The most tangible outcomes of a volatile three-year medical-political struggle in Massachusetts appear to be that you can now get your rash examined in a CVS pharmacy, but you can't buy cigarettes while you're there—at least not at a Boston CVS.
When MinuteClinic, a CVS subsidiary, announced its plans to open facilities in Massachusetts and seek waivers from regulations that traditional healthcare institutions must follow, the controversy erupted immediately as organized medicine came at them with its guns blazing.
On March 30, 2008, the state Public Health Department put new guidelines in place for “limited-service clinics” and MinuteClinic would eventually receive 21 licenses for such facilities with the first opening in the town of Medway on Sept. 17, 2008.
In all, there are some 500 MinuteClinics in 25 states, with 17 open in Massachusetts. The company plans to open at least 18 more in the near future, but none so far are planned for Boston where Mayor Thomas Menino and others have virulently opposed them arguing that they would have a negative impact on the city's network of community health centers.
“The problem with the market-based system for healthcare is that you can't keep dividing off the parts that can make you money and leave the rest of it,” says Bill Walczak, CEO of the Codman Square Health Center in Boston's Dorchester neighborhood. “You can create the usual incentives and disincentives but, clearly, what we don't have is a system designed to keep people healthy. And, obviously, a pharmacy operating as a clinic that diagnoses only eight different sicknesses is extremely fragmenting and damaging to the safety net.”
On the other hand, as the state serves as the nation's laboratory for universal health insurance coverage, Massachusetts has learned that coverage doesn't necessarily equate to access. This point was recently hammered home by a survey conducted by the Merritt Hawkins & Associates healthcare search and consulting firm, which found that Boston had some of the longest wait times to see a physician.
In a telephone survey of 1,162 medical offices conducted between September 2008 and March 2009 covering five specialties—cardiology, dermatology, family practice, OB/GYN and orthopedic surgery—in 15 metro areas, Merritt Hawkins found the average wait time in Boston to be 49.6 days. The next-highest area was Philadelphia, where the average wait was 27 days.
To see a family practice physician, a patient in Boston needed to be patient. The wait is 63 days. The next-longest wait is the 59 days it takes to see a family doctor in Los Angeles. According to Merritt Hawkins, you only have to wait a week to see a family practice physician in Miami.
“There was a need for and a demand for these types of services and this type of care,” says Chip Phillips, president of MinuteClinic. “Generally, I would say the clinics in Massachusetts have performed well and the traffic ramped up quickly.”
When MinuteClinic first sought to open in Massachusetts, it requested waivers for state regulations that require an area for soiled linen storage, separate entrances for patients, minimum exam-room space, patient bathrooms with handwashing stations, and a separate reception desk.
When the Massachusetts Medical Society got wind of this one might say the soiled linen hit the fan.
“They did not feel like they had to comply with the regulations that have been in place forever because it wouldn't fit into their business model,” says Bruce Auerbach, M.D. the immediate past president of the Massachusetts Medical Society and vice president and chief for emergency services at 128-bed Sturdy Memorial Hospital in Attleboro. “The position of the medical community was that it was not appropriate to waive the rules that had been put in place to ensure handicapped access, infection control and patient privacy to conform to the business model of a profit-making enterprise. We made the case that the existing regulations should not be waived, and—if they wanted to exist as a licensed clinic in Massachusetts—they had to follow what all the entities need to follow.”