CVS MinuteClinics to Open in RI — with Conditions

Rhode Island Director of Health Michael D. Fine today approved an application by CVS Caremark to open seven MinuteClinics across Rhode Island.

Piggybacking the decision is a set of conditions that Fine said are designed to address concerns raised by physicians worried about the effect on quality of care for Rhode Islanders if the application were approved.

The seven clinics would be located in CVS stores in East Greenwich, Cranston, Woonsocket, Wakefield, Providence, Westerly and North Smithfield.

Specifically, physicians raised concerns about potential conflicts of interest with the clinics offering primary care and prescribing meds under the same roof as a pharmacy, the "potential fragmentation of primary care delivery and effect on the primary care business model," and access for patients in underserved communities, Fine said in a statement.

In his analysis included in the approval decision, Fine characterized the concerns as "consternation" and noted that the health marketplace has put them at a disadvantage. They have been "significantly undercapitalized" for many years, working as a business in a world "in which they have little effective market power" because of regulations at the same time they must meet standards of professional practice.

They also are prohibited from selling drugs, making money from self-referrals, and except for group practices, can't own labs or imaging facilities. 

And they're not allowed to combine forces to bargain with insurers outside of forming huge group practices and even then, they're constrained by antitrust laws.

"Given these legal restrictions, it is no surprise that primary care physicians and practices generally have not consolidated, and thus lack the ability to invest in new infrastructure and develop new services," Fine wrote in his decision. "We desperately need to bring new sources of capital investment to build a primary care delivery system that is adequate to address Rhode Island's needs."

Other concerns relate the potential erosion of the primary care practice model and the impact on low-income neighborhoods where nonprofits and neighborhood clinics have been doing the heavy lifting for years. 

The conditions alone aren't the only reason Fine said he approved the application.

"CVS is a great Rhode Island company," Dr. Fine said. "A company whose character, commitment, competence, and standing in the community is well documented. It is likely that these facilities will provide safe and adequate treatment for individuals receiving MinuteClinic services."

And he said he believes that "tired and trapped as it is," the primary care community of Rhode Island "still has the ability to exert major, and even profound, influence on public policy."

He noted the objections of physicians about the sale of tobacco products at CVS during their previous application process. 

"It is possible," he said, that their resistance "had some influence" on the corporations' decision to stop selling tobacco products this year. 

"By going tobacco free, CVS is exemplifying the notion of health in all policies," Fine wrote.

The full decision is attached to this article. Click "download .pdf" to grab it.

Before Woonsocket-based CVS officially gets its license, they must agree to the conditions as well as return final paperwork.

The state Health Services Council voted to recommend approval in an 11-1 vote at its April 29 meeting. Two members abstained from the vote.