The AAFP Board of Directors has revised its official policy on retail health clinics to reflect the Academy's opposition to a growing expansion of scope of services provided by many such clinics. In addition, the Academy has discontinued its practice of entering into formal agreements with retail health clinics that support the AAFP's desired attributes.
The AAFP created its retail health clinic policy in 2005 when it became clear that the clinics were increasing in number nationwide. Subsequently, five retail health companies signed agreements with the AAFP to abide by the Academy's desired attributes for such clinics. The four retail health organizations that still hold signed agreements -- MinuteClinic, RediClinic, The Little Clinic and BellinHealth Fast Care -- have been notified that those agreements will be terminated.
In a letter sent to those companies, the Academy said its decision was not intended to reflect negatively on any retail health clinic company. Rather, it was made after observing the evolution of the retail health clinic model into expanded service lines. "The practice of having formal agreements has run its course," says the letter.
When the first few retail health clinics appeared on the health care scene in 2000, the business model featured clinics staffed primarily by nonphysician professionals, such as nurse practitioners. Clinics were designed to treat patients for a limited number of acute illnesses, such as sore throats and ear infections.
Now, nearly a decade later, clinics are operating in 32 states. According to the Convenient Care Association(www.ccaclinics.org), the number of retail clinics has grown to nearly 1,200 nationwide. Notably, two of the nation's largest retail health chains have disclosed to the AAFP their intent to move forward into chronic disease management.
"The AAFP revised its policy because some clinics are expanding their scope of service beyond what the Academy thinks is appropriate," said AAFP President Lori Heim, M.D., of Vass, N.C. The expansion of clinic services most likely reflects the reality that retail clinics need to treat more than walk-in patients with acute health problems to survive economically, she added.
In its revised policy statement, the Academy notes that it does not endorse retail health clinics and believes that the clinics could interfere with the medical home model of care. The AAFP "opposes expansion of their scope of service" and stands against the diagnosis, treatment and management of chronic medical conditions in the retail clinic setting.
"In those markets where RHCs (retail health clinics) exist, the AAFP has defined a set of attributes related to their design and operation that are important to the patient care offered in this setting. It is the individual physician's choice whether or not to sponsor or work cooperatively with a retail clinic," says the policy.
Heim added that some family physicians have successfully established good working relationships with retail clinics, "particularly when it comes to referring patients and communicating what treatment a patient received. We applaud that collaboration," said Heim.
"When our members decide to work with retail health clinics, the AAFP strongly recommends that they do so in a manner consistent with the attributes listed in our policy because ensuring the patient's best interest and good health is the ultimate goal," she said.
The Academy's policy urges all retail clinics to abide by the list of desired attributes, which, in addition to a limited scope of clinical services, should include
- evidence-based medicine,
- a team-based approach,
- a system of referrals to physician practices, and
- electronic health records.
Heim commended family physicians who have expanded their office hours and changed their office procedures to allow for same-day appointments to accommodate patients with urgent health care needs.
"We need to see more of those kinds of changes, because we know that above all else, patients like the convenience that retail health clinics offer," she said.