Store-Based Health Care Is Booming

Retail Health Clinics Expand, But Concerns Rise Over Quality, Conflicts

(AP)  In June, the American Medical Association urged state and federal agencies to look into whether pharmacy chain-owned clinics urge patients to get their prescriptions filled on site. That followed buyouts of miniclinics by two big-name pharmacy operators: Walgreen bought Conshohocken, Pa.-based Take Care Health Systems in June, and CVS acquired Minneapolis-based MinuteClinic last year.

Dr. Peter Carmel, a trustee on the AMA board, said "the path of abuse is wide open," and the clinics need to be better regulated.

A growing number of states have passed legislation to better define the role of the nurse practitioner at these clinics, but store-based clinic executives say some of the state rules are too burdensome and hinder growth. According to the American College of Nurse Practitioners, approximately 23 states allow nurse practitioners to treat patients on their own. The remainder requires some formal relationship with a physician, which varies from supervision to collaboration. In Texas, for example, the physician is required to be at the site for 20 percent of the time a clinic is open.

Store-based health clinics are held to the same high standards as doctors' offices, said Tine Hansen-Turten, executive director of the Convenient Care Association. She pointed out that store clinics are either monitored by a state board of nursing or board of medicine, and sometimes by both.

AMA also wants to ban the practice of health insurance companies waiving or lowering co-payments for clinic patients, which it calls a conflict of interest.

Dr. David Plocher, the senior medical officer at Blue Cross Blue Shield of Minnesota, said that "the normal market forces should determine such things." His company has reduced or waived co-payments for 25 member companies who use MinuteClinics and several other store-based clinics.

The savings can be significant.

A visit to a store-based clinic averages about $60, but a doctor's visit costs twice as much, particularly in urban markets, according to Barry Barnett, a health care consultant for PricewaterhouseCoopers. That compares to about $300 for an emergency room visit, according to Barnett.

About 40 percent to 50 percent of clinics take insurance. Hansen-Turten estimated 50 percent of clinic customers pay cash, but she noted that the majority have insurance.

Like many of his industry peers, Michael Howe, president and CEO of MinuteClinic, said the concerns about quality are overblown.

"I wouldn't call it express care. I would call it efficient care," added Howe.

The AMA denies that its criticism of these clinics is being driven by economic interests, though there's no doubt that primary physicians could lose some business as their insured patients go elsewhere for minor ailments.

But health care consultants say that while the clinics may help save customers money and time, their ability to reduce overall health care costs will probably be limited given that they are really tackling the most minor of health problems.

A bigger effect lies in increased worker availability as employees don't have to take as much time out of their work schedules to go to a doctor's office, according to Dr. Tim Newman, senior medical consultant for Watson Wyatt Worldwide.

The growing number of onsite clinics at workplaces, staffed by physicians, actually have more of a potential to reduce overall health care costs since they focus on disease management, not episodic illnesses. The onsite clinics are not part of the Convenient Care Association's total count, since they are not store-based clinics and have a different model.

Store clinics are proving to be good business; they take about 12 to 18 months to break even. For retailers, the highest-margin products continue to be pharmaceutical, and clinics average about one drug prescription per patient, according to clinic providers. Also, stores can enjoy additional sales when sick customers pick up other items.

But it's still big challenge to gain trust among consumers wary about being treated at a local drug store. Dr. Susan Bowers-Johnson, the medical director for the current four clinic locations at Duane Reade, said that a father recently brought in his 4-year-old child who had a sore on his hand. He said if she was going to prescribe antibiotics, he would rather get them through his family physician.

"Many people are skeptical," she acknowledged.

[puzzler125]

I was seen by a Nurse Practitioner and she was more thorough than any doctor I've been to in the last years since HMOs started! Inspections must be on the same level as other healthcare facilities but did you know Dr's offices can be shamefully underinvestigated? My surgeon (post-gallbladder surgery) had a solution in his office that was not changed for five weeks as indicated on a wall check sheet (labelled "weekly"). When I pointed it out at my first visit I made a mental note to check it at my next visit. The previous six weeks were now all falsely signed and dated!

[tmkgls]

Part 2:

My opinion is that the regular clinics, which are extensions of hospitals, are in an uproar because they will lose money since these store clinics are not associated with them. (I hope it stays that way - hospitals/clinics appear to have mini-monopolies as it is.)

The regulation by the government should be as strict as any clinic/hospital. They should be investigated as thoroughly as any clinic/hospital to check that doctors, nurses, and practitioners, etc. have legal credentials and clean work histories. Their premises should also be inspected for cleanliness. In addition, these clinics should be watched so they do not pressure the patients to purchase any prescription or non-prescription items they are prescribed at the store their clinic is in. If all this is done correctly then these clinics may help us in many ways.

