Study: Retail health clinics as good as doc office

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Study: Retail health clinics as good as doc office
Not only is care cheaper, but in some cases, better than ERs, research finds

By Alex Johnson
Reporter
updated 3:55 p.m. ET, Fri., Sept . 4, 2009

There is no evidence to back up doctors’ warnings that low-cost retail health clinics in hundreds of pharmacies and other stores across the country could expose customers to substandard medical care, researchers said this week.

The clinics, which operate under names like MinuteClinic, TakeCare and MediMinute, have become increasingly popular as convenient options for Americans seeking routine care without the expense of visits to doctors’ offices or hospital emergency departments.

More than 1,200 such clinics now dot the country since the first ones opened in pharmacies under the QuickMedX name (now MinuteClinic) in 2000, according to the Convenient Care Association, the industry’s trade group. A company called AeroClinic has even opened retail locations in two airports — Hartsfield-Jackson Atlanta and Philadelphia International — with plans to expand as early as this fall.

Some physicians’ groups, such as the American Academy of Pediatrics and the American Academy of Family Physicians, have raised concerns about potential conflicts of interest and the quality of care at retail clinics, where immunizations and treatment for routine illnesses like middle ear infections and sore throats are generally offered by nurse practitioners rather than doctors.

But the new research, the first large-scale study of the care provided in U.S. retail clinics, found “no difference in the quality offered to patients visiting retail clinics, physician offices and urgent care centers.” For some services, retail clinics even did slightly better than hospital emergency rooms, said the researchers, who published their findings in two papers this week in the Annals of Internal Medicine.

The studies are likely to add to the debate over controlling health care costs as President Barack Obama and Congress seek an agreement on a new health care system. The research, which was organized by the nonprofit Rand Corp., found that retail clinics charged significantly less for services commonly offered for several hundreds of dollars by doctors in private settings.

“These findings provide more evidence that retail clinics are an innovative new way of delivering health care,” said the lead author, Ateev Mehrotra, a physician and professor at the University of Pittsburgh School of Medicine. “Retail clinics are more convenient for patients, less costly and provide care that is of equal quality as received in other medical settings.”

Clinics not available to everyone
If anything, the authors said, the biggest concern about retail clinics — more than 400 of which are operated by Wal-Mart Stores Inc. alone — is that there aren’t enough of them.

Nearly half of all retail clinics are concentrated in just five states — Florida, California, Texas, Minnesota and Illinois — while 18 states have none at all. As a result, less than a third of Americans live within a 10-minute driving distance from one, the studies found.

For patients who can get to one, a retail clinic offers several advantages over visits to traditional doctors’ offices or urgent care centers.

Nearly all of them accept major insurance plans, and because they are usually attached to pharmacies, patients can fill their prescriptions immediately. Meanwhile, the costs for routine procedures like flu shots, sore throat exams and cholesterol screenings are significantly lower — an average of $110, compared with $166 for doctors’ offices, $156 for urgent care centers and $570 for hospital emergency departments.

To track the quality of care, the researchers studied outcomes for three routine illnesses — middle ear infections; pharyngitis, or a sore throat caused by inflammation of the pharynx; and urinary tract infections — for hundreds of patients each at doctors’ offices, urgent care centers, hospital emergency rooms and MinuteClinic retail clinics in Minnesota.

They recorded no significant differences in patient outcomes except in emergency departments, where prescription costs were higher and quality scores were significantly lower than in the other settings.

Researchers say doctors’ fears unfounded
As a result, the researchers found “no evidence to support the concerns” of physicians groups that retail clinics might be likely to overprescribe antibiotics or overlook some conditions because doctors are not conducting examinations.

In 2007, the American Academy of Family Physicians issued a statement raising those and other questions — including concerns about disrupting the traditional doctor-client relationship — and stressing that “the Academy does not endorse these clinics.”

Three years ago, the American Academy of Pediatrics raised similar objections in a policy statement in which it said it “strongly discourages their use.”

Mehrotra, the studies’ lead author, acknowledged doctors’ concerns and said “we need to continue to examine retail medical clinics as they grow in number.” But he said “the results we have seen thus far” suggest that retail clinics do “provide high-quality care in a convenient and cost-effective fashion.”

