The Impact of Mini-Clinics

Here's an idea: let's start selling toiletries, batteries, and milk in medical practices. Why not? Walgreen's, Target, and other retail outlets are selling flu shots, physicals, and an ever expanding list of minor healthcare services traditionally provided in physician offices. And, so-called minute or mini-clinics are appearing in a plethora of untraditional locales. 

What are they?

These mini-clinics share several common elements:

• They are found in high traffic retail settings. Walgreens, CVS, Wal-Mart, Rite-Aid, and Target all offer mini-clinics in some of their stores

• They are staffed by nurse practitioners or physician assistants; generally one per shift

• They offer a range of low-acuity services, including immunizations and flu shots; wellness counseling (smoking cessation, weight loss, hypertension); minor skin care; school and camp physicals; and care of minor illnesses such as allergies and colds

• They participate with many insurance companies

• They have published, straightforward pricing

• They have extended evening and weekend hours of service

• They do not "keep" patients; patients are referred back to their primary-care doctors

Got a minute?

These clinics thrive on what our society seems to want most: convenience. While our government promotes patient-centered medical homes, many patients are less interested in a vested relationship with their doctors than in getting care when they want it and where they want it. We live in an impatient society, which has become an ideal Petri dish for mini-clinics.

I am surprised at the number of my friends who forego their family doctor or pediatrician for instant care. And their reasons always seem to be the same - I can get in quicker; I don't need to wait; and I don't need to make an appointment. For physicians, the takeaway should be that patients want their physicians to be available when the need arises. Another lesson? Patients increasingly feel their time is just as valuable as their physicians'.

What do they mean for practices?

Mini-clinics can compete with primary-care practices. If a practice consistently has openings in its schedule, it will feel the impact of losing just one appointment a day to a mini-clinic. If your practice has unfilled appointments or is in growth mode, make sure you are competitive by catering to patient convenience. Remember, patients use convenience and friendliness as proxies for clinical quality.

While I understand the niche these clinics fill, I hesitate to denounce them. After all, physician practices have added ancillary services in the name of patient convenience for years. Are these services more convenient for patients than going to the hospital? Absolutely. Do these services improve practices' bottom line? Yes.

Many of my colleagues feel that the impact of mini-clinics has been minimal. They see the role of these clinics much as the insurance executives see them: a cheaper, after-hours alternative for minor problems. Mini-clinics can also help with the deluge of school and camp physicals during crunch weeks. And as one manager noted, practices can produce more income with two follow-up appointments in a 30-minute slot, than one 30-minute appointment for a single physical.

No doubt, practices will see an expansion of the services offered by mini-clinics over time, perhaps along the lines of workers’ compensation care. If it can be done quickly, inexpensively, and safely in a retail setting, it will be offered. I do not foresee mini-clinics expanding into high-acuity care; those services carry a much higher degree of malpractice exposure. Nor do I see mini-clinics as a viable threat to primary care. Still, many of them will continue to thrive in a niche capacity, and primary-care practices operating in markets with mini-clinic penetration should focus on patient convenience as a hallmark of their service.

Lucien W. Roberts, III, MHA, FACMPE, is vice president of Pulse Systems, Inc., and a former practice administrator. For the past 20 years, he has worked in and consulted with physician practices in areas such as compliance, physician compensation, negotiations, strategic planning, and billing/collections. He can be reached at lucien.roberts@yahoo.com.