[NPInfo] Tenn Retail Clinic Article

[nursinglaw at aol.com]

Dave,
 
I am at a retail clinics conference, and the owners of the clinics have discussed this and other legislation designed to protect physicians as the physician shortage and the shifts in the retail world beg for the use of NPs and PAs.
 
The Convenient Care Association mentioned three states where legislative initiatives have passed or seem imminent, to include:
 
--Texas, where a bill was passed which required physician presence 20% of the time that a clinic is open;
--Illinois, which will mandate medical director supervision; and 
--Tennessee, where this type of activity which serves as a precursor to legislation is occuring.
 
Interestingly, the  CCA and clinics which are taking the lead in these areas indicated that they have not been able to get NPs or PAs interested in helping them lobby against this legislation.
 
While I cannot and do not speak for the retail clinics (and I do not have an employment relationship with any of them), the spoke from a perspective where they reflected some of the frustrations of nurses who practice independently -- they are caught between the legitimate opportunity to practice (or to allow NPs and PAs to practice) and their reliance on physicians because they cannot hire nurses directly (the corporate practice of medicine issue).
 
I suggested that when they see these issues arising that they attempt to develop grassroots advocacy efforts if, and only if, they cannot get the organized nursing groups and associations to work with them.
 
While the retail clinics advocate for a "medical home", I think they see the physician shortage looming and they are frustrated by the stranglehold that docs are placing on their structures.
 
On the flip side, I was surprised because the retailers espouse use of medical guidelines and quality indicators, because nurses and nursing has not shared any validated indicators with them -- I couldn't understand why those working in these settings are not sharing the current nursing research.
 
Those of you out there who might have more knowledge than me on this issue, let me know if I am missing the mark.  I sat and listened intently this week because I wanted to get a sense of how we can capture the interest of this industry as more than employees; and use them to protect the advanced practice (PA, CNS) scope of practice as well.
 
 
Winifred Carson-Smith, Esq.
nursinglaw at aol.com
202/232-5193
202/347-7000

 
 
-----Original Message-----
From: dmittman at comcast.net
To: acc-circle at listserve.com; NPinfo at nurse.net; PAForum at mc.duke.edu
Sent: Mon, 14 May 2007 2:03 PM
Subject: [NPInfo] Tenn Retail Clinic Article


PAs and NPs need to work together on this.

In-store clinics draw eye of Tennessee physicians group
There's a boom going on, and the TMA wants to make sure the clinics are safe
and provide quality care
Nashville Business Journal - May 11, 2007by Erin Lawley Nashville Business
Journal
    €
Retail-based clinics have shown a dramatic increase throughout the nation,
up from 88 in 2005 to 268 last year, and industry watchers say the trend is
showing no sign of slowing, citing their popularity as an easy-access option
for patients.
View Larger
The boom in retail-based health clinics has the Tennessee Medical
Association looking into whether to ask lawmakers to keep a tighter rein on
the phenomenon.
"While TMA fully supports patients having access to medical care, we want to
make sure it's given in a safe manner," says Dr. Mike Minch, TMA board
chairman.


TMA may turn its fact-finding mission into a call for legislation come the
next legislative session.
"If legislation needs to be on the books in Tennessee, we'll make
recommendations of what the legislation should look like," says Minch.
Retail health clinics are located inside larger retailers, such as grocery
stores or pharmacies, and offer limited, general medical services including
vaccinations and care for conditions such as allergies and bladder
infections. They're typically staffed by a nurse practitioner in
collaboration with off-site physicians, and tout quick, low-cost visits.
Clinics under brands such as MinuteClinic, RediClinic and The Little Clinic
have been cropping up across the country because of their popularity with
patients who like the speed and convenience.
CVS/Caremark Corp.'s MinuteClinic is the largest player with about 180 U.S.
sites, but Wal-Mart Stores Inc. plans to open 400 clinics in the next three
years and up to 2,000 over the next five to seven years. MinuteClinic has
seven locations in the Nashville area, including Brentwood, Franklin, Green
Hills, Hendersonville, Hermitage, Madison and Vanderbilt.
Few rules apply to retail clinics because of their unique business model.
For instance, standards on how physicians supervise nurse practitioners
assume the two are in the same office. In a retail clinic, physicians may
visit the office only sporadically to review charts or see patients.
That lack of regulation is what prompted Dr. Patricia McLelland of
Chattanooga to introduce a resolution at TMA's recent House of Delegates
meeting listing principles to ensure safety at these clinics. The TMA board
is investigating what rules are in place in Tennessee - if any - so it can
make recommendations and consider backing legislation.


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