® APRIL 2018 VOLUME 12, NUMBER 7 THE JOURNAL OF URGENT CARE MEDICINE® www.jucm.com The Official Publication of the UCAOA and CUCM ALSO IN THIS ISSUE cme 29 Case Report Don’t Get Fooled by Gastrointestinal Pain 33 Health Law and Compliance Protect Your Business When Employees Leave 36 Revenue Cycle Management There’s Nothing Incidental About Incident-to Billing cme Practice Management Ensuring Your Office Layout Enhances Your Bottom Line CLINICAL cme Saving Patients’ Skin–and More– When Body Art Goes Bad LETTER FROM THE EDITOR-IN-CHIEF The Change Gang: Adopting a Disruptive Culture e’ve all heard it: Why do we have to “Urgent care is at a crossroads; Wchange? This is the way we’ve always done things! Change is difficult, even for the status quo is not going to get those of us who embrace it. But it is espe- cially difficult for non-owner employees. the job done.” After all, why welcome the discomfort and some might declare, nobody knows for certain which levers to uncertainty of change if there is no upside to your personal pull for success. This is where we have to get our staff com- bottom line? This is perhaps one of the biggest challenges fortable piloting ideas, with all the flexibility and patience that we face as the urgent care industry matures and competition comes with it. for a finite number of patients increases. If we don’t differ- Once your staff understands the necessity for change, solic- entiate, we die. But getting everyone on board with disruptive iting their suggestions will help them feel like they are an active change is a difficult task. part of the evolution, rather than victims of it. The practice Perhaps the most important first step we can take is to leader’s job is to set the stage, identify customer dissatisfiers, develop a mutual understanding that change is necessary. and then enlist the staff to help solve the problem without any Setting the tone for an adaptive and innovative culture starts boundaries for ideas. Consider the way we historically welcome with a conversation about the future and the challenges to con- our patients to their care encounter: “Driver’s license, insur- tinued success in a rapidly changing business environment. ance and credit card…please.” Now go sit down, fill out a lot of Our staff understands that we are dependent on our patients redundant paperwork, and then wait until we privilege you with as consumers of healthcare and can certainly comprehend the our care. Not the most inviting way to show we care, but this need to adapt to their evolving preferences. They also under- is how we’ve done it forever. You can’t change it now! Or can stand that we are competing with others for their business. you? You will be surprised by the creative energy your staff can It can help to start the conversation with a little history. When demonstrate when you enlist them in the process. You may urgent care first came on the scene, there was a pent-up even ask them to rank the ideas based on cost, feasibility, demand for access to healthcare. Some forward-thinking physi- and impact. If you can choose at least one of these ideas to cian entrepreneurs made up the bulk of the early growth in pilot, you have successfully engaged your team in the process urgent care by addressing the access issues. The mere avail- of disruptive change and given them a sense of ownership and ability of healthcare at convenient times and locations was responsibility for its success. Suddenly, they are leading on their enough to attract large numbers of patients. Everyone was own, willingly embracing what they once bemoaned. happy, and business was plentiful. Urgent care is at a crossroads and the status quo is not going Fast forward to the last 5 years and access is no longer an to get the job done. Creating a disruptive culture that gener- issue. There is an urgent care on every corner, a retail clinic ates enthusiasm for change and staff ownership will help pro- in every pharmacy, and even an inexpensive video consult avail- pel your urgent care down the challenging roads ahead. I able from every phone. Even traditional healthcare has entered the fray, making primary, specialty, and emergency care more patient-centric and accessible. Access is of little value anymore. Now the industry is focused on providing superior service and efficiency with more sophisticated operations, technologies, and other innovations to serve an increasingly demanding clientele. Everything about the urgent care encounter is now ripe for disruption, from navigation to registration, payment Lee A. Resnick, MD, FAAFP to care coordination; it’s all under review. And despite what Editor-in-Chief, JUCM, The Journal of Urgent Care Medicine www.jucm.com JUCM The Journal of Urgent Care Medicine | April 2018 1 Recommend MUCINEX® # doctor recommended 1 cough & cold brand* Maximum strength MUCINEX® 12-hour products help thin and loosen mucus in patients with upper respiratory infections Use as directed. Recommend other leading brands from the RB portfolio Delsym® reduces the uncontrollable urge to cough— at the source—and lasts for 12 hours Cepacol® INSTAMAXTM delivers the power of 2 maximum strength pain relievers for sore throat Children’s Mucinex® chest congestion products keep the mucus moving for children ages 4 to under 12 Use as directed. Give them what they need, when they need it! Off er your patients on-site sales Visit booth #502 at the 2018 Urgent Care Convention & Expo: Evolution 2.0 May 6-9, 2018, Paris Hotel, Las Vegas, Nevada Or contact Ellen Rendle: [email protected]/(859) 462-2245 * MUCINEX® is the #1 Recommended Brand in the Adult Cough/Cold category in the US among the Universe of Physicians (IQVIA, ProVoice Survey). MAT 52 weeks through December 2017. ©2018 RB All rights reserved. REV. 020118 ™ The Official Publication of the UCAOA and CUCM APRIL 2018 | VOLUME 12, NUMBER 7 CLINICAL 11 Tattoos and Piercings: What the Urgent Care Provider Needs to Know The popularity of body art has grown dramatically among all ages, ethnicities, and gender groups. And the occurrence of complications has grown right along with it. Be prepared to assess and treat them, and to counsel patients who may have ‘buyer’s regret’ about adorning their bodies. Tracey Quail Davidoff, MD IN THE NEXT ISSUE OF JUCM PRACTICE MANAGEMENT You’ve seen them in your urgent care center. Facility Design: Cultivating Collaboration One or two may have cornered you at your 21 child’s soccer game. The fact is that patients in the Back Office with back pain are everywhere—up to 80% Current trends in office design favor open spaces that reflect a team of the U.S. population experiences it at approach with an open design. On the other hand, managers and some point in their lives, in fact. If you’re clinicians may feel strongly about having a private office. What’s best among them, you know firsthand the only for your location? thing that matters during an acute episode is getting relief. Are you prepared to evaluate Alan A. Ayers, MBA, MAcc them; treat, transfer, or reassure them; and distinguish people in real anguish from CASE REPORT those who are seeking medication to use recreationally or feed an addiction? Read Cardiopulmonary Emergency Masquerading as the cover article in the May issue of JUCM 29Gastrointestinal Symptoms and you will be. A patient complaining of gastrointestinal pain or discomfort could have DEPARTMENTS simply had a bad meal, or be experiencing a life-threatening event. Be prepared to see the distinctions on the spot. 06 Continuing Medical Education Nihar B. Gala, MD 09 From the UCAOA 24 Abstracts in Urgent Care HEALTH LAW AND COMPLIANCE 36 Revenue Cycle Management Q&A 39 Insights in Images The Importance and Validity of Nondisclosure and 48 Developing Data 33Nonsolicitation Clauses for Urgent Care Center Owners Nondisclosure and nonsolicitation clauses offer urgent care operators CLASSIFIEDS some level of protection from outgoing employees’ taking proprietary 45 Career Opportunities information, customers, and patients with them when they leave your employ. Make sure you understand their limitations. Alan A. Ayers, MBA, MAcc TO SUBMIT AN ARTICLE: JUCM utilizes the content management platform Scholastica for article submissions and peer review. Please visit our website for instructions at http://www.jucm.com