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Retail Clinics May Expand Access to Care, But Don’t Cut ED Costs

Retail clinics have started to expand their role in the care continuum, but may not be reducing emergency department visits for low-acuity conditions.

By Jennifer Bresnick

- Retail clinics have often been floated as a lower-cost alternative to emergency department visits for patients with minor complaints, but a new study in the Annals of Emergency Medicine indicates that patients might not really be trading the ED for the corner drugstore.

Retail clinics and care coordination

RAND Corporation researchers studied more than 2000 emergency departments in 23 states over five years, and concluded that the rise of retail clinics has not contributed to measurable decreases in ED use for low-acuity visits.

"One hope for retail clinics was that they might divert patients from making expensive visits to the emergency department for minor conditions such as bronchitis or urinary tract infections," said Grant Martsolf, lead author of the study and a policy researcher at RAND. "But we found no evidence that this has been happening.”

"Instead of lowering costs, retail clinics may be substituting for care in other settings such as primary care practices or spur some patients to seek care for problems they previously would have treated on their own."

The finding may be slightly worrying for providers, especially in the primary care setting, who have hoped that retail clinics may ease the strain on their calendars without driving care costs too high. 

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Retail clinics are typically staffed by nurse practitioners, who can provide basic services for complaints such as ear aches, sore throats, or sinus infections.  They can also receive immunizations and chronic disease management support.  Patients do not usually need to make an appointment, which increases the convenience factor, and often have little more than a short wait to see a clinician.

The study found retail clinic penetration into areas traditionally served only by emergency departments doubled between 2007 and 2012, although 56 percent of EDs still did not have a retail clinic in their geographic “catchment area” by 2012. 

The study specifically controlled for urgent care centers, which add another tier to the non-traditional service site equation and may fall between retail clinics and EDs for the types of cases they treat.  A lack of complete data on the urgent care center environment prevented the researchers from adding the variable to their study.

In areas where retail clinics did start to take hold, they proliferated quickly, the researchers found.  Mean penetration in these areas increased from 15.2 percent to 40.2 percent over the study period, perhaps indicating that once patients had experience with the setting, they responded positively enough to warrant an investment in additional clinic sites.  

Retail clinics have tried to position themselves as valid alternatives to PCPs, urgent care centers, and emergency departments for minor issues, and many have adopted name-brand electronic health records and sophisticated analytics tools to aid in population health management and care coordination.

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However, instead of serving as alternative care sites, they may simply be expanding low-cost access to patients who cannot afford traditional provider services. 

"Retail clinics may emerge as an important location for medical care to meet increasing demand as more people become insured under the Affordable Care Act," said co-author Dr. Ateev Mehrotra, an associate professor at the Harvard Medical School and an adjunct researcher at the RAND Corporation.

In addition to providing affordable alternatives to uninsured or low-income patients, the smaller price tag and convenience of retail settings may encourage more patients in general to seek care when they otherwise would have stayed home.

A previous study published in Health Affairs in 2015 found that nearly 60 percent of retail clinic visits represented new users of health services instead of users who were using the clinics to replace other care settings, the authors note. 

Many retail clinics have opened in relatively wealthy areas, not low-income, inner-city locations, which may contribute to the notion that patients with a little extra money for healthcare spending are likely to visit a low-cost clinic for ailments that would have otherwise gone untreated.

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For patients on Medicaid, however, emergency departments may still be the most cost-effective option.  “Retail clinics might be less of an option for these patients because only an estimated 60 percent of them accept Medicaid,” the study explained. “In comparison, 97 percent accepted private insurance and 93 percent accepted Medicare.”

“As demand increases, it may become increasingly important for patients to find accessible and convenient locations to seek care for low-acuity conditions. Retail clinics may emerge as an important care location to meet this increasing demand, but contrary to our expectations, they do not appear to be leading to meaningful reductions in low-acuity ED visits.”

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