Docs not happy with Caremark, Wally World, and others!

Doctors push law on clinics in stores
Patients are put at risk, they contend
By Bruce Japsen
Tribune staff reporter
Chicago Tribune Online Edition
May 6, 2007

The Illinois State Medical Society, which represents more than 13,000 doctors, is pushing a proposed law to more closely monitor hundreds of in-store clinics being opened by retail giants Wal-Mart Stores Inc., Walgreen Co. and CVS/Caremark Corp.

The doctors claim the clinics, staffed by advanced-degree nurses and physicians' assistants, are largely unregulated and therefore put patients' health at risk.

The Illinois group said it also will lobby for federal laws aimed at increasing regulation of the clinics at the annual American Medical Association meeting next month in Chicago.

"[Doctors] see this as a very big competitive threat to the traditional office-based physician," said Todd Swim, a Chicago-based principal with Mercer Human Resource Consulting. "Employers have had on-site services like these staffed by nurse practitioners or physicians, and this, too, is preventative, routine medical care but hardly the scale and scope of a Wal-Mart. Whenever Wal-Mart sneezes the whole world shakes."

The potential loss of business for doctors is great because most health insurance companies are beginning to cover retail clinic procedures. The clinics are also designed as an option for low-cost care for the huge number of Americans who have no health insurance and would pay out of pocket.

Wal-Mart, the world's largest retailer, said late last month that it plans to open as many as 400 clinics in U.S. stores in the next three years and more than 2,000 within five to seven years.

Walgreens, based in Deerfield, expects to have about 250 locations nationwide by the summer. It already operates about 60 clinics, including 17 in its Chicago-area stores.

CVS/Caremark operates more than 150 retail health clinics, including a half-dozen recently opened or scheduled to open in the Chicago area.

Facing off against the doctors' powerful lobbying organization are the powerful pharmacy and retail industry lobbyists, who are trying to block the proposed legislation. Retailers say the clinics are staffed by licensed health professionals who track their patients' health in medical records and make referrals.

The American Academy of Nurse Practitioners expects more legislative initiatives like Illinois' as retail clinics expand throughout the country, but an official said efforts by doctors and their lobbies have been pushed back in states that include Georgia and Missouri.

"[Doctors] are concerned about losing patients, and I think this is going to get them more patients and get people in to see them," said Jan Towers, a nurse practitioner and director of health policy for the American Academy of Nurse Practitioners. "It will help because nurse practitioners will be referring them to health providers in the community."

Wal-Mart officials declined to comment for this story.

Walgreens is advocating that the Illinois bill be "held this year" so that "everyone involved has a chance to discuss their concerns."

"Increased regulation has the potential to restrict access to these health-care services and create more costs to patients," Walgreens spokesman Michael Polzin said. "That would work against the growing concern over affordable, quality health care that our Health Corner Clinics are directly addressing."

Most clinics are open seven days a week, and no appointment is necessary. They treat patients with routine maladies in 15 minutes or less and work under physicians' supervision, although doctors usually are not on site. Most treatments are for ailments such as ear and sinus infections, strep throat and athlete's foot.

Some clinics are establishing ties with traditional medical-care providers such as physician practices and hospitals.

In Will County, for example, CVS subsidiary MinuteClinic has formed an alliance with Silver Cross Hospital in Joliet. The hospital accepts referrals for patients needing emergency room and urgent and primary care. In addition, a member of the Silver Cross medical staff serves as MinuteClinic's medical director in Will County, the pharmacy chain said.

"Silver Cross' alliance with MinuteClinic helps us achieve our mission of caring for the health-care needs of our community residents and to educate people about living healthier," said Ruth Colby, chief strategic officer of Silver Cross.

Doctors say they are concerned about the quality of care if the clinics uphold their promise to treat patients in less than 15 minutes. The doctors said that is not enough time for consultation, and that follow-up may not be adequate.

"We want the Illinois Department of Public Health regulating these like all other providers of care," said Dr. Rodney Osborn, a Peoria anesthesiologist who is president of the Illinois State Medical Society. "These retail storefront clinics, if you will, should face standards just as there are for hospitals, surgery centers and doctors offices. This is a brand-new animal, and that is why legislation has been written."

The bill moving through the Illinois legislature and headed for a committee hearing this month, doctors say, would slow the retailers' expansion by requiring permits for each in-store clinic. In addition, the doctors say marketing should be regulated and physician supervision of clinic nurse practitioners should be increased.

The doctors group is hoping to get a bill passed before the spring legislative session ends.

The Illinois State Medical Society is one of the state's biggest spenders on elections. Last year it contributed $925,000, putting it behind only the Service Employees International Union ($1.2 million) and the Illinois Hospital Association ($938,000) on a list of the top 20 contributors compiled by the Illinois Campaign for Political Reform for the 2005-06 election cycle.

The Medical Society's efforts to deal with the retail clinics has support of other doctors groups, particularly those who provide primary care, such as the American Academy of Pediatrics' Illinois chapter, which said it worries about medical care in retail clinics for children, saying most nurse practitioners do not have a specialty for children.

About a mile and a half from a Walgreens clinic in Mount Prospect staffed by a nurse practitioner, family physician Dr. John Sage said he and his six colleagues worry about competition, particularly from suburban retail clinics. He said he believes retailers are cherry-picking patients with insurance.

"The people that are putting these clinics together are smart people, and they are picking and choosing the neighborhoods that they put these in," said Sage, 60, a family physician for three decades.

"What is going to happen to the future of family medicine going forward in the future? Do people want corporate-style medicine?"

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