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D-H Partners With CVS on Six Walk-In Clinics

CVS Caremark Area Director Anne Pohnert slides clinic hours onto the door of the MinuteClinic at the CVS Pharmacy in West Lebanon, N.H. on Dec. 3, 2013. Walking out of the examination room, Nurse Practitioner Margaret Salinas works at the clinic on their opening day. (Valley News - Jennifer Hauck)

CVS Caremark Area Director Anne Pohnert slides clinic hours onto the door of the MinuteClinic at the CVS Pharmacy in West Lebanon, N.H. on Dec. 3, 2013. Walking out of the examination room, Nurse Practitioner Margaret Salinas works at the clinic on their opening day. (Valley News - Jennifer Hauck) Purchase photo reprints »

West Lebanon — Dartmouth-Hitchcock has partnered with a drug store chain to open six retail medical clinics in New Hampshire, an arrangement that the state’s largest health care provider said will improve access for patients.

Under the agreement with CVS Caremark, Dartmouth-Hitchcock physicians will serve as medical directors for the MinuteClinics located inside CVS stores. The West Lebanon MinuteClinic opened Tuesday, and other locations that are either up and running or will be soon include Concord, Salem, Hampton, Manchester and Nashua.

The walk-in clinics will be open seven days a week and patients can get an array of primary care services without an appointment, including diagnosis and treatment of common illnesses such as strep throat, bladder infections and ear infections, as well as flu vaccinations and treatment of minor wounds.

The cost of most services is between $79 and $89 and most types of insurance are accepted.

Although staffed with CVS’s licensed nurse practitioners, Dartmouth-Hitchcock physicians will consult on some care, confirm diagnoses and also be involved in patient education.

The partnership is not a replacement for primary care in the Upper Valley, said Ethan Berke, Dartmouth-Hitchcock’s director of primary care in the northern region. Rather, it is a supplement that will help patients receive fast care and improve coordination within the region’s health care system.

“It’s an access point for us to start taking care of chronic diseases that aren’t being taken care of because (patients) don’t have a primary care physician,” Berke said.

Sometimes called a “doc-in-a-box,” retail walk-in clinics have exploded in number over the past decade. They quadrupled between 2007 and 2009, and by 2010, there were close to 1,200 such clinics in the U.S., according to the Rand Corp. , a think tank in California.

The opening of six MinuteClinics in New Hampshire is part of the company’s plan to open 150 clinic locations nationwide this year. In the 13 years since it launched, MinuteClinic has grown to 750 locations in 28 states and the District of Columbia.

Some physician groups have raised concerns about the quality of care at retail clinics, and insurers worry they will drive health spending higher because patients will avail themselves of more services due to the convenience.

However, growing evidence suggests that the concerns over cost and quality are not valid, according to Rand.

The clinic in West Lebanon is a simple set-up — a single exam room near the back of the CVS store and next to the pharmacy, with a work station for the nurse practitioner and cupboards for medical supplies. There was no exam table inside on Tuesday, though nurse practitioner Margaret Salinas said one was coming soon.

Dartmouth-Hitchcock will not share in the revenue from treating patients and instead is paid a flat fee for the medical director, Berke said. The partnership could funnel more patients into the Dartmouth-Hitchcock system, however.

A goal is to coordinate care for MinuteClinic patients “who are part or seek to be part of D-H primary care services,” according to a joint news release from CVS and Dartmouth-Hitchcock.

Eventually, MinuteClinic will be linked with the electronic medical record system at Dartmouth-Hitchcock, allowing the sharing of patient information, with that person’s permission.

The intention is not to collect more patient dollars for Dartmouth-Hitchcock, Berke said. Rather, it is aimed at avoiding duplication of care in the system, lowering costs and improving access by giving treating people where they live and work.

Sarah and Elliott Crocker, of St. Johnsbury, Vt., were passing through the West Lebanon CVS store yesterday when they came upon the MinuteClinic. Both said they had used walk-in clinics before.

One of those occasions happened two years ago when they were visiting their daughter in Massachusetts. Sarah Crocker, 66, had what she believed was bronchitis. Being away from her doctor, she went to the walk-in clinic and learned that she had a sinus infection.

“They took very good care of me,” she said.

She has visited retail clinics several times since and is drawn to the convenience, she said. No appointment is necessary and if she needs prescription medication, she can walk out of the exam room to the pharmacy counter.

“And if I have to wait 15 minutes, look at all this shopping,” she said.

Not all retail clinics are connected with a health care system like Dartmouth-Hitchcock, but such partnerships increasingly are being sought out as federal health care reforms offer incentives for collaboration, said Anne Pohnert, the area director for MinuteClinic in this region. Other institutions that partner with MinuteClinic include Massachusetts General Hospital in Boston, Cleveland Clinic and Emory University in Atlanta, she said.

“We’re really trying to be proactive in making strategic affiliations given the Affordable Care Act,” Pohnert said Tuesday.

Roughly half of MinuteClinic patients do not have a primary care doctor, Pohnert said, and there could be opportunities to get these patients connected with one. There also is an opportunity to provide urgent care services that someone might otherwise seek at an emergency department, which is more costly and time-consuming.

“Time is money,” said Michael Adams, a Dartmouth-Hitchcock physician and the medical director for three of the MinuteClinics, including the one in West Lebanon. “You could go to the emergency room and wait several hours.”

There will still be times, of course, when patients have to go to the emergency room. The MinuteClinic is intended for only basic care. It does not have an X-ray machine and could not treat more serious injuries. In those cases, the clinic staff would connect the patient with a hospital or even call 911 if needed, Pohnert said.

“Anything can happen,” she said. “I think that’s why having a board certified nurse practitioner and a well-trained medical director makes it work.”

Chris Fleisher can be reached at 603-272-3229 or cfleisher@vnews.com.