'Convenient care clinics' growing, but not all Maryland doctors like

Daily Record, The (Baltimore), Apr 4, 2008 by Karen Buckelew

At the end of the cat food aisle in Target Corp.'s Towson store, Miranda Collins toils away, evaluating sinus infections, dispensing vaccinations and measuring blood pressure.

She's providing a new kind of convenience for customers who've grown used to popping in and out of big-box stores to grab everything from cereal to power tools to new shoes.

Collins is a nurse practitioner, and her little corner of the Towson Target is known as a convenient care clinic, designed to provide quick service for patients with relatively simple medical concerns.

The clinics are a growing phenomenon at retailers including CVS, Wal-Mart and Walgreen's.

Proponents say the clinics give patients what they want -- fast, affordable care when they need it -- while keeping them out of overcrowded emergency rooms and relieving the pressure on overburdened doctors.

But physicians are worried about the loss of the "medical home" - - a primary care doctor who sees patients regularly, maintains thorough records and tracks their care and medications.

"Some physicians have stronger feelings about this than others," said Dr. Edward L. Langston, chair of the board of trustees of the American Medical Association.

Said Dr. Martin P. Wasserman, executive director of the Maryland doctor's association, MedChi: "Somebody's trying to make additional money. While it's convenient for patients, it doesn't provide ongoing continuity of care."

The clinics are a response to a growing need for instant gratification among Americans, according to Dr. Jonathan Weiner, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health.

They also address the demands for more affordable health care options, from both insurers and patients.

"Consumerism and convenience and personal control are things we like in all areas of our life," Weiner said.

"Most people feel none of those things when it comes to their health care," he added.

The clinics are catching on. In 2006, there were 250 convenient care clinics in the U.S., according to the Convenient Care Association, a Philadelphia-based trade group.

The number has since almost tripled, reaching 940 clinics run by 20 companies in 30 states, according to the association.

The clinics have created a new niche in the health industry.

They're a far cry from ordinary medical offices, or even urgent care centers with more comprehensive capabilities.

Most convenient care clinics are staffed by nurse practitioners, sometimes physician assistants. They're often overseen by affiliated doctors -- Greater Baltimore Medical Center physicians work with Target's Maryland clinics -- who review charts and consult when necessary, and take referrals and follow up with patients as well.

Maybe most critical, the clinics will only treat patients suffering from a relatively short list of conditions.

At Target, which began a pilot program for the clinics in Maryland last August, the list includes strep throat, ear infection, flu, minor burns, stitch removal, cold sores, flu shots and more.

They're conditions considered common enough to keep the clinics busy, but not serious enough to require more comprehensive care, according to Dr. Sarah Whiteford, a family practice physician at GBMC who oversees Target's Towson location.

The American Medical Association began developing policies regarding the clinics in 2006. One of its strongest recommendations is that the clinics stick to their brief symptom list.

"The key is to have a limited range of services, a very prescribed protocol of care," the AMA's Langston said.

Treating those conditions is appropriate for the nurse practitioner and doesn't require extensive diagnostic work, emergency care or unusual medications.

"It's inappropriate for patients to utilize the emergency department for something like a sore throat," Whiteford said. "It's more efficient for the patient, and you're saving health care dollars."

The clinics offer bargain prices to both consumers and insurers. In Baltimore, the Target clinics -- which charge from $49 to $69 for various services -- accept five insurance plans, and some plans will reimburse members for care if presented with a receipt, according to Target.

MinuteClinic, the Minneapolis-based chain, began by accepting cash payments from patients for its services, which range from $30 to $110.

Now, in Maryland, it accepts 25 different health plans.

A visit to a doctor's office or emergency department, in contrast, can cost hundreds or even thousands of dollars.

But patients shouldn't have to choose between seeing a doctor they trust or paying their rent, said Wasserman. The core problem, he said, lies within a health care system that has left 47 million Americans uninsured, according to the latest data from the U.S. Census Bureau.

"In our country, we pay too much to receive too little and protect too few," Wasserman said.

CareFirst BlueCross BlueShield, which covers certain services at the clinics, including vaccinations for both flu and pneumonia, prioritizes the medical home for its members, said Dr. Daniel Winn, vice president and senior medical director in CareFirst's medical and networks management division.