On The Forefront Of Healthcare

The Clinic at Walmart (now closed)
rrstar.com

Hello Everyone:

It is a very lovely afternoon and Yours Truly is here with you.  The primaries roll on and today is semi-Super Tuesday.  Six states go to the polls and The Blogger Candidate Forum will bring you the highlights. 

Before we get started on today's subject, retail health clinics, Yours Truly and Blogger Candidate Forum would like to take a minute to pass along some helpful information about the Coronavirus or COVID-19.  It is natural to be scared and want to get as much information as possible about a terrible illness that has not been contained.  Scared and worried is good but do not it cause you to fall for the wealth of misinformation on the social media.  Use that energy to take sensible precautions: frequently wash your hands for 20 seconds, do not touch your face, sneeze and cough into your sleeve, try to avoid large crowds and if you or someone you know is sick, please stay home.  One final request, please leave some toilet paper on the shelves for the rest us.  Thanks, onward.

If you go to your local Walmart or CVS Pharmacy, chances are you will find a small medical clinic.  These clinics are a recent trend in healthcare accessibility.  The idea behind it is simple, put clinics that provide care for simple acute conditions, like the flu, dispensed by a nurse practitioner.  They also offer vaccinations and treat some injuries.   The retail clinics offer extended weekend hours, typically when traditional doctors' offices are closed  The first retail clinics appeared in 2000, operating out of pharmacies, grocery stories, and big box stores.  It sounds like a great idea: Put a small medical clinic inside the places where people shop, that deliver preventive care, thus help reduce needless emergency room visits and costs.  Are they a more effective way to get medical care or simply the latest big thing?  Let us begin with the evolving role of retail clinics.

Retail clinics have been suggested as alternatives to non-essential emergency room visits.  By non-essential, Yours Truly means going to the ER for school vaccines.  The Rand Corporation reported "up to 20 percent of emergency department care for a nonemergency condition could take place at a retail clinic or urgent care center potentially generating cost savings as high as $4.4 billion annually" (rand.org; 2016; date accessed Mar. 3, 2020).  Currently, there are at least 2,700 retail health clinics operating in 44 states and Washington D.C., which have treated more than 40 million patient; with a $1.4 billion market share and projected $200 billion flow from traditional medical venues (thejournalofmhealth.com; Sept. 30, 2019; date accessed Mar. 3, 2020).  What we can conclude is that market share for retail clinics is large and will likely continue to grow, especially as COVID-19 continues to spread like wildfire.  Let us take a closer look at the geographic breakdown of the retail clinics.

Map of geographic locations of retail health clinics in the U.S.
rand.org

The Rand Corporation published a brief in 2016, The Evolving Role of Retail Clinics, in which it mapped their locations based on an analysis of 2014 data.  The researchers found that 74-percent of the 2,737 retail clinics across the United States were concentrated in the South and Midwest.  Over a third of the clinics were found in California, Florida, Illinois, Minnesota, Texas (rand.org; 2016; date accessed Mar. 3, 2020).  The brief noted, "These results largely echo prior RAND research on retail clinic locations.  That work used cross-sectional data from industry and foundation sources to analyze the characteristics of 982 retail clinics operating in the United States (as of August 2008" (Ibid).  The RAND Corporation revealed:

• About 35 percent of the U.S. urban population lived within a ten-minute driving distance of a retail clinic
• Retail clinics tended to be located in higher-income urban and suburban settings with higher concentrations of white residents and fewer back and Hispanic residents.  Only 12.5 percent were located in medically underserved areas.  For comparison, 21 percent of the U.S. population lives in such areas.  Even after adjusting for location of pharmacies and supermarket chains, clinics were less likely to be located in medically underserved neighborhoods than in other areas (Ibid)

Pretty shocking when consider that under served neighborhoods (i.e. low- to moderate-income) are often at greater risk for infectious diseases.  Of the number of retail clinics in the United States right now, three-quarters are owned by CVS and Walgreens; factoring in clinics operated by Kroger, Walmart, Target, and RiteAid, they totaled 93-percent of the retail health clinics nationwide (Ibid).  What kinds of services are available at the nearest CVS?

stamfordadvocate.com

• Clinics offered treatment for a limited set of conditions for which they had treatment protocols, including acute respiratory infections--which accounted for 60 percent of all retail clinic visits--other minor illnesses, immunizations, sports physicals, and screening services, such as lipid or diabetes screening.

