What Primary Care Can Learn From Retail Clinics

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Photo credit: Mike Mozart/FLICKR (cropped from original)

It is Friday evening and you are happy to arrive at the restaurant you made a reservation for two weeks ago. You have high hopes for your visit, as the restaurant had good reviews according to comprehensive online ratings. You walk into the restaurant and discover that nothing on the menu has prices. But, you are really hungry, so you dine anyway. A few weeks later you receive a bill in the mail and discover your meal cost much more than you anticipated.

As odd as this restaurant sounds, this is a snapshot of how the U.S. healthcare system currently serves and bills patients. The way a hospital calculates how much a procedure costs is complicated and largely remains a mystery to the consumer.

Now imagine a doctor’s office with weekend hours, short wait times and a menu with prices right next to each service. This is what retail clinics (also known as walk-in clinics or convenient care clinics) have accomplished. Retail clinics currently allow patients to navigate their medical care with a higher degree of transparency, convenience and accessibility that primary care currently does not offer.

In 2000, CVS opened the first MinuteClinic, which sparked a new era of retail clinics. Today, the industry is booming. CVS reports to have more than 800 MinuteClinics across the country. Additionally, similar clinics can be found in Walgreens, Walmart, Target, and other large retail store settings.

When patients visit the clinic, they sign in at an electronic kiosk to see a health professional (usually a nurse or physician’s assistant). The patient’s medical history is reviewed, and symptoms are discussed. After appropriate diagnosis, the practitioner provides the patient with a summary, a receipt and educational material. The visit summary can then be sent to the patient’s primary care physician.

Services that are offered include diagnosing, treating, and writing prescriptions for minor illnesses (strep throat, pink eye, ear/nose/throat infections), tuberculosis testing, and providing vaccinations for flu, pneumonia, pertussis and hepatitis.

At CVS, the cost to treat minor illnesses range from $79-$99 – a significant discount compared to a doctor’s office. A 2009 study found that treatment of common ailments such as sore throat, ear infections, and urinary tract infections cost at least 30 percent less at a walk-in clinic compared to ambulatory care settings. A variety of health insurance plans are accepted at these clinics, just as in a doctor’s office.

Moreover, the financial burden of emergency room visits can also be relieved if patients start to use retail clinics more for non-emergency care. According to a report in HealthAffairs, about a quarter of all emergency room visits could instead take place in retail clinics, significantly decreasing patients’ out of pocket spending.

Retail clinics require no appointment, aim to limit wait times, and are located in other one-stop shops. In one study, nearly half of the visits to such clinics were on the weekends or other off-hours when doctors’ offices are typically closed. If the wait time exceeds thirty minutes, MinuteClinic gives patients text message alerts so they can shop or run errands while waiting. And, since retail clinics are open during weekends and offer longer hours, patients don’t have to take time off work just to make a special trip to see their physician. 

Some experts voice the concern that retail clinics provide less quality care. At least for non-complex patients with one or two ailments, quality care is actually not compromised at retail clinics. For instance, a 2014 study published in the American Journal of Managed Care reports that children visiting MinuteClinics performed better for urinary tract infections, strep throat, and ear infection treatments compared to outpatient centers and emergency departments.

While retail clinics, like one-stop pharmacies, can cover basic needs, patients who have more complicated conditions, should not neglect going to see a primary care expert.

“Patients may be completely unaware of what level of care they need,” said Dr. Stephen Persell, a physician and professor of internal medicine at Northwestern University. “The person they see in a retail clinic may have lower training than a primary care doctor.”

In other words, retail clinics are limited when it comes to delivering comprehensive care. Unlike physician’s offices in large hospitals, retail clinics do not benefit from the hierarchy of care in which multiple layers of expertise are involved for patients with complex conditions.

“Patients who start to develop things like chronic kidney disease from diabetes or hypertension become fairly complex, and they have to manage their medication more carefully,” Persell said. “I think clinicians with higher levels of training may be better suited to do that.”

Dr. Howard Chrisman, a professor of radiology at Northwestern University expressed a similar sentiment. “Hospitals tend to have a team around them, whether it be primary care, social work, or nutrition - you have a whole team that’s built around the diabetic patient access through care continuum,” he said.

It is important to recognize that retail clinics are not exactly a cure-all, but one layer of the stratification that constitutes primary care. The merit in recognizing this hierarchy of care is to see through the unique and diverse needs of patients. Some patients are healthy and require just preventative services. Others have acute needs, or chronic diseases. Preventative and acute services can be offered to patients with retail clinics, as they are faster and more accessible.

When it comes to the future of primary care, hospitals have a lot to learn from retail clinics. “What retail will do is look at where traditional healthcare providers have failed,” said Dr. Chrisman, when asked about how the field of primary care is evolving. “In all the areas including transparency, accountability, cost-control, access, overall service, we have failed on many of those fronts. I think retail knows that.”

Healthcare providers need to understand these “cracks” of consumer dissatisfaction and decide what role they want to play in that conversation. We are already seeing progress made in joining the movement of retail clinics with hospitals, as partnerships between the two are being established. MinuteClinics have a growing list of clinical affiliations including large hospitals such as Cleveland Clinic. The collaboration of the two systems will lead to primary healthcare that can be delivered with comprehensiveness that does not neglect transparency and convenience.

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