White Coat Notes

Services to be expanded at Mass. store-based medical clinics

CVS pharmacy is shown in Hialeah Gardens, Fla.
This Nov. 1, 2011 photo, shows a newly opened CVS pharmacy. (AP Photo/Wilfredo Lee) AP

The range of health care services children can receive at store-based medical clinics in Massachusetts was significantly expanded by state regulators Wednesday, a change that will allow toddlers as young as 18 months old to receive immunizations at MinuteClinics.

The expansion, over the objections of many of the state’s medical societies, will allow nurse practitioners at these clinics to perform virtually the same services as their counterparts at other health facilities.

A 2012 state law aimed at controlling health care costs directed the state health department to “promote the availability” of these clinics as a point of access for health care services, a requirement that prompted the latest changes because, the department said, existing regulations conflicted with the statute.

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Under the new rules, children will be able to receive all of their immunizations from in-store clinics. Previously, the clinics were only allowed to dispense flu shots, and were not allowed to treat children under 2 years old.

A number of physician organizations, including the Massachusetts Medical Society and the Massachusetts Chapter of the American Academy of Pediatrics, urged regulators earlier this year to keep the restrictions on clinics for treating children under the age of two. They argued that the changes would fragment health services to families at a time when regulators have been trying to encourage patients to stick with their family physicians so their care can be better coordinated, improving outcomes and, it is hoped, lowering costs.

Medical Society President Dr. Ronald Dunlap said in an interview Wednesday that doctors are particularly concerned that nurse practitioners at these limited services clinics, as they are formally known, do not have the expertise or training to treat very young children. He said the dosing of many medications are quite different for children, and various bacteria behave differently in younger bodies.

“The average nurse practitioner would not have that background unless they worked in pediatrics,” he said.

The medical society is also concerned that the new regulations are unclear about whether the clinics have to specify in their license what types of patients they are staffed to treat.

“If you are posting that you are treating 18-month-old children, you should have someone on the staff who is able to do that,” said William Ryder, the society’s legislative and regulatory counsel.

Members of the Public Health Council, an appointed body of academics and health advocates that sets regulations, raised similar concerns at a meeting Wednesday but ultimately voted unanimously to adopt the service expansion.

Several panel members noted that after they approved the original state regulations in 2008 for in-store clinics, Department of Public Health administrators promised a status report that would examine the quality of care they were delivering and whether they were obeying state rules.

The first clinics opened in 2008, and state records show that 41 clinics—all CVS MinuteClinics—are now operating in Massachusetts, but the Public Health Council has yet to receive a status report.

“It is imperative that we look ... at whether services are being provided by people who have the appropriate licensure,” said panel member Dr. Alan Woodward, a past medical society president.

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