The Express Care centers are “an investment in the future” rather than a big contributor to the system’s profits now, Herde said. Like many new operations, they have to build a customer base over time.
Source: Louisville Courier-Journal
Baptist Healthcare has clinics in several Walmarts
December 26, 2011 By Leave a Comment
Sore Throat on Aisle 4: Retail Clinics Match Quality of Doctor’s Office
September 2, 2009 By 3 Comments
The next time you go to the drugstore to pick up shampoo or paper towels, you might get that cough checked out, too.
More than a quarter of the U.S. population lives within a 10-minute drive from a retail walk-in medical clinic (or convenient care clinic) that can provide appointment-free screenings and examinations of minor afflictions right inside the store.
Staffed mostly by nurse practitioners, these clinics offer lower costs and longer hours than a standard physician’s office. But how does the quality of treatment at these convenient alternatives compare? Pretty well, according to a pair of studies published online yesterday in Annals of Internal Medicine.
“Retail clinics could serve a relatively large demographic,” says lead study author of one of the studies, Ateev Mehrotra, a professor of medicine at the University of Pittsburgh School of Medicine and a researcher at the RAND Corp., a nonpartisan research group. “I had thought of these clinics as being a new issue, a novel way of [providing] care,” he says, but after looking into their prevalence, he found that they “could have a substantial impact on the health system.”
The first retail clinics opened nearly a decade ago, and as of August 2008, there were nearly 1,000 of these clinics around the country, which had received some three million visits. “The increasing number of patients who receive care at retail clinics has fueled concerns about increased health care costs, greater rates of misdiagnosis, overuse of antibiotics, and decreased delivery of preventative care,” the authors in one of the studies wrote.
Many of those concerns may be unfounded, according to the studies, based on patient records from a major insurer in Minnesota, where the clinics first emerged. The quality of care for treating three common acute afflictions—ear infections, sore throats and urinary tract infections—was just as good at retail clinics as at physician offices and urgent care centers, and better than emergency rooms (ERs), when checked against standard clinical treatment guidelines.
The findings about the nurse-only clinics were no surprise to Mehrotra, who cites previous studies showing no difference between care given by physicians as opposed to nurse practitioners.
Nevertheless, Rebecca Patchin, chair of the American Medical Association and an assistant professor of anesthesiology at Loma Linda University School of Medicine in California, recommends that, “store-based clinics have appropriate physician oversight on site and that patients be clearly informed of the qualifications of the person providing care.”
Depending on nurses for care, however, is one of the ways retail clinics keep costs down, which can be important for those who seek care there—often young and uninsured folks, Mehrotra says. Most of the clinics take insurance, Medicare and some Medicaid, but out-of-pocket prices are also listed on a service menu, allowing patients to evaluate the cost before treatment. Total costs for treating the three common minor afflictions noted above were on average 30 to 40 percent lower at a retail clinic than at a physician office or urgent care center and 80 percent lower than at ERs.
Sporadic treatment at retail clinics could disrupt continuity of treatment and preventative care, some medical groups worry. But, the study authors found, the number of patients who had preventative care within three months of treatment was about the same across all types of facilities (about 14 percent).
Most clinics are run by for-profit chains such as CVS pharmacies; Walgreens and Target that also have in-store pharmacies, causing Mehrotra and others to worry about medication overprescription. “We actually found, and perhaps surprisingly, retail clinics were not more likely to prescribe,” Mehrotra says.
Physician groups caution that the clinics should not become the sole locus of treatment. “Store-based health clinics can offer patients an option for episodic care, but cannot replace the patient–physician relationship,” Patchin said in a prepared statement.
How might changes in the health care system and the number of insured individuals alter the use of retail clinics? “It’s hard to know,” Mehrotra says. He points to anecdotal results from Massachusetts, where more people have gotten insurance, showing that it has become more difficult to get in to see physicians, so a retail clinic model might become increasingly popular.
“From a societal perspective, it might lead to a better allocation of health care resources if more patients with a mild illness go to a retail clinic,” the paper authors noted. The American Medical Association, for its part, has yet to issue an unqualified endorsement of retail clinics. As Patchin said in her statement, “Convenience should never compromise safety.”
Source: Scientific American
Drive-Thru Medical: Retail Health Clinics’ Good Marks
September 1, 2009 By Leave a Comment
Doctors are having a hard go of things. Squeezed by falling reimbursements, soaring malpractice insurance and punishing patient loads, they shouldn’t have much to fear from the likes of Wal-Mart. But the fact is, the greeter in the red vest is increasingly going toe-to-toe with the doctor in the white coat — and winning — thanks to the growing phenomenon of retail health clinics.
Retail clinics — free-standing, walk-in medical providers located in drug stores, shopping malls and stores like Wal-Mart, Target and Walgreens — are rapidly becoming to the health-care industry what Fotomat was to the camera world. There are roughly 1,000 clinics now operating in the U.S., offering acute care for such routine problems as throat infections and earaches as well as providing diabetes and cholesterol screenings, routine checkups and vaccinations. The fees are low — and conspicuously posted; nearly all of the clinics treat both the insured and uninsured, and there is little or no waiting time. With 50 million Americans lacking health insurance and family budgets collapsing under the weight of medical costs, what’s not to like about the clinics?
Plenty, say physicians associations, whose members warn that clinics — which are typically staffed by nurse practitioners and are positioned in stores that also sell prescriptions — will be inclined to misdiagnose and overprescribe. Worse, they are not built to provide long-term care for chronic conditions such as hypertension, and they threaten the ideal of a lasting doctor-patient relationship, denying consumers a so-called “medical home.”
