Retail clinics attracting legislator interest

In a year in which much growth is expected in the retail health clinic industry, interest at the legislative level is perking up as well.

According to Dick Cauchi, health program director for the National Conference of State Legislatures, interest in the clinics has been rising on a legislative level due to the dramatic increase in the number of clinics -- currently near 1,200, up from 350 in 2006.

Florida in 2006 limited practicing physicians to supervising no more than one clinic and four nurse practitioners and physician assistants. New Hampshire passed a bill in 2008 that established a commission to investigate the clinics. And while Massachusetts took no legislative action, its Dept. of Health last year implemented new regulations that included what conditions the clinics could treat and what age groups could be treated, and set guidelines for the sale of tobacco products at stores attached to such facilities.

Though most legislation has failed to pass, observers say with each new bill retail clinics get more attention -- and more alliances are struck between organized medicine and others in hopes of getting future bills passed. Cauchi said past failures may result in a change of strategy for newcomers.

In Indiana, for example, a bill regulating retail clinics -- including a provision that the clinics have an entrance separate from that of the retail operation -- failed to make it out of committee.

Yet, Richard Feldman, MD, past president of the Indiana Academy of Family Physicians and chair of the academy's Commission on Legislation and Governmental Affairs, said he thought the IAFP was taking a novel approach by forging a relationship with the Coalition of Advanced Practice Nurses of Indiana to draft the proposed legislation. The Indiana State Medical Assn. also collaborated on the drafting of the bill.

Dr. Feldman said he felt the collaboration with the nurse practitioners, who generally staff retail clinics, would be the key to the bill's success. But he noted there was "very little sympathy for the issue" in the Indiana Legislature this year.

The bill's author, state Sen. Patricia Miller, RN, said she plans to reintroduce another version next year, and she plans to involve all groups again.

The NCSL held an educational session last year for legislators interested in learning about the retail clinic growth and state legislative efforts that were successful. The interest in that session prompted the group to launch a Web site devoted to legislative activities surrounding retail clinics and scope of practice laws (link).