A new report authored by Manatt Health www.manatt.com funded by the Robert Wood Johnson Foundation (RWJF) www.rwjf.org offers unique insight into the growing role of retail clinics within the healthcare system including the opportunities and challenges they face concerning information exchange and EHRs.
The April 2015 report “Building a Culture of Health: The Value Proposition of Retail Clinics” underscores the important role retail clinics play providing low cost access to routine primary care. The authors report that there are more than 1,800 retail clinics nationwide serving more than 10.5 million visits from patients each year.
Report highlights include:
- Retail clinics represent two percent of all U.S primary care encounters
- For commercially insured patients, the cost of care initiated at retail clinics at $110 is lower than similar care received in physician offices at $166 per visit, $156 to visit an urgent care center, or $570 at emergency departments
- Up to 27 percent of emergency department visits could be handled at retail clinics or urgent care centers, which could save as much as $4.4 billion yearly
The report emphasizes that telehealth has the potential to reduce cost and improve both access to care for rural and underserved communities and also support treatment of patients with acute and chronic conditions at retail clinics.
Live telehealth consults can extend the scope of consultative, diagnosis, and treatment service options by connecting patients and practitioners at the retail clinic’s originating site to a remote primary care physician or specialist.
State laws often limit the type of providers allowed to use and be reimbursed for telehealth services and affects providers licensed to practice medicine in other states. Medicare only covers reimbursement for telehealth in limited settings and never in retail clinics so Medicare needs to reimburse for appropriate services.
Today, many retail clinics are adapting their offerings to provide basic chronic care management services and forming partnerships with area health systems so they can integrate with other community providers.
The authors offer some recommendations on how retail clinics can be better integrated into the delivery system:
- Use a more complete set of clinical measures to assess performance against other primary care providers to improve the quality of care provided in retail clinics
- Address various federal and state policy barriers, including scope-of-practice restrictions and pediatric vaccination administration policies, along with the specific issue of Medicare reimbursement for telehealth
- Improve access in underserved communities through partnerships between municipalities and state governments and open new retail stores with clinics in disadvantaged areas
- Standardize scope of practice rules for Nurse Practitioners (NP) and Physician Assistants (PA) and remove restrictions preventing NPs and PAs from practicing to the full extent of their license and training
- Examine more expansive roles retail clinics can play in supporting public health and emergency response efforts
Go to www.rwjf.org/content/dam/farm/reports/issue_briefs/2015/rejf419415 for the report.