Retail Clinic Route Best Low-Cost Care?

Dr. Jennifer Ashton Discusses Pros and Cons of Clinics and Shares Tips for Using Them

(CBS)  Are doctors' visits getting too expensive for you?

You may want to try out a low-cost option known as a retail health clinic, found in a growing number of pharmacies, as people seek medical treatment on-the-fly.

Staffed by nurse practicitioners, these clinics offer treatment for minor health problems when a patient can't get an appointment or afford to go to a doctor or hospital.

Retail health clinics are available at pharmacies, such as CVS and Walgreens, as well as supermarkets like Kroger and Publix, and may be a way for some to get medical help in the down economy.

But are these clinics are a reliable place for medical care?

"Early Show" co-anchor Maggie Rodriguez posed that question to CBS News medical correspondent Dr. Jennifer Ashton.

"The buyer has to be beware," Ashton told "Early Show" co-anchor Maggie Rodriguez Monday. "The patient has to use the same amount of caution as if looking for a doctor."

Ashton said clinics like these usually offer very basic evaluation and treatment for minor health issues such as urinary tract infections, throat or ear infections, or minor skin infections. These clinics, she said, are meant ot treat minor ailments. For simple issues, she said, the knowledge of a nurse practitioner is satisfactory.

Ashton said charges vary, but can start at $60 -- without tests or medications -- while most doctors visits start at $100. Ashton pointed out that, even during a doctor visit, patients aren't seen by the doctor the entire visit.

Although retail clinics were started on a cash-only basis (and still accept cash), many now accept insurance.

But who should -- and shouldn't -- use them?

Ashton said patients who are generally healthy and don't have a regular physician should use clinics for a minor problem. The clinics may also be a good alternative, she said, for people who are traveling and/or can't get in touch with their regular health care provider.

However, people with one or more chronic medical conditions, those with a complicated medical history, and those who have their own physician, she said, shouldn't use the low-cost clinics.

What should you do when you visit a low-cost retail clinic?

Ashton's recommendations:

1. Know your own medical history.
2. Bring a list of all medications.
3. Get a phone number in case things worsen.
4. Follow-up with your regular provider or arrange follow-up.

Ashton added patients should also get a record of their visit to the clinic to know what tests were done, what medications were recommended, and what type of medical professional saw you. She also suggested retaining a copy of all records.

Ashton said if you want to use a retail clinic, you should weigh the pros and cons.

These clinics are not for everyone, she said. The clinics may even receive financial incentives, she said, to prescribe medications if they are associated with the pharmacy. Also the nurse practitioner may not have the same medical knowledge as a physician.

[eliseledbetter]

So, is CBS going to do anythig about this stupidity or not? NOT.
I'll never know because I will never watch The Early Show

[NJ_FNP]

Wow, confusing NP's with LPN's, are you kidding me? Well researched piece CBS. Thanks for reminding me why I DO NOT watch CBS anymore. No wonder your ratings remain in the tank. Just more of the same old one sided views. And poor Maggie....gee, I hope she gets over her "freaking out". I'm sure Dr. Ashton will write for some Xanax, "just in case". How long has it been since Dr. Ashton actually practiced anyway? And what part of "MD" makes her an authority on Nurse Practioners and their scope of practice? Any answers to those questions CBS?

[proud_FNP]

I love to watch cbs news early show and try to watch it most of the mornings. I am surprised that Maggie would post such a question about whether these health clinics are safe and whether we NP (Nurse Pracitioners) not LPN nor RN's are qualifed to do our jobs......
As doctors we have have a approved master's program circulum and have to be give board certification exam and be liscenced by the state to practice. Rules of texas. For maggie and Dr. Ashton I am sending you the links to do your research before you speak on air. As for Dr. ashton we are not only trained in minor aliments but also chronic health problems and we can take care of patients with blood pressure, diabetes, heart disease etc.
I think the least CBS can do is rectify their statements and maggie and Dr Ashton give a public apology for their statments.

