RETAIL CLINICS: WHAT’S IN STORE FOR HEALTH CARE?

You’ve got that telltale tickle in your throat again, and you’re pretty sure it’s not just another cold. But your doctor’s office says the next open appointment is in two weeks. You’re traveling for business in another city. You don’t have a primary care physician to call. You’re self-employed and don’t have health insurance.

For all these reasons and more, potential patients are turning increasingly to retail clinics to cure their minor ailments.

According to a 2008 report by Mary Kate Scott of Scott & Co., the number of retail clinics in the United States grew from 150 to nearly 700 clinics last year. Renting space in drugstore chains such as CVS and Walgreens, major retailers such as Wal-Mart, and even hospitals, the clinics are filling a need for convenience, cost and a more consumer-like approach to health care.

What’s on the menu

Most retail clinics operate something like this: Appointment times are guaranteed, but up to 90 percent of patients just walk right in. They start by choosing their problem from the clinic’s menu of common complaints — think bronchitis, ringworm, ear infections. Many clinics also offer services such as childhood and adult vaccinations, pregnancy tests, and seasonal items such as flu shots and school and camp physicals. There are set prices for all of these services, displayed at the clinic’s entrance. Patients then sign up to see a health care specialist, who could be a nurse practitioner, physician’s assistant or even an M.D. in some cases. Most consultations take less than 15 minutes.

The short wait was a big draw for Tim, a Tucson, Ariz., college student who suspected he had a sinus infection. He visited a retail clinic housed in a nearby drugstore: “I got an appointment with my regular doctor last year for this same thing, and I ended up seeing a nurse practitioner there anyway. So I thought I would go where I knew I could probably get the same experience in less time and with less hassle.”

Nancy Dawson, a nurse practitioner and manager of operations for Minute Clinic in Tucson, says convenience seems to be a big factor in whom the clinics attract. Parents with young children and young adults are some of the heaviest users, “although we see all age groups,” she says. “It depends on the time of year, whether it’s flu season, time for seasonal allergies, or with our younger population, time for physicals.”

There’s no need to bring your full medical history along if you choose to use a retail clinic, but be prepared at least to tell the clinician about any current medications you’re taking, including any vitamins or supplements. If you’re there to get a vaccination, it’s helpful to bring in your shot record so that the vaccination can be recorded.

After your treatment, you’ll receive a printout of the results of your physical exam, your vital signs such as blood pressure, any in-clinic treatment you received, and any medications prescribed. The clinics can send a record of this record to your primary care physician if you ask them to do so — according to a 2007 survey, 78 percent of patients opt for this service. The clinics will also submit the records to your insurance company at your request.

The clinics create electronic health records for each patient that documents their visits and any relevant medical history. Dawson says the records are a “huge benefit” for patients who might find themselves at a Minute Clinic in another town or state. “You can retrieve prior visits from any clinic computer and more accurately evaluate what is currently going on with them.”

Most clinics accept a patient’s health insurance. And for the uninsured, some data suggest that the clinics can offer basic preventive and acute care at prices lower than those incurred in the ER or urgent care clinics. The retail clinics keep their costs down by limiting their services and their space — exam rooms are about the size of a walk-in closet in most places. There’s no room for an X-ray machine or ultrasound, lab, or other expensive equipment.

Tine Hanson-Turton, executive director for the Convenient Care Association, an industry membership group for retail clinics, says the “affordability of a visit to a convenient care clinic can encourage a patient to receive care early on,” preventing costly work absences and in some cases treating conditions before they become more complicated or severe.

…And What’s Not

Lacerated arm? Broken ankle? Clinical depression? Sorry, the retail clinic is not for you.

“We can’t treat sprains, strains or fractures because we have no X-ray machines,” says Mila Garcia, a nurse practitioner and manager of operations for the Phoenix Minute Clinics. “The other things that people ask for all the time and that we don’t do are pain medications, especially for migraines.”

Tim would recommend retail clinics for people “who already have a good idea of what they have,” although he was impressed by the clinical guidelines that his nurse practitioner used to eliminate other, more serious ailments in his case. For more mysterious health issues, he would make an appointment with his regular doctor, he says.

For the most part, Dawson says people “are very well-versed” in what the clinics do and do not offer. “For those who don’t know what our service includes, an electronic message board spools the information. And some people just want direction on what the next step in taking care of themselves would be.”

The 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,” Scott recommends.

For these patients, the clinics maintain a strong referral relationship with local urgent care and primary care physicians, Garcia says. The practices return the favor. “When everyone was being hit really hard by the flu season, we found that the urgent care or primary physicians would refer back to us, and tell their patients that we could get them in and out quickly,” Dawson recalls.

The clinics can also offer a referral to primary care doctors within a few miles’ radius who are taking new patients. “If you don’t have a medical home, we try to direct you toward one,” Dawson said.

In a 2006 survey conducted by Aurora QuickCare, a Wisconsin-based member of the Convenient Care Association, patients with no health insurance and those with high deductibles were especially pleased with their care at the retail clinics. And in a 2007 Harris Interactive/Wall Street Journal poll, 90 percent of retail clinic patients said they were satisfied with their care.

What’s In Store

As retail clinics become more popular with patients, they may add more preventive care and options to manage chronic conditions, such as intravenous therapy and downloading data from medical devices, Scott says.

The Phoenix clinics already work with the CVS drugstores to offer different preventive health screenings each month, including blood pressure, cholesterol, diabetes and skin cancer analysis, Garcia says.

The retail clinic concept has also proven popular with hospitals and large health maintenance organizations, and Scott says that more than a third of the clinic operator systems are part of hospital systems. “They’re either looking to use retail to serve existing patients that they want to keep in network, and they also see it as a change to access new patient groups within the community,” she says.

Doctors’ groups in a few states such as Tennessee and Kansas have raised questions about whether there is enough doctor supervision of these clinics, most of which are staffed by nurse practitioners. The American Academy of Family Physicians does not endorse the clinics, saying they could interfere with a patient establishing a “medical home” with a primary care doctor.

The American Medical Association has softened its stance on retail clinics, although the group recently called for a ban on the sale of tobacco or tobacco-related products in stores which house the clinics.

Retail Clinics: The Right Choice?

Not sure if a retail clinic is the right choice for you? Take a look at our list of pros and cons to find out what you could gain or lose if you decide to step inside.

Pro

• Guaranteed appointment times
• Short consultations — most less than 15 minutes
• Convenient locations and hours
• Up-front pricing
• Lower prices than ER or urgent care
• Cash or insurance accepted
• Electronic health record available at all locations
•  Some studies suggest clinics more likely to practice evidence-based medicine

Con

• Short consultation may not leave much time to explain health history, details of current complaint
• May detract from the development of a “medical home” and relationship with primary care doctor
• Limited set of conditions treated — care for chronic conditions and major ailments not available
• May miss important follow-up care required for certain conditions, such as infections
• Some insurance companies waive co-pay at clinics — which could force some patients to choose clinics when they would prefer to see their primary care doctor
• Oversight of clinics varies from state to state
• Usually will not be treated by an M.D.

Adapted in part from, Retail Medical Clinics: Okay in a Pinch, but No Substitute for Real Health Coverage, Families USA

Original post by the Center for Advancing Health. Updated by the GW Cancer Institute January 2016.