Yves here. Having lowest of low end retailers take a flier with mobile clinics is yet another proof of the poor state of health care in the US. I would be curious to learn how countries in Europe encourage/incentivize doctors to practice out in the boonies. One can envision remedies, like scholarships for doctors who agree to practice in designated areas for at least five years, but dreaming up solutions and getting them implemented are in two different universes.
Needless to say, giving the poverty of local alternatives, some of the users of this service are fans. But your humble blogger is not comfortable with a purely profit-motivated party so remote from the health care industry providing treatments.
By Sarah Jane Tribble, KFF News Chief Rural Health Correspondent, who previously covered health care for Cleveland’s NPR and PBS affiliate and spent more than a decade as a staff writer for newspapers across the country. Originally published at KFF Health News
On a hot July morning, customers at the Dollar General along a two-lane highway northwest of Nashville didn’t seem to notice signs of the chain store’s foray into mobile health care, particularly in rural America.
A woman lifted a child from the back of an SUV and walked into the store. A dog barked from a black pickup truck before its owner returned with cases of soda. Another woman checked her hair in a convertible’s rearview mirror before shopping.
Each went right by a sign exclaiming “Quick, Easy Health Visits,” with an image of a mobile clinic.
Just after 10 a.m., registered nurse Kimberly French arrived to work at the DocGo mobile clinic parked in the store’s lot. She checked her schedule.
“We don’t have any appointments so far today, but that could change,” French said. “Last night we didn’t have any appointments and three or four people showed up all at one time.”
Dollar General, the nation’s largest retailer by number of stores, with more than 19,000, partnered with New York-based mobile medical services company DocGo to test whether they could draw more customers and tackle persistent health inequities.
Deploying mobile clinics to fill care gaps in underserved areas isn’t a new idea. But pairing them with Dollar General’s ubiquitous small-town presence has been heralded by investment analysts and some rural health experts as a way to ease the health care drought in rural America.
Dollar General’s latest annual report notes that about 80% of the company’s stores are in towns with populations of fewer than 20,000 — precisely where medical professionals are scarce.
Catering to those who want urgent or primary care, the mobile clinics take private insurance as well as Medicaid and Medicare. The company’s website says DocGo’s self-pay rates start at $69 for patients without insurance or who are out of network. DocGo officials said Tennessee patients may be charged different rates but declined to provide details.
On the ground in Tennessee, primary care doctors and patients are skeptical.
“Honestly, they don’t really grasp, I don’t think, what they’re getting into,” said Brent Staton, a family medicine doctor and the leader of the Cumberland Center for Healthcare Innovation, a statewide organization that helps small-town family care doctors coordinate care and negotiate with insurers, including Medicare.
Michelle Green manages the popular Sweet Charlotte grill about 10 miles south of Dollar General’s most rural test site. Green, who was handing out hamburgers and hand-cut fries during a Saturday rush, said she hadn’t heard of the mobile clinic. She said with a shrug that Dollar General and health care clinics “don’t go together.”
“I wouldn’t want to go to a health care clinic in a parking lot; that’s just me,” Green said, adding that someone might go if “you’re sick and you can’t go anywhere else.”
Bumps in the Road
The Clarksville-area pilot, which launched last fall, is in a federally designated primary care shortage area for low-income residents.
About 1,000 patients have been seen in the company’s clinics, either at Dollar General sites or community pop-up events, and some became repeat visitors, according to DocGo. Payment is taken outside on a mobile device and, once inside, patients meet with an on-site staff member, like French, and connect via telehealth on an iPad screen with a physician assistant or nurse practitioner.
The clinic rotates between three Dollar General pilot sites each week. The stores are in the Clarksville area and, early this summer, the van stopped going to the most rural site, near Cumberland Furnace, because of low utilization, according to company leaders. DocGo moved that location’s time slot to busy Fort Campbell Boulevard in Clarksville.
“We do try for months in a given area to see where it makes sense and where it doesn’t,” former DocGo CEO Anthony Capone said in a July interview. “Our goal is to align the supply we have with the demand of the local community.”
Capone, though, said he thought the pilot would work in rural areas when insurers are signed on to refer their members to the mobile clinic. DocGo recently announced a deal with Blue Cross Blue Shield of Tennessee.
Capone abruptly resigned on Sept. 15 after the Albany Times Union reported he lied about having a graduate degree.
