Practice Management
Q: What is case-rate reimbursement, and how does it work in the urgent care sector? A: Case rate, sometimes called flat rate, describes a reimbursement structure in which providers receive a flat reimbursement rate for every patient visit, no matter what service they provide. Case-rate reimbursement means that the urgent care is contracted with the payor to receive the same reimbursement regardless of the acuity of care, whether it’s the treatment of a hangnail or …
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A 22-year-old man presents to urgent care with a round, hyperpigmented patch on his arm. He reports that it’s “itchy,” and that it appeared soon after taking a second dose of a sulfonamide he’s taking for a persistent sinus infection. View the photo and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
Read MoreAn 82-year-old man presents with complaints of palpitations. He denies chest pain, shortness of breath, dizziness, fever, vomiting, or confusion. Upon exam, you find: General: Alert and oriented Lungs: CTAB Cardiovascular: Regular and tachycardic without murmur, rub, or gallop Abdomen: Soft and nontender without rigidity, rebound, or guarding View the ECG and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.
Read MoreA 42-year-old man arrived at your urgent care center complaining of thumb pain a day after taking a fall while skiing. You find that the pain is worse with movement in any direction; in addition, he exhibits limited ability to grip anything using his thumb. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. <1–nextpage–> Differential Diagnosis Avulsion …
Read MoreUrgent message: While many people perceive HIPAA as a law governing patient privacy, protection and standards for personal health information is only one aspect of this law, which was originally intended to regulate health insurance. Alan A. Ayers, MBA, MAcc is Vice President of Strategic Initiatives for Practice Velocity, LLC and is Practice Management Editor of The Journal of Urgent Care Medicine. Introduction Ask anyone—even the owner of an urgent care center—what HIPAA is, …
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Urgent message: While Boerhaave syndrome is a rare finding, a relatively high number of cases may present in the urgent care setting. As such, awareness of and vigilance for related symptoms are essential to taking a proper history and, ultimately, early diagnosis of acute, subacute, or chronic Boerhaave syndrome. John Shufeldt, MD, MBA, JD, FACEP, Amber Hawkins, and Carli Nichta, MS4 Introduction Boerhaave syndrome is a spontaneous esophageal rupture indicated in some cases by …
Read MoreGLENN HARNETT, MD Innovative Rapid Tests Show Promise in Influenza Key point: Novel DIAs and rapid NAATs had markedly higher sensitivities for influenza A and B in both children and adults than did traditional RIDTs, with equally high specificities. Citation: Merckx J, Wali R, Schiller I et al. Diagnostic accuracy of novel and traditional rapid tests for influenza infection compared with reverse transcriptase polymerase chain reaction: a systematic review and meta-analysis. Ann Intern Med. 2017;167(6):394-409. …
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Urgent message: Less than one out of a hundred cases of children ingesting foreign bodies requires surgical intervention. Identifying which children that could apply to, which need endoscopic removal, and those who can wait for spontaneous passage is an essential role for the urgent care provider. Herlene Chatha, MD and Hansel Otero, MD The case: An otherwise healthy 2-year-old boy is brought to your urgent care center by his parents, who are concerned that he …
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Urgent message: U.S. healthcare has been a monolith of inefficiency, limited access, and untenable costs for decades, due mainly to a lack of healthy competition. Today’s healthcare landscape, however, spurred by converging market forces, is rapidly evolving into a competitive marketplace, with urgent care being one of the key catalysts for this welcomed and long overdue change. Alan A. Ayers, MBA, MAcc is Vice President of Strategic Initiatives for Practice Velocity, LLC and is Practice …
Read MoreIt pains me to write this column. The opioid epidemic is arguably the most catastrophic and enduring public health crisis since the flu epidemic of 1918—yes, even worse than the HIV/AIDS epidemic of the ‘80s. Since 2000, over 200,000 people have died from overdoses of prescription opioids alone, another 300,000 from heroin and synthetic opioids. Now synthetic fentanyl has infiltrated the market with the most toxic opioid ever known. The overdose death curve is steepening. …
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