Those, at least, are the arguments, though it was impossible to know how well-founded they were — until now. In twin studies published this week in the Annals of Internal Medicine, the Rand Corp. reports on an extensive survey of cost, quality and availability of retail health operations, and on nearly all measures, the clinics scored high.
The studies, which took months to compile, were based on the performance of the 982 retail clinics that existed in the U.S. as of August 2008 — a tenfold increase since 2006. While that proliferation is impressive, as with much else in the health-care system it doesn’t necessarily mean equal access to care. Clinics exist in only 33 states, and in those that have them, an overwhelming 88.4% are in urban areas. Just 10.6% of the U.S. population lives within a five-minute drive of a clinic, and 28.7% lives 10 minutes away. The South is better served than the Midwest and West, and all three regions are better served than the East. Just five states (Florida, California, Texas, Minnesota and Illinois) are home to 44% of all American retail health clinics.
But perhaps the more relevant question is, How good is the care at these stop-and-shop operations? To answer that, the Rand investigators focused on just one state, Minnesota, because clinics are well-established there and because one large health plan has been providing clinic coverage for its members for five years, meaning that there was a rich vein of data to mine. The investigators focused on data on 2,100 patients who had gone to a clinic for one of three common complaints: sore throat, urinary tract infection and earache. These were compared to patients who had visited doctors’ offices, urgent-care facilities and emergency rooms for the same ailments. The investigators judged quality of care by 14 different measures, including what kinds of tests were ordered, what drugs were prescribed and whether follow-up visits were scheduled.
If the results are any indication, the next time you have a routine medical need, you should probably make haste to a clinic. On a quality scale of 0% to 100%, the clinics finished first with a 63.6% while urgent-care centers and doctor’s offices followed within a couple of points. Habitually overcrowded emergency rooms came in last at a distant 55.1%. When it came to fees, the results were even more dramatic. For the various kinds of services studied, the average visit to a retail clinic cost $110, versus $156 for urgent care and $166 for a family doc. As for ERs? A cool $570. While even $110 for a clinic visit seems pricey, that is only the average for the three procedures studied. Minute Clinic, the industry leader with 514 outlets, charges just $62 for a minor illness or injury exam and $20 to $66 for a wellness or prevention visit.
Average cost per lab test in the Rand study also differed significantly depending on the provider: $15 at retail clinics, $27 at urgent-care facilities, $33 at doctors’ offices and a whopping $113 at the ER. The study did not bear out the fear that retail clinics would be inclined to overprescribe drugs, and when the clinics did write a prescription, the out-of-pocket cost was lower: $21 compared to a high of $26 for ERs.
“These findings provide more evidence that retail clinics are an innovative way of delivering health care,” says Dr. Ateev Mehrotra, a professor at the University of Pittsburgh Medical School and the lead author of the study. “Retail clinics are more convenient for patients, less costly and provide care that is of equal quality.”
Neither the clinics nor the studies are perfect, as the Rand team concedes. Even an exhaustive survey of one state is still a study of just that state. And the very accessibility of those Minnesota clinics might have encouraged more visits by mildly ill people whose complaints would have vanished on their own. Give the clinics so many easy pitches to hit and you may artificially drive up their average. Still, with local and regional hospitals such as the Cleveland Clinic increasingly working in partnership with such retail operations, more and more of these in-store outlets are likely to open. Which means more and more of us will be putting health care on the weekly shopping lists, along with the milk and bread.
Source: Time Magazine
Retail Medical Clinics Offer Quality Care: Study
August 31, 2009 By Leave a Comment
Walk-in retail clinics staffed by nurse practitioners provide high-quality care for routine illnesses, a new study has found.
Writing in the Sept. 1 issue of the Annals of Internal Medicine, study author Dr. Ateev Mehrotra said that retail clinics — which are typically staffed by nurse practitioners and found in drug stores and other retail chain stores such as Target and Wal-Mart — provide a good standard of care for sore throat, ear infections and urinary tract infections. Mehrotra is an assistant professor at the University of Pittsburgh School of Medicine and a policy analyst at Rand Health.
“I’m interested in how we deliver new forms of health care,” said Mehrotra, who compared data from retail clinics, doctors’ offices, urgent care centers and hospital emergency departments. “There’s been a lot of discussion about the quality and effectiveness of these clinics; I wanted to find out more. From the patients’ perspective, their appeal is twofold. They’re convenient and they provide significant cost savings.”
Retail clinics have become increasingly widespread in recent years. One such operation is CVS’s MinuteClinic, the focus of Mehrotra’s research. MinuteClinic staffers treat minor illnesses and injuries, and provide vaccinations and various health and wellness services. Customers can walk in without an appointment, and the clinics are open seven days a week. Most visits take no more than 15 minutes, and costs vary from $30 to $110, according to the MinuteClinic Web site.
According to Mehrotra, one-third of Americans live within a 10-minute drive of a retail clinic, and more than 6,000 of these clinics are expected to open across the United States within five years. Surveys of patients who received care at retails clinics have been positive, he added.
Mehrotra’s research team analyzed information contained in insurance claims of 2,100 Minnesotans between 2005 and 2006. The study authors chose the three diagnoses because they made up a combined 40 percent of the clinics’ caseload.
Using various statistical tools, the researchers found that the standards of care in retail clinics in Minnesota were consistent with accepted medical guidelines for those ailments, including the frequency and type of lab tests performed and drugs prescribed.
Treatment costs at the retail clinics were 30 percent to 40 percent lower than in physicians’ offices and urgent care centers, and 80 percent lower than in emergency rooms. The researchers did not detect any significant misdiagnoses, Mehrotra said.
