History teaches us so many lessons, most of which we quickly forget until the next history-making crisis. Nothing in history is a more predictable crisis producer than “fear.” Fear sows panic, panic sows irrational behavior, and irrational behavior sows wars, economic disasters, bigotry, and protectionism. When the dust settles, we analyze our missteps and, often, recognize most of the fallout could have been avoided had we learned from history. The Great Depression was a real …
Read MoreClinical Challenge: June, 2009
The patient is a 32-year-old male who woke up at 1 a.m. with a burning sensation in the mid-chest (a first-time event, he reports). The patient is not diaphoretic, and has no dyspnea. He is generally healthy and has no known risk factors for heart disease. His physical exam is unremarkable. In addition, you find: BP: 154/102 Pulse: 68 Sat: 99% Temperature: 97.3°F View the electrocardiogram taken (Figure 1) and consider what your next steps …
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8-year-old boy experiencing rash on abdomen
The patient is an 8-year-old boy whose mother brings him in with an acute, pruritic rash involving the inferior abdomen. On examination, you find a large, scaly plaque at the midline of the inferior abdomen. You observe the child scratching during the exam. View the image and consider what your next steps would be.
Read MoreAbstracts in Urgent Care – May 2009
Occult Bacteremia is Rate in Young Children with Unexplained Fever Key point: Since introduction of the pneumococcal vaccine, urinary tract infection has become the most common bacterial infection in children who have fever without localizing signs. Citation: Waddle E, Jhaveri R. Outcomes of febrile children without localizing signs after pneumococcal conjugate vaccine. Arch Dis Child. 2009; 94: 144-147. Occult bacteremia and invasive disease are important concerns in children with unexplained high fever. Investigators retrospectively compared …
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26-year-old male who twisted his ankle
The patient is a 26-year-old male who slipped and twisted his left ankle. He is unable to bear weight on the ankle and there is marked local swelling circumferentially around the ankle. Otherwise, he is generally healthy. View the x-ray taken and consider what your diagnosis and next steps would be.
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May 2009
Coding for Observation, and More on Established vs. New Patients
Q. Is it possible for observation status codes (99217-99220) to be billed in an urgent care facility? A. Observation codes will require the point of service (POS) to be a hospital. If your urgent care is operated by a hospital and you can legitimately use a hospital POS, then you may be able to use these codes. If you use the physician office (POS-11) or urgent care (POS-20) place-of-service codes, then you could not use …
Read MoreEvaluating Your Clinic’s Competitive Strengths
Pull Up! Pull Up!
I am often asked what inspired my love of flying. Although this is the first time I have admitted it in public, I am proud to say that it all began with the movie Airplane! Dr. Rumack: You’d better tell the captain we’ve got to land as soon as we can. This woman has to be gotten to a hospital. Elaine Dickinson: A hospital? What is it? Dr. Rumack: It’s a big building with patients, …
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Putting Patients First: Redefining Quality in the Patient Experience
Urgent message: Patients are the ultimate judges of the quality of care you provide, and the opinions are likely to be swayed by factors that have little to do with your clinical expertise or skill. Alan A. Ayers, MBA, MAcc Service industries – from retail stores to restaurants, hotels, and even banks – have embraced the customer’s point of view by meshing contemporary design, cutting-edge technology, and process engineering to develop services that are increasingly …
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