- The Washington Times - Wednesday, September 16, 2009

Morgan McHale, 5 — her exhausted eyes peeking over a white surgical mask — is clutching her Barbie while waiting to be seen by a nurse practitioner. “She’s got a fever — about 102 — and a sore throat,” says her mom Courtney McHale.

However, instead of going to see her pediatrician, Morgan and her mom are at a MinuteClinic at a CVS.

Promising cash-strapped, time-squeezed customers a cheaper, faster alternative to certain kinds of doctor vists, MinuteClinic and other retail medical clinics operated by chains such as Target Corp., Walgreen Co. and Wal-Mart Stores Inc. are growing at an explosive rate across the country, perhaps tangibly reshaping the realities of health care delivery on the ground while politicians debate reform in Washington.

“Her pediatrician didn’t have any appointments today so this is my backup,” Ms. McHale explains on a recent afternoon at the clinic in Annapolis near their Davidsonville home. “They’re fabulous here.”

“They” are nurse practitioners Linda Davies and Robiyale Shelley. In other words, there is no doctor on duty.

Is that a problem?

The patients in the “waiting room” — a nook with seven black chairs right next to the aisles of tuna fish cans, M&Ms and cold medicines — don’t seem to think so.

“If I’m really sick, I’m not going to the MinuteClinic,” says Maureen Bondurant, who is at the clinic to get a flu shot. “This is just convenient for things like vaccinations and colds.”

On this recent afternoon the average appointment time — including the wait and the visit with the nurse practitioner — was between 30 and 45 minutes.

Ms. Bondurant’s opinions on the MinuteClinic jibe with the findings of a recent Rand report that shows that retail medical clinics — there are now more than 1,000 nationally — are seen as a complement to regular doctor’s visits (or, in the worst-case scenario, ER visits.).

“Patients don’t see them as replacing their doctor,” says Dr. Ateev Mehrotra , a lead author and researcher of the Rand report.

In fact, a vast majority of patients were able — on their own — to distinguish between a severe condition that needed a doctor’s attention (whether at the ER or office) versus a less severe one that could be treated at a retail medical clinic.

“Patients are showing that they’re self-triaging,” says Dr. Mehrotra, who is board-certified in internal medicine and pediatrics and serves as an assistant professor of medicine at the University of Pittsburgh School of Medicine.

Ms. Davies agrees and says she seldom sees cases that she and her colleague can’t handle and have to refer elsewhere.

“We see a lot of colds, ear infections and strep throat; and we do a lot of vaccinations,” she says. “On rare occasions we will send someone to the ER, but we try not to.”

For example, if someone comes in with a high fever and difficulty breathing and something like pneumonia is suspected, that patient will be sent to the ER, she says.

On this afternoon, though, most patients are waiting for flu shots offered at $30.

The Rand report shows that the retail clinics offer exams at about 60 percent of the cost of a regular doctor’s visit; and about 20 percent of the cost of an ER exam. (For MinuteClinic prices: www.minuteclinic.com/services.)

Most people who visit the clinics have insurance, but Ms. Davies says the frequency of visits from uninsured patients is going up.

(Nationally, according to Rand, about one third of patients visiting the retail medical clinics have no insurance).

Part of the reason the care at the clinics is cheaper, says Ms. Davies, is the lower overhead costs and the fact that the nurse practitioner (instead of a higher paid doctor) does all her own paperwork and billing.

“We’re pretty computer savvy here,” she says while showing off her credit card scanner and computer which holds patient records.

But for Mark Solsman, who was visiting the MinuteClinic in Annapolis to get a flu shot, a time savings is worth more than any money savings.

“I am one of those consumers who would be willing to pay more to a health organization that respects my time,” Mr. Solsman says. “I hope this revolutionizes health care. This fits and respects the schedules of working moms and dads.”

The Annapolis MinuteClinic is open seven days a week and on most holidays.

While there is obvious public demand for quick, inexpensive medical care, there are still questions — both economic and medical — about retail clinics.

Dr. Mehrotra says that while the clinics clearly fill a market niche, it’s less clear that they actually make money.

“We’ll see if it’s a profitable business model,” Dr. Mehrotra says. “If it’s not, it’s not going to grow.”

The American Medical Association cautions that the retail medical clinics — which recently started moving into chronic illness management (such as diabetes and high blood pressure) — should stick to a limited list of services and be upfront with patients about the “qualification of the person providing care.”

“Patients deserve timely access to affordable, high-quality care provided by health care professionals that are appropriately and adequately trained,” adds Dr. Rebecca J. Patchin, chair of the AMA, via e-mail. “Convenience should never compromise safety.”

According to the Rand report, though, convenience did not seem to compromise safety in retail clinics.

But how about the doctor-patient relationship and continuity of care?

“We don’t know what - if any - adverse effects retail clinics would have on the patient-physician relationship,” Dr. Mehrotra says.

But he speculates that it might be weakened if the patient sees the doctor less (due to more frequent visits to retail medical clinics).

“Maybe there will be less trust. But that’s not something we looked at,” Dr. Mehrotra says.

Trust — and gratitude — though, is something Ms. McHale expresses for the MinuteClinic, as she’s ready to fill a prescription for antibiotics for the ear infection with which Morgan was just diagnosed (the exam and treatment report will be sent to Morgan’s regular pediatrician).

The nurse “did it all by herself, and it took no more than 15 minutes,” she says, nodding to Ms. Davies and thanking her.

The entire visit was 30 minutes, and at the end of it, Morgan — relieved of her white surgical mask — walked off with a sugar-free lollipop and a smile from ear to ear.

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