Airport Clinics Provide Quick Access to Low-Cost, Routine Services for Travelers, Airport/Airline Employees
Airport Clinics Provide Quick Access to Low-Cost, Routine Services for Travelers, Airport/Airline Employees
AeroClinic operated walk-in health care clinics offering minor ill-care/well-care services for travelers and airport employees, as well as occupational health services for airport employers, in the Atlanta and Philadelphia airports. Staffed by a part-time physician, physician assistants, and nurse practitioners, the clinics provided limited, low-cost primary care services to individuals aged 2 years and older, including the following: the diagnosis and treatment of common respiratory, head/ear/eye, skin, digestive, and urinary conditions; general and specialty-focused preventive care; health screenings; and vaccinations. Ninety-five percent of clients indicate high satisfaction with the service. Information provided in June 2013 indicates that the program has been discontinued.
AeroClinic, Inc., was located in Atlanta, GA.
Date First Implemented
The Atlanta airport clinic opened in June 2007, and the Philadelphia clinic opened in December 2008.
AeroClinic was designed to provide a quick, convenient, affordable solution to accessing treatment of common illnesses that require quick attention. It sought to attract a specific set of patients, including the frequent traveler (who may find it difficult to find time to access these services), airport and airline employees, and government employees who work in the airport.
Description of the Innovative Activity
AeroClinic's clinics offered quick access to a focused set of services to walk-in patients traveling through the airport, who are 2 years of age and older, and airport or airline employees. Charges for services were lower than in the typical emergency department, urgent care center, or physician's office. Travelers typically sought medical care for sore throats, ear aches, nausea, and falls. Key elements of the typical retail clinic are described below:
Physical Space, Staffing, Hours of Operation
- Physical space: The airport-based clinics were between 1,000 and 1,200 square feet and consisted of two examination rooms, a laboratory, and a waiting area. There were two clinics in the Atlanta airport; one was located just outside the main security gate and the other was on the second floor of the atrium and served primarily airport employees. The clinic in Philadelphia was located in the main concourse just inside the main security gate so travelers did not have to go through security twice to visit the clinic.
- Staffing: Each clinic was staffed by either a nurse practitioner or a physician assistant, along with a medical assistant. One physician worked 24 hours a week in the Atlanta clinics, usually at midday during peak demand. The Atlanta clinic also had one full-time medical assistant who catered to the airline/airport employee population by focusing on drug screenings and physicals, and a part-time physical therapist to address workplace-related injuries. Staffing in Philadelphia was planned to be similar when demand for those occupational health care services increased. The decision to use a nurse practitioner versus a physician assistant depended, in part, on each state's regulations relating to their scope of practice.
- Hours of operation: The Atlanta clinic was open from 8 a.m. to 7 p.m. weekdays, 9 a.m. to 5 p.m. Saturday, and 11 a.m. to 4 p.m. Sunday. The Philadelphia airport clinic was open from 7 a.m. to 7 p.m. daily.
- Appointments: Patients were generally served on a walk-in (first-come, first-served) basis, although it was also possible to schedule an appointment through the company Web site or by calling the clinic.
Focused Set of Services
Each clinic offered a limited set of well-defined services. These services were designed to be offered during a visit of approximately 15 minutes in length. (Those under the age of 18 had to be accompanied by a parent or legal guardian.) The services provided are outlined below:
Diagnosis and treatment of common respiratory conditions, including cold and flu symptoms, coughs, sore throat, strep throat, sinus infection, cold sores, allergies, and bronchitis.
Diagnosis and treatment of common head, ear, and eye conditions, including headaches, earaches, swimmers ear, pink eye, and eye irritation.
Diagnosis and treatment of muscle aches and pain, including back pain and minor sprains and strains.
Diagnosis and treatment of common skin conditions, including minor skin infections and rashes.
Diagnosis and treatment of common digestive and urinary problems, including nausea and vomiting, indigestion, diarrhea, and urinary tract infections.
