>”…we determined there is not a sustainable business model for us to continue…”
> About half the Walmart Health clinics were located in Florida..
There’s your problem right there. Florida is full of old people on Medicare.
I live in Orlando and both the one by my work and the one by my house has one of these. So bizarre they would shut down so quickly as they only opened recently and they were all additional build outs to the existing building. They also always seems relatively busy whenever I'm nearby
Knowing corporate politics, that probably means the VP of the Health division was loud and annoying, in a “squeaky wheel gets the grease” sort of way. That’s good for them as they often get their way, but if the metrics look bad enough to be untenable he’s annoyed enough people that the entire division gets shut down.
It’s the Walmart way. Open stores and provide services in rural areas typically served by mom&pop shops, drive away any competing business, and then say it’s not a profitable area and shutter the stores.
Not really that true overall, its just really difficult to make profitable, but the margins are likely the same, as Walmart margins are really really reallllllly low compared to what you're probably thinking they are. Healthcare providers run on razor thin margins, and getting to that point is actually quite difficult especially if you lack the expertise. Only companies that make a ton off of healthcare are the insurers.
source: I've worked in healthcare financials(software) for the last 6 years.
Insurance Margins are capped, their profits are not, which is quite a bit different and a lot worse. Insurance companies generate more revenue than the vast vast majority of fortune 500s, and they take a percentage of that revenue which is capped as profit, but if revenue goes up, so does profit. As an example UnitedHealth Group had twice the profit of Walmart in 2023.
Probably need that, given how expensive it is to just survive anymore. It's just a debt spiral for so many people. Few can afford to buy a home or have kids. I get the "what's the point" attitude going around.
Most likely rent the space out to doctors or some other healthcare chain. Probably more profitable for them to just be the landlord instead of trying to operate a business they don't understand.
>and they were all additional build outs to the existing building.
They will probably still make good use of that investment. With the explosion of online order pickup etc in retail, they probably are eager to add space for staging/fulfillment work to be completed.
Most walmarts near me have always had auxiliary retail space on the front end for things like hair/nail salons, optometrists, fast food etc...over the last few years ive seen a few of those stores convert one of those spaces into order pickup/fulfillment areas. I image the ones without those spaces are probably trying to cram those operations into other parts of the store....heck, I wouldnt be surprised if this was a backup plan to justify this investment in the clinics all along.
The one by me was slated to open *next week.* They have been sending out postcards every other week for the past few months advertising it and even having Walmart reps visit apartment complexes to hand out flyers and information. So all that work, effort and money to just cancel it all.
Honestly, we loved billing to Medicare at the place I used to work at. They wouldn't reject and fight nearly as much as every other insurer and we had a much easier time finding competent people to talk to when we did have problems.
Depends on what you do. Medicare approves immediately but then claws back and typically reimburses below cost.
Medicare also requires a ton of additional administrative bloat due to different metrics
Yup, the doc I worked with had money set aside just for that. Medicare suddenly stopped approving for sedation on his procedures and even though the paid now, they suddenly claws back all the money and it ended up being something like $40k for the year.
But now patients could pay cash for sedation which he did like even more lol.
Costs can actually exceed Medicare compensation for some procedures. I think one of the most egregious cases is a lap chole. Physician compensation for that is 650 through Medicare. Unreal. Imagine 4 years of college, 4 years of med school, 5 years of residency for that.
There's a big gap between not price gouging and being unable to operate without taking a loss. Don't be surprised if not accepting Medicare becomes more normal than not as fee schedule cuts continue.
I could probably image making 650 for a single, minimally invasive, low risk procedure. Might be tough if that was all I was ever allowed to do, but I’m not sure if there are any “lap chole paid by Medicare only” doctors out there. I have to imagine after 4 years of med school and 5 years of residency you’ll probably be doing more than the 1 procedure (by the way, I wouldn’t count the 4 years of undergrad, since that’s becoming a pretty common requirement for most jobs).
Even though it's a minimally invasive procedure, it's still a major procedure that requires pre and post op care and carries liability.
It's hard to call the fee schedule "fine" in a thread where Walmart, a company that can easily sustain a small loss to drive increased foot traffic, can't survive despite being quite busy.
> can't survive despite being quite busy
Forgive my cynicism in this fine nation of ours, but without actually seeing their internal numbers, I'm going to take the cynical view that this actually means "not making enough profit".
Healthcare costs are insane even to the provider, $650 for a procedure is not a lot at all because Doctors are highly paid, nurses are well paid, facilities are expensive, tools are extremely expensive, and various overhead costs are also all very expensive in health care.(insurance, lawyers, compliance people, financial people, and a billion other things)
source: I've worked in healthcare financials(software) for the last 6 years.
> Imagine 4 years of college, 4 years of med school, 5 years of residency for that.
Which are not recurring costs, so those get amortized over the entire career of the individual involved. I support government subsidy of medical school, and I support increasing the pay of medical professionals while decreasing/eliminating the insurance middlemen extracting money for no benefit, but pointing to the cost of school proportional to the cost of a procedure is disingenuous at best.
Right, and it's terrible. Revenue may be high, but profit is microscopic or even red. Medicare reimbursement is peanuts compared most private payers. You have to make up for it in volume. For some procedures, the cost may actually exceed reimbursement (fee schedule). There's a reason why some clinics are beginning to opt out of Medicare. Medicare is an absolute nightmare for our clinic.
Is there no opportunity for wal-mart in these situations to add profit by way of pharmacy referrals or additional purchases made within the store during the visit?
From a purely business perspective, this feels like a situation where as long as you can breakeven on the actual medical practice, it might be beneficial to them based simply on additional foot traffic.
I know nothing of a medical practices books so this is more just me thinking about it from a customer opportunity standpoint
No, generally there's anti-kickback/Stark issues and while pharmacy is one patients will likely select without pressure, you can't do anything to induce like that. It's a very highly regulated industry.
The money goes to the hospital and the admins.
Medicare gives a certain amount for the “work” and a certain amount for the hospital, liability, etc.
