Lorie Vick of Orlando, Fla., had originally stopped at her local CVS drugstore to buy contact-lens solution, but then she saw signs for flu shots. She walked to the back of the store and saw the offer came from MinuteClinic, a mini-healthcare center next to the pharmacy counter that offered treatments for minor ailments ranging from allergies to warts. Fifteen minutes later, Vick got her shot, and the next day she brought her teenage son Tim back for his.
"It would have taken twice or three times as long waiting at my doctor’s office, so this is great," Vick said.
Tim agreed and added, "You can look at more stuff here."
More people are heading to their local drug store instead of their family doctor for medical checkups. Establishments like MinuteClinic, Take Care and RediCare are taking up more space in major retail stores to diagnose, treat and write prescriptions for patients with common illnesses.
MinuteClinic, the nation’s largest operator of retail clinics, has 116 stores in 17 states and boasts of seeing more than 600,000 patients since it started in 2000. It was purchased by CVS last July. Other major retailers, eager to boost profits and customer share, are following suit. Target, Kroger, Wal-Mart and Walgreen are partnering with more than a dozen clinic operators to open thousands of in-store health care centers in the next two years.
Because many clinics just lease space in their stores, retailers don’t expect to make money from the health clinics themselves but rather from increased customer traffic before and after appointments.
They also increase retailers’ emphasis on health care, said Michael Polzin, spokesman for Walgreens, which will have TakeCare clinics in 60 stores by year’s end. "The pharmacy makes up two-thirds of our revenue so we consider ourselves a healthcare retailer anyway. These clinics add to our reputation of being more convenient and accessible to customers."
Cheap, convenient health care
The clinics are typically small, with one or two exam rooms, and are staffed by board-certified nurse practitioners or physician assistants, but usually have a physician's oversight. At Take Care clinics, for example, doctors review 10 percent of patient charts and visit clinics once a month. Clinics can treat anyone over the age of 18 months, but if an ailment is too serious, such as asthma or diabetes, clinics refer patients to a local doctor or emergency room.
No appointments are required, they are open evenings and weekends and visits often take no more than 15 minutes. If the wait is still too long, some clinics give out pagers so people can shop while waiting.
Patients know ahead of time what they’ll pay for their treatment because prices are posted outside each center. For those with health insurance, MinuteClinic charges the office co-pay indicated on the insurance card; those paying out of their own pocket are charged between $49 and $59 per treatment. That compares favorably that to a standard doctor’s visit, which could cost over $100.
Even though most Americans have yet to see these mini-clinics in their corner drugstores, those who have are pleased with the speedy, inexpensive care. A Harris Poll of 2,200 people found that while only 7 percent of respondents had visited a clinic, 89 percent of them were happy with the care they got.
Vicki Partridge paid $39 for a pregnancy testing at an Early Solutions clinic in Taylor, Mich., during her lunch hour. She had gone there for pinkeye treatment a month prior, so the nurse practitioner pulled up her files, saw that she had insurance and was allergic to penicillin. Partridge was in and out within 30 minutes, less time than it would have taken round-trip to her doctor’s office. "It was so worth not having to go through the hassle of making an appointment, and it was probably cheaper," she said.
The clinics say they are not being used only by people without health insurance. A report by the California HealthCare Foundation found they also appeal to high-income consumers with insurance who like the easy convenience.
"A lot of our patients are parents and their children who have busy lifestyles but still want high-quality care," said Donna Haugland, MinuteClinic’s director of operations and a nurse practitioner.
As health-care costs keep rising and companies shift more of the burden onto employees, people will seek out cheaper alternatives. Some health insurers are already waiving the co-pay for visits to the mini-clinics because they are proving to be cost-savers.
"These clinics are serving an underinsured market in a greater capacity than traditional health care has," said Gary Paquin, director of The Paquin Group, a health care retail consulting firm. "Insurance companies are happy because clinics’ lower costs mean people deal with their health care issues faster instead of letting them get to crisis stage and going to the emergency room, which costs far more money."
HealthPartners, a health maintenance organization in Minnesota, analyzed two years of MinuteClinic claims data and found total costs were 25 percent less than those at doctors' offices or urgent-care clinics. The study also found that prescription costs were $3 higher for MinuteClinic clients, and that was attributed mostly to higher prices at store pharmacies and less use of generic drugs.
While Wal-Mart and Target is now selling $4 generic drugs, they are only offering a small part of their total generic inventory at that cost. Other pharmacies are not expected to follow suit since much of their money comes from brand-name medications. Instead, they plan to emphasize retail clinics as the best method of low-cost health care.
"Our market share among seniors has grown twice as fast as any other age groups, so we don’t plan to match Wal-Mart’s prices," said Polzin of Walgreens. "Their offer doesn’t cover any brand-name medication and only covers less than 5 percent of all generic drugs out there." Once customers read the fine print, he said, they’ll see they can get a better deal elsewhere.
Medical community fights back
Many doctors feel threatened by the rise of retail clinics and are fighting back by expanding their office hours and same-day appointments. But some medical groups are taking a ‘can’t beat 'em, then join 'em’ approach. The American Medical Association and the American Academy of Family Physicians issued medical guidelines for the clinics to follow during patient care.
Even hospitals are trying to look more attractive by adding Starbucks outlets, restaurants and medical spas. "Patient revenues are going into decline so hospitals need a new money source," said Paquin. "They’re trying to look more like airport terminal stores, even shopping malls,"
MinuteClinic’s Haugland says operations like hers are a change agent in health care. "It’s a positive force for making medical costs more transparent. We’re now a part of the health care community because we fill the niche of convenient care that people need."
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