Retail Clinic Visits For Low-Acuity Conditions Increase Utilization And Spending

Ashwood, J. Scott; Gaynor, Martin; Setodji, Claude Messan; Reid, Rachel O.; Weber, Ellerie; Mehrotra, Ateev

doi:10.1377/hlthaff.2015.0995

Cited by 65 publications

(40 citation statements)

References 37 publications

(27 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Additionally, claims do not provide sufficient information to determine if virtual visits were used in situations when individuals would have otherwise waited to see if the problem resolved on its own. A recent study suggested that RHCs increased utilization for low-acuity visits due to their lower price or convenience [19]. However, whether this is good or bad is a matter of perspective, since while costs may increase, the alternative care options may allow patients who may not have otherwise received appropriate care to receive the care they needed.…”

Section: Discussionmentioning

confidence: 99%

Virtual Visits for Acute, Nonurgent Care: A Claims Analysis of Episode-Level Utilization

2017

View full text Add to dashboard Cite

BackgroundExpansion of virtual health care—real-time video consultation with a physician via the Internet—will continue as use of mobile devices and patient demand for immediate, convenient access to care grow.ObjectiveThe objective of the study is to analyze the care provided and the cost of virtual visits over a 3-week episode compared with in-person visits to retail health clinics (RHC), urgent care centers (UCC), emergency departments (ED), or primary care physicians (PCP) for acute, nonurgent conditions.MethodsA cross-sectional, retrospective analysis of claims from a large commercial health insurer was performed to compare care and cost of patients receiving care via virtual visits for a condition of interest (sinusitis, upper respiratory infection, urinary tract infection, conjunctivitis, bronchitis, pharyngitis, influenza, cough, dermatitis, digestive symptom, or ear pain) matched to those receiving care for similar conditions in other settings. An episode was defined as the index visit plus 3 weeks following. Patients were children and adults younger than 65 years of age without serious chronic conditions. Visits were classified according to the setting where the visit occurred. Care provided was assessed by follow-up outpatient visits, ED visits, or hospitalizations; laboratory tests or imaging performed; and antibiotic use after the initial visit. Episode costs included the cost of the initial visit, subsequent medical care, and pharmacy.ResultsA total of 59,945 visits were included in the analysis (4635 virtual visits and 55,310 nonvirtual visits). Virtual visit episodes had similar follow-up outpatient visit rates (28.09%) as PCP (28.10%, P=.99) and RHC visits (28.59%, P=.51). During the episode, lab rates for virtual visits (12.56%) were lower than in-person locations (RHC: 36.79%, P<.001; UCC: 39.01%, P<.001; ED: 53.15%, P<.001; PCP: 37.40%, P<.001), and imaging rates for virtual visits (6.62%) were typically lower than in-person locations (RHC: 5.97%, P=.11; UCC: 8.77%, P<.001; ED: 43.06%, P<.001; PCP: 11.26%, P<.001). RHC, UCC, ED, and PCP were estimated to be $36, $153, $1735, and $162 more expensive than virtual visit episodes, respectively, including medical and pharmacy costs.ConclusionsVirtual care appears to be a low-cost alternative to care administered in other settings with lower testing rates. The similar follow-up rate suggests adequate clinical resolution and that patients are not using virtual visits as a first step before seeking in-person care.

show abstract

Section: Discussionmentioning

confidence: 99%

Virtual Visits for Acute, Nonurgent Care: A Claims Analysis of Episode-Level Utilization

2017

View full text Add to dashboard Cite

show abstract

“…Virtual care is also understood as a means of making care more convenient to patients and is gaining momentum in the United States and other advanced health systems alongside other innovations such as retail clinics and other forms of walk-in care [15-20]. There is, at present, limited empirical evidence about how patients view virtual care and more specifically virtual visits, how such care affects overall primary care use, and whether integration of virtual visits in existing relationships or more as a “walk-in” service matters.…”

Section: Introductionmentioning

confidence: 99%

Virtual Visits and Patient-Centered Care: Results of a Patient Survey and Observational Study