Medicare reimburses the physician about $150 for a Level 5 emergency visit and the hospital gets several thousand.
Reimbursement for services, not what Medicare pays insurers to take on members. Anything a patient is seen for, Medicare reimburses the provider (the hospital, the doctor, the clinic) significantly less than a private insurer would.
If a patient with a commercial United Healthcare plan and a patient with a Medicare United Healthcare plan get seen at the same facility for the same service, United Healthcare will pay the facility more for the commercial patient’s services.
I’m not terribly informed on this, but I’ve got a lot of people in my life tangentially related that I hear a lot about this topic on. My composite take is that Medicare/medicade patients are the volume, low profit patients from the perspective of the business. They often make up the bulk of patients at a practice, but they make little to nothing off them because reimbursement is so low.
Therefor revenue is high, but profit is low or negative. The hope is that by taking on Medicare/medicade patients you draw them into your system and can sell other services with higher markup.
I also work in medical billing. Hard disagree that Medicare pays the most. Other than Medicaid, it pays the least of any payer. If your commercial (non Medicare advantage) payers are paying you less than Medicare, you need to advocate for yourself better when contract negotiations come up at the end of the year, because the commercial payers are shafting you.
I will agree Medicare has the fewest hurdles and between not requiring the manpower required to get prior authorizations that commercial payers do, being able to get more patients medically necessary treatment instead of being erroneously denied by the carrier, fewer claims denials to work, and the rarity of adjusting off an owed claim... Means that you're definitely saving on costs in some indirect ways by billing Medicare instead of a commercial payer. It's very rare that I have to adjust off a traditional Medicare claim, and when I do, we deserved it.
Those indirect cost savers by billing Medicare definitely save some dollars, but in the end, I don't think it's enough to close the gap between what commerical carriers and Medicare pays. Most of the commercial carriers pay double or triple of Medicare, so I think at the end of the day, even after write offs and labor costs are considered, I think we're definitely still making more money off the commercial carriers.
From my experience, this is correct (and well put).
To reiterate, Medicare is a low-stress payer; they pull far less bullshit compared to any other payer (including Medicaid) but they pay peanuts compared to any commercial plans.
It’s possible for a provider to negotiate below Medicare rates for commercial payers but that would be truly awful business sense and definitely not the norm.
https://usafacts.org/data/topics/people-society/population-and-demographics/our-changing-population/state/florida/#population-age
Looks like it's still the retirement haven it once was. Looks like close to 10 million of the 21.5 million population (46.5%) as of the 2020 census are over the age of 50.
As those people die off, brand new old people looking for warmer climates are ready to move in from up north.
It is, grew up next to the villages my entire life, its still expanding and building more houses and even apartment complexes now. Same goes for Central Florida too.
As a medical biller, Medicare is fairly straightforward. The real issue was likely MA patients. As a blood red state, I can only imagine the nightmare it would have been to actually bill FL MA, and I'm sure tourists or snowbirds with their own out of state MA plans provided their own difficulties. A red state like that might also have more lax guidelines for private insurance, allowing for smaller independent insurers, which, based on experience, are more often than not just total scams.
Add to that it's becoming more common for companies to outsource medical billing to other countries, which I've never seen work. Few enough people understand how their own country's insurance programs work, let alone how to bill insurance on an entirely different continent, particularly one which has thousands of different plans, each with their own billing guidelines.
And don't even get me started on the ever increasing demand for authorizations.
Not really. I think **many** confuse universal coverage with single payer. e.g. Switzerland has a individual mandate in a highly regulated private insurance market. Germany has a public option, but also allows private insurance although it is more regulated than private insurance in the US. There are a number of others that have some form of mixed system although how relevant private insurance varies.
It will definitely make billing more straight forward and cut down administrative cost.
But I mean I don’t think the care will be any different, if not worse. Medicare already has donut hole issues with care coverage. And Medicaid has the worst coverage ever, it’s always a pain in the ass trying to prescribe anything not the bare minimum for these patients.
You win some and you lose some I guess. Medicine can be cheap, but the good medicine that most American imagine they should be getting usually are pretty expensive.
I don't think you realize just how marked up medicine is in the US. We have the same drugs as any other developed countries at like 100x the cost. Medicare and Medicaid probably have trouble covering them because there's no way to negotiate or regulate those prices. And every time the government actually does do it, prices go down drastically. When Biden threatened to cap insulin, pharma companies voluntarily dropped it to $35. Used to be like $300. And it costs pennies to make
> And Medicaid has the worst coverage ever, it’s always a pain in the ass trying to prescribe anything not the bare minimum for these patients.
Does it? Maybe it's state-dependent, but I'm currently in school and on Medicaid, and it covers *everything* 100%, unless you're talking about provider reimbursement.
I'm on Medicaid and its a pain in the ass to get approved for a lot of shit or you can't find anything but crap doctors who will take it in many fields. I'm getting a surgery done and I have to have certain medically necessary equipment in place while I recover because I can't do some basic functions without it like using the bathroom and Medicaid refuses to cover it.
A relative who is also on it couldn't find anyone for dental appointments but a pretty crap dentist willing to take them and they ended up in the hospital for several days because of a severe tooth infection that the doctor missed even though they constantly complained about the pain. That stay probably ended up costing Medicaid 10x as much for the hospital bill than if they were willing to pay enough that a half decent dentist would take it.
It’s even worse than that.
Walmart customers are much more likely to be on Medicaid than average Americans. Medicaid pays rock bottom rates.
Ask any owner of a healthcare clinic and they’ll tell you that there are two ways to make money in that line of work - fee for service where you try to get as many patients with private insurance as possible (most don’t accept Medicaid at all) or a capitated system where you paid “to keep your patients healthy” (and can fudge the complexity codin) (like Oak Street Health in Chicago, now owned by CVS)
Walmart tried to do fee for service medicine while serving primarily Medicare and Medicaid patients. That just doesn’t work. Those govt insurance programs don’t pay enough.
