In-store clinics: Should you worry?

If you walk into the CVS drugstore in a shopping plaza near Annapolis, MD, you'll find the usual displays of cosmetics, toiletries, first aid products, over-the-counter medications, and the pharmacy in the back. But tucked into a corner between the greeting cards and a one-hour photo shop, there's something new: a walk-in "MinuteClinic," staffed by a nurse practitioner ready to treat a variety of common ailments.

To appreciative patients, this miniclinic offers the ultimate in convenience-easy access to low-cost treatment by experienced professionals, with no appointment necessary. To local primary care doctors, however, the clinic represents a potential threat to their patient relationships-and to their practice income. To the healthcare industry, MinuteClinics-and a growing number of smaller competitors-represent a minor revolution in the delivery of routine medical care.

Launched in 2002, MinuteClinic already has 22 units in the Minneapolis and Baltimore areas, staffed by NPs (or PAs in Minnesota), and plans to open dozens more near other cities over the next year. Like the one near Annapolis, most will be located in suburban shopping plazas in stores like CVS, Target, or supermarkets that have their own pharmacies, making it easy for patients to get prescriptions filled.

Clinic fees range from $25 for athlete's foot to $99 for allergy testing. But $40 to $50 will cover treatments for most common illnesses like bronchitis, strep throat, or ear, sinus, skin, and bladder infections. The NPs also administer vaccines, and do screenings for cholesterol, pregnancy, thyroid, diabetes, and heart disease. Health screenings range from $42 to $72. About two-thirds of the patients receive prescriptions; others are advised to take OTC medications.

Since MinuteClinics are typically covered in-network by area health plans, most patients are charged only a copay, typically $10 to $20. In fact, some plans encourage enrollees to utilize the clinics because their fees are considerably lower than those charged by EDs, urgent care clinics, and physicians. According to MinuteClinic, which charges $48 to treat strep throat (plus $14 if an overnight culture is required), the average cost at a doctor's office is more than $100, and more than $300 at an ED.

Unlike urgent care clinics, MinuteClinics don't deal with complex conditions or serious injuries. "We treat common medical conditions that can be handled with one visit, and don't require a full workup or follow-up care," say Debra Benoit, an NP who supervises the company's Baltimore area clinics. "For instance, we treat minor cuts and abrasions, but we don't treat wounds that need sutures, or orthopedic problems that require X-rays. If the patient has high blood pressure, we won't prescribe medication; instead, we'll refer him to a primary care doctor."

A new model of medical efficiency

Each MinuteClinic is a model of low-overhead efficiency: There's no receptionist, no waiting room, and no separate office. After signing consent and HIPAA forms, the patient enters a room about the size of a typical doctor's exam room and takes a seat. The NP sits at a nearby desk with a computer and a printer. There's a refrigerator and a minilab, but no exam table, ECG, or X-ray machine.