Editorial: Retail Medicine; Drop-In Clinics Fill a Niche

Over the years, Dartmouth-Hitchcock has been involved in enough partnerships, collaborations and mergers with other health care providers that news of yet another such arrangement generally commanded little more attention than a U.S. House vote to repeal Obamacare. Alliances came and alliances went, but for most Upper Valley patients, they seemed to hold little significance beyond confirmation that the medical center was committed to maintaining market share and regional influence.

Not so with the most recent announcement: D-H will be working with the CVS drug store chain to operate six retail medical clinics in New Hampshire. The Upper Valley MinuteClinic opened last week at the CVS store in West Lebanon.

The notion that the nonprofit medical center is working with a private retail giant is not only attention-grabbing, it’s a bit unsettling: Providing medical care in a retail setting would seem to entail some risk that the interests of patients might be subordinated to the demands of successful commerce.

From what we’ve read of the CVS-Dartmouth-Hitchcock venture, though, it makes perfect sense — and not just from the standpoint of the providers. The medical clinics hold promise of meeting a need that the health care industry has otherwise failed to.

The clinics will offer primary care but, as staff writer Chris Fleisher reported last week, they are not intended to supplant the care that patients receive from family doctors or general practitioners. CVS will make nurse practitioners available for people who seek professional diagnosis and treatment for what might be regarded as common medical concerns. For the most part, this will be a CVS operation: The nurse practitioners will be employed by the pharmacy chain; D-H will be paid a flat fee for serving as the clinics’ medical director by way of offering consultation, confirmation of diagnoses and patient education.

Our guess is that most people reading about such a service can easily imagine how it might come in handy. It is not at all unusual to be afflicted with something that doesn’t quite warrant the time and expense of a trip to the doctor’s office, but would benefit from a professional opinion. For the many people who don’t have a primary-care doctor or the flexibility to accommodate whatever scheduling their doctor’s office can offer, the opportunity to pop into the local drug store and get something quickly checked out is a welcome alternative. CVS says it will accept most types of insurance coverage and that visits will typically cost between $80 and $90 — an amount that will certainly be a burden for some, but is still considerably less than most health care services.

While new to this area, such retail walk-in clinics are becoming increasingly common around the country, according to Fleisher, with more than 1,200 venues in 2010, more than a quadrupling of the number from just a few years earlier. Although some medical professionals have questioned the quality of care available at these operations, it strikes us that having quick access to a licensed nurse practitioner is exactly the level of care that’s appropriate in many instances. Clearly, it’s hard to improve upon the care provided by a skilled primary care doctor who’s familiar with a patient, but there are times when that level of attention isn’t necessary, or worth the hassle and time involved in getting access to it.

That filling this particular niche might also serve the interest of D-H in expanding its patient base and CVS’ core mission of making money doesn’t detract from the value of having these walk-in clinics available.