Specialty-focused preventive care, including women's and men's wellness examinations, vision and hearing examinations, HIV and sexually transmitted disease counseling, and other preventive care related to allergies, diabetes, heart health, and cancer.
Health screening and general preventive care, including routine blood tests, blood pressure measurement, cholesterol measurement, diabetes testing (glucose only), tuberculosis testing, mononucleosis testing, and pregnancy tests.
Vaccinations, including for flu and pneumonia, chicken pox, tetanus, shingles, meningitis, polio, DTaP (diphtheria, tetanus, pertussis), MMR (measles, mumps, rubella), and hepatitis A and B for adults and children. The clinic also provided vaccinations required for travel, such as for malaria.
Occupational health services for airline and airport employees, including care for injuries, preemployment physicals and screenings, drug testing, minor physical therapy, and other services tailored to the needs of the airlines and the airport as employers. AeroClinic developed partnerships with the airlines and other onsite airport employers to provide these services.
Medications: The AeroClinic stocked roughly 35 prepackaged, common pharmaceuticals that could be dispensed (where allowed by law) onsite to patients, which is a major convenience for travelers. When appropriate, the physician assistant or nurse practitioner provided a prescription for other medications that were not carried onsite.
Pricing and Insurance
Fees: The average visit for acute services cost between $75 and $85. Fees for routine minor care of common illnesses (respiratory, head/ear/eye, skin conditions, digestive and urinary conditions) ranged from $25 to $100; fees for specialty-focused preventive care ranged from $10 to $30, fees for health screenings range from $20 to $50, and fees for vaccinations ranged from $35 to $200.
Insurance: AeroClinic accepted United, Aetna, Blue Cross, Coventry Health Care, and TRICARE insurance.
Personal Health Record and Evidence-Based Protocols
The system: Through a partnership with McKesson, AeroClinic used a Web-based, patient-friendly information technology system that provided direct and secure access to a personal health record (PHR) for each AeroClinic patient.
Information included: The PHR automatically included all treatments and services (including prescriptions that were ordered and/or filled) provided by AeroClinic, along with information on allergies, health problems and conditions, and health history, including laboratory and test results.
Integration with evidence-based guidelines and protocols: The PHR system had evidence-based guidelines and protocols embedded in it.
Sharing with other providers: To promote seamless care, patients had the option of making this record available to their primary care physician and other providers.
Ongoing Quality Control
Chief medical officer review: AeroClinic's chief medical officer reviewed cases at each airport's clinic and met with clinicians at least once every quarter to address problem areas, tweak protocols, and deal with other issues that arose.
Local physician oversight: In both Philadelphia and Atlanta, a local physician worked under contract with AeroClinic to provide oversight of the clinic staff. These physicians were on call 24 hours a day, 7 days a week to provide advice over the telephone or in person as requested by clinic staff. This type of physician oversight is required by law. In addition, these physicians visited the clinic once or twice a week to review patient records and maintain quality control. As noted, in Atlanta, the local physician also worked in the clinic on a part-time basis.
Marketing of Clinic
AeroClinic was involved in multiple marketing initiatives that were designed to reach both frequent travelers and airport and airline employees. Key initiatives are described below:
- Marketing to frequent travelers: AeroClinic was working with airlines to reach consumers in the following variety of ways.
- By putting information about the clinic on airline ticket jackets and in in-flight magazines (which are perused by 90 percent of travelers).
- By sponsoring programs such as blood pressure screenings and flu vaccines in airline's in-airport clubs for frequent travelers.
- By allowing those who visit the Atlanta clinic to go through the first-class security line. The Atlanta clinic was located outside of security, which meant that a clinic visitor still had to go through security after his or her visit. Many travelers want to get through security as soon as possible, and may resist the idea of going to the clinic beforehand. To help alleviate this concern, AeroClinic negotiated with the airlines to allow all clinic visitors to go through the first-class security line, which tends to be much shorter.
