Walmart Clinics now staffed by hospitals.

[Guest guest]

Here is the link to the article.

Our local hospital is planning to put an evening acute care clinic into practice about 20 miles downvalley (midway between another hospital 40 miles away).

The midvalley docs fear this will take away work-in patients for the next day for bread/butter stuff like UTI, sinusitis, etc.

Locke, MD

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http://www.ama-assn.org/amednews/2008/02/25/bil10225.htm

Wal-Mart partners with hospitals to rapidly expand in-store clinics

Analysts say the giant retailer wants the good will a trusted hospital name can provide. Hospitals, meanwhile, say they don't intend to compete with physicians.

By Pamela Dolan, AMNews staff. Feb. 25, 2008.

As big-name national retailers and pharmacy chains continue to open in-store clinics, a familiar face soon may enter the fray as well -- your local hospital.

Wal-Mart recently announced plans to partner with community hospitals across the country to open up 400 new retail clinics inside its stores by 2010, in addition to the 55 it already houses. Thirteen of those are owned and operated by hospital systems.

The rebranded "Clinic at Wal-Mart" also will sport the name of the partnering health system providing the nurse practitioners and physician assistants dispensing care, as well as the doctors overseeing them. But Wal-Mart would standardize the clinics so they have a similar look and feel, such as having each clinic post a price list and keep similar hours.

Among Wal-Mart's first expansions will be in its home state of Arkansas, where St. Health System will own and operate four clinics in Little Rock scheduled to open in April.

At least half of the 400 new clinics will be opened through a deal with RediClinic, a chain owned by AOL co-founder Steve Case's Revolution Health. RediClinic will seek commitments from hospital systems as partners for Wal-Mart clinics, starting in Atlanta and Dallas. Hospitals could be contracted as strategic partners without an ownership stake. Or they might split a stake in the facility, such as RediClinic and Memorial Hermann do in 11 H-E-B grocery clinics in Houston.

While organized medicine is studying the impact that Wal-Mart's expansion may have on physicians, experts say hospital involvement is further proof that the clinics are becoming an integral part of the wider health care delivery system. This conclusion comes despite numerous growing pains, including the late January shutdown of 23 Wal-Mart clinics after its contractor, CheckUps, ran into unspecified financial trouble.

Kate , principal of the Marina del Rey, Calif., consulting firm & Co., said hospital involvement gives the in-store clinic concept "further legitimacy."

is about to publish a guidebook, The Hospital Retail Clinic Tool Kit, in response to the several hospitals she said asked her for advice about entering the clinic market.

said the clinics started integrating themselves with the traditional health care setting when they began accepting insurance.

"In the last two years, they have gotten a lot closer to the hospital systems," she said. Now, more than one-third of clinic operators are affiliated with hospitals.

Two-pronged approach

has seen hospitals both partner with clinic chain operators and open clinics themselves. Systems such as Sutter Health in Northern California and Geisinger Health Systems in Danville, Pa., have opened their own retail clinics. Wal-Mart has partnered with Aurora Health Care in Milwaukee and Memorial Health System in South Bend, Ind., for 13 of its existing clinics.

Wal-Mart hopes that by creating a company-wide brand, the clinics will become more standardized. The move is part of Wal-Mart's corporate strategy to improve its image and change its reputation from one of being bad for communities and a burden on the health care system to one of being a good corporate citizen and a partner in health care access and affordability, experts say.

Other steps have included the expansion of Wal-Mart's health insurance plans, for which more than 70% of its employees are now eligible, and the expansion of its $4 prescription drug program.

The company also is pushing for wider adoption of electronic medical records by requiring clinic operators to use them. And the company is providing personal health records for its employees through its partnership with Dossia.

"Wal-Mart thinks that by affiliating with hospitals it will be creating linkages between the clinics and the hospitals," said Regina Herzlinger, DBA, a Harvard business professor and one of the leading proponents of consumer-directed health care. People who come to these clinics might not have a primary care physician and could find one through a referral from the clinic, "so it's good for Wal-Mart, and I hope good for the hospitals," she said.

Hospitals in the in-store clinic business say physicians have nothing to fear from them.

O'Neil, chief operating officer of Memorial Health System, which runs six Wal-Mart clinics in Indiana, said Memorial entered the retail clinic market as a way to expand access to care and extend its primary care network.

