CVS Caremark Corp. has opened up its first Fort Wayne MinuteClinic at 6279 E. State Blvd., but it won't be the last.
Two more MinuteClinics will open at Fort Wayne CVS stores before the end of the year, confirmed Brent Burkhardt, spokesman for the clinic group, which is 650 strong at present. Another MinuteClinic is slated to open by July 1 at the Leo-Cedarville CVS. Warsaw also has a new MinuteClinic.
Along with other walk-in retail clinic chains such as Kroger's Little Clinic and Walgreen's Take Care Health, MinuteClinic is gearing up for an anticipated swell of newly insured people come Jan. 1, 2014, when the Patient Protection and Affordable Care Act is fully implemented.
Currently, Fort Wayne has no walk-in clinics in Kroger or Walgreen's stores — but that may change, too, if the upward trend nationally follows locally.
Early reports on insurance exchanges being developed by states raise concerns that, despite medical coverage for the currently noninsured, many of these individuals will only be able to afford plans with lower-cost premiums and higher deductibles. So going to the doctor for routine care, even for chronic illness management, may be avoided or delayed because of high out-of-pocket expenses.
MinuteClinics' Chief Medical Officer, Dr. Nancy Gagliano, says the clinics are not seeking to be patient's medical homes but notes, “For people who are newly insured or who have a change in insurance, we can help them get situated with a primary-care physician. We do anticipate a number of patients with high deductibles,” she said of the expected influx of patients in the coming months. “Instead of going to the emergency room, they can get care at reasonable cost.”
A Harris-Interactive/HealthDay poll, released in January, found a 19 percent increase in adult usage of retail clinics in the past four years. When adding in work-based clinics, poll results of 3,000 U.S. adults found more than one in four had used walk-in clinics in the past two years. Survey respondents reported greater satisfaction with retail clinics compared to work-related clinics.
If the major street intersection near you now has a CVS on one corner and a Walgreen's on another, clinics may soon reside on the same corners. By 2015, the number of retail health clinics is projected to double, according to Accenture, a global management consulting company.
An additional 300 MinuteClinics are planned nationwide by the end of 2014, Burkhardt says.
What kind of care can patients expect at MinuteClinics? Gagliano says, “We are very, very focused on high, high-quality care.”
That care is not provided by physicians but by nurse practitioners in Indiana. In many states, nurse practitioners (NP) and physician assistants (PA) are the providers. Indiana law, however, is more restrictive for scope of practice for PAs compared to NPs. Though both must have collaborative or supervising physicians, currently, the supervising physician for an Indiana PA must be in the same or an adjacent county.
That changes beginning July 1, when a new law takes effect allowing PAs' supervising physicians to “be within reasonable travel distance from the facility to personally ensure proper care of the patients.”
Just how that is interpreted is unclear. But Indianapolis, where Dr. Deborah Balos, the collaborating physician for Fort Wayne MinuteClinics, resides, is likely not considered a reasonable travel distance from Fort Wayne.
MinuteClinics' Website states: “In support of our goal to improve patient care, we are collaborating with medical systems in the communities we serve.” Indiana MinuteClinics are affiliated with Indiana University Health, and clinics are accredited by the Joint Commission as ambulatory health care centers.
Although Fort Wayne RediMed clinics are not accredited by the Joint Commission, a physician is on site. Mid-level providers, such as PAs, also provide care, says Leslie Fennig, chief operating officer and vice president of nursing services for Lutheran Health Network's four RediMed urgent-care centers.
Patients visiting a MinuteClinic do self check-in at a kiosk. Nurse practitioners work alone, at least at the East State Boulevard clinic. MinuteClinic NPs use proprietary software integrated with an electronic medical records system and which is based on national clinical practice guidelines, explains Gagliano. As the clinician proceeds with the exam, prompts are given if additional information is needed, a lab test is warranted or even if the patient's condition requires care by a doctor or hospital.
Because of strict adherence to approved clinical guidelines, MinuteClinics have some of the highest ratings for such things as not overprescribing antibiotics, Gagliano points out.
“We look at ourselves as an access point, a bridge,” she says. “Every person who doesn't have a primary care physician gets a printout for who's accepting new patients. For those who already have a doctor and who grant permission, a summary of the clinic visit is sent to their doctor.