Dollar General stores have a “tremendous opportunity” to have “a major impact on health there and really bond themselves as a member of the community,” said Tom Campanella, the healthcare executive-in-residence at Baldwin Wallace University, who has managed mobile clinics in rural places.
Near tiny Cumberland Furnace, south of Clarksville, William “Bubba” Murphy stopped on his way into a Dollar General, paused to wave and holler hello to friends getting out of their cars, and shared that multiple family members — his sister-in-law, nephew, and niece’s boyfriend — used and liked “the little clinic on wheels.”
“We don’t have to go to town and fight all that traffic,” he said. “They come to us. That’s a wonderful thing. It helps a lot of people.”
Over on busy Fort Campbell Boulevard in Clarksville, Marina Woolever, a mother of three, said she might use the clinic if she didn’t have insurance. Natural health professional Nichole Clemmer glanced toward the clinic and called it a “ploy” to make more money.
Jefferies lead equity analyst Corey Tarlowe, who follows discount retailers, said the clinics will help “democratize” access to health care and simultaneously boost traffic to Dollar General stores.
With its rapid growth in recent years, Dollar General has faced accusations that its stores kill off local grocery stores and other businesses, reduce employment, and contribute to the creation of food deserts. More recently, the U.S. Labor Department said the chain “continues to discount safety” for employees as it has piled up more than $21 million in federal fines.
Crystal Luce, senior director of public relations for Dollar General, said the company believes each new store provides “positive economic benefits,” including new jobs, low-cost products, and its literacy foundation. On the federal fines, Luce said Dollar General is “committed to providing a safe work environment for its associates and shopping experience for its customers.” The company declined to provide an interview.
The DocGo pilot, she wrote, is intended to “complement” the DG Wellbeing initiative, which is a corporatewide push. Dollar General wants to increase “access to basic health care products and, ultimately, services over time, particularly in rural America,” Luce wrote.
States away, DocGo is under fire for a no-bid contract to provide housing, busing, and other services for asylum-seekers in New York. State Attorney General Letitia James is investigating complaints levied by migrants under the company’s care. In August, DocGo officials said claims aired by sources in a New York Times article that first reported the problems were “not reflective of the overall scope and quality” of the services the company has provided.
The company’s pilot with Dollar General is “supported with funding from the state of Tennessee,” DocGo’s Capone said during the company’s first-quarter earnings call. The Dollar General partnership is cited in quarterly grant reportsDocGo’s Rapid Reliable Testing LLC submitted to the state, according to records KFF Health News obtained through public information requests.
In the grant filing, DocGo listed Dollar General along with other organizations as “trusted messengers” in building vaccine awareness.
Dollar General declined to respond to a question about its involvement in the grant. Instead, Luce stated, “We continue to test and learn through the DocGo pilot.”
‘Relational Care’
The goal of the $2.4 million grant, funded by the Centers for Disease Control and Prevention and distributed by the Tennessee Department of Health, is to administer covid-19 vaccines. In a written response provided by DocGo’s marketing director, Amanda Shell Jennings, the company said, “Dollar General has no involvement with the TN Department of Health grant funding or allocations.”
The grant covers storage and maintenance of covid-19 vaccines on the DocGo mobile clinics, Jennings’ statement said, adding that, as of September, DocGo has held 41 vaccine events and provided 66 vaccines to rural Tennesseans.
Lulu West, 72, was visiting a friend at the Historic Cumberland Furnace Iron Museum when she stopped to consider the mobile clinic. West said she would rather go to her primary care doctor.
“When you say mobile clinic outside a Dollar General it just kind of has a connotation that you may not be comfortable with. You know what I mean?” she said.
That kind of response doesn’t surprise Carlo Pike, a doctor who for years has practiced family medicine in Clarksville. He said he’s not worried about the competition because providing primary care is about developing relationships.
“If I can do this relationship right,” Pike said, “maybe we can keep you from getting a [blood] sugar of 500 [mg/dL] or from Grandpa climbing up a ladder and trying to fix something he has no business with and falling off and breaking his leg.”
Staton said the Cumberland Center for Healthcare Innovation, his accountable care organization, has saved Medicare and Medicare Advantage companies more than $100 million by focusing on preventive care and reducing hospitalizations and emergency visits for patients.
