StuWilli, Author at Journal of Urgent Care Medicine

“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 …

Modifier -X {EPSU}, Pneumococcal Immunizations

Q. Have there been any updates from CMS (Centers for Medicare & Medicaid Services) regarding the new -X modifiers that were introduced in January of this year? A. CMS released MLN Special Edition article SE1503 on January 22, 2015 (see http://www.cms.gov/Outreachand- Education/Medicare-Learning-Network-MLN/MLN MattersArticles/Downloads/SE1503.pdf), stating that there would be forthcoming guidance as to the appropriate use of the new -X {EPSU} modifiers and “that guidance will include additional descriptive information about the new modifiers” before implementing …

Clinical Challenge 2: March, 2015

The Case The patient presented with fever and difficulty swallowing. He was visibly anxious, leaning forward on the examination table and spitting into a cup. View the image taken (Figure 1) and consider what your diagnosis would be.

Woman with Papules on the Hand

A 40-year-old woman with a history of human immunodeficiency virus (HIV) presents with flat-topped verrucous papules on her hands. Her most recent CD4 count was approximately 150 cells/μL. She notes that she regularly uses sunscreen on her face but not on her hands, and she is wondering whether the lack of sunscreen could be a cause of the lesions. View the image taken (Figure 1) and consider what your diagnosis would be.

The Great Flu Shot Conundrum

Alan A. Ayers, MBA, MAcc, is Practice Management Editor for JUCM, serves on the Board Directors of the Urgent Care Association of America, and is Vice-President of Strategic Initiatives for Experity. Urgent Message: Flu shots decrease health-care expenses, workplace absenteeism, and lost productivity, so why do most insurers not cover their cost when patients get the shots at urgent care centers? It is time for this practice to change. According to the U.S. Centers for …

Fracture of the Penis with Urethral Rupture

Urgent message: Failure to diagnose and, if necessary, repair penile fracture can result in devastating consequences such as stricture, fistula, and long-term voiding difficulty. TAYT ELLISON, MS-3, SHAILENDRA SAXENA, MD, PhD, LAURA KLUG, PharmD, and SANJEEV SHARMA, MD Although penile trauma is not a common presentation in the urgent care setting, it is under-reported because of embarrassment, as are other injuries related to sexual activity. The urgent care clinician should be prepared to evaluate these …

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 …

Clinical Challenge: March, 2015

The Case The patient presented with an upper respiratory infection after vertebroplasty. A chest x-ray was ordered to rule out pneumonia. View the image taken (Figure 1) and consider what your diagnosis would be.

Urgent Care Evaluation of Fatigue

Ever heard the old (and not so funny) joke about two health-care providers having a conversation at the urgent care center? First provider: “Ever seen a case of _____?” Second provider: “Turns out I have seen plenty of cases . . . just never diagnosed any!” With a nonspecific presenting condition such as fatigue, it is difficult to obtain an adequate medical history and to perform a thorough physical examination unless the differential diagnosis is …

Medical Malpractice Trial, Part 1: The Events

John Shufeldt, MD, JD, MBA, FACEP I recently spent 3 amazing weeks in a medical malpractice trial. Over the next few months, I would like to share the experience with you. Despite the fact that I practice law and have been an expert witness for more than 20 years, the experience opened my eyes and has definitely changed how I practice medicine in the urgent care setting. I took copious notes during the trial and …