HCMC is late entry in Twin Cities retail clinic race

By now, the little kiosk is a familiar sight: A solo nurse practitioner, a price list on display, a busy retail location.

But the name on the sign is new: Hennepin County Medical Center.

Minnesota's biggest public hospital opened its first retail clinic in February, at a Wal-Mart in Bloomington, almost 10 miles away from its campus downtown.

Its debut comes at a strange time in the retail clinic business. Since the precursor to MinuteClinic started in the Twin Cities a decade ago, everybody from grocers to drugstores to hospitals has opened versions of the bare-bones clinics, offering fast care and low prices without appointments. There are now about 1,200 outlets around the country, according to the Convenient Care Association, a trade group.

Yet the industry is going through an awkward adolescence. It's no longer the brash young upstart, but neither is it quite sure what it wants to be when it grows up.

Many consumers like the retail clinics, but operators have found it hard to make money, mainly because the business is highly seasonal. Faced with long, quiet periods between flu seasons, and stiff competition from deep-pocketed, established players such as MinuteClinic and Target Clinic, many operators have closed unprofitable outlets. Some are adding new services, in a bid to drum up more regular traffic, while others have gotten out of the business altogether.

HCMC officials appear undaunted.

"Models of care are evolving very quickly right now," said Dr. Steve Sterner, who oversees clinics for HCMC. "A lot of us believe retail clinics can play an integral role in these models."

Several predecessors

HCMC is late to the game. Since late 2006, Mayo Clinic, Fairview Health Services and HealthPartners have each opened a handful of retail clinics. Last year, Allina, the biggest hospital and clinic chain in the Twin Cities, leapfrogged the competition by inking a partnership with MinuteClinic.

Still, HCMC's debut has one industry analyst scratching his head.

"What doesn't ever make sense to me is several [operators] have opened thinking that retail foot traffic equals patient traffic," said Tom Charland of Merchant Medicine, a retail clinic consultancy based in Shoreview. "We are just starting to see hospitals' [retail] operations start to close now."

Two years ago Robbinsdale-based North Memorial Health Care bought a chain of urgent care centers and retail clinics, with the intention of adding more. Instead, it ended up combining several of the urgent care centers with its primary care clinics and getting out of retail clinics altogether. The five remaining retail clinics, called Now Express Care, closed Feb. 19.

"Low demand for this service along with saturated markets led to this decision," North Memorial said in a statement last week. As the birthplace of retail clinics, the metro area has among the highest concentrations of retail clinics in the country.

Elsewhere around the country, Akron General ExpressCare in Cleveland, Ohio, and St. Alphonsus Express Care in Boise, Idaho, both single retail clinic locations owned by hospitals, also closed recently.

HCMC officials say they see the new venture as another way of serving current patients and attracting new ones.

"It's a vital service to the patient population," Sterner said. "We are not trying to make a lot of money."

While HCMC is best known for its trauma and critical care downtown, it also has four primary care clinics scattered around the metro and is building a new clinic in Brooklyn Park. The Bloomington Wal-Mart is just 3 miles from HCMC's primary care clinic in Richfield.

"We have a lot of patients here anyway," Sterner said. "We're providing a convenient, cost-effective service for the patients in their community."

As the new health reform law kicks in, and more people get insurance, it will be even more important to offer cheaper options for simple ailments outside of the emergency room, he said.

Sterner won't divulge the price tag for the 500-square-foot space -- with two exam rooms, a lab, a bathroom and an electronic medical record system -- but he says it's at the "lower end" of the $100,000 to $300,000 it usually takes to build a retail clinic. The clinics are typically staffed by a nurse practitioner or a physician's assistant.

Set pricing for treatments

The HCMC retail clinic is one of about 70 run by various partners in Wal-Mart stores nationally. Another one in Minnesota opened in Oak Park Heights in December and is operated by Stillwater Medical Group.

So far, patients at the Bloomington clinic have come in with seasonal allergies and strep throat, said Brenda Baker, a physician's assistant. A few kids came in with ear infections after spending time at a nearby water park. Several guests from neighboring hotels wanted prescriptions that they left back home.

The price for minor ailments such as allergies, flu or pink eye is $59, just below the $62 MinuteClinic charges.

Slow season

Spring is typically a slow time for retail clinics. Some days, they've seen as few as four patients; other days, as many as 12. About half the patients have no insurance and pay out of pocket. Most are new to HCMC.

The clinic needs to see 15 to 20 patients a day to break even, Sterner said.

Some think the future of retail clinics lies in broadening their limited menu of services.

Earlier this month, MinuteClinic launched monitoring services for patients diagnosed with diabetes, asthma, high cholesterol and high-blood pressure. These included blood sugar tests and foot exams for diabetics, breathing tests for asthmatics and a lipid profile for those with high cholesterol.

MinuteClinic, now owned by Woonsocket, R.I.-based CVS Caremark Corp., will send the test results directly to the patient's primary care doctor.

HCMC won't go down that route, at least for now.

"It's something we've discussed," Sterner said. But for now, chronic-disease management is something that will stay at HCMC's primary care clinics.

Chen May Yee • 612-673-7434