Retail Approach to Healthcare<br>Coming under Increased Scrutiny

Retail health clinics have attracted quite a bit of attention over the last year, partly because of the fast-growing nature of this patient-care model. Indeed, industry experts estimate that the number of clinics operating in the United States could nearly double by the end of 2008, reaching as high as 1500. Sporting names like “MinuteClinic,” “QuickHealth” and “WellnessExpress,” retail health clinics market themselves as a quick, convenient alternative for consumers to obtain treatment for a limited assortment of medical conditions (such as ear infections, strep throat, minor burns, etc.), healthcare screenings and vaccinations. Operating inside grocery stores, pharmacies and “big box” merchandisers like Wal-Mart, the clinics typically employ nurse practitioners or physician assistants who often have collaborative arrangements with off-site physicians (depending on state law requirements). Costs for services generally range from $40 to $80, with many clinics even posting a list of their healthcare services on fast-food-style menu boards in their waiting areas. According to the California Healthcare Foundation, which published a recent white paper discussing the emergence of retail health clinics in the United States, these clinics offer “convenience care” to consumers by being open for extended hours and on weekends, by not requiring appointments and by providing short wait times (on average, most visits take about 15 to 20 minutes). Patients also have the added convenience of filling prescriptions immediately following a visit when the retail health clinic is located inside a drug store (like CVS or Walgreens) or a retailer with an on-site pharmacy (such as Wal-Mart). But not everyone is pleased with the concept of convenience-driven health care. To date, one of the most outspoken critics of retail health clinics has been the American Medical Association (AMA). At a June 2007 annual meeting of physician leaders, the AMA announced that it would press for more oversight of retail health clinics by asking state and federal agencies to investigate ventures between retail clinics and pharmacy chains with an emphasis on inherent conflicts of interest, patients’ welfare, and professional liability concerns. The AMA also pledged to continue to work with state and specialty medical societies in developing guidelines for model legislation that regulates the operation of store-based health clinics, as well as to oppose the waiver of any state and/or federal regulations for these clinics that do not comply with existing standards for medical practice facilities. Some states are already following the AMA’s lead by taking a closer look at the operation of retail health clinics in their own backyards. In Massachusetts, for example, healthcare officials have begun pushing for tighter regulation of clinics following a recent announcement by CVS to open 20 to 30 MinuteClinics in and around the Boston area. One result is that the Massachusetts Public Health Council has issued proposed regulations that set out the rights and obligations of “limited services clinics” operating in the state. The regulations, if adopted, would require, among other things, that retail health clinics establish guidelines for referring patients whose needs exceed clinic services, for limiting the number of repeat encounters with individual patients and for ensuring that clinic personnel do not promote the use of services provided by the host retail location. The Public Health Council plans to hold a public hearing on the proposed regulations sometime this month. In California, the growth of retail clinics has likewise been slowed by regulatory constraints. According to a recent report issued by the Hospital Association of Southern California, few retail health clinics operate in the state because of a requirement that virtually all retail clinics must be operated by a medical corporation owned by a physician in accordance with the state’s Corporate Practice of Medicine guidelines. The report notes that California law “does not necessarily bar nurse practitioners from being an active part of a clinic’s corporate entity, but physicians must play a role regarding what diagnostic tests are appropriate for a particular condition, participate in the hiring and firing of staff, and serve as the custodian for medical records, among other requirements.” Finally, state medical associations and specialty medical societies have become increasingly vocal about possible continuity of care problems created by a retail approach to healthcare. The Connecticut State Medical Society, for example, has published a position statement calling for all retail clinics in the state to be formally associated with a physician practice or similar entity that is capable of coordinating the continuum of medical services that is outside the scope of clinics. (It has also expressed unease about the practice of some health insurers waiving co-payments and deductibles to encourage the use of retail clinics.) Similarly, the American Academy of Pediatrics (AAP) has issued a policy statement in which it “strongly discourages” the use of retail health clinics for babies, kids and teens because the clinics “do not support the AAP’s commitment to a ‘medical home model’ that provides accessible, family-centered, comprehensive, continuous, coordinated, compassionate and culturally effective care for which the pediatrician shares responsibility with the family.” Despite these patient and continuity of care concerns, it is unlikely that retail health clinics will disappear from the U.S. healthcare landscape altogether, due in large part to consumer demands for convenient, low-cost healthcare alternatives. However, given the increased scrutiny of this patient-care model by the AMA and others, owners and operators of retail health clinics can undoubtedly expect to encounter legislative, regulatory and public relations hurdles in the future. September 2007