Retail Clinic Treating Mostly Uninsured
Wal-Mart jumped into the healthcare arena with their retail clinic program called Convenient Clinics to provide improved access to care earlier this year and towards the end of last year when many media headlines broke the story of retail clinics. There was an immediate flurry of activity with store chains such as CVS in the Boston, MA area where some 2000 of these clinics were to be established over the coming months and year (2008). Since that time the retail clinic story has fallen to the wayside especially after some political contention between CVS and the Boston area legislators that stipulated no retail clinic would be erected within the city limits of Boston. Political leaders cited patient safety and quality of care concerns as the impetus for their negative stance on the issue.
The other item surrounding the retail clinic issue was concern for their financial viability in today’s fiscally constrained healthcare market. Fears of inadequate reimbursements from third party payers and insufficient customer quantities would force many to close their doors shortly after opening. In fact some retail clinics did just that earlier this year in a few of the Southern states. Nurse practitioners and other clinic staff showed up to work at their retail clinic to find the doors locked and the clinics closed.
In light of the turbulence surrounding the retail clinic issue Wal-Mart continues to operate their clinics. Recent profiles of patients visiting the clinics show most to be adults (79%) and less than one third to be children (21%); more than half of the patients seen at these clinics are uninsured, (55%). When patients were asked about other alternatives to seeking care at Wal-Mart about half said they would use their primary care provider (40-50%), a little more than a third said they would use an urgent care center (20-35%), less than a fifth of the patients said they would seek care in a local emergency department (10-15%), and 5-10% of the patients would just forego seeking treatment if the Wal-Mart clinic was not available to them.
A few questions need to be asked with respect to these numbers. If almost half of these patients would go to their primary care provider (PCP) in lieu of the retail clinic why didn’t they start there? Likely convenience played a role and obtaining access to their primary care provider in a timely fashion. Additionally their insurance status may have been a factor as well since more than half of these patients seen had no insurance. I suspect that these patients may have been seeking the best care they could find based on their out of pocket expenses. These retail clinics are likely to cost less than a local ER and less than an office visit with their PCP. The remaining question to be asked surrounds Wal-Mart’s clinic long term sustainability in light of the large percentage of uninsured patients being treated. Will Wal-Mart be able to see an acceptable ROI.
— Source: “Wal-Mart’s Perspective: Retail Care,” as presented by Dr. John Agwunobi, Wal-Mart Stores Inc., April 22, 2008, at the 5th Annual World Health Care Congress, via MCOL
About the Author
Mike Pringle is the author of Healthcare Today where he offers commentary and insight regarding today’s healthcare issues. Additionally he provides regular commentary for Red Scrubs and editorial content for Future Healthcare. He has over 20 years of nursing experience working both domestically and internationally. Mike has a Bachelor’s Degree in Nursing and a Masters Degree in Public Administration with a Healthcare emphasis. He specializes in both Emergency and Critical Care Nursing. He currently works at Falmouth Hospital as a Shift Manager for the emergency department.
Dan responds:
Posted: June 18th, 2008 at 10:09 pm →
Quick When You’re Sick- A Dream Comes True
Recently in the media, issues have been addressed regarding the specialty of primary care or family practice doctors and the shortage of them in the U.S. In summary, reasons for the shortage that exists are due to the specialty not being that profitable for a doctor compared with other specialties. As a consequence, the doctors view the specialty as not a desirable choice apparently quite often, although the specialty is greatly needed in the health care system and for the public health.
As a layperson, I view primary care as ultimately a specialist in nothing in particular, yet knowledgeable in a large variety of medical areas, which I believe, makes them very valuable to those patients seeking restoration of their health. Furthermore, there is a comfort level with those in this specialty compared with other specialties, one could speculate. So the shortage of primary care doctors is in fact disappointing. Perhaps most disappointing is the atrophy of the doctor-patient relationship unique with such doctors.
Yet one possible solution is what is known as retail care clinics, and their popularity was increasing not long ago for a variety of reasons. And their eventual need has yet to be determined and is only speculated by others at this time.
First, I’ll offer a definition of a retail clinic: A retail clinic is a medical treatment facility that is usually located in a convenient location, such as a shopping area, and are smaller than most doctors’ offices in regards to geographical space. Usually, these clinics are staffed with a nurse practitioner that often have the ability and authority to provide the same quality care as a primary care physician, and do so with the same standards regarding accountability and autonomy. If you happen to go to one for what may be considered a mild ailment, for example, for such conditions as allergies or the flu, you will notice a unique and pleasant paradigm towards your care at such a clinic in comparison with present medical offices that are possibly demoralized if not largely apathetic:
These urgent care light clinics are normally and amazingly quick for a patient treated at such a location. You are normally in and out of there within a half hour or so. This includes a thorough assessment and treatment regimen offered. Unlike typical doctor offices, these clinics are walk-in clinics, so there is no over-booking of patients, which is what typically occurs at current offices of doctors, as many are focused on daily volume of patients, as they are usually a member of a large health care system that instructs these offices in such a way.
With these convenience care clinics, you actually dialogue with your health care provider more so than you have experienced in a traditional doctor’s office due to other doctor offices often being incredibly busy from seeing too many patients during a typical day for reasons described above. And this is not to imply that the health care providers at typical doctor offices do not care about you and one’s particular health issues, yet possibly is due to limited resources, possibly.
The cost of going to such a retail clinic, which is sometimes termed an ‘urgent care light’ clinic or convenience care clinic, that have already been mentioned, is usually about ¾ or less than the cost of a typical primary care doctor visit, I understand.
You will likely notice no decline in the quality of care that you receive. In fact, likely you will experience greater quality on many different levels, both on a personal and clinical level, yet this premise lacks certainty due to the many variables involved.
Critics of such clinics include the American Medical Association and various medical societies, yet in my opinion, they are simply vexed because of the invasion of these clinics on their turf and their infiltration into their group without being invited, perhaps.
If it is discovered that you need greater medical care or attention than the retail clinic can provide for you during your visit at their urgent care light clinic, you will most likely be referred to a nearby location that can provide the care you are determined to need by the clinic’s heath care provider, who has likely has some familiarity and possibly some relationships with the hospitals and others in the medical community for which they serve.
So most patients of these retail clinics are pleased with the care they receive from them, which is why they continue to grow in number under different names, as they have become franchises, yet the concept of this pay as you go health care is fairly new, only the future will tell if this method is preferred by those seeking minor restoration of their health.
These retail clinics, it appears, provide possibly provide a response to the shortage of primary care doctors that some believe exist, and possibly are an answer to other problems that exist in the health care system in the U.S., which includes wait time and frequent distant relationships from their other health care providers. One could conclude that the retail clinics seem in a way more authentic than the dominant structure, and may be more beneficial ultimately for the public health, with exceptions, of course.
Dan Abshear
“Follow where reason leads.” — Zeno of Citium
Author’s note: What has been written is based upon information and belief