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Within a few months, customers at Memphis Ike’s stores may get more than big discounts on toilet paper and soft drinks; the four Ike’s outlets will likely mean the local introduction of store front primary care.

So far, most Memphis medical practices have expressed little concern about the doc-in-a-box concept, which is steamrolling across the nation. Most primary care providers are already so busy turning patients that a few walk-in clinics don’t seem to pose a threat. After all, minor medical centers spooked everyone 20 years ago, and today it can still take two weeks to get an appointment with an internist.

But business consultant Alan Flippen believes quick clinics are a new, distinct threat. Minor meds evolved into broad service clinics, often specializing in occupational medicine. Quick clinics by design are limited in scope and draw a bead on the foundation of primary care practices.

Memphis doctors, he said, have won a reprieve that should not be squandered: in other markets where primary care doctors have been complacent, the walk-in clinics have captured up to 20 percent of their business.

“In every trend, from managed care to practice management, it always ends up with someone trying to get money out of the doctor’s pocket,” Flippen said. “Everybody thinks doctors have too much money, and makes them the target.”
Flippen’s business, ADF Medical Practice Development, specializes in building relationships between patients and specialty practices. He’s recently been working on a new concept called HealthStar to help primary care practices respond to quick clinics. This fits with his business because specialists rely on primary care providers for referrals.

Quick clinics tend to attract an affluent, middle class clientele willing to lay down $50 to have their minor ailment treated immediately. Most clinics are staffed by a nurse practitioner, who would also handle comparable cases in a physician practice — a fact the patient grasps.

The industry’s Convenient Care Association says that 94 percent of pediatric patients and 85 percent of adult cases are minor respiratory problems, from a sore throat to the flu.

Today, there are more than 500 quick clinics operated by a dozen companies. But that will change rapidly. Wal-Mart has decided to muscle in on the business and plans 2,000 clinics in as little as five years. The allure is obvious: no waiting and posted prices.

“This evolution in the delivery of care is in response to the physician shortage; companies have found a product people want,” said Michael Minch, chairman of the Tennessee Medical Association.

As primary care is undermined by low reimbursements, current providers are changing their practices and newly minted physicians are avoiding fields such as family medicine and pediatrics, Minch said. That is only going to fuel the growth of the quick clinic industry.

“Doctors can compete with the clinics if they want to be open nights and weekends, and treat people as they walk in; otherwise we’re there to complement the family doctor,” said Steve Cooley, CEO of Dallas-based SmartCare Family Medical Centers, and spokesman for the Convenient Care Association.
Quick Clinics don’t want ongoing patient relationships, he said, and send patients back to their regular doctors for follow-on care.

“Most primary care visits are not life threatening, and are these simple conditions that make us miserable,” Flippen says. “In other markets, the quick clinics have proven to change patient behavior. When people get used to that convenience, they return to the quick clinic.”

Most primary care practices have already developed a response to quick clinics without realizing it. They have nurse practitioners to handle minor problems, and a walk-in sign-up sheet for those who don’t have an appointment. Harbor of Health on Mud Island even guarantees same-day service for those who call in advance.

Practices can prepare themselves before quick clinics open in Memphis by realigning services and playing to their strengths.

“If that nurse practitioner at Wal-Mart looks in your throat and sees something of concern, she will refer you to your doctor, but chances are you’ll put it off,” Flippen said. “If your internist is in the next room and can look down your throat immediately, it’s more likely to be treated.”

Along with emphasizing quick service, practices can stress the fact that patients have been treated for years by the same staff, and all their records are easily at hand, he says.

A primary care practice can do these things on its own. HealthStar is designed as a turn-key version, tailored to each practice. Flippen has about 30 doctors already committed. They’ll each pay $200 a month, which will be pooled to pay for marketing the service. Media and in-office advertising will drive patients to the HealthStar Web site, which encourages them to see their regular doctor.
“People already think of their own doctor first, so this is about reinforcing that habit,” he says. “With almost 20 years in this business, my instincts tell me that we can retain half of the patients that would otherwise be lost.”

Going head-to-head with Wal-Mart is scary enough, Flippen said, but there’s an ominous element in Wal-Mart’s long-term strategy. The retailer intends to form alliances with local hospitals, and probably specific specialty practices. If a quick clinic captures a patient and there is something serious, the patient could be lost forever to a different referral network.



October 2007

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