Provider Credentialing: An 800-Pound Gorilla

Credentialing has become a recurring nightmare for physicians of all specialties, in every state and in every practice setting. Eager for a fresh start, and energized by new opportunity, we decide to make a job change. Recruiters colorfully praise these openings, as if every job pays more than our current one, is closer to parks and culture, and exists in a region with a lower cost of living and, of course, better weather. After a …

Read More

From Good to Great: A Guide for the Urgent Care Provider

It’s easy to think that all the steps we physicians and advanced practice providers must take before we are professionals make us great. After all, doesn’t everyone admire our impressive signature with its collection of professional certifications at the end? Not so fast. Greatness is not conferred or bestowed by degrees or certifications, and often it isn’t officially recognized. Instead, greatness is practiced, like yoga or karate. It is never a final achievement; it is …

Read More

Rediscovering Your Service Mission

It comes as no surprise to anyone that health care is broken. Too many interest groups, too much regulation, too many poorly aligned incentives, too many unrealistic expectations, and too many myopic solutions. Worse, the physician voice has been weakened and handicapped by a combination of our patient-first mission and by the distraction inherent in a profoundly complicated professional discipline. Think of it this way: If your primary mission was profit and the financial engineering …

Read More

Value-Based Reimbursement Is Premature, But That Won’t Stop It

Lee A. Resnick, MD, FAAFP Private payor reimbursement trends nearly always follow Medicare’s lead, and at no other time in history has the physician reimbursement model been so scrutinized. In an attempt to control unwieldly healthcare spending, payors are understandably looking to be creative. When they look at the drivers for increased health spending, one thing is clear: Diagnostic testing and imaging services grew far faster since 2000 than any other health-care service. According to …

Read More

EHR Interoperability: A Bridge to Nowhere

Lee A. Resnick, MD, FAAFP In the beginning, interoperability and health information exchange (HIE) were key selling points for physicians considering adoption of and investment in electronic health records (EHRs), but today most are left feeling misled, stranded on a bridge that leads nowhere. The Healthcare Information and Management Systems Society (HIMMS) defines EHR interoperability as “the ability of different information technology systems and software applications to communicate, exchange data, and use the information that …

Read More

“Why Are You Calling Me?” How to Fix Relationships with Emergency Departments

Lee A. Resnick, MD, FAAFP In my last column I covered the 3 main causes of poor communication in transferring patients from urgent care centers to emergency departments (EDs). I discussed how poor communication creates risk, disrupts work flow, and erodes professional satisfaction. Poor interprofessional relationships and inadequate planning and structure are creating an environment ripe for these breakdowns. Reversing the trend requires a focus on rehabilitating relationships, initiating outreach, and developing coordinated policies and …

Read More

“Why Are You Calling Me?” The Problem with Patient Transfers in Urgent Care

Lee A. Resnick, MD, FAAFP According to the 2012 Benchmarking Survey from the Urgent Care Association of America, about 4% of urgent care patients are referred to an emergency department (ED) for ongoing care. Some get there by personal vehicle, and others are transferred by emergency services, private ambulance, or other critical-care transportation. Given an average patient volume of 40 patients per day for a single urgent care center, that is 1.5 ED transfers per …

Read More

Evaluating Chest Pain in Urgent Care— “Catch 22 and the Three Bears”: Part 2

Lee A. Resnick, MD, FAAFP In my last column, I introduced a framework for evaluating chest pain in urgent care. In this month’s column I discuss a risk and probability stratification that can assist in disposition decision-making. The following discussion considers existing evidence, but there is no formal guideline for this process in the outpatient setting. Our goal is to make a risky scenario into something we can live with. This model is for risk-stratification …

Read More