Can Local Hospitals End-Run Obamacare?


By Jack Cashill


Healthcare providers show amazing nimbleness, even in the face of a central-planning disaster like the ACA.

    “So you’ve got this crazy system,” said former president Bill Clinton at a pre-election rally this fall in Michigan, “where all of a sudden 25 million more people have healthcare and then the people who are out there busting it, sometimes 60 hours a week, wind up with their premiums doubled and their coverage cut in half. It’s the craziest thing in the world.”

    Clinton honored the party line with the 25 million part. Actually, he did more than that: He enrolled at least 5 million more people in Obamacare than even the Obamacare Web site dared claim. In the second half of his comment, however, Clinton wandered a bit off the rhetorical track, committing what is sometimes known as a “Kinsley Gaffe.”

    Named after journalist Michael Kinsley, who introduced the concept, this species of gaffe unfolds when a speaker “accidentally reveals something truthful about what is going on in his or her head.”

    Something truthful it was. The slow-motion implosion of the Affordable Care Act helped assure Hillary Clinton’s defeat and, by extension, its own demise. The dismantling of this top-down monster, however, will take some time. In the interim, healthcare providers have the opportunity to show what can be accomplished from the bottom up. The good news this Christmas is that they are beginning to see the wisdom of going private and getting small.

    CVS figured this out some time ago. The drug store giant now has more than a dozen “Minute Clinics” in the metropolitan area. Staffed by nurse practitioners and physician assistants, these clinics specialize in family healthcare. In a useful twist, CVS tells you who ought not come to one of their shops, specifically people with truly urgent problems like severe chest pain, excessive temperatures, and even “suspected poisoning.” Personally, I’d call the cops on that last one.

    Otherwise, it’s all good—ringworm, pink eye, sprains, minor wounds, acne, bladder infections, you name it, plus physicals, vaccinations and wellness services. Although like most males I believe in seeing a doctor only when death is imminent, I found myself getting a flu vaccine at my local CVS on a trip originally conceived to buy me a six-pack. It’s that convenient.

    Plus, the price is right. You can pay for a TB test as easily as you can a tube of toothpaste. The clinics take credit cards, checks, and most insurance plans. The truly cool thing is that you can check the wait times before you go. I am looking at a 7-minute wait at a clinic three miles away and a 21-minute wait at a clinic two minutes away. I think I’ll go with the 7-minute wait. My head lice are acting up.

    The health systems are getting in the game as well. Living in Midtown, I used to brag that there were three hospitals within walking distance where I could get a heart transplant. True, if I needed a heart transplant, I probably wouldn’t walk to the hospital to get one, but the proximity was reassuring.

    Some years back, hospitals decided it wasn’t all about me and started to decentralize. The pace has picked up. There are now three free-standing emergency centers in the metro, two of which are affiliated with HCA Midwest and one with Shawnee Mission Health. The fact that these centers are required to take all comers may explain why each of the three is on the Kansas side.

By thinking small, as in neighborhood-level small, healthcare providers are ditching the monolithic hospital model and delivering care where people can readily access it.

    These physicians-staffed centers are where you go when the head lice bore down into your brain or when your spouse really does poison you. That the local newspaper of record headlined its article on the phenomenon, “Freestanding ER model worries some,” suggests the free-standing model probably makes economic sense.

    The newest health-delivery craze to hit the metro, the “micro-hospital,” differs from the free-standing ERs only around the edges. The micro-hospital typically has a handful of inpatient beds. Three such entities are currently in some phase of development—again, all on the Kansas side.

    The first to come on line will be in Overland Park and allied with Saint Luke’s Health System. Although micro-hospitals meet all the regulatory requirements of a larger hospital, health systems can build them cheaper, obviously, and quicker than they could a traditional hospital.

    Over time, this will allow health systems a lot more flexibility as to where to place beds and when to place them. If this trend continues, I may soon have to bike out to the suburbs to get a new heart, but then again, it shouldn’t really be about me.

    To be sure, for some big-thought thinkers, profit is as much an irritant as the aforementioned head lice. They question whether providers with an eye on the bottom line will dehumanize healthcare delivery. As I was writing this article, I had the opportunity to test that proposition.

    I was nursing a skin irritation too minor to merit a doctor’s visit but too ugly to ignore. So I checked the CVS stores in my area and found one with zero waiting time. As advertised, there was no wait. Registration was fully automated and simple enough that I succeeded on first pass, something I have never done when, say, buying an airline ticket.

    When I showed the CVS nurse my ailment, a freaky thing happened: she sweetly discouraged me from following through with the consultation. Instead, she walked me over to the appropriate aisle, selected the appropriate nostrum, told me how to use it, and sent me on my way with $125 more in my bank account than I might otherwise have had.

    Yes, Virginia, there is a Santa Claus, and if you got your gifts on time this year, chances are the beast pulling his sled was named “profit.”

About the author

Jack Cashill is Ingram's Senior Editor and has been affiliated with the magazine for more than 30 years. He can be reached at jackcashill@yahoo.com. The views expressed in this column are the writer's own and do not necessarily reflect those of Ingram's Magazine.

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