Retailing Finds a Small Niche in the Independent Clinic

Teri Guidi

Some clinics sell vitamins. Others hawk headscarves and bras fitted with prosthetic breasts. Still others sell wigs, swimwear, and shirts with detachable breast pockets (for easy port access). Whether the practice is large, with a boutique staffed by a full-time employee, or small, with an unmanned rack in the waiting room, it isn’t uncommon for a clinic to try selling nonmedical products to patients.

Although the sales bring in a nominal amount of revenue at best, clinic administrators say patients appreciate the convenience of “1-stop shopping,” and administrators appreciate satisfied patients. Oncology management consultant Teri Guidi said rural clinics could benefit the most from selling items. Patients would appreciate the convenience and practices could use the additional revenue; however, clinical retailing has its limitations, she said.

“I don’t know that it’s becoming any more popular—at least not drastically so—than it has been over the years, and that’s in part just because it isn’t generating a whole lot of revenue for anybody,” Guidi said. “It’s creating some headaches—whether it’s inventory control, or additional purchasing—that weren’t there before. That may be part of the reason we don’t see more of them: these headaches.”

Staff from 2 clinics interviewed by Oncology Business Management™ agreed that Guidi is correct about the value proposition. Retailing items directly from the clinic isn’t a moneymaker, they said. Rather, the sales add to what PJ Sidhu, the administrator of Joliet Oncology-Hematology Associates in Illinois, calls the “intangible value” of patient satisfaction.

Having products on site that complement the treatment process can improve patient satisfaction, which is important for meeting the goals of the Merit-Based Incentive Program, notes Kathy Oubre, chief operating officer of Pontchartrain Cancer Center in Louisiana, referring to the CMS payment modification program launched this year. Private payers have put similar pressure on practices, she said. “As insurance companies entertain the idea of more value-based care, patient satisfaction surveys, which weren’t super present years ago, have been gaining traction.”

From the practice’s own perspective, in an age when many patients shop around for their provider, “from front to end,” it’s important to find new ways to meet patients’ needs and expectations, and offering helpful nonmedical products can boost satisfaction, Oubre said.

Careful selection of what to sell is key. Assessing a product’s usefulness is a good way to determine whether its presence in the clinic would be helpful or exploitative. The American Medical Association Code of Medical Ethics offers some guidance on this front. Opinion 8.063 addresses the sale of nonprescription products that ostensibly benefit a patient’s health, while Opinion 8.062 tackles the sale of nonhealth-related goods.

“In general, physicians should limit sales to products that serve the immediate and pressing needs of their patients,” the AMA writes in Opinion 8.063. “For example, if traveling to the closest pharmacy would in some way jeopardize the welfare of the patient (eg, forcing a patient with a broken leg to travel to a local pharmacy for crutches), then it may be appropriate to provide the product from the physician’s office.”

The AMA discourages practices from selling products that provide no benefit to a patient’s health. “This activity risks placing undue pressure on the patient and risks demeaning the practice of medicine,” the AMA writes in Opinion 8.062, echoing a segment of another opinion in which it says marketing any unnecessary product to a patient poses a “risk of patient exploitation.”

Physicians should only sell nonhealth-related goods from their offices for the benefit of community organizations, the AMA writes. The goods should be low-cost, the physician should not profit from their sale, sales should not be a “regular part” of the clinic’s business, and sales should be conducted in a dignified manner, ensuring patients are never pressured into making purchases.

Oubre keeps the guidelines in mind when selecting what items to sell, she said. Two years ago, when there was a push for oncology practices enter the vitamin market, Oubre considered bringing vitamins into the clinic, she said. But the physicians advised against it, saying there was no data to back up the vitamins’ usefulness for cancer patients, so she decided not to pursue it. “It’s a marriage of what’s good for the patient and what the physicians deem appropriate,” Oubre said.

