Are Retail Clinics the Future of Health Care?

In "How Our Faith in Supermarkets, Nurses and Pharmacists Can Drive Health," health economist Jane Sarasohn-Kahn reports that two of the most trusted industries are supermarkets and hospitals and two of the most trusted professions are nursing and pharmacy. She also reports that "who we trust has a huge influence on who we engage for health."

Sarasohn-Kahn posits that this confluence will mean that self-care, particularly using retail clinics and seeking healthy products and advice in retail settings will become increasingly important and may be the best major drivers of health in our nation.

Her conclusion dovetails with the findings two studies funded by INQRI and published in Health Affairs earlier this year. One, led by Joanne Spetz at the University of Cailfornia, San Francisco, found that increasing use of retail clinics in which nurse practitioners provide primary care and practice independently, can dramatically reduce health care costs - by as much as $810 million in 2015, if those clinics account for 10 percent of outpatient primary care visits.

The other, led by David Auerbach of RAND and funded in part by the Donaghue Foundation, found that increasing the number of and the use of models of health care delivery that rely on nurse practitioners or physician assistants as primary care providers could offset the expected primary care physician shortage in 2025.

One thing is certain, there are many options for expanding access to health care and serious thought must be given to increasing the use of nurse practitioners and physician assistants as primary care providers in a range of settings.

INQRI In the News

New guidelines from the Joint Commission highlight the key role of nurses in preventing central line-associated bloodstream infections (CLABSIs), Infection Control Today reports. "Nurses are on the front lines and can take advantage of their constant contact with patients and other caregivers to explain infection control techniques and help health facilities develop and enforce standards of care that have been proven effective against CLABSI," said INQRI grantee Patricia Stone, PhD, MPH, RN.  She is also quoted in Long-Term Living,  Advanced Healthcare Network for Nurses, and Becker’s ASC Review.  

The health care system must ready itself for the influx of newly insured patients resulting from the Affordable Care Act, and advancing the role of nurses may be one way of addressing a potential physician shortage, according to an MSNBC.com article. The Institute of Medicine’s "Future of Nursing Report" is quoted in the article: “Now is the time to eliminate the outdated regulations and organizational and cultural barriers that limit the ability of nurses to practice to the full extent of their education, training, and competence.”

A Reuters Health article profiles the INQRI-funded study "Scope-Of-Practice Laws For Nurse Practitioners Limit Cost Savings That Can Be Achieved In Retail Clinics" and quotes co-lead investigator Joanne Spetz. "It appears there are cost savings when those nurse practitioners are allowed to operate autonomously in the retail clinic settings," Spetz told Reuters Health.

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.

INQRI In the News

A new INQRI-funded study, which shows that retail clinics can reduce costs when Nurse Practioners (NPs) practice independently, is making headlines. The study, led by Joanne Spetz and Stephen Parente is in current issue of Health Affairs.

News media and blog coverage has included the Albuquerque Business Journal, which notes that New Mexico allows NPs autonomous practice. The study was also covered in The Lund Report and The Incidental Economist.

Additionally, the INQRI-coordinated study to examine whether public reporting laws are effective in encouraging hospitals to improve nurse staffing levels and improving patient outcomes is also receiving attention, recently being featured on News-Line.com.

INQRI Study Shows Retail Clinics are Convenient, Cost-Effective, Provide Quality Care

A new INQRI-funded study shows that retail clinics can reduce costs when Nurse Practioners (NPs) are allowed to practice independently, potentially by nearly $472 million or more in 2015.

Retail clinics are an increasingly popular option for people who need diagnosis and treatment for common, non-life-threatening conditions. NPs are the primary care providers in these clinics, which are located in a range of settings, including pharmacies, grocery stores and “big box” stores. First established in 2000, there are now more than 1,200 retail clinics nationwide.

The research team for the study was led by Joanne Spetz, professor at the Institute for Health Policy Studies and associate director for Research Strategy at the Center for the Health Professions at the University of California, San Francisco, and Stephen Parente, director of the Medical Industry Leadership Institute at the Carlson School of Business, University of Minnesota. The team compared claims data over a two-week period for 9,503 patients who visited retail and non-retail clinics from 2004 to 2007. Researchers compared costs in states that require NPs to be supervised by or collaborate with physicians, states that allow NPs to practice independently but not prescribe, and states in which NPs are allowed to practice and prescribe independently. The study is in the November issue of Health Affairs.

The researchers found that insurance claims over a two-week period were lower following retail clinic patient visits than after visits to other settings, such as doctor’s offices and emergency departments, for the same conditions. Insurance expenditures for retail patient visits were even lower in states that allow NPs to practice independently. Payments for prescriptions were slightly higher in states where NPs are allowed to prescribe, but that increase in cost was mitigated by the lower cost of an NP practicing independently.

Adjusted to 2013 dollars, the average two-week cost for non-retail clinic visits was $704, for retail clinic visits in states with no NP independence it was $543, and for retail clinic visits in states where NPs have independence in practice, it was $484. The average cost for retail clinic visits in states where NPs had independence in practice and prescribing was $509.

Retail clinics are projected to account for about 10 percent of outpatient primary care visits by 2015. The study’s authors projected that the cost savings realized from using retail clinics at that level would be $2.2 million. The savings would be increased by $810 million if all states allowed NPs to practice independently and by $472 million if NPs were allowed to practice and prescribe independently.

Read the study.