Today’s Managing Health Care Costs Number is $14
Health Affairs published research from RAND this week that suggests that retail clinics have not been the cost saver we were all hoping. From the researchers:
Per person per year spending on visits for low-acuity conditions among retail clinic users increased by $35 for retail clinic visits and decreased by $21 for physician office and ED visits, compared to spending among nonusers from 2010 to 2012.
How could $60 retail clinic visits, with no imaging facilities and a limited menu of treated diagnoses, break the bank?
The researchers found that 58% of the new visits to retail clinics were “new” visits, rather than substitutes for previous visits to physician offices or emergency rooms. This is often a problem in health care with “disruptive innovations,” which are less expensive but inferior to the incumbent service. Even the disruptive innovation ends up being accretive, increasing costs, because it causes a utilization spike greater than the savings from any substitution. An excellent example of this is that it took close to two decades after the advent of angioplasty before the rate of coronary artery bypass surgery started to decline. Patients weren’t getting angioplasties instead of cardiac surgery – rather a new group who would not have had surgery were getting angioplasty.
This is an excellent study. The researchers did propensity matching of those who used and did not use retail clinics, and then compared the change in utilization and cost among the two groups. The sample size was large (over 500,000 retail clinic users and over 800,000 nonusers. Complete claims files allowed the researchers to search for alternative explanations. The data was for the period from 2010 to 2012 – before access to telemedicine services increased dramatically and when high deductible health plans were less prevalent. All health plan members had access to retail clinics, and the out of pocket cost was similar to office visits. This might mean that the increased “new” utilization will be even higher with plan designs that lower the out of pocket costs for retail clinics further.
Previous research from these researchers has shown that retail clinics don’t overprescribe antibiotics more than physicians in offices or emergency departments, and retail clinic visits are not associated with a decrease in preventive care or worse diabetes care. Previous studies even suggested some cost savings.
Retail clinics are clearly meeting a patient need. We might be getting this additional access for a price, though, rather than with a rebate.
