Massachusetts Medical Society Expresses Praise, Caution on State Approval of Limited Service Clinics; Advocates "Medical Home" Concept for Best Care

Contact: Richard P. Gulla 
rgulla@mms.org
781-434-7101
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Waltham, Mass. -- January 10, 2008 -- Bruce Auerbach, M.D., President-Elect of the Massachusetts Medical Society, expressed both praise and caution in reacting to the state's Public Health Council (PHC) approval of revised regulations governing the operation of limited service clinics.

The new regulations were approved at the Council's January 9th meeting, after lengthy discussions about key clinical and operational issues at both its December and January meetings. 

Dr. Auerbach said the Council's actions in strengthening the regulations will enhance the public health and safety of patients who choose to use the facilities for very minor medical problems.

"The medical community's biggest concerns about these clinics -- sanitation and infection control, fragmentation of care, and physician oversight -- have been heard and appear to have been addressed to a significant degree," said Dr. Auerbach. ”The revised regulations are certainly improved from their original version."

The Medical Society, along with organizations representing pediatricians, family physicians, hospitals, and community health centers, had raised a number of concerns about limited service clinics when the Department of Public Health (DPH) received the first application for such a facility in 2006. Among the issues of concern were quality of care, patient privacy, fragmentation of care, sanitation and infection control, and physician oversight.  

As a result of advocacy by the medical community, DPH created a separate set of regulations for limited service clinics. DPH has taken the further step of dedicating additional resources to ensure oversight, to include a staff person to review applications and monitor planning and operations and the assignment of DPH's new Medical Director, Lauren Smith, M.D., to oversee clinical issues and chair an advisory committee.

"The combination of a new regulatory framework and qualified staff to review outcomes and ensure compliance is a substantial improvement and public health commitment," said Dr. Auerbach. "The Council has given a serious and thoughtful look at a major public health issue and acted in the interests of public health and patient care." 

"Limited service clinics may or may not play a role in enabling access for an array of very minor problems, and we have seen no evidence that they actually reduce overall costs to the system or improve access to comprehensive primary care," said Dr. Auerbach. "Further, we know that emergency department overcrowding is a problem that will not be alleviated by any clinic that treats minor problems."

Dr. Auerbach noted that the new regulations do provide for periodic evaluations and reporting to the Public Health Council and set up a mechanism by which they will review newly licensed clinics to assess their value, quality and impact. 

Dr. Auerbach also cautioned patients about using such clinics. "Patients must remember that these clinics will be very limited in what they can treat," said Dr. Auerbach, "and that optimal care will come from having a long-term relationship with a primary care provider, a provider who is not isolated from the system of care. We will continue to advocate for the concept of a "medical home," where patients can establish a long-term physician-patient relationship with a primary care physician. We believe this model provides the best care for patients of all ages." 

Among the key provisions added to the approved regulations or actions planned by the Department of Public Health:

• the assignment of the Department of Public Health's Medical Director to oversee clinical issues and chair an Advisory Committee;
• the assignment of a dedicated Public Health employee to review applications and monitor planning and operations of the clinics;
• new language requiring improvements in sanitation efforts, handicapped accessibility, and interpreter services;
• improved guidelines, in concert with the Bureau of Communicable Diseases, for infection control;
• the review and credentialing of staff qualifications and clinical competencies for pediatric care;
• improving processes for back-up care and referral for more serious conditions; 
• regular reporting to the Public Health Council on the status of limited service clinics before and after becoming operational.

Dr. Auerbach also applauded the Department of Public Health, Secretary Bigby, Commissioner Auerbach, and the Public Health Council for conducting an open and public process, with public hearings, a public comment period, and the willingness to listen to the viewpoints of all interested parties. "The process was an example of transparency at its best," said Dr. Auerbach. 

Dr. Auerbach said that the efforts of the medical community, in advocating for a public and open process in how these new clinics will be established and governed, allowed the public to become more informed about the application procedures for medical clinics, issues of conflict of interest, clinical issues relating to patient care, as well as other issues such as patient privacy, handicapped accessibility, and care for diverse populations.  

The Massachusetts Medical Society, with more than 19,300 physicians and student members, is dedicated to educating and advocating for the patients and physicians of Massachusetts. The Society publishes The New England Journal of Medicine, one of the world’s leading medical journals; the Journal Watch family of professional newsletters covering 11 specialties; and AIDS Clinical Care. The Society is also a leader in continuing medical education for health care professionals throughout Massachusetts, conducting a variety of medical education programs for physicians and health care professionals. Founded in 1781, MMS is the oldest continuously operating medical society in the country.