“We’re just small rural primary care docs doing our jobs with a process that works,” Staton said. In another interview, Staton called it “relational care.”
DocGo surveyed its patients and found that 19% of them did not have a primary care physician or hadn’t seen theirs in more than a year. In the written responses Jennings provided, DocGo said it follows up with every patient after the initial visit, offers telemedicine support between visits, and provides ongoing preventive care on a regular schedule.
But despite its outreach, DocGo struggled to get a foothold in rural Cumberland Furnace.
Lottie Stokes, the president of the community center in Cumberland Furnace, said DocGo’s team had “called and asked to come down here.” Stokes said she would rather use the local emergency medical technicians and firefighters, who she knows are “legit.”
Her father-in-law, Bobby Stokes, who’s nearly 80 years old, said he used the mobile clinic before it moved locations.
His wife couldn’t breathe. They pulled into the parking lot and climbed onto the van.
“We wasn’t in there five minutes,” he said. “They done the blood pressure test and what they need to do and put her in the car and said, ‘Get her to the hospital, to the emergency room.’”
The DocGo staff, he said, did not ask for payment: “Nothing.”
“They were more concerned with her than they were with I guess getting their money,” he said, adding that his wife is doing well now. “They told me to get there, and I took them at their word. My car runs fast.”
KFF Health News correspondent Brett Kelman contributed to this report.
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back in the late 70. or early 80’s a friend had his medical school paid for by the Public health service for which he spent several years as doctor on an “indian” reservation in Maine after which he continued to doctor in Maine. The suggestion in the first paragraph has been done.
But that was in the era of the Great Society, before the Reagan rollback. This is a different era, and among other things, college and med school are vastly more expensive than then. To again invoke a saying from Maine, “You can’t get there from here.”
My daughter just graduated medical school and there apparently is a program – I think she said by the Biden administration where if you practice in an under served area for 10 years (?) all loans are forgiven. Of course, there is no guarantee that the program won’t be canceled along the way, leaving you with massive debt. She is a family doctor, interested in working in a rural area where she is doing her residency but said that she was advised to only do clinical work part time because the stress / burnout rate is very high leading to doctors and nurses leaving.
My son, who finished his family practice residency a couple of years ago and is now practicing in rural Wisconsin, is in a loan repayment program with the local rural hospital where they pay off his medical school loans if he stays for 5 years. This seems to be a pretty good deal and he really likes his job.
Hmmm? I wonder if that was what she was talking about or something like that. I’ll have to ask her. My concern with government programs is that since every time a new administration comes in they seem intent on undoing whatever the previous administration did, she might end up signing up for something that is later canceled. I’m hoping she finds a private practice somewhere where she gets a chance to really know her patients and has a not just reasonable but good quality of life.
This is still a thing, in many cases the communities themselves will sponsor a medical student who will then work in the area for a prescribed period. I have a friend who did this in South Dakota.
Americans fail to understand they live in a collapsing Empire run by a synarchy.
There was an echo of his idea in the TV show “Northern Exposure” where-
‘In the show Rob Morrow played New York City native Joel Fleischman, a recently graduated physician who is sent to practice in Anchorage, Alaska, for several years to repay the state of Alaska for underwriting his medical education. Much to his chagrin, he is assigned to the much smaller and remote town of Cicely, which is in need of a general practitioner.’
https://en.wikipedia.org/wiki/Northern_Exposure
I bet that a lot of doctors would take up that offer in exchange for wiping their debt clean.
You beat me to it. I loved that show by David Chase who later did The Sopranos. He himself said it was a trying experience managing all the actor egos.
Meanwhile my town suddenly had a rash of urgent care clinics a few years back and now almost all of them are gone., Significantly the only one left is run by the local hospital monopoly which bought up the competing hospital.
Which is to say there’s a lot of money involved in any gesture toward medical care and the medical industrial complex is likely to keep things going their way. Certainly cheesy Dollar General seems unlikely to take them on. Walmart might (and has talked about it).
> Northern Exposure
“It’s not the thing you fling, it’s the fling itself.”
So the state gave $2.4m to a company whose business model is an RN in a taco truck. The equity analyst quoted says this will boost traffic to Dollar General; the former CEO indicated that insurers would refer patients to these mobile clinics. This reeks of a callousness which in health-care seems usually to be distracted from by the delusion that a public good is being performed. Just the name “DocGo” gives me the heeby-jeebies. Refreshingly thorough reporting, though.
