Number of patients receiving care at retail clinics increases

More in-store clinics are opening in preparation for a possible role in accountable care organizations and other aspects of health system reform.

By — Posted Dec. 19, 2011

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Patients are growing more comfortable with retail clinics, which are beginning to expand in anticipation of increased traffic because of health system reform.

A study in the November 2011 American Journal of Managed Care, which analyzed the claims data of 13.3 million Aetna enrollees from 2007 to 2009, found a tenfold increase in patient traffic to clinics in grocery stores, pharmacies and big-box stores.

Researchers identified claims for 11 conditions, such as upper respiratory infections and pharyngitis, that could be treated in a retail clinic. There were 0.6 visits to a retail clinic per 1,000 enrollees in January 2007, and this rose to 6.5 by December 2009. Aetna covered care provided in the retail clinic setting, and co-pays were comparable to a physician visit.

Patients who lived less than a mile from a retail clinic were much more likely to access care at one than those who lived more than 10 miles away. Visits also were more common among patients 18 to 44 years old and those without a chronic condition.

During the time of the study, the number of clinics more than doubled, from about 500 in 2007 to more than 1,100 in 2009. Experts say patients may have become more comfortable and familiar with retail clinics, which offer limited services, usually with a nurse practitioner or physician assistant supervised by an off-site doctor. The health professionals often are employed by a local hospital or health system contracted to provide the care.

The growth was not linear. Usage in the study peaked in February 2009 at 6.8 visits per 1,000, then fell below 4 before rising in the fall. The numbers reflect the seasonal nature of retail clinics, which tend to be busiest in the fall and winter, during the peak of flu season.

"It likely comes down to people's experience," said Jeff D. Emerson, head of health care management and the regions at Aetna. "As the study points out, convenience is a key factor. Further, if people have a good experience, then they are more likely to go back and also to tell their friends. As a result, use grows."

During the past year, Kristin Drynan, MD, a family physician with Fox Valley Family Physicians in Geneva, Ill., has noticed that more of her patients receive some care at local retail clinics. Her practice has early morning and Saturday hours for urgent needs, but sometimes she and her fellow physicians are so busy that patients cannot get an appointment that fits their schedule.

"Most of the patients that I have seen that come back into our office went to a retail clinic because we didn't have the hours that they were looking for, or we were full," Dr. Drynan said.

The number of retail clinics is continuing to rise after some stagnation in 2009. There are 1,353 walk-in clinics across the country, an increase from 1,209 as of Dec. 1, 2010, according to a monthly report issued Dec. 1, 2011, by Merchant Medicine, a retail clinic consultancy firm in Shoreview, Minn.

Much of the growth is driven by MinuteClinic, the retail health care division of CVS Caremark. Starting in 2011, the company committed to opening 500 clinics within five years. The company opened 100 in 2011 and had a total of 552 as of Dec. 1, 2011. Other large chains are holding steady or growing more slowly.

"It's not an across-the-board expansion, but it's definitely picking up," said Tom Charland, CEO of Merchant Medicine.

The growth is in part because those who run retail clinics are preparing for a possible role in accountable care organizations and other aspects of health system reform. The venues may be a way to meet demand as many more people gain insurance, but the shortage of primary care physicians continues.

"We are adding clinics and developing relationships with major health systems around the country to collaborate on patient care and share clinical information electronically," said Andrew Sussman, MD, president of MinuteClinic. "We see an important role for MinuteClinic as part of a 'medical neighborhood,' complementing and collaborating with primary care practices and health systems around the country."

Despite the growth in the number of clinics and use by patients, retail clinics represent a very small part of the health system and, for the moment, do not appear to be affecting the financial health of physician practices, analysts said.

Researchers are looking at whether patients are using retail clinics instead of visiting primary care physicians or an emergency department or attempting to let the problem resolve on its own. MinuteClinic says 50% of people receiving care at its facilities do not have a relationship with a primary-care physician.

About $700 million most likely will be spent at walk-in clinics in 2011, but this is only 0.02% of the $2.7 trillion that the Centers for Medicare & Medicaid Services projects the U.S. will spend on health care in 2011, according to Merchant Medicine.

American Medical Association policy states that clinics should establish ways to ensure continuity of care with physicians and have processes for referring patients who require primary care. The organization adopted policy at its June 2011 meeting saying it will communicate with insurance companies on potential consequences of shifting patients to clinics not staffed by physicians.

"Store-based clinics may be useful for minor episodic care, but they cannot replace the important patient-physician relationship," said AMA President Peter W. Carmel, MD.

Dr. Drynan said retail clinics aren't affecting her financially. She said the biggest impact has been the hassles she experiences in trying to get information from retail clinics about her patients who have gone there.

When Dr. Drynan's patients receive care at a retail clinic, she sometimes receives a report on what occurred at the visit. Sometimes she doesn't. In that case, if "they don't get better and they come to me, I don't have much information to go on," she said.

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More insured patients turning to retail clinics

The monthly utilization of retail clinics went up over time among patients insured by Aetna. The monthly rate of retail clinic visits per thousand enrollees, with months chosen based on peaks and valleys in the visit cycle, with the summer months tending to quieter than those in the winter:


Source: Trends in Retail Clinic Use Among the Commercially Insured, The American Journal of Managed Care, November (link)

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External links

"Trends in Retail Clinic Use Among the Commercially Insured," American Journal of Managed Care, November (link)

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