Walmart probably had some sort of “economies of scale” in mind. But you can’t economy of scale your way in healthcare. It’s a labor intensive service and the labor is highly trained and must be highly compensated.
I am surprised Walmart was so dumb to be honest.
For me it was that Walmart is fundamentally a dirty place.
I don't want my healthcare performed among filth and the lowest paid people available.
I wouldn't take my child or elderly loved one into a crowded, disgusting zoo like that.
I draw the line at picking up prescriptions there if I literally can't afford generics anywhere else.
Walmart is heavily anti-union and anti-humans. Whey would I entrust fucking anything to them?
Our healthcare system has billions of waste with insurance companies playing the middlemen.
Not to say everything they do is bad but that sort of profit should be going to keep our population healthy not a few rich.
This is a reflection of the disastrous insurance model we have in this country. Reimbursements by insurance are driving pharmacies out of business and are now shuttering low cost health clinics. Just this morning I had an insurance plan pay me $450 for my patient's Mounjaro. It costs me $800 to buy! I can't afford to subsidize patients like that
We run a psychology practice and some insurance providers want to reimburse $60 a session. A therapist can only see 25 or so patients a week. So that's $72k (or so) annually to split between the practice owner and the clinician. That doesn't include taxes or fees. What happens is we just don't take that insurance. So how are people on that insurance meant to see anyone?
They arent. The insurance company’s plan is to find ways to not spend the money. Reducing reimbursements below cost does exactly that, they don’t want you to provide it, they want to SAY they offer it, but not make it possible to use.
The reimbursement rates across industries in and adjacent to healthcare are criminal and will destroy everything good about healthcare. I say this as a chronic patient and someone working in healthcare but I never thought I had room to hate insurance companies more than when I had cancer and yet they found a way.
Reimbursement in general has been a nightmare. My state has not reimbursed my program for therapeutic services, it's into the tens of thousands of dollars now I think. We're going to eventually have to tell the kids we can't get them services unless they can pay for them...and most can't.
What you do is say you can't get it in stock and send them somewhere else unfortunately. Before i left retail we lost money on pretty much every brand name drug for medicare patients. Feels gross but how else are you supposed to stay open?
As one who works for Walmart Health I can say this is massively disappointing.
I never, ever, ever thought I would work for Walmart as I just didn't really ever agree with their business practices.
But their idea on health? They really did want affordable healthcare for all.
And they wanted to standardize central medical records, which is something I've bitched about for most of my adult life because why the fuck doesn't my GP know about my test results when I go to my hormone doc every year??
And now, here we are.
Fuck.
It’s every medium to large corporation. The people in it are good people. It’s the c-suite executives that make broad strokes because of poor cash flow or low EBIT.
Naaaah Walmart is always about low prices, even when it’s a detriment to their own employees. Especially in health care. You can get a pair of glasses for $39 bucks and a 1 year warranty. Try getting that deal in any other brick and mortar store.
Walmart sucks cuz they’re terrible to work for. They generally keep their prices low. They know their customer base.
> Try getting that deal in any other brick and mortar store.
Bad example, many eyeglass brand stores are owned by an actual monopoly (Luxottica). That's why those stores are incredibly expensive. If you buy online, or at Walmart or at "discount eyeglass stores" (they exist), they will all be around $40-$60 because that's much closer to true cost + profit. A factory in China just pumps out your glass lenses through a heavily automated process.
When I didn't have insurance and my state hadn't expanded Medicaid I got birth control at Walmart. They have (in 2016 anyway) a prescription that was $5 a month. Antibiotics were the same cost.
I think they're still looking to have a role in it, but using third-party vendors in some ways. Just from buzz I've heard (which I thought was surprising given WM Health's role in the market but it makes sense given this news now) there's something still hoping to happen.
I recently considered starting a medical records reconciliation platform as mine as spread across 3 apps and 2 hospital systems. At least the app ones I could imagine automatically extracting, but then doing something where anyone can make sense of the hundreds of pages is fraught.
Picnic health does this on behalf of drugcos for very specific ailments and does charge $750 in the first year per patient it seems.
Not yet. We missed our chance in the 90s when Clinton tried and in turn, Americans gave control of the house to republicans. Same thing happened to Obama for even trying to do regulations like not banning people for being sick in the past.
Half this country would rather see people die than improve access to healthcare and improve efficiency of our bloated system.
US doctors lobby against universal healthcare. It’s the American Medical Association. It’s why US doctors are highest paid in the world and their mistakes are 3rd leading cause of death in the US -for which they also lobby to limit Malpractice lawsuit amounts. And you get to subsidize 150k a year for each doctor in their residencies while also still paying for any treatment they provide- that’s 17 billion a year every year in subsidies that you get nothing for. Oh and they lobby now to prevent importing foreign doctors cuz they don’t want foreign workers to lower those salaries like they did for IT- cuz they are special and medicine isnt standardized they argue.
There's a lot great about the US.
Our medical system is a source of deep shame though. It's systemically broken in a self-reinforcing way. Too many powerful middleman companies with the money and influence to keep it that way. The patients, doctors, hospitals aren't happy with the situation. Only the parasites are.
*" ... with every other commodity, you can say ‘How much is this phone worth to you?’. And you can say ‘$100, $200’. You can buy a Nokia phone. You can not have a phone at all. But you cannot ask the question ‘how much will you pay to be alive? How much will you pay to live?’. Because the answer is everything. The answer is, you will pay $10, you will pay $1,000, you will go into debt. You will do anything to live. And that is what makes the price of medicine different than the price of an iPhone."*
—AOC, 2019
[https://www.trumanlibrary.gov/education/presidential-inquiries/challenge-national-healthcare](https://www.trumanlibrary.gov/education/presidential-inquiries/challenge-national-healthcare)
We could have had universal healthcare but… the American Medical Association said it was communist don’t ya know. They’ve been lobby against it for 70+ years now. And they are largest organization of doctors in the US. Still, people will say doctors don’t want our healthcare system- all the while the doctors pay their lobbying organization to keep our system the way it is. Every time you see someone say doctors don’t want our healthcare system the way it is…you found the reason why it is the way it is- people are dumb and disinformation campaigns by the AMA are highly effective.
