COUNCIL OF THE CITY OF PHILADELPHIA2 JOINT COMMITTEES ON COMMERCE AND3 ECONOMIC DEVELOPMENT AND PUBLIC HEALTH4 AND HUMAN SERVICES5 6 7 Room 400, City Hall8 Philadelphia, Pennsylvania Monday, December 6, 20109 1:20 p.m. 10 11 PRESENT: COUNCILWOMAN MARIAN B. TASCO, CHAIR12 COUNCILMAN CURTIS JONES, JR. COUNCILWOMAN BLONDELL REYNOLDS BROWN13 COUNCILWOMAN MARIA QUINONES-SANCHEZ 14 RESOLUTION 090608 - Resolution authorizing15 Council's Committees on Commerce and Economic Development and Public Health and Human16 Services to hold joint hearings on the lack of retail medical clinics in chain stores within17 the city as compared with the surrounding suburbs and the degree to which such clinics18 could provide Philadelphians affordable and convenient healthcare services as well as19 promote local economic development. 20 - - -21 22 23 24 25 2 1
Good2 afternoon. The Joint Committee on3 Commerce and Economic Development and4 Public Health and Human Services will now5 come to order. We are here today to hear6 testimony on Resolution No. 090608, and7 we ask the Clerk to read the resolution.8
Resolution 090608,9 authorizing Council's Committees on10 Commerce and Economic Development and11 Public Health and Human Services to hold12 joint hearings on the lack of retail13 medical clinics in chain stores within14 the city as compared with the surrounding15 suburbs and the degree to which such16 clinics could provide Philadelphians17 affordable and convenient healthcare18 services as well as promote local19 economic development.20
Thank you.21 Our first witness -- let me22 first recognize the Councilmembers who23 are here. We have Councilwoman Blondell24 Reynolds Brown and the sponsor of this25 3 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 resolution, Councilman Curtis Jones.2 Would you like to have opening3 comments?4
Thank you,8 Madam Chair, and I appreciate you holding9 these hearings. I'd also like to thank10 my colleague Councilwoman Blondell11 Reynolds Brown, who has been a longtime12 advocate for health considerations in13 Philadelphia, being the prime sponsor of14 the menu labeling bill, which is one of15 the strongest of its kind in the nation.16 This is a continuation on17 President Barack Obama's interest in18 moving the United States, and in19 particular our city, forward by way of20 healthcare concerns, which have economic21 development impacts.22 W.E.B. DuBois said inequities23 in opportunity and social condition have24 long perpetrated health disparities in25 4 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 Philadelphia and across the country.2 This was said at the turn of the last3 century, and it is true now.4 One of the things that was5 brought out in the hearings on menu6 labeling was the fact that in inner7 cities, many of the illnesses, many of8 the types of diseases are9 disproportionately, disproportionately10 impacted upon poor people. President11 Barack Obama's first lady, Michelle12 Obama, pointed out a concept called food13 deserts, food deserts, where it is easier14 to find a gun than it is to find a fresh15 vegetable and definitely adequate16 healthcare.17 So what this hearing is18 designed to do is to look at a concept19 that the private sector came up with.20 Didn't need a government resolution,21 didn't need a government law to do it,22 but said that the average person should23 be able to access average healthcare.24 Nothing as elaborate as a surgery,25 5 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 nothing as complicated as chemical2 treatments, but every now and then, to3 prescribe something that can deal with4 everything from the common cold to some5 allergies, because left untreated, those6 common colds and allergies develop into7 more complicated healthcare. So if we8 can nip them in the bud, we can save9 ourselves and society a lot of time, a10 lot of aggravation and pain and a lot of11 money.12 So these health clinics were13 designed to go into communities and14 allow -- what I used to like in school15 was when I got sick, I would go see the16 nurse. I'd walk up to the counter, and17 they kind of knew my name and they kind18 of knew, Well, weren't you here last week19 for something else. But they knew who I20 was, they treated my concerns, and if it21 was something more serious, they sent us22 on or sent us home to a hospital or to23 the care of our primary physicians.24 Well, these retail health25 6 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 clinics are a lot like that. People get2 to know you. They know some of your3 history. It is not a cookie-cutter4 operation in the sense that you are just5 a file. You are a person from the6 community. It's almost a small-town7 rendition of what used to be the8 neighborhood pharmacist brought back to9 cities and urban areas.10 So to that end, it was our hope11 that we encourage the development of such12 centers in inner city neighborhoods and13 to develop that concept in partnership14 with the private sector, because they15 are -- let me say for the record what16 they are not. They are not the public17 Health Department of the City of18 Philadelphia. They are for-profit19 enterprises. But, conversely, the cough20 medicine that is paid for in the suburbs21 costs the same as in inner city areas,22 and so should the services afforded to23 both of their customer bases.24 And with that, I'd like to turn25 7 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 it over again to Madam Chair for the2 hearings.3
Thank you4 very much.5 Let me recognize Councilwoman6 Maria Quinones-Sanchez who has joined the7 Committee.8 Our first witness will be Kevin9 Dow, Deputy Director, Philadelphia10 Department of Commerce.11 (Witnesses approached witness12 table.)13
Good morning,14 Councilmembers. With me today is Andrew15 Frishkoff, the Director of Office of16 Neighborhood and Business Services --17 Neighborhood Economic Development18 Services. Excuse me. I'm glad to be19 here this morning. My name is Kevin Dow20 and I'm the Chief Operating Officer of21 the Commerce Department. I'm here to22 testify on Resolution No. 090608.23 This resolution seeks to24 investigate the lack of retail medical25 8 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 clinics within the City and the disparity2 in a number of medical clinics in chain3 stores within the City as opposed to in4 the surrounding suburbs. Also under5 consideration are the impacts of an6 increase in medical clinics in chain7 stores on neighborhood economic8 development, as well as the potential for9 increasing affordable and convenient10 healthcare services for Philadelphians.11 A recent University of12 Pennsylvania School of Medicine study13 found retail medical clinics are more14 likely to be placed in high-income15 communities. At that time -- at the time16 that this resolution was introduced in17 September of 2009, there were only two18 retail medical clinics in Philadelphia19 despite a large number of chain store20 pharmacies within the City limits. The21 paucity of medical clinics that provide22 affordable healthcare needs to be23 addressed.24 This resolution proposes that25 9 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 the addition of medical clinics to2 existing stores in areas underserved by3 healthcare facilities would increase4 revenues to those stores and improve5 economic growth. We agree, but caution6 that the Office of Neighborhood Economic7 Development in the Commerce Department8 feels that the context of the chain9 pharmacies has to be considered within10 promoting local economic growth.11 In March 2009, Econsult12 published a report detailing a strategic13 investment framework for commercial14 corridors in Philadelphia. The report15 found that chain pharmacies are16 beneficial by all measures in a corridor17 and are most beneficial when they are in,18 not near, a mixed corridor. Chain19 pharmacies are really several stores in20 one - prescription drug seller, basic dry21 goods retailer and convenient store - and22 should be seen as an amenity to a23 neighborhood. The chain retail24 pharmacies have been determined to have a25 10 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 positive effect on neighborhood2 businesses when they are located on a3 commercial corridor, but are considered4 to have a negative impact on neighborhood5 businesses when they are located off the6 corridors. Therefore, any increase of7 service at corridor-based drugstores will8 have a positive economic development9 benefit, but increase of service at other10 drugstores may have no economic11 development benefit, meaning those off of12 the drugstores. We also believe that13 this increase of stores, retail medical14 clinics, has an increase of jobs for our15 community.16 Regarding the quality of17 healthcare provided by retail medical18 clinics, the Department of Commerce19 cannot comment. We are here to support20 measures relating to increasing economic21 development in the City. As the22 Commonwealth's Department of Health is23 responsible for regulating -- for the24 regulation of these medical clinics, it25 11 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 would be their duty to ascertain the2 quality and efficacy of the healthcare3 treatment provided in these clinics.4 Thank you for your5 consideration of these comments. I would6 be happy to answer any questions of the7 Committee members at this time.8
