Expanding Retail Health's Scope of Practice Is Not in Patients' Best Interest

Change is afoot in the retail health industry as companies look to expand the scope of practice for their clinics beyond simple acute health problems. Some states are saying "yes" to such expansion, seeing it as a way to address physician shortages, rising health care costs and emergency department overuse. But expanding retail clinics' scope of practice is the wrong solution when it comes to addressing these health care problems, and it's not in the best interest of the American public. The AAFP opposes such an expansion because of the potential negative impact on the quality of care in these clinics.

AAFP members are all over the board when it comes to retail health. Some are strongly opposed to retail clinics, while others serve as supervising physicians for the clinics or receive patient referrals from the clinics.

The Academy itself does not endorse the concept of retail clinics and believes they have the potential to interfere with the patient-centered medical home, which is the best solution to the health care problems listed above. In an effort to shape the business model for retail clinics, the Academy in June 2006 announced it had developed a list of Desired Attributes of Retail Health Clinics and asked retail health companies to indicate their support. The attributes include having a "well-defined and limited scope of clinical services" and "clinical services and treatment plans that are evidence-based and quality improvement-oriented." The attributes also say that retail clinics should "encourage all patients to have a 'medical home.'"

In 2007, three prominent retail health companies -- MinuteClinic, RediClinic and Take Care Health Systems -- signed agreements supporting the Academy's list of desired attributes. Other companies subsequently came on board. But the winds appeared to shift this year when Take Care dropped its support, apparently because of plans that include expanding its clinics' scope of practice.

One key driver of the push for expanded scope could be the "corporatization" of the retail health industry. Take Care, for example, has been bought by Walgreens, and Minute Clinic was bought by CVS. These conglomerates paid big bucks for their purchases, so there's sure to be pressure to make the clinics profitable, an achievement that apparently has eluded any retail health chain so far. The move to expand scope -- and for Walgreens, the even more ambitious plan to integrate its retail clinics, pharmacies, over-the-counter sales and disease management interests -- are most likely responses to this pressure.

Retail health customers probably will accept an expanded scope of services, because research indicates they've been very satisfied with the clinics thus far. But just because consumers accept the expansion doesn't mean it's in their best interest.

That's because as retail clinics add services, they could reach the point of overextending themselves, no longer being fast, efficient, cheap, and -- most importantly -- not being able to maintain quality and patient safety. Consumers may not be able to distinguish when this tipping point is reached.

The AAFP will work on the national level to counter the trend toward an expanded scope for retail health. But keep in mind that you can play an important role on the state level and in your own practice. Here's how: