Drugstore Clinics: A Rapidly Growing Option For Sick People

March 28--Lois Gridley wasn't feeling well. She had just taken her 10-year-old son to the pediatrician and he had strep throat. She worried she might have it, too.

But she couldn't get an appointment with her primary-care doctor. So Gridley went online to find the nearest CVS pharmacy clinic and got an examination there.

"I didn't want to wait," Gridley, 51, of St. Clair Shores, said this month at the CVS MinuteClinic in Fraser. "My throat was hurting."

As millions of additional patients are expected to gain insurance through the Affordable Care Act in the next few years, drugstore chains are planning to add hundreds of clinics nationally. In metro Detroit, CVS Caremark and Rite Aid have clinics. Other chains may enter the market.

Since the walk-in clinics opened in 2000, an estimated 15 million people have been treated, according to Convenient Care Association, a trade group. By the group's count, there are more than 1,400 of these clinics in 35 states.

A key selling point for customers is convenience: The retail clinics are close to home, open late and on weekends and no appointment is needed. Patients are seen quickly -- and they can pick up over-the-counter and prescription medications at the same time.

A visit to a metro Detroit CVS starts at $79. Rite Aid, the other major pharmacy chain in Michigan, champions a virtual approach, offering time with nurses and doctors via a video link in the store. Nurse time is free; a 10-minute video chat with a doctor costs $45.

Retail clinics are increasing in numbers and are becoming so popular that 13 states -- including neighboring Illinois and Indiana -- have considered legislation to regulate them, according to a National Conference of State Legislatures report.

Attorney Dan Schulte, whose law firm represents the Michigan State Medical Society, said that from a legal perspective, one question is whether there is proper licensing and supervision of the medical staff.

And some doctors have expressed concerns that patients might try to replace family physician visits with trips to the clinic and that sick people might not get the full spectrum of care they need. The American Academy of Family Physicians opposes pharmacy clinics expanding beyond treating minor acute illnesses.

"We are worried about fragmentation of the health care system," said Jeffrey J. Cain, a doctor and president of the group, which represents more than 105,000 U.S. doctors.

A family physician knows his or her patient and their medical histories and can coordinate overall health care, Cain said.

He said the academy also fears health decisions could be made by people motivated by profit and not overall care.

Cain also pointed to a 2010 survey that showed family doctors changing to better compete by offering some of the same conveniences as retail clinics -- same-day scheduling (73%), extended hours (48%) and weekend appointments (31%).

But, even with those changes, there are limits.

"I can't be there 24/7 and my patients use them (retail clinics)," said Dr. Sharon Geimer, an internist and pediatrician who has a practice in Sterling Heights. "They provide quick care, but continuity can be inconsistent."

Sports physicals

The retail clinics also offer services, such as sports physicals, that might be required by schools and recreation leagues.

Earlier this month, CVS announced a deal to be the official provider of physicals for Pop Warner Little Scholars, a national nonprofit with youth football, dance and cheerleading programs.

CVS, which has 640 clinics nationally, offers a dozen clinics in metro Detroit. They are all branded under the name MinuteClinic and staffed by nurse practitioners.

"MinuteClinic is just another option where people can go for help," said May Hang, the company's state practice manager. "You don't have to go to the emergency room for a sinus infection or an earache."

Last year, Hang said, CVS added two clinics in metro Detroit and hopes to add more. Nationally, the Woonsocket, R.I., company said it aims to open 150 clinics this year and continue expanding through 2017 to hit 1,500 clinics.

Limits to care

Still, Hang acknowledged there are limits to the care the clinics can provide. The MinuteClinics don't stitch wounds or mend broken bones, for example. And Hang said patients who visit too often or have chronic illnesses are urged to visit their family doctor.

The clinic, she said, should not replace a physician's care.

Camp Hill, Pa.-based Rite Aid, the other major pharmacy chain in Michigan with clinics, has nine in metro Detroit. They operate under the NowClinic name, and have partnered with OptumHealth, which provides the doctors and nurses. Instead of in-person visits, however, the company offers a virtual clinic in a retail setting. Patients go to a private room, where they talk to a doctor or nurse for about 10 minutes via video or phone.

"It's live, real time; but no doctor or nurse is in the room with you," said Rite Aid spokeswoman Ashley Flower. "It's the first of its kind."

Rite Aid piloted the clinic concept in metro Detroit in 2011. This month, the company added 58 NowClinics in four more markets -- Baltimore, Boston, Philadelphia and Pittsburgh. The company does not take insurance payments, but the visits can be submitted for insurance reimbursements.

Flower said the virtual clinics are not intended to replace a patient's relationship with a primary-care doctor or hospital.

She said: "If someone comes in and says: 'I have chest pains,' we're going to say: 'You need to go to an emergency room.' "

But as demands for health care grow, retail clinic operators could expand services, especially as they partner with large health systems. CVS has an affiliation with the Henry Ford Health System, which it would like to enhance.

Mike Cannon, the store manager of the Fraser CVS, said a retail clinic "doesn't necessarily translate into more retail sales."

But sometimes it does.

Gridley's strep test turned out to be negative -- and the nurse practitioner who examined her suggested she pick up some saline solution and Zyrtec to treat her symptoms.

Her bill was $116: $89 for the exam, $27 for the test. She paid a $15 insurance co-pay with a credit card.

"Since I'm here," said Gridley, seeming relieved by her diagnosis, "I'm going to shop."

More Details: Detroit-area CVS, Rite Aid clinics

CVS clinics

--35300 Cherry Hill, Canton

--39350 Nine Mile, Farmington Hills

--33021 Garfield, Fraser

--17120 Kercheval, Grosse Pointe

--21777 Twenty-one Mile,

Macomb Township

--720 General Motors, Milford

--44300 Five Mile, Northville

--3010 Walton, Rochester Hills

--2115 Twenty-five Mile, Shelby Township

--30920 Southfield Road,

Southfield

--100 W. Maple, Walled Lake

--4995 Highland, Waterford

Rite Aid clinics

--51341 W. Huron River Drive,

Belleville

--4151 S. Canton Center, Canton

--42481 W. Thirteen Mile, Novi

--24850 Greenfield, Oak Park

--6970 N. Rochester, Rochester Hills

--23201 Marter, St. Clair Shores

--39000 Van Dyke, Sterling Heights

--1971 W. Maple, Troy

--3273 W. Huron, Waterford

How to make the most of your visit

--Keep track of your health care visits, medications and test results.

--Take a written list of questions and symptoms with you.

--Bring your insurance card, and make sure it's up-to-date.

--Take notes for future reference and records.

--Ask about treatment side effects, risks and benefits.

--Share the information with your primary-care physician.

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