Cash-and-Carry Medicine:

Grocery Stores Add Health to Sundries and Notions

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Medical Economics Feature - January 2006

By  Larry BeSaw
Editor

It's Saturday afternoon and time for a trip to the supermarket. On the shopping list are milk, bread, a cholesterol screening, dog food, paper towels, a flu shot, a blood pressure check, ice cream, potato chips, treatment for poison ivy, beer, and a school physical for the kids. And if there's time, throw in a prostate cancer screening and some antibiotics for that rash.

That just may be a reality for Texans quite soon if the people who run RediClinics can persuade them to get routine health care from a nurse practitioner at the local grocery store instead of from their doctor. The clinics offer patients vaccinations and other medical care without an appointment at prices ranging from $45 to $150. They don't take insurance.

It may be a tough sell, though, since a national survey indicates most Americans are skeptical about the quality of care they would receive in onsite retail clinics. Physicians aren't convinced either. They worry about continuity of care and the possibility a serious medical condition might be overlooked as something minor.

Operated by InterFit Health, five RediClinics opened this past summer in five HEB grocery stores in Houston. RediClinic spokesperson Sandy Kinsey said in November the firm plans to open two more in HEB stores in San Antonio and one in Round Rock.

RediClinics also can be found in New York, Oklahoma, and Arkansas. Ms. Kinsey says the company plans to go national eventually. 

Good Medicine?

When the clinics opened, Harris County Medical Society President Robert Vanzant, MD, acknowledged that they might help ease overcrowding in Houston hospital emergency departments. But, he said, "physicians are concerned with continuity of care with this type of limited-service clinic. When care is disrupted, a domino effect of negative outcomes is a real potential."

His concerns include disruption of the physician-patient relationship, which could have a negative outcome on the patient; getting information from physicals and nonurgent lab work back to the patient's primary care physician for total evaluation and appropriate preventative measures; the importance of patients having a medical home to assure quality of care; and "duplication of services, which will increase the cost of health care and could be harmful to the patient."

Susan Strate, MD, chair of Texas Medical Association's Council on Socioeconomics, says the nurse practitioners' lack of knowledge about the patients' medical history is troubling. "That one bothers all of us a lot because if you don't know the patient's history and there is not an established record there, then that's a big problem," she said. "These are higher risk situations for medical errors."

Houston neonatologist Michael Speer, MD, chair of the Texas Patient Safety Alliance, says the clinics "may be okay if they are used for specific limited care and that information is communicated back to the patient's own physician to make sure you have the totality of health care in mind."

He says there's no doubt the clinics are convenient as they are open at times that most physician offices are not. They could enhance health care if an electronic "smart card" system were available to patients and their physicians. The care the patient received at a RediClinic would be loaded onto the smart card and their medical record would be automatically updated.

"Unfortunately, we don't have that. So under the current system, no, it's not a good idea, except for the fact that it's convenient and people may get their flu shots when they might not ordinarily do so, and they may get other things done such as colon cancer or prostate cancer screening. At least they will have that information at hand and can seek out their own physician for follow-up care."

Houston family physician Y. Jesse Chang, MD, says there's no cause for concern because the nurse practitioners are supervised by physicians. Dr. Chang, a member of Southwest Doctors PA in Houston, is among a group of physicians who oversee the medical care in the clinics. He says the rules the clinic operate under require physicians to be on site 20 percent of the time the clinics are open and to audit at least 20 percent of the patient charts to make sure they are getting proper care. The physicians do not treat the patients themselves; they observe what the nurse practitioners are doing, he says, adding that there are one and sometimes two physicians monitoring each of the five clinics in the Houston area.

He says the nurse practitioners take a "complete history" of the patients when they come in. "It is very similar to a patient going to any clinic."

Dr. Chang says the nurse practitioners "are there to take care of the more urgent acute-care issues, not to be a manager of chronic medical problems. Physician oversight is there. These nurse practitioners know their limits. They're not there trying to do something they're not qualified to do," he said. "They're certainly not forced to see anything they're not comfortable with or something they feel is better taken care of by an MD." 

Public Doubts

The Wall Street Journal last year asked 2,245 adults to respond to a series of statements about retail onsite clinics. Only 7 percent said they had ever used such a clinic. Of those who had, almost 90 percent gave high marks to the clinics for quality of care, cost, convenience, and staff qualifications.

Whereas 78 percent of all respondents said they "agree strongly or somewhat" that the clinics are a fast and easy way to get basic medical services, 75 percent said they agree strongly or somewhat that "serious medical problems" might not be accurately diagnosed. And, 71 percent said they would agree strongly or somewhat that they would be worried about the qualifications of the staff of a clinic not run by physicians.

Larry BeSaw can be reached at (800) 880-1300, ext. 1383, or (512) 370-1383; by fax at (512) 370-1629; or by e-mail at  Larry BeSaw.  

SIDEBAR

RediClinics at a Glance

Walk-in RediClinics, the  company's Web site  says, "provide fast, affordable treatment for routine medical conditions, as well as preventive care" for adults and children over 2. They are "staffed by certified nurse practitioners who diagnose, treat, and prescribe medications to help you get well." They also provide "health screenings, medical tests and panels, vaccinations, immunizations, physicals, and counseling to help you stay well."

  • The clinics are open seven days a week and operate on extended hours on weekends.
  • No appointments are necessary.
  • The typical visit takes about 15 minutes.
  • The charge for diagnosis and treatment of respiratory; head, ear, and eye; skin, hair, and nail; and digestive conditions is $45.
  • Fees for preventive services (screenings, tests and panels, vaccinations, physicals, and disease counseling and monitoring) depend on the quantity and extent of testing. Most screenings, tests, and panels cost from $10 to $150.
  • They do not take insurance.
  • Patients can get a summary of their chart to give their primary care physician.
  • Screenings and tests for which results are immediately available are available on site. Results of all other tests and screenings are available to the patient online through personal health records or by e-mail.

The RediClinics Web site says the clinics are designed for people who want "fast, convenient, and affordable treatment of a routine medical condition," or who want "easy, inexpensive access to health screenings, medical tests and panels, immunizations (including flu shots), physical exams, chronic disease monitoring, and weight management."

They are not, it warns, "for medical emergencies -- such as broken bones or deep lacerations -- or for more serious medical conditions that warrant the attention of a physician."

 

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