Thank you,11 Madam Chair.12 Thank you for that. It is13 important. I know you're going to speak14 next, but --15
No. He's just here16 to help me out. This is the tag team17 from this point on.18
A couple of19 clarifying points. You mentioned near --20 in commercial corridors, drugstores are21 better in the corridor versus near the22 corridor. Can you tell us why?23
Well, one -- well,24 first of all, it's a matter of25 12 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 aggregation of businesses. So you have2 on commercial corridors, you have other3 businesses there, and so by placing these4 onto those commercial corridors, it5 augments those operations of those other6 businesses. So increasing the foot7 traffic, we see that the CVS's of the8 world create lighting, they are open,9 they have security. So that all benefits10 the corridor as a whole from a safety and11 presentation perspective.12 We know that when there's a13 conducive environment for residents to go14 to a corridor, they will come. So when15 you go and place them outside like in a16 stand-alone facility outside of that17 corridor, there's not confluence of the18 businesses there.19
I just20 wanted to clarify that on the record.21 Of the 100 or so commercial22 corridors, how many of them are anchored,23 if you would, by a major drugstore like24 that and would you consider them truly25 13 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 anchors and draws, if your theory is2 correct, better to have them in and not3 near?4
I don't have a5 quantifiable answer for you today. We6 can research that for you. However, to7 the question -- so I don't have an answer8 to how many corridors are anchored by9 drugstores. I will say that the question10 of do they serve as anchors, they11 themself, the answer is yes, absolutely.12 The size of them, the -- over the years13 they've grown into a decent size, again,14 to become all kinds of service all in15 one, amenities, the dry goods, the16 drugstores, the convenience aspect of it.17 And then if you add a retail medical18 clinic, these are sizable facilities. So19 by the sheer nature of their size, they20 become anchors to the commercial21 corridors.22 The other aspect of anchors is23 that they are located typically on24 corners with parking. So when you put25 14 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 that together and look at it in the2 context of a commercial corridor, that3 makes it an anchor facility.4
Yes. Good8 afternoon. My name is Andrew Frishkoff,9 Director of Neighborhood Economic10 Development for the Commerce Department.11 The Econsult analysis covered12 ten years of Revenue Department data,13 business privilege tax data coded by14 corridors and also then overlaid that15 where there were these chain drugstores.16 We also -- they looked at supermarkets17 and a number of other impacts as well.18 Both supermarkets and these chain19 drugstores serve as anchors when they're20 located on corridors. And so for the21 time period up through 2006, Councilman,22 we can get for you the information about23 how many corridors have these drugstores.24
I'm sure25 15 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 some of our participants today will have2 some information about where their stores3 are located.4 To your knowledge, how many5 retail pharmacies or clinics do we have6 in Philadelphia, to your knowledge?7
The clinics12 themselves? I would say minimal, a13 handful, if any. We don't know of any14 there that have actual clinic facilities15 there at this point in time. So while I16 don't have this as a sure-fire answer, I17 know anecdotally it's probably a handful,18 if that.19
Point being20 I figured you would not have that kind of21 data. I just wanted for the record that22 we don't know, that we are going to keep23 track of it now.24
And I think2 it's an important factor as we start to3 look at the matrix of different options,4 people at different incomes have. There5 are those people -- well, I guess I'll6 ask this in the form of a question. Do7 you know what the average wait time is8 for a public health clinic in the City of9 Philadelphia? And to say no is okay.10
Let me help13 you. You can wait for a doctor six14 months. So whatever was bothering you in15 the first part of your illness, either16 you got better from or it got worse. And17 so what these retail clinics do, in my18 mind, is serve as an early warning system19 or early treatment system that will20 either say, hey, this is something more21 serious than we are prepared to deal with22 and you need to seek a higher level of23 care, or this is something, if you take24 these two pills and a little bit of25 17 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 chicken soup, will go away.2 So it fills an important vacuum3 that we as a municipality can't fill, but4 on a private-sector business model5 potentially can.6
I just9 wanted to say that.10 Thank you, Madam Chair.11
Thank you.12 Any other questions?13 Councilwoman Sanchez.14
Yes. I15 wanted to ask, because you made the point16 around the importance of having these17 pharmacies in our corridors. What are we18 doing as a Commerce Department to help19 entice when pharmacies are looking to20 locate in the City in terms of trying to21 get them on the corridors since, based on22 your testimony, we know the importance23 that they can serve as anchors? What are24 we doing?25 18 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081
And I'll ask Andy to2 jump in in a moment, but we do a number3 of different things. We have business4 attraction strategies, just from a5 general perspective, when we have6 business attraction -- and that's a7 reactive way. Somebody comes to us,8 typically larger companies, will say, I'm9 looking to place my business -- in this10 particular instance would be a pharmacy11 or something -- in a commercial corridor.12 It can be they already have identified13 the corridor or they're looking for us to14 help them -- excuse me; a spot on a15 corridor or they're looking for us to16 identify. So we can either take two17 prongs. One, help them with the spot18 they've already looked at and help them19 through the processes that we do through20 our Office of Business Services, helping21 them navigate License and Inspection,22 Health and things of that nature.23 Typically larger pharmacies, they have --24 they know the drill in that regard, so25 19 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 our involvement might be less there.2 We might also be involved where3 they say, We don't know where, we're4 looking for a place, can you help us5 identify a corridor that might need it6 that you know of that would have the7 space requirements that we're looking8 for.9 The other piece is that we work10 with commercial corridor managers11 throughout the City of Philadelphia. The12 idea there is to work on their individual13 commercial corridors to identify14 opportunities for growth. So it would be15 particular to any one corridor. So if16 you take the North 5th Street corridor,17 you can look at that and say, Okay, we18 know what the mix of businesses are. We19 know that there's a local kind of20 pharmacy here. We don't want to put a21 CVS two doors down, but maybe two miles22 down might be more appropriate.23 So we work with individual24 community development corporations in25 20 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 that regard to help them identify their2 particular commercial corridor.3 Andy, you want to add anything?4
Yeah. Just on5 the Neighborhood Economic Development6 side, we're working primarily with7 community development corporations and8 private developers. Our Business9 Services and Business Attraction team10 would work directly with the pharmacies.11 But we've worked with developers on North12 5th Street. Esperanza's pharmacy13 development, Commerce facilitated the14 acquisition of that project on North15 Broad Street. The project at Broad and16 Westmoreland, we used our Renewal17 Community Tax Incentives to help with18 making that a drugstore-anchored retail19 development. And also in South20 Philadelphia on Oregon Avenue as part of21 the Forest City Quartermaster Plaza, we22 used the Renewal Community Tax23 Incentives.24 So in our unit we're working25 21 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 more through the developers and assisting2 them to make it possible for the3 pharmacies. The Business Attraction Unit4 would work directly with the industry5 itself.6
So it would be great7 to get one of those at 59th and Market8 too, right?9
I think14 it's important, because one of --15 obviously always a challenge with the16 corridors is the issue of parking, and I17 only say this because as -- and I don't18 know what the City is going to be doing19 with its NTI piece, but if we're going to20 be able to draw some of these big folks21 into some of these corridors that can22 make a difference, could be a tipping23 point one or the other, then I want to24 see some of that. I want to see, when we25 22 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 look at the City significance investment,2 some of that saying where do we have a3 corridor where a pharmacy might play a4 good anchor and assure that we're doing5 some of the land assembly, because in the6 case of the North 5th Street pharmacy,7 the relationship that they now have with8 the businesses around parking and sharing9 parking is very unique, but it's been10 very important to the expansion of Tierra11 Colombiana, the Family Dollar and a bunch12 of other stuff.13 So I just -- I want to be able14 to -- I wanted to put that on the record,15 because then I want to look at are we16 going to make one or two investments as17 it relates to that, because that could be18 key, and obviously Front and Allegheny19 being huge. We don't have another small20 pharmacy there, but that type of anchor21 could really tip it the other way,22 because you have a growing corridor23 there.24 So thank you.25 23 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 Thank you, Madam Chair.2
