Retail clinics: Should you get into the game?

June 1, 2007

By treating sore throats in a supermarket or pharmacy, medical practices can gain new patients.

Key Points

At the Price Chopper supermarket in Putnam, CT, right behind the pharmacy and next to the cough syrup and Tylenol, a 160-doctor medical group called ProHealth Physicians operates a glorified exam room for walk-in patients.

This space of roughly 150 square feet has an exam table, a computer, a fax machine, a refrigerator stocked with vaccines, and the usual diagnostic and testing gear of primary care. A physician assistant or nurse practitioner treats minor ailments like ear infections, bronchitis, and rashes; charts the patient encounter electronically; and collects the fee, which is $45 for a basic visit. More than half the patients lack a regular primary care physician, so guess where they're referred to for any follow-up treatment? ProHealth Physicians.

The Connecticut doctors see an opportunity where others see a threat. The burgeoning number of clinics in supermarkets, pharmacies, and department stores strikes many primary care doctors as low-cost competitors, since you can staff them with a midlevel. The competition seems more ominous given that insurers have started to pay for clinic visits and even waive copays, potentially steering patients away from their regular doctors to the upstarts in Walgreens and Wal-Mart. Worst of all, the argument goes, retail-clinic care amounts to fragmented care, because patients are better served by a primary care physician who can address their needs in a coordinated fashion.

"We wanted to not only enhance primary care, but also promote our group as a medical home for patients-or in business terms, gain market share," says ProHealth medical director and internist James Cox-Chapman.

Other medical groups are entering the world of retail medicine where brand names like MinuteClinic and Quick Care promise the convenience associated with fast food. It could be an opportunity for you, too, provided that you possess the capital and business smarts to operate outside an office-based practice. We'll explore how doctors are surfing this healthcare wave instead of getting swamped by it.

This bare-bones operation stays within its mission

"Minimalist" is a good way to describe the experience at the new MedAccess clinic. Patients are first supposed to triage themselves after studying a sign outside the clinic that lists what MedAccess won't treat. The sign tells them to go to their regular primary care doctor, a hospital ED, or an urgent care center if they take more than seven maintenance medications, have a temperature over 103 degrees, have a trauma from an automobile accident or work injury, or have any injury that may require an X-ray. Patients under the age of 2 are excluded, too.

The MedAccess clinic has replaced the paper charts in a doctor's office with an EHR system, which automatically enforces what the triage sign says. If an NP or PA checks off that the patient has a temperature of 104 degrees, the EHR system won't let the midlevel proceed with charting the visit.

Computerization makes it easier for ProHealth, composed entirely of primary care doctors, to oversee the work of its midlevels at a distance. RN and clinic coordinator Dale Staub reviews each electronic chart to ensure that patients do not fall under the exclusionary criteria. Physicians assigned to the NPs and PAs also scrutinize the charts.

The NP or PA on duty is a one-person show, signing in patients and collecting their money as well as treating them. Then again, it's been hard to justify a larger staff so far. On a good day, a midlevel might see 15 patients over a nine-hour stretch. "The volume is starting to pick up," notes internist Cox-Chapman.

There are other encouraging signs. Patients express gratitude for the ability to pop in and out as opposed to scheduling a doctor's appointment, says PA Dan Mussen. Cox-Chapman says he hears similar kudos from area businesspeople. "Their employees take less time off from work when they come to us."