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VOL. 123 | NO. 227 | Wednesday, November 19, 2008

Retail Clinics Continue Rise In Memphis Market

By Tom Wilemon

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QUICK MEDICINE: Anesha Cowan, left, the nurse practitioner at the clinic inside a Walgreens in Cordova, and Elizabeth Jones, lead nurse practitioner for the Take Care Clincs in the Memphis area, say business has steadily increased since Walgreens began providing the service. -- PHOTO BY TOM WILEMON

Walgreens has gotten a jump-start on retail clinics in the Memphis market, but more chain stores are likely to begin offering the service, which has its fans and critics.

Walgreens in September opened four Take Care Clinics in the Memphis metropolitan area and plans to add another four. Wal-Mart could be next through a partnership with RediClinic. Another service, MinuteClinic, has set up operations in Knoxville, Chattanooga and Nashville.

These clinics offer vaccinations, physical examinations, some prescriptions and other health care services with convenience and savings. No appointment is necessary. The average fee for basic services at a Take Care Clinic is between $59 and $74 for cash payers or whatever an insurance co-pay is. A flu vaccination in Memphis costs $25 with no office fee.

The clinics are staffed by nurse practitioners instead of doctors.

“We’re not the answer to the problems that we’re having in this country with the health care system, but we are definitely part of a viable solution,” said Elizabeth Jones, the lead nurse practitioner for the Memphis clinics.

Portal for bigger issues

The first clinics, which are positioned next to the pharmacies, opened here in late September at the Midtown, Bartlett, Cordova and Southeast Memphis stores. The areas targeted for expansion include Olive Branch and Horn Lake.

Anesha Cowan, a nurse practitioner who works at the Cordova clinic, said about 16 to 23 patients visit each day. The most common ailments the clinic has treated are seasonal allergies, upper respiratory infections and sinus infections.

The clinics also do limited diagnostic testing, treat skin conditions, minor injuries and perform physical exams. However, nurse practitioners will advise patients to seek the help of a physician or hospital emergency room when warranted, said Dan Zacchei, a spokesman for Take Care Health Systems, which is a wholly-owned subsidiary of Walgreens.

“There has been a number of cases where people have gone in for one thing at a clinic and been referred to an emergency room or a specialist,” Zacchei said. “We have a story from one patient. He went in to get something routine. The nurse practitioner immediately identified he had a blood clot. They saved his life by making him go to the emergency room right then.

“Even though (a Take Care Clinic is) obviously not somewhere you want to go for an emergency, it still provides that link or that portal into the broader health care system.”

Health on the run

The clinics are especially important to people without health insurance who otherwise might not seek any type of care, he said.

The Take Care Clinics and other retail clinics are on the radar screen of physicians and community clinics. The American Medical Association has issued a policy statement on store-based clinics that calls on them to have direct access and supervision by physicians.

“Store-based health clinics can offer patients an option for routine health care services, but cannot replace the patient-physician relationship,” Dr. William A. Hazel Jr., an AMA board member, said in a statement.

The AMA has also pointed out that not all states have a licensing system for retail clinics. However, there is no such requirement for doctors’ offices, either, in many states.

Tennessee is one of those with no such requirement. Retail clinics have no obligation to report when they open a facility, said Andrea Turner, communications director for the Tennessee Department of Health.

“Retail clinics are not licensed health care facilities through the state,” Turner said. “They are operations similar to a doctor’s office. If there is any issue related to the care or services provided, that information can be reported to the Department of Health, where an investigation will be conducted (to) determine if there has been any violation of an individual practitioner’s license or rules and regulations as set forth by that respective medical professional board.”

The National Association of Community Health Centers issued a report in June on retail clinics that pointed out their limitations.

“Convenient care clinics do not provide comprehensive, ongoing care by design,” the report stated. “In addition to limited acute primary care, convenient care clinics typically provide preventive services, including screening for conditions such as diabetes, hypertension, cholesterol and obesity as well as vaccines. The limited set of services that can be profitably and quickly provided in the convenient care clinic setting precludes comprehensive care.”

A larger issue

However, no one argues that retail clinics provide greater accessibility for people on busy schedules who don’t want to have to wait for an appointment with a doctor or more traditional clinic.

“On the plus side, some of these facilities have more convenient hours,” said Charles “Chuck” Bell, programs director for Consumers Union, the publisher of Consumer Reports. “That is a problem for many patients, as they have trouble getting access to providers after work or on weekends and so on. One of the challenges is just making sure that the patient gets integrated into other systems of care, that whatever data and records that particular clinic encounters, how does that get integrated into some type of primary care system?”

The nonprofit health care consumer advocacy organization Families USA has called for integration between retail clinics and health care providers that can be a medical home for patients.

“The real solution to America’s health care crisis won’t be found in the next hot health trend, or across from the paper towel aisle in your local Wal-Mart,” the organization concluded in its report. “It will be found in comprehensive health care reform that ensures high-quality, affordable health care for all.”

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