Just by way5 of the anatomy of a deal, typically Rite6 Aid, CVS, Walgreen, not to single out7 people, do they own -- is it my8 understanding they don't attempt to own9 the land? They just want a long-term10 lease and --11
Typically, yeah.12 Typically it's a development deal. It13 could be -- you got pad sites. So the14 pad site might be within the larger15 market, you know, larger supermarket or16 retail center site. So like South17 Philadelphia you got a pad site. You got18 a Superfresh in there. So that's owned19 by the developer. The large retail20 outlet would rent and lease that from a21 long-term lease.22 If you go into the23 neighborhoods, different situation.24 Sometimes they have ownership structures25 24 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 because they've acquired some of the old2 pharmacies over the years, so they might3 have that. Typically what we see now is4 that they're going in, leasing the sites5 from ownership. Their preference is to6 lease the sites, even on the commercial7 corridors.8
I'll ask9 them why that is, but do we market10 City-owned property to them from time to11 time? Is there -- you know, the Public12 Property has a pilot program where they13 are in fact looking at our inventory and14 in a way marketing them. Do we emphasize15 these kinds of things?16
The short answer is17 do we market the properties, we are18 beginning to do that. The answer is yes.19 Public Property, the RDA is now beginning20 to look at marketing its bank of21 properties.22 The longer answer is, are they23 specifically looking at specific corners24 that could be identifiable for a retail25 25 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 pharmacy? I can't answer that. I'd2 venture to say probably not. That's a3 pilot program that we have going on. We4 think there's success there. As that5 begins to get more and more attraction, I6 would believe that we can then get better7 at trying to identify specific sites.8 One of the things that we do9 from in our Office of Business Services10 is to work with the neighborhoods. So,11 again, take Leeoff's (ph) over there on12 Woodbine Avenue. Is that Bryn Mawr and13 Woodbine? It's been vacant for a long14 time, right?15
So it was once a17 thriving pharmacy there called Leeoff's.18 And so what we are trying to work with is19 to work with the CDC over there, whether20 that's the Wynnefield CDC or work with21 those organizations over there to say,22 Okay, let's try to develop a plan that23 would enable that site to be more24 conducive for a CVS to move in or25 26 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 something of that nature. So we do it2 site specific, organizational specific3 with the CDC that's neighborhood4 specific. So it could be different in5 individual neighborhoods, but that's an6 example where we would love to be able to7 attract a national retail chain store8 there like a CVS.9
You might10 want to -- I've in another life sat on11 that side of the aisle, as I often tell12 you, but you might want to -- sometimes13 we as a city and economic development14 entities tend to do carpet bombing and we15 want whoever will move in and we market16 in brochures to whomever will listen, but17 sometimes if we go industry specific,18 smart bombs, if you would, and target an19 industry, find out what their particular20 needs are by way of footprint, by way of21 other amenities, by way of demographics22 that they're looking for and then target23 those particular properties, whether in24 the Seventh District, that fit the25 27 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 profile of the company, something we2 might want to -- that's a thought for3 another day.4
I appreciate6 your testimony.7 Thank you, Madam Chair.8
I'm9 probably going to ask questions you may10 not have answers to.11 Some years back when we saw the12 increase in the number of pharmacies in13 the community, particularly the first14 onslaught came with the Rite Aids and15 then CVS and then, of course, Walgreens.16 And at that time, there was some notion17 in the underground, the 411, that these18 stores were being open particularly in19 certain neighborhoods that would provide20 the location for the location of liquor21 stores if ever the state decided to22 privatize the Liquor Control Board23 system. Have you heard that?24
Not recently.25 28 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081
So now2 there's talk on the table again about3 that whole issue. At the point of -- if4 that should happen -- let's say a5 hypothetical -- what impact do you see6 that, I mean, on the community as well as7 would there be a zoning requirement to go8 back since they were built and9 constructed under one zoning code? Would10 they have to go back to the Zoning Board11 for a hearing?12
There are -- let me13 make a statement that I am clearly not14 the expert on this, but let me comment15 and say that if the state system were to16 be sold to private entities, I would17 believe that there would be legislation18 passed that would require certain zoning19 of particular outlets where they might20 be. The question being is, do current21 commercial zoning outlets fit that22 already and then, therefore, negate any23 new zoning coming in, or do they not and24 then, therefore, there needs to be some25 29 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 sort of zoning pass.2 These facilities are zoned as3 commercial entities. They're drugstores.4 There's a very specific zoning for that.5 Would that -- would state legislation6 that would pass for the sale of the state7 liquor store be incorporated into the8 current structure? I don't know. And9 that's not for you or I to decide that.10 That's for the state legislators, and11 that's where I think we need to do some12 strong advocacy in that regard for the13 possibility of that.14
When you15 think of medical clinics in chain stores,16 how do you see if that possibility17 happens with the emergence of liquor18 stores being part of the drugstore as we19 know it and then you tie in a medical20 clinic?21
So you're making the22 assumption, one, that we have a store23 that has a medical clinic and then, two,24 at the advent of the change of the liquor25 30 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 system, that that's added in, what's the2 impact of having both in that particular3 location?4
It's5 interesting that you don't have that many6 medical clinics in Philadelphia in the7 pharmacies as you do in the suburban8 areas. There may be some connection to9 the future.10
Madam Chair,11 point of information. Let me say this to12 you: I would -- in my district, I can13 only speak for my district. But if we14 have outnumbered liquor stores versus15 retail health clinics, there will be a16 problem. There will be a problem,17 because that says okay -- that would send18 a bad signal. I'll just leave it at19 that.20
I would venture to21 say it would send a bad signal as well.22 Hence, why the privatization of the23 liquor stores in our state and our24 Commonwealth is a significant -- so25 31 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 significant that we must make sure that2 we have our voices heard at the state3 level to ensure that whatever legislation4 is passed to achieve that, it takes into5 consideration the neighborhoods by which6 all of you and I serve.7
As I watch8 the -- and I'm certainly pro business. I9 mean, I want us to have business in the10 City of Philadelphia. I'm not anti.11
But I do13 always look for the unintended14 consequences and sometimes the initial15 motive. But it's interesting that I have16 in a two-block radius two pharmacies.17 You can walk to one from the other, and18 another one up further on Wadsworth and19 another one on Cheltenham. So right in20 that little square of the 50th Ward, I21 have four pharmacies.22
So if they have23 retail medical clinics, I think that's a24 very, very good thing. I think that the25 32 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 access to quality healthcare -- I'm not2 going to opine about the quality part3 about it, but the access to healthcare is4 critical, I think, for the 50th Ward. It5 gives them additional options to be able6 to get healthcare. Taking it to the next7 level, predicting the future, is, if I8 had that ability, I'd share the wealth.9 I really do.10 And I want to comment just11 simply, we recognize that the12 Councilwoman from the district is an13 ardent supporter of businesses, and I14 want to say that for the record, and we15 appreciate that.16
And thank17 you very much. You can see by the number18 of thriving businesses in my district,19 right?20 Thank you very much.21 Any other questions?22 (No response.)23
Thank you24 very much. You have anything else you25 33 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 want to say?2