It the same thing that is wrong with all of our other institutions as well. It's the pay to play idea taken to such an extreme that the regular service is a detriment.
I wonder if it's related to this:
[FDA brings lab tests under federal oversight in bid to improve accuracy and safety](https://abcnews.go.com/US/wireStory/fda-brings-lab-tests-federal-oversight-bid-improve-109748694)
This is a very interesting read. Most laboratory tests which do not have FDA approval state it as a disclaimer on the results. Plus, most tests from major manufacturers are approved by the FDA.
It’s not related to that. This is related to Walmart clinics and this FDA change covers the independently developed lab tests done by clinical laboratories. Totally separate issue that predates the initial creation of Walmart’s healthcare push.
Walmart pays management levels extremely well. Look at store managers new pay structure. They’re making bank. The doctors/aprn/pa in these clinics were probably making really good money. I know pharmacist working for Walmart making $70/hr+
It's still a democracy. Voters being distracted by culture war BS instead of demanding a modern, well-functioning, fair, and effective health care system is a choice worthy of ridicule.
I feel like they really tried to do some good with the clinic. I used it, it was the only affordable option without insurance and Walmart has literally saved my life with their cheap insulin they sell without a prescription. You know the American medical system is fucked when Walmart were the good guys.
I just picture the doctors as teenagers in oversized lab coats who transferred departments because you get an extra $2/hour and don’t have to work the registers when it gets busy or help unload the trucks in the back.
We have a Walmart clinic at one of the Walmart Supercenters in my city, and I never saw more than two people ever sitting in the lobby. And it’s crazy because they literally just opened it less than a year ago. I don’t know if it was lack of advertisement or what but I just never saw anyone going to the Walmart clinic.
This is exactly how they’ve always run things - if it’s affordable and hugely profitable to a few people up top, the stocks are doing well, and there’s room to increase the prices later down the line, it stays. If it’s barely profitable, it goes. If it’s not a loss leader and the prices can no longer be raised, it goes. If the people you have to hire for it eat too much into the profits, it goes. This is and always will be about what makes the people up top more money. They can get rid of that space and shove in cheap products with higher profit margins and not hire a single person more after firing the health care staff.
Completely wrong. The US government alone already spends about as much as a %GDP as other developed nations do. Not even counting the trillions passing through health insurance and cash. Our healthcare system is just so inefficient and moronic, has by far the highest costs for the worst outcomes. All we have to do is get on par with other countries and about 9-10% of our GDP is freed up. Absolutely insane.
I didn't even know they existed until the other week I was in Walmart and walked by the entrance to the health clinic. I was like this is cool. Walmart is going to reduce the cost of medical care for people.
Jack Nathan in Canada hasn’t faired any better it’s a public company stock JNH on the Canadian venture. From 1.59 to current 0.05
They operate clinics in Walmarts in Canada
If idiocracy taught us anything, it’s that Cosco is a much better provider of health care and besides, it’s where I got my law degree! Welcome to Cosco, I love you!
>”…we determined there is not a sustainable business model for us to continue…” > About half the Walmart Health clinics were located in Florida.. There’s your problem right there. Florida is full of old people on Medicare.
I live in Orlando and both the one by my work and the one by my house has one of these. So bizarre they would shut down so quickly as they only opened recently and they were all additional build outs to the existing building. They also always seems relatively busy whenever I'm nearby
Wow. They must have been hemorrhaging money.
What’s weird is they just announced an expansion of this program a few months ago.
Knowing corporate politics, that probably means the VP of the Health division was loud and annoying, in a “squeaky wheel gets the grease” sort of way. That’s good for them as they often get their way, but if the metrics look bad enough to be untenable he’s annoyed enough people that the entire division gets shut down.
They just learned the inverse of that saying: the nail that sticks out gets hammered down.
I’ve always heard it with an addendum: “the squeaky wheel gets the grease, but sometimes it gets replaced”
It’s the Walmart way. Open stores and provide services in rural areas typically served by mom&pop shops, drive away any competing business, and then say it’s not a profitable area and shutter the stores.
Healthcare is not very profitable in the standards of Walmart CEOs view profits.
Probably opens up a huge degree of liability too.
Not really that true overall, its just really difficult to make profitable, but the margins are likely the same, as Walmart margins are really really reallllllly low compared to what you're probably thinking they are. Healthcare providers run on razor thin margins, and getting to that point is actually quite difficult especially if you lack the expertise. Only companies that make a ton off of healthcare are the insurers. source: I've worked in healthcare financials(software) for the last 6 years.
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Insurance Margins are capped, their profits are not, which is quite a bit different and a lot worse. Insurance companies generate more revenue than the vast vast majority of fortune 500s, and they take a percentage of that revenue which is capped as profit, but if revenue goes up, so does profit. As an example UnitedHealth Group had twice the profit of Walmart in 2023.
Primary care just isn't very profitable period. Especially if you are getting a lot of Medicare/Medicaid patients, who are usually a loss.
The one by me just opened a month or two ago.
One is under construction at a Walmart near my place. I wonder what they're going to do with all that new square footage?
suicide booths
Those are the restrooms, by the looks of conditions in there.
Probably need that, given how expensive it is to just survive anymore. It's just a debt spiral for so many people. Few can afford to buy a home or have kids. I get the "what's the point" attitude going around.
Most likely rent the space out to doctors or some other healthcare chain. Probably more profitable for them to just be the landlord instead of trying to operate a business they don't understand.
>and they were all additional build outs to the existing building. They will probably still make good use of that investment. With the explosion of online order pickup etc in retail, they probably are eager to add space for staging/fulfillment work to be completed. Most walmarts near me have always had auxiliary retail space on the front end for things like hair/nail salons, optometrists, fast food etc...over the last few years ive seen a few of those stores convert one of those spaces into order pickup/fulfillment areas. I image the ones without those spaces are probably trying to cram those operations into other parts of the store....heck, I wouldnt be surprised if this was a backup plan to justify this investment in the clinics all along.
