Retail clinics emerge as a way to satisfy the growing demand for healthcare created by the newly insured under the ACA, but contrary to expectations, they do not appear to be leading to meaningful reductions in low-acuity ED visits.
Retail clinics that opened near emergency departments (ED) had little effect on rates of low-acuity visits to them, according to a study published online in Annals of Emergency Medicine.
“With increased patient demand resulting from the expansion of health insurance coverage, retail clinics may emerge as an important care location, but to date, they have not been associated with a meaningful reduction in low-acuity ED visits,” the authors wrote.
The number of retail clinics grew from 130 in 2006 to nearly 1,400 in 2012, according to the study. Retail clinic penetration rate (the proportion of the ED catchment area that overlaps with a 10-minute drive radius of a retail clinic) more than doubled (8.1 to 16.4) between 2007 and 2012 among states in the study sample. One-third of the urban population in the United States lives within a 10-minute drive of a retail clinic.
During the same period, low-acuity visits among EDs with significant increase in retail clinic penetration (10% per quarter) decreased by 0.03% per quarter and only among patients with private insurance. This is equivalent to about 17 fewer ED visits among privately insured patients over the course of the year for the average emergency department if the retail clinic penetration rate increased by 40% in that year, according to the study.
An accompanying editorial by Jesse M. Pines, MD, director of the Center for Healthcare Innovation & Policy Research, the George Washington University School of Medicine and Health Sciences, commented on this study.
"“One of the value propositions of retail clinics is to reduce costs through providing an alternative to emergency departments. Despite dramatic increases in retail clinics across the U.S., ED volumes have not been substantially impacted," Pines told Managed Healthcare Executive.
He described three factors that contribute to this lack of “substitution” effect retail clinics and more broadly for convenience settings, which include retail clinics, urgent care centers, and direct-to-consumer telemedicine.
1. There is more demand for acute care than the current supply of doctors and hospitals. Retail clinics help meet this demand but do not replace other visits.
2. The reasons people use retail clinics and emergency departments are really unrelated. People use retail clinics when they have minor complaints, and most people use the ED when they really think they’re sick.
3. People who do use ED for low-acuity conditions-such as patients with Medicaid insurance-do not have access to retail clinics because often they do not take Medicaid insurance and they are not located in poorer neighborhoods where Medicaid patients live.
“The fact that retail clinics and likely by extension telemedicine and urgent care centers do not substantially reduce ED use is very important,” Pines says. “It means that the push to expand capacity for episodic care outside the ED does not save money on ED visits, and will likely increase costs. However, for many patients retail clinics provide increased access to care, which in the end is a good thing because patients can get the care they need and want.”
When considering coverage of non-ED settings for acute care, executives should consider that a major effect may be to increase, rather than decrease costs because of the increased access, according to Pines. “This is not inherently negative because convenience settings, like retail clinics, can help meet the unmet needs for acute, unscheduled care,” he says.