Nashville Int'l Adds Healthcare Clinic & Wellness Store

When the Metropolitan Nashville Airport Authority included a healthcare clinic in its concessions master plan for Nashville International Airport (BNA) back in

factsfigures Project: Healthcare Clinic & Wellness Store Location: Nashville (TN) Int'l Airport Private Provider: CareHere Opened: Aug. 2011 Size: 900 sq. ft.; 3 exam rooms Potential Patients: 300 airport authority employees, 5,000 other airport workers & nearly 10 million annual passengers Clinic Volume: 200 patients/month Benefits: On-site clinic helps reduce employees' time away from work for doctor visits; keeps public safety officers available for more urgent police/fire matters; provides routine & emergent care for passengers; expands airport retail into travel-related wellness products. Overall Concessions Master Plan: Included $40 million in capital projects that began in 2006 & concluded earlier this year.

2004, board commissioners specified that they didn't want it to be like clinics in other larger U.S. hubs - that is, subsidized by the airport or even a hospital.

"We wanted an airport clinic that was a self-sustaining business model," explains Rebecca Ramsey, Metropolitan Nashville Airport Authority assistant director of properties.

CareHere, based in nearby Brentwood, TN, not only met that need but also considered BNA as a viable expansion opportunity. At the time, the company operated more than 100 workplace clinics in 20 states, but none were in airports. Although CareHere had refined its approach to onsite primary and chronic care for seven years, company president Ernie Clevenger acknowledges that opening the clinic at BNA was a bit "scary." The airport location also included a retail shop - another new element for CareHere.

Stretching its traditional business model, the company expanded its target market for the BNA clinic beyond the airport authority employees (numbering about 300) and sought to also serve the 5,000 other people who work at the airport and the 9 million passengers who travel through BNA each year. According to Clevenger, there are about 300,000 Americans who travel so much, they essentially "live" in airports, despite what their mailing addresses indicate. He wants these ultra-frequent fliers to develop a trust with CareHere and eventually consider the airport clinic as their primary care provider.

"Today they don't," acknowledges Clevenger. At best, they see an airport clinic as a secondary source for care - an idea confirmed by an informal survey of 500 passengers at BNA.

"Our goal is to improve that image so they view the airport clinic as their primary care provider," he explains. "When they need a physical or someone to manage their diabetes, asthma or COPD (chronic obstructive pulmonary disease), or whatever their condition may be, we want them to consider the airport clinic to be a top-tier provider."

At the same time, the company is applying its usual goals to the BNA location: reducing healthcare costs and saving employers money.

When the BNA clinic opened in August, CareHere promoted its physicals and screening services (pre-employment, random and post-occurrence) to the airlines and concessionaires.

Depending on their insurance coverage, the price can be easy on patients' wallets. Employees usually have no co-pay or deductible cost for services at CareHere clinics; employers' plans often cover such expenses. Passengers using the airport clinic pay cash or use their health insurance.

The Doctor Will See You Now

Each of the BNA clinic's three exam rooms contains an examination table and a computer monitor and keyboard that can be pushed to the wall to allow more room during patient exams. Medical equipment includes an electrocardiogram (EKG) unit that is slightly larger than a deck of playing cards and a spirometer to help assess conditions that affect breathing. Lab equipment allows services such as drug screenings to be done at the clinic. Imaging, such as X-rays or computed tomography (CT) scans, is not currently available.

Patient care typically begins with a nurse, who checks vital signs and gathers information about symptoms and medical history, then continues with a nurse practitioner, physician assistant or physician. According to Clevenger, clinics have a nurse practitioner on staff 50% of the time and a physician on staff 50% of the time.

Electronic records enable CareHere to employ telemedicine when needed. If a physician is not on duty but needs to be consulted, patient information is transmitted via the Internet. That's when CareHere's all-electronic medical records come into play, notes Clevenger, who previously served as chairman of the Workforce for Electronic Data Interface, which advised the U.S. Department of Health & Human Services.

