jucmcov-0615.qxp_final 5/24/15 11:55 AM Page 1 JUNE 2015 ™ VOLUME 9, NUMBER 9 THE JOURNAL OF URGENT CARE MEDICINE® www.jucm.com The Official Publication of the UCAOA a n d UCCOP PUBLICATION BRAVEHEART A AgilityHummingbirdAd_Print2.pdf 1 5/26/15 12:15 PM Zoom in on ICD-10. 3XD C .3 7 9 M V Y CM MY .62 CY D 1 X D 3. 07 D . 6 X X X 9 1 X D D W W W Y Y Y W 1 9 V V V . V 1 2 X X X 6 X A A W W W .4 CMY 5 3 X X X 1 9 X S S X S 6 V V .4 V . 2 X A A A .D 5 A 1 3 5 6.1 D 6 W W W 9 W 4 Y W R 89 . 1 4 9 .1 6 9 K 2 Z .29 5 X A A 9 A 1 5 Y 3. W W W 1X 6 W .0 D Z 0 0 V .29 5 X 5 A W With 68,000 ICD-10 diagnosis codes there's definitely one that's your sweet spot. Luckily, with AgilityUC, the right code pops out every time. It’s designed for the specialized nature of facilities that do both Urgent Care and Occupational Medicine. Search ICD-10 codes with exact terms, abbreviations, aliases, acronyms, medical conditions, and even fuzzy logic. A perfectly fitted software solution helps you scan the field to make sure the right one catches your eye. Learn more at nhsinc.com. Software for Urgent Care nhsinc.com The Art of the Right Fit® © 2015 Net Health. All rights reserved. Ad_FullPage_Sized.indd 1 5/26/15 7:55 PM resnick-0615.qxp_Layout 1 5/24/15 11:44 AM Page 1 LETTER FROM THE EDITOR-IN-CHIEF Maintenance of Certification: A Punch in the Gut n an era of plummeting leverage and influ- compared with the expected outcome of a population of simi- ence over health care and the well-being lar patients. It seems like ABMS board members have over - Iof our practices and patients, physicians estimated their own wisdom and ability to establish the quali- desperately need representation. Our col- fications necessary to certify the most capable physicians. If that lective voice has been muzzled when it is not the case, then perhaps this is all about money. Consider comes to health-care delivery and eco- this: The American Board of Internal Medicine spent nomics. We have been relegated to serving as the voice of pub- $53 million on MOC in 2013. About half of that went to “exam lic health and clinical best practice, nothing more. How did we development, administration, and exam delivery.” That’s get here, and what are our representatives in our professional $25 million worth of self-serving influence. Then there’s the organizations doing to overcome this situation? American Academy of Family Physicians, with its $100 million In previous columns I have discussed the nearly unbearable annual budget and a bushel of executives paid annual salaries regulatory and compliance environment we are forced to prac- well over $300,000, flying first class (with their families) hither tice within. Most of these conditions have been imposed on and thither across the country to attend board meetings. us by outside forces with self-serving agendas. Surely our own Where did we go wrong? Well, when you elect an unpaid physician societies are fighting hard to regain control over our board of directors to a “nonprofit” organization, and have them profession and to push back against the undue burden and suf- serve 1- to 2-year terms, the only consistent voice is really from focating weight of rules and requirements? Well, unfortunately the executives with money and power and the will to use those not. In an almost unfathomable move, boards that are mem- tools in their self-interest. Have a different idea for how things bers of the American Board of Medical Specialties (ABMS) have should go? It’s like the “rogue” Democrat or Republican look- added to our hardship by bloating the certification process with ing to “reform” an entrenched party with special-interest hands requirements for maintenance of certification (MOC) and recer- in their pockets. You know how that turns out. tification that for most physicians are simply too much keep up The only way forward is for physicians to collectively expose with. And yet, despite the dearth of evidence that these added their specialty societies for their failure to represent. The good requirements improve outcomes, protect the public, or make news is that this is actually starting. The National Board of Physi- better physicians, we remain subject to the added load. cians and Surgeons is a splinter group aiming to make board I have bemoaned MOC before, but a new physician survey certification more rational. The American Board of Physician from Medical Economics has me freshly infuriated: http:// Specialties has a similar goal. Both are gaining acceptance with medical economics.modernmedicine.com/medical-economics/ disgruntled physicians and, perhaps more importantly, with pay- news/poll-primary-care-physicians-say-moc-does-not-make- ors and hospitals. Perhaps the urgent care community and its them-better. Of the 2000-plus