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Where do Retail Health Clinics Fit Into the Market?

by Evan Grossman, VP of Consulting Services

You’ve probably seen them, more present than ever: Signs outside local drug stores saying “flu shots available,” “shingles vaccine here,” or other similar messages. As retail health clinics—like those that exist inside those drug stores—continue to become a more frequent participant along the healthcare continuum, I thought we’d take a look at the stats we have on these retail clinics and consider their place in the market.

You’ve probably noticed that retail clinics often get a bad rap from traditional health care providers. In a recent Modern Healthcare article, Dr. Sam Unterricht, president of the Medical Society of the State of New York, was quoted as saying, “The society, and physicians in general, think retail clinics are a threat to the quality of care and a threat to physicians financially.” And the athenahealth 2013 Physician Sentiment Index results found nearly 40% of the physicians surveyed believe retail clinics take business away from primary care physicians (PCPs) without delivering the same quality of care.

Before we add to the conversation, let’s discuss what a retail clinic is. Retail clinics are typically defined as walk-in medical facilities located inside pharmacies and retail chains, such as CVS, Walgreens or Target, where care is delivered by nurse practitioners, often without a physician on premises.

As mentioned above, quality of care is just one of a handful of concerns many health systems and physicians like Dr. Unterricht have about this rapidly growing segment of care—growing so fast, in fact, that a recent Accenture report projects the number of retail clinics will double over the next three years.

While physicians feel these storefront-style clinics will impact their own wallets, the Accenture study reports they are also projected to save the industry more than $800 million in annual costs by 2015. The reason is simple: care delivered in a retail setting often costs less than in a doctor’s office or emergency room.

At athenahealth, we have a vested interest in seeing the utmost quality of care provided wherever it’s delivered. With our up-to-the-minute insights from over 47,000 providers—from PCPs to specialties to retail clinics—we were interested in seeing what data shows in terms of access, cost and quality for this non-traditional model of care. Our findings:

A) Convenience and Time Savings
We see a stark contrast when comparing the times of day that patients visit retail clinics vs. primary care doctors: 42% of a retail clinic’s patients are seen when most doctors’ offices are closed (after 6pm and on weekends).

Time of Day for Patient Visits, PCP Practices vs. Retail Clinics

Time of Day for Patient Visits, PCP practices vs. Retail Clinics

To address the length of time spent during a patient visit, we looked at more than 500,000 patient visits to PCPs on our cloud-based software platform (athenaNet) during 2012, and compared that to more than 100,000 visits to a major retail clinic client. On average, the retail clinic visits were significantly shorter (61% less time, see figure below).

A few aspects could factor into this:

  1. On average, wait time at the retail clinic was 7% shorter than wait time at the PCP.
  2. PCPs did an average of double the work – based on work RVU’s (Relative Value Units) – and took triple the time to do it. That’s not necessarily unexpected, as retail clinics focus on delivering a much smaller range of services during patient visits.

Average Time of Patient Visits, PCP vs. Retail Clinics

Average Time of Patient Visits, PCP vs. Retail Clinics

(The comparison was made only for PCP visits in which one of the most common retail clinic services was billed (flu shot, vaccine administration or strep test).)

B) Quality of Care
Adhering to protocols can signify, and often result in, high quality care in certain situations. Using adherence to protocols as an example—in this case the appropriate prescribing of antibiotics—our data shows that retail clinics can actually outperform many primary care practices.

Percent Acute Bronchitis Patients NOT Prescribed an Antibiotic

Figure 3 shows that, for the instance of acute bronchitis, a retail clinic followed the American College of Physicians and Centers for Disease Control and Prevention guideline 86% of the time, more often than most primary care doctors on our network.

We can hypothesize that it may be easier for an employed clinician of a large organization (such as those in retail clinics) to follow protocol and resist the angry parent insisting on an antibiotic for their sick child. Or, perhaps that the clinician is focused on diagnosing and managing a much smaller scope of patient complaints. Regardless, the results are significant.

C) Payments
Retail clinics typically receive lower reimbursements than primary care providers. This is partially because they rely heavily on nurse practitioners, and is also perhaps a reflection of their overall approach as a low-price provider.

Collections per RVU (Median)

It’s clear that retail clinics will play a vital role in health care in the coming years, and it’s important for large health systems and independent practices alike to decide how to respond to (and/or partner) with these growing organizations.

Next month, I’ll follow up here with some direction on how this can be accomplished.

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