Home Forums Discussions General Discussion Wal-mart vs Primary Care

Well, I couldn't believe it when the medical director for Wal-mart showed up at our pediatric service meeting announcing they were a "gateway" to primary care.

Everyone at the meeting was basically debating with him about communication. But, now Wal-mart has access to all of their EMRs which all are Logician due to the hospital and federal grant money purchasing them. Interestingly, all of the other pediatricians, besides me, work on salary so they really don't care if Wal-mart sees their patients. This access is to the patient records at the practices. They apologized they couldn't connect to Amazing Charts. There is no way I am going to allow Wal-mart anywhere near my patient records.

I, of course, don't. So, I was rather upset and let it be known that this was a "gateway" out of our practice. I also told the medical director that we would dismiss any patient who used their facility during office hours.

By the way, they don't use E & M coding and CPT codes to charge patients. They just have what they call a "Menu Board" with a price list like you would see at a restaurant. Example:

Common cold $50
Sore throat $50
"Severe" sore throat $110
Pink eye $50
Ear wax removal $110
Sports physicals $50

Pneumonia vaccine $99 (I still don't know what a pneumonia vaccine is. Is that Prevnar? Pneumovax? You can get a Pertussis and Hib pneumonia -- is that a pneumonia shot?)

TB testing $20 (second visit free!) Just what I want. A person with possibly tuberculosis running up and down the aisles in the busiest retail store in the world.

Pregnancy test (urine) $15 So, what if a 15 yo turns up positive? Are they going to council them and send them to the maternity section?

HIV testing. Will they council positives there?

They provide and charge for ALL required school shots so children could get all of their immunizations there.

THIS HAS ME FURIOUS! First, they put all the mom and pop stores out of business. But, at least one could argue that was capitalism. Now, they are aiming at the private practitioner. And, of course, with healthcare reform, all we hear about is fixing primary care all the while allowing stores like Wal-mart, which have no business in medicine, to be licensed to practice medicine.

Not to mention the fact that they probably ePrescribe directly to their pharmacy, which must be some type of conflict of interest. I know that some providers on here do carry his or her own meds they sell, so I would like to hear from them.

I am shocked, but not surprised. I hope the legalities /authorities look into this alleged doctoring!

Is their medical director a doctor? If yes, then how is it legal for him or her to operate like that? Where does the board stand on this?

EasyRider,

Can you be more specific on the "for him or her to operate like that?" Thanks.

Also, I believe they use mid-levels that they hired away from EMMC's ED.

Almost all of these clinics use mid-levels but have to have a medical doctor sign off on protocols. They just want to skim the easy visits and profit off primary care and turf everything else to someone else. Unfortunately much of this is due to greed of doctors in the past who created the concept of mid-levels to increase their profits. I don't want to start a whos better talk of mid-levels vs doctors, but I really believe doctors started this in the past.

Not to worry. As soon as the new health reform kicks in, they'll double and triple our pay for cognitive services for the really complex and sick people, and we can shift the colds and "pink eye" to Walmart and the Minute Clinics.

Or I might be overly optimistic.

I wonder how Walmart is going respond when they misdiagnose acute glaucoma, iritis or herpetic episcleritis as viral conjuctivitis. Can you see the USA Today headline: "Walmart let me go blind!"

There is a certain range of services those minute clinics can offer.
"TB testing $20 (second visit free!) Just what I want. A person with possibly tuberculosis running up and down the aisles in the busiest retail store in the world.

Pregnancy test (urine) $15 So, what if a 15 yo turns up positive? Are they going to council them and send them to the maternity section?

HIV testing. Will they council positives there? "

Why would I, as a walmart customer, would go to the store if I know they are testing for TB there? It is one thing when clinic like this attracts people with strep throat (although I think even this is questionable), but it is certainly the public safety issue when customer can get exposed to TB just because walmart wants to make extra money.

I think the TB testing is a rather mute point - the only people who are looking for this is people who need a note for their daycare they work at or the nursing home they work for..... not thinking they have TB but just need a note. People who think they have TB show up at the ER, the Health Dept., etc.

Unfortunately I think they pick the items with the highest profit margin - most small clinics try not to do TB tests due to the fact that the bottle only supposedly lasts 30 days once you use one.

Since I think "Obamacare" will only make primary care even less profitable as all visits shift to $40.00 per visit I think it is all relatively moot.

Pessimism or realism .... you decide.

