Will Retail Clinics Be a Key Player in Post-Health Reform World?

Cheryl Clark, for HealthLeaders Media , April 8, 2010

Sutter launched its Express Care three years ago in six locations, says program director Pete Dzwilewski. It closed three of the clinics that weren't doing well, but for the other three, "there's been year-on-year growth" with each clinic seeing about 20 patients per day.

Clinic providers, usually nurse practitioners and physician's assistants, are employed by Sutter, not Rite Aid.

And they are supervised by Sutter physicians. Patients' symptoms, diagnoses, recommended care, and prescriptions written are all logged into an electronic medical record or transmitted by mail to the patient's non-Sutter provider, Dzwilewski says.

Without those guarantees, the CMA warns patients against getting care at such clinics, which are not likely to build much of a base in California because of two laws that discourage the practice, Corcoran says.

The first is the state's bar against the corporate practice of medicine, which prohibits any company—profit or nonprofit—from directly hiring a physician. The only way to get around that would be for a grocery store or drug store to lease space to a physician, who then would hire the providers who actually see the patients.

But under the second California law, physicians are precluded from supervising more than four nurse practitioners or physician's assistants, a rule that doesn't exist in states where retail clinics are prevalent. In those states, physicians may employ and supervise dozens of retail clinic providers.

"There is no stretch one can make to say this is good medicine or good delivery of care," Corcoran says. "The answer, frankly, is that it's neither."

Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, however, sees a middle ground.

"I think you have to expand primary care in just this way," he says. "We don't have nearly enough primary care out there and efforts to place it in retail clinics, while making good business sense, make good public health sense."

But, he adds, "what we need is clear ethical standards to govern these new types of clinics" that is without clinic providers pushing patients to buy certain products or more products than they need.

"And there should be constant reminders to the patients and providers to follow up with and keep the doctor informed" on their care, he says.

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