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Bread, milk -- and a diagnosis

These walk-in clinics are quick and convenient. But are they for everyone?

January 22, 2007|Shari Roan | Times Staff Writer

WHAT a Monday morning this was shaping up to be. Carrie Clemens' head pounded, breathing through her stuffy nose was difficult and her symptoms were worse despite a weekend of bed rest. But work beckoned -- and she had no time to visit the doctor.

And so, before checking in at her job, Clemens stopped by a small walk-in clinic at a Costa Mesa Rite Aid. There, she received a sinusitis diagnosis from a nurse practitioner, filled a prescription for an antibiotic to treat it and was out in 15 minutes.

"I can pop in here and get on with my day," says Clemens, 32, of Huntington Beach. "And I won't have to wait for hours in my doctor's office with a bunch of other sick people."

As the nation's healthcare system struggles to provide affordable care to all who need it, store-based health clinics are springing up around the country. By using mostly nurse practitioners instead of doctors, and operating in a corner of an existing business, the clinics are able to provide some basic health services for around $40 to $70 per visit -- in less time than it takes to eat lunch. Most are even open evenings and weekends, when the lights are out in private doctors' offices.

For The Record
Los Angeles Times Wednesday January 24, 2007 Home Edition Main News Part A Page 2 National Desk 1 inches; 63 words Type of Material: Correction
Walk-in clinics: An article in Monday's Health section about walk-in clinics described Carrie Clemens' visit to Lindora Health Clinic, reporting in a positive way her experience as a patient at the clinic. Clemens is also an employee of Lindora Inc. but did not acknowledge this fact when asked about her place of employment. The Times learned of it after publication of the article.
For The Record
Los Angeles Times Monday January 29, 2007 Home Edition Health Part F Page 6 Features Desk 1 inches; 61 words Type of Material: Correction
Walk-in clinics: A Jan. 22 article about walk-in clinics described Carrie Clemens' visit to Lindora Health Clinic, reporting in a positive way her experience as a patient at the clinic. Clemens is also an employee of Lindora Inc. but did not acknowledge this fact when asked about her place of employment. The Times learned of it after publication of the article.

Some doctors and health experts worry that the clinics may not always provide quality medical care -- and that they could prevent a patient from forming a relationship with a primary-care doctor. But clinic operators say their services are an innovation whose time has come. The emphasis on convenience and low cost fills an unmet need in today's healthcare system, they say.

"Consumers are increasingly finding that access to their primary-care doctor is problematic," says Mary Kate Scott, a Los Angeles-based healthcare consultant who wrote a report on the trend last year for the California HealthCare Foundation. "Either you don't have a primary-care doctor or it takes a very long time to get an appointment."

With deductibles and co-pays ever increasing for doctors' visits, many consumers find the flat fees charged by retail clinics a bargain, says Scott. When not covered by insurance, the cost for a doctor's visit can cost $70 and up. Even with insurance, co-pays of $35 are commonplace. Add that to additional premiums charged if the yearly deductible hasn't been met and walk-in clinics' fees become comparable.

For uninsured Americans or those without primary-care physicians, such clinics can help avoid crowded hospital emergency rooms and the resulting long waits.

"A large number of uninsured people are hourly workers," says Michael Howe, chief executive of the Minneapolis-based chain MinuteClinic. "If these people have to go to an emergency room for care, it's not just the cost they are bearing, it's the lost wages as well."

Walk-in clinics, which are usually set up in drugstores, groceries or big-box stores such as Wal-Mart, are expected to grow from more than 200 in 2006 to as many as 2,000 by the end of this year, according to a report by the California HealthCare Foundation, an independent philanthropic organization based in Oakland that focuses on improvements in healthcare delivery.

No more doc-in-a-box

The premise behind quick, after-hours medical care is not new. Two decades ago, walk-in clinics -- often referred to as doc-in-a-box -- were opening in almost every city and suburb.

Almost as quickly, it seems, the clinics were shuttered -- victims of low profits despite their popularity with consumers.

Today's walk-in clinics are different, clinic operators say, and thus stand a better chance of surviving. Doc-in-a-box clinics were typically free-standing centers, staffed by both doctors and nurses who provided a broad range of primary-care services, even X-rays and lab tests. Such clinics accepted insurance and charged fees similar to those of primary-care doctors.

But the centers -- with all the expenses of a regular doctor's office but no regular patient base -- simply weren't cost-effective.

"What they found was that if you're trying to provide vast needs in primary care, this was not the best way to do it," says Dave Mandelkern, founder and president of QuickHealth, a chain of walk-in clinics based in Burlingame, Calif.

In contrast, the retail-based clinics opening today are usually staffed by nurse practitioners or physician assistants, both of which can prescribe a wide range of medications within their specialty area (such as pediatrics or primary care). The clinics are tiny -- usually 500 square feet or less. Nurse practitioners or physician assistants are authorized by the clinic operator to treat and prescribe medications for 25 to 40 simple conditions, including colds and flu, pinkeye, minor skin burns, bug bites, poison ivy and urinary tract infections. The clinics also offer a limited range of inexpensive, on-the-spot diagnostic tests such as pregnancy, mononucleosis and strep testing. Most provide flu shots and other basic immunizations.

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