CCA touts retail clinic value, even when it comes to ED visits

WASHINGTON - A study published online earlier this week in the Annals of Emergency Medicine reported that retail clinics opened near emergency departments had little effect on rates of low-acuity visits to them. And an accompanying editorial suggested that the primary effect of opening retail clinics is to increase health care use, not substitute for emergency department visits



"Retail clinics may emerge as a way to satisfy the growing demand for health care created by people newly insured under the Affordable Care Act, but contrary to our expectations, they do not appear to be leading to meaningful reductions in low-acuity emergency department visits," stated lead study author Grant Martsolf of the RAND Corporation. "Although the growth in retail clinics has been significant in recent years, the only decrease in low-acuity visits to emergency departments was seen among patients with private insurance, and that decrease was very small."



However, the Convenient Care Association, representing approximately 2,300 clinics in 43 states, took issue with that conclusion, specifically that retail clinics had no material impact on emergency room visits. "To date, retail clinics have provided close to 40 million Americans with access to affordable, high-quality healthcare," stated Tine Hansen-Turton, executive director, CCA. "Approximately 40% of the services provideed in retail clinics are non-acute and preventative in nature, keeping healthcare costs down and promoting health and wellness."



In fact, Hansen-Turton noted, more than half of retail clinic users do not have a medical home, which means if they didn't have a retail clinic to turn to, the emergency room would have been their default destination. "As we know from other studies, the cost of retail clinic visits are 40% to 80% lower than those traditional sites," Hansen-Turton said. "In one such study, a visit to a grocery store clinic could cost as much as $460 less than a visit to the emergency room."



The number of retail clinics grew from 130 in 2006 to nearly 1,400 in 2012. The rate of retail clinic penetration – in other words, the proportion of the emergency department 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 emergency departments 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 approximately 17 fewer emergency department 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.



Hansen-Turton cautioned that conclusions drawn from 2012 data points may no longer bear relevance against today's marketplace, however. "At the peak of the study data period, there were only about 1,200 retail clinics in operation and the visibility and public knowledge about clinics was limited," she said. "Therefore the small reduction in ED visits (1.2%) noted is likely to be much greater today with approximately 2,300 clinics currently in operation, nearly double the figure referenced in the study."



Besides, Hansen-Turton continued, the findings of the study do not take into account the existence of the more than 9,000 urgent care centers in operation where patients may seek acute care.



"In conclusion, retail clinics are the only healthcare access point that are truly consumer-driven and meet patient healthcare needs in a timely, affordable, high-quality manner," Hansen-Turton said. "While reducing the number of ED visits was never the main objective of the clinics, insurers are seeing the positive impact from a quality and cost perspective, while consumers appreciate the convenience and access that the clinics provide."