Friday, December 13, 2013
By CHAD TERHUNE Los Angeles Times
LOS ANGELES - If you thought it was hard getting a doctor's appointment, just wait until 30 million more Americans join the line.
Mary Hull, left, a nurse practitioner, examines Blake Howard, 12, at the Minute Clinic at a CVS store in Arcadia, Calif. Blake’s mother Monique, at right, brought him to the clinic to get a physical for youth football.
Gary Friedman/Los Angeles Times
Nurse practitioner Mary Hull gives an eye test as part of a physical exam for Blake Howard at a CVS in Arcadia, Calif. Retail clinics in stores may help alleviate primary care shortages.
Gary Friedman/Los Angeles Times
By 2020, the U.S. faces an estimated shortage of 40,000 primary-care doctors with no way to remedy that in just a few years.
As a result, more consumers may soon find themselves getting their checkups and help in managing their high blood pressure, heart disease or diabetes at the local pharmacy or Walmart as the Affordable Care Act extends health insurance to 30 million people and puts unprecedented strain on an already fragile network of primary care.
Pharmacy giant CVS Caremark Corp., Target Corp. and other retailers are aiming to help alleviate the doctor shortage with hundreds of walk-in clinics run by nurse practitioners to treat ear infections and other routine ailments and increasingly help people suffering from chronic illnesses.
These companies, after struggling to turn a profit from these clinics for the last decade, are now eager to capitalize on an influx of newly insured patients.
"People could have long wait times to see a doctor as the federal law gets implemented in 2014, and that will drive more interest in these retail clinics," said Ateev Mehrotra, a researcher at the University of Pittsburgh School of Medicine and Rand Corp., a nonprofit think tank.
One of the Americans receiving coverage under the law is likely to be Silvana Washington, a 57-year-old home-health aide in Los Angeles with diabetes and hypertension.
Washington often waits as long as three hours to be seen at a county-run medical clinic that serves the uninsured.
She said she would welcome more options, like getting her blood pressure checked during a weekend shopping trip.
"I think a lot of people would like that," Washington said.
Experts say it remains to be seen whether more clinics at the workplace or close to home just create more unnecessary care that drives the nation's $2.6 trillion medical tab even higher.
There are also concerns that a proliferation of these clinics will undermine efforts in the health care overhaul to better coordinate care, particularly for patients whose conditions are among the most complex and expensive to treat.
These clinics are already popular with consumers who like the idea of strolling in for care with no appointment seven days a week. They are typically small operations adjacent to the pharmacy where one nurse practitioner may see patients and handle billing.
There are no doctors on site.
Most health insurers consider these clinics an in-network visit, so people are responsible for their standard co-payment, and the uninsured may pay $70 to $90 for a visit.
Monique Howard of Arcadia, Calif., a special-education teacher, brought her 12-year-old son, Blake, to a CVS MinuteClinic last month for a $49 physical he needed for youth football, and they were seen right away.
Her pediatrician recommended the clinic because the doctor's office would have charged $150, because her insurance didn't cover another annual physical until August.
The weekend and evening hours would be a plus for her husband, who doesn't like to miss work to see the doctor, she said. "I think I found the best-kept secret in town."
There are more than 1,350 in-store clinics nationwide, according to research firm Merchant Medicine, and that number could top 3,000 by 2016.
CVS MinuteClinic, which is the biggest retail clinic chain with nearly 600 locations, plans to open 100 clinics a year.
Rival Walgreen Co. has more than 350 Take Care Clinics. Walmart has nearly 150 in-store clinics, and Target opened nine more last week, raising its total to 53.
These in-store clinics have performed well thus far. Studies by Rand found that these clinics provide care at costs that are 30 percent to 40 percent less than similar care provided at a physician's office and that the care for routine illnesses was of similar quality.
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