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Volumn 35, Issue 1, 2009, Pages 205-231

Retail health clinics: How the next innovation in market-driven health care is testing state and federal law

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; COMMERCIAL PHENOMENA; DECISION MAKING; ECONOMIC ASPECT; FINANCIAL MANAGEMENT; GOVERNMENT; HEALTH CARE DELIVERY; HUMAN; LEGAL ASPECT; OUTPATIENT DEPARTMENT; UNITED STATES;

EID: 68049105036     PISSN: 00988588     EISSN: None     Source Type: Journal    
DOI: 10.1177/009885880903500106     Document Type: Note
Times cited : (6)

References (237)
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    • For an overview of consumer-driven health care, and its positive impact on costs, access, convenience, and information, see REGINA HERTZLINGER, CONSUMER-DRIVEN HEALTH CARE: IMPLICATIONS FOR PROVIDERS, PATERS, AND POLICY-MAKERS (2004).
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    • 107, FECs provide the same primary level of care offered at hospital emergency rooms. Though they focus on providing basic primary care, they are capable of handling major trauma and often expected to be "prepared to medically respond to any life or limb threatening condition. ", FECs are often located in consumerfriendly places like shopping center. Id, at 105
    • FECs provide the same primary level of care offered at hospital emergency rooms. Though they focus on providing basic primary care, they are capable of handling major trauma and often expected to be "prepared to medically respond to any life or limb threatening condition. " Mitchell Katzman, Freestanding Emergency Centers: Regulation and Reimbursement, 11 AM. J. L. & MED. 105, 107 (1985). FECs are often located in consumerfriendly places like shopping center. Id. at 105.
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    • California Healthcare Foundation, Urgent care clinics operate during extended hours, offering short waiting times for consumers coming in on a walk-in basis. Id. at 14. They provide services similar to the acute care typically administered by primary care physicians at their private offices, and also more complex episodic care administered at hospital emergency rooms, such as on-site radiology, care of simple fractures, "point-of-care testing, " urinalysis, pregnancy tests, hemoglobin testing, and diagnosis of chest pains, among other things
    • See ROBIN WEINICK & RENEE BETANCOURT, No APPOINTMENT NEEDED: THE RESURGENCE OF URGENT CARE CENTERS IN THE UNITED STATES 7-9 (California Healthcare Foundation 2007), http://www.chcf.org/documents/policy/ NoAppointmentNecessaryUrgentCareCenters.pdf. Urgent care clinics operate during extended hours, offering short waiting times for consumers coming in on a walk-in basis. Id. at 14. They provide services similar to the acute care typically administered by primary care physicians at their private offices, and also more complex episodic care administered at hospital emergency rooms, such as on-site radiology, care of simple fractures, "point-of-care testing, " urinalysis, pregnancy tests, hemoglobin testing, and diagnosis of chest pains, among other things. Id. They do not, however, offer a full suite of emergency room-type treatments. Id. at 5. This is the primary means by which I differentiate urgent care centers from FECs. This distinction becomes important when discussing state regulation of these clinics, which varies depending on the degree of care provided at them. In the case of both FECs and urgent care centers, I primarily refer to independently-owned facilities. Hospital-owned FECs and urgent care centers would fall under various state laws and regulations governing hospitals, making them poor comparisons to RHCs, which are mostly owned by non-hospital corporations.
    • (2007) No Appointment Needed: The Resurgence of Urgent Care Centers in the United States , pp. 7-9
    • Weinick, R.1    Betancourt, R.2
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    • Laura Landro, The Informed Patient: Options Expand For Avoiding Crowded ERs, WALL ST. J., Aug. 6, 2008, at D1, available at http://online.wsj.com/ article/SB121798121529515219.html.
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    • 84900600998 scopus 로고    scopus 로고
    • Mcclinics: "convenient care" clinics are taking off
    • Also known as store-based health clinics, walk-in health clinics, limited services clinics, convenient care clinics, retail-based clinics, and even "McClinics." See generally
    • Also known as store-based health clinics, walk-in health clinics, limited services clinics, convenient care clinics, retail-based clinics, and even "McClinics." See generally McClinics: "Convenient Care" Clinics are Taking Off 383 ECONOMIST 74 (2007).
    • (2007) Economist , vol.383 , pp. 74
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    • Retail health clinics
    • May 15
    • Maria Finarelli & Nivi Pillai, Retail Health Clinics, HOSP. & HEALTH NETWORKS, May 15, 2007, http://www.hhnmag.com/hhnmag-app/jsp/ articledisplay.jsp?dcrpath=HHNMAG/Article/dat a/05MAY2007/070515HHN-Online- Finarelli&domain=HHNMAG.
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    • Evaluating the clinical preparation of physician assistant versus nurse practitioner students and the characteristics of their preceptors
    • Both PAs and NPs provide health care services to patients in various environments and receive their own respective types of licenses to practice medicine. NPs are more specialized in their expertise and deal with the bedside care of patients, while PAs perform the type of services that physicians do, diagnosing and treating illnesses. See
    • Both PAs and NPs provide health care services to patients in various environments and receive their own respective types of licenses to practice medicine. NPs are more specialized in their expertise and deal with the bedside care of patients, while PAs perform the type of services that physicians do, diagnosing and treating illnesses. See Robyn E. Mitchell, Evaluating the Clinical Preparation of Physician Assistant Versus Nurse Practitioner Students and the Characteristics of Their Preceptors, 4 INTERNET J. ACAD. PHYSICIAN ASSISTANTS (2004).
    • (2004) Internet J. Acad. Physician Assistants , vol.4
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    • Retail approach to health care coming under increased scrutiny
    • Common treatments include: bladder infections, strep throat, poison ivy, pregnancy tests, vaccination, removing stitches, writing prescriptions, colds, sunburns, wart removal, sprained ankle care, ear infections, minor burns, etc. See, Sept.
    • Common treatments include: bladder infections, strep throat, poison ivy, pregnancy tests, vaccination, removing stitches, writing prescriptions, colds, sunburns, wart removal, sprained ankle care, ear infections, minor burns, etc. See Jennifer Griffin, Retail Approach to Health Care Coming Under Increased Scrutiny, BIRMINGHAM MED. NEWS, Sept., 2007, http://birmingham.medicalnewsinc. com/news.php?viewStory=996;
    • (2007) Birmingham Med. News
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    • Retail health clinics - and their critics - Growing
    • Aug. 12, available at
    • Anne D'Inocenzio, Retail Health Clinics - and Their Critics - Growing, OAKLAND TRIB., Aug. 12, 2007, available at http://findarticles.com/p/articles/ mi-qn4176/is-/ai-n19476786;
    • (2007) Oakland Trib.
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    • State open to in-store clinics, but delays cvs decision
    • July 18, at, available at
    • Liz Kowalczyk, State Open To In-store Clinics, But Delays CVS Decision, B. GLOBE, July 18, 2007 at B4, available at http://www.boston. com/news/local/articles/2007/07/18/state-open-to-in-store-clinics-but-delays- cvs-decision.
