MinuteClinic seeks waivers of Massachusetts public health rules

Three medical associations and two other health care organizations in Massachusetts have asked the state's Dept. of Public Health to exercise careful consideration and hold a public hearing before waiving certain clinic requirements in favor of MinuteClinic, the Minneapolis-based operator of retail-based health clinics.

MinuteClinic asked the state for exemptions from several requirements, such as providing receptacles for soiled linens and having examination rooms of a certain size, in preparation for its plans to open clinics in Boston-area CVS pharmacies.

The Massachusetts Medical Society, the Massachusetts Academy of Family Physicians, the Massachusetts Chapter of American Academy of Pediatrics, the Massachusetts Hospital Assn. and the Massachusetts League of Community Health Centers obtained copies of the requests and sent a letter to the state's public health commissioner asking for a review.

"There should not be one set of rules in place for physician practices and a separate set of rules for these commercial ventures," said Dale Magee, MD, a Shrewsbury, Mass., ob-gyn and president of the Massachusetts Medical Society. "If we're going to take care of the same patients, we should have the same standards."

In 18 pages of waiver request forms, MinuteClinic asked for exemptions from administrative and sanitation requirements that the company feels don't apply to the retail model.

For example, state regulations say exam rooms must be 80 square feet, but MinuteClinic's are only 54 "because of the limited scope of services" provided, according to one request. Another regulation calls for a workroom area for soiled items, but MinuteClinic wrote it "generates no soiled linens."

In their letter, the five organizations said the state "should not allow an express waiver of certain clinic requirements without a public hearing and review by the Public Health Council ... [g]ranting waivers of basic public health protections and standards of care to a for-profit company in order to reduce the economic burden to that company in competing with other health care providers is a public policy decision that is unfair to providers who are struggling to meet a great set of current regulatory and licensure requirements."

Providence, R.I.-based CVS Caremark Corp., of which MinuteClinic is a subsidiary, released a statement that said MinuteClinic follows nationally established clinical practice guidelines from the American Academy of Family Physicians and the American Academy of Pediatrics.

"Our experience is primary care practitioners who learn more about the model really embrace the concept," said CVS spokeswoman Carolyn Castel. "We believe that as the MinuteClinic model is understood more fully, that MinuteClinic will become a reality in Massachusetts."

CVS operates 190 MinuteClinics in 20 states.

The organizations' letter also expressed general concerns about retail-based health clinics and asked the public health department to "ensure that if they have a full clinic license they will have the capacity to respond to the needs of all walk-in patients from the community and not just those that generate low risk and complexity visits."

Dr. Magee said that although he likes the idea of a convenience clinic, he is troubled by the clinic/pharmacy connection.

"There is a conflict of interest for pharmacies vending medical services on their sites," he said.

The AMA House of Delegates last year passed policy stating that retail clinics are consistent with the organization's belief there should be multiple entry points for patients into the health care system, although it acknowledges they are controversial among physicians. The AMA, as well as national family physician, pediatric and internist organizations, has offered standards for how retail clinics should interact with physicians to ensure quality, safety and continuity of care. The Convenient Care Assn. adopted its own set of standards in March, though the clinics say all of these standards reflect what they are doing.

But resolutions were introduced for this year's AMA Annual Meeting that ask delegates to take a harder stance against retail clinics. Results of that discussion will be covered in next week's AMNews.