Lee A. Resnick, MD, FAAFP With all the renewed talk of tax hikes on the “rich” to pay for everything from healthcare to job creation, I can’t help but see the with anger over how we define rich in this country. The top tax rate targets incomes of $150,000-$200,000. This despite a rapidly growing “ultrarich” class that consists of earners between $1 million and untold billions. Now millionaires and billionaires pay less as a percentage …
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22-year-old suffers fall onto right shoulder
This otherwise healthy 22-year-old patient fell and landed directly on the right shoulder. The presentation included marked local swelling and decreased range of motion. View the image taken and consider what your diagnosis would be.
Read MoreClinical Challenge 2: September, 2011
The patient, an otherwise healthy 10-year-old, fell and suffered a blow to the shoulder. The patient presented with a decreased range of motion. 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.
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26-year-old presents limited range of motion in shoulder
The patient, an otherwise-healthy 26-year-old, suffered a blow to the left shoulder and presented with a limited range of motion. View the image taken and consider what your diagnosis and next steps would be.
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September 2011
Abstracts in Urgent Care: September, 2011
Antibiotics Are Not Equal to Appendectomy for Appendicitis Keypoint: The incidence of peritonitis at 30 days was higher in the antibiotic group than in the surgery group; 68% of patients treated with antibiotics did not require appendectomy Citation: Vons C, Barry C, Pautrat K, etal. Amoxicillinplus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, ran- domised controlled trial. Lancet. 2011;377(9777): 1573-1579. Four recent randomized trials suggest that antibiotics alone can …
Read MoreDeveloping Data: September, 2011
In each issue on this page, we report on research from or relevant to the emerging urgent care marketplace. This month, we offer a look at data from the 2010 Urgent Care Benchmarking Survey Results. These data 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,” the qualifications for which included accepting walk-ins during all hours of operation, as well as …
Read MoreMedical Necessity in E/M Coding, Part 3: Correctly Coding the Physical Exam
DAVID STERN, MD (Practice Velocity) Some coding auditors do not understand the urgent care setting. As a result, they have been inappropriately downcoding evaluation and management (E/M) levels— not based on levels of documentation, but rather on whether the documentation is supported by their “view” of medical necessity, even though these auditors have usually never been providers and lack clinical experience. In this situation, the best defense is a strong offense. This column reviews medical …
Read MoreTo Board or Not to Board…That Is the Question!
Lee A. Resnick, MD, FAAFP With the announcement of the Board of Certification in Urgent Care Medicine (BCUCM), an American Board of Physician Specialists (ABPS) member board, the urgent care community is abuzz about its meaning, value, and importance for specialty recognition of the discipline and professional identity for its physician practitioners. Some believe the American Board of Medical Specialties (ABMS) is the only body with the authority to anoint specialty certification and provide board …
Read MoreClinical Challenge: September, 2011
The patient, an otherwise healthy 18-yearold, presented with pain in the upper arm. There was no history of trauma. 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.
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