    • (2007) B. Globe
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    • supra note 14. Wait time at emergency rooms, in contrast, averages 222 minutes nation-wide. Tom Costello, NBC News, Nov. 20
    • Griffin, supra note 14. Wait time at emergency rooms, in contrast, averages 222 minutes nation-wide. Tom Costello, NBC News, Hospitals Work to Improve ER Wait Times, Nov. 20, 2006, http://www.msnbc.msn. com/id/15817906.
    • (2006) Hospitals Work to Improve ER Wait Times
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    • Retail clinics attracting those without regular doctors
    • RAND Corp, Sept. 10, available at, RHCs are also proliferating abroad, including Britain
    • RAND Corp, Retail Clinics Attracting Those Without Regular Doctors, WASH. POST, Sept. 10, 2008, available at http://www.washingtonpost.com/wpdyn/content/ article/2008/09/10/AR2008091001849.html. RHCs are also proliferating abroad, including Britain.
    • (2008) Wash. Post
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    • See, supra note 11
    • See McClinics, supra note 11.
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    • RAND, supra note 16.
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    • Most adults satisfied with care at retail-based health clinics
    • Press Release, Apr. 11, hereinafter Retail-Based Health Clinics
    • Press Release, Most Adults Satisfied with Care at Retail-Based Health Clinics, HARRIS INTERACTIVE, Apr. 11, 2007, http://www.harrisinterartive.com/ news/allnewsbydate.asp?NewsID=1201 [hereinafter Retail-Based Health Clinics].
    • (2007) Harris Interactive
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    • One clinic operator stated, "we're learning every day about consumers and the retail world. making these changes has required a mindset shift.', Cal. Health Care Found, available at
    • One clinic operator stated, "[w]e're learning every day about consumers and the retail world... making these changes has required a mindset shift.' MART KATE SCOTT, HEALTH CARE IN THE EXPRESS LANE: RETAIL CLINICS Go MAINSTREAM 12 (Cal. Health Care Found. 2007), available at http://www.chcf.org/ documents/policy/HealthCareInTheExpressLaneRetailClinics2007.pdf.
    • (2007) Health Care in the Express Lane: Retail Clinics Go Mainstream , pp. 12
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    • Compared to the HMO model, "retail clinics offer a trusted brand at the point of service, not at the point of insurance enrollment. This difference opens up many more innovative possibilities regarding customer service and quality." Sage, supra note 5, at
    • Compared to the HMO model, "retail clinics offer a trusted brand at the point of service, not at the point of insurance enrollment. This difference opens up many more innovative possibilities regarding customer service and quality." Sage, supra note 5, at 513.
  • 25
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    • Scope of practice: Need for continuing dialogue
    • 2005, the AMA established the "Scope of Practice Partnership, " a nationwide initiative to restrict non-MD scope of practice. See, Jun. 6
    • In 2005, the AMA established the "Scope of Practice Partnership, " a nationwide initiative to restrict non-MD scope of practice. See Edward L. Langston, Scope of Practice: Need for Continuing Dialogue, AM. MED. NEWS, Jun. 6, 2008, http://www.amaassn.org/amednews/2008/06/02/edca0602.htm.
    • (2008) Am. Med. News
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    • Id. at 2.
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    • Look who's buying retail
    • See, Nov. 19
    • See Andis Robeznieks, Look Who's Buying Retail, MODERN HEALTHCARE, Nov. 19, 2007, http://www.accessmylibrary.com/coms2/summary-0286-33521424-ITM.
    • (2007) Modern Healthcare
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    • Can nurse practitioners and physicians beat parochialism into plowshares?
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    • (2002) Health Affairs , vol.21 , pp. 133
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    • Who needs doctors? physicians wary of retail clinics staffed by nurse practitioners
    • Jun. 21
    • Jim Ritter, Who Needs Doctors? Physicians Wary of Retail Clinics Staffed by Nurse Practitioners, CHICAGO SUN-TIMES, Jun. 21, 2007.
    • (2007) Chicago Sun-Times
    • Ritter, J.1
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    • See Kowalczyk, supra note 14.
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    • supra note 14
    • D'Inocenzio, supra note 14.
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    • Continuity, the medical home, and retail-based clinics
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    • See generally Stephen Berman, Continuity, the Medical Home, and Retail-Based Clinics, 120 PEDIATRICS 1123 (2007), available at http://pediatrics.aappublications.org/cgi/reprint/120/5/1123.
    • (2007) Pediatrics , vol.120 , pp. 1123
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    • See ANNIS, supra note 23, at 4-6.
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    • Interpersonal continuity of care and care outcomes: A critical review
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    • See John W. Saultz & Jennifer Lochner, Interpersonal Continuity of Care and Care Outcomes: A Critical Review, 3 ANNALS FAMILY MED. 159, 164 (2005), available at http://www.annfammed.org/cgi/reprint/3/2/159.
    • (2005) Annals Family Med. , vol.3 , pp. 159
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    • See HANSEN-TURTON ET AL. supra note 22, at 11.
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    • See generally, Sept. 1, Pharmacies are open about their goals to increase prescriptions through their RHCs because pharmaceuticals are a high margin item and "core to their economic model."
    • See generally Chip Means, Retail Clinics' Economics Eyed, HEALTHCARE FINANCE NEWS, Sept. 1, 2007, http://www.healthcarefinancenews.com/printStory. cms?id=6950. Pharmacies are open about their goals to increase prescriptions through their RHCs because pharmaceuticals are a high margin item and "core to their economic model."
    • (2007) Healthcare Finance News
    • Means, C.1
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    • Scott1
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    • See D'Inocenzio, supra note 14.
    • D'Inocenzio1
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    • Study debunks theories on retail health clinics
    • See, Sept. 11, available at
    • See Kathy Robertson, Study Debunks Theories on Retail Health Clinics, SACRAMENTO BUS. J., Sept. 11, 2008, available at http://www.bizjournals.com/ sacramento/stories/2008/09/08/daily51.html.
    • (2008) Sacramento Bus. J.
    • Robertson, K.1
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    • See Convenient Care Association, Convenient Care Quality & Safety Standards, last visited Feb. 12
    • See Convenient Care Association, Convenient Care Quality & Safety Standards, http://www.ccaclinics.org/index.php?option=com-content&view= article&id=6&Itemid=13 (last visited Feb. 12, 2009).
    • (2009)
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    • Are retail clinics a healthy choice?
    • NOV. 7, available at, Note that under such a model, it becomes clear why RHCs are willing to adopt the CCA standards: market conditions already dictate to RHC operators that it is in their financial interests to limit their scope of practice, build electronic record keeping systems, and refer patients to local primary care providers for major treatments
    • Keith Darce, Are Retail Clinics a Healthy Choice?, SAN DIEGO UNION-TRIBUNE, NOV. 7, 2007, available at http://www.signonsandiego.com/ uniontrib/20071107/news-In7clinics.html. Note that under such a model, it becomes clear why RHCs are willing to adopt the CCA standards: market conditions already dictate to RHC operators that it is in their financial interests to limit their scope of practice, build electronic record keeping systems, and refer patients to local primary care providers for major treatments.
    • (2007) San Diego Union-Tribune
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    • See Sage, supra note 5, at 511.
