Retail Clinics Have Hit a Wall -- But May Have a Way Over It

Retail clinics, which were predicted to sweep the country not long ago, have plateaued at around 1200 outlets -- roughly the same number as a year ago. Some are closing. There are plenty of possible reasons, including the seasonality of patient demand and insufficient traffic in host stores. But the best explanation may be that the retail model, in which nurse practitioners treat minor acute problems like colds and rashes, simply can't generate enough cash flow to make retail clinics profitable.

That theory comes from Paul Keckley, executive director of the Deloitte Center for Health Solutions and a veteran observer of the healthcare scene. In a Tennessean article about Kroger (KR) supermarkets closing 20 of its Little Clinic locations, Keckley said, "Unless you have a full set of services, it's hard to make that [retail clinic] model work profitably just on [patient] visits."

This is a lesson that primary-care physicians have already learned. Without adding ancillary services such as in-house laboratories, dermabrasion or sports medicine, many family doctors and internists find it difficult to keep going. Their reimbursement has not risen as fast as their expenses, so it's imperative for them to develop profitable sidelines.

Retail clinics are in the same predicament. They have lower overhead than primary-care practices do, so they can break even if they see about two patients an hour -- far fewer than a typical primary-care doctor does. But some clinics don't get that many patients, and they don't offer ancillary services. A few clinics have begun to expand into chronic disease care, which could enlarge their appeal and attract patients who will come back regularly. But there's a limit to what nurse practitioners can do on their own without a doctor's supervision.

Meanwhile, the retail clinic wave seems to have crested for now. CVS and Walgreens (WAG), both of which had ambitious expansion plans, have shuttered some outlets. And Walmart (WMT), which at one time planned hundreds of clinics, has less than 60, most of them operated in conjunction with hospitals. Hospitals have also backed clinics in other retail stores, both as a way to keep people out of the ER and to attract paying patients to their healthcare systems.

In the long run, retail clinics could make a comeback. According to Deloitte -- Keckley's company -- the clinics will grow 10 percent from 2010 to 2012. After that, the Deloitte report says, growth will top 30 percent annually in 2013 and 2014. Healthcare reform and an expansion of clinic services will drive that growth, the consulting firm forecasts.

It's certainly true that millions of newly insured people could increase demand for retail clinic services, given the inadequate supply of primary care. But there are other possible beneficiaries of this demand, including worksite clinics, urgent-care clinics, and community health centers. The primary-care configuration of the future is still uncertain, but it's likely that most patients will have a harder time getting an appointment with a physician than they do now.

Image supplied courtesy of Infrogmation at Wikimedia Commons.