All South Carolina Medicaid patients soon will be able to use medical clinics in retail stores for wellness visits, preventive services and minor illnesses and injuries.
Beginning this month, the state is allowing CVS MinuteClinics and other retailers to enroll as providers in Medicaid, the state and federally funded health insurance program for low-income and disabled people.
S.C. Medicaid Director Tony Keck said the move is intended to keep people with basic health issues away from high-cost emergency rooms. It also could expand access to medical care as the state faces doctor shortages that are expected to worsen when hundreds of thousands of residents become insured for the first time under the national health-care overhaul.
Pediatricians and primary care doctors, who stand to lose Medicaid patients to retail clinics, oppose the state’s decision.
Officers from the S.C. Medical Association and the S.C. chapter of the American Academy of Pediatrics said they worry retailers will disrupt the “medical home” model that encourages patients to have a single set of doctors and nurses coordinating all their care.
Keck, who said state officials began discussing retail clinics at his request earlier this year, had stern words for physicians who oppose the decision.
“You guys close at 4:30,” Keck said. “People work during the day. They need some place to go after hours instead of the ER. We need to make it available to them.”
The level of demand among Medicaid patients for such clinics is unclear, and patient advocates are split about the benefits of the new access.
Sue Berkowitz, executive director of the Appleseed Legal Justice Center in Columbia, said patients could begin relying on MinuteClinics for primary care and chronic disease management instead of routinely seeing physicians with deeper knowledge of their medical histories.
“This contradicts the idea of long-term coordinated care,” said Berkowitz, noting the state Medicaid agency has embraced the medical home model. “It breaks the continuity of care.”
But John Ruoff, the former program director of South Carolina Fair Share, said he counts any new access as an opportunity “to serve more people better.”
“You might have to wait a week and a half for an appointment at your medical home when instead you can go to” a retail clinic sooner, said Ruoff, who now is an independent health-care consultant in Columbia.
The type of treatment covered includes preventive care and “episodic” treatment for allergies, earaches, sore throats, blisters, burns and bug bites, among other ailments, according to the Medicaid agency.
“None of that requires a highly trained physician,” Ruoff said.
Patients under 5 will not be covered — a concession the state made to pediatricians who said they worried about insufficient checks on immunizations and development for young children. The state is requiring retailers to fax clinic notes to patients’ primary care doctors within 24 hours of visits “in order to maintain the Primary Care Medical Home model,” according to a bulletin describing the changes.
Dr. Debbie Greenhouse, president of the S.C. chapter of the American Academy of Pediatrics, said those updates are not good enough.
“Say you take a 6-year-old to a retail clinic for a well-child visit, but there’s no real conversation about what’s going on in school,” Greenhouse said.
“In reality, the child could be struggling — not keeping up with peers. It should trigger a much more thorough investigation of their vision, hearing, perhaps learning differences. That would never happen if the initial conversation never takes place.”
The S.C. Medical Association said in a statement it “is concerned” the use of retail clinics will lead “to a fracturing of health care for South Carolina’s patients.”
“A little more access at the expense of lesser quality and poorer patient and population health is not the ideal direction for health care in South Carolina,” the association said in its statement. “We continue to work with (the Department of Health and Human Services) to develop solutions to patient access that emphasize … a long-term physician-patient relationship.”
The executive director of the Convenient Care Association, a Philadelphia-based trade group, acknowledged that retail clinics are “a resource, not a medical home.”
“We don’t want to be the only sources of health care,” Tine Hansen-Turton said of her association’s members.
Retail clinics aim to refer Medicaid patients to primary-care doctors who could become their regular providers, Hansen-Turton said.
Ruoff, the health-care consultant, said the doctors mostly are worried the clinics will take away customers.
“It’s money out of their pockets,” he said of losing patients on Medicaid.
The program, however, reimburses physicians less than Medicare or private insurance. “The doctors keep talking about shortages. Well, if there’s not enough doctors, let’s remove from waiting rooms the ones that don’t need a higher level of care and make it easier for everyone else to get an appointment and get seen.”
Tom Charland, CEO of research firm Merchant Medicine, said the clinics “have to be where Medicaid people are” in order to expand access to care.
South Carolina has 25 retail clinics, all of them in CVS stores, according to Minnesota-based Merchant Medicine. More than half of the state’s clinics are in either Columbia or Greenville. The Charleston area’s retail clinics are located in Mount Pleasant and on George Street downtown.
Dr. Andrew Sussman, president of CVS MinuteClinic and Associate Chief Medical Officer for CVS Caremark, said in a statement that the company plans to open new clinics in Fort Mill later this month and in Bluffton this fall. Further expansion could happen later this year and early next year as part of the company’s plans to add 100 clinics a year through 2015, Sussman said.
“As thousands of South Carolinians acquire insurance as a result of health care reform, we think MinuteClinic can play an increasing role in expanding access to high-quality, convenient and affordable care,” Sussman said in the statement.
MinuteClinic already is considered “in-network” for some South Carolina Medicaid patients who have managed-care plans, according to CVS. Medicaid programs in several other states already cover care at retail clinics, according to the Convenient Care Association.
“It certainly wouldn’t surprise me that there is interest, given some of the increasing challenges of physician availability in general in this country,” Matt Solo, executive director of the National Association of Medicaid Directors, said in an email.
South Carolina will maintain a list of new retail providers on its website when clinics begin enrolling. Patients will be notified of the changes in the coming months, Keck said.
Reach Renee Dudley at 937-5550.
Nurse practitioner Q. LaJoyce Kwakye checks 4-year-old Maddox Blackburn’s temperature as his brother Braxton and mother, Angel Blackburn, look on at the Mount Pleasant CVS MinuteClinic.×
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