RAND Studies Retail Clinics
On everything that could be measured, the verdict is all thumbs up. The RAND Corporation found that less than half of patients seeking care in a retail clinic setting (39%) had a primary care physician. An estimated 16% to 27% (depending on location) of retail clinic patients were uninsured. Customers liked the convenience, low-cost, shorter wait times and transparent pricing. Many were dissatisfied with traditional primary care, and there is no evidence that the quality of care was lower than traditional primary care.
Still, the language of the report is full of caution, stressing “concerns” and “unanswered questions.” One wonders why? It was produced under contract for the Department of Health and Human Services.
Last question asked and answered.
Hey, John. They weren’t produced by a HHS sponsored pilot program. How could they possibly be any good?
I suspect that Medicaid costs could be cut everywhere if Medicaid would agree to pay the market price whenever Medicaid enrollees went to a walkin clinic. But I suppose that taking advantage of the market just isn’t bureaucratic enough for the typical Medicaid bureaucracy.
Retail clinics developed outside the third-party payment system and were (mostly) under the radar of the third-party payment establishment. There is a certain skepticism on the part of bureaucratic, public health elites about whether convenient care, quickly delivered by someone other than your primary care doctors is beneficial.
However, patients apparently don’t see a problem with not having to take time off work, drive across town and wait in a crowded waiting room to have their sore throat looked at. This is especially true of patients who are paying cash and obtaining the services for half the price of traditional physician visits. The survey showed that many of those that patronized retail clinics were dissatisfied with traditional primary care and nearly half did not have a primary care physician.
Ken, same thing is true of Medicare. It should be a simple matter to say “We’ll cover walkin clinics and pay the same price everyone else is paying.” But I suspect that nothing that happens at HHS is ever simple.
From the Article:
“However, potential per-episode savings must be weighed against the fact that retail
clinics could increase overall utilization by attracting patients who might not have otherwise sought care; an increase in utilization from this group would increase overall health care spending. Studies that have modeled the likely impact of retail clinic growth on system spending have found that, in the best-case scenario, there would be modest savings of less than 1 percent of national spending.”
So the retail clinic really brings no benefit unless you have a sore throat and happen to be at WalMart. But hey, the sore throat medicine is in aisle 3. What convenient marketing.
Aren’t we spending millions and millions on government run health care reforms to increase primary care utilization because, we’ve been told over and over and over, it decreases overall expenditure? (Not necessarily true, but it is the mantra.)
Second, the policy goal is not to control overall spending. What I and others choose to spend on health care is nobody’s business. The point is to reduce costs which, apparently, this does.
People on road trips with sick kids in need of antibiotics for something like strep understand and appreciate retail clinics. The sore throat medicine in aisle 3 isn’t going to cut it.
Linda,
from the article:
“Retail clinics offer a consistent and limited scope of services (Rudavsky et al., 2009). As of August 2008, all retail clinics provided treatment for minor infections, such as sore throats, ear infections, and sinus infections. Nearly all treated minor skin conditions and allergies and also offered immunizations and routine preventive screening. Such services as smoking-cessation counseling and counseling related to HIV or sexually transmitted diseases were offered less frequently, at 58 percent and 3 percent of retail clinics, respectively. A later chapter discusses the current movement to expand this scope of care.”
This is not primary care. This is school nurse stuff.
If your kid got strep while on the road I would suggest urgent care or a local doctor visit. According to RAND, WalMart does not do strep and it can be a dangerous infection.
Retail clinics do not seem to reduce overall costs based on the article but what retail clinics will do is create synergy between diagnosis and over the counter consumables. The next study should indicate whether retail clinics suggest one OTC over others and are the retail clinics receiving a premium for that.
The Walmart web site lists the companies that do the clinics in various stores. As of today, at least two of them specifically say that they do treat strep throat. Perhaps RAND researchers didn’t bother to check to see what the clinics actually offer?
As for smoking cessation, WalMart offers that on aisle whatever, in over-the-counter form, for less.
To expect that smoking cessation or HIV and STD counseling and treatment are a measure of the quality of care offered in retail clinics aimed at the mass market strikes me as bizarre.
As far as this customer is concerned, if you can diagnose me and offer a product to treat what ails me I’m happy. Some pediatricians fill common prescriptions in their offices. It costs a little more but it sure beats dragging a sick toddler all over to get the meds.
If Walmart does it for less, more power to them.
Linda,
I went to the WalMart website and here is the list of services they provide:
From the website:
“All clinics offer essential preventative and routine health services for a standard set of common health aliments and screening needs that can be performed without urgent or emergency care, including:
Acne, Bladder infections, Blood sugar testing, Camp and school physicals, Cholesterol screening, Common vaccinations, Ear aches, Flu, Insect bites and stings, Minor wounds, Sinus infections, Upper respiratory infections, Wart removal”
It also states the costs:
An average Get Well visit costs $65 or less.
By the way there was only one clinic in all of California and no strep services.
Do you still want to say RAND was incorrect?
But your right, it is your choice on how you spend your medical dollars.
The master list of nationwide Walmart clinics is at http://i.walmart.com/i/if/hmp/fusion/Clinic_Locations.pdf. It lists the individual clinics and provides links to specific information on the services they offer.
There is one clinic listed in California (out of about 400 nationwide). It is at the Walmart at 40580 Albrae Street in Fremont. It is staffed by Washington Township Medical Group. Their website says that the clinic offers “Walk-ins and scheduled family practice appointments.”
If you further check the WTMG’s web page and click on locations to see what services each location provides, you will see that one of the services they specifically list, at the Walmart clinic, is “Sore throat/Strep throat,” cost $69.
The quote you provided from the RAND paper says nothing about strep treatment. You are the one who asserted that Walmart clinics do not treat strep throats.
Linda,
I already checked both sites yesterday, and to qualify for the Med Groups family practice off-site location you need insurance and make a scheduled appointment.
Also, you brought up strep:
Linda Gorman Says:
August 24th, 2010 at 6:24 pm
People on road trips with sick kids in need of antibiotics for something like strep understand and appreciate retail clinics. The sore throat medicine in aisle 3 isn’t going to cut it.
I simply went to the website and showed you what WalMart lists themselves.
I suspect that Medicaid costs could be cut everywhere if Medicaid would agree to pay the market price whenever Medicaid enrollees went to a walkin clinic. But I suppose that taking advantage of the market just isn’t bureaucratic enough for the typical Medicaid bureaucracy.