Okay.4 Thank you.5 The Chair recognizes Caroline6 Ridgway, Policy Director, Convenient Care7 Association.8 (Witnesses approached witness9 table.)10
13 My name is Caroline Ridgway. I'm the14 Policy Director for the Convenient Care15 Association. 18 All right. 21 They're small healthcare facilities22 located inside retail stores, primarily23 inside retail pharmacies. There are a24 growing number also inside supermarkets25 34 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 2 They're open seven days a week, including3 evenings and holidays, open to walk-in4 patients. So no appointments are5 required. 6 Visits take about 15 to 20 minutes,7 allowing patients to go on their lunch8 break, after work, while they're running9 errands. Very time effective. 12 Day-to-day operations are13 staffed by nurse practitioners and14 physician assistants, with physician15 oversight as appropriate under state law16 and regulation. 19 A little bit about the20 demographics of our patient population:21 Tend to be frequented most often by22 younger adults between the ages of 18 and23 44. Families with children also are24 frequent users of these clinics, and25 35 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 6 And there's sort of a common7 set of reasons that people tend to use8 these clinics. Upper respiratory9 infections are one of the most prevalent10 reasons for visiting. The clinics do a11 lot of vaccines and other preventive12 care. Flu vaccines are a major part of13 our business, and obviously we're ramping14 up there this time of year. 18 Industry history: The industry19 is really relatively new. The first20 clinic actually opened in 2000. So only21 a decade ago. But even with that, the22 bulk of the industry growth was really23 only in 2007 and 2008. So we're really24 talking about only a few years here that25 36 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 3 Today, we estimate there are4 about 1,200 of these clinics spread5 across the country. That's in about 356 different states. 12 The Community Care13 Association -- that's the group I work14 for -- we represent the industry. 17 In our membership we've got about 9018 percent, we estimate, of all clinics open19 out there. 22 We were founded in the fall of23 2006. 25 37 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 Our local presence: Currently,2 three members of the CCA have or are3 exploring clinic locations here in the4 Philadelphia region. You'll see their5 logos on the slide here, MinuteClinic,6 which is within CVS stores, Take Care7 Health, which is within Walgreen stores;8 and the Einstein Network is a more recent9 member of the CCA. They're still in the10 planning stages. 20 Next I'm going to talk a little21 bit about the value of the clinics,22 starting with access. People really do23 rely on these clinics for the24 accessibility and the convenience. As25 38 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 many as 60 percent of our clinics say2 that they don't have a primary care3 provider. 12 We see a high population of patients with13 health savings accounts and high14 deductible health insurance plans for15 whom the cash payments, it's really16 important to them to be able to have17 access to someplace that's more18 affordable. 21 population reports that they live within22 a ten-minute drive of a clinic. And23 you'll see here a statistic that24 according to our membership, 40 percent25 39 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 9 Moving on to affordability,10 once patients are in the door, the11 financial accessibility is also very12 appealing to them. 17 And just as a brief aside, at18 the end of this presentation, you'll see19 a slide that has all of my references20 that I've used. 24 The clinics are devoted to,25 40 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 committed to transparency in pricing. So2 the cash cost associated with services is3 posted. 8 Most insurance plans are9 accepted, so in that case, you can just10 pay your co-pay. Average cash price if11 you're paying cash is around $60. And12 consumers, insurance companies and13 employers all find this to be very14 beneficial.
For employers it's -- they15 find it -- it increases the productivity16 of their employees, because they can take17 less time off for sick time. Payers find18 it to be very cost effective. 25 41 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 Moving on to quality, day to2 day, as I mentioned, the clinics are3 staffed by nurse practitioners and4 physician assistants. These are5 Master's-level educated, fully certified6 and credentialed providers able to7 diagnose, treat and prescribe. 10 Certain of our quality and safety11 standards include the use of electronic12 health records. One hundred percent of13 the clinics with membership in the CCA14 use electronic health records. Use of15 evidence-based guidelines developed by16 national governing bodies, such as the17 AMA, the American Academy of Family18 Physicians and others. 22 And, again, third-party23 research has also demonstrated strong24 adherence to these evidence-based25 42 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 guidelines. In some cases, better than2 99 percent demonstrated adherence, as3 well as strong clinical outcomes,4 equalling or bettering the quality5 demonstrated in primary care offices,6 urgent care centers, as well as emergency7 rooms. And a final important point to8 make about quality is that while the9 convenience and the cost may be the most10 superficial drivers of use of these11 clinics, if the quality weren't also12 there, patients wouldn't go. 14 Moving on, responding to15 national need: As I mentioned earlier,16 the clinics provide an entryway into the17 healthcare system for our patients who18 may lack access otherwise. Really they19 provide a starting point. They're not an20 ending point. They're not meant to be a21 medical home. 25 43 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 You need to talk to somebody, but you2 don't need to go to an emergency room,3 you don't necessarily need to wait your4 PCP. You just need somebody. 14 Just to briefly recap, we are a15 young industry, but absolutely with16 active interests in expanding to meet17 growing need. 21 With that, I'd just like to22 thank you and take any questions. As I23 mentioned, all of my references are24 included, as well as my contact25 44 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 2
Thank you so5 much for that information. I have a6 couple of -- now, you don't address the7 business model or the business decision.8 You do?9
So my12 questions should be more dedicated to the13 use of the service, correct?14
Thank you17 for being polite and kind.18 Insurance companies, how19 long -- you said that the first clinic20 came on around 2000. How long after that21 did insurance companies start to22 recognize and pay for this kind of23 service? Did that happen simultaneous or24 did you have to drag them?25 45 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081
Well, I don't2 know that saying we had to drag them was3 necessarily accurate. It sort of -- it4 grew organically. The first few years5 actually the clinics that were in6 existence were a cash-only model based on7 their business model, but it was patients8 who ultimately said that, you know, We9 love these clinics, we'd really like to10 be able to use our insurance. So it was11 more in the mid 2000's, I'd say, that the12 clinics' operating companies started to13 reach out to payers and have14 conversations with them about ways in15 which they might be considered as16 in-network providers, and it's just grown17 steadily ever since.18
In large part,21 yes. The consumers really demanded this.22 So it's grown very steadily over the last23 several years. Now the clinics all24 accept nearly all major insurers. They25 46 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 accept Medicare, where feasible. They2 accept Medicaid in many cases. So it's3 really -- it's grown quite extensively4 over the last probably five years.5
Is there a6 standard by which healthcare7 professionals are trained, certified and8 licensed that participate in this9 particular aspect of healthcare?10
Well, most of the11 providers who work in our clinics are12 family nurse practitioners. So they13 would be certified and licensed according14 to the state in which they practice.15
When you say16 "most," is that based on law, based on17 practice, based on --18
Well, family19 nurse practitioners are probably the most20 common provider in our clinics, simply21 because they're able to practice with a22 great deal of independence and autonomy23 across the country really. Physician24 assistants --25 47 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081
I guess what2 I'm trying to get to is, my auto mechanic3 is a heck of a guy, but I don't want him4 dispensing pills or medicine to me.5
So what is7 the standard minimum by which a person8 can participate and be a staffer at one9 of these?10
You would have to11 have some level of independent12 prescribing authority.13
And where is14 that standard found in law or in15 practice?16
That would just17 be across the board in the healthcare18 practice generally. There are19 licensure -- each type of clinician is20 subject to the licensure of his or her21 profession, which dictates the scope to22 which they are able to practice.23
But what I'm24 asking is --25 48 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081
