Study: Retail Clinics Hike Health Care Costs

Savings offset by increased use of medical services

Retail clinics, long seen as an antidote to more-expensive doctors’ offices and emergency rooms, may actually boost medical spending by leading consumers to get more care, according to a report from Kaiser Health News.

A new study published in the March issue of Health Affairs has shown that, rather than substituting for a physician office visit or a trip to the hospital, 58% of retail clinic visits for minor conditions represented a new use of medical services. Those additional visits led to a modest increase in overall health care spending of $14 per person per year.

“This challenges the conventional wisdom that retail clinics save the health care system money,” said co-author Dr. Ateev Mehrotra, an associate professor of health care policy at Harvard Medical School. “The increase in spending from new utilization trumps the savings we saw from replacing doctor visits and the emergency department.”

There are more than 2,000 in-store clinics nationwide, and they handle approximately 6 million patient visits annually, the study noted. Many health insurers and employers encourage people to use these clinics, in some cases waiving co-payments. But Mehrotra said policymakers and health insurers should realize that promoting more-convenient options, from retail clinics to online doctor visits, may spur more use and higher costs.

“As we make things more convenient, people will use it a lot more,” Mehrotra said.

The new study doesn’t contradict earlier research, which found that retail clinics provide care that costs 30% to 40% less than similar care provided at a physician’s office and that the treatment for routine illnesses was of similar quality. But it does suggest that those savings are more than offset by increased use of medical services, according to the authors.

Dr. Andrew Sussman, president of the MinuteClinic unit at CVS, criticized the study as “flawed” and too reliant on old data. He said that about half of MinuteClinic patients don’t have a regular family physician, and his clinics are able to prevent minor conditions from becoming major illnesses requiring costlier care.

The study “is not an accurate assessment of retail clinic cost savings and value,” Sussman said. “It is a step backward to think of people who did not have a primary-care physician and get care as excess utilization.”

The study’s authors couldn’t assess the effect that retail clinics have on overall medical use and total spending because they didn’t have data on inpatient care or prescription drug use — two large components of health care spending.

The researchers looked at data on 3 million Aetna Inc. members from 2010 to 2012 and their medical use tied to 11 low-acuity conditions, such as sinusitis and urinary tract infections. The patients were divided between users of retail clinics and people who did not visit them.

The researchers found that much of the new use was for ailments that typically cleared up on their own, such as a fever, cough, or runny nose. But Mehrotra said he doesn’t want the study to be seen as criticizing people for seeking medical help. Rather, he wants to emphasize that convenience is going to increase utilization.

“If the retail clinics wouldn’t have been around, people would have stayed home,” he said. “New utilization accounts for most retail clinic visits.”

The researchers noted some limitations to their study. For one thing, it was confined to the commercial insurance population, excluding people on Medicare, Medicaid, or the uninsured. In addition, it didn’t factor in benefits, such as the time saved by going to a retail clinic.

Tom Charland, an industry analyst and chief executive of the research firm Merchant Medicine, said retailers have had mixed results with in-store clinics. CVS and Kroger Co. continue to open new locations, whereas Wal-Mart Stores Inc. and Target Corp. pulled back on the business after lackluster results, he said.

These clinics have been seen as one way to address a lack of primary-care physicians in some areas of the country as the Patient Protection and Affordable Care Act expands insurance coverage to millions of Americans. Some major health systems, including the Cleveland Clinic and the University of California, Los Angeles, have partnered with retail clinics to help meet the increased demand.

But Mehrotra said health plans and employers should carefully consider how they cover care at retail clinics. “If the goal is to lower costs,” he said, “then encouraging use of retail clinics may not be a successful strategy.”

Sources: Kaiser Health News; March 8, 2016; and Health Affairs; March 2016.