Now, wait just a minute

MGMA Connexion, Apr 2006 by Schneck, Lisa H

In-store clinics may lure patients from physician practices

Who would think that a threat to your medical practice could come from the Wal-Mart or Target store down the street?

But if one of those merchants - or supermarkets or chain drugstores - features instore health care, your business could lose patients.

This burgeoning trend is led by Minute-Clinic of Minneapolis, which started in 2000 in several Cub Foods stores. MinuteClinic and its competitors place nurse practitioners or physician assistants on-site in large retailers to provide quick care for common complaints such as sore throats, coughs, ear infections and sinus infections. They can also provide prescriptions and vaccinations and screenings for diabetes, cholesterol, pregnancy, thyroid and heart disease. State laws mandate that quick-stop clinics be supervised by board-certified family practice physicians, available by phone at all times.

MinuteClinic advertises that:

* No appointments are needed;

* Locations are convenient;

* Visits take approximately 15 minutes;

* Services are covered by most insurance plans; and

* Hours are extended and include weekends.

Treatment costs range from $28 to $110, and patients must be 18 months and older. MinuteClinic providers will see patients 16 and 17 years old without an adult hut with written permission from a parent or guardian.

MinuteClinic claims a 99 percent customer satisfaction rate and saving "countless hours of wasted time."1

Competition for primary care practices?

If such stop-while-you're-shopping clinics pose any threat to medical practices, primary care groups are the ones to worry.

Mark Pottenger, clinic administrator, Northwest Family Physicians, a 19-doctor family medicine practice in Minneapolis - the heart of MinuteClinic territory - definitely considers the trend a menace to his group's bottom line. The organization has responded by adopting same-day scheduling in its three offices, installing electronic health records and "aggressively moving forward with e-visits," says Pottenger, a member of the Medical Group Management Association (MGMA). The practice has had evening and weekend hours "for years," he notes, as well as two urgent-care clinics.

Pottenger concedes that his practice hasn't quantified the effect of quick-stop clinics on its business, but says patient volume in one office near a MinuteClinic site has seen a drop-off in some types of visits. His biggest concern is that quick-stop clinics remove the "easy" patients from doctors' schedules, leaving the chronic, complex patients who take more time to treat but don't necessarily generate high revenue.

Practices not in quick-stop clinics' markets don't perceive threat

Some practices without quick-stop clinics in their areas don't express concern. "I don't see a threat. Some people may be comfortable with that [minimal] level of care, but a mom who values a doctor's input won't change. My doctors have extremely strong relationships with their patients," says Kathie Huttegger, FACMPE, a MGMA member and administrator, St. Louis Pediatric Associates Inc., Manchester, Mo.

Pete Mertzanis, MGMA member and practice administrator, TriValley Primary Care, Perkasie, Pa., a 29-physician group, says, "My take on it is that [quick-stop clinics] are not going to do well because they're too expensive. Co-pays [from insurers] will not continue to increase - they have leveled off here - and these clinics then charge about $44 for a visit. If they could do business in the $30-per-visit range, I'd be concerned. I don't see them siphoning off our business long-term."

Although TriValley Primary Care has no quick-stop clinics in its area now, Mertzanis says that if they enter the marketplace, "we'd probably make changes to compete - perhaps in our hours of operation and scheduling more same-day appointments."

Partnership may be one approach

In Atlanta, a city with established quick-stop clinics, at least one family medicine group sees an opportunity rather than a threat. Kendrick Family Practice, a two-provider office, recently partnered with MinuteClinic to receive referrals. "In this market, we have to find any way we can to get people to come to us," says Eric Love, Kendrick's practice manager and an MGMA member. "If one of their patients has issues beyond what they can treat, they will refer to us. We don't feel threatened by them - they do something a little different than what we do."

Pottenger agrees that working together is an option. "I think there's great potential for collaboration. They [quick-stop clinics] have no intention of taking the place of family physicians. They just want to take care of quick, simple things."

That's the outlook that James Woodburn, MD, MinuteClinic chief medical officer, likes to hear. "We have demonstrated that we become part of the community. There's more than enough [patient care] for everybody. We take care of people when doctors' offices aren't open. We're following the same path into the community as urgent-care clinics did in the 1990s. It's hard for some groups to adapt, at first, but then everyone adjusts."