April 2, 2007

Healthcare, Aisle Three
By Laura Gater
For The Record
Vol. 19 No. 7 P. 24

While picking up a loaf of bread and a gallon of milk, time-conscious consumers can now take care of some healthcare needs as well. Take a look inside retail health clinics and discover how they’re assuming a larger role in the business of healthcare.

While making your weekly trip to the grocery story to stock up on fruits, vegetables, and orange juice, you can also have that earache checked out—without leaving the store. Yes, many grocery stores, in addition to providing photo shops, beauty salons, and banks, now offer health clinics as well. This is truly “one-stop” shopping, the epitome of true convenience for the customer. From strep throat and bladder infections to mononucleosis and influenza, retail health clinics cater to a bevy of ailments.

Thousands of Americans are choosing to save time and money by obtaining medical care at these locations. There are currently retail-based health clinics in 40 states. Most retail health clinics are staffed by physician assistants and nurse practitioners, although some have a physician on site during office hours.

Convenience Attracts Patients
“We believe patients searching for relief from medical symptoms, busy workdays, and overstress who don’t have time to make an appointment and go to a doctor are attracted by our service, and also parents who need their kids treated immediately so as not to miss school,” explains Cris Ross, MBA, chief information officer for MinuteClinic. “We treat common illnesses quickly and efficiently so people can return to their normal lives.”

Headquartered in Minneapolis, MinuteClinic is a subsidiary of CVS Corporation and is the country’s largest provider of retail-based healthcare. It operates 156 retail health clinics in 19 states. MinuteClinics are also located in Cub Foods stores and Quality Food Centers. Certified by the Joint Commission, the clinics, open seven days per week, are staffed by board-certified family nurse practitioners and physician assistants who are supervised by a medical physician who is on call during all hours of operation.

Based in Houston, RediClinic has 35 locations nationally, and operates clinics in H-E-B stores in Texas, Walgreens stores in Georgia, and Wal-Mart stores in Oklahoma, Arkansas, and Virginia. Certified nurse practitioners work with local physicians at RediClinic to diagnose, treat, and prescribe medications for common medical conditions. The clinics also offer health screenings, medical tests, vaccinations, and physical exams, according to Nisha Gidwani, the company’s marketing manager, adding that services are available seven days per week.

RediClinic’s parent corporation, InterFit Health, plans to open 75 new clinics in the next year and 500 new units by 2009, enabling the company to bring its form of nonemergency care to millions of consumers throughout the United States. This expansion will occur partially through its existing retail partnerships, as well as through a new partnership with Walgreens, the nation’s largest drug store chain.

RediClinic offers both “Stay Well” and “Get Well” services. “Stay Well” services include allergy testing, cholesterol profiles, osteoporosis screening, physicals, and vaccinations. “Get Well” services include treatment for cold and flu, pink eye, poison ivy, and urinary tract infections. “Ninety-eight percent of patients rate the care they receive at RediClinic as ‘outstanding,’” says Gidwani.

Protocols Guide Visits
Standard protocol at MinuteClinic includes taking each patient’s basic medical and medication histories, according to Ross. Part of the protocol is also reviewing symptoms, looking at objective data, such as vital signs, and assessing each patient’s condition. “The visit is entirely guideline driven,” says Ross. “Visits are highly structured based on industry-standard protocols.”

Patients seeking the convenience of a retail health clinic usually do not bring in a medical record, electronic or paper. Therefore, adherence to protocols and guidelines is strict to accurately assess each patient’s current medical condition and history and to make a proper diagnosis.

Treatment Without Medical Records
At RediClinic, some patients do bring in personal health records, but that is rare. To compensate for the lack of a medical record, as a part of the registration process, patients are asked questions about their medical history. The nurse practitioner assesses each patient’s condition to determine appropriate treatment and references the medical history when available. “At the request of the patient, RediClinic medical records can be forwarded to the patient’s primary care physician electronically or by fax,” says Gidwani.

At MinuteClinic, it is also rare for patients to bring in their medical records, but a medical history is also taken at registration.

Insurance Pays
Many insurance companies pay for visits to retail health clinics, and most clinics accept the office visit copay indicated on patients’ insurance cards. Treatment prices are posted prominently at retail health clinics. (See sidebar for a sample “menu.”)

MinuteClinic belongs to a large network of nationwide insurers. In fact, Ross says, the majority of visits are paid for by insurance providers. Meanwhile, RediClinic accepts Humana, Aetna, and UnitedHealthcare insurance.

Stores Don’t Benefit
“Although MinuteClinic is wholly owned by CVS, we absolutely do not have any incentive to improve the business of CVS,” states Ross. “We do not have any cross-sell of scripts with CVS. Patients can take their prescriptions anywhere.”

Stores occupied by RediClinic do not benefit from the clinic’s presence either, according to Gidwani, who adds the clinic is merely a tenant. While there is no direct benefit from having a clinic located in a store, it’s obvious there are some residual effects that do help the host store. For example, patients may purchase an assortment of sundry items.

