1. The Impact of Retail Clinics on Quality, Access, and Costs Ateev Mehrotra, MD, MPH University of Pittsburgh School of Medicine RAND Health

2. Ongoing Debate about Merits of Retail Clinics IssuePositivesConcerns 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

3. Ongoing Debate Quality Access & PCP relationships Costs

4. Antibiotic Prescribing Rates Are Similar Mehrotra et al., Annals of Internal Medicine, 2009

5. Quality of Care in Retail Clinics is the Same or Better than Found in Other Settings

6. Quality Findings Consistent With Other Research Patient satisfaction very high 1 Quality –Follow-up visit rates lower 2 –Care concordant with guidelines 3 –HEDIS scores higher than most health plans 4 1 Harris Interactive 2 Rohrer, Qual Manag Health Care, 2008 3 Woodburn, AJMQ, 2007 4 Jacoby, AJMQ, 2010

7. Ongoing Debate Quality Access & PCP relationships Costs

8. 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

9. Age Distribution of Patients Mehrotra et al., Health Affairs, 2008 Retail Clinics Emerg Room MD Office

10. Most Retail Clinic Patients Report No Primary Care Physician

11. Ongoing Debate Quality Access & PCP relationships Costs

12. Significant Per Episode Cost Savings at Retail Clinics Mehrotra et al., Annals of Internal Medicine, 9/09

13. 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 Billion Weinick et al., Health Affairs 2010

14. 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

15. IssueOur Findings QualityNo evidence to support concerns Antibiotic prescribing is similar Access & PCPs Retail clinics serve different population than physicians CostsPer condition, there are substantial savings if patients shift care from ED to retail clinics Summary of Research

16. 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