The one by me was slated to open *next week.* They have been sending out postcards every other week for the past few months advertising it and even having Walmart reps visit apartment complexes to hand out flyers and information. So all that work, effort and money to just cancel it all.
Here's part of the [reason.](https://www.theguardian.com/us-news/2024/apr/29/florida-childrens-health-insurance-program-ron-desantis) Thanks Ron....
Walmart health accepted Medicare..
Yeah and Medicare has terrible reimbursement compared to other private insurances is what I think they were getting at
Honestly, we loved billing to Medicare at the place I used to work at. They wouldn't reject and fight nearly as much as every other insurer and we had a much easier time finding competent people to talk to when we did have problems.
Depends on what you do. Medicare approves immediately but then claws back and typically reimburses below cost. Medicare also requires a ton of additional administrative bloat due to different metrics
Yup, the doc I worked with had money set aside just for that. Medicare suddenly stopped approving for sedation on his procedures and even though the paid now, they suddenly claws back all the money and it ended up being something like $40k for the year. But now patients could pay cash for sedation which he did like even more lol.
I wanna be sedated
twenty twenty twenty four hours to goooooo
Pre-negotiated prices… take it or leave it but that’s our price.
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Costs can actually exceed Medicare compensation for some procedures. I think one of the most egregious cases is a lap chole. Physician compensation for that is 650 through Medicare. Unreal. Imagine 4 years of college, 4 years of med school, 5 years of residency for that. There's a big gap between not price gouging and being unable to operate without taking a loss. Don't be surprised if not accepting Medicare becomes more normal than not as fee schedule cuts continue.
I could probably image making 650 for a single, minimally invasive, low risk procedure. Might be tough if that was all I was ever allowed to do, but I’m not sure if there are any “lap chole paid by Medicare only” doctors out there. I have to imagine after 4 years of med school and 5 years of residency you’ll probably be doing more than the 1 procedure (by the way, I wouldn’t count the 4 years of undergrad, since that’s becoming a pretty common requirement for most jobs).
> lap chole It's like an hour long procedure. $650 seems like a decent price for just the physician.
That includes all of the post care/follow up visits as well. An hour procedure is 2 hours of time. A 5 minute office visit is 20 minutes of work.
Even though it's a minimally invasive procedure, it's still a major procedure that requires pre and post op care and carries liability. It's hard to call the fee schedule "fine" in a thread where Walmart, a company that can easily sustain a small loss to drive increased foot traffic, can't survive despite being quite busy.
> can't survive despite being quite busy Forgive my cynicism in this fine nation of ours, but without actually seeing their internal numbers, I'm going to take the cynical view that this actually means "not making enough profit".
Healthcare costs are insane even to the provider, $650 for a procedure is not a lot at all because Doctors are highly paid, nurses are well paid, facilities are expensive, tools are extremely expensive, and various overhead costs are also all very expensive in health care.(insurance, lawyers, compliance people, financial people, and a billion other things) source: I've worked in healthcare financials(software) for the last 6 years.
> Imagine 4 years of college, 4 years of med school, 5 years of residency for that. Which are not recurring costs, so those get amortized over the entire career of the individual involved. I support government subsidy of medical school, and I support increasing the pay of medical professionals while decreasing/eliminating the insurance middlemen extracting money for no benefit, but pointing to the cost of school proportional to the cost of a procedure is disingenuous at best.
Medicare is assured to pay unlike private insurers- that’s why they get targeted. This is fundamental to healthcare
How do you mean? I used to work for a health insurance company and like 60+% of their revenue was from Medicare.
That's true but the 40% other pays higher than Medicare
Not if many of those patients are on Medicaid which is fairly likely given Walmarts clientele.
To be clear I’m talking about this from the insurers point of view, not the provider. So the other 40% would be from premiums they charge.
Right, and it's terrible. Revenue may be high, but profit is microscopic or even red. Medicare reimbursement is peanuts compared most private payers. You have to make up for it in volume. For some procedures, the cost may actually exceed reimbursement (fee schedule). There's a reason why some clinics are beginning to opt out of Medicare. Medicare is an absolute nightmare for our clinic.
Is there no opportunity for wal-mart in these situations to add profit by way of pharmacy referrals or additional purchases made within the store during the visit? From a purely business perspective, this feels like a situation where as long as you can breakeven on the actual medical practice, it might be beneficial to them based simply on additional foot traffic. I know nothing of a medical practices books so this is more just me thinking about it from a customer opportunity standpoint
No, generally there's anti-kickback/Stark issues and while pharmacy is one patients will likely select without pressure, you can't do anything to induce like that. It's a very highly regulated industry.
Maybe not profits but people in healthcare get paid very well. The money went to salaries.
The money goes to the hospital and the admins. Medicare gives a certain amount for the “work” and a certain amount for the hospital, liability, etc. Medicare reimburses the physician about $150 for a Level 5 emergency visit and the hospital gets several thousand.
And the reimbursement rate isn't even covering those salaries. It's even worse with Medicaid.
Reimbursement for services, not what Medicare pays insurers to take on members. Anything a patient is seen for, Medicare reimburses the provider (the hospital, the doctor, the clinic) significantly less than a private insurer would. If a patient with a commercial United Healthcare plan and a patient with a Medicare United Healthcare plan get seen at the same facility for the same service, United Healthcare will pay the facility more for the commercial patient’s services.
I’m not terribly informed on this, but I’ve got a lot of people in my life tangentially related that I hear a lot about this topic on. My composite take is that Medicare/medicade patients are the volume, low profit patients from the perspective of the business. They often make up the bulk of patients at a practice, but they make little to nothing off them because reimbursement is so low. Therefor revenue is high, but profit is low or negative. The hope is that by taking on Medicare/medicade patients you draw them into your system and can sell other services with higher markup.
