Retail Health Clinics: State Legislation and Laws                                      

Updated: November 2009*.
Compiled by NCSL Health Program staff: Richard Cuachi and Andrew Thangasamy

Retail health clinics have grown in number from a few that first opened in early 2000, to more than 1,100 clinics as of February 2009.  These clinics are generally open seven days a week, with extended weekday hours; no appointments are necessary and visits generally take 15 to 20 minutes due to the limited scope of services offered. The large majority are co-located within a larger retail store, ranging from supermarkets and "big-box" discount super-stores to drug stores.

According to the Convenient Care Association, a trade association for retail clinics, the top medical conditions treated at these clinics include: sore throat, common colds, flu symptoms, cough, and sinus infection.  Visits to these clinics generally cost consumers between $45 and $75.  In some retail clinics, such as MinuteClinics in Minnesota, prices for various medical services are posted on an electronic sign.  Many health insurance companies will cover and reimburse clinic visits and some have waived co-pay fees at these clinics.  A recent study discovered that 67 percent of retail clinic visits were paid for by insurance (Medicare, Medicaid, private insurance, or workers' compensation). In contrast, about 90 percent of visits to primary care physicians are paid by insurance. Most clinics can refer patients to local doctors or emergency rooms and the availability of these clinics can help people avoid emergency rooms.   

As of October 2008, state legislation that specifically addresses these retail clinics has been relatively limited.  However, at least seven states considered legislation and two bills were signed into law, during the 2007-2008 legislative session.  One additional state (Massachusetts) created regulation governing retail clinics through executive action.  State legislators have heard recommendations from interests representing multiple sides of the issue.  Some suggest that such clinics are a positive innovation and should be encouraged by state and local governments.  These and other advocates promote the clinics as a convenient and affordable alternative for people with relatively minor health care needs.  Others suggest caution and may seek to regulate the structure or qualifications of the personnel providing the medical services.  For example, some physician groups have raised concerns about the clinics and whether they will disrupt continuity of care.  Yet others call for a more in-depth study of the issue rather than immediately creating new statutes.

Looking at the business side of retail clinics and worried about conflict of interest, in 2007, New York state regulators investigated business relationships between drugstore companies and retail clinics to examine if patients treated in a retail clinic were being improperly steered to the affliated, onsite pharmacy locations to fill their prescriptions.  In a related issue, New York, Illinois, Rhode Island, and Tennessee recently also considered legislation to limit locations with retail clinics from selling tobacco products.  There has been no federal regulation of retail clinics as of early 2009.

NCSL has published a LegisBrief titled "Retail Store Health Clinics" available for download from the NCSL Bookstore. 

The following chart lists proposed and enacted legislation targeting retail clinics in the states in 2007-2008.

Legislation Table (Highlighted rows indicate signed laws)  

Massachusetts: An Example of Retail Clinic Regulation

In early 2008 Massachusetts created regulations for the operation of retail health clinics, terming them "Limited Services Clinics."  These included a specific list of services that these clinics are limited to providing.  The table below lists those services as provided by Ms. Denise Egan, Limited Services Clinic Coordinator in the Health Care Safety and Quality Bureau of the Massachusetts Department of Public Health. [PowerPoint slides]

RETAIL CLINICS STATE-BY-STATE, February 2009.

Retail clinics have grown not only in their numbers, but also in their overall distribution across the states.  From their beginnings in Minnesota in 2000, retail clinics have spread out to a total of 37 states as of February 2009.  The following map represents the distribution of these clinics across the different states.









Source: Merchant Medicine, LLC.


Scope of Practice Laws for Non-Physician Medical Practitioners

Retail clinics are staffed primarily by non-physician medical practitioners such as nurse practitioners (NPs), advanced nurse practitioners (ANPs), and physician assistants (PAs). State practices and laws vary regarding the flexibility of these non-physician medical practitioners to prescribe drugs and practice medicine.  The following chart summarizes state laws affecting the ability of non-physician medical practitioners to prescribe drugs and practice medicine.