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    • See SCOTT, supra note 19, at 4.
    • Scott1
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    • supra note 11. RHCs were found to be "most cost-effective" in a comparison of providers of strep throat treatments
    • McClinics, supra note 11. RHCs were found to be "most cost-effective" in a comparison of providers of strep throat treatments.
    • McClinics1
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    • HANSEN-TURTON ET AL. supra note 22, at 17.
    • Hansen-Turton1
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    • Use and costs of care in retail clinics versus traditional care sites
    • 1289, available at, The same study found a trend of increasing costs at RHCs over a four-year period of time, though the same effect was calculated in emergency rooms, urgent care clinics, and doctors' offices. Id. at 1289
    • Marcus Thygeson et al., Use and Costs of Care In Retail Clinics Versus Traditional Care Sites, 27 HEALTH AFF. 1283, 1289 (2008), available at http://content.healthaffairs.org/cgi/reprint/27/5/1283. The same study found a trend of increasing costs at RHCs over a four-year period of time, though the same effect was calculated in emergency rooms, urgent care clinics, and doctors' offices. Id. at 1289.
    • (2008) Health Aff. , vol.27 , pp. 1283
    • Thygeson, M.1
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    • See HANSEN-TURTON ET AL. supra note 22, at 17.
    • Hansen-Turton1
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    • SCOTT, supra note 19, at 19-20.
    • Scott1
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    • RAND, Press Release, Retail Medical Clinics Attract Patients Who Do Not Have Regular Health Care Providers Sept 10
    • RAND, Press Release, Retail Medical Clinics Attract Patients Who Do Not Have Regular Health Care Providers (Sept 10, 2008), http://www.rand.org/news/ press/2008/09/10.
    • (2008)
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    • See SCOTT, supra note 19, at 18.
    • Scott1
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    • See ANNIS, supra note 23, at 3.
    • Annis1
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    • National Health Expenditure 2007 Highlights, Centers for Medicare & Medicaid Services, available at
    • National Health Expenditure 2007 Highlights, Centers for Medicare & Medicaid Services, available at http://www.cms.hhs.gov/NationalHealthExpendData/ downloads/highlights.pdf.
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    • See Thygeson et al., supra note 45, at 1290.
    • Thygeson1
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    • Id
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    • One report summarized it aptly: "retail clinics challenge consumers, clinicians, governments, employers, and carriers to address the shortcomings of the traditional health care system by investing in primary care and integrating the lessons they offer for providing better, faster, easier, and cheaper care." See, supra note 19, at
    • One report summarized it aptly: "retail clinics challenge consumers, clinicians, governments, employers, and carriers to address the shortcomings of the traditional health care system by investing in primary care and integrating the lessons they offer for providing better, faster, easier, and cheaper care." See SCOTT, supra note 19, at 23.
    • Scott1
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    • supra note 23, at Executive Summary. For a further look at how primary care physicians are responding
    • ANNIS, supra note 23, at Executive Summary. For a further look at how primary care physicians are responding
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    • see, Sept. 16
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    • Scott1
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    • States boost scrutiny of drugstore clinics
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    • Zachary Seward, States Boost Scrutiny of Drugstore Clinics, WALL ST. J., Aug. 6, 2007, available at http://online.wsj.com/article/SB118661845968892421. html.
    • (2007) Wall St. J.
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    • D'Inocenzio, supra note 14.
    • D'Inocenzio1
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    • Sage1
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    • Hansen-Turton1
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    • Fewer us med students choosing primary care
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    • Carta Johnson, Fewer US Med Students Choosing Primary Care, WASH. POST, Sept. 10, 2008, available at http://www.washingtonpost.com/wpdyn/content/ article/2008/09/09/AR2008090902001.html.
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    • See Christopher J. Conover & Frank A. Sloan, Does Removing Certificate-of-Need Regulations Lead to a Surge in Health Care Spending, 23 J. HEALTH POL. POL'Y & L. 455, 455-457 (1998).
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    • Conover, C.J.1    Sloan, F.A.2
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    • See Nursing Home of Dothan, Inc. v Alabama State Health Planning & Dev. Agency, Ala. App, nursing home
    • See Nursing Home of Dothan, Inc. v Alabama State Health Planning & Dev. Agency, 542 So. 2d 935 (Ala. App 1988) (nursing home) ;
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    • Humana Med. Corp. v. State Health Planning & Dev. Agency, 460 So. 2d 1295 (Ala. App. 1984) (hospital).
    • (1984) So. 2D , vol.460 , pp. 1295
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    • See Auburn Med. Center, Inc. v. East Alabama Health Care Auth., Ala. Civ. App, ambulatory surgical center
    • See Auburn Med. Center, Inc. v. East Alabama Health Care Auth., 847 So. 2d 942 (Ala. Civ. App. 2001) (ambulatory surgical center) ;
    • (2001) So. 2D , vol.847 , pp. 942
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    • State Health Planning & Development Agency v. Baptist Health System, Inc., Ala. Civ. App, rural health clinic
    • State Health Planning & Development Agency v. Baptist Health System, Inc., 766 So. 2d 176 (Ala. Civ. App. 1999) (rural health clinic).
    • (1999) So. 2D , vol.766 , pp. 176
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    • SARAH E. B. STANTON
    • SARAH E. B. STANTON, SURVEY OF STATE CERTIFICATE OF NEED PROGRAMS 9 (2006), http://dls.state.va.us/GROUPS/COPN/meetings/102506/SurveyPPT.pdf.
    • (2006) Survey of State Certificate of Need Programs , vol.9
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    • First retail health clinic opens in area
    • Setting up an RHC costs between $75, 000 to $250, 000, depending on location, size, and scope of services offered. See, Jan. 13, Given that most state CON thresholds are over $1 million, RHCs will not be required to satisfy state CON laws
    • Setting up an RHC costs between $75, 000 to $250, 000, depending on location, size, and scope of services offered. See Christina Rogers, First Retail Health Clinic Opens in Area, ROANOKE TIMES, Jan. 13, 2008, http://www.roanoke.com/business/wb/146862. Given that most state CON thresholds are over $1 million, RHCs will not be required to satisfy state CON laws.
    • (2008) Roanoke Times
    • Rogers, C.1
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    • For list of typical "regulated services, " see, National Conference of State Legislatures, August 21
    • For list of typical "regulated services, " see CERTIFICATE OF NEED: STATE HEALTH LAWS AND PROGRAMS, National Conference of State Legislatures, August 21, 2008, http://www.ncsl.org/programs/health/cert-need.htm.
    • (2008) Certificate of Need: State Health Laws and Programs
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    • See also, supra note 7, at, Recently, urgent care centers in Michigan, New York and Maine had to obtain state CONs before opening their doors
    • See also Katzman, supra note 7, at 112. Recently, urgent care centers in Michigan, New York and Maine had to obtain state CONs before opening their doors.
