Milk, Eggs & 1 Strep Test, Please

September 2006 Special Sections

When Matt Haugen noticed an itchy, red rash on his hands and face the day after going kayaking in early June, he needed to find a doctor. But as a self-employed massage therapist with no health insurance, he followed a tip from a friend and headed to a nearby MinuteClinic at Cub Foods in Minnetonka. Twenty minutes later, he drove home with a diagnosis of poison ivy, two prescriptions, and a good feeling about the experience. 

Getting Inside the Trend
Haugen’s decision to seek medical care in a retail clinic like the Minneapolis-based MinuteClinics, rather than in a traditional primary care setting, is one consumers are making more and more as time and money have become increasingly important considerations.

But while the trend toward “convenience care” is indisputable, there is some debate over the quality and scope of care these clinics can deliver. Although a physician is always available by phone, the clinics are only staffed by physician assistants and nurse practitioners, and there is a clear limit to the services they offer. “We do not take care of headaches, abdominal pain, back pain, or cuts and sprains,” says Jim Woodburn, MD, chief medical officer of MinuteClinics. “Those are conditions that [consumers] should take to a primary care physician or an emergency room.” 

Beverly Krueger, a registered nurse and administrator at Southdale Pediatric Associates Ltd., worries about the risk of valuing speed over thoroughness and high-quality, comprehensive care. “More often than not, we see patients a day or two after having used one of these [convenience] clinics. This can be due to not getting better, [but it also] makes care very fractioned,” she says.

Although many in the health care community share Krueger’s concerns, it seems consumers do not. Loie Lenarz, MD, chief clinical officer for Fairview Health Services in Minneapolis, says retail clinics are an answer to market demand. “Indications are that there will be many more retail clinics than there are today,” she says. “The single most significant driving factor is consumer expectations around accessibility and service, and the health care industry has historically been very poor at understanding that we need to meet those customer needs.”

Patients seeking more convenient care have also turned to urgent care centers to address routine medical needs. According to Jon Bylander, MD, chair of the department of urgent care in St. Louis Park, his department recorded 214,000 patient visits in 2005, a 15 percent increase from the year before. “There seems to be a need out there for access that’s not being fulfilled by the regular primary care clinics or even specialty clinics at times, so it’s a void that we’re filling,” he says.

Transparent Prices and Customer Mentality
Matt Kramer, vice president of sales and marketing for NOW Medical Centers in Minnetonka, says the growth of retail clinics stems from consumers taking more responsibility for their health needs and the development of high-deductible health plans, or health savings accounts. These type of health plans give consumers control of their health care dollars by furnishing them with a savings account to pay for medical expenses. “Health care is literally the most bizarre industry in America because there is no transparency in pricing,” he says. “As the prevalence of consumer health savings accounts increases, people are going to ask ‘how much does this cost?’”

NOW Medical Centers has six free-standing urgent care centers and three retail clinics, and it hopes to open twelve more retail clinics by the fall. “It’s all about referring to our customers as customers—not as patients,” Kramer says. “It’s about treating them like any other customers in the retail environment.”
The experience of visiting a retail clinic is very different from that of visiting a primary care clinic. They typically are small kiosk-type settings in grocery stores or drug store chains, and they treat a limited “menu” of about twenty-five common conditions; mainly strep throat, pink eye, ear infections, bronchitis, sinus infections, and urinary tract infections. They also offer flu shots and other vaccinations.

In the last eighteen months, the number of MinuteClinics, which were recently purchased by CVS Corporation, has risen from nineteen to eighty-four in the ten states in which they are located. By the end of the year, Woodburn says, the number will increase to nearly 250, something he attributes to the convenience factor as well as the unmet health care needs of the uninsured, who often cannot afford a primary care clinic visit.

Prices for typical services are posted in the waiting room at retail clinics, and visits start at just $49. Patients are usually in and out the door in fifteen to twenty minutes and, in most settings, they have to walk only a few steps to get their prescriptions filled at the in-store pharmacy. If there is a wait, patients can calculate how long it will be by multiplying the number of people in the waiting room by fifteen minutes. Or, if they want to run errands while they wait, they can either use a pager and  stay nearby or leave a cell phone number with the clinic and run out to pick up the dry cleaning.

