Quick Hit Michael Sandler Wednesday January 23rd, 2013, 5:37pm

Pluses And Minuses Of Retail Clinics Still Being Debated

Retail medical clinics in stores such as CVS and Walgreens can be a cheaper and more convenient option for patients seeking relief from minor ailments. But just how these clinics fit in to the country’s health care system, and how much they fragment an already disjointed system, is being debated by primary care physicians and retail clinic representatives.

The clinics accept patients on a walk-in basis, are open on nights and weekends, and accept most insurance plans. But the clinics do not have actual doctors on staff; instead, nurse practitioners and physician assistants attend to the patients. Retail clinics offer treatment for common illnesses, vaccinations, and monitoring of chronic conditions.

According to Walgreens spokesman Jim Cohn, there are more than 360 Walgreens Take Care Clinics across 19 states. Cohn told Progress Illinois that retail clinics are the next logical step in the evolution of health care, and provide cost relief to a health care system that is already overtaxed.

A Rand study found that care provided at the clinics is 30 percent to 40 percent less expensive than going to a physician’s office.  

MinuteClinic, the CVS version of the retail clinic, currently has 35 locations across the state of Illinois, according to Dr. Nancy Gagliano, the MinuteClinic Chief Medical Officer. Gagliano, a former primary care physician who worked at Massachusetts General Hospital for 21 years, said she understands why physicians are uneasy about patients visiting a MinuteClinic. Gagliano said if a patient’s condition goes beyond a nurse practitioner’s safe zone, the patient is referred to a primary care doctor.

“There’s no need for them (doctors) to hunker down and defend their turf,” Gagliano said. “It (the retail clinic) is a supplement, not alternative, to primary care.”

But some in the medical community believe retail clinics can fracture the health care system. Dr. Jeff Cain, president of the American Academy of Family Physicians (AAFP), a Kansas-based organization that represents primary care doctors, said tests can get duplicated at a retail clinic. Or worse, Cain said, medicine prescribed at a retail clinic can cause a reaction because the nurse practitioner may not know what other medications the patient is taking. When a patient then goes back to their primary care doctor, Cain said the doctor won’t know what happened at the retail clinic.

To that end, Gagliano said MinuteClinics are working to improve medical record sharing. In Illinois, she said MinuteClinic has forged a partnership with Advocate Health Care, the largest integrated health system in the state. These partnerships allow for on-duty nurse practitioners to look at a patient’s health records and see what conditions they might have. As soon as the clinic visit is over, the record is saved electronically so the patient’s primary care doctor can see when the patient visited and for what purpose.  

Cain came to the defense of doctors in another area, too. He debunked Gagliano’s theory that doctor’s office hours don’t match up well with people’s busy schedules, saying doctors have recognized the convenience of retail clinics and have more appointment slots open. According to the AAFP’s 2010 Practice Profile Survey of its members, 73 percent said they offer same-day scheduling, more than 48 percent have early morning or evening extended hours, and more than 31 percent offer weekend appointments.

Even though Gagliano doesn’t see a need for primary care doctors and retail clinics to compete, one Chicago doctor views competition as a good thing. Dr. Stacy Tessler Lindau, an associate professor of OBGYN and a practicing physician at the University of Chicago, said competition raises the games of physicians and helps control costs. But overall, Lindau said quality of care is most important, followed by access.

“On the South Side of Chicago, there’s a gap between what people need and what people have,” she said. “I’m open to retail clinics if they can close the gap.”

A member of the Illinois General Assembly agrees with Lindau. State Rep. Mary Flowers (D-Chicago), chairperson of the Health Care Availability Access committee, said there is a place for retail clinics. “There are less doctors in the community now,” Flowers said. “For the times when things pop up, I think the clinics are convenient. But I would never encourage my constituents to use this as their primary care physician.”

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