Co-author Marcus Thygeson, medical director of HealthPartners Inc., a Minnesota health maintenance organization unaffiliated with MinuteClinic, agreed, saying the research should be “reassuring to consumers.”

While retail clinics offer a limited set of services, “the price is affordable and the quality — at least at MinuteClinic — seems to be as good as you would get in the average doctor’s office,” he said.

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Well, that's not what I hear from my friends who're actually moonlighting/locum tenens at these places. Poorly run by HS/GED grads with 8 months of community college who know nothing about medicine much less how to pronounce the names of the vaccines. No accountability. And since some large corporation owns these clinics, no one takes pride in maintaining quality either in care or documentation and feel powerless to make change for the better. Volumes are low, poorly supplied. Everyone who works there (MA, FNP, or MD) are all clock watchers and waiting for their next gig, trying to minimize their risk as much as possible. Patients are cash pay, so you can't even help them if needed to be worked up or better controlled. My friends (plural) say it's like working in a 3rd world country.

No thanks.
 
I'm calling B.S. on the cost figures in this quote:

Meanwhile, the costs for routine procedures like flu shots, sore throat exams and cholesterol screenings are significantly lower — an average of $110, compared with $166 for doctors' offices, $156 for urgent care centers and $570 for hospital emergency departments.

No way is it cheaper to get care at the average urgent care center than the average PCP's office. Every urgent care center I've ever seen pads the bill like crazy with unnecessary ancillary tests. I can tell you for a fact that nobody who comes into my office for any of the simple things that you would go to a retail medical clinic for would ever leave with a $166 bill. Their data is crap, I guarantee it.

As for "patients being able to fill their prescriptions immediately," this is overrated. They still have to stand there and wait on the pharmacist after they hand over their script. What if you don't want to use their pharmacy? In my office, I can send an e-prescription to the pharmacy of a patient's choice and it'll be waiting for them when they go to pick it up. Some pharmacies around here still offer home delivery.

Furthermore, nobody's talking about the obvious conflict of interest when clinics are sending patients to the in-store pharmacy, either.

The bottom line is that most "quality measures" don't measure quality. Any trained monkey can give somebody antibiotics for a sore throat if they have a positive rapid strep test. However, the protocols go out the window when the diagnosis isn't so obvious.
 
Members don't see this ad :)
Study: Retail health clinics as good as doc office
Not only is care cheaper, but in some cases, better than ERs, research finds

By Alex Johnson
Reporter
updated 3:55 p.m. ET, Fri., Sept . 4, 2009

There is no evidence to back up doctors' warnings that low-cost retail health clinics in hundreds of pharmacies and other stores across the country could expose customers to substandard medical care, researchers said this week.

The clinics, which operate under names like MinuteClinic, TakeCare and MediMinute, have become increasingly popular as convenient options for Americans seeking routine care without the expense of visits to doctors' offices or hospital emergency departments.

More than 1,200 such clinics now dot the country since the first ones opened in pharmacies under the QuickMedX name (now MinuteClinic) in 2000, according to the Convenient Care Association, the industry's trade group. A company called AeroClinic has even opened retail locations in two airports — Hartsfield-Jackson Atlanta and Philadelphia International — with plans to expand as early as this fall.

Some physicians' groups, such as the American Academy of Pediatrics and the American Academy of Family Physicians, have raised concerns about potential conflicts of interest and the quality of care at retail clinics, where immunizations and treatment for routine illnesses like middle ear infections and sore throats are generally offered by nurse practitioners rather than doctors.

But the new research, the first large-scale study of the care provided in U.S. retail clinics, found "no difference in the quality offered to patients visiting retail clinics, physician offices and urgent care centers." For some services, retail clinics even did slightly better than hospital emergency rooms, said the researchers, who published their findings in two papers this week in the Annals of Internal Medicine.

The studies are likely to add to the debate over controlling health care costs as President Barack Obama and Congress seek an agreement on a new health care system. The research, which was organized by the nonprofit Rand Corp., found that retail clinics charged significantly less for services commonly offered for several hundreds of dollars by doctors in private settings.

"These findings provide more evidence that retail clinics are an innovative new way of delivering health care," said the lead author, Ateev Mehrotra, a physician and professor at the University of Pittsburgh School of Medicine. "Retail clinics are more convenient for patients, less costly and provide care that is of equal quality as received in other medical settings."

