CVS's Minute Clinic, Target's Clinic, The Clinic at Walmart, Walgreens' Take Care Health Clinic—what do they have in common? They are part of a growing breed of retail clinics that provide fast, low-cost, convenient care for customers. They are also located in more affluent communities, according to a new study from the University of Pennsylvania School of Medicine.
Most retail clinics, also called convenient care clinics, tend to be located in areas of higher incomes with higher percentages of Caucasian residents, according to a new study, "The Geographic Accessibility of Retail Clinics for Underserved Populations," published in The Archives of Internal Medicine in May.
The haves and the have-nots
"Retail clinics allow for convenient use of medical services for relatively low acuity needs," said Craig Evan Pollack, MD, MHS, Robert Wood Johnson Foundation Clinical Scholar at the University of Pennsylvania in Philadelphia. "They are not only designed to be convenient but are also a lower cost alternative."
However, only about 13% of the nearly 1,000 U.S. retail clinics are located in underserved communities, that is, areas designated by the Health Resources and Services Administration to have fewer primary care physicians, higher infant mortality rates, poorer populations, and senior citizens.
The study found that convenient care clinics are not as prominent in areas with higher rates of poverty, lower incomes, and higher percentages of African Americans and Hispanics, highlighting the socio-economical irony that these types of clinics are not located in areas where people need them the most.
"If retail clinics are to improve access for these populations, they must be located in places where they are able to be reached," states the study.
The purpose of the quickie-clinic
The retail clinic was first developed in 2000, giving consumers an option for one-stop shopping for their medical needs, while getting their groceries. Existing chain stores such as pharmacies and supermarkets offered preventative care services and quick visits for common illnesses, most often for sore throat, cold, and flu patients, according to the Convenient Care Association (CCA).
Typically operated by a nurse practitioner under the supervision of an off-site physician, the retail clinic is usually opened 24/7 for walk-in customers with no appointment needed. The visit time lasts about15-20 minutes. Retail clinics accept most insurance co-pays, including Medicare and Medicaid. For those that pay out of pocket, a clinic visit costs significantly less than going to the PCP or emergency department, with an average price of $40-$75 per clinic visit. As the lowest cost option without government support, according to the CCA, the retail clinic also boasts price transparency by clearly posting their prices for the consumer.
Since its inception, retail clinics have gained momentum, providing care to more than 3.5 million patients, according to the CCA, with the most locations in Florida, California, Texas, Illinois, and Georgia, according to the study.
Longtime proponents of retail clinics say they are advantageous for providers and hospital emergency departments, as convenient care clinics divert patient loads from overcrowded ERs and freeing up the limited number of PCPs from their already booked schedules.
For patients, retail clinics are faster, cheaper, and easier (to access) for customers who report that high levels of satisfaction, according to previous studies. In fact, 35% of retail clinic patients are self-pay, indicating that they either have high-deductible health plans or no insurance at all, according to Tine Hansen-Turton, MGA, JD, executive director of Convenient Care Association in Philadelphia.
And despite its touted benefits of aiding vulnerable populations, the retail clinic wasn't designed for the population with the greatest need, according to Pollack.
A gap in medical care?
"The convenient care industry was never devised as a safety net," according to a statement from the CCA. There already exists, in the U.S., a functional safety net with community, school-based, and rural health centers. Instead, the convenient care clinic is a niche provider, a natural extension and partner to existing medical services, said Hansen-Turton.
"We weren't designated as a safety net, but we do provide valuable access point across socio-economic [classes]," she said.
Retail clinics continue to grow in numbers, although some clinic locations are seasonal operations, according to Hansen-Turton.
Pollack admits that more research is needed. His study looked at retail clinics in proximity to where medically underserved residents live, but doesn't look at where they travel to shop or seek medical services.
"If we determine that retail clinics are beneficial…then we need to think about their current distribution and incentivize their opening in underserved communities," he said.
Karen M. Cheung is associate editor at HCPro, Inc., and blogger for HospitalistLeadership.com. She can be contacted at kcheung@hcpro.com.