Retail clinics are projected to increase at a healthy 20%–30% per year over the next 6 years, with sales rising from $548 million in 2008 to $2 billion in 2013, according to a market research report from New York-based Kalorama Information.
Despite huge growth in the retail clinic sector, the emergence of these clinics has not hurt primary care physicians as much as “we thought it would have,” said Dr. Ted Epperly, president of the American Academy of Family Physicians. The impact has been softened in part by the fact that primary care physicians in many regions have expanded their hours to meet the demand for same-day visits.
Dr. Yul Ejnes, a member of the American College of Physicians' Board of Regents, called the projected boom in retail clinics “just a symptom of a bigger problem,” and a sign of a dysfunctional health care system. In an interview, he conceded that the retail clinic is a model that's here to stay. But if the medical home concept was “executed to its fullest, on the flip side, the need for retail clinics could diminish.”
Alternatively, retail clinic leaders, such as MinuteClinic President Chip Phillips, see the clinics as successfully filling a gap left by the dwindling number of primary care physicians.
Overall, there are some 1,214 retail clinic locations in the United States, with each clinic generating about $450,000 in sales, Kalorama reports.
MinuteClinic, the Minneapolis-based subsidiary of CVS Caremark Corp., now claims more than 560 locations in 25 states.
Still, even retail clinics are tweaking their model. In mid-March, MinuteClinic said that it would shutter 89 clinics until the next cough, cold, and flu season. Over time, it has become clear that the company “didn't need as many of the clinics as we had opened,” Mr. Phillips said in an interview.
These locations could be taken off line for part of the year without reducing access in those markets, Mr. Phillips said. He still sees the retail clinic as a strong business model, saying that it provides ready access to low-cost, high-quality care.
Typically, the clinics offer a menu of services for common ailments such as allergies, bladder infections, pink eye, ear infections, and strep throat. Many also offer screening tests for cholesterol, hypertension, and diabetes. Vaccines are also a significant offering. The prices for these services are publicly available, with most diagnostic and treatment services running at about $62. Services are provided by nurse practitioners, who are supervised by physicians on contract with MinuteClinic. The clinics are considered in-network providers with 60 insurers.
As of now, “it's hard to tell what impact the recession will have,” Mr. Phillips said, adding that it's possible it may fuel more business as people seek low-cost health care.
According to the Kalorama report, the economic downturn could indeed propel people to retail clinics, but it's also possible that as Americans rein in spending, health expenditures also may see a reduction.
“Over the next few years, retail clinics may capture a portion of the business currently serviced by physicians,” the report said.
Some physicians have expressed concern that the retail clinics could supplant or interfere with the attempts to establish a health delivery model based on the patient-centered medical home.
Mr. Phillips disagreed. “We don't see ourselves as competition to the primary care medical home concept,” he said, adding that MinuteClinic's role “is different than, and can be supportive of, the medical home.”
Dr. Epperly agreed that clinics can fit in with the medical home if lines of communication are kept open between the clinics and primary physicians.
“My sense is that we can work together in ways that make the clinics an extension of the patient-centered medical home.” Patients can be seen in a retail clinic for an acute process, but then be referred back to their medical home, he said.
AAFP aims to ensure that the clinics adhere to principles it adopted for the sector. For instance, the clinics must have a well-defined and limited scope of clinical services.
ACP and the American Medical Association also adopted guidelines for retail clinics. The ACP insists, for example, that there should be physician supervision and 24-hour coverage to answer questions that may arise, according to Dr. Ejnes, who is also chairman of the ACP's medical service committee.
However, there's “nothing that holds their feet to the fire” to abide by these principles, said Dr. Epperly. “In my experience, about a third of the time they are followed, but most of the time they're not.” There needs to be a reduplication of effort to get patients back into a regular place of care.
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