I hate to write this, but there are increasing signs that one of the most significant disruptive forces in American health care today is slowly being sucked into the same old way of doing business. I speak of the convenient clinics. I’m not saying the news is all bad. The Convenient Clinic Association still reports good stories about patients with high-deductible health plans who appreciate the lower costs and higher prices of convenient clinics.
However, now that the health plans, a.k.a. the 3rd party payers, are honing in, things are changing. And changing, I fear, for the worse.
See CIGNA’s recent announcement about expanding its network to include more convenient clinics: “retail clinic claims are processed at the same benefit level as an office visit to a primary care physician. For example, if a CIGNA member’s co-insurance for a physician visit is 20 percent and the cost of the service is $60, the member’s out-of-pocket cost for a typical visit would be $12.”
Well, that’s just not the way it’s supposed to work. In fact, it’s horrible because it threatens to turn the convenient clinics into just another cost driver for the 3rd party payers. I suppose CIGNA thinks it can fool people into believing that CIGNA pays the remaining $48, but I hope we all understand that the cost of convenient clinics will now be rolled, opaquely, into our premiums. And that the clinics, like the doctors and hospitals, will start working for the health plans instead of the patients.
And what about the uninsured patient? What will he do when the convenient clinic’s costs go into an upward spiral, after adding on the costs of bureaucratic compliance implicit in belonging to CIGNA’s network? And the list price at the convenient clinic starts to look like the hospital’s chargemaster? When CIGNA decides the co-pay should be $15, and the convenient clinic increases its list price to $75?
And, I contemplate with horror, convenient clinics contracting with the carriers to serve Medicare, with all the lobbying, logrolling, and corruption in that program!
Pretty soon, prices at convenient clinics will be as opaque and meaningless as they are elsewhere in American health care. Oh well, maybe this is idiosyncratic and all will be well…..
……but my confidence is shaken.
(Nota bene: Lest you think this is an anti-CIGNA rant, I defended the health plan against John Edwards’ contemptible accusations that CIGNA caused a young woman’s death by denying her a liver transplant).
Convenient Clinics: Becoming Part of the Problem?
John R. Graham
I hate to write this, but there are increasing signs that one of the most significant disruptive forces in American health care today is slowly being sucked into the same old way of doing business. I speak of the convenient clinics. I’m not saying the news is all bad. The Convenient Clinic Association still reports good stories about patients with high-deductible health plans who appreciate the lower costs and higher prices of convenient clinics.
However, now that the health plans, a.k.a. the 3rd party payers, are honing in, things are changing. And changing, I fear, for the worse.
See CIGNA’s recent announcement about expanding its network to include more convenient clinics: “retail clinic claims are processed at the same benefit level as an office visit to a primary care physician. For example, if a CIGNA member’s co-insurance for a physician visit is 20 percent and the cost of the service is $60, the member’s out-of-pocket cost for a typical visit would be $12.”
Well, that’s just not the way it’s supposed to work. In fact, it’s horrible because it threatens to turn the convenient clinics into just another cost driver for the 3rd party payers. I suppose CIGNA thinks it can fool people into believing that CIGNA pays the remaining $48, but I hope we all understand that the cost of convenient clinics will now be rolled, opaquely, into our premiums. And that the clinics, like the doctors and hospitals, will start working for the health plans instead of the patients.
And what about the uninsured patient? What will he do when the convenient clinic’s costs go into an upward spiral, after adding on the costs of bureaucratic compliance implicit in belonging to CIGNA’s network? And the list price at the convenient clinic starts to look like the hospital’s chargemaster? When CIGNA decides the co-pay should be $15, and the convenient clinic increases its list price to $75?
And, I contemplate with horror, convenient clinics contracting with the carriers to serve Medicare, with all the lobbying, logrolling, and corruption in that program!
Pretty soon, prices at convenient clinics will be as opaque and meaningless as they are elsewhere in American health care. Oh well, maybe this is idiosyncratic and all will be well…..
……but my confidence is shaken.
(Nota bene: Lest you think this is an anti-CIGNA rant, I defended the health plan against John Edwards’ contemptible accusations that CIGNA caused a young woman’s death by denying her a liver transplant).
Nothing contained in this blog is to be construed as necessarily reflecting the views of the Pacific Research Institute or as an attempt to thwart or aid the passage of any legislation.