In 2008, retail clinics have seemed to shut their doors in states like New York, Nevada and Indiana. Overall, 69 clinics in 15 states have given up the ghost, including those located inside Wal-Mart stores.

What’s going on here? Is the strategy backfiring? Even one of the largest proponents of in-store retailer clinics, CVS Caremark Corp., indicated that it is slowing down its retail in-store clinic plans.

The reasoning here is plain and simple: the break-even does not come nearly as fast as most retailer in-store clinic operators would like. It takes a minimum critical mass of patients to get a profit in the bank, and even though Wal-Mart generates more retail traffic than any other company, its shoppers are just not visiting those clinics at a pace to make business plans work.

So it’s impatience at work, not unlike quarterly numbers-obsessed Wall Street in a way. But Wal-Mart isn’t giving up: it still plans on 400 co-branded in-store clinics by 2010 with marketing names of major hospitals for each location. It’s built-in marketing for the market, saving Wal-Mart from having to create awareness or spend advertising dollars.

Source: BloggingStocks
Original Publication Date: May 14, 2008

It was late in the afternoon, and she was flying to Canada the next day.

in Smyrna, near Laney’s home, so she drove there. “I was in and out very quickly,” said Laney, who was tested for strep throat by a nurse practitioner. “I was very impressed.” And she was on the plane the next day.

The MinuteClinic site that Laney visited is one of more than 50 such medical facilities within retail stores in the Atlanta area. The walk-in clinics — open through the early evening and on weekends, when doctors offices typically aren’t — provide care for minor illnesses and offer vaccinations, physicals and other testing.

The Atlanta area is the leading market for in-store clinics, with sites at Walgreens, Publix and Wal-Mart locations as well as CVS, according to the trade group Convenient Care Association. This marriage of retail with medical treatment has spread rapidly since 2000 — especially during the past two years — with a total of about 1,000 in operation across the country. And while the trend may have stalled in some markets, not so in Atlanta. The number of area Publix stores that offer walk-in medical sites, for example, is projected to jump from nine to 18 this year.

Michael Howe, CEO of industry leader MinuteClinic, said when searching for possible locations, “You’re really looking for families with children — consumers who are typically time-constrained.” Atlanta’s demographics fit that target audience, he said.

Facing Herculean drive times, many metro Atlantans prefer a medical site close to home or work, especially with those with later hours, experts say.

“People don’t want to travel more than 10 minutes,” said Lisa Loscalzo of The Little Clinic, which has sites in the Publix stores. “With rising gas prices, people are definitely looking for one-stop shopping.”

Laney, a genetic counselor at Emory University School of Medicine’s Department of Human Genetics, cited those extended hours as a reason she decided to give the clinic a try.

“This is a very convenient option for folks with minor ailments who work standard business hours,” she said.

The retail clinics generally are staffed by nurse practitioners — registered nurses who have advanced education and clinical training.

With average prices well under $100 — and often accepting an insurance co-pay — in-store clinics represent an emerging option within the patchwork health care system for treatment of minor ailments.

But doctors’ organizations have expressed concern, cautioning that nurse practitioners must adhere to strict practice guidelines, and emphasizing clinics should not replace the doctor/patient relationship.

“They simply cannot compete with the comprehensive services and long-term peace of mind offered by a primary-care physician who is acquainted with the patient,” the Medical Association of Georgia said in a statement.

The American Medical Association last year called for investigations into possible conflicts of interest in business ventures between in-store clinics and pharmacy chains.

Nurse practitioners, meanwhile, assert they’re not replacing the doctor, but instead offer an easy portal into the health system. There are some doctor-staffed urgent care centers with extended hours, and nurse practitioners can refer patients there.

In addition, nurse practitioners can help the drop-in patients find a permanent doctor. “If a patient needs a health care home, we can refer them to a local physician,” said Lillian Williams of Take Care Health Systems, which runs clinics at Walgreens.

Ivy Spencer of The Little Clinic added, “We always refer [patients] back to the primary care physician.” And sometimes doctors refer people to the clinics, nurse practitioners say.

