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BREAKING NEWS REGARDING
RETAIL-BASED CLINICS
AAP LEADERSHIP PRESENTS PEDIATRICIANS' CONCERNS
ABOUT RETAIL-BASED CLINICS AT WAL-MART MEDICAL CLINIC
SUMMIT
Approximately 35 representatives from 10 different RBC companies
met with Wal-Mart representatives July 25-26 at the Wal-Mart home
offices in Bentonville, Arkansas. The group met to discuss issues such
as legal issues as clinic tenants, media and outreach, the
characteristics of a tenant agreement with Wal-Mart, marketing, and
Wal-Mart’s health and wellness agenda.
As part of this meeting, Wal-Mart invited the American Academy of
Pediatrics (AAP), the American Academy of Family Physicians (AAFP),
and the American Medical Association (AMA) to participate in a panel
discussion with Wal-Mart and Retail-based Clinic representatives on
July 26 th. The purpose of the panel discussion was to communicate
each association’s position on Retail-based Clinics and to begin
discussion as to how potential concerns could be addressed. A
summary of this discussion follows.
Presentation by the AAP
Robert M Corwin, MD, FAAP, a former member of the AAP Board of
Directors, represented the AAP on the panel. Dr Corwin focused on the
AAP’s commitment of being “dedicated to the health of all children.” He
stated that the Principles on Retail-based Clinic’s were currently
undergoing legal review and would then need to be approved by the
Board of Directors. Dr Corwin provided clarity that this was not a
concern about working with nurse practitioners or physician assistants.
Many pediatricians work very closely and collegially with nurse
practitioners and physician assistants. The concern is related to the
best model of care for children.
Moving forward, Dr Corwin utilized the AAP Medical Home policy
statement to outline the Academy’s concerns with the Retail-based
Clinic model of care. He outlined the characteristics of care provided in
the medical home model: accessible, continuous, comprehensive,
coordinated, family-centered, compassionate, and culturally effective.
Given the commitment to this model, the AAP is concerned that this
Retail-based Clinic model – based on convenience – cannot be a
substitute for the medical home model.
Dr Corwin outlined specific concerns with the Retail-based Clinic
model:
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The fragmentation of care at the medical home
The potential effect on the quality of care provided at an Retailbased Clinic
Children with special health care needs and chronic diseases,
who may not be readily identifiable, receiving their care at an
Retail-based Clinic
The maintenance of a complete, accessible, central health record
that contains all pertinent patient information
The use of tests for the purposes of diagnosis without proper
follow-up
The possible public health issues that could arise when patients
with contagious diseases are in a commercial, retail environment
with little or no isolation (e.g., rashes, mumps, etc.)
Finally, Dr Corwin noted that only seeing children with “minor
conditions,” as many Retail-based Clinics indicate will be the case, is
misleading and problematic. Many pediatricians utilize the opportunity
of seeing the child for something “minor” to address issues in the
family, catch up on immunizations, identify undetected illness, and
continue strengthening the relationship with the child and family.
These visits are not unimportant, but rather provide an opportunity to
work with patients and deal with a variety of other issues.
Dr Corwin closed by reminding the group that the Principles will be
forthcoming after legal and Board review, and the AAP would be open
to continued dialogue should further questions arise.
Appropriateness of care in an Retail-based Clinic setting
Dr Corwin responded to a specific question given to him regarding
whether or not it was appropriate to use an Retail-based Clinic just to
obtain a “quick diagnosis” when a pediatrician isn’t available for
several days. He informed the group that most pediatricians are
available on a same-day basis. He reiterated that the medical home is
still the best primary care delivery system, especially for children.
Techniques for winning the support of local physicians
Dr Corwin commented that communication between practices and
Retail-based Clinics has to be on a local basis. The AAP principles that
are forthcoming will provide guidance to pediatricians as to how to
respond to Retail-based Clinics. He also recommended that they talk to
the pediatric societies (local, county, state) and family physician
societies.
How Retail-based Clinics gain the support of the 3 associations
The AAFP reported that its Executive Committee is currently in the
process of approving a memorandum of understanding (MOA) this
week that the AAFP would then use to partner with an Retail-based
Clinic. The AAFP reiterated that it has published “attributes” and not
“guidelines,” but affirmed that it would endorse a Retail-based Clinic
that met the AAFP’s published attributes. They wanted to continue
working with Retail-based Clinics and others to achieve healthcare
coverage for all and increasing the number of primary care providers.
The AMA reiterated its interest in working with Retail-based Clinics on
the AMA’s advocacy agenda, focusing on issues such as medical
liability reform, Medicare physician payment reform, expanding
coverage for the uninsured, improving public health, and patient safety
and quality improvement.
Dr Corwin maintained the stance that the AAP could not endorse
Retail-based Clinics as a best model of care for children. The medical
home model is the best model of care. Some of the Retail-based Clinic
models that are physician staffed and more comprehensive indicated
they were committed to being a medical home. Dr Corwin noted that
this is a different model than other Retail-based Clinics that very
limited in scope and staffed only by nurse practitioners. He reiterated
that once the AAP principles are published, the Academy would be
willing to hold ongoing discussions to further clarify its stance, should
questions still exist.
At least 2 of the Retail-based Clinics indicated that the concerns of the
AAP should be taken into consideration.
FINAL COMMENTS
Dr Corwin was able to capture the interest of the group by stating that
the Retail-based Clinic model is not an appropriate model to provide
medical care to any child. He emphasized that children are different –
they are not “mini adults.” This requires a different model of care and
it is the AAP’s opinion that the medical home model is the best
practice.