August 13, 2007

Brought to you by Thomas Jefferson University’s Department of Health Policy

Volume II, Number 30

Quality of Care in Convenient Care Clinics Questioned

As convenient care clinics continue to crop up across the country, questions are being raised
about the quality of care that is being offered. More than 730 retail clinics currently exist nationwide
and CVS, Wal-Mart Inc., Walgreen Co., and Target Corp. have plans to increase that number by the
end of the year. The clinics are staffed primarily by nurse practitioners rather than physicians which
raises a lot of questions about quality, most recently by the American Medical Association. Some
states are taking measures to put regulations in place for these retail clinics. California has a law that
only allows physicians to own retail clinics. Florida requires the clinics to use signage to indicate the
presence of a physician and medical personnel must disclose their credentials. In Texas and
Wyoming nurse practitioners have more freedom to practice in retail clinics. Massachusetts
proposed a law last week to limit the number of visits a patient can make to a clinic. They are also
considering space requirements (50 sq. ft.), no waiting room and no bathroom, which raises safety
concerns. Philip C. Nasca of the Public Health Council expressed his concerns by stating, “this kind
of commercialized setting might not result in optimal patient care.” MinuteClinic, CVS Caremark
Corp.’s retail clinic that leads the industry, stands by the care they are providing. A study which will
be published later this year in the American Journal of Medical Quality found that 99.15% of patients
presenting in the clinic with a sore throat were given proper treatment. (Wall Street Journal, 8/9/07)
HIV Testing in the ED
HIV testing is becoming routine in emergency department care and the Health Research and
education Trust released an online guide to help implement testing procedures. The Centers for
Disease Control and Prevention recommended voluntary HIV screening as part of routine medical
care last September. They offered support for this guide to help health care providers overcome the
legal and reimbursement concerns in implementing this new procedure. “Emergency departments
are the predominant point of care among patients who have limited access to care,” said Gretchen
Williams Torres, director of research at HRET. “ED-based testing can be a great opportunity to
screen a wide population of patients who would not normally be tested.” HRET is an AHA affiliate.
(AHA News Now, 8/8/07)
Hospitals Boost Patients’ Power As Advisors
After years of confining patient outreach efforts to decor and food service, some hospitals
are creating advisory councils whose members help plan new facilities, set hiring standards, and
interview job candidates, the Wall Street Journal reported. Later this year, Medicare will require
hospitals to publicly disclose patient satisfaction data on the Medicare website in order to receive full
reimbursement for their services. Hospitals now have a strong incentive to increase patient
satisfaction, better respond to complaints, and avoid costly malpractice litigation. The nonprofit
Institute for Family-Centered Care is working with hospitals to create patient and family councils.
Patient advisers “provide a vital perspective on the experience of care that administrators and
providers simply don’t have”, says Beverly H. Johnson, the institute’s founder and chief executive. A
recent survey by the University HealthSystem Consortium, an alliance of large academic centers
and their affiliated hospitals, showed that only half of its members have such councils in place. But
the group has launched a project to help members adopt guidelines from the Institute for Family-
Centered Care. “We are making people aware of how important it is, but there is still a lot of fear
about loss of control” in bringing families and patients into decision making in hospitals, says
project leader Kathy Vermoch. (Wall Street Journal, 8/8/07)

Any questions regarding this newsletter can be directed

to Valerie Pracilio at valerie.pracilio@jefferson.edu or
Bettina Berman bettina.berman@jefferson.edu.