Contact: Richard Gulla
781-434-7101
rgulla@mms.org
Waltham/Boston - July 23 - Saying that “the existing regulations are unique in their comprehensive approach to public protection,” the Massachusetts Medical Society (MMS) today testified before the Department of Public Health in strong opposition to proposed changes in public health regulations governing limited service clinics (LSCs).
At issue are proposed regulatory changes required by Chapter 224, the health care cost control bill passed by the legislature last year. These changes would change some requirements for the operation of LSCs and delete language from existing regulations that limit the services the clinics may provide, including those to children and toddlers. Such changes, MMS argued, would serve to promote LSCs as primary care providers, which is contrary to existing law.
In written testimony, MMS said that the current legislative language in Chapter 224 contains significant limitations on care provided by LSCs, but that these limitations do not appear to be reflected in the proposed regulations from the Department of Public Health.
Noting that Chapter 224 declares that “nothing in this section [Chapter 224] shall be interpreted to allow a limited service clinic to serve as a patient’s primary care provider,” the MMS said that the current statutory limitations “realistically reflect the limited role the retail clinics service in providing ambulatory care.”
Specifically, the Medical Society objected to the following proposed changes:
- Limits of Services for LSCs - MMS objected to the deletion of language from existing regulations that defines the limits of services LSC’s may provide, including any service for which it is not licensed, a ban on childhood immunization (except for influenza vaccine), and no treatment for children younger than 24 months.
- Guidelines for practice - MMS objected to a change in the requirement that LSCs develop practice guidelines to one that LSCs simply utilize guidelines, a step the MMS said “may be deference to large corporate guidelines where one size fits all nationally.” The MMS said such a step is “inconsistent with Massachusetts laws regarding supervision of nurse practitioners” and that “national commercial guidelines are not adequate,” as scope of practice may vary by state, by the training of nurse practitioners, and by individual guidelines of a supervising physician.
- Referrals of Repeat Customers - MMS objected to a change in language regarding referral of repeat customers to primary care providers. Current regulations require the referral of repeat customers to primary care providers, but the proposed language only requires policies regarding referrals. “This is inconsistent with the statutory prohibition on serving as a primary care provider and is a significant reduction in the protections existing regulations give to the public,” MMS said.
- Required Disclosures - MMS objected to a change that would eliminate the requirement that LSCs prominently post their services and be replaced by a requirement to prominently disclose available services. Noting that disclosure is an act taken upon request, the MMS testified that “Posting of services is of value to the public. Mandated disclosure is a retail setting is of little value to consumers.”
While the MMS recognized the work the DPH has done in attempting to restructure the regulations regarding LSCs in a manner consistent with legislative requirement, it also urged the DPH to fulfill its role of “protecting the public even as its follows the mandates of the legislature.”
The complete testimony is available at www.massmed.org/testimony
The Massachusetts Medical Society, with more than 24,000 physicians and student members, is dedicated to educating and advocating for the patients and physicians of Massachusetts. The Society, under the auspices of NEJM Group, publishes the New England Journal of Medicine, a leading global medical journal and web site, and NEJM Journal Watch alerts and publications covering 13 specialties. 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.