Time at a Premium
The rise of convenience care can also be attributed partly to the  waning of relationships that patients used to have with their primary care physician, says David Johnston, MD, medical  director of WestHealth’s urgent care center. “If you don’t know your doctor, one doctor is as good as another,” he says. Part of the eroding of these relationships is the consumer expectation of quick attention. “If you had a sick relative and you called your family physician on a weekend, you might get a call back in five minutes or five hours,” he adds.

The full impact of the popularity of retail clinics on health care is yet to be realized, but it already can be seen in the same-day evening and weekend hours many primary care and specialty clinics are offering as they strive to become more patient-centric.

Interestingly, many experts interviewed for this article say they view this trend as a much-needed dose of competition for an ailing health care system. “There’s plenty of unmet demand out there,” Woodburn says. “Everyone can win this way.”

To remain competitive, the urgent care center at WestHealth in Plymouth introduced “Express Care,” where patients with a common condition seen in retail clinics can get treated faster than patients with conditions requiring more involved care. Twenty to 30 percent of urgent care patients fall into this category. “They move through faster because it’s a once-in, once-out visit with the physician assistant,” says Pat Karsten, WestHealth’s director of urgent care. “[This is] our attempt to serve that population.”

Urgent care clinics are usually more expensive than retail clinics because they are staffed by physicians in addition to nurse practitioners and physician assistants, they can treat more complex conditions, and they offer diagnostic services, such as magnetic resonance imaging. But not even higher copayments discourage patients who would rather stop by at their convenience rather than take time off of work, because a visit to an urgent care center is still cheaper than a visit to an emergency department. As a result, WestHealth’s urgent care center is seeing a more constant number of patients with conditions that they have to refer to an emergency department. “We’re trending toward more acute usage,” Karsten says.
The Critical Question: What’s Best for the Patient?
Lenarz echoes Krueger and cautions that the proliferation of retail clinics and the withering away of relationships with primary care physicians may carry some risk. “By and large, in its current model—in other words, where the care is delivered isolated from other care patients receive and without a connection to their usual provider—we risk fragmenting care in a way that could lower the quality of it,” she says. “For some patients with significant ongoing health problems, it could be sub-optimal.”

However, Lenarz is also optimistic that retail clinics and primary care clinics could jointly deliver care efficiently and effectively by forming partnerships or by primary care clinics going into the retail clinic business for themselves. “And I suspect that’s where we’re going to see the direction move,” she says. “You try and make it work so that it’s the best thing for the patient.”

One thing is for certain, no one sees this trend going anywhere but up. “I think it’s going to accelerate,” Woodburn says. “There’s pent-up demand.”

Does Your Health Plan Cover Convenience Care?
Once you’ve decided that a convenience care clinic or urgent care center is appropriate for your needs, the next step is determining whether your health insurance will pay for it.

Ask your insurance carrier whether the clinic or center you want to visit is in your provider network. Health care providers typically contract with insurance carriers to offer negotiated rates as preferred providers. As an example, MinuteClinics has contracts with several big insurance carriers, such as Blue Cross Blue Shield of Minnesota, says Roger Feldman, the  Blue Cross professor of health insurance at the University of Minnesota. “If you’re a member of Blue Cross, you now have passed the first hurdle and know that MinuteClinics is a preferred provider in your network.”

The next question is how much you will pay for a visit, or your copayment. Primary care copayments typically range from $15 to $25. However, some self-insured employers will waive some or all of the copayment if an employee visits a convenience care clinic, because they feel it’s worth the cost savings for them. Self-insured employers are usually very large and bear the risk of insuring their employees themselves. Consult your benefits department or benefits manual to see if this situation applies to you.

Once you have determined your copayment, you should be prepared in case the convenience care clinic is not able to care for your condition and refers you to another provider, Feldman says. In that case, you again have to check to see if the referral clinic is in your network. If it isn’t, you may want to consider going to your own primary care provider or another in-network provider.

These steps also apply to visits to an urgent care center, although you will likely pay a higher copayment for an urgent care visit “because they have to be staffed to see patients on demand, so that means they’re going to be more expensive,” Feldman says.