Nice ~14 minute interview conducted by ReachMD nurse practitioner Mimi Secor with The Little Clinic’s Dr. Roger Green (VP Western Division). Good sound quality, and an information-filled brief overview of the state of retail clinics in 2013.
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.
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.”"
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…..
It’s urgent care clinics. For extra credit, it’s urgent care clinics plus community health centers.
There are over 10,000 urgent care clinics; there are approximately 1,200 community health centers. Both deliver a lot of routine non-emergency health care to people in the US. Neither populate the graph of retail clinics above.
The 3rd installment in Sean Deale’s series of reports on retail clinics (Retail Clinics: The Evolution of CVS’s Minute Clinic, Sean Deale, In-Store Trends, 5/9/12) zeroes in on industry leader MinuteClinics and specifically the barriers to more rapid growth of clinics for MinuteClinic and other industry participants.
(Installment 2, posted April 19, ably recounted the establishment & growth to date of Walgreens’ Take Care Clinics, but failed to mention anything about Take Care’s initiatives in the area of operating on-site clinics for employers – which to be fair is probably in keeping with In-Store Trends editorial charter).
Sean asks this pair of keen questions in installment 3:
Why has the Minute Clinic not made its way into ALL of CVS’ 7,300 stores in the US? Is there a major barrier to entry for retailers considering the introduction of retail clinics?
In answer, Sean identifies five major hurdles for clinics operators generally. We found all basically on point, especially the first:
Awareness – the overall concept and availability regionally has been slow to penetrate consumer awareness beyond for flu shots
We feel Sean may have overlooked the role that the existence of urgent care clinics has played in the gradual introduction of retail clinics. His post does consider the opportunity that long ER wait times and waits for physician appointments present to clinic operators, but it does not take into account the existence of between 7 & 9 thousand urgent care clinics, which serve a market quite similar to that targeted by retail clinics.
Our back-of-the-envelope calculations indicate that if clinics are intelligently sited, there is plenty of demand to go around; for example, considering only visits to emergency rooms that might be more appropriately treated at retail or urgent care clinics, each current clinic would be faced with 40 to 50 patients per day.
But the key word with respect to siting is intelligently. Maybe locating smart is part of what is taking retail clinics so long to grow in numbers.
If you’re looking for a no-nonsense digest of where retail clinics are today, we dont’ know why you haven’t already clicked through to acquire this new KnowledgeSource report: Retail Clinic Growth Has Resumed (Knowledge Source, April 2012)
Most of the story covers the not-all-that-new news that many observers guess about 100 to 150 new clinics may appear during 2012. Here are the things we thought you should zoom in on:
“Duane Reade, a subsidiary of Walgreens, may expand its DR Walk-In clinics from 12 to 20 stores this year”. Duane Reade is not merely a subsidiary of Walgreens – it’s a subsidiary of Walgreens whose stores – and retail clinics – are in New York Cit-ayyy. “If you can make it there, you can make it…”, etc. Plus, DR Walk-In clinics are physician-staffed, rather than with RNs or PAs. We aren’t sure that makes a lot of difference for recipients of treatment in those clinics, but it IS different from the model for the “prototypical” retail clinic.
Safeway still has not opened a single one of the 100 clinics Merchant Medicine suggested they were on the cusp of opening almost a year ago. It doesn’t take that long to physically build a clinic space, so something’s holding them up — that is, if they are actually planning to open clinics in their stores. Tom Charland hasn’t been wrong often, so don’t look for US to bet against him.
MinuteClinic has closed a couple handfuls of clinics since the beginning of the year – despite their oft-referenced 5-year plan to open ~500 clinics all by itself over the next 4 years.
Ok, that’s not mentioned in this article, and probably not in the Merchant Medicine report. We just thought we would point it out.
We tour retail and walk-in clinics’ location search tools irregularly, out of curiosity, and on the chance that we’ll learn something new.
Recently it occurred to us that some of you may do the same – and that you have lived to tell about it.*
So we’ve created a short poll to make it easy for you to tell us which ones you like. (Note that we have NOT made it easy for you to belittle our choice of poll name….)
We’ll go first: we’re not big fans of any of the leading firms’ location search tools.
And we feel they’re getting worse, rather than better.
We’re not convinced the clinic chains are really thinking about what people in the market for their clinics’ services are looking for when they’re looking for a clinic to treat them, or someone they know.
Our ideal locator would sweetly satisfy more than one of the following needs:
Easy to use (no multiple nested menus, lots of typing of street addresses in places I’m not familiar with – same with insisting on zip codes. Who memorizes zip codes? And while I’m at it, why can’t I search with phone numbers? and shouldn’t my phone’s location information let the application find clinics near me without me needing to key in address info? Ahhhh, don’t get us started…).
Fast results (hey, I’m feeling sick here – don’t keep me waiting)
Usable with any internet or mobile phone browser (apps? We don’t need no steenkin’ apps)
Accessible by any cellphone – not only smartphones
Clear, easy-to-understand directions
1-Click phone call to the specific clinic location – NOT number for the eager-to-help, but not-often-geographically-knowledgeable central help desk staff, thank you
We feel none of the leading clinics locator tools satisfies many of these criteria. Sweet is scarce among them.
But enough about our biased attitudes: which clinic’s location search tools are your favorites? To make it easier for you compare them, we’ve provided links to 5 of the largest retail & urgent care enterprises’ search utilities:
We’re picking on them because we’re fans – but something’s missing from the “Cost Per Episode” portion of this chart from a December 20, 2011 investor presentation by MinuteClinic President Andrew Sussman:
We just think the dollar distinction amongst venues is more significant – and more favorable to retail clinics – than the chart, as presented, suggests.
To be fair, there are several interesting slides in the full presentation deck. We especially liked slide #10, which covers a growth projection for the non-acute treatment share of MinuteClinic visits. Doctors, are you watching…?
….CVS-Caremark’s stock surged last Tuesday afternoon in the hours after this presentation. Retail clinics aren’t the health-care system we’re used to — but when what we’re used to are long wait times and expensive care, that could be a welcome change.