In-store Clinics Give Doctors Heartburn
In June, the American Medical Association prepared to make life tough for the medical clinics cropping up in supermarkets and drugstores around the country. At its annual meeting, the group called for state and federal agencies to investigate potential conflicts of interest between the clinics and pharmacy chains. But instead of calling on the government to create regulatory roadblocks for in-store clinics, many health experts and consumer advocates believe doctors should take lessons from them.
The MinuteClinics, RediClinics, and QuickHealths are spreading fast. After first appearing in Minnesota in 2000, retail outlets numbered 60 nationwide by January 2006, and 280 at the beginning of this year. By 2012, there will be an estimated 5,000 clinics in operation, according to Mary Kate Scott, a healthcare and technology consultant who has analyzed their emergence for the California Healthcare Foundation. Patients get a limited menu of basic medical services for common ailments like strep throat and ear infections, as well as common vaccines. Some clinics do physicals. Prices range from about $50 to $80—and employers often require only a copayment and sometimes waive it altogether.
Typically, retail clinics contract with or are owned by drugstore or supermarket chains. Increasingly, hospital systems seeking to extend their "brand" and provide a whole range of options to consumers are opening clinics as well. Scott notes that the number of hospitals with retail clinics jumped from 15 last year to 60 this year. "The consumer says, 'I like that brand, and I'm more likely to use a clinic if I see they're affiliated with a hospital,'" she says. In a few cases, doctors have begun to own and operate retail clinics themselves. The clinics are generally staffed by nurse practitioners or physician assistants, who are supervised to varying degrees by physicians.
The clinics treat patients on a walk-in basis, and many are open seven days a week, with evening hours. Consumers love the convenience. In a January survey of 11,000 adults by Forrester Research, 56 percent said they visited a retail clinic because its hours were convenient, and nearly half said they went because it was conveniently located. Meanwhile, 28 percent said a too-long wait for an appointment with their doctor prompted them to drop by a retail clinic instead. Would they visit a retail clinic again? More than half said yes.
According to the AMA, however, consumers may be receiving improper care. The association argues that the pharmacy chains that have joint ventures with clinic businesses have an inherent self-interest in seeing that drugs are prescribed and prescriptions filled at their store. "If you own both sides of the operation, shouldn't people look at that?" asks Peter Carmel, a neurosurgeon and AMA board member. He suggests that such arrangements should perhaps either be prohibited or regulated.
Potential conflicts have been addressed, says Kent Lillemoe, chief financial officer for industry pioneer MinuteClinic, a wholly owned subsidiary of CVS Caremark Corp. MinuteClinic operates 200 clinics nationwide, many of them in CVS drugstores. Noting that only about half of patients receive a prescription, Lillemoe says the company doesn't track whether the prescription is filled at CVS or indeed is filled at all. "That's part of our firewall," he says. "We don't think it's appropriate for us to know."
The AMA also objects to the fact that some employers either reduce or waive the copayment when their employees visit a retail clinic instead of a doctor's office, warning that the practice may jeopardize the quality of care. Nonsense, says David Plocher, chief medical officer for Blue Cross and Blue Shield of Minnesota. A BCBS analysis found that a retail clinic visit costs about half what a doctor's office visit costs to manage the same condition, says Plocher, while the quality of care is at least as good. "It's called competition," he says, "and competition is a very healthy thing."
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