physician’s treatment plan.

Conclusion

Of course, as a consequence, it has been said that one inevitable outcome of the above is a decline in doctor-patient trust. And so, is this a real or perceived notion; please opine?

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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