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Dr. Ken’s Corner: Are Retail Clinics Cutting Down On ER Visits?

The concept seemed to be a no-brainer. Too many people going to the emergency room for minor ailments earaches, upper respiratory infections, rashes, and other non-emergency problems. Why not give patients the option of less expensive, convenient clinics located in drug stores and other retail outlets? Fifteen years later, hundreds of retail clinics have been opened at CVS Pharmacies, Walgreens, Walmart, Kroger’s and other retail sites, usually no more than 10 minutes from a hospital emergency room. What’s not to like? Wait times are short, appointments are not necessary, and they accept private insurance and Medicare.

Dr. Ken Teufel is the Medical Director at Interim Physicians.

Predictions were that retail clinics would cut down on costly ER visits for minor health issues. In the first study to look at this hypothesis, the nonprofit research group RAND looked at five years of data from more than 2000 emergency departments in 23 states covering the years 2007 to 2012.  The conclusion: With increased patient demand resulting from the expansion of health insurance coverage, retail clinics may emerge as an important care location, but to date, they have not been associated with a meaningful reduction in low-acuity [i.e. non-emergent] ED visits” (Annals of Emergency Medicine, November 2016).

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 of this happening, said lead author Grant Martsolf. 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 would have previously treated on their own, he added.

The study’s authors also point out that retail clinics may be less of an option for Medicaid patients because only an estimated 60% of them accept Medicaid (in comparison, 97% accepted private insurance and 93% accepted Medicare). Also, older patients are more likely to go the ER, since they often have more complex health issues. For other patients, deciding where to go for care can be a dilemma, not knowing if their health problem is serious or minor.

Despite these issues, retail clinics are more popular than ever.  Besides, says Dr. Andrew Sussman, chief medical officer at CVS, the RAND study’s findings are based on old data.  In 2012, the peak year of the study, there were only 1,200 retail clinics in the U.S.  By the end of 2016, says Sussman, there will be 2,150 clinics in the United States, and that number will exceed 2,800 in just two years (Accenture).

Recently, an increasing number of hospital systems have decided to partner with retail clinics to encourage more efficient use of retail clinics for non-emergencies. The vision is the same as it was 15 years ago: lower costs and shorter ER wait times.


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