Impact of Retail Medicine on Standard Costs in Primary Care: A Semiparametric Analysis

Abstract

Retail medicine clinics have become widely available. However, few studies have been published that compare retail clinic costs of care to standard medical visits for similar patients. The purpose of this study was to compare standard medical costs during a 6-month period after visiting a retail medical clinic to care received in a conventional medical office setting. Medical records of primary care patients (both adults and children) seen in a large group practice in Minnesota in 2008 were analyzed for this study. Two groups of patients were studied: those who used a retail walk-in clinic (N = 141) and a comparison group who used regular office care for same-day, acute visits (N = 137). Patients treated for 5 common conditions (pink eye, sore throat, viral illness, bronchitis, and cough) were selected. The dependent variables were standard costs using federal rates and the rank of standard costs. Multiple linear regression analysis was used to adjust for differences between groups. Median costs did not differ between sites ($126.30 for usual care and $88.10 for retail, P = 0.139); mean cost ranks were 132.5 for usual care and 115.6 for retail (P = 0.088). After adjusting for previous visit history, age, and sex, patients who received care in the retail setting had lower standard costs and lower cost rank than patients who received usual care (b = -52.9 [P = 0.006] and b = -24.5 [P = 0.021], respectively). After selection of cases with common conditions and adjustment for unequal variances, age, sex, and number of office visits in the previous 6 months, our retail clinic appeared to reduce medical costs for patients during the 6-month period after the index visit.

AAP Principles Concerning Retail-Based Clinics

“…Charges for minor illnesses treated are often less than a physician office and much less than an emergency department. 11,12 Many RBCs bill insurance carriers, and some are able to bill Medicaid. 8 Data on outcomes specifically looking at pediatric patients are limited, but minor illnesses, such as acute pharyngitis, demonstrate no significant issues with early return visits to primary care physicians.…”

“…8 Data on outcomes specifically looking at pediatric patients are limited, but minor illnesses, such as acute pharyngitis, demonstrate no significant issues with early return visits to primary care physicians. 7,12,13 RBCs are located in retail stores, such as grocery stores, drug stores, or "big box" stores. Average driving time for patients is less than 5 minutes, and average income and education for communities with RBCs are above average nationwide.…”

Increased medical cost metrics for patients 50 years of age and older in the collaborate care model of treatment for depression

“…Earlier studies of outpatient clinical care have suggested a strong association between increased use of resources before an intervention and the amount of use after an intervention. As such, to fully appreciate the impact on an individual patient's use, prior use should be controlled . High utilizers may already have additional resources, such as general care managers, that control potential future utilization.…”

Strategic Response by Providers to Specialty Hospitals, Ambulatory Surgery Centers, and Retail Clinics

“…20,21,22,23 Finally, recent studies of RCs have found that they also engage in cream skimming the less severely ill patients but deliver less costly care, controlling for severity. 24,25 There is some evidence regarding quality standards practiced in such clinics and comparable levels of quality of care relative to physician offices. 11,14,26,27 However, the clinics seem to attract patients lacking a primary care physician, suggesting they may serve as more of a safety net provider than a disrupter.…”