"We don't believe these clinics will be the solution to deal with the health care challenges we are facing as a nation, but we think they can be a catalyst," he said.

Carmela Coyle, senior vice president for policy at the American Hospital Assn., said hospitals are not doing this for financial reasons, or to compete with doctors.

"This is less about taking business away than getting people care when they need it," Coyle said.

Still, Strate, MD, immediate past chair of the Texas Medical Assn.'s Council on Socioeconomics, said she is concerned that the hospital partnerships will result in more patients going to the hospital for follow-up care rather than a primary care physician. Clinics may steer patients to the emergency department when their problems go beyond the clinics' scope, she said.

A better partnership would be between Wal-Mart and community physician groups, Dr. Strate said.

The American Medical Association adopted policy at its 2006 Annual Meeting acknowledging that retail health clinics were controversial, but ultimately it decided that the clinics fit long-standing AMA policy that encourages "multiple entry points" into the health care system.

In 2007, the AMA board resolved to ask state and federal regulators to investigate possible conflicts between clinics and the hospital chains that are affiliated with them.

The AMA, as well as the American Academy of Family Physicians, has developed principles for in-store clinic operations to ensure patient safety and continuity of care, in addition to helping patients without doctors find one. The American Academy of Pediatrics opposes in-store clinics, saying they add to the fragmentation of the health system.

Tom Charland, president and CEO of Merchant Medicine, a retail operator consultancy group based in Shoreview, Minn., and former senior vice president of strategy and business development for MinuteClinic, said he sees the Wal-Mart clinic expansion as an opportunity for physician groups to enter into joint, in-store clinic ventures with hospitals.

That is particularly the case in smaller metropolitan areas, he said. "I think we will now see an impact ... where the big names have not opened up yet."

Physician groups and hospitals will see this as a chance to "open up with a trusted brand before [CVS-owned] MinuteClinic comes to town," Charland said.

Discuss on Sermo Back to top.

ADDITIONAL INFORMATION:

Wal-Mart clinic locations

The retailer plans to open 400 additional in-store clinics by 2010. The company has 55 clinics operating currently.

Clinics

Clinic operator

Arkansas

2

RediClinic

California

4

Quick Health

Colorado

15

SmartCare

Florida

4

Express Aid, Solantic

Indiana

6

MedPoint Express, owned by Memorial Hospital & Health System, South Bend, Ind.

Oklahoma

2

RediClinic

Texas

6

My Healthy Access

Virginia

9

RediClinic, in affiliation with Bon Secours Richmond Health System, Richmond, Va.

Wisconsin

7

Aurora Quick Care, owned by Aurora Health Care, Milwaukee

Source: Wal-Mart

Back to top.

Where the in-store clinics are

According to a recent study, there were about 500 retail clinics open or planned in the United States. More than 1,500 are expected by the end of 2008. The report counted clinics as of September 2007, so this list does not reflect recent activity such as CheckUps going out of business, or other clinics such as MedPoint Express that have opened more locations.

Clinic operator

Clinics

Locations

AtlanticCare HealthRite

4

N.J.

Aurora QuickCare

20

Wis.

Bellin Health Fast Care

3

Wis.

Corner Care Clinic

14

Ill., Ind., Ohio, N.Y., Pa.

Early Solutions Clinic

6

Mich.

FastER Care

5

Calif.

Geisinger CareWorks Convenient Healthcare

2

Pa.

Healthy Access

7

Md., Texas

Lindora Medical Clinics

1

Calif.

MedBasics

2

Texas

MediMin

3

Ariz.

MedPoint Express

3

Ind.

MinuteClinic

168

Ariz., Conn., Fla., Ga., Ind., Kan., Md., Mich., Minn., Mo., Nev., N.J., N.Y., N.C., Ohio, Tenn., Texas, Wash.

ProntoClinics

4

Fla.

Quick Quality Care (CheckUps)

23

Ala., Fla., La., Miss.

QuickClinic

6

Ohio

QuickHealth

9

Calif., Idaho

RediClinic

46

Ark., Ga., Okla., Texas, Va.

SmartCare Family Centers

19

Colo., Ga.

Solantic

13

Fla.

Sutter Express Care

6

Calif.

Take Care Health Systems

50

Ill., Kan., Mo., Pa.

The Little Clinic

24

Fla., Ga., Ind., Ky., Ohio

Trinity MedXPress

1

Iowa

Source: "Health Care in the Express Lane: Retail Clinics Go Mainstream," & Co., September 2007

Back to top.

