McClinics

[Guest guest]

I'd be very interested in the opinions of our physicians about this? Also,

have any of us made a response to these settings?

-Wes Ogilvie

Austin TX

'McClinics' serve up fast health care

But some doctors worry the trend is a prescription for trouble.

By _ Ann Roser_

(http://www.statesman.com/news/content/news/stories/local/06/mailto:maroser@stat\

esman.com)

AMERICAN-STATESMAN STAFF

Monday, June 12, 2006

ROUND ROCK — More Americans want their health care delivered fast, like their

burgers, and clinics that promise quick care are popping up across the

country, including one inside Round Rock's H-E-B plus that has been operating

for

more than three months.

Retail clinics in grocery stores, pharmacies and Wal-Marts tap into the " big

box " phenomenon that many consumers can't resist: one-stop shopping at a

chain store that's fast, affordable and convenient. No appointment is

necessary.

There's no insurance paperwork and, often, no waiting.

The RediClinic in the H-E-B Plus on East Palm Valley Boulevard is staffed by

a nurse practitioner who treats about 30 relatively simple conditions such as

respiratory ailments, rashes, digestive problems and urinary tract

infections. The cost is $45. Lab work and screenings cost extra. People with

more

serious or chronic conditions are referred to a doctor or the emergency room.

When the nurse writes a prescription, many patients walk only a few steps to

the

H-E-B pharmacy to fill it.

But some family practice physicians and doctors' organizations worry that

retail health care has a downside. They're concerned about patients

misunderstanding the care they're getting. They also worry about the potential

for

mistakes and the quality of supervision.

" It's not a healthy trend, " said Dr. Larry Fields of Ashland, Ky., president

of the American Academy of Family Physicians. " What people need is a medical

home where all of their medical history resides. Anything that takes away

from that eventually leads to problems. "

RediClinic officials say the goal is to get more patients into a primary care

home and to be a stop-gap measure for the uninsured and the

time-constrained. About half of the people who use RediClinics are uninsured

and don't have a

regular doctor, they said.

" We're not trying to replace any part of the health care system. We're trying

to complement it, " said Web Golinkin, CEO of InterFit Health of Houston, the

parent of RediClinics. InterFit's biggest investor is Revolution Health

Group, created by AOL co-founder Steve Case.

" In the ideal world, it would be great if everybody had a physician and could

get in on a timely basis, " Golinkin said, " but that's just not happening

right now. " a Barron, 35, of Pflugerville, who visited the RediClinic on

Tuesday with her children, said she was thrilled to have the retail option. She

moved with her family from Southern California a month ago and is waiting for

her husband's health insurance to kick in. Her 7-year-old daughter, ,

said a rash on her thumb was hurting. Barron wasn't sure how to handle it, and

the pediatrician she plans to use told Barron a visit would cost $100.

Barron said the RediClinic nurse wasn't sure what was wrong with but

recommended an over-the-counter cream.

" We're going to try some hydrocortisone, " Barron said. " It makes me feel

better " to know what to do.

Barron received a $5 discount coupon for a future visit. Every customer gets

one, to encourage a return. Those who go online and fill out a questionnaire

get a $10 coupon.

Analysts predict the retail clinic trend is here to stay. Consumers are

demanding convenience, and the number of uninsured people continues to climb.

The

clinics plan to expand quickly.

RediClinic, which has 10 other locations — including five in the Houston area

and one in San — has plans for 75 more clinics in the next 12 months

and 500 by 2009, company officials said. RediClinic's larger cousin,

MinuteClinic, has 81 clinics in nine states and plans to triple that by year's

end.

Insured patients who use RediClinic can try to get reimbursed on their own,

but Round Rock clinic manager Pamela Garner-, a nurse practitioner, said

she didn't know how often that works. H-E-B employees and their families,

who she said have turned out to be good users of the clinic, get a $25 discount

if they have insurance from the company's carrier, which Garner- said

doesn't cover clinic care.

RediClinic is negotiating with several big insurers about submitting claims

for patients and hopes to have agreements within six months, Golinkin said.

The goal is to capture people who walk off because their co-payments for doctor

visits are less than $45. Other retail clinics are doing the same thing,

though some critics say that adding insurance to the mix will inevitably drive

up the clinics' costs.

