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Tuesday, July 17, 2007

State signals its open to retail medical clinics

By Liz Kowalczyk, Globe Staff

State public health officials are moving to allow medical clinics to open in retail stores, but are delaying a decision on whether to let CVS Corp. open 20 to 30 "MinuteClinics" in the Boston area.

The state announced today that it will propose new regulations by Aug. 8 to permit the operation of "limited scope" medical clinics. But the plan postpones the Department of Public Health's decision about whether to allow CVS to open primary care clinics in its pharmacies, beginning in Weymouth. CVS had hoped to open its first clinics this fall, but the start date could be delayed because the company will have to reapply under the new regulations.

The company indicated in a statement today that it would reapply.

Still, the announcement indicates that Massachusetts health officials are open to allowing retail medical clinics -- and other types of smaller clinics run by community health centers or hospitals -- to help ease emergency room overcrowding, provide better access to basic medical care, and as a convenience to consumers.

"What we believe is that there is enough evidence that the provision of limited clinical services in what might be called non-traditional settings has benefit that is worthy of consideration," said public health commissioner John Auerbach.

Retail medical clinics are taking off nationally, with about 400 in drugstores, discount chains, and supermarkets in other states.

At MinuteClinics in other states, nurse practitioners and physician assistants typically spend about 15 minutes with a patient, treating 20 or so common conditions, such as bladder infections, strep throat, and poison ivy, giving pregnancy tests and vaccines, removing stitches, and writing prescriptions. The clinics usually charge $59 a visit, and CVS officials said they are negotiating with Massachusetts health insurers to cover their members' visits.

The average wait is 20 minutes, company officials said, and MinuteClinics don't require appointments and have evening and weekend hours. Their motto: "You're sick. We're quick!"

In its application, CVS asked the health department to waive some of the state's current requirements for licensing clinics. For example, none of the conditions treated at MinuteClinics require blood tests, so the company does not believe it should have to comply with requirements for blood collection equipment and facilities.

But groups representing doctors, hospitals and community health centers had objected to giving CVS special consideration, and called for a public hearing on the proposal. They also had raised concerns about how patient safety and infection control would be monitored in the clinics. Today, the groups praised the health department for deciding to propose uniform rules that apply to all applicants and to hold a public hearing, probably sometime in the fall.

Auerbach said that, rather than granting numerous waivers to CVS, issuing new regulations would make the requirements clear to any entity that wants to apply to operate a limited-service clinic. For example, he said, a community health center could apply to open a satellite clinic in a homeless shelter.

James Hunt, president of the Massachusetts League of Community Health Centers, said he would encourage members to apply. But he said the organization remains opposed to retail clinics because they "fragment care," encouraging people to get treatment outside their regular doctor's office or health center, which are most familiar with their medical history.

The new regulations could include provisions requiring medical clinics to report a patient's visit quickly to the patient's regular doctor, Auerbach said.

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