The MIPS Mess

It should not be terribly surprising to anyone that the massive government effort to incentivize quality has run into some serious challenges. Adjudicating quality has always been a briar patch of exceptions, confounders, red tape, and bias. To make matters worse, as with large government efforts, you end up with a whole bunch of unintended consequences that typically add cost and effort to the very practices that can handle it the least. As we all …

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Virtual Urgent Care: Boom or Bust?

Telemedicine remains a hot topic of debate in urgent care circles. In fact, it seems like every urgent care conference I attend lately has a telemedicine track or expert panel. JUCM recently featured a point-counterpoint discussion between two industry leaders, Stanford Coleman, MD, MBA, FAAP and William Gluckman, DO, MBA, FACEP—whose opinions on the topic are as well-reasoned as they are divergent. So, let me add my two cents. The discussions and analyses I’ve been …

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I’m Not a Lawyer, But I Play One…

Like many of you, the fear of a medical malpractice claim casts a wide shadow over everything I do. Like most of you, my intent is always to do no harm and provide the best care possible for every patient despite significant challenges. And like all of you, I wonder how we got to a place where any level of inaccuracy or misjudgment became a breach of the standard of care. While some reforms have …

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Longitudinal Assessment: A Dent in the ABMS Armor?

With the volume of dissent against Maintenance of Certification (MOC) now at a fever pitch, American Board of Medical Specialties (ABMS) boards are finally making changes to their recertification programs with the intent of reducing the burden on physicians. The issue could not be more acute than in urgent care, where many UCA member physicians have been practicing for years. Working outside of their specialties of training and growing more distant from the best practice …

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Urgent Care and Antibiotics: Advancing Care and Stewardship

Antimicrobial stewardship is defined as a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms. Stewardship initiatives in the hospital are paving the way for the rest of healthcare through education campaigns, monitoring, and restrictions. Outpatient practice is beginning to catch up as the stories of resistance grow and the lines between nosocomial and community-acquired infections blur. …

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Anger Management: Hostile Encounters in Urgent Care

Eliminating disruption, distraction, and dissatisfaction is paramount to delivering efficient and high-quality care these days. More than ever, urgent cares are competing to differentiate themselves by moving patients through the encounter faster and with a more reliably exceptional experience. We’ve adopted slick technologies and  reconfigured work flows to improve care delivery. So, why do our teams still struggle with consistency? Why do we still see high levels of burnout and turnover—and what can we do …

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Slow Medicine: ‘Unprescribing’ America

#TimesUp; #NeverAgain; #Privacy; #OpioidCrisis; #BlackLivesMatter…. The last year has been a dramatic one for turning points in long-festering social issues. For decades, we turned our cultural cheek on problems we knew existed (misogyny and bias) or should have seen coming (opioids, mass killings and privacy). But in 2017 and into 2018 we are witnessing a tidal wave of resistance and public denunciations against the ugly side of American life. A collective enough is enough echoes …

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Chasing Flu: Predictably Unpredictable

Chasing Flu: Predictably Unpredictable

I have managed urgent cares for nearly 20 years and can officially say that predicting flu is for fools! Perhaps I should have known—after all, the CDC, WHO, ACIP and even Google all get it wrong, with spectacular consistency. Despite all the research, public and private money, and sophisticated analytics, we just can’t seem to find a way to predict the behavior of a fairly banal collection of viral RNA wrapped in a host membrane …

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The Change Gang: Adopting a Disruptive Culture

We’ve all heard it: Why do we have to change? This is the way we’ve always done things! Change is difficult, even for those of us who embrace it. But it is especially difficult for non-owner employees. After all, why welcome the discomfort and uncertainty of change if there is no upside to your personal bottom line? This is perhaps one of the biggest challenges we face as the urgent care industry matures and competition …

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Hiring Right Requires the Right Approach

Employing an organizational psychologist or paying for expensive employee screening services is simply not in the cards for most urgent care centers. Yet, hiring “right” is perhaps the most important thing we do and the implications on our practices are considerable. Here are just a few of the areas most impacted by our talent acquisition success (or failure): Risk, quality, and liability Patient satisfaction Operations and work flow Culture Now let’s look a little more …

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