The majority of retail clinics accepted commercial, Medicare, and Medicaid coverage, and all accept cash payment regardless of insurance status (Ibid)

Who are the typical retail health clinic patients?

health.harvard.edu

The RAND Corporation researchers examined the details of over 1.3 million retail clinic visits between 2000 and 2007; comparing the information gleaned from that analysis with national data on primary care doctor visits and emergency rooms.  "According to the study's findings: The largest group of clinic users was young adults, ages 18-44, who accounted for 43 percent of patient" (Ibid).  Nationally, patients between those ages accounted for 23 percent of in office primary care visits (Ibid).  The patient profile breakdown:

• Only about one-third of clinic users said that they had a primary care physician
• Two-thirds of retail clinic visits were paid for with health insurance, compared with 90 percent of visits to primary care physicians

About 90 percent of visits to retail clinics were for preventive care and for ten simple acute conditions: upper respiratory infections, sinusitis, bronchitis, sore throat, immunizations, inner ear infections, swimmer's ear, conjunctivitis, urinary tract infections, and blood tests.  The same conditions accounted for 18 percent of visits to primary care physician offices and 12 percent of emergency department visits (Ibid)

Thus far, the statistics suggest that retail health clinics are a convenient way to access basic medical services.  The number of clinics across the United States is increasing and it is worth mentioning how great it would be if someone did a study that correlated the number of retail clinics with states that expanded Medicare coverage or why they are not located in under served communities.  Yours Truly is thinking out loud for minute.  Convenience aside, it is worth taking a look at the pros and cons of retail health clinics.

sites.psu.edu

 Retail health clinics are part of a burgeoning trend to make healthcare more accessible.  Dr. Ateev Mehrota, an associate professor of health care policy at Harvard Medical School said,

Twenty years ago you had to go to an emergency department if you got sick and needed immediate care.  Now we have an explosion of options. such as retail health clinics (health.harvard.edu; Jan. 15, 2016; date accessed Mar. 10, 2020).

Having options is great, if they are available to you but options are just one of the benefits of a retail health clinics.

Retail health clinics' biggest selling points are the extended hours and no appointments necessary.  This is good if you work odd hours or a parent with a child who falls ill in the middle of the night.  Another pro is they have set prices for services, which you can check out on the website.  "For example, a wellness visit is $59 at Walmart.  A cholesterol screening at CVS is $59 to $69" (Ibid).  Cholesterol screenings at CVS still costs between $59-$69 (cvs.com; Mar. 10, 2020) and a clinic visit at Walmart can cost about $75 (walmart.com; date accessed Mar. 10, 2020).  This makes it easy for an individual or family with limited means to plan for medical treatment.  Dr. Mehrota added,

We have found in our data that clinics are 30% to 40% cheaper than a doctor's office visit, and 80% cheaper than an emergency room visit,... (health.harvard.edu; Jan. 15, 2016; date accessed Mar. 10, 2020).

Since the retail clinics do accept insurance, it makes the cost of vaccines more affordable.  Does the lower cost mean low quality care?  Again, Dr. Mehrota,

We have found that the quality of care at retail clinic is equal to or superior to some doctor's offices, because the clinics are more likely to follow national guidelines of care,... (Ibid)

Those are the benefits of retail health clinics but what about the downsides?

Retail health clinics are not right for everyone, especially for the elderly.  Dr. Mehrota said,

Health care is different for older adults.  The care you'll need for even a simple problem might more complicated.  For example, a urinary tract infection will affect an older woman much differently than a younger woman, putting the older woman at risk for dehydration, confusion, falls, and even sepsis,... (Ibid)

For an elderly person with a chronic condition, a simple illness might indicate something bigger that can only be detected by a regular clinician, eg. the person's primary care physician.

Another issue is the communication gap.  Right now, there is no national platform for healthcare information sharing between retail clinics and a primary care physician.  This makes consistency of care difficult and can lead to confusion.  Incomplete medical histories are another source of the communication gap.  A patient who does not bring with them a complete list of medications could end being prescribed something that will dangerously interact with the current medication.

A retail health clinic is great for minor issues, like a flu shot or cold, or as a backstop if you cannot see your regular doctor.  However, you should bring with you a complete list of medications, tell the clinician you see about your full medical history, ask the clinician to send the visit information to your regular doctor, and consider a follow up with your regular doctor.  Retail health clinics are great if you are generally healthy and have a minor ailment.  They work best if you keep the lines of communication open.  Retail health care are on the forefront of more accessible healthcare and have the potential to deliver wellness care to more communities across the United States.   

 

rand.org