"I wonder how Walmart is going respond when they misdiagnose acute glaucoma, iritis or herpetic episcleritis as viral conjuctivitis. Can you see the USA Today headline: "Walmart let me go blind!"

I am sure they can afford cash for the lawsuit. And, they will probably just refer to the ophthalmologist next to Macdonalds.

I am excited about the Blue Light special where you get the second visit for half price.

Be sure and clarify "optometrist" next to McDonalds..... I have never seen a ophthalmologist there.... like to make that distinction. Unfortunately these clinics see bread and butter primary care as a cash cow...not sure why they think that.

Actually, I meant ophthalmologist.

I will say the only good thing is the optometrist in our Wal-Mart has been there many years - unusual as many come and go. Minute Clinics and things like them I think will not do well in our current economy, I see FQRHC's springing up and I don't think I would be expanding with the current "healthcare reform issues".

Take care.....

Something tells me Walmart won't be using AC.

I hate words like Walmart and Riteaid. Is it:

Walmart
WalMart
Wal-mart
Wal-Mart

Riteaid
Rite Aid
etc.

I think they make sure that whatever you type - the internet will lead you to them. Personally it is the worst store in our area and we really never go there. Unfortunately many people think they are just the greatest -- I think it is ironic that the primary insurance for their employees is Medicaid ... and they support Obama and reform.

They don't provide private insurance for their employees? Can they do that? I know here I have to at least offer to pick up part of their private insurance.

Most states have no requirement and most Wal-Mart employees I have seen are retired and on medicare (working part time) or on medicaid....

I've had patients with Wal-mart-provided health insurance. As I remember they had to be employed for six months before they were eligible, and it wasn't the greatest insurance plan, but it was a third-party plan.

I wonder if smoke-inhalation/injury due to fire is excluded (bad inside joke).

I think you will find Wal-mart makes it difficult to get insurance through them by using the part time slots, etc.

I thought the whole issue with health insurance is that it is provided mostly by employers.

Although I don't like the idea of Wal-Mart having access to doc's EMRs, I don't really see the argument here. It's competition. NP and PAs are already seeing patients and this is on a set fee basis. If I were a patient without insurance, $50 is usually cheaper than a doctor's visit.

Do I like it? No. Do I see it as a horrible concept? No. In my area (which is Wal-Mart's backyard), we don't have enough PCPs and it's tough to get into see a doc for simple things in a timely manner.

I don't mean to step on the primary doc's feet here but this is where we're headed. Patients see a NP or PA, if they can't handle it they send it to the next level, and so on. We do that now by sending to a specialist when it is over our heads or out of our realm. That's what the government will want to because they can pay the NP and PA a lot less.

Welcome to modern "medicine"

At the risk of starting a flame war (which I am fully ready to engage in), that is the most short-sighted post I have ever read. "Do you see it as a horrible concept? No." Well, of course you don't. You're a surgeon. No competition there. I wish Wal-Marts put in operating rooms and undercut all the general surgeons so you could see it as a wonderful concept. And, I can't ever recall one of our general surgeons referring a case to anyone.

If you are a patient without insurance in my area, $50 is $50 more than you will pay at my office. First, we give you 35% off right off the top. If you can't pay that, it's free. I'll even pay your cab fare. And, I make money. I am the most successful pediatrician in this area, by far. But, I won't be if Wal-Mart is allowed to set up shop anywhere they wish.

Sure, the government may want to move to all PAs and NPs. Does that make it right? Hell no. Which is why I am writing this post. It's bad medicine. Do you think that even ONE NP or PA at Wal-Mart (and I mean Wal-Mart if anyone on here is a mid-level on here and takes offense) will EVER sit down after work and read up on a patient? Read a journal article on their patient? No. And, that is good care? No, you are not stepping, you are stomping all over the primary care doctor's feet. Are they going to call the patient back after they understand the problem better. And, you may say the ED doesn't either. The ED does not WANT to do primary care. They don't bill themselves as primary care. They simply HAVE to do primary care, because we let them. Wal-Mart advertises Get Well Services and Stay Well Services.

And, you use the analogy that this is like PCPs sending a patient to a specialist. It's not even close. If I decide with my patient that they need a specialist, it then becomes a partnership. The specialist sees the patient, hopefully fixes the patient and sends me a consult note. Many times, the consultant continues to see that patient as we work together. Wal-Mart sending the patient to the ED is not nearly the same. It's bad care referring the patient for more bad care.