“The increasing number of patients who receive care at retail clinics has fueled concerns about increased health care costs, greater rates of misdiagnosis, overuse of antibiotics, and decreased delivery of preventive care,” Mehrotra and colleagues wrote in the study. “When we compared these aspects of care in retail clinics, physician offices, urgent care centers, and emergency departments, we found little evidence to support these concerns.”
Dr. Scott D. Hayworth, chief executive officer of Mount Kisco Medical Group in New York, one of the largest medical practices in the Northeast, remains unconvinced and is no fan of the retail clinic model.
For one, physicians provide more comprehensive and expert care, and they know their patients’ medical history, he said.
“These [clinics] are clearly picking a few minor ailments, which tend to be less expensive to treat,” said Hayworth, who has about 200 physicians on staff as well as nurse practitioners and physician assistants. “When you have more serious illnesses, you need more back-up,” which drives up costs, he added.
Nurse practitioners and physician assistants (PAs) are effective in traditional medical settings, where there are always supervising doctors, Hayworth said. But in a retail clinic, there is no supervising doctor present, he said, adding, “Say a sore throat turns out to be something more serious. A PA may miss that diagnosis.”
Mehrotra acknowledged that his study had several limitations. It was based entirely on data from one state. It looked at predominantly young, female, insured patients who were relatively healthy and affluent. And it focused on only three diagnoses.
Still, Mehrotra said, his study provides evidence that retail clinics can offer a safe level of care and have a place in the health-care system.
Source: U.S. News & World Report
New Texas Law Expands Access to Safe and Affordable Care at Convenient Care Clinics
August 28, 2009 By Leave a Comment
Legislation passed in Texas this year will, effective September 1, 2009, amend Texas law governing physician alternative practice sites, such as retail-based Convenient Care clinics. SB 532, supported by the Convenient Care Association and the Texas Medical Association, and sponsored by State Senator Dan Patrick (R-Houston) and Representative Garnet Coleman (D-Houston), increases Texans’ access to affordable health care while ensuring high standards for quality of care.
Convenient Care clinics are health care facilities located in high-traffic retail outlets with pharmacies. They are staffed by nurse practitioners and physician assistants who provide affordable, accessible, non-emergency care to consumers who otherwise might not be able to get it conveniently and at a low-cost.
SB 532 streamlines requirements for physicians who oversee the nurse practitioners and physician assistants working at Convenient Care clinics. This, in turn, reduces clinic costs without compromising quality of care or integration with the medical community, which is particularly important in Texas where 25 percent of the state’s resident’s are uninsured and 20 percent report having forgone medical care due to its high costs.
“Convenient Care clinics have treated millions of patients throughout the country and hundreds of thousands of patients in Texas over the last four years. The new law governing alternative practice sites helps ensure that these clinics will continue to provide easy access to affordable health care throughout the state,†said Tine Hansen-Turton, Executive Director of the Convenient Care Association.
“This new law ensures that physicians will continue to monitor convenient care clinics in order to protect patient safety, ensure positive health outcomes, and make certain that patients with more serious illnesses are referred for appropriate follow-up care,” said William H. Fleming III, MD, president of the Texas Medical Association.
Currently, four Convenient Care Association member companies operate clinics inside retail outlets in Texas.
- MinuteClinic, in CVS/pharmacy stores
- RediClinic, in H-E-B stores
- Take Care Health Systems, in Walgreens pharmacies
- CHRISTUS Medical Group, in Walmart stores
“While our nation argues how to overhaul the health care system, Texas continues making steady and strong steps toward meaningful reform. I’m proud to be a part of the effort for increasing access to quality health care,” said Senator Patrick. “It creates more opportunities for Texans to receive affordable, basic medical care in convenient retail locations, and as a result, it frees up physicians so they can spend more time treating patients with complex medical conditions.â€
“Our state’s physician practices, urgent care clinics and emergency rooms are overburdened, resulting in excessive wait times and unnecessarily high costs for patients,†said Representative Coleman. “Allowing Convenient Care clinics to serve as accessible, affordable points of care for common family illnesses will help to relieve the stress on our health care system and reduce its cost.â€
Source: EarthTimes
Cox, Walmart Open Fourth Clinic in the Ozarks
August 13, 2009 By Leave a Comment
Today, Walmart and CoxHealth announced a fourth location of “The Clinic at Walmart†operated by CoxHealth, to be located in the Independence Walmart supercenter, 2021 E. Independence. This convenient care clinic will open Monday, Aug. 31. The clinic will offer the same fast, affordable access to basic health care services available at all other locations, and will be the second location in Springfield.
Amy Lea, director of clinics for CoxHealth Regional Services, says all clinic locations have remained busy this summer with patients seeking treatment for outdoor injuries and minor bug bites. “We’re also seeing a demand for sports physicals as families get ready for the fall sports season,†she said.
The clinics serve as an alternative for people at least 18 months old who are sick enough to need care, but aren’t sick enough to need the level of care available in an emergency department or urgent care clinic. The clinics are also an affordable option for patients who might otherwise postpone or avoid care because they lack insurance or have concerns about the cost.
The clinics offer upfront pricing and prompt access to acute and preventive care for common health ailments treatable without urgent or emergency care, including sore throats, sinus infections, upper respiratory infections, earaches, bladder infections, insect bites and stings, cholesterol screening, blood sugar testing, vaccinations, drug screening and routine physicals. Clinics offer walk-in service seven days a week and evening hours.
Source: KSPR.com
Med-Point Express closes its doors today in Mishawaka
August 10, 2009 By Leave a Comment
Today is the last day you can conveniently walk into the Mishawaka Wal-Mart and quickly get in to see a nurse practitioner for a cold, sore throat or physical.
After three years, Memorial Hospital and Health System is closing the Med-Point Express it opened nearly four years ago on Indian Ridge Boulevard.
