Sens. Dan Inouye, D-Hawaii, and Thad Cochran, R-Miss., introduced a resolution to designate the week of Aug. 2 to 8 as National Convenient Care Clinic Week. The resolution passed in the Senate on July 22.
Inouye and Cochran are calling for "supporting the goals and ideals of raising awareness of the need for
accessible and cost-effective health care options to complement the
traditional health care model."
This action recognizes the contribution convenient care has made to the healthcare landscape of this country. A 2009 RAND study published in the Annals of Internal Medicine (see abstract here)
notes that retail health facilities offer
treatment of common ailments at a substantially lower cost than
physician offices, urgent care centers and emergency rooms while
providing equal or better levels of care quality.
"We are very excited to launch Convenient Care Week. Convenient care clinics and their providers are part of the solution to ensure that all Americans have access to quality primary care when and where they need it at a price they can afford," said Tine Hansen-Turton, executive director of the Convenient Care Association, in a statement.
I read an article this morning about a new convenient care clinic inside a Walmart store in Odessa, Texas. It's operated by Medical Center Hospital and seems to have all the same qualities of your average convenient care clinic, but a little bit more: you get a buzzer to carry around the store, like you would at a restaurant, that alerts you when the NP is ready for you.
“'It’s like at Chili’s,' said Al Smith, the clinic’s nurse
And that's not all. Apparently the clinic offers free pregnancy testing. I surely have not heard of any convenient care clinic providing free pregnancy tests. If that's true, it's quite an interesting addition!
A little-used business model for convenient care could be gaining ground: the franchise, or turnkey, model. Bellin Health in Minneapolis has 35 clinics, most of which follow the franchise model, according to JSOnline. Bellin takes care of all the details, for a price: "Bellin oversees the building and design, supplies the furniture and
signs, and provides the marketing campaign. It also pays the build-out
costs, typically about $150,000." Bellin Health plans to continue opening more similar clinics.
Right now Bellin sells its FastCare franchises to other healthcare systems, but I say this is an area of opportunity for NPs to become business owners. In the Convenient Care Report column last June ("The Silver Lining"), I mentioned a clinic chain that sold turnkey franchises - ASAP Medical Clinics in Portland, Maine - however, it seems that those clinics are no longer open.
Good news for convenient care, and NP jobs: Target is expanding its fleet of in-store convenient care clinics. The company announced that it plans to open eight new clinics this fall, and they're hiring NPs for the clinics now.The new clinics will be in the Chicago and Palm Beach, Fla., areas.
This could be pretty big news for NPs if they decide to continue expanding their line of clinics. Target currently operates 28 clinics in two states. Considering there are more than 1,700 Target locations across the country, there's certainly room to grow and create more NP job opportunities. We'll keep an eye out for more developments!
This week Walgreens and Take Care announced that its cofounder, president and CEO Peter Miller was leaving Take Care to pursue a new entrepreneurial venture. So we'd like to take a moment to reflect on his contributions as they relate to NPs in convenient care.
In 2008, soon after I first started writing about the convenient care industry - we still called it "retail health" then - I went to the Take Care Health Systems headquarters in Conshohocken, Penn., and talked to Peter Miller. First I took a tour of the office, including a very impressive visual display in their call center that showed what clinics were open, under construction or in planning stages. At the time, Take Care was relatively new (founded in November 2005) and they were in the process of growing from about 100 clinics to more than 300 clinics in one year. The world was before them!
Then I sat down with Peter Miller and listened while he spoke passionately about the convenient care model. They had the right idea from the start:
"The opportunity here is so clear, but the opportunity alone isn't going to produce success. What creates success is what we've built our company on - creating an exceptional patient experience. We've spent lots and lots of energy saying you can't just put a clinic in the back of a drug store and expect everything's going to work out. It's all about thinking through all the issues you need to in order to create an exceptional experience for patients ... and frankly also an exceptional environment for nurse practitioners to work in, and that has been the focus of this company since we started."
He also talked about a founding goal of the company, which was to incorporate nurse practitioners into the corporate leadership. They of course have been the most effective convenient care operator to do so - they started out with NP Sandra Ryan as their chief nursing officer, and she's been with the company for years now. NPs interested in learning about business are encouraged to move up the ranks to regional and then market lead NPs. "The most important thing is for leadership to really understand what it means to be sitting in the seat, in the clinic, taking care of a patient," Miller told me.