- In Atlanta, during the H1N1 flu outbreak (also referred to as “swine flu”), the clinic partnered with the U.S. Centers for Disease Control and Prevention (CDC) and provided clinic space so CDC officials could screen passengers arriving from areas with high infection rates. At that time, the clinic handed out many brochures detailing effective infection prevention measures.
- Marketing to airline and airport employees: AeroClinic made a concerted effort to reach airline and airport employees, including those who work for airport-based retail stores and other concessionaires. These initiatives were quite successful, with more than half of the clinics' business coming from employees, especially in Atlanta. Services such as drug screenings and physicals, for example, were quite popular. Examples of the kinds of activities that were used in Atlanta (with similar activities under way in Philadelphia) include the following:
- Placing information (e.g., feature articles) in airport newspapers that go to all airport employees.
- Sponsoring “lunch-and-learn” sessions to promote health education and wellness.
- Reaching out to the health and wellness directors of each of the major airlines, who are responsible for employee health. These directors agreed to put information about the clinic in employee break rooms and in paycheck “stuffers.”
Context of the Innovation
The genesis for this idea was AeroClinic's chair and chief executive officer Felker Ward, who has more than 30 years' experience in the airport concessions business. He recognized that the growth in airline travel combined with concerns about security has led to a situation where the average traveler has roughly 90 minutes of excess time at the airport. A variety of retailers have recognized this trend, and, as a result, airports are focusing more on consumer-oriented services such as retail shopping. With demands growing for more consumer-oriented health care services, there is an opportunity to offer a consumer-friendly clinic in the airport. Given the size of many major airports (at the time, Atlanta's airport had 55,000 employees and Philadelphia's airport had 35,000 employees, not including the millions of travelers who come through these airports each year), these clinics had a potential customer base that was roughly the size of a small city.
Results from AeroClinic and similar retail-based clinics suggest that an airport-based clinic could be an effective way to provide easy access to low-cost, high-quality care to frequent travelers and airline or airport employees .
Client volume: The number of clients seen by the Atlanta airport–based clinic has climbed from approximately 40 patients per day to roughly 55 in 2009, most of whom are airline/airport employees. In the spring of 2009, the new Philadelphia clinic was treating approximately 10 clients per day. Because of its prominent location in the terminal—and its placement inside the security gate—about half of the Philadelphia clients are travelers.
High satisfaction rating: AeroClinic reports that 95 percent of its customers who responded to customer service satisfaction surveys give the clinics a “very satisfied” ranking for service.
Similar, retail-based clinics receive high marks: The airport-based clinic is quite similar in concept to retail-based clinics that are being put up in stores and malls throughout the nation. A survey by Harris Interactive, for example, found that 92 percent of clinic users were satisfied with the convenience and 89 percent with the quality of care received. Deloitte's 2008 Survey of Health Care Consumers found that consumers were comfortable seeking care from retail clinics, especially if appropriately credentialed medical personnel staff it and up-to-date computer equipment is used, and its 2009 Survey of Health Care Consumers showed that 13 percent of consumers have visited a retail clinic in the past year and 30 percent said they would do so if it cost 50 percent or less than seeing a doctor in a doctor's office.
Planning and Development Process
Key steps in the planning and development process included the following:
- Complying with regulations, licensing, and other issues: Each state has different regulations related to the corporate practice of medicine, allowed scope of practice for nurse practitioners and physician assistants, licensing requirements, health and sanitation requirements, and the like. AeroClinic used a team of individuals to work with local stakeholders to ensure that they complied with all relevant rules and regulations.
- Training: All staff went through a 2.5-day training session, consisting of the following:
- One-half day general session about the company, the business model, and the airport environment (e.g., security issues, etc.)