It was a first for Memorial, which has become a hospital systems consultant to mainly not-for-profit groups opening express retail clinics.
And this particular location was a first for Wal-Mart, after the retail giant decided to test the concept in its stores, says Diane Stover, vice president for marketing and innovation strategy at Memorial in South Bend.
“We were happy to be the first in the country in the Wal-Mart model,” she says. “We were a national leader because we saw this was an improvement in access.
“We had a great three years at the Mishawaka Wal-Mart,” Stover adds, “but location-wise people have so many options.”
Patients on Friday were to receive a postcard in the mail directing them from now on to visit the nearby Main Street Med-Point or the Med-Point Express at Martin’s Super Markets, 936 Erskine Plaza, South Bend.
Memorial continues to operate Med-Point Express clinics at Wal-Mart stores in Valparaiso (1) and Indianapolis (3). It closed a Plymouth clinic last year.
The health system also runs an express clinic at the Cobblestone Crossing Martin’s store in Elkhart.
Initially, in-store clinics became popular for busy people and the uninsured because of their convenience and cost. The price for most visits is less than $70. Retail clinics offer treatment for common ailments such as upper respiratory infections and allergies, as well as physical exams and vaccinations mainly by nurse practitioners.
Stover said the typical retail clinic visit takes about 15 minutes, whereas it often takes an hour — or more — for a traditional Med-Point visit due to patient load and the greater number of ailments that can be treated by the physician on staff.
But national statistics show that the overall growth of retail clinics slowed in 2008, even as CVS, Walgreens and others add them.
In fact, the industry will not come anywhere near the 6,000-clinic figure some analysts predicted for 2011, according to Merchant Medicine, a Minnesota-based retail clinic consultancy firm.
Indiana has such walk-in retail clinics as The Little Clinic, inside Kroger grocery stores, MinuteClinic, which is operated by CVS Caremark, and Corner Care Clinic.
Some Meijer stores also offered in-store clinics for a short time in Indiana and Michigan.
Stover said Memorial will continue looking for suitable locations to improve access to health care with retail clinics. But she agrees the number of clinics will continue to retract before the number greatly expands.
“There have been failed attempts at this business all over the country,” Stover says. “Because we were one of the first hospital systems in the country to do this, we’ve watched many mistakes be made and helped people avoid them. We’re taking what we’ve learned and are applying it for future planning.”
Source: South Bend Tribune
Retail Clinics Help Some Cover Basic Health Needs
June 25, 2009 By Leave a Comment
The debate over health care reform is heating up. Doctors, nurses, even patients showed up on Monday at the Fairmont Hotel to push their solution – Single Payer, or government run, healthcare. They were picketing a $500 per head luncheon featuring U.S. Secretary of Health Kathleen Sebelius.
At issue is the rising cost of health care. More money is being spent on it now than ever before, but yet more people are underinsured or doing without coverage. Some consumers are turning to retail health clinics in big box stores. One chain, Quick Health Clinics said its patient traffic is up as much as 35 percent.
But Ben Hipes has his own solution. Since he can’t get health insurance because of a pre-existing condition, he visits a “Quick Health Clinic” located inside his local Walmart in Fremont.
“This is the only place pretty much that I can come and afford it,” Hipes said.
Dave Mandelkern, the CEO of Quick Health said its clinics look much like any physicians exam room, complete with exam tables and medical grade equipment. The company does not cut corners when it comes to quality of care. Quick Health is just one of 1100 medical retail clinics located in box box stores or pharmacies across the country.
Doctors or medical assistants treat everything from colds to allergies. A basic visit costs $59, a fraction of the cost of an emergency room visit. Quick Health said it keeps rates low because the company keeps a lid on costs.
“We have an influx of patients who just lost their insurance and they found the place very convenient, very inexpensive and very quick,” said Dr. Leo Fuentes, a Quick Health staff physician.
And if you can’t get away from work, these clinics have evening and weekend hours. Ben Hipes said he’s made about five visits to a Quick Health Clinic and that even his children get their health care there.
While these clinic offer quick, fast and affordable care and may help in early detection of medical problems, some critics caution that more serious health issues could be overlooked because patients don’t develop a steady relationship with a doctor.
Source: CBS5.com
Wal-Mart Medical Clinics Stumble
June 19, 2009 By Leave a Comment
Two years ago, Wal-Mart Stores announced plans to have retail medical clinics in 400 of its stores by 2010 and said it saw the potential for as many as 2,000. By February 2008, the retailer had 78 clinics. But now,—after failed venture-capital collaborations, a few faulty partnerships, and a reassessment of the business model—it has only 31.
For a company known for its retail acumen and dominance, that retrenchment illustrates the complicated nature of incorporating basic-care facilities into a big-box business model. Americans have shown increased interest in retail medical clinics, which are typically open seven days a week and operate until as late as 8 p.m. According to the Convenient Care Assn., a trade organization, visits doubled nationally between 2007 and April 2009, to 14% of the population from 7%. The retailing behemoth, however, is still formulating an appropriate model. “Wal-Mart is not a drugstore. I’m not surprised that there would be false starts,” says Candace Corlett, president of consultancy WSL Strategic Retail. Pharmacy chains, meanwhile, have seized a large swath of the retail clinic market.
Still, Wal-Mart sees plenty of opportunity and says it remains on track to have 400 clinics within the next few years to take advantage of growth in the field.
medical mcdonald’s
Wal-Mart collects a brand fee and income from renting space to the clinic operators—and uses its massive buying clout to buy equipment for them—but it holds no ownership stake in the clinics. These offices, also known as “convenient care” clinics, are typically staffed by nurse practitioners or physician assistants and offer basic treatments for common ailments such as strep throat, sinus infections, and rashes.
