CHICAGO — The American Medical Association here is asking authorities to investigate in-store clinics for conflicts of interest that could lead to poor quality of care.
Many member physicians urged the association to ban or slow the growth of retail clinics during the AMA's annual meeting, held late last month. In response, the association resolved to ask state and federal agencies to find any factors putting patients at risk.
In its resolution, which was introduced by the Illinois Delegation of the AMA House of Delegates, the association calls for the investigation of ventures that pose a potential for conflict of interest in prescription writing and filling based on the financial relationship of retail clinics with retail pharmaceutical companies, or where unfair competition exists due to large retail pharmaceutical companies becoming involved with delivery of health care in order to increase pharmaceutical sales.
The AMA was driven by “retailers who have stated that store-based health clinics help drive additional store traffic, which can increase sales of lucrative prescription drugs and other non-health-related products,” the association said in a statement.
A main factor in the investigation, then, will be whether or not patients are influenced to fill prescriptions at the retail pharmacy on-site. “If patients are prescribed a medication, they can get it filled at any pharmacy they choose,” Walgreens spokesman Michael Polzin told SN.
Deerfield, Ill.-based Walgreen Co. acquired Take Care Health Clinics, Conshohocken, Pa., in May and plans to expand its now 63 in-store clinics to more than 400 by the end of 2008. “Our clinics also have electronic prescribing capabilities that allow the nurse practitioners to send a prescription electronically to any pharmacy the patient chooses,” Polzin added. “A conflict of interest is simply not an issue.”
Money, however, is another concern for the AMA. As part of the resolution, it opposes waiving or lowering patient co-payments to physicians at clinics. “These financial incentives may inappropriately steer patients to these clinics on the basis of cost rather than quality of care,” the statement said.
Currently, Blue Cross Blue Shield of Minnesota, Eagan, Minn., reduces or waives co-payments when patients visit store-based health clinics, AMA spokesman Robert J. Mills told SN. In addition, the AMA received a letter from the president of the Medical Association of the state of Alabama raising similar concerns regarding the recent trend of insurers waiving co-payments for patients who use store-based health clinics, Mills said.
However, for those running the clinics, it isn't about luring patients who can already afford doctors' visits, it's about providing care to those who normally can't afford them, clinic advocates said.
The in-store clinic model is a part of the “solution to our broken health care system,” said Tine Hansen-Turton, executive director of the Convenient Care Association, Philadelphia, in response to the AMA's decision. “Convenient care clinics have proliferated in retail settings throughout the country due to a widespread lack of access to high-quality, affordable health care in America.”
CVS/pharmacy, Woonsocket, R.I., now has over 170 clinic locations since its purchase last year of MinuteClinic, Minneapolis, and has plans to expand. Wal-Mart Stores, Bentonville, Ark., plans to open some 2,000 clinics in the next five to seven years.
As for supermarkets, Bi-Lo, Greenville, S.C., is working with Wellspot, Birmingham, Ala. H.E. Butt Grocery Co., San Antonio, has clinics from Rediclinic, Houston. Kroger, Cincinnati, and Publix, Lakeland, Fla., both work with the Little Clinic, Brentwood, Tenn. Minyard's Food Stores, Coppell, Texas, has clinics from MedBasics, Irving, Texas. Schnuck Markets has clinics from InstaClinic, St. Louis. Many more supermarkets are either piloting locations or looking for partners.
Out of concern for their own image with shoppers, as well as with the clinics' staying power, retailers choose partners based on quality. “Convenient care clinics collectively boast a 98% satisfaction rate,” Hansen-Turton said.
The AMA said operational guidelines would ensure such quality. At its meeting, the association updated principles for quality and safety at in-store clinics and vowed to develop legislation that regulates the operation of convenient care clinics.
Still, clinics will continue to grow, and retailers will open their doors to investigations. “I think the investigators may find that legislators and the people they represent have been demanding accessible and affordable health care for a number of years, and that is exactly what retail clinics are delivering,” Polzin said.