Your doctor is in aisle four

Retail clinics, online docs and other new health-care options aim to deliver fast, reliable treatment, no appointment necessary. And you might be able to pick up some groceries at the same time.

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By Amanda Gengler, Money Magazine writer

clinics.03.jpg
In and out: At Minute Clinics, run by CVS, a typical visit takes 15 minutes or less.
the_alstons.jpg
Family affair: For minor ailments, the Alstons of Flemingon, N.J., routinely head to the nearest urgent-care center.
What a sore throat will cost you
Your throat is killing you and you suspect strep. Here's an idea of how your treatment choices might stack-up, in time and dollars.
HEALTH-CARE OPTION CO-PAY RETAIL PRICE LENGTH OF VISIT
Emergency room $75 $328 3 hours
Urgent-care clinic 30 130 1 to 1 1/2 hours
Doctor's office 20 122 1 hour
Company clinic 0 0 Less than 30 minutes
Retail clinic 20 69 Less than 30 minutes
Web visit 20 30 5 minutes
Source:Notes: Doctor's office doesn't inlude wait to get an appointment. Web visit doesn't include wait for response. Lab costs may also apply to any of the in-person visits above

NEW YORK (Money) -- Did you wake up with pinkeye? Or maybe a painful sore throat or a nasty rash? You want relief and you want it now. Well, good luck getting it.

Nearly a third to half of consumers have trouble getting a doctor's appointment when they want one, and more than three-quarters report long waits once they're in their physician's office. Fall ill at night or on a holiday or weekend and your only option may be the emergency room, where you could wait hours for treatment (sicker patients get to jump the line) and pay $75 to $300 or more for the privilege, depending on your insurance coverage.

At least that's what your health-care choices used to be. Recently there's been a boom in nontraditional medical facilities that aim to deliver fast, easy-to-access care, often for a lot less than the cost of a regular doctor visit.

Over the past two years, the number of retail clinics in pharmacies, supermarkets and big discount stores has jumped from 200 to 1,100. Freestanding walk-in clinics, also known as urgent-care centers, have become more prevalent as well, with an estimated 8,000 nationwide. Meanwhile, a slew of employers are now providing health care at the office, hoping to save money and boost productivity. And a small but growing number of physicians are even offering Web consultations, typically for less than half the cost and a tiny fraction of the time of an in-person appointment.

The big draw for patients: convenience. With most of these health-care options you don't need an appointment, you don't have a long wait once you're there, and you can get care in the evening and on weekends. They're cheaper than going to the E.R. and may also cost less out of pocket than regular doctor visits, especially if you have a high-deductible insurance plan and pay the full price, not just a co-pay.

Consumers so far have expressed satisfaction with the treatment these facilities provide, and physicians groups have acknowledged that they afford better access to health care. That said, these options aren't suitable for every medical problem, and they're no substitute for "the kind of continuous care that comes with a doctor-patient relationship that's been cultivated over time," notes Families USA, a health-care advocacy group.

So don't give up your family doctor. But do use these services for what they're good at. Read on to learn where to go when.

Retail clinics
  • Best for: Simple ailments (like strep throat or pinkeye), plus preventive care (flu shot or blood-pressure check)
  • Price: About $50 to $75 a visit
  • Insurance coverage: Usually, but check with your carrier.
Flu shot on the go

Last fall Kristin Baker, a yoga and Pilates instructor, received the flu vaccination for the first time. A few students were heading after class to get it in a nearby grocery store, so Baker tagged along. "It was great," says the 37-year-old Texas resident, who had never visited a clinic before but plans to return. "We waited in line maybe five or 10 minutes, and I actually picked up a few things at the grocery store at the same time." Cost of the shot: $25, but because Baker had a coupon, her flu vaccine was free.

Peruse the health aisles of a national pharmacy like CVS (CVS, Fortune 500) or Walgreens, (WAG, Fortune 500) a supermarket chain like Publix or a big-box superstore like Target (TGT, Fortune 500) or Walmart (WMT, Fortune 500) and you're increasingly likely to stumble upon the kind of clinic where Baker got her flu shot. Often only two rooms, these health centers are limited in scope: They treat about 25 common ailments, from rashes to sinus infection, in addition to providing immunizations and screenings for, say, blood pressure or cholesterol.