Clinics mesh basic care with a retail philosophy that stresses convenience and savings. Prices are usually displayed on menu boards. Visits typically cost $45 to $75, not including prescriptions. The clinics perform physicals, drug tests, blood work, and other noninvasive screenings without the lengthy waits, high prices, and hefty paperwork often associated with hospitals. For more serious cases, the clinics refer patients to a doctor or emergency room. The goal is to “simplify, like a Starbucks or a McDonald’s,” says Karen Bowling, CEO of Solantic, a Jacksonville, (Fla.)-based company that operates 26 clinics, three of them in Wal-Mart stores.
Wal-Mart isn’t alone in searching for a profitable business model in an industry that is striving for greater awareness and traffic. Retail clinics need customer traffic to cover their $500,000 to $600,000 yearly operating costs. With each visit bringing an average of $59 to $80, a clinic requires roughly 20 patients per day to break even and 30 to turn a healthy profit. Walgreens subsidiary Take Care Health Systems, for example, operates more than 345 offices and sees patients as young as 18 months. By expanding its hours and services, Take Care Health had estimated sales of $450,000 per location in 2008, according to Kalorama Information, which publishes health-care market research. “I think the challenge in [making the clinics] profitable is as simple as getting to the point where you have an adequate amount of consumer awareness,” says Chip Phillips, president of MinuteClinic, which has 500 retail clinics in 25 states and operates as a unit of drugstore chain CVS Caremark.
location, location, location
Wal-Mart has more than 1 million potential clients among its employees alone, and it is betting that the combination of rising health-care costs and consistent traffic from budget-minded shoppers will prove successful. However, the enterprise has been marked by early stumbles and is taking longer than expected to develop. Industry experts and clinic operators cite brand confusion, advertising problems, broken partnerships, and the recession as factors in Wal-Mart’s halting foray in the field.
Location is key, too. Freestanding retail clinics operating out of strip malls draw attention from auto traffic or public transportation stops. Solantic, for example, sees more business at such locations, and especially at its Orlando International Airport site. Wal-Mart’s clinics, however, are typically situated inside near the store’s main doors—along the same row as its photo studios and Subway sandwich shops—rather than near its pharmacies, and may catch a consumer’s eye only on the way out. Plus, the company doesn’t allow signage directly outside the store to promote the clinics and restricts indoor signs to areas near the clinic offices, says Natassia Orr, administrator of Broward Health Weston in Weston, Fla. At Wal-Mart, “the challenge is from an awareness perspective,” Solantic’s Bowling says.
The retailing giant does run in-store TV advertising and promotions on walmart.com, and is “working with our existing clinic operators to determine how we can better communicate to our customers about the benefits of clinics,” company spokeswoman Christi Gallagher says.
As unlikely as Wal-Mart’s foray may seem, its venture into the clinic business comes as no surprise to Paul Keckley, executive director of the Deloitte Center for Health Solutions in Stamford, Conn. “Think of it not as running a clinic but running a health-care services organization,” he says. The company already provides prescription drugs, including increasingly popular generics, and medical products. By incorporating clinics, Wal-Mart offers consumers yet another reason to come inside, and increases its potential indirect revenue. Kalorama publisher Bruce Carlson estimates that for every 70 clinics, a big-box store can pull in $13.5 million a year in indirect sales. “Initially, it looked like the box stores were going to be the entities that were going to really have a lot of these clinics,” he says.
drugstores capture clinic market
Instead, brands already known for their drugstores—CVS, Walgreens, and Rite-Aid—have captured the bulk of the market. By the end of 2008 there were 934 retail clinics in drugstore chains, or more than 20 times the number in Wal-Mart stores, according to Kalorama research. Carlson estimates there will be more than 1,000 in drugstores by 2010, but only about 70 in big-box stores. Broward Health closed its pair of Express Aid locations earlier this year after treating an average of five patients a day since opening the clinics in early 2008. “The easy part was providing health care. That’s what we do,” says Orr.
Unlike the subsidiary relationship many drugstores have with their clinics, Wal-Mart operates on a landlord/tenant basis with its retail operators. While clinics at CVS or Walgreens can lean on their partners during tough times, tenants cannot. “Certainly, some of the operators were affected by the downward economy,” says Tine Hansen-Turton, executive director of the Philadelphia-based Convenient Care Assn.
Many locations that faltered were networks of venture-capital enterprises. Wal-Mart requires its independent operators to hire health professionals to deliver care, says Mary Kate Scott, founder and CEO of Scott & Co., a health-care consultancy. For venture capitalists looking to invest in a rapidly profitable business, running a co-branded clinic with two partners is a difficult proposition. “When you don’t deliver the service or own the brand or own the space, you have almost nothing,” Scott says. “Essentially, the investors lost with the Wal-Mart strategy.”
In January 2008, nascent clinic operator CheckUps closed its 23 Wal-Mart locations across the South after failing to raise enough money. Then in June, Colorado-based SmartCare Family Medical Centers shuttered all 15 of its in-store businesses. RediClinic, whose largest investor is AOL co-founder Steve Case’s Revolution Health Group, parted ways with Wal-Mart in December, shelving plans for 200 co-branded clinics nationwide. The company also has clinics in 21 Texas grocery stores. RediClinics declined to comment about its business partnerships.
new partners
Insiders aren’t overly concerned with Wal-Mart’s false start. “Remember, we’re still very much a young industry,” says Hansen-Turton. “The beauty of a young industry is that you can try different models.” With patient visits rising and satisfaction surveys showing high marks, retail clinics are confident they’ll succeed. According to a 2008 Wall Street Journal/Harris study, 90% of adults were satisfied with the quality of care they received at clinics, 88% were satisfied with staff qualifications, and 86% were satisfied with the cost.
