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No waiting, no hassles: The rise of retail-based clinics

Some Americans are going broke trying to pay their medical bills. Those debts are a leading cause of bankruptcy. People are looking for an alternative. Increasingly, some are turning to retailers for medical help.

The number of retail health clinics -- found in grocery stores and places like CVS, Target and Walmart -- has nearly doubled since 2007, from about 700 nationwide to more than 1,300, says J. Scott Ashwood, a senior research programmer and analyst with Rand Corp., who focuses on health care. Visits have increased tenfold among those with insurance. "It's hard to estimate the visit rates among the uninsured," says Ashwood.

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What's the attraction? It boils down to two words: convenience and price.

retail-based clinics are on the rise"They are open after work and weekends when doctors' offices are closed. There is no waiting in most locations. You don't need an appointment; you just show up and see the nurse practitioner. They also post their prices on boards where consumers can see the range of services available and the price [if they pay out of pocket]," says Ashwood.

Retail clinics are less expensive than doctors' offices and urgent care centers (about 60 percent to 70 percent of the cost) and much less expensive than emergency rooms at hospitals (about 20 percent of the cost), so there is an opportunity to save money on treatment if you pay out-of-pocket, says Ashwood.

Caroline Ridgway, policy and communications director with the Convenient Care Association, the national trade association for retail health clinics, says, "There is a great need for more points of entry into the health care system, and a great need for more affordable, yet still high-quality health care for our basic health needs. These clinics help fill that need while supplementing existing health care delivery settings such as primary care practices and urgent care centers."

Not a prescription for all ailments

However, the quick-hit medical care is not about comprehensive care. Instead of seeing a medical doctor, you'll be treated by a nurse practitioner or physician's assistant. Mostly you get help for things like colds, flu, allergies, minor scrapes or burns, immunizations, blood pressure, and blood glucose checks.

"Retail clinics focus on a small set of simple acute care and preventive care. Most people seek care for immunizations, flu shots, as well as upper respiratory infections, sinusitis, bronchitis, and earaches," says Ashwood.

Clinics should not be used for emergency care, Ridgway says. "They cannot take X-rays or provide suturing. Anyone experiencing a medical emergency should call 911 and seek care from emergency professionals. The clinics are also not intended to be a medical home. Patients are encouraged to maintain a relationship with a primary care provider of some kind," says Ridgway.

Who’s looking out for you?

And despite all the convenience and savings, there are some concerns about retail health clinics, especially from the physician community.

Dr. Jeffrey Cain, president-elect of the American Academy of Family Physicians, says retail health clinics have a role in treating things like ear and bladder infections. However, he is concerned about a new movement -- retail health clinics wanting to expand into chronic disease management.

"Is Walmart the best place for your health care? If you have a sore throat, yeah. But can Walmart meet all my needs, or is Walmart looking out for my wallet? I can shop, visit the clinic, and then get my prescription too," says Cain.

Some doctors also are worried about the continuity of care. "People get the best health care when they have a medical home," says Cain. In other words, a primary care physician with a patient develops a long-term relationship. "That doesn't happen in a 10-minute visit. You want a doctor talking with you about your kid's high school graduation," says Cain.

Physician involvement in health care is vital, says Dr. Peter Carmel, president of the American Medical Association. What may appear to be a minor medical condition may in fact be something serious. Without physician oversight, a serious illness may be overlooked until it is too late, he says.

However, according to Ashwood, there is limited evidence that there is a negative impact on continuity of care. "Most people who seek care at retail clinics do not have a usual doctor, so there isn't a relationship to interrupt," he says. Ashwood also contends that the quality of care provided at retail clinics is the same as the quality of care found elsewhere. "In part, this is because they focus on simple acute conditions and follow best practices for treatment."

For all the debate about what's appropriate and what's not from the corner drug store, there's likely no turning back. CVS Caremark has announced plans to open over 500 clinics in the next five years.

"We need more primary care in this country, regardless of the outcome of the Supreme Court's decision on the Affordable Care Act," Ridgway says. "Convenient-care clinics offer the lowest-cost private option for health care, and the convenience and accessibility, coupled with the good quality, are very attractive to patients. Patient satisfaction with clinics has been very high, typically 90 percent and better."

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