Princeton, N.J.—Retail clinics (also called convenient care clinics) are an increasingly popular option for people who need diagnosis and treatment for common, non-life-threatening conditions. Nurse practitioners (NPs) are the primary care providers in these clinics, which are located in a range of settings, including pharmacies, grocery stores and "big box" stores. First established in 2000, there are now more than 1,200 retail clinics nationwide. Research shows that they provide quality health care and reduce health care costs. A new study shows that they can further reduce costs when NPs are allowed to practice independently, potentially by nearly $472 million or more in 2015.
The research team, which was led by Joanne Spetz, PhD, professor at the Institute for Health Policy Studies and associate director for Research Strategy at the Center for the Health Professions at the University of California, San Francisco, and Stephen T. Parente, director of the Medical Industry Leadership Institute at the Carlson School of Business, University of Minnesota, compared claims data over a two-week period for 9,503 patients who visited retail and non-retail clinics from 2004 to 2007. Researchers compared costs in states that require NPs to be supervised by or collaborate with physicians, states that allow NPs to practice independently but not prescribe, and states in which NPs are allowed to practice and prescribe independently.
The study was funded by the Robert Wood Johnson Foundation's Interdisciplinary Nursing Quality Research Initiative (INQRI) and is in the November issue of Health Affairs.
The researchers found that insurance claims over a two-week period were lower following retail clinic patient visits than after visits to other settings, such as doctor's offices and emergency departments, for the same conditions. Insurance expenditures for retail patient visits were even lower in states that allow NPs to practice independently. Payments for prescriptions were slightly higher in states where NPs are allowed to prescribe, but that increase in cost was mitigated by the lower cost of an NP practicing independently.
Adjusted to 2013 dollars, the average two-week cost for non-retail clinic visits was $704, for retail clinic visits in states with no NP independence it was $543, and for retail clinic visits in states where NPs have independence in practice, it was $484. The average cost for retail clinic visits in states where NPs had independence in practice and prescribing was $509.
Retail clinics are projected to account for about 10 percent of outpatient primary care visits by 2015. The study's authors projected that the cost savings realized from using retail clinics at that level would be $2.2 million. The savings would be increased by $810 million if all states allowed NPs to practice independently, and by $472 million if NPs were allowed to practice and prescribe independently.
"Our findings underscore earlier research findings indicating that when NPs practice to the full extent of their training, they can deliver highly efficient high-quality primary care," said Spetz. "We believe that primary care practices should leverage NPs' knowledge and skills and the increased availability of convenient care delivery settings to expand access to health care. They also need to work to improve care coordination, as continuity of care can be an issue with retail clinics as compared with hospitals."
This study is one of a series funded by INQRI to examine issues related to select recommendations of the Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health. Those recommendations are:
- removing scope of practice barriers;
- expanding opportunities for nurses to lead and diffuse collaborative improvement efforts;
- increasing the proportion of nurses with BSNs to 80 percent by 2020;
- doubling the number of nurses with doctoral degrees by 2020;
- preparing and enabling nurses to lead change to advance health; and
- building an infrastructure for the collection and analysis of interprofessional health care workforce data.
INQRI supports interdisciplinary teams of nurse scholars and scholars from other disciplines to address the gaps in knowledge about the relationship between nursing and health care quality. It is helping to advance the recommendations of the Institute of Medicine’s landmark report, The Future of Nursing: Leading Change, Advancing Health, which include fostering interprofessional collaboration and preparing and enabling nurses to lead change. By requiring research teams to include a nurse scholar and at least one scholar from another health care discipline, INQRI not only fosters interprofessional collaboration, the Initiative also increases the methodological rigor of the research conducted.