CVS seeks to open clinics in its stores

CVS Corp. has asked Massachusetts health officials for approval to open the first of 20 to 30 planned "MinuteClinics" in Boston-area stores that executives said will offer patients fast, inexpensive care in a region struggling with packed emergency rooms and closed doctors' practices.

Retail medical clinics are taking off nationally, with about 400 in drugstores, discount chains, and supermarkets in other states. If Massachusetts officials approve the plan, the CVS medical clinics would be the first store-based clinics in the state .

Company executives said they would open the first clinic in a CVS at 474 Washington St. in Weymouth; they would not disclose the other planned locations.

At MinuteClinics in other states, nurse practitioners and physician assistants typically spend about 15 minutes with a patient. They are trained to treat 20 or so common conditions, such as bladder infections, strep throat, and poison ivy, give pregnancy tests and vaccines, remove stitches, and write prescriptions. The clinics would usually charge $59 a visit, and CVS officials said they are negotiating with Blue Cross and Blue Shield of Massachusetts, Harvard Pilgrim Health Care, and Tufts Health Plan to cover their members' visits.

Michael Howe, chief executive of MinuteClinic, which CVS bought last year, said the clinics "are one piece of the solution for improving access in the state" and are not intended to replace primary care doctors. "But it can give consumers back something they're looking for -- time," he said. MinuteClinic's slogan is, "You're sick. We're quick!"

The average wait is 20 minutes, Howe said, and MinuteClinics don't require appointments and have evening and weekend hours.

Massachusetts public health officials, who license clinics and must determine if they can operate safely, said they are moving cautiously on the proposal. There has been no organized opposition, but some Massachusetts doctors are concerned about the possible negative impact on patient care. They worry that serious problems will be missed when patients are treated outside their regular physicians' offices, or when they are treated by nurse practitioners and physician assistants without on site supervision from a doctor.

Dr. Allan Goroll, an internist at Massachusetts General Hospital, said the opening of clinics in CVS stores and in Walmarts in other states reflects "the sorry state of primary care in America." He said insurers underpay primary care doctors, leading to a physician shortage. One answer, he said, is more investment by payers in primary care practices.

"We don't need another doc- or nurse-in-the-box practicing in isolated, uncoordinated fashion and burdening practices with requests for information" about patients they are not familiar with, he said in an e-mail.

MinuteClinic now has 145 locations in CVS pharmacies, Targets, and other stores in 18 states. He said the company analyzed demographics and access to care in the Boston market before developing its plan. The region has a large number of families with two working parents, which may indicate a strong need for quick care, Howe said. The retail clinics also can provide extra business for CVS when patients fill prescriptions in the stores and buy other merchandise.

CVS has submitted an application for the Weymouth site, and has asked health officials to approve it as a template that can be applied to 20 to 30 additional sites, Howe said. In addition to state approval, local zoning officials will have to approve some of the sites, and he said the company already has sought zoning permits at those locations.

In its application, CVS asked the Department of Public Health to waive some of the state's requirements for licensing clinics. For example, none of the conditions treated at MinuteClinic require blood tests, executives argue, so the company does not believe it should have to comply with requirements for blood collection equipment and facilities.

State health officials have asked doctors and community health centers for their opinions. If state officials are persuaded that retail clinics do not provide adequate care, they could reject the request to waive the requirements. CVS executives said the only state where they've faced organized opposition to MinuteClinics is Georgia.

The Massachusetts Medical Society, which represents many of the state's doctors, said it generally opposes waiving requirements, but will have to review the CVS request.

John Auerbach, commissioner of public health, said his agency will take at least a month to make a decision, given that MinuteClinics would be a new type of facility in Massachusetts.

He said the clinics have benefits; patients with minor illnesses would not have to wait hours for care in ERs, particularly when their doctor's office is closed. But he said he has concerns, too.

MinuteClinic nurses and physician assistants do not have access to patients' medical records, which could lead them to miss trends that indicate a serious underlying illness.

Auerbach said he also is worried about the impact on community health centers if MinuteClinics siphon off patients with the simplest problems, leaving health centers to treat only those with complex illnesses, an imbalance that could hurt them financially.

Howe said the lack of coordinated care is a problem for the entire medical system, not just retail clinics. To try to overcome this concern, MinuteClinic providers give patients a copy of the notes from their visit, and faxes a copy to the primary care doctor, he said.

The company wants to establish referral relationships with physicians, and instead of being a threat to their business, Howe said the clinics could relieve pressure on their practices, especially after hours. And, he said, patient satisfaction is high.

"We find that once people use the service, they love it," he said. "We see satisfaction ratings above 90 percent."

Liz Kowalczyk can be reached at kowalczyk@globe.com.