Contrary to researchers' expectations, data shows that for low-acuity ailments, the proliferation of retail healthcare clinics across the United States does not reduce patient volumes at hospital emergency departments.
Retail medical clinics located near hospital emergency departments do not reduce visits to the emergency departments for minor health ailments, a RAND Corporation study shows.
The study, published online this week in Annals of Emergency Medicine, examined five years of data from 2,000 emergency departments in 23 states for 11 low-acuity ailments such as respiratory infections and ear aches.
"One hope for retail clinics was that they might divert patients from making expensive visits to the emergency department for minor conditions such as bronchitis or urinary tract infections, but we found no evidence that this has been happening," said Grant Martsolf, lead author of the study and a policy researcher at RAND.
"Instead of lowering costs, retail clinics may be substituting for care in other settings such as primary care practices or spur some patients to seek care for problems they previously would have treated on their own," Martsolf said.
There are nearly 2,000 retail clinics across the United States now, and they receive more than 6 million patient visits annually. These clinics are often staffed by nurse practitioners, with prices that are often considerably lower than at a physician's office or an emergency department, often because fewer tests are performed.
Methodology
RAND used information from the federal Healthcare Cost and Utilization Project State Emergency Department Databases from 2006 to 2012 to combine emergency department use with information about the opening of retail clinics obtained from Merchant Medicine, a research firm that tracks trends in walk-in medicine.
Retail clinical penetration was measured as the percentage of an emergency department's catchment area that overlapped with a 10-minute drive of a retail clinic. The 11 low-acuity conditions studied are commonly seen in both retail clinics and hospital emergency departments.
According to the study, the number of retail clinics grew from 130 in 2006 to nearly 1,400 in 2012. The proportion of the emergency department catchment area that overlaps with a 10-minute drive radius of a retail clinic more than doubled between 2007 and 2012 among states in the study sample. One-third of the urban population in the United States now lives within a 10-minute drive of a retail clinic.
During the period studied, there were only about 17 fewer low-acuity trips to the emergency department in one year for privately insured patients living in areas where the retail clinic penetration rate increased by 40% in that year, which is less than a 1% reduction, the study found.
"Retail clinics may emerge as an important location for medical care to meet increasing demand as more people become insured under the Affordable Care Act," said study co-author Ateev Mehrotra, MD, an associate professor at the Harvard Medical School and an adjunct researcher at RAND.
"But contrary to our expectations, we found retail clinics do not appear to be leading to meaningful reductions in low-urgency visits to hospital emergency departments."
Walk-in Clinics Boost Utilization
An editorial accompanying the study suggested that the primary effect of opening retail clinics is to increase healthcare use, not substitute for emergency department visits.
"Given that convenience settings don't prevent ER visits, what can be done in an era where looming government reforms may soon restrict the very payments that support them?" said editorial author Jesse Pines, MD, of the George Washington University School of Medicine and Health Sciences. "The answer is not to build more convenience settings, but to improve the value of existing settings by increasing the connectivity among providers and with longitudinal care."
Retail Health Industry Reaction
In response to the RAND findings, the Convenient Care Association, the national trade association for the retail health industry, issued a statement.
"Retail clinics provide accessible, affordable high-quality healthcare in locations that are convenient for patients and consumers and today there are approximately 2,300 clinics in 41 states and the District of Columbia," said Tine Hansen-Turton, Executive Director of the CCA.
"The RAND Study relied upon old data from when there were only about 1,200 clinics in operation." Hansen-Turton explained that "with the growing number of retail clinics today and in the future, clinics will have a bigger effect on the reduction of low-acuity visits to emergency rooms."
She further noted that "the study did not take into account the more than 9,000 urgent care centers in the areas of the study, thereby leaving an opportunity to for additional research to better understand the complete picture of where low-acuity visits are taking place."
John Commins is the news editor for HealthLeaders.