Questions over in-store clinics
State health officials see pitfalls in CVS plan
State health regulators expressed deep concern yesterday about proposals to open medical clinics in retail stores, fearing that patient care could be compromised.
During a briefing, Public Health Council members said they are worried that patients who go to retail clinics instead of their doctors for minor illnesses would not receive the consistent medical treatment that is associated with the best health outcomes.
"The fragmentation of care and quality concerns me," said member Lucilia Prates Ramos, director of the Massachusetts Medicare & Medicaid Outreach & Education Program. "I find this worrisome."
The regulations would allow public health officials to tightly limit the type of care that the clinics provide and the number of times patients visit the clinics annually.
CVS has argued that retail clinics would help ease pressure on crowded emergency rooms and provide quick access for patients with minor problems, such as the flu and poison ivy, who cannot get in to see a primary care doctor. At MinuteClinics in other states, nurse practitioners and physician assistants typically spend about 15 minutes with a patient, treating 20 or so common conditions.
Officials in Florida and Arizona have spoken favorably about their experiences with retail store clinics there, but Paul Dreyer, director of the Massachusetts Division of Health Care Quality, told council members that information is largely anecdotal.
Public Health Council member Philip C. Nasca, a University of Massachusetts epidemiologist, said that if clinics are allowed in Massachusetts, the Health Department must collect information on the quality of treatment that patients receive.
"There's obviously a paucity of data here," he said.
The council also expressed fear that some patients might use the clinics as a way to get prescriptions their regular physician isn't willing to write. Council member Albert Sherman, a vice chancellor at the UMass Medical Center in Worcester, said he was especially concerned that drug abusers might use the clinics as a way to feed their habits.
Dreyer discounted that possibility.
"We don't anticipate that limited-service clinics will be prescribing drugs of interest to drug abusers," Dreyer said.
But groups representing doctors, hospitals, and community health centers in Massachusetts have raised concerns about how patient safety and infection control would be monitored in the clinics.
The Health Department plans to hold a public hearing on the issue Sept. 5.
CVS officials, who promised to continue to work with the Health Department, said a telephone survey of 504 Massachusetts residents last month indicated the need for retail clinics. According to CVS, three in 10 survey respondents said that they had gone to the emergency room because they or a family member could not get an immediate appointment when they were sick with a common illness. About 69 percent of those surveyed said that having a retail clinic open in their neighborhood would give their family better access to quality health care.
"MinuteClinic can serve a critical health care need by providing convenient, affordable access to quality health care for common medical conditions," MinuteClinic president Michael Howe said by e-mail. "As Massachusetts expands access to health insurance to hundreds of thousands of people, we know that demand for basic health care services will increase."
The 15-member council, appointed by Governor Deval Patrick, is expected to vote on the regulations in the fall.
"If the council came back and said we don't want this model, then we would not issue licenses to these sorts of facilities," said state Public Heath Commissioner John Auerbach. "My read is they're open-minded, but they have a lot of concerns they would like to see addressed in the process before they vote."
