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Communications Medicine Technology

Rite Aid Drug Stores Offer Virtual Doc Visits 138

Posted by Soulskill
from the please-state-the-nature-of-the-medical-emergency dept.
Lucas123 writes "Rite Aid today announced it is offering virtual face-to-face physician consultations through an in-store kiosk. The virtual consultation services are currently being tested in the Detroit area, but the company expects they will do well and the virtual consults will expand to other regions. The service costs $45 for a 10-minute physician consultation. Consultations with nurses are free."
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Rite Aid Drug Stores Offer Virtual Doc Visits

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  • by Anonymous Coward on Tuesday September 27, 2011 @03:17AM (#37524100)

    Has the US health care system really come to this?

    Please enlighten me, do Americans consider $45 for a 10 minute virtual doctor visit an attractive price?

    In Australia seeing a real physician (GP) in the flesh within a few hours for any reasonable length of time typically costs between $35-$60, of which the public health system pays $35. So net cost to me is $FREE-$25.

    I recently dropped a weight on my foot which fractured my toes, I went to my local bulk billing GP without an appointment, was seen within 30 minutes, was referred to get an X-ray across the road without an appointment (wait time - 10 minutes, X-ray time, 10 minutes, result with professional summary time - 40 minutes), then returned to the original GP, wait time - 5 minutes.

    Total net cost to me for all of the above - $0 (no private health insurance involved here).

  • by jellomizer (103300) on Tuesday September 27, 2011 @08:39AM (#37525242)

    Doctors pay is only the small part of the cost. Don't blame the Professional doing the work.

    Where does your money go...
    1. Malpractice insurance - Because the Doctor makes a mistake people feel they should sue them for a ton of money, although he is just trying to help.
    2. Unpaid Health Care - Health care has a high rate of treatment to people who cannot afford to be treated. So that is factored into the cost
    3. Insurances and Medicare/Medicaid - Their goal is to find a way not to pay the doctor unless they go threw a bunch of loops requiring more staff or cutting into his business time. Heck just dealing with the IT Staff alone you run into the biggest IT Idiots in the world. Here is how a typical integration project works....
    ME: My claim has been rejected why is that.
    INSURANCE COMPANY (IC): We changed our format around.
    ME: When was I notified about this
    IC: We posted the notification change on our webpage in www.insurancecomapyname.com/edi/specifications/hipaa/99dnnvnakkk222/837/changes.html
    ME: I am looking at the page right now I don't see a path to get there.
    IC: You should have this link bookmarked.
    ME: When did you tell people about this page.
    IC: We had the link up for one day on December 25th 2 years ago.
    ME: Can I have YOUR 837 specifications....
    IC: We follow the 837 standard you should know it.
    ME: I want a copy of your version of the specifications.
    IC: It is just like what we require on the paper form.
    ME: Please can I have the specs to be sure I am doing it your way.
    IC: OK... (Gives you a generic 837 standard spec)
    ME: (Follows the specs as giving, runs the test and gets rejections back, a week later) What is wrong why isn't this working.
    IC: Well we don't follow those areas of the specs. We put those values in this filed
    ME: (Follows the specs as giving, runs the test and gets rejections back, a week later) What is wrong why isn't this working.
    IC: Well we don't follow those areas of the specs. We put those values in this filed ... (this will be about 25 iterations sometimes in those iterations we again beg for the full specs to follow for them)
    ME: Ok it seems to process why is it rejecting.
    IC: Well the claim is too old so we wont pay it.
    4. Staff, front desk, practice managers, billers, nurses....
    5. Building upkeep
    6. Medical Equipment ...
    The doctor while getting paid well isn't really everything you are paying for.

  • by Dunbal (464142) * on Tuesday September 27, 2011 @09:24AM (#37525574)

    Hey no problem. Communication is what it's all about. I'm glad you had a positive experience.

    My point of view is that of a physician, because I am one myself. It's absolutely true that any pre-schooler can follow an algorithm and "cure" disease with a high degree of success. After all that is why, in your country, you let nurses and "physician assistants" screen patients and do the grunt-work. Medicine is not hard. However I will argue that in the US medicine has become all about the technology and the tests, and not at all about the patient. I don't practice in the US, but one hears stories of regular CT scans for migraines, abdominal ultrasounds for appendicitis, etc. Mixed in with these stories is a healthy dose of "defensive medicine" (I will do these tests exclusively to lessen my likelyhood of being sued for negligence because there is a faint possibility of a misdiagnosis).

    At the end of the day when you add it all up, you end up with a very expensive health system. Yeah ok you paid $20 for the consultation. Now how much did the X-ray cost? How much did the spirometry (blowing in the tube) cost? Even if you didn't pay up front, someone somewhere paid for the equipment, the film, and the little disposable cardboard toilet-paper roll thing you blow in (you would not believe how much those cost!). Now compare that with visiting someone like me, who probably would have prescribed you the same antibiotic and the same cough syrup after a couple minutes of listening to your lungs through your back, and tapping you on the ribs with my finger. No x-ray. No spirometry. Which is more efficient?

    A doctor is not supposed to order tests just to order tests. They only do that on medical shows. Well no, they are doing that regularly in the US. But you are supposed to know the results of the test before you get it. The test exists to prove your hypothesis (the diagnostic impression), not to "brute-force" a diagnosis. Now admittedly there are cases where a diagnosis is not clear - older patients with several chronic diseases, unconscious patients, pediatric patients, patients with very slight symptoms. These are harder to diagnose and more testing might be required. But in the example you gave me - a patient with a severe cough - the possibilities are very limited. Yes there are many many possibilities - pulmonary fibrosis, sarcoidosis, lung cancer, TB, asthma, etc etc etc. However you consider the age of the patient, how long you've had the symptoms, how severe the symptoms are, obstructive versus restrictive problem (through a physical exam, no spirometry required), and it's a pretty safe bet we're up against pneumonitis (viral most likely) or pneumonia (bacterial). Despite everything the CDC and infectologists say about overprescription of antibiotics, I would probably send you home with antibiotics (viral infections do sometimes turn into bacterial ones due to all that inflammation) and a note to come back in a few days if you are not recovered. If you don't recover, THEN we start looking at x-rays, etc.

    What they are doing is all the testing up front. That's great when you want to sell tests. It's great when you have patients who are more trusting of a machine than the human doctor sitting in front of them. But it's not really good "medicine". My $0.02.

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