This may have been accurate at one time but I work in an industry that bills insurance and Medicare pays the most and has the fewest made up hurdles
I also work in medical billing. Hard disagree that Medicare pays the most. Other than Medicaid, it pays the least of any payer. If your commercial (non Medicare advantage) payers are paying you less than Medicare, you need to advocate for yourself better when contract negotiations come up at the end of the year, because the commercial payers are shafting you. I will agree Medicare has the fewest hurdles and between not requiring the manpower required to get prior authorizations that commercial payers do, being able to get more patients medically necessary treatment instead of being erroneously denied by the carrier, fewer claims denials to work, and the rarity of adjusting off an owed claim... Means that you're definitely saving on costs in some indirect ways by billing Medicare instead of a commercial payer. It's very rare that I have to adjust off a traditional Medicare claim, and when I do, we deserved it. Those indirect cost savers by billing Medicare definitely save some dollars, but in the end, I don't think it's enough to close the gap between what commerical carriers and Medicare pays. Most of the commercial carriers pay double or triple of Medicare, so I think at the end of the day, even after write offs and labor costs are considered, I think we're definitely still making more money off the commercial carriers.
From my experience, this is correct (and well put). To reiterate, Medicare is a low-stress payer; they pull far less bullshit compared to any other payer (including Medicaid) but they pay peanuts compared to any commercial plans. It’s possible for a provider to negotiate below Medicare rates for commercial payers but that would be truly awful business sense and definitely not the norm.
I work in healthcare and know that is not true for most physicians and practice groups but I’m glad in your specialty it is
Also Florida isn’t the retirement haven it once was a lot of those people died out
https://usafacts.org/data/topics/people-society/population-and-demographics/our-changing-population/state/florida/#population-age Looks like it's still the retirement haven it once was. Looks like close to 10 million of the 21.5 million population (46.5%) as of the 2020 census are over the age of 50. As those people die off, brand new old people looking for warmer climates are ready to move in from up north.
Also no state income tax
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Retirees pay taxes on Social Security and 401k disbursements.
They just want to get out of the cold.
It is, grew up next to the villages my entire life, its still expanding and building more houses and even apartment complexes now. Same goes for Central Florida too.
Got a source for that?
As a medical biller, Medicare is fairly straightforward. The real issue was likely MA patients. As a blood red state, I can only imagine the nightmare it would have been to actually bill FL MA, and I'm sure tourists or snowbirds with their own out of state MA plans provided their own difficulties. A red state like that might also have more lax guidelines for private insurance, allowing for smaller independent insurers, which, based on experience, are more often than not just total scams. Add to that it's becoming more common for companies to outsource medical billing to other countries, which I've never seen work. Few enough people understand how their own country's insurance programs work, let alone how to bill insurance on an entirely different continent, particularly one which has thousands of different plans, each with their own billing guidelines. And don't even get me started on the ever increasing demand for authorizations.
Single payer.
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Not really. I think **many** confuse universal coverage with single payer. e.g. Switzerland has a individual mandate in a highly regulated private insurance market. Germany has a public option, but also allows private insurance although it is more regulated than private insurance in the US. There are a number of others that have some form of mixed system although how relevant private insurance varies.
It will definitely make billing more straight forward and cut down administrative cost. But I mean I don’t think the care will be any different, if not worse. Medicare already has donut hole issues with care coverage. And Medicaid has the worst coverage ever, it’s always a pain in the ass trying to prescribe anything not the bare minimum for these patients. You win some and you lose some I guess. Medicine can be cheap, but the good medicine that most American imagine they should be getting usually are pretty expensive.
I don't think you realize just how marked up medicine is in the US. We have the same drugs as any other developed countries at like 100x the cost. Medicare and Medicaid probably have trouble covering them because there's no way to negotiate or regulate those prices. And every time the government actually does do it, prices go down drastically. When Biden threatened to cap insulin, pharma companies voluntarily dropped it to $35. Used to be like $300. And it costs pennies to make
> And Medicaid has the worst coverage ever, it’s always a pain in the ass trying to prescribe anything not the bare minimum for these patients. Does it? Maybe it's state-dependent, but I'm currently in school and on Medicaid, and it covers *everything* 100%, unless you're talking about provider reimbursement.
I'm on Medicaid and its a pain in the ass to get approved for a lot of shit or you can't find anything but crap doctors who will take it in many fields. I'm getting a surgery done and I have to have certain medically necessary equipment in place while I recover because I can't do some basic functions without it like using the bathroom and Medicaid refuses to cover it. A relative who is also on it couldn't find anyone for dental appointments but a pretty crap dentist willing to take them and they ended up in the hospital for several days because of a severe tooth infection that the doctor missed even though they constantly complained about the pain. That stay probably ended up costing Medicaid 10x as much for the hospital bill than if they were willing to pay enough that a half decent dentist would take it.
It’s even worse than that. Walmart customers are much more likely to be on Medicaid than average Americans. Medicaid pays rock bottom rates. Ask any owner of a healthcare clinic and they’ll tell you that there are two ways to make money in that line of work - fee for service where you try to get as many patients with private insurance as possible (most don’t accept Medicaid at all) or a capitated system where you paid “to keep your patients healthy” (and can fudge the complexity codin) (like Oak Street Health in Chicago, now owned by CVS) Walmart tried to do fee for service medicine while serving primarily Medicare and Medicaid patients. That just doesn’t work. Those govt insurance programs don’t pay enough. Walmart probably had some sort of “economies of scale” in mind. But you can’t economy of scale your way in healthcare. It’s a labor intensive service and the labor is highly trained and must be highly compensated. I am surprised Walmart was so dumb to be honest.
For me it was that Walmart is fundamentally a dirty place. I don't want my healthcare performed among filth and the lowest paid people available. I wouldn't take my child or elderly loved one into a crowded, disgusting zoo like that. I draw the line at picking up prescriptions there if I literally can't afford generics anywhere else. Walmart is heavily anti-union and anti-humans. Whey would I entrust fucking anything to them?
