Wal-Mart clinics offer pros, cons for patients.

WAL-MART STORES INC. OF Bentonville is pushing the next trend in health care: in-store clinics.

Wal-Mart already has 12 such clinics, including one in Fayetteville, and by the end of the year it hopes to have 50 more.

Other retailers, such as Target and Kroger, are warming up to the idea of having health clinics in their stores as owners look for a way to lure customers inside.

"I think it's going to take off like wildfire," said Candace Corlett, principal of WSL Strategic Retail, a Manhattan, N.Y., retail consulting firm. "It's affordable for many people who don't have health insurance."

Each in-store clinic is staffed by a nurse practitioner who will treat 20 of the most common aliments, such as strep throat and bladder infections, for around $50. The health clinics also offer to get the patients in and out within about 15 minutes. No appointment is necessary, and the clinics are open on the weekends.

But the concept makes the some doctors' blood pressure rise.

"My take on it is, 'Would you come to my office to buy a pair of pants?'" said Dr. Larry Fields of Ashland, Ky., president of the American Academy of Family Physicians. "If you would, then you should probably go to Wal-Mart to get your health care."

The American Medical Society said the in-store clinic concept is too new for it to have a position, but it plans to consider the clinics at its annual meeting in June. Fields said that since the clinics already exist, the American Academy of Family Physicians supports the clinics treating a limited number of illnesses.

Fields said the ideal people who should go to the retail clinics are young, healthy and have an illness that would eventually get better on its own.

"But if you have an underlying disease, or take other medications or have something that is not a cold--like chest pain--you should avoid these things like the plague," he said.

Trying to avoid the clinics will be difficult, since they are popping up all over the country.

The leader in the industry is MinuteClinic of Minneapolis, which has 81 clinics in 10 states has announced plans to open another 150200 clinics by the end of 2006.

Even Walgreens of Deerfield, Ill., is considering adding in-store health clinics.

"We haven't made any announcements at this point," said Walgreens spokesman Michael Polzin. "We are looking at the concept and determining how best it would benefit our customers."

Early Clinics

In 1999, Dr. Doug Smith, a family doctor in Minnesota, opened the first MinuteClinic in a strip mall, Dr. Jim Woodburn, MinuteClinic's chief medical officer, said. Then the clinic moved into a grocery store and business started taking off.

Smith realized there was need for a place where sick people could receive treatment for simple illnesses quickly.

The move has been paying off.

While Woodburn wouldn't reveal MinuteClinic's revenue figure, it charges $49-$59 to treat a patient. A clinic could see up to 48 patients a day, which translates to revenue of nearly $1 million a year.

He said the success of in-store health clinics could send chills through the medical industry, as they may lower the price of health care and even force pediatric groups to stay open later in order to compete.

In the Twin Cities, pediatric groups are adding hours and are now open on Sundays, Woodburn said.

"And when you ask them[why are they staying open], they say it's because of the competitive pressure that we're putting on them to maintain their excellent patient relationship," he said.

The clinics may also help provide affordable health care to the approximately 46 million Americans who don't have health insurance, Woodburn said.

Woodburn said, so far, 10 percent to 15 percent of the 430,000 patients seen by MinuteClinic have been uninsured.

While MinuteClinic was growing, Wal-Mart was being hammered by labor organizations and legislators who complained that the country's largest retailer didn't offer its workers adequate health insurance.

Wal-Mart fought back in February; it announced that it would expand health coverage for its 1.3 million employees and add more than 50 health clinics at its stores.

"With an emphasis on affordability and convenience, these clinics will give the communities we serve access to quality care while providing an alternative to expensive emergency room visits," Wal-Mart said in a news release.

Wal-Mart spokesman Kevin Gardner said Wal-Mart will lease space to RediClinic of Houston.

Gardner said the clinics are designed to meet the basic health needs of the local communities and Wal-Mart's customers.

"These clinics are not designed to replace regular doctor visits, but they're designed to be convenient and a valuable resource for routine preventive care," Gardner said.

