Illinois bill says stores can't have both clinics and tobacco

The latest proposal also includes a ban on the sale of alcohol in host stores.

By Pamela Lewis Dolan — Posted March 10, 2008

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The Illinois State Medical Society is pushing a revised bill that would set tougher rules for in-store clinics.

The big difference: Outlets hosting health clinics would be prohibited from selling alcohol or tobacco products, which would prevent many grocery stores, pharmacies or big-box retailers from adding clinics.

ISMS President Rodney Osborn, MD, a Peoria anesthesiologist, said it is incongruent to deliver care in the same location that sells unhealthful products. He said retailers need to decide whether it's worth more to have the clinics, or the tobacco and alcohol sales.

Otherwise, the bill, introduced in the Illinois House on Feb. 14, contains many of the same provisions as a bill that passed a third reading in the Illinois House but didn't make it to the Senate before the end of 2007.

The revised bill would require that physicians be medical directors of no more than two clinic locations; prohibit insurers from reducing co-pays or offering other financial incentives to steer patients to retail clinics; establish scope of practice for nurse practitioners and physician assistants at the clinics; and require clinics to report visits and outcomes to a patient's primary care physician.

Also, clinics would be required to give patients a written notice "stressing the importance of having a personal physician who can provide the full range of health care services."

"Our intent is not to ban retail health clinics," Dr. Osborn said in a statement. "Yet we're concerned that since these clinics deliver only episodic or single-instance care, we must work to ensure patients receive needed follow-up care -- an important medical consideration routinely handled by primary care doctors but not retail clinics."

Provisions in the Illinois bill are similar to rules established by the Massachusetts Dept. of Public Health in January, although the Massachusetts regulations do not include the alcohol and tobacco sales restrictions.

Tine Hansen-Turton, executive director of the Convenient Care Assn., said the trade group for retail clinic operators is reviewing the Illinois legislation. "Anything that deprives people of access to affordable high-quality care is always a concern to us."

According to the National Conference of State Legislatures, Illinois joins four other states that have bills aimed at in-store clinics. Florida is the only state that has enacted law governing clinics. Its law addresses scope of service and supervision.

Dick Cauchi, NCSL health program director, said while retail clinics are on the radar screens of legislators across the country, there have been no patterns in how states are approaching the matter.

Bills pending in North Carolina and New Hampshire would ask the appropriate committees and departments to investigate clinics and propose further legislation. Texas and Oklahoma are weighing bills aimed at scope of service and supervision.

While acknowledging the clinics are controversial, AMA policy adopted in 2006 states the clinics fit long-standing AMA policy that encourages "multiple entry points" into the health care system. The AMA joined the American Academy of Family Physicians in developing attributes for the clinics to ensure continuity of care and safety. In 2007, AMA delegates resolved to ask state and federal regulators to investigate possible conflicts between clinics and hospital systems that are affiliated with them.

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