So to be in4 your association, the person who is5 dispensing this healthcare has to be a6 what level educated, certified person?7
Would have to be8 minimal Master's-level certified to9 prescribe independently.10
Okay. That11 was my question. All right.12 Compare what the average cost13 that -- I think you said it in your14 presentation -- that a person comes up to15 the counter. What's the average cost?16 Was it $60?17
That's about the18 average. Some costs are going to be19 less. If you go in just for a flu shot,20 that's going to be 20-some dollars.21
For the average24 is about $60.25 49 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081
Now, how2 does that compare to a primary physician3 and/or an ER?4
The primary care5 physician and urgent care centers are6 going to be more in the 100, 125, 1507 dollar range cash price, and emergency8 visits -- and, again, it's important to9 note that the studies that have looked at10 cost comparisons have looked specifically11 at services that would be given in all12 three settings. So they're not going to13 look at the cost of brain surgery,14 because obviously one of these clinics15 isn't going to be doing brain surgery.16 But for the services that would be17 offered in all three settings, the18 average cash price in an emergency room19 is going to be more like four or five20 hundred dollars.21
Are there22 any statistics that reflect how often a23 practitioner in one of these retail24 health clinics refers someone on to25 50 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 something more intense?2
Yeah. There was3 one study that actually did look at that,4 and they say that only about two5 percent -- I think the number they came6 up with was 2.3 percent of patients are7 referred on for more serious intensive8 care.9
Thank you.12 The Chair recognizes13 Councilwoman Quinones.14
Thank15 you.16 Let me just say how important17 and timely this discussion is, and for18 the purposes of the record, we in19 Philadelphia are kind of behind the ball20 as it relates to urgent care. I believe21 there's only one urgent care facility, I22 think it's Bravo Health Insurance on23 Broad and Lehigh. And obviously now with24 Councilman Jones bringing this issue25 51 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 around the Convenient Care piece of it2 being so important, that you have these3 levels of healthcare access that we could4 be providing if we can kind of create5 these models.6 You say that you're not part of7 the business model of this. Who can we8 go to to really look at the business9 model? What's the tipping point?10 Councilwoman Tasco, who has been active11 here for many years, has watched hospital12 and hospital and hospital close down, and13 we need to get in front of that in terms14 of the business model, because what we've15 heard from the hospitals is once you get16 to 50 percent Medicaid, that's your17 tipping point, that's when you start18 going downhill.19 Where can we go get information20 about what the business model tipping21 point is? Because Philadelphia is poor.22 We have a huge poverty rate. We have a23 huge amount of folks uninsured. Just24 this weekend I was doing a campaign with25 52 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 CHIP, because it's astonishing to me that2 we still have 22,000 kids who are not3 insured in Pennsylvania, yet we have the4 coverage opportunities that exist.5 So where could we go to get6 that data?7
To talk about the8 business model really you're going to9 need to talk to the companies that10 operate the clinics. They're the ones11 who really are responsible for deciding12 when and where they open clinic locations13 and deciding when and where they offer14 new service expansions and things of that15 nature. And each company is going to16 vary slightly obviously in the17 difference -- in how they go about it,18 because it is a private-sector industry.19 So I would recommend speaking directly to20 the companies that do operate the21 clinics, and the Convenient Care22 Association is happy to act as liaison,23 if we can be of any assistance.24
That25 53 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 would be helpful to us, because2 ultimately that's going to be the driver3 of whether we really come to terms with4 this. I am hopeful -- and I haven't had5 an opportunity to talk to Bravo around6 their urgent care piece to see if it has7 made sense. The recent urgent care8 centers came to be was because we were9 trying to divert people from emergency10 rooms, and in their case, they can do11 broken bones and some of other stuff that12 these clinics can't, but clearly is13 services that are much more expensive if14 they are issued through the emergency15 room.16 We'd be interested -- maybe17 there's one or two big providers who have18 many of these clinics. We'd be19 interested in that conversation as20 government, and as we develop policy, we21 need to know what that is so that we can22 be supportive of the industry. Anything23 that obviously adds healthcare access in24 communities, particularly communities25 54 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 like the one I represent, we should be2 interested.3 I don't believe in this4 particular case the market is going to5 drive it. I think public policy is going6 to have to drive it and the need for us7 to provide a service, because of the8 people that we're trying to make sure get9 served.10 So I'd be happy and I'll make11 sure we work with the bill sponsor to12 have a conversation with maybe one or two13 of those larger providers so that we can14 become familiar with this very important15 issue that unfortunately when we're16 talking about all the other crazy stuff17 we don't pay attention to, but it's so18 important.19
And I22 thank you so much for your presentation.23 Thank you.24
Thank you.25 55 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081
Thank you2 very much. I have to go across the hall3 to a meeting. Councilman Jones is going4 to continue this discussion, and I've5 asked him to ask a couple of questions6 for me. I'll try and come back before7 you leave, but thank you very much for8 attending.9
Oh, let me11 ask you a question. I do have to go. I12 have the Council Commissioner waiting.13 You talked about your referral14 network. What other kinds of services15 are provided at these clinics in the16 drugstore to the extent -- what services17 do you provide?18
It's fairly basic19 stuff. So we see a lot of upper20 respiratory infections, a lot of ear21 infections, urinary tract infections,22 minor skin conditions, sprains and23 strains, but nothing that would rise to24 the level of needing sutures. We don't25 56 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 have any serious diagnostic equipment in2 the clinic space, so anything that would3 require an x-ray or anything of that4 nature would have to be referred out.5 So it's really your pretty6 basic stuff, lots of cough and cold, flu,7 preventive and wellness care. It's the8 kind of stuff that, you know, you wake up9 on a Saturday morning and you just don't10 really feel right, or your kid gets sick11 after school one day. It's the pretty12 low-level, non-emergent but acute stuff,13 so non-chronic, for the most part.14
So if the15 nurse practitioner could find something16 that may be troublesome, would they refer17 them to a specific doctor, specific18 hospital or to say, You need to go get19 further care? And then is there any20 follow-up?21
It would be on a22 case-by-case basis in terms of they would23 assess what exactly the scope of the24 problem was. Obviously if there's an25 57 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 emergency, they contact 911 services and2 the patient is transferred to emergency3 care immediately. If it's more of a,4 Well, this might be a chronic thing, you5 probably just need some follow-up tests,6 we suggest you check in with your PCP7 next week. If they don't have a PCP,8 they'll try and give them a list of local9 PCPs who are accepting new patients, and10 they do try and do follow-up to the best11 of their ability with calls, postcards in12 the mail, things of that nature.13
Thank you,19 Madam Chair, for those insightful20 questions, particularly ones that we will21 be following up as to the next state22 administration and their interest in23 state stores and privatizing some of24 that, not taking a side on that issue one25 58 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 way or another, but it serves as a2 heads-up as what the possible impacts in3 Philadelphia are.4 Thank you for this insightful5 information. The only thing I can say is6 we want more of them and we'll be looking7 to stay in touch with you on how they're8 working out.9
Absolutely.10 We're in agreement. Thank you very much11 for your time and look forward to12 continuing to work with you.13
Paulette Thabault17 and Michael Ayotte from CVS MinuteClinic18 and CVS Caremark.19 (Witness approached witness20 table.)21
State your24 name for the record.25 59 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081
Yes. Good2 afternoon. My name is Paulette Thabault.3 I'm the Chief Nurse Practitioner Officer4 for MinuteClinic, a division of CVS5 Caremark.6
Before you7 give your testimony, my colleague would8 like to say a few words.9 Councilwoman.10
