Retail Clinics: The Smart Response

Retail clinics in shopping center are spreading across the US fueled by the demand for “cheap” and accessible health care. Most of them are staffed by nurse practitioners and offer treatments for minor aches and pains. Many doctors and medical organizations have expressed their concerns that such clinics may siphon of patients from their traditional medical practices thereby jeopardizing their bottom-line. Furthermore, the quality of care rendered at those clinics is being questioned, especially in the absence of licensed doctors on-site. All of the above points are justified and valid, but the fact remains that many under- or uninsured seeking an alternative to the existing system of long-waits at bursting ERs or in crowded doctor waiting rooms. We should consider adopting and changing our practices to meet their demands and needs thereby attracting those potential patients to our medical practices. Now, traditional medical providers are stepping up to the counter, driven by the threat of new competition, the opportunity to recruit new patients -- and real concerns about the quality of care. Some large regional health-care systems are starting their own clinics directly with retail partners, while other medical groups and doctors offices are signing contracts to supervise clinic staff, and striking up referral arrangements with retail clinics. If you can fight them, join them!

The New Force In Walk-In Clinics Hospitals and Doctors Seek
Slice of Burgeoning Business; Getting Referrals at ShopRite
WSJ July 26, 2006; Page D1
(See Corrections & Amplifications item below.)
With catchy slogans like "You're Sick! We're Quick!" retail health clinics are spreading fast in supermarkets, drugstores and big-box chains across the country, luring patients with walk-in treatment for minor ailments like strep throat -- at about half the cost of a typical doctor visit.
The phenomenon has been largely driven by small start-up chains, such as MinuteClinic, RediClinic and Take Care Health Systems, which run the outlets under agreement with retailers and have had few formal ties to the medical establishment.
Now, traditional medical providers are stepping up to the counter, driven by the threat of new competition, the opportunity to recruit new patients -- and real concerns about the quality of care. Some large regional health-care systems are starting their own clinics directly with retail partners, while other medical groups and doctors offices are signing contracts to supervise clinic staff, and striking up referral arrangements with retail clinics.
In southeastern New Jersey, for example, AtlantiCare, the region's largest health-care system with about 450 staff physicians and a network that includes two hospitals and a health plan, will open its first in-store HealthRite clinic next month in a Somers Point, N.J., ShopRite supermarket. It's the first of seven initially planned, and the company may also franchise to other health systems. Geisinger Health System, of Danville, Pa., with hospitals, physician practices and other health services, is opening its first CareWorks Convenient Healthcare clinic in the Weis Markets grocery chain next month, and will open as many as 75 sites throughout the region in the next five years. Memorial Baptist Health system in South Bend, Ind., is operating Medpoint express centers in local Wal-Mart Super Centers.
Staffed mainly by nurse practitioners who are licensed to treat a wide range of minor illnesses and prescribe medications, retail clinics have grown rapidly over the past five years as retailers, including CVS, Kroger, Wal-Mart Stores and Walgreen, have signed up with more than a half-dozen clinic operators. Earlier this month, CVS, with 6,100 retail outlets, agreed to acquire MinuteClinic, which currently operates 83 clinics in outlets including CVS, Bartell Drugs and QFC Foods in markets such as Baltimore; Nashville, Tenn.; and Washington, D.C., suburbs, and plans to add more than 1,000 by 2009.
By the end of the decade, the number of clinics could grow nearly tenfold to 10,000, says Peter Miller, chief executive officer of Take Care Health, which runs 16 clinics in Walgreens and Rite Aid drugstores in Portland, Ore., Kansas City, Mo., and St. Louis. Take Care plans to open 1,400 clinics by 2009. "We're offering health care on patients' terms instead of on the health-care system's terms," says Mr. Miller.
While some experts question whether the clinics can generate adequate profits for operators and retailers, by opening their own clinics or signing referral agreements, hospitals and physicians can capture a piece of the action at a time when competition for patients is a growing concern. In a new report, the California HealthCare Foundation predicts that retail clinics "could change the way many people receive routine, non-urgent medical care."
Last month, the American Medical Association and the American Academy of Family Physicians warned that retail clinics with no ties to health-care systems could lead to more fragmentation of patient care, inadequate follow-up for patients, and missed opportunities for preventive care. Both groups called on the clinic operators to ensure that clinics are supervised by doctors and to establish formal referral systems with local doctors and hospitals.