The 2 South Louisiana clinics under Oubre’s leadership sell Chemo Beanies, a product developed by local family that is now sold widely, and a mouthwash designed to protect against ulcers and mouth soreness during treatment. The mouthwash can be expensive when sold by prescription to patients with high co-pays, Oubre said. It is much cheaper to buy without a prescription, so selling it in the store makes it more accessible, Oubre said.

Practices should consider accessibility when deciding whether to get into retail sales at all, Guidi said. For a patient in a metropolitan area bustling with stores and billboards, seeing items for sale in a cancer clinic might elicit a groan—more unnecessary marketing, and to a vulnerable population, no less. But for a patient in a rural area, having access to items that otherwise would be out of reach could elicit a positive reaction.

Oubre used the example of a bra fitted with prosthetic breasts, for people who undergo mastectomies. Patients in a rural area may be able to order the bra online, but they wouldn’t be able to try it on first—unless their clinic happened to carry it. “If you live 100 miles from a city, the last thing you want to do is make that trip and try to find something, so if your own practice has it—even if it’s not the Lexus of bras, and more of a Toyota Camry—it will increase patient satisfaction to have access,” Oubre said.

Guidi agreed. Selling items in “small, rural places where 1-stop shopping is really important makes more sense,” she said. “That is to the practice’s credit: They are being sensitive to the entire patient.”

When deciding whether a product is a good fit for an in-clinic sale, Oubre also considers whether a patient would be more comfortable engaging with that product in a medical setting. Although her practice does not sell bras fitted with prosthetic breasts, she considers those items appropriate to sell in a practice.

“From a patient perspective, it saves them from having to go look somewhere else for something that they want. They’re already here, they have a great relationship with the nurses, and it’s a much more private setting than going to your local CVS Pharmacy that may not sell them, and then you’re standing in your local CVS/Walgreens in front of strangers trying something on that is rather personal and should be more of an intimate experience,” Oubre said.

Diane Labriola, manager of the boutique at Joliet Oncology-Hematology Associates, said prosthetic bras are one of the top sellers at her clinic, which also sells hats, wigs, compression garments, and scarves. She said she just began selling a T-shirt with a detachable breast pocket that gives doctors easy access to a patient’s port. “I’m always looking for new items to bring in,” Labriola said. “Stuff to help them in any way.”

Sidhu, the clinic’s administrator, said that Joliet Oncology-Hematology opened its 400-square-foot boutique in 2009, 38 years after the clinic opened. He said the practice of retailing items to patients isn’t profitable, but he considers it worthwhile for the clinic. “We don’t meet expenses,” Sidhu said, “but it adds intangible value. We knew going into it that (financial gain) wasn’t the purpose.”

Oubre said the 2 items her clinic sells bring in modest profits, but every penny counts in an age of declining payment. “We’re a multimillion-dollar practice, and selling 5 beanies a week is about $100,” she said. “It may not pay the light bill, but it helps.” In addition, patient response is very strong. Oubre said she can hardly keep the Chemo Beanies on the shelves.

Chemo Beanies, a business founded by sisters Angelle Albright and Danielle Fournier of Covington, Louisiana, has taken off since it was created in 2011. When Fournier was diagnosed with breast cancer in 2010, five years after Albright’s cancer went into remission, Albright brainstormed for ways to help her older sister cover her head once she lost her hair. She designed a cap using a lightweight, elastic fabric with a flap in the back to cover the neck. After Fournier showed up at the clinic wearing hers, other patients asked her where she got it.

A few months later, family members launched an online store for Chemo Beanies. Four years later, the company was on track to selling an annual total of 58,000 of these garments. The company names its beanie styles after women who have faced cancer, many of them Chemo Beanies customers.

Pontchartrain will now place an order for a Chemo Beanie if a particular style is not in stock. “If a patient says, ‘I was online last night. Can you get me this style?’ we say, ‘Absolutely!’“ Oubre said. “We say, ‘We’ll have it waiting for you when you get to the doctor next week.’“