Retail clinics gain new respect

As health costs and doctor wait times mount and health reform ushers in an integrated team approach to patient care, retail health clinics appear poised for another growth surge.

Among recent developments: CVS Caremark’s MinuteClinic unit will expand to roughly 1,060 clinics by 2015 to keep up with booming demand; Massachusetts has broadened the preventive and diagnostic services clinical nurse practitioners can provide; and South Carolina’s retail clinics now can provide preventive and acute care to Medicaid patients.

Two powerful forces are driving the surge: access and cost. There’s growing recognition among providers and payers that retail clinics are a cost-effective solution to both the shortage of primary care physicians and spiraling health costs. “Patients will go any place that saves them money,” observed Ken Berndt, CEO of Careworks Convenient Healthcare, the clinic and urgent-care division of Geisinger Health System in Pennsylvania.

But “even above cost” on patients’ priority list, he said, is to have ready access to a health professional — be it a pharmacist, a nurse practitioner or physician’s assistant in a walk-in clinic, or a primary care physician. “Patients want care when they want care,” said Berndt.

With “the increasing shortage of primary care physicians across the country,” noted Tine Hansen-Turton, executive director of the Convenient Care Association, “nurse practitioners and physician assistants ... will, more and more, be looked to as key front-line primary care providers.” What’s more, she added, the industry’s nearly 1,400 clinics comprise “the lowest cost, nonsubsidized providers of primary health care” at a time when “many consumers’ out-of-pocket costs go up.”

Retail clinics — along with the nation’s roughly 9,000 urgent care centers — also will play a critical role as reform spawns new concepts like accountable care organizations and medical homes.

The medical establishment, for its part, seems at last to be embracing retail care centers as a source of relief to overcrowded waiting rooms and overloaded primary care physicians. In May, the influential Journal of the American Medical Association featured an article extolling the virtues of retail clinics and a team approach to primary care.

“With good communication between multiple specialists, convenient access in evenings and on weekends, and familiarity with local community resources, the retail clinic potentially could be an important component of coordination of care aimed at reducing disease exacerbations, unnecessary hospitalizations and adverse drug interactions,” noted JAMA contributor Christine Cassel.