Do you know why you don't have enough PCPs in your area, Travis? It's because they don't get paid enough. So, let's not fix the real problem. Let's have Wal-Mart clinics. Hell, why don't we put medical students in K-Mart and treat for free. They can learn and patients without health insurance will be treated. Not nearly as well as they would get from a NP or PA, but, hey, it will give access.

And, I am not sure you understand the concept of mid-levels. A doctor can pay a mid-level less, but they still charge the same for a 99213. But, Wal-Mart can make it happen by moving the Thomas the Train section down 300 feet.

It sucks that the mom and pop stores were put out of business by the giants. I guess that's captitalism. But, this is not the same. Selling a CD at a lower price still gives the consumer the same quality CD. Selling the treatment of a UTI at a lower price doesn't. Or are they going to do the ultrasound? When will they do the VCUG? Oh, sure, you can tell me that I will get the report and have the same information to go on. But, I will be damned if I am calling that patient for a follow-up visit or even seeing them for a follow-up visit. They will get the same letter any of my patients get if they go to Wal-Mart during office hours which, by the way, are the same, 9 to 9. Which is come get your records and take them to Wal-Mart.

As a doctor here always says, "We sell a certain brand of medicine. If they want it, they will come here and stay here. If they don't, they won't." So, if one of my patients doesn't want to pay me what I am worth for the level of care I provide, they can leave.

Let's take that UTI for $110. You know, the patient without insurance who can get a great deal for peeing in a cup. Hi, Mrs. Jones, the U/A was negative. So, we didn't do a culture based on the reflex. Or, even, the culture was negative, too. So, no UTI. What's that? Why is she still in pain? I don't know. You should probably pay your PCP who knows what he is doing $75. I just got off the phone with a mother explaining hypercalciuria to her. No UTI, but had calcium oxalate crystals everywhere. Simple treatment. Increase the water, decrease the salt.

But, it won't matter. Cause that same patient can go to the ED at 11PM when their daughter has dysuria.

Sad, very sad.

Because they don't know any better. Ask your patients, espeically the younger ones in their 20s or 30s, if they know what TB is. Or Tetanus. or Lockjaw (tetanus). and these are the same arogant fools who will march into your office demanding an antibiotic for a stuffy nose because anytime they have a stuffy nose (or a cough) they need an antibiotic. And if you werent going to give it thats because you are a stupid (no, stooopid) and incompetent doctor.

ok . rant is over. sorry. gee, and i'm not even a doctor.

Hey Bert, hope you don't hate me, but I'm actually working at the Walmart clinic in Bangor tomorrow... As far as I know, there is no connection with EMMCs EMR because it was not a centricity product at walmart. When I went through training, they told me that it was only acute things and I was to always refer back to the PCP for follow-up. Also, they e-rx to any pharmacy in town, not just their own. If you'd like to come by and talk, that would be cool because from the looks of the schedule, they don't see very many people as of yet. If you have anymore questions, fire away.

Travis, I'm not even a doctor and I take offense at the issue of its simple competition...especially about the NPs and PA (oooh, going to get somebody on this board mad at me now).

It not the same training. Its not the same standard. And with WalMart they seem to be exempted from even the same rules that the docs have. Its not a level playing field.

I remember one time when Vicky had referred a patient to specialist. I forget what kind. What I remember is that the consultation came back signed by the NP. Not the MD. She sent a letter back stating that she would accept it as the consult if he co-signed it. Guess what? He didn't dare! He did write a fresh one, signed only by him, that was somewhat different. Can you imagine if something bad happened and it ended up in court? I sent the patient to a sub-specialist for "expert" advice, but accepted this other persons dianosis??

You don't know who is going to be up in there at WalMart--prob. the same clowns they hire at CareCore and at the DOH.

oops. sorry again. Tanj, Bert, stop setting me off man! Gee I prob. need appollogize to some folk after this rant. bad day.

Scott, wow small world. Trying to think of a PA or NP now named Scott. One question? Is there an M.D. or D.O. at the clinic at all hours like there is at WIC and St. Joe's and EMMC? No, I don't hate you. I don't hate too many people and, if I named them, you would probably know them, lol. But, I don't respect what you're doing. Sorry. First, you use eClinical Works. How does AC fit into your equation. But, apparently you weren't invited to the pediatric service meeting. That is where your medical director or whoever he is and some other director was there handing out the "menu board." That's what is called..a menu. Those that use Centricity (and I will always call it Logician) which is PCHC (another great provider of medicine -- please read sarcasm there) and Husson Pediatrics. They were all talking about Walmart interfacing with their EMR. Not exchanging data, but being able to read their info. Just as I can read Powerchart.

