The concept has made a stir across the country: retail-based mini-clinics offering fast, inexpensive care for common ailments. No waits, no appointments – just walk in and, in 15 minutes, find out if your sore throat is strep, and get a prescription if you need one.
MinuteClinic Inc., the best-known of these new health care providers, has so much faith in this business model that it’s pumped millions into clinics in Minnesota and Maryland – and despite losing $7.7 million between 2002 and 2004, it continues to expand.
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Now, as part of a larger-scale deal with Woonsocket-based CVS Corp., MinuteClinic is seeking to invest $2 million to $2.5 million to set up five clinics at CVS stores in Rhode Island. The company applied for a license in May, aiming to open by Sept. 5. That’s not going to happen.
At an initial hearing July 28, the R.I. Health Services Council barraged MinuteClinic with questions about its finances, its policies, and its willingness to treat people who can’t afford to pay.
The company has also faced criticism from the Rhode Island Medical Society, whose president, Dr. Fredric V. Christian, said it could become a “disruptive player” in the system, “potentially undermining doctor-patient relationships, and contributing to the fragmentation and ill-coordination of health care services.”
Health Insurance Commissioner Christopher F. Koller has expressed similar concerns, and recommended changes to the way the clinics operate.
For almost two hours last Tuesday, MinuteClinic officials tried to assuage the Health Services Council members’ concerns, explaining in detail how patients are treated and reasserting that they provide plenty of free care and won’t turn anyone away.
But it wasn’t enough. Another hearing is expected in mid- to late September.
The council’s questions focus on three separate issues: MinuteClinic’s role in improving access to care for poor and uninsured Rhode Islanders; the company’s financial health; and the quality and reliability of the care it will provide.
A key selling point of the MinuteClinics is that they’re cheaper than doctors, urgent-care clinics or emergency rooms – typically $44 per visit, compared with the $96 a top Blue Cross & Blue Shield of Rhode Island official cited for urgent care, or the $350 cost of an ER visit.
Yet if affordability is such a big deal, council members kept asking, why has MinuteClinic targeted five of the wealthiest places in Rhode Island? (The proposed sites are Barrington, the Garden City area of Cranston, East Greenwich, Wakefield and the East Side of Providence.)
“The locations we have selected are the areas that have the demographics with which we have been successful over the years,” said Dr. Jim Woodburn, the firm’s chief medical officer. He and Catherine Wisner, vice president for clinical quality, also noted that they’re working with Blue Cross to make the clinics available to RIte Care subscribers served by the insurer.
“I’m disappointed by the answer,” said Robert J. Quigley, the council chairman. “I wanted to know why you’re not in the areas where you’d be serving the indigent or uninsured.”
The MinuteClinic officials said repeatedly that their clinics do serve many uninsured people – they’re 10 percent of the Minnesota clinics’ patients, and 15 percent of those in Maryland. (What they didn’t say is that in both cases, that’s less than the share of uninsured adults in those states – 11 and 18 percent, respectively, according to the Kaiser Family Foundation.)
Council members and R.I. Department of Health staffers also found fault in the company’s claim that 12 percent of the care it provided was “charity care.” In fact, a breakdown provided by MinuteClinic showed only 2 percent of visits involve “free care” in the sense that the patient isn’t billed for services the clinic normally charges for.
Another 8 percent of visits are also free because MinuteClinic has a policy of providing free evaluations to all patients, but not charging those whom the on-site nurse practitioner can’t treat herself, and who are referred to doctors, urgent care clinics and ERs.
There was no accounting for the other 2 percent the company had claimed.
Nevertheless, both Woodburn and Wisner stressed that MinuteClinic would serve all patients as best it could, regardless of whether they could pay, and it wouldn’t deny treatment even to people who had outstanding bills from previous visits. Quigley said he wanted that in writing.
As for setting up shop in less wealthy neighborhoods, Wisner said, “we will consider locations throughout Rhode Island once the success of the first phase has been shown.”
The viability of those first five clinics, however, is also a concern for the council. MinuteClinic had been asked to demonstrate its “immediate financial capability” to expand into Rhode Island given its “consistent and increasing net losses” elsewhere. The company replied that it had $18.9 million in assets, including almost $17.6 million in cash. But council members continued to ask about profitability; application documents show that, for example, the Barrington clinic is expected to lose $93,400 in 2005 (that presumed September-to-December operations), lose $95,567 in 2006, and make $107,133 in 2007.
Council member John W. Flynn asked how many visits each clinic in Maryland and Minnesota gets, and why the Rhode Island clinics should be expected to be profitable, since “MinuteClinic has demonstrated that all they’ve been able to achieve is deficits.”
Woodburn replied that it takes two or three years to “ramp up” each clinic, and he added that in Minnesota, the oldest, “most established” sites are actually “well above the profitable line,” seeing 40 or more patients per day. “In the last few months we’ve reached the tipping point of public acceptance,” he said.
Even if MinuteClinic manages to sway the council on both those major issues, quality-of-care questions also promise to be a stumbling block. None of the existing clinics has ever faced official complaints for a “complication or adverse event,” the company replied to a written question, and the patient complaints that do come in (about 4 per 10,000 visits) “range from dissatisfaction about the hours of operation being too limited to complaints about not receiving antibiotics despite testing negative for strep throat, for example.”
Still, council members questioned the effectiveness of the MinuteClinic model – from big-picture questions such as the clinics’ role in the system, to practical issues such as patient privacy, the availability of restrooms, the feasibility of diagnosing, treating and billing a patient in 15 minutes, and the adequacy of a proposed 24-hour customer service line, which would be staffed by a registered nurse from 6:30 a.m. to 10:30 p.m. Central time, but would go to an answering service overnight.
The council promised to give MinuteClinic a new list of questions to answer within the next few days.
