Unregulated Health Care? | Groups clamor for oversight of CVS clinics
The recent proliferation of health clinics in CVS pharmacies across Connecticut has touched a nerve with major health organizations that say they need to be regulated.
Minnesota-based MinuteClinic, which was acquired by CVS in 2006, now operates in 16 CVS stores in the state. The clinics tend to charge between $50 and $80 per visit, making them highly attractive to uninsured patients who can’t afford more expensive trips to physicians.
“They are starting to pop up all over Connecticut and, as we see it, there’s no real oversight,” said Ken Ferrucci, director of government relations for the Connecticut State Medical Society. “We want to see how they’re going to fit in the public health discussion because right now we don’t like it that they are part of the system.”
But Michael Howe, MinuteClinic’s CEO, noted that the physicians and nurses that work at clinics must all be licensed.
“The idea that some medical societies have been pushing that the health clinics are totally unregulated is a complete misrepresentation of the facts,” Howe said. “Like every other health care provider, we have very strict standards we adhere to.”
Massachusetts recently passed regulations requiring retail-outlet health clinics to apply for licenses and provide a list of their services.
In Connecticut, the state Department of Health does not license the clinics, and it has not pushed for further regulation. However, the DPH would review a complaint against a clinic, according to William Gerrish, a spokesman for the department.
“If you filed a complaint about, say, a bad flu shot, you could still file it with us,” Gerrish said. “But unlike a hospital or a nursing home that’s licensed, it would not be investigated like a regular complaint.”
In that hypothetical situation, the DPH could levy sanctions against the clinic’s practitioners, but it would have little recourse against the clinic itself.
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Ferrucci said the CSMS is concerned about a number of issues, including clinic policies for referring patients.
“There are unanswered questions about protocol for getting scripts filed,” he said. “What about clinics operating in stores that sell tobacco, which we oppose?”
The CSMS also raised concerns about questionable practices at retail-based health clinics in other states that could spread to Connecticut. Ferrucci noted that certain health insurers reportedly have agreed to waive patients’ co-payments and deductibles when they visit the retail clinics.
“It is illegal to do so in current (Connecticut) statutes and it creates a huge advantage,” Ferrucci said. “It’s not happening, to our knowledge, in Connecticut, but we want to be very clear that it doesn’t happen.”
Other national health care organizations have also taken positions on retail-based health clinics.
The American Academy of Pediatrics officially opposes the use of the clinics by children due to the fragmentation of care and the treatment of children by physicians who don’t have access to their health records. The AAP also raised concerns about patients with illnesses circulating in a retail store.
The American Medical Association has issued a policy statement on retail-based clinics that calls for them to ensure continuity of care for patients and to establish referral systems for conditions beyond the scope of their services.
Howe countered that the quality of care his outlets offer is as good as any physician’s office, at least for minor ailments.
“The medical community needs to study the model and see how it can fit into the overall landscape,” Howe said. Although they may not serve every health need, they are a legitimate part of the healthcare system, he asserted.
Convenient Health Care
Massachusetts Department of Public Health Commissioner John Auerbach agreed. He said the clinics “well serve an important function, making care for minor medical treatment more convenient,” assuming they are well regulated.
Massachusetts passed its regulation in January after conducting months of public hearings on what it has termed Limited Service Medical Clinics.
MinuteClinic’s Howe said he was involved in the hearing process in Massachusetts and that his company applied for its first license in that state earlier this month. He said he would take an active part in any public discussions on the issue in Connecticut.
Another clinic company, Farmington-based ProHealth Physicians, also tested the waters in Connecticut by opening a site at a Price Chopper store in Putnam in 2006. It has since closed it down due to slow business, but the company has not ruled out trying again.
“We did have one and we thought highly of the potential,” said Jack Reed, president of ProHealth Physicians. “That particular site did not generate enough volume. We decided that the strategy is very capital intensive, but we still support it.”
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