What do they all have in common besides Centricity? A salary. The federal government pays PCHC and Pen Peds and EMMMC pays the other practice. I, Bert, the only solo practitioner in town, goes head to head and toe to toe with the federal government and EMMC, the second largest hospital in Maine and the largest health system in Maine. And, still their patients switch to me. Why? Because I provide good quality of care, they only see me, and they can page me 24/7/365. Now, I have to go against the largest retail store in the world. I kind of relish the thought of beating both Walmart and the federal government. But, it's kind of easy. My office has one goal. To provide good medicine. I don't think that is Walmart's goal. And, it's certainly not the government's goal.

I know you can send meds to other pharmacies. But, don't you think the same one-stop shoppers who will go to your clinic are also going to want to get their medications there? And, please tell your medical director since I wasn't allowed to say this to him at our meeting. "Being wildly successful does not = being needed." And, please, can you convince Walmart to spring for a real fax machine? Hell, I'll even pay for a Brother fax for them. We won't even send scripts to Brewer Walmart, because the faxes won't go through.

And, you don't need to send those eClinical Works notes to me. Just fax me a letter that says Joe Smith came to our clinic today at 2PM. And, let him know he will need a new physician. Because we already have form letters dismissing patients with zero days notice. After all, they can't have a serious, on-going issue that needs 30 days notice if they are going to Walmart for their care.

@Wayne - I can't thank you enough for backing me on this one.

@Scott again - I know of three doctors in Bangor who use Amazing Charts. None of can afford Logician or eClinical Works or eMDs, etc. I still don't see where you and AC make sense.

PS When you talk about the "looks of the schedule." How can there be a schedule if this is a walk in clinic?

Wal Mart is smart. Take the simple stuff and don't bill the insurance. In my area, we have Walgreens and CVS with "Minute Clinics."

One of my patients went there and was dx with otitis. I saw him the next day with a perfectly normal ear that had a retracted TM.

I have an NP, but she is well trained and will call me when she is out of her comfort zone (and she is type A.) For some routine work it can work well.

They have a medical director over a series of clinics. If they had 1 phone call a day, the director would not be able to get any other work done. If he is not getting calls, they may well be missing things.

I thought Wal Mart was selling eCW? Did they buy a special link to Centricity because it was common in your area? I know the system they are selling has a stand alone database, not the centrally stored (sharable) database. Interesting how they adapt to markets.

I have no idea how they will get the information. I think I missed something. Years ago when Pen Peds paid their own way, the meeting would have been different. But, Bangor is now EMMC and FQHC vs the FP and Pediatric little guy. And, we're holding our own.

Hey Bert, I am a BC family medicine DO. How does AC fit? Well, I'm planning on moving back to Indiana in Aug 2010 and setting up shop and so far, AC seems to be the way to go! As far as what I meant by looking at the schedule, I was just talking about what they had seen on previous days. lol so far I've had one patient today and it happened to be someone I see in the clinic normally anyway. lol

Anyway, I think that answers your questions. I certainly admire people like you, Adam, and Jack in town who are out there doing it all American style, private practice and that is certainly my goal. I actually philosophically fall very closely to you. You're second paragraph in the post before the last one (that's confusing to say) hits the nail right on the head. People will come to you because they want quality.

Personally, I'm a strict Constitutionalist and believe that the government should have absolutely no role in medicine what so ever. No Medicare, no medicaide, no physician licensing, etc. I think anyone should be able to hang up a shingle and practice "the healing arts" and leave it up to the consumer to decide if they are getting what they pay for. If physicians or some other entitiy wants to start a "consumers reports" for physicians to make that job easier for consumers that's great, but as far as the government and the FDA I don't think we need them at all.

You are certainly correct about the corporatism that is going on. So many confuse coporatism with capitalism and that is not the case. The thing that is frustrating is that large companies, Allscripts, GE, Walmart, EMMC, are getting all of this help and small companies , AC, you, are not. Does that mean that you should get help too? i think that no one should get help, let the market sort it out.

