Do Retail-Based Clinics Pose a Threat to Your Practice?

Retail-based medical clinics (RBCs) have taken the ideas of convenience and one-stop shopping to a new level, and have cropped up throughout the country at a rapidly growing rate. With numbers expected to reach into the thousands in 2009, these clinics are located in drug stores and shopping centers like WalMart and Target, and bear names that reflect their philosophy of service, such as "MinuteClinic" and "QuickHealth." These clinics advertise themselves as both convenient and affordable, and have an added appeal for those who fall into the categories of under or uninsured.

Quality of Care  

Although RBCs are able to perform only a limited number of simple medical procedures such as strep tests, limited school physicals, and treat ear infections, the proliferation of these clinics has many pediatricians worried about the affect they will have on their own practices. While pediatricians could lose patients and business to this walk-in healthcare industry, there is also the concern that visits to these clinics will result in fragmented care and compromise the quality of continuous care.

While the threat of Retail-Based Clinics has loomed since early 2001, the dramatic rise in the past several years has heightened the alarm among many pediatricians and primary care doctors. But this perceived threat could be relatively unfounded, said Chip Hart, director of Pediatric Solutions at PCC. "From my point of view, good pediatricians have nothing to worry about when it comes to retail-based clinics. Practices are more afraid than they need to be."

Not a One-Stop Shop for Health

"The experience of our clients indicates that the convenience of these clinics is generally overrated," said Hart. "If a patient visits a clinic, they will frequently just be referred to their primary physician for something the clinic is not certified to do. Then the patient ends up paying twice and having to make two appointments–in the end not convenient and not cost-effective." 

The entrance of RBCs into the medical arena did not set the stage for responsible care, said Hart. There are many stories about these clinics that are indicative of their irresponsible care, such as when a drug store clinic began offering back-to-school physicals for $30 in conjunction with $30 worth of products from the store. "This is ultimately illegal, and clinics are not able to offer these type of deals," he said. Another instance of inappropriate behavior occurred when an insurance company waived copays as an incentive to encourage visits to RBCs in an effort to save themselves money. "The insurance company was forced by the state to stop this behavior."

Because of the potential negative effects on quality of care for patients, the American Academy of Pediatrics (AAP) has taken a firm stance against retail-based clinics. "The Academy does not often take stances like this," said Hart. "I'm impressed that they did so and think it will play an important role as customers weigh the option of visiting one of these clinics."

Responsible Care

Even though RBCs may not pose as much of a threat to pediatric practices as first envisioned, it is still in pediatricians' best interest to be aware of them and respond to their emergence as a chance to reaffirm their relationship with their patients as an authority in children's health. "I recommend to pediatricians that they put more emphasis on being specialists," said Hart, "and in doing so, concentrate on conducting well visits, complex sick visits, and working with chronically ill patients. These are all areas where retail clinics cannot compete." 

One area where retail-based clinics may have an advantage is in very low complexity visits such as strep tests. "Practices that are attached to providing many of these services may be affected by RBCs."

Hart also said of retail-based clinics that, so far, the frequency with which they are cropping up and their effect on pediatric practices is a very regionalized issue. "Practices are dealing with this on many different levels. Some places seem to be more affected such as New Jersey and Tennessee."

Because so many new RBCs plan to open in the next year, Hart conceded that their affect on pediatric practices may very well increase for a time, but he added, "I do think it will level off and may even go away for many practices." 

For pediatricians who are feeling the impact of RBCs on their practices, Hart offers several suggestions. "I suggest asking your customers why they're going to these clinics and not your practice. That way, you can look to your own practice and evaluate what retail-based clinics are offering that your practice itself should provide." In many cases, the reasons are related to hours and availability. "The reality is, if your hours are not convenient, there will be patients who won't be able to come to your practice." He added that if pediatricians can see patients after 5 p.m., they can actually get paid more for the visit by using an after hours code.

Hart also suggests to PCC customers ways they can use their Partner Practice Management system to help respond to RBCs, such as generating personalized handouts to give patients for well visits, preventative care, and chronic care. "I always tell our clients that patients should be walking out of their office with a handful of personalized pieces of paper with their practice's name and address on it. You want patients to feel like they're getting the best care in your office, a level of care they can't get elsewhere."

Pediatric practices should also take special care to recall patients for appointments such as well-visits and chronic care, like asthma and ADHD re-checks. Partner can be used as a tool to help recall these patients, so that your practice can provide services that cannot be offered by retail-based clinics.

"Pediatricians who do nothing about the problem are losing an opportunity and it's too bad," said Hart. "Pediatricians are often afraid to take action to affect problems in their office."

Although it is the responsibility of providers to maintain their patient base, Hart also noted that patients need to be aware of their own health when considering a visit to a retail clinic. "An important aspect of quality medical care is the continuity of care. Patients will be sacrificing this by visiting any of these clinics. We're talking about people who don't know you or your child trying to provide medical help and advice. The advantages of going to a pediatrician are having continuity of care and seeing someone who knows what is happening with you and your family."