[tmkgls]

Part 1:

If a healthy person wants to pay - let them. If they didn't have these clinics they would be going to a regular clinic anyway and taking up precious time for the seriously ill. It's their money - let them spend it where they want.

If illegals - not all but just the ones who expect a free ride - go to one of these they have to pay right away. They'll stick with an emergency room where they're only billed - that way they don't have to pay. The same goes for many people besides illegals - let's please not stereotype.

A way to help eliminate any contagions is by having a separate outside entrance. The level of contagion is most likely just as high in regular clinics as these store clinics. Many regular clinics house various areas of medicine from broken bones to dermatology problems to strep infections, etc. - even TB before they are diagnosed. Many ill people go to regular clinics all the time thereby many different infectious illnesses are in the air and germs are on furniture, doorknobs, etc.

[sjc_1]

If it is anything like the fee clinics that we have in strip malls, they will charge you $100 and tell you to go see a doctor. It is not a doctor that sees you but a doctor's assistant, usually a nurse or a doctor from a foreign country that is mot licensed to practice medicine here. If they can put a bandaid on it and give you an asprin then that is about it. More like an overprice first aid station.

[my2centss]

The illegals normally go to the emergency rooms, and do not pay. That is why so many emergency rooms are closing, or facing finacial trouble.

[sparks224]

Oh great, another disgusting scam.

[drivelphobe]

This clinic approach sounds interesting, but the chance of exposure to something dangerous and contagious is high. I agree with another poster that illegals will be the main customer base.

Healthcare costs could be substantially reduced if physicians would treat the sick and get out of the business of misleading healthy individuals to come in for preventative care. Health insurers should not pay anything for treatment of healthy individuals. When you're sick or injured, go to the doctor or hospital. If not, stay away. The greedy medical community wants more income so they have dreamed up the scam of all scams, to treat healthy people and get paid for it. This has got to stop. How many times have you known someone who goes in for a scan, gets great results, and dies within a year from cancer. The tests are no more than a revenue drivers for these greedy medical practitioners and hospital administrators.

[olebd]

I'd worry about catching something from somebody who is seeing a medical professional in a place where I go shopping for basic needs. What if the person who comes in thinking they have a common cold has something more serious like TB? The chance of spreading it to others seems greater.

Seems a bit unfair to those of us who would rather see our family doctor in a normal medical setting.

In my opinion, these places are probably intentionally set up for illegals. If not, they will more than likely be used by them more than anyone else.

[ramos937]

This is a business long overdue. My son and I can go to our local HEB store that has a medical clinic inside as an independent business. While my son does the grocery shopping, I can be seen by a registered nurse. She listens to me, makes sure I tell her of medicinces(?) I am currently taken, makes an evaluation of my condition. If I just something like a cold, she gives me a shot of pennicillen(?), I pay the bill and am out the door. They even take health insurance.

If see suspects that I am suffering from something serious, she checks with my doctor and follows his advice.

If there is a long line, I take a number and join my son, when the clinic is ready for me, I am paged over the store system.

My major savings is time. Last time I went to the doctor, I had an appt for 9 AM. He did not get to the office until 10 AM and saw me around 11 AM.
All I had was the flu. This was before I started going to the store clinic. Another savings is cost, the flu shot cost $60 (paid by insurance), the doctor's visit cost somewhere around $100 (paid by insurance).

Let's keep and improve the store clinic program. It saves time and money yet delivers great medical care.

[nskduke]

Clinics at Wal-Mart. Lets think about this for a second. Bad idea! Hell knows where the medication comes from. Its bad enough that Wal-Mart is know China made, but to have clinics.

Wal-Mart=China, get the picture!! Sure their medication maybe cheap, but is it safe and effective. And what about the so called doctors they hire, will they be highly educated enough to tell you what the hell is really wrong with you when you go for a check up.

Be smart, lrts think before we act. What you are seeing maybe too good to be true.

[my2centss]

Why not go shopping while your family is seeing the Dr? You are going to be there all day anyway. As to the AMA saying medical care needs to be more comprehensive, sitting at the doctor's office 3 hours to be seen for 2 minutes, and told to try this presciption, is not comprehensive.

[itgranny]

I just read an article from another site stating the US now ranks 43 in longevity while remaining 1st in cost. Most of these other countries have got universal health care but the US doesn't seem to get it (in other words, corporate america/politians won't let go of their cash cow).

I don't have a problem with this sort of care. For some, it is the difference between an affordable office visit and an emergency room visit. For others it will mean the difference between being seen when problems are small or when the problem gets so big it requires hospitalization.