Doctors, retailers square off

AMA to seek probe of in-store clinics

By Bruce Japsen
Tribune staff reporter
chicago tribune

In an attempt to ratchet up scrutiny on the proliferation of in-store clinics being opened by retail giants, the American Medical Association said Monday that it will ask state and federal agencies to launch widespread investigations into the fast-growing patient-care model.

The AMA’s policymaking House of Delegates, meeting in Chicago, said lack of regulation at retail clinics might be fostering liability concerns, health risks and potential conflicts of interest between the clinics’ nurse practitioners who order prescriptions and the pharmacies that fill them. Often, the clinic is near the pharmacy counter in those retail stores.

The AMA, the nation’s largest doctor group, is reacting to moves by retailers such as Wal-Mart Stores Inc. and Deerfield-based Walgreen Co. that will effectively bring several thousand retail clinics to U.S. consumers in the coming years. One retail clinic operator run by giant CVS/Caremark Corp. was concerned enough about the AMA’s clout on the issue that it deployed an executive here to defend its interests.

AMA action on such topics means the group and its affiliated state societies will push for increased regulation and attempt to slow the growth of the clinics. One clinic operator said Monday the AMA’s move would do just that and have an adverse effect by slowing a new concept that increases patient access to medical care and offers patients a convenient option.

“Our primary focus is patient safety and patient care, and the retail clinics have a different mission of selling products and prescriptions,” said Dr. Rodney Osborn, a Peoria anesthesiologist who is president of the Illinois State Medical Society, an AMA delegation among the most outspoken on scrutiny of retail clinics. “We want these clinics to be accountable.”

Even before the AMA’s commitment to advocate for increased regulation, several state medical societies have been using their clout to push for new laws where retail clinics first popped up. In California, for example, store-based clinics are required to be a part of a medical corporation owned by a physician as part of regulations that doctors say have curtailed the spread of retail clinics there.

But retail clinic operators said Monday that the AMA’s move is more of a protectionist measure to put the interests of physicians ahead of patients.

By following the AMA’s lead, “medical societies would actually be taking actions that would decrease access to care by putting more regulatory hurdles and burdens on the [retail] facilities,” said Dr. Rebecca Hafner, an AMA member and medical director of strategic alliances for MinuteClinic, a subsidiary of CVS/Caremark, which operates nearly 200 retail clinics, including about a half-dozen in the Chicago suburbs. “The net result of this is that it will make it harder for companies to open clinics.”

Most clinics are open seven days a week with no appointment needed. They treat patients with routine maladies and are under physicians’ supervision, though doctors usually are not on site. Most clinics are for ailments such as ear and sinus infections, strep throat and athlete’s foot.

“If the AMA is going to push this agenda, they may find that legislators and their constituents have been demanding accessible and affordable health care for years,” said Walgreens spokesman Michael Polzin. “And that is exactly what retailers are delivering as a supplement to the primary care physician. As they push back against retail clinics, it would result in higher health-care costs and prevent some patients from receiving care that they are receiving.”

For those without health insurance, the retailers often charge less than $60. That is significantly less than the $100 or more a doctor would charge for an office visit, analysts and insurers say. Out-of-pocket costs for those with health insurance coverage have tended to be the same $20 co-pay at a retail clinic as at a doctor’s office, retailers have said.

But doctors say the health insurers have recently created an “unfair playing field” by waiving patients’ co-payments at retail health clinics. Doctors say that is designed to get patients to bypass a more comprehensive visit to the doctor’s office.

Supporters of retail clinics say such complaints about insurance coverage show the AMA’s interest in the issue is largely financial.

“It’s going to affect their bank account, that is why they oppose retail clinics,” said Edie Brous, a nurse and lawyer from New York who represents nurses on license issues. “The real reason physicians oppose retail clinics has nothing to do with patient safety or quality care. Rather, it is pure profit-driven, anti-competition greed.”

Retail health clinics say they and the nurse practitioners who staff them know their limits and have increasingly been establishing referral relationships with hospitals.

In addition, most retailers such as Walgreens do not treat patients under 18 months old. But pediatric groups testified before the AMA earlier in the week that retailers still might be treating patients that are too young.

The AMA actually backed down from attempts by some doctors to have the national doctor group push an outright ban of retail health clinics or take a stand that would push for age limits on whom retailers could treat.

One AMA leader said pediatric care is too complex for nurse practitioners and thinks retailers should increase the age limit to three years or even older.

“Children are unable to communicate their symptoms appropriately,'” Dr. Stuart Cohen, a San Diego physician and AMA delegate representing the American Academy of Pediatrics. “Children can complain of a sore throat, and it could be chronic allergies and hay fever.”

The retail clinic operators called such testimony, much of it made Sunday as part of a committee gathering information for Monday’s vote, “unsubstantiated allegations,” said MinuteClinic’s Hafner.

MinuteClinic said its studies show patients are “99 percent satisfied” with the care provided.

Hafner also said MinuteClinics has not been hit with the medical malpractice suits doctors so often complain about.
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