Diane Kniffin, a teacher, left her Smyrna school last week to seek care for her poison ivy at a nearby Walgreens clinic. After getting an examination, a prescription and over-the-counter medication, Kniffin said she was able to return to her class within an hour. She appreciated that convenience, with her regular doctor’s office in Woodstock, miles away.

Such clinic visits generally cost less than a doctor’s office visit and much less than being treated in a hospital emergency room, where many people go for relatively minor health problems.

The clinics also attract many “working poor” who lack insurance, said Michael McCann, director of legislation and public policy for the Georgia Nurses Association. The hours, he added, “are more friendly to working families. Very few primary care doctors offer evening or weekend hours.”

The clinic concept — minus the retail — has surfaced at Atlanta’s Hartsfield-Jackson International Airport. AeroClinic, staffed by nurse practitioners and physician assistants, serves both travelers and airport employees.

For minor health problems, such clinics make a lot of sense to Gary Starzmann, who recently took son Alexander, 7, who had a sore throat, to a CVS store in Vinings, near their home.

“It’s basically the convenience and speed of it,” Starzmann said.

Source: The Atlanta Journal-Constitution
Original Publication Date: May 14, 2008

Like the Internet, the clinics aren’t going away. But an initial wave of enthusiasm does seem to be passing, as some clinics go bust and others scale back expansion plans, the WSJ reports.

In the past few years, hundreds of clinics, typically staffed by nurse practitioners and physicians assistants, have sprung up in grocery stores, pharmacies and big-box retailers. They treat only simple ailments, post their prices for all to see and don’t require appointments.

But the business model turns out to be a bit trickier than some thought. In recent months, 69 clinics in 15 states have shut down, including those in Wal-Marts and Medicine Shoppes (a unit of Cardinal Health). CVS is scaling back expansion plans for its MinuteClinics, and may close some of its clinics.

“We have seen fallout in this industry, on a smaller scale, that is not unlike the dot-com bubble,” Tom Charland, a consultant and former vice president for strategy at MinuteClinic, told the WSJ. “The big mistake was for people to think they could reach break-even in six months.” A more realistic target is 18 months to two years.

Like the dot-com world, though, retail clinics will persist, even as some businesses fail. Walgreen still plans to more than double the number of its TakeCare clinics this year, adding some 240 locations by the end of the year.

Source: The Wall Street Journal
Original Publication Date: May 7, 2008

Hailed as an inexpensive option for treating minor health ailments like sore throats and rashes, the retail clinics have grown in number to 963 as of May 1 from just 125 three years ago. The clinics typically feature nurse practitioners who can prescribe basic drugs, and the price for a visit ranges from $50 to $75.

But in recent months, retail health-clinic operators based in New York, Nevada, Indiana and Alabama have closed their doors, shuttering 69 clinics in 15 states.

Source: The Wall Street Journal
Original Publication Date: May 7, 2008

Take Care is a subsidiary of Walgreens. The company has 168 Take Care Health Clinics in 17 cities, with plans for more than 400 by year’s end.

The initial Colorado locations are in the Walgreens at 5190 W. 120th Ave. in Broomfield; 19028 Lincoln Ave. in Parker; and 4401 Wadsworth Blvd. in Wheat Ridge.

The clinics are staffed by nurse practitioners who treat patients 18 months and older for common illnesses and can write prescriptions. The hours are 8 a.m.-7:30 p.m. Monday through Friday and 9:30 a.m.-5 p.m. Saturday and Sunday.

Source: Denver Business Journal
Original Publication Date: May 6, 2008

Source: Supermarket News
Original Publication Date: May 2, 2008

Twelve Take Care Health Clinics at Nashville-area Walgreens will participate.

With the addition of Blue Cross, which covers nearly one-third of Nashville’s insured individuals, approximately 80 percent of insured residents in the area can receive treatment.

BlueCross plans accepted at Take Care Health Clinics will include Network P/Blue Preferred, Network S/Blue Select, Network V/CoverTN and BlueCross Federal Employee Program and out of state BlueCard.

Source: Nashville Business Journal
Original Publication Date: April 29, 2008

In overseeing the new health services market, FTC favors policies that balance consumer protection and business competition, William Kovacic, the agency’s chairman, said at the Innovations in Health Care Delivery conference.

