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NPs Lower Costs at Retail Health Clinics

 |  By Alexandra Wilson Pecci  
   November 12, 2013

Nurse practitioners at retail clinics provide high-quality, low-cost care, research shows, but the savings for operators could be even greater if scope-of-practice restrictions were lifted.

It's a familiar scene to busy parents: You've got errands to run, dinner to make, and a kid with a sore throat and fever. You know that even if you could manage to land a last-minute appointment with the pediatrician, you'd be stuck waiting for the doctor for at least an hour once you get there.

With your child's fever rising, that retail clinic at your local big box store starts to look like a great idea. And there's a bonus: There's a pharmacy there, too.

Over the past decade and a half, the use of retail clinics has risen quickly. A study released last week by the Center for Studying Health System Change and funded by the Robert Wood Johnson Foundation found that in 2010, an estimated 4.1 million American families reported using retail clinics in the previous 12 months, compared to 1.7 million families in 2007.

And according to a separate study funded by the Robert Wood Johnson Foundation's Interdisciplinary Nursing Quality Research Initiative and appearing in the November issue of Health Affairs, nurse practitioners who work in these clinics can provide high-quality, lower-cost care.

Lower Costs
Researchers found that "visits to retail clinics were associated with lower costs per episode, compared to episodes of care that did not begin with a retail clinic visit." Those costs were lower when NPs practiced independently, the study said.

Moreover, eliminating NPs' scope-of-practice restrictions would potentially provide even greater cost savings, finds the study, "Scope-Of-Practice Laws For Nurse Practitioners Limit Cost Savings That Can Be Achieved In Retail Clinics."

The study estimates that the "savings would be $810 million greater if all states allowed NPs to practice independently and $472 million greater if NPs could both practice and prescribe independently."

The Convenience Factor
The increased use of and cost savings from retail clinics have several implications for nurse and other healthcare executives, says study co-author Joanne Spetz, PhD, a professor at the Institute for Health Policy Studies and associate director for Research Strategy at the Center for the Health Professions at the University of California, San Francisco.

"I think hospital leaders and primary care clinics can be thinking of how they can leverage retail clinics or how they can have an urgent care drop-in clinic-type model," Spetz tells me. "That convenience factor in meeting people's needs is going to be increasingly important."

In the interest of serving—or maybe reclaiming—patients who want this kind of convenience, healthcare organizations might consider establishing drop-in clinics of their own. Nurse practitioners are the logical choice for staffing such clinics, Spetz says.

Retail clinics provide relatively limited care and don't usually treat conditions that require follow up. NPs are great at providing this kind of care because they "really do have a great level of knowledge for that," Spetz says. "They have the clinical skills to know if someone is truly sick… but they are also really adept at providing the really basic primary care services that people are coming to these clinics for."

Restrictions Apply
Because scope-of-practice laws are burdensome, healthcare organizations that do dive into the drop-in clinic world might consider lobbying their legislators to ease up on those laws so they can realize some of the potential cost savings outlined in the study, Spetz says.

Finally, the study authors suggest there needs to be improved care coordination between traditional providers and retail clinics.

"That information that the patient was even [visiting the retail clinic] may or may not make it back to the primary care office," Spetz says, therefore it would behoove hospitals to open the lines of communication between themselves and retail clinics. "Everyone needs to be more cognizant about how they can share information."

The bottom line? Retail clinics aren't going away and might just be the perfect marriage between nurse practitioners' skills and patient needs and demands. And for the cost-savings from retail clinics to be even greater, APRNs must not be limited by scope of practice laws.

"I've never seen a study that showed that restrictions on NP's practice improved patient safety," Spetz says.

If those burdens are costly, and don't improve patient safety, then what's the point?


See Also: Slideshow: How to Open an Urgent Care Center

Alexandra Wilson Pecci is an editor for HealthLeaders.

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