Retail clinics contend with regulations
PHILADELPHIA —Nurse practitioners working within in-store retail health clinics are well-aware that ensuring continuity of care and partnering with the local medical community has been, and will continue to be, a top priority of in-store health clinic providers. But what may be not so apparent is that several states, some more so than others, have regulations in place that can make it difficult for such clinic operators to survive.
“There are [six states] that have on-site physician supervision regulations, and that can be really burdensome to our members,” said Ann Ritter, policy director for the Convenient Care Association. “It is attached to the old model of providing healthcare services with the idea that the doctor is in their office with the nurse practitioner all of the time, and it is very different from our members’ model where you have one nurse practitioner in many different sites.”
CCA—which regularly monitors practice regulations for nurse practitioners and physician assistants in each state, as well as any new bills or regulations being introduced—named six states that have on-site physician support requirements for nurse practitioners.
Texas is by far the most strict, as it has a 20 percent on-site supervision requirement for physicians. Alabama and South Dakota come in second with each mandating a 10 percent on-site requirement for physicians. The other states are Georgia (four hours a month); Illinois (once a month, no duration specified); and Virginia (must make “regular” site visits).
Such stringent requirements, such as in Texas, can be difficult for clinic operators to comply with, especially given the nation’s shortage of primary care physicians. Requiring a physician to be on-site also increases overhead costs. In order for clinic operators to provide affordable care, they must keep overhead costs down.
“All of us have a vested interest in having accessible [healthcare] providers in the community and providing care because we have a shortage on the family physician side. So we look at it from even a broader perspective, and it probably isn’t the best utilization of [a physician’s] time either,” added Tine Hansen-Turton, executive director of the CCA.
In Texas, for example, the Texas Medical Association estimates that there are only 43,000 physicians to treat 23 million people. Furthermore, at least 50 percent of all patients seen in Texas convenient care clinics are uninsured or underinsured.
Looking to expand access to health care in Texas, Rep. Rob Orr in February introduced HB 1096, which did not get passed in time before the state legislature, which meets every other year, ended its session. HB 1096 aims to reduce the strict physician on-site requirement and increase the number of advanced practice nurses that one physician may supervise. Texas currently prohibits physicians from supervising more than three advanced practice nurses.
By removing or reducing overly burdensome physician supervision requirements, H.B. 1096 would have allowed advanced practice nurses and physician assistants working in the state’s convenient care clinics and other community-based clinics to provide accessible and affordable health care for all Texans. The bill would have improved access to care for working families across Texas and drove down overall healthcare costs by promoting efficient use of physicians’ time and energy and leveraging Texas’ existing healthcare resources and providers, Hansen-Turton explained.
Also complicating matters is what is known as the “corporate practice of medicine” doctrine. While the CPOM prohibitions vary by state, it generally means that a business corporation that is not owned by healthcare professionals cannot employ healthcare professionals to provide medical services. CPOM prohibitions may be found in state statutes or regulations, or they may stem from court decisions or state attorney general opinions. Some states may even have CPOM prohibitions that are not enforced.
“California has certain requirements about [CPOM], but we do have members there working within the confines of the law and have elected to do so, obviously building that into their model,” said Hansen-Turton. “All of our members follow the law.”