Reccent acquisitions of retail health clinics by major pharmacy chains have sparked a debate concerning the economics and ethics of providing care down the aisle from name-brand drugs.
Major retail corporations such as Wal-Mart, Walgreens and CVS have all scooped up retail health clinic operators in the past year, increasing the presence and potential staying power of the “convenient care” centers.
The American Medical Association, which emphasizes that it is not opposed to retail health clinics, has called for regulation of the clinics and new principles to make sure there are no unfair incentives for patients to choose them over local physician practices.
Among the regulations sought by the AMA are investigations of ventures between retail clinics and pharmacy chains with an emphasis on inherent conflicts of interest and guidelines for model legislation that regulates the operation of store-based health clinics.
“There are clear incentives for retailers to participate in the implementation and operation of store-based health clinics,” said Peter Carmel, MD, an AMA board member.
“There is absolutely no conflict of interest because patients are free to take a prescription to any pharmacy they choose,” said Lauren Tierney, spokesperson for Take Care Health, which was acquired by Walgreens.
Tierney said Take Care is aligned with all current AMA guidelines for retail clinics, and its nurse practitioners are meeting or exceeding national guidelines for prescribing.
“If the AMA pushes this agenda, its members may find out that legislators and their constituents have been demanding accessible, affordable and high-quality health care for years. And that’s exactly what retail clinics are delivering,” she said.
Adding to the controversy is the concept of co-payment reductions and waivers, which some insurers are allowing retail clinics to offer. These provide an unfair incentive for patients to choose the clinics over physicians, the AMA said.
“We physicians are scrutinized heavily for conflict of interest,” said William Hazel, MD, secretary of the AMA’s board of trustees. “Physicians are not allowed to waive or reduce co-pays, and we believe that the playing field should at least be level.”
The AMA acknowledges the growing role and popular trend of retail clinics, said Hazel.
“We believe they are not a substitute for having a physician in an ongoing medical home, and we would be averse to insurance companies allowing retail companies incentives to bring patients to them that they would not allow physicians to do,” he said.
Tine Hansen-Turton, executive director of the Convenient Care Association, said the co-payment waiver is a semantic and administrative issue. “There are two ways of contracting with a managed care company. You’re either in the primary care or specialty bucket, and convenient care is really in the specialty bucket,” she said.
The CCA works closely with the American Academy of Family Physicians and the American Academy of Pediatrics to make sure retail clinics are on par with care provision, Hansen-Turton said.
Additionally, the clinics often connect patients with a primary care physician in their community if they don’t have one.
“These clinics are not here to take away work from medical homes,” she said.