Retail Clinics: Two Points of View

Retail clinics are a growing part of today’s healthcare delivery system. On that point, the American Medical Association and the Convenient Care Association (which represents retail health clinics) agree. But they differ in just how important – and independent of physicians – those clinics should be. Those differences became apparent this summer.

Meeting at the 2017 AMA Annual Meeting in June in Chicago, the AMA House of Delegates affirmed that retail health clinics “have been playing a steadily growing role in healthcare.”

But delegates also warned that the clinics should not “expand their scope of services beyond minor acute illnesses,” such as sore throat, common cold, flu symptoms, cough, sinus infection or others. They also said that retail clinics should:

  • Avoid offering services such as infusions or injections of biologics.
  • Have a “well defined and limited scope of clinical services.”
  • List the services they offer as well as the qualifications of the onsite health professionals before providing care.
  • Use local physicians as medical directors or supervisors of retail clinics.

They added that such clinics should:

  • Help patients who lack a primary care physician or usual source of care to identify one in the community.
  • Use electronic health records to transfer a patient’s medical records to his or her primary care physician and to other healthcare providers, with the patient’s consent.
  • Produce patient visit summaries, which are transferred to the appropriate physicians and other healthcare providers in a meaningful format that prominently highlights salient patient information.
  • Work with primary care physicians and medical homes to support continuity of care and ensure provisions for appropriate follow-up care are made.

 ‘Complementary role’
In a written response to the AMA’s statement, Convenient Care Association Executive Director Tine Hansen-Turton said, “Convenient care clinics can play a complementary and access-enhancing role with respect to the delivery of chronic care.

“[R]etail clinics fill a gap that would otherwise be filled by costly and unnecessary emergency room visits,” she said. “Patients who do not have a primary care provider are educated about the importance of such a relationship, provided with a list of primary care providers in the area, and encouraged to establish a relationship with a primary care provider.

“For patients with chronic conditions, compliance with treatment and medication regimes is critical to long-term health, and CCA members believe that [retail clinics] can serve as a valuable partner to the [primary care physician] and Patient Centered Medical Home (PCMH) community in the treatment of these patients,” said Hansen-Turton. CCA cited three reasons why retail clinics are well-suited for the task: guidelines-based care; commitment to collaboration and data-exchange with primary care physicians; and convenient, community-based locations and extended hours.

The first retail clinics opened at the turn of the millennium. The AMA estimates more than 2,800 clinics will be in operation this year, but the Convenient Care Association pegs the number closer to 2,300.

Hansen-Turton added:

  • Convenient care clinics already use electronic health records “to ensure high-quality healthcare and monitor evidence-based practice performance. Indeed, there was widespread use of EHRs in CCCs well before it became even moderately accepted by most primary care physician offices.”
  • Members of the Convenient Care Association pledge to “provide access to the visit record, written discharge instructions and educational materials to patients upon leaving the clinic to ensure that patients understand any diagnosis made, recommended treatment and care plans.”
  • Retail clinics in CCA pledge to “encourag[e] patients to establish an ongoing relationship with a primary care provider, and to mak[e] appropriate and careful referrals for follow-on care and/or for conditions that are outside of the scope of the clinic’s services.”
  • CCA members pledge to “build collegial relationships with the traditional healthcare system and its providers, to share patient information as appropriate and ensure continuity of care. All patients are given the option of sharing their healthcare record with other providers.”
  • Convenient care clinic providers agree to “adhere to evidence-based protocols that adhere to established clinical practice guidelines and regulations.

“CCCs are not operating off of standing orders, but rather employ educated professionals who make decisions based on evidence-based practices as well as individual patient needs,” said Hansen-Turton. “Moreover, studies have demonstrated that retail clinics have excellent clinical quality outcomes, adhere to evidence-based guidelines, and provide cost-effective care.

“Many CCCs already work collaboratively with multiple large health systems and physician groups, providing ongoing monitoring and care for patients with chronic disease.”