bnapolitano, Author at Journal of Urgent Care Medicine

An Urgent Care Approach to Influenza—Before Onset

Urgent message: The urgent care clinician must have a thorough understanding of different influenza types and strains, disease course, and preventive measures—including, but not limited to, vaccination—at the outset of flu season. Introduction Influenza is most deadly in the very young, very old, and those with comorbid conditions. Typically, onset is rapid and seasonal, though patients may initially present with few or nonspecific symptoms. Complicating things further, there are many different strains of the flu. …

Abstracts In Urgent Care – November 2018

From ID Week: Outbreak-Related Hep A Infections Are on the Rise Key point: Hepatitis A infection may be evolving from common-source exposure to outbreak exposure. Urgent care clinicians can influence this phenomenon by recommending that at-risk adults receive immunization. Citation: Foster M, Hofmeister M, Yin S, et al. Changing epidemiology of hepatitis A virus infections—United States, 2009–2017. Oral Abstract Session. ID Week 2018. Available at: https://idsa.confex.com/idsa/2018/webprogram/Paper74176.html. Accessed October 8, 2018. Between 2007 and 2017, the …

Big Changes in Medicare Evaluation and Management Reimbursement

The Centers for Medicare and Medicaid Services (CMS) has published the proposed changes for the Calendar Year (CY) 2019 Physician Fee Schedule (PFS).1 Probably the most controversial of these proposed changes is the Patients Over Paperwork initiative, which streamlines documentation requirements and reimbursement for Evaluation and Management (E/M) services in the office and outpatient setting, affecting Current Procedural Terminology (CPT) codes 99201 through 99215. CMS has announced that it plans to eliminate differential payments for …

A 45-Year-Old Woman with Suddenly Discolored Skin

Case A 45-year-old woman presents with a complaint of “a brown spot” on her back. Upon examination, you confirm there is a reticular hyperpigmented patch of skin, which she says she noticed after using a heating pad to relieve myalgia after working in her garden. She confesses that she fell asleep with the heating pad on the area, she thinks for several hours. View the photo and consider what your diagnosis and next steps would …

The Tax, Legal, and Business Implications of Providing a Company Vehicle, Vehicle Allowance, or Mileage Reimbursement

Urgent message: The nature of a multisite urgent care business entails operations and clinical leadership travelling among various sites, so a sensible, easily administered, and cost-effective policy for paying employee vehicle must be established to assure tax and legal compliance. Alan A. Ayers, MBA, MAcc is Chief Executive Officer of Velocity Urgent Care and is Practice Management Editor of The Journal of Urgent Care Medicine. Urgent message: The nature of a multisite urgent care business …

A 52-Year-Old Man Who Is Lightheaded and Dizzy

Case The patient is a 52-year-old man who presents to your urgent care center with lightheaded dizziness, which he says has been present for the past 3 days. It is worse with standing. He reports that he has been spending a lot of time in the sun lately. He denies chest pain, shortness of breath, abdominal pain, or paresthesias. He does not take any medications. His personal medical history untreated hypertension, and there …

Narcan or Narcan’t: An Ethical Dilemma for a Modern Scourge

With opiate abuse and overdose rates at epidemic levels, the campaign for easing access to the potentially life-saving reversal agent Narcan (naloxone) has gained significant momentum. It began with EMS and law enforcement, but has since expanded to schools, community centers, and public spaces; now it is available over the counter in most every state. Some experts and law enforcement agencies have declared this a well-intentioned mistake. Increasing access, they say, is a “moral …

Last Year’s High Death Toll from Flu Partially Explained—and the Data Should Frustrate You

As this year’s influenza season really gets going, the Centers for Disease Control and Prevention has released a report with some data that should make you sit up and take notice. In fact, it should spur you to action. In a year when flu killed at least 79,000, less than 40% of adults in the United States received the influenza vaccination. The highest death toll in decades coincided with the lowest immunization rate in 7 …

Drug-Resistant Salmonella Infection Spreads to 29 States

Patients in 29 states have been diagnosed with Salmonella infection attributed to consuming tainted chicken products. Worse, public health officials say testing shows this particular strain to be resistant to multiple antibiotics often used to treat patients with severe Salmonella infections. No deaths have been reported, but scores of patients have been hospitalized. Ask patients who present with diarrhea, fever, and abdominal cramps what they’ve eaten in the past 12–72 hours, and consider giving a …

Is Urgent Care Doing Enough—Are You Doing Enough—to Slow the Spread of STDs?

Treatment and prevention of sexually transmitted diseases may be the particular expertise of clinicians who staff sexual health clinics—but that doesn’t mean those responsibilities are their exclusive domain. Primary care and urgent care will need to step up their game if the current upswing in many STDs is to be turned around, as noted in a recent article from Kaiser Health News. Screening and treatment are both well within the expertise of urgent care providers. …