You feel that telltale constriction in your throat again, you wonder if it’s just the weather’s doing. You call up your doctor’s office only to find that the next appointment is in a week. You do not have a primary care physician to consult. You have a tight budget, or worse, you do not have a health insurance.

What to do?

You are at a crossroad.

Leading straight to a retail health clinic.

This is one of the typical scenarios causing more and more patients to turn to retail health clinics to get prescriptions for minor ailments such as a general cough and flu symptoms, throat and urinary tract infections, sinusitis, etc.

Run mostly by nurse practitioners and physician assistants, these walk-in medical facilities are located inside pharmacies, giant supermarkets and retailers such as Target and Wal-Mart. CVS’s Minute Clinic is the biggest chain among these retail clinics, with over 800 locations in CVS pharmacies.

The boom of the retail health settings

The industry saw its boom back in 2007 where the numbers of families using retail clinics nearly quadrupled from the previous year. This was really a dot-com boom moment in the healthcare industry.

“Retail clinics have become mainstream; there have been more than 30 million patient visits to these types of clinics to date,” says Tine Hansen-Turton, executive director of the Convenient Care Association. The numbers are expected to reach 3000 by 2016.

 

What makes them famous?

• Convenience

The Holy Grail behind the proliferation of these clinics is convenience. Patients can walk straight in to the retail health clinic at any time of the day, even weekends without an appointment. Nearly half of the visits made to these clinics are during doctor’s off-hours when their clinics are closed allowing faster access to care.

“The medical profession has a problem and I think the retail clinics have found it. The problem is access,” says Charles Cutler, MD, chair of the American College of Physicians (ACP) Board of Regents.

• Costs

Apart from convenience, it’s the cost factor which motivates most patients to divert their way towards these clinics. Not only these accept most insurance co-pays but also accept uninsured patients. Research by Dr. Ateev Mehrotra, a health policy researcher shows that the average cost of treatment at a retail health clinic is about 30-40% less at a retail clinic than a physician’s office and even more so compared to emergency rooms and urgent care centers.

Families belonging to lower-income brackets are more likely to be the visitors of these clinics due to the low-cost advantages. A Study by HSC confirms that families with at least one uninsured member were more than three times as likely as those with insurance sought care in a retail clinic due to no regular source of care.

• Transparency

Not only cost but transparency is also a factor which keeps these clinics filled with patients. Just like restaurants, they offer a menu of services with their prices so that there aren’t any eyebrow raised moments at the end of the day.

Disruption to the development of a Medical Home

First, these are run by nurse practitioners rather than doctors, now that may be okay for minor ailments and routine antibiotic prescriptions but what about more severe conditions? Are they really up for that?

Various medical academies have a positive opinion of these retail clinics; however, they too draw the line when it comes to handling the scope of services which these provide.

Although most deals with minor conditions, some such as Walgreens have announced managing chronic conditions such as asthma, diabetes, and high blood pressure. This kind of expansion from their end leads to the unremitting problem of fragmentation of healthcare. It hinders the development of a ‘medical home’ and can affect the relationship between a patient and a primary care physician.

“The ideal system for medical care would be that every patient is part of a ‘medical home’ so that she or he doesn’t need to go to a retail clinic.” Says Wergin, MD, president-elect of the American Academy of Family Physicians (AAFP) 

According to a research by Dr. Mehrotra, patients who received care at a retail clinic were less likely to follow up within the year with their primary care physician.

In-depth detail capturing at risk

Given the specificity of ICD-10, it’s possible that the clinician may not capture the detail in depth as a primary care physician would for patient documentation.

It’s vital that the retail clinician notify the primary care physician of all details of his encounter with the patient. It’s a standard procedure for member retail clinics according to the Convenient Care Association, however; it doesn’t always go as planned.

Adverse Impact on Patient’s health

Since these visits are short, there isn’t much time to explain medical history in detail. Furthermore, patients might also not remember the important details mentioned in their medical record which could affect their healthcare delivery. Not being able to recall their medication or perhaps their allergies could cause serious effects to their health which nullifies the cost and convenience advantages which these clinics have to offer.

According to Mary Scott of Scott & Co “these clinics are great for people who are relatively healthy, but once you’re taking multiple medications or have multiple chronic conditions, you should be seeing your primary care doctor”

Not acknowledging their existence is one way to deal with them however if they do show up on your radar you have to remain vigilant. Some patients may hesitate to inform you about their visit to the retail health clinic, it’s like the walk of shame which no one wants to talk about. This again could hamper the communication which is necessary for the effective care of the patient.

Patient’s responsibility two-fold

Under retail clinics, the responsibility of continuity in record keeping lies at the patient’s end. Clinicians do forward their health records but there’s a high probability that the EHR software used by the primary care physician and the clinician isn’t compatible which renders the information useless.  This can be prevented by asking patients to provide you with a printed copy of the health record just to be on the safe side.

Staying at the top of your game

What can you do to ensure that your revenue cycles remain intact? Instead of hating these clinics for taking away your patients, you need to question yourself where do you lack in providing care? Here are a few helpful tips:

1. Build a fast track clinic inside your practice to treat many of the minor ailments which retail clinics treat in a timely manner.
2. If you can provide that extra need of convenience such as extended hours, it could really help retain patients for e.g. Offering evening appointments on specific days to busy professionals.
3. With the advent of telemedicine, this has become even more convenient. E-visits can maximize the convenience of the patients without having to leave their home.
4. Bring in your marketing tactics, emphasize your unique selling points, where you differentiate from these retail settings. If your practices offer services like cosmetic procedures or massage therapists, promote them. Let the patients know that their healthcare encounter is in safe hands and is comprehensive to the nth detail.

If you can’t beat them, join them

With all that being said, it’s important to consider the current state of the healthcare industry. With the affordable care act, a number of people with insurance will demand a higher quality of care delivery from their primary care physicians, thus increasing their demand. However, the dearth supply of doctors would drive these patients towards the retail clinics.

The tremendous shortage of primary care doctors is expected to reach 45,000 by 2020 according to Dr. Sussman, CMO at CVS/Caremark. She also argues that retail health settings do not intend to replace continuous care by physicians; rather they’ve always been there to complement the healthcare system.

PCP’s and hospitals can consider these clinics as a blessing in disguise rather than a perceived rival. One option is to form a Partnership to deal with the ever-growing demand of patients, capacity difficulties and the financial implications of healthcare reform.

PCP’s can refer to the low acuity cases to these retail clinics while dealing with the chronic ones themselves leading to higher revenues and enhanced patient relationships. These already offer extended hours and convenient locations which can help reduce your burden. Partnerships can also ensure the smooth flow of information to avoid missing out on any specific details mentioned previously.