"We provide care for simple conditions, a very focused, episodic kind of care," says Donna Haugland, chief nursing officer for the national chain Minute Clinic, owned by CVS. And you'll get that care fast - the clinics don't require an appointment, they have weekend and extended weekday hours, and they claim you'll be in and out in less than 15 minutes - no waiting-room reading materials required.

The limited services (and prices) are posted in the waiting room as well as on the clinic's Web site. Fees typically run $50 to $75 (plus lab costs, if necessary) vs. $55 to $250 for the same services at a physician's office, according to a 2008 Deloitte report. All of the national chains now accept most major insurance policies, including Medicare. If your plan is accepted, you'll typically be charged the same co-pay as you would be at your doctor's office; high-deductible plan members may pay the full cost - but it will likely be cheaper than a regular doctor's appointment.

You usually won't find a doctor at a retail clinic. Treatment is more often provided by nurse-practitioners and physician's assistants. The medical community generally agrees that such health-care providers are qualified to handle the basic services offered.

"A retail clinic with a nurse-practitioner is okay as long as it has this limited scope of practice and an in-state physician on call who can be contacted if necessary," says Ted Epperly, president of the American Academy of Family Physicians. He adds that centers should send records of patients' visits to their regular M.D.s; as a patient, you should confirm that happens.

It's up to you to do the initial triage to determine if a retail clinic is appropriate for your symptoms. Sore throat? Sure. But a sore throat accompanied by dizziness or shortness of breath? Probably not. Also understand you won't get follow-up care. If your symptoms persist or return, go to your family doctor.

One last caveat: Don't use these clinics for routine care or checkups. That's what your family doctor is for. "We want our patients to have a primary-care provider," says Haugland. "We're not a medical home."

Find a nearby clinic at the site of industry group Convenient Care Association, ccaclinics.org.

Company clinics
  • Best for: Preventive care (immunizations and screenings); basic ailments; disease management
  • Price: Typically $0
  • Insurance coverage: Yes
Staying healthy on the job

The workplace health center is making a comeback, with nearly a third of companies having a clinic or planning to open one by 2009, according to benefits consultant Watson Wyatt. The 21st-century version of the old company clinic usually provides a broader array of medical services than retail clinics do but may not be equipped to do everything your regular doctor's office can. The centers emphasize prevention and wellness, often offering chronic-disease management programs for conditions like diabetes and obesity. You can typically get some immunizations and screenings as well.

Altruism isn't the motive. Healthy employees are more productive employees, the reasoning goes, and don't have to take as much time off from work as sickly ones. Plus, the companies expect to shave money off their health insurance bills, says Watson Wyatt senior consultant Marne Bell.

But in this case, at least, what's good for the boss is also good for the employees. You usually pay nothing for the services the company clinic provides; at the few companies that do charge, costs are usually lower than at the doctor's office (you may have a co-pay of $10, for instance). Prescriptions may be discounted too. Typically, all benefits-eligible employees, even part-time workers, can use the centers. A quarter of companies open the door to covered dependents, and 20% extend access to retirees.

Moreover, nothing beats the convenience. The centers are usually on-site. You can generally get an appointment within a day or simply walk in and be back at your desk in less than 30 minutes. As with retail clinics, you'll generally see nurse practitioners and physician's assistants, although some companies employ a doctor. If you do use the company clinic, just be sure to keep your regular doc in the loop about the care you get there.

Jennifer Walker, 44, an insurance claims quality reviewer at Prudential, knows firsthand the benefits of having a health center where she works. About a year ago, Walker developed a serious blood clot in her arm, and for six months after she had to have blood drawn regularly for monitoring. So every other day she went down two floors to Prudential's health center to have the check done. The process took 10 or 15 minutes, hardly interrupting her workday, and cost her nothing. Best of all, says Walker, "the staff there helped me understand the whole thing and made me feel like I wasn't going through it alone."

