The idea of receiving healthcare in a drugstore, supermarket or other retail location has caught on with an increasing number of patients who appreciate the convenience and cost.
Often in partnership with a local hospital or health system, retail clinics, also known as convenient-care clinics, are gaining patients and adding locations, bolstered in part by acceptance from insurers willing to contract for reimbursement with them.
More recently, some retail clinic companies are expanding their care beyond the kind they've been known for so far—such as treating patients with cold and flu symptoms and providing vaccinations and sports physicals—by adding chronic care and disease management to their offerings.
Despite some physician group opposition to that broadening of care, retail clinics are expected to continue to grow even as the healthcare system transforms under the Patient Protection and Affordable Care Act.
“Several of our members are expected to grow significantly,” says Tine Hansen-Turton, executive director of the retail clinic trade group Convenient Care Association. Growth is coming from higher patient volume and an increasing number of clinics, according to Hansen-Turton.
Indeed, a study published in September in the journal Health Affairs found that retail clinic visits grew 300% from 2007 to 2009, climbing to 5.97 million estimated visits in 2009 from 3.52 million in 2008 and 1.48 million in 2007.
Those visits, based on an estimated average cost of $110 for a retail clinic visit derived in a separate study, translate to $657 million in spending on retail clinic care in 2009.
“Utilization is way up,” driven mostly by a high level of patient satisfaction, as opposed to clinic expansion, says Web Golinkin, board president of the Convenient Care Association and CEO of RediClinic, which operates 30 retail clinics within H-E-B grocery stories in Texas. Patients are recognizing the value that retail clinics provide in offering quality limited-scope care at an affordable price and in an easy-to-access fashion, he says.
Retail clinics, which generally provide care through an advanced-practice nurse, have thrived based on their ability to offer attractive hours with no appointments needed, convenient locations and low cost, with cost being particularly attractive to the uninsured and those with high-deductible health insurance plans, the study authors wrote. The research found that in the three-year period studied, 70.5% of the patients who visited a retail clinic had some form of insurance, leaving close to 30% of the patients uninsured.
While the number of clinics is rising, the recession tempered that growth for a while, Hansen-Turton says. She says there are an estimated 1,400 retail clinics nationwide, up from about 1,000 clinics in 2009.
Two of the three retail clinic companies that were the basis of the Health Affairs study together operate close to 1,000 clinics on their own. MinuteClinic, owned by drugstore chain and drug distributor CVS Caremark Corp., operated 614 clinics as of last week, up 13% from 541 as of Sept. 30, 2008, according to the company, while Take Care Clinic, run by a subsidiary of Walgreen Co., had 360 clinics as of Aug. 31, 2012, up 66% from Aug. 31, 2008. Data for the third chain, the Little Clinic, was unavailable.
Hospitals and health systems have helped fuel the growth by forming partnerships with retail clinics. The clinics can see a boost to their reputation by linking with a well-known provider and may refer patients to the system as well as get referrals back, says Robert Gift, a director for IMA Consulting. The health system, meanwhile, fills a gap in its continuum of care and might reduce unnecessary visits to emergency rooms, Gift says.
In July, UCLA Health System, Los Angeles, signed an agreement with MinuteClinic to have UCLA physicians act as medical directors for 11 retail clinics in Los Angeles County. Dr. David Feinberg, president of UCLA Health, says that a desire to create more outlets for care was the primary motivation for doing the deal.
“Despite having two great medical campuses, we're not always accessible,” Feinberg says. And it was very clear that the care was very high quality, he says. When UCLA executives were contemplating the agreement, their personal experience with the retail clinics helped convince them to proceed, Feinberg says. “Many of us had already used MinuteClinic.”
Bellin Health, a Green Bay, Wis.-based system, took a different tack by jumping into the field itself, forming a retail clinic company that offers co-branded retail clinic care under the names of the partnering health system and FastCare, which is owned by the not-for-profit organization. In addition to its own four Bellin FastCare clinics, there are 30 other FastCare-affiliated clinics in 10 states that are part of partnerships with 20 healthcare systems, says Steve Lazzari, director of FastCare.
“It's kind of a well-kept secret,” Lazzari says. “We plan on growing our clinics by 15 to 20 per year,” he says.
But even with the swift growth in volume seen at retail clinics, in relative terms they still make up a small percentage of overall outpatient visits in the industry and are unlikely to play a dominant role in outpatient care anytime soon, experts say.
“They will continue to grow, but there will be a limit to that growth,” Gift says. The Health Affairs study notes that even with the growth to nearly 6 million patient visits in 2009, the number of retail clinic visits falls far short of other forms of outpatient care, with about 577 million physician office visits annually and an estimated 117 million ER visits.
Some retail clinics are looking to expand further by focusing more on chronic disease care; the Health Affairs study found such care accounted for just 1.1% of retail clinic visits in 2009. In April, MinuteClinic announced it would offer a hemoglobin A1C and blood glucose test for monitoring diabetes, a microalbumin test for checking kidney function, a body mass index calculation, a cholesterol test and a comprehensive foot exam.
Similarly, Take Care announced in May that it would add three tests to its offerings: the A1C test; the microalbumin test; and a fecal occult blood test, which is a lab test to identify blood in the stool, which can be an indicator of colon cancer or polyps.
Many primary-care physicians, though, don't want retail clinics going beyond their current limited scope. A concern is that patients will rely too much on retail clinics and won't be getting proper chronic disease care or will not participate in newer care models such as accountable care organizations and medical homes.
Research published this month indicated that people who visit a retail clinic instead of a primary-care doctor for a minor illness may be less likely to visit a physician the next time they have a similar condition. Retail clinics might disrupt the patient-physician relationship, says Rachel Reid, the lead author of the study and a medical student at the University of Pittsburgh School of Medicine. But the results also found that retail clinics didn't negatively affect preventive care or diabetes management, according to the study, titled “Retail clinic visits and receipt of primary care,” published in the Journal of General Internal Medicine.
Regardless, primary-care physicians say they oppose a broadened role for retail clinics. Dr. Jeffrey Cain, a family physician in Denver and president of the American Academy of Family Physicians, compared retail clinics to eating at a fast-food restaurant, saying the clinics are OK to visit once in a while but aren't appropriate for patients' regular diet of chronic-care needs.
“We understand that retail clinics may have a role, but we're not in favor of this expansion into chronic care,” Cain says.