AAFP’s Concerns
The American Academy of Family Physicians (AAFP) has a formal focus group to monitor consumer concerns regarding retail health care. AAFP President Rick Kellerman, MD, says AAFP members are divided over concerns about the quality of retail healthcare. Some are concerned about the quality, or what they perceive as a lack of it, while others realize retail health clinics abide by guidelines and protocols similar to what more conventional medical clinics follow.

“I can’t say that all AAFP members feel the same about retail health clinics,” says Kellerman. Also, he acknowledges that retail health clinics have said they are not a substitute for regular physician care.

“Fragmentary” care is a big problem among patients today. Patients without a regular physician or healthcare insurance usually only seek medical care when they have an acute condition that requires immediate attention, according to Kellerman.

Retail health clinics cannot replace a patient’s personal physician, he says, although they can complement the work of a personal or primary care physician.

Meeting the AAFP Criteria
Last year, the AAFP published a list of “desired attributes” that all retail clinics should have to ensure the safe care of patients. These five attributes (see sidebar) cover scope of service, evidence-based medicine, team-based approach, referrals, and electronic health records (EHRs).

MinuteClinic, RediClinic, and Take Care Health Systems, three of the most prominent retail health companies, have all signed an agreement in support of the AAFP’s desired attributes. In doing so, they have formally recognized the value of a personal medical home in which patients have an ongoing relationship with a family physician or primary care doctor.

In addition, RediClinic has created a National Advisory Board for Clinical Quality to further its commitment to quality healthcare. Founding members include representatives from the AAFP, American Academy of Nurse Practitioners, American College of Nurse Practitioners, and the Joint Commission.

To further enhance the AAFP’s guidelines, the American Medical Association has recently recommended eight principles to ensure that high-quality care is provided at in-store health clinics nationwide. These principles suggest that store-based health clinics: have a well-defined and limited scope of services; have standardized medical protocols derived from evidence-based medicine; are staffed with practitioners who have direct access to physicians; use protocols that ensure continuity of care with physicians in the community; have a local physician referral system; communicate the qualifications of their healthcare professionals; adhere to appropriate sanitary and hygienic guidelines; and encourage the use of EHRs.

For a complete description of the principles, visit www.ama-assn.org.

— Laura Gater’s medical and business trade articles have been published in Healthcare Traveler, Radiology Today, Corrections Forum, Credit Union BUSINESS, and other national and online publications.

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AAFP’s Desired Attributes
In an effort to address concerns about the quality of care provided at retail health clinics, the American Academy of Family Physicians (AAFP) developed a list of “desired attributes” all retail clinics should have to ensure safe care for patients.

• Scope of Service — Retail clinics must have a well-defined and limited scope of clinical services.

• Evidence-based Medicine — Clinical services and treatment must be evidence-based and quality improvement-oriented.

• Team-based Approach — The clinic should have a formal connection with physician practices in the local community, preferably with family physicians, to provide continuity of care. Other health professionals, such as nurse practitioners, should only operate in accordance with state and local regulations, as part of a “team-based” approach to healthcare and under responsible supervision of a practicing, licensed physician.

• Referrals — The clinic must have a referral system to physician practices or other entities appropriate to the patient’s symptoms beyond the clinic’s scope of work. The clinic should encourage all patients to have a “medical home.”

• Electronic Health Records (EHRs) — The clinic should have an EHR system sufficient to gather and communicate patient information with a family physician’s office, preferably one that is compatible with the Continuity of Care Record supported by the AAFP and others.

— Source: American Academy of Family Physicians

MinuteClinic Price List*
Treatments
(Prices listed do not account for application of insurance to the cost of treatment)

Common Illnesses
Allergies (ages 6+): $59
Pink Eye and Styes: $59
Bladder Infections (females ages 12 to 65): $69
Bronchitis (ages 10 to 65): $59
Ear Infections: $59
Sinus Infections (ages 5+): $59
Strep Throat: $69 (48- to 72-hour culture, add $19)
Swimmer’s Ear: $59

Additional Treatments
Flu Diagnosis (ages 10 to 65): $93
Mononucleosis: $69
Pregnancy Testing: $49

Skin Conditions
Athlete’s Foot: $59
Cold Sores (ages 12+): $59
Deer Tick Bites (ages 12+): $59
Impetigo: $59
Minor Burns: $59
Minor Skin Infections and Rashes: $59
Minor Sunburn: $59
Poison Ivy (ages 3+) : $59
Ringworm: $59
Wart Removal (ages 5+): $69

Vaccines
DTaP (Diphtheria, Tetanus, and Pertussis): $65
Flu (October through December): $30
Hepatitis A (adult): $85
Hepatitis A (child): $54
Hepatitis B (adult): $65
Hepatitis B (child): $50

*Prices vary according to region