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Rethinking the Role of Retail Clinics

December 19, 2016 News 3 Comments

HIStalk takes a deeper dive into a recent study that found retail clinics have a negligible impact on nearby ED admissions.
By
@JennHIStalk

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Retail clinics have gotten a bad rap lately, thanks to an Annals of Emergency Medicine-published study that found the clinics had a less-than-hoped-for impact on local ED visits. While that particular statistical nugget certainly made for good headlines, a deeper dive into the research finds that such clinics may well be on their way to not only alleviating low-acuity ED visits, but to finally becoming a trusted part of the care continuum.

Evolution of a Business Model

Since debuting in 2001, retail clinics seem to have grown exponentially, taking up valuable real estate in strip malls, pharmacies, shopping malls, and even the local commuter train station. Accenture predicts that their numbers will close in on 3,000 within the next several months – a 46 percent increase over 2014 figures. Patients – primarily those with private insurance – have become accustomed to their convenient hours, accessibility, and increasingly transparent pricing.

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Health systems have certainly jumped on the retail clinic bandwagon for a variety of reasons. “Hospitals and health systems are employing a variety of strategies to reduce the use of emergency department and hospital readmissions,” says Nancy Foster, AHA’s vice president of quality and patient safety policy. “One such strategy is partnering with existing retail clinics or creating their own. This helps patients by giving them an additional access point for critical follow-up care after a hospitalization. And by having a formal partnership, the hospital or health system can more easily share follow-up instructions with clinical staff at the retail clinics.”

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Mount Sinai Health System (NY) is one such health system that has recognized the need to offer additional access points as part of broader population health programs. The system, which has seven hospitals and over 140 physician practices, announced a partnership with urgent care company CityMD earlier this month, and seems intent on closing the loop between urgent care and primary and specialty care visits. The partners plan to jointly establish quality metrics for a shared network of preferred providers, ensuring that CityMD patients have immediate access to specialty care through Mount Sinai providers. They will also share EHRs for faster data access, though they haven’t gotten into specifics as to how their respective Epic and EClinicalWorks systems will talk to one another.

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Some clinics, like the new Westmount Place Walk-in Clinic in Ontario, are opening with the express intent of alleviating the local ED’s physician shortage. “We know we are in a crisis from an emergency room perspective if our hospital is fundraising for an emergency room resident,” explains local government official Catherine Fife. “Having urgent care centers like this, which are community based, is an important asset we need to have in more communities across the province.”

Rethinking the Results

Though the Westmount clinic’s provenance puts it outside the purview of the AEM study, it provides a concrete example of the potential role retail and urgent care clinics can play in a community’s care continuum, including significantly reducing ED visits.

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This potential did not show up in study results because, according to MinuteClinic President and CVS Health Executive Vice President and Associate Chief Medical Officer Andrew Sussman, MD, it looked at data from 2,053 EDs between 2007 and 2012 – a time when awareness and general usage of retail clinics was very early on.

“The results show statistically significant reductions in low-acuity ED use for commercially insured patients in communities where retail clinics were open,” he explains. “While the reduction may be small (1.2 percent), you should keep in mind that the old data evaluated in this study had only 1,200 clinics at its peak. MinuteClinic alone has 1,100 clinics today across 33 states. The effect of retail clinics today is far greater than the early phase of their development in this study.”

“The study also doesn’t take into account the presence of any urgent care clinic sites in a particular area,” he adds. “There are far more urgent care sites, around 9,000, than retail clinics in the US overall. Urgent care has been growing at about 8 percent annually, compounding their effect. Without knowing the precise location of the large number of urgent care sites, it is impossible to interpret the trends of low-acuity care seen in EDs.”

From Concept to Cost-Savings

Sussman goes on to point out that the study’s results should ultimately be viewed through the lens of today’s healthcare ecosystem rather than that of five years ago, when “coordinated care” was still in its infancy and “value-based care” was a concept confined to a cocktail napkin. “We have far more clinics, much higher levels of utilization, and higher awareness of retail clinic services,” he says. “Also, transparent retail clinic pricing is particularly attractive to today’s growing number of Americans with high-deductible health plans, not present prior to 2012, and as consumerism in healthcare grows. In addition to private insurance, today more retail clinics accept Medicaid than they did during the study period.”

Sussman brings up a good point: Retail clinics, which traditionally have opened in suburban communities with higher-income, privately-insured consumers, are seeing reimbursement opportunities increase thanks to Medicaid expansion. Couple that with the burgeoning interest of health systems – especially where shared referral networks and healthcare technology are concerned – and you have a recipe for retail clinic success when it comes to significantly impacting ED visits and even hospital readmissions.

Sussman sums up by saying, “in today’s retail clinic world, we would expect to see even more significant reductions in ED low-acuity visits due to retail clinic presence. Many millions of patients appreciate the access to care and cost savings that retail clinics provide.”

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Currently there are "3 comments" on this Article:

  1. I think we all agree that convenient care options (whether pharmacy based clinics, urgent care centers, or increasingly tele-visits) are growing quickly.
    What is a bit more murky is: Where did all these patients come from – how many would have gone to their PCP vs. an ER vs. stayed at home.
    To assess this more fully – one has to take a good look at the stats BOTH the PCP and ER offices, as well as survey these patients to find out what they would have done without the convenient option (I know that many of the telehealth companies do this consistently, I wonder if the other convenient care options do as well?).
    Some early analytics I’ve looked at suggest that the major drop is at the PCP office, with minimal impact on the ER. Which makes sense- these are very low acuity issues.
    Over the past ten years, I’d suggest that the typical PCP schedule likely had around 20-25% of these low acuity cases (mainly URI), and that now these are under 10%.
    This has two major implications:
    GOOD NEWS: PCPs have more time for the complicated cases that they should be spending more time on (“appropriate height of license”).
    BAD NEWS #1: We all still use the same scheduling blocks in place for the past few decades… but now docs are being asked to see more complicated patients, AND do more regulatory-based documentation… meaning that this shift in lower to higher acuity is a big cause of burnout! The progressive PCP practices have realized this and are starting to provide longer visit times so the doctors can deal with everything in a sane way.
    BAD NEWS #2: These low acuity visits often were a way to bring patients “back into the fold” and manage their other chronic issues at the same time (ie They didn’t come in when they felt well, only when they felt sick)… .so one unintended consequence might be that patients are missing out on chronic care and preventive maintenance since they have less face time with their PCPs. We are starting to see pharmacy based clinics consider if/how they play in that arena as well; and Urgent care centers being opened by large HC systems to at least preserve some continuity.

    NOTE: The other group of big patients that use these convenient care options likely do NOT have a PCP… and so we hope that this can serve as an opportunity to convert them over to seeing one.. but I have not seen a study on that yet.

  2. My experiences may be anecdotal, but with two young children, I have used our local suburban retail clinic or urgent care clinic approximately 15-20 times over the past 5 years for my children, my spouse, and me. In essentially ALL of our visits, the visits occurred on the weekend–when our PCP wasn’t open. Other visits were from 3-9pm, when our PCP is also either closed or too busy to see us on the same day. Almost all of the cases in my family have been for strep throat, ear infection, or UTI. So yeah, maybe one could argue we diverted business from PCP vs ER, but the ER would have been our other option due to the episodes occurring over weekends. (Please someone tell me why the kid always has the worst symptoms of sore throat and/or gets a fever at 7pm Friday night?!?! or Sunday night?!?!)







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