Clinics not available to everyone
If anything, the authors said, the biggest concern about retail clinics — more than 400 of which are operated by Wal-Mart Stores Inc. alone — is that there aren't enough of them.

Nearly half of all retail clinics are concentrated in just five states — Florida, California, Texas, Minnesota and Illinois — while 18 states have none at all. As a result, less than a third of Americans live within a 10-minute driving distance from one, the studies found.

For patients who can get to one, a retail clinic offers several advantages over visits to traditional doctors' offices or urgent care centers.

Nearly all of them accept major insurance plans, and because they are usually attached to pharmacies, patients can fill their prescriptions immediately. Meanwhile, the costs for routine procedures like flu shots, sore throat exams and cholesterol screenings are significantly lower — an average of $110, compared with $166 for doctors' offices, $156 for urgent care centers and $570 for hospital emergency departments.

To track the quality of care, the researchers studied outcomes for three routine illnesses — middle ear infections; pharyngitis, or a sore throat caused by inflammation of the pharynx; and urinary tract infections — for hundreds of patients each at doctors' offices, urgent care centers, hospital emergency rooms and MinuteClinic retail clinics in Minnesota.

They recorded no significant differences in patient outcomes except in emergency departments, where prescription costs were higher and quality scores were significantly lower than in the other settings.

Researchers say doctors' fears unfounded
As a result, the researchers found "no evidence to support the concerns" of physicians groups that retail clinics might be likely to overprescribe antibiotics or overlook some conditions because doctors are not conducting examinations.

In 2007, the American Academy of Family Physicians issued a statement raising those and other questions — including concerns about disrupting the traditional doctor-client relationship — and stressing that "the Academy does not endorse these clinics."

Three years ago, the American Academy of Pediatrics raised similar objections in a policy statement in which it said it "strongly discourages their use."

Mehrotra, the studies' lead author, acknowledged doctors' concerns and said "we need to continue to examine retail medical clinics as they grow in number." But he said "the results we have seen thus far" suggest that retail clinics do "provide high-quality care in a convenient and cost-effective fashion."

Co-author Marcus Thygeson, medical director of HealthPartners Inc., a Minnesota health maintenance organization unaffiliated with MinuteClinic, agreed, saying the research should be "reassuring to consumers."

While retail clinics offer a limited set of services, "the price is affordable and the quality — at least at MinuteClinic — seems to be as good as you would get in the average doctor's office," he said.

wonderful! Now we can encourage even further fragmented Health Care. Hey at least there is money saved. That is what it is all about, saving money. Yes a retail clinic can diagnose a Chest Cold. What if that 'chest cold' is a P.E.?
People absolutely have to take a stand against this nonsensical 'health care'. It is ridiculous, and can actually worsen the current Health Care economy in the long run, by discouraging continuity of care with the same doctor.
This is absurdity. :thumbdown:
This is truly a sad turn of events.
 
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The fine print of the study says that outcomes measured were simple conditions like OM, pharyngitis, UTI.

How will the nurses sell this? "WE'RE JUST AS GOOD AS DOCTORS (implying for all conditions) See? This study proves it!"

It's about marketing. People don't have time to actually read the studies. They just want a catchphrase.
 
The fine print of the study says that outcomes measured were simple conditions like OM, pharyngitis, UTI.

How will the nurses sell this? "WE'RE JUST AS GOOD AS DOCTORS (implying for all conditions) See? This study proves it!"

It's about marketing. People don't have time to actually read the studies. They just want a catchphrase.

That's all that matters, and the cat's already out of the bag on this. Blame the AMA for ignoring primary care for decades and allowing nurses and PAs to fill a void. Too late to stop it.
 
Well, that's not what I hear from my friends who're actually moonlighting/locum tenens at these places. Poorly run by HS/GED grads with 8 months of community college who know nothing about medicine much less how to pronounce the names of the vaccines. No accountability. And since some large corporation owns these clinics, no one takes pride in maintaining quality either in care or documentation and feel powerless to make change for the better. Volumes are low, poorly supplied. Everyone who works there (MA, FNP, or MD) are all clock watchers and waiting for their next gig, trying to minimize their risk as much as possible. Patients are cash pay, so you can't even help them if needed to be worked up or better controlled. My friends (plural) say it's like working in a 3rd world country.

No thanks.