A Welcome Addition

According to Ramsey, BNA's new CareHere clinic complements the airport's Department of Public Safety - a unit that includes first responders and emergency medical technicians with more extensive training and a full array of equipment, including automated external defibrillators (AEDs) and intravenous therapy equipment. Because BNA public safety officers are responsible for providing police and fire services as well as medical assistance, it's in the airport's best interest to have another source for very basic medical needs such as requests for Band Aids and aspirin, explains Ramsey.

"That's where the airport clinic's ability to provide a broad range of services helps out," she relates. "By providing basic services, they not only help free up the officers to focus on more urgent matters, but should the need arise, the clinic can provide advanced services also."

Just a month after it opened, the BNA clinic had its first major medical success: When a young passenger complained of abdominal pain, a gate agent encouraged the boy's mother to take him to the airport clinic. The CareHere nurse who evaluated him suspected appendicitis and rushed the boy and his mother to nearby Summit Medical Center by ambulance, where an emergency appendectomy was successfully performed.

"The doctors said the boy's appendix could have ruptured on the plane," Clevenger relates. Instead, the gate agent, airport clinic staff and airport authority emergency medical team worked together to help prevent a passenger's serious condition from worsening.

Most days at the clinic are not so dramatic, with an equal split of passengers and airport employees as patients, reports Kelly Butler, the on-site CareHere general manager. Currently, the clinic treats about 200 patients per month. According to Butler, airport employees consider the airport clinic a great convenience. Appointments that would otherwise take them off campus from work for half of a day are completed on-site in a matter of minutes, he notes.

Ramsey agrees: Convenience and saving time away from work for basic healthcare issues are great benefits for airport employers and employees alike. Immunizations fall squarely in that category. In early October, the clinic was administering about nine flu shots per day. Travel-related shots are also offered, with Vitamin B-12 injections and hepatitis vaccines being the most sought-after.

Wellness Retail

Fully 60% of the 900-square-foot clinic at BNA is devoted to retail goods focused on prevention and wellness. And the traveling public is its primary market, explains Butler.

With nearly 400 items in stock, inventory includes over-the-counter medicine, natural remedies, Garden of Life dietary supplements, contact solutions, bath/beauty products and natural snacks and drinks. According to Butler, travelers' favorite snacks include nuts, pretzels and dark chocolate from Nashville's own Olive & Sinclair Chocolate Co. Waters, organic sodas, energy drinks, teas and coconut water are also popular, he adds.

For travelers looking to work out on their trip, the store sells Gym-to-Go Kits, from Travel Trim. Each kit includes an exercise tube, door attachment, exercise reference card, software (with information about trails and parks, healthy eating, exercise logs, etc.), a fast food guide and workout DVD.

According to Butler, customers often tell him they're glad to see a health-related store at the airport and ask him if it is part of a chain. To date, the answer is no, but CareHere hopes the answer will eventually be yes.

While additional clinics and wellness stores in other airports are of interest, Clevenger says a specific timeframe has not been established. "We must first be successful in our mind here," he explains. "We've got to get the model right. We've got to serve passengers and employees with trusted care to the point they will come back and trust us with delivering primary care or chronic care. Then, I think we could look at other airports."

According to data collected at other CareHere locations, more than 50% of employees will name the clinic as their primary care provider after a year of access to on-site care. After three years, the percentage rises even further.

Up, Up & Away

CareHere's presence at BNA provides the company with access to the traveling public and the opportunity to develop its plans for in-flight telemedicine.

Clevenger explains: "If people are flying and they have a medical need, we want to be able to use telemedicine to deliver care or assist until the plane can land. We want to stabilize the patients until emergency services on the ground can take over."

The technology exists to make this happen, he notes, but questions regarding what care can be given in an airplane remain unanswered. Coordinating with the airlines to come up with a viable plan will be crucial, he adds, noting that no specific timelines have been set for such an initiative.

"If we can be successful with telemedicine, that opens up opportunities for people who are chronically ill and afraid to fly," he adds. "It fits the model of taking medicine to the patient rather than asking the patient to come to the medicine."

In the meantime, initial goals of both CareHere and the Metropolitan Nashville Airport Authority are being accomplished. In the short time CareHere has been at the airport, Ramsey reports, "we have received numerous comments as to the benefit of having this service and these products for sale on site."