Retail Clinics Branch into Chronic Disease Treatment

Taking It to the States

Physician groups also are fighting back in state legislatures by backing laws to regulate the clinics.

"The objections we've seen have fallen into three buckets," said Caroline Ridgway, policy director of the Convenient Care Association. "One bucket would be clinic operation," such as legislation proposed in Illinois to regulate the size of retail clinics. "In some cases we've seen attempts to mandate that the clinic have its own separate entrance, so that patients would not be allowed to access the clinic via its retail host."

The second "bucket" would be practitioner-related issues, such as laws to restrict the clinics' scope of practice, and the third "bucket" would be what Ridgway called "non-sequitur" issues, such as proposals to bar health facilities from operating in proximity to places like grocery stores where alcohol and tobacco are sold.

One place where the association has worked together with physicians to make it easier for clinics to operate is in Texas, where the state traditionally had very strict laws on physician supervision of nurse practitioners, who provide much of the care that's delivered in retail clinics.

"Each doctor could only supervise three nurse practitioners," explained Katharine Witgert, program manager at the National Academy for State Health Policy. "They had to be on-site 20 percent of the time, and [physically] review 10 percent of the charts."

In 2009, the legislature voted to ease some of those restrictions: physicians can now supervise up to four nurse practitioners; they only have to be on-site 10 percent of the time; and they can conduct chart reviews remotely, Witgert said.

She added that Massachusetts is the only state thus far to have written regulations that specifically address retail clinics. The Massachusetts regulations also require that retail clinics who see patients that don't have a primary care physician try to connect those patients to a primary care provider, she noted.

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