I moonlight in a physician-owned/operated urgent care. The rule is that if the workup requires more a plain film and the most basic of rapid somethings and basic labs, it needs to go to the ED. We refuse their copay and tell them to go to the ED. The throughput is high, and patient satisfaction is pretty high as well. We don't CT and have no pharmacy attached to us.

There's another urgent care in my area that work people up to and including CT(!) and if there's something that needs admission, they send to the ED. Of course, they sometimes forget to send copies of labs and images, so the ED has to repeat the labs and imaging - for free. I wouldn't be comfortable working people up to that point at the urgent care.
 
I moonlight in a physician-owned/operated urgent care. The rule is that if the workup requires more a plain film and the most basic of rapid somethings and basic labs, it needs to go to the ED. We refuse their copay and tell them to go to the ED. The throughput is high, and patient satisfaction is pretty high as well. We don't CT and have no pharmacy attached to us.

There's another urgent care in my area that work people up to and including CT(!) and if there's something that needs admission, they send to the ED. Of course, they sometimes forget to send copies of labs and images, so the ED has to repeat the labs and imaging - for free. I wouldn't be comfortable working people up to that point at the urgent care.

The clinics, which operate under names like MinuteClinic, TakeCare and MediMinute, have become increasingly popular as convenient options for Americans seeking routine care without the expense of visits to doctors’ offices or hospital emergency departments.

I'm referring to these clinics specifically. I moonlight at urgent cares also, which are physician-owned and hospital-owned. My experience is like yours and they run very smoothly and professionally. From what I hear, retail clinics don't even come close.
 
wonderful! Now we can encourage even further fragmented Health Care. Hey at least there is money saved. That is what it is all about, saving money. Yes a retail clinic can diagnose a Chest Cold. What if that 'chest cold' is a P.E.?
People absolutely have to take a stand against this nonsensical 'health care'. It is ridiculous, and can actually worsen the current Health Care economy in the long run, by discouraging continuity of care with the same doctor.
This is absurdity. :thumbdown:
This is truly a sad turn of events.

That's the thing that makes this debate so rancorous. You (and doctors in general) are concerned about each individual patient. Most policy makers, I would bet, are concerned about the cost/benefit ratio. So, if a cheaper alternative can treat 90% of patients successfully, the lower cost wins.

In addition, politicians are like children and can only think a day in advance (or in this case, one election in advance). So, even if long term costs are increased by these clinics because of poorer follow-up and management, if it saves a buck today, it helps them get elected tomorrow. Just my 2 .¢..
 
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politicians...only think...one election in advance)...if it saves a buck today, it helps them get elected tomorrow

Perhaps, but that's the kind of thinking that has driven American industry into the ground. It's also the kind of thinking that is responsible for our current economic situation.

Companies (and this country) used to be "built to last." Now, they're only built to last until the end of the fiscal year.

You have to take the long view. If you do so, it's impossible to imagine a scenario where the dumbing-down of primary care makes any sense whatsoever. If we don't invest in primary care today, we will surely suffer tomorrow.
 
People don't have time to actually read the studies.

Or to think about them: Most pharyngitis, for example, doesn't need treatment at all. Even bacterial ph. is self-limiting in most cases. Academically, treatment is justified only to protect against future cardiac disease, which can show up much later than the observation time in this neat little nurse's study.

This study didn't look at increase in antibiotic resistance, incidence of rheumatic heart disease, chronic cystitis, recurrent OM, or any of the things that fall too far into fuzzy logic to have weight in thoughtless decision algorithms.
 
Perhaps, but that's the kind of thinking that has driven American industry into the ground. It's also the kind of thinking that is responsible for our current economic situation.

Companies (and this country) used to be "built to last." Now, they're only built to last until the end of the fiscal year.

You have to take the long view. If you do so, it's impossible to imagine a scenario where the dumbing-down of primary care makes any sense whatsoever. If we don't invest in primary care today, we will surely suffer tomorrow.

It's surprising how wrong people can be when they stray away from medicine or the question at hand.

How can one build a company to last? Technology companies are only as good as the latest edition of their software. One can invest billions in a company. But these efforts to build something lasting amount to nothing if some hotshot kid somewhere writes a piece of software which invalidates the existence of the company.

And you're dreaming if you think the US was built to last. Stolen land and technological CHANGE are the basis of America.

