Health, Safety Should Rule Clinics

By Bruce Auerbach, MD

The debate over retail health clinics in the Commonwealth is a healthy one. From the outset, when MinuteClinics filed its application to set up shop in Weymouth, to last month, when the Department of Public Health correctly recognized that the best way to evaluate this new approach to healthcare was to set new requirements for "limited service clinics" and hold public hearings on them, the pros and cons of retail clinics have been considered. This is transparency in healthcare at its best.

Proponents claim that these clinics are a key part of healthcare reform and will improve access, be convenient and affordable, and provide for continuity of care. Yet there is not sufficient evidence to support these claims.

The company’s initial application was rife with requests for exemptions from state regulations on such critical issues as space requirements, infection control, and handicapped accessibility. These areas are critical to public health and safety. The regulations now under review appear to be nothing more than a conversion of this waiver application into new draft regulations to allow such clinics.

In healthcare, convenience and affordability are not always compatible with public health and patient safety. Many physicians are concerned that retail clinics, as proposed, have few provisions for sanitation and hygiene, storage and disposal of medical waste, and accommodation for the handicapped.

Further, continuity of care is not assured through such clinics. The fragmentation of care, especially for children and those who may have multiple chronic conditions, needs to be thought through carefully.

Staffing patterns are another concern. How many nurses will a supervising physician oversee? With CVS recently announcing its intention to open as many as 60 to 80 such clinics in the first year, what will be the guidelines for physician supervision of nurse practitioners? How many clinics and what geographical areas will a physician be responsible for?

And then there is the the inherent conflict of interest, where patients can obtain medications and prescription drugs from the same profit-making organization engaged in diagnosing and prescribing – something tacitly prohibited for physicians and hospitals. Prescription errors have increased in Massachusetts, and the Food and Drug Administration has reported that it has received 2 1/2 times more reports of serious health problems linked to medications in 2005 than it did in 1998.

As an emergency physician, I believe that the argument that such clinics will improve the capacity of the state’s healthcare system by diverting patients from emergency departments is a hollow one. Emergency departments always focus on genuine emergencies. Any crowding that exists is not related to patients with minor ailments, but rather inadequate inpatient resources to efficiently transfer patients from the emergency department for more extensive services.

Will these clinics lower healthcare costs? While the cost per visit at such a clinic is less than other venues, there is not sufficient data to support the assertion that they are either a replacement for a more expensive visit at a different site of service, or whether the problem was so minor that the costs would have been incurred at all.

The Department of Public Health and its newly reconstituted Public Health Council are wise to proceed cautiously, through a public process, in developing regulations. Limited service clinics can perhaps play a role in enabling access for a small array of minor problems. But many physicians believe their role must be specifically stated and monitored, their integration and collaboration with the existing healthcare delivery system assured, and their participation in facilitating enrollment into our universal healthcare process mandated.

Good health policy dictates that medical clinics be established with health and safety as the top priorities and not because they demonstrate a good "business model." This is not a competitive or "turf" issue for physicians. Above all else, it’s an issue of public health and safety. We must put more value on the practice of medicine and patient safety than to driving traffic into stores and selling prescriptions.

Bruce Auerbach, MD
MMS President-Elect

This op-ed appeared in the Boston Globe on Sept. 18, 2007.

  1. HealthBlawg says:

    Minute Clinics in the news again

    A tip of the hat to Ben Kruskal at Dr. Ben’s Blog for pointing to Mass Medical Society president-elect Bruce Auerbach’s Boston Globe op-ed piece on Minute Clinics and DPH’s response (and to earlier posts of Paul Levy’s, at Running

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