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In-Store Clinics New Wave in Retail

Posted on: Thursday, 9 February 2006, 03:03 CST

By PHIL GALEWITZ Palm Beach Post Staff Writer

Walk into the new Wal-Mart Supercenter here, past the McDonald's and the ice cooler and adjacent to the nail salon in front of cash register No. 4, and you'll see the latest trend in health care: a medical clinic inside a store.

Behind a glass window, Quick Quality Care is staffed by a nurse practitioner who specializes in treating minor ailments such as sore throats, ear infections and nagging coughs. The nurse also can give school physicals and immunizations, prescribe drugs and do certain blood tests.

"We're just like a regular doctor's office," said Leslie Sparks, a nurse practitioner at the three-room clinic, which has treated about a dozen patients a day since it opened in late January.

Urgent care clinics, also called a "doc in a box," have been around for decades to help people with non-emergency care, particularly those who don't have a regular physician and want to avoid a trip to the costly and usually busy hospital emergency room. In the latest rendition, the clinics are opening in busy retail outlets and are open during typical store hours, including nights and weekends.

Publix, Florida's largest grocer, said Monday it would set up health clinics in the next few months at some of its stores in South and Central Florida.

"It's about convenience and maximizing customers' time," Publix spokeswoman Maria Brous said.

Wal-Mart, the nation's largest retailer, is testing the marriage of retail and medicine with several clinic companies, including Quick Quality Care. Target and drugstore chain CVS also have joined the trend, and Walgreens stores are exploring the possibility.

The business model is simple: An outside company operates a clinic generally staffed by nurse practitioners or physician assistants offers a range of basic tests and treatments at a lower cost than a doctor's office, less than $50 for most services. The clinic operators typically lease space from the retail establishments.

Although the in-store clinics offer a promise of reducing emergency room crowds and giving people expanded access to health services, some medical groups are raising red flags.

"I think there's a better way to approach medical care than going to a nurse practitioner in a Wal-Mart," said Dr. Troy Tippett, a Pensacola neurosurgeon and president of the Florida Medical Association.

Tippett is concerned that nurse practitioners in the clinics won't have close physician supervision, and the patients at the clinics won't have a doctor to follow up on their care. Florida rules governing nurse practitioners are vague about how much doctor supervision is required.

Tad Fischer, executive vice president of the Florida Academy of Family Physicians, said he's all for expanding access to care, but the retail clinic concept makes him nervous.

"We are going to watch them carefully," Fischer said. "We don't want this to turn into drive-by health care."

Quick Quality Care is the creation of Dr. Neal Krouse, a Deerfield Beach family doctor, and Jack Tawil, a retail developer from New York. The clinic in the Stuart Wal-Mart is the second of three in Florida the company has planned with the retail giant. The first opened in Tampa in November and another is planned for Cape Coral this winter.

Tawil said the company has no interest in competing with local doctor offices and he said the company's clinics will refer patients to area specialists as needed.

The nurse practitioners work under Krouse's supervision and he is available by phone whenever nurses need him. The nurses keep all patient records on a computer and they work under protocols Tawil set up to handle various medical conditions.

The clinics eventually will help alleviate some of the crowds and long waits in emergency rooms, Tawil said. If there's a wait to see a nurse at a clinic, a patient will be given a beeper to carry while shopping at Wal-Mart, he said.

"We want to help fill in the gaps in health care because so many people don't have a regular doctor," he said.

HildeGard Delaini, 65, of Port St. Lucie and Germany stopped in at the clinic at the Stuart Wal-Mart to check her levels of the blood thinner coumadin. Delaini doesn't have a regular doctor in the area and the clinic offered the service without a wait.

"Things are always getting easier in America," she said.

The store clinics employ nurse practitioners because they are paid less than doctors, who also have higher malpractice insurance costs.

With most Wal-Mart stores employing 400 to 500 people, the clinics also give employees a convenient place to get health care, Tawil said.

phil_galewitz@pbpost.com

Packaging retail, medicine

Publix: Has a deal to put health clinics in some of its stores this year in South and Central Florida. It is working with Little Clinics of Kentucky.

Wal-Mart: Working with several clinic operators, including Quick Quality Care, which has opened a clinic at the Wal-Mart Supercenter in Stuart.

Target: Working with MinuteClinic to open clinics at its stores.

CVS: Testing clinics around the country.

Walgreens: Exploring the idea.

Shopping and health care convenience

Health care clinics staffed by nurses and physician's assistants are becoming increasingly common in retail stores.

Services provided at centers

- Routine screenings and physicals

- Aid for minor illnesses (e.g., ear and bladder infections, strep throat)

- Referrals for follow-up, emergency help

- Immunizations

- Limited diagnoses

Updated records

- Track visits to watch for symptoms of a larger medical issue

- Can be sent to primary physicians

Waiting list

Walk-in patients have option to shop while waiting

Cost

Most clinics will charge $30 to $70; insurance co-payment may be accepted

Source: MinuteClinic

THE ASSOCIATED PRESS

Source: Palm Beach Post

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