The Changing Face of Health Care Facilities: Retail Medicine

In this spotlight series we will explore changes to care delivery driven by the Affordable Care Act (ACA) and the increasing sophistication of patients who want health care that is affordable, transparent, and accessible. 

Today the spotlight is on retail medicine. 

Retail medicine is increasing its presence in the U.S. and a variety of health care organizations and analysts are taking notice. First the stats: 

A study released by Accenture last year projects the number of retail clinics to double by 2015. That would mean by the end of this year there would be close to 3000 walk-up retail clinics in pharmacies, big box stores like Target, and grocery stores. 

Other analysts are more cautious about the growth rate citing regulatory and policy roadblocks. Harvard Business Journal authors Jason Hwang and Ateev Mehrotra  point out that despite high growth rates early on, retail medicine has failed to live up to expectations. They cite a variety of reasons for stalled growth: 

• Traditional providers have been reluctant to let go of what they view as high-margin work that offsets the losses from caring for more complex problems.
• Retail clinics have not been effective in attracting the largest population of non-consumers: the poor.
• Retail medicine clinics are often staffed by nurse practitioners. Regulatory limitations and reimbursement issues surrounding nurse practitioners have slowed down growth.
• Medicaid plans that serve the poor have been reluctant to cover care in retail clinics.

The urgent need to get non-urgent patients out of the ER 

Patients, often uninsured, who use the ER to provide non-urgent care services, drive up the cost of health care. According to the Convenient Care Association, 12 to 14 percent of all ER visits were for conditions that could have been treated at a retail medical clinic. 

As the ACA adds more individuals to the insured patient population, it will put a higher burden on primary care physicians at a time when the pool of doctors is on a downward trend. Retail medicine can alleviate the demands on primary care physicians for routine visits. 

The patient population is accustomed to searching for products and services online and comparison shopping. That behavior is being applied to health care decisions. Patients want more transparency in cost, more affordable options (especially in light of the increase in high-deductible plans), and convenient access to care which retail clinics can provide. 

Hospital valuations are now more focused on factors demonstrating agility to the changing compensation culture.  Shifting non-urgent patients from the ER to more appropriate care settings demonstrates this ability and therefore increases the value of health care facilities. 

One of the arguments against retail medicine is that patients are not being seen by a physician who may be more qualified to spot serious conditions. In fact, the American Academy of Pediatrics released a cautionary statement to parents recently about using retail medicine clinics to treat children. Other concerns that have been sited beyond quality of care are the disruption of doctor-patient relationships or continuity of care.  Furthermore, the American Academy of Family Physicians (AAFP) is opposed to the expansion of the scope of services of retail clinics beyond minor acute illnesses. However, the Academy recognizes that retail medicine can be a component of patient-centered care, but we must ensure patient care is not further fragmented.

In spite of the challenges and concerns, some hospital systems are looking for ways to capitalize on the benefits and utilize retail medicine as a way to expand their footprint. For example, Bronson Methodist Hospital in Portage, Michigan recently opened a new walk-in medical clinic at a local Meijer Store. Bronson staffs the retail clinic with physician assistants and nurse practitioners who work under the supervision of an emergency services group that alsostaffs ERs at Bronson’s hospitals in three local facilities.  If the clinic is successful, the hospital may consider adding additional locations across its market.

CHE Trinity Health in Livonia, Michigan also recently joined the ranks of health systems expanding via retail medicine when they entered into a “clinical care collaboration agreement” with Walgreens, the nation’s largest drugstore chain.  They state that “the collaborative model will enable retail clinic collaborations, outpatient pharmacy services and expanded prescription and disease management programs.”

By asserting a role in retail medicine as Bronson Methodist, CHE Trinity and other facilities have done, health care systems and physician practices can provide care oversight, more easily transfer visit records from retail outlets to primary physicians, and take a proactive role in funneling patients to an appropriate care setting for minor needs. Retail medicine should not replace the role of a primary care physician, but should be considered a viable role in an integrated healthcare delivery system.  The goal is to provide patients with quick and convenient access to care while getting the ear aches and other minor illnesses out of the emergency rooms.