Austin-based health care consultant Preston Gee said the clinics are the

latest examples of medical care on demand.

" In the larger scope of things, we're seeing a migration away from the

traditional medical sites, the hospital campus and the doctor's office, " said

Gee,

senior managing director at Phase 2 Consulting in Austin, a health care

management and economic consulting firm.

The proliferation of same-day surgery centers, imaging centers and, to some

extent, mobile vans that provide screenings are examples of that trend, said

Gee, a former executive with St. 's HealthCare. He expects the retail

clinics to have more staying power than the free-standing urgent care centers

staffed by doctors, with expensive equipment and high overhead costs.

Retail clinics have much lower overhead: They're staffed by nurse

practitioners (highly trained nurses who provide care and write prescriptions

under a

doctor's supervision), the equipment is less costly, and they're inside

stores.

" We used to think that there was inherent value in the venue " of a hospital

or doctor's office, Gee said. " In this particular component, there's value in

the convenience. There's value in accessibility. There's value in cost. We're

a society very interested in those kinds of things. "

He thinks competition in health care can be good.

Fields, with the American Academy of Family Physicians, doesn't think the

clinics compete with doctors and said many of the conditions the clinics treat

would get better if left alone.

Even so, he advises primary care physicians to re-examine how they take care

of patients. More of them should consider working through the lunch hour,

extending office hours into evenings and weekends and accommodating patients who

need same-day appointments, he said.

The Texas Medical Association said its main concern is for patient safety. It

adopted a policy last month to monitor the quality, safety, health outcomes

and coordination of care delivered at the retail clinics.

Dr. Strate, a Wichita Falls pathologist who is chairwoman of the

medical association's panel that developed the policy, said patients who don't

have a primary care doctor are at risk of thinking they are getting more

comprehensive care than they're receiving. She worries that patients with

chronic

problems will try to get primary care at the clinics instead of seeking the

watchful care of a regular doctor.

Garner- said she doesn't treat chronic conditions, such as diabetes.

Although she might do a blood test for a diabetic interested in getting a sugar

level, those patients are referred to doctors, she said. Dr. ph Annis,

an Austin anesthesiologist and chairman of an American Medical Association

council that studied the retail clinics for a report due out this month, said

his concern is that nurses might be inadequately supervised by physicians.

Representatives of the retail industry said the clinics provide limited

services under strict controls. Dr. Steve Berkowitz, chief medical officer for

St. 's HealthCare, said he is not worried about the quality of care or

supervision.

The two nurse practitioners at the RediClinic, along with a certified medical

technician, are overseen by emergency room doctors who practice at Round

Rock Medical Center, operated by St. 's. By Texas law, the doctors are on

site 20 percent of the time. They review charts on site and consult with the

nurses by phone.

The Round Rock clinic, which opened in February, sees a handful of patients a

day. Some days it doesn't see any patients, but Garner- said she

expects traffic to pick up as more people hear of the clinic.

" It's feast or famine, " she said of the flow at the clinic, which is open

from 7 a.m. to 7 p.m. Monday through Friday, 9 a.m. to 5 p.m. Saturday and noon

to 5 p.m. Sunday.

More than half of the patients are store shoppers who happen by, she said.

Some are interested only in screenings. Jim Grooms, 54, of Round Rock asked

technician Ponch how much a liver function test costs. Grooms could

not find the price in a clinic brochure, which was in Spanish only.

, who said English-language brochures were on order, outlined the

blood

tests, totaling $115.

Grooms, who lacks health insurance, was happy with the price. " This would

cost $200-plus at my doctor's office, " he estimated. He would have no

complaints, he added, if the clinic had a brochure he could read.

[Guest guest]

I work PRN for a form of this type of clinic. It is A RV/Bus that has a

schedule each Mo. that it goes and sets up and See's patients. It is true that

this is sometimes the only medical care these people ever see and it is a big

challenge sometimes with the language barrier. We have a Nurse Practitioner and

a Paramedic that staff the bus and a Medical Director that reviews the protocols

and treatments. Many of the patients we see are illegal immigrant's and don't

go to a traditional clinic for fear of being sent back to where ever they are

from. and we don't always speak the same language as they do. We do try our

best and when possible we have a translator explain treatments and doses. We

have a few times had to call the local ambulance for transport for cases that it

was just not safe for us to trust the patient to go on there own, we have never

hesitated to call 911 guess it is the Paramedics in us. We also in the fall

give flue shots and we are also working

with the state and give low cost Immunization's to children. I think we have a

pretty good thing going, it works well for quite a few patients that would not

otherwise seek medical care.