physicians surveyed, 96% representatives should rally around one or both so that we too expressed dissatisfaction with MOC, and 95% proclaimed that can have a home that allows us to practice our chosen disci- it does not make them a better physician. A full 75% feel that pline without the absurdity of MOC within a specialty we no there should be an alternative way of achieving board certifi- longer practice. Imagine that! n cation that does not require testing at all. Despite the nearly unanimous dissent of physicians, our own member societies have ruled otherwise. There are only two possible explanations for why our elected leaders would so blatantly betray us: money or ego. Or is it both? In clinical research on physicians, ego bias is defined as sys- Lee A. Resnick, MD, FAAFP tematic overestimation of the prognosis of one’s own patients Editor-in-Chief, JUCM, The Journal of Urgent Care Medicine www.jucm.com JUCM The Journal of Urgent Care Medicine | June 2015 1 Ad_FullPage_Sized.indd 1 3/27/15 4:26 PM TOC-0615.qxp_Layout 1 5/24/15 11:45 AM Page 3 ™ The Official Publication of the UCAOA and UCCOP June 2015 VOLUME 9, NUMBER 9 CLINICAL 9 Shoulder Pain in the Urgent Care Shoulder pain is not always "just another musculoskeletal complaint." It may be referred pain indicating life-threatening conditions. Mizuho Spangler, DO, and Michael B. Weinstock, MD Shoulder pain, computer artwork. PRACTICE MANAGEMENT IN THE NEXT ISSUE OF JUCM The ubiquity of smartphones with audio and video The Role of Urgent Care recording capabilities increases the chances that 19 patients will openly or covertly record interactions in an Integrated Care System: with physicians. In our Practice Management section, Insights from Intermountain experts will spell out the legal and privacy implications so that you can develop appropriate policies and Healthcare training for your urgent care center. Integrated health systems can improve access and clinical outcomes and reduce patients' costs. Alan A. Ayers, MBA, MAcc DEPARTMENTS 7 From the UCAOA CEO CASE REPORT 27 Abstracts in Urgent Care 23 Pediatric Periorbital 29 Insights in Images Cellulitis from an Intranasal 33 Health Law Button Battery 35 Coding Q&A Foreign-body insertion is common in toddlers and has potentially serious consequences. 40 Developing Data May Mohty, MD, FAAP, FAAUCM, and Jacob Anderson, DO CLASSIFIEDS 37 Career Opportunities www.jucm.com JUCM The Journal of Urgent Care Medicine | June 2015 3 TOC-0615.qxp_Layout 1 5/24/15 11:45 AM Page 4 JUCM EDITOR-IN-CHIEF Joseph Toscano, MD Lee A. Resnick, MD, FAAFP San Ramon (CA) Regional Medical Center Chief Medical and Operating Officer Urgent Care Center, Palo Alto (CA) Medical WellStreet Urgent Care Foundation President, Institute of Urgent Care Janet Williams, MD, FACEP EDITOR-IN-CHIEF Medicine Rochester Immediate Care Lee A. Resnick, MD Assistant Clinical Professor, Case Western [email protected] Reserve University Mark D. Wright, MD MANAGING EDITOR Department of Family Medicine University of Arizona Medical Center Katharine O’Moore-Klopf, ELS [email protected] ASSOCIATE EDITOR, PRACTICE MANAGEMENT JUCM EDITORIAL BOARD JUCM ADVISORY BOARD Alan A. Ayers, MBA, MAcc Alan A. Ayers, MBA, MAcc Michelle H. Biros, MD, MS ASSOCIATE EDITOR, CLINICAL Michael B. Weinstock, MD Concentra Urgent Care University of Minnesota CONTRIBUTING EDITORS Tom Charland Kenneth V. Iserson, MD, MBA, FACEP, Sean M. McNeeley, MD Merchant Medicine LLC FAAEM John Shufeldt, MD, JD, MBA, FACEP Richard Colgan, MD The University of Arizona David Stern, MD, CPC University of Maryland School of Medicine MANAGER, DIGITAL CONTENT Gary M. Klein, MD, MPH, MBA, CHS-V, Brandon Napolitano Jeffrey P. Collins, MD, MA FAADM [email protected] Harvard Medical School mEDhealth advisors ART DIRECTOR Massachusetts General Hospital Tom DePrenda Benson S. Munger, PhD [email protected] Tracey Quail Davidoff, MD The University of Arizona Accelcare Medical Urgent Care Emory Petrack, MD, FAAP Kent Erickson, MD, PhD, DABFM Petrack Consulting, Inc.; Unlimited Patient Care Center, PLLC Fairview Hospital 120 N. Central Avenue, Ste 1N Thomas E. Gibbons, MD, MBA, FACEP Hillcrest Hospital Ramsey, NJ 07446 Doctors Care Cleveland, OH PUBLISHERS William Gluckman, DO, MBA, FACEP, Peter Rosen, MD Peter Murphy CPE, CPC [email protected] • (201) 529-4020 Harvard Medical School FastER Urgent Care Stuart Williams David Rosenberg, MD, MPH David Gollogly, MBChB, FCUCP [email protected] • (201) 529-4004 (New Zealand) University Hospitals Medical Practices CLASSIFIED AND RECRUITMENT ADVERTISING College of Urgent Care Physicians Case Western Reserve University [email protected] School of Medicine Pete Murphy - (201) 529-4020 • Stu Williams - (201) 529-4004 Wendy Graae, MD, FAAP PM Pediatrics Martin A.