The growing acceptance, use and demand for retail medicine is driven by rapid advances in digital technology, evolving demographic and cultural expectations, and legislative changes in healthcare delivery, most of which were underestimated just a few years ago.
Retail clinics, which began operating in their present format in 2000, are medical clinics located in pharmacies, grocery stores, and “big box” stores, such as Target and Walmart. These clinics offer extended weekend and evening hours, walk-in availability, and short wait times. Many visits to retail clinics are in the evenings and weekends, when primary care offices are not available. The clinics treat a limited range of health conditions, such as minor infections and injuries, and provide vaccines and other preventive care. Care is delivered by a nurse practitioner or physician assistant. Prices are typically fixed and transparent*.
A key facilitator of retail (i.e. non-traditional site) clinics is the development of easy to use rapid point of care testing, electronic data storage, telephone apps for mobile information exchange, clinic locations, and appointments; and connections to other on-site services such as the pharmacy, allows defined but complete services to be provided.
In an early study**, the largest group of clinic users were younger adults, age 18–44, who accounted for 43 percent of patients. Nationally, this group made up only 23 percent of patients who visited primary care physicians. This study further showed that:
1. Only about one-third of clinic users said that they had a primary care physician.
2. Two-thirds of retail clinic visits were paid for with health insurance, compared with 90 percent of visits to primary care physicians.
3. About 90 percent of visits to retail clinics were for preventive care and for ten simple acute conditions: upper respiratory infections, sinusitis, bronchitis, sore throat, immunizations, inner ear infections, swimmer’s ear, conjunctivitis, urinary tract infections, and blood tests. The same conditions accounted for 18 percent of visits to primary care physician offices and 12 percent of emergency department visits.
Demographically, this data indicates millennials are the largest demographic group accessing these retail clinics, reflecting their economic situation, as well as the cultural preferences of this generation. (convenient rapid access, less likely to have a particular primary physician, adept with mobile technology).
(As a side note, more recently, the percentage of users over 65 has also grown rapidly, possible reflecting longer wait times to access traditional physician services)
A recent study found that the Affordable Care Act has added pressure to a twofold problem that already exists in our country: a physician shortage and increasing wait times. The study’s conclusion notes that “an increase in the number of people with access to health insurance. does not always guarantee access to a physician”***.
As wait times to see a doctor lengthen, more and more people are turning to retail health clinics. The number of visits to such clinics quadrupled from 1.48 million in 2007 to 5.97 million in 2009, according to a study published in the journal Health Affairs, and topped 10 million in 2012, New research by Accenture forecasts that the number of retail health clinics will exceed 2,800 by 2017 with a capacity for 25 million patient visits in 2017, up from 16 million in 2014.
Retail Medical Clinics Will Expand Their Testing Menu and Offer More Clinical Lab Tests****
Clinical laboratory managers should take note of one important development. In the early stages of the retail clinic movement, few of these rapid clinics were linked to hospitals or medical centers. Today, 1 in 10 has a hospital connection, according to Merchant Medicine News, an online newsletter for the clinic industry.
A Managed Care Magazine article, reported that Blue Cross & Blue Shield’s plan now has traditional provider contracts with retail clinics, and the clinics are on the menu of provider options all members receive. The article further pointed out that some employers are offering employees incentives to use retail clinics by waiving copayments.
Retail clinics are positioning themselves to play a major role in the delivery of basic primary care services. Consumer and payer acceptance of the “convenience care” model has brought the concept to a tipping point in its potential to shift the way that some basic primary care—and medical laboratory testing—services are delivered. Pathologists and clinical laboratory managers should expect to see, over time, a steady increase in the menu of diagnostic testing offered by retail clinics.
This is a positive development for smaller labs and pathologists, since convenient care clinics will need fast, accessible test services and will value the expertise of pathologists and laboratory scientists who can help interpret medical laboratory test results. For pathologists and clinical laboratory managers, the rapid expansion of retail clinics means that it may become commonplace for pharmacies to draw the patient’s blood, then “sell” the ordered lab tests and collect payment while the consumer is still in the retail store.
Rapid clinic operators recognize that there are financial incentives to providing medical laboratory tests. They also know there is even more money to be made by giving the patient immediate access to purchase the prescription drug(s) that would be indicated, based on the diagnostic test results performed by the clinician in the retail clinic.
* The Evolving Role of Retail Clinics. RAND Corporation. Research Briefs. http://www.rand.org/pubs/research_briefs/RB9491-2.html
***Rosario, K. Wait Times to See a Doctor Have Increased Under Obamacare.LifeNews.com. NATIONAL
Jan 30, 2014 | 6:12PM Washington, DC. http://www.lifenews.com/2014/01/30/wait-times-to-see-a-doctor-have-increased-under-obamacare/
****Retail Clinics Are Poised to Offer More Health Services Participate in ACOS, and Offer Expanded Menu of Clinical Pathology Laboratory Tests, Dark Daily September 11, 2013. http://www.darkdaily.com/retail-clinics-are-poised-to-offer-more-health-services-participate-in-acos-and-offer-expanded-menu-of-clinical-pathology-laboratory-tests-911#axzz4RVYwn2N6