He shared with me a Take Care business concept they affectionately call "secret sauce," which really was anything but secret: "creating a culture of friendship and fierce conversation and open-book management, an environment where people work in a world of possibility instead of frustration and downward spiraling." And, he said, NPs are the key ingredient in the secret sauce. So, keeping NPs satisfied with their jobs was the company's main goal.
And I still hear NPs from Take Care talk about how much they love their jobs, especially Sandra Ryan, who spoke with emotion in her voice when I asked her to comment on Miller's announcement. "I'm thrilled for him," she said, because he has been a true champion for nurse practitioners "and for myself as the first chief NP officer in the industry, and that was because they believed in me and they believed so strongly in the role and knew they had to have a strong voice for NPs to really build it right."
Kudos to Miller for championing nurse practitioners! We wish him the best in his new venture.
We had a reader ask us about whether it was difficult to obtain insurance reimbursement when running a convenient care clinic. So, for the answer we went to the source, Bette Tucker, NP, who owns Express Care Clinic in Lincoln, Neb., and wrote an article in ADVANCE about opening the clinic: Opening a Retail Clinic.
Here's what Bette has to say:
We have had no trouble with insurance companies paying us. Some pay 15% less than they pay physicians, but it would be that same way in a physician office. Actually, some convenient care clinics have gotten special contracts with insurance companies. We have not, but I believe MinuteClinic and the larger ones have. We opened a full medical office and urgent care in February. We have NPs working in the clinic with our medical director available if needed be. It is doing well. I think the future is going to bring a lot of this with all the new health care coming.
So, getting set up for reimbursement in a convenient care clinic could potentially be easier than for a primary care clinic. Just something to think about if you're looking to open your own convenient care clinic.
To any nurse practitioner who has ever worked in convenient care: How long did you stay? We're taking a poll, so please go to the ADVANCE for Nurse Practitioners home page and choose your answer in the question in the far left side of the page (scroll down a bit).
I think turnover in convenient care could be high relative to other practice settings, because a lot of feedback I get from NPs about the setting is that it's too monotonous to stay very long. But I could be wrong, so I need you to tell me! You'll see more on this topic as my research continues.
A comment to our previous blog post (What Frustrates NPs in Convenient Care?) asked what kind of salary/pay NPs make in convenient care. As you may or may not know, every other year we at ADVANCE for Nurse Practitioners conduct a very thorough salary survey of nurse practitioners.
In the 2009 ADVANCE for Nurse Practitioners National Salary and Workplace Survey of NPs, we found that the average annual full-time salary for NPs in retail health was $89,049 (median $88,000) in 2009. Family practice NPs earned $86,520 on average (median $83,000).So, according to our survey results, convenient care NPs are making a bit more than primary care NPs.
Since our commenter is still in school, she might be interested in the figures for new grads: In 2009, the average annual full-time salary for NPs working in retail health with 2 years' or less experience was $83,791 (median $82,000); in family practice, it was $79,197 (median $77,000).
See the survey report here.
See the results for new grads here.
I was interested to hear from NPs who've worked in convenient care for at least a year, to see if anything has changed in the working environment for them, especially because clinic chains are starting to provide more services (see a related video here). So, I posted a question about it on Facebook to see what kind of response we got. I got a good mix of responses from NPs, but no one said much about whether things have changed over the long haul, but I think that's because there may be a high turnover rate in convenient care. And one of the biggest reasons seems to be the sense of frustration with treating the "same old" conditions repeatedly that can overtake the solo NP working in a convenient care or urgent care clinic. Here are some comments I got:
- My biggest problem was in being relieved for vacation or other needed off-time.
- The turnover of NPs is high because of this, they have to learn and juggle so much more than just patient care, writing school/work excuses, cleaning, billing/coding, entering insurance info, balancing daily deposit, etc.
- Nurse practitioners in convenient care settings are somewhat isolated from the entire medical community. We have to work so hard to gain credibility with the private physicians since many of them refer to these clinics as "Doc in a Box". Eventually, I had well-respected physicians in the area referring overflow patients to me which was a huge breakthrough; however, it took so much hard work to gain their approval and respect. If you mess up, it's over... lots of pressure for an NP! That may not be the case for all convenient care providers, but it was my experience. It's easy to see why so many NPs get frustrated and throw in the towel.
- I believe we feel isolated in convenient care for several reasons. In my case, I was the only provider with one receptionist and eventually a nurse. I was in the office working on charts all of the time while they were in the front, so I was "alone" in that respect. Also, even when there is a heavy patient load most of the conversation is limited to health concerns, so there is very little time to socialize with the patients.
