What mobile clinics in Dollar General parking lots say about health care in rural America

CLARKSVILLE, TENNESSEE — Customers at the Dollar General on a two-lane highway northwest of Nashville on a hot July morning didn’t seem to notice signs of the chain store’s foray into mobile health care, particularly in rural America.

A woman walked into the store while lifting a child from the back of an SUV. Before its owner returned with cases of soda, a dog barked from the back of a black pickup truck. Another woman checked her hair in the rearview mirror of a convertible before going shopping.

Each walked right past a sign that read, “Quick, Easy Health Visits,” and featured an image of a mobile clinic.

Kimberly French, a registered nurse, arrived at the DocGo mobile clinic parked in the store’s lot shortly after 10 a.m. She looked over her schedule.

“We don’t have any appointments so far today, but that could change,” French went on to say. “Last night we didn’t have any appointments and three or four people showed up all at one time.”

Dollar General, the nation’s largest retailer by store count, with over 19,000 locations, partnered with New York-based mobile medical services company DocGo to see if they could attract more customers while addressing persistent health inequities.

The use of mobile clinics to fill care gaps in underserved areas is not a novel concept. However, combining them with Dollar General’s ubiquitous small-town presence has been heralded as a way to alleviate rural America’s health-care drought by investment analysts and some rural health experts.

According to Dollar General’s most recent annual report, roughly 80% of the company’s stores are in towns with populations of fewer than 20,000 people, precisely where medical professionals are scarce.

The mobile clinics accept private insurance as well as Medicaid and Medicare for those seeking urgent or primary care. According to the company’s website, DocGo’s self-pay rates begin at $69 for patients who do not have insurance or who are out of network. Officials with DocGo said Tennessee patients may be charged differently, but they declined to elaborate.

Primary care doctors and patients in Tennessee are skeptical.

“Honestly, I don’t think they realize what they’re getting into,” said Brent Staton, a family medicine doctor and the director of the Cumberland Center for Healthcare Innovation, a statewide organization that assists small-town family medicine doctors in coordinating care and negotiating with insurers such as Medicare.

Michelle Green is the manager of the popular Sweet Charlotte grill, which is located about 10 miles south of Dollar General’s most rural test location. During a Saturday rush, Green, who was serving hamburgers and hand-cut fries, said she had never heard of the mobile clinic. Dollar General and health care clinics, she shrugged, “don’t go together.”

“I wouldn’t want to go to a health care clinic in a parking lot; that’s just me,” Green said, adding that “you’re sick and you can’t go anywhere else.”

Potholes in the Road

The Clarksville-area pilot, which began last fall, is located in a federally designated low-income primary care shortage area.

According to DocGo, approximately 1,000 patients have been seen in the company’s clinics, which are located at Dollar General locations or at community pop-up events, and some have become repeat visitors. Outside, patients pay with a mobile device, and once inside, they meet with an on-site staff member, such as French, and connect with a physician assistant or nurse practitioner via telehealth on an iPad screen.

Each week, the clinic rotates between three Dollar General pilot sites. The stores are in the Clarksville area, and the van stopped going to the most rural location, near Cumberland Furnace, earlier this summer due to low utilization, according to company leaders. DocGo relocated that location’s time slot to Clarksville’s busy Fort Campbell Boulevard.

“We try for months in a given area to see where it makes sense and where it doesn’t,” said former DocGo CEO Anthony Capone in a July interview. “Our goal is to align the supply we have with the demand of the local community.”

Capone, on the other hand, believes the pilot will work in rural areas once insurers agree to refer their members to the mobile clinic. DocGo just announced a partnership with Blue Cross Blue Shield of Tennessee.

Capone resigned abruptly on September 15 after the Albany Times Union reported that he lied about having a graduate degree.

Dollar General stores have a “tremendous opportunity” to have “a major impact on health there and really bond themselves as a member of the community,” according to Tom Campanella, the healthcare executive-in-residence at Baldwin Wallace University and a former manager of mobile clinics in rural areas.

William “Bubba” Murphy stopped on his way into a Dollar General near Cumberland Furnace, south of Clarksville, to wave and holler hello to friends getting out of their cars, and shared that multiple family members — his sister-in-law, nephew, and niece’s boyfriend — used and liked “the little clinic on wheels.”

“We don’t have to go to town and fight all that traffic,” he went on to say. “They approach us. That’s a wonderful thing to say. It benefits a large number of people.”

Marina Woolever, a mother of three on Clarksville’s busy Fort Campbell Boulevard, said she might use the clinic if she didn’t have insurance. Nichole Clemmer, a natural health professional, glanced toward the clinic and dismissed it as a “ploy” to make more money.