Recent closures

While new retail clinics continue to open, there have been some notable closures. Experts say it takes between 24 and 36 months for clinics to begin making a profit. Having too little capital has been blamed for many clinic closures.

Clinic operator

Locations

Affordable Basic Care

Ind., Mich.

Corner Care Clinic

Ind.

CuraQuick

Iowa

InstaClinic

Miss.

CheckUps

Ala., Fla., La., Miss.

Smarter Care

Calif.

Wellness Express

Calif.

Source: Tom Charland, retail clinic analyst; "Health Care in the Express Lane: Retail Clinics Go Mainstream," & Co, September 2007

[Guest guest]

I guess I wasn't clear. The patient is responsible for their pharmacy co-pay, just as they are responsible for their copay with us. It's just that it's illegal not to collect the pharmacy copay, but only a contractual obligation to collect the visit copay. I don't know how quickly the pharmacies get their reimbursement. StrazMust be some bright pharmacists in Virginia. I suspect that must be fairly widespread. Why do you suppose pharmacy has set up the rules such that third party payors CANNOT hold up their payments for 30-60-90 days or more, but we (physicians) have been dumb enough to provide no cost financing for everyone….? From: [mailto: ] On Behalf Of StrazzulloSent: Saturday, March 01, 2008 11:19 AMTo: Subject: Re: Walmart Clinics now staffed by hospitals. Is it a conflict of interest for pharmacies to provide medical care? No conflict of interest for MDs to sell drugs, a lot of old time GPs would sell drugs to patients for patient convenience (some small towns may not have had a pharmacist or one similar to the pharmacist in It's a Wonderful LIfe) and an increase in income per visit. In Virginia, each practitioner needs an additional license to dispense prescriptions at a cost of $250 per year. You can make money selling generics for what the Insurance copay is. If you plan to sell more expensive prescriptions such as Augmentin or Cipro generic or brand name; you'll need to find a way to participate in the insurer managed pharmacy programs to remain competitive with pharmacies for insured paients. A lot easier said than done. I've sold prescription drugs for several employers over the years. To maintain my individual ethics, I do not make prescriptive choices based on the meds available in our pharmacy. Sticking to this policy has caused my employers to bring up my relatively low in-house dispensing percentage on occasion, but they are smart enough to recognize that my answer that I will not allow their economic choices of which drugs to stock affect my prescribing habits is unimpeachable(and I would consider reporting being disciplined for this to the State Board). I also remind them that I have tried to effect the process of drug selection for our formulary with varying degrees of success. We tend to sell meds for acute problems such as Abx, NSAIDS, analgesics, antitussives, antihistamines, etc; while ignoring meds for chronic problems. Also, in Virginia, prescriptions must be payed for at time of dispensing and cannot be billed. Straz I am all for your idea but isn't there some conflict of interest for docs to sell rx drigs? We get slammed from all directions it seemsOn 3/1/08, Pratt <karen.oaktreecomcast (DOT) net> wrote: I saw this article in AMNews. Our local Long's Drugs has a walk-in clinic, too. It's run by a local group in town. A friend of mine who is a patient at that group went into the drug store clinic on a weekend and she said it was "weird" to go to the doctor in a drug store. All of the major pharmacies in town are really pushing for these cash-only clinics. Our biggest fear is that it will do just as mentioned – take away the "easy" visits and leave the doctors with just the difficult visits. We're already considering in-house dispensing through Vantage RX. If we see that the pharmacy clinics start to take away business, we will definitely start to compete with them by dispensing our own meds. Our hope is that they will all open at the same time and that there will be so much local competition that they will all fail, sort of like the Hospital-owned medical groups in the late 90's. PrattOffice ManagerOak Tree Internal Medicine P.C.From: [mailto: ] On Behalf Of Locke's in ColoradoSent: Thursday, February 28, 2008 6:26 PMTo: Locke's in ColoradoSubject: Walmart Clinics now staffed by hospitals.. Here is the link to the article.Our local hospital is planning to put an evening acute care clinic into practice about 20 miles downvalley (midway between another hospital 40 miles away).The midvalley docs fear this will take away work-in patients for the next day for bread/butter stuff like UTI, sinusitis, etc. Locke, MD==================================================http://www.ama-assn.org/amednews/2008/02/25/bil10225.htmWal-Mart