More turning to walk-in clinics for convenience, cost

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BY TONY PUGH
MCCLATCHY WASHINGTON BUREAU/TNS

WASHINGTON — The tradition and inconvenience of appointment-based health care is under attack across America.

Nurse practitioner Blen Abdi injects Jessica Carpenter with an immunization at the CVS in Pentagon City in Arlington, Va., on May 6.(KEITH LANE/MCCLATCHY DC/TNS)
Nurse practitioner Blen Abdi injects Jessica Carpenter with an immunization at the CVS in Pentagon City in Arlington, Va., on May 6.
(KEITH LANE/MCCLATCHY DC/TNS)

A growing number of walk-in health clinics, with late-night and weekend hours, on-site prescription drugs and cheaper prices, are proving a hit with busy patients who’ve grown tired of getting medical treatment when it’s most convenient for doctors.

Walk-in clinics include the nation’s 1,900-plus retail health clinics and more than 6,400 urgent care centers.

Most urgent care centers are freestanding facilities run by private equity investors, hospitals, insurers or small independent outfits with one or two locations. Larger corporate groups, like Concentra and US Healthworks, operate several hundred outlets.

Retail clinics, located in pharmacies, supermarkets and big-box retailers, are dominated by a few large corporate players like CVS Health’s MinuteClinic, Walgreens’ Healthcare Clinic and The Little Clinic located in Kroger, King Soopers and other food stores.

Services offered
Urgent care centers handle non-life-threatening ailments and usually have a doctor on site. They provide X-rays, apply orthopedic casts and typically treat injuries like sprains, falls, broken bones and wounds that require stitches.

Retail clinics, staffed by nurse practitioners and physician assistants, provide non-emergency care, including vaccinations, physicals and screenings for routine illnesses like colds, skin conditions, strep throat and sinus infections.

Some retail clinics also help manage chronic conditions such as asthma, diabetes and high blood pressure, a development that has drawn the ire of the American Academy of Family Physicians.

“This kind of foray into chronic disease management is problematic because it really fragments patient care” by utilizing multiple caregivers that may not share patient information, said Dr. Wanda Filer, the academy’s president-elect.

The American Academy of Pediatricians has advised parents not to bring their children to retail clinics, saying they don’t provide youngsters with “high-quality regular preventive health care.”

The group also said that urgent care centers should only be used to compliment a child’s primary caregivers, not replace them.

‘Medically homeless’
Part of the problem is that 40 percent to 50 percent of retail clinic patients don’t have a primary care physician.

“The reality is there’s a lot of people who are medically homeless,” said Dr. Andrew Sussman, president of MinuteClinic and associate chief medical officer at CVS Health. “So when they get sick, even when they get sick with a relatively routine problem, they don’t have someone they can easily go to.”

Tine Hansen-Turton, executive director of the Convenient Care Association, which represents more than 95 percent of the nation’s retail clinics, disputed the claim that her member clinics don’t work well with local caregivers.

She said most do inform doctors when their patients come in for treatment, and the clinics try to connect patients without doctors to local physicians and pediatricians who are taking new patients.

“We think it’s important that people have a medical home that they can go to and get their primary care needs filled,” Hansen-Turton said. “Because we’ve never said that we wanted to be the ongoing primary care provider for patients. We’re there for acute minor illnesses.”

Expansion, growth
At urgent care centers, which debuted in the early 1980s, about 63 percent of patients already have primary physicians, according to the Urgent Care Association of America. But they often can’t get appointments when they need to, said Dr. John Kulin, an association board member who owns several urgent care centers in New Jersey.

“The primary system is overloaded,” Kulin said. “They’re filled up for the episodic stuff already. They can’t get patients in immediately. So were just serving as an extension of their office while (freeing up) the emergency departments to take care of the more acute needs.”

With a national shortage of doctors, higher rates of chronic illness and more people with health insurance under the Affordable Care Act, it’s no surprise that walk-in clinics are booming.

Kulin said the number of urgent care centers are projected to grow by 20 percent a year for the next several years. The average center handles 14,000 patient visits a year and more than 80 percent of centers expect to expand their services, according to the association.

Retail clinics have grown from 258 in 2007 to more than 1,900 this year.

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