Let’s hope Dollar Gen doesn’t have mission creep and begin offering birthing services. Maybe a woman would be offered water birth option in a wading pool in the parking lot! Hell, they could even set up another pool to christen the babies of God botherers
If Dollar General hired midwives I would expect one helluva lot of pregnant woment to start going to Dollar General parking lots.
Also understand that the real service being offered is the ability to offer legit medical prescriptions for antibiotics and other drugs. The burden of traveling for healthcare is much greater than most urbanites realize, especially for those without cars which is a Venn diagram that overlaps heavily with the elderly and impaired.
I hate Dollar General’s business plan, but this is a good use of their parking lots.
Doctors used to do house calls. That would serve the very elderly population best it seems. My impression is that doctors are the same in that the majority want to interact with and serve patients. What has changed is the model under which they are forced to practice. It’s made more and more impersonal and filled with rules meant to minimize patient interaction and maximize profits.
As for the parking lots – I see what you’re saying on a practical level but it just seems icky. Would the wealthy want a trailer in a parking lot for their medical care? It just seems dirty, noisy and lacking in privacy and dignity.
You asked about Europe, Yves. I hear from Hungary that there is a shortage of doctors throughout the country, including in Budapest. It reflects what I understood was a problem in several sectors in the peripheral EU countries. The best candidates, typically younger and more mobile, seek work in core EU countries. To other interests its a feature, not a bug.
A rhetorical question, but if you’re in the desert looking for water, does the bottled water need to necessarily a Fiji or Evian? I am thinking out loud here, in a cynical fashion, just suppose that there are literally zero options in remote or rural America, for people without the proper means or methods to “healthcare access” in this country where politicians tout the best healthcare systems in the world. It may well be getting simple screens here, say for diabetes or high blood pressure, could be a net positive.
I probably would avoid visiting such a clinic myself, Dollar General started to drop the ball in the past 12 or so months ( just my two cents ). Shelves are stocked or bone dry, no real in between. Staffing has or had always been a bit on the light side in the small retail stores nearby. Added thought, can it be much worse than Amazon spreading their tentacles into the healthcare economy?
I strongly suggest that we invest that federal/state money in a sustainable, effective healthcare model instead of a (family blog) capitalist, greed at all costs model that they’ll happily bar you from if you can’t pay and will quickly crapify if you can. Yeah, I know, a pipe dream, but funneling more money to another monopolist isn’t going to solve this problem.
One would think that the easiest place for Dollar General to look and gauge their success is the pharmacy chains like Rite Aid, CVS, and Walgreens, who sorta ventured into the market years ago. We got our flu shots before leaving at the counter at CVS, where the possibility of a flu shot was offered with every purchase, ‘free’ to those with insurance and pretty cheap to those who didn’t.
Such services are performed by the staff for the pharmacy, which is chronically understaffed. I had to stand around and wait twenty minutes for that shot. Whereas the stores that operate out in these little PNW towns (in addition to Dollar General) are all employee owned, fully staffed, well-stocked, and the service is exemplary.* The employee/owners probably live local too. A better choice for primary healthcare outreach.
*More skin in the game, they want customers leaving the store satisfied, especially tourists. They also sold me ‘8 pieces of dark’ that was best fried chicken I’ve had in months anywhere. T’wasn’t healthy but crispy and delicious.
I go to most of the cheapskate stores–Walmart, Aldi, Lidl–but Dollar General never. They are the rural retail equivalent of Kudzu.
Whereas the other three, even Walmart, are a classier act. I’ve been going to Aldi for years now and we were unusual in the South for having one. The small store size is super convenient.
The heavy German industrial presence around here probably accounts for our pioneer German grocery status.
In the rather rural area of upstate NY I’m often in, a hospital can be a half hour ride, in good weather. In bad, forget it. The Dollar General may be a few miles away. An RN in a taco truck may be the thing that at least gets somebody’s symptoms looked at, and helps get them into the medical system. But it’s not going to go far if they can’t afford the care they need.
I wonder why DocGo, though. As the article notes, they’ve been in trouble in NYC, so there must be some money sloshing around in the background waiting to fall into somebody’s pockets.
