Retail health clinics are expanding incredibly across the U.S. Both Walgreens and CVS Caremark have seen rapid growth of clinic sites. "This year, we added 45 clinics," says Andrew Sussman, associate chief medical officer for CVS Caremark and Minute Clinic President.
Insured patients are increasingly turning to the convenience of drugstore clinics like Minute Clinic and other medical resources outside the traditional doctor's office setting when they can't schedule day-of appointments with their primary-care provider. Some without health insurance say they find them a faster, less pricey alternative to urgent care or emergency room visits.
Almost half of Minute Clinic's clientele don't have a primary-care doctor of their own, Minute Clinic president Andrew Sussman says.
Access to health care is key," says Gabriel Weissman, spokesperson for Take Care Health Systems, which operates nearly 400 clinics inside Walgreens drugstore chains in 19 states.
The satellite medical suites address acute, but not typically life-threatening conditions such as strep throat, flu symptoms and bladder infections. Many offer vaccinations, and sports and camp physicals as well.
Nurse practitioners and physician assistants typically staff the locations. The typical visits to Minute Clinics by children are for conditions such as poison ivy, bronchitis, chickenpox and earaches which do not normally requie physician intervetion.
There are about 1,250 retail-based convenient care clinics in the USA. Two-thirds are in drug stores and one-third are in retail settings, such as Wal-Mart and Target, and supermarket chains, says Tine Hansen-Turton, executive director of the Convenient Care Association in Philadelphia. The growth has been significant, she says: in 2006, there were only 175 such locations.
Retail and drugstore chains are not in the game alone. Health insurers are getting in on the game, too. Cigna Medical Group has 11 CareToday clinics located in strip malls in Phoenix, according to spokeswoman Leigh Woodward. They take uninsured patients, too. A visit for an earache runs $59, not including medication costs.
There are advantages and disadvantages to the clinics, says internist David Winter, chairman of HealthTexas and Baylor Healthcare System, who has a private practice in Dallas. "They're great for quick diagnoses of acute illnesses like earaches and sprained ankles, or for immunizations, but they're not good for the management of chronic conditions such as diabetes and heart failure," he says. He says complicated diagnoses, such as vague chest pains, are best treated by a physician or at a hospital emergency room where diagnostic tests can be run.
Minute Clinics, for example, aren't outfitted to treat concussions, broken bones, and heart attacks. When the condition the patient presents is beyond the nurse practitioner scope of practice they call 911 to gain access to more advanced emergency care. They also don't treat children under 18 months.
Quality of Care is High
Writing in the Sept. 2009 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.
Retail Health Clinics and Health Care Reform
CVS plans to continue expanding in anticipation of the PPACA (Patient Protection and Affordable Care Act)— which goes into effect in 2014 — when more people will have health insurance coverage and access to care, says Anne Pohnert - a CVS family nurse practitioner, who not only staffs the Vienna clinic three days a week, but also is manager of operations for the 16 CVS Caremark Minute Clinics in Northern Virginia.
Health Insurance Coverage and Retail Health Clinics
Retail clinics did begin by targeting patients who were either uninsured and underinsured and paid for most health care out of their own pockets. As retail clinics gained momeentum, health insurers began contracting with retail clinics. At present most patients use insurance, at least partially, to pay for their visits.
In fact Aetna is an example of an insurer that has offered coverage for walk-in or retail clinics since 2005, paying claims no differently than for any other provider.
But some insuers, such as Blue Cross Blue Shield and Health Partners, recognize that care is cheaper at retail clinics and the quality is on par with doctor's offices so they have reduced co-pays for retail clinic visits. According to a 2009 report by RAND Health, an average visit to a retail clinic (excluding lab tests or prescriptions) costs about $66. Compare that to visiting a doctor’s office ($106), an urgent care center ($103) or a hospital emergency room ($570).
