The growing trend of healthcare retail services, in which patient care services are offered by non-physician healthcare professionals or in nontraditional settings for a profit, has drawn increasing concern in the medical community.
The spread of such services pose potential safety hazards to patients, according to a recent report on the American Academy of Family Physicians' 2014 State Legislative Conference. Key concerns addressed during the conference are shown below.
1. Lack of medical professional oversight. North Carolina AFP executive vice president Greg Griggs, MPA, CAE, said retail clinics in his state have risen rapidly in the last few years. At the time the first Minute Clinic in North Carolina opened in Raleigh in 2005 (purchased by CVS in 2006), company representatives said the clinics would be staffed by nurse practitioners and physician assistants and that a physician located within one hour's distance from the clinic would serve as medical director. However, North Carolina AFP and the North Carolina Medical Society later learned that the organization's first medical director was licensed to practice in North Carolina but actually lived in Las Vegas, according to the report.
2. Lack of care coordination. Another issue associated with the Minute Clinics in North Carolina was that the company said clinics would send patients' medical records to their PCPs, but these were rarely sent. When records were sent to PCPs, transmission was usually done by fax, according to the article. The lack of communication with PCPs and overall lack of coordination created by these retail clinics can lead to the continued fragmentation of care.
3. Retail clinics are not suited for population health management. According to the report, the geographic regions of North Carolina in which clinics were installed also generated concern among the medical community. Instead of opening sites in areas with reduced access to care, CVS chose to place its 58 clinics in primarily urban areas where incomes are higher.
"This is a business model, not a healthcare model," Mr. Griggs said. "I don't think the 'retailization' in healthcare will go away. There's too much opportunity."
4. Pharmacists delivering screening and treatment. According to the report, pharmacists in some states are providing care previously reserved for nurses and physicians, including administering patient screening tests, making diagnoses and providing treatment, and they're doing this without physician supervision.
An example of such practices is the nine-month pilot project called rapid diagnostic testing that funded health screenings offered by pharmacists in Michigan, Minnesota and Nebraska. The pilot, supported by the University of Nebraska Medical Center College of Pharmacy and Michigan's Ferris State University, includes a 20-hour certification course in rapid diagnostic testing for pharmacists, offered by the Michigan Pharmacy Association. According to the report, in pharmacies that offered the RDT during the pilot session, physician supervision was minimal, with one physician overseeing 27 pharmacies participating in Michigan, for example.
5. Freestanding emergency clinics have fewer regulations than hospital-based EDs. Freestanding emergency clinics have proliferated across Colorado because of a loophole in state law that allows independent, freestanding EDs to operate according to different rules than those imposed on hospital-based EDs.
The law allows for these freestanding clinics to increase access to care in the state's rural corners and to make emergency services available at ski resorts. As for-profit institutions, they are defined as community clinics but have no affiliation to hospitals and are not required to comply with hospital standard procedures, such as accepting all patients or stabilizing them before a transfer to another health center. They can also slap much higher price tags to the services they offer because the clinics do not negotiate rates with insurance companies.