According to Jefferies lead equity analyst Corey Tarlowe, who follows discount retailers, the clinics will “democratize” access to health care while also increasing traffic to Dollar General stores.

Dollar General has been accused of killing off local grocery stores and other businesses, reducing employment, and contributing to the creation of food deserts due to its rapid growth in recent years. The U.S. Labor Department recently stated that the chain “continues to discount safety” for its employees, despite having accumulated more than $21 million in federal fines.

According to Crystal Luce, Dollar General’s senior director of public relations, each new store provides “positive economic benefits,” such as new jobs, low-cost products, and its literacy foundation. Regarding the federal fines, Luce stated that Dollar General is “committed to providing a safe work environment for its associates and a positive shopping experience for its customers.” The company refused to conduct an interview.

She wrote that the DocGo pilot is meant to “complement” the DG Wellbeing initiative, which is a company-wide push. Dollar General intends to expand “access to basic health care products and, ultimately, services over time, particularly in rural America,” according to Luce.

DocGo is under fire in New York for a no-bid contract to provide housing, transportation, and other services to asylum seekers. State Attorney General Letitia James is looking into complaints from migrants in the company’s care. DocGo officials stated in August that claims made by sources in a New York Times article that first reported the problems were “not reflective of the overall scope and quality” of the services provided by the company.

DocGo’s pilot with Dollar General is “supported with funding from the state of Tennessee,” according to Capone during the company’s first-quarter earnings call. According to records obtained through public information requests, the Dollar General partnership is mentioned in quarterly grant reports DocGo’s Rapid Reliable Testing LLC submitted to the state.

DocGo listed Dollar General and other organizations as “trusted messengers” in raising vaccine awareness in the grant application.

Dollar General declined to comment on its participation in the grant. Luce, on the other hand, stated, “We continue to test and learn through the DocGo pilot.”

‘Relational Care’

The Tennessee Department of Health will administer COVID-19 vaccines as part of a $2.4 million grant funded by the Centers for Disease Control and Prevention. DocGo’s marketing director, Amanda Shell Jennings, stated in a written response, “Dollar General has no involvement with the TN Department of Health grant funding or allocations.”

According to Jennings’ statement, the grant covers the storage and maintenance of COVID-19 vaccines on DocGo mobile clinics. DocGo has held 41 vaccine events and provided 66 vaccines to rural Tennesseeans as of September.

Lulu West, 72, was on her way to see a friend at the Historic Cumberland Furnace Iron Museum when she thought about the mobile clinic. West stated that she would rather see her primary care physician.

“When you say mobile clinic outside a Dollar General, it has a connotation that you might not be comfortable with.” “Do you understand what I mean?” She stated.

Carlo Pike, a doctor who has practiced family medicine in Clarksville for many years, is not surprised by the response. He claims he isn’t concerned about competition because providing primary care is all about building relationships.

“If I can do this relationship right,” Pike went on to say, “maybe we can keep you from getting a [blood] sugar of 500 [mg/dL] or from Grandpa climbing up a ladder and trying to fix something he has no business with and falling off and breaking his leg.”

Staton claims that his accountable care organization, the Cumberland Center for Healthcare Innovation, has saved Medicare and Medicare Advantage companies more than $100 million by focusing on preventive care and reducing hospitalizations and emergency visits for patients.

“We’re just small rural primary care docs doing our jobs with a process that works,” Staton went on to say. Staton referred to it in another interview as “relational care.”

DocGo surveyed its patients and discovered that 19% of them did not have a primary care physician or had not seen one in over a year. DocGo stated in written responses provided by Jennings that it follows up with every patient after the initial visit, provides telemedicine support between visits, and provides ongoing preventive care on a regular basis.

Despite its reach, DocGo struggled to establish itself in rural Cumberland Furnace.

Lottie Stokes, president of the Cumberland Furnace community center, said DocGo’s team “called and asked to come down here.” Stokes stated that she would prefer to use local emergency medical technicians and firefighters whom she knows are “legit.”

Bobby Stokes, her father-in-law, who is nearly 80 years old, said he used the mobile clinic before it moved.

His wife was struggling to breathe. They drove into the lot and climbed into the van.

“We wasn’t in there five minutes,” he told me. “They done the blood pressure test and what they need to do and put her in the car and said, ‘Get her to the hospital, to the emergency room.'”

He stated that the DocGo staff did not request payment: “nothing.”

“They were more concerned with her than I guess with getting their money,” he explained, adding that his wife is now doing well. “They told me to get there, and I trusted them. “My car is very fast.”

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