Other NPs said they quite liked the work, of course. Pay and benefits tend to be good, and schedules can be flexible. And perhaps with time, as clinics continue to evolve, these frustrations will lessen. But for those looking to get a job in convenient care now, take these into consideration when deciding if it's the job for you.
Judging by the lack of mainstream coverage as of yet, it seems that the closure of about 30 clinics by The Little Clinic is being taken as a nonevent by most major media outlets.
It is a pretty big deal in the industry, because it marks a long-awaited purchase of TLC by Kroger. Some clinics are still owned by Solera, but about 100 were purchased by Kroger, according to the Tennesseean. Now the top three convenient care clinic operators are owned, at least in majority, by large companies with the financial backing to support clinics that won't be profitable for years. It means more security for the remaining clinics - and the NPs working in them.
Even this week there was news of more clinics closing, this time all of the clinics operated by a health system near Minneapolis, according to twincities.com (news that I found via the Healthcare311 News blog):
Robbinsdale-based North Memorial Health Care said
Tuesday that it has closed its five remaining retail health clinics,
including east metro locations in Apple Valley, Stillwater and White
"A low demand for this service along with a saturated market ...
led to this decision," said Robert Prevost, a spokesman for North
Memorial. The clinics closed Feb. 19 and followed closures of several
NOW Express Care retail clinics by North Memorial in 2009.
Again, as has been said often, it's tough to keep convenient care clinics afloat without lots of money to back them. They aren't big profit centers, but they are a great service that patients love, and so there's no doubt they'll still be a big part of healthcare in the years to come.
I heard this morning from an NP at The Little Clinic, who said that effective tomorrow, April 2, TLC is closing all clinics in five of its markets: Detroit, Toledo, Houston, Indianapolis and Richmond. This, by my estimation after looking at the TLC Web site, amounts to closure of 25 out of 146 clinics, or 17% of their clinics, if we include clinics near those cities. Employees were told about the closure on Tuesday and that the closures were necessary to
promote the remaining clinics and regions that will remain open. The company reportedly offered relocation to other clinics, but that would most likely mean moving out of state.
I checked with the communications folks for TLC, and received a statement:
On March 30, 2010, The Little Clinic announced that it is leaving five markets – Indianapolis, Houston, Toledo, Detroit and Richmond – and closing five additional clinics in three markets effective Friday, April 2. With these closings, Kroger and The Little Clinic are focusing on strengthening this business model to better service the health care needs of customers in an affordable, convenient manner.
The Little Clinic, a wholly owned subsidiary of Kroger and based in Brentwood, Tenn., will continue to operate clinics in Columbus, Cincinnati, Denver, Knoxville, Lexington, Louisville, Memphis, Nashville and Phoenix. The company will revisit expansion plans for 2011 and beyond once it completes the process of streamlining its operations.
This is the biggest set of clinic closures since MinuteClinic went "seasonal" with 90 of its clinics in March of 2009. Perhaps the lack of an official retail partnership for so long hurt the chain financially. We will keep you updated as we learn more.
If you read our last post or saw the news yourself, you already know that the American Academy of Family Physicians has changed its stance on convenient care clinics.But ABC News published an article today explaining some operators' plans to expand services into chronic disease management: "Retail Clinics Branch Into Chronic Disease Treatment."
The article describes discussion that took place at a convenient care summit recently held in Philadelphia, which I was not able to attend (But I do know that the presentations are available online for purchase, if anyone really wants to see them. Click here to check it out.)
MinuteClinic is already offering some chronic disease management, and Take Care is headed down that road. So, convenient care wants to become part of the solution for disease prevention. Would you be more inclined to work for a convenient care clinic if that were the case?
I had just read a synopsis of the beginning of the NP role. In it the author describes a physician telling the NP that she should watch him do an ear wash because she could not do it.
Then I opened my e-mail to learn the American Academy of Family Physicians is now against retail clinics (AAFP Board Revises Retail Health Clinic Policy).
The AAFP's announcement says, "The AAFP Board of Directors has revised its official policy on retail health clinics
to reflect the Academy's opposition to a growing expansion of scope of
services provided by many such clinics. In addition, the Academy has
discontinued its practice of entering into formal agreements with
retail health clinics that support the AAFP's desired attributes."
