Q&A: Taking the pulse with Mitch Rothschild of Vitals

Selecting a doctor can be a frustrating process filled with too many unknowns, especially in today’s evolving landscape. Looking to help patients take the guesswork out of finding the ideal doctor, Vitals has developed online tools at Vitals.com to give patients visibility into quality, cost and availability. With its finger on the pulse of the state of doctor-patient relationships, Drug Store News caught up with CEO Mitch Rothschild to talk about some of the consumer healthcare trends, the ongoing physician shortage and how Vitals can work with retail pharmacies.

DSN: As healthcare reform takes effect, what impact will this have in the midst of an ongoing physician shortage?

Mitch Rothschild: One of the other impacts of the Affordable Care Act that is not as well known, but clearly is happening, is that you have the development of Accountable Care Organizations, or ACOs. ACOs shift the risk to the provider or the system. … So, because you’ve got that shift now of the risk to the providers, they are saying, ‘Well as long as we’re taking the risk, we might as well also take the insurance risk.’ So, there are a large number of partnerships that are happening between hospital systems and the insurance companies. … What is happening with a lot of primary care doctors is they are shifting from a fee-for-service to where the hospital system or partner plan is saying [for example], ‘We are going to give you a patient population of 500 diabetics and your job is just to take care of them.’ … As a result, the doctors are able to handle a lower volume of patients. … So, there is a chronic and institutional shortage that is happening and is going to occur.

DSN: Can you elaborate on the impact on alternative care?

Rothschild: What has happened is you are having alternative care [sites] coming up. For example, Walgreens has, I think, 375 of these healthcare clinics, and CVS has the MinuteClinic. Those are now providing the lower level care that would normally have been provided by a doctor. … Ten years ago it was almost all administered by the doctor, and now that has been pretty much outsourced to nurse practitioners and the folks in the wellness clinics. You also have a large growth of urgent care centers where people are going in for a specific need, knowing they will pay a little bit more but will wait a little bit less and will be seen right away. … There’s also been a huge growth of telemedicine. … Similarly, the doctors themselves who are still in the old fee-for-service model are taking on more patients. We saw average wait times of when people are sitting in the waiting room go up 6% in 2013.

DSN: Tell us more about the findings of Vitals’ research on the nationwide physician shortage.

Rothschild: Generally speaking, the wait times go up in direct proportion to the number of doctors, by and large, there are per 1,000 patients in a city. The average in this country is a little [more than] three [doctors] per 1,000. Some places, like the Deep South, have lower percentages, so the wait times get hit harder. … If you look at the [cities] that have the best access, it tends to be more urban; if you look at the place where it’s the worst, you are [looking at the] Southwest. So, it is a function of population growth and historically where the doctor shortages have been.

DSN: How is Vitals helping consumers navigate the current climate?

Rothschild: We come at it from a consumer-centric point of view. The normal decision making that you use to buy anything else — whether it is a car or a television set — the three criteria you typically use are, for some crazy reason, not available in the doctor world. The three factors, when we’ve broken it down into how you decide to buy anything, are based on quality, cost and availability. … What we are trying to do with Vitals — and we’ve been pretty successful at it as we have 12 million people a month that come to the site — is give you visibility [or transparency] on all three: quality, cost and availability.

DSN: How can Vitals help retail pharmacies and clinics?

Rothschild: I would certainly encourage any drug store to work with us because we work with a lot of providers. We have 12 million people [who] want access. The more information we know about what’s open and when is the pharmacy open — getting that information to us we can publicize that. … With the clinics, that is something we want to integrate into the mix. We have a lot of pharmaceutical advertising on the site, which basically pays for the ability to [provide our service] free to consumers, and the reason we have that is because 82% of the people who come to our site see a doctor they found on Vitals within 30 days. So, they are going to get a prescription and get it filled. So, if you want them to go to your drug store we can geo-target that. If you are giving them an incentive to come to the store, we can geo target and drive those folks to drugstore A versus drug store B.