- One-day session on the clinic's medical model and use of clinical protocols
- One-day session on technology, focusing primarily on use of the electronic medical records and practice management systems
- Working with local provider community: The physicians who were under contract to perform quality control and oversight had strong ties to the local community and established relationships with hospitals and physicians in the area. These physicians helped to introduce the concept of the clinic to the local practitioner community. Because of its location and the fact that it served many transient individuals, the airport-based clinic was not likely to be perceived as a potential replacement for (and thus a threat to) local practitioners, and there was limited resistance to the concept thus far.
Resources Used and Skills Needed
- Development costs: Although costs varied by airport, the capital costs for building an airport-based clinic range between $150,000 and $250,000.
- Staffing: As noted earlier, each clinic was staffed by two full-time equivalents (FTEs)—a nurse practitioner or physician assistant and a medical assistant—to cover routine visits. In Atlanta, an additional FTE medical assistant provided drug screenings, physicals, and other services to employees, while a part-time physical therapist treats work-related injuries in the Atlanta clinic. A FTE receptionist also worked in the Atlanta clinic. As traveler and airport employee demand for services increased in Philadelphia, a physician and additional occupational medical staff were to be hired.
Funding for the airport clinics came from private investors.
Tools and Resources
More information is available at the AeroClinic Web site: http://www.theaeroclinic.com.
Getting Started with This Innovation
- To start a clinic in a nontraditional location, make efforts to understand the local environment and relevant constituencies: In an airport, for example, efforts must be made to meet with and understand the needs and requirements of the department of aviation, those involved in security, local concessionaires, the airlines, and others.
- Understand the demographics and dynamics of the target consumer and various consumer subsegments: As with any business, efforts must be made to understand the target consumer. For an airport-based clinic, there are a number of consumer segments, with differing characteristics. Frequent travelers, airline employees, and airport employees will vary significantly in terms of their incomes, insurance status, and other demographic characteristics. In addition, travelers going through “origination/destination” airports (where most passengers live or are visiting) are different from those going through “hub” airports (where most passengers are connecting).
Sustaining This Innovation
- Adjust services to meet the needs of the different constituencies served: Company leaders were surprised to see how different the needs were for airport employers and employees versus frequent travelers, who tended to be more affluent. Employers and employees were particularly interested in drug testing (for applicant screenings and performance evaluations) and the treatment of work-related injuries through a physical therapist. Travelers were more interested in routine diagnosis and treatment of common conditions, such as colds, sore throats, etc.
- Be patient and persistent in targeting consumer segments: As noted, the Atlanta clinic catered primarily to airline and airport employees, with travelers representing only 20 percent of clinic visits. It will take time to educate frequent travelers about a clinic's existence and location and to get them to consider adjusting their schedules and routines to take advantage of clinic services.
Contact the Innovator
Note: Innovator contact information is no longer being updated and may not be current.
Rosemary M. Kelly
Executive Vice President
1745 Phoenix Boulevard, Suite 340
Atlanta, GA 30349
Ms. Kelly has not indicated whether she has financial interests or business/professional affiliations relevant to the work described in this profile.
More information is available on the company's Web site, http://www.theaeroclinic.com. In addition, a number of articles and publications have been written about a similar concept—store-based, retail clinics, including the following:
- Scott MS. Health care in the express lane: the emergence of retail clinics. Oakland, CA: California HealthCare Foundation, 2006. Available at: http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20H/PDF%20HealthCareInTheExpressLaneRetailClinics.pdf.
- Bohmer R. The rise of in-store clinics—threat or opportunity? N Engl J Med. 2007;356(8):765-8. [PubMed]
- Freudenheim M. Attention shoppers: low prices on shots in the clinic off aisle 7. The New York Times, May 14, 2006.
Scott MS. Health care in the express lane: the emergence of retail clinics. Oakland, CA: California HealthCare Foundation, 2006. Available at: http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20H/PDF%20HealthCareInTheExpressLaneRetailClinics.pdf.
Keckley P, Eselius L. 2009 Survey of Health Care Consumers: Key Findings, Strategic Implications. Deloitte Center for Health Solutions. May 2009.