I appreciate your comments and they are actually shared by many at EMMC. when I voluntered to take some shifts I was ridiculed as a "big business sell out" by many because Walmart shuts down small businesses because they can compete with price. Small business needs to learn to capitalize not on price, but quality. That is why you are still succeeding!

I just thought of good idea, I'm going to try to set up a cardiometabolic lipid clinic in the Dunkin Donuts next door.
"Hello, I would like two boston creams, a bear claw, and a cup of coffee" "Would you like to add a statin to that today?"

Or more like what is really going to be after O gets done with healthcare. "Your total will be $3 today; you have exceeded your caloric limit for the day, you will now procede to the next window to be put on Metformin and a Statin by our government employed Dunkin donuts cardiometabolic risk reducer who is a high school graduate who has taken a two hour course in DM and lipid management."

Scott,

I appreciate your thoughts and honesty. I am sorry that that those at EMMC have used that term. They, are in no danger of losing their jobs.

I think it is admirable of you to remain neutral and interact with my posts even though mine contain a bit more venom. And, as always, hearing both sides is helpful.

PCHC received $10,000,000 of stimulus money mainly to be uses as intrastructure. This is not because they need it, it is because the government is clueless as to where best to put the money and they have a past history of giving money to FQHCs. All of the FQHCs and RHCs received stimulus money. At least Coldstream I can stomach, because they are actually doing what they are supposed to be doing.

Maybe I will take you up on that cofee or lunch some time. And, it would be very, very interesting if your last name began with "T." But, I would find that too small of a world.

All I can say is..."I told you all".

No, no, Leslie. You have to say more than that. I have been counting on you.

Wow, I wasn't ready for Bert to "go postal" on me but if I were on the other side of things I would understand. Your anger about this situation is palpable.

First, I never said it was a "wonderful concept". I said "is it a horrible concept? no". For the docs it's not good of course but from Wal-Mart's perspective its simply a Walk-In clinic and those exist everywhere. This is not new. I get patients from Walk-In clinics just like the E.R. where the patient has no real doc and I'm it. I hate it but IT ISN'T NEW. It's only new for Wal-Mart and they tend to sell comparable products/services for cheaper. They are just saying that basic sore throats and UTIs are cookbook medicine. THAT is where we're headed. The governement and JCAHO are trying (and succeeding) and making "basic" medicine cookbook and protocol driven. I HATE THAT.

Some other clarifications: I refer to other docs quite often. I see abdominal pain that gets a Gastroenterologist or an OB/GYN consult. I see hand stuff that gets sent to Hand surgeons. Breast patients and others get reconstructive surgery referrals to my Plastics colleagues. ENT gets a moderate amount of stuff that I see. There's others but I had to clarify that incorrect statement that I don't send cases to anyone.

But, you are absolutely wrong when you say that general surgeons don't have competition. No, its not by Wal-Mart but it's by our own. That's what Wal-Mart is doing...they are using other PCPs, NPs, PAs who get to work shift work and don't have to be on 24/7/365 like you or run a clinic/business. A lot of docs like that. A version of the abused E.R. except with paying patients. Of course Wal-Mart wants this.

I have lost more business to Proton Pump Inhibitors, Interventional Radiologists and Interventional Cardiologists, Interventional Nephrologists, etc. General surgeons are having to re-invent ourselves constantly. We used to do vascular, thoracic, colorectal, breast, even orthopedic and urologic surgery. Not anymore. There is a "specialist" taking each of those "more lifestyle manageable" specialties. So competition is there and we've had to adjust. It sucks, I hate it, my pay has dropped just like every general surgeon in the past 20 years, but I've adjusted.

That being said, this IS different. It's corporate. All I was trying to say is that is where we are headed. That's absolutely why I didn't do primary care. The PAs and NPs can do a huge amount of the "basic/simple" care and we let them (and even encourage them at times). Sure, they bill for an office visit the same now, but in the corporate world and future Obamaland, they can do it for cheaper. Is the quality the same? I'm sure that varies with the practitioner. But sadly, most patients are ignorant enough to medicine that they know no difference unless the treatment doesn't work.

Anesthesia fights it some with the CRNAs who get paid less to do the same job. If I were a hospital, I would have one anesthesiologist and 97 CRNAs. The nursing lobby is amazing.

WalMart IS doing what I think can be done successfully...take out the middle man which is the crappy insurance companies. The amount of money/time I spend on insurance crap is ridiculous. This is why a lot of PCPs are going to cash only practices.

