Each Patient Counts: Massachusetts Medical Society Weblog

Minute Clinics: A Final Word, For Now

It’s time for us to close the loop on this chapter of MinuteClinics.

Careful readers of the MMS’ materials over the last seven months know that we had many concerns over how CVS planned to roll out these facilities. We stated clearly that if CVS wanted to call them clinics, they should act like clinics, no matter how limited their services.

I remain unconvinced that these clinics will save money, which is the hope of good people like Rick Lord at AIM. I remain skeptical that they will augment our fragile primary care system.  I am actually worried they will further undermine it. I remain skeptical of many more things, more than I have space to list.

Perhaps this is an idea that can be tried, at least for a few years, now that the state has imposed some reasonable rules for their operations. I wish the DPH and the Public Health Council would have gone farther in its rule-making, but nothing in life is perfect.

The real story here is that our often-criticized regulatory system worked. When these clinics surfaced last spring, CVS asked for a virtually regulation-free blessing from the state. With CVS’ political and economic firepower, it would not have been a surprise if they got what they asked for.

But they didn’t. A large number of responsible individuals and groups with direct knowledge of the Massachusetts health care environment stepped forward and raised many legitimate questions that slowed what seemed like a runaway train. We made strong, reasonable arguments that the application should not be fast-tracked. Then we argued that some basic, fair regulations had to be in place. The MMS is proud of our commitment to the public health, patient safety and access to quality care. And we are proud of our role in facilitating oversight of limited service clinics. DPH Commissioner John Auerbach did a great job managing the issues, and the Public Health Council did its job, as well.

The DPH will be watching what happens over the next few years, and so will we.

Bruce Auerbach, MD
President-Elect
Massachusetts Medical Society

For Success, All Must Contribute to the "Common"

By B. Dale Magee, M.D., M.S, MMS President

The state’s Health Care Quality and Cost Council faces a challenge that is bigger than the Big Dig. After all, that project took 20 years to spend 15 billion dollars. The state spends that much in health care about every four months. If our health care access legislation is to succeed, the Council must find a way to bring one sixth of the state’s economy, the state’s largest industry, under control.

At the first meeting of the Council in the New Year on January 2, Dr. Don Berwick, president and CEO of the Institute of Healthcare Improvement and an elected member of the nation’s prestigious Institute of Medicine, provided just the right analogy when he compared our health care system to a “commons” - the space at the center of colonial towns where folks would bring their livestock to graze. If everyone acted only in their self-interest, the land would soon be overgrazed and all would lose. The challenge, he said, was to find a way to inspire those involved to view their duty as not only a personal gain, but also as a contribution to the good of the community. One needed to only look at those attending the meeting - consultants and those advocating for various constituencies - to know that this would be a hard sell. But we ignore him at our own peril.

Each of us - physicians, nurses, insurers, and all involved with delivering care, as well as patients - needs to find ways to contribute to the success of this effort and put in something for the common good. Acting strictly in our own interest, or the tired old approach of saying that what helps our group ultimately helps everyone, will only give us more of what we already have - an industry that is edging out other sectors of the economy even as it delivers a service that contains too much waste. According to Dr. Berwick, the level of waste in our health care system is “phenomenally high” - accounting for as much as 30 percent of the health care dollars we spend.

The Massachusetts Medical Society has convened a group of medical directors from physician groups across the state. A retreat was held in early December when we brought in national experts to give us insight into how we can use data to understand and improve the value of the care that we deliver. We intend to build on this effort by reaching out to the plans and the state to see how we can further the agenda of bringing better value to the care that doctors deliver. Physicians, given the right information, can work to remove duplication and unneeded elements from a plan of care. And patients, knowing that their doctors rather than outsiders are addressing this issue, will be more comfortable with the results.

Dr. Berwick said that he would like to challenge all medical specialties to find ten things that they could improve upon to cut waste out of the health care system. I believe that his challenge should extend to all in health care and that the public needs to become more aware that more care does not mean better care. Those speaking up at the council need to go beyond recommending what should be done; they need to let everyone know what they will be contributing to the “common.”

This was originally posted on the "CommonHealth" blog on Jan. 8, 2008