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What retail clinic growth can teach physicians about patient demand


 

Access: It's one word that may ultimately reignite the expansion of retail medicine in 2014 and beyond. CVS Caremark has added 200 new clinics since 2011, with another 850 planned by 2017. While it’s still too soon to predict a large-scale national expansion in clinic numbers, some experts believe their calling card—convenience—should be a consideration for every medical practice in the United States.

Retail clinics made their way into the healthcare market in the early 2000’s and began to grow significantly about 7 years ago. Since 2006 the number of retail clinics nationwide has expanded eight-fold from roughly 200 clinics to nearly 1,600 today.

These walk-in clinics, which tend to be located inside pharmacies, supermarkets, or “big-box” retailers, are typically staffed by nurse practitioners and physician assistants. They treat minor ailments such as strep throat and minor wounds, and offer vaccinations and physicals. Recently, some have begun to manage chronic conditions such as diabetes, high blood pressure, and asthma.

The Affordable Care Act (ACA) is expected to further strain the nation’s primary care capacity. Many view that as a chance for these clinics to play a larger role in providing basic primary care services. Just how large of an impact they may have on the healthcare system in general, and on independent office-based primary care practices specifically, depends on many factors.

As health reform’s implementation unfolds and new care models costs are developed, the future of retail clinics is far from clear. “This could go in a lot of directions,” says Ha T. Tu, senior health researcher with the Center for Studying Health System Change (HSC).

The growth of retail clinics

The retail clinic industry saw its biggest gains in 2007, when the number of clinics more than quadrupled from the previous year. “That period can almost be compared to the dot-com boom of the late 1990s when people were entering the (dot-com) industry without regard for how they would make money. That’s exactly what was happening,” says Thomas Charland, chief executive officer of healthcare consultancy, Merchant Medicine, LLC.

Though the industry’s growth flattened by 2008 and 2009 a number of surveys predicted that with an already existing shortage of primary care physicians and the implementation of the ACA on the horizon, growth would once again pick up at a rapid pace.

A report out earlier this year from the consulting firm Accenture predicted an expansion rate of 25%-30% per year between 2012 and 2015, thereby doubling the number of retail clinics nationwide, and possibly saving the healthcare system as much as $800 million per year in the process.

Many of the projections have been overly optimistic, Charland says. “The only one growing is CVS,” he says. “Apart from Minute Clinic we haven’t seen a lot of growth in new markets and most of their growth in 2011 and 2012 was in existing markets by adding clinics where the population has already achieved some level of acceptance.”

Most of the other big players in the retail clinic space, including Walgreens’ Take Care, Kroger’s Little Clinic, and Target, have remained static during the past four to five years. Walmart has seen about a 50% drop in retail clinics in their stores in the last year and a half.  “It’s dropped off dramatically,” Charland says. 

Despite the slowed growth in the clinics’ expansion, a recent study coauthored by Tu with the Center for Studying Health System Change found that the number of families using retail clinics tripled between 2007 and 2010. Still, just 3% of the population is seeking care in the retail setting. 

A number of dynamics may be behind the small number of people using retail clinics, according to Tu. First, the clinics are concentrated in large metropolitan areas, making them largely unavailable to people living outside big cities. The clinics are limited in the scope of services they provide, which by nature limits their use. And there still seems to be a lack of trust on the part of ­consumers.

“A lot of consumers still question the quality of care in retail clinics or just prefer to get primary care from a primary care physician. Those are all issues behind the relatively limited use of retail clinics,” Tu says.

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Additional information regarding the Medical Economics Top 100 EHR list

Most primary care physicians will see only small payment increases in 2014 from Medicare and commercial payers. The good news is that the sustainable growth rate formula stands a good chance of being repealed, and whatever replaces it will reward value over volume.

One area of Americans with Disabilities Act (ADA) compliance that can be confusing for medical practices is the obligation to provide sign language interpreting services to patients who are deaf and hard of hearing. That requirement is more stringent than many realize.


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