Analysis: Clinics not a 'walk-in' the park

By OLGA PIERCE, UPI Health Business Correspondent  |  Aug. 22, 2006 at 11:58 AM
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WASHINGTON, Aug. 22 (UPI) -- Businesses are investing heavily in walk-in health clinics at retail stores, which could be a real boon to consumers who cannot -- or will not -- wait and pay higher prices to see a doctor.

But questions remain about how they will fit into the overall healthcare system.

"It's about access to healthcare," said John Elliot II, chairman and CEO of Arcadia Resources, a medical staffing company that is operating seven clinics at department stores in Indiana and announced this week it will add seven more in Michigan.

Like hundreds of other walk-in clinics popping up in retail settings around the country, the Arcadia clinics will be booths in department stores, staffed by nurse practitioners under the supervision of doctors who are not on-site.

For predetermined flat fees, usually ranging from $35 to $50, such clinics diagnose and write prescriptions for common conditions like strep throat, ear infections, influenza and seasonal allergies, often with little or no wait.

They can be found adjacent to pharmacies or alongside the produce aisle in Walgreen's, Kroger and Wal-Mart stores, and drug store giant CVS recently acquired Minute Clinic, which operates 83 clinics nationwide.

"A lot of Americans don't go to the doctor because of access issues," Elliot told United Press International. "Between the wait and the uncertain cost, it's just a horrible experience."

Walk-in retail clinics, however, are "going to be a great experience. The people we're hiring are going to be people you want to come back and see," Elliot said.

And the clinics offer the convenience of 'I just want to get in and get out of here -- here's my fifty bucks,' he said.

From a business perspective, Elliot said, there is tremendous room for growth. With 55,000 retail outlets in the United States where the walk-in sites could potentially be located, as many as 100 million Americans may find their way into clinics in the next five years.

While in the early days of walk-in clinics, services were provided on a cash-only basis, many insurers are now offering coverage. Given the savings to health plans -- 50 percent or more in many cases -- this seems likely to continue.

But for the underinsured or uninsured, the clinics are about more than just convenience.

Knowing up front exactly how much services are going to cost matters a lot more to customers who have to pay all costs out of pocket, Margaret Laws, director of public finance and policy at the California Healthcare Foundation, told UPI. "Sometimes you have $39 but you don't have $149. Some would say you shouldn't think about cost in healthcare, but if you're low-income and you're going to get a bill, you have to think about it."

Despite these advantages, however, a report released by the foundation in July raises questions about the future of the clinics which are, thus far, a somewhat speculative business venture, Laws said.

From a business perspective, it is not clear if the business interests of the clinic operators and their retail hosts will remain in alignment in a way to make the arrangements profitable for both sides, she said. The goal for clinics is to turn a profit offering services, while the goal for hosts is to increase traffic in their stores and at their pharmacies, and these may not always go together.

It is also not clear whether the phenomenon will catch on at all with consumers, Laws added. "The clinics are really in a test phase right now. Most companies are in the very early stages of roll-out.

"We'll know a lot more in about six months," she said.

Questions have also been raised about the quality of healthcare provided by the clinics -- especially if they are used as a replacement for a traditional primary-care medical office. The nurse practitioners who staff the clinics are not medical doctors, and, unlike at doctor's offices, they are not directly supervised. The clinics are also not equipped to screen for many more complicated conditions.

However, these objections may be based more in philosophy than reality.

Most uninsured individuals lack a medical home already in the fractionalized American healthcare system, Laws said, and clinics are unlikely to make this much worse.

Doctors and clinics are also finding new ways to cooperate. The Arcadia clinics will be operated in partnership with the Physicians' Organization of Western Michigan which will provide medical oversight and ensure best practices in clinic operations.

The American Academy of Family Physicians, while expressing some qualms about the clinics, has issued guidelines about how clinics should be operated as a supplement for doctors' care. For medical records, for example, it is recommended that clinics store information electronically so that it can be easily shared with a doctor's office.

And the care provided by nurse practitioners -- who perform in the walk-in clinics the same services they normally do in traditional medical offices -- is just as good or even better than the care one would get at a doctor's office, Jan Towers, director of health policy at the American Academy of Nurse Physicians, told UPI.

"Safety's really not an issue. Nurse practitioners have a long track record of being very safe, high-quality providers," she said.

In addition to undergoing the training required of registered nurses, nurse practitioners receive extra medical education equivalent to a master's degree. Now ubiquitous at clinics and doctor's offices, they are able to conduct medical evaluations and prescribe medications but are paid about half of the average family doctor's salary.

If anything, Towers said, the nurse practitioners at walk-in clinics are limited in the services they provide by the physical facilities of the walk-in clinics, rather than by their level of training, and the areas in which nurse practitioners specialize, like disease prevention and wellness promotion, make them particularly well-equipped to perform their role at the clinics.

Nurse practitioners also might be better able than doctors to diagnose patients and refer them to the additional care they require, Towers said. "They bring their nursing framework with them. They are very good listeners and that may make people -- especially the uninsured -- talk about their health problems in a way that they might not at a primary care office."

These skills will also help the clinics complement the rest of the healthcare system, she added, because nurse practitioners will catch conditions early, refer patients to the help they need, and relieve some of the strain on clinics and emergency rooms.

"Clearly, if we help keep people healthy, they won't need as much of any kind of healthcare," she said.

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