The patient is a 23-year-old male who presents with a complaint of pain in the heel area after slipping down four steps. He is limping but able to bear weight. On exam, you note local tenderness and swelling over the area of the Achilles tendon. Other findings are unremarkable. View the x-ray 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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Assessment and Initial Care of Fingertip and Nailbed Injuries
Urgent message: Whether required due to a crushing blow or close contact with a sharp surface, proper initial care for fingertip and nailbed injuries is essential to good outcomes and can often be administered in the urgent care setting. Scott M. Zimmer, MD Fingertip injuries are one of the most common conditions seen in urgent care and emergency room settings. From door crush to table saw injuries, the proper initial care is vital in the …
Read MoreA Recipe for Medical Decision Making
Lee A. Resnick, MD, FAAFP No other specialty requires more expertise in medical decision making than urgent care medicine. We specialize in the evaluation and management of the “undifferentiated patient,” with limited access to diagnostic and consultative resources. Our scope of care is one of the broadest in medicine, requiring breadth of knowledge across disciplines. Our patients are almost entirely new to us, giving us limited clinical and personal insight into their presentations. Finally, constraints …
Read MoreManaging Through Change
JOHN SHUFELDT, MD, JD, MBA, FACEP The urgent care sector in particular, and healthcare in general, is undergoing a sea change—a phrase that has its origins in Shakespeare’s The Tempest: Full fathom five thy father lies Of his bones are coral made Those are pearls that were his eyes Nothing of him that doth fade But doth suffer a sea-change Into something rich and strange. Shakespeare was referring to the corpse of Ferdinand’s father being …
Read MoreHedging Your Bets: The Art of Market Segmentation
If you have more than one child or grew up with at least one sibling, you have probably experienced “segmentation.” That is, you have most likely used different tactics and strategies in dealing with each of your children or you were treated somewhat differently than your siblings. Segmentation within the urgent care occupational health market follows the same principle; a communication technique that is effective with one audience may not work as well with another. …
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The Front Office: Window to Your Practice
Urgent message: Patients will return again and again—and tell their friends, too—if your center’s manager and employees are unfailingly courteous, com petent, and thorough. Alan A. Ayers, MBA, MAcc, Experity If you’re planning to own and operate an urgent care center, you’re probably not thinking about managing an administrative office. Instead, you envision yourself hurrying between exam rooms, suturing cuts, setting fractures, and dispensing orders. Digging your way out of paperwork, refereeing staff disputes, tracking …
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18-year-old male landed hard on heel
The patient is an 18-year-old male who jumped or fell from a \”short height\” but landed hard on his heel. He is able to ambulate, but cannot put any pressure on his heel. Examination and history reveal nothing remarkable. View the x-ray taken and consider what your diagnosis or next steps would be.
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9-year-old boy injures shoulder in fall
The patient is a 9-year-old boy who received a blow to the shoulder from a height of approximately 6 ½ feet. He has limited elevation of the arm due to pain. Examination and history reveal no additional factors. View the x-ray taken and consider what your diagnosis or next steps would be.
Read MoreDeveloping Data: October, 2008
In Developing Data, JUCM will offer results not only from UCA’s annual benchmarking surveys, but also from research conducted elsewhere to present an expansive view of the healthcare marketplace in which urgent care seeks to strengthen its presence. In this issue: How did patients in a national study of visits to emergency departments in the United States rate their experience according to select key indicators of satisfaction? One can surmise from the data that participants …
Read MoreNebulizer Treatment Coding and Take-backs on 99051
DAVID STERN, MD (Practice Velocity) Q.Payors do not seem to want to pay on the code E0572 (aerosol compressor, adjustable pressure, light duty for intermittent use). What can we do to get payment? A.This code is not for simple use of the aerosol compressor, but is actually used to code for sale of the actual nebulizer machine. Thus, this code would rarely be appropriate for use in the urgent care setting. Q.How do we get …
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