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'On-Demand' Healthcare Gaining Ground

In our on-demand society, few are willing to wait for anything anymore and healthcare is becoming no exception. Increasing time demands has spawned a new trend around the country. Two new clinic enterprises, MinuteClinics, Inc. and Take Care Inc.,  promise to get you diagnosed and out the door in just minutes, while you get a gallon of milk for dinner at the same time.

In today's world it should come as no surprise that even medicine and healthcare are available on demand. We’re not talking about urgent or emergency care in a typical healthcare clinic setting.  Instead, minute clinics are popping up at traditional retail stores and shopping centers such as Target and Wal-Mart locations.  For instance, inside a Nashville CVS pharmacy you'll find a MinuteClinic. Their slogan: “You're sick, We're quick.”

The new clinics are aimed at everyone from harried parents dropping by with sick kids on the weekend, to busy professionals ducking in for a prescription during work hours. Generally, at both MinuteClinic and Take Care no appointments are necessary. While the retailers don't profit directly from the new services, the hope is that the clinics will boost business if patients fill their prescription at the store pharmacy, or pick up other items on their way out. (Target's MinuteClinics even offer patients a clip-on beeper after they sign in, to encourage patients to shop until the nurse practitioner is ready to see them.)

“The cost of a patient coming here is a lot less than going to a physician's office or an emergency room or event an urgent care.”

There's no appointment necessary, people are seen on a first come, first served basis. Rhonda Walker showed up recently with a sore throat.  Walker says: “It's a convenient, easy location and you don't need an appointment, you run in and run out.“

There's even a menu of services, from flu and hepatitis to poison ivy and ringworm. The prices are what the patient's insurance company is charged. The companies limit their services to a strict list of roughly 30 basic services and diagnoses, ranging from athlete's foot to tetanus shots.

Neither company allows nurse practitioners to prescribe drugs for health situations that require continuing care such as antidepressants, birth control or heart medications.

Cindy Culpepper, the manager at a Minnesota MinuteClinic says,  “The cost of a patient coming here is a lot less than going to a physician's office or an emergency room or even an urgent care.”   Cost-effectiveness is due to lesser needs for equipment and staff and health plans across the country are embracing this new patient-friendly alternative.   Visits take about 15 minutes.  Currently, under a University of Minnesota health plan, Culpepper says that plan copayments for treatments and screenings at her MinuteClinic are $5 for university employee members of HealthPartners Classic, Patient Choice, and Preferred One. MinuteClinic will submit claims for members of Definity Health. There is no copayment for vaccines.

The idea is growing exponentially. MinuteClinics can be found in CVS and Target stores in three states, including Minnesota. Wal-Mart is working with InterFit Health and other companies to open clinics in Oklahoma, Arkansas, Florida and other states. (The pharmacy chains must partner with outside companies because federal health-care laws banning "self referrals" prohibit pharmacy chains from running their own clinics.)

There are no doctors at either MinuteClinics or Take Care locations, everything is done by a nurse practitioner. That has some physicians believing these patients are taking unnecessary chances with their health because a major problem could be missed.

In one of the more-novel uses of technology employed by Take Care, a computer software program will be involved in actually diagnosing illnesses. The patient's sign-in information will be transmitted electronically to a computer terminal inside the treatment room, where the nurse can enter additional information about the patient's symptoms and conditions as he or she talks with the patient.

The software system will eventually generate a diagnosis and a recommended course of treatment. If the nurse practitioner disagrees with a computer-generated diagnosis, he or she can opt to override the system. When a prescription is written, it will be transmitted electronically to the store pharmacy, or another pharmacy. The system will also create an electronic medical record for each patient that can be transferred to a primary-care physician.

Involvement and encouragement from health plans

Health insurers have embraced the concept because the clinics promise considerable savings. While a typical doctor visit for a basic illness costs an insurer about $110, a visit to one of the clinics usually costs under $60. In addition, the clinic services are far cheaper than the emergency room, which is where patients often wind up when they need medical care outside business hours. (A strep throat test at the emergency room can cost over $300.)

The visits, which start at $25 at MinuteClinics, include such things as flu shots, school physicals and strep tests. The clinics are open at the same time as the store pharmacy, so the companies are hoping you fill your prescriptions there, too. Prescriptions are where they make their money.

Some insurers are actively encouraging patients to use the clinics by lowering the co-pay. In Minnesota, companies including Blue Cross Blue Shield of Minnesota and Graco Inc., have reduced or eliminated co-pays for employees who opt to use a MinuteClinic instead of a doctor. Take Care has deals in place with several insurers in Portland.

Another creative answer is cash-only clinics. The Patmos Emergi-Clinic (Patmos stands for payment at the moment of service) takes cash, checks and credit cards only. Affordable costs make it a boon for low-income and uninsured patients. A typical office standard visit costs $35, a set of blood tests $20 and a pregnancy test $10; all prices are posted. A visit, says Dr. Robert Berry, founder and only doctor, "costs something between an oil change and a brake job."

A visit, says Dr. Robert Berry, "costs something between an oil change and a brake job."

The trend is rapidly spreading in pharmacy chains as they look for means to stem losses to mail-order pharmacies and big-box stores. Three of the nation's largest drugstore chains -- Rite Aid Corp., Brooks Eckerd Pharmacy and Osco Drug -- have announced plans to open health clinics in the coming months. All three have partnered with a Pennsylvania-based health-care start-up called Take Care Health Systems, LLC that will lease space inside the pharmacies and operate the clinics.

Take Care is also in talks with Walgreen Co., the nation's largest pharmacy chain (by sales volume). The first Take Care clinics were expected to open at Rite Aid stores in Portland, Ore., by the end of 2005.  Take Care aims to have 1,300 clinics open by the end of 2007.

Physicians fear mis-diagnoses

The fear, of course, is that with no doctor present — only general medical professionals — a patient could be misdiagnosed. The trend is drawing criticism from some doctors groups, who could lose business if patients turn to the clinics for basic care. Doctors also contend that patients could wind up with lower-quality care because the clinics don't have physicians on site.

"Serious illnesses sometimes present with simple symptoms," says Edward Hill, president of the American Medical Association. "A cough might be something as simple as a cold, or something as serious as congestive heart failure. The ability to ferret out the 20 percent of serious illnesses that present with simple symptoms is why we went to medical school."

To alleviate physician fears, both MinuteClinic and Take Care work with a network of local physicians who are available by phone if the nurse practitioner needs help with a diagnosis. And the companies say the clinics can act as an entryway to the primary-care system because they offer referrals to patients who don't have a doctor.

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