Chattanooga: Doctors push back against retail clinics

By Emily Bregel
http://timesfreepress.com

Minute ClinicSome primary care physicians are pushing back against walk-in health care clinics cropping up in drug and grocery stores to offer quick treatment for simple ailments.

“Some of it is a McDonald’s-ization of medicine,� said Dr. Richard Moody, family physician with Chattanooga Family Practice Associates.

His practice responded to consumers’ “want it now� mindset by opening its own on-site “quick clinic� staffed by physician assistants who treat walk-in patients with coughs, colds and other simple ailments.

The practice even sends letters to patients who have visited retail health care clinics, such as the MinuteClinics in CVS, to advise them of this new option, Dr. Moody said.

“It’s all about responding to the community’s needs and making sure we remain competitive, making sure people understand that we have just begun our own little MinuteClinics, so to speak,� he said.

MinuteClinics and other retail health clinics market themselves as convenient, affordable alternatives to a doctor’s visit when the problem is simple, such as a strep throat, swimmer’s ear, bronchitis or uncomplicated urinary tract infections.

But some doctors argue that a trip to the physician’s office can be just as affordable, with an insurance copay, and at times just as quick.

“Some folks have gone into the minute walk-in and found there’s a lot of people there and they had to wait as long as their regular doctor,� said internist Dr. Charles Adams in Fort Oglethorpe, Ga. He said his office has always had a policy of trying to work in last-minute patients whenever possible.

The average cost of a MinuteClinic visit is $59 or an insurance co-payment, said Ray Howard, manager of operations for MinuteClinic in Chattanooga and Knoxville. With weekend and evening hours, the clinics give a convenient option to health care consumers, he said.

“Health care is becoming consumer driven,� he said. “We’re basically filling a niche of providing health care when the consumer needs it.�

More and more doctors recognize that the clinics’ on-demand health care service is a big draw for busy patients, said Dr. Vince Viscomi, president of the Chattanooga and Hamilton County Medical Society.

A shortage of primary care physicians nationwide means doctors’ schedules often are packed and last-minute appointments might not be available, Dr. Viscomi said.

“Until we change the number of primary care physicians that are available, then these (retail health clinics) will continue to exist just because a primary care doctor can only spread him- or herself so thin,� he said.

Doctors try to make room for those last-minute patients by keeping a few slots free during the day, he said. Some are hiring more “physician extenders,� or assistants who can evaluate simple cases in the doctor’s office and still have access to a physician if needed.

Still, primary care physicians worry retail clinics could undermine their relationships with patients and compromise continuity of care.

A doctor visit for the simple ailment — now treatable at walk-in clinics — can offer a chance to identify a more serious condition, said Dr. Collin Cherry, an internist with Beacon Health Alliance in Chattanooga.

“We’re looking at the whole person,â€? he said. “That encounter for a seemingly minor problem provides an opportunity for follow-up on things that may not be on the patient’s mind. … That’s the way most skin cancers are identified, as incidental findings.â€?

Mr. Howard said retail clinics keep primary care physicians informed when their patients are treated. If a patient already has a primary care physician, documentation of the visit is faxed to the physician, he said. Nurse practitioners at MinuteClinics also refer patients without their own doctors to physicians in the area who are accepting new patients, Mr. Howard said.

Retail health care clinics cannot replace comprehensive primary care, he said.

“I can’t stress enough the importance of keeping the primary care provider in the loop and wanting primary care providers to feel this is a good thing,� Mr. Howard said. “We’re not doing health care for chronic conditions such as diabetes and hypertension.�

GROWTH IN CLINICS

In Tennessee, there are now 25 MinuteClinics in CVS stores. Nationally the number of MinuteClinics has grown from 100 locations in 2006 to 515 currently, according to the company.

Chattanooga’s first retail health care clinic, a Wellspot clinic, opened at the Red Bank Bi-Lo in 2006, but Birmingham, Ala.-based Wellspot went out of business and closed all of its locations in February.

Wal-Mart has begun to roll out its own walk-in health care clinics, though none have opened in Tennessee, said spokesman Dennis Alpert. The company plans to open 400 clinics by 2010, according to a news release.

For Harrison, Tenn., resident Jennifer Johnson, the MinuteClinic was the quickest option when her son Ryan was sick last week.

After staying up almost all night with the 21/2-year- old who had a fever and an earache, she didn’t want to lose any time in the morning before getting him feeling better, she said.

“When I had called my child’s pediatrician, they didn’t have an available appointment until 4 p.m.,â€? she said. “I wanted to go ahead and get him seen and get some medicine started. … I really saw the exact same result today that I would have seen at the doctor’s officeâ€? for the same $20 co-pay.

Dr. Cherry said physicians’ practices will make every effort to fit in a patient who needs a last-minute appointment, so patients should always call their doctor before going to another provider.

An in-person visit sometimes isn’t necessary, Dr. Cherry said. Before heading to a retail health care clinic, “folks need to first see if they can’t be seen or handled (by their primary care physician) over the phone. Oftentimes, patients will just assume that they can’t be,� he said.

regulation

Physicians’ groups in Tennessee have raised concerns about regulating the nurse practitioners and physicians assistants who often staff the clinics.

As required by state guidelines, a supervising physician is available by phone for the nurse practitioners working in MinuteClinics, Mr. Howard said. But doctors here are still concerned that no physician is available on site.

Dr. Viscomi said if complications arise, clinic staff are “going to probably be extra cautious, and figure it’s just safer to send someone to the emergency room�

If a patient were seen in their regular doctor’s office, the physician “might do a couple simple tests and avoid the need for that expensive, time-consuming trip to the emergency room,� he said.

MinuteClinics staff are governed by national treatment guidelines that dictate when patients should be referred to a higher level of care, Mr. Howard said. For example, patients who come to the clinics in need of stitches are referred to urgent care clinics or an emergency room, he said.

Doctors also raised a potential conflict of interest between the clinics, which offer prescriptions, and the pharmacies in which they often are housed.

Mr. Howard said MinuteClinics use electronic prescribing which can send a patient’s prescription to any pharmacy. The prescriptions do not have to be filled at CVS pharmacies.

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