Retail Clinics Provide Equivalent Care for Less

Studies Confirm Availability and Quality

Explosive growth in the number of retail-based health clinics operating in the United States during the past decade has been accompanied by concerns over care quality and continuity. By providing preventive medicine such as vaccines as well as acute care for minor ailments and injuries, retail clinics are providing a more affordable alternative to the emergency department for those who are uninsured, cannot get to their doctor’s office, or who simply want the convenience of basic medical care without the need for an appointment or uncertainty about the price. Investigators recently published results of a study demonstrating that retail clinics can provide care for common illnesses at 30% to 40% lower costs while delivering similar quality compared with physicians’ offices or urgent care centers.

Published in the September issue of the Annals of Internal Medicine [2009;151(5):321-328], the retrospective study examined beneficiary claims from enrollees in a large Minnesota health plan who were treated for otitis media, pharyngitis, or urinary tract infection in retail clinics, physicians’ offices, urgent care centers, or emergency departments. The review comprised claims data from 2005 and 2006 and compared costs per episode, performance on 14 quality indicators, and whether patients received 7 preventive care services during their initial appointment or the subsequent 3 months. A total of 2100 episodes, made up of 700 episodes for each of the illnesses, were included.

At the time the investigators conducted their study, the health plan from which records were reviewed had been covering the use of retail clinics for >5 years. In addition to quality measures, they attempted to determine total cost of care for treatment of the acute illness for the 6 months before and after the episode.

Lower average costs were reported for episodes treated at retail clinics ($110) compared with matching episodes for which treatment was initiated at physician offices ($166), urgent care centers ($156), and emergency departments ($570; all P<.001). The investigators said that the main driver of the difference in costs was evaluation and management visits.

The costs for prescriptions were similar in retail clinics, physician offices, and urgent care centers ($21, $21, and $22, respectively; P<.001). Laboratory and imaging services cost an average of $15 at retail clinics compared with $33 at physician offices, $27 at urgent care centers, and $113 at emergency departments (P<.001 for each comparison).

The comparison of quality and preventive care measures found similar results for retail clinics, physician offices, and urgent care centers. Aggregate quality scores were 63.6%, 61.0%, and 62.6%, respectively (P>.05), and patients treated in these settings received preventive care within 3 months of their visit 14.5%, 14.2%, and 13.7% of the time (P>.05). At emergency departments, quality scores were 55.1% (P<.001 vs retail clinics), and 10.7% received any preventive care (P=.003 vs retail clinics).

Similar percentages of episodes included follow-up visits for patients initially treated at retail clinics (16.0%), physician offices (15.1%), and urgent care centers (14.2%; P>.050). Episodes that originated in emergency departments were the most likely to have follow-up visits (24.5%; P<.001 vs retail clinics).

The authors noted that patients who receive care at retail clinics tend to be younger, less likely to have a regular primary care physician, and more likely to be uninsured. Limitations of the study included differences in illness severity despite efforts to match patients at different care sites as well as the limited number of quality measures and preventive care services reviewed for the study.

Availability
Results of another study published at the same time [Ann Intern Med. 2009;151(5):315-320] provided an update on the availability and convenience of retail clinics by quantifying characteristics such as location, scope of practice, prices, acceptance of insurance, and ownership. The cross-sectional, descriptive study also estimated the proportion of the US population that lives within a short driving distance of such a clinic.

In August 2008 the investigators identified 982 retail clinics run by 42 operators in 33 states. Of these clinics, 88.4% were in urban areas, and 44% were in Florida, California, Texas, or Minnesota. All clinics offered treatment for sore throat at an average cost of $78, and treatment for skin conditions, immunizations, pregnancy testing, and lipid or diabetes screening was offered at >95% of the clinics in the study. Private insurance coverage was accepted by 97%, and Medicare fee-for-service was accepted by 93%.

Using the inventory of clinic locations compiled in August 2008 combined with census data from the year 2000, authors estimated that a retail clinic is available via a 5-minute drive for 10.6% of the total US and 13.4% of the urban US population. A retail clinic is located within a 10-minute drive for 28.7% of the total and 35.8% of the urban US population. The authors concluded that retail clinics are positioned to provide immunizations and care for simple acute conditions for a substantial segment of the urban US population.

Expansion in the number of retail clinics appears to have leveled off this year, and MinuteClinic has dominated the retail healthcare market. According to Merchant Medicine’s US Retail Clinic Industry Snapshot, the top 3 operators of retail clinics in the United States as of August 2009 are MinuteClinic (452 locations), TakeCare (345 locations), and The Little Clinic (109). The top 3 retailer locations for clinics are CVS Pharmacy, Walgreens, and Kroger. Florida leads all other states with the most retail clinics (137), followed by Texas (77) and Tennessee (76). In total, the number of retail clinics in the United States was up to 1111 at press time, compared with about 200 in late 2006.—Charles Boersig