Clinics In Stores, Cash-Only Doctors Shake Up Pricing

June 22--The rising cost of health-care, along with higher insurance deductibles and co-pays, is fueling changes in the way medical services are being delivered.

Retailers, such as grocery and drugstore chains, who have for years offered in-store vaccinations, have expanded to set up full-scale health clinics inside stores. These clinics, unlike hospital ERs and urgent care centers, display pricing information upfront for consumers paying cash.

In addition, some physicians who have grown weary of the rising demands from insurance companies are changing to cash-only systems.

Although both trends have been spreading across the country for several years, Toledo consumers are just beginning to have access to these nontraditional service models.

South Toledo resident Erica Banas, 39, found herself fighting a stomach bug that has been circulating in the area for months. But instead of going to her doctor or an urgent care, she sought help at her nearby Kroger store.

When Kroger opened its new marketplace store in Holland, on Orchard Centre Drive in January, the grocery retailer brought the retail medicine into the Toledo market.

Although Kroger has operated health clinics in its stores in other cities for years, this was the first of its kind in northwest Ohio, said Meggan Brown, regional clinical director for the Little Clinics.

The Little Clinic inside the Kroger store offers seven-day-a-week services for common ailments.

Patients can be treated on the spot by a nurse practitioner without an appointment, Ms. Brown said. Patients who are paying with cash also can get immediate information about the cost of services as they are displayed on a bright video monitor in the waiting area.

Typical visit is $85

"A typical sick visit is $85. If there are any additional charges, we will tell you upfront and if additional tests are needed, we are not going to do it without your permission," Ms. Brown said.

The Little Clinic company started in 2003 and has grown from six locations in 2006 to 162 locations in 2015, said Jennifer Martin, spokesman for the clinics. Kroger purchased the company in 2010 so the clinics are now located exclusively in its stores.

"It's kind of nice. It's right down the street and I don't have to run to the doctor for just something really minor. I can just come here and be able to get treated for little minor things," Mrs. Banas said.

The stomach flu that Mrs. Banas was suffering from is one of a handful of common problems that the clinic has been treating in the past few months, said Kathryn Fischer, one of the two family nurse practitioners who oversee care at the clinic.

The clinic is also treating coughs, colds, flu symptoms, poison ivy, and performing numerous sports physicals for children, said Pat Stewart, patient care technician, who is the first to greet and check-in patients at the front desk.

"It gets busiest in the afternoon and on weekends when people are off work," she said.

Although cash prices are posted for all services, most patients are billing costs through their insurance companies at rates that are similar to those a doctor's office would charge, Ms. Fischer said.

"Some people have high deductibles and would rather pay $85, the cash price, than bill their insurance," she said.

No X-rays

The clinic can perform many medical services.

But unlike an urgent care or an emergency department, it cannot provide imaging such as X-rays or lab services.

Ms. Fischer can write prescriptions, however, and receive results for patients at her site, she said.

She works closely with physicians at area urgent care centers and will send patients there if they need services the clinic can't offer, she said.

"I can't suture in my clinic. I will call the urgent care doc and say I have someone who sliced their hand and ask him to assist," Ms. Fischer said.

Although company officials would not say how many patients use the clinic, they said the numbers continue to grow since it opened this year.

One reason Kroger didn't open health clinics in the Toledo area earlier was a lack of nurse practitioners, Ms. Brown said.

The company is now finding candidates through a program at the University of Toledo Health Sciences Campus.

Kroger plans to open a second Little Clinic in a store it hopes to build at Secor Road and Monroe Street, spokesman Jennifer Jarrell said.

Kroger is awaiting approval from the city of Toledo to construct that marketplace store on 19 acres in West Toledo.

"As Kroger continues to grow and remodel in the Toledo region, we will continue to grow the Toledo division" Ms. Brown said.

In addition to Kroger, retail giants such as Walmart, Target, CVS, and Walgreens have opened clinics in stores, but none are currently operating in Toledo.

According to the Convenient Care Association, a national trade group, the number of retail clinics has grown rapidly in the United States since 2010.

The group projects that by 2016 the number of retail clinics will grow to approximately 3,000 from about 1,900 today .

Accepts cash only

Local primary care physician Nick Pfleghaar said he opened a first of its kind medical practice in the Toledo-area.

Dr. Pfleghaar'sPerrysburg office, Davinci Medical Direct Primary Care, accepts cash only for services.

He does not bill insurance companies, but rather relies solely on a monthly fee from patients.

Patients pay $50 to $100 monthly depending on their age, and in return they visit the doctor as often as necessary at no additional cost, Dr. Pfleghaar said.

"Say you cut yourself and you need stitches -- we'll bring you in and stitch you up and that doesn't cost you anything. You just pay for the material, but there is no profit being made on that. It's all at cost," Dr. Pfleghaar said.

Patients are given his cell phone number and can contact the doctor anytime day or night.

Dr. Pfleghaar said he web chats with patients, communicates by text message, and he has made several house calls.

"When people call and they need to get in today, they get in today. They don't get sent to the urgent care, which was a huge problem in my previous practice," he said.

Just three years out of residency, Dr. Pfleghaar gave up a steady paycheck as a hospital-employed physician at Bowling Green Family Physicians to start this practice three months ago.

He has gone from 3,000 patients in Bowling Green to 75 in his new practice.

He hopes to grow that to about 600.

National movement

Some of his colleagues thought he was crazy to leave a steady paycheck and a tried and true medical practice to plot a new course.

But this cash-only model is working in other parts of the country, he said

Dr. Pfleghaar called it "a movement" that is popular on the West Coast and is spreading across the country.

He is following the lead of a group of Wichita, Kan., doctors who operate a large direct primary care group, Atlas MD.

Laurence Bauer, chief executive of the Family Medicine Education Consortium, a Dayton-based advocacy agency for family physicians, called direct pay programs and concierge medicine "the wave of the future of primary medicine."

"I would say we are just getting started in Ohio, but I think it's got a bright future," Mr. Bauer said.

The trend started in North Carolina about 10 years ago, but several others states have been ahead of the curve, including Nevada and Washington, he said.

Dr. Pfleghaar's direct primary care practice is the first that he has heard of in the Toledo area, but there are several such doctors in Dayton, Columbus, and Cincinnati, Mr. Bauer said.

"They are popping up faster than anybody can keep track of," he said.

The growth is being fueled, he said, by the frustration that primary care physicians are feeling because of the red tape being imposed on them and their patients by insurance companies and federal regulations.

"They are opting out," he said.

Dr. Pfleghaar said he is keeping his overhead low by doing everything himself at his clinic.

Even as his practice grows, however, he anticipates no need to hire staff to handle billing because his payment model is so simple.

Several other doctors have opened concierge medical practices in the Toledo-area over the past two years, but they bill insurance companies for services in addition to collecting a monthly or yearly fee from patients.

Contact Marlene Harris-Taylor at [email protected] or 419-724-6091.

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