Corner-store doctor gains traction in New York

In her hometown of Chicago, Kiratiana Freelon got her flu shots at her local drugstore. After moving to New York last year for graduate school, she planned to do the same. But instead of the familiar sharp prick of a vaccination, Ms. Freelon, 33, felt only disappointment. The nearest drugstore clinic was in New Jersey.
Health clinics inside drugstores, which offer immunizations and treatment for minor conditions, have exploded nationwide but largely bypassed New York. The state is home to merely 17 retail clinics, including six of the more than 800 MinuteClinics that are nestled in CVS drugstores nationwide.
Because New York only allows individuals, not corporations, to own medical practices, the clinics currently operate by renting out space to a practitioner—a model that’s kept them from expanding. New regulations tucked into Gov. Andrew Cuomo’s budget, however, could change that, allowing corporations to operate retail clinics—but with caveats that would limit the scope of services they can offer.
Customers like Ms. Freelon—young, relatively healthy and price-conscious—have fueled the clinics’ growth. But New York state health officials believe that clinics’ quick, episodic care exacerbates the current fragmented delivery system, in which providers have little access to a patient’s medical history.
The state has been spending millions of dollars to move New Yorkers into new models of care whereby a primary care doctor or practice manages the entirety of a patient’s health. By 2020, 80% of patients are scheduled to be in such an arrangement, according to the state’s Health Innovation Plan. Retail clinics, the thinking goes, could undermine this goal.
‘Promote prevention’
That’s why regulators want to allow corporations to operate the clinics if they agree to several conditions. Chief among them: Clinics would be required to keep a patient’s electronic medical records and make referrals to primary care doctors for customers who say they don’t have one.
800+—Number of MinuteClinics in CVS stores nationwide
6—Number of those in New York state
“If the main care people are getting is from walk-in clinics, things are going to get missed,” said Dr. Jo Ivey Boufford, president of the New York Academy of Medicine, who also advises the state Health Department on public health policy. “When you’re a primary care physician, you really take responsibility for a patient over time. You know them, you know their families, and you want to promote prevention.”
Retail clinics would also be prohibited from treating children under 2 years old and from administering childhood immunizations. And drugstores would have to inform customers that they don’t need to buy medicine from their pharmacies. Four basic immunizations, including the flu shot, are available in most pharmacies. To get other shots, and to diagnose and treat sickness and minor injuries, New Yorkers need to see a doctor or nurse practitioner.
The rules are meant to prevent a patient from using a walk-in clinic to treat a chronic condition, such as diabetes. (Retail clinics differ from urgent care facilities, which offer more extensive medical services but are also facing more regulations.)
The proposed regulations, which are expected to pass the Legislature, would create a new licensure category of “limited-services clinics.” The stores would be required to display prominent signs with the new nomenclature.
There are just nine retail clinics in the city: Duane Reade, a subsidiary of Walgreens, advertises a “doctor on premises” in seven Manhattan locations. CVS Caremark has two MinuteClinics in the city and four more in the suburbs.
Making retail clinics easier to open will expand their growth because they tend to be both cheaper and more convenient than a doctor’s office. The clinics are staffed by nurse practitioners, not expensive M.D.s. Half of visits to a MinuteClinic take place on evenings and weekends, said Dr. Andrew Sussman, president of MinuteClinic.
‘Bare minimum’
When they expand in New York, retail clinics could ease the strain of—and compete with—overburdened doctors and alleviate emergency-room crowding for patients who use ERs because they are open late. As many as one-fifth of doctor visits, and one-tenth of emergency-room visits, are for issues that could be treated at a retail clinic, a Rand Corp. study found.
Drugstores that operate retail clinics support New York’s proposal. Kevin Cleary, CVS Caremark’s Albany lobbyist, said at the state’s public hearings on the regulations Nov. 20 that the chain has no interest in treating chronic conditions or competing with doctors who do.
Ms. Freelon, the graduate student, first went to a Chicago Walgreens for a shot because she said she “was getting overcharged at the doctor’s office for something my insurance wouldn’t cover.” Her insurance covered the immunization, but not the office visit. “You don’t have to worry about that as much at drugstores because everything is bare minimum,” she said.
The allure of low prices is causing some insured patients to rethink seeing their doctor, said Dr. Kaveh Safavi, global managing director for the health care industry at consulting firm Accenture.
“If I have a 25% copay for a $200 visit, it’s a $50 copay, whereas a clinic visit can be $45,” he said. “Now you have individuals saying, ‘The charges I have coming out of my doctor’s office with insurance leave me with a bigger bill, so I’m going to look at some other options.’ ”
These choices can make doctors squirm, but they’re unavoidable in the long term, he added.
“The journey to a more affordable health care system is going to require some models to be disrupted,” said Dr. Safavi. “There’s no way that’s going to stop.”