bnapolitano, Author at Journal of Urgent Care Medicine

A 46-Year-Old Obese Man with a Painful Skin Lesion

The patients is an obese 46-year-old man who complains of a painful skin lesion located between folds of skin that were touching each other. He reports looking in the mirror at home and seeing the area was very red and erythematous. He also says sometimes it feels like a burning sensation on his skin. This was most evident after being outside in the hot, humid weather. View the image taken and consider what your diagnosis …

A 6-Year-Old Boy with Leg Pain After a Hard Impact

The patient is a 6-year-old boy who was brought to your urgent care center by his parents with pain in his right leg. They explain that he while playing with friends he tried to jump from one side of a concrete retaining wall to the other—and coming up short. View the images taken and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.

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 …

Multiple Findings Including STEMI, Low Voltage, and Type 2 AV Block in a 72-Year-Old Woman

The patient is a 72-year-old woman who presents with 2 hours of chest pain with associated diaphoresis. She has a remote history of breast cancer. No leg pain or swelling or history of pulmonary embolism. On exam, you find her stated weight of 313 pounds is correct. In addition: General: Alert and oriented X 3, ambulatory Lungs: Clear to auscultation Cardiovascular: RRR without m/r/g, distant heart sounds Abdomen: Soft and NT without r/r/g Ext: Normal …

Be Ready for the ICD-10-CM 2020 Updates

October 1, 2019 introduces 273 new diagnosis codes, 21 deactivated codes, and 35 code description revisions to the International Classification of Diseases, 10th Revision, Clinical Modification set, bringing the total ICD-10-CM code count to 72,184. The following describes those that are most relevant to the urgent care provider. Chapter 8: Diseases of the Ear and Mastoid Process (H60-H95) There is just a small change to note here, where code H81.4, “Vertigo of central origin” was …

Competing for Patients in a Digitally Connected World

Urgent message: In today’s tech-driven, digital-everything society, industry-leading consumer companies all leverage technology to reducing friction—ie, steps, obstacles, and unnecessary effort—in making their products and services fast, convenient, and accessible. The urgent care operation that can align with this growing trend and leverage technology to root out friction will win loyalty and patronage from today’s digitally native healthcare consumer. Alan A. Ayers, MBA, MAcc is Chief Executive Officer of Velocity Urgent Care and is Practice …

Keep Valued Occ Med Clients by Helping Them Measure the Value of Your Services

You’ve done the hard part—selling your occupational medicine services and delivering on your promise of providing excellent care—but now you have to ensure the client recognizes the value you bring to the table. After all, return-on-investment is only as good as the data demonstrating it. What about return-on-value (ROV), though? As noted in a recent article in Milwaukee Business News’s Biz Times, the subtle difference may point decision-makers in slightly different directions. You should seize …

Help Patients Understand OTC Tamiflu Doesn’t Negate the Need for Urgent Care Flu Visits

With Sanofi now tasked with negotiating approval of Tamiflu to be sold over-the-counter, and with the 2019–2020 influenza season off to an early start, urgent care providers need to put on their health educator hats to both ensure patient safety and protect profitability during one of the busiest times of the year. It’s likely patients will think they have fewer worries than ever about the flu, but nothing could be further from the truth. First …

Profitable or Not, Cost Savings May Demonstrate Value in Virtual Care

One of the business arguments against telehealth is that no one has demonstrated it has strong revenue-building capabilities, to date. That’s still the case, but Intermountain Healthcare has quantified that cost savings can be realized with virtual medicine rooted in urgent care. As detailed in an article recently published on HealthLeaders, the average total cost of virtual care for a specified selection of presentations was $429, compared with $661 for on-site visits. (Compare both with …

Does Assembly Bill 5 Doom Locum Tenens in California?

Here’s the fact: California legislators approved a bill (Assembly Bill 5, or AB 5) that will reclassify “gig” workers from contractors to employees. Now here’s the fear: AB 5 will essentially doom the concept of locum tenens clinicians in the state. The bill was conceived as a way for gig workers to get benefits from the companies they contract with—though coverage of the bill has largely focused on app-based transportation companies Uber and Lyft. The …