As a retail clinic practitioner, I knew we followed the guidelines that the AAFP wanted. It wasn’t hard because we have always followed those guidelines: evidence-based medicine, a team-based approach, a system of referrals to physician practices, and electronic health records. And I’m sorry they are taking their marbles and going home. But two of the major retail clinics have Joint Commission Accreditation and follow guidelines that are even more stringent than doing what we all consider good practice. How many medical practices have this kind of accreditation and safety practices?
A thought occurred to me when it seemed obvious that this was a turf battle: Let them have it. Let them do all ear washes, toenail trimmings, injections, counseling of diabetics, monitoring hypertension patients. For just one single day let them have their turf back.
The hubris continues to amaze me.
We do these things in their offices on a daily basis, but we can’t do them in a retail clinic? They claim that the retail clinic doesn't fit into the medical home model. But if the "medical homes" were doing such a great job following hypertension, why is it still such a national health problem? Leave it to these medical homes and all the people with chronic illnesses they monitor and counsel will continue to be in and out of the hospital. This country deserves better than we are getting.
Sure, there are brittle diabetics, uncontrolled hypertension and other illnesses that not all NPs should handle. And we don’t. We have the mindset to use the telephone, electronic medical records, involve other disciplines, and for heaven's sake the knowledge of our limitations and the ability to refer the patient that most "medical homes" never use. However, when we do the exact same thing, as well if not better than a physician does, we generally get 80% of what they do. So money is part of this turf war.
Unfortunately, although I wish we had nothing to do, in healthcare there has been and always will be enough room for everyone.
Walgreens, owner and operator of Take Care Clinics, was selected by Fast Company Magazine as one of the healthcare industry’s most innovative companies as part of the magazine’s "Fast 50" issue, which celebrates the world's most innovative companies.
Other healthcare companies included were Kaiser Permanente, patient-community network Patients Like Me, robotic surgery leader Intuitive Surgical and technology providers GE and Cisco. Walgreens was recognized for leadership in healthcare services, from its national network of Take Care Clinics at select Walgreens stores to its efforts in health and wellness services and chronic care management, including its recently unveiled Walgreens Optimal Wellness initiative, a program designed to educate and treat patients suffering from chronic conditions like diabetes.
Walgreens aims to become a community health provider, and here's how they say they're doing it:
Fast Company Magazine also featured Walgreens in July 2009: “Why Walgreens Is Building Its Own Universal Health-Care System.” The complete list of companies and related stories appear in the March 2010 issue of Fast Company magazine currently on newsstands and online at www.fastcompany.com/MIC.
- Take Care Clinics, located at 357 Walgreens stores in 19 states, have delivered care to nearly 3 million Americans since its 2005 launch.
- Walgreens Take Care Health Systems counts more than 700 in-store health clinics and employer-based health and wellness locations across the country. Through Take Care Health Systems, Walgreens delivers employer health care services, including on-site health, wellness, fitness and pharmacy solutions for a client’s employee population, combined with cutting-edge programs for managing drug spending.
- Walgreens and Take Care Clinics administered more than 7 million seasonal and H1N1 flu vaccines this season.
- Walgreens employs nearly 70,000 healthcare providers, including pharmacists, physicians, nurse practitioners, physician assistants, fitness and health coaches and more.
- Walgreens focuses on disease prevention and health education, recently announcing a limited-time offer for free blood glucose testing at its pharmacies and Take Care Clinics. Walgreens launched Optimal Wellness, a self-care educational program for people with chronic conditions (initially type 2 diabetes) that capitalizes on the power of face-to-face interaction with the community pharmacist and nurse practitioner.
I received an email from a reader of the ADVANCE for Nurse Practitioners Convenient Care Report column. This reader called convenient care clinics a "cancer whose spread is being halted" and believes that "once euphoria is gone, the concept would not
be able to sustain itself."
The reader, who identifies as a nurse practitioner, wrote that they worked in a convenient care clinic and wasn't well respected in the position. "But retail health is addicting. Good money, excellent benefits, flexible
hours, a promise of 'independence.' New grads often fall for it."
And, in closing, our reader says, "Down with 'retail health.'
Long live the office practice of advanced nursing."
At ADVANCE, we work to give a voice to nurse practitioners and help NPs advance their careers and enhance their practice. We also encourage you to engage with one another on these blogs and forums and on our Facebook page. So, I thought these comments about convenient care might encourage you to either agree or disagree with this reader. Please comment with your thoughts!