But achieving that balance has been elusive, especially at the state level, industry insiders say. Rhode Island and Illinois, for example, have proposed “onerous bills … that would prevent clinics from flourishing,” said Sara Ratner, senior legal counsel at MinuteClinic, a division of CVS Caremark that operates more than 500 retail clinics in 25 states. 

Lawmakers have proposed banning retail clinics from operating in stores that sell tobacco, dictating the proximity of restrooms and water fountains, and requiring strict physician oversight requirements. Texas law already requires limited-service clinics to have a physician on the premises during 20 percent of its operating hours — even if a physician is available for remote consultation.

“They have to take time to go to a clinic and sit there,” said Web Golinkin, president of the Convenient Care Association. “None of these regulations are based, to my knowledge, on any research.”

States’ requirements for physician oversight — the ratio of doctors to nurse practitioners, for example — also vary widely, Ratner said, making it “extremely difficult to create a business model that complies with every state.”

However, some states are making it easier to operate retail clinics. Earlier this year, the Massachusetts Health Department issued regulations that exempt retail clinics from some federal, state, and local public health and safety requirements. Health care providers in Massachusetts, which last year passed a law requiring all residents to have health coverage, have struggled to keep up with spikes in demand for services.

The retail clinic sector is booming. Analysts say the industry, which barely existed a year ago, could have 6,000 sites in operation by the end of 2012. Clinics are operated by retailers such as Walgreens, CVS and Wal-Mart, which plans to open 400 sites by the end of 2009; independent operators such as RediClinic; and hospital-owned operators.

Retail clinics leverage technology — electronic medical records, telemedicine, evidence-based diagnosis — to advance a business model predicated on a limited menu of services, convenience, consumer satisfaction, value and price transparency.

“Innovation is critical,” said William Sage, vice provost of health affairs at the University of Texas School of Law. “At the end of the day, the genie is out of the bottle, and it’s not going back.”

Source: Government Health IT
Original Publication Date: April 28, 2008

Already, Oklahoma has walk-in clinics in two Wal-Mart Supercenters, three CVS stores and at least one supermarket. Those numbers are expected to increase.

Last year, Wal-Mart announced plans to add 400 more clinics to Supercenters nationwide by 2010. Clinics already in operation are run by third parties, but Wal-Mart is installing co-branded clinics in 200 stores. These are partnerships between the retailer, RediClinic and local hospital systems.

Work is already under way, with the first of the new clinics expected to open this month.

“So far,” said Wal-Mart spokesman Phillip Keene, “only the cities of Little Rock, Dallas and Atlanta will have co-branded clinics.”

MinuteClinic, which mainly operates in CVS pharmacies, has served over 1 million patients and boasts on its Web site of “aggressive national growth plans (that) mean we hope to have a … health care center near you soon.”

Dr. Manuel O. Crespo has watched the growth of retail clinics with interest. A longtime family doctor in Oklahoma City, he sees the positives and negatives of the small clinics.

“As a general rule, when someone becomes ill, they wish to be seen immediately,” Crespo said. “Many physicians can’t work patients in on a same-day basis.”

Quick clinics provide a handy alternative. Fast and relatively inexpensive, they offer ready access to a medical professional — whether it’s an actual doctor or a nurse practitioner.

Got a runny nose and cough? Have a minor infection? Need some vaccinations? Retail clinics are a convenient way to go.

Filling a niche
“I believe that they (clinics) will continue as they seem to fill a niche in the health care system,” Crespo said.
That niche, however, is fairly specific. A quick clinic is no substitute for an emergency room or a primary care physician — someone familiar with your medical and family history, someone who knows what medications you take and how they might interact.

“One of the problems that I have found is that there is a lack of communication between these acute care clinics and the primary care of these patients, and therefore the continuity of care is frequently broken,” Crespo said.

Many clinic patients, however, have no family doctor and no insurance benefits, making it difficult for them to obtain regular treatment.

“According to feedback data gathered by operators of clinics … approximately 55 percent of customers seeking care at these in-store clinics don’t have health insurance,” a Wal-Mart fact sheet notes. “For customers without a primary care physician, they provide an important point of entry into the health care system.”

And they’re only going to become more common.

