Community Voices features opinion pieces from a wide variety of authors and perspectives. (Submission Guidelines)

Retail health clinics are popular, but lack oversight

The story on the website goes something like this. It’s cold in Minnesota during the winter. And when you have a sick child, that cold is your enemy. A small prescription or pinkeye can turn into an ordeal if you end up digging your way out. Doctors’ offices close, and many parents end up in the emergency room with sick kids. One Minnesota dad decided that there must be a better way to deal with the issue. And thus Minute Clinic was born.

Minute Clinic is that ubiquitous storefront nurse who can diagnose very basic issues like ear infections and strep throat in convenient locations like your local pharmacy or (as I discovered recently) the skyway. The idea is simple enough. A person is sick; the problem is not a huge one. A nurse practitioner diagnoses and sends you back out into the world, prescription in hand to take on the day. And hey, if the Minute Clinic happens to be in a pharmacy, even easier.

Ahhh, if life were just that simple. The Minute Clinic “retail health care” model is gaining popularity, growing from just 83 locations in 2006 to over 500 in 2007. By the end of 2008, more than 2,000 locations are projected to be up and running. Much of that growth stemmed from a partnership between pharmacy giant CVS and Minute Clinic. But Minute Clinic isn’t in the retail clinic business alone. There are at least a dozen competitors that follow the same model, with names like MedicalMart and SmartCare. And while expansion and growth in retail clinics is slowing with the economy, it’s still the fastest-growing sector in the medical field today.

Reports of lax regulations
That kind of growth isn’t without its problems. Retail clinics have their share of critics. There have been several reports of lax regulations for the medical professional behind the “counter,” normally a nurse practitioner. In 2007, there were several reports of under- or overmedicating patients. But it’s hard to gauge how many patients had issues after visiting a retail location. There’s just not an independent oversight board for all retail clinics.

In 2007, the American Medical Association released a report over just that issue. Without an oversight board, the report argued, there was no way to make sure that the patients seen were getting quality care. Minute Clinic’s website explains that if offers “thoughtful, caring, and above all, qualified” clinicians to take care of a patient’s medical needs. The website also clarifies that the medical professionals behind the counter monitor each other with peer-to-peer review. According to the website, the physicians on the board review the electronic data from the clinics, but do not oversee individual clinics.

Without that oversight, things can go wrong. Minute Clinic’s public-relations firm released a statement citing accreditation with a nonprofit peer regulatory council called the Joint Commission. however, the Joint Commission doesn’t require that a retail clinic be licensed or certified in order to be a member. A quick call to the Minnesota Department of Health clarified that retail clinics in Minnesota carry a lab license to oversee lab work done at the facilities, but that the facilities themselves are not certified.

The AMA also urged local agencies to look into the partnership between retail clinics and the pharmacies they are located in. While it may be convenient to have a retail clinic inside a pharmacy, it could be viewed as a conflict of interest to prescribe medication to be filled just a few steps away. Pharmacies that have retail clinics on-site have seen a huge spike in pharmaceutical sales, and the retail pharmacy industry is taking notice. You can now find a retail clinic in most major pharmacies, and even in places like Costco.

Relationship with insurers
Finally, the AMA report addressed the relationship between retail clinics and insurance companies. Retail clinics do offer some forms of health insurance. For the uninsured, it can be cheaper to visit a retail clinic than an urgent-care facility. There is some concern that retail clinics have lower copays than a visit to a physician’s office.

The AMA argued that copays should be the same low price for all, so people wouldn’t be tempted to use the retail clinic for more complex care. And for the uninsured, a 2007 report out of California shows that between the $30 to $80 per visit and the cost of medication, the final bill can be hundreds of dollars. For the uninsured, retail clinics just don’t provide an answer.

Retail health clinics are a good example of starting to move Minnesota ideals in the right direction. Trying to make health care accessible for everyone is an ideal that we are known for nationwide. We just need to make sure that we do so in a responsible and regulated manner. We also need to ensure that retail clinics and their partnerships with pharmacies benefit people before companies.

Elizabeth Rich is a graduate research fellow at Minnesota 2020, a think tank based in St. Paul. This article originally appeared on 2020’s website.


Want to add your voice?

If you’re interested in joining the discussion by writing a Community Voices article, email Susan Albright at salbright [at] minnpost [dot] com.

Comments (1)

  1. Submitted by Kenneth Powers on 10/21/2008 - 04:38 pm.

    October 21, 2008

    MinnPost.com

    RE: October 2 article, “Retail health clinics are popular, but lack oversight”

    MinnPost.com is right. Patients should think carefully about where they seek medical treatment—even if it’s for something as seemingly minor as a cold or pinkeye.

    One important way that outpatient clinics such Minute Clinic can demonstrate a commitment to quality and safety is through an independent evaluation known as accreditation. Through its Ambulatory Care Accreditation program, The Joint Commission examines the operation of accredited outpatient clinics from top to bottom, including important areas such as assessing patients, providing needed care, the qualifications of staff, safe medication use, equipment, and emergency procedures. Accredited clinics also must work to continuously improve patient outcomes.

    Patients should seek out accredited facilities (www.qualitycheck.org) and ask detailed questions. The not-for-profit Joint Commission helps consumers find the right outpatient clinic by offering a free “Helping You Choose” guide that outlines questions to ask. (Please visit http://www.jointcommission.org to view the brochure online or call 630.792.5800 to request a copy.)

    For the millions of Americans seeking treatment at outpatient clinics, Joint Commission accreditation offers assurances that a clinic has made a commitment to safe, quality care.

    Sincerely,

    Michael Kulczycki
    Executive Director, Ambulatory Care Accreditation
    The Joint Commission

Leave a Reply