    • Katzman1
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    • St. Joseph's to open urgent care centers
    • See, Feb. 20
    • See Jay Greene, St. Joseph's to Open Urgent Care Centers, CRAIN'S DETROIT BUSINESS, Feb. 20, 2008, http://www.crainsdetroit.com/article/20080220/SUB/ 401893l69;
    • (2008) Crain'S Detroit Business
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    • Fox hospital to open center for urgent care
    • Mar. 12
    • Carolyn Norton, Fox Hospital to Open Center for Urgent Care, DAILY STAR, Mar. 12, 2002, http://old.thedailystar.com/news/stories/2002/03/12/urgent.html;
    • (2002) Daily Star
    • Norton, C.1
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    • Mid coast hospital proposes expansion
    • Sept. 5
    • Meridith Goad, Mid Coast Hospital Proposes Expansion, PORTLAND PRESS HERALD, Sept. 5, 2008, http://pressherald.mainetoday.com/story.php?id= 208478&ac=PHnws.
    • (2008) Portland Press Herald
    • Goad, M.1
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    • An increasing number of RHCs are being opened by traditional health care providers. See generally, supra note 25
    • An increasing number of RHCs are being opened by traditional health care providers. See generally Robeznieks, supra note 25.
    • Robeznieks1
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    • Center to advance palliative care, corporate practice of medicine doctrine
    • available at
    • MARY H. MICHAL ET AL., CENTER TO ADVANCE PALLIATIVE CARE, CORPORATE PRACTICE OF MEDICINE DOCTRINE 50 STATE SURVEY 2 (2006), available at http://www.nhpco.org/files/public/palliativecare/corporate-practice-of-medicine- 50-statesummary.pdf.
    • (2006) State Survey , vol.50 , pp. 2
    • Michal, M.H.1
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    • supra note 90, at
    • MICHAL ET AL., supra note 90, at 2.
    • Michal1
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    • supra note 90, at
    • MICHAL ET AL., supra note 90, at 2.
    • Michal1
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    • See, &, supra note 8, at
    • See WEINICK & BETANCOURT, supra note 8, at 7.
    • Weinick1    Betancourt2
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    • See id, at
    • See id. at 13.
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    • supra note 5, at
    • Sage, supra note 5, at 504.
    • Sage1
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    • It is important to note, however, that some states with CPOM prohibitions on the books do not enforce them. See, supra note 90, at
    • It is important to note, however, that some states with CPOM prohibitions on the books do not enforce them. See MICHAL ET AL., supra note 90, at 2.
    • Michal1
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    • See, supra note 19, at
    • See SCOTT, supra note 19, at 22-25.
    • Scott1
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    • On-call goes retail: Defining the doctors' role
    • For an example of such a relationship, see, Sept. 11
    • For an example of such a relationship, see Tyler Chin, On-call Goes Retail: Defining the Doctors' Role, AMERICAN MEDICAL NEWS, Sept. 11, 2006, http://www.amaassn.org/amednews/2006/09/11/bisa0911.htm.
    • (2006) American Medical News
    • Chin, T.1
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    • supra note 90, at, 10. Other states include: Indiana, Mississippi Iowa, Louisiana, New Mexico, Ohio, Utah, and Tennessee
    • MICHAL ET AL., supra note 90, at 2, 10. Other states include: Indiana, Mississippi Iowa, Louisiana, New Mexico, Ohio, Utah, and Tennessee.
    • Michal1
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    • See id, at
    • See id. at 6-17.
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    • See, §, West
    • See CAL. BUS. & PROF. CODE § 2400 (West 2003) ;
    • (2003) Cal. Bus. & Prof. Code , pp. 2400
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    • supra note 41
    • Darce, supra note 41;
    • Darce1
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    • SCOTT, supra note 19, at 24.
    • Scott1
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    • Convenient medical clinics: Reshaping the healthcare landscape
    • June
    • Ronald Schmidt et al., Convenient Medical Clinics: Reshaping the Healthcare Landscape, HEALTH FINANCIAL MANAGEMENT, June, 2007, http://findarticles.com/p/articles/mi-m3257/is-6-61/ai-n19311747/pg-1.
    • (2007) Health Financial Management
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    • 07-116, 3, available at
    • 07-116 Op. Tenn. Att'y Gen. 2, 3 (2007), available at http://www.attorneygeneral.state.tn. us/op/2007/OP/OP116.pdf.
    • (2007) Op. Tenn. Att'Y. Gen. , pp. 2
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    • § 13:35-6.16 f 4 i, New Jersey: "health care facility or health care provider'
    • N. J. ADMIN. CODE § 13:35-6.16 (f) (4) (i) (2009) (New Jersey: "health care facility or health care provider') ;
    • (2009) N. J. Admin. Code
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    • § 25-22.5-l-2 a 22 E, Indiana: "health facility"
    • IND. ADMIN. CODE § 25-22.5-l-2 (a) (22) (E) (2009) (Indiana: "health facility").
    • (2009) Ind. Admin. Code
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    • supra note 90, at
    • FURROW ET AL., supra note 90, at 79.
    • Furrow1
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    • Eliminating scope of practice and licensing laws to improve health care
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    • (2003) J. L. Med. & Ethics , vol.31 , pp. 236
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    • See id
    • See id.
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    • Information about pas and the pa profession
    • addition to providing basic care, PAs can prescribe medication in all 50 states. See, last visited Mar. 3
    • In addition to providing basic care, PAs can prescribe medication in all 50 states. See Am. Acad. Physician Assistants, Information About PAs and the PA Profession, http://www.aapa.org/geninfol.html (last visited Mar. 3, 2008).
    • (2008) Am. Acad. Physician Assistants
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    • See, supra note 22, at, 13. One state that recently attempted to buck this trend, Georgia, ultimately rejected a bill that would have prohibited NPs from practicing in retail settings. H. B. 603, Ga. 2006, available at
    • See HANSEN-TURTON ET AL., supra note 22, at 9, 13. One state that recently attempted to buck this trend, Georgia, ultimately rejected a bill that would have prohibited NPs from practicing in retail settings. H. B. 603, 2006 Gen. Assem., Reg. Sess. (Ga. 2006), available at http://www.legis.ga.gov/legis/ 2005-06/pdf/sb603.pdf.
    • (2006) Gen. Assem., Reg. Sess , pp. 9
    • Hansen-Turton1
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    • See, supra note 26, at
    • See Phillips Jr. et al., supra note 26, at 135-36.
    • Phillips, Jr.1
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    • The primary care paradigm shift: An overview of the state-level legal framework governing nurse practitioner practice
    • 25-26
    • Ann Ritter & Tine Hansen-Turton, The Primary Care Paradigm Shift: An Overview of the State-Level Legal Framework Governing Nurse Practitioner Practice, 20 HEALTH LAW. 21, 25-26 (2008).
    • (2008) Health Law , vol.20 , pp. 21
    • Ritter, A.1    Hansen-Turton, T.2
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    • HANSEN-TURTON ET AL., supra note 22, at 10.
    • Hansen-Turton1
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    • Physician assistant and nurse practitioner prescribing: 1997-2002
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    • Hooker, R.S.1    Cipher, D.J.2
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    • See, supra note 19, at
    • See SCOTT, supra note 19, at 26.