,, LP

ExLngHrn@... wrote:

I'd be very interested in the opinions of our physicians about this?

Also,

have any of us made a response to these settings?

-Wes Ogilvie

Austin TX

'McClinics' serve up fast health care

But some doctors worry the trend is a prescription for trouble.

By _ Ann Roser_

(http://www.statesman.com/news/content/news/stories/local/06/mailto:maroser@stat\

esman.com)

AMERICAN-STATESMAN STAFF

Monday, June 12, 2006

ROUND ROCK — More Americans want their health care delivered fast, like their

burgers, and clinics that promise quick care are popping up across the

country, including one inside Round Rock's H-E-B plus that has been operating

for

more than three months.

Retail clinics in grocery stores, pharmacies and Wal-Marts tap into the " big

box " phenomenon that many consumers can't resist: one-stop shopping at a

chain store that's fast, affordable and convenient. No appointment is necessary.

There's no insurance paperwork and, often, no waiting.

The RediClinic in the H-E-B Plus on East Palm Valley Boulevard is staffed by

a nurse practitioner who treats about 30 relatively simple conditions such as

respiratory ailments, rashes, digestive problems and urinary tract

infections. The cost is $45. Lab work and screenings cost extra. People with

more

serious or chronic conditions are referred to a doctor or the emergency room.

When the nurse writes a prescription, many patients walk only a few steps to the

H-E-B pharmacy to fill it.

But some family practice physicians and doctors' organizations worry that

retail health care has a downside. They're concerned about patients

misunderstanding the care they're getting. They also worry about the potential

for

mistakes and the quality of supervision.

" It's not a healthy trend, " said Dr. Larry Fields of Ashland, Ky., president

of the American Academy of Family Physicians. " What people need is a medical

home where all of their medical history resides. Anything that takes away

from that eventually leads to problems. "

RediClinic officials say the goal is to get more patients into a primary care

home and to be a stop-gap measure for the uninsured and the

time-constrained. About half of the people who use RediClinics are uninsured and

don't have a

regular doctor, they said.

" We're not trying to replace any part of the health care system. We're trying

to complement it, " said Web Golinkin, CEO of InterFit Health of Houston, the

parent of RediClinics. InterFit's biggest investor is Revolution Health

Group, created by AOL co-founder Steve Case.

" In the ideal world, it would be great if everybody had a physician and could

get in on a timely basis, " Golinkin said, " but that's just not happening

right now. " a Barron, 35, of Pflugerville, who visited the RediClinic on

Tuesday with her children, said she was thrilled to have the retail option. She

moved with her family from Southern California a month ago and is waiting for

her husband's health insurance to kick in. Her 7-year-old daughter, ,

said a rash on her thumb was hurting. Barron wasn't sure how to handle it, and

the pediatrician she plans to use told Barron a visit would cost $100.

Barron said the RediClinic nurse wasn't sure what was wrong with but

recommended an over-the-counter cream.

" We're going to try some hydrocortisone, " Barron said. " It makes me feel

better " to know what to do.

Barron received a $5 discount coupon for a future visit. Every customer gets

one, to encourage a return. Those who go online and fill out a questionnaire

get a $10 coupon.

Analysts predict the retail clinic trend is here to stay. Consumers are

demanding convenience, and the number of uninsured people continues to climb.

The

clinics plan to expand quickly.

RediClinic, which has 10 other locations — including five in the Houston area

and one in San — has plans for 75 more clinics in the next 12 months

and 500 by 2009, company officials said. RediClinic's larger cousin,

MinuteClinic, has 81 clinics in nine states and plans to triple that by year's

end.