partners with hospitals to rapidly expand in-store clinicsAnalysts say the giant retailer wants the good will a trusted hospital name can provide. Hospitals, meanwhile, say they don't intend to compete with physicians.By Pamela Dolan, AMNews staff. Feb. 25, 2008.As big-name national retailers and pharmacy chains continue to open in-store clinics, a familiar face soon may enter the fray as well -- your local hospital.Wal-Mart recently announced plans to partner with community hospitals across the country to open up 400 new retail clinics inside its stores by 2010, in addition to the 55 it already houses. Thirteen of those are owned and operated by hospital systems.The rebranded "Clinic at Wal-Mart" also will sport the name of the partnering health system providing the nurse practitioners and physician assistants dispensing care, as well as the doctors overseeing them. But Wal-Mart would standardize the clinics so they have a similar look and feel, such as having each clinic post a price list and keep similar hours.Among Wal-Mart's first expansions will be in its home state of Arkansas, where St. Health System will own and operate four clinics in Little Rock scheduled to open in April.At least half of the 400 new clinics will be opened through a deal with RediClinic, a chain owned by AOL co-founder Steve Case's Revolution Health. RediClinic will seek commitments from hospital systems as partners for Wal-Mart clinics, starting in Atlanta and Dallas. Hospitals could be contracted as strategic partners without an ownership stake. Or they might split a stake in the facility, such as RediClinic and Memorial Hermann do in 11 H-E-B grocery clinics in Houston.While organized medicine is studying the impact that Wal-Mart's expansion may have on physicians, experts say hospital involvement is further proof that the clinics are becoming an integral part of the wider health care delivery system. This conclusion comes despite numerous growing pains, including the late January shutdown of 23 Wal-Mart clinics after its contractor, CheckUps, ran into unspecified financial trouble. Kate , principal of the Marina del Rey, Calif., consulting firm & Co., said hospital involvement gives the in-store clinic concept "further legitimacy." is about to publish a guidebook, The Hospital Retail Clinic Tool Kit, in response to the several hospitals she said asked her for advice about entering the clinic market. said the clinics started integrating themselves with the traditional health care setting when they began accepting insurance."In the last two years, they have gotten a lot closer to the hospital systems," she said. Now, more than one-third of clinic operators are affiliated with hospitals.Two-pronged approach has seen hospitals both partner with clinic chain operators and open clinics themselves. Systems such as Sutter Health in Northern California and Geisinger Health Systems in Danville, Pa., have opened their own retail clinics. Wal-Mart has partnered with Aurora Health Care in Milwaukee and Memorial Health System in South Bend, Ind., for 13 of its existing clinics.Wal-Mart hopes that by creating a company-wide brand, the clinics will become more standardized. The move is part of Wal-Mart's corporate strategy to improve its image and change its reputation from one of being bad for communities and a burden on the health care system to one of being a good corporate citizen and a partner in health care access and affordability, experts say.Other steps have included the expansion of Wal-Mart's health insurance plans, for which more than 70% of its employees are now eligible, and the expansion of its $4 prescription drug program.The company also is pushing for wider adoption of electronic medical records by requiring clinic operators to use them. And the company is providing personal health records for its employees through its partnership with Dossia."Wal-Mart thinks that by affiliating with hospitals it will be creating linkages between the clinics and the hospitals," said Regina Herzlinger, DBA, a Harvard business professor and one of the leading proponents of consumer-directed health care. People who come to these clinics might not have a primary care physician and could find one through a referral from the clinic, "so it's good for Wal-Mart, and I hope good for the hospitals," she said.Hospitals in the in-store clinic business say physicians have nothing to fear from them. O'Neil, chief operating officer of Memorial Health System, which runs six Wal-Mart clinics in Indiana, said Memorial entered the retail clinic market as a way to expand access to care and extend its primary care network."We don't believe these clinics will be the solution to deal with the health care