    • Scott1
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    • H. B, 2007, Pa, available at
    • H. B. 1253, 2007 Gen. Assem., Reg. Sess. (Pa. 2007), available at http://www.legis.state.pa.us/cfdocs/legis/PN/Public/btCheck.cfm?txtType= HTM&sessYr=20 07&sessInd=0&billBody=H&billTyp=B&billNbr= 1253&pn=1548.
    • (2007) Gen. Assem., Reg. Sess , vol.1253
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    • Ama's backing to boost retailer health clinics
    • December 22, at
    • Gregory Lopes, AMA's Backing to Boost Retailer Health Clinics, WASH. TIMES, December 22, 2007, at A01.
    • (2007) Wash. Times
    • Lopes, G.1
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    • Id
    • Id.
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    • Some clinics are moving towards offering a "full suite of acute and preventive care.", supra note 19, at, Clinical services at RHCs are expected to "expand as new medical devices enable rapid, accurate, binary diagnoses."
    • Some clinics are moving towards offering a "full suite of acute and preventive care." SCOTT, supra note 19, at 6. Clinical services at RHCs are expected to "expand as new medical devices enable rapid, accurate, binary diagnoses."
    • Scott1
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    • Id, at, Some examples mentioned include: imaging devices services, disease management, and "wellness" services including "school physicals, diabetes screening programs, nutrition counseling, hearing tests, and asthma medication. "
    • Id. at 3. Some examples mentioned include: imaging devices services, disease management, and "wellness" services (including "school physicals, diabetes screening programs, nutrition counseling, hearing tests, and asthma medication. ")
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    • Id, at, 30
    • Id. at 29, 30.
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    • Retail clinics contend with regulations
    • States with such limitations that are not mentioned below also include: Alabama, South Dakota, Illinois, and Virginia. See, Sept. 24
    • States with such limitations that are not mentioned below also include: Alabama, South Dakota, Illinois, and Virginia. See Antoinette Alexander, Retail Clinics Contend with Regulations, DRUG STORE NEWS, Sept. 24, 2007, http://findarticles.com/p/articles/mi-m3374/is-12-29/ai-n21053464.
    • (2007) Drug Store News
    • Alexander, A.1
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    • supra note 19, at
    • SCOTT, supra note 19, at 22.
    • Scott1
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    • See discussion above supra Part III i
    • See discussion above supra Part III (i).
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    • 85036770325 scopus 로고    scopus 로고
    • "It is attached to the old model of providing healthcare services with the idea that the doctor is in their office with the nurse practitioner all of the time, and it is very different from our members' model where you have one nurse practitioner in many different sites." Alexander, supra note 119
    • "It is attached to the old model of providing healthcare services with the idea that the doctor is in their office with the nurse practitioner all of the time, and it is very different from our members' model where you have one nurse practitioner in many different sites." Alexander, supra note 119.
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    • See, supra note 26, at
    • See Phillips Jr. et al., supra note 26, at 137.
    • Phillips, Jr.1
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    • See, supra note 23
    • See ANNIS, supra note 23.
    • Annis1
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    • H. R, 2006, Fla, available at, The Board subsequently limited the number to four licensed health care practitioners per supervising physician
    • H. R. 669, 2006 Gen. Assem., Reg. Sess. (Fla. 2006), available at http://www.flsenate.gov/data/session/2006/House/bills/billtext/pdf/h069900.pdf. The Board subsequently limited the number to four licensed health care practitioners per supervising physician.
    • (2006) Gen. Assem., Reg. Sess , vol.669
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    • Physicians pushing state lawmakers to regulate burgeoning retail clinics
    • See, Jun. 4
    • See Kevin B. O'Reilly, Physicians Pushing State Lawmakers to Regulate Burgeoning Retail Clinics, AM. MED. NEWS, Jun. 4, 2007, http://www.amaassn.org/ amednews/2007/06/04/prl10604.htm.
    • (2007) Am. Med. News
    • O'Reilly, K.B.1
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    • supra note 125. Georgia recently considered a law that would have specifically prohibited NP prescription authority at clinics housed in retail locations with an on-site pharmacy
    • O'Reilly, supra note 125. Georgia recently considered a law that would have specifically prohibited NP prescription authority at clinics housed in retail locations with an on-site pharmacy.
    • O'Reilly1
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    • supra note 19, at
    • SCOTT, supra note 19, at 22.
    • Scott1
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    • regulations affect any "free-standing urgent care center, " which is defined as "a location, distinct from a hospital emergency room, a physician's office, or a free-standing clinic, whose purpose is to diagnose and treat illness or injury for unscheduled, ambulatory patients seeking immediate medical attention. ", MD. CODE REGS. 10.09.77.01
    • The regulations affect any "free-standing urgent care center, " which is defined as "a location, distinct from a hospital emergency room, a physician's office, or a free-standing clinic, whose purpose is to diagnose and treat illness or injury for unscheduled, ambulatory patients seeking immediate medical attention. " MD. CODE REGS. 10.09.77.01 (2008).
    • (2008)
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    • 14-090-010, § 10.0 Weil, available at
    • 14-090-010 R. I. CODE R. § 10.0 (Weil 2008), available at http://www2.sec.state.ri.us/dar/regdocs/released/pdf/DOH/DOH-3495.pdf.
    • (2008) R. I. Code R.
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    • 16-4000-4404, § 10.1.2 Weil, available at
    • 16-4000-4404 DEL. CODE REGS. § 10.1.2 (Weil 2008), available at http://regulations.delaware.gov/AdminC ode/title16/4000/4400/4404.shtml.
    • (2008) Del. Code Regs
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    • See, H. R, Tex, available at
    • See H. R. 1096, 80th Gen Assem., Reg Sess. (Tex. 2007), available at http://www.legis.state.tx.us/tlo docs/80R/billtext/pdf/HB01096I.pdf.
    • (2007) 80Th Gen. Assem., Reg Sess , pp. 1096
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    • Physician assistants act 46
    • See, §, e 5
    • See Physician Assistants Act 46, 63 PA. CONS. STAT. § 13 (e) (5) (2007).
    • (2007) Pa. Cons. Stat. , vol.63 , pp. 13
  • 156
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    • 140.313
    • MASS. CODE REGS. 140.313 (2008).
    • (2008) Mass. Code Regs. , vol.105
  • 157
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    • H. R, Ill, available at
    • H. R. 5372, 95th Gen. Assem. (Ill. 2008), available at http://www.ilga.gov/legislation/BillStatus.asp? DocNum=5372&GAID= 9&DocTypeID=HB&LegId=36672&SessionID=51&GA=95.
    • (2008) 95Th Gen. Assem. , pp. 5372
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    • See, supra note 119
    • See Alexander, supra note 119.
    • Alexander1
  • 159
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    • supra note 14
    • Griffin, supra note 14.
    • Griffin1
  • 160
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    • See, supra note 7, at
    • See Katzman, supra note 7, at 111-12.
    • Katzman1
  • 161
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    • See, 50/32.5
    • See 210 ILL. COMP. STAT. 50/32.5 (2004).
