bnapolitano, Author at Journal of Urgent Care Medicine

American Well Buys Avizia—with More Attention to Urgent Care Expected

Healthcare merger-mania hasn’t forgotten about the telehealth business, as American Well revealed that it will acquire Avizia. The appeal for American Well will be to expand its acute care offerings, as Avizia’s hospital-based business reflects more than 40 clinical specialties, including telestroke and telebehavioral health services. At the same time, Avizia said it expects that the newly expanded company “will offer…[an] enterprise telehealth platform for urgent care, chronic disease management, acute care, and postacute care.” …

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 …

A 45-Year-Old Woman with Acute Chest Pain

Case The patient is a 45-year-old woman who presents after experiencing chest pain for the past 2 hours. She has some minimal dyspnea, but no diaphoresis. She takes birth control pills and is a smoker. She denies family history of cardiac disease. Upon exam, you find: General: Alert and oriented Lungs: CTAB Cardiovascular: RRR without murmur, rub, or gallop Abdomen: Soft and NT without r/r/g Ext: No peripheral edema or calf pain, pulses 2+ and …

Management of Acute Exacerbation of Chronic Low Back Pain in the Urgent Care Setting

Urgent message: A systematic approach to evaluating, diagnosing, and treating low back pain in the urgent care setting reduces unnecessary hospital visits, identifies red flag symptoms that warrant further diagnostic or neurosurgical evaluation, promotes returning to work quicker, and helps to reduce the number of opioid prescriptions that are prescribed for episodic exacerbation and/or chronic conditions. Ashley Clay, MS, PA-C Introduction Up to 80% of the United States population experiences back pain at some point; …

An Uncommon Clinical Presentation of Ovarian Torsion

Urgent message: Abdominal pain is an extremely common complaint in the urgent care setting. The differential diagnosis of abdominal pain is often a challenge, however, because many symptoms and signs are nonspecific. Ovarian torsion usually presents with sudden onset of severe, unilateral lower abdominal pain, associated with nausea and vomiting; however, in a small percentage of cases, the clinical course is prolonged, as the torsion can be intermittent. While failure to consider ovarian torsion in …

New Rules for Beneficiary Inducements at Urgent Care Centers

Urgent message: Unlike other retail businesses, which commonly provide gift cards and other incentives in marketing or as remediation for unsatisfactory service, urgent care operators must be aware of various statutes prohibiting “inducements” to patients. 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. People in the U.S. love the idea of getting something for nothing. Businesses across the …

Thinking Differently About Paid Time Off

Alan A. Ayers, MBA, MAcc is Chief Executive Officer of Velocity Urgent Care, LLC and is Practice Management Editor of The Journal of Urgent Care Medicine. Urgent message: As 24/7 connectedness becomes the norm in the modern workplace, innovative technology companies have begun exploring unlimited paid time off (PTO) policies as a way to promote better work/life balance. Could unlimited PTO also become a trend in a healthcare industry that is likewise becoming increasingly 24/7 …

A 40-Year-Old Veterinarian with Scaly Lesions

Case The patient is a 40-year-old man who presents with annular, scaly lesions on his arm which appeared over the past week. The patient is a veterinarian, and was diagnosed with type 2 diabetes last year. View the photo and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

A 51-Year-Old Male with a Persistent Cough

Case The patient is a 51-year-old man who presents to urgent care complaining of a persistent cough. He reports it started “about a month ago,” but his wife, who is with him, insists it’s been at least 6 weeks. 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.

Reduction in Reimbursements for Modifier -25

Q: Last fall, Anthem Blue Cross Blue Shield sent a notice to physicians in several states regarding their intent to reduce reimbursement rates on any evaluation and management (E/M) services billed with modifier -25, “significant, separately identifiable E/M,” by 50% effective January 1, 2018. What are the implications for urgent care? A: This announcement initially spurred action from the California Medical Association (CMA) to coordinate with the American Medical Association (AMA), as well as other …