At 9:30 May 8, 2013, MinuteClinic’s display for its new Tipp City Ohio location:Tweet
We’re amazed we have never before image-Googled the phrase “Emergency Room Billboard”. Who hasn’t, after all?
Anyway, a small sampling of the results concludes this post.
Note that, to a signpost, coast-to-coast, the pitch of these billboards is not for “life-saving treatment”, “easy access to hospital services”, or the like.
No, the value proposition on offer is – wait for it – short wait times. For fevers, and “boo-boos”, and other not-really-life-imperiling stuff.
Well, at least they are not pitching their “everyday low prices” for their services. Yet.
You’ll find it on page 4 of Rand’s Research Brief: Flattening the Trajectory of Health Care Spending:
Facilitate High-Value Innovation (Rand, 2012)
(Note that the graph is found, incongruously, under the heading Further Expand Use of Health Information Technology; while HIT does figure in retail clinics’ delivery of high-value health care, it is not principally an HIT “play”)
It’s fair, and important, to note that Rand employs – or maybe it’s merely contracts with – Ateev Mehrotra MD, probably the most authoritative observer/researcher of the retail clinics phenomenon to date. Rand has published a number of Dr. Mehrotra’s studies. What’s most important is that retail clinics ARE embematic of high-value health innovation in the US – and that the chart deftly conveys the evidence for it in a ‘tri-fold’ chart: charts indicating comparable clinical quality bookend a chart indicating retail clinics cost markedly less than treatment source alternatives.Tweet
Prominent articles on retail clinics published in the past 3 weeks range from the sublime to the ridiculous.
The Sublime: Retail Clinic Visits and Receipt of Primary Care, Rachel O. Reid, J. Scott Ashwood, Mark W. Friedberg, Ellerie S. Weber, Claude M. Setodji and Ateev Mehrotra, Journal of General Internal Medicine, 11/1/12), Ateev Mehrotra’s latest report on retail clinics, which examines retail clinics’ impact on individuals’ relationships with primary care physicians. While the study did produce some empirical evidence that retail clinic usage might diminish an individual’s engagement with a primary care doc, Mehrotra et al take pains to examine the tenuous nature of that evidence at present. For instance, the research team urges that “[f]uture studies should assess the impact [of retail clinic usage on primary care MD relationships] over the longer term” given that the study only looked at subjects’ treatment visits to clinics and/or primary care doctors over a 12 month span.
We feel too many of the articles on the Mehrotra report belong on the Ridiculous end of the Sublime/Ridiculous spectrum, inasmuch as they zoom in so eagerly on the “clinics are probably bad for your health!” angle, while ignoring evidence that, for instance, clinic usage does not derail patients’ receipt of care from primary care physicians for preventive care or diabetes management.
Articles in this vein from leading news outlets are particularly egregious: Retail Clinics May Cut Into Primary Care: Study, Chicago Tribune/Reuters, 11/1/12).
The Ridiculous: 10 things walk-in clinics won’t tell you, Jen Wieczner, MarketWatch/Wall Street Journal, 11/2/12)
Purposefully ‘controversial’ at a 10th-grade level of comprehension of that term, this “top 10″ style article, which draws on the Mehrotra study, features ‘alarming’ assertions of this kind throughout:
“1. “We might put your family doctor out of business…””, and even MORE ridiculously, “6. “We practically self-regulate.”"
Ms Wieczner seems like an earnest, industrious individual – she’s apparently written a number of articles for various publications – but she cannot be legitimately described as an authority on health care topics generally or clinic-based care specifically. Her profile confirms this. However, we are prepared to wager her observations on parties in the Hamptons or horseracing are nonpareil.Tweet
There they go again….
A couple of weeks ago, we reported on a( new Florida MinuteClinic location that has apparently detoured far up the coast to Massachusetts:.
Three weeks ago, we reported on a( California MinuteClinic location that had apparently set down in Florida.
This time MinuteClinic has moved a clinic in Crown Point, Indiana to Crown Point, Ohio:
Watch this space for new adventures in geographic redistribution. Have any examples of your own? Let us know….Tweet
When the count topped 18, we stopped totting up the recent articles taking approving note of the ‘sharp increase’ in retail clinics visits uncovered by recent research from Dr. Ateev Mehrotra and Judith Lave. Mehrotra & Lave’s study, published in Health Affairs last week, documented a fourfold increase in retail clinic visits from 2007 to 2009.
Not so fast.
Now, nearly six million clinics visitors is certainly nothing to sneeze at. But there’s a devil or two in the details of the visits data that should give at least a few of those uninhibited cheerleaders pause.
First there’s the mix of visits that comprise those 6 million trips. We commented about this in a post on August 20th; a hefty share of recorded visits in 2007-09 were principally for vaccinations – about 1/3 of the total visits. What’s the big deal? Just that the pharmacy chain parents of two of the largest retail clinics operators are moving aggressively to have all of their pharmacists trained and delivering vaccinations, at all of their pharmacies. And those pharmacies far outnumber the nation’s 1,300-odd retail clinics. So there will be, and more accurately probably already is, a bunch of cannibalization going on.
We anticipate that retail clinics vaccination counts since 2009 have plateaued, or will do so soon. And the growth rate for non-vaccination services has been considerably more gradual – see the green line in the chart below;
Second, when those 6 million visits are spread over 1,300 clinics, the numbers are less inspiring; each clinic is treating an average of around 13 visitors per day. Genuine viability probably requires much more like double that figure. If visits growth has continued to date, many clinics may be approaching if not exceeding that sustainable figure – but that growth rate leaned heavily on vaccination visits, so…..
Last Thursday we posted a screen cap of a California MinuteClinic location that had apparently set down in Florida.
Today, we have for your viewing contemplation a new Florida MinuteClinic location that has apparently detoured far up the coast to Massachusetts:
Is this some sort of trend? Our tireless clinics watchdogs here at Healthcare 311 will leave no stone unturned, no map unfolded, in our efforts to assure that you are the first to know….Tweet
We took a recent month of daily Healthcare 311 search activity and matched it with the 2007-2009 retail clinics visits data charted in the Mehrotra/Lave retail clinics visits study published in the August Health Affairs. The pattern of daily search activity seems to closely match the pattern of retail clinic visits recorded by the leading clinics operators:
Our search activity data is drawn from a fairly typical four weeks’ worth of search data. The Mehrotra/Lave data covers clinic visits activity over the period 2007-2009. We intend to analyze into our search data further to see if the search/visits correlation holds over a variety of time periods. For instance, is the ‘Thursday search dip’ significant?Tweet