By Diana Swift
Promoted by policy makers and insurers as a way to decrease healthcare costs, easy-access retail clinics appear to do the opposite, according to a study published in the March issue of Health Affairs.
Health Affairs talks with DPC Journal and Others: ” Abstract Direct primary care represents a new model for providers eager to spend more time with fewer patients and bypass insurance headaches.”
Researchers led by J. Scott Ashwood, PhD, an associate policy researcher at the RAND Corporation think tank in Santa Monica, California, found that visits to these clinics, conveniently located in supermarkets, pharmacies, and large chain stores for handling low-acuity conditions, led to an additional $14 per person per year in spending.
About three fifths (58%) of visits were new uses, rather than substitutions for pricier consultations in regular physicians’ offices or the emergency department.
“These findings do not support the idea that retail clinics decrease health care spending,” Dr Ashwood and coauthors write.
At this time, the United States has almost 2000 of these burgeoning and profitable clinics; their numbers are expected to reach 2800 by 2017.
Annually, they clock more than 6 million patient visits for a limited range of preventive services, such as immunizations, and care for low-acuity problems such as urinary tract infections and sinusitis. Although cheaper per visit, retail clinic consultations “may also lead to new utilization (when patients who previously would not have sought care visit a retail clinic because of its lower price or perceived convenience), which increases both the total number of patient visits and spending,” the authors write.
Using claims data from health insurer Aetna, the investigators tracked use and spending for retail clinic users vs nonusers in 22 cities during 2010 to 2012. The cohorts involved 13.3 million enrollees aged 65 years or older seeking care for 11 common low-acuity conditions, which in 2012 drove 62.3% of retail clinic visits.
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Health Affairs talks with DPC Journal and Others: ” Abstract Direct primary care represents a new model for providers eager to spend more time with fewer patients and bypass insurance headaches.”
Interestingly, retail clinic usage increased from no visits per 1000 per quarter in 2005 to 11 visits per 1000 in the fourth quarter of 2012. By 2012, 3.0% of all Aetna enrollees had used a retail clinic.
Roughly 42% of retail visits for low-acuity conditions represented substitution and 58% represented new use. “Instead of decreasing spending overall, we found that use of retail clinic was associated with 21 percent higher spending for low-acuity conditions (an increase of $14 per person per year relative to $66 spent by nonusers,” Dr Ashwood and colleagues write.
During 2010 to 2012, annual per person spending among retail clinic users rose by $35 (95% confidence interval, $34 – $37) for retail clinic visits and decreased by $21 (95% confidence interval, −$31 to −$11) for visits to physicians’ offices and emergency departments.
In 2010, retail clinic users and nonusers racked up 71 combined physician office and emergency department visits for low-acuity conditions per 100 enrollees, and no retail clinic visits. From 2010 to 2012, however, users showed an increase of 69 retail clinic visits per 100 enrollees (95% confidence interval, 66 – 72). Compared with nonusers, users made fewer visits during 2010 to 2012 to physician offices and emergency departments: 29 fewer per 100 enrollees (95% confidence interval, −46 to −12). Hence, the $21 in savings from the substitution of retail clinic visits for care at costlier venues offset 60% of the increased $35 spending on retail clinic visits.
The results, however, run counter to insurer efforts to encourage retail clinic by direct marketing and waiving copayments. “If these interventions were driven by a desire to decrease health care spending, our results imply that they may not be completely effective,” the investigators write. They add that the findings should assist insurers in making future decisions about coverage of retail clinics and other convenient-care options.
The situation has the ring of “If you build it, they will come.”
“For example, the innovation of personal computers increased the number of computers sold, and the introduction of laparoscopic technology greatly increased the number of cholecystectomies performed,” Dr Ashwood and colleagues write.
They also note that overall cost–benefit depends on perspective, and patients may be willing to pay for the easy accessibility of retail clinic care. “It is reasonable to assume that patients who seek care at retail clinics gain value from new utilization if they would otherwise have not sought care for their health conditions,” they write.
Physicians, however, have raised concerns about the value of retail clinics for chronic care and the siphoning-off effect when patients return to these clinics instead of to regular primary care.
The American Academy of Pediatrics has recommended against their use for child health care.
“Future research should investigate how retail clinics affect the coordination of care, care for chronic illnesses, and overall spending,” the authors conclude.
This study was supported by the Robert Wood Johnson Foundation, which had no role in any aspect of the study. The authors have disclosed no relevant financial relationships.
Health Aff. 2016;35:449-455. Full text
