• Quote: Retail clinic use continues to grow

    The proportion of American families who reported using a retail clinic in the previous year nearly tripled between 2007 and 2010, increasing from 1 percent of U.S. families in 2007 to 3 percent in 2010, according to a new national study by the Center for Studying Health System Change (HSC). In 2010, an estimated 4.1 million American families reported using retail clinics in the previous 12 months, compared to 1.7 million families in 2007.When asked why they chose retail clinics over other care settings, most clinic users cited convenience factors: extended operating hours, walk-in visits and a convenient location. However, uninsured and low-income families were much more likely to cite lower cost and lack of a usual source of care as reasons for choosing retail clinics. As retail clinics expand across the country, part of the uptick in use reflects consumers’ growing geographic access to clinics. In 2010, for example, nearly three in 10 U.S. families lived within five miles of a clinic—up from 23 percent in 2007. This increasing geographic access was somewhat skewed toward higher-income families. Thirty-seven percent of those with incomes at least six times the poverty level lived near a retail clinic in 2010 compared to 25 percent of those with incomes no more than twice the poverty level—presumably reflecting clinic operators’ decisions to locate in more-affluent communities. Higher-income families were nearly twice as likely as lower-income families to use retail clinics.

    Looking forward, with insurance expansions under national health reform expected to pressure primary care capacity in many communities, retail clinics may play a larger role in providing basic preventive and primary care services. Some retail clinics also are expanding their scope to encompass services like chronic condition management. However, it remains unclear whether such strategies will succeed and, more broadly, whether retail clinics will grow beyond their current limited role in the health care delivery system and finally emerge as the widespread “disruptive innovation” that some have long predicted.

    HSC Research brief No. 29

    Until we get our act in gear, and start offering the convenience and ease that retail clinics do, traditional physician practices are going to bleed patients to these clinics. Prior coverage of retail clinics here, here, here, here, and here.

    @aaronecarroll

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    • Some of the prior coverage of retail clinics contrasted their seductive convenience with seemingly contradictory ideals of medical school (“continuity of care”, “medical home”).

      As a young, healthy-so-far person who’s moved around a fair bit, I’d love the continuity of care that I could imagine Walgreens/CVS providing if it were my all-hours, always-nearby “medical home”. Especially if it were thoroughly integrated into an equally national and corporate secondary/tertiary care network. Like Kaiser apparently is, but everywhere.

      Maybe I represent a small slice of the people pie, and maybe things will change once I have some conditions to manage, or some kids. But I suspect it’s hard for people who are familiar with private practice on both sides of the interaction to appreciate how mystifying and off-putting that sort of archaic small-holder setup is for someone whose commercial interactions are otherwise with impersonal but relatively well-organized corporations, even for other services like car repair and eye exams.

      My fantasy is that by the time I really need to interact routinely with the healthcare system, the retail clinics will have brought about (from the top and the bottom at once, as it were) the large-scale corporatization of healthcare delivery, with all the benefits of standardization and quality control and efficiency we’ve seen in other domains. I want ready access to a real working system, whether through the web, by phone or 10 minutes away in person, not 20 minutes of fast-talk every year or so with the same absent-minded overworked individual (if I’m lucky, that is, and if I haven’t moved).

      • Its not clear to me that PCPs will lose business to retail clinics.

        Most people’s insurance plans have the same copay regardless of whether they go to a retail clinic or their PCP. So cost is not the real issue.

        Uninsured patients go to retail clinics over PCPs, but those patients were never going to a PCP anyways, so it is not true to say that the PCP “lost” those uninsured patients to a retail clinic. At any rate, retail clinics DONT WANT uninsured patients. There’s a reason why all these retail clinics are opening up in upper middle class areas, despite the fact that demand is much higher in urban slums.

        The main reason people go to retail clinics is not cost, it is access/convenience. In that scenario, if the PCP is full and cant see you until tomorrow, and you choose to go to a retail clinic instead, how is the PCP losing anybody? He’s already full. The retail clinics take the ‘excess’ patient load, they dont divert away from the PCP.

        PCP vs retail clinic is not a zero sum game.

      • Ditto Ivan

        And don’t forget to get all of your reports and records. The US system keeps them in the hands of the provider and there’s nothing like realizing that your records are unavailable. I had a baseline mammogram at a doctor’s office, which got merged a few times in the distant past. I don’t know who inherited my records. It turned out to be a total waste of time.

        What has my cholesterol been doing? Only continuity tells you if you are slowly inching up or just staying the same. Ditto blood pressure.

        When I finally put all my records on a computer, I realized that my eyes weren’t getting worse, my prescription fluctuations were probably more a statement about the lack of accuracy of defining a prescription than real changes in my sight.

        I strongly recommend you take charge of your records. Now there are apps that can store this.

      • As another healthy 30-something I agree that the traditional private practice is mystifying and off-putting to someone who does not have frequent interactions with health care. Since I’ve been an adult I’ve never had “a relationship” with a health care provider. That’s due to a combination of moving around and being healthy. I don’t need or want a medical home and it would be a waste of resources to try to set one up with me. A retail clinic with a robust electronic health record would suit my current needs just fine.

        I don’t expect I will learn to navigate the health care system for myself until I either become pregnant or seriously ill. (And I have no plans right now to do either!)

    • I used a Walgreens clinic a couple weeks ago, on a Saturday, for the first time. I just needed an immunization (not flu). The pharmacist checked my insurance and helpfully informed me that I could get the shot for free if I got it at my doctor’s office. At Walgreens it cost $64. I went ahead and got it at Walgreens, though. To go to the doctor would require taking at least a couple hours off work (depending on when I could get an appointment), and then I’d have to pay $15 for parking. The $64 at a convenient location at a convenient time was totally worth it. Also, now that I’ve seen the clinic, I’m more likely to use it for minor things in the future. The concept initially seemed sketchy to me but was worth it just for an immunization. But it was clean, they seemed competent, and it was very convenient. I’m sold on the idea.

    • As a PCP (ret.), I’m not sure that we need to get iur act in gear. In Europe, for instance, minor illnesses are handled by pharmacists. This is just an modification of that scheme. Most people who go to a retail clinic with simple ailments don’t need to be seen by a physician. As long as NP/PAs are pushing more complicated cases to urgent cares and clinics, I think that this kind of treatment is absolutely appropriate.

      We do lose continuity of care which most of the time really isn’t a problem. A middle-aged, healthy woman, for example, who goes to a retail clinic every few years for an uncomplicated UTI will get appropriate care (telephone medicine would be fine here, too). A middle-aged obese woman who goes to a variety of providers with vaginal candidiasis that occurs every time she finishes the diflucan may suffer from a missed diabetes diagnosis for an extended period. Improved electronic communications between providers needs to be built into the retail system. Additionally, retail clinics are not set up to provide chronic care and should not be taking on that role.

    • It might be important to distinguish between a clinic at a pharmacy, and one of the freestanding clinics run by the likes of Concentra. Two surprises: the former will often only have a nurse practitioner seeing patients, while the latter may charge ER rates.