A businessman's struggle to obtain a Friday night strep test for his son and a family physician's willingness to stay after hours to provide that test launched a new concept in patient-centered care six years ago.
Family Physician Launched Retail Health Concept
By Leslie Champlin
2/22/2006
That concept -- retail health -- took root in 2000 when FP Doug Smith, M.D., of Long Lake, Minn., and businessman Rick Krieger pondered ways to make urgent care more convenient. They joined businessman Steve Pontius in opening QuickMedx in three Minneapolis-St. Paul area Cub Food Stores. The trio designed the clinics to provide convenient, fast and inexpensive access to basic health care to patients without requiring unreasonable office hours for physicians.
Since then, QuickMedx has transformed into MinuteClinic, expanded to 63 clinics and drawn at least 10 competitors into the retail health arena, including Take Care, MediMinute, The Little Clinic and Solantic.
"There was no way we could copyright the clinics," said co-founder Smith. "It was a concept.”
Since then, QuickMedx has transformed into MinuteClinic, expanded to 63 clinics and drawn at least 10 competitors into the retail health arena, including Take Care, MediMinute, The Little Clinic and Solantic.
"There was no way we could copyright the clinics," said co-founder Smith. "It was a concept.”
Limited Scope of Practice
Minute Clinics limit their services to common ailments and requests -- strep throat, mononucleosis, influenza, female bladder infections, ear infections, sinus infections and pregnancy testing -- that can be identified with a rapid lab test and managed by nurse practitioners using medical protocols that follow national guidelines.
"The idea was to provide a small scope of practice, not urgent care in a grocery store," said Smith. "We did not have an entire clinic setting. And we had a low threshold for referring people to a higher level of care. If they were too acute or too high-risk, they were referred to a physician."
Moreover, Smith had no intention of supplanting his own or other physicians’ practices with the clinics. The clinics were designed to complement physician care by providing convenient services. In addition, retail health can supplement a physician’s patient census by referring repeat customers to local physicians for ongoing care, said Smith.
"If a patient comes in with a sinus infection for a third time, we send him to a doctor," said Smith. "If the nurse sees that a patient has hypertension, she makes sure that person has a doctor who follows up on the blood pressure."
"The idea was to provide a small scope of practice, not urgent care in a grocery store," said Smith. "We did not have an entire clinic setting. And we had a low threshold for referring people to a higher level of care. If they were too acute or too high-risk, they were referred to a physician."
Moreover, Smith had no intention of supplanting his own or other physicians’ practices with the clinics. The clinics were designed to complement physician care by providing convenient services. In addition, retail health can supplement a physician’s patient census by referring repeat customers to local physicians for ongoing care, said Smith.
"If a patient comes in with a sinus infection for a third time, we send him to a doctor," said Smith. "If the nurse sees that a patient has hypertension, she makes sure that person has a doctor who follows up on the blood pressure."
List of Desired Attributes
The AAFP's stance is that retail health clinics should follow a list of desired attributes released by the Academy in December.
- Such clinics should have a well-defined and limited scope of clinical services.
- They should offer clinical services and treatment plans that are evidence-based and quality improvement-oriented.
- They should establish formal connections with physician practices in the community, preferably with family medicine practices, to provide continuity of care. Other health professionals should operate only in accordance with state and local regulations and should be part of a care team operating under physician supervision.
- hey should develop and utilize codified systems for referring a patient to a physician when the patient’s symptoms exceed a clinic’s scope of services.
- They should use electronic health record systems -- preferably, systems that are compatible with the continuity-of-care record supported by the AAFP -- that can communicate patient information to a family physician’s office.
Insurance Plan Approval
Health insurance and managed care companies like the concept of retail health clinics because the services save money. Retail clinics charge an average of $49 to treat most conditions; physician office charges generally run between $85 and $110 for the same service.
The result is that Medicare as well as Aetna, Blue Cross/Blue Shield, CIGNA, UnitedHealthcare and other health insurers cover services at retail health clinics. Some, such as Blue Cross in Minneapolis, waive copayments when patients seek help from retail clinics.
Moreover, people who use retail health clinics overwhelmingly report satisfaction with the services. A 2005 Harris poll indicated 89 percent of patients who used the clinics were satisfied with quality of care, 80 percent were satisfied with cost and 92 percent were satisfied with convenience. MinuteClinic data concur; 99.9 percent of that company's customers said they were satisfied with services provided, according to data collected during the company's four years of operation.
The result is that Medicare as well as Aetna, Blue Cross/Blue Shield, CIGNA, UnitedHealthcare and other health insurers cover services at retail health clinics. Some, such as Blue Cross in Minneapolis, waive copayments when patients seek help from retail clinics.
Moreover, people who use retail health clinics overwhelmingly report satisfaction with the services. A 2005 Harris poll indicated 89 percent of patients who used the clinics were satisfied with quality of care, 80 percent were satisfied with cost and 92 percent were satisfied with convenience. MinuteClinic data concur; 99.9 percent of that company's customers said they were satisfied with services provided, according to data collected during the company's four years of operation.