Relying on retail clinics for care does carry certain risks. The clinics typically don't have private exam rooms or physicians on site -- though state regulations require nurse practitioners to have some level of oversight by a sponsoring physician. Clinics generally don't have procedures for follow-up with repeat visits. And because they don't do comprehensive physical exams or the most sophisticated tests, doctors warn, the clinics may miss more-serious conditions.
Traditional health-care providers say that the new wave of clinics that they operate or support will have advantages over independent clinics. Larger medical facilities have more experience to provide training, and the relationships will allow greater continuity of care, including sharing of medical records. They say they will be able to quickly link patients with a doctor or hospital if need be, but their clinic charges and costs will be comparable with those of the independent clinics.
Patrick Nemechek, a Kansas City internist sought a referral arrangement with Take Care clinics near his office. "Part of the reason these clinics are doing so well is the failure of the health-care system to take care of the consumer's needs," says Dr. Nemechek. He often sends patients with "quick, simple" issues to Take Care clinics, while the clinic refers patients with more serious concerns such as a spike in blood pressure.
In St. Louis, SSM Health Care, with eight hospitals and nearly 2,000 staff physicians, recently agreed to help supervise Take Care clinics in the area and review medical records to ensure care is appropriate; Take Care will refer patients with more serious health-care issues to SSM doctors, where they can establish continuing relationships. "We see this as an opportunity to participate in an evolution of health care but also to help shape it in a way that serves patients first," says SSM regional president, Ron Levy.
When Take Care signed an agreement to open 20 Health Corner clinics in Chicago Walgreens stores this fall, it also struck a deal with Advocate Health Partners, Oak Brook, Ill., which includes more than 900 primary-care physicians and 1,800 specialists, for each to refer patients to the other. Advocate doctors will review clinic medical records and supervise nurse practitioners.
Memorial Hermann Healthcare System in Houston and Hillcrest Medical Center in Tulsa, Okla., are providing medical oversight for RediClinic, a unit of Houston-based InterFit Health, which has 75 clinics in retailers such as Duane Reade, H-E-B grocery stores, Wal-Mart and Walgreens, and plans to open 500 new units by 2009.
Some health systems see more advantages to entering the clinic market directly. "As a local health system we think it's important to provide new levels of access to health care for patients, and to compete in areas where private entrepreneurs are rushing in," says Don Parker, president of the AtlantiCare unit that is opening HealthRite clinics in ShopRite stores. While clinics may compete with AtlantiCare's own staff doctors, he says, clinics can treat minor ailments and allow doctors "to concentrate on more complex issues of care and patients with chronic conditions."
AtlantiCare clinics will offer tips for healthy grocery shopping, and AtlantiCare is talking to ShopRite about offering nutritional tours of the supermarket aisles and better labeling of foods for healthy diets.
Clinic operators say they have reached out to local physicians to supervise nurse practitioners, and sought to establish referral relationships with doctors, urgent-care centers and emergency rooms. James Woodburn, a physician who is MinuteClinic's chief medical officer, says he sends letters to physicians in each market the company enters to ask if they are accepting new patients, and if so adds them to a database for referrals.
Retail-clinic operators say that sometimes nurse practitioners do fail to recognize more-serious illness, but that nothing has given rise to any legal action (clinics generally carry some malpractice insurance). The bottom line, they say, is that retail clinics fill a need, take steps to ensure care is high-quality, and encourage patients to seek regular care from a doctor.
Uninsured patients pay cash, while insured patients are charged a co-pay that may be slightly more or less than what they have to pay at the doctor's office, depending on the clinic. Take Care clinics bill insurers 10% to 30% less than doctors do, Mr. Miller says.
Blue Cross & Blue Shield of Minnesota, which analyzed 22,956 visits by its members to MinuteClinics from June 2004 to June 2005, found the clinics cost about half an office visit -- or $43 versus $87 -- and less than half for other related costs such as lab services.
Chris Shandrow, a 29-year-old creative-arts director at a local church, sought care for a pesky sinus infection at a Walgreens clinic operated by Take Care, when he first moved to the Kansas City area with his wife and children without a primary-care doctor. He was in and out with a prescription within 10 minutes and was charged a $20 co-pay. "I know I'm going to need to get a regular doctor, but the convenience of being able to pop in there was really worth it," he says.
• Email me at informedpatient@wsj.com1.

Corrections & Amplifications:
Memorial Health System of South Bend, Ind., is operating Medpoint express health clinics in Indiana. This column incorrectly identified as Memorial Baptist Health.