Her are links in case Dr. Ashton knowes it all would love to do some research on Nurse Pracitioners. But my guess is she is all high and mighty to admit her mistake or even do research about Nurse practitioner as she is MD ( oh my god a doctor - know it all).

http://aanp.org/NR/rdonlyres/7404DF20-0895-46E1-8EB7-EB01AAF392CA/0/InfoRelease.pdf ( this link tells you that oh the poor nurse practitioners were actually called to the white house to discuss health care...)

http://aanp.org/AANPCMS2/AboutAANP/About+NPs.htm ( this link tells you eveything about the role, education circulum and scope of practice for NP's).

This really makes me think if I want to watch CBS early show from now on.

[cpr1952]

Well CBS as you can tell from the comments from my fellow nurses around the country who watched your program on retail health clinics run by nurse practioners you really dropped the ball on this one. So are you going to fix this irresponsible and erroneous reporting or what? And if you do, please interview a nurse practioner instead of some TV doc who obviously knows nothing about the profession of nursing.

[eliseledbetter]

I cannot type or spell as I am so angry

[eliseledbetter]

What are Jennifer Ashton's qualifications?
She says she is a doctor but has she ever practiced medicine? It is so strange that a person puts an MD after their name and suddenly become experts. I have been a nurse for over forty years, am a bord certified FNP and my ethics and professionalism get to be questioned by someone who claims to be a doctor?
CBS and The Early Show need to learn to fact chck. And if they are interested in knowing about nurses they need to talk to nurses.
Or if they wish, I have many stories to tell about unethical, ill trained MDs to have "led" the health care systme into the mess we have today.
I read the transcript of theshow but refuse to waste my time on listening to the video. It makes me wonder how accurate CBS is in it's other reports.

[dragonfly52]

I watched the CBS segment on retail health clinics and was appalled that Dr. Ashton referred to Nurse Practitioners as "nurses that can write prescriptions" and as "LPNs". Obviously the doctor CBS chose to interview has no idea what nurses do nor the different educational levels of nursing practice. LPNs are Licensed Practical Nurses with a high school diploma and about 12 months of vocational training. Nurse Practitioners are Registerd Nurses (BSN) with a graduate degree, a Master of Science in Nursing (MSN), many have doctorate degrees. That's right there are Doctors of Nursing and many of us teach in universities.
Nurse Practitioners are primary health care providers that are well trained to work within their scope of practice and recognize when to refer their patient to a physician. The information stated by Dr. Ashton was misleading and not a true representation of the role of Nurse Practitioners in healthcare. Needless to say there has always been a tug-of-war between MDs and NPs as many MDs fear that NPs are taking their clients ($$$$) by offering convenient health care services at an affordable price. It was also noteworhy that Dr. Ashton disagreed with the NPs diagnosis during the television interview without ever examining the child, reviewing her health history, or assesing her laboratory findings, all of which the Nurse Practioner would have done before diagnosing her patient. Viruses don't respond to antibiotics and the treatment and nursing care (increasing fluids, rest, monitoring temperature, etc.) that the NP prescribed for her patient was correct. Sometimes patients need to be "nursed back to health" instead of "doctored up" with pills. Perhaps Dr. Ashton would have prescribed antibiotics for the non-existent bacterial infection, thereby decreasing the effectiveness of antibiotics when an actual bacteria caueses an infection. Over prescription of antibiotics by physicians when they are not required is a well known issue that currently threatens medical treatment by creating drug resistant strains of diseases. I'm sure that Dr. Ashton can comment on that fact on her next Early Show interview about physicians overprescribing drugs. Next time CBS if you want to present a story about nursing care and the nursing profession in all of its many facets and settings just interview a Real Nurse (RN). CBS you should set the record straight.

[wildcatnp]

How sad!! First NPs are not LPNs-NPs are graduate prepared, advanced practice nurses with years of experience and several thousand hours of preparation. Check your facts before spreading it over the airways!! Second, research over and over again have shown that patients prefer NPs, the quality of care is the same to MDs and we spend more time with our patients educating them and taking the time to make sure our patients leave the office/hospital understanding what to do to help care for themselves. Finally, in a time when there are not enough MDs to care for the patients, especially those without insurance, we all need to work together as PCPs to care for those in need and in a cost-effective manner. CBS, you need to correct yourself and inform the public of the FACTS concerning NPs.

