Use of Retail Clinics

By February 1, 2017Commentary

Retail clinics are somewhat widespread, particularly in pharmacies and some chain mass-market retailers and grocery stores.  There are about 2000 of these clinics and they treat a small range of acute conditions, usually with non-physician clinicians, and have begun widening their services to include routine chronic condition care.  Because their unit costs are smaller, many payers include them in their network and may even have lower cost-sharing for their use.  A study from the Blue Cross Blue Shield association looks at trends in the use of these clinics.   (BCBS Study)   Such use has doubled in the last five years among Blue Cross plans’ commercial members, rising from 12.2 visits per 1000 members to 24 visits.  Overall, however, retail clinics account for less than 1% of all outpatient visits.  People on individual plans have lower retail clinic use than do those who get coverage through their employer.

The most common conditions treated at retail clinics were upper respiratory conditions, which accounted for almost half of all such visits, ear infections, urinary tract issues and dermatologic needs.  There is a seasonality to retail clinic use, with a spike in the winter, probably cold and flu-related, and a dip in the summer.  And women are much more likely to use this site of care than men, having a 72% higher use rate.  Younger patients are also more likely to use retail clinics.  ER visits for these minor conditions remained relatively stable over the study period, while office visits for them declined by over 10%.  Nearly 30% of ER visits could have been handled at a retail clinic, at a very substantial cost saving, both to the payer and the member.  A retail clinic visit costs a tenth or less than an ER one does.  For an ear infection for example, a retail clinic visit is $36 on average, while an ER one is $414.  The cost to the patient may be even greater, as an ER visit is often subject to a deductible.  It appears that there are good reasons for payers to encourage more use of the retail clinics.

Kevin Roche

Author Kevin Roche

The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry through Roche Consulting, LLC. Mr. Roche is available to assist health care companies through consulting arrangements and may be reached at khroche@healthy-skeptic.com.

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