Sources: Survey of Pharmacy Law 2008, National Association of Boards of Pharmacy; Scope of Practice Laws in Health Care: Rethinking the Role of Nurse Practitioners, California Health Care Foundation.

Examples & Expanded Notes from "Scope of Practice" Table
1. FL as part of a debate on the role of retail clinics, limits the number of health care professionals (nurse practitioners and physician assistants) a primary care physician is able to supervise to four (2007 Statute).

2. GA grants Nurse Practitioners prescribing authority under close physician supervision (SB 480 - 2008). 

3. In terms of the ability of some non-physician medical practitioners to prescribe drugs independently, note that some states such as AK, ID, and others require these medical practitioners to prescribe only within the scope of their specialty. 

KEY Dark Blue = MinuteClinic Purple = TakeCare Green = RediClinic Light Blue = TheLittleClinic Turquoise = Wal-Mart Orange = Target

Example: Colorado Health Charges - Comparison, Summer 2009

RAND Corp. study in August examining costs at retail clinics for treating ear infections, sore throats and urinary tract infections. Graphic published by the Denver Post, September 30, 2009 (c)

Health Groups' Statements on Retail Health Clinics
1.  American Academy of Pediatrics Statement in Opposition to Retail Health Clinics. (http://aappolicy.aappublications.org/cgi/content/full/pediatrics;118/6/2561).                                                             
2.  American Academy of Family Physicians Statement of Non-Endorsement of Retail Health Clinics. (http://www.aafp.org/online/en/home/policy/policies/r/retailhealthclinics.html).                                        
3.  Convenient Care Association, which is a trade association of retail clinics, released this report titled,
"Convenient Care Clinics: The Future of Accessible Health Care"
(http://www.convenientcareassociation.org/whitepaperfordistribution.pdf)

NCSL Resources:
1. NCSL Web Conference (archived resource), "Innovations in Health Policy: Retail Clinics and the Health Care Workforce" November 2008.  (http://www.ncsl.org/programs/pubs/ncslwebinars.htm#4)
2. "Retail Clinics: Location, Hours of Operation and Low Cost making them slightly more popular." by Anna C. Spencer, NCSL Staff.  State Health Notes, vol. 23, issue 533, February 17, 2009. (http://www.ncsl.org/programs/health/shn/2009/gs533.htm)

Non - NCSL Research on Retail Clinics
1. White Paper on Retail Clinics, "Convenient Care Clinics: The Future of Accessible Health Care," published by the Convenient Care Association. (http://www.acnpweb.org/files/public/CCAWhitePaperFINAL.pdf)
2. "Health Care in the Express Lane: The Emergence of Retail Clinics," by Mary Kate Scott, Study conducted for the California Health Care Foundation. (http://www.chcf.org/documents/policy/HealthCareInTheExpressLaneRetailClinics.pdf)
3. "Retail Clinics: 2008 Year-End Review and 2009 Outlook," published by Merchant Medicine, LLC. (http://www.merchantmedicine.com/News.cfm?view=21)
4. Mehrotra, Ateev et al. (2008) "Retail Clinics, Primary Care Physicians, and Emergency Departments: A Comparison of Patients' Visits," Health Affairs, vol. 27, number 5, pp. 1272-1282. (http://content.healthaffairs.org/cgi/content/abstract/27/5/1272) (Journal subscription maybe required)
5. "Retail Clinics providing similar quality of care as EDs, Physicians' offices." HealthLeaders Media, September 1, 2009.

Related Media Articles:
"Coloradans shop for health care in retail-store clinics" - Denver Post, 9/30/09.
"Could Walk-In Retail Clinics Help Slow Rising Costs?"  USA Today, 8/24/06. (http://www.usatoday.com/money/industries/health/2006-08-24-walk-in-clinic-usat_x.htm)
"Some Walk-In Clinics Closing After Boom," Minneapolis Star Tribune, 8/11/08 (http://www.startribune.com/business/26850829.html)
"Getting Well While You Shop," TIME, 6/22/09 (http://www.time.com/time/specials/packages/printout/0,29239,1903873_1903925_1903791,00.html)

 
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