Study: Retail Clinics Contribute to Higher Health Care Costs

March 24, 2016 02:45 pm Jessica Pupillo

Retail clinics, often touted by policymakers and insurers as offering health care savings, actually contribute to an increase in health care spending, according to a study published in March in Health Affairs.(content.healthaffairs.org)

[Pharmacist talking to woman holding infant]

Almost 2,000 retail clinics, located in pharmacies, grocery stores and "big-box stores" in the United States, provide care for low-acuity conditions, according to the study "Retail Clinic Visits for Low-Acuity Conditions Increase Utilization and Spending." Each year, more than 6 million patient visits occur at these retail clinics.

The study analyzed Aetna insurance claims data from 22 U.S. cities for 11 low-acuity conditions from 2010 to 2012. Researchers tracked spending for these conditions and determined whether retail clinic visits were substitutions for care at physicians' offices, urgent care centers or emergency departments, or whether they represented new utilization.

The study found that 3 percent of Aetna enrollees used a retail clinic in 2012. Researchers estimated that 42 percent of those retail clinic visits represented substitution, predominantly for physician office visits. Of these substitutions, 93 percent were for physician office visits, researchers estimated, and about 7 percent were for emergency department visits.

Story highlights
  • Retail clinics, often touted as offering health care savings, actually contribute to an increase in health care spending, according to a study published in March in Health Affairs.
  • Researchers analyzed Aetna insurance claims data from 22 U.S. cities for 11 low-acuity conditions from 2010 to 2012.
  • The study found that 3 percent of Aetna enrollees used a retail clinic in 2012 with an estimated 42 percent of those visits representing substitution for care, predominantly for physician office visits.

The remaining 58 percent of visits represented new health care utilization. Overall, retail clinic use drove up health care spending by $14 per person, per year, the study found. Pharmaceutical utilization was not addressed in this study.

Concern Remains About Continuity of Care

"I’m not sure that any of us found (these study results) too surprising," AAFP President Wanda Filer, M.D., M.B.A., of York, Pa., told AAFP News.

The study underscores the need for retail clinics to rapidly transmit visit details back to the patient’s primary care physician to ensure continuity of care and care coordination, she said.

Filer’s comments echo similar concerns in the AAFP policy on retail clinics, which states, "Care delivered in retail clinics can be a component of patient-centered care, but must work in coordination with the patients' primary care physician to ensure that care is not further fragmented. Fragmentation and unaccountable silos of care are in direct opposition to achieving continuous whole-person care with improved health outcomes for both the individual and society."

Continuity of care also is one of the governing characteristics(1 page PDF) established by the Academy in July 2015 to guide collaboration between retail clinics and the AAFP. The guidelines tell retail clinics to refer patients back to their primary care physician for ongoing care and to help patients who do not have a primary care physician locate one within the community.

While Filer respects patient choice, she said retail clinic visits should be "the exception, not the rule." And retail clinics are not ideal locations to provide chronic disease care, she added.

The study also reinforces the need for chronic disease care to be done in a primary care office because research suggests retail clinic care uses more resources, Filer said. "In a family physician’s office, we can achieve quality of care and patient satisfaction at a lower price point," she said.

Majority of Family Practices Offer Expanded Hours

Family physicians have continued to make their practices more accessible to patients, offering same-day and extended-hours appointments, Filer said. But family physicians should do a better job of letting their patients and community know they are available. This is especially true, she said, when it comes to those most likely to use a retail clinic: millennials and working families.

"It's incumbent on all of us to make sure that our patients know if they need to be seen, they can call us," Filer said. "Many of the patients I've seen who have gone to retail clinics didn't know we were open or assumed they couldn't get an appointment."

According to the AAFP 2014 Practice Profile, 81 percent of family practices offer same-day scheduling. Furthermore, 55 percent offer early morning or evening appointments and 33 percent offer weekend appointments. Family physicians also are increasingly offering email communication and web portals with secure messaging options, as well.

Many low-acuity conditions can be handled via a phone call or email, Filer said. "This is where the value of continuity of care comes into play," she said. And this type of low-cost care was not identified in the retail clinic study's health care spending averages for physician office visits.

"This behooves all of us to redouble our efforts and say, 'We are your medical home. Let us show you what we can do for you,'" Filer said.

Related AAFP News Coverage
AAFP Board Takes Tough Stand on Retail Clinics
(7/31/2015)

Questions About Retail Health Clinics Yet to Be Resolved, Says Former AAFP President
(6/21/2012)