Wal-Mart health clinics divide US medics

Wal-Mart health clinics divide US medics
By Christopher Bowe in New York
Copyright The Financial Times Limited 2007
Published: May 23 2007 16:18 | Last updated: May 23 2007 16:18



Can a retail store deliver healthcare? Wal-Mart, the largest US retailer, thinks so, together with CVS, Walgreens and Rite Aid, the leading US drug store chains. But as all four move ahead with plans to expand “walk-in clinics” in their stores, the doctors of Illinois are fighting back.

The state could be the first to impose stricter regulation on the new generation of walk-in clinics, where nurse-practitioners can examine patients, conduct basic procedures such as inoculation, and prescribe for minor illnesses, while charging less than a doctor’s practice.

Massachusetts is also considering whether and how to license the state’s first retail clinics, proposed by drugstore group CVS and its MinuteClinics unit. And the industry expects more challenges ahead.

Walk-in clinics represent one of the most advanced and aggressive attempts by US business and entrepreneurs to drive reform of the healthcare system.

This year hundreds will be opened in some of the US’s largest drugstore and retail groups, and thousands of clinics could be running in the next decade.

Advocates say the clinics will improve access to healthcare and reduce costs; that they will reduce more expensive visits to hospital emergency rooms; and that they will catch some illnesses before they become serious and costly. As a result, physicians will have more time for complex cases.

But the clinics also have a direct impact on doctors, who see themselves as the gatekeepers of common, everyday healthcare.

Dr Rodney Osborn, president of the Illinois State Medical Society, said: “This is a brand new animal. That’s why we believe legislation is important to guarantee patient safety ... They’re not putting these things in to provide healthcare; these people are businessmen.”

Dr Arnold Milstein, chief physician at Mercer health consultancy, says doctors are playing on patient fears to thwart change.

“[Doctors] wrap themselves in the holy garb of quality ... completely ignoring the facts that all the research shows current care stinks,” Dr Milstein says. “The weaknesses that are endemic in the current healthcare system are being trotted out to block innovation and change.”

The clinics see themselves as advancing medical care, not diminishing its quality, with a retailer’s focus on service: the slogan of CVS’s MinuteClinic, for instance, is “You’re sick, we’re quick”.

Hal Rosenbluth, chairman of clinic company Take Care and head of the industry group Convenient Care Association, says any pushback against the clinics actually validates their existence, and adds that the concept is here to stay.

“That’s what people are clamouring for - they want healthcare on their terms not the system’s,” says Rosenbluth. Doctors’ quality concerns, he says, are merely anti-change “turf protection.”

On a national level, the American Medical Association, the doctors’ lobby group, has taken a cautious tone, issuing guidelines last year for clinics. They call for a well-defined scope of services; standardised medical protocols; and clear definitions of medical qualifications. They also call for closer doctor oversight, and emphasise the importance of referrals to doctors, which the leading clinics promise.

In any case, retail clinic companies are expanding nationally. In May, Walgreens bought Take Care, following CVS’s MinuteClinic acquisition last year. Both Wal-Mart and Target, the leading discounters, are opening clinics.

Their national footprint could eventually support the development of a much-discussed but elusive electronic records system for the US, as the clinics build patient databases, see more patients, and give patients printouts of their diagnoses and treatments.

Nevertheless, there are still some tough questions, raised by doctors and others, on the clinics and whether they can deliver what they promise.

First, despite US business’s push to inject and increase consumer principles into healthcare, it is still unproven whether people understand how to shop for medical care like other products, or even whether they want to do so. Clinics also could be a controversial way for employers to push more health costs on to employees.

Second, retail clinics claim they will increase doctors’ business by referring new patients or allowing them to spend more time on higher-value tasks.

But experts agree that they could be sapping high-margin, easy tasks like vaccinations from doctors’ businesses, and that clinics do not yet generate significant referral business to doctors.

Third, the clinics are for-profit businesses. Dr Osborn, of Illinois, says: “They’re not at this to increase doctors’ business; they’re in it to make money. That’s a smokescreen.”

More than anything, however, the retail clinics show that business is pushing for change on its own without waiting for government. And walk-in clinics could do for US healthcare what low-cost Southwest Airlines did for the airline industry, by making healthcare better, faster, and cheaper.

“This is a conceivably disruptive innovation of our happy little empire,” Dr Milstein says.