The Minute Clinic Movement: Model for the Future or 60 Seconds of Fame?
Retail health clinics offer convenience for basic care., but aren't for everyone; financial viability remains an issue
Located in mini-malls and discount stores and sporting catchy slogans such as “You’re Sick, We’re Quick,” a new wave of retail health clinics promise to transform a small piece of the health care landscape, according to a report by the California HealthCare Foundation (CHCF).
The idea behind the clinics is this: As Americans are asked to pay more out of pocket for their medical care, they will begin to approach these purchases with more of a shopper’s eye. It’s an idea gaining in popularity. Last week, drugstore chain CVS announced that it will acquire MinuteClinic, an operator of 83 in-store clinics in ten states.
Proponents believe retail clinics offer a way to help reduce inappropriate use of hospital emergency rooms for basic medical services. For the un- and under-insured, the clinics offer an alternative way to access primary care services. According to the report, Health Care in the Express Lane: The Emergence of Retail Clinics, the number of retail clinics in the United States is poised to grow from fewer than 100 today to several thousand by the end of 2007.
“There’s a scarcity of new ideas about how to improve the cost and delivery of health care, and retail clinics have the potential to bring much-needed innovation,” said Mark D. Smith, M.D., M.B.A., president and CEO of the California HealthCare Foundation. “However, their survival isn’t dependent on successfully competing with physicians; it’s coffee shops, banks, even vending machines—whatever is the most profitable use per square foot for the retailer.”
Thus far, consumers have mixed feelings about the clinics. A 2005 online Harris poll found that 78% of the public thinks the clinics could provide a fast, convenient way to receive basic medical services, but 75% had concerns about the quality of care. Only 7% of the survey’s 2,245 respondents had actually visited a retail clinic.
Questions remain about how the clinics will fare as a business model. Most of the privately owned clinics are leasing space in retail outlets and they will stay in business only if they meet exacting profit targets. Some states, including California, have regulations on the scope of practice of nurse practitioners that make it more costly and difficult to operate such clinics, the study finds.
A Retail Approach to Health Care
In many ways, in-store health clinics are more of a phenomenon for the retail industry than for health care. The retail clinic model relies on low prices, quick throughput of patients, minimal staff, and propriety software systems that can reliably manage selective medical diagnoses and information, only possible with a short list of simple procedures.
Most are staffed with non-physician practitioners (typically physician’s assistants or nurse practitioners) who provide basic medical care, including writing prescriptions, for a limited number of conditions. Visits take approximately 15 minutes and patients with significant or unusual medical concerns are referred to outside physicians.
For people with health insurance, retail clinics may actually cost more out of pocket than the copayments they would typically pay at the doctor’s office. However, according to the study, more clinics are beginning to accept insurance, and in fact, some insurers are starting to encourage their use by offering lower copayments than for a physician office visit.
Surveys indicate that the clinics appeal most to high-income consumers willing to pay for convenience, or uninsured consumers, who have no cheaper alternative and whose work schedules can’t accommodate long emergency room waits.
The California Market
While the size of the California market is attractive to clinic operators and retailers, regulations governing nurse practitioners pose a hurdle because they make it more costly for the clinics to operate. In California, the nurse practitioner must be an employee of a company owned by a physician who supervises them remotely.
As of June 2006, only one of the national chains, Wellness Express, had established outlets in California—all located in Longs Drug Stores in Northern California (Campbell, Davis, and Sunnyvale). Local chains do exist in the San Francisco Bay Area, including Quick Health, which operates a physician-staffed clinic in Farmacia Remedios, a pharmacy that appeals to Spanish-speaking consumers.
Looming Turf Battles
A looming turf battle with physicians may affect the spread of retail clinics. The American Medical Association (AMA) in June established eight guidelines to ensure that patients who visit retail clinics receive high-quality care. The guidelines include asking in-store clinics to follow state laws and general medical protocols, establish ways to interact with local physicians, use electronic health records, inform patients of nurse practitioners’ qualifications, and keep the facilities sanitary and hygienic.
Anticipating these concerns, clinic operators have been firm about their limited scope of practice. For instance, the report finds, the clinics all offer treatment for seasonal allergies, but not asthma, and generally don’t treat chronic conditions such as diabetes.
About the Report
Written by Mary Kate Scott, Health Care in the Express Lane: The Emergence of Retail Clinics is designed to provide a snapshot of the retail clinic field, an industry undergoing constant evolution. It describes the forces, individuals, and companies behind the retail clinics, as well as where they’re located, what consumer needs they are attempting to address, and how they relate to the rest of the health care system.
About the California Health Care Foundation
The California Health Care Foundation is dedicated to advancing meaningful, measurable improvements in the way the health care delivery system provides care to the people of California, particularly those with low incomes and those whose needs are not well served by the status quo. We work to ensure that people have access to the care they need, when they need it, at a price they can afford.