challenges we are facing as a nation, but we think they can be a catalyst," he said.Carmela Coyle, senior vice president for policy at the American Hospital Assn., said hospitals are not doing this for financial reasons, or to compete with doctors."This is less about taking business away than getting people care when they need it," Coyle said.Still, Strate, MD, immediate past chair of the Texas Medical Assn.'s Council on Socioeconomics, said she is concerned that the hospital partnerships will result in more patients going to the hospital for follow-up care rather than a primary care physician. Clinics may steer patients to the emergency department when their problems go beyond the clinics' scope, she said.A better partnership would be between Wal-Mart and community physician groups, Dr. Strate said.The American Medical Association adopted policy at its 2006 Annual Meeting acknowledging that retail health clinics were controversial, but ultimately it decided that the clinics fit long-standing AMA policy that encourages "multiple entry points" into the health care system.In 2007, the AMA board resolved to ask state and federal regulators to investigate possible conflicts between clinics and the hospital chains that are affiliated with them.The AMA, as well as the American Academy of Family Physicians, has developed principles for in-store clinic operations to ensure patient safety and continuity of care, in addition to helping patients without doctors find one. The American Academy of Pediatrics opposes in-store clinics, saying they add to the fragmentation of the health system.Tom Charland, president and CEO of Merchant Medicine, a retail operator consultancy group based in Shoreview, Minn., and former senior vice president of strategy and business development for MinuteClinic, said he sees the Wal-Mart clinic expansion as an opportunity for physician groups to enter into joint, in-store clinic ventures with hospitals.That is particularly the case in smaller metropolitan areas, he said. "I think we will now see an impact ... where the big names have not opened up yet."Physician groups and hospitals will see this as a chance to "open up with a trusted brand before [CVS-owned] MinuteClinic comes to town," Charland said.<image001.gif>Discuss on Sermo Back to top. ADDITIONAL INFORMATION: Wal-Mart clinic locationsThe retailer plans to open 400 additional in-store clinics by 2010. The company has 55 clinics operating currently. ClinicsClinic operatorArkansas2RediClinicCalifornia4Quick HealthColorado15SmartCareFlorida4Express Aid, SolanticIndiana6MedPoint Express, owned by Memorial Hospital & Health System, South Bend, Ind.Oklahoma2RediClinicTexas6My Healthy AccessVirginia9RediClinic, in affiliation with Bon Secours Richmond Health System, Richmond, Va.Wisconsin7Aurora Quick Care, owned by Aurora Health Care, MilwaukeeSource: Wal-MartBack to top.Where the in-store clinics areAccording to a recent study, there were about 500 retail clinics open or planned in the United States. More than 1,500 are expected by the end of 2008. The report counted clinics as of September 2007, so this list does not reflect recent activity such as CheckUps going out of business, or other clinics such as MedPoint Express that have opened more locations.Clinic operatorClinicsLocationsAtlanticCare HealthRite4N.J.Aurora QuickCare20Wis.Bellin Health Fast Care3Wis.Corner Care Clinic14Ill., Ind., Ohio, N.Y., Pa.Early Solutions Clinic6Mich.FastER Care5Calif.Geisinger CareWorks Convenient Healthcare2Pa.Healthy Access7Md., TexasLindora Medical Clinics1Calif.MedBasics2TexasMediMin3Ariz.MedPoint Express3Ind.MinuteClinic168Ariz., Conn., Fla., Ga., Ind., Kan., Md., Mich., Minn., Mo., Nev., N.J., N.Y., N.C., Ohio, Tenn., Texas, Wash.ProntoClinics4Fla.Quick Quality Care (CheckUps)23Ala., Fla., La., Miss.QuickClinic6OhioQuickHealth9Calif., IdahoRediClinic46Ark., Ga., Okla., Texas, Va.SmartCare Family Centers19Colo., Ga.Solantic13Fla.Sutter Express Care6Calif.Take Care Health Systems50Ill., Kan., Mo., Pa.The Little Clinic24Fla., Ga., Ind., Ky., OhioTrinity MedXPress1IowaSource: "Health Care in the Express Lane: Retail Clinics Go Mainstream," & Co., September 2007Back to top.Recent closuresWhile new retail clinics continue to open, there have been some notable closures. Experts say it takes between 24 and 36 months for clinics to begin making a profit. Having too little capital has been blamed for many clinic closures.Clinic operatorLocationsAffordable Basic CareInd., Mich.Corner Care ClinicInd.CuraQuickIowaInstaClinicMiss.CheckUpsAla., Fla., La., Miss.Smarter CareCalif.Wellness ExpressCalif.Source: Tom Charland, retail clinic analyst; "Health Care in the Express Lane: Retail Clinics Go Mainstream," & Co, September 2007 -- M.D.www.elainemd.com