Tuesday, December 12, 2017

CVS-Aetna Merger and Retail Based Clinics

CVS-Aetna merger, will it happen? Probably, because the FTC and Justice Department no longer worry much about size, although it's possible that their rejection of the Time-Warner/ATT merger might portend a changed view, or it might be only an evanescent political transaction. Whatever.

If it does happen, one of the effects could well be further expansion of Retail Based Clinics. I have an economist friend who thinks this could be good: more competition favoring increased access and efficiency. I take a different view. I think RBC's decrease quality inexorably. I wish I could move the American Academy of Pediatrics to take a robust view here and protect America's children from bad medical care, but no can do, have tried. Can't move that bureaucracy.

See my prior post on RBC's, and why they are a very poor idea –

So I'm reduced to posting, here on my blog, and on the Section on Administration and Practice Management listserve, albeit this comes with the feeling of pissing into the ocean. Ahh, well, life in the big city.

But I have to say, posting on the listserve has its rewards, not only in the relief of getting something off my chest, but then provoking learned and amusing rejoinders. For the edification of my readers, here are three trenchant comments that boldly foresee the potential results of this merger and RBC expansion.

1. All Aetna patients will have lower drug co-pays...but only if the prescriptions are filled at CVS.
2. Aetna patients will have $0.00 co-pays for all Minute Clinic visits, plus they receive a $10.00 coupon to use at CVS...but only that same day.
3. Aetna patients are welcome to the Minute Clinic for all their Immunizations without those annoying annual well exams. 
4. No appointment? No problem! No wait Sports Clearance exams. In and out in 10 minutes guaranteed or we give you a $10.00 same day credit to use at CVS. 
5. Are you tired of those long waits at your Pediatrician's office for those annual well exams? Tired of answering those same stupid questions about how your kids are developing? Tired of your Pediatrician asking those personal questions about your Family History? Tired of your Pediatrician waiting until you leave the room until they ask your children questions about sex, drugs, sexual orientation and God knows what else? Well come to see us at CVS. We do none of that. Try our 10 by 10 physicals. $10.00 and 10 minutes to get that priceless piece of paper so your child can play football, or soccer, or field hockey. And don't worry. If by some small chance we actually pick up any abnormalities in your child we will try our best to mail a copy of our note from our central office in East Ekvelt, RI to a pediatrician of your choosing within 10 business days. 

What's wrong with that??

Jon Caine, MD

6. And should your child have an adverse reaction to the Z-pack that everyone with a cough is given ($10 CVS coupon if we fail to prescribe the antibiotic of your choice at the time of your visit), never fear. Your child’s pediatrician is under contract to Aetna to provide coverage 24/7/365, and respond to your call within 30 minutes. 
7. In our quest to provide quality healthcare at a reasonable cost, your child’s pediatrician will see a reduction in payment if an antibiotic is prescribed within three days of your child being diagnosed with a cold. Here at CVS/Aetna, we win both ways when that happens: More business for the pharmacy AND a lower medical cost ratio! Our stockholders are thrilled!

Jesse Hackell MD

And…once they are the only health plan in a region, they will rejuvenate shopping centers which have turned to Dave and Busters as their anchor.  There is no room in a CVS for 100 visits/hr, so they will lease all of those struggling store fronts and open up The Thoracic Outlet Mall with stores becoming physician, I mean NP specialty centers like the Hair Transplantary, Bananas Republic Urology, Gourdstoms Neurology, Victoria’s Secret gynecology, and, of course back from the gas chamber, Farts Authority GI group.

Russell Libby, MD

Thanks, guys – you outdid yourselves again!

Budd Shenkin

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