AMA Discusses Consumer Clinics, Other Issues
At the annual meeting of its House of Delegates on Sunday, the American Medical Association urged increased oversight of retail-based health clinics, the Chicago Tribune reports. According to the Tribune, the number of retail health clinics -- which lease space from large retailers and provide treatment of routine sicknesses by nurse practitioners -- will increase from less than six establishments five years ago to several hundred projected by the end of 2006.
AMA members testified that the clinics should not be a substitute for traditional doctor-patient care and that they need more uniform state rules mandating closer relationships with physicians. They also expressed concern about the educational levels of nurse practitioners and the suburban locations of the clinics, questioning whether the facilities are "cherry-picking" higher-income patients.
AMA is expected this week to recommend a requirement that doctors be involved in the protocols of the clinics and that nurse practitioners establish a referral system with physician practices, among other proposals, the Tribune reports.
Rebecca Patchin, an AMA board member who is a former nurse, said, "The AMA is concerned about patients who would seek care in a free-standing clinic and have a more serious disease that would not be initially diagnosed or diagnosed quickly" in retail clinics.
Clinic developers and the nurse practitioners on staff maintain that the service is an important and convenient way for consumers to access the health care system, especially for the 45 million uninsured U.S. residents who might not be able to afford traditional doctor visits, according to the Tribune.
Jan Towers, director of health policy for the American Academy of Nurse Practitioners, said, "Access to care is very important. Even with episodic conditions, people end up in an emergency room because they cannot get into a doctor's office, and that costs the health care system" (Japsen, Chicago Tribune, 6/12).
Representatives of the Coalition for Patients' Rights on Thursday urged AMA to stop efforts to block state legislative initiatives that expand the capabilities of nonphysician medical providers, CQ HealthBeat reports.
Mitchell Tobin, senior director of professional practice affairs for the American Association of Nurse Anesthetists and member of the coalition, said AMA has taken its opposition to the health provider groups' expansion efforts -- such as measures that would expand prescription authority for psychologists or reduce the required amount of physician supervision for nurse anesthetists -- "to an all new level." Tobin said AMA has asked its members to commit thousands of dollars to its efforts to block state initiatives.
The AMA is "essentially declaring war on providers who are not physicians," Tobin said, adding, "It is outrageous that the AMA and other physician organizations are attempting to restrict access to our services."
In a statement, AMA's Patchin said that while her group's members "have great respect for all members of the health care team," all medical professionals must have "the clinical education and training to provide the service they perform" (Carey, CQ HealthBeat, 6/9).
AMA this week will consider a proposal from one of its committees to recommend whether the group should lobby for a federal tax on sugar-sweetened soft drinks, with proceeds going toward anti-obesity efforts, the Chicago Sun-Times reports. Soda is "devoid of nutritional value" and contributes to increasing obesity rates, the AMA committee said. According to the committee, one study found that the odds of a child becoming obese increase 60% for each additional can of soda consumed every day.
However, the committee report did note that other studies have found no link between soft drinks and obesity. The committee wants the proceeds of an unspecified tax to go toward initiatives such as physical activity programs and healthier school meals.
Diet soda, flavored milk and sugary fruit drinks should be excluded from the tax, the committee said. The Center for Science in the Public Interest estimated that a one-cent-per-can tax would raise $1.5 billion annually.
More than a dozen states have already imposed such taxes, but several have been repealed, and the funds are usually used for general purposes instead of obesity efforts, according to the Sun-Times.
Taxing soft drinks is "misguided," Kevin Keane of the American Beverage Association said, adding that it would "not move the needle one ounce in addressing health and wellness issues" (Ritter, Chicago Sun-Times, 6/11).