Journal of Urgent Care Medicine

More Data Quantify ED Visits That Could Be Avoided

Nonbiased parties outside of the urgent care arena are picking up on the idea that many people who visit the emergency room don’t really need to be there—and there are more data demonstrating that all the time. Most recently, the International Journal for Quality in Health Care published research stating that 3.3% of ED visits are “avoidable” altogether. The data reflect more than 424 million ED visits by patients between 18 and 64 years of …

Attention Operators: You Won't Have to Report Pay by Gender, Race After All

When President Trump took office, he vowed to take steps to make life easier for business operators. The White House just announced one step in that direction would be reversing an Obama administration decision to make employers, including urgent care operators, report how much they paid workers and break down the data by gender, race, and ethnicity. Obama believed doing so would help quantify (and ultimately curb) pay discrimination, while Trump maintains that the process …

Are You Maximizing Claims on Radiology, Pathology, and E/M Services?

Date-of-services rules can be cumbersome on a good day—and can even turn an otherwise good day into a major headache for coders. A Medicare administrator contractor (MAC) put forth a provider outreach and education (POE) recommendation recently aimed at leveling out that “uphill battle” when it comes to complying with date-of-service requirements. An article in published online by DecisionHealth recommends clarifying the specific date-of-service rules your urgent care center follows when reporting common radiology, pathology, …

Your Antibiotic Stewardship Efforts Are Paying Off

A new study by the Blue Cross Blue Shield Association indicates that efforts to curb inappropriate antibiotics prescribing are working. The project considered 173 million claims reflecting the care of subscribers <65 years of age who filled antibiotic prescriptions between 2010 and 2016, finding that prescriptions for antibiotics fell 22% for infants, 16% for children, and 6% for adults during that time frame. Patients in the South and Appalachia were more likely to fill prescriptions …

Intermountain Quantifies Goal to Cut Opioid Prescriptions

The need to reduce access to opioid pain medications is pretty well accepted at this point, though much of the outcry is vague and often geared toward echoing statistics about the very real epidemic of addiction and death. However, Intermountain Health, which operates InstaCare urgent care centers in Utah and Idaho, has gone a step further by crunching its own numbers and devising a plan to cut opioid prescriptions across its systems by 40% by …

Urgent Care Data Would Feed NJ ‘Master Person Index’ to Help Prevent Mistaken Identity

Lax record keeping, the transient nature of online identities, and continually changing mobile phone numbers make it hard enough to keep tab on “who’s who” in your patient records. Add common names to the mix and it’s easy to see how patient identity could be hard to keep straight—the consequences of which could be severe in terms of patient safety and your adherence to confidentiality laws. New Jersey thinks one solution would be Master Person …

Connecticut Tries (Again) to Regulate Urgent Care Centers

Connecticut lawmakers apparently think “If at first you don’t succeed…” is the perfect approach to slapping licensing fees on the urgent care industry. Democrats in the state House of Representatives have inserted a provision in the current proposed budget that would require all urgent care centers there to carry a distinct license. The problem (for them) is, they don’t have an abiding definition of what constitutes an urgent care center. Currently, the law views urgent …

Independence Blue Cross Slashes Reimbursements on Modifier 25

Independence Blue Cross has implemented a new policy that cuts reimbursements on procedures billed with modifier 25 (“Significant, separately identifiable E/M service”) by half for care given to Medicare Advantage members and patients covered by private insurance plans. The lower rate does not apply to traditional Medicare claims. Independence covers patients under its own name, but also through QCC Insurance Company, Keystone Health Plan Eastand AmeriHealth. The move sets Independence apart from other payers, including …

UCA Files Comments on Medicare QPP

The Urgent Care Association vowed to represent the industry’s interests when the Centers for Medicare and Medicaid Services (CMS) released its final rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA) last October. In effect, CMS imposed guidelines for clinicians participating in Medicare’s Quality Payment Program (QPP), and defined two possible pathways: the Merit-Based Payment Incentive Program (MIPS) or the Advanced Alternative Payment Models (APMs). UCA made good on its promise this week by …

Can Hospitals Find Salvation by Offering Primary Care in the ED?

Hospitals and health systems have been taking a hard look at how they can maintain financial stability in recent years. As you’ve read here, many are venturing into urgent care, both on and off campus. Now, some are taking another step toward becoming everyday community health providers by offering, essentially, primary care in their emergency rooms. An article in Modern Healthcare details how one of them, Carolinas Healthcare System, realized the same old way of …