In a rapidly evolving health care landscape, pharmacies aren’t just pharmacies anymore; increasingly, they are health care clinics, too.
That is big news for nurse practitioners (NPs), who provide the bulk of care in the growing number of health care clinics in pharmacies and other retail stores. “It is a comprehensive and important role that not only aligns with the education and training of nurses but enables broad support for the patient-centered medical neighborhood,” said Angela Patterson, MS, FNP-BC, the chief nurse practitioner officer on the CVS MinuteClinic executive team.
Retail-based clinics are a “great option for employment and for a career” for NPs because they offer convenient, community-based places to work, flexible schedules, and career paths for leadership, said Sandy Ryan, MSN, RN, FAAN, chief clinical officer at CareCam Health Systems, past chief NP officer at Walgreens, and an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (2011-2014). In addition, they promote nurse-led care; increase the visibility of nurses in the health care system; and promote nurses as leaders, not only in health care but also in business, she added.
Tine Hansen-Turton, MGA, JD, FAAN, executive director of the Convenient Care Association, a trade group for the nation’s 1,800-plus retail-based health care clinics, agreed. “Retail clinics have become mainstream, there is no doubt about it,” she said, noting that there have been more than 30 million patient visits to these types of clinics to date. “It’s a great future for NPs.”
And that future is expected to get even brighter, she said. By 2016, the number of retail-based clinics is projected to reach 3,000, according to the Convenient Care Association, a supporter of the Future of Nursing: Campaign for Action. The Campaign is a joint effort of RWJF and AARP to improve health by transforming nursing. The Convenient Care Association is a “nurse champion” and a member of the Champion Nursing Coalition, a group of business, consumer, and health professional organizations that support the Campaign.
The number of retail-based clinics may eventually reach 5,000, according to Ryan, who was the first chief NP officer in the convenient care industry. “There is still potential for this model to grow significantly, both in the number of clinics and in the scope of health care services delivered to patients,” she said.
Retail-Based Clinics Growing Quickly to Meet Consumer Needs
The convenient care industry got its start in 2000, when the first retail-based clinic opened in Minnesota. The industry has grown quickly since then, with locations springing up across the country. Today, clinics are operating in major national pharmacy chains, including Walgreens, CVS, and Rite-Aid, grocery stores such as Kroger, and “big box” stores like Target; they are run by both private organizations and health systems.
Proponents say retail-based clinics are increasing patient access to care in their communities just as primary care provider shortages are becoming more acute. Unlike care provided at some of the more traditional settings, retail-based clinics are open in the evenings and on weekends, allowing patients to access care after traditional work hours. Visits are quick, typically lasting between 15 and 20 minutes, and no appointments are needed.
Supporters also note that retail-based care reduces health care costs. Retail clinics accept most insurance co-payments, and uninsured patients typically pay between $40 and $75 per visit. That’s less, on average, than similar care provided at physician offices and appreciably less than similar emergency room care, according to the Convenient Care Association. Retail clinics, Hansen-Turton said, “continue to be the lowest-cost private option.”
Some groups, however, offer cautions. The American Academy of Pediatrics, for example, warned that retail-based clinics fragment care and do not support the “medical home” concept of continuous, coordinated care, in a statement last year. “The American Academy of Pediatrics recognizes that convenience and access to care will continue to be important drivers of how health care is delivered,” James Laughlin, MD, FAAP, wrote. “However, the expertise of the pediatrician and the medical home should continue to be recognized as the standard for care of children.”
Patterson, however, cites a study funded by RAND Corp. that found that retail clinics provide the same quality of care as ambulatory care facilities and emergency departments, but at much lower costs. Other studies have found similar results, Patterson said, and that retail-based health care scores high in patient satisfaction measures. “The quality of care is excellent and patient satisfaction is clearly high,” Patterson said.
Proponents of retail-based care also note that it is not intended to replace continuous, coordinated care by physicians or other primary care providers or serve patients with complex conditions. “Clinics have always been, and will always be, a complement to the health care system,” Ryan said. “They are not meant to be a competitor to other providers; they are meant to be an access point that didn’t exist before.”
Patterson, meanwhile, notes that MinuteClinic practitioners share visit summaries with primary care providers, have formed clinical affiliations with major physician-led health systems, and work with on-call medical directors. “MinuteClinic is part of the patient’s extended health care team,” she said.
Scope-of-Practice Restrictions Affect Care at Retail Clinics
While Ryan is optimistic about the future of nurse-led retail clinics, some barriers remain. The same scope-of-practice laws that restrict NP practice in some states, for example, may also prevent nurse-led clinics from more fully serving patients. But states are gradually loosening these types of restrictions, allowing NPs and other advanced practice registered nurses (APRNs) to practice to the full extent of their education and training. Last year, Minnesota became the 19th state, in addition to the District of Columbia, to allow NPs to practice without physician supervision.
Further, eliminating restrictions on APRNs could significantly lower health care spending, according to a 2013 article published in Health Affairs. “Eliminating restrictions on NPs’ scope of practice could have a large impact on the cost per episode that can be achieved by retail clinics,” the study states.
“I think the future is incredibly bright for NPs,” Ryan said. “Compare where we were 10 years ago to where we are today: NPs are more visible, the public has trust in them, and big organizations like Walgreens and CVS are saying, ‘Hey, we believe in NPs, and they have a significant role to play in health care.’”