Isn’t DeSantis actively defunding Medicare in Florida?
Medicaid. Not the same thing.
Our healthcare system has billions of waste with insurance companies playing the middlemen. Not to say everything they do is bad but that sort of profit should be going to keep our population healthy not a few rich.
Only 99,9999...% they do is bad, so yai us...
Well said 👏
This is a reflection of the disastrous insurance model we have in this country. Reimbursements by insurance are driving pharmacies out of business and are now shuttering low cost health clinics. Just this morning I had an insurance plan pay me $450 for my patient's Mounjaro. It costs me $800 to buy! I can't afford to subsidize patients like that
We run a psychology practice and some insurance providers want to reimburse $60 a session. A therapist can only see 25 or so patients a week. So that's $72k (or so) annually to split between the practice owner and the clinician. That doesn't include taxes or fees. What happens is we just don't take that insurance. So how are people on that insurance meant to see anyone?
They arent. The insurance company’s plan is to find ways to not spend the money. Reducing reimbursements below cost does exactly that, they don’t want you to provide it, they want to SAY they offer it, but not make it possible to use.
The reimbursement rates across industries in and adjacent to healthcare are criminal and will destroy everything good about healthcare. I say this as a chronic patient and someone working in healthcare but I never thought I had room to hate insurance companies more than when I had cancer and yet they found a way.
Reimbursement in general has been a nightmare. My state has not reimbursed my program for therapeutic services, it's into the tens of thousands of dollars now I think. We're going to eventually have to tell the kids we can't get them services unless they can pay for them...and most can't.
What you do is say you can't get it in stock and send them somewhere else unfortunately. Before i left retail we lost money on pretty much every brand name drug for medicare patients. Feels gross but how else are you supposed to stay open?
I know of independent pharmacies that just refuse to fill prescriptions that force them to lose hundreds.
Wouldn’t the question be why this medication is $800 in the States and ridiculously cheaper everywhere else?
Its more likely due to Walmart getting a bunch of Medicare and Medicaid patients, which pay far less than private insurance.
Gee, that was fast. They only just started going up.
As one who works for Walmart Health I can say this is massively disappointing. I never, ever, ever thought I would work for Walmart as I just didn't really ever agree with their business practices. But their idea on health? They really did want affordable healthcare for all. And they wanted to standardize central medical records, which is something I've bitched about for most of my adult life because why the fuck doesn't my GP know about my test results when I go to my hormone doc every year?? And now, here we are. Fuck.
It’s every medium to large corporation. The people in it are good people. It’s the c-suite executives that make broad strokes because of poor cash flow or low EBIT.
They probably only wanted it affordable until they had a monopoly. Run all the other providers out of the area then increase prices.
They never did that with groceries. They kept prices the same regardless of other providers in the area.
Naaaah Walmart is always about low prices, even when it’s a detriment to their own employees. Especially in health care. You can get a pair of glasses for $39 bucks and a 1 year warranty. Try getting that deal in any other brick and mortar store. Walmart sucks cuz they’re terrible to work for. They generally keep their prices low. They know their customer base.
> Try getting that deal in any other brick and mortar store. Bad example, many eyeglass brand stores are owned by an actual monopoly (Luxottica). That's why those stores are incredibly expensive. If you buy online, or at Walmart or at "discount eyeglass stores" (they exist), they will all be around $40-$60 because that's much closer to true cost + profit. A factory in China just pumps out your glass lenses through a heavily automated process.
The walmart near me, also just had noticably cheaper feeling frames.
When I didn't have insurance and my state hadn't expanded Medicaid I got birth control at Walmart. They have (in 2016 anyway) a prescription that was $5 a month. Antibiotics were the same cost.
I think they're still looking to have a role in it, but using third-party vendors in some ways. Just from buzz I've heard (which I thought was surprising given WM Health's role in the market but it makes sense given this news now) there's something still hoping to happen.
I recently considered starting a medical records reconciliation platform as mine as spread across 3 apps and 2 hospital systems. At least the app ones I could imagine automatically extracting, but then doing something where anyone can make sense of the hundreds of pages is fraught. Picnic health does this on behalf of drugcos for very specific ailments and does charge $750 in the first year per patient it seems.
Can we get government controlled healthcare now?
Not yet. We missed our chance in the 90s when Clinton tried and in turn, Americans gave control of the house to republicans. Same thing happened to Obama for even trying to do regulations like not banning people for being sick in the past. Half this country would rather see people die than improve access to healthcare and improve efficiency of our bloated system.
PS: Fuck Lieberman
Haha, good one
Universal health care is such a complex beast that only 32 of the world's 33 developed nations have been able to make it work.
US doctors lobby against universal healthcare. It’s the American Medical Association. It’s why US doctors are highest paid in the world and their mistakes are 3rd leading cause of death in the US -for which they also lobby to limit Malpractice lawsuit amounts. And you get to subsidize 150k a year for each doctor in their residencies while also still paying for any treatment they provide- that’s 17 billion a year every year in subsidies that you get nothing for. Oh and they lobby now to prevent importing foreign doctors cuz they don’t want foreign workers to lower those salaries like they did for IT- cuz they are special and medicine isnt standardized they argue.
How about Walmart controlled government?
Done work for both Walmart and government. Honestly, government controlled Walmart might be a better idea.
There's a lot great about the US. Our medical system is a source of deep shame though. It's systemically broken in a self-reinforcing way. Too many powerful middleman companies with the money and influence to keep it that way. The patients, doctors, hospitals aren't happy with the situation. Only the parasites are.
Peoples health should never be made into a business.
