Minute clinic: moving Minnesota health care policy forward, or two steps back?

Minute Clinic is that ubiquitous storefront nurse who can diagnose very basic issues like ear infections and strep throat in convenient locations like your local pharmacist or (as I discovered recently) the skyway. The idea is simple enough. A person is sick; the problem is not a huge one. A nurse practitioner diagnoses and sends you back out into the world, prescription in hand to take on the day. And hey, if the Minute Clinic happens to be in a pharmacy, even easier.

Ahhh, if life was just that simple. The Minute clinic "retail health care" model is gaining popularity, growing from just 83 locations in 2006 to over 500 in 2007. By the end of 2008, over 2,000 locations are projected to be up and running. Much of that growth stemmed from a partnership between pharmacy giant CVS and Minute Clinic. But Minute Clinic isn't in the retail clinic business alone. There are at least a dozen competitors that follow the same model, with names like MedicalMart and SmartCare. And while expansion and growth in retail clinics is slowing with the economy, it's still the fastest growing sector in the medical field today.

That kind of growth isn't without its problems. Retail clinics have their share of critics. There have been several reports of lax regulations for the medical professional behind the "counter", normally a nurse practitioner. In 2007, there were several reports of under or overmedicating patients. But it's hard to gauge how many patients had issue after visiting a retail location. There's just not an independent oversight board.

In 2007, the American Medical Association released a report over just that issue. Without an oversight board, the report argued, there was no way to make sure that the patients seen were getting quality care. Minute Clinic's website explains that they offer "thoughtful, caring, and above all, qualified" clinicians to take care of a patients medical needs. Nowhere on the website does it say that these nurse practitioners and physician's assistants have access to an actual physician. And without that oversight, things can go wrong. Calls to Minute Clinic to clarify this position were not returned at press time.

The AMA also urged local agencies to look into the partnership between retail clinics and the pharmacies they are located in. While it may be convenient to have a retail clinic inside a pharmacy, it could be viewed as a conflict of interest to prescribe medication to be filled just a few steps away. Pharmacies that have retail clinics on-site have seen a huge spike in pharmaceutical sales, and the retail pharmacy industry is taking notice. You can now find a retail clinic in most major pharmacies, and even places like Costco. Finally, the AMA report addressed the relationship between retail clinics and insurance companies. Retail clinics do offer some forms of health insurance. For the uninsured, it can be cheaper to visit a retail clinic than an urgent care facility. There is some concern that retail clinics have lower copays than a visit to a physician's office. The AMA argued that copays should be the same low price for all, so people wouldn't be tempted to use the retail clinic for more complex care. And for the uninsured, a 2007 report out of California shows that between the $30.00-$80.00 per visit and the cost of medication, the final bill can be hundreds of dollars. For the uninsured, retail clinics just don't provide an answer.

Retail health clinics are a good example of starting to move Minnesota ideals in the right direction. Trying to make health care accessible for everyone is an ideal that we are known for nationwide. We just need to make sure that we do so in a responsible and regulated manner. We also need to ensure retail clinics and their partnerships with pharmacies benefit people before companies.