News & Commentary

Retail Medical Clinics Don’t Take Burden off EDs

One of the hopes about retail clinics is that they would help to reduce the number of emergency department (ED) visits for minor health problems at hospitals in their vicinity. That is not the case, according to a Rand study published in the Annals of Emergency Medicine. Look closer, though, and the findings suggest that retail clinics may steer some privately insured people away from hospital EDs.

ED visits are one of the most expensive silos in health care, and curtailing their overuse has long been on insurers’ wish list. Retail clinics are located in drug stores like CVS or Rite Aid or in large retail stores like Target or Walmart. Often, care is provided by a nurse practitioner rather than a physician.

This study looked at more than 2,000 emergency departments across 23 states from 2007 to 2012. The overall finding was that the opening of retail clinics was not associated with any significant reduction in visits to emergency departments for 11 low-acuity ailments (allergic rhinitis, bronchitis, conjunctivitis, other eye conditions, influenza, otitis externa, otitis media, pharyngitis, upper respiratory infections/sinusitis, urinary tract infections, and viral infections).

When the researchers broke down the ED statistics by payer, the privately insured group was the only one for which both the number (1,235 in 2007 versus 950 in 2012) and rate (119 per 1,000 ED visits in 2007 versus 108 in 2012) of low-acuity ED visits decreased during the study period.

Ateev Mehrotra, MD, an associate professor at Harvard Medical School and a member of the Managed Care editorial advisory board, was one of the co-authors of the study. He says that “contrary to our expectations, we found retail clinics do not appear to be leading to meaningful reductions in low-urgency visits to hospital emergency departments.”

Privately insured Americans may be the exception to the rule, because many retail clinics have opened in higher-income neighborhoods, where a greater proportion of residents have private insurance compared with residents of low-income neighborhoods, according to the study.

Retail clinics first began appearing in 2000, and now there are nearly 2,000 in operation across the United States, according to Rand. The clinics account for about six million patient visits a year. Clinic visits are less expensive than physician office or ED department visits, both because fees are lower and fewer tests tend to be performed.

Locations and hours of retail clinics are designed to satisfy an unmet desire for convenience in health. A report by Pricewaterhouse­Coopers in June projected that 40% of consumers (consumers were not defined) will seek care from a retail clinic this year.

But that convenience is apparently feeding demand for care that might not otherwise exist. Earlier this year, Mehrotra was the senior author on a paper published in Health Affairs that found that 58% of the visits to retail clinics for the same 11 low-acuity conditions represented new utilization, not substitution for care that would have been delivered elsewhere. That research, which used 2010–2012 Aetna claims data, found that retail clinic use was associated with an increase in health care spending of $14 per person per year.


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