Yes. I11 want to put your testimony in context.12 Councilmembers, CVS has been a13 consistent, committed contributor to the14 senior citizen workshops that I've been15 doing now for five years and they've been16 partners for the last two years, and it's17 in my -- it's my estimation that CVS18 walks the talk, to use your expression,19 and have been serious about making20 available what you bring to seniors,21 including job opportunities for seniors,22 which is, in many ways, unprecedented.23 So I wanted to put that on the24 record. A, say thank you, but, B, let25 60 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 others know that you are, in my view, a2 corporate citizen that is serious about3 issues that you ultimately put your arms4 around.5 Thank you very much.6 Thank you.7
Thank you8 for that comment. We echo that and want9 to just say that all of this is designed10 for us to do more business, have more11 interaction to be further penetrated into12 the Philadelphia marketplace.13 Please present your testimony.14
22 MinuteClinic walk-in medical23 clinics are located within select24 CVS/pharmacy stores. There are over 50025 61 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 8 MinuteClinic sites are located in all9 types of communities since we believe10 that the need for low-cost, accessible11 care is universal. 17 All MinuteClinic sites are18 staffed by Board-certified nurse19 practitioners who offer expert medical20 care and are able to diagnose, treat and21 prescribe, when appropriate, for family22 medical problems. All of our clinicians23 have collaborative practice agreements24 with local physicians who provide25 62 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 supervision, review cases and are2 available for questions during clinic3 hours. 11 Our clinics are open seven days12 a week. There's no appointment13 necessary, and we offer transparent,14 low-cost pricing for patients, along with15 accepting most insurance plans. 21 MinuteClinic is the pioneer and22 the largest provider of retail healthcare23 in the United States. MinuteClinic24 launched the retail health clinic concept25 63 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 in December 2000, just ten short years2 ago. Since that time, more than eight3 million patients have been seen and4 treated. The first retail health centers5 were located in grocery stores in6 Minneapolis-St. Paul. CVS acquired7 MinuteClinic in September of 2006. 17 As part of our health and18 wellness outreach in 2009 and again this19 year, we have offered free flu shots to20 at-risk and needy populations. This year21 we partnered in this effort with Direct22 Relief USA, a non-profit organization23 that works with 1,100 clinics and health24 centers in all 50 states. Rising Sun25 64 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 4 In addition, we've also offered5 free A1C tests to encourage the more than6 24 million Americans with diabetes to7 better monitor their condition. 13 MinuteClinic has always been14 committed to delivering the highest15 quality care. We were the first retail16 clinic to receive accreditation in 200617 and then reaccreditation in 2009 from the18 Joint Commission, the national evaluation19 and certifying agency which accredits20 15,000 healthcare organizations such as21 hospitals, hospital services, nursing22 homes and laboratories, and applies the23 same rigorous standards to our24 accreditation as the nation's leading25 65 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 healthcare institutions. Quality of care2 at MinuteClinic was recently evaluated by3 independent Rand Corporation in a study4 that was published in September of 20095 in the Annals of Internal Medicine. 11 MinuteClinic has a nationwide12 interactive proprietary electronic13 medical record. This tool allows for14 high-quality care through our use of15 nationally recognized guidelines. In16 addition, we support continuity of care17 by providing a patient's physician with a18 copy of the medical record of their19 patient's encounter within 24 hours of20 the patient visit. More than 95 percent21 of MinuteClinic patients rated our22 services as "excellent," according to23 Press Ganey survey data. This benchmark24 is extremely difficult for any healthcare25 66 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 provider to obtain. In addition, our net2 promoter score -- that is a measure of3 the likelihood to refer a family or4 friend -- is 82. 7 So our history can be described8 as a series of phases. The initial phase9 dealt with the development of this new10 high-quality, affordable healthcare11 delivery model. 18 So that leads us to today. CVS19 Caremark has recently announced that we20 will be expanding the number of clinics21 that we have nationwide. We believe this22 will be responsive to the current23 shortage of available primary care24 providers and the future demand created25 67 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 by the enacted healthcare reform and2 universal access.
MinuteClinic plans to3 add 100 new clinics to our national4 footprint in 2011. 11 When we became aware of12 Councilman Jones' resolution, we met with13 the Councilman to discuss the care14 provided at MinuteClinic as well as our15 plans for clinic expansion. We also16 discussed the Council's resolution that17 seeks to address the lack of medical18 clinics in chain stores within the City19 as compared with the surrounding suburbs20 and the degree such clinics could provide21 Philadelphians with affordable and22 convenient healthcare services, as well23 as promote economic development. 25 68 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 First, the process that every2 clinic practice goes through for a site3 selection is intense. As with the siting4 of any medical practice, choosing an5 appropriate location requires the6 consideration of a variety of factors and7 is essential to the retail health clinic8 being successful for the long run. 22 Urban host locations tend to have smaller23 footprints and different traffic patterns24 which can make site selection25 69 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 challenging. 4 Second, we believe the model5 and its basic principles of providing6 high-quality, easily accessible,7 affordable care is relevant and needed in8 almost all areas. 14 Three-quarters of our current visits are15 covered by insurance. Extended hours16 means that patients receiving17 high-quality care on demand need not take18 time off from work to receive medical19 care. Furthermore, rather than waiting20 in emergency rooms or at home for a21 doctor's appointment, they can be treated22 when it's convenient for them and their23 families. In turn, lowered absenteeism24 will improve area productivity and,25 70 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 therefore, have a positive economic2 impact. 13 Lastly, approximately 5014 percent of our patients nationally do not15 have a physician. They are the medically16 homeless. If not for our care, they17 might go without medical treatment or18 wait until their condition reached a19 worse point in its course. We actively20 refer these patients to established care21 with a physician in their area who are22 accepting new patients as a follow-up to23 their experience. In this capacity, we24 serve as an important conduit for25 71 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 10
I'm going to11 allow Councilwoman Blondell Reynolds12 Brown.13
Thank you.14 It is striking that to date15 there has been one in Philadelphia. How16 did that community end up being the, some17 might say, fortunate, others might say18 lucky, whatever you might call it? And19 this underscores Councilman Jones' vision20 and mission for this hearing, recognizing21 that there are dozens of communities22 across Philadelphia that equal in profile23 or not to this particular section of24 town. I'm curious to know what25 72 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 strategically led you to that location.2 Thank you.3
I'm also joined4 today by Mike Ayotte, who is our Director5 of Government Affairs.6 (Witness approached witness7 table.)8
Well, as I13 mentioned in my testimony, there are a14 number of factors that go into15 determining the appropriate site for a16 clinic. We do want to open our clinics17 in places that will be successful for the18 long term so that we're able to continue19 to stay open, and some of those factors20 are the zoning rules for the area, the21 ability to be able to place a clinic so22 that we have enough space in the store to23 have a clinic that has the appropriate24 privacy and space, also the access to25 73 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 transportation so that patients in the2 surrounding area can come to the clinic.3 So there are a number of different4 factors that go into the evaluation of a5 site.6
If I could,7 Councilwoman Brown, the clinic that's8 opened currently opened in 2007, and9 there's actually another clinic that was10 opened at about the same time in District11 10, and that clinic has closed, and part12 of it was insurance coverage for the13 marketplace, part of why -- it's now14 called the seasonal clinic. We can open15 it up for flu shots, et cetera. But part16 of it was only a --17
