The physicians opposing the mini-clinics are fighting a losing battle. The clinics fill a need, and as long as they don't step beyond their narrowly self-defined role, it is going to be difficult to stop their growth.
Drugstores face scrutiny in race for clinics
By Bruce Japsen
Tribune staff reporter
May 20, 2007
Unable to get an appointment with their regular doctor days before a holiday, Linda Shepherd and her husband stopped in after work at the in-store health clinic at a Walgreens in suburban St. Louis.
There was no wait to get in. A nurse practitioner treated the 46-year-old Shepherd for bacterial pneumonia and her husband for sinusitis.
The couple were able to pick up the antibiotics and decongestants that were prescribed only steps from the small private office where they were examined. Total elapsed time: roughly 30 minutes.
"Either you find a clinic like this or you go to an urgent care center or you go to the hospital," Mrs. Shepherd said. "You don't have much other choice."
Clinics like Walgreens' are the new battleground among retailers that include Wal-Mart Stores Inc. and CVS/Caremark Corp. and are expected to number more than 2,000 in the next few years, five times the less than 400 currently in operation, according to estimates.
Last week the clinic race was accelerated with Walgreen Co.'s purchase of Take Care Health Systems LLC, which will help the Deerfield-based drugstore chain roll out clinics to 400 of its stores by 2008.
The growth in clinics comes in the face of close scrutiny from the medical profession. Doctor groups such as the American Medical Association say clinics should have a well-defined role so patients know they are getting treated for routine maladies. Medical groups also say clinics' nurse practitioners should have direct access to a physician and referral systems so that patients with severe medical issues can be treated elsewhere.
Doctors, too, want to catch a ride on the retail medicine wave. MedicalMarts plans to open "physician-based family practice clinics" in Meijer Inc. supercenter stores in Aurora, Algonquin and St. Charles this summer. Las Vegas-based MedicalMarts has a goal of 400 clinics in retail outlets across the country by the end of 2009.
"What we believe is the next phase is what we are doing because nurse practitioners need to be backed by physicians and we are physicians," said Dr. Kenneth Richmond, a Wilmette physician and vice president and chief medical officer for MedicalMarts.
But even doctors who dislike the retail clinics are hard-pressed to argue about the convenience they offer people with minor maladies. And employers and insurers who pick up the tab expect to see huge savings if these new health models prevent even a small number of people from going to emergency rooms, which can charge hundreds of dollars to treat minor ailments, the specialty of the clinics.
For those without health insurance the retailers' charge is often less than $60. That is significantly less than the $100 or more a doctor would charge for an office visit, analysts say. Out-of-pocket costs for those with health coverage would be the same $20 co-pay at a doctor's office as at a retail clinic, insurers and retailers say.
The Shepherds paid about $60 each, and were pleased with the convenience and the time they saved going to the clinic.
"Maybe this is one of those things to get the doctors to have more weekend hours and later hours because it was nice knowing that I did not have to wait three or four days to go somewhere because I can't always afford to take time off," said Mrs. Shepherd. She also said she had no problem receiving health care from a nurse practitioner in a retail setting, noting that a nurse practitioner in her own physician's office just last week performed her Pap smear because her doctor was busy with other patients.
Yet even in their infancy clinics are becoming busy enough that they do not always treat patients in less than 15 minutes, as some claim. Some patients interviewed by the Tribune say it is not uncommon for exams to last a half hour or longer, especially for first-time visits, when forms need to be filled out.
Take 34-year-old Laurie Estes of Wheeling, who was treated last Tuesday at a Walgreens clinic in north suburban Mt. Prospect. Estes, who was fatigued with congestion, was relieved that she could be helped by the asthma medication Xopenex, a common medicine prescribed to open airways. Her prescription was filled within minutes. She said her wait to see the nurse was five minutes. The entire visit, she said, lasted at least a half-hour.
It might have been longer, but she already had a relationship with the nurse practitioner. "I got lucky that I got the same lady that my son had," Estes said, referring to her 6-year-old son Jake's treatment two weeks earlier for strep throat.
Unlike some of the other retailers, Walgreens does not advertise speedy treatment, said spokesman Michael Polzin. "It's not about the speed and quickness but access [to medical-care service] and convenience."
CVS' MinuteClinic boasts treatments in 10 to 15 minutes. But a company spokeswoman said "first-time patients may take a little longer since they may have more questions about MinuteClinic's services on their first visit."
CVS/Caremark operates more than 150 retail health clinics, including a half-dozen recently opened or scheduled to open in the Chicago area. CVS said it expects to see 25 to 35 patients a day at each of its clinics once they are established.
The clinics are proving attractive to people who do not have medical coverage.
In a recent speech Wal-Mart's executive vice president of finance, Charles Holley, said, "50 percent of our customers that use these clinics do not have some kind of insurance."
Wal-Mart's pharmacy business was one of the few bright spots in the firm's otherwise dim April sales report. The giant retailer had not reported such poor overall sales performance since it began tracking such figures 28 years ago.
Wal-Mart, which now has 76 clinics, said late last month that it plans to open as many as 400 more in U.S. stores in the next three years and more than 2,000 within five to seven years.
In the Chicago area Walgreens clinics have seen 13,000 patients since the first eight clinics opened in November. Today there are 17 clinics in the Chicago area out of about 60 across the country.
Critics, and even consumers who like the retail clinics, say their services are limited and that there is a possibility of being turned away.
"If it's not stitches or something severe, it's a nice thing to do," said Christine Bieruta, of Des Plaines, who made two visits to Walgreens Health Corner Clinic at 1701 E. Kensington Road in Mount Prospect in mid-December. "When I came, it was in the evening and there was a wait but not as long as it would have been at an urgent care center or an emergency room."
But when Bieruta's twin granddaughters got a "nasty cough" the clinic said it couldn't see them because it does not treat patients under 18 months old. "My daughter was going to bring the twins but they were too young," Bieruta said.
Physician lobbies such as the Illinois State Medical Society say the clinics' nurse practitioners need to have direct access to and supervision by doctors. The Illinois group is pushing a proposed bill that would require that doctors collaborate with no more than two nurse practitioners.
A Walgreens spokesman said the company's clinics are adequately supervised by doctors and hospitals, and added that nearly 20 percent of patients at its Chicago-area clinics have been referred to "a primary care office, specialist or urgent care center for follow-up treatment." The majority were referred to primary care physicians, the spokesman added.
Still, at least one Joliet pediatrician questions the Walgreens referral system. He said he has seen children who were misdiagnosed at one of the chain's clinics three blocks from his practice and that its pharmacies have never contacted him about caring for his patients.
"I have not had one fax [about any of his patients] from the Walgreens," said Dr. Paul Tortoriello of Will County Medical Associates.
Tortoriello said he has had follow-up visits from his patients who had gone to the retail clinics only to come to his office on their own days later. In one instance, he said, a child who was misdiagnosed with strep throat had an allergic reaction to an antibiotic that was prescribed by the clinic's nurse practitioner. Instead, the child had a virus and it worked its way through the child's system. He did not disclose the identity of the patient, citing federal privacy laws.
"It's not that we physicians are so high and mighty that we sit on a pedestal. But nurse practitioners are just not as qualified, and I see 30 or 40 sick kids a day," Tortoriello said.
Retailers say the relationships with doctors and hospitals are getting stronger every day. The Chicago area's largest hospital operator, Advocate Health Care, for example, and its doctors have a referral relationship with Walgreens clinics that includes efforts to ensure quality such as peer review of clinic treatments and practices.
----------
bjapsen@tribune.com
Copyright © 2007, Chicago Tribune
chicagotribune.com |
