Over the past two years, retail health clinics have proliferated
across the country. The clinics primarily are based in chain
pharmacy and grocery stores, and are staffed by advanced practice
nurses (APNs) or physician assistants (PAs). Retail health clinics
market themselves as a place for patients to obtain quick, low-cost
care for minor illnesses and injuries.
The concept has proved popular with patients. Organized medicine
and public health officers have raised questions about the quality
and safety of care in these clinics. They also have expressed
concerns that retail health clinics further undermine efforts to
promote patients' use of a medical home.
The overall number of retail health clinics in Texas is still
low but quickly rising. At least two dozen clinics are known to
exist in Texas, with new ones popping up on a regular basis.
Besides their popularity with consumers, health plans and Medicare
support the model by reimbursing for medical services patients
receive at the clinic, in some cases, even lowering or eliminating
copayments for care received.
In 2006, the TMA House of Delegates adopted policy relating to
retail health clinics. TMA did not oppose their development, but
outlined critical patient safety, public health, and
quality-of-care principles that retail health clinics should abide
by, including maintaining existing state laws governing physician
supervision and delegation relating to advance practice nurses and
physician assistants. The TMA policy is similar to policies adopted
by the American Academy of Family Physicians and AMA. TMA, working
collaboratively with county medical and state specialty societies,
met in 2006 with representatives of RediClinics, a Texas-based
clinic operator, to discuss medicine's concerns. We also discussed
how local medical societies and physicians could work with the
clinics to assure safe, effective care.
The most contentious issue about the model is whether the APNs
and PAs staffing the clinics are appropriately supervised by a
physician and practicing within their respective scopes of
practice. Texas has strong physician oversight requirements that
were developed over more than a decade by medicine in collaboration
with nurses and PAs. The agreed-upon requirements work well across
many settings.
These requirements have not impeded development of convenience
clinics (nor has the Texas Medical Board [TMB] received any
complaints about their enforcement). However, there is movement to
free clinics from such patient protections. Two lawmakers filed
bills to weaken physician oversight: Rep. Rob Orr (R-Burleson)
filed House Bill 1096, and Sen. Dan Patrick (R-Houston) filed
Senate Bill 800. As filed, both bills would have increased the
number of APNs or PAs a physician could supervise from three to
six. The bills also would eliminate the requirement that physicians
be on the premise at least 20 percent of the time. The national
Convenient Care Association advocated adoption of the legislation,
as did the Texas Association of Business (TAB); Texas Public Policy
Foundation, a conservative Texas-based think tank; and numerous
health plans and drug store chains.
TMA and the state specialty societies vigorously opposed the
legislation on grounds that the changes would undermine patient
safety and health care quality. SB 800 died quickly and did not
receive a hearing. However, HB 1096 passed the House Public Health
Committee, after the author made some amendments in attempt to
assuage medicine's concerns, and moved onto the House floor, though
it was never debated.
While the bill ultimately died, its support, even among many
friends of medicine, revealed the popularity of the retail health
clinic concept. Medicine's challenge in the future is to articulate
that while retail health clinics provide convenience and
affordability, they must adhere to medicine's high standards for
quality and safety.
During the interim, TMA will track the development of retail
health clinics closely and evaluate regulatory and legislative
initiatives. Additionally, TMA will meet with the corporate
sponsors and partners of retail clinics to encourage their
commitment to quality and patient safety in the services offered in
those retail settings.
Retail Health Clinics TMA Staff Team:
Legislative: Dan Finch
Policy: Helen Kent Davis, Rich Johnson, and Karen Batory
Legal: C.J. Francisco
Overview
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Managed Care/Insurance Reform
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Scope of Practice
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Responsible Ownership
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Corporate Practice of Medicine
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Health Care Funding
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