Insured patients who use RediClinic can try to get reimbursed on their own,

but Round Rock clinic manager Pamela Garner-, a nurse practitioner, said

she didn't know how often that works. H-E-B employees and their families,

who she said have turned out to be good users of the clinic, get a $25 discount

if they have insurance from the company's carrier, which Garner- said

doesn't cover clinic care.

RediClinic is negotiating with several big insurers about submitting claims

for patients and hopes to have agreements within six months, Golinkin said.

The goal is to capture people who walk off because their co-payments for doctor

visits are less than $45. Other retail clinics are doing the same thing,

though some critics say that adding insurance to the mix will inevitably drive

up the clinics' costs.

Austin-based health care consultant Preston Gee said the clinics are the

latest examples of medical care on demand.

" In the larger scope of things, we're seeing a migration away from the

traditional medical sites, the hospital campus and the doctor's office, " said

Gee,

senior managing director at Phase 2 Consulting in Austin, a health care

management and economic consulting firm.

The proliferation of same-day surgery centers, imaging centers and, to some

extent, mobile vans that provide screenings are examples of that trend, said

Gee, a former executive with St. 's HealthCare. He expects the retail

clinics to have more staying power than the free-standing urgent care centers

staffed by doctors, with expensive equipment and high overhead costs.

Retail clinics have much lower overhead: They're staffed by nurse

practitioners (highly trained nurses who provide care and write prescriptions

under a

doctor's supervision), the equipment is less costly, and they're inside

stores.

" We used to think that there was inherent value in the venue " of a hospital

or doctor's office, Gee said. " In this particular component, there's value in

the convenience. There's value in accessibility. There's value in cost. We're

a society very interested in those kinds of things. "

He thinks competition in health care can be good.

Fields, with the American Academy of Family Physicians, doesn't think the

clinics compete with doctors and said many of the conditions the clinics treat

would get better if left alone.

Even so, he advises primary care physicians to re-examine how they take care

of patients. More of them should consider working through the lunch hour,

extending office hours into evenings and weekends and accommodating patients who

need same-day appointments, he said.

The Texas Medical Association said its main concern is for patient safety. It

adopted a policy last month to monitor the quality, safety, health outcomes

and coordination of care delivered at the retail clinics.

Dr. Strate, a Wichita Falls pathologist who is chairwoman of the

medical association's panel that developed the policy, said patients who don't

have a primary care doctor are at risk of thinking they are getting more

comprehensive care than they're receiving. She worries that patients with

chronic

problems will try to get primary care at the clinics instead of seeking the

watchful care of a regular doctor.

Garner- said she doesn't treat chronic conditions, such as diabetes.

Although she might do a blood test for a diabetic interested in getting a sugar

level, those patients are referred to doctors, she said. Dr. ph Annis,

an Austin anesthesiologist and chairman of an American Medical Association

council that studied the retail clinics for a report due out this month, said

his concern is that nurses might be inadequately supervised by physicians.

Representatives of the retail industry said the clinics provide limited

services under strict controls. Dr. Steve Berkowitz, chief medical officer for

St. 's HealthCare, said he is not worried about the quality of care or

supervision.

The two nurse practitioners at the RediClinic, along with a certified medical

technician, are overseen by emergency room doctors who practice at Round

Rock Medical Center, operated by St. 's. By Texas law, the doctors are on

site 20 percent of the time. They review charts on site and consult with the

nurses by phone.

The Round Rock clinic, which opened in February, sees a handful of patients a

day. Some days it doesn't see any patients, but Garner- said she

expects traffic to pick up as more people hear of the clinic.

" It's feast or famine, " she said of the flow at the clinic, which is open

from 7 a.m. to 7 p.m. Monday through Friday, 9 a.m. to 5 p.m. Saturday and noon

to 5 p.m. Sunday.

More than half of the patients are store shoppers who happen by, she said.

Some are interested only in screenings. Jim Grooms, 54, of Round Rock asked

technician Ponch how much a liver function test costs. Grooms could

not find the price in a clinic brochure, which was in Spanish only.

, who said English-language brochures were on order, outlined the blood

tests, totaling $115.

Grooms, who lacks health insurance, was happy with the price. " This would

cost $200-plus at my doctor's office, " he estimated. He would have no

complaints, he added, if the clinic had a brochure he could read.