Rhode Island Minute Clinic Experience

Yul D. Ejnes, MD, FACP, governor of the Rhode Island (RI) Chapter (now Chair of the Board of Governors), discussed Rhode Island physicians’ experience with in-store clinic conglomerate, MinuteClinic (MC). Based in Minnesota, MinuteClinics are staffed by nurse practitioners (NPs) and physician assistants (PAs) who treat common low-risk conditions like strep throat, ear infections, and the flu. The clinics are open seven days a week with extended weekday hours and are located in shopping plazas in Target stores, CVS or supermarkets that have their own pharmacies. The company currently has clinics in Georgia, Indiana, Maryland, Minnesota, North Carolina, and Tennessee. Last spring, MinuteClinic announced its intention to open clinics in Rhode Island CVS pharmacies.

Dr. Ejnes said when it became known that MinuteClinic intended to open clinics in Rhode Island CVS pharmacies, the medical community met to decide how to respond. The state medical society convened a meeting of primary care specialties (family medicine, pediatrics, internal medicine and urgent care) to develop a strategy. He said that after the medical community’s initial response of anger – “how dare they do this?” – it later became clear that the response should be based on the impact on patient care rather than turf issues or money. He said that a strategy was developed that identified the medical community’s concerns about patient safety and quality which would involve the regulatory process in RI as well as public relations. He said that the questions raised by the medical society and specialties included: Were the clinic providers going to be supervised in compliance with the standards in the state RI?

How would results be communicated to the patients’ primary physicians? Would there be 24 hour access for emergencies if patients treated at MinuteClinic had complications?

How would patients or clinic providers access advice on what to do next? He said that these questions were part of a regulatory and public relations strategy developed in Rhode Island. A meeting of the medical society counsel was held with the CEO of MinuteClinic, and others, where some of the concerns were communicated. The MinuteClinic representatives said that they would address the medical society’s concerns about a conflict of interest situation for MinuteClinics located in CVS pharmacies where prescriptions are written and could also be filled. The MinuteClinic representatives said that they would facilitate the filling of prescriptions at any pharmacy. Dr. Ejnes noted that he did not think that most patients would go somewhere else to fill their prescription if they were already in a CVS pharmacy. In addition, MinuteClinic representatives emphasized their ability to communicate, use electronic health records and desire to fax reports overnight to the primary physician, if one is identified. Dr. Ejnes said that Rhode Island required MinuteClinic to apply and fulfill the requirement to become an organized ambulatory healthcare facility. He said that the physician community then testified at the Department of Health raising their concerns about the value of patients with acute problems going to their doctors’ office; the importance of a continuous relationship with a doctor and the opportunity to care for the whole patient. He said that the state heard the concerns of the physicians community and the insurers, particularly Blue Cross which subsequently created a policy requiring all of its participating physicians to have 24 hour phone access so that if a patient has a problem during off hours he or she could talk to their doctor rather than hear a recording to go to the emergency room. He said that for MinuteClinic to be credentialed as a provider it would have to provide the same 24 hour phone access.

Dr. Ejnes said that the ultimate cause of MinuteClinic’s withdrawal was not the stated concerns of the physician community or outrage from patients or insurers but the absence of plumbing. He said that MinuteClinic would have to comply with a state requirement that organized ambulatory care facilities have bathrooms. Dr. Ejnes noted that since MinuteClinic would probably be located in a small area in CVS with a sound proof partition, the addition of bathrooms would be too costly. MinuteClinic withdrew its application and suspended future plans (for now).

Dr. Ejnes said that the lessons learned by the RI physician community are: Coalitions can be effective. Instead of having all of the affected groups go at it individually, working together under the auspices of the medical society was helpful.

Look at the issue from the patient’s perspective. Making it a patient issue instead of a physician revenue concern gave the physician community more credibility and led to the improvement in overall care in the state because of the Blue Cross 24-hour requirement.

Ask why MinuteClinic is so attractive to patients and whether there are things that physicians should be doing for patients that are causing them to go to MinuteClinic for care.

Consider other issues such as payment reform at a state level and the creation of incentives to encourage physicians to stay open late or on weekends which would reduce the need for MinuteClinic.

Dr. Ejnes said that as a result of this experience with MinuteClinic the physician community is taking a look at open access scheduling and redesigning offices to provide more early and late hour coverage.

View the Rhode Island MinuteClinic Fact Sheet distributed at the State Health Policy Networking Session.