I’ve been interested in retail clinics for years. It’s a wonderfully simple idea: there are a range of conditions for which a doctor just isn’t the right tool for the job, any more than you need a trained engineer to change a light-bulb. If someone has inflamed tonsils (pharyngitis), a urinary tract infection or an ear infection (otitis media – you’ll need the vocab for the next section) sending them to a physician or an emergency room makes no sense – you have an expensive provider delivering by-the-book care. And in the event that the patient has something serious masquerading as something common? They’ll almost certainly get the basic care anyway and end up coming back in later.
Retail clinics, such as CVS’ MinuteClinic chain, are intended to provide an alternative. Rather than going to the Emergency Room, you go to your local drug store, get checked out in a few minutes and are handed the prescription. If your condition goes off-script, they send you to a doctor or to the ER. The clinics are manned by nurse practioners or physician assistants, depending on the state, and supervised by a physician who may be off site.
Until recently we haven’t had much insight into the effectiveness of retail clinics. That’s beginning to change. In the current issue of the Annals of Internal Medicine, Ateev Mehrotra and colleagues analyze the long-term costs of care in retail clinics in Minnesota for the three conditions I listed above. You can read the abstract of the article here. Here’s the summary:
Overall costs of care for episodes initiated at retail clinics
were substantially lower than those of matched episodes initiated at
physician offices, urgent care centers, and emergency departments
($110 vs. $166, $156, and $570, respectively; P < 0.001 for each
comparison). Prescription costs were similar in retail clinics, physician
offices, and urgent care centers ($21, $21, and $22), as were
aggregate quality scores (63.6%, 61.0%, and 62.6%) and patient’s
receipt of preventive care (14.5%, 14.2%, and 13.7%) (P < 0.05
vs. retail clinics). In emergency departments, average prescription
costs were higher and aggregate quality scores were significantly
lower than in other settings.
In other words – if a patient goes to the retail clinic rather than ER, the insurance company saves $460, and the patient gets care faster and suffers less discomfort. The quality scores show that retail clinic customers do not suffer in terms of other healthcare services (such as scheduled preventive procedures) compared to those who seek initial care in a physician office.
As we like to say in healthcare economics, this is only an initial study. It’s biggest weakness is an inability to control for severity of the underlying condition – it’s conceivable that only healthier patients took a chance on the retail clinics, leaving the physician offices and emergency rooms to handle a much sicker group. I don’t think this is likely, however. With these three conditions it is difficult for the patient to judge severity when the disease presents itself. Minnesota is particularly well seved by retail clinics – it’s MinuteClinic’s home turf – so access issues are also unlikely to play a role.
In general, I think these are promising results, and they should help encourage insurance providers to reimburse for care delivered in the retail clinic setting. That should help with adoption – the market has not exploded, and MinuteClinic has even resorted to running some clinics seasonally.
Oh, and for those looking for an informatics connection: retail clinics tend to be pretty good at operating electronically and making patient data available to the patient upon request. MinuteClinic, again, was one of the early Google Health partners, and they’ve long seen electronic health information exchange as a key component of their integration with local health systems.