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Retail Clinics: a Supplement not a Substitute for Traditional Health Care Choices

Retail clinics add about $147 million to the utilization of healthcare resources in the U.S.

In recent years,  patients have been increasingly demanding access to outpatient care. Retail clinics aim to supply this demand by providing a cost effective and convenient solution. First opening in 2000, retail clinics have expanded exponentially and accounted for 10.5 million visits in 2012.  Retail clinics provide a venue of care for those that do not have any other usual source of care, whether they have.

Source: Christopher Cornelius (Flickr/CC)

Source: Christopher Cornelius (Flickr/CC)

A recent article in Health Affairs examined the extent to which retail clinics offer healthcare cost savings. The authors used data from Aetna enrollees under the age of 65 from 22 cities to evaluate utilization and spending across low acuity conditions between matched users and nonusers living within 20 miles of a retail clinic. The authors evaluated the change in use of other sites of care (ED visits and physician office visits) to determine if retail clinics were offering a substitution or new utilization phenomenon. Spending was calculated as the average annual per person spending on low acuity visits for one of the 11 conditions examined and looked at both costs savings from substitutions and increased spending from new utilization.

Of the retail clinic visits studied, 42% represented a substitution, primarily of a physician office visit, and 58% represented a new utilization of healthcare resources. Overall spending for low acuity visits increased by $14, finding that retail clinic visits actually increased healthcare spending.

As more patients acquire insurance, there is an increasing demand for access to prompt care. Many primary care offices have long wait periods in order to get an appointment and emergency department wait times may deter patients. to patients as many have walk-in appointments and boast quick turnaround times. Insurance companies have also been willing to include retail clinic visits as part of their plans. Some encourage patients to choose retail clinics by waiving copays in order to prevent more expensive physician office or ED visits. However, this study shows that retail clinics do not replace other  visits but may actually represent additional healthcare utilization.

In the evolving landscape of healthcare, retail clinics provide an accessibility that traditional venues of care have been unable to provide. However, in order to provide cost savings, there needs to be better integration of information from retail clinics to the PCP office. As these retail clinics do not see patients for chronic conditions, data about these visits can be essential for PCPs to improve care coordination and chronic disease management.

commentary by Sharmistha Dev

Abstract

Retail clinics have been viewed by policy makers and insurers as a mechanism to decrease health care spending, by substituting less expensive clinic visits for more expensive emergency department or physician office visits. However, retail clinics may actually increase spending if they drive new health care utilization. To assess whether retail clinic visits represent new utilization or a substitute for more expensive care, we used insurance claims data from Aetna for the period 2010-12 to track utilization and spending for eleven low-acuity conditions. We found that 58 percent of retail clinic visits for low-acuity conditions represented new utilization and that retail clinic use was associated with a modest increase in spending, of $14 per person per year. These findings do not support the idea that retail clinics decrease health care spending.

PMID 26953299  Ashwood, JS, et al. Health Affairs. 2016; 35 (3): 449-55.

Sharmistha Dev, MD, MPH
About Sharmistha Dev, MD, MPH

Sharmistha Dev is a clinical instructor at University of Michigan Department of Emergency Medicine and Department of Internal Medicine. She earned her Master of Public Health and medical degree from University of Illinois at Chicago. She tweets at @DrSDev. Contact: Facebook | Twitter | More Posts