By Margaret Shapiro
Washington Post Staff Writer
Tuesday, September 15, 2009
Walk-in medical clinics run by CVS, Wal-Mart and other retailers provide care for routine illnesses that is as good as, and costs less than, similar care offered in doctors' offices, hospital emergency rooms and urgent care centers, according to a new Rand Corp. study. The cost savings over emergency rooms, in particular, was quite dramatic.
Physicians groups, including the American Medical Association and the American Academy of Pediatrics, have raised concerns about the quality of care in the retail clinics, particularly about whether they over-prescribe medications since many of them are owned by pharmacy chains and whether they do adequate follow-up. But the Rand study found no major differences in these areas between the clinics and the other medical sites surveyed.
"A lot of rhetoric in the health-care reform debate has been about improving value in the delivery of health care," said Ateev Mehrotra, a University of Pittsburgh physician who was the study's lead author. "These clinics are a new way of delivering care that fit the definition of improving delivery of health care" by keeping costs down and providing comparable quality.
The study, was published this month in the Annals of Internal Medicine. An abstract is available at http://www.annals.org/cgi/content/abstract/151/5/321. Annals also published a related study reporting that one-third of Americans live within a 10-minute drive of such a facility. In the Washington area, the biggest operator of walk-in clinics is CVS (MinuteClinic).
"Located in retail stores, such as pharmacy, discount or grocery chains, these clinics require no appointments, are open on weekends and evenings, report little waiting time, and offer services limited to immunizations and treatment of minor acute conditions," according to the comparative study. It also said the clinics, which are usually staffed by nurse practitioners and physician assistants rather than doctors, tend to "serve a population that is younger, more likely to be uninsured, and less likely to have a primary care physician."
The study examined the cases of 2,100 patients who from 2005 to 2006 were treated for routine illnesses -- ear infections, sore throats or urinary tract infections -- and compared them to patients treated for similar problems at doctors' offices, ERs and urgent care centers. The study used claims from a large Minnesota health plan that has allowed enrollees to use retail clinics for more than five years.
"The costs of care in retail clinics were 30 to 40 percent lower than in physician offices and urgent care centers and 80 percent lower than in emergency departments" of hospitals, according to the study. The cost differential was sharpest in the area of "evaluation and management" by medical personnel. That cost averaged about $66 at a retail clinic, compared with $103 in a physician's office and $358 in a hospital emergency department. In the area of laboratory and radiology tests, the average cost per episode was $15 in a clinic, $33 in a doctor's office and $113 in an ER. For prescription drugs, there was little or no difference in average costs.
As for quality, the study evaluated care based on 14 indicators, including tests given, whether antibiotics were prescribed and whether follow-up treatment occurred. In general, the researchers found that the "scores of retail clinics were equal to or higher than those of other care settings." They could not independently assess the accuracy of diagnoses, but noted that "if a patient's condition is misdiagnosed . . . we would expect more patients to have a follow-up visit -- which was not the case."
The study, whose primary funder was the California HealthCare Foundation, was careful to point out that its evaluation applied only to cases of the three common illnesses surveyed and therefore should not used to generalize about quality of care and cost for other medical conditions.