Quality must come first in retail health clinics

As these facilities emerge, organized medicine is working to ensure that patients are protected.

Posted July 23, 2007.

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As the number of store-based health clinics skyrockets, physicians are taking steps to make sure patients aren't sacrificing care for convenience. After all, it is becoming increasingly clear that retail clinics should play by the same rules as everyone else -- with no favoritism by regulators or health plans -- to ensure that patients receive high quality treatment .

Consider the numbers: In 2006, according to a report by the American Medical Association's Council on Medical Service, about 200 store-based health clinics were in business nationwide. Projections indicate that as many as 1,000 more could open by this year's end.

This market response is partly attributed to consumers who value convenience. Forrester Research, according to the council's report, published a survey of 11,000 households in January finding that only about 3% of respondents had visited a retail-based clinic. But those who did were younger, more affluent and more likely to have children than were non-visitors. The top reasons they cited were the convenient hours and location, as well as long wait times for appointments with their physicians. Only 9% made the choice because other health care options were more costly.

As the appeal of retail clinics takes off, so do the questions about how to ensure they comport with medicine's central dictum, "First, do no harm." And a key concern surrounds their impact on physician practices -- specifically, their potential to interrupt the physician-patient relationship and to undermine coordination of care.

Clearly, the American Medical Association is right to continue its efforts to protect the interests of patients and physicians. AMA delegates recently added imperative to the organization's attention to guiding these clinics' evolution.

At the Association's June meeting, its physician delegates took the important action of calling for investigations into conflicts of interest posed by joint ventures between store-based health clinics and pharmacy chains, as well as into patients' welfare and professional liability concerns.

In addition, the organization will continue to work with state and specialty medical societies to develop model regulatory legislation and oppose any waivers that exempt these clinics from existing standards for medical practice facilities. Meanwhile, the AMA's Advocacy Resource Center will continue tracking such developments at the state level. Several states have either passed or are now considering legislation that would impact in-store clinics.

Legal activity is also in the mix. For instance, three Massachusetts medical societies are trying to block a waiver of medical practice laws for such clinics.

Clearly, the time for stepped-up attention is now, while these facilities are still in their infancy.

Last year, the AMA adopted nine specific principles, beginning with the requirement that store-based health clinics have a well-defined and limited scope of clinical services, consistent with related state laws.

The framework also, among other things, stipulated that these clinics should use standardized medical protocols derived from evidence-based practice guidelines and encourage patients to establish relationships with a primary care physician. Clinics should have clear arrangements by which their practitioners have direct access to and supervision by physicians. They also should have in place protocols to facilitate ongoing care, as well as a referral system to guarantee appropriate treatment if the patient's condition is beyond the clinic's scope.

At this year's meeting, delegates added an important principle regarding health insurers' co-payment policies. In some circumstances, insurers are waiving or lowering co-payments only for patients who receive services at store-based clinics.

Physicians are concerned that such incentives may steer patients to these clinics on the basis of cost, rather than quality.

Bottom line: Life is busy, and convenience, even when it comes to health care, can be a motivator. But quality and continuity of care should not be allowed to fall victim to this market force.

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