FPs Are Key Players in Florida-Based Retail Health Clinics

The emergence of retail health clinics has generated an entirely new prototype for providing acute care. Their hallmark characteristics -- completely open access to acute care services and a published price list for the services provided -- appeal to the public. However, their clinical model -- reliance on nurse practitioners -- causes concern among physicians and, despite surveys indicating high user satisfaction rates, raises some doubt regarding quality of care among patients.

Enter Solantic. Based in Jacksonville, Fla., Solantic staffs its retail health care clinics only with board-certified family physicians, who are supported by medical assistants and who deliver only acute care. The clinic physicians refer any continuity-of-care patients to primary care physicians in the community.

It's a model that meets patient expectations for convenience and affordable prices and that complements the services of community-based physicians who are struggling to meet patient demand, said FP Grant Tarbox, D.O., vice president for clinical operations and chief medical officer at Solantic.

"Our philosophy is to deliver acute care without getting into continuity of care," said Tarbox about the company. When patients present with an ongoing medical condition, he added, "We refer them to the continuity-of-care physicians -- which are the family physicians in the community."

The concept of physician-staffed retail clinics apparently has gotten the most traction on the East and West coasts. LiveWell Medical Clinic opened in San Bruno, Calif., in January, and QuickHealth has two clinics in San Francisco. Like Solantic, these clinics' physicians provide diagnostic and treatment services on a drop-in basis.

Solantic operates 12 retail clinics, including two in Wal-Mart Supercenters, in Florida. Most clinics are open 7 a.m. to 9 p.m. Monday through Friday and 8 a.m. to 4 p.m. Saturdays, Sundays and holidays. Wal-Mart associated clinics are open 9 a.m. to 9 p.m. daily, including holidays.

"We are based on a retail model," said Tarbox. "When patients walk into a clinic, they see a menu of services and prices, and they know what they're going to pay."

Depending on the location, Solantic charges virtually the same as retail health clinics that rely on nonphysician health care workers. For patients who pay cash, prices range from $10 for an à la carte blood pressure screening to $25 for a school or sports physical to $165 for a physician visit that includes diagnostic services and such treatments as sutures; intravenous medication administration; and crutches, braces or cast boots. Patients who have insurance just pay the copayment, and the clinic files their insurance paperwork for them.

"If we get backed up, we give the patients pagers and tell them they can go home or go shopping while they wait," said Tarbox. "Then, 15 minutes before we're ready for them, we page them and let them know their turn is coming. That kind of convenience was unheard of in the health care community. It offers flexibility that people love. They aren't tied to being in the office and they don't lose their spot in line if they want to step out and use their time most efficiently."

The model ensures that Solantic complements rather than competes with family physician practices in the community, according to Tarbox. "In Florida, community doctors now can go home at 4:30 or 5:00, and their voice-mail message advises patients to go to Solantic for after-hours acute care," he said.

The Solantic clinics also provide entry to medical homes for patients who wouldn't otherwise have a regular physician. "Many of these patients weren't being seen by a physician," said Tarbox of the patients seen in Solantic clinics. "Some (community) physicians may be seeing more business because these patients have come in for an acute issue and we've identified a chronic condition" that requires ongoing care in a medical home.

Communication between Solantic and the patient's medical home also is key, said Tarbox. The Solantic clinics maintain electronic health records for each patient, and patients receive a compact disc with all their encounter information, including x-rays, lab results, diagnoses, prescriptions and physician recommendations. Patients can take the CDs to their medical homes, which can integrate the information into the office's EHR or print the information out for inclusion in paper charts.

Solantic clinics also may help reduce inappropriate use of emergency rooms, a significant factor in trying to control escalating health care costs, according to analysts.

"The emergency department provides a significant amount of unscheduled urgent care, often because there is inadequate capacity for this care in other parts of the health care system," says the National Hospital Ambulatory Medical Care Survey: 2003 Emergency Department Summary, released by the CDC in May 2005. (PDF file: 38 pages / 875 KB. More about PDFs.)

The report notes that from 1993 to 2003, the number of emergency room visits grew 26 percent, from 90.3 million to 113.9 million. From 1993 to 2003, the overall emergency department utilization rate in the general population increased by 12 percent, from 35.5 percent to 39.9 percent.

Retail clinics also can offer a balance between work and personal life for staff physicians. Two physicians staff each clinic, and they decide between them what hours they work. Solantic maintains a list of part-time physicians who can fill in during sick leave or vacation.

The company pays a rate that equals or exceeds the average income for family physicians and covers the physician's continuing medical education costs, medical liability premiums, and health and dental insurance. "The model allows the family physician to be a doctor again," Tarbox said. "They have no hospital calls, no after-hours on-call, no pagers. They can go home and enjoy their lives."