Physicians’ Organizations Concerned about Increasing Number of Retail Health Clinics

The first retail health clinic in the U-S opened just seven years ago. The estimated number of clinics now is 300 and that number is expected to increase considerably by the end of the year. Clearly, the idea of quick and convenient health care for common ailments has found an audience. And organized medicine wonders whether the spread of so-called walk through health care will change the practice of primary care medicine. WOSU’s Judith Brachman and Christina Morgan prepared this report on one type of retail clinic appearing in pharmacies in the central Ohio area .

Pickerington resident and MinuteClinic patient Sheryl Cordell is fairly typical of those who visit retail clinics. She has a family physician, but she also has a problem she thinks needs immediate attention what appears to be an infected toe. That’s what brought her to a MinuteClinic.

It’s a great stop gap, says Cordell. So I did not have to make another appointment with my doctor on Thursday when I have an appointment on Monday anyway.

This was Cordell’s first visit to a retail health clinic, and she says she liked the care she received from the nurse practitioner on duty. She told me what to do, bandaged me up, wrote a prescription for antibiotics because it’s definitely infected and told me to follow up with my doctor on Monday when my appointment is.

Cordell did not have to wait, and she did not have to pay out of pocket. Medicare and her gap insurance covered the visit.

The MinuteClinic exam room where Cordell was seen is inside the CVS pharmacy in Pickerington. It is about the size of a respectable walk-in closet. A tiny waiting area outside the exam room and a do-it-yourself sign-in nook indicate the speed at which health care is dispensed. Family Nurse Practitioner Kelly Lehman manages the five Columbus-area MinuteClinics.

We see people as they sign in – typically in a 15 minute appointment, 15 to 20 minutes.

Lehman says 15 minutes is long enough to handle the limited scope of ailments such clinics are prepared to treat.

We see things that are fairly common. The number one diagnosis is strep throat. We also see ear infections, sinus infections, bronchitis, urinary tract infections, all types of skin infections.

Lehman says MinuteClinics will not treat a variety of problems including: abdominal pain, profuse bleeding, anyone whose immune system is compromised or children under the age of 18 months. She says nurse practitioners will refer patients to physicians in the area or, if necessary, to urgent care or a free clinic.

Nurse practitioners staff MinuteClinics 72 hours per week – including evenings and weekends. Under Ohio law, nurse practitioners are supervised by a physician, so a doctor is on call – available by phone to the Minute Clinics – every hour they’re open.

The physician by phone connection is not enough for the Ohio State Medical Association. Family Practice Dr. Randy Wexler speaks for the OSMA when he says one of the biggest concerns organized medicine has about retail clinics is oversight.

In physicians’ offices, there are regulations and oversight to make sure specimens are handled properly bodily fluids. These walk-in clinics do not have oversight and argue they don’t need oversight. Yet, for some of the diagnoses they look at still they would need a urine sample. The Ohio Department of Health has a role in regulatory oversight of retail clinics. But a spokeswoman says, that role is minimal and involves only laboratories contained within the clinics.

Wexler argues that retail clinics further fragment health care in the U.S. Associate Professor in Pediatrics in the Ohio State College of Medicine Ann McLearney says the health care system in the U-S is already beyond fragmentation.

It’s not so much a system as a haphazard combination of provider types and provider locations. What happens is, a lot of individuals – whether or not they have insurance – are not able to get in to see their regular provider within a reasonable period of time.

McAlearney says the debate over retail clinics is less about quality versus convenience and more about who wins the patient, that is, the consumer

When you have a system as overcrowded as we have a physician shortage looming, a nursing shortage now .it’s hard to get in to see your physician. You might have to wait two weeks for something you feel is urgent but isn’t urgent enough to make their cue. Wexler says organized medicine sees a conflict of interest in retail clinics which are generally found under the same roof as a pharmacy and a range of over-the-counter medications. MinuteClinic is a subsidiary of CVS. Nurse Practitioner Kelly Lehman says, patients are given a choice

They can fill a prescription in the store if they want to, but all patients are told they can fill their prescription wherever they like. We have an arms- length relationship with CVS in terms of not sharing numbers and those kinds of things. The pharmacy doesn’t have any relationship with us and vice versa in terms of what we’re prescribing or how many patients are getting prescriptions.

Wexler disagrees. I understand what they’re saying, but let’s look at the reality of it. How many people would seek care in one location and then leave that location to purchase what has been recommended. If they couldn’t make money, they wouldn’t be doing it.

And since retail clinics apparently address a need and hold the promise of making money, Associate Professor in Pediatrics in the Ohio State College of Medicine Ann McAlearney predicts entrepreneurs will find additional ways to offer health care in familiar settings – perhaps a health club.

Specialty clinics specialty hospitals it’s a niche someone saw and capitalized on.

McAlearney also predicts that retail clinics will not be the last surprise in the Marketplace.