Retail Healthcare News

She’s providing a new kind of convenience for customers who’ve grown used to popping in and out of big-box stores to grab everything from cereal to power tools to new shoes.

Collins is a nurse practitioner, and her little corner of the Towson Target is known as a convenient care clinic, designed to provide quick service for patients with relatively simple medical concerns.

The clinics are a growing phenomenon at retailers including CVS, Wal-Mart and Walgreen’s.

Proponents say the clinics give patients what they want — fast, affordable care when they need it — while keeping them out of overcrowded emergency rooms and relieving the pressure on overburdened doctors.

But physicians are worried about the loss of the “medical home” — a primary care doctor who sees patients regularly, maintains thorough records and tracks their care and medications.

“Some physicians have stronger feelings about this than others,” said Dr. Edward L. Langston, chair of the board of trustees of the American Medical Association.

Said Dr. Martin P. Wasserman, executive director of the Maryland doctor’s association, MedChi: “Somebody’s trying to make additional money. While it’s convenient for patients, it doesn’t provide ongoing continuity of care.”

The clinics are a response to a growing need for instant gratification among Americans, according to Dr. Jonathan Weiner, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health.

They also address the demands for more affordable health care options, from both insurers and patients.

“Consumerism and convenience and personal control are things we like in all areas of our life,” Weiner said.

“Most people feel none of those things when it comes to their health care,” he added.

The clinics are catching on. In 2006, there were 250 convenient care clinics in the U.S., according to the Convenient Care Association, a Philadelphia-based trade group.

The number has since almost tripled, reaching 940 clinics run by 20 companies in 30 states, according to the association.

The clinics have created a new niche in the health industry.

They’re a far cry from ordinary medical offices, or even urgent care centers with more comprehensive capabilities.

Most convenient care clinics are staffed by nurse practitioners, sometimes physician assistants. They’re often overseen by affiliated doctors — Greater Baltimore Medical Center physicians work with Target’s Maryland clinics — who review charts and consult when necessary, and take referrals and follow up with patients as well.

Maybe most critical, the clinics will only treat patients suffering from a relatively short list of conditions.

At Target, which began a pilot program for the clinics in Maryland last August, the list includes strep throat, ear infection, flu, minor burns, stitch removal, cold sores, flu shots and more.

They’re conditions considered common enough to keep the clinics busy, but not serious enough to require more comprehensive care, according to Dr. Sarah Whiteford, a family practice physician at GBMC who oversees Target’s Towson location.

The American Medical Association began developing policies regarding the clinics in 2006. One of its strongest recommendations is that the clinics stick to their brief symptom list.

“The key is to have a limited range of services, a very prescribed protocol of care,” the AMA’s Langston said.

Treating those conditions is appropriate for the nurse practitioner and doesn’t require extensive diagnostic work, emergency care or unusual medications.

“It’s inappropriate for patients to utilize the emergency department for something like a sore throat,” Whiteford said. “It’s more efficient for the patient, and you’re saving health care dollars.”

The clinics offer bargain prices to both consumers and insurers. In Baltimore, the Target clinics — which charge from $49 to $69 for various services — accept five insurance plans, and some plans will reimburse members for care if presented with a receipt, according to Target.

MinuteClinic, the Minneapolis-based chain, began by accepting cash payments from patients for its services, which range from $30 to $110.

Now, in Maryland, it accepts 25 different health plans.

A visit to a doctor’s office or emergency department, in contrast, can cost hundreds or even thousands of dollars.

But patients shouldn’t have to choose between seeing a doctor they trust or paying their rent, said Wasserman. The core problem, he said, lies within a health care system that has left 47 million Americans uninsured, according to the latest data from the U.S. Census Bureau.

“In our country, we pay too much to receive too little and protect too few,” Wasserman said.

CareFirst BlueCross BlueShield, which covers certain services at the clinics, including vaccinations for both flu and pneumonia, prioritizes the medical home for its members, said Dr. Daniel Winn, vice president and senior medical director in CareFirst’s medical and networks management division.

“While such clinics can offer convenient service and valuable care, they cannot take the place of a primary care physician,” Winn said in an e-mailed statement.

The value of having a regular doctor is somewhat intangible, Wasserman said.

“When a person is sick, the doctor knows the person in the context of their entire life experience,” he explained. “They can often, because he or she knows the patient, get a sense of whether this person is seriously ill or has a problem that’s going to resolve.”

Convenient care clinics, though, are designed to bring patients in one door and out the other as soon as possible, maybe never to be seen again by the same nurse practitioner.

Rizwan Altaf, a Bel Air resident, said he’s visited several of the clinics for various services — vaccinations, flu symptoms — and has brought his children, ages 12 and 9, as well.

None of his family members see a primary care physician, said Altaf, a manager at the Towson Target.

“It’s so convenient,” he said of the clinic. “I don’t have to wait in line.”

Like Altaf, 30 percent to 40 percent of convenient care patients do not have a primary care provider, according to the industry association.

Even for patients with a regular doctor, getting an appointment on short notice can be hard — physicians say they’re having to see ever more patients to keep up with the costs of staying in practice.

And most of the clinics are open late on weeknights and all day on weekends — the hours when doctor’s offices usually are closed.

It’s possible, said Weiner, consumers don’t care about continuity of care. Maybe they just want to be able to pick up cat food and a tetanus shot in the same trip.

“These clinics are really here to attract mom or dad to the Target or CVS or Wal-Mart so they can do their other shopping,” Weiner said.

“It should be seen for what it is,” he added. “It’s not really a desire to improve the overall health care quality of the patient, but to provide some perceived convenience.”

The Towson Target clinic — tucked in the back of the store, near the pharmacy — sees a lot of those incidental patients, said Collins.

“We get people just walking back here saying, ‘Oh, we didn’t know you were here,’” she said.

Doctors have noticed the desire for convenience, and some are making changes. They’re offering extended hours or making their e-mail addresses available to patients.

Some, like Whiteford, are getting directly involved with the clinics.

“Retail-based clinics are here and coming and we’ll not be able to stop it,” she said. “You’ve got to roll with it. Becoming involved at this level is the best thing I can do to have some control over the quality of care.”

As long as the clinic staff are properly credentialed and follow the treatment protocols set up for them by the oversight physician, the American Medical Association has made peace with the clinics.

“I’m a family physician,” said Langston, who practices in Indiana. “I don’t see there’s a threat as long as [the clinics] are administered and practiced according to that design.”

Wasserman, however, is not satisfied. He said the real issues lie within a health system where so many are uninsured and where doctors have to struggle to stay in business.

“We want to get together and fix the problems,” Wasserman said. “Fix them the right way. Don’t put Band-Aids on festering wounds.”

Source: The Daily Record
Original Publication Date: April 3, 2008