Maybe they can do better? Fee for service is kind of insane. Urgent care strep throat $250 + meds makes no sense. It should be $50 total or less.
1. You interact with a receptionist. They use commercial software to track your visit, find an appropriate medical professional for your condition, and fit you into a schedule/queue.
2. You see a medical professional, often a nurse, that checks your vitals and updates your chart. This professional will often take a swab of the infected area.
3. The swab is sent to a lab, where medical grade equipment and a trained technician analysis the sample.
4. You see a medical professional with the prescription pad. Usually an MD or NP. They are responsible for the diagnosis. Strep infection could be a symptom of a larger problem. People without a bacterial infection need to be treated, but shouldn't be given antibiotics. This professional needs to carefully listen to the patient and clearly explain their condition, and what to expect from treatment.
5. You see clerk at checkout. Your entire bill is reviewed by your insurance company.
6. You see a pharmacy tech, a pharmacist oversees your prescription being filled, a medical grade product is provided. Lots of liability at this step. Lots of security and shrinkage concerns for the business.
Keep in mind that throughout this entire process staff is held to higher education, background, and training standards than the general population, all software is built for HIPPA and costs more than standard enterprise software, all equipment is built to a very high standard, all offices are more sanitary than average businesses, and many of the trades are seeing long term labor shortages. Throughout the process you'll probably take an hour of professional time.
1. I signed in using an automated terminal. A tablet which scanned my ID and insurance card. I sit down in the waiting room. A few minutes later a nurse comes to get me.
2. The nurse takes my temperature and swabs my throat for a rapid test which is then done in front of me. The nurse leaves the room while the test is reacting. The interaction takes about five minutes.
3. A NP came in to look at the test and my throat. The only interaction I had with the NP was when they asked me if I thought I had strep to which I replied "yes". The NP diagnosed me with strep and wrote me a script for amoxicillin in less than five minutes.
4. I left the urgent care clinic without seeing the clerk at checkout. The entire visit including waiting to see a medical professional took less than 30 minutes.
5. Ten minutes later I pick up my course of antibiotics at a pharmacy four blocks away. The price of the medicine was free with insurance and $15 dollars without.
Strep tests cost $35 dollars retail. The price to visit the clinic was $200 dollars ($165 sans the price of test). The per hour cost of medical care was $990 dollars.
The sensitivity of rapid strep tests is already low (and the cost/risk of untreated strep quite high), to the point where standard-of-care already dictates that negative rapid results be followed up with a lab culture. Not everyone follows that in all circumstances, but it is considered standard of care.
The real-world accuracy of OTC rapid strep tests performed at home by untrained non-clinicians is even lower.
There are cases in which a strep diagnosis is warranted without all of the above, but the picture you're painting is overly optimistic in terms of cost, and measurably degrades quality of care for patients compared to the status quo.
https://afcurgentcareathenstn.com/are-rapid-strep-tests-accu...
98% is the specificity in the link you cited, not the sensitivity, which would be the relevant statistic. That's also a consumer-facing marketing page for an urgent care clinic that just cites "sources", so you should probably take anything you read there with a grain of salt. It's essentially an advertisement.
But furthermore, we're not talking about the tests performed in a clinic by a clinician. We're talking about OTC tests performed at home by an untrained non-clinician.
https://www.aafp.org/pubs/fpm/issues/2008/0200/p48.html#:~:t....
This is the danger of Googling around for information without any contextual domain knowledge.
- You're quoting a statistic from an op-ed (op-eds are not fact-checked, let alone peer-reviewed)
- You're misquoting the statistic as provided by the op-ed (that op-ed is written about a test with 95% specificity, as claimed by the author)
- You're quoting an op-ed written by a witness called to testify in the defense of a physician who was sued for not following the documented standard-of-care - hardly an impartial source
- You're quoting an op-ed written about a single case (n=1). Furthermore, it is chosen not even as a medical case study but rather because the legal case is of financial interest to the author
- The op-ed is nearly fifteen years old - and, as it turns out, the prevalence and risk of rheumatic fever is radically different in 2023 than it was in 2008, for the worse.
- Even if you discount all of the above, the op-ed as taken at face value is written about a case in which a patient didn't get a backup culture drawn and ended up requiring two heart valve replacements (!) after a false negative on the rapid strep test. Regardless of whether or not the doctor is legally liable, it's not a good argument that rapid tests are sufficient.
If you go about looking for information to support your argument, it's often likely that you'll be able to find something that on the surface seems to support your case. But if you don't have the necessary domain knowledge to evaluate the trustworthiness of the source, the accuracy of the claim, or even its relevance to the matter at hand, that can lead you astray.
That's doable. The thing I don't like about this approach is that I'm not sure how it works on the margins. A rapid covid test has a lower accuracy than a strep swap processed in a lab. What do the people with very sick throats but not strep do? How does it catch people that have a more fundamental health issue? Are there common pitfalls that the system might snag on, like individuals not carefully reading dialog boxes and quickly incorrectly clicking that they do not have a antibiotic allergy.
I'm privileged, but my personal bias is to pay more for higher quality health care instead of paying less for lower quality healthcare.
So yeah, maybe Amazon can do better at least on the administration side.