    • (2004) Ill. Comp. Stat. , vol.210
  • 162
    • 85036725738 scopus 로고    scopus 로고
    • Defined as a facility separate from a hospital that displays itself to the public as offering "immediate medical treatment" for "life-threatening medical condition, " and is "capable of treating all medical emergencies that have life-threatening potential." 16-4000-4404, § 1.0 Weil
    • Defined as a facility separate from a hospital that displays itself to the public as offering "immediate medical treatment" for "life-threatening medical condition, " and is "capable of treating all medical emergencies that have life-threatening potential." 16-4000-4404 DEL. CODE REGS. § 1.0 (Weil 2009).
    • (2009) Del. Code Regs.
  • 163
    • 85036727812 scopus 로고    scopus 로고
    • Id. at §
    • Id. at § 9.0.
  • 164
    • 72549106899 scopus 로고    scopus 로고
    • process includes demonstrating a commitment to maintaining "safe and adequate treatment" and a high quality of care, § 23-17-3, Weil, An FEC is defined broadly as any non-hospital facility providing "prompt emergency medical care."
    • The process includes demonstrating a commitment to maintaining "safe and adequate treatment" and a high quality of care. R. I. GEN. LAWS § 23-17-3 (Weil 2008). An FEC is defined broadly as any non-hospital facility providing "prompt emergency medical care."
    • (2008) R. I. Gen. Laws
  • 165
    • 85036763935 scopus 로고    scopus 로고
    • Id. at §
    • Id. at § 1.1.
  • 166
    • 85036771467 scopus 로고    scopus 로고
    • Id. at §
    • Id. at § 5.0.
  • 167
    • 85036732354 scopus 로고    scopus 로고
    • Id. at § 7.0, 8.0, & 9.0 requiring a governing board, administrator, and medical director
    • Id. at § 7.0, 8.0, & 9.0 (requiring a governing board, administrator, and medical director).
  • 168
    • 85036737241 scopus 로고    scopus 로고
    • Id. at § 15.0-18.0
    • Id. at § 15.0-18.0.
  • 169
    • 85036750341 scopus 로고    scopus 로고
    • Id. at § 19-21
    • Id. at § 19-21.
  • 170
    • 85036762419 scopus 로고    scopus 로고
    • Defined as a non-hospital health care facility with a "separate staff functioning under. a clinic administrator or health officer" which provides "ambulatory health services.", 10.09.08.01
    • Defined as a non-hospital health care facility with a "separate staff functioning under... a clinic administrator or health officer" which provides "ambulatory health services." MD. CODE REGS. 10.09.08.01.
    • Md. Code Regs.
  • 171
    • 77951021642 scopus 로고    scopus 로고
    • See, 10.09.36.02
    • See MD. CODE REGS. 10.09.36.02 (2008).
    • (2008) Md. Code Regs.
  • 172
    • 77950979780 scopus 로고    scopus 로고
    • See, 10.09.08.02
    • See MD. CODE REGS. 10.09.08.02 (2008) ;
    • (2008) Md. Code Regs.
  • 173
    • 77950978576 scopus 로고    scopus 로고
    • 10.09.77.02
    • MD. CODE REGS. 10.09.77.02 (2008).
    • (2008) Md. Code Regs.
  • 174
    • 77951008348 scopus 로고    scopus 로고
    • See, 10.09.08.03
    • See MD. CODE REGS. 10.09.08.03 (2008) ;
    • (2008) Md. Code Regs.
  • 175
    • 77951003387 scopus 로고    scopus 로고
    • 10.09.77.03
    • MD. CODE REGS. 10.09.77.03 (2008).
    • (2008) Md. Code Regs.
  • 176
    • 0347306537 scopus 로고    scopus 로고
    • A freestanding urgent care center is defined as an "outpatient treatment center" that is open 24-hours and provides "unscheduled medical services that are not otherwise routinely available in primary care physician offices.", §, A 21
    • A freestanding urgent care center is defined as an "outpatient treatment center" that is open 24-hours and provides "unscheduled medical services that are not otherwise routinely available in primary care physician offices." ARIZ. REV. STAT. ANN. § 36-401 (A) (21) (2003).
    • (2003) Ariz. Rev. Stat. Ann. , pp. 36-401
  • 177
  • 178
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    • See, &, supra note 8, at
    • See WEINICK & BETANCOURT, supra note 8, at 22.
    • Weinick1    Betancourt2
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    • See, supra note 7, at
    • See Katzman, supra note 7, at 112.
    • Katzman1
  • 180
    • 85036734473 scopus 로고    scopus 로고
    • Speaking of physician licensure in the context of FECs, one author noted that "licensure regulations do not address the adequacy of the facility, equipment, or ancillary personnel." Id
    • Speaking of physician licensure in the context of FECs, one author noted that "licensure regulations do not address the adequacy of the facility, equipment, or ancillary personnel." Id.
  • 181
    • 85036758670 scopus 로고    scopus 로고
    • Massachusetts Secretary of Health and Human Services, Judy Ann Bigby, on drafting RHC-specific licensing in her state: "it became clear from our review that the current Department of Public Health regulations governing medical clinics don't address the operation of medical clinics with limited scopes of services. Rather than considering applications that require numerous waivers, we believe we should consider an alternative set of regulations that, if approved, will make the application process for operating limited service medical clinics transparent to any entity that feels they have a role in their community."
    • Massachusetts Secretary of Health and Human Services, Judy Ann Bigby, on drafting RHC-specific licensing in her state: "[i]t became clear from our review that the current Department of Public Health regulations governing medical clinics don't address the operation of medical clinics with limited scopes of services. Rather than considering applications that require numerous waivers, we believe we should consider an alternative set of regulations that, if approved, will make the application process for operating limited service medical clinics transparent to any entity that feels they have a role in their community."
  • 182
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    • See, supra note 119
    • See Alexander, supra note 119.
    • Alexander1
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    • 1001, available at
    • MASS. CODE. REGS. 140. 1001 (2008), available at http://www.mass.gov/ Eeohhs2/docs/dph/regs/105cmr140.pdf.
    • (2008) Mass. Code. Regs. , vol.105 , pp. 140
  • 184
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    • Id
    • Id.
  • 185
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    • H. B, §, a, Ill, available at
    • th Gen. Assem., Reg. Sess. § 25 (a) (Ill. 2008), available at http://www.ilga.gov/legislation/fulltext.asp?DocName= &SessionId=51&GA=95&DocTypeId= HB&DocNum=5372&GAID= 9&LegID=36672&SpecSess=&Session=.
    • (2008) Th Gen. Assem., Reg. Sess. , vol.25 , pp. 5372
  • 186
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    • Id. § 25 a 1
    • Id. § 25 (a) (1).
  • 187
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    • Id. § 25 a 2
    • Id. § 25 (a) (2).
  • 188
    • 85036724354 scopus 로고    scopus 로고
    • Id. § 25 a 4
    • Id. § 25 (a) (4).
  • 189
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    • Id. § 25 a 5
    • Id. § 25 (a) (5).
  • 190
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    • Id. § 25 a 6
    • Id. § 25 (a) (6).
  • 191
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    • Id. § 45
    • Id. § 45.
  • 192
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    • Id. § 50
    • Id. § 50.
