Health Department Weighs Regulating Physician Practices
In recent years, we have witnessed the rapid evolution of many innovative models for delivering health care services. Most basic are the so-called "walk-in clinics" sometimes staffed by a primary care physician but more often by a nurse practitioner or a physician assistant.1 These are commonly found in pharmacies and retail stores with high customer traffic. They offer low cost services such as flu shots, cold and sore throat remedies, treatment of minor injuries, and other basic health care services on-site. At the opposite end of the spectrum are large physician-owned multi-specialty practices that have grown to include hundreds of physicians, nurses and other health care professionals operating at dozens of locations. While patients are seen in the practice's various offices, most of the physicians have admitting privileges at local hospitals, so they can also attend their patients needing in-hospital treatment and procedures. Additionally, they offer their patients the opportunity to get both primary and specialist physician services from one organization, which can enhance the continuity and quality of care.
In between are private medical practices offering primary care physician services in storefront offices in multiple locations. Patients can either schedule an appointment in advance, or simply walk into a location and be seen promptly by a physician. These and many other models of delivering health care services have become quite popular. They came about in response to various factors not the least of which are the many patients who do not have a regular physician, the increasing difficulty on the part of patients who do have a physician to schedule a timely visit, and their convenience. Macro factors driving the growth of these providers include escalating medical costs, changing market conditions, consolidations and closings of hospitals, reductions in reimbursement payments, and the impact of the Affordable Care Act.2
The proliferation of these new models of care delivery has prompted New York's Public Health and Health Planning Council (PHHPC) to look into how these practices are structured, owned and controlled, the quality of care they are providing, and their effects on the health care marketplace in New York, all with a view toward determining whether regulation of some or all of them would be appropriate. However, there are potentially significant obstacles to any attempt by the PHHPC to regulate these practices.
Historically, there has been a reasonably clear division of responsibilities in New York State's regulation of health care delivery between the Department of Health and the Department of Education. The Health Department licenses institutional providers of health care and has sweeping regulatory and supervisory powers over them. Articles 28 and 36 of New York's Public Health Law (PHL) define the types of health care providers that are subject to licensure and regulation by the Health Department. These include but are not limited to:
• general hospital
• public health center
• diagnostic center
• treatment center
• outpatient clinic
• ambulatory surgery center
• nursing home