Can You Really Compete With Retail Clinics -- and Succeed?

Leigh Page

Disclosures

March 18, 2015

In This Article

Can Physicians Limit Retail Clinics' Activities?

When retail clinics first came to the attention of the medical community some 10 years ago, many physicians wanted them to be strictly regulated. They were concerned that NPs in the clinics might provide inferior care, their services would fragment healthcare delivery, and the pharmacy chains would use the clinics to boost their sales of prescription drugs.

In fact, in 2007 the American Medical Association (AMA) called[18] for a federal investigation into potential conflicts of interest for pharmacy-based clinics. Apparently no such investigation has taken place, and Dr Mehrotra's 2009 study in Annals of Internal Medicine suggested that this concern was misplaced. It found that per-patient costs of prescriptions written in retail clinics were no higher than those written by doctors for the same conditions.

Meanwhile, the medical profession called for state legislation to limit retail clinics' activities. As of 2011, 16 states had considered such bills, according to an analysis[19] by the National Conference of State Legislatures. Only Florida passed one, but it was limited to supervision of NPs in retail clinics, and Massachusetts passed a comprehensive set of regulations. All the other bills failed.

One reason for this failure of legislation was that the Federal Trade Commission warned lawmakers that they could violate federal antitrust laws by placing overly strict limits on clinics' growth.[20] Another reason is that recent studies have shown that NPs don't provide lower quality of care for the low-acuity services in a retail clinic. "The research comparing nurse practitioners with doctors on several measures of care has been reassuring," Dr Mehrotra said.

The Massachusetts regulations do have some teeth. They limit the conditions that retail clinics can treat and require them to develop rules for communicating with and referring patients to practices. But the regulations haven't stopped retail clinics from entering the state. In fact, CVS alone now operates 52 clinics there, according to its website.

Will Clinics Begin to Cover More Services?

Retail clinics have had to deal with a lopsided calendar, said Thomas Charland, CEO of Merchant Medicine, a consultancy on walk-in healthcare. In the winter, they are crowded with patients with sore throats, strep throat, and sinus infections, but in many cases they sit relatively empty the rest of the year, and some of them have had to close down in the summer.

To combat this seasonality, Charland said many clinics are adding more services that generate volume at other times of the year. For example, many of them now offer camp physicals in May and school sports physicals in August. Clinics have also taken on preventive services, such as flu shots. And in 2013, Walgreens' clinics took a big step, adding services for chronic conditions, such as treatment and management of asthma, diabetes, and hypertension. The company recently announced that preventive services, screening, and chronic care visits now make up 50% of all visits, up from 15% in 2013. The rest of the clinics' services are traditional acute care visits.

Retail clinics have a lot of room to grow. Dr Mehrotra estimated that they could handle 18% of all PCP visits. But it's up to patients to decide where they want to be treated, and they have different ideas about that, depending on the condition.

The 2012 Harris Poll asked people when they'd go to a retail clinic instead of a doctor's office. Two thirds preferred going to a retail clinic for a flu shot, and just over one half preferred using them for cold or flu symptoms, but interest fell after that. Whereas 49% would prefer going to retail clinics for a cut or puncture wound and 47% to check blood pressure or cholesterol, the numbers fell to 39% for a possible fracture or sprain and to 36% for an asthma flare-up or low blood sugar.

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