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How Not To Restrict Retail Clinics

Posted Aug 24 2008 1:54pm
Illinois' House Bill 5372 is a much more enlightened approach to quality health care than Massachussetts caving in to the pecuniary interests of a small group of entrepreneurs and pandering to the consumers' need for immediacy in their interactions with the health care system, no matter what damage results .

However, it is a fantastic example of how not to produce a sensible solution.

The FTC has been invited to comment and its first salvo is pretty negative, as reported here (sub req) and here .

We already know that the FTC believes that retail clinics have the potential of "making basic health care more accessible and affordable." This is the worst piece of hocum perpetrated on the American people since the war on terror.

The Illinois Medical Society, whose advocacy informed the bill, clearly took every possible step to restrict retail clinics (taken from their press release ):

  • The facility must have a referral system to physician practices or other health care entities appropriate to the patient's symptoms outside the limited scope of services provided by the facility.

  • The facility shall provide notification of any patient visits and outcomes to the patient's designated physician.

  • The facility shall establish appropriate sanitation and hygienic protocols. The facility shall have a designated receptionist and waiting area.

  • At the conclusion of each visit, patients shall be given a written notice stressing the importance of having a personal physician who can provide the full range of health care services. Patients shall be notified in writing of their opportunity to purchase medications from any provider whenever they receive a prescription at a clinic.

  • Illinois health care services provided must be in accordance with a limited scope of services as determined by the facilities' medical director and approved by the Department of Public Health.

  • No health care services may be provided unless a physician licensed to practice medicine in all its branches, an advanced practice nurse (APN), or a physician assistant (PA) is on the premises at the time the services are provided.

  • The facility must have a medical director who is a physician licensed to practice medicine in all its branches with active medical staff privileges to admit patients to a local licensed hospital. Collaboration of APNs or supervision of PAs shall not be construed to necessarily require the presence of a collaborating or supervising physician as long as methods of communication are available for consultation with the physician in person or by telecommunications in accordance with written protocols.

  • The facility shall maintain medical records for all patients for the period required of a licensed hospital under the Hospital Licensing Act.

  • All personnel shall wear on his or her person a clearly visible identification indicating his or her professional licensure status while acting in the course of his or her duties.

  • The facility shall operate under written protocols approved by the medical director and the APNs or the PAs providing services at the facility.

  • Payers shall not be allowed to waive or lower co-payments or offer financial incentives for visits to retail-based clinics in lieu of visits to primary care physicians’ offices.

  • Individual stores wherein these clinics exist will be prohibited from selling tobacco and alcohol products.

Everything is perfect until the last two clauses. The latter is clearly designed to expose the profit motives of pharmacy chains who speak with forked tongue: on one hand promote improved access to health care but on the other sell products deleterious to the health of the people whom they purport to serve. The former is pure protectionism.

There are also clauses that restrict advertising fee comparisons by retail clinics, that a medical director can oversee no more than two retail clinics, a required receptionist and separate waiting area as well as an exemption for hospital or physician-owned retail clinics. In fact, higher copays for retail clinics would really make a lot of sense: if you want convenience you should have to pay for it.

So it's OK for us, but not for other people?

Every action provokes a counter-action. Did Illinois physicians think that there would not be objections to some of these clauses? To restrict advertising is simply wrong. There is no rationale for a medical director supervising the implementation of policies at more than one clinic. The need for a receptionist and waiting area does not level the playing field as much as prohibit a field of economic activity that relies on low overhead. The exemption... well, the US is the place I would expect such a two-faced clause to be challenged and ripped apart by adherence to simple constitutional principles. The exemption alone does more damage to the credibility of the bill, its sponsors and its advocates than any hard-nosed competitor could wreak.

This bill seems to be intentioned to provoke the reactions of external stakeholders. It appears to be the product of a purely confrontational approach to protecting one's turf, rather than a collaborative approach to promoting the health of the population.

Like it or not, external stakeholders have a lot to say about how we run our business. Removing the most restrictive clauses would let the rest of the bill stand on its own and make sure the correct message gets out: retail clinics add absolutely no value to the health system if the care delivered there is provided without the context of continuing primary care.

Market forces must decide the ultimate fate of retail clinics, maybe then, the FTC would revisit their assumptions about how the health care market actually works.
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