The Impact of Retail Clinics on Quality, Access, and Costs

1. The Impact of Retail Clinics on Quality, Access, and Costs Ateev Mehrotra, MD, MPH University of Pittsburgh School of Medicine RAND Health

2. Ongoing Debate about Merits of Retail Clinics

3. Ongoing Debate • Quality • Access & PCP relationships • Costs

4. Antibiotic Prescribing Rates Are Similar Mehrotra et al., Annals of Internal Medicine, 2009

5. Quality of Care in Retail Clinics is the Same or Better than Found in Other Settings

6. Quality Findings Consistent With Other Research • Patient satisfaction very high1 • Quality • Follow-up visit rates lower2 • Care concordant with guidelines3 • “HEDIS scores” higher than most health plans4 1 Harris Interactive 2 Rohrer, Qual Manag Health Care, 2008 3 Woodburn, AJMQ, 2007 4 Jacoby, AJMQ, 2010

7. Ongoing Debate • Quality • Access & PCP relationships • Costs

8. Significant Fraction of U.S. Population Has Access to a Retail Clinic • Almost 90% of clinics in urban areas • 38% of urban population live within a 10 minute drive • Few clinics in underserved areas • 13% in Health Professional Shortage Areas compared to 21% of population Rudavsky, Mehrotra, JABFM, 2010

9. Age Distribution of Patients Emerg Room Retail Clinics MD Office Mehrotra et al., Health Affairs, 2008

10. Most Retail Clinic Patients Report No Primary Care Physician

11. Ongoing Debate • Quality • Access & PCP relationships • Costs

12. Significant Per Episode Cost Savings at Retail Clinics Mehrotra et al., Annals of Internal Medicine, 9/09

13. What Fraction of ED Visits Could be Seen at Alternate Sites? sore throat, pink eye, sinus infection, ankle sprain, minor fracture 17% 27% All ED Visits Limited to ED visits when retail clinics and urgent care centers open chest pain, abdominal pain Potential Savings of $4.4 Billion Weinick et al., Health Affairs 2010

14. Potential Cost Savings if Retail Clinics Become Widespread Nationally • Institute of Medicine • $2.0 - 7.5 billion annual spending reduction • Impact on total US health care budget • ~0.1% of $4.6 Trillion Hussey, et al. NEJM, 2009 IOM, 2009

15. Summary of Research

16. Should We Encourage Use of Retail Clinics • Potential Benefits • More convenience for patients • Save money • Potential Concerns • Increase fragmentation of health care • Worsen financial situation of EDs • Patients may not “self-triage” correctly