Slowly but surely, chains like CVS and Walgreen's have built a solid market in the retail care space, offering a convenient, affordable environment for consumers with minor ailments to get care. While some hospital chains are moving aggressively into the urgent care center market, few are attempting to tap the fast-care, low-acuity market the way these retail drugstores have.
Rather, most hospitals continue to take all comers in their traditional emergency departments, often treating patients who only need a few minutes of a physician's time. As we all know, this is a wasteful, costly practice that leaves hospitals with a lot of bad debt. What's more, treating low-acuity patients in the ED uses resources that could be best deployed elsewhere. But hospitals continue to handle things the way they always have.
These days, however, I'd argue that it's long overdue for hospitals to adopt the retail care model. With an affordable, low-overhead retail-style clinic on the hospital's premises, patients can be triaged, then guided to the level of care they actually need. Having a retail-style clinic near the ED, or integrated in the building down the hall, could do much to resolve ED crowding. And compared to providing high cost care to mildly sick patients, many of whom show up because they have no money and no alternatives, retail care could save hospitals a fortune in unpaid bills.
Given such a win-win situation, why do hospitals continue to stick to business as usual in this respect?
One reason, I'd suggest, is plain old-fashioned inertia. While there are exceptions, the hospital business changes rather slowly and makes most important decisions by committee. The decision to create a hospital retail clinic may not be gigantic on the scale of operations, but it does require a change in strategy, some capital investment (I've heard estimates in the $1 million range) and the willingness to invest energy to make it work. At such a tumultuous time in the hospital industry's history, it's likely that many health leaders aren't ready to turn that corner just yet.
Another reason hospitals aren't charging into this territory, it seems, is that they're not sure if a retail clinic is the most profitable use of their space and staff. Clinics based in retail drugstores attract not only patients, but customers who will fill their prescriptions and buy the many other products available in a retail setting. Retail-style clinics in a hospital setting may or may not stand in their own two feet as a profit center. Even if they divert costly patients away from the ED, having a retail clinic run in the red may not seem to be worth the time and expense of establishing one.
All this being said, I believe hospitals will eventually need to do something along retail clinic lines to lower the burden on their ED. Over and over again, experts have predicted that one trend or another would shift the less-sick into other channels spontaneously, but it hasn't happened. Hospitals are going to have to admit that they can't just hope public policy, health plan trends or other forces outside the building divert lower-acuity patients to other settings. It's time they took it upon themselves to do so.