Urgent-care centers
  • Best for: Acute conditions that need quick attention but aren't life threatening (a sprain or a sliced finger)
  • Price: About $80 to $250 a visit
  • Insurance coverage: Most centers accept the major health plans
Medical care without the bumps

One day back in 2007, Marshall Alston's son Justin, then 14, started developing large bumps on his legs. That evening, rather than wait to get a doctor appointment or sit for hours in an emergency room, Marshall took his son to a walk-in urgent-care center near their New Jersey home. The doctor quickly determined Justin suffered from a staph infection. "My son got the appropriate medicine, and I was reassured to learn it was nothing more serious," says Marshall, a human-resources executive. They were in and out in just over an hour, and Marshall paid only his regular $25 co-pay, less than the $100-plus he'd have paid in the E.R.

Urgent-care clinics fill a health-care middle ground: They're a step up in level of care from the retail clinic and a step down from the emergency room. Unlike typical retail and company clinics, these centers employ physicians. Thus they can treat more serious injuries and illnesses. Appropriate injuries include minor burns and deep cuts that require stitches, and you can also get treatment for ailments such as bronchitis and ear infections. (More serious symptoms, such as chest pains, still belong in the E.R.) The centers usually do not track and coordinate care, meaning you have to see your primary doctor if you need follow-up treatment. These services aren't meant to be a replacement for a family physician. Bottom line: Choose urgent care "when your primary-care physician is unavailable or you have an injury that's more severe than your primary-care office or retail clinic is equipped to take care of but not severe enough to belong in the emergency room," says Lou Ellen Horwitz, executive director of the Urgent Care Association of America.

Like retail clinics, these centers are typically open weekends and late on weeknights, and patients can walk in without an appointment. The wait is longer than at a retail clinic- patients are usually out in 60 to 90 minutes- but still a lot less than the three hours that's standard in the E.R., says Horwitz. You can expect to pay more than you would at a company or retail clinic, but it's still cheaper than the E.R. For example, your co-pay may be $30 at urgent care vs. $20 at a retail clinic and $75 at the E.R.

To find a facility near you, start by searching at ucaoa.org. Not all centers are listed, however, so also try doing a Web search for "urgent-care center" and your town. Since most centers are not nationally accredited, verify that the physicians are board certified in a primary-care specialty or emergency medicine; you can find the most up-to-date list at abms.org.

Online messaging
  • Best for: Care that doesn't require an exam, follow-ups or questions about prescriptions
  • Price: $30 to $50 a visit
  • Insurance coverage: A few insurers, such as Aetna and Cigna, now cover it, but most don't.
No office visit required

Just as technology may have helped you slash the number of trips you take to the bank or mall, it may also help keep a lid on the number of trips you take to the doctor. Although a relatively small number of physicians currently offer "Web visits"- 8%, according to health-care data firm Manhattan Research - the ranks are growing. That's in part due to the creation of secure messaging programs, which alleviate concerns about patient privacy. What might be even more influential in bringing doctors to the Web, says Manhattan Research vice president Meredith Abreu Ressi, is that some insurers, including Aetna and Cigna, now reimburse doctors for online consultations.

Ask your doctor if he or she is one of the online messaging pioneers, and then understand how this service can help you. Online messaging is intended for simple maladies and follow-up care that do not require your doctor to see you. It's a good way to ask your doctor about prescription issues such as side effects and alternatives. You can ask how to best treat a sore throat, allergies or a recurring rash. If you are monitoring your blood pressure or a chronic disease, you can send your doctor regular updates. What these visits are not meant for: treating more serious complications such as chest pain or requesting a prescription for an ailment you've diagnosed yourself online.

When you go for a Web visit, you log in, type in your symptoms and are then prompted to answer specific questions based on those symptoms. "It is the usual questions that we would ask a patient in the office," says Karon LoCicero, an internal medicine physician in Tampa who began consulting with patients online about a year ago. The doctor responds within, say, eight business hours by e-mail or phone or requests that the patient come in. LoCicero says that it cuts the time wasted playing phone tag with patients. "The patients really like it," she says. "It is convenient for them; it is also convenient for us."

Of course, you may not actually need to rely on e-mail as the only hope to reach your usually-booked-solid doctor. In response to the rise in urgent-care centers, retail clinics and company clinics, many M.D.s are trying to give patients better access to care, extending hours and scheduling time for last-minute appointments. So don't assume that the old-fashioned appointment isn't still an option.  To top of page

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