Milk, Bread and... Medical Care? Healthcare goes Retail

Milk, Bread and... Medical Care? Healthcare goes Retail

Milk, Bread and... Medical Care? Healthcare goes Retail

Retail medical clinics have done what the healthcare industry has been unable or unwilling to do - give consumers what they want...fast, convenient and affordable care for minor problems

   

Milk, Bread and... Medical Care? Healthcare goes Retail

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You know the routine – up early, make breakfast, pack kids’ lunches, telephone the carpool mom, dash to work, run out at lunch to pick up a few groceries, back for afternoon meetings, make a fast getaway to pick up the kids from soccer, arrive at home in time to make dinner while helping kids with homework. Your partner arrives at home then you’re out to the PTO meeting, choir rehearsal or library building committee. You finally get home, exchange a few words with your other half, check a few emails then off to bed. Tomorrow, the cycle starts again.

And then it happens. You wake up with a headache, a fever of 101, a severe sore throat that’s red, swollen and speckled with white patches. Now what? How do you fit in being sick? If we’re being honest with ourselves, we know that it’s just not possible to be sick, so we take some acetaminophen and drag ourselves through the critical parts of the day because we have to. 

But this situation has a twist – you probably have a common viral infection but you may have a strep throat. Untreated strep can result in much more serious problems such as rheumatic fever or subacute bacterial endocarditis. You don’t need complications and you certainly don’t want your whole family to end up with strep. Okay, so you need to have your throat evaluated. How are you going to get an appointment with your medical provider? If you do manage to get an appointment today, will it work in with the cannot-not-be-cancelled parts of your day?

Enter the retail medical clinic, a medical office conveniently located in a retail setting, possibly in a major pharmacy chain or big box store and maybe sandwiched in between the nail salon, photo studio and optical shop. 1

Retail medical clinics provide convenient, quick and affordable medical care - three adjectives which are not in the medical vocabulary!

  • Convenient - No appointment necessary, open early morning, evenings and weekends, these medical facilities are specifically designed to respond to your need for same day, quick and convenient care. About half of all retail clinics are located within pharmacies, the rest in other retail settings such as big box stores.
  • Quick - The retail clinic offers a very limited number of rapid turnaround services so visits are very brief.  Typical services available include treatment of minor infections, such as sore throat and cough,  treatment of minor skin conditions,  immunizations, preventive screening, such as cholesterol testing or diabetes screening, pregnancy testing and treatment of allergies.
  • Affordable - Strictly speaking, retail clinics are significantly less expensive than other alternatives for urgent care such as emergency departments and doctors’ offices. In a study by HealthPartners, the average cost for an urgent care visit (33% of all visits to retail clinics are for the evaluation of a sore throat) was $72 in the retail setting vs. $91 or $106 in other non-acute settings. 2

However, if you have to pay out of pocket for services, $72 is much greater than the standard co-pay for most insurances. But, this problem should be disappearing as more and more clinics organize themselves to accept insurances. The California HealthCare Foundation in 2006 reported that 40% of clinics accepted insurance; a 2009 article in the Annals of Internal Medicine reported that 97% of clinics sampled accept insurance. 3 Of course, if you are uninsured, the retail clinic is a bargain compared to the price you will pay anywhere else in the system.

Setting Visit Alone Visit plus Prescription
Retail Clinic $72 $101
Doctor’s Office  $91 $122
Urgent Care Center  $106 $130
Hospital ER $310 $328

Consumers really like retail clinic care although usage has not yet become widespread.  In fact 90% who have used a retail clinic are pleased with the services received according to Harris Interactive. 4 People appreciate the easy access and rapid turnaround that helps rather than worsens the daily pressures of an active life.

However, at the same time, retail medical clinics continue to remain controversial. and understandably the 'medical establishment' remains concerned about the quality and continuity of retail clinics. 5,6 And let's not forget that lurking in the shadows is the tired old issue of competition.

So, what are the downsides?

