Retail based clinics on the rise

Massachusetts joins list of states allowing retail-based clinics Physician practices adapting to consumer-driven healthcare model

An estimated 700 healthcare clinics now offer low-cost services in pharmacies and retail stores across the United States, a number which could reach into the thousands within a few short years, and the primary care physician model of healthcare delivery is bumping up against consumer-centered models emphasizing price and convenience.

In January, a Massachusetts health regulatory agency declared it would allow CVS Corp. to open MinuteClinic walk-in clinics at its pharmacies, joining about 30 other states that allow retailers to provide limited services such as strep throat tests and flu shots administered by nurse practitioners or physician assistants under remote supervision of a physician.

Physician organizations, including the American Medical Association (AMA), the American Academy of Family Physicians (AAFP), and the American Academy of Pediatrics (AAP), contend that retail-based clinics (RBC), also known as convenient care clinics or “doc in a box,” contribute to fragmented care and undermine the medical home model of care by a primary physician.

The AMA has also expressed concern over the potential for conflicts of interest: 35% of RBC customers leave with a new prescription and 95% of those prescriptions are filled by the host retailer's pharmacy, according to the California Health Care Foundation.

But physician opposition has not slowed down RBC growth, and an increasing number of physician practices are adopting methods to improve their delivery of services: allowing for same-day scheduling of appointments, offering expanded hours, locating practices in more accessible locations such as shopping centers, and offering telemedicine services.

RBCs are typically owned by retailers, including Target Corp., Wal-Mart, and Osco Drug. Wal-Mart intends to open as many as 400 RBCs in the next three years, expanding to up to 2,000 clinics within seven years. Even hospitals have begun to open clinics to compete and build their brands.

The Convenient Care Association (CCA), an industry group representing the clinics, proposes that RBCs provide low-cost and easy access to services for people who may not have a primary care physician.

With the cost of a visit typically in the range of $40 to $70, a majority of consumers who have visited an RBC express satisfaction with price, quality of care, and convenience of the clinics. With consumers seeking more convenient, affordable access to care, the CCA states, RBCs fill a demand and reduce pressure on hospital emergency departments (ED).

Payers such as Cigna, Humana, Aetna, BlueCross/BlueShield, and UnitedHealth Group have agreed to cover retail visits, which are cheaper for the insurers than covering ED visits.

The AAFP recommended that RBCs provide a well-defined and limited scope of evidence-based services under the supervision of physicians; maintain electronic health records; and provide referrals to physician practices. Three of the largest retail clinic companies—MinuteClinic, TakeCare Health, and RediClinic—bowed to pressure from the AAFP and agreed to abide by their recommendations.

The AAFP has advised it membership that RBCs could prove beneficial to their practices of they establish referral relationships with the clinics or forge partnerships to provide physician oversight of clinic staff.