Some state regulators are taking a hard look at retail health clinics, which have attracted their share of proponents and detractors.

Massachusetts has proposed new rules governing retail clinics, including a limit on how often a patient could go to one. In addition, according to news reports, California passed a law this year that retail clinics must be owned by physicians, and Florida requires clinics to disclose the medical professional's credentials to patients and post a sign indicating whether a physician is present. Rhode Island has balked at allowing retail clinics in the state at all.

By contrast, though, Texas and Wyoming have loosened some restrictions on treatment by nurse practitioners.

Meanwhile, the clinics keep proliferating, with hundreds of them operating in drugstores and grocery stores across the country through companies like MinuteClinic, RediClinic, Med-Basics, QuickHealth, Take Care Health Systems and Corner Care Clinic.

Nurse practitioners provide routine physicals, vaccinations, pregnancy tests and treatment for common minor illnesses, such as allergies, rashes, insect bites and ear infections. They refer patients to a private-practice doctor or hospital if symptoms suggest a more serious illness. Patients may walk in without an appointment and receive treatment at night and on weekends, when many physician offices are closed.

Some insurers are willing to cover the charges at the clinics. Take Care Health Systems recently signed a national contract with Aetna to become part of the insurer's national network of medical providers.

Action in Massachusetts

In response to an application by CVS to open a MinuteClinic in one of its stores, the Massachusetts Department of Public Health recently proposed regulations that would allow retail clinics to operate under certain restrictions.

Under the proposals, clinics must identify the conditions they treat; see individual patients for no more than a fixed, small number of visits per year; develop clinical pathways that enable nonphysician practitioners to make treatment and triage decisions; maintain rosters of primary care physicians accepting new patients; and provide that roster to patients when necessary.

John Auerbach, Commissioner of the Department of Public Health, comments, "If approved, these proposed regulations will not only help make very basic medical care convenient, they could also expand access to health care to very vulnerable populations."

Secretary of Health and Human Services JudyAnn Bigby, says, "Rather than considering applications that require numerous waivers, we believe we should consider an alternative set of regulations that, if approved, will make the application process for operating limited-service medical clinics transparent to any entity that feels they have a role in their community."

Doctors skeptical

The American Medical Association has voiced concerns about quality of care at the clinics and disrupting the continuity of care for patients, whether insured or uninsured.

It recently called for state and federal officials to investigate potential conflicts of interest posed by joint ventures between store-based clinics and the major pharmacy chains like CVS and Walgreens.

The AMA also expressed concern about retailers expecting clinics to drive additional store traffic, which can increase sales of prescription drugs and products not related to health care.

"There are clear incentives for retailers to participate in the implementation and operation of store-based health clinics," says AMA Board Member Dr. Peter Carmel.

"The nation's physicians want the AMA to ensure these incentives do not compromise the basic obligation of store-based health clinics to provide patients with quality care."

The doctors' organization is against waiving any state or federal regulations for retail clinics that do not comply with existing standards of medical practice facilities.

In addition, the group opposes financial incentives, like waiving copays, for going to retail clinics, saying the "incentives may inappropriately steer patients to these clinics on the basis of cost, rather than quality of care."

Clinics' champions include nurses

Proponents argue that doctors who oppose retail clinics are fiscally motivated and are preventing access to affordable and convenient care.

Defending the standard of care at the clinics, the American Nurses Association says, "nurse practitioners in retail clinics provide convenient and cost-effective health care to an increasing number of Americans who would otherwise delay seeking care."

Ray Brusca, vice president of benefits at Black and Decker, feels the state regulations are unnecessary.

"It's just an attempt from the doctors to prevent money from leaving their practice," he says, noting that physicians and medical associations have more political power than retail clinics do right now.

He believes the quality concerns from medical associations are unfounded. He calls the quality of care at the clinics excellent.

"I would stack that care up against any care I've had from a physician," he remarks.

Black and Decker, a power tool manufacturer based near Baltimore, designed its health plan so that employees pay the same copay when they visit a retail health clinic as when they visit a physician's office, regardless of what the clinic's standard charges are.

Michael Howe, the president of MinuteClinic, says that most state legislators recognize the consumer acceptance of retail clinics and support them.

For treatment protocols, MinuteClinic uses medical guidelines from the American Academy of Family Physicians, American Academy of Pediatrics and the Institute of Clinical Systems Improvement.

"The concern that is raised is not one that's raised from an informed perspective," Howe says.

He rejects the notion that clinics inside pharmacies represent a conflict of interest. "We make it clear to the patients that they have the right to fill the prescription wherever they want to. The idea that we're directing is not true."