  • Staffed by non-MDs
    Clinics are generally staffed by mid level practitioners, such as nurse practioners and physician assistants, rather than by medical doctors.  They are licensed to diagnose, treat and prescribe medications for common medical conditions, as well as administer preventive care.  They are not, on the other hand, trained to sort through the complex web of medical symptoms that some people may possess.
  • Minor Ailments Can’t Always be Treated in Isolation
    Many people, especially as they age, are afflicted with a number of chronic disorders that can be made worse by minor problems that are treated without understanding the larger medical picture.  Treating an infection like a strep throat in a diabetic without considering the larger system effects can be unwise. They argue that mid level practitioners were meant to make the process of receiving medical care more efficient by handling minor problems but not meant to substitute for MD expertise differentiating between apparent minor illness and more serious medical problems.
  • Violation of the Medical Home Concept of Care
    Health experts and insurers have stressed the importance and effectiveness of a “medical home”—a place where patients have a personal physician who oversees and coordinates their care. This approach dismisses the strategy of viewing a person in terms of isolated symptoms on an episodic basis and supports a model of whole person care coordinated by a skilled practitioner. 
    When people are treated by a variety of professionals, care and medical history can become fragmented, making it more difficult to form an overall picture of an individual’s healthcare status. For example, if a person has a urinary tract infection diagnosed once at her doctor’s office, once at a retail clinic near her home and once at a clinic near her job, no one sees the emerging picture of an ongoing problem that could mean resistant kidney infection or other problems.  Doctors use every contact opportunity to check on related health issues and provide counsel and direction. The retail clinic removes that interaction.
  • Standards of Care
    There are currently no overall regulations or licensing requirements specific to this new delivery system. Given that many retail clinics have been retrofitted into spaces that were originally designed as retail space, there are often insufficient bathrooms and hand washing facilities available. Furthermore,  the antagonists argue that 'retail clinics' should be held to a higher standard of care than what's required for a typical doctor's office. And there are even concerns that retail clinics are uniformly not even meeting generally accepted standards of care. However, the National Convenient Care Association, in a study of their membership found that mid level practitioners followed established guidelines more often than doctors. 7
  • Conflict of Interest
    Over half of retail clinics are located in pharmacies, and even in big box stores, which is convenient for the patient who needs a prescription filled and a convenient source of revenue for the pharmacy. Retailers of course hope that clinic users will shop at the same time and fill their prescriptions on-site. 8
    MinuteClinic, one of the earliest retail clinic operations, notes that its clinics see 25-30 patients a day. Approximately 70% of those patients become new pharmacy users, 38% will make an over the counter medicine purchases while there and 80% will make a general merchandise purchase during the same visit. Target clinic customers report similar results with 95% of users filling their prescription at a Target pharmacy. Plus, although 90% of Target clinic users came for the medical care, they bought retail merchandise as well.
  • Fragmented Medical Care
    When you receive your care in many different provider locations without a common medical record, the responsibility for communicating information falls back to you as the consumer. Many people simply aren’t good at managing or communicating that information. As a result, it’s difficult for your primary physician to get a complete picture of your health.
  • Substituting Convenience Care for Primary Care
    When convenience care is available, some people choose to simply react to urgent problems as they arise but fail to establish a relationship with a primary care doctor who can manage overall care. This strategy may work for young people who have do not have long term problems but as you age, there is a need for a more comprehensive approach to care.
  • Overuse
    Some healthcare analysts argue that many minor problems that are seem in retail clinics do not require treatment. When appointments are somewhat less available, people make better choices about when to get medical care. Retail clinics may encourage unnecessary visits that are underwritten by insurance companies, adding to the cost of care.

In a nutshell, here are the issues.

Pros

Cons

Fast and convenient; reduces time away from work; hours fit modern schedules

Doctors often use urgent visits to check in on other health issues and provide counseling; retail clinics take away the opportunity for that communication

Affordable, especially for the uninsured

May encourage unnecessary visits

Research shows adherence to standards of care to be better than MD office

Quality includes care of the whole patient; retail clinics can only respond to a limited set of issues

Retail clinics refer to primary care doctors, bridging the gap

Retail clinics fragment care

Doctors have always faced the issue of over treating to increase revenues or as a defensive measure

Conflict of Interest with retailer motives

The Bottom Line

Despite the controversy, as retail clinics become more and more available to help with the minor problems that beset all of us, it makes perfectly good sense to use a retail clinic to get your sore throat evaluated, have your child’s ears checked for infection or have that rash looked at.

Retailers and physicians may be fighting for your business and that’s just fine – it’s about time consumers had some control in the healthcare process.

But, don’t let the retail clinic become your primary source of medical care. Be sure that you keep your overall medical care in the hands of a competent medical provider. Ask the retail clinic to either forward a summary of your care to your doctor or give you a copy that you can bring to the office to be placed in your medical record.

Retail clinics have done what the healthcare industry has been unable or unwilling to do – give consumers what they want – fast, convenient, affordable care for minor problems. Healthcare has finally gone retail! 

Published August 6, 2010, updated July 15, 2012

Photo By: getyourlifestraight.com


References

  1. Healthcare in the express lane: the re-emergence of retail clinics, California HealthCare Foundation, 2007
  2. Care and Cost Trends in Retail Clinics, HealthPartners September 2008
  3. Mehrotra A et al, Comparing Costs and Quality of Care at Retail Clinics With That of Other Medical Settings for 3 Common Illnesses, Ann Intern Med. 1 September 2009;151(5):321-328
  4. Harris Interactive Study Finds Satisfaction with Retail-Based Health Clinics Remains High, Harris Interactive, WSJ.com May 21, 2008
  5. Retail Medical Clinics: Update and Implications - 2009 Report, Deloitte
  6. Rohrer JE, Impact of Retail Medicine on Standard Costs in Primary Care: A Semiparametric Analysis, Population Health Management. December 2009, 12(6): 333-335
  7. Convenient Care Clinics: High Quality Care, Convenient Care Association
  8. Downs M, Health Care in a Big Box, MedicineNet.com, March 7, 2005

Susan M. Brissette brings 30 years of experience in healthcare, ranging from positions as Chief Executive Officer and Chief Operating Officer in the acute care hospital setting to Senior Executive for a major national healthcare management company. Ms. Brissette holds a BS in Biology from Northeastern University and an MS in Health Policy & Management from the Harvard School of Public Health. She has lectured on healthcare management at the University of Massachusetts, developed a healthcare delivery system for a mining company in Cajamarca, Peru, and recently led the Afghanistan Public Health Redevelopment Task Force for the Washington Harvard Alumni Group. She has consulted on healthcare projects in Poland, Romania, Israel, Kuwait, Peru, Canada, and Mexico. She now owns and operates SB Cass Associates, a healthcare consulting firm located in upstate New York. Ms. Brissette’s consulting practice handles client projects ranging from business plan development for clinics, assisted living facilities, and clinical research groups to the development of market research reports for the pharmaceutical and biotechnology industries. She has written dozens of healthcare articles published on the internet and in national professional and consumer journals. She has also authored or edited online courses on HIPAA compliance, corporate security, childhood obesity, and business ethics.

Susan Brissette can be reached at SB Cass Associates [email protected]

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