StuWilli, Author at Journal of Urgent Care Medicine

Beware Deceptively ‘Simple’ Diagnoses

A pair of recent news stores add up to a cautionary tale for clinicians inclined to assume ailments commonly identified in the urgent care setting pose no serious threats. One case resulted in the partial amputation of a child’s leg, while the other cost a child her life. In Akron, OH a 6-year-old girl’s strep throat was followed by a flu diagnosis. When her left leg began to swell and she begged her parents not …

Greenway Health Suffers Direct Hit in Ransomware Attack, Affecting EHR Platform

Greenway Health has acknowledged that some of its customers lost full use of the company’s Intergy electronic health records platform due to a recent ransomware attack. The company says it expects minimal loss of data, and that there is no evidence to suggest that any patient data has been misused at this time. Greenway has vowed to support affected practices, and maintains that no further problems are expected, either on Intergy or its other platforms.

Be Careful When Asking About the ‘S’ Word in Interviewing Candidates

Different markets have different standards of living—and compensation. So, it’s important to get a sense early on whether what you’re willing to pay aligns well with qualified job seekers. That’s going to be a lot tougher if an emerging trend continues to grow, however. Some cities and states are forbidding interviewers from asking candidates about their current, or most recent, salary. Legislation to that effect was just passed in Philadelphia, though the city will delay …

May 2017

Elbow Pain and Swelling After a Fall

Case A 28-year-old woman presents to urgent care with elbow pain and swelling following a mechanical fall. She reports the pain is worse with range of motion. There is no shoulder or wrist pain, and no paresthesias. Exam confirms pain with palpation and decreased range of motion. The radial pulse is 2+; sensation distal to the elbow is grossly intact. The patient is afebrile, has a pulse of 104, respirations 20, and BP 124/80. View …

Abstracts in Urgent Care – May 2017

Consider Vitamin D Supplementation for Patients Prone to URIs Key point: Vitamin D supplementation was both safe and protective against acute respiratory tract infection. Citation: Martineau AR, Jolliffe DA, Hooper RL, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017;356:i6583. An ounce of prevention would definitely be a good idea when it comes to upper respiratory infection. With the currently limited treatments for …

An 18 Month-Old-Boy with Vomiting

In Bouncebacks, we provide the documentation of an actual patient encounter, discuss patient safety and risk-management principles, and then reveal the patient’s bounceback diagnosis. This case is from the book Bouncebacks!, available at www.anadem.com and www.amazon.com. History of Present Illness John is a healthy 18-month-old boy. One morning shortly after Christmas, he awoke with cough and congestion. After breakfast, he had an episode of vomiting. Though his symptoms remained mild over the next 3 days, …

Are Alternative Payment Models Catching On?

There’s little evidence that emerging payment models (eg, concierge medicine, cash-only practices, and accountable care organizations [ACOs]) are gaining any serious traction in urgent care—but that doesn’t mean they’re not making headway elsewhere. ACOs, in particular, are growing in usage among physicians, according to the Medscape Physician Compensation Report 2017. Usage of cash-only and concierge models is also growing, albeit much more modestly, as the graph below shows. Data source: Medscape Physician Compensation Report 2017. …

Optimizing Tax ID Numbers, and Coding for Health Risk Assessments

Q: We are planning to open a new clinic that will offer both primary care and urgent care services. Can we use the same tax identification number (TIN) when we start negotiating contracts with insurance payors? A: Based on our experience with doing this many times, if you attempt to use the same TIN for both primary care (PC) and urgent care (UC), you are likely to see the following results: Some payors are likely …

A Multimodal Intervention to Reduce Antibiotic Use for Common Upper Respiratory Infections in the Urgent Care Setting

Urgent message: Upper respiratory infections (URIs) are the most common presenting complaint in urgent care. Regardless of etiology or provider specialty, antibiotics are prescribed 60% of the time for the treatment of URIs, contributing to drug-resistant respiratory organisms. Employing a multimodal intervention, the authors we were able to appreciate a modest, statistically significant decrease in the rate of antibiotic prescribing among urgent care providers. Introduction Antimicrobial resistance is arguably one of the greatest risks to …