After hiccups with independent operators, Wal-Mart plans to increase collaboration with established medical providers. Gallagher says more than 400 hospitals and health systems are trying to open sites in the retailer’s stores. Janet Teske, a nurse practitioner and manager of Quick Care clinics in six Wisconsin Wal-Marts, says she’s benefited from the relationship. The clinics are part of the larger Aurora Health Care network of hospitals and health-care service providers in the state and retail clinics act as an outpost. Visits to Quick Care clinics have tripled over the past year, to between 20 and 40 people per day. By partnering with a health-care system like Quick Care, Wal-Mart can provide patients backup when they need further medical care. Retail clinics also give emergency rooms a release valve for heavy traffic, especially during flu season.
With plans for clinics across the country, Wal-Mart says it will seek continuity through its branding and electronic medical records. Store façades will say “The Clinic at Wal-Mart” and display the name of a local hospital system, offering both the credibility of established health-care systems and the low-price attraction of the Wal-Mart brand. Keckley, of the Deloitte research center, is confident that Wal-Mart’s partnerships with hospitals, coupled with the business of its pharmacy and health-care departments, will prove successful. “They’re not stupid,” he says. “They see the spending curve on health care.”
Source: BusinessWeek
Getting Well While You Shop
June 12, 2009 By Leave a Comment
If there’s one thing most patients lack, it’s patience. And who can blame them? When you’re burning up with fever or your child has an earache or that sore throat you’ve been nursing doesn’t seem to be going away, the last thing you want to hear is that your doctor’s next open appointment is a month from now.
Good thing then that there’s a supermarket or pharmacy nearby. Need to buy some shampoo or pick up a few things for dinner? Why not see the doctor — or, more accurately, the nurse practitioner or physician’s assistant — while you’re at it?
For all the complexities of the U.S. health-care crisis, most Americans experience the problem in a straightforward way: it’s just too hard to schedule face time with your family doctor, and it costs too much when you finally get in the door. Of the approximately 1 million physicians working in the U.S., just 30% provide primary care. If you do get an appointment during the week, you’ll probably have to take off time from work and carve out at least a few hours to sit in a waiting room. And if you get sick on a weekend, good luck.
That, of course, is assuming that you have a doctor in the first place, not a given in a country where up to 50 million people lack health insurance. Even for the insured, ever changing corporate health plans may mean that a physician you see one year is not available to you the next. In times of illness, more and more people just show up in emergency rooms, which increases crowding and slashes revenues as bills to the uninsured go unpaid. In the past 13 years, at least 190 ERs have responded by shutting their doors.
Enter the retail health clinic. In the past decade, more and more pharmacies like CVS and Walgreens, supermarkets such as Kroger and Publix and big-box stores like Wal-Mart have made space for clinics that treat minor ailments, administer vaccines and examine kids who need medical forms to enroll in camp. In those nine years, storefront clinics have logged at least 3.4 million visits. Today there are about 1,200 such clinics, pulling in some $550 million in annual revenue, by one estimate. Doctors, worried that the clinics will dig into their bottom line, are resisting the trend, but it’s hard to argue that the innovation wasn’t needed.
Early Detection
The cornerstone of prevention is early detection. Minor problems caught right away — from infections to mild hypertension to a suspicious lesion — may never blossom into major problems. But the inaccessibility of doctors makes early detection more difficult.
Among the new ranks of providers filling the void is the Little Clinic, a company that operates 99 in-store clinics in nine states. The Little Clinic experience is an unabashedly retail one. You can get in and out in 15 minutes during hours that extend into evenings and weekends. Prices are clearly displayed, as is the menu of ills the clinic can address, such as strep throat, sinus infections and flu. There are also preventive services like cholesterol and hypertension screening.
And the cost? For basic acute ailments, an uninsured person will spend about $60 (without tests) at a retail clinic, compared with $60 to $110 at a doctor’s office or hundreds more in an ER. And while the retail-clinic model launched on a cash-only basis, most outlets now accept insurance, used by about two-thirds of patients, according to a study by the Rand Corp. published in 2008.
There are some practical benefits to combining the place where you see your health-care provider with the place where you shop. “I can walk [patients] out of the clinic and show them a nutrition label,” says Sabrina Freeman, a nurse practitioner and manager at the Little Clinic. Everyone agrees physicians should stress prevention, but during an appointment, “you probably spent five minutes with somebody talking about those things.”
Nobody has any illusion that clinics are in the business as an act of altruism. The companies make money — money consumers might not otherwise have spent on health care. The Rand study showed that 90% of adult visits to retail clinics are for 10 common, often minor, reasons. But the same kinds of patients represent only 13% of traffic in doctors’ offices. While some are migrating from their doctors to the clinics, others would have sought no medical help and would have gotten better on their own.
Doctors have emerged as the biggest critics of the new trend. “The most profitable part of a family physician’s practice is exactly what retail health clinics are going after,” says Dr. Ted Epperly, head of the American Academy of Family Physicians. A family doctor treating the same conditions can see five patients an hour. Take away this revenue and doctors will be left with only complicated cases that yield less profit.
But there are less mercenary concerns too. In 2007, the American Medical Association called for an investigation into retail clinics, arguing that drugstores, which position clinics directly adjacent to pharmacies, have a conflict of interest. For instance, floating above the pharmacy counter at many CVS stores are cardboard bubbles reading think minuteclinic, raising the worry that the clinics have an incentive to write too many prescriptions, which will then be filled at the pharmacy. (No AMA investigation took place.)
