Concerns over the role of retail-based clinics in patient care has intensified, with a growing number of physicians and medical associations calling on state and federal officials to closely monitor and create standards for the clinics.
Late last month, for example, the American Medical Association requested that government health agencies investigate whether joint ventures between in-store clinics and pharmacy chains create conflicts of interest that could be detrimental to patients health. The action, which came out of the AMAs annual delegate meeting in Chicago, was spurred by retailer statements that in-store clinics steer additional traffic into stores, helping to increase sales of prescription drugs and other products.
The nations physicians want the AMA to ensure these incentives do not compromise the basic obligation of store-based health clinics to provide patients with quality care, said AMA Board Member Peter Carmel in a written statement issued by the organization.
Other medical organizations are also lining up to scrutinize the rapidly expanding retail-clinic industry, saying the care model has high potential for interrupting patients relationships with their primary-care physicians and negatively affecting both patients health and physicians livelihoods. I think the biggest concern is that the (in-store care) model is totally opposite to the holistic-care model weve promoted, said Illinois State Medical Society President-Elect Shastri Swaminathan, a staff psychiatrist at 309-bed Advocate Illinois Masonic Medical Center in Chicago. The society was among the organizations pushing for AMA delegates to issue a request for greater federal and state oversight, and possibly a wholesale ban, of retail-based clinics.
Among the concerns cited by Swaminathan and other critics are that in-store clinics lack of on-staff physicians (patients are typically treated by nurse practitioners or physicians assistants) and their focus on episodic treatment of a limited number of conditions puts patients at risk for undiagnosed serious illnesses.
You can make a very strong case that there needs to be oversight of retail-based clinics, said Richard Wade, a spokesman for the American Hospital Association. Wade noted that his organization has taken no official position on the role of in-store clinics in healthcare. That may be largely because of partnerships between some hospitals and retail-based clinics. RediClinic, which has locations at Wal-Mart and several other drugstore chains, has oversight agreements with five hospital systems, including four-hospital Bon Secours Richmond (Va.) Health System and five-hospital Memorial Hermann Healthcare System in Houston.
Nevertheless, Wade believes some governmental oversight could be a good thing for the industry and patient safety. There is no standard definition on the state level about what these clinics are, what they can do and what kinds of services they can offer. Its a matter of public confidence.
In recent months, several medical associations have taken steps to ensure exactly that. On June 11, for example, five Massachusetts medical associations sent a joint letter to the states public health commissioner, John Auerbach, requesting a public vetting of a license application made by CVS Caremark Corp.-owned MinuteClinic to open its first Massachusetts location at a CVS pharmacy in Weymouth.
The letter was sent in response to waiver applications made by MinuteClinic, which requested that the organization be relieved of several operational requirements. The nine requests included waiving the obligation to create a soiled-linens workroom, dedicated toilet facilities for patients, designated wheelchair space in the waiting area and a separate patient entrance.
Right now, the requests are being treated (by the Department of Public Health) as an administrative decision, and at the very least wed like to see a public hearing of those waivers, said Dennis Dimitri, president-elect of the Massachusetts Academy of Family Physicians, one of the organizations that sent the letter. In general, were likely to oppose the granting of those waivers; DPH has them in place to protect the public, he added.
But MinuteClinic Chief Executive Officer Michael Howe doesnt see the request as unfair or unusual, and says requests such as the ones made by his company to the Massachusetts health department are frequently made by healthcare providers there. Donna Rheaume, a health department spokeswoman, couldnt say if MinuteClinics requests were typical, but said the department has made no decisions yet on the hearing or waiver requests.
Howe also says he has no problems with a public vetting of MinuteClinics waiver requests. But I think it has to be a fair and evenhanded vetting, he noted. We shouldnt be held to standards other providers arent held to.