2007 Legislative Compendium: Retail Health Clinics

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

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