10 January 2017

Retail Clinics Near EDs Do Not Decrease Low-Acuity ED Visits

The opening of retail clinics within a 10-minute drive of emergency departments (EDs) has not resulted in reduced ED utilization for low-acuity conditions such as influenza, urinary tract infections and earaches, according to a recent study by RAND Corporation researchers. The study was published in the Annals of Emergency Medicine, the peer-reviewed scientific journal for the American College of Emergency Physicians (ACEP).

The findings contradict the assertions of some healthcare experts and policymakers that increasing the number of retail clinics could reduce ED visits by patients with low-acuity conditions. The study notes that about 13.7% of all emergency department visits are for low-acuity conditions, per a Modern Healthcare article. During the past 10 years, the number of retail clinics, usually located within large retail chains such as Walmart, has surged from 130 clinics in 2006 to nearly 1,400 clinics in 2012 and to more than 2,000 in 2016. 

Researchers found no correlation between the opening of a retail clinic and a reduction in ER visits for low-acuity conditions during the period they analyzed, 2007–2012. A possible factor is that Medicaid patients represent the largest proportion of ED visitors with low-acuity conditions, and only 60% of retail clinics accept Medicaid. Low-acuity visits among EDs with a significant (10 percent per quarter) increase in retail clinic penetration decreased slightly, by 0.03 percent per quarter, and only among patients with private insurance. That is equivalent to approximately 17 fewer emergency department visits among privately insured patients over the course of the year for the average emergency department if the retail clinic penetration rate increased by 40 percent in that year, per an ACEP news release on the study.

Interestingly, Grant Martsolf, PhD, MPH, RN the study’s lead author and a policy researcher at RAND Corporation, said that retail clinics may be motivating patients to seek care when they normally wouldn't, according to the Modern Healthcare article. He explained that the convenience of a local clinic may be encouraging people to seek out healthcare services more often in situations when they usually wouldn’t seek care from their primary care providers or the ED, such as when they have an ear infection. 

An accompanying editorial, “Why Retail Clinics Do Not Substitute for Emergency Department Visits and What This Means for Value-Based Care,” by Jesse Pines, MD, MBA, FACEP of the George Washington University School of Medicine and Health Sciences in Washington, D.C. offered three theories as to why retail clinics (referred to in the editorial as “convenience settings”) increase health care use. Per the ACEP news release, Dr. Pine theorized that they meet unmet demands for care; that motivations for seeking care differ in emergency departments and convenience settings; and that groups of people who are more likely to use emergency departments for low-acuity conditions do so because they have little access to other types of care, including convenience settings.