Is time right for MinuteClinic in Rhode Island?

IN A MINUTE: Nurse practitioner Corissa Pond enters patient data inside her Minute Clinic in a Seekonk CVS/pharmacy. MinuteClinic has filed a new application with R.I. seeking to open seven clinics. / PBN PHOTO/MICHAEL PERSSON
IN A MINUTE: Nurse practitioner Corissa Pond enters patient data inside her Minute Clinic in a Seekonk CVS/pharmacy. MinuteClinic has filed a new application with R.I. seeking to open seven clinics. / PBN PHOTO/MICHAEL PERSSON

Eight years ago, when MinuteClinic first tried to open retail health clinics in Rhode Island, the Minneapolis-based company withdrew its application for a certificate of need after facing significant opposition from Rhode Island’s doctors, among others.
Arguing on behalf of the state’s physicians, the Rhode Island Medical Society worried that the quick care provided by MinuteClinics would diminish the doctor-patient relationship and discourage patients from having a medical home.
“RBCs (retail-based clinics) are structurally unsuited to provide primary care, preventive care, chronic disease management or emergency care,” the society stated in a 2008 white paper on retail clinics.
Now, MinuteClinic has filed a new application with the state seeking to open seven clinics in CVS Caremark Corp. stores from Woonsocket to Westerly. The public comment period on its Nov. 1 application hasn’t yet begun, but when it does, the society will once again voice its opinion about the retail-based model, said Steven R. DeToy, director of legislative and government affairs.
“Many of the same questions remain,” he said.
Among them: Will the clinics interrupt continuity of care to the detriment of patients? Is so-called convenience care really the model of health care delivery that the state should embrace? Is it right for the state to license clinics in stores that sell tobacco? Back in 2005, and now, the latter idea is objectionable to the Rhode Island Medical Society, DeToy said.
“Whether you agree with the model or disagree with the model, everybody is in agreement that they [clinics] should not be located in retail establishments that sell tobacco,” DeToy said.The seven CVS stores, where the clinics are proposed, sell tobacco.
At the same time, as DeToy noted, much has changed in the last eight years that could signal a different outcome for MinuteClinic’s new application. Not only has the health care climate in Rhode Island – and nationally – changed dramatically with the adoption of the Affordable Care Act, among other developments, but also MinuteClinic’s business model has changed. Dr. Andrew Sussman, MinuteClinic’s president, believes enough changes have taken place in health care in general, and also in the operation of MinuteClinic’s, to assure their approval by the state this time. He noted that Minute Clinics address the national shortage of primary care physicians, which is expected to reach a deficit of 45,000 by the year 2020.
MinuteClinics are staffed by nurse practitioners, who specialize in family health and can write prescriptions for commons illnesses such as sinus and bronchial infections. They can also treat minor cuts and skin conditions and give vaccinations for the flu, tetanus, pneumonia and hepatitis A and B. There are 750 MinuteClinics in 27 states that together have seen 17 million patients since they first opened in 2000, according to Sussman. He said MinuteClinic aims to fill an existing gap in health care delivery, not disrupt the continuity of patient care.
“We’re not trying to replace the role or care of the primary care doctor,” he said.
“Many of the patients we see don’t have a physician,” he said.
If they don’t, MinuteClinic provides them with a list of local doctors who are accepting new patients and if they do, MinuteClinic sends a report to the patient’s doctor detailing the care the patient received at the clinic, he said.
“We want them to have continuity of care,” Sussman said.
In addition to addressing a shortage of primary care physicians, the new MinuteClinics will help provide care to the many thousands of newly insured patients expected as a result of the Affordable Care Act, thereby taking the burden off hospital emergency rooms, Sussman said. If approved in Rhode Island, the clinics will provide free care to patients of the Rhode Island Free Clinic, a promise that has been hailed by Marie Ghazal, CEO of the Rhode Island Free Clinic. Noting that the clinics will be open seven days a week, with evening hours, Ghazal said the clinics will be a “great complement” to the care provided at Rhode Island Free Clinic.
On the business side of things, two major changes have taken place since 2005, when MinuteClinic first sought approval in Rhode Island. First, CVS purchased the Minneapolis chain in 2006, then moved it – along with 200 jobs – to Woonsocket. As a result, MinuteClinic is now led by New England physicians, a fact that should make it more acceptable to Rhode Island doctors, according to Sussman.
In addition, since 2009 MinuteClinic has affiliated itself with 30 large health care systems around the country.
Asked to respond to the objection that the clinics share space with stores that sell cigarettes, Dr. Sussman said, “Our nurse practitioners tell people not to smoke.” Additionally, the clinics offer smoking-cessation information to patients, he said.
In its application for a certificate of need, MinuteClinic said it would open in four Rhode Island CVS stores 60 days after it gets approval from the state, then phase in the remaining clinics over the next three years. Clinics are proposed for stores in Woonsocket, Cranston, North Smithfield, East Greenwich, Providence, Wakefield and Westerly. Capital costs are projected at $155,000 and there is no financing plan.
MinuteClinic’s expansion in Rhode Island, if permitted, is part of a nationwide effort to add 150 clinics in 2014, with a total of 1,500 clinics in 35 states by 2017. •

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