  • 193
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    • See discussion supra in Part III ii
    • See discussion supra in Part III (ii).
  • 194
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    • Id. § 105
    • Id. § 105.
  • 195
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    • See discussion supra in Part III ii
    • See discussion supra in Part III (ii).
  • 196
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    • See Letter from, State Representative, State of Illinois 5 May 29, available at
    • See Letter from Maureen K. Ohlhausen et al., Federal Trade Commission, to Hon. Elaine Nekritz, State Representative, State of Illinois 5 (May 29, 2008), available at http://www.ftc.gov/os/2008/06/V080013letter.pdf.
    • (2008) Federal Trade Commission, to Hon. Elaine Nekritz
    • Ohlhausen, M.K.1
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    • Id, at
    • Id. at 8.
  • 198
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    • Id, at
    • Id. at 6.
  • 199
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    • Id, at
    • Id. at 7.
  • 200
    • 85036731869 scopus 로고    scopus 로고
    • at
    • Id. at 1-2.
  • 201
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    • See H. R, § 25 a 3 Ill, available at
    • See H. R. 1885, 95th Gen. Assem., Reg. Sess. § 25 (a) (3) (Ill. 2007), available at http://www.ilga.gov/legislation/95/HB/PDF/09500HBl885lv. pdf.
    • (1885) 95Th Gen. Assem., Reg. Sess.
  • 202
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    • Id. § 25 a 8
    • Id. § 25 (a) (8).
  • 203
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    • Id. § 25 a 9
    • Id. § 25 (a) (9).
  • 204
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    • First retail clinic opens in medway drugstore
    • See, Sept. 17, available at
    • See Elizabeth Cooney, First Retail Clinic Opens in Medway Drugstore, B. GLOBE, Sept. 17, 2008, available at http://www.boston. com/news/health/blog/ 2008/09/first-retail-cl.html.
    • (2008) B. Globe
    • Cooney, E.1
  • 205
    • 85036724106 scopus 로고    scopus 로고
    • See discussion supra at Part III i
    • See discussion supra at Part III (i).
  • 206
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    • See H. R, 12008, New Hamp, available at
    • See H. R. 1484, 12008 Gen. Assem., Reg. Sess. (New Hamp. 2008), available at http://www.gencourt.state.nh.us/legislation/2008/HB1484.html.
    • (2008) Gen. Assem., Reg. Sess. , vol.1484
  • 207
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    • § 1395nn, Stark II
    • U. S. C. § 1395nn (1998) (Stark II) ;
    • (1998) U. S. C. , vol.42
  • 208
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    • § 1320a-7b, anti-kickback
    • USC § 1320a-7b (1994) (anti-kickback).
    • (1994) USC , vol.42
  • 209
    • 85036758762 scopus 로고    scopus 로고
    • analyzing the impact of Stark II and anti-kickback law on RHCs, it should be noted that those choosing not to accept Medicaid and Medicare reimbursements fall outside the reach of both statutes
    • In analyzing the impact of Stark II and anti-kickback law on RHCs, it should be noted that those choosing not to accept Medicaid and Medicare reimbursements fall outside the reach of both statutes.
  • 210
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    • The medicare-medicaid anti-fraud and abuse amendments: Their impact on the present health care system
    • 692
    • Theodore N. NcDowell, The Medicare-Medicaid Anti-Fraud and Abuse Amendments: Their Impact on the Present Health Care System, 36 EMORY L. J. 691, 692 (1987).
    • (1987) Emory L. J. , vol.36 , pp. 691
    • NcDowell, T.N.1
  • 211
    • 85036726411 scopus 로고    scopus 로고
    • Neither the Centers for Medicare and Medicaid Services nor the Health and Human Services Office of Inspector General have yet issued any advisory opinions regarding RHCs
    • Neither the Centers for Medicare and Medicaid Services nor the Health and Human Services Office of Inspector General have yet issued any advisory opinions regarding RHCs.
  • 212
    • 85036765221 scopus 로고    scopus 로고
    • Clinic operators tout quality care after ama complaint
    • Sept. 24
    • Clinic Operators Tout Quality Care After AMA Complaint, DRUG STORE NEWS, Sept. 24, 2007, http://findarticles.com/p/articles/mi-m3374/is-12-29/ai- n21053480.
    • (2007) Drug Store News
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    • § 1395nn a 1
    • U. S. C. § 1395nn (a) (1) (1998).
    • (1998) U. S. C. , vol.42
  • 214
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    • Id. § 1395nn a 1 B
    • Id. § 1395nn (a) (1) (B).
  • 215
    • 85036724780 scopus 로고    scopus 로고
    • Id. § 1395nn a 1 A
    • Id. § 1395nn (a) (1) (A).
  • 216
    • 85036728560 scopus 로고    scopus 로고
    • However, some states have passed comparable laws for non-federal programs. See, Anti-Kickback Law and Suspect Financial Agreements: FAQ, last visited Nov. 25
    • However, some states have passed comparable laws for non-federal programs. See Am. Coll. Radiology Bulletin, Anti-Kickback Law and Suspect Financial Agreements: FAQ, http://www.acr.org/SecondaryMainMenuCategories/ BusinessPracticeIssues/FeaturedCategor ies/AntiKickback/ AntiKickbackLawandSuspectFinancialAgreementsFAQDoc3.aspx (last visited Nov. 25, 2008).
    • (2008) Am. Coll. Radiology Bulletin
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    • supra note 67, at
    • Mehrotra et al., supra note 67, at 1272.
    • Mehrotra1
  • 218
    • 85036770385 scopus 로고    scopus 로고
    • For a list of the DHS, as released by the Centers for Medicare & Medicaid Services, see HHS.gov, List of CPT1/HCPCS Codes Used to Describe Certain DHS Categories, last visited Mar. 3
    • For a list of the DHS, as released by the Centers for Medicare & Medicaid Services, see HHS.gov, List of CPT1/HCPCS Codes Used to Describe Certain DHS Categories, http://www.cms.hhs.gov/apps/ama/license.asp?file=/ PhysicianSelfReferral/downloads/2008 CodelistpublFR1-15-08.zip (last visited Mar. 3, 2009).
    • (2009)
  • 219
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    • See, supra note 68
    • See Rice, supra note 68;
    • Rice1
  • 220
    • 85036724238 scopus 로고    scopus 로고
    • supra note 22, at
    • HANSEN-TURTON ET AL., supra note 22, at 5.
    • Hansen-Turton1
  • 221
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    • ". if a nurse practitioner employee is free to refer to the entity of his or her choice, and the nurse practitioner independently chooses to refer to an entity in which her or her employer has a financial relationship, it is not clear that a Stark violation has taken place. The Office of the Inspector General has said that in such a case it would evaluate the specific facts of the situation. ", 2d ed
    • "... if a nurse practitioner employee is free to refer to the entity of his or her choice, and the nurse practitioner independently chooses to refer to an entity in which her or her employer has a financial relationship, it is not clear that a Stark violation has taken place. The Office of the Inspector General has said that in such a case it would evaluate the specific facts of the situation. " CAROLYN BUPPERT, NURSE PRACTITIONER'S BUSINESS PRACTICE & LEGAL GUIDE 141 (2d ed. 2004).