Can you hold18 on for a second. On Councilwoman Brown's19 question, list what your selection20 criteria is. You did it in the21 presentation, but again underscore it,22 and then what your selection criteria was23 for the one that is open.24 If I were to follow this to its25 74 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 logical conclusion, I probably could show2 you a dozen stores in my district or3 sites that could meet that. I understand4 that you are not a non-profit per se.5 You are a for-profit, but there's gold in6 them there hills by way of our7 marketplaces as well. So I really want8 to get a better sense --9
-- narrower11 sense of what is your business model12 decision and then what was your rationale13 for going where you went.14
If I can, I think15 back in 2007, I'm not sure I have a good16 answer for you for that. I think in 200717 it was just a new market industry. We18 were trying to put places up. It could19 have been just the location that was20 picked. It had enough size in it. We21 needed to put a clinic in it, and we did.22 The clinic that's half a mile away is23 closed, and part of our learning was24 that -- and I think you saw it in25 75 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 Caroline's presentation -- is that we2 kind of back in 2007 had a thought that3 we could do it like drugstores, and the4 market penetration area is much5 different. So a half a mile away, it was6 a parasite on itself. So it was -- you7 didn't need to have it that close.8 So I don't really have all the9 factors for today to give you. We've10 gone through some of them. We can again11 come back with the business folks that12 actually do the real estate and have them13 give you some in-depth, but in general,14 the ones that Paulette has mentioned and15 Caroline mentioned in hers are really16 kind of determining factors. And then17 all the sudden the economy went south,18 and at that point in time, the industry19 grew very rapidly, and part of the rapid20 growth became and part of a clinic21 location became where we could put22 clinics in and where we could construct23 them rapidly and inexpensively, and that24 was not the right model, because we have25 76 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 some clinics that are not open today2 because of that.3 We went through a period of4 time where we grew none at all, and even5 the industry didn't grow. And basically6 that was the period, I think, the phase7 that Paulette talked about about the8 learning phase. And I think now we've9 learned how to run the clinics. We've10 learned how to better operate the11 clinics, and I think we're probably12 better at locations to be able to grow13 and commit to growth long term. The14 worst thing we can do is open and close a15 clinic or open and reduce the hours.16 So we can come back with a much17 more depth presentation for you or even18 just meet with you individually on what19 it takes to do that. And you're right,20 you probably have plenty of places that21 meet that criteria. We're looking at 2622 different states. Probably will only put23 clinics in -- as Paulette mentioned,24 we've committed to putting one into the25 77 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 City, but we're looking at existing2 marketplaces for additional clinics and3 then, from there, continue to grow out.4
Yeah. I7 wanted to make note of during your8 testimony you talked about the 75 percent9 insured and 25 percent uninsured, and it10 goes back to my question. Do you11 currently have any information that12 allows you to see the model in terms of13 insured versus uninsured as a baseline?14 Is that one of your criterias?15 If you can't answer that now,16 when you provide additional information,17 we'd like to see that.18
In addition,19 is there a mix of insurances, public,20 private, that make sense better than21 others that can give us some insight to22 your selection?23
Well, I think24 that what I'd say is that our prices are25 78 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 lower in cost. So whether you're insured2 or uninsured, the accessibility to the3 lower-cost healthcare service that's4 still very high quality is available at5 MinuteClinic. It is important that the6 surrounding population, if they're7 wanting to use their insurance, that they8 have insurance and then they would come9 and use their co-pay and be limited to10 the co-pay for them. But now we're11 seeing many more businesses looking to12 the higher deductible health plans, and13 that's a significant out-of-cost --14 out-of-pocket cost to individuals who are15 using the clinic. So in that sense, the16 effect whether they're insured or not17 doesn't impact as great. It's really the18 cost of the services that comes into --19 that's more important to consider.20 For the uninsured, obviously21 the lower cost is going to be attractive.22 I don't know if that -- did that answer23 your question? In terms of the mix --24
What I'm25 79 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 trying to get to is, if I have Medicaid,2 what is the reimbursable impact on your3 bottom line versus Blue Cross, and is4 there a mix that is --5
Or Health8 Partners. I mean, is there a mix that is9 preferable one to the other? And I'm10 speaking for the spirit of Councilwoman11 Sanchez.12
I don't think that13 that's the established point. What I14 mean by that is, it's more the fact --15 let's take Medicaid as an example. Fee16 For Service Medicaid, Keystone Mercy17 Health, large MCO of Medicaid, and18 Health -- I think it's Health Partners,19 if you're not in the mix that the area20 takes -- so, for example, we may be in21 the Fee For Service, but we may not be in22 Health Partners, and most of the people23 in that neighborhood may be Health24 Partners. So it's not necessarily which25 80 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 one pays more or less, because our2 billable number is less. And if I'm3 speaking out of turn, tell me. But nurse4 practitioners and physicians' assistants5 that work in the clinics are paid at a6 less of a percentage rate than a7 physician is. So we have such a low8 billable dollar amount because the model9 cost is kept down, it's not really which10 one of the mix is it. It's being in the11 right plans to match wherever you're at.12
Again,13 that leads to the public policy14 discussion, because many of these plans,15 hospitals choose to do one or the other16 and not both, and for us, it's important.17 And even though that decision is more of18 a state decision versus ours with these19 Medicaid HMOs, it becomes an important20 one to being able to provide a diverse21 array of services in the healthcare, and22 it's a discussion I've had with23 providers, particularly the providers who24 are brave enough to come into my25 81 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 districts and provide services, is2 if they take Health Partners and then3 Keystone Mercy tells them no, then I've4 gotten into the competitive discussion of5 this is about the clients and these are6 about the patients. But that becomes an7 important public policy discussion for8 us, because there is no practice of you9 take one or the other and not both, and10 the people who get hurt in this are then11 the actual patients.12 So I'm glad for that13 clarification, because it is a point that14 we don't always get to make, and I know15 many of us when we interface with our16 state legislators talking about --17 particularly when we're talking about18 Medicaid and many times they ask us to19 help lobby on their behalf, they need to20 understand that some of these practices21 around doing that and limiting hospitals22 to certain plans, there's a detriment to23 a broader access piece. So thank you24 very much for that.25 82 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081
Couple other2 points. Councilwoman Tasco referenced3 the possibility of the libations coming4 to your facilities. What is the5 footprint by which physically, amount of6 space you need to operate a clinic? And7 that obviously competes for shelf space8 for other things. So what is the9 footprint, square footage need, of a10 clinic?11
I don't know the12 exact square footage, but it's typically13 an office, if you imagine a small office.14
It doesn't17 require a lot of space. We have to have18 a facility that's large enough to19 accommodate -- if you could think of a20 typical physician's office size, that's21 about the size that you would expect.22
And you23 cited in your testimony that the service24 provided by these facilities are rated as25 83 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 good or on par with those provided by2 physicians and/or ERs, and that's an3 important note to make.4
Yes. That was5 published by the Rand Corporation. They6 looked at similar services that were7 provided in our clinics and -- not8 MinuteClinics per se, but the retail9 clinics, and compared those to -- these10 comparisons were on quality and cost to11 the physician's office, the urgent care12 center and the emergency room, and the13 retail clinic provided equal or better14 quality and at a lower cost.15
I know there16 are people listening to this right now17 that can talk about sitting in emergency18 rooms for hours and hours and hours and19 hours only to find out that they were20 going to get a prescription, a couple21 pills and sent home that could have been22 resolved in one of these retail clinics.23 You also talked about medical24 records, electronic transfer of medical25 84 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 records.2
