Profit Motives

Even with safeguards in place, the reality of the corporate world could compromise practices on the ground, says Simon.

For example, while a supervising physician is required to be available by phone, clinic nurses could avoid calling too often for fear of being tagged as a cost center.

“Realistically, a nurse is going to be reluctant to call the supervising physician every time a kid walks in with a sore throat or the croup to make sure it’s not epiglotitis,” he says.

“If they find her making too many calls to the physician, the retailer could say, ‘We have someone here with not enough confidence in her abilities.’ The clinics run on volume and quickness.”

But Ratner says if collaborating physicians find they’re fielding too many calls, MinuteClinic will bring in more to pick up the slack, or look into adding a new clinic somewhere nearby.

“We have the ability to respond to demand in a unique way,” she says, noting that MinuteClinic is accredited by the Joint Commission. “We will not compromise quality in order to generate greater profit.”

Critics complain that the profit motive could push clinic staff to over-recommend prescriptions and over-the-counter medications to boost the pharmacy’s bottom line.

Ratner points to safeguards for this as well.

MinuteClinic puts a statement on every prescription saying the patient can fill it at any pharmacy. Any e-prescriptions are linked to all pharmacies in the area. And MinuteClinic trains nurse practitioners not to direct the prescription to the CVS pharmacy.

However, Simon remains unconvinced.

“You want a slice of the health care dollars pie and if you’re a pharmacy, it is going to boost sales of over-the-counter and prescription medication,” says Simon, who is a former pharmacist himself. “It then becomes at least in part a product-sale-driven kind of practice with inherent conflicts and risks.”

Next: Fragmented Care