Retail Clinic Revolution: Clinic legislation takes state-by-state approach
In the decade before 1775, Massachusetts was the cornerstone of revolutionary activity. It would go down in history as the site of such historic events as the Boston Massacre and the Boston Tea Party. Today, more than 200 years later, is the state once again making history in the retail clinic revolution?
In January, the convenient care industry celebrated a victory in Massachusetts as state health officials approved regulations allowing for limited-service medical clinics, marking the end of a long review process that included two public hearings and the submission of hundreds of pages of testimony regarding the regulations.
Sparking the move to create specialized regulations: CVS’ application to open a MinuteClinic in one of its stores in Weymouth.
According to the state Public Health Council, early in the application review process it became clear that Department of Public Health regulations governing medical clinics did not address the operation of medical clinics with limited scope of services.
Rather than consider applications requiring numerous waivers from full-service clinic regulations, the department decided to create a specialized set of rules.
The convenient care industry applauded the approval of the regulations, which not only paved the way for CVS to embark on its plan to operate about 120 MinuteClinics across the state over the next few years, but also likely caught the eye of other states wading through clinic-related regulations.
“[Massachusetts] really validated the clinics as a new concept, from our perspective at least,” said Tine Hansen-Turton, executive director of the Convenient Care Association. “Remember in Massachusetts, though, they probably had more specific regulations to care, in general, than we have seen anywhere else in the country, so there it was so important to be written into and defined in their regulations as a service entity.”
| States to Watch | Proposed legislation |
| Tennessee | The Tennessee Medical Association is proposing regulations that would significantly restrict NP and PA practice. In addition, proposed state legislation (SB 3502 and HB 3205) prohibits the sale of cigarettes at any place of business where medical services, including operation of a health clinic or prescribing of medication, also are offered to the public. |
| Oklahoma | State legislators proposed bills that would impose strict ratio requirements and would require physician ownership of convenient care clinics. As of Feb. 21, SB 1523 and SB 1638 did not pass out of committee and are dead. Industry members, including the Oklahoma Nurse Practitioners Association, are watching for amendments that could be added to other existing bills. |
| New Hampshire | HB 1484 establishes a commission to study retail health clinics and develop legislation to regulate the operation of retail health clinics and limited-service clinics. |
| Illinois | State Rep. Mike McAuliffe, R-Chicago, in 2007 introduced HB 1885, the Retail Health Care Facility Permit Act, which would charge the Illinois Department of Public Health with regulating healthcare services provided in a retail store or pharmacy. The proposed law failed to pass before deadline, but is expected to be reintroduced this year. Backing the proposed legislation is the Illinois State Medical Society. |
| Rhode Island | SB 2356 would prohibit the sale of cigarettes in a facility that maintains a health-care facility and a pharmacy at the same location. |
What really set Massachusetts apart from other states, explained Hansen-Turton, is that the state defines any type of healthcare service, and each entity that provides service is defined and guided by specific regulations. As of January, retail-based clinics are now defined by the state as “limited-service clinics.”
While the approval of limited-service clinics likely caught the eye of other states, legislative and regulatory activities vary state-by-state and seemingly day-by-day. Keeping abreast of the latest can be difficult.
As officials throughout the states become increasingly familiar and better understand the retail clinic model, which emerged only about eight years ago, the dust begins to settle, but there’s no denying that some resistance still exists in certain states.
“Health care is a state-by-state issue when it comes to regulations, and we want to be treated the same way in each state as other providers would be,” Hansen-Turton said.
When asked to identify a major legislative or regulatory issue currently facing the convenient care industry, Hansen-Turton was quick to bring up proposed legislation in Rhode Island and Tennessee that aims to prohibit any type of medical service where there are tobacco products being sold. This is an issue that obviously impacts retail-based clinics, but it also is a larger issue for the entire chain drug industry.
“It is really an issue that is not [directly] related to us but impacts access to service delivery,” Hansen-Turton said.
The CCA currently is working with legislators in those states in hopes of finding a viable solution.