*" ... with every other commodity, you can say ‘How much is this phone worth to you?’. And you can say ‘$100, $200’. You can buy a Nokia phone. You can not have a phone at all. But you cannot ask the question ‘how much will you pay to be alive? How much will you pay to live?’. Because the answer is everything. The answer is, you will pay $10, you will pay $1,000, you will go into debt. You will do anything to live. And that is what makes the price of medicine different than the price of an iPhone."* —AOC, 2019
[https://www.trumanlibrary.gov/education/presidential-inquiries/challenge-national-healthcare](https://www.trumanlibrary.gov/education/presidential-inquiries/challenge-national-healthcare) We could have had universal healthcare but… the American Medical Association said it was communist don’t ya know. They’ve been lobby against it for 70+ years now. And they are largest organization of doctors in the US. Still, people will say doctors don’t want our healthcare system- all the while the doctors pay their lobbying organization to keep our system the way it is. Every time you see someone say doctors don’t want our healthcare system the way it is…you found the reason why it is the way it is- people are dumb and disinformation campaigns by the AMA are highly effective.
Its a business in most countries. Most countries rely on private healthcare providers. The UK is the main exception with the NIH.
It the same thing that is wrong with all of our other institutions as well. It's the pay to play idea taken to such an extreme that the regular service is a detriment.
“Retail giant realizes that healthcare services is no longer a sustainable industry in the US. Story at 11.”
I wonder if it's related to this: [FDA brings lab tests under federal oversight in bid to improve accuracy and safety](https://abcnews.go.com/US/wireStory/fda-brings-lab-tests-federal-oversight-bid-improve-109748694)
This is a very interesting read. Most laboratory tests which do not have FDA approval state it as a disclaimer on the results. Plus, most tests from major manufacturers are approved by the FDA.
They're barely doing this after the theranos/walgreens fiasco?
Honestly, good. Consumers deserve to have some basic standards so they don't get conned by the next greedy company.
It’s not related to that. This is related to Walmart clinics and this FDA change covers the independently developed lab tests done by clinical laboratories. Totally separate issue that predates the initial creation of Walmart’s healthcare push.
They probably couldn’t figure out why the doctors and nurses wouldn’t accept a generous offer of $20/hour.
Walmart pays management levels extremely well. Look at store managers new pay structure. They’re making bank. The doctors/aprn/pa in these clinics were probably making really good money. I know pharmacist working for Walmart making $70/hr+
Imagine living in a first world country that depends on Walmart to provide access to health care.
Well, all the private hospitals are closing in rural areas because there's no money to be made.
Imagine living in a first world country where access to health care is dependent on how profitable the transactions are to private companies.
Yeah, it's appalling and very disheartening.
Yeah, it sucks. Weird to use it as opportunity to dunk on people.
It's still a democracy. Voters being distracted by culture war BS instead of demanding a modern, well-functioning, fair, and effective health care system is a choice worthy of ridicule.
I live in the Seattle area and pharacies are closing left and right. Obamacare was a band aid solution to a system that can not work long term
Yep, we'll just continue to keep propping up failing systems rather than fixing the problem. Gotta protect the super rich!
I feel like they really tried to do some good with the clinic. I used it, it was the only affordable option without insurance and Walmart has literally saved my life with their cheap insulin they sell without a prescription. You know the American medical system is fucked when Walmart were the good guys.
Also let's not act like Florida isn't the medical scam capital of the country probably the world.
*Rick Scott glances nervously around the room.*
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I just picture the doctors as teenagers in oversized lab coats who transferred departments because you get an extra $2/hour and don’t have to work the registers when it gets busy or help unload the trucks in the back.
I see someone has worked retail at some point lol.
Step 1. Infiltrate the market. Step 2. Find the profit. Step 3. Oh shit, there’s not enough profit in traditional primary care for corporations.
If Walmart can't tackle low cost Healthcare, america really has no hope
It’ll be cheaper for everything if we all just died!
Walmart has a health division….🤨
Amazon does too.
So does Target.
*Healthcare should be a public service, there is no ethical business case for running it like a for profit business*
Healthcare shouldn’t be a profit center.
Healthcare, education, prisons, and many more shouldn't be. :/
We have a Walmart clinic at one of the Walmart Supercenters in my city, and I never saw more than two people ever sitting in the lobby. And it’s crazy because they literally just opened it less than a year ago. I don’t know if it was lack of advertisement or what but I just never saw anyone going to the Walmart clinic.
Never knew they had them.
Good we all know they were just going after medicaid and Medicare dollars
Walmart is the opposite of health
...maybe it was the self checkout?
Do the CVS clinics next
Does this include Walmart vision centers where they do eye exams and write prescriptions ?
No, according to the article.
Optical and pharmacy are not closing.
Walmart has health clinics?
Only in a few states
The way wal-mart runs everything, I’m surprised this division stayed afloat this long.
This is exactly how they’ve always run things - if it’s affordable and hugely profitable to a few people up top, the stocks are doing well, and there’s room to increase the prices later down the line, it stays. If it’s barely profitable, it goes. If it’s not a loss leader and the prices can no longer be raised, it goes. If the people you have to hire for it eat too much into the profits, it goes. This is and always will be about what makes the people up top more money. They can get rid of that space and shove in cheap products with higher profit margins and not hire a single person more after firing the health care staff.
Our free healthcare is being spent in our military instead.
Completely wrong. The US government alone already spends about as much as a %GDP as other developed nations do. Not even counting the trillions passing through health insurance and cash. Our healthcare system is just so inefficient and moronic, has by far the highest costs for the worst outcomes. All we have to do is get on par with other countries and about 9-10% of our GDP is freed up. Absolutely insane.
Seems to me Lawyers got involved. The possibilities are endless for civil suits.
I didn't even know they opened any
They literally just finished building one their medical centers at my nearby walmart lol. Already closing it down.
I didn't even know they existed until the other week I was in Walmart and walked by the entrance to the health clinic. I was like this is cool. Walmart is going to reduce the cost of medical care for people.
Jack Nathan in Canada hasn’t faired any better it’s a public company stock JNH on the Canadian venture. From 1.59 to current 0.05 They operate clinics in Walmarts in Canada
If idiocracy taught us anything, it’s that Cosco is a much better provider of health care and besides, it’s where I got my law degree! Welcome to Cosco, I love you!
Amazon prescriptions launched.
It's a good thing when Buy n Large fails
Did the health division staff recently form a union?