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Operator of Georgia Clinics Operated By Physicians Challenges Competitor

Posted on: Sunday, 15 January 2006, 15:00 CST

By Mike Tierney, The Atlanta Journal-Constitution

Jan. 14--Jordan Rice had an idea and the financing to breathe life into it: Open urgent care centers operated by nurse practitioners in area Wal-Marts.

So Rice floated the concept by the state board of medical examiners in 2003 and was informed that it would not fly, he says. The rub: Georgia is the lone state that prohibits nurse practitioners from prescribing medicine, unless it is done under a doctor's supervision.

Rice altered his plan and, in November, snipped the ribbon on a walk-in clinic in Woodstock called Immediate MedCare, the first of 20 on the company's drawing board for metro Atlanta. In contrast to the earlier incarnation, all would be staffed by physicians.

While the president and chief executive of Immediate MedCare maintains that clinics run by doctors hold special appeal for patients, it bothers him that rival chain MinuteClinic, recently launched in selected CVS stores, is designed similarly to his discarded blueprint -- and administered by nurse practitioners.

Last month, Rice e-mailed the medical examiners board about MinuteClinic, claiming that "we were told there were several issues with this model."

Regarding the doctor-less offices, he wrote: "Clearly, these nurses are not under direct supervision of any physician and any agreements and ... are pretty much a sham in terms of what a real Medical Director does.

"If these people are not in violation ... then why can we not do the same model?"

Michael Howe, CEO of MinuteClinic, said in an e-mail statement that prior to entering Georgia, "MinuteClinic conducted appropriate due diligence and met or communicated with several organizations involved with regulation and oversight to discuss our business model and ensure that we would operate within their guidelines. No major objections were raised."

In an interview, Rice stressed that he was not targeting MinuteClinic, only seeking to level the playing field for the variety of urgent care centers.

"I was very upset when this group from Minnesota comes down and opens up in CVSes," he said. "We were told emphatically that nurse practitioners in Georgia could not write prescriptions . ... A physician pretty much has to be on-site."

Dr. Jim McNatt, the state board's medical director, said in an interview that physicians need not be present in the clinics. Nurse practitioners cannot prescribe medicine, he said, but can call in prescriptions under a physician's guidance. (MinuteClinic has a physician on call.)

"Technically, we don't have prescription privileges," said Mary Jo Goolsby, director of research and education for the American Academy of Nurse Practitioners. "That doesn't mean we don't prescribe. We just have to do it in a physician's name."

"It's sort of an awkward situation," McNatt acknowledged about abiding by the state law.

In e-mails to the examiners board, Rice did suggest a "hidden agenda," with MinuteClinics designed to "drive more prescriptions to CVS." MinuteClinic patients are not required to fill their prescriptions at the drugstores where they visit, although the convenience makes it likely that they would.

In addition to a doctor on the premises, Immediate MedCare outlets offer such amenities as Starbucks coffee and high-definition TVs in the half-dozen or more exam rooms. Most are located in free-standing buildings or upscale strip shopping sites. "We try to have the look and feel of a small boutique hotel," Rice said.

The standard fee is $72, according to Rice, about $13 more than at MinuteClinics, which are one-room operations tucked into the corners of scattered CVS stores.

"For a few dollars more," Rice said, "you get to see a real physician."

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Copyright (c) 2006, The Atlanta Journal-Constitution

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WMT, CVS,

Source: The Atlanta Journal and Constitution

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