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Walmart Humana Merger


While nurses like us and other clinicians have been worrying about patient care, documentation and the new CoPs, Walmart and Humana have been getting cozy in the back room working out the details of yet another mega-deal.

The idea has an upside. A full 90 percent of Americans live within 15 minutes of a Walmart. That could go a long way to eliminating any access to care problems. Walmart’s drug prices are often less than competitors’ and could possibly be lower if they were the preferred pharmacy for Humana. Folks could see a physician or nurse practitioner, ask that their scripts be electronically sent to the pharmacy to be filled and go shop for everything from an oil filter for their car to Roma tomatoes while they wait- how convenient.

This sounds so good that maybe the good people involved in this potential deal are blind to the downside. Or, maybe they have never been to a Walmart.

Why do you go to Walmart? I go because stuff costs less. I do not expect sales associates to ask if I need help or because they play catchy background music. I dont expect anyone to help me pair cheese and fruit although to be honest, Kraft singles go with just about anything. I go to Walmart because stuff is cheap and in return, I lower my quality expectations. Have you ever compared a Walmart T-shirt to one from The Gap? Gap T-shirt’s make me happy. I would have to be sedated if I found a better T-shirt.

Walmart employees tend to be good people but the retail giant’s recruiting strategy is putting a computer in a conspicuous spot in the store to interview prospective employees. There is rarely just one person answering the questions so they must be hard.  To be fair, Walmart offers mostly entry level positions – starter jobs. I have never worked for Google or Microsoft but I don’t think this is how they filter through countless applicants.

I have to ask myself if this is the approach they will take to hiring the health care professionals that staff the Walmart and Humana clinics. ‘Our Mediocre doctors and nurses are the backbone of our clinic’, their tagline might read. ‘We’ve lowered our standards so you can pay less’. Do you want a mediocre practitioner in a starter job taking care of your child or grandmother?

And if someone has the flu, a standard script (computer generated from Humana’s algorithm) is probably all that’s needed for a patient who will spend the next 45 minutes infecting everyone else in the store. Watch as Walmart clinics go viral. Literally.

When flu season comes to a halt, things get trickier. As a recovering Walmart shopper, I am confident when I say that pretty much every one in the store is a potential patient. Unlike Whole Foods where you may run into your Yoga friends wearing yoga pants, the Walmart shoppers squeezed into a Spandex Lycra blend are not practiced in the art of Ashtanga.

And Walmart goes out of their way to perpetuate an endless supply of patients. Ramen noodles sell for a dime a piece but it is cost prohibitive for low income families of four to eat a meal including boneless, skinless chicken breasts. Red beans and rice, a perfect protein thats easily affordable always has directions to add sausage which enhances the flavor as much as it plumps up those thighs. The cheap high fructose corn syrup disguised as fruit juice costs only a fraction of the price of the real stuff. In the South where Roman Catholic values prevail, grocery bills rise each time a sibling is added and these low prices are appealing even if they kill folks eventually.

What happens if one of the Walmart shoppers/victims with a history of eating on the Walmart plan

falls out in the store? Can you see the utter chaos as the mediocre care practitioners try to read their CPR pocket card and perform chest compressions simultaneously? How many potential patients will remain loyal to Humana after they see a patient die because, after 22 attempts, there were no more IV catheters left in the crash cart and emergency drugs could not be administered.

If this deal goes through, it will be a failure for everyone involved. Humana may save money on drugs but by the end of a year, Blue Cross will emerge as the premiere insurance carrier by default. Physicians and Nurse Practitioners with restricted licenses rendering mediocre care may be an effective cost savings approach but without being surrounded by competent colleagues who can teach them or at least watch their backs, million dollar payouts will become the norm.  After all, there will be a lot of witnesses.

Walmart needs to spend their cash on improving the experience of their employees and Humana might think about increasing the speed of paying claims. And I need to be able to sleep without worrying about receiving Walmart branded healthcare.

But the most important reason to speak out against this deal is because it is nothing more than business – a way to make money.  They could have respected us enough to at least pretend they were aiming to meet needs of the people who made them successful in the first place.

Your thoughts?

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Veteran’s Day


When I looked up Veteran’s Day on the internet earlier in the week, the first links that appeared were related to office closures such as banks and public offices.  There was nothing about actual men and women who served in the Military.  But, there is a lot going on with the Veteran’s Health Administration and I learned some shocking facts about Veterans when researching this post.  First, approximately 8 percent of our prisoners are veterans.  The good news is that the number is falling and while there are probably a few veterans who simply committed crimes unrelated to their service to our country, many of them have PTSD.

Prison is the extreme but there are many more veterans who are suffering from PTSD.  I never thought of it as a condition that affected the elderly but Dementia and PTSD have a relationship.  Additionally, the traditional treatment of long term use of benzodiazepines to manage anxiety with PTSD is now suspected of contributing to Alzheimer’s Disease and other Dementias.  Medication recommendations have changed and are successful, but Dementia and PTSD are still closely correlated.  These are our patients – Medicare beneficiaries who fought in wars that ended long ago continuing to suffer from PTSD and losing the cognitive ability to cope.

Although younger men and women in the military are taught how to recognize PTSD and get help when needed, the older generation lived in an age when they were supposed to ‘suck it up’.  They viewed mental illness as weakness.  They had a preconceived notion that men were supposed to be ‘strong’ and boys didn’t cry.  Some of them have lived miserable lives.  But as they are approaching the end of their lives, you can help them by learning to assess for PTSD and assist your patient in getting the help they need.

The Veterans Health Administration has a seemingly unlimited amount of information available for Veterans and Healthcare Providers.  There are continuing education courses online at no cost for nurses that grant credit.  There are teaching guides that can be downloaded that will help you teach your patients about PTSD. They are yours by clicking the blue box.National Center for PTSD homepage

When I worked in critical I took care of a patient shot six times by her retired husband.   According to her family, they were the perfect couple but a flashback to a combat zone ultimately caused the death of my patient.  A few years later, in the cath lab, a patient with Alzheimer’s Dementia became very angry when a physician of Asian decent walked into his room prompting the patient to scream something about killing those Japs.  The physician was a kind man and didn’t take offense but imagine how very frightened my patient was thinking that the ‘enemy’ had found him.

Jails are now designating areas for Veterans.  The Hospice Benefit has a program to recognize veterans.  Home Health nurses won’t wait for a program to formally assist Veterans. Let’s get started by learning about PTSD and getting our Veterans Treatment.

They were willing to die for us.  We can lighten the pain of their ongoing suffering.

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