Monday, November 25, 2013

Bread, Milk, Pneumonia Shot: How Retail Clinics are Changing the Landscape of Healthcare

By Olga Yakusheva, Marquette University

When your child gets a sudden fever, it’s bad enough. When your child gets a sudden fever on a Friday night, it can be downright terrifying. You calm yourself with the thought that it is most likely nothing serious and can wait until Monday, all the while trying hard to push away the memory of that recent Sunday family trip to the ER for what turned out to be a simple ear infection.

Thankfully, these situations are becoming less frequent as more and more people get access to retail health clinics. Retail clinics, also called convenient care clinics, are small clinics located in pharmacies, grocery stores, and supermarkets, where a nurse practitioner (NP) or physician assistant will see you for a range of simple conditions (ear infections, cuts and small burns, and such), preventive care, or vaccinations. The clinics accept patients on a walk-in basis and are typically open after hours and on weekends. Most visits last about 15 minutes and prescriptions can often be purchased before leaving the store. Many clinics accept insurance, and some insurers now cover retail clinic services. Although a relatively new phenomenon in the US health care landscape, close to six  million patients visited retail clinic visits in 2009 alone, and an estimated 6,000 retail clinics or more will be operating in the US by the end of the year.

Along with convenience, retail clinics provide care at a lower cost. A study funded by INQRI and recently published in Health Affairs found that choosing a retail clinic for the initial visit can reduce the overall cost of care over the next two weeks by as much as $160-$220 per patient, and that these cost saving are greater where NPs are allowed to practice independently without a physician’s supervision. In addition to direct cost savings, having access to convenient care could lower costs by averting complications that may otherwise result when patients delay seeking care.

While currently accounting for less than 5% of all outpatient primary care visits, the share of visits to retail clinics is projected to increase more than two-fold by 2015. If the cost savings continue into the near future, the projected expansion of the retail clinic market could save our economy over $2 billion, and potentially much more if it were accompanied by a uniform expansion of NP scope of practice laws. Joanne Spetz, the lead author of the study, says that these findings “underscore … that when NPs practice to the full extent of their training, they can deliver highly efficient high-quality primary care.”

Critics of retail clinics bring up a number of potential drawbacks to wide adoption of retail clinics. These concerns include the possible erosion of existing patient-physician relationships, diminished continuity of care, over-prescription of medications (particularly antibiotics), and overall reduced quality of care. While existing studies show the quality of care provided at retail clinics to be similar to conventional primary care settings, the Spetz study did find that when NPs were allowed to prescribe, payments for prescription medications were slightly higher.

These concerns notwithstanding, the rapid growth of the retail clinic sector over the last decade tells us that they are meeting a growing consumer demand for convenient, high-quality affordable care. As health care policy changes under the Affordable Care Act continue to roll out, retail clinics will play an increasingly important role in alleviating growing pressures on our primary care system. In the meantime, we may all need to start getting used to the idea of putting routine tests and vaccinations on our grocery lists.

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