Ateev Mehrotra, MD; N. Marcus Thygeson, MD; Elizabeth A. McGlynn, PhD
Potential Conflicts of Interest: None disclosed.
Mehrotra A., Thygeson N., McGlynn E.; Comparing Costs and Quality of Care at Retail Clinics With Those of Other Medical Settings. Ann Intern Med. 2010;152:267. doi: 10.7326/0003-4819-152-4-201002160-00022
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Published: Ann Intern Med. 2010;152(4):267.
Dr. Kochar is correct that the follow-up care of an episode at a retail clinic could occur at another care site. But we doubt that this affected our quality scores. Fewer than 20% of episodes included any follow-up visits. Also, our quality measures generally focused on care around the first visit. For example, we looked at antibiotic prescriptions for otitis media that were filled on the day of the first visit or in the subsequent 2 days.
We shared Dr. Kochar's concern that patients who presented to a physician's office could be more ill and that this might drive some of the cost differences we observed. Yet, our sensitivity analyses that directly addressed this issue did not support this concern. The major driver of cost differences is reimbursement for the first visit. Costs that are probably related to severity of illness (for example, laboratory costs and follow-up visits) were less important. Nonetheless, as we note in our article, residual differences could exist between the patient populations at the care sites, although we feel that matching on income, level of illness, and insurance plan minimizes these differences.
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