Analysis of State Regulations and Policies Governing the Operation and Licensure of Retail Clinics

The recent growth of retail clinics across the United States presents opportunities and challenges for states working to address access, costs, and quality issues within their health delivery systems.  With more than 1,000 sites in 37 states, the emergence of retail clinics as an alternate provider has shaken up traditional health care models and can no longer be viewed as a passing trend for the following reasons:
• Retail clinics are accessible. They are usually found in suburban settings within a drug store, grocery store, or mass merchandise store. They are open during evening and weekend hours, without waits or appointments.
• Retail clinic services often cost less. Because clinics are mostly staffed by lower cost providers such as nurse practitioners and have lower overhead costs, prices for services can be substantially less than alternatives such as an emergency room or urgent care center.
• Retail clinics provide evidence-based care.  They deliver a limited range of services, but all services delivered adhere to established clinical practice guidelines.
Despite these apparent benefits, the growth of retail clinics poses many challenges for states. Many of these challenges are familiar, such as scope of practices issues, corporate practice of medicine laws, and reimbursement policies. But there are other issues for states to consider, including:
• Retail clinics may fragment patient care. By delivering services outside a patient’s medical home, primary care providers may not be aware of immunizations provided or reoccurring problems.
• Retail clinics may provide inappropriate care. Physician groups worry that limited physician oversight and reliance on computerized treatment protocols may lead to serious problems being missed or the wrong care being delivered.
• Retail clinics may strain safety net providers. Some community health centers are concerned that they will have to compete with retail clinics for primary care providers and possibly patients.
This paper explores how states are using their regulatory and licensing tools to promote, structure, or limit the growth of retail clinics. State approaches in these areas differ, as do state interpretations of how existing regulations fit the retail clinic model. While most states are not regulating retail clinics, those that do, provide a variety of approaches that may be useful for those considering future action.
Issue Brief

Retail Clinics

356.4 KB