One of the clinic's selling points, he said, is a menu of services posted outside the office that tells prospective patients exactly what a procedure will cost before they step into the examination room. The average cost is $45.

Gardner wouldn't say how much RediClinic will pay to rent space in Wal-Mart stores.

Wal-Mart is still in the testing phase for the clinics, but so far "we are hearing very good feedback from our customers," Gardner said. "Our focus is always on the customer, and we have a history of offering a variety of health care solutions like our pharmacies ... or our optical shops, and this fits in nicely with that existing portfolio of health care services."

He said the retail health clinics are similar to the retail optical shops that are already in Wal-Mart stores.

"The key difference is the opticians are managed by us whereas the health clinics are managed by third parties," Gardner said.

Analyst

Consumers have been waiting years for something like retail health clinics, according to Corlett, the principal of WSL Strategic Retail.

Patients don't have time to make an appointment and see a doctor for relatively minor illnesses.

"You let something slide because you just don't have time to get to the doctor," Corlett said.

And more consumers are trying to get everything done in one stop.

Corlett said her firm's study found that 38 percent of consumers are willing to drive farther to get a lot done under one roof. And 49 percent of shoppers say they choose their favorite store because it allows them to accomplish several things at once.

"So we have time-starved shoppers who want to be able to go and buy the dog food, buy the baby food and get a flu shot," she said.

She said the business model should take off because it allows people without health insurance to be treated for minor illnesses for about $50.

B.J. Miller, a senior manager of for the retail consultant Kurt Salmon Associates of New York, also expects to see retail health clinics expanding.

"I think everyone's getting their toes wet," Miller said. "There's a lot of different people there that are starting to get into it.... Everyone's seen it be fairly successful."

In addition to drawing more traffic to the store, the businesses could boost sales to their pharmacies if the sick customer decides to fill his prescription there, Miller said.

Doctor Prognosis

Fields, the president of the American Academy of Family Physicians, said he hopes the clinics will give follow-up reports to the patients' family doctors. And patients who don't have a regular doctor should be encouraged to find one and get integrated into the health care system, Fields said.

"These things are not medical homes," Fields said. "The best thing anybody can have in the medical system today is medical home."

Fields acknowledged that the retail clinics do help in providing care for symptoms that probably would get better on their own. But he thinks the real reason for the rush to establish such clinics is somebody "sees a quick buck" in it.

"I mean, if it was good health care somebody would have done it a long time ago," he said.

Fields also said he would load up on malpractice insurance if he were the owner of a retail health clinic.

"It won't take long before attorneys go where the money is," Fields said. "Nurses don't carry much liability insurance because they didn't go to medical school, so their knowledge is limited so therefore their risk is limited."

He said his association, which has about 95,000 members, is trying to work with the in-store clinics to protect the patients.

"We're even encouraging our members [to be] ... a referral source or a supervisor to try to make sure the standard of care is kept up," Fields said.

Wal-Mart spokesman Gardner said the medical clinics aren't trying to replace the doctor-patient relationship.

"We're looking to provide a low-cost, convenient solution for the 20 most common ailments," he said.

Dr. Geoffrey Goldsmith, chair of the department of family and preventive medicine at the University of Arkansas for Medical Sciences in Little Rock, said the in-store clinics offer several benefits to patients.

"Some people are looking for health care based on not only how convenient the location is but also cost," Goldsmith said.

But the clinics have to be well maintained and look professional for the trend to succeed.

"As long as every single one of them is focused on quality and superior delivery of care, we're all going to benefit; society will benefit," Woodburn said. "The pitfall is if somebody's not paying attention or is undercutting or underestimating the amount of effort you have to put in to ensure quality, then everybody in this sector (will suffer)."

GET REDI: The RediClinic at this Fayetteville Supercenter is one of 12 in-store health clinics Wal-Mart has open in its test program. By the end of the year, the Bentonville retailer plans to have an additional 50 in-store clinics at its stores.

MARK FRIEDMAN

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