Family doctors also argue that retail clinics undercut the concept of a “medical home,” a care provider who knows your history and can act as a director for all your medical needs. The clinics counter that with as many as 60% of their patients reporting that they don’t have a primary-care provider, there’s not much to undercut.
Nonetheless, clinics insist that they don’t want to be anyone’s medical home. They say they refer many patients — particularly people who come in too often, which may indicate a chronic illness — to doctors in the community. For uninsured patients who need more substantive treatment, a referral list includes low-cost community health centers or physicians who offer sliding-scale fees. “These clinics are a portal to the health-care-delivery system,” says CVS’s Chip Phillips, president of MinuteClinic.
That’s important. Many clinic patients come in with an acute problem and, while there, learn they have a chronic one. “We catch a lot of things in people who just don’t go to the doctor. Maybe they have high blood pressure and don’t know it,” says Anne Pohnert, a nurse practitioner and manager of MinuteClinics in Virginia. A retail clinic is not equipped to manage chronic hypertension, but spotting the problem is a first step.
Some retailers take this concept further, working with local health systems and hospitals. This eases ER crowding and helps a hospital extend its brand. The Cleveland Clinic is partnering with CVS in Ohio, and the Mayo Clinic has an outpost at a grocery store in Minnesota.
Despite the misgivings of doctors, retail clinics are changing the way family practices operate — and possibly for the better. Surveys show that many family doctors are now lengthening their hours and leaving more appointments open on a first-come, first-served basis.
In times of economic crisis, the ability of the free market to solve problems may come into question. But in one vital corner of the economy, a little creative capitalism is helping fill a gap.
Source: Time
Walgreen, CVS add healthcare services to in-store clinics
June 5, 2009 By 3 Comments
Amid the economic downturn and slow growth for retail and outpatient medical care services, pharmacy giants Walgreen Co. and CVS Caremark Corp. are rolling out new specialized services at their in-store clinics, going beyond treatment of routine maladies.
Launched over the last four years to care for such simple ailments as ear and sinus infections, strep throat or pinkeye, retail clinic operators now are training nurses to do specialized injections for such chronic conditions as osteoporosis and asthma.
In addition, they are offering treatments for advanced skin conditions that include removal of warts and skin tags or closing minor wounds. Care for minor “sprains and strains” also is being offered at some retailers, and pilot projects are underway for breathing treatments and special infusions of drugs derived from biotechnology.
“We want to create a health corner — a real center that looks like you are walking into the doctor’s office,” Walgreen Chief Executive Greg Wasson said of the retailer’s Take Care brand clinics.
There is a business reason for adding services. Walgreens and CVS have slowed their expansion of clinics and are instead making attempts to boost revenue by adding new lines of business in their clinics.
Typically staffed by advanced-degree nurses known as practitioners, most of the nation’s more than 1,100 retail health clinics are open seven days a week, with no appointment needed. The model has been greeted by health insurers, employers and consumer groups as one way to address the rising number of uninsured Americans, estimated at more than 46 million.
Retail clinics not only market themselves as a convenience, they also can be less expensive, providing a competitive threat to primary-care doctors and even specialists. Costs for services for those paying out of pocket at retail clinics generally run $55 to $75 compared with $100 or more for a visit to a primary-care physician.
The physician community says consumers should look at the added services by clinics with skepticism, particularly when it comes to care for chronic ailments. And doctors say what a consumer may see as routine may turn out to be something worse.
“A sprain could be a muscle tear or a break, for crying out loud, so how does a [retail] clinic know when the patient comes in that they are going to treat a sprain?” said Dr. James Milam, president of the Illinois State Medical Society. “When my nurse gives an injection, I am here. The patient needs a regular doctor who has a history with the patient, knows their history, their family history and their illnesses.”
But retailers say they are not going beyond “scope of practice” laws that regulate what nurse practitioners can and cannot do. The clinics are under physicians’ supervision, though doctors usually are not on site.
“These are new services we were not providing that our customers asked us to provide,” said Chip Phillips, president of MinuteClinic, a CVS subsidiary. “We are slowly and gradually expanding our services.”
MinuteClinic said this spring that it had added treatments for sprains, acne, wound care, motion sickness and testing for tuberculosis. In Columbus, Ohio, CVS’ MinuteClinics are piloting a program to provide asthma patients with nebulizer breathing treatments.
In Tampa and Orlando, Fla., Walgreens has launched a pilot program to provide injections for patients with asthma and osteoporosis.
“A high percentage of new drug development is targeted toward biologics that will require clinical administration,” Walgreens spokesman Michael Polzin said.
Wal-Mart Stores Inc., which works with several outside companies to staff clinics in its stores, has remained focused on “providing the stay-well and get-well services that we have always done, such as ear infections, soar throats and bladder infections,” said Christi Gallagher, a Wal-Mart spokeswoman, adding that the company is “always looking for ways to better serve our customers.”
Source: Los Angeles Times
Health Care in a Hurry
June 4, 2009 By Leave a Comment
Ever get knocked in the shins by a shopping cart while you’re waiting for a medical treatment? These days, it’s becoming more of a distinct possibility. Retail health clinics are quietly sprouting up around the nation at local drugstores and supermarkets, often tucked in a corner just past the mouthwash and Flintstones Vitamins.
With the battered economy putting more pressure on people’s ability to cover health costs, and the ranks of primary-care physicians dwindling, analysts say these clinics could become a nifty niche for U.S. drugstores (CVS pharmacy, Walgreens), supermarkets (Kroger, Cub Foods) and big-box chains (Wal-Mart, Target), which have shoehorned about 1,100 of them into stores. Indeed, while their growth has slowed lately, the number of clinics shot up tenfold between 2006 and 2008 alone, drawing nearly four times as many customers over the same time period.
