Analysis: Quick clinics get longer look

WASHINGTON, May 9 (UPI) -- As the number of walk-in health clinics at grocery stores and pharmacies increases, so is the level of scrutiny they're receiving.

The Illinois state Legislature is considering a bill that would place the clinics under the authority of the state Public Health Department, which would be charged with licensing clinics, monitoring the level of physician supervision and limiting marketing.

"We're very concerned that, without state supervision these storefront clinics can potentially jeopardize patients' care," said Rodney Osborn, president of the Illinois State Medical Society, one of the key backers of the bill.

"We need to be certain the clinics function at the same standard as hospitals, doctors' offices and every other type of facility," he told United Press International.

By the end of the summer there will be about 500 such clinics in retail outlets across the country, and if a plan announced by Wal-Mart this week is realized, by the end of the decade that number could be in the thousands.

The clinics, staffed by nurse practitioners, provide care for common ailments like strep throat, urinary-tract infections and ear infections. Patients do not need an appointment, and they know the cost of treatment before they receive it.

Unlike doctors' offices, most of the clinics also have evening and weekend hours.

Critics, including many doctors, say they provide only precursory care to patients without delving into their medical histories or keeping adequate records. In many of the clinics the nurse practitioners also work without the supervision of an on-site physician.

Clinic operators say they provide an accessible, affordable alternative for uninsured patients -- or anyone with a non-serious health problem who is in a hurry -- that will bring more patients into the healthcare system.

As the number of the clinics continues to skyrocket, other states, including Georgia and Missouri, are considering or have considered laws like Illinois' to place limits on how the clinics can operate.

Proponents of the laws have also said they plan to bring up the issue at an upcoming meeting of the American Medical Association.

Currently, clinics are inadequately regulated, Osborn said. The law is needed to make sure physicians are on site to supervise care and refer patients to specialty care or hospitals if necessary.

Without regulation, the clinics' emphasis on speed could mean serious conditions that would be identified at a doctors' office will go undiagnosed, he said.

"When you see someone for the first time, you can't do an adequate history and physical and treat them and get them out the door in 15 minutes."

And by concentrating the clinics in relatively affluent neighborhoods with low uninsured populations, Osborn said, the clinic operators could actually undercut primary care even for patients who do not go to the clinics.

But opponents of the law say the increased regulation could keep clinics from serving their original purpose of providing affordable basic care.

"Any increase in regulation has the potential to restrict access to services and increase costs for the patient," said Michael Polzin, spokesman for the Walgreens chain of pharmacies, which operates about 60 clinics.

The clinics are already subject to oversight by state boards and must conform to guidelines established by the American Medical Association, he said, so there is no reason not to hold the bill until more discussions can be had about its potential impact.

Instead of cherry-picking affluent neighborhoods, he added, the clinics provide a needed service in low-income areas.

"Our pharmacies serve every demographic in the country," Polzin said. "We have more presence in underserved areas than any other retailer, and we intend to take the same approach with clinics."

Nurse practitioners question the claim that they are not able to take care of patients without a doctor's supervision.

"Nurse practitioners function without physicians on site all over the country, and not just in retail clinics," Jan Towers, director of health policy at the American Academy of Nurse Practitioners, told UPI.

The nurses can be an important point of contact that draws patients into the healthcare system, referring them to other needed care, she said.

The speed of the clinics is not the result of less patient interaction, Towers said. "'Quick' means patients don't have to sit in the waiting room and wait a long time."