Wednesday, September 26, 2007

Walk-in health clinics flourishing, but many doctors skeptical of care

Tatiana Fredericks needed treatment for minor pain last week, only to learn her doctor had the day off. Mary Ann Arman just moved to South Florida from Texas and learned her kids needed more vaccinations to start school. Both ended up at a walk-in clinic in Pembroke Pines, one in a fast-growing but controversial breed of retail health outlets that promise convenience, speed and low prices. Offering a new choice to the uninsured, clinics are trying to carve a niche handling minor care such as infections, colds and burns. But the clinics — often in drugstores, supermarkets and discount stores — have drawn heavy fire from critics who say they undercut a pillar of m edicine: Patients do best seeing a doctor who knows them.

Some doctors argue that they lose touch with patients who go to retail clinics, that most clinics are run by advanced-trained nurses working alone, that they promote superficial care without follow-up and that they bring sick people near healthy shoppers.

Florida, with many uninsured and transient residents, has emerged as a key start-up area for walk-in clinics in retail stores. The concept is so untested that physicians are divided and not sure what to tell patients who want to go. "It's not really well defined when it's advisable to use these places or when it's not," said Dr. William Hazel Jr., a board member of the American Medical Association from Virginia. "We urge caution. We do see problems with this type of medical care. There's no continuity."

Fredericks sees a role for them. The day her regular doctor was gone, the office worker, 23, dreaded going to an emergency room to wait for hours and pay hundreds. For a sudden illness in the past, she had seen a doctor at a free-standing, walk-in clinic called Solantic, so she went back. "I believe in having a regular doctor. But I felt I needed to get this addressed immediately," Fredericks said. "The clinics, they're just an easy way. I waited 10 minutes and the price is right." She paid $50.

Free-standing walk-in centers have been around for decades, but the rapid spread of nurse-staffed clinics in retail stores in the past year has fueled more opposition to the walk-in model. At least 520 walk-in clinics have opened in U.S. retail stores, and their trade group, the Convenient Care Association, predicts more than 700 this year and 5,000 eventually. Florida has licensed 47 with 15 in the works, according to the Agency for Health Care Administration.

CVS is the biggest player with 262 clinics, including 12 in Broward and Palm Beach counties. Wal-Mart has 76 and plans for 2,000. The chain simply leases space to operators, including the tax-assisted North Broward Hospital District, which next month plans to open its first clinics in South Florida stores, in Lauderdale Lakes and Coral Springs. Publix has 33 clinics, including four in South Florida. Winn-Dixie has three in north Florida. Walgreens has 60 and Target 17, none yet in Florida.

Typically, the clinics are open seven days a week until 8 p.m. No appointments are needed and the average wait is 15 to 25 minutes, the trade group reports. Most have sprouted in suburbs where families usually have health insurance, and 50 to 70 percent of clinic users are covered. Insured patients face a co-pay of about $20. Uninsured or cash patients pay $50 for a basic visit and up to $250 for tests or procedures. Services such as vaccinations start at $20.

Clinics may boast service seldom seen in medicine. Some call patients on their cell phones when a nurse is available, so people can shop or get coffee instead of waiting. Some let patients call ahead to get on a waiting list. "They love that. It's kind of like retail applied to health care," said Karen Bowling, chief executive of Solantic, a Jacksonville chain with 10 freestanding clinics and three in Wal-Marts. Operators contend clinics may relieve crowded hospital emergency rooms in South Florida and nationally, where rising numbers of uninsured patients have boosted traffic.

Some walk-in patients have had no prior contact with a doctor and otherwise would not have bothered seeking treatment. Clinic operators said they urge all patients to get a regular doctor. "Patients need more than one access point to the medical system and our clinics are here if people need that access," said Michael Howe, chief executive of the CVS subsidiary MinuteClinic.

But critics — mainly doctors — say clinics fragment medicine as patients see multiple health providers, none of whom has a complete picture of a patient's health. That raises the risk of drug interactions or missed clues to a serious illness.....


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