Illinois bill proposes stricter requirements for retail clinics

The state medical society says the regulations are needed for patient safety, but the clinic industry says it already has appropriate guidelines in place.

By Doug Trapp — Posted March 26, 2007

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A new bill in Illinois would require retail health clinics to have more physician supervision and limited advertising.

The Retail Health Care Facility Permit Act would allow doctors to supervise no more than two advance practice nurses. Right now the state has no limits, said Illinois State Medical Society spokeswoman Laurie Peacock.

Peter Eupierre, MD, the society's president, said the bill is focused on preventing harm. "Medicine is not something that you can practice through a drive-in kind of approach," said Dr. Eupierre, an internist in Melrose Park, near Chicago.

Take Care Health Systems, which operates 13 Illinois clinics in Chicago-area Walgreens, says the legislation goes too far.

The firm allows one physician to supervise four or five nurse practitioners, said company spokeswoman Lauren Tierney. Doctors must be available by phone at all times nurse practitioners are working.

The company's physicians review at least 10% of patient records, which are 100% electronic. Up to 20% of its Chicago-area patients have been referred to a primary care physician or specialist for follow-up care, said Take Care's chair, Hal Rosenbluth.

The firm complies with in-store clinic guidelines outlined by the American Academy of Family Physicians and the American Medical Association, Tierney said.

The AMA principles call for clinics to use a well-defined, limited scope of clinical services and a referral system to ensure continuity of care with doctors in the community. Patients should be informed of the staff's qualifications, the clinic's treatment limitations and where follow-up treatment is obtainable. The AAFP has similar guidelines. Both call for using electronic medical records compatible with physicians' offices.

The bill wouldn't force the company to close locations but would add cost and bureaucracy to its system, Tierney said.

Dr. Eupierre said he understands the burdens regulations pose to the clinics. But in this case, rules are necessary to ensure care is delivered properly, he added.

The measure would prohibit retail clinics from running ads comparing their prices with those of other medical professionals. Dr. Eupierre said that provision is needed because an exam by a nurse practitioner can't be equated with one by a doctor.

In general, there has not been a movement toward more retail clinic regulation, said MinuteClinic President and CEO Michael Howe. States have typically been looking at retail clinics as a way to relieve overcrowded emergency departments of the routine care they deliver, Howe said.

For example, Pennsylvania Gov. Ed Rendell unveiled a universal health reform plan in February calling for allied health professionals to practice to the fullest extent of their training.

At least 300 retail health clinics operate nationwide. By year's end, that number might grow to 600 to 700, said Tine Hansen-Turton, executive director of the Convenient Care Assn., a group representing retail clinics. Take Care clinics have seen more than 100,000 patients nationally since they began operating in November 2005.

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Regulating retail clinics

The Retail Health Care Facility Permit Act, backed by the Illinois State Medical Society, would require all retail clinics in the state to:

  • Have medical directors who can admit patients to a local hospital.
  • Limit collaborative agreements to no more than two advanced-practice nurses per physician.
  • Avoid using testimonials or "claims of superior quality of care" and avoid making fee comparisons to other licensed health care professionals.
  • Obtain annual facility permits from and submit to inspections by the Illinois Dept. of Public Health. Each facility would have to maintain certain medical records and sanitation standards.

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