[shannameyers]

Irresponsible is the best word to describe the poor effort that was actually given to the story about retail health clinics. In my GRADUATE schooling to become a nurse practitioner I learned the basic concept of fact checking. Obviously the people responsible for fact checking were either absent the day the story was approved or just incompetent. There were multiple mistakes in the broadcast. First, the voice over stated that "nurses" at the retail clinic could prescribe medicines but chose not to since the patient suffered from a virus. The "nurse" is not just a nurse, she is a registered nurse who went back to further her education to become an advanced practice nurse which in all states of the US requires a minimum of at least a master's degree. In most states an actual board certification is required to practice as an advance practice nurse (nurse practitioner). Secondly, the physician who apparently CBS feels is competent to speak as an expert called nurse practitioners "LPNs". Worse she thought it necessary to then again incorrectly define "LPNs" as licensed nurse practitioners. That is a huge disrespect to all nurse practitioners because LPNs are an entry level provider with a minimum of nine months of training. Worse, stating that patients should contact their physician to let them know that they were treated by what she obviously felt was less than capable nurse practitioners defeat the entire purpose of having retail therapy clinics. The benefit is not only for the patient to have easy access to very qualified care but also to the primary care offices (both physician and nurse practitioner driven). Retail clinics allow the primary care offices to see the patients that have illness that are more complex in a timely manner. Sending all the retail clinic patients back to the primary care office only slows down the entire process. I encourage CBS to provide an update to the retail clinic segment. I would also consider looking into new fact checkers and a physician who hasn't lost touch with the actual reason why most of us go into the medical field.. to help patients with the truth not scare them with false information!

[pielegniarka]

Shame shame shame ! on CBS and on Dr. Ashton. NP stands for Nurse Practitioner, not LPN !!! basic stuff. Dr. Ashton really has no clue about NP's and shouldn't even attempt to pretend that she does. CBS and that reporter with the comment about questioning the diagnosis....because it didn't come from an MD ?!?!? Ridiculous, in 2009 !!! i am absolutely disgusted with this segment and the misrepresentation of NP's, many of whom have DOCTORATE education.

[dookfnp]

Shame on CBS. I physically cringed when I heard the reporter say she would question that diagnosis of a "virus". Cudos to the NP who provided excellent care and excellent patient/parent education! I am an NP who owns my own primary care office. We are excellent PCP's and I am now getting new patients BECAUSE I am an NP! We need to continue to provide the same high quality care we have been. Our reputation is improving daily and more and more people understand our abilities, skills and talents. One MD and one misinformed reporter took us down a notch in 30 seconds. We will bounce back, but we deserve and should expect a public apology from CBS.

[RyanFNP]

Along with many of you, I am disappointed and angered at the down right stupidity of this entire segment. However, I am not angry with the MD but rather CBS! Many physicians, along with Dr. Ashton, share the same sentiment when they find that NP's are PCP's caring for patients from whom they cannot make a buck off of. I'm irritated that instead of interviewing NP's and truly learning what it is we do and how we care for patients, they choose to interview someone from a different profession who knows very little about what NP's do and have her serve as our representation. Fabulous job CBS! Way to really get the accurate details in your report! The sad thing is that many of the patients who need help the most and could actually receive it from a NP within their budget will now not show up for any healthcare because of your erroneous reporting. Many lay individuals except whatever they hear as gospel truth. I hope that someone will catch the big error of LPN's serving in Minute Clinics and do a 1 minute search for the difference between a LPN and NP's, CBS certainly couldn't even do that. CBS, I hope you throughly pleased with yourself.

[zetalady1993]

CBS....you need to correct your definition of a NP!!!!!! Please give the public correct information. They rely on you for accurate information. I am highly disappointed!

