Retailers Position For Clinic Expansion

WALKER — Shoppers mill around the Meijer Inc. store on Alpine Avenue NW, browsing for life's essentials: bottled water, strawberries on sale, shampoo and socks.

Now they also can stop at Affordable Basic Care for another of life's essentials: health care. The Alpine Meijer store hosts one of four health clinics in Grand Rapids-area Meijer stores, offering basic services such as sore throat checks and vaccinations for a flat fee. With these in-store clinics recently becoming one of the hottest trends for retail chains that offer prescriptions, more may be headed to Grand Rapids stores.

"How they'll succeed is up to the marketplace," said Dr. Paul Farr, president of the Michigan State Medical Society.

Wal-Mart in April announced that it plans to add 2,000 clinics to its stores nationwide. Walgreen Co. revealed this month that it is acquiring Take Care Health Systems, which operates 50 clinics in five cities. CVS Pharmacies, which recently merged with pharmacy benefit giant Caremark, owns MinuteClinics. Rite Aid has in-store clinics only in California, but is considering expansion. Target also has been mentioned as another retailer eyeing in-store health services.

None of the chains would reveal any plans they may have to bring clinics into the Grand Rapids market. Meijer was unable to provide comment.

Whether owned by the retailer or operated under a contract, the clinics' main purpose is to lure people to the pharmacy counter in the hopes that they'll buy more on the way in and on the way out.

"I think that this is all about the battle for the relationship with prescriptions," said Steve Borders, a health administration professor at GrandValleyStateUniversity. "If you go into Walgreens today, it hardly looks like a drug store. Where they make their real money is on those impulse buys that people do, going to the counter and picking up a candy bar on the way out."

Physicians' Organization of West Michigan operates ABC clinics in 16 Meijer stores in Michigan and Indiana and plans to add 15 more, said Dave Silliven, POWM executive director.

"We felt that we were a good partner to work on this project with them, because physicians are licensed to practice medicine and that is our business," said Silliven.

Grand Rapids-based POWM provides nearly 600 member doctors with business support such as group purchasing, transcription services, practice consulting and managed care contracting support.

Silliven said the clinics are not making money for POWM.

"No, it's not meant to be a money-maker. It's not meant to be a money-loser, but it's all about delivering quality care. Our first intent was to be involved with Meijer locally. When they asked us to expand, we were happy to accommodate them.

"We made a decision we're just going to work with Meijer and that's it. We have no desire to be a national player in this arena," Silliven said "Our focus is on working with Meijer, and I think they appreciate that. They are a big enough partner, and we're just happy with that relationship. As long as they're happy with it, we'll continue to work at it."

In Grand Rapids, ABC clinics are located in the Meijer stores in Jenison, on

54th Street SW

, Alpine Avenue NW and Plainfield Avenue NE. POWM also operates ABC clinics in DeWitt, Lansing, Portage and Traverse City, and nine in Indiana. The clinics accept cash, check or credit cards and will provide a receipt for patients to use in seeking insurance reimbursement.

The clinics are staffed by a contract company, Silliven said, and employ nurse practitioners and physician assistants. Michigan law demands that those delivering care must be properly licensed and overseen by a physician, and Silliven said that's enough regulation.

"Already there is plenty of regular oversight for delivering health care to the population," he said. "Some out there think the clinics need something special. But that won't do anything but harass the continued expansion, but doesn't offer any special benefit."

Patients at ABC clinics include young families, people who don't have a regular doctor and some who don't have insurance, Sillivan said. "We're seeing really a very broad spectrum of different utilizers," he said. He thinks people like the convenience of getting treatment for minor health issues while they are shopping at Meijer and have access to the retailer's free antibiotics.

Physician reactions have been mixed, Silliven said.

"Physicians are in the business of practicing medicine, and they must accommodate the requests of their customers," he said. 

"I've seen physicians be open longer hours, take walk-ins and be open on weekends. The marketplace is going to determine how physicians or anyone in the business is going to be successful or not successful. Health care is a business, and the patients are customers. Physicians and hospitals and pharmacies and durable medical — everybody has to adhere to the request of customers."

Farr, a gastroenterologist in Grand Rapids, said in-store clinics may give the low-income uninsured, who often rely on expensive emergency room visits for basic care, a choice between a $700 bill and a $100 charge. "I know the one I want," he said.

"The good is, they really are where the people are," Farr said. "The ease and convenience couldn't be better. And since it is on a cash basis, I'm positive the service will be very good.

"The bad part is we still have the underserved, the uninsured, or people who don't have money to pay with their Visa who are not going to get the care. They're taking the profitable side and not taking the bad risk: the uninsured or Medicaid."

Clinically, Farr said, the concern is about communication with the patients' primary care doctors, lack of follow-up care, and lack of prevention services around such common issues as smoking and cholesterol.        

Affordable Basic Care Services

Treatments
Examples: pink eye, sore throat, poison ivy, suture removal, warts

Charge: $59

Lab tests

Examples: pregnancy, A1C for diabetics, cholesterol

Charge: $10 to $25

Screenings

Examples: Blood sugar, TB, vision

Charge: $29 (Blood pressure check is free.)

Vaccinations

Examples: DPT, MMR, polio

Charge: $30 to $110