2017

View full text Add to dashboard Cite

BackgroundVirtual visits are clinical interactions in health care that do not involve the patient and provider being in the same room at the same time. The use of virtual visits is growing rapidly in health care. Some health systems are integrating virtual visits into primary care as a complement to existing modes of care, in part reflecting a growing focus on patient-centered care. There is, however, limited empirical evidence about how patients view this new form of care and how it affects overall health system use.ObjectiveDescriptive objectives were to assess users and providers of virtual visits, including the reasons patients give for use. The analytic objective was to assess empirically the influence of virtual visits on overall primary care use and costs, including whether virtual care is with a known or a new primary care physician.MethodsThe study took place in British Columbia, Canada, where virtual visits have been publicly funded since October 2012. A survey of patients who used virtual visits and an observational study of users and nonusers of virtual visits were conducted. Comparison groups included two groups: (1) all other BC residents, and (2) a group matched (3:1) to the cohort. The first virtual visit was used as the intervention and the main outcome measures were total primary care visits and costs.ResultsDuring 2013-2014, there were 7286 virtual visit encounters, involving 5441 patients and 144 physicians. Younger patients and physicians were more likely to use and provide virtual visits (P<.001), with no differences by sex. Older and sicker patients were more likely to see a known provider, whereas the lowest socioeconomic groups were the least likely (P<.001). The survey of 399 virtual visit patients indicated that virtual visits were liked by patients, with 372 (93.2%) of respondents saying their virtual visit was of high quality and 364 (91.2%) reporting their virtual visit was “very” or “somewhat” helpful to resolve their health issue. Segmented regression analysis and the corresponding regression parameter estimates suggested virtual visits appear to have the potential to decrease primary care costs by approximately Can $4 per quarter (Can –$3.79, P=.12), but that benefit is most associated with seeing a known provider (Can –$8.68, P<.001).ConclusionsVirtual visits may be one means of making the health system more patient-centered, but careful attention needs to be paid to how these services are integrated into existing health care delivery systems.

show abstract

“…About one in five urgent care center users said they chose their provider because the location was “more convenient, compared to other facilities like hospitals, doctors’ offices and community health centers.” Locating primary care clinics in convenient sites might likewise lure patients with nonemergency conditions away from expensive and less convenient emergency departments . Ironically, however, a study of pharmacy‐based retail clinics “found that 58 percent of retail clinic visits for low‐acuity conditions represented new utilization and that retail clinic use was associated with a modest increase in spending, of $14 per person per year.” Accordingly, commentators wonder whether other convenient, lower‐priced options such as “telehealth” or kiosks offering testing in stores “could also end up leading to overall increases in health spending, despite being touted as cost‐savers.” • Every U.S. state has a vaccination mandate but also has procedures for exempting individuals on medical, religious, or philosophical grounds. Several authors have proposed “making [nonmedical] exemptions for immunizations more difficult to obtain.” Their idea is to make the legal procedure for obtaining exemptions more “arduous” by, for instance, requiring “a notarized parental statement, counseling, and health department approval,” as some states do.…”

Section: Articlesmentioning

confidence: 99%

“…12 Ironically, however, a study of pharmacy-based retail clinics "found that 58 percent of retail clinic visits for low-acuity conditions represented new utilization and that retail clinic use was associated with a modest increase in spending, of $14 per person per year." 13 Accordingly, commentators wonder whether other convenient, lower-priced options such as "telehealth" or kiosks offering testing in stores "could also end up leading to overall increases in health spending, despite being touted as cost-savers." 14…”

mentioning

confidence: 99%

Can Rationing through Inconvenience Be Ethical?

Eyal¹,

Romain²,

Robertson³

2018

Hastings Center Report

View full text Add to dashboard Cite

In this article, we provide a comprehensive analysis and a normative assessment of rationing through inconvenience as a form of rationing. By "rationing through inconvenience" in the health sphere, we refer to a nonfinancial burden (the inconvenience) that is either intended to cause or has the effect of causing patients or clinicians to choose an option for health-related consumption that is preferred by the health system for its fairness, efficiency, or other distributive desiderata beyond assisting the immediate patient. We argue that under certain conditions, rationing through inconvenience may turn out to serve as a legitimate and, compared to direct rationing, even a preferable tool for rationing; we propose a research agenda to identify more precisely when that might be the case and when, alternatively, rationing through inconvenience remains ethically undesirable. After defining and illustrating rationing through inconvenience, we turn to its moral advantages and disadvantages over other rationing methods. We take it as a starting assumption that rationing, understood as scarce-resource prioritization, is inevitable and, in a society that has goals beyond optimizing health care for individual patients-such as improving societal health care, education, or overall welfare-prudent and fair.

show abstract

Retail Clinic Visits For Low-Acuity Conditions Increase Utilization And Spending

Cited by 65 publications

References 37 publications

Virtual Visits for Acute, Nonurgent Care: A Claims Analysis of Episode-Level Utilization

Virtual Visits for Acute, Nonurgent Care: A Claims Analysis of Episode-Level Utilization

Virtual Visits and Patient-Centered Care: Results of a Patient Survey and Observational Study

Can Rationing through Inconvenience Be Ethical?

Contact Info

Product

Resources

About