Retail clinics grow in popularity, but still put only a dent in patient care

Patient traffic to retail clinics doubled every year between 2007 and 2009, reaching nearly 6 million visits in 2009, according to an analysis by RAND Corp. researchers published online Aug. 15 in Health Affairs.

The pace of growth adds weight to some analysts’ belief that retail clinics will remain a permanent part of the health care system. Researchers hope to analyze how primary care physician offices have been affected by patients’ visits to retail clinics.

The RAND study examined visits to the largest retail clinic chains, which make up 80% of the retail clinic volume, and extrapolated from those numbers to estimate that total visits rose from 1.5 million in 2007 to 6 million in 2009.

Visits to retail clinics still make up a small number of total outpatient visits. The study noted that patients make about 577 million physician office visits and 177 emergency department visits each year.

The demographic profile of retail clinic customers didn’t change much from the smaller number of retail clinic visits between 2000 and 2006 that RAND examined in previous research, with the exception of a rise in the number of patients 65 and older. About 7.5% of retail clinic patients were senior citizens in the earlier period, and that share nearly doubled to 14.7% in the 2007-2009 study period.

From 2007-09, 40.8% of visits to retail clinics were for immunizations, a point that retail clinic expert and consultant Tom Charland said was important in terms of forecasting growth. Charland is CEO of retail clinic consulting firm Merchant Medicine, based in Shoreview, Minn., and a peer reviewer for the RAND study.

Because so many pharmacies began offering flu shots on the heels of retail clinics’ success, he said he doubted retail clinics would have been able to continue to increase the number of visits for vaccinations after 2009. A drop-off in flu shots could have been part of the reason for a wave of retail clinic closings in 2009 and thereafter, he said.

Retail clinics have been adding services to their offerings, including care for chronic illnesses, something that could shift the number and type of visits that show up in the next analysis, Charland said.

The total number of retail clinics in operation dipped slightly in 2009 and early 2010, held steady near 1,200 through early 2011, and began to rise again in 2011, according to Charland’s market data. As of July 1, he counted 1,351 clinics in 39 states.

Charland pointed out that retail clinics on average are still short of breaking even financially. He expects growth to pick up significantly once the first clinics clear a profit. The vast majority of clinics in operation are pharmacy-owned: CVS’ MinuteClinic and Walgreens’ Take Care clinics. The chains have 922 clinics combined.

Despite all the caveats to the growth in retail clinic volume, the rise in traffic may tell physicians something important in terms of how they can accommodate patients’ needs, said Ateev Mehrotra, MD, MPH, a Pittsburgh internist and pediatrician and RAND policy analyst who co-wrote the study.

“About 44% of visits were at times when doctors’ offices were typically closed,” he said. “There’s been an increasing push overall [in terms of] what do we do about after-hours care, and this work highlights the importance of that.”

Offering care after normal business hours, providing e-visits or even house calls might be good advice for physicians who want to see more patients. But some physicians already are overwhelmed with high patient volume, said Dr. Mehrotra, an assistant professor of medicine at the University of Pittsburgh School of Medicine.

“It’s not clear that all doctors need new business,” he said. “If that’s the case, could these clinics be one other venue that doctors can direct patients to when they can’t see them?”

Dr. Mehrotra said he hopes to publish a study soon examining the way primary care physicians’ relationships with patients have been affected by retail clinic visits.

Charland said the health system is going to change dramatically in the next five years and it’s clear retail clinics will be part of the future health system, either as medical homes as an alternative to traditional primary care offices or as partners with physicians’ offices.

“I do believe there’s going to start to be cooperation between all of these various players,” he said.