Retail clinic visits by young, insured patients with PCPs on the rise

Your young, insured patients increasingly are visiting retail clinics for healthcare.

Visits to retail clinics quadrupled from 2007 to 2009, and up to 40% of their patients paid out-of-pocket for their care despite reporting they had a primary care physician (PCP).

Since first appearing in 2000, retail clinics have received criticism from the American Medical Association (AMA) and the American Academy of Family Physicians (AAFP), among other physician groups, for their potential to disrupt patient relationships with PCPs and continuity of care. Those concerns increased in 2010 when some retail clinics began offering care for chronic conditions such as asthma and diabetes. Also, by the end of 2010, the number of retail clinics increased to about 1,200 from just 300 in 2007.

“The increased demand for primary care might reduce access to PCPs, which may increase the demand for retail clinics,” note Ateev Mehrotra, a policy analyst at the Rand Corp. and associate professor of medicine at the University of Pittsburg School of Medicine, and Judith R. Lave, professor of health economics in the Department of Health Policy at the University of Pittsburg, authors of a new study published in the September issue of Health Affairs.

The most common retail clinic patients were young adults without PCPs. But visits by patients aged at least 65 years increased to 14.7% during the 2007 to 2009 study period, compared with 7.5% in a previous study than ran from 2000 to 2006. Other visit data gleaned from the most recent study indicate that Monday is the most popular day for retail clinics, but 44% of retail clinic visits overall occurred when physician offices were likely to be closed. Upper respiratory or urinary tract infections were the most frequently diagnosed conditions in patients visiting retail clinics for illnesses.

The spike in older patients visiting retail clinics may be attributed to a substantial increase in visits for vaccinations over the study period, the authors note. But preventive care visits also are on the rise, with an increase to 47.5% of visits during the study period from 2007 to 2009 compared with 21.8% of visits from 2000 to 2006.

Chronic care visits accounted for just 1% of retail clinics visits. The number of patients with insurance who visited retail clinics increased by more than 3% over the study period, and the number of visits by patients without PCPs saw a similar increase. Visits by patients without insurance and those who did report having a PCP dropped by about 3% each.

In terms of retail clinics’ share of healthcare spending, assuming prior estimates of $78 per visits, the authors estimate retail clinics took in about $460 million in 2009 with a grand total of 5.97 million visits overall in contrast with 577 million visits to traditional physician offices and 117 million visits to emergency departments the same year.

“It will be interesting to track demand at retail clinics after the Affordable Care Act is fully implemented,” study authors note. “Newly insured people will probably seek primary care in the traditional setting, which could decrease the demand for retail clinics. However, if wait times for appointments with PCPs increase nationwide, as they have in Massachusetts after that state’s health reform, demand for the clinics might increase.”

A Deloitte report from 2009 offers estimates retail clinics will continue to grow, topping out at around 4,000 clinics by 2015 after an initial downturn in 2009.

The study compiled data from Minute Clinic, TakeCare, and Little Clinic-the three largest retail clinic operators in the United States, which together operate 81% of the nation’s retail clinics.

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