Medical clinics where you shop

Last week, I wrote a story about the mini-clinics inside grocery and drug stores. It included this paragraph:

“Most treatments are priced at 59 dollars. You’d be billed twice or three times as much at a traditional urgent-care clinic. MultiCare accepts insurance and Medicaid, so most people end up with just a co-payment either way. To break even, the mini-clinic needs to see at least 25 patients a day. That covers rent and the salary for the Nurse Practitioner who staffs it. The one-person staff keeps costs down – along with treating only minor ailments. Is this the next big trend? Not yet, despite hype from some chains. It’s been moderately successful in other parts of the country – but not a revolution.”

For Tacoma’s MultiCare health system, the key is integrating the retail clinic with their larger system. Many of the patients (including the two that I interviewed in the drugstore) were referred from MultiCare’s traditional urgent-care clinic, which was overcrowded.

The question I did not address, but hinted at, in the story is this: Are these retail clinics a good indicator of how much you pay for inefficient overhead during your basic medical appointment? We’ve been hearing for years how wasteful the medical system is, and how paperwork eats up a big share of every dollar. But this seems to be a graphic illustration, at least for all those visits that didn’t need fancy MRI machines and surgical suites nearby.

Advertisements

Microbes on the beach

More on microbes. This time, it’s the effort to understand the vast number of species that live all over our environment. Most of these (like 95%) can’t be grown in the laboratory, so they haven’t been studied much. For the past decade there’s been a rush to use new DNA sequencing technologies to identify and learn about these bacteria. That’s how we became aware of how little we know.

One effort along these lines is happening in my backyard, or not far from it. A group at the University of Washington is sampling mud from Lake Washington. They’re developing ways to pinpoint species that live there, focusing on bacteria that subsist on methane and related compounds. If you’re interested, you can read a summary from the press release, or visit the lab’s website.

Spicy microbes

Ecology is full of surprises. And often those surprises have to do with microbes. I’ll write more about microbes in the coming months. I was lucky this week to be able to write about chili peppers and the strange ecology that allowed them to evolve spiciness.

Short version: Josh Tewksbury at the University of Washington, and a team of researchers, found that the spicy substance inside peppers acts as a defense against a fungus. That fungus destroys the seeds inside the peppers. (It turns them black and generally very gross looking.) In climate zones where the fungus grows more readily, the peppers evolved to be spicier. Specifically, they produce more capsaicin. The same chili species in drier zones is not spicy at all.

But what makes it not just interesting, but fascinating, is the three-way relationship between the chili plant, the fungus and a tiny insect. Without all three, the world would be full of bland food.

The insects, as Tewksbury describes them, have mouths shaped like drill bits. They drill into the chili fruit and into the seeds, and eat the nutritious inside of the seeds. They can do a lot of damage, but they don’t destroy all the seeds. However, the holes they drill allow the fungus to get inside the waxy fruit surface and seed surface. By secreting a spicy substance around the seeds, the plant keeps the fungus at bay, just enough to keep the fruit and seeds looking healthy.

As long as the chili peppers look tasty, birds will eat them, as birds are not sensitive to spiciness. And birds are the main distributors of chili pepper seeds.

If you take any of the creatures out of the system, you don’t get spicy habaneros or jalapenos or any of the other peppers we know and love. In fact, all spicy peppers, along with sweet peppers, evolved in the dry forests of Bolivia, Argentina and Paraguay. People bred many varieties from just a few core species. They spread around the world, including to India and Thailand, only post-Columbus.

Wow.

Medicine and shopping

I’ve been watching the trend of drugstores (and supermarkets) adding mini-medical clinics inside their stores. It’s an interesting idea, sort of an end-run around all the hassle of trying to get an appointment with your doctor and be seen in a timely manner. Instead, just walk into the nearest drugstore and have your minor ailment checked out. And, it’s supposed to provide an option for people without insurance.This started on the East Coast, and Bartell Drugs first tested it here in Washington a couple years ago, by contracting with a chain called Minute Clinics. Apparently, that didn’t work out so well.

Now, Rite Aid is trying a new angle, at two of its stores in Tacoma. It’s teaming up with a local health-care provider, in this case MultiCare Health System. MultiCare is huge in Tacoma, the dominant medical provider, with four hospitals, and a network of primary care and Urgent Care clinics. MultiCare is staffing the mini-clinics (with ARNP’s — Nurse Practitioners) as one more branch of its network.

According to a story in the Puget Sound Business Journal, these clinics do better (financially) when there’s a shortage of primary care providers — so, outside major cities. In Houston, they’re converting the mini-clinics to telemedicine clinics, because it was too expensive to pay a nurse to sit there all day.

Will this ever be an important trend in medical care? Is it helpful to have a service like this? Or does it just seem like a new type of marketing?

How many people get HIV?

If you heard my story this morning about HIV infection rates (“How many people get HIV?”), you might have wondered, What’s changed? Why are the estimates different from in the past?

The issue has to do with when people first became infected with HIV. Here’s the problem: Many people walk into a clinic and get diagnosed as HIV-positive long after they were first infected (a year later, or many years later). Therefore, the number of “newly diagnosed HIV cases this year” does not tell you how many people became infected this year

Maria Courogen, of the Washington Department of Health, explained to me that a new, two-stage HIV test has been developed. The second stage can distinguish between a recent infection and an older infection. When you’re first infected, your body mounts a big immune response, and the number of antibodies spikes way up. After a few weeks, the antibodies begin to subside

A federally-funded study took this two-stage test to 22 communities across the U.S. and compared how many people were newly-infected vs. infected earlier. They used this data to extrapolate and estimate the number of new infections per year

It doesn’t change much. For most people, you won’t do anything differently whether there are 570 new cases or 700 new cases per year in Washington state. I think there are two reasons we sat up and paid attention. Because we haven’t heard any really new news about HIV in America And, since the new estimate is in fact an increase, it served as a reminder that the epidemic isn’t going away.