[RyanFNP]

I, too, was more upset with CBS for their lack of informative research than with the statements made by the MD. I expect that type of reaction from the MD, but had higher expectations for the person who is making public statements viewed by millions.

[marygreensolantic]

While it was encouraging to view this story, it would have been even more beneficial to enlighten consumers about URGENT CARE CENTERS. These centers can differ vastly from the retail walk-in model in that many (as is in the case of my employer, Solantic)are staffed by M.D.s and offer expanded services above and beyond the retail clinic model to deal with a higher acuity, such as digital x-rays, on-site laboratory services, administration of IV fluids and so forth. Urgent care is expedient, convenient and cost-effective and yet another option in the healthcare continuum when immediate, acute care is needed.

[cwleminger]

Are you aware that the largest health insurance company in the United States has a payment policy that discourages members from using these low cost clinics? WellPoint applies a higher, specialist deductible to services provided by these clinics. My Wellpoint policy charges $20 deductible for visits to my Primary Care Provider. It charges me $30 for visits to these low cost clinics. This does not strike me as being an effective means of controlling rising health care costs. Instead of discouraging members from going to these clinics I think WellPoint should be encouraging members to use them by charging either the same or a lower deductible than they charge for seeing the PCP. These clinics charge less than PCP's and can take some of the workload off our overburdened PCPs. The health insurance industry policy towards these low cost clinics needs to be investigated as part of the overall investigation of ways to reduce our health care costs.

[sam-kiley]

bonjour
j'ai vu le reportage, intéressant, moi prsonnellement je ne me fierai pas a une infirmiére qualifiée ou pas, pour examiner mes enfants et encore moins me prescrire une ordonnance surtout en cas de maladie (angine etc) il n'ya pas de maladies mineures, la preuve une angine mal soignée peut avoir des conséquences graves, et seul un médecin peut soigner et veiller au suivi...
je ferai confiance a ces cliniques pour des soins d'urgencs, premiers secours, en cas d'accidents( blessures, brulures etc) sans plus....
merci docteur ashton..pour toutes explications...vous qui etes medecin qu'en pensez vous..au revoir



au revoir

[karencaseyFNP]

I too am sadly disappointed at the misrepresentation of NPs in the medical world as reported by CBS. Thank you Anitra for your well written account of what NPs are and what we can and cannot do.
As for Dr. Ashton's assertion that NPs only handle basic, minor illnesses, she is surely mistaken. We are in specialist offices as well as Family Practice offices ordering tests, labs and interpreting them as any MD does. I am quite certain that there are many NPs in specialty practices who are more knowledgeable in their field than many GPs, including Dr. Ashton.

[mindyfine]

It was a misrepresentation of what Nurse Practitioners are, and how we are prepared. I hope that this HUGE error is corrected. NPs are Masters-degree prepared and have to sit for boards just like MDs do. Unbelievable!

[RyanFNP]

Please don't forget that many NP's have Doctorate's and many have completed post-doctorate work. The other funny thing is that many medical students are taught by NP's! We must not be all that bad huh?

While NPs also sit for boards, they do not take the same boards as MDs. While nurses are a respected part of the health care system, they are not qualified to deal with complex health issues. If you want the same responsibilities as an MD, go to medical school. While your experience may make you more knowledgeable than medical students, you aren't the one bearing the legal responsibility for the patient.

[ellerbybrown]

I watched this segment this morning. I am appalled that Dr. Ashton referred to Nurse Practitioners as "nurses that can write prescriptions and LPNs". This statement is partially correct. LPNs are Licensed Practical Nurses with a high school diploma and one year of vocational training. In the state of Tennessee, LPNs can NOT prescribe meds or even push certain IV medications. Nurse Practitioners are Registerd Nurses with a graduate degree,a Master of Science in Nursing. Nurse Practitioners are mid-level providers that are well trained to work within their scope of practice and recognize when to refer to a physician. The information stated by Dr. Ashton was misleading and not a true representation of the role of Nurse Practitioners in healthcare.