Practice Management
Urgent message: Diagnosing UTI in a child is challenging in the urgent care setting. Fever, abdominal or back pain, frequency or new onset of incontinence all should raise your index of suspicion. KIMBERLY GIBSON, MD Cases such as the following are common in urgent care and they present unique challenges: J.S., a 2-year-old girl, presents to an urgent care clinic on a Saturday afternoon for evaluation of low-grade fever and fussiness. Her parents have been …
Read MoreLee A. Resnick, MD, FAAFP In my last column, I explained how physician reimbursement is determined by a relatively obscure and highly politicized committee shockingly biased by a specialist representation. The so called “RUC” (Relative Value Scale Update Committee) has created a pay formula that heavily favors proceduralists at the undeniable expense of the primary care physician. This biased system of reimbursement has not only created an unbalanced pay scale amongst physicians, but has equally …
Read MoreThese data from the 2010 Urgent Care Benchmarking Survey are based on responses of 1,691 US urgent care centers; 32% were UCA members. The survey was limited to “full-fledged urgent care centers” accepting walk-ins during all hours of operation; having a licensed provider and x-ray and lab equipment onsite; the ability to administer IV fluids and perform minor procedures; and having minimal business hours of seven days per week, four hours per day. In this …
Read MoreDAVID STERN, MD (Practice Velocity) Q. What is the new modifier PD? A. If your urgent care center is owned by a hospital or health system, then Medicare has a new modifier for your center. The new HCPCS Level II Modifier PD is defined as a “diagnostic or related non-diagnostic item or service provided in a wholly owned or wholly operated entity to a patient who is admitted as an inpatient within 3 days, or …
Read MoreNormalization of Vital Signs Does Not Reduce Risk for Acute Pulmonary Embolism Key point: Up to one-third of patients whose abnormal triage vital signs reverted to normal values had PE. Citation: Kline JA, Corredor DM, Hogg MM, et al. Normalization of vital signs does not reduce the probability of acute pulmonary embolism in symptomatic emergency department patients. Acad Emerg Med. 2010; 19(1): 11-17. In a prospective single-center study, researchers evaluated whether normalization of vital signs …
Read MoreJOHN SHUFELDT, MD, JD, MBA, FACEP So you missed the “cancer.” Maybe you still don’t even know you missed it. At this point the patient (your business) is dying and you plod along unaware of the impending doom, like a smoker with a chronic cough. Your business is losing weight, its cheeks are sunken, skin sallow, as it grows weaker each passing month. One day soon it will start coughing up blood, and then it …
Read MoreIn each issue, JUCM will challenge your diagnostic acumen with a glimpse of x-rays, electrocardiograms, and photographs of determining conditions that real urgent care patients have presented with. If you would like to submit a case for consideration, please email the relevant materials and presenting information to [email protected]. The patient, a 45-year-old man, presented with vomiting and chest pain. View the image taken (Figure 1) and consider what your diagnosis would be. > Resolution of …
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The patient was a 5-year-old male. His parents reported that he had been febrile for the past several days (fever between 101°F and 103°F [38.3°C to 49.4°C]) and had become increasingly irritable and ill appearing. Exam revealed bilateral conjunctival injection without exudate, dry red lips and red tongue, and perineal erythema with overlying scale. The patient’s lymph nodes were swollen. View the images taken (Figures 1, 2 and 3) and consider what your diagnosis would …
Read MoreThe patient, a 21-year-old female, presented with trauma to her right wrist. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.
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