AMA toughens stance on retail health clinics
■ The Association plans to take its concerns about treatment shortcomings directly to insurance companies.
Chicago -- The American Medical Association adopted policy in 2007 opposing the practice of insurers encouraging the use of retail clinics by waiving or reducing co-pays. The Association now will take direct action against the practice by communicating directly with insurance companies on what it sees as the consequences of steering patients to nonphysician-staffed clinics.
Policy adopted by the AMA House of Delegates on June 21 says that by directing patients to seek care outside primary care relationships, decisions may be made with limited information, and tests or procedures may be duplicated, leading to higher health care costs for a decreased level of quality.
Though a small number of clinics are staffed by physicians, most are staffed by nurse practitioners and physician assistants. Insurers have said they support this model of care because it is a lower-cost alternative to emergency departments or physicians' offices when patients have minor ailments. Some insurers even have opened their own clinics.
In committee testimony on the issue, pediatrician Dolleen Licciardi, MD, a delegate for the Louisiana State Medical Society from Destrehan, spoke on behalf of the delegation in favor of the resolution.
In Louisiana, she said, pharmacists are allowed to provide care by administering shots, such as vaccines, without a doctor's order.
"The scope of practice is changing more and more," she said. "It's an important issue, and remember it's not just the nurse practitioners and physician assistants, it's the pharmacists now."
Others who spoke in favor of the policy said it helped strengthen the medical home model that places the primary care physician in charge of coordinating the patient's care.
Existing AMA policy says clinics should have established protocols for ensuring continuity of care with physicians, and have a referral process in place for patients in need of a primary care physician.