Major players catch a case of quick-clinic fever

ALBERT LEA, MINN. - Far from its world-renowned Rochester campus, the Mayo Clinic is conducting an intriguing research project in a low-slung Albert Lea mall, right next to a nail salon.

The ALMC Express Care clinic in this southern Minnesota town is a Mayo-affiliated retail operation, where a lone nurse practitioner treats simple ailments without appointments.

The 262-square-foot kiosk marks a stunning turnaround in how the medical establishment is reacting to the proliferation of MinuteClinics and other such outlets.

Once derided by doctors as providing disjointed and possibly unsafe care, medical centers are starting to open their own retail clinics as a way to keep existing patients and reach new ones.

Now Mayo is hoping the year-old Albert Lea clinic will be a prototype for similar clinics across the sprawling Mayo Health System in southern Minnesota, western Wisconsin and northern Iowa.

On Friday, Mayo officials said they will open a Mayo Express Care clinic at a yet-to-be named strip mall in Rochester early next year.

"A couple of years ago, medical centers thought if they ignored [the trend], it would go away," said Tricia Dahl , associate clinic administrator at the Albert Lea Medical Center. "But patients tell us this is what they want."

Mayo is not alone. Minneapolis-based Fairview Health Services has opened Fairview Express Care clinics in Coborn's Superstores in Albertville and Elk River and is planning two more in Princeton and Hastings. In Rochester, Olmsted Medical Center opened OMC FastCare at a ShopKo last summer and plans a second late this year.

Retail clinics are "clearly not a flash-in-the-pan event," said Tom Holets , president of Allina Medical Clinic, which owns 45 primary care clinics in and around the Twin Cities. Allina has yet to open its own, but recently wrapped up a three-year study that concluded "we must be in this marketplace," Holets said.

The moves are defensive. The retail clinics have "skimmed off simple health conditions that are reimbursed well [and] left primary care clinics with their noses barely above the water," said Dr. Loie Lenarz , chief clinical officer of Fairview.

An explosion of clinics

The no-frills retail clinic, with its limited menu, low prices and walk-in access, is an example of what business consultants call disruptive technology.

Five years after the first MinuteClinic opened in the Twin Cities, 362 outlets have popped up in 24 states, with a goal of 400 by the end of 2007. MinuteClinic is now owned by CVS Caremark Corp, the country's biggest provider of prescription drugs. Target followed suit with its own brand of clinics, as did a host of other chains.

Patients like the fact that they can zip in and out quickly while shopping. Employers and insurers like the lower prices.

The explosion in retail care has shocked traditional providers out of complacency, forcing many hospitals, clinics and pediatric practices to start offering same-day appointments, extended urgent care hours and even patient care on weekends.

Now a small number of those providers are setting up their own retail clinics. By co-opting the idea, they say, they overcome a key worry raised by the American Medical Association -- fragmented care. At Mayo Express Care, for example, a nurse practitioner will have access to patient medical records already stored at Mayo.

"We're looking at this as part of a system of care," said Dr. David Herman, who leads the primary care effort at Mayo.

Many providers interested

Even those who haven't taken the plunge are watching closely.

At a Minnesota Hospital Association meeting in Brainerd in September, Albert Lea executives took to the stage to talk about their mall clinic experiment. They were inundated with questions.

"It was everything from 'How much does it cost?' to 'Do you have a separate bathroom?'" recalled Michelle Strobel, a partner in the health care practice of accountancy firm Virchow Krause & Co., who was in the audience.

Steve Waldhoff , Albert Lea's chief administrative officer, has given that presentation three times and will do so again in January to Minnesota Hospital Association trustees.

In late 2005, Albert Lea Medical Center surveyed patients by phone, asking if they would use a retail clinic. The majority said yes. With several big retailers such as Wal-Mart in town, Albert Lea executives say they knew it was only a matter of time before a convenience clinic opened in their backyard.

In December 2006, they took the plunge, opening ALMC Express Care at the site of a former Dairy Queen in Northbridge Mall. Two months later, the nearby Love's Truck Stop opened a medical clinic, its door tucked in the back of the Love's store next to a rack of leather jackets.

Waldhoff sees parallels between retail health care and fast food franchises -- both emphasizing consistency and customer satisfaction. All that particularly appeals to customers with health savings accounts and high deductibles who are closely watching their health spending, he said.

As safeguards, the clinic doesn't treat patients younger than 18 months. If a patient comes in with the same complaint three times in a row, the nurse practitioner will send the patient to the medical center to see if there's a more complex underlying issue.

A day at Express Care

On a recent weekday, Brandy Hanes , a nurse practitioner, had seen a 7-year-old girl for strep throat ($57) and a flight school student with an ear infection ($47).

Then a worried-looking woman arrived pushing a stroller. Her 7-month-old baby had a fever and appeared to have an ear infection. Since the baby was less than 18 months old, Hanes called the medical center and got her an appointment that afternoon with a pediatrician. The woman had no insurance and didn't want to go in to urgent care, which costs more than a scheduled office visit with a doctor.

That was one of four appointments Hanes arranged that day for walk-in patients, who otherwise might have waited days to get an appointment the old-fashioned way.

Waldhoff and Dahl note that the clinic is still very much a work-in-progress. For example, they recently decided to stop treating deer-tick bites, referring patients instead to the medical center for Lyme's disease lab tests.

They're also considering adding services. Ear washes to remove wax build-up, wart removal and some early smoking cessation efforts may be introduced in the next three months.

The clinic now sees an average of 12 to 15 patients a day. It will need 15 to 18 patients a day to cover operating expenses, Dahl said.

And just as it's hard to hire primary care physicians these days, it's also difficult to find the nurse practitioners to staff the clinic.

"Our biggest struggle is keeping staff," Dahl said.

Chen May Yee • 612-673-7434

Chen May Yee • mychen@startribune.com