JOHN SHUFELDT, MD, JD, MBA, FACEP I used to love to watch Raymond Burr in “Perry Mason.” He would get some poor witness on the stand and, in the middle of her testimony, look at the jury while he handed the witness an incriminating document and say very loudly, “What about this?” At which point the witness would dissolve into tears with her head in her hands and confess to basically everything including the crime …
Read MoreClinical Challenge: June, 2013
The patient, a 4-year-old boy, tripped and twisted his right ankle. He was not able to bear weight on his right foot. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.
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Rhabdomyolysis
Urgent message: For patients with flu-like symptoms, a careful history and examination are important to rule out more threatening diagnoses. SHRINESH V. PATEL, MD Overview In late winter/early spring, urgent care providers often encounter patients with flu or flu-like illnesses. It is easy to assume that an individual with a typical pattern of flu-like symptoms has the flu and not consider other pathologic processes.However, alternative diagnoses should always be in the differential, and careful history, …
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Creating Value By Adding Physical Therapy to Urgent Care – Part 1: Initial Considerations & Rationale
Urgent message: Many urgent care clinics face new competition and the landscape for reimbursement is changing. One tactic for enhancing profitability is to consider the addition of new services. Adding Physical Therapy to your practice can result in more satisfied patients, better clinical outcomes and a stronger bottom line. LAUREL STOIMENOFF, PT and HILARY HELLMAN, SLP Eighty percent of Americans will experience low back pain at some time in their lives. Many of these patients …
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20-year-old man with left elbow pain and swelling
The patient, a 20-year-old man, presented with left elbow pain and swelling since last night. He was at a heavy metal concert, was pushed by the crowd and fell backward onto the elbow. On physical exam, the patient’s left elbow was swollen and tender over the olecranon process with no other points of tenderness. His elbow pain increased with any attempts at range of motion testing and he was reluctant to fully extend the elbow.
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8-month-old infant who reportedly stopped crawling
The patient, an 8-month-old boy, was brought in by a caretaker, who reported that the infant had stopped crawling. View the image taken (Figure 1) and consider what your diagnosis would be.
Read MoreDeveloping Data: May, 2013
These data from the 2012 Urgent Care Industry Benchmarking Study are based on a sample of 1,732 urgent care centers; 95.2% of the respondents were UCA members. Among other criteria, the study was limited to centers that have a licensed provider onsite at all times; have two or more exam rooms; typically are open 7 days/week, 4 hours/day, at least 3,000 hours/year; and treat patients of all ages (unless specifically a pediatric urgent care). In …
Read MoreMid-level Providers, Resident Providers, Non-payment for S9088, Non-payment for E/M 99205, POS -20 for Family Practice
DAVID STERN, MD (Practice Velocity) Q. Our urgent care is staffed by nurse practitioners (NP) 6 days per week and all of the billing is processed under the medical director for all insurance companies. I have three separate questions: Is it legal for a new Medicare patient entering the ur- gent care setting to be billed under the medical direc- tor if he is not on site and has never seen the patient? Is it …
Read MoreThe Game Part 1
JOHN SHUFELDT, MD, JD, MBA, FACEP In the movie The Game, Nicholas Van Orton (played by Michael Douglas) is a very wealthy and successful businessman. Unfortunately, his successes come at the cost of his family life and close, personal relationships. His brother, Conrad (played by Sean Penn), gives him a gift on his 48th birthday. The gift is enrollment into a live-action game where Nicholas is the principal player. This game initially consumes then seemingly …
Read MoreAbstracts in Urgent Care: May, 2013
Ondansetron Safe During Pregnancy Key point: No significant association between the antiemetic on- dansetron and adverse pregnancy outcomes. Citation: Pasternak B, Svanstrom H, Hviid A. Ondansetron in pregnancy and risk of adverse fetal outcomes. N Engl J Med 2013;368:814-823. In this retrospective cohort study, ondansetron had been prescribed for nausea and vomiting in almost 2000 of some 600,000 pregnancies. Ondansetron users were no more likely than nonusers to experience spontaneous abortion or stillbirth, or to …
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