AMA House of Delegates

AMA meeting: Delegates seek more oversight of retail clinics

The AMA house tries to ensure the clinics don't get special treatment from regulators and insurance companies, and don't compromise quality of care.

By Pamela Lewis Dolan — Posted July 16, 2007

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Citing concerns that retail-based clinics may be too much retail and not enough clinic, the AMA House of Delegates at its Annual Meeting last month approved resolutions that call for an investigation into the growing industry.

During testimony before the reference committee addressing medical practice, many AMA members expressed concerns with patients getting prescriptions written and filled under the same retail roof.

"Maybe MinuteClinic should change its name to Nurse Kiosk," quipped Raj Lal, MD, a thoracic surgeon from Oak Brook, Ill., referring to one of the largest retail clinic chains, now owned by Providence, R.I.-based CVS Caremark Corp.

The AMA house adopted policy that calls for state and federal probes into a possible conflict of interest between the clinics and the pharmacies that own or host them. The new policy also opposes the waiving of state and federal regulations for retail clinics that do not comply with standards for medical practice facilities, and opposes the practice of insurers reducing or lowering co-pays to encourage the use of the clinics.

Members expressed concern that insurers and state regulators might be giving the clinics favorable treatment, placing traditional practices at a competitive disadvantage.

A year ago the AMA board acknowledged that retail health clinics were controversial but ultimately decided the clinics fit long-standing AMA policy that encourages "multiple entry points" into the health care system. It also developed guidelines that clinics must follow.

In July 2006 there were approximately 90 clinics across the U.S. Today there are more than 400. As the clinics grow in popularity, some retailers, such as CVS Corp. and Walgreens, have stepped beyond the role of host and bought out entire chains.

Some societies are already entrenched in fights over state governments considering waiving medical practice laws for retail clinics. Three Massachusetts medical societies are asking the Massachusetts Dept. of Public Health to hold public hearings before making a decision on MinuteClinic's request that it waive certain requirements, such as the size of the clinics and sanitation requirements.

The House of Delegates also opposed the practice of insurers lowering or waiving co-pays to encourage use of the clinics, 40% of which accept traditional health plans. Some plans, such as Blue Cross Blue Shield of Minnesota, have already begun waiving co-pays.

No other issue sparked as much discussion at the reference committee meeting. The majority of speakers favored an all-out opposition to retail-based clinics.

"Mayo Clinic, Cleveland Clinic, MinuteClinic? I don't think so," said Robert Goldberg, DO, a physical medicine and rehabilitation specialist from New York, who is also the president of the Medical Society of the State of New York.

Dr. Goldberg said the clinics would be fine if they were owned by doctors, "but they aren't."

Laws vary in each state regarding scope of practice and the role of physician assistants and nurse practitioners, who normally staff retail clinics without a physician on site. As part of its resolution, the AMA also resolved to work with state and specialty societies in developing guidelines and model legislation.

Other testimony dealt with concerns for patient safety and the implied conflict of interest between the clinics and the retailers who own and host them.

"The AMA is concerned that when patients go to retail-based clinics they get the same quality of care that they get in a physician's office," said board Trustee Peter W. Carmel, MD, a pediatric neurosurgeon from Newark, N.J.

When Rebecca Hafner, MD, a family physician from Minneapolis, stepped to the microphone, she admitted being nervous. Then she introduced herself as medical director for strategic alliance for MinuteClinic.

She said the testimony she was hearing was "all based on fear and unsubstantiated evidence."

In a prepared response to the AMA's action, MinuteClinic CEO Michael Howe said, "MinuteClinic follows nationally accepted, physician-developed treatment guidelines that ensure prescriptions are only issued when evidence-based testing demonstrates a need and where clinically appropriate."

Dr. Hafner said less than 50% of patients receive a prescription at all.

"Convenient care clinics have proliferated in retail settings throughout the country due to a widespread lack of access to high-quality, affordable health care in America," said Tine Hansen-Turton, executive director of the Convenient Care Assn., a trade group for the retail-based clinic industry, in a prepared statement.

"We are surprised that the AMA would take the position that it has, because so many physicians and other health care professionals have accepted this new model and see it as part of the solution to our broken health care system," she said.

Despite the overwhelming feelings against the clinics, the AMA board stopped short of calling for complete opposition.

Rochester, N.Y., orthopedic surgeon William A. Dolan, MD, reference committee chair and a newly elected AMA trustee, said despite the dislike of retail clinics, "We have to treat them legally." He said a call for an all-out ban could result in an antitrust judgment similar to one by chiropractors in the 1980s when the AMA attempted a boycott of chiropractic services.

"I think it would be naïve to think that [fear of litigation] wasn't a factor," Dr. Carmel said.

Back to top


Meeting Notes: Medical practice

Issue: Insurers have implemented policies to fine physicians when patients chose to use out-of-network services.
Proposed action: "Vehemently oppose" any penalties insurance companies use against doctors when patients independently use out-of-network services. [Adopted]

Issue: The time psychiatric patients spend in emergency departments is steadily increasing, exacerbating ED crowding issues.
Proposed action: Work with other stakeholders to study the issue and develop recommendations regarding the national scope of the psychiatric bed shortage problem and its impact on the nation's emergency and general medicine resources, including ED overcrowding. [Adopted]

Issue: As more physicians move toward adoption of health information technology, they find the buying decision challenging because so many options are available.
Proposed action: Use the AMA Web site and Association publications to educate physicians about issues to consider when purchasing health information technology systems, including ensuring that there is adequate technical support. [Adopted]

Issue: Health care spending continues to rise more quickly than wages and inflation.
Proposed action: A host of strategies, including reducing preventable disease, improving efficiencies in health care delivery, reducing nonclinical costs that do not add to the value of patient care and improving health-related decision-making processes. [Adopted]

Back to top

Quick growth in quick care

The number of retail-based clinics increased by almost 350% over the past year. Studies show there could be consumer demand for as many as 5,000 clinics over the next five years.

July 2006 90
December 2006 255
July 2007 400
December 2007 700
December 2008 1,500
2010 2,500

Note: Values for December 2007 and beyond are projected.

Source: Mary Kate Scott, for the California Healthcare Foundation

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn