Retail health clinics sprout in area; doctors feel threat, have concerns
By Mike Scott
Retail health clinics have made their way into metro Detroit and are competing with doctors’ offices for routine patient visits.
Clinics contend that the quality of care is high and that when a patient requires urgent care or a visit to a physician’s office, the process is seamless, said May Hang, manager of operations in metro Detroit for Minneapolis-based MinuteClinic, a wholly owned subsidiary of CVS Pharmacy.
Doctors and other groups, though, remain skeptical about how the clinics are operated and consider them a potential competitive threat.
There are 17 MinuteClinic locations in Southeast Michigan, with an 18th opening in Northville this April. All clinics are staffed by certified nurse practitioners who fax or e-mail details of a patient visit to the appropriate primary care physician upon patient permission.
A nurse practitioner is taught to refer a patient to appropriate care immediately if the person shows an abnormal vital sign or requires treatment or diagnosis beyond the practitioner’s skills, Hang said.
Since the retail clinic industry is still in its early stages, it is difficult to track the exact number of clinics currently open in the region or country.
Jack Fyock, vice president at Livonia-based Market Strategies International, said the latest numbers show that there are fewer than 1,000 U.S. retail clinics operating, but that number is expected to reach 1,000 soon. Market Strategies conducted a retail clinic market study in April 2007.
Some expect the number of clinics to grow to 4,000 to 5,000 over the next five years.
Retail clinics are being evaluated by Michigan hospitals and health care systems, said Peter Schonfeld, senior vice president of policy for the Michigan Health & Hospital Association in Lansing. The emergence of these clinics is part of a trend to improve access to care, but physicians are concerned about limited doctor supervision on site.
â€œGetting routine care at a hospital can be an imposing task for some patients, and in those cases providing that care away from the hospital setting can be beneficial to all parties,â€? said Schonfeld. â€œYet (some consumers) who are high risk still will require visits to a physician’s office or a hospital for some of those routine services.â€?
One of the biggest concerns of the MHHA membership is that supervisory roles in a retail clinic setting will remain with physicians themselves, Schonfeld said.
Dr. Chris Bush, a primary care physician in Riverview and a board member with the Michigan State Medical Society, said Michigan also is not equipped to make sure patient care records are shared between clinics and primary doctors.
â€œSome physicians might become involved with retail clinics, but the vast majority wishes they would go away,â€? Bush said. â€œUnless the state of Michigan develops a standardized electronic medical record format, the results of a visit to a retail clinic or even an urgent care (center) may never get back to the primary care physician and become part of the medical record.â€?
While some physicians may consider retail clinics a threat to business, the impact of lost physician practice revenue is due more to Michigan’s economic downturn than the emergence of retail clinics, Bush said. The future impact of retail clinics, though, is unknown, he said.
In adition, many medical concerns handled by a walk-in clinic can either be treated at home by the patient, such as the common cold, or should be something that is handled by a physician, such as vaccinations, Bush said.
â€œNurse practitioners play an important role in health care, but, in general, they don’t have the skill or experience to (properly) diagnosis a patient.â€?
The MinuteClinic locations in the Detroit region have three primary care physicians who are available by phone to support practitioners and also are involved in staff training, Hang said.
About 7 percent of Americans have visited a retail clinic at least once, according to an estimate by the Convenient Care Association, an industry trade group formed last year.
That number is expected to increase as national pharmacy operators such as Wal-Mart, CVS, Target and Walgreen Co. create agreements with miniclinic providers like RediClinic and MinuteClinic.
Support among health insurance companies is growing, although the majority of visits are paid out of pocket now. About 40 percent to 50 percent of clinics accept insurance from providers like Humana Inc., UnitedHealth Group Inc. and Aetna Inc., according to CCA.
It remains to be seen if the clinics will prove to be a profit center for retailers. MinuteClinic offers standard pricing on common ailments. For example, having a sore throat checked costs $59, and a strep throat test would cost an additional $10, Hang said.
To compete effectively, retail clinics need to have the right strategy, Fyock said.
â€œIt can be a viable way of getting basic health care to underinsured individuals, but how effective logistically and financially the clinics will be is being evaluated,â€? he said.