Retail medical clinics are becoming a common site in many cities and towns. The clinics, popular for their lower prices, can provide quality care comparable to that offered in physicians' offices, urgent care centers, or hospital emergency departments, according to two separate studies from RAND appearing in this month's Annals of Internal Medicine.
More than 1,000 retail clinics currently operate in the United States in places such as pharmacies, discount stores, and grocery stores. In addition to lower costs, these clinics require no appointments, are open on weekends and evenings, and report shorter waiting times.
However, since the first retail clinic opened in 2000, several physician organizations, including the American Medical Association and American Academy of Pediatrics, have raised concerns about the quality of care that retail clinics deliver—arguing that visiting a retail clinic could lead to unforeseen complications that result in higher healthcare costs.
To evaluate the validity of those concerns, the researchers analyzed claims data from a large Minnesota health plan that has been providing coverage for its enrollees at retail clinics for more than 5 years. The researchers compared the cost, quality of care, and the delivery of preventive services for 2,100 patients who received care for three conditions commonly treated in retail clinics—otitis media, pharyngitis, and urinary tract infection [UTI]. These episodes were matched with other episodes in which these illnesses were treated first in physician offices, urgent care centers, or emergency departments.
The researcher found that the quality of care in retail clinics was similar to that provided in physician offices and urgent care centers and slightly superior to that of emergency departments.
Nurse practitioners, rather than physicians, generally provide the care in retail clinics. The findings were consistent with previous research that found no difference between the quality of care delivered by nurse practitioners and physicians, according to Ateev Mehrotra, MD, a professor at the University of Pittsburgh School of Medicine and one of the RAND researchers.
"What was surprising a bit to me was the issue on impact on preventive care," Mehrotra says. Earlier concerns had emerged that patients who visit retail clinics would be less likely to receive preventive care than if they had received similar care at a physician's office.
This was not the case. Instead, the researchers found that rates of preventive care received at the initial visit through the subsequent three months were similar for retail clinics and physician offices. For patients who visit a retail clinic, preventive care was typically delivered in a physician's office, which suggests that the clinics were not disrupting opportunities for preventive services.
The costs of care in retail clinics were 30% to 40% lower than in physician offices and urgent care centers, and they were 80% lower than in emergency departments. The differences were related to lower reimbursements for evaluation and management visits and lower rates of laboratory testing in retail clinics.
In the second study, the researchers noted that 42 operators ran 982 clinics in 33 states as of August 2008. More than 88% were located in urban areas; and nearly half (44%) of all clinics were located in five states (Florida, California, Texas, Minnesota, and Illinois). Almost all (97%) accepted private insurance and Medicare fee for service (93%).
Among 42 clinic operators across the country, 25 were existing healthcare companies that operated 11% of the clinics, and three were for profit retail chains that operated 73% of the clinics.
Mehrotra adds that even while there had been much criticism of retail clinics by established healthcare providers, the study showed that "a number of these current providers—physician groups and hospital chains—believe in the model and they are willing to enter the model themselves."