Shopping for medical care

Starting today, Philadelphians will be able to sample one of the hottest trends in medical care - primary-care clinics in retail stores.

Four MinuteClinics will open in CVS stores in Northeast Philadelphia, Lansdale and Rosemont. Three clinics opened in South Jersey - Delran, Runnemede and Sewell - about two weeks ago.

Clinics like these, which typically treat minor problems, take no appointments, and are staffed by nurse practitioners, have been springing up in grocery, drug and discount stores across the country over the last few years. MinuteClinic is the first to open in Philadelphia, even though the industry trade group and one of the larger retail-clinic companies are located in this region.

Nationally, the number of medical clinics in stores has grown from 150 last October to more than 500 now, said Tine Hansen-Turton, executive director of the Convenient Care Association. The group, founded in Philadelphia last year, projects 1,500 clinics by the end of next year and twice as many in 2009.

MinuteClinic, a subsidiary of CVS Caremark Corp., plans to open an additional 12 to 15 clinics in the region before year's end.

The clinics offer early-morning, evening and weekend hours, plus clearly posted prices. They focus on relatively mundane medical problems - bladder and ear infections, flu, poison ivy - and promise to refer patients with more serious maladies to emergency rooms or doctors' offices. MinuteClinic will give shots, including flu shots.

Doctors groups have argued that the nurse-run clinics need strict limits and government regulation, plus significant physician oversight. Some say apparently minor symptoms can be signs of significant problems.

"Our concern is people showing up at the CVS when they have a heart attack or a stroke," said Mark Piasio, an orthopedic surgeon and president of the Pennsylvania Medical Society.

"Access is one thing, but proper care is another," he added. "We want to make sure you have access to proper care."

But Hal Rosenbluth, chair of Conshohocken-based Take Care Health Systems, a MinuteClinic competitor, said people want alternatives. "There should be choice, and people should have health care on their terms, not the system's," he said. "The system is obviously broken. Otherwise, there would not be Take Care health clinics or MinuteClinics."

Hansen-Turton said Philadelphia's older, relatively small stores have been a barrier to entering this market, because it's harder to spare the room for a clinic. MinuteClinics, for example, require 200 to 225 square feet. As a center of medical training, this region is also well-stocked with physician competitors.

Based in Minneapolis, MinuteClinic has grown from 19 clinics in two states in June 2005 to more than 275 in 24 states today. It plans to have more than 400 clinics by the end of the year. "It's a geometric kind of growth pattern," said Michael Howe, the company's chief executive officer.

Take Care is also growing. The chain, which was purchased this year by Walgreen Co., has plans to grow from its current 57 clinics to 400 by the end of 2008. Asked whether the company expected to open in Philadelphia and its suburbs, Hal Rosenbluth, Take Care's chairman, said, "We will have a very large presence early next year." He declined to name a specific number of clinics, but said Take Care's strategy was to "go into an area and saturate."

MinuteClinic is not seeking locations that are low on doctors, Howe said. Though 30 percent of patients have no primary-care doctor, most use the clinics because they're convenient. "Having convenient access to high-quality care is something everybody wants to have," he said.

MinuteClinic takes health insurance. So far, Aetna, Cigna and others have signed on in this area. The clinics accept Medicare in most markets, but have few Medicaid contracts. Overall, about 85 percent of visits are billed to insurance. Patients with cash generally pay $59 and up. Flu diagnosis runs $93.

In their first months, clinics treat six to 10 patients a day. Established locations see 15 to 30, Howe said. Fewer than half get a prescription. He said he didn't know how many patients bought items like cough medicine in the store.

The primary benefit to CVS, he said, is in creating a stronger bond with customers. "I think any retailer is looking at how they can create a lifetime relationship with a customer," he said.

Do the clinics make money? "We see profitability in the established markets . . .," Howe said. "Overall, we are still in the investment mode."

The following are the addresses of MinuteClinics in the Philadelphia area:

Pennsylvania

840 Valley Forge Rd., Lansdale.

1218 E. Lancaster Ave., Rosemont.

1301 Rhawn St., Philadelphia.

6501 Harbison Ave., Philadelphia.

New Jersey

Route 130 and Tenby Chase Dr., Delran.

824 Black Horse Pike, Runnemede.

307 Egg Harbor Rd., Sewell.

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MinuteClinic, CVS, Rite Aid and many other chain stores will be offering flu shots this fall. For more details on flu-shot clinics, go to http://go.philly.com/flu

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