Sitting on a vinyl bench covered with tissue paper, 13-year-old Abby Sneddon found herself having her pinkeye examined last week in a rather unlikely setting -- the local grocery store.

In a cramped exam room near the store's pharmacy aisles, a physician assistant peered into her ears and nose, and asked her to open up and say "ah."

"I would much rather come here than the emergency room," said her mother, Roxane Sneddon, 50, whose family is uninsured at the moment. She said she was attracted to the medical service's flat fee of $49.50 for treatment, a bargain compared with a hospital visit.

"This fills a need for those of us that are unhealthy and uninsured," she added.

The low-cost clinic designed for treatment of minor illnesses is among the first of six planned for Kroger stores in the region under the locally owned Redi-Health Clinic brand, said Dr. Murray Joiner, founder and president of the Roanoke-based company. The first one opened in late December at the Cave Spring Corners Kroger on Brambleton Avenue.

Although new to the Roanoke Valley, store-based clinics have already begun to alter the health care landscape nationwide. And now Joiner, a physician with practices in Roanoke and Lynchburg, is bringing the medical model to the Roanoke Valley by starting a regional chain.

Past decade has seen explosion in retail clinics

More than 800 store-based clinics are now in operation nationwide, while nearly a decade ago there were none, according to industry reports.

The majority of them are operated by chain retailers such as Wal-Mart, Target and CVS, or by hospital systems trying to extend their reach into the commercial marketplace.

The industry leader is CVS subsidiary MinuteClinic, which is based in Minneapolis with more than 360 clinics nationwide.

The industry has lately seen more local physician groups entering the business, said Tine Hansen-Turton, executive director for the industry's trade group, the Convenient Care Association. The Philadelphia-based association was established in late 2006 and has about 21 members.

"The fact we are seeing more physician groups opening these clinics is an important evolution," said Hansen-Turton, noting that they are reinforcing the clinics' viability for expanding access to medical care.

The concept behind the Roanoke clinic is simple: The clinics treat minor ailments such as sore throats and bladder infections for a $49.50 flat fee per visit. Some insurance plans are accepted and no appointments are required.

To keep overhead costs low, the offices are staffed by nurse practitioners or physician assistants, who can legally treat and prescribe medicine for illnesses under a supervising physician.

Their popularity is being propelled by a combination of higher insurance co-payments, a sharp rise in the number of uninsured and a growing shortage of primary care doctors.

Advocates of retail-style clinics herald them as a cheaper and more convenient alternative to the doctor's office or emergency room.

At the same time, the business model, which emphasizes low overhead and quick turnaround times, has drawn criticism from some physician groups, including the American Medical Association, who fear the clinics are poorly regulated and will lead to lower-quality care by encouraging patients to forgo regular visits with primary care doctors.

"It is certainly a young industry. In the nation, most of the clinics haven't even been open two years," Hansen-Turton said.

Joiner said he financed his first location with his own money and will be looking to secure financing for future additions. He said his long-term plans call for adding 26 clinics -- and more than 100 high-paying jobs -- to Southwest Virginia.

The Roanoke clinic, Joiner said, focuses on offering low-cost medical services to patients lacking insurance or a primary care physician, so that simple health problems can be caught early.

"Everyone knows the problem with health care is access," he said.

Joiner said the clinic is intended to act as an entry point into the established physician networks for those without a regular doctor. To this end, he said, the clinics will keep a list of local health care providers willing to take new patients and offer referrals on a rotating basis.

He stressed that the clinic is not a substitute for primary care, and that its staff will work with patients' physicians to relay medical information.

In Virginia, retail clinics are treated like doctor's offices and are regulated by the state board of medicine.

"We are not replacing your doctor," said Joiner, who has been practicing in the region for 19 years.

"We're like a spare tire."

Joiner, who specializes in physical and rehabilitative medicine, said he was driven to start the business after seeing the damage caused when patients don't have access to health care.

He has modeled his business after a similar Michigan upstart, Early Solutions Clinic, which started operations in 2005.

The startup cost for a clinic ranges from $75,000 to $250,000 depending on the space and range of services, Hansen-Turton said. For most clinics, it can take up to two years to break even, she added.

Even so, Joiner hopes to open a second clinic within the next three to six months. He says he's eyeing Kroger stores in Vinton, Troutville, Smith Mountain Lake and Salem.

If successful, the chain could have broader implications for local health care providers, said Christopher Bailey, senior vice president of the Virginia Hospital and Healthcare Association, based in Richmond.

The clinics could help relieve pressure on busy hospital emergency rooms by relieving them of patients needing only routine treatments, he said. They also could provide some competition to hospitals and their primary care outpatient services, he said.

"In economic terms, these operations are a classic disruptive innovator," Bailey said, adding that the store-based model will likely pressure more established health care providers to match their retail-style service and transparency in pricing.

"In that sense, they are a stimulant for the physician practices and the Carilion Clinics of the world that need to respond," he said.

Carilion Clinic, however, has already embarked on its own efforts to deliver faster, more accessible care to nonemergency patients.

In fact, the nonprofit at one time considered a similar, walk-in style service, said Dr. Howard Graman, the medical director of Carilion's physician practices, but opted instead to increase availability by hiring more doctors in the area and adjusting schedules so patients can receive same-day care.

Last fall, Carilion also opened its third urgent care center in the valley at Roanoke Community Hospital. The center is designed to treat less-pressing medical cases. But the center offers a broader array of diagnostics than the store-based clinics, including X-rays, that could aid in the treatment of more complex conditions, Graman said.

"We recognize that there is a relative shortage of primary care in the Roanoke Valley and that we struggle to keep enough new doctors out there for people who want to find a doctor easily," Graman said.

The retail clinic, he added, is one alternative to managing the shortage and can provide reasonably safe treatment for a limited number of ailments. However, he cautioned that the clinics may fall short in detecting the more poorly defined illnesses.

Patients, Graman said, should be attentive to their symptoms and choose medical treatment carefully. "If the patients self-select appropriately and know that it's a cold and that's all it is, then to keep it to that realm, the risk is not as great."

Redi-Health's patient counts ahead of plan

So far, the Redi-Health Clinic has averaged 10 to 12 patients a day, Joiner said, noting that it has already exceeded his expectations.

"I thought we'd have no patients or three patients a day. Ten to 12? I'm ecstatic," Joiner said.

For some Kroger customers, the idea of buying medical care in the same place as one's milk and eggs struck them as a bit odd.

"We have too much of a fast-paced life," said Eyvette Robertson, 38, who lives in Franklin County. "We have drive-thru pretty much anything, and I don't think health care should be one of those things."

She questioned whether the clinics would be as thorough as a doctor's office in their treatment, especially given the quick turnaround time on visits.

"You don't want there to be a drive-in, quick fix, walk-out and then something is wrong," said Robertson, a mother of four. "Nurse practitioners have training to a point and that is all."

Yet, for other shoppers, the supermarket-style convenience was very much the attraction.

"If I had to go to the doctor's office, I'd be sitting in the waiting room for a long time making everybody else sick," said Mary Nelson of Roanoke, who came into the clinic last week sniffling and blowing her then rosy-colored nose.

After a 15-minute exam, Abby Sneddon returned to the small, glassed-in waiting room. Her mother was clasping a prescription for eyedrops.

Roxane Sneddon went to the counter and plunked down her $49.50 in cash. "It's less stressful," she said.

"When you go to the doctors' offices, you don't know what you're going to spend."