By Tim Christie
The Register-Guard
EUGENE, Ore. — Samuel Decker needed a refill of his asthma medicine, but had no doctor and no health insurance.
The 34-year-old glass artist recently moved to Eugene, so he hasn’t had time to find a primary-care physician. And his insurance company dropped him after he was a day late paying his premium.
Decker said he could have looked up a doctor in the phone book, made an appointment, and paid $200 to see a physician in a conventional medical clinic.
Instead, he stopped by Eugene Urgent Care at 13th and Patterson. After a short wait, he saw nurse-practitioner Mitch Boriskin, who spent about 25 minutes discussing how best to manage his asthma, and wrote his prescriptions. Decker paid $95 for the visit.
“It’s my only option right now,” he said. “I can’t afford to see a regular doctor.”
Decker’s visit to an urgent care clinic is emblematic of a potentially sweeping change in the way health care is delivered in Eugene and across the country: The rise of retail medicine.
While urgent care and actual retail clinics -- those operated inside stores -- represent different business and medical models, both are responding to health care consumers’ demand for convenience, accessibility and affordability, industry experts say. And that demand is driving explosive growth for both kinds of clinics.
The number of urgent care clinics nationally has doubled to about 8,000 in the past four years, according to the American Academy of Urgent Care Medicine. The number of retail clinics, meanwhile, increased from tenfold from 2006 to 2008, to nearly 1,000 outlets across the country, according to a recent study in the Annals of Internal Medicine. Nearly 3 million patients have visited the retail clinics, which typically operate inside a pharmacy, grocery store or big box retailer.
A year ago, people in Eugene and Springfield who needed immediate medical care that didn’t rise to the level of a visit to the emergency room had one choice: PeaceHealth Medical Group’s urgent care clinic on the RiverBend campus. Today, in addition to PeaceHealth’s urgent care, they can visit one of two Eugene Urgent Care clinics, or the new PeaceHealth Check-up clinic inside the Market of Choice grocery store in south Eugene.
Urgent care clinics are intended for people who are suffering from medical complaints that may require immediate attention but aren’t a threat to life or limb, and don’t require a trip to the emergency room. The clinics also are an option for patients who don’t want to wait to see their own doctor, or may not have a physician.
The two Eugene Urgent Care clinics are owned and operated by a group of veteran emergency physicians and nurse-practitioners. They opened their first clinic at 598 E. 13th in December 2008, and their second clinic at 1800 Coburg Road in October. They charge $95 for an office visit; 20 to 30 percent of patients pay cash rather than use insurance.
Dr. Holly Jo Hodges, who left a family medicine practice in Prineville to work for Eugene Urgent Care this fall, points to two factors: A shortage of primary-care physicians, and what she called consumers’ “drive-through mentality.”
“Everyone wants it their way now,” she said. “No one wants to wait for anything.”
“If you need to be seen today, we’re your option,” she added. “They know they can walk in here. Most people are in and out in an hour.”
Urgent care is “the fastest growing specialty in medicine right now,” said Gary Reilly, executive director of the American Academy of Urgent Care Medicine.
“Health care consumers are more savvy,” he said. “They are more attuned to the concept of getting immediate care for those injuries and ailments that don’t require an emergency room.”
Retail clinics are a newer model of health care, first appearing in 2000. Retail clinics offer a more limited scope of services, usually provided by a nurse-practitioner or physician assistant, and generally charge lower prices. PeaceHealth’s retail clinic, for example, charges $39 for health screenings, vaccinations, and treatment of minor cuts and scrapes, and $59 for treatment of common ailments such as colds, sore throats, earaches, and skin conditions.
Even as they’ve experienced rapid growth across the country, retail clinics also have been the subject of controversy. Leading doctor groups such as the American Medical Association, the American Academy of Pediatrics and the American Academy of Family Physicians have expressed concern about the rise of retail clinics.
Dr. Lori Heim, president of the American Academy of Family Physicians, said her group is concerned about retail clinics because they “further fragment care.”
“Now you’re going to have patients going to the ER, to urgent care, to retail clinics -- yet we want one group responsible for coordinating care,” she said. “There’s not been an effort uniformly to connect retail clinics to whoever their primary care physician is. That’s a real problem for continuity of care.”
Heim said she also tells family medicine doctors they need to do a better job of seeing patients in a timely fashion, but that’s not easy if a practice is already heavily booked. The underlying problem is the shortage of primary care physicians, she said.
“We need more primary care providers, and the primary care providers we have need to retool their practices so they are a patient-centered medical home.”
In the meantime, health care consumers are voting with their feet and their wallets in favor of retail medicine, said Mary Kate Scott, a health-care consultant from Marina Del Rey, Calif. PeaceHealth hired Scott several years ago to consult on retail clinic strategy, she said, but she was not involved in setting up their Eugene clinic.
“Consumers around the country have responded with tremendous enthusiasm to retail clinics,” she said. “Consumers are saying in essence, this is what I want for a limited set of conditions. ... You can never underestimate the power of consumer response.”
Nine of 10 adults who have used the clinics were somewhat or very satisfied with the clinics’ quality, cost, convenience and staff qualifications, according to a WSJ.com/Harris Interactive health care survey conducted in May 2008.
With retail clinics, she said, the health care industry is doing what nearly ever other industry has done: Offering a limited subset of services and doing it well and doing it cheaply, like businesses that do nothing but offer oil changes.
“The consumer has said it’s getting incredibly expensive and difficult to wait at a doctor’s office, and the consumer is having a tremendously difficult time getting access to see a doctor,” she said. “Consumers are getting smarter, and we’re teaching them get smarter, about these minor conditions.”
Oregon Medical Group doesn’t operate a retail clinic, although it has looked at the idea, CEO Cris Noah said. Instead, the large practice promotes convenience and access for patients by operating 14 clinics in Eugene and Springfield, and by operating an after-hours clinic at its Crescent Avenue office, which offers scheduled appointments until 10 p.m. weekdays and from 8 a.m. to 5 p.m. weekends.
“It’s very effective and convenient for patients,” Noah said.
PeaceHealth spent about two years studying retail clinics before deciding to take the plunge in Eugene, said Tracy Ellis, PeaceHealth’s director of strategic planning.
“Part of the whole model is to rationalize medicine so people have different forms of delivery where they can get access to care,” he said. “If you’ve got a sore throat, (a retail clinic) is right there, it’s less costly to provide, and the pricing is transparent.”
Between 30 and 40 percent of patients who use retail clinics are uninsured or underinsured, and about 30 percent would go to no other medical provider, including an urgent care or emergency room, Ellis said.
“We saw this as a way to extend access” to health care, he said.
Not all retail clinics have been successful.
“The model is delicate in its balance of volumes and costs,” Ellis said. “You want pricing to be at the point where you’re at least breaking even.”
The retail clinics that have failed generally have been in locations that didn’t attract the right volume of patients, he said. That’s why PeaceHealth liked the location in the front of Market of Choice’s flagship store.
Another factor in PeaceHealth’s favor is that retail clinics operated by health systems have tended to do better than those backed by venture capitalists. The fact that PeaceHealth is a well-established name in the Eugene market was “huge,” he said.
“People trust the dove,” he said, referring to PeaceHealth’s corporate logo.
Partnering with Market of Choice, another strong brand in the Eugene area, helps the clinic’s prospects as well, he said.
“Everybody said, ‘I get that -- it’s PeaceHealth and Market of Choice,’” he said. “If you’re Brand X, it’s a much more confusing proposition.”
Copyright 2009 The Register Guard
Distributed by McClatchy-Tribune Business News