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Walk-in health clinics have been popping up across New Jersey as a more convenient way for people to get nonemergency care, but they may not be in the best location to serve the neediest residents, according to new data from the Robert Wood Johnson Foundation.
There are 217 urgent-care clinics either open or opening soon across the state, and 43 retail clinics located in pharmacies and supermarkets. There are also two freestanding emergency rooms — one in Plainfield and the other in Hammonton — affiliated with hospitals to compensate for the closing of local medical facilities.
The RWJF report Recent Changes in Primary Care Delivery and Health Provider Systems in New Jersey notes that “dozens of new clinics have been opening around the state over the last five years” to meet a demand for convenience.
Retail clinics, usually staffed by nurse practitioners or physician assistants, can handle minor illnesses and injuries, vaccinations, and preventive care. Urgent-care clinics have at least one doctor on staff, offer imaging and laboratory services, and can deal with more serious problems that do not rise to the level of emergency. Both types are typically open extended or off hours seven days a week to handle walk-in clients. By contrast, the freestanding emergency rooms, like a hospital ER, are open 24 hours a day and treat emergencies and mental-health issues.
In New Jersey, the clinics also differ based on ownership. CVS owns all but nine of the retail clinics; the others are in Walgreens and ShopRite stores. They also typically have an affiliation with a local provider for referrals. Urgent-care clinics may be run by hospitals, physician groups, or private companies.
Every county has at least one retail or urgent-care clinic except for Salem. Bergen, the state’s most populous county, also has the largest number of clinics — 30.
Report author Alan Baumgarten said changes in medical payments are one reason for the growth in urgent-care clinics.
He said provider groups “are seeing a shift away from payment based on filling beds to managing the health of a population within a given budget. Operating urgent-care clinics creates an opportunity to divert inappropriate emergency room visits to a less expensive setting.”
There is another reason related more to money than to helping those most in need.
“A second reason is that establishing new urgent-care clinics is part of an overall strategy to extend the geographic reach of those systems into developing, more affluent areas, where the payer mix is likely more favorable, with more families with good commercial coverage and fewer that are uninsured or on Medicaid,” he said.
The report states that the expansion of Medicaid eligibility in New Jersey has added 420,000 more Medicaid enrollees since the beginning of 2014, for a total of 1.7 million recipients, with more than nine in 10 them enrolled in one-of-five managed-care organizations.
Baumgarten argues that while these clinics could be a way to ensure that there is adequate primary-care capacity for those on Medicaid, their payment rates and geographical locations are two barriers to that.
“The payment rates for Medicaid patients in New Jersey are generally too low to be appealing to convenient-care clinic operators,” he wrote. And there is “a geographic mismatch in where the new convenient-care capacity is being added and where families covered by Medicaid live.”
Walk-in clinics are usually located in areas where the population is of higher income and where they fit in with retail stores, with high traffic and evening and weekend hours, according to the report. Baumgarten noted that there are no clinics in the city of Camden, but there are several in nearby communities. The median household income in Camden, according to the U.S. Census Bureau’s 2013 American Community Survey, was about $26,000, and nearly half the population — about 35,000 people — are on Medicaid or another means-based insurance. Nearby Cherry Hill, by contrast, has a total of 8 retail and urgent-care clinics. Its median household income exceeds $88,000 and only 7.5 percent of residents use Medicaid.
“For many New Jersey provider systems and for CVS, the largest operator of retail clinics, it appears that their approach to convenient care is that it creates new points of presence and additional convenience for patients,” Baumgarten wrote. “But it does not appear that these clinics will play a significant role in improving access for Medicaid recipients.”