Re: In-store health clinics take off

Jim Higgins wrote:
In-store health clinics take off
http://www.detnews.com/apps/pbcs.dll/article?AID=/20070827/LIFESTYLE03/708270392


During a very bad allergy flare-up, Crystal Armstrong knew she needed professional help, but without health insurance or a primary care doctor, treatment was likely to be expensive.

So she took a friend's advice and stopped by the Meijer store in Allen Park, where a nurse practitioner saw her as soon as she walked in. The bill for the visit was less than $50 and she was out of the door in 15 minutes with a prescription in hand. "It was a lot cheaper than going to the emergency room," said Armstrong, 23, who has been charged more than $200 for past emergency room visits for minor illnesses. "I was in and out."

Patients like Armstrong have fueled the rapid growth of in-store health clinics in Michigan, which offer quick, low-cost treatment of common maladies such as ear infections, allergies and strep throat. But the idea that people can be treated for bronchitis at the same place they buy their groceries has sparked a turf war between doctors and the growing convenient care industry.

Doctors are raising their eyebrows at what they call a piecemeal approach to health care, while advocates for the convenient care industry insist that patients no longer need to be restricted by long waiting periods and doctors' limited office hours.

Doctors are squealing about unfair competition.
They are plainly panicked that a lot of their easiest money makers are
being lost.

Clinics sprout up in state

In the past 18 months, 28 clinics have sprouted up around the state, mainly in southeastern Michigan. There are about 500 in-store clinics nationwide and the number is expected to grow to 700 by the end of the year and reach nearly 3,000 by 2009, according to the Convenient Care Association.

And they're badly needed in such places where unemployment is high
and most jobs don't offer medical insurance.

The clinics, typically staffed by nurse practitioners and physician assistants, are often open seven days a week and in the evenings. Most clinics accept health insurance, boast no appointments are needed and that visits last about 15 minutes, including wait time.

How could the long time victims of arrogant physicians not love that.

But the growth has prompted the American Medical Association to issue a nationwide advisory calling for states to regulate the clinics -- which operate in places like CVS, Wal-Mart, Target and Meijer -- out of concern that there may be a conflict of interest between the clinics and the pharmacy chains that host them, as well as gaps in holistic care of patients.

Yeah, Like they're really worried about the drug companies.

"Dropping into a clinic to take care of a sore throat isn't the same as being sure that you're vaccinated, managing your diabetes, or your hypertension or your cholesterol fat," said Dr. William A. Hazel, an AMA board member, who added that it's important for people not to substitute the clinics for a family doctor.

People have to be trusted to know when such clinics are appropriate.
In any case, some professional help is better than none, and these
places tell patients when a doctor or emergency room is needed.

Convenient care advocates say they offer patients an easy, affordable routine health care option and that the move by the AMA is a sign that doctors feel threatened by the risk of losing patients.

They're feeling it already in some areas and the meows for help are
getting louder. Soon the AMA will be contributing ever larger amounts
to buy new laws from their representatives.

"There will be tremendous pressure for traditional physicians to be offering more convenient services," said Devon Herrick, health economist for the National Center for Policy Analysis, a nonprofit organization that promotes a competitive, private health sector.

Herrick said doctors are losing money because more people are going to retail health clinics to treat colds and coughs instead of to their primary doctors. "It's basically telling these physicians that they're about to lose -- or that they could lose -- the easy cases," he said.

"Doctors do feel threatened," Hazel said. "You can acknowledge that and still have good, honest, ethical reasons that the retail clinics have to be run properly."

Has there been any evidence that they're not being run properly?

Regulations in the works

In response to doctors' concerns, the Michigan State Medical Society is working with Michigan's Department of Community Health to establish statewide regulations for in-store clinics by the end of the year.

See ?

Among the guidelines they'd like to establish are a limit to the scope of illnesses that can be treated and a patient referral system to local doctors. They also want care providers -- typically nurse practitioners or physician assistants -- at retail clinics to be clear about their qualifications at the outset of a visit. And they want the clinics to maintain electronic records and communicate with patients' primary doctors, said David Fox, medical society spokesman.

Moves that might help raise the costs of the clinics ?

Many clinics are developing networks of local doctors for referral when patients require care beyond what they can provide.

"We are an adjunct to the medical providers in the regions," said Kent Lillemoe, chief financial officer of MinuteClinic, the largest U.S. provider of retail-based health care, which expanded to the Detroit area less than a year ago. "We are not trying to be a medical home for everyone."

Lillemoe said 70 percent of MinuteClinic's patients nationwide have a primary care physician and about 80 percent of them visit MinuteClinic only once a year. With 13 clinics locally, and three more on the way this year, Detroit has become one of MinuteClinic's largest markets. Other retail clinics report similar success in the region. Eight of the 15 clinics in Meijer stores around Michigan are Early Solutions Clinics, which will open seven more Meijer locations by the end of the year.

Patients get affordable option

Some clinic officials say they're providing affordable care for people who'd otherwise go without.

That's the way it appears around here.

Juliet A. Santos, president of Early Solutions Clinic, said that about 40 percent of her patients are uninsured. "We are seeing a majority of people who don't have insurance and they're looking for access and affordability."

Even so, the American Academy of Pediatrics discourages the use of these clinics for children and some parents agree that it's better to stick to their family doctor when it comes to their kids.

"I'd be a little bit concerned about the quality" of care, said Kathleen McCarthy, a Beverly Hills mother of two infant sons. "We just call our doctor after hours."

I'm sure that in Beverly Hills you can do that.
Might not work in Detroit.

The pediatric society's policy on retail clinics outlines concerns about diagnosis without proper follow up, lack of a central health record and irregular monitoring of children with chronic diseases.

"Our concern is that even during so-called minor visits, we use those platforms to check up with the families," said Robert M. Corwin, one of the main authors of the academy's policy on retail health clinics.

Some care IS better than none and for many areas it will reduce the
overload of minor cases for emergency rooms.
.

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