David Sandman

David Sandman

It was a regular day in the office, packed with meetings, phone calls, and documents to review. Suddenly, I started to not feel well.

The symptoms escalated very quickly: fever, aches, headache, sore throat, dry cough. More tired than anything, I wanted to curl up on the floor of my office and go to sleep. It seemed like it could be the flu, and that made sense; at least two people in my office had already contracted the flu virus and been out of work for a while. The news was full of reports about how this year’s flu epidemic was in full swing. The CDC had issued warnings, and social media was brimming with sad stories of otherwise healthy people (including a 21-year-old bodybuilder) who had actually died of the flu. I’d had my flu shot earlier this fall, but the vaccine isn’t always 100% effective, so I knew I could be at risk.

A colleague urged me to get checked out. He told me that if I did have the flu, I needed to get tested and know for sure right away. If you catch the flu early enough after the onset of symptoms, you can start on antiviral medication that might at least lessen the duration and severity of the illness. Time mattered.

There was no way I was going to be able to get in to see my primary care physician on short notice. He’s a solo practitioner with a busy practice; I normally book appointments with him weeks in advance. Going to an urgent care/retail clinic seemed like the best bet, even though I had never used one before. Here are my ratings of the experience:

AccessA+. There is an urgent care center literally in the ground floor of my apartment building. I called them and confirmed that they did rapid flu testing; they encouraged me to either walk in or simply reserve an appointment and preregister online to save even more time. I booked an appointment for right after work and entered my basic info and insurance information. When I arrived, I checked in with a kiosk, did a tiny bit more paperwork like sign their HIPAA forms, and barely sat down before they whisked me into the exam room. It couldn’t possibly have been more convenient or quicker. At my doctor’s office, it isn’t unusual for them to keep me in the waiting room for up to an hour even when I arrive on time.

CostB-. My copay for this place was $50, compared to what would have been only $5 had I seen my regular primary care doc. Same exact test, same exact care, but somehow it cost 10 times more to get seen in one venue rather than another. This is one more example of the completely messed up way we finance our health care system. By the way, the copay for the prescription I got was another $30, so I was $80 out of pocket before I even turned around. And that is with health insurance. I can afford the $80, but that would be a struggle for a lot of people.

Quality: totally fine. It’s often hard for patients to evaluate the clinical quality of care they receive. In this case, my needs and the care were so basic and routine that I really can’t give a letter grade. They administered the swab test, told me I’d tested positive for the influenza virus, and phoned in a prescription. Done. The quality was at least adequate. It would’ve been smart for the medical personnel to wear masks around me before the positive results came in rather than after as a means of infection control, but that’s more about them than me.

They made efficient use of a team approach to care. Someone who I guess was a physician assistant did most of the work. She took my vitals (temperature, blood pressure, oxygen), went through the symptoms and allergy checklists, and administered the test. I saw a doctor only fleetingly when he gave me the diagnosis.

Integration: A. I was really surprised at how much, and how, they knew about my medical history. I can only suppose they got it through my insurance records. They had a history of meds I’d taken and confirmed whether I still took them. They knew I had high cholesterol. And they knew who my primary care doc was, and asked if I wanted the results to be sent to him.

My experience having the flu was miserable, but my first and only experience to date with retail/urgent care was a good one. It provided the right care at the right time in the right place. It worked out because there was alignment with what I needed: incredibly easy and quick access for very simple and routine care and they took my insurance. These clinics clearly have a positive role to play in the overall health care delivery system. Governor Cuomo’s proposed FY 2019 budget would promote further growth of practices that treat common health care complaints in retail settings such as a pharmacies, grocery stores, or shopping malls.

As positive as my experience was, the role of these clinics has its limits. I’m not abandoning my primary care doctor by any means. If I had a more serious medical issue or needed ongoing complex care, I wouldn’t consider going back there. Analyses supported by the New York State Health Foundation have called for more regulation of and reporting by convenient care clinics. It would have been a lot harder to find a center like the one I visited if I lived in a low-income, medically underserved neighborhood; most of them are located in higher income communities. But overall, my “retail therapy” gave me just what I needed. That plus rest, juice, chicken soup, and binge TV helped me beat the flu.

By David Sandman, President and CEO, New York State Health Foundation
Published in Medium on February 5, 2018

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