Nonurgent care clinics tested at select Wal-Marts

The in-store clinics will be run independent of the retail giant and staffed by physician extenders.

By Tyler Chin — Posted Oct. 17, 2005

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If anyone needed more evidence that the concept of the clinic in a retail store was gaining more traction, witness the latest entrant in this business -- Wal-Mart.

Wal-Mart Stores Inc. has become the latest retailer to rent space to medical clinics staffed by physician extenders assigned to treat minor, nonurgent conditions such as colds and sore throats. Physicians themselves are not on site.

What Wal-Mart is doing is no different from what Safeway grocery stores are doing in the Washington, D.C., area, renting space to Starbucks, banks and dry cleaners to offer better service to customers, said American Hospital Assn. spokesman Rick Wade.

"It's as much a sign of how people are living their lives, how fast-paced things are and how multitasked people are," Wade said. "So I think the phenomenon of the clinic in the store or in the mall is here to stay."

As part of a test, the world's largest company is renting space to four organizations that will open medical clinics at 12 of its stores in Arkansas, Indiana, Florida and Oklahoma. So far, three have opened, and the remainder are expected to open by Jan. 31, 2006.

Whether Wal-Mart will add clinics in more stores will depend on how shoppers at the testing stores respond, said Sharon Weber, a Wal-Mart spokeswoman.

Though exact numbers aren't available, analysts agree that the concept of in-store medical clinics is already growing. For example, on Sept. 29, MinuteClinic announced that it would add nearly 60 clinics in 10 unidentified cities by year's end. The Minneapolis-based company now has 40 outlets in CVS, Target, Cub Foods and other retailers in Indiana, Maryland, Minnesota and Tennessee.

But analysts say Wal-Mart, because of its size, could take growth of in-store clinics to another level if it decided to roll it out to more stores.

Observers expect growth to continue as employers shift a greater share of health care costs to their employees. "As more and more people are paying more and more for health care services out of their own pocket, then convenience as well as cost become issues," Wade said.

Double benefit

But a big reason that the number of store-based clinics staffed by nurse practitioners or physician assistants are growing around the country is that the clinics and their landlords both stand to benefit, analysts say. The clinics' operators gain access to a potentially large customer base while the stores collect rent and potentially lure more customers who might buy groceries, over-the-counter medications or prescriptions.

Wal-Mart isn't seeking to boost traffic, because 110 million people shop weekly at its 3,218 stores around the country already, Weber said. But, she said, "what we're really looking to do is see what we can do to further enhance their shopping experience and how we can help them further, not only with convenience but with value."

So far, Wal-Mart has clinics open in its Fayetteville, Ark.; Mishawaka, Ind.; and Owasso, Okla., stores. The clinic in Mishawaka and two others in Indiana will be operated by South Bend, Ind.-based hospital network, Memorial Health System.

Memorial has been working on the concept for 18 months. It hooked up with Wal-Mart because another part of the organization already sells home health equipment at a Wal-Mart store in South Bend. Through that contact, the health system approached and met with Wal-Mart earlier this year, said Michael O'Neil, president and chief operating officer of Memorial. Coincidentally Wal-Mart had been thinking about testing the concept and selected Memorial as one of its four vendors, O'Neil said. The other vendors are Quick Quality Care in Deerfield, Fla.; Houston-based RediClinic; and Solantic in Jacksonville, Fla.

The relationship between Wal-Mart and Memorial Health is strictly that of landlord and tenant, O'Neil said. The retailing giant doesn't market the Mishawaka clinic, called MedPoint Express, though it has agreed to have its cashiers stuff flyers advertising the service in shopper's bags. Memorial Health also is marketing MedPoint Express through newspapers, billboards and word of mouth, relying on patients' familiarity with its freestanding MedPoint urgent care centers, O'Neil said. The clinic is averaging 10 patients daily, O'Neil said, adding that he expects that number to hit between 20 and 30 during the next few months.

The clinic accepts insurance, but it markets itself as a less expensive alternative to other office visits. O'Neil said the clinic's base cash fee, before any insurance adjustment, is half of a physician's office and one-third less than an urgent care center.

The Indiana State Medical Assn. is concerned that patients might use the clinics as a replacement for physicians. "People might forgo more traditional medical care and sort of treat the symptoms ... and be less likely then to do the preventive care [screenings] that we know are also part of good health and a healthy lifestyle," said Kevin Burke, MD, president of the medical society.

The AMA does not have an official policy on store-based medical clinics but is concerned about whether the physician extenders are supervised by licensed physicians, said AMA President J. Edward Hill, MD.

"I don't know what the provisions and protocols will be for this clinic, but if they are good and the nurse practitioners are supervised by licensed physicians and these supervisors are immediately available to them, I don't see any particular problem," Dr. Hill said.

MedPoint Express protocols were developed by Memorial Health's physician group, and its nurse practitioners are supervised by physicians whom they can call at any time, O'Neil said. MinuteClinic and other in-store clinic operators -- including another hospital system, Milwaukee-based Aurora Health Care, which has opened six store-based clinics -- make similar claims.

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