The Impact of Retail Clinics on Quality, Access, and Costs

Ateev Mehrotra, MD, MPHUniversity of Pittsburgh School of Medicine

RAND Health

Ongoing Debate about Merits of Retail Clinics

Issue Positives Concerns

Quality • Follow guidelines, thus ensuring quality

• Deliver poor quality services

• Overprescribe antibiotics

Access &PCP Relationships

• Improve access for all patients

• New safety-net provider

• Undermine patient-doctor relationships

Costs • Decrease ED visits• Decrease overall

costs

• Increase costs due to unnecessary follow-up

Ongoing Debate

• Quality• Access & PCP relationships• Costs

Antibiotic Prescribing Rates Are Similar

Mehrotra et al., Annals of Internal Medicine, 2009

Quality of Care in Retail Clinics is the Same or Better than Found in Other Settings

Quality Findings Consistent With Other Research

• Patient satisfaction very high1

• Quality– Follow-up visit rates lower2

– Care concordant with guidelines3

– “HEDIS scores” higher than most health plans4

1 Harris Interactive2 Rohrer, Qual Manag Health Care, 2008

3 Woodburn, AJMQ, 20074 Jacoby, AJMQ, 2010

Ongoing Debate

• Quality• Access & PCP relationships• Costs

Significant Fraction of U.S. Population Has Access to a Retail Clinic

• Almost 90% of clinics in urban areas• 38% of urban population live within a 10 minute

drive• Few clinics in underserved areas

� 13% in Health Professional Shortage Areas compared to 21% of population

Rudavsky, Mehrotra, JABFM, 2010

Age Distribution of Patients

Mehrotra et al., Health Affairs, 2008

Retail Clinics Emerg RoomMD Office

Most Retail Clinic Patients Report No Primary Care Physician

Ongoing Debate

• Quality• Access & PCP relationships• Costs

Significant Per Episode Cost Savings at Retail Clinics

Mehrotra et al., Annals of Internal Medicine, 9/09

What Fraction of ED Visits Could be Seen at Alternate Sites?

chest pain, abdominal pain

sore throat, pink eye, sinus infection, ankle sprain, minor fracture

27% 17%

All ED Visits Limited to ED visits when retail clinics and urgent

care centers open

Potential Savings of $4.4 BillionWeinick et al., Health Affairs 2010

Potential Cost Savings if Retail Clinics Become Widespread Nationally

• Institute of Medicine ‒ $2.0 - 7.5 billion annual spending

reduction• Impact on total US health care budget

‒ ~0.1% of $4.6 Trillion

Hussey, et al. NEJM, 2009

IOM, 2009

Issue Our FindingsQuality No evidence to support concerns

Antibiotic prescribing is similar

Access & PCPs

Retail clinics serve different population than physicians

Costs Per condition, there are substantial savings if patients shift care from ED to retail clinics

Summary of Research

Should We Encourage Use of Retail Clinics

• Potential Benefits– More convenience for patients– Save money

• Potential Concerns– Increase fragmentation of health care– Worsen financial situation of EDs– Patients may not “self-triage” correctly