the impact of retail clinics on quality, access, and costs
Post on 09-Feb-2016
38 Views
Preview:
DESCRIPTION
TRANSCRIPT
The Impact of Retail Clinics on Quality, Access, and Costs
Ateev Mehrotra, MD, MPHUniversity of Pittsburgh School of Medicine
RAND Health
Ongoing Debate about Merits of Retail Clinics
Issue Positives Concerns
Quality • Follow guidelines, thus ensuring quality
• Deliver poor quality services
• Overprescribe antibiotics
Access &PCP Relationships
• Improve access for all patients
• New safety-net provider
• Undermine patient-doctor relationships
Costs • Decrease ED visits• Decrease overall
costs
• Increase costs due to unnecessary follow-up
Ongoing Debate
• Quality• Access & PCP relationships• Costs
Antibiotic Prescribing Rates Are Similar
Mehrotra et al., Annals of Internal Medicine, 2009
Quality of Care in Retail Clinics is the Same or Better than Found in Other Settings
Quality Findings Consistent With Other Research
• Patient satisfaction very high1
• Quality– Follow-up visit rates lower2
– Care concordant with guidelines3
– “HEDIS scores” higher than most health plans4
1 Harris Interactive2 Rohrer, Qual Manag Health Care, 2008
3 Woodburn, AJMQ, 20074 Jacoby, AJMQ, 2010
Ongoing Debate
• Quality• Access & PCP relationships• Costs
Significant Fraction of U.S. Population Has Access to a Retail Clinic
• Almost 90% of clinics in urban areas• 38% of urban population live within a 10 minute
drive• Few clinics in underserved areas
� 13% in Health Professional Shortage Areas compared to 21% of population
Rudavsky, Mehrotra, JABFM, 2010
Age Distribution of Patients
Mehrotra et al., Health Affairs, 2008
Retail Clinics Emerg RoomMD Office
Most Retail Clinic Patients Report No Primary Care Physician
Ongoing Debate
• Quality• Access & PCP relationships• Costs
Significant Per Episode Cost Savings at Retail Clinics
Mehrotra et al., Annals of Internal Medicine, 9/09
What Fraction of ED Visits Could be Seen at Alternate Sites?
chest pain, abdominal pain
sore throat, pink eye, sinus infection, ankle sprain, minor fracture
27% 17%
All ED Visits Limited to ED visits when retail clinics and urgent
care centers open
Potential Savings of $4.4 BillionWeinick et al., Health Affairs 2010
Potential Cost Savings if Retail Clinics Become Widespread Nationally
• Institute of Medicine ‒ $2.0 - 7.5 billion annual spending
reduction• Impact on total US health care budget
‒ ~0.1% of $4.6 Trillion
Hussey, et al. NEJM, 2009
IOM, 2009
Issue Our FindingsQuality No evidence to support concerns
Antibiotic prescribing is similar
Access & PCPs
Retail clinics serve different population than physicians
Costs Per condition, there are substantial savings if patients shift care from ED to retail clinics
Summary of Research
Should We Encourage Use of Retail Clinics
• Potential Benefits– More convenience for patients– Save money
• Potential Concerns– Increase fragmentation of health care– Worsen financial situation of EDs– Patients may not “self-triage” correctly
top related