Primary care doctors could see scope of care decline with rise of retail clinics

Ateev Mehrotra, MDAs retail clinics expand their scope of care beyond low-acuity conditions, the threat they pose to existing primary care practices grows, according to an article in the Journal of the American Medical Association.

"Primary care practitioners risk a slow but steady decline in their scope of care if they do not offer a viable alternative to these new convenient care options," writes Ateev Mehrotra, MD, a policy analyst with the RAND Corporation and a professor at the University of Pittsburgh School of Medicine.

To some extent, retail clinics' further encroachment into what has traditionally been primary care's territory is already happening. Earlier this year, Walgreen's announced a foray into chronic care management, assessment and treatment, including conditions such as high cholesterol, diabetes and hypertension.

Walgreen's move didn't please the American Academy of Family Physicians (AAFP). “Our healthcare system is already fragmented, and our concern is that the expansion of retail clinics into chronic care will lower quality, increase costs, and pose a risk to patients’ long-term health outcomes,” Jeffrey Cain, MD, the AAFP's president said at the time.

It's undeniable that what Mehrotra calls "the convenience care revolution" is spreading. Retail clinic visits increased four-fold between 2007 and 2009 and now account for almost 6 million annual visits, he notes.

This popularity of retail clinics - and similar alternatives like urgent-care clinics and employer-based clinics - indicates that these convenient options are filling an unmet need. Previously, patients didn't have many alternatives to seeking basic care from primary care providers aside from the emergency department, Mehrotra writes.

Now, the alternative to traditional primary care providers has become big business, and that hasn't been lost on big business. At least one chain of retail clinics is backed by a venture capital firm. With 50 million annual visits at approximately $100 each, convenience care potentially represents a $5 billion annual market, Mehrotra notes.

And to the extent that retail clinics are able to capture more of that market for low-acuity visits, it could take business away from traditional primary care practices.

"The loss of revenue from treating low-acuity conditions could lead to increased financial pressure on primary care practitioners and emergency departments," Mehrotra says.

So what's a primary care practice to do? In a phone interview, Mehrotra offered three possible measures primary care practices could take to keep pace with the convenience care revolution.

• Offer same-day appointments

• Offer online visits

• Open up a nearby retail clinic and refer low-acuity visits there

"All of these are mechanisms to address the same thing: Most patients have a preference of going to a primary care physician, but that appointment has to be timely or they'll go someplace else," Mehrotra says.

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