CVS MinuteClinic Application: An Advocacy Timeline

2006

• CVS-MinuteClinics seeks entry into Massachusetts markets by applying for clinic licenses. These applications are not public.
  
  
• Late 2006: MMS is asked by the DPH informally for concerns about retail settings. Staff researches approaches in other states and determines that existing regulations on bathrooms and clinic requirements make this not an issue in Massachusetts.

May 2007

• MMS is asked for comment from the Boston Globe on reports that the DPH intends to circumvent existing regulations by granting nine waivers from existing clinic requirements, and to grant clinic licenses to several MinuteClinics.
  
  
• The MMS objects strongly in the media to granting multiple waivers of basic public protections to MinuteClinics or any other entity. MMS President Ken Peelle engages in media interviews expressing concerns about retail clinics as a model and the pending DPH waiver approvals.
  
  
• May 29: The MMS convenes a group including the Massachusetts League of Community Health Centers, the Massachusetts Hospital Association, the Mass Academy of Family Physicians, the Mass. Chapter of the American Academy of Pediatrics, the Mass Chapter of the American College of Emergency Physicians.

June 2007

• The group calls upon Secretary of EOHHS Bigby and DPH Commissioner Auerbach to deny waivers and hold regulatory hearings on the possible entry of retail based limited clinics to Massachusetts and the Commissioner agrees.
  
  
• June 14: First objection by medical community appears in public, as the Boston Globe carries story about concerns of five provider groups to CVS plans for retail clinics. Additional stories in the days ahead appear throughout Massachusetts media.

July 2007

• DPH Commissioner John Auerbach sends letter indicating that opposition to waivers will be considered in reviewing MinuteClinics’ applications but with no comment on further action or hearings.
  
  
• Joint Press Releases and Calls for Hearings Issued by Massachusetts Medical Society, Massachusetts Hospital Association, Massachusetts Chapter, American Academy of Pediatrics, Massachusetts Academy of Family Physicians, Massachusetts League of Community Health Centers, Massachusetts Psychiatric Society, Massachusetts Chapter of the American College of Physicians, Massachusetts College of Emergency Physicians
  
  
• MMS advocates in all possible ways for public hearings on the issue.

August 2007

• The DPH agrees to shelve the pending applications and waivers and present the issue to the Public Health Council to initiate a regulatory change dealing with retail clinics. At its August meeting the PHC votes to go to immediate public hearing on regulations on September 5. Retail stores will not receive full clinic licenses and waivers will not be granted.
  
  
• Aug. 9: MMS objections to retail clinics receive national airing and platform, as the Wall Street Journal covers the story with an interview with MMS President-Elect Bruce Auerbach, M.D., with continuing coverage from the Boston Globe, and New England Cable News. MMS works with existing and expanding coalition of concerned parties and organizations to identify areas of concern in the regulations.

September 2007

• September 5: Dr. MMS President-Elect Bruce Auerbach, M.D., presents detailed testimony at a public hearing on limited license clinics. In eight pages of testimony, Dr. Auerbach details the concerns about quality, safety, handicapped access, conflicts of interest and other factors in the regulations as proposed. MMS expresses concerns that the proposed regulations simply codify many of the waivers that raised initial objections.  Coalition members participate as well. Nurse practitioners, MinuteClinics, their supervising physician, and others support the regulations.
  
  
• Sept. 6: MMS President-Elect, in Boston Globe interview, calls proposed regulations an "open surrender of basic standards."
  
  
• Sept. 18: A second hearing is held in Worcester with many physicians testifying including the MMS.  On the same day, Boston Globe op-ed by Dr. Auerbach appears, arguing for priority to health and safety issues

October-November

• DPH staff revises proposed regulations without further public review. MMS and others keep up advocacy and media efforts.

November-December

• The coalition sends a personalized letter to each member of the Public Health Council with detailed concerns about the proposed regulations.
  
  
• December 12: The Public Health Council meets and in an unprecedented action rejects the revised regulations and tasks the DPH staff with addressing 13 areas and returning to the council.

January 2008

• Jan. 9: The Public Health Council reviews the proposed regulations, accepts the way in which DPH staff has addressed their prior concerns in numerous areas, amends them to strengthen warnings on tobacco in clinics housed in retail stores that sell tobacco and to require limited clinics to specify provisions for telephone backup and referral. The DPH also commits to an advisory group, a medical director and a dedicated staff person to oversee applications and operations.