    • (2004) Nurse Practitioner's Business Practice & Legal Guide , pp. 141
    • Buppert, C.1
  • 222
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    • 880, "Moreover, referrals made by nonphysician practitioners generally do not implicate section 1877 of the Act, which focuses exclusively on referrals by physicians. However, if a referral made by a physician assistant or nurse practitioner or other nonphysician is directed or controlled by a physician, we are treating the referral as an indirect referral made by the directing or controlling physician, who is, in fact, the 'referring physician. ' This interpretation is necessary to prevent the use of nonphysician practitioners to circumvent section 1877 of the Act." Medicare and Medicaid Programs; Physicians' Referrals to Health Care Entities, Jan. 4, When I use the term "physician" hereinafter, I also mean NPs and PAs imputed to a physician
    • "Moreover, referrals made by nonphysician practitioners generally do not implicate section 1877 of the Act, which focuses exclusively on referrals by physicians. However, if a referral made by a physician assistant or nurse practitioner (or other nonphysician) is directed or controlled by a physician, we are treating the referral as an indirect referral made by the directing or controlling physician, who is, in fact, the 'referring physician. ' This interpretation is necessary to prevent the use of nonphysician practitioners to circumvent section 1877 of the Act." Medicare and Medicaid Programs; Physicians' Referrals to Health Care Entities, 66 Fed. Reg. 856, 880 (Jan. 4, 2001). When I use the term "physician" hereinafter, I also mean NPs and PAs imputed to a physician.
    • (2001) Fed. Reg. , vol.66 , pp. 856
  • 223
    • 85036726814 scopus 로고    scopus 로고
    • supra note 19, at
    • SCOTT, supra note 19, at 4.
    • Scott1
  • 224
    • 85036744419 scopus 로고    scopus 로고
    • exception requires that the compensation agreement be written out, detailing the services to be provided by the referring physician, for a specific period of time, and the amount paid to be fixed at fair market value and to not vary with the volume or value of the referrals. See, § 1395nn e 3
    • The exception requires that the compensation agreement be written out, detailing the services to be provided by the referring physician, for a specific period of time, and the amount paid to be fixed at fair market value and to not vary with the volume or value of the referrals. See 42 U. S. C. § 1395nn (e) (3) (1998).
    • (1998) U. S. C. , vol.42
  • 225
    • 85036726695 scopus 로고    scopus 로고
    • exception requires that payments made to the lessor be detailed in writing, the space allocated be a reasonable size, the term be over one year long, the rent amount fixed and at fair market value, and that the "lease would be commercially reasonable even if no referrals were made between the parties." See id, § 1395nn e 1 A. The last element may be the most difficult to prove because it seems doubtful that pharmacies would house RHCs if not for the anticipated revenue from drug prescription referrals
    • The exception requires that payments made to the lessor be detailed in writing, the space allocated be a reasonable size, the term be over one year long, the rent amount fixed and at fair market value, and that the "lease would be commercially reasonable even if no referrals were made between the parties." See id. 42 U. S. C. § 1395nn (e) (1) (A). The last element may be the most difficult to prove because it seems doubtful that pharmacies would house RHCs if not for the anticipated revenue from drug prescription referrals.
    • U. S. C. , vol.42
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    • See, supra note 19, at
    • See SCOTT, supra note 19, at 12.
    • Scott1
  • 227
    • 85036731533 scopus 로고    scopus 로고
    • Among other requirements, the compensation arrangement with the employed physician has to be for fair market value and cannot be affected by the volume or value of referrals. See, § 1395nn e 2
    • Among other requirements, the compensation arrangement with the employed physician has to be for fair market value and cannot be affected by the volume or value of referrals. See 42 U. S. C. § 1395nn (e) (2) (1998).
    • (1998) U. S. C. , vol.42
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    • See, §§ 1320a-7b
    • See 42 U. S. C. §§ 1320a-7b (1994).
    • (1994) U. S. C. , vol.42
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    • Be not afraid of change: Time to eliminate the corporate practice of medicine doctrine
    • See, 261
    • See Nicole Huberfeld, Be Not Afraid of Change: Time to Eliminate the Corporate Practice of Medicine Doctrine, 14 HEALTH MATRIX 243, 261 (2004).
    • (2004) Health Matrix , vol.14 , pp. 243
    • Huberfeld, N.1
  • 230
    • 85036735833 scopus 로고    scopus 로고
    • See, supra note 116
    • See Lopes, supra note 116.
    • Lopes1
  • 231
    • 85036761226 scopus 로고    scopus 로고
    • employee/employer exception does not apply to independent contractors. See, §, 952 i
    • The employee/employer exception does not apply to independent contractors. See 42 C. F. R. § 1001. 952 (i) (2008) ;
    • (2008) C. F. R. , vol.42 , pp. 1001
  • 232
    • 85036770133 scopus 로고
    • §, b 3, Hospitals contracting with physicians as independent contractors, therefore, must rely on the "personal services" safe harbor, which requires that the compensation arrangement be detailed in writing, for a term longer than a year, and the amount fixed at fair market value and not varying with the volume or value of the referrals
    • U. S. C. § 1320a-7b (b) (3) (1994). Hospitals contracting with physicians as independent contractors, therefore, must rely on the "personal services" safe harbor, which requires that the compensation arrangement be detailed in writing, for a term longer than a year, and the amount fixed at fair market value and not varying with the volume or value of the referrals.
    • (1994) U. S. C. , vol.42
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    • §, 952 d
    • C. F. R. § 1001. 952 (d) (2008).
    • (2008) C. F. R. , vol.42 , pp. 1001
  • 234
    • 85036736538 scopus 로고
    • A 1989 OIG Fraud Alert details the anti-kickback concerns of joint ventures: insufficient risk and attracting, retaining, and compensating physicians in the joint venture based on past or anticipated referral volume. See Publication of OIG Special Fraud Alerts, Dec. 19
    • A 1989 OIG Fraud Alert details the anti-kickback concerns of joint ventures: insufficient risk and attracting, retaining, and compensating physicians in the joint venture based on past or anticipated referral volume. See Publication of OIG Special Fraud Alerts, 59 Fed. Reg. 65372-(Dec. 19, 1994).
    • (1994) Fed. Reg. , vol.59
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    • Retail medical clinics: Issues for consideration
    • See, NOV. 6
    • See Jeff Sinaiko, Retail Medical Clinics: Issues for Consideration, DRUG STORE NEWS, NOV. 6, 2006, http://findarticles.com/p/articles/mi-m3374/is-15-28/ ai-n16865108.
    • (2006) Drug Store News
    • Sinaiko, J.1
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    • For further details on the space rental safe harbor, see, §, 952 b
    • For further details on the space rental safe harbor, see 42 C. F. R. § 1001. 952 (b) (2008).
    • (2008) C. F. R. , vol.42 , pp. 1001
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    • supra note 5, at
    • Sage, supra note 5, at 514.
    • Sage1


* 이 정보는 Elsevier사의 SCOPUS DB에서 KISTI가 분석하여 추출한 것입니다.