Who Could Possibly Object to Expansion of Low-Cost, Convenient Retail Health Clinics in Texas?
By Mark J. Perry
Texas has only about 85 of the 1,200 retail health clinics in the nation. San Antonio does not have a single one. The clinics are popular wherever they exist because nurse practitioners can treat common ailments and minor injuries with little waiting time and fees that average about $60, much less than emergency rooms. The clinics operate evenings and weekends and accept insurance plans. The clinics would represent real health care reform, especially in Texas. Most of the state, 179 counties out of 254, is classified as medically underserved. Among them are 45 metropolitan counties.
MP: Who do you suppose could possibly object to, and successfully block, the expansion of affordable, convenient retail health clinics in Texas, including in the medically underserved areas? Find out here, I am sure you can probably guess.
Legislature shuts door on nurse care
The word in Washington is that health care reform, not immigration or energy, is Congress' top priority this year.
This means universal, or near universal, insurance coverage is likely. Insuring nearly everyone means more health care, right? Wrong. If the number of health care providers remains the same, it means less health care for everyone. If universal coverage materializes, you won't want to fall ill, especially in Texas.
Look at Massachusetts, where waits to see primary care doctors grew to as long as 100 days as of last September. The state's new insurance policy extended coverage in 2006 to 439,000 more people. The number of doctors putting out "no new patients" signs also is rising, the Boston Globe reported.
That is why it is disappointing that bills and amendments died during the Texas legislative session that would have allowed advanced practice nurses to diagnose and to prescribe for common, minor illness and injures without doctor supervision.
You can blame Texas doctors.
Despite better protections from malpractice lawsuits and lower malpractice premiums, Texas has a doctor shortage. Nevertheless, the Texas Medical Association took every step to ensure physicians will have a tight rein on the activities of well-trained nurses.
The barrier against nurses will continue to keep low-fee retail health clinics, such as those operated by Walgreen and CVS drug store chains, from expanding in Texas. The state law requiring doctor supervision adds too much cost to the clinics.
Texas has only about 85 of the 1,200 retail health clinics in the nation. San Antonio does not have a single one. The clinics are popular wherever they exist because nurse practitioners can treat common ailments and minor injuries with little waiting time and fees that average about $60, much less than emergency rooms. The clinics operate evenings and weekends and accept insurance plans.
The clinics would represent real health care reform, especially in Texas. Most of the state, 179 counties out of 254, is classified as medically underserved. Among them are 45 metropolitan counties, including Bexar.
The only bill making it through the Legislature this session expands the geographic limit for nurse practitioners to work at clinics away from their doctors, but it retains doctor supervision.
Houston neurologist Dr. William Fleming III, TMA president, said the association opposes giving prescription authority to nurses because it would "eliminate patient protections afforded by the Texas Medical Board." Nurse prescriptions should be written "only under a physician's care," Fleming said.
State Rep. Wayne Christian, R-Center, disagrees. "The Legislature has given an inch when the people of Texas are in need of a mile. All of the insurance/CHIP/Medicaid/Medicare in the world will be of no use if there is not a provider to provide health care," said Christian, who had no success with a bill giving unsupervised nurses the ability to diagnose and to prescribe, as happens in 33 other states.
Opening more retail clinics in Texas would give doctors more time to treat serious conditions. Doctors still would have plenty of patients.
Nothing will change now until the 2011 legislative session, except for the possibility of even more crowded doctor waiting rooms.
Legislature shuts door on nurse care (23 May 2009)
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