A couple of4 questions on that, and you're ahead of5 some of the clinics actually in our6 neighborhoods that do not have electronic7 records. And do you share those records8 with a retail clinic within CVS that9 might be in Walgreen and do they share10 back and forth through corporations?11
We have a12 proprietary electronic medical record,13 and what that -- what we do with our14 record is, at the end of every visit, the15 patient is provided with a copy of their16 visit so that they can take it with them,17 and it provides patient education about18 things that they should be watching for19 for follow-up, recommendations and that20 type of thing, any kinds of education21 that might be related to their treatment.22 And then with their permission, we23 provide an electronic or a fax copy of24 that visit to their primary care25 85 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 provider. If they don't have a primary2 care provider, we provide them with3 information on local providers who are4 accepting new patients. So we try to get5 our patients who don't have any6 connection to the traditional healthcare7 system established and connected.8
So9 hypothetical, if I'm at CVS, I'm in10 visiting Councilwoman Sanchez today and I11 go in, get treated and then I'm over in12 Councilwoman Blondell Reynolds Brown's13 neck of the woods at the Rite Aid, but14 the record is over there, will they share15 records?16
We wouldn't17 share with Rite Aid, but what we would do18 is, if you are here in Philadelphia and19 you were seen and then you happen to be20 traveling in another state and you went21 to a MinuteClinic there, your record22 would be accessible to the nurse23 practitioner seeing you there so that24 they would know what treatment you had25 86 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 had in the past.2
Under the3 business model that you use and what you4 choose, services, there are varying types5 of clinics, I'm assuming. Some have a6 minimal amount of services offered. Give7 me the a la cart, if you would, from the8 Cadillac version to the Hyundai.9
With the10 exception of where there are some11 regulatory limitations, in nearly all of12 our clinics all of the services are the13 same in terms of the types of -- the14 breadth of the services that we provide.15 So it is the acute services that you16 heard Caroline speak about. But in17 addition, in MinuteClinic we have also18 introduced the chronic care monitoring.19 We also do a significant number of20 preventive care types of visits and21 school physicals, camp physicals, college22 physicals, those types of things, sports23 physicals, Department of Transportation24 physicals.25 87 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081
Well, they're7 seasonal only to the extent that that's8 what the demand might drive. Like the9 camp physicals are pretty much seasonal10 because they occur in the summertime, but11 if someone were going to a winter camp,12 they could still come and have a physical13 in the winter. It's driven by the14 demand.15
Final16 question. What impact on your business17 model has Obama's healthcare plan had?18
Well, I think19 that we are anticipating that the20 extension to universal coverage is going21 to increase the already present demand22 for primary care services. When you look23 at where the primary care shortages are24 across the country and you see that there25 88 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 are going to be another 32 million2 insured, we can only anticipate that that3 demand for primary care services and4 access to healthcare is going to5 increase, and we think that our company6 is going to be able to provide a very7 important source of entry for medical8 services for individuals who don't have9 it.10
Councilman Jones,11 can I just make a comment? If you look12 at the Massachusetts model as being a13 potential total access, the wait times14 for physicians, ERs, et cetera, escalated15 dramatically when that all occurred. So16 you can see there'll be an access issue17 when this goes universal.18 And if I can just add one other19 piece on the quality. Paulette had a20 slide that talked about the Joint21 Commission, and the Joint Commission22 accreditation -- I don't like to toot our23 own horn, but it's a very large step.24 Some of -- the Joint Commission accredits25 89 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 particularly units here in Philadelphia,2 the Albert Einstein Medical Center,3 Shriners Children, U Penn. You can name4 a bunch of -- it's a very high-level5 standard and it's one in which I think6 the quality gets tested.7
Are you10 guys, in light of the Obama healthcare11 reform, looking to get federal12 designation at some point? Because that13 takes you up to the next level. Right14 now you're at the local and the state15 levels, but the federal is the next one16 that would open you up to the ability to17 receive the federal subsidies that is18 going to come down with some of this19 healthcare piece. Are you in line for20 that? Is that part of what you're21 looking to do?22
I would not say23 that we are anticipating federal24 designation. However, we are looking to25 90 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 be included as important providers under2 the accountable care organizations that3 are anticipated as part of the healthcare4 reform, and we hope that we will be able5 to participate.6
That's a7 good maybe, right? Thank you.8 Thank you.9
-- and17 participation today.18 Are there any other witnesses19 on this resolution?20
Very well.23 We will recess to the call of the Chair.24 And thank you very much for your25 91 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 participation.2 Closing remarks by any of my3 colleagues? Then if not, I will take the4 prerogative -- oh, go ahead.5 Councilwoman Blondell Reynolds Brown.6
Thank you.7 I would urge the Administration8 to do what you do already, pay9 exceedingly close attention to the fluid10 activity in Harrisburg around the issue11 of state stores. I clearly remember the12 vigorous debate that went on for months13 and months and months, and it's one of14 those debates where we can't in no way be15 in catch-up mode but be exceedingly clear16 about what the Administration's17 expectations are around this potential18 new enterprise and how we do not expect19 it to impact on communities here in20 Philadelphia, and that those who are21 serving as our voices and advocates in22 Harrisburg know the history first and23 then know what the Administration's24 expectations are going forward.25 92 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 Thank you very much.2
Well, I want3 to say in closing, thank you, first of4 all, for your participation. Thank you5 for choosing Philadelphia as your site6 for your association's national7 convention. It shows great minds think8 alike. You chose Philadelphia, and we9 are definitely recruiting and choosing10 you.11 It is a matter of life and12 death in some communities. The13 underserved communities often are the14 worst hit by healthcare disparities.15 This Council is taking that very16 seriously. There's not a time that goes17 by that I don't point out the fact that18 the Fourth District does not have a19 public health facility owned by the City.20 So, therefore, retail clinics like yours21 cannot be a panacea to all ills, but be22 an important possible solution in that23 demand. We recognize clearly you are a24 for-profit entity, but we believe25 93 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 sincerely there is gold in them there2 hills and you should explore a little3 harder in your selection criteria.4 I will say that the cost of5 cough syrup in the suburbs is the same as6 at 60th and Market and, therefore, the7 services should be the same. We are not8 picking on your industry. We will hold9 every industry to that same standard,10 that if you do it in the suburbs, then11 you should at least have a rationale as12 to why you do or don't do it in the inner13 cities. And today we accept that we14 don't know what happened in 2007, but as15 you move forward, as the opportunity for16 expanded markets and alcohol and beverage17 sales comes about, this body will find a18 way either through zoning or through19 other legislation to be impactful. So it20 will be difficult to explain to me why we21 have a retail liquor outlet but don't22 have a healthcare retail clinic. That23 will be hard to justify in my mind.24 So we welcome you as strategic25 94 12/6/10 - COMMERCE/PUBLIC HEALTH - RES. 0906081 partners, where there will be mutual2 benefit, you profit and we profit by the3 services that you deliver by way of4 healthcare.5 Thank you very much.6 (Joint Committees on Commerce7 and Economic Development and Public8 Health and Human Services concluded at9 2:40 p.m.)10 - - -11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 95 1 CERTIFICATE2 I HEREBY CERTIFY that the3 proceedings, evidence and objections are4 contained fully and accurately in the5 stenographic notes taken by me upon the6 foregoing matter on December 6, 2010, and that7 this is a true and correct transcript of same.8 9 10 11 12 --------------------13 MICHELE L. MURPHY14 RPR-Notary Public15 16 17 18 (The foregoing certification of this19 transcript does not apply to any reproduction20 of the same by any means, unless under the21 direct control and/or supervision of the22 certifying reporter.)23 24 25