One major drawing card, of course, is price: They’re cheaper than doctors. (A handful of store-based clinics are staffed by physicians; more typically, it’s nurse-practitioners, masters-educated nurses with the ability in most states to write prescriptions.) The Deloitte Center for Health Solutions recently found that a typical clinic visit costs between $50 and $75, compared with $55 to $250 for a physician. One clinic even recently announced that it would waive sick-visit fees through 2009 for anyone who can prove that they are both unemployed and uninsured.
The main reason people go this route, though, is to save time. With names like MinuteClinic and Curaquick, these facilities promise vaccines, simple screenings and treatment for routine illnesses, like ear infections or pinkeye, with Jiffy Lube speed and convenience. In fact, while most doctors still live by the 9-to-5 credo, retail clinics offer evening and weekend hours that work better with Americans’ hectic schedules. And most take major insurance.
Still, despite promises of shorter waits, some clinics can have long lines or such strict treatment limitations that patients often leave frustrated. Physicians have raised concerns about whether store clinicians can know enough about their patients’ medical histories with such brief contact, especially those with multiple chronic conditions, like diabetes and depression.
And with only about half of U.S. in-store clinics currently profitable—and some drug chains deriving nearly 70 percent of their revenue from the pharmacy counter—critics wonder whether the clinics might lean toward overprescribing meds, a charge the chains deny. CVS pharmacy’s MinuteClinics, for one, says its protocol is not to prescribe antibiotics unless a patient meets a strict list of preconditions; for a sinus infection, for instance, you’d need to have been sick with symptoms like “yellow or green drainage†for seven days and unresponsive to over-the-counter drugs.
Clinic champions, however, remain bullish. “Years from now,†says Tine Hansen-Turton, head of the Convenient Care Association, an industry trade group, “we’ll say the clinics made Americans healthier because they let patients get care earlier in their illnesses, on their schedules.†Unsure what to expect, we decided to give this new trend a tryout, shopping our own minor ailments around these minuscule medical facilities.
As we pull into the strip mall in Riverside, Conn., we have no trouble finding the large MinuteClinic sign above the CVS pharmacy entrance. But inside is another story. The clinic is stashed in a far corner of the store; even standing 10 feet away, we miss it—until the pharmacist points out a nondescript door and, next to it, a small check-in kiosk.
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Nearby, a flat-screen TV displays something we’ve never seen in a lifetime of doctor visits: a price list for the clinic’s 30-plus services. There are treatments for routine ailments like strep throat ($77), bladder infections ($67) and swimmer’s ear ($62), as well as wellness offerings like camp physicals ($59) and cholesterol screening ($45).
Checking in on a quiet weeknight around 7 p.m., we have the place to ourselves, so the nurse-practitioner ushers us right in for our flu shot. The clinic turns out to be roughly the size of a small kitchen pantry (85 square feet), with few trappings of a medical office—no visible exam table and no eye charts. Instead, there are a few plastic chairs, a supply cabinet and a desk, on which sit a computer and a bottle of hand sanitizer.
And while this location has a small sink, not every MinuteClinic does. Donna Jeskey, then operations manager for MinuteClinic’s New Jersey locations, says, “Using hand sanitizer between each visit, like our nurses do, is just as safe—if not safer—for the patient.†Still, the company says it is currently in the process of retrofitting all of its clinics with sinks.
As our nurse gives the syringe a preparatory flick, she tells us how busy she’s been, administering 50 flu shots alone the day before. Turns out, the majority of the company’s fall and winter business comes from flu shots—a service it aggressively promotes in stores with frequent loudspeaker ads and cardboard placards hanging over nearly every aisle.
To our delight, she also informs us that our insurance fully covers the $30 vaccine. “Nice insurance,†she says. “Do you work for a hedge fund?†Then she flits over to the pharmacy to chat up customers waiting for prescriptions. “I can take a look at your cold,†she offers.
At Take Care Clinics, tucked inside more than 340 Walgreens drugstores, CEO Peter Miller says the biggest challenge is long lines, sometimes stretching almost two hours at popular locations. And it turns out he isn’t kidding. Having developed a sore throat and fever the day after a major holiday, when most doctors’ offices are clamped up tight, we drive to the nearest Take Care Clinic, located on a busy commercial strip in suburban St. Louis. When we get there, the check-in kiosk announces a full two-and-a-half-hour wait.
Had we known that we could, we’d have called ahead to the company’s toll-free number to get the wait time and put our name in the queue. The company says it also staffs some clinics with a “concierge†to manage backups, but on this day there’s none in sight—just a nurse-practitioner pulling double duty. Between patients, she comes to the reception desk, takes our cell phone number and offers to call 15 minutes before she can see us (which she does). At least we don’t end up trapped with the usual collection of magazines.
Once inside the clinic, it feels like a doctor’s office. We find ourselves oddly comforted by the front-and-center exam table, the standing scale and wall-mounted blood-pressure cuff. After taking a fairly detailed history and examining us, the nurse asks what antibiotics we usually take, since we get frequent sinus infections; she then prescribes a different one, explaining that it will keep us from developing a drug resistance.
Two days later, following Take Care protocol, she calls to see how we are feeling and ask if we need additional information or a doctor referral. (The company’s clinicians get bonuses, in part, based on customer satisfaction ratings.) That follow-up is one way that, CEO Miller says, “we’re putting the patient first during every part of the process.†Of course, the company’s not above a little up-selling. Before we leave the office, the nurse suggests we consider a neti pot—one of Oprah’s favorite sinus remedies, she says. “It’s in aisle 10C.â€
Source: SmartMoney
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