The emergence of the Convenient Care Clinic

There are an estimated 200 CCCs throughout the United States today. The clinics are located in convenient locations such as drug stores, food stores and other retail settings with pharmacies, enabling patient accessibility and making it easy and convenient for patients to get their needed prescriptions filled onsite. Therefore, it seemed suitable to call this revolution in health care delivery the “Convenient Care Industry.”

The health care clinics range in size from one exam room to multiple exam rooms, with sinks and exam tables. The clinics generally occupy 200-500 square feet and are outfitted with all the necessities of an outpatient health care office. Federal laws require that owners and operators of the clinics rent retail space at fair market value. The NPs who staff the CCCs work for the operators of the clinics and have a collegial relationship with the pharmacy staff of the retail setting. The average cost to set a center up is approximately $75,000, excluding payroll and corporate overhead costs. Most of the clinics are open seven days a week – twelve hours a day during the workweek and eight hours on Saturday and Sunday. These hours are generally more convenient than a traditional doctor’s and primary care provider’s office. The health clinics are usually busier on the weekends, in the evening and at lunchtime reflecting their convenience and consumer-focus. Most of the clinics see patients 18 months of age and older and visits generally take 15-25 minutes for diagnosis and treatment. CCCs believe strongly in the transparency of medical costs; thus, the clinics visibly post their health care services, treatment costs and information on NPs as providers of care. The basic cash cost for a visit to a CCC ranges from $40-$70. Additional charges may also be assessed for diagnostic screenings and immunizations. Many insurance plans cover visits to CCCs, allowing the patient to pay their co-pay.

The clinics are primarily staffed by NPs, along with physician assistants (PAs) and physicians tied to a corporate entity. The NPs and/or PAs and in some instances physicians provide all the medical care and also handle some administrative functions. Some of the CCCs also have medical assistants who aide the NPs or physicians and help with patient flow. Most clinics use proprietary software systems, electronic health records and technology to enhance the patient experience and continuity of care within the medical community.

In general, the CCCs have written guidelines and established protocols that the providers use to assist with their decision-making process and to ensure the highest level of patient care and satisfaction. For example, when a patient arrives at a clinic, they will register to be seen, sometimes using a touch-screen computer terminal (similar to an airline self-check-in kiosk), where they will enter basic demographic information and the reason for their visit. This sign-in process is the beginning of the patient’s Electronic Health Record. In some cases, this information is then immediately transmitted electronically to a computer terminal inside the treatment room, where a provider is notified of a patient waiting to be seen. Once the patient is escorted to the exam room, the provider validates the information provided by the patient at check-in and enters additional medical information about the patient's symptoms and conditions, as well as any pertinent medical history.

NPs perform CLIA-waived lab tests, write prescriptions if needed, and transmit prescriptions electronically to the store pharmacy or any pharmacy that accepts electronic scripts. Or, if the patient prefers, a printed script can be given at the conclusion of the visit and hand carried to the pharmacy. To ensure continuity of care, the patient is given a copy of their health record at the end of the visit, which they are able to share with their primary health care provider or any other member of the health care team. In many cases, operators of CCCs simply make the patients’ Personal Health Records available to their PCPs, referral physicians or hospitals, pending patient request and approval. This information can also be faxed to any provider that the patient designates to further enhance the continuity of care process. At this time, records cannot be e-mailed due to the unsecured method of transmission. However, the longer-term goal is to exchange the patient’s health record electronically with the provider the patient authorizes and chooses. As CCCs continue to work with physicians and other health care providers, and as relationships and technologies develop, safe and secure electronic sharing of records will be much more standard and common. In turn, patients will also be able to access their health record online.

Many physicians across the nation have partnered with CCCs in providing a collaboration and referral network system for patients that come to the clinics. Many of these physicians welcome the CCCs as an alternative for their patients. However, some medical groups opposed the formation of the CCCs, basing their objection on the fear that patients would not receive quality care or get integrated health care, and that NPs were not qualified or suited to work in an independent setting. However, others believed that the creation of the CCCs was spurred by patients’ desire for more convenient, affordable health care, and that CCCs represent a needed alternative for access to health care for patients.

To date, the American Academy of Family Physicians, American Medical Association and American Academy of Pediatrics, have responded to the formation of the CCI by calling for increased regulation of the practice and industry. They have published principles and guidelines in an attempt to regulate CCI operations and to address the quality of care delivered. The American College of Nurse Practitioners has adopted a resolution in support of the CCI and its role in improving access to care. The CCI industry welcomes the input of such organizations to work in collaboration with the CCI to contribute to the shaping of quality care and accessibility within the delivery system. Several CCCs have reached out to the greater medical and nursing community, to encourage their participation in a meeting on access, integration, and most importantly, how they can unite together to serve the needs of patients. The demand for this new model of care arises out of an urgent issue recognized by so many across the entire spectrum of healthcare providers — that of access to care. The need for continued dialogue between the CCI and the medical/nursing community is critical. The CCI looks forward to working with medical and nursing organizations, and the local communities where they operate to ensure integrated patient care and the delivery of a quality patient healthcare experience.

Conclusion

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