More on the DocGo problems in NYC:
https://comptroller.nyc.gov/newsroom/nyc-comptroller-lander-declines-to-approve-432-million-docgo-contract-for-work-on-asylum-seeker-emergency/
“…purely profit-motivated party so remote from the health care industry…”
That made me laugh out loud. Today, the entire Medical Arts system is “for profit.” Those entities that are not formally “for profit,” must raise prices, hourly rates etc. just to keep up with the malefic influences of the true, up front “for profit” organizations.
The CEO, and yes, he is referred to as that in the Hospital halls, of our local big Medical Provider pulls down a salary in the six figures. This for a smaller regional outfit.
DocGo at Dollar General is the best capitalism can do to address health care in the rural USA.
Meanwhile, capitalism spawns bloated, over-built, medical-care factories at constantly inflating prices for urban-dwellers.
And then they can helicopter the rural people in who can’t get care where they live – kaching! Those rides are not cheap.
I see the helicopters come into Portland every so often and I always thought it was for the rare, drastic emergency. But I recently met the person responsible for the fundraising for the helicopter service in Maine and she told me they make a few trips per day on average. Maine Med hospital is a sprawling development eating up an ever larger portion of the city even though the population isn’t really rising that much, and the rural hospitals continue to be hollowed out.
Yeah and the USA already with the lowest hospital beds per capita rate.
https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022
After years of having doctors and others looking down their noses at me because I’m not a devout follower of allopathic medicine, an RN taco truck in a dollar store parking lot would be very appealing.
After how I’ve badly been treated by conventional medicine, I am NOT seeking any long-term relationship with it.
This strikes me as a Late Stage Capitalism version of the Chinese “Barefoot Doctors” programs.
See: https://en.wikipedia.org/wiki/Barefoot_doctor#:~:text=Barefoot%20doctors%20(Chinese%3A%20%E8%B5%A4%E8%84%9A%E5%8C%BB%E7%94%9F,in%20rural%20villages%20in%20China.
As long as medical care is not treated as a “Public Policy,” this sort of economic triage will bedevil us.
My Inner Cynic whispers in my ear; “They really are trying to kill you!”
What’s the rule # 2 maxim? Go forth and perish. I’m just breaching a half century upon earth, and still retain a sliver of hope to see a decent retirement if only a short while.
Hope, delusion, just not visions of grandeur and luxury cruising. Unless that is “cruising down the motorway, got my girl by my side…” Rockin Into the Night by 38 Special.
LOL. I just paid my Hospital bill before coming here, and thought this might interest anybody who might still believe the “US has the best health care in the world”.
I have medicare advantage insurance and live in a small metro area. Here are the details from my lab work last July.
$512.00 Lab bloodwork ..
-$462.62 adjustments (the insurance company discount)
-$29.38 payments (what the insurance company paid)
———–
$20.00 balance (what I have to pay).
I pity anyone who might have to pay full price ($512.00) for this simple lab test.
The joke about the costs of blood work is that “they make it up in volume.”
Yeah, USA #1: the US has the most expensive “health care” in the world, while producing the worst health outcomes in the OECD and even worse than many developing countries. We have a steadily declining average life expectancy as well.
In the ever more corrupt and declining empire, you don’t get what you pay for, you get extorted. But we are not to take it personal: it’s strictly business.
And the abruptly resigned CEO of DocGo was named… A. Capone.
I recall a Congressional hearing about 8-10 years ago where some primary care docs in the USA testified that they wanted to go into underserved areas of America, to work part-time out of mobile and/or pop-up clinics to fill the gap. They said they were hindered by high hurdles, having to get new licenses and other permissions from state to state and sometimes even locally. They testified that it was easier to volunteer for work as a doctor in a foreign nation than in the USA.
Therefore, it may not have been easy to legally get that rather humble mobile van into the Dollar General parking lot. Further, the appropriations for federally qualified health centers which work in the underserved areas are always subject to Congressional appropriations and disposition — which isn’t very promising at the present.
Pop-up services can be tricky. A mobile clinic has to find the right location for the population it aims to serve and then be there consistently so that people know about it, believe it has good intentions, and is for them to use (not someone else). Sometimes these things are under-advertised or moved all over the place so people don’t know where to find them or what to expect.
The part that kind of gives me chills is contracting with private companies for a public service. Some contracts are poorly executed and evade monitoring.
They should have nailed Mr Capone for income tax evasion, not credentials fraud.