By Bruce Japsen, Contributor, Forbes | APRIL 6, 2013 | Walgreen’s latest push into primary care has one major doctor group taking issue with the retailer’s expansion into “management for chronic conditions” such as high cholesterol, diabetes and hypertension.
The nation’s largest drugstore chain earlier this week announced that its more than 330 Take Care clinics staffed by advanced degree nurses known as nurse practitioners were expanding the scope of the health care services beyond routine maladies like treating strep throat or pink eye.
The American Academy of Family Physicians is upset about the latest Walgreen expansion into retail clinic services that provide assessments of chronic care conditions.
Walgreen is now providing new services that include “assessment, treatment and management for chronic conditions such as hypertension, diabetes, high cholesterol, asthma and others, as well as additional preventive health services.” Walgreen said it was moving further along than clinics run by rivals like CVS/Caremark (CVS) or Wal-Mart Stores (WMT).
But some physicians are upset by the expansion, saying it will further splinter an already fragmented health care system and therefore harm quality and patient safety.
“It is more difficult to comprehensively manage a patient’s care if they are treated in multiple settings,” said Dr. Jeffrey Cain, president of the American Academy of Family Physicians in a statement to Forbes. Here’s a link to the academy’s policy statement in regard to retail clinics.
“Our health care system is already fragmented, and our concern is that the expansion of retail clinics into chronic care will lower quality, increase costs, and pose a risk to patients’ long-term health outcomes,” Cain added. “Retail clinics may not have some specialty services needed to treat those with complex diseases. In addition, family physicians establish relationships and get to know their patients, which better enables them to help someone with diabetes learn how to eat better, start exercising and stick with their treatment plan.”
But Walgreen says the services offered at its Take Care clinics meet the company’s “objective to help address the need for greater access to care by working collaboratively with physicians to support and complement their care plans for chronic patients.”
Walgreen, for example, has formed various affiliations with large hospital systems and doctor-led clinics across the country to create patient-care protocols and other programs. Walgreen has also formed and is joining with larger providers to create accountable care organizations, which organize a collection of medical-care providers to care for a group of patients.
ACOs work to keep patients healthy and out of the more expensive hospital setting. If ACOs are successful and reduce costs, the providers in the organization divvy up the savings with the health plans that are paying them.
“With this service expansion, Take Care Clinics now provide the most comprehensive service offering within the retail clinic industry, and can play an even more valuable role in helping patients get, stay and live well,” said Dr. Jeffrey Kang, senior vice president of health and wellness services and solutions, Walgreens.
Yet Walgreen may still have some physician groups to win over as it forges ahead in its effort to be a larger provider of health care services.
The American Medical Association, for example, and the retailer have discussed the new service expansions but the nation’s largest group said it had no comment on the retailer’s latest move. A source close to the AMA said the doctor group was evaluating the expansion into chronic care services.
Still, the AMA and Walgreen have had various meetings over the years in regard to retail clinic expansion, which led to the AMA’s House of Delegates adopting policy in 2006 that was updated in 2007 on retail clinics. And Walgreen said it has been abiding by AMA policies.
The following are key aspects of the AMA policy:
- “Store-based health clinics must have a well-defined and limited scope of clinical services, consistent with state scope of practice laws.
- Store-based health clinics must use standardized medical protocols derived from evidence-based practice guidelines to ensure patient safety and quality of care.
- Store-based health clinics must establish arrangements by which their health care practitioners have direct access to and supervision by MD/DOs, as consistent with state laws.
- Store-based health clinics must establish protocols for ensuring continuity of care with practicing physicians within the local community.
- Store-based health clinics must establish a referral system with physician practices or other facilities for appropriate treatment if the patient’s conditions or symptoms are beyond the scope of services provided by the clinic.
- Store-based health clinics must clearly inform patients in advance of the qualifications of the health care practitioners who are providing care, as well as the limitation in the types of illnesses that can be diagnosed and treated.
- Store-based health clinics must establish appropriate sanitation and hygienic guidelines and facilities to ensure the safety of patients.
- Store-based health clinics should be encouraged to use electronic health records as a means of communicating patient information and facilitating continuity of care.
- Store-based health clinics should encourage patients to establish care with a primary care physician to ensure continuity of care.”.