Wal-Mart plans more in-store clinics; up to 2,000 in 5 years

The nation's largest retailer says it will expand operations until more than half of its stores have clinics.

By Pamela Lewis Dolan — Posted May 14, 2007

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Wal-Mart recently announced plans to significantly increase the number of in-store health clinics around the country.

The discount retailer said it plans to open up an additional 400 in-store clinics within the next three years and possibly 2,000 within the next five to seven years. Wal-Mart currently has clinics in 75 stores in 12 states.

The expansion would mean about 55% of Wal-Mart's stores would have clinics by 2012.

"We think the clinics will be a great opportunity for our business," said Wal-Mart president and CEO Lee Scott in a speech at the April World Health Care Conference in Washington, D.C., where the plans were first announced. "But more importantly, they are going to provide something our customers and communities desperately need -- affordable access at the local level to quality health care."

American Medical Association policy states that retail clinics are consistent with its belief there should be multiple entry points for patients into the health care system, although it acknowledges they are controversial among physicians.

Realizing the demand for this type of care, last year the AMA and the American Academy of Family Physicians separately developed a list of guidelines that retail clinics should follow and that physicians should consider when deciding whether to associate with a retail clinic. Among the attributes on each list is the suggestion that the clinics have a referral process and encourage patients to establish a relationship with a primary care physician.

Wal-Mart consulted with the AAFP while making its plans for the expansion, said Rick Kellerman, MD, the academy's president.

Generally, in-store clinics are staffed by a nurse practitioner or physician assistant to treat minor conditions. The clinics use software to help identify whether patients might have a more serious condition that needs referral to a physician. The clinics have contracts with hospitals or physician groups so that physicians are on call for any necessary consultation.

Clinics sell themselves on their convenience, with long hours and locations where people shop. Dr. Kellerman said the Wal-Mart expansion -- and the growth of in-store clinics in general -- shows that patients desire that kind of convenience and access to care.

Partnering with local hospitals

In its official announcement of the expansion plan, Wal-Mart said it plans to partner with local hospitals and practices to operate the clinics, such as it does with MedPoint Express, which is affiliated with the Memorial Health System in South Bend, Ind., and operates three clinics in Wal-Mart stores in Indiana. Other Wal-Mart clinics are operated by other local systems and companies.

According to Wal-Mart spokesman Kevin Gardner, the contractors who operate the clinics make their own staffing decisions, with Wal-Mart having no control.

Some are staffed with physicians while others are staffed with physician assistants or nurse practitioners, he said.

Dr. Kellerman feels confident the new clinic operators will comply with the attributes as all three of the largest retail clinic operators -- Minneapolis-based MinuteClinic Inc. (a division of the drugstore chain CVS), Pennsylvania-based Take Care Health Systems Inc. and Houston-based RediClinic -- have signed onto them.

But, he said, the level of involvement by the supervising physician at each site varies, depending on state laws.

Most importantly, said Dr. Kellerman, is that "all admitted that the retail clinics are not a substitute for a medical home."

Some fear Wal-Mart's expansion will lead to similar mass expansion projects by other retailers hoping to stay competitive.

Neil Trautwein, vice president of employee benefits policy council for the National Retail Federation, said he expects more retail clinics will open because retailers have found them to be a great way to get people inside the stores. But "I don't think it will become a Starbucks or McDonald's situation with one on every corner," he said.

"The market will sort itself out and it will depend on whether Joe and Jane Consumer will find them to be of useful value," he said.

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