2008 Congress of Delegates

Board to Study Policy Proposal for Retail Health Clinics

By Barbara Bein • San Diego
9/17/2008

At a time when retail health clinics are expanding, the AAFP Congress of Delegates has asked the Board of Directors to study a detailed policy on retail health clinics that entails almost a dozen different guidelines.

The COD referred a resolution introduced by the North Carolina AFP to the Board during the AAFP's annual meeting here. The resolution asked the Academy to adopt a policy that retail health clinics should meet a long list of "minimum guidelines" that some delegates and leaders described as "complicated" and "specific" but also "workable and fair."

Some of the 11 provisions in the resolution are

that any midlevel provider, whether a nurse practitioner or physician assistant, be physically located in the same state as the primary practice location of the supervising physician;
that the maximum number of clinical sites supervised by a physician be four, with exceptions for academic institutions, prisons, psychiatric institutions and sites in medically underserved counties;
that facilities have adequate handwashing opportunities, and a handwashing facility in the retail store but not within the clinic would be "insufficient";
that the scope of clinical services be clearly defined and made widely available to the public so patients won't delay care believing the retail clinic can provide it, and that misrepresenting the scope of practice in advertising be considered illegal;
that clinical services be evidence-based with treatment plans that are oriented to quality improvement;
that all patients seen at the clinic be referred back to their current primary care physician, and if a patient does not have a primary care physician, a referral be made to a primary care physician in the local community for follow-up, including physicians in private practice, public health clinics or other primary care offices;
that the name, title, practice address and phone number of the supervising physician be posted in a clearly visible location at the clinic; and
that patients have visible notification that they do not have to get prescriptions at the retail pharmacy where care is given.

In testimony before the Reference Committee on Organization & Finance on Sept. 15, AAFP Board Chair Rick Kellerman, M.D., of Wichita, Kan., suggested referring the resolution to the Board. He noted that the Academy already has Desired Attributes of Retail Health Clinics, and the Board could examine how well the proposed policy matches up with those attributes.

"There's a lot of specificity that may have unintended consequences," he said, questioning how the policy would work in some regions of the country.

Speaking in favor of the proposed new policy, Robert Rich, M.D., of Bladenboro, N.C., president of the North Carolina AFP, testified that a lot of work went into the "complicated" resolution, but it is "workable and fair." He said the chapter recognizes that there may be concerns in academic areas.

Michael Kennedy, M.D., of Kansas City, Kan., immediate past president of the Kansas AFP and an alternate delegate, said many of the issues covered in the resolution are already being addressed in his state. But he said he would like to see the language simplified and then taken to individual chapters.

"We agree in concept. We have great concerns about the detailed wording of the resolution," he said.

Speaking against the resolution, Rebecca Hafner-Fogarty, M.D., of Avon, Minn., who is the medical director of strategic alliances for MinuteClinic in Minnesota, testified that the Academy already has "reasonable guidelines" and existing policy should be reaffirmed. She objected to singling out retail health clinics.

"Shouldn't all clinics provide evidence-based medicine?" she asked about a guideline in the proposed policy.

Frank Brown, M.D., of Ogden, Utah, an alternate delegate, agreed with opposing the policy. He said it requires retail health clinics to meet limits that the membership doesn't have to meet. As an example, he noted the provision that a physician would supervise a maximum of four clinical sites of the retail health clinic.

"We don't want the Academy to use its resources on this," Brown said.

The Academy's desired attributes note that the AAFP does not endorse retail health clinics and believes such health care delivery could interfere with the patient-centered medical home.

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