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More health clinics opening at drug stores

Baltimore, MD -- February 19, 2015 -- Patricia Williams of Baltimore, who is getting a vaccination, smiles at nurse practitioner Ifeanyi Adeolokun before getting her shot at the CVS Minute Clinic in Harbor East.
Baltimore, MD -- February 19, 2015 -- Patricia Williams of Baltimore, who is getting a vaccination, smiles at nurse practitioner Ifeanyi Adeolokun before getting her shot at the CVS Minute Clinic in Harbor East. (Barbara Haddock Taylor / Baltimore Sun)

Tucked in the back corner of the Rite Aid drugstore on York Road in North Baltimore sits a small medical office with two exam rooms equipped with freezers of vaccines, blood pressure monitors and the many other tools needed to diagnose and treat common illnesses like sinus infections and earaches.

A clinical assistant in scrubs sits at a front desk waiting to assist the next person who shows up with a runny nose or queasy stomach. A nurse practitioner waits in the back ready to provide care. Patients can show up any time during the 12 hours a day the facility is open, no appointment needed.

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Rite Aid Corp. is the latest retailer to jump into the medical clinic market, a concept that has grown exponentially since the first opened in 2000 in Minneapolis. The pharmacy company announced earlier this month that it had opened 24 RediClinics in its stores in the Baltimore, Philadelphia and Washington markets, including 10 in Maryland.

RediClinics are among 1,869 clinics at retailers such as Target and Walgreens that have opened across the country, according to Merchant Medicine, a consulting firm that tracks the industry.

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Many factors are driving the growth, including a doctor shortage, additional people getting insurance under health reform and the aging baby boom population, analysts and retail executives said. Consumers are also paying more out of pocket medical expenses, and retail clinics are more transparent with their prices than hospitals and emergency rooms. Some studies have shown they are less expensive.

"Access to health care services has been an ongoing challenge to the health care system for a number of years," said Jim Cohn, a spokesman for Walgreens, which has one clinic in the region, a partnership with Johns Hopkins Medicine at an East Baltimore store. "We believe retail health clinics are well positioned to meet that need and help bridge critical gaps in health care."

But it's convenience, more than anything else, that's driving the growing trend of what Merchant Medicine has dubbed walk-in medicine. Urgent-care centers, similar to retail clinics but located in stand-alone buildings and with the ability to treat more complex cases, also have seen an influx of patients in recent years.

"We thrive on the fact that we can see you right away," said Agnello Anthony, the practice manager for the retail clinic's in Baltimore-area Rite Aid stores.

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A doctor's office may not be able to see a patient for a few days. New patients sometimes face appointments weeks or even months away. A retail clinic can treat a patient that same day.

The clinics are also open at odd times, when doctors' offices are closed, so people can drop in early in the morning, after work, over the weekend and even on holidays.

At CVS' MinuteClinic locations, 50 percent of those who seek care come in at off times, said Brent Burkhardt, a spokesman for the chain. MinuteClinic is the fastest growing retail clinic, with 960 locations, and it expects to reach 1,500 clinics in the next two years. There are about three dozen in Maryland, including 12 spread throughout the Baltimore region.

Patricia Williams recently visited a MinuteClinic at Harbor East in Baltimore. She winced and turned her head as a nurse practitioner prepared to stick her with an injection of the measles, mumps and rubella vaccine. The nursing student needed to get the vaccine quickly — by the next day — to qualify to start her clinical studies.

Williams was joined by Briana Redd, 18, who studies with her at Columbia Nursing in Randallstown. She needed the vaccine for the same reason.

"If you go to the doctor, they have appointments, but here you can just walk in the same day and get treated the same day," Redd said. "I didn't have time to waste."

The number of consumers like Redd who go to retail clinics increased from 1.48 million in 2007 to 10 million in 2012, according to research by Ateev Mehrotra, an associate professor at Harvard University and policy analyst at RAND, a research and policy organization.

Despite these successes, critics of retail clinics have existed since their inception. The concerns came mostly from doctors' groups worried about quality of care and the possibility that patients might stop seeing their primary care doctors for regular checkups and follow-up care.

In a position paper, the American Academy of Family Physicians said retail clinics can lead to "fragmented" health care if not coordinated with a primary physician. The group believes that retail clinics should only treat minor conditions and should not treat chronic conditions.

"It might be real convenient to run to a drug store and see someone with a white coat who may or may not be a doctor, but that is not the best way to get your healthcare," said Gene Ransom, CEO of MedChi, the state's medical society. "The best way is to have a relationshp with a real physician."

Retail clinic operators, including Rite Aid, said they are not trying to replace primary care, but rather complement it.

"We want to make sure patients receive the best treatment possible," said Robert Thompson, Rite Aid's executive vice president of pharmacy. "We want to make sure when they do have a primary care physician the information is shared for follow-up and to make sure it is included in the record."

Many hospitals are starting to partner with retail clinics to improve the sharing of patient information. But Mehrotra said that sharing information can be difficult because different health systems use various computer systems. It is often left largely up to the patient to share medical information.

And some retail clinics are expanding beyond treatment of minor ailments. Walgreens has begun to treat chronic conditions in its clinics such as high blood pressure, asthma and diabetes — diseases some medical groups think should be left to primary care physicians.

In some states, lawmakers have tried to prevent retail clinics from opening or wanted to restrict their scope, with little success.

It is unclear how profitable retail clinics are for the parent company. While they can drive traffic to the pharmacy and other parts of the store, Mehrotra said, they have high overhead.

"If you took the square footage and stuck Fritos and photos there, you'd make money," Mehrotra said. "Fritos and Cokes just sit there. You don't have to pay a staff."

But Tom Charland of Merchant Medicine said while it takes time to ramp up a clinic, they eventually do bring in profits. Part of the challenge is changing mindsets about where people get health care.

Shoprite of Howard Park recently opened the Q-Care health suite, which is managed by Park West Health Care System in partnership with the nonprofit UpLift Solutions. A clinic spokeswoman said it took a while for people to get used to the concept, but it has caught on.

"The response from the community has been largely good once they figure out it is there," said Patrice Wallace, the spokeswoman. "They don't expect when they go to do their grocery shopping they can also get treated for the flu."

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