All this being said, I know what your saying and I'm actually on your side. My fellow PCPs don't get paid enough and that's why they're leaving. I see that. BUT, it's happening, it's going to happen, and you/we must adjust and figure out how to win this battle.

I believe the relationship with the doc is the key which will keep us all in business forever. Humans love consistency and there is a great level of comfort going to the same doctor for your medical problems (not to mention better care but no one cares about that anymore)

Sorry, Bert. I really have little else to say. Remember, I have been at this for well over 30 years. When I started in IM over 20 years ago I did it all and it was wonderful. But, I have been witness to physicians giving away our domain, be that good or not I know not. But, if 80% of what I do can be done by Wal-Mart then so be it. We will continue to see the decline in Medical School applicants, graduates and generalists. Why spend 12 years learning a trade that, according to many, can be performed by someone with a high school diploma and a book of protocols. When I went to Physician Assistant School (a whopping 24 months and a high school diploma was all that was required) they taught us medicine using protocol. When I went to work as a P.A. (back in the 70's) I realized I was too poorly prepared and that the protocol book was ridiculous. I got scared. I got mad. I got smart...I went to Medical School. Or so I thought it was smart. Now I wonder. Do you know why we don't see lawyers or paralegals working for Wal-Mart? Because most politicians are lawyers and they would never give up their domain, their status, their credentials to Wal-Mart. Doctors have been stupid and now with Obamacare on the horizon, we have no ammunition left. Sorry, Bert. I used to think I could change things but my days as a sign-toting, sit-inning, go to jail for the cause days are long-gone. I just want to make it through the next 8 years. We gave it away. We have no one to blame but ourselves.

Leslie

See, I knew you had more to say. And, I always respect your comments. That's why I wanted them.

It's nice to see the flames directed away from me

This convo is sure to keep board ratings way up. I am enjoying it immensely. *pulls zipper on flame-proof foil-like suit up over his head and peeping out through tiny peep window*

You should be glad Paul is not here. He would go "postal" and "FedEx." I really don't care aobut CCHIT and HIPAA -- sure I have my opinions -- but when it's my bread and butter, yes I get angry.

Yes, this is very new. There are walk-in clinics everywhere and, while they may exist only to make money, they are clinics to provide care. They are not there to add to the bottom line. If they don't provide good care, good hours, etc., they will not exist. Capitalism vs Corporatism as Scott says. And, I have never gotten a referral from that type of walk-in care.

See here, you back me up. IT'S ONLY NEW FOR WALMART... Exactly! And, PLEASE don't tell me that basic sore throats and UTIs are cookbook medicine. They are not. No medicine is cookbook medicine. That's the fun thing about being a PCP. You never know when the basic sore throat is going to be an early retropharyngeal abscess. But, hey, I guess that may be the "severe sore throat." Please tell me how that is legal under E & M coding. And, they DO bill insurance.

And, that is why I am upset. Because it IS different. It is bad medicine. Why is Walmart so different? It isn't because of the mid-levels or Scott who is a D.O. It is because they are taking advantage of a captured audience -- in fact relying on that captured audience. I would be rich if I had 5,000 people a day walking through my office.

THIS IS COMPLETELY UNTRUE. Walmart takes ALL major insurance companies. They take co-payments. Self-, out-of-state and out-of-country insurance plans will require payment at the time of service. Understand, that if Walmart collects $1.00 in cash for a Mainecare patient, it is fraud, and Mainecare WILL come down on them. It is COMPLETELY illegal to accept any amount of money from a Medicaid patient in cash if the clinic/office is a Mainecare provider. I don't see the difference between Walmart's pricing structure and mine. My patients can pay cash if they are self-pay or have private insurance. We can bill their insurance company and take their cash. I do know that my patient would never pay $115 for a clean ear. That is outrageous.

The trick then is NOT to be a Mainecare (or other medicaid) provider. Then when you charge them CASH, it is not illegal. I suspect they don't take Medicaid. They want REAL bucks.

They realize that many of the people who come to walk in clinics have no concept of quality of care, nor does the patient care. They want a return to work note, they want antibiotics for their viral sore throat and they want to be seen without bringing up their weight, diabetes or other preventive measures we hound them on. I guess you get what you wish for.

Do you really want to take care of these folks? I say let Walmart have 'em.

Cute, but yes, my patients go there.