That being said, I agree with earlier sentiments that medicine (and it's funding/budgetary system) need a longer-term view. Medicine should be about the patient's total lifespan, not just one office visit.

But that doesn't mean that somehow building companies "to last" will solve America's problems.

There's only one thing that can last....new ideas!!!!
 
Perhaps, but that's the kind of thinking that has driven American industry into the ground. It's also the kind of thinking that is responsible for our current economic situation.

Companies (and this country) used to be "built to last." Now, they're only built to last until the end of the fiscal year.

You have to take the long view. If you do so, it's impossible to imagine a scenario where the dumbing-down of primary care makes any sense whatsoever. If we don't invest in primary care today, we will surely suffer tomorrow.

It's surprising how wrong people can be when they stray away from medicine or the question at hand.

How can one build a company to last? Technology companies are only as good as the latest edition of their software. One can invest billions in a company. But these efforts to build something lasting amount to nothing if some hotshot kid somewhere writes a piece of software which invalidates the existence of the company.

And you're dreaming if you think the US was built to last. Stolen land and technological CHANGE are the basis of America.

That being said, I agree with earlier sentiments that medicine (and it's funding/budgetary system) need a longer-term view. Medicine should be about the patient's total lifespan, not just one office visit.

But that doesn't mean that somehow building companies "to last" will solve America's problems.

There's only one thing that can last....new ideas!!!!
 
It's surprising how wrong people can be when they stray away from medicine or the question at hand.

If you're trying to tell me I'm "wrong," you're going to have to be more specific.

How can one build a company to last?

Obviously, you don't know. That doesn't mean I'm wrong. Maybe start by reading the book.

And you're dreaming if you think the US was built to last.

Again...be specific. You might start by reading the U.S. Constitution.

I agree with earlier sentiments that medicine (and it's funding/budgetary system) need a longer-term view.

Great. So, you were paying attention after all.

But that doesn't mean that somehow building companies "to last" will solve America's problems.

It sure as hell wouldn't hurt.

There's only one thing that can last....new ideas!!!!

Let us know when you have one.
 
The fine print of the study says that outcomes measured were simple conditions like OM, pharyngitis, UTI.

Selection bias, simple as that. Are they equivalent to PCPs? I don't know, I would think that for the most part probably, except when things get complicated. Which happens a lot.

But you're not going to see that popping up in a hugely biased extremely limited self-serving propaganda piece like this.
 
Obviously, you don't know. That doesn't mean I'm wrong. Maybe start by reading the book.

Hahaha...I'm laughing my ass off. I can't believe you referenced that book here. It's just another crummy succeed in business book written with the benefit of hindsight and lacking any really information about the business world. And it's worth exactly what the used copies sell for.....1c. Stick to medicine. Your business insights are uninspiring.
 
Stick to medicine. Your business insights are uninspiring.

Not sure what "business insights" you're referring to, since I haven't offered any.

Before you interrupted, we were talking about the short-term solutions being offered by politicians, and several of us (including you and I) both remarked on the need for the government to take a longer view.

Frankly, it sounds like we're all in agreement on that.
 
Not sure what "business insights" you're referring to, since I haven't offered any.

Before you interrupted, we were talking about the short-term solutions being offered by politicians, and several of us (including you and I) both remarked on the need for the government to take a longer view.

Frankly, it sounds like we're all in agreement on that.

Blue Dog,

How do you encourage your representatives to think long-term? I completely agree that we need to re-focus our political process, but don't know how to do it. I feel that corporate interests and the loud, angry sects of Americans pretty much control our politics. There's no place in it for rational discussion and real solutions.
 
How do you encourage your representatives to think long-term? I completely agree that we need to re-focus our political process, but don't know how to do it. I feel that corporate interests and the loud, angry sects of Americans pretty much control our politics. There's no place in it for rational discussion and real solutions.

Tell them. Literally.

Write letters. Take advantage of the AAFP's "Connect for Reform." Get involved in your state and national medical associations. Most state academies are involved in one-on-one lobbying of state legislators. Support family medicine PACs like the AAFP's FamMedPAC.

More info on getting involved here: http://www.aafp.org/online/en/home/policy.html

More info on grassroots advocacy here: http://www.aafp.org/online/en/home/policy/grassroots/adv-toolkit.html
 
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