Money & Medicine
Pediatricians voice concerns about retail health clinics
St. Louis Business Journal - by Julia M. Johnson
Some area physicians and health administrators are finding retail-based health clinics a tough pill to swallow.
Several doctors and medical executives released a letter to local media this week saying the clinics don't provide comprehensive care for children.
The letter was written by Dr. Jerome O'Neil, president of Pediatric Care LLC, and co-signed by Doug Ries, president and CEO of SSM Cardinal Glennon Medical Center; Dr. Martin Schmidt, immediate past president of the medical staff at Glennon; Lee Fetter, president of St. Louis Children's Hospital; Dr. Charles Dougherty, medical staff president at Children's; Dr. Eliot Casey, immediate past chair of pediatrics at St. John's Mercy Medical Center; and Dr. Jerry Rosenblum, president of the St. Louis Pediatric Society.
The nurse-practitioner-staffed clinics opened in nine Walgreens and three Schnucks stores here since late summer. Walgreens' clinics are operated by Take Care Health Systems of Conshohocken, Pa., and the Schnucks clinics are run by a St. Louis firm, instaClinic, led by nurse practitioner Patricia Sohn.
"My concern about overtreatment of viral illness with antibiotics has been confirmed" by what's happening in the clinics, Dougherty said. He said patients of his practice have visited store clinics and received inappropriate treatment for their conditions. He cited cases of antibiotics given for viral conditions, and a child treated for swimmer's ear when she actually had a foreign object in her ear canal.
"Treatment of viral processes with antibiotics is bad medicine," he said. "I don't know if the motivation is just patient satisfaction, sending them out the door with something in their hands so they'll be happy and come back. But if people keep overprescribing antibiotics, the drugs eventually won't work anymore."
"Another concern is the financial incentive Walgreens may have to open these clinics in stores," Schmidt said. "I have heard of nurse practitioners at the clinics walking a child's prescription over to their own pharmacy counter and not giving the parents a choice on where to fill it."
Peter Miller, president and chief executive of Take Care, said he is aware of disapproval among some doctors but maintains his clinics are growing in clientele.
"We have seen 15,000 patients in our nine St. Louis centers," he said. "We're seeing 10 to 20 per site, per day. That's up a bit from a few months ago." He said Take Care's 10 Kansas City clinics are seeing 15 to 25 per day. The company also has clinics in Chicago and Pittsburgh.
Take Care's clinics see patients age 18 months and older for a range of minor illnesses. They charge cash clients between $59 and $74 for services. Miller said he is pleased with the progress of the clinic program in St. Louis and overall.
Schmidt said his practice has not seen a negative financial impact from the in-store clinics, but it may extend its hours to accommodate more patients.
O'Neil said his main objection to the in-store clinics is that they don't constitute a "medical home" where kids can receive full care and where their complete histories are on file. "The clinics may be able to increase the convenience factor, but the tradeoff is not worth it," he said.
Miller responded to physician criticism by saying that his clinics operate under Centers for Disease Control recommendations for antibiotic use, and that all patient records are reviewed by a second nurse practitioner. He said all patients receive a follow-up phone call within 24 hours, and 10 percent of patient records are reviewed by collaborating physicians.
"I'd argue our quality management and oversight are more than what some medical practices are doing," he said. "We get about one patient complaint per 1,000 visits."
"Most of our patients are healthy adults who are in a hurry or can't get in to see their doctors," said instaClinic's Sohn. "We refer enough patients to doctors that I think we're actually helping build their practices."
In November, Take Care began accepting Anthem Blue Cross Blue Shield health insurance. instaClinic has begun accepting GHP and HealthLink insurance.
Miller said Take Care is looking to add three to six more clinics in St. Louis. instaClinic has a fourth Schnucks location opening this winter. Its clinics charge cash-paying patients between $29 and $110 for various services, and see 5 to 12 individuals per site per day.
jjohnson@bizjournals.com
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