The American Medical Association (AMA) wants retail health clinics to be investigated for possible conflict of interest.
Retail health clinics, also called store-based health clinics, are walk-in health centres inside large supermarkets, pharmacies and stores such as Wal-Mart, CVS, Walgreen and Rite Aid. You can see a nurse practitioner or physician assistant who can carry out basic procedures such as give injections and write prescriptions for minor illnesses. And they charge less than a doctor’s practice.
The retail health clinic staff are supervised by a physician who does not have to be on site.
The potential conflict of interest arises because the clinic is not wholly independent of the store which sells the drugs the prescriptions are made out for.
Retail clinics, of which there were more than 200 in the US in 2006 and there are plans to build another 1,000 by the end of this year, are joint ventures between the retail store and a pharmacy chain.
The AMA said that its call for an investigation was prompted by stores saying that retail clinics boost sales of prescription drugs and other products not related to health and “help drive additional store traffic”.
AMA Board member Dr Peter Carmel said that:
“There are clear incentives for retailers to participate in the implementation and operation of store-based health clinics.”
“The nation’s physicians want the AMA to ensure these incentives do not compromise the basic obligation of store-based health clinics to provide patients with quality care,” he added.
Delegates at the AMA Annual meeting voted for the AMA to ask federal and state agencies to investigate joint ventures between retailers and pharmacy chains, and look especially at conflicts of interest that affect the welfare and health risks of patients as well as professional liability.
The AMA says retail clinics undermine and disrupt the relationship between patients and their doctors, and make it much harder to decide who is responsible when things go wrong.
The AMA also wants to press ahead with developing guidelines for legislation to control the operation of retail clinics, together with state and other medical societies, and it opposes waiving of state or federal regulations for retail clinics that do not follow existing standards of medical practice.
Dr Carmel also mentioned that health insurers are allowing retail clinics to waive or lower patient co-payments while forcing doctors to collect the fees. This financial incentive might influence patients to seek treatment at retail clinics on the basis of cost rather than quality of care, (while presumably denying doctors the chance to offer the same inducement should they wish to do so).
The AMA delegates approved an additional principle to get health insurers to treat them on a par with retail clinics regarding co-payment rules.
“The AMA believes health insurers should be prohibited from waiving or lowering co-payments only for patients that receive services at store-based health clinics,” said Dr Carmel.
Other national medical societies are also keen to ensure that AMA standards are followed by store-based health clinics, said the AMA in a prepared statement.
Some newspaper reports have asked whether the medical profession is perhaps more concerned that the greater accessibility of retail clinics, the low hassle factor of not needing an appointment, could eventually become so attractive that doctors will lose business.
An editorial in the Chicago Sun-Times earlier this week put it like this: “any parent who has endured the difficulty of getting an appointment with the pediatrician for a screaming child’s earache … will see the local retail clinic as an attractive alternative.”
The issues are complex. On the one hand there is the need to ensure high level of care and this includes continuity and good management, which is hard to do if patients are going to drop into the nearest convenient walk in clinic for treatment. Who is then responsible for making sure the prescription in place A does not conflict with the treatment prescribed in place B? The patient? The overseeing doctor, who it would seem is more tightly constrained by professional standards and health insurance payment rules than the retail clinic?
And on the other hand is the right of patients to have access to health care at the time they want it and a cost they can afford. If it is technically and ethically possible to do this then it should be done.
A spokesman for one of the stores that operates a retail clinic said patients want more accessible and affordable healthcare, and retail clinics meet that need, while keeping the patient’s doctor informed.
Written by: Catharine Paddock
Writer: Medical News Today