Retail Healthcare News

The first of the clinics, to be housed in the retailer’s supercenters, are expected to open in Little Rock and Atlanta in April. The four Little Rock clinics will be operated in partnership with St. Vincent Health System, a part of the Catholic Health Care Initiatives system.

The move is the Bentonville-based retailer’s latest effort to play a role in changing the nation’s health-care system, as well as create greater efficiency and bring down costs.

The company aims to have 400 of the clinics operating by 2010. It already contracts with RediClinic and other providers for walk-in clinics at several stores, but without a formal arrangement with local hospitals.

Alan Winkler, vice president of clinic operations for St. Vincent Health System, said the hospital system will operate the Little Rock clinics on its own, unlike in many markets where hospitals are partnering with RediClinic to open Wal-Mart clinics.

“Essentially we are leasing the space from Wal-Mart,” Winkler said. The system will be responsible for the profit and loss at the clinics.

The health system will provide nurse practitioners, frontdesk attendants and supervising doctors. Winkler said the doctors will work remotely — as well as in the stores for a few hours a week — to review care and give input and direction if a nurse practitioner needs help.

John Agwunobi, Wal-Mart’s president of health and wellness, said the clinics will post prices for treatment of certain medical conditions so patients will know their out-of-pocket cost upfront. The clinics also will file insurance claims.

“We’re not going the route of running our own clinics. We believe they are best when linked into a larger system,” he said.

Glen Mays, an associate professor at the University of Arkansas for Medical Sciences in Little Rock, said doctors likely are concerned about the competition from the clinics.

However, Mays also believes physician groups have potentially legitimate concerns about quality and continuity of care.

“Physician organizations are trying to promote this concept of a ‘medical home,’ where the primary-care physician can kind of manage all the care needs of the patient. With these retail health clinics, that has the potential to make health care more episodic and less coordinated,” he said.

On the plus side, he said, the clinics could enhance preventive care such as flu shots and screening services.

The American Medical Association criticized retail clinics last year, saying conflicts of interest are posed by ventures between retail clinics and pharmacy chains that use the clinics to raise traffic in stores, which can lead to more sales of prescription drugs and other products.

H. Lee Scott, Wal-Mart’s president and chief executive officer, outlined plans last month for the world’s largest retailer to help streamline the U. S. healthcare system. In a speech to about 7, 000 company managers in Kansas City, he said Wal-Mart would provide electronic health records to its U. S. employees and retirees by the end of 2010.

Those same kinds of records will be created for clinic patients and will be accessible from other Wal-Mart clinics if the patient seeks care somewhere besides the local Wal-Mart, Agwunobi said.

“What your company does best is exactly what the U. S. health-care system needs the most,” Scott told the Kansas City gathering. “It needs more affordability. It needs more accessibility. It needs to be more efficient. And it needs leaders with a genuine desire to work together for positive change.” He also said Wal-Mart will contract with other employers to help them manage prescription claims.

Based on data from clinics already operating in its stores, Wal-Mart says, 55 percent of walk-in patients are uninsured. The company says it intends to treat common conditions such as sore throats, sinus infections, earaches and bladder infections and provide preventive care such as cholesterol screening, blood sugar testing, vaccinations and routine physicals.

Wal-Mart also is a partner in the Better Health Care Together coalition, a group of large employers and unions that is pressing for health-care change nationwide. The coalition recently hosted its first regional meeting in Little Rock.

Retail clinics are a way for St. Vincent to provide new access points to primary care for patients, Winkler said. It will also expand the hospital’s brand recognition.

Wal-Mart’s effort isn’t the only clinic rollout with which St. Vincent has associated itself.

The hospital system is assisting clinics opened in the Little Rock area by MedBasics Family Health Centers of Irving, Texas, in USA Drug and USA Drug Express stores. USA Drug is based in Pine Bluff.

Separately, St. Vincent runs 13 of its own freestanding clinics throughout central Arkansas.

“We have extensive experience in owning and operating clinics,” Winkler said, but the MedBasics and Wal-Mart initiatives are its first forays into clinics in retail settings.

The retail clinics, staffed by nurse practitioners, will have a narrower scope than St. Vincent’s traditional clinics. Those freestanding clinics are mainly staffed by doctors, but also can have nurse practitioners on-site.

With the USA Drug clinics, St. Vincent is providing two supervising, or “collaborative” doctors to help MedBasic’s own nurse practitioners at each site, as well as a medical director for the clinic program. As in the Wal-Mart clinics, St. Vincent’s doctors will work remotely and on-site to review care and help nurse practitioners.

The first three of the clinics opened in USA Drug stores in late December and early January in Little Rock, North Little Rock and Bryant and have extended evening and weekend hours.

Arkansas doesn’t track how many retail clinics are in the state, a spokesman for the state Health Department said. Nationwide, there are more than 500 instore clinics, but in the next few years that is forecast to multiply into thousands, MedBasics said in a January news release. Doctors affiliated with St. Vincent have been supportive of the clinics, Winkler said, and some will be the supervising physicians. While it is possible that the clinics may ease some of the burden for emergency rooms by providing services for people who don’t need emergency care, that wasn’t the intent, Winkler said. “I don’t know that we’ll see a dramatic shift in that,” he said.

Source: Arkansas Democrat Gazette
Original Publication Date: February 8, 2008