Source: NewsOK.com
Original Publication Date: April 20, 2008

Now, Walgreen Co. is getting into the act in Massachusetts with its own clinic chain, Take Care Health Systems.
 
Take Care spokeswoman Lauren Tierney confirmed that the chain plans to open Take Care clinics in the Boston metro area this year in selected Walgreens stores. Tierney declined to provide any specifics about the locations or the timing of the openings.

But she says the chain expects to have at least 400 clinics by the end of the year nationwide, more than doubling its current level of about 160.
  
CVS Caremark Corp., which is based in Woonsocket, R.I., has a bit of a head start in this state, but not by much. Even though CVS disclosed its plans a year ago to open its MinuteClinics here, the rollout was held up while the state Department of Public Health crafted regulations for the retail clinics, which are overseen by nurse practitioners.
  
The regulations were finished in January, and CVS submitted plans last month to open its first 20 clinics under the new rules. Paul Dreyer, the state agency’s director of health care quality and safety, says it will probably take the agency less than six months to approve the CVS plans.

He says he expects the approval process will be faster for future applicants as regulators become more familiar with the concept.
  
The country’s two largest pharmacy companies have taken similar approaches by buying clinic chains and keeping their brands intact. CVS reached an agreement to purchase the Minneapolis-based MinuteClinic group about two years ago, while Walgreens bought Conshohocken, Pa.-based Take Care last May.

Analysts say the companies fulfill an unmet need among consumers for easily accessible, affordable health care. 
 
“We think it’s not just a fad,” says Derek Leckow, an analyst at Barrington Research. “This is going to be the way that health care is delivered for these types of services.”
  
Mitchell Corwin, an analyst with Morningstar, says the drugstore companies will benefit by increasing foot traffic into their stores. These clinics typically aren’t profitable yet. But Corwin says it makes sense for CVS and Walgreens to bet on their success.

“They have the resources to invest in these clinics, build them up quickly and achieve critical mass,” he says. “It’s much more difficult for a smaller, regional chain.”
  
The drugstore chains’ deep pockets are evident in the industry’s rapid growth in the past year. The first of these retail clinics, a precursor to the MinuteClinic chain, opened in Minneapolis in 2000, according to Tine Hansen-Turton, executive director of the Convenient Care Association.

There were about 200 at the end of 2006, and now there are about 975 across the country, she says. She expects that number will increase to 1,500 by the end of this year.
  
She says consumers like the fact they can be treated for a range of common ailments, with visits that can be as short as 15 to 20 minutes for a typical price of $60 per visit. Nurse practitioners can write prescriptions, but can refer patients to doctors if more complex care is needed.
  
The emergence of these “convenience clinics” has not been without controversy. Doctors’ groups in Massachusetts and other places across the country have raised several concerns about them.
  
Dr. Bruce Auerbach, the Massachusetts Medical Society’s president-elect, says the benefits of these clinics are being oversold. Auerbach says there’s a risk that nurse practitioners may be encouraged to overprescribe or recommend products that might be available two aisles away to boost the parent company’s bottom line.
   
Auerbach says he doesn’t view these clinics as threats to physicians’ businesses, partly because the clinics aren’t designed to entirely take the place of primary care providers or hospital emergency rooms. He says the long-term benefits of seeing the same primary care doctor over a period of years could be lost at a drugstore clinic.
  
Auerbach says he has seen no evidence that the clinics address the expensive nature of health care. But it’s hard to know how much money these clinics can save patients in Massachusetts until the concept is given a chance here.
  
Take Care’s confirmation of its imminent arrival in this state comes as state lawmakers debate ways to tackle the problem of skyrocketing health-care costs. The state Senate on Thursday passed a wide-ranging bill aimed at curbing medical expenses.
  
With the pressure from employers to ease the burden caused by the 2006 state law mandating insurance coverage, it seems likely that lawmakers will pass health care cost reforms by the time they adjourn from formal sessions this summer.
 
Sure, the executives at public companies such as Walgreens and CVS are motivated to boost their company’s profits. But this private sector solution may prove to be at least as effective at making health care affordable and accessible to consumers as any piece of state legislation.

Source: The Daily News Tribune
Original Publication Date: April 19, 2008