Retail clinics would spell disaster for community medical homes

Patient access to quality and timely physician care could get even worse if big box store chains are permitted to open medical clinics, as proposed in the New York State Budget.

New York doctors already face an untenable economic squeeze between rising practice costs—led by our notoriously high malpractice costs—and a continued squeeze in payments by health insurers, particularly for primary care services.

Exacerbating these challenges is the de facto requirement that a medical practice invest tens of thousands of dollars for electronic record systems to better manage patient care.

These factors have forced more and more physicians into closing their community practices and joining large health systems to be able to continue to deliver care. In fact, a recent Avalere study reported the number of physicians who have become hospital employees in New York nearly doubled from 2012-2015. The loss of independent practice for physicians may sever many long-time patient relationships, as an employment arrangement may bring with it a change in practice patterns dictated by the employer.

It is hard to overestimate the pivotal role that community primary care and pediatric practices play in managing patient health, either managing chronic conditions such as asthma, diabetes and hypertension, or slowing the progression of these diseases to prevent avoidable hospitalizations. Primary care physicians also coordinate the patient’s care through referrals to needed specialty care physicians, administer immunizations, and remind patients to take their medications and schedule follow-up care.

Simply put, primary physicians are the patient’s “medical home,” a place for patients to trust and depend on for their well-being. Yet the retail clinic proposal would jeopardize these medical homes for many patients. Far from complementing the delivery of care, as they claim, the medical community is very concerned that this proposal will produce an explosion of these big-box, store-owned clinics that will drive more primary care physicians out of practices.

These concerns are exacerbated by the proposed acquisition of health insurer giant Aetna by drug store and drug benefit manager CVS Health. If the merger is approved, it could push the merged entity to selectively contract with these Minute Clinics at the expense of community medical practices.

Coincidentally, of course, these locations will be where patients can have their prescription medications filled. While such care sites have existed in retail stores in New York, there was always an important distinction that assured that the physician, nurse practitioner, or physician assistant providing care not be directly employed by the corporation. The practitioner pays rent for the space.

This arrangement, which protects the independent decision-making of the health care professional against corporate interference, works perfectly fine in many regions of the state.

However, legislative proposals would break down these walls, enabling the corporation to directly employ health care providers to deliver services to the public, breaking a long-standing New York State tradition of prohibiting corporate practice of medical care delivery.

The accumulation of power in our health care system across the pharmaceutical and medical delivery sectors will be harmful for our patients. The New York State Legislature must step up to prevent this proposal from going forward.

— Charles Rothberg, MD, is Immediate Past President of the Medical Society of

the State of New York