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The Rise of Retail Health Care Clinics in America

When Uwe Reinhardt noticed pus coming out his son's eye, he panicked. "When he is your firstborn, and you don't know where to go" you worry, Reinhardt, a Princeton healthcare economist, said. It was past 5 p.m. – after hours for his family doctor –so he had to take his son to the emergency room. They waited three hours just to be told that his son had an eye infection and needed a topical cream to treat it – a diagnosis that any doctor could have made. "How is this consumer friendly?" Reinhardt wondered.

He is not alone. Over the last decade patients have been seeking cheaper and more convenient healthcare. CVS, Walgreens and Target are just a few stores that have in-store clinics to treat minor illnesses. Then there are urgent care centers – some stand-alone and some affiliated with hospital systems – which treat more serious, but non-life-threatening, conditions.

Cooper Health System, based on Camden, has jumped on the urgent care center trend. They opened a center in Audubon last year, and they are opening a new center in Sicklerville, as well as partnering with Ravitz ShopRite in Cherry Hill to offer retail clinic services in-store.

And Cooper is just one of many hospitals across the state and country that are getting into the urgent care game.

But which to use?

Retail clinics and urgent care centers are usually open longer than doctors' offices and are often cheaper than hospital emergency rooms. Convenience and inexpensive prices are arguably their most important qualities.

Generally, retail clinics are nested in other stores and treat anything that needs a prescription or little medical attention – conditions like colds, rashes and blisters, minor cuts and bruises, and vaccinations. Prices are static and relatively inexpensive compared to an emergency room for doctor's visit. (An appointment for a cold, allergies or similar conditions costs $75 at Target's retail clinic; a seasonal flu shot costs about $30.) These clinics are usually staffed with nurse practitioners and physician assistants who are overseen by an off-site doctor.

For more severe conditions – broken bones, stitches, serious cuts and burns – patients could seek out an urgent care center. These centers are also usually staffed with nurse practitioners and physician assistants, but tend to have an on-site doctor. Like retail clinics, prices are fixed and inexpensive when compared to the emergency room.

Treatment for strep throat in an emergency room, for example, may cost around $500, where as it may cost $110 at an urgent care clinic, according to Likewise, treatment for bronchitis could cost $600 in an emergency room and $130 at an urgent care clinic. These prices are averages, however, and depend on a variety of factors. Your health plan may also affect prices.

For any more severe conditions, like severe shortness of breath, severe pain or anything life-threatening, patients still should visit their closest emergency room.

No Long "Boxable"

As retail clinics and urgent care centers mature, the range of services they offer is expanding and starting to overlap.

The blurring of services between the formerly distinct medical care centers has been sudden, according to Jennifer Reinhold, a professor of clinical pharmacy at the University of the Science of Philadelphia.

"If we had this conversation maybe a year ago," she said, "everything would have been 'boxable.'"

Some retail clinics are starting to offer treatment for chronic conditions, like high blood pressure and diabetes. Clinics typically offer sports and school physicals. CVS's Minute Clinics are pushing their new smoking cessation program. The business has grown from bandages and vaccines to a potentially constant medical presence in patients' lives.

Similarly, urgent care centers offer monitoring of chronic conditions and vaccinations, and also have the equipment to take x-rays and run blood work, among other things. Further, some urgent care centers are starting to specialize. The Rothman Institute runs an urgent care center focused on orthopedics in Marlton, N.J. The Children's Hospital of Philadelphia manages a pediatric urgent care center in Mays Landing, N.J.

Filling a niche

Urgent care centers started in the 1980s and flew under the radar until the 2000s, when the first retail clinics started to pop up. Over the last five years, the centers have exploded in popularity. If you drive down any major road in New Jersey, you are bound to see more than a few newly constructed urgent care center buildings.

Retail clinics and urgent care centers have proliferated for a few reasons. The most obvious is the convenience. A shortage of primary care doctors coupled with overcrowded emergency rooms creates long wait times for patients seeking routine or relatively minor care. This created an opportunity for investors who swooped in to offer patients a faster alternative and to reap the profits.

"This is what capitalism is about: if you leave a gap in things people need, capitalists will ooze into it," said Reinhardt, the Princeton healthcare economist.

"They fill a niche that physicians in traditional medical practice have not been able to fill and that the ER has not been able to fill: and that is to respond to somewhat serious medical issues cheaply and quickly."

Greater access to health insurance via the Affordable Care Act and changes to Medicare may also be driving patients to these clinics. As more patients gain insurance and seek the lowest healthcare prices, retail clinics and urgent care centers – both of which take insurance as well as offer standard prices for the uninsured – are filling that need and steering patients away from potentially cost-prohibitive hospitals.

"The ACA asked all of us where people are getting care," said Tine Hansen-Turton, executive director of the Convenient Care Association, the industry trade group for retail clinics.

A Tiered System

Between a lack of primary doctors and overcrowded emergency rooms, and convenience of a waking into a storefront in a shopping plaza and ordering healthcare as easily as Chinese food, it seems like retail clinics and urgent care centers are here to stay. These clinics are filling in the space between hospital emergency rooms and primary care doctors, treating the conditions that require neither but still need some attention.

But, experts say, that doesn't mean patients should stop seeing their primary care physicians. Instead, these clinics are more like supplements to family doctors.

"I think [retail clinics and urgent care centers] are here to stay," said Barbara Smith, senior vice president of ambulatory operations at Cooper Medical School of Rowan in Camden. "I think they add value for the patient, but over time you want that patient to have a relationship with a primary care physician."

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