Are Retail Clinics Empowering Patients or Fragmenting Care?
Retail clinics have exploded in popularity since they first entered the healthcare market in 2001. In the past three years alone, the number of retail clinics in the U.S. has expanded from 700 to more than 2,450. The proprietary clinics are primarily owned by private companies, and operate by renting space in pharmacies, big-box stores, and even the occasional hospital. Retail clinics are more attractive to patients than physician visits and urgent care clinics because they offer similar care quality for lower costs and shorter wait times.
Clinics inside pharmacies and other retail stores can be more convenient for patients than urgent care clinics or physician visits, particularly for those with young children and who work during the day. Though most retail clinics do offer visits by appointment, approximately 90% of patients just walk in. The average consultation takes just 15 minutes. Retail clinics are primarily staffed by nurse practitioners (NPs), with some locations partnering with local hospitals and physician groups as well.
Top 10 IDN-Affiliated Retail Clinics by Number of Primary Care Physicians
|Clinic Name||# Physicians||IDN Name|
|Rediclinic Stone Ridge||47||HCA San Antonio Division|
|Rediclinic Tomball||39||Memorial Hermann Health System|
|The Clinic at Walmart – Chillicothe||35||Adena Health System|
|HyVee – Grand Island||33||CHI Health|
|Rediclinic Oxford Ave||30||Aria – Jefferson Health|
|Rediclinic Barker Cypress||23||Memorial Hermann Health System|
|Rediclinic Blanco||20||HCA San Antonio Division|
|Rediclinic Whitesville||20||Hackensack Meridian Health|
|The Clinic at Walmart – Springfield (E Independence)||19||CoxHealth|
|Rediclinic Pin Oak||18||Memorial Hermann Health System|
Fig 1 Data from Definitive Healthcare
Most patients visiting retail clinics seek acute episodic care, or treatment of a short-term illness or injury. This includes treatment of minor cuts, burns, and rashes; sinus infections; ringworm; and school and camp-related wellness visits. Retail clinics are also reliable alternatives for certain kinds of preventative medicine, like the flu shot or other vaccinations.
Though retail clinics work well for acute conditions, they are not a replacement for emergency department services. Retail clinics are too small for on-site x-ray and other imaging technology, which means they cannot help patients with sprains, fractures, or broken bones. Similarly, they are not equipped to treat serious lacerations, puncture wounds, or burns.
At the end of each appointment, patients are offered a printed summary of their visit. Providers also record the visit in an EHR system for easy record-keeping and data sharing with a patient’s primary care physician or other healthcare provider. These records can also be sent to a patient’s insurance company for reimbursement. If a patient is not insured, retail clinics accept cash or credit card payments at the time of the visit—often at significantly lower prices than an urgent care clinic or physician’s office.
In addition to employing nurse practitioners, retail clinics foster relationships with local hospitals, physician groups, and other providers for effective connected care. This allows retail clinics to refer patients without a primary care physician to one in the area, encouraging them to seek regular medical care with a single provider. In turn, physicians can refer patients to retail clinics for less serious acute care needs. These relationships are strengthened by the ease of patient data-sharing through the near-universal adoption of EHR systems.
As the number of retail clinics increases, industry leaders question whether there will be any negative effects on the industry. If retail clinics are so prevalent, will they drive traffic—and funding—away from hospitals and urgent care clinics? Will the increase in patients seeking more frequent care cost more for payors in the long run?
A 2016 study published in Health Affairs addresses these concerns. The study found that 40 percent of patients visited a retail clinic instead of their primary care physician or an urgent care clinic for conditions they would have sought care for anyway. These visits lowered costs due to retail clinics’ lower prices. However, 60 percent of retail clinic visits were for routine medical care rather than episodic care, and would not have been sought by patients had the retail clinic not been available. This indicates an increase in service utilization and an overall increase in healthcare spending of $14 per person per year. But is this necessarily detrimental to the healthcare industry?
Patients who seek care at a retail clinic over a physician or urgent care clinic primarily do so for cost and convenience. An uninsured or low-income patient may be deterred from seeking care because they cannot afford it. It may take days or weeks to schedule an appointment with a physician’s office for something simple like a flu shot or summer camp examination. A patient may work during the day with little flexibility for time off. In all these cases, the existence of retail clinics increases patients’ ability to seek care for issues that would otherwise go untreated.
In addition to bettering patient accessibility, retail clinics could assist in taking some of the workload off emergency departments that may already be struggling to meet patient demands. In the same Health Affairs study, researchers at the National Bureau of Economic Research found that emergency department visits for influenza and diabetes fell by 13.6 percent and 3.6 percent respectively between 2006 and 2014.
Top 10 Retail Clinics by Total Population
|Clinic Name||Total Population||CBSA Population Growth from 2015|
|Rediclinic Pin Oak||33,201||1.88%|
|CVS Minuteclinic – Katy (Grand Pkwy)||33,201||1.88%|
|Walgreens Healthcare Clinic – Yorkville||26,230||0.21%|
|CVS Minuteclinic – Windermere||22,670||2.48%|
|CVS Minuteclinic – Port Saint Lucie||20,218||2.44%|
|CVS Minuteclinic – The Woodlands||20,181||1.88%|
|Rediclinic Indian Springs||20,181||1.88%|
|Rediclinic North Woodlands||20,181||1.88%|
|Walgreens Healthcare Clinic – The Woodlands||20,181||1.88%|
Fig 3 Data from Definitive Healthcare
One issue plaguing retail clinics, hospitals, and other facilities is the shortage of providers. Because retail clinics primarily employ nurse practitioners, it can be difficult to keep a clinic fully staffed to maintain regular hours. Typically, two to three NPs are required to keep a retail clinic running regular hours every week. If the number of available NPs gets too low, retail clinics can be forced to remain closed for one or more days per week—reducing their unique ability to offer convenient operating hours to patients. However, in urban areas where NPs are plentiful, retail clinics can be an opportunity for relatively independent employment with predictable hours and less stress than a traditional hospital setting.
As retail clinics continue to proliferate and expand their healthcare offerings, patients may be more likely to seek medical care outside their primary care physician’s office. While this is not damaging in itself, it can lead to fragmented patient care. This is where EHR systems and partnerships are most important. Retail clinics offer a place for patients to seek care quickly, and attending NPs can recommend local physicians’ offices where patients can receive reliable long-term care.
*Core Based Statistical Area: geographic region anchored by a metropolitan or micropolitan area defined by the Office of Management and Budget for use in the U.S. Census.
Definitive Healthcare recently introduced Retail Clinic analytics to our database. You can find a complete list of updates here.
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