Cover Story

Cost of convenience: Impact of retail clinics on the health care market

In pharmacies, supermarkets and ‘big box’ stores across the country, retail health clinics have experienced exponential growth, stemming largely from patients’ involvement in their own care — and the financial burden that comes with it.

No longer the ‘novelty’ health care alternative they were considered when the first retail-based clinic opened in Minnesota in 2000, there are now 2,300 such clinics in 43 states and Washington D.C., serving more than 35 million patients annually, according to recent estimates from the Convenient Care Association.

Madeline M. Joseph, MD, chair of the American College of Emergency Physicians Pediatric Committee, noted concerns about the pediatric quality of care available at retail clinics as well as expansion into chronic care management.

Photo courtesy of University of Florida College of Medicine-Jacksonville

Aside from the advantage of extended evening/weekend hours and convenient locations, retail clinics also offer lower average costs than urgent care centers, primary care providers or emergency departments, due in part to the lower salaries of the staff of nurse practitioners and physician assistants and the narrow scope of low-acuity services they provide.

With the current shortage of primary care physicians projected to worsen in the coming years, retail clinics are expected to expand their range into the primary care market, offering services such as routine physical exams. Such development, however, has not been without its critics.

Several organizations, including the American Academy of Family Physicians, the American College of Physicians, and the American Medical Association, have formal positions on retail clinics, voicing concerns that quality of care, impact on continuity of care and communication gaps with primary care providers have not been addressed during retail clinic expansion.

One of the strongest opponents, the AAP warned that retail-based clinics were an inappropriate source of primary care for children, because they fragment care and do not support the pediatric ‘medical home’ concept of coordinated care.

Although most of the present tension between retail clinics and the primary care community has arisen over the treatment of low-acuity conditions, larger retail clinic conglomerates have recently proposed broadening the scope of their practice into chronic care management; this raises a concern for pediatricians who cite the potential for care coordination disruption due to multiple care providers. Infectious Diseases in Children spoke with experts in pediatric medicine regarding the success of — and increased patient reliance on — retail clinics, how the growing retail clinic prevalence impacts the pediatric office, and whether pediatricians should be drawing the line on encroachments from this increasingly popular model of care.

Health sells — but who’s buying?

“Retail clinics are just one part of what I term the ‘convenience revolution’ of health care,” Ateev Mehrotra, MD, MPH, associate professor in the department of health care policy at Harvard Medical School, said in an interview. “Other health care options for children include urgent care centers, telemedicine, kiosks, and even house call companies in which nurse practitioners and physicians come to your home –all of these options are driven primarily by convenience.”

In addition to convenience, recent studies have shown that a major driver of retail clinic growth is the cost. Despite the access provided by the Affordable Care Act, 27.3 million U.S. residents remain uninsured and, along with low-income consumers, are forced to ‘shop’ for more affordable health care options: lower costs and the lack of a standard care provider factor heavily into retail clinic selection.

In a 2008 study published in Health Affairs, Mehrotra and colleagues examined data from more than 1.3 million visits to retail clinics from 2000 to 2007 compared with national data on analogous visits to emergency departments (EDs) and primary care offices. According to study results, retail clinics’ largest demographic were young adults aged 18 to 44 years, only one-third of whom reported that they had a primary care provider.