StuWilli, Author at Journal of Urgent Care Medicine

Make Sure Vacationers in Your Area Can Find You

Whether your location is fixed in a resort town or a couple of blocks off the interstate, it’s likely people from other areas will be passing through or spending some time nearby this summer. Some of them are going to catch a fish hook to the finger, eat tainted seafood, or be struck with the same URIs they’d be prone to back home. (In fact, insurance industry estimates hold that 20% of people will become …

In Texas, Progress Toward Prohibiting ‘Surprise Billing’ by Freestanding ERs

Protecting patients against the suspect billing practices—especially “surprise billing”—of freestanding emergency rooms seems to be a high priority in the Texas legislature. Most recently, a bill that offers patients more ways to contest bills was signed into law; Senate Bill 507 expands the use of mediation to contest surprise medical bills. This problem is perceived as especially great in Texas, which is home to more than half of the freestanding ERs in the country. Further, …

Wellmont Wants to Align Urgent Care Centers More Closely with Other Facilities

Wellmont Health System is taking a hard look at how it can integrate services among its urgent care centers and hospital facilities. The company has announced a goal of having an urgent care center within 30 minutes of every patient in its region. It’s noteworthy that Wellmont views distance between the urgent care center and the patient (and not the nearest hospital) to be of key importance. Given the trend toward viewing urgent care centers …

When Billing by Exam Type, the Revenue Is in the Details

Q: What is the difference between a detailed exam and an expanded problem-focused exam? A: Unfortunately, there is no straightforward answer to that question. The Centers for Medicare and Medicaid Services (CMS) provides some guidance in the 1995 and 1997 guidelines (https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-Publications-Items/CMS1243514.html). The 1995 guidelines state the documentation of the examination as follows: Problem-Focused – A limited examination of the affected body area or organ system. Expanded Problem-Focused –A limited examination of the affected body …

An 18-Year-Old Woman with Sudden Rash, Vomiting, and Cramping

Case An 18-year-old woman was swimming in the Atlantic Ocean off the coast of Florida when suddenly she experienced a sharp, stinging pain on her arm. That evolved into a severe ache shortly, accompanied by a painful red lesion. She vomited on her way to your urgent care center, and still feels nauseous. She is also complaining of muscle cramps. View the photo and consider what your diagnosis and next steps would be. Resolution of …

Faith Healer: Relieving the Burden of Control

“Grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.” I’m not usually one to quote religious text, but this excerpt from the Serenity Prayer resonates. Perhaps the most pointed and overwhelming challenge facing physicians today is the loss of control over our profession. The last three decades have seen dramatic erosion of the status, ownership, and independence of physicians. The …

Urgent Care Operator’s Liability for a Car Crash into the Center

Urgent Message: The owners and operators of urgent care centers are liable only for “foreseeable” events, which generally excludes a car crashing into an urgent care center and other “freak” accidents. Perhaps it’s the last story on a newscast, or in the strange-but-true section of the newspaper or a website: a vehicle crashes into an urgent care center. As strange as this news may seem, it’s not entirely uncommon. In the past decade, there have …

A 38-Year-Old Woman with Shoulder Pain

Case A 38-year-old female patient presents with acute shoulder pain following a fall on an outstretched arm during a spring skiing vacation. There is a normal appearance to the shoulder, but significant pain even with minimal attempts at range of motion. The clavicle and elbow are nontender. Neurovascular status is intact. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the …

The Red-Hot Joint

Urgent message: Septic arthritis can lead to significant morbidity if not treated in a timely manner. Bacteria within the synovial space can lead to rapid joint destruction and irreversible loss of function. When patients present to the urgent care center with a red, hot, swollen, painful joint, every attempt must be made to rule out this disease entity to prevent significant morbidity and mortality. Introduction Patients frequently present to urgent care with a red, swollen, …

An Unexpected Cause of Amenorrhea

Urgent message: The simplest explanation for a mundane symptom may not always reflect the correct diagnosis. Urgent care providers should consider all the possibilities in order to reach the correct conclusion as early as possible, or risk missing a more serious underlying diagnosis. Introduction Sometimes a simple complaint results in a common diagnosis, but other times a rare diagnosis will be discovered. The following case illustrates the importance of considering a wide differential and obtaining …