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State's first in-store medical clinics to open

MinuteClinics to treat minor ills


By Liz Kowalczyk
Globe Staff / September 6, 2008
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CVS Corp. will open the state's first retail medical clinics next month in Medway and Tewksbury, promising fast and convenient treatment in its drug stores for patients with minor ailments such as colds and rashes.

The state Department of Public Health said yesterday it has approved licenses for the first two clinics. The decision follows more than a year of debate about whether to allow this new model of medical care in Massachusetts and strong opposition from doctors.

CVS has applied for licenses for medical clinics in 26 additional stores, and Walgreens Pharmacy has submitted plans for competing clinics in 15 of its Eastern Massachusetts stores.

CVS's new clinics will be staffed by nurse practitioners, not doctors, and will charge the patient or his or her insurance company $59 for most visits. The clinics will treat 31 conditions, including strep throat, infections of the ear, eye, sinus, bladder and bronchial tubes, insect bites, minor burns, and rashes. They will be open 8 a.m. to 8 p.m. weekdays and 10 a.m. to 4 p.m. weekends.

"We know that one of the biggest nonfinancial barriers to healthcare is hours of operation," said Dr. JudyAnn Bigby, Massachusetts secretary of health and human services. "Many providers are open 9-to-5 when people are working and their kids are in school. If this helps increase access, people are going to appreciate that.

"The data from other states suggests that [the clinics] do provide convenient and good care to people for the limited number of services they provide," Bigby added.

Chip Phillips, president of MinuteClinic, CVS's retail clinic subsidiary, said he expects to have the first two clinics open within 30 days. He said MinuteClinic decided to expand into Massachusetts because the company's analysis showed a shortage of primary care providers and overuse of emergency rooms for minor ailments. The company hopes to open as many as 100 clinics across the state.

Because the company had to obtain health department approval to open the clinics - and will be subject to ongoing oversight - Phillips said, doctors now are more willing to work with the company. MinuteClinic, for example, will send visit records to customers' primary care doctors and provide a list of doctors for those customers who don't have one.

MinuteClinic can help improve access by "freeing up primary care doctors if we take care of these simpler kinds of conditions," he said.

Dr. Bruce Auerbach, president of the Massachusetts Medical Society, which represents most of the state's doctors, said he is still concerned that the clinics will further fragment care, because patients will be treated by different providers who may not fully communicate with each other. "Whether the clinics do anything to help our healthcare system remains to be seen."

Dr. Andrew Escoll, a family physician in Tewksbury, said the clinics are a bad idea.

"We're trying to move to a more integrated model of medicine. And this is counter to that trend in every way." Escoll said he's also concerned about nurse practitioners seeing patients without a doctor onsite and about the clinics over-prescribing antibiotics. Nurse practitioners are registered nurses with advanced training.

Escoll said his office in Tewksbury, which includes five doctors and a nurse practitioner, is open weeknights until 8 or 9 p.m. and weekend mornings. This summer, the practice hired another doctor so it could increase urgent care appointments. But, he acknowledged, the office does have to turn patients away sometimes because there are no openings that day.

"People are clamoring for access to urgent care, and we're trying to provide that," he said. "I have nothing against competition in Tewksbury at all. But [the clinics] are more healthcare we don't need."

Bigby said that the clinics are not intended to replace primary care doctors, but she hopes they will provide some value to the healthcare system, especially in reducing unnecessary emergency room use. She said the state will be able to track whether people who don't need to go to an emergency room, for treatment of a cold for example, are using a clinic instead.

Dr. Lauren Smith, medical director for the health department, said that when officials granted CVS the clinic licenses last month, they included a number of requirements. Nurse practitioners must screen patients carefully for complicated illnesses and medical histories that indicate they should be seen by a doctor or in an emergency room. Someone who has a cold, but also has a history of serious asthma, for example, should be sent to their doctor for treatment, Smith said.

"We're focused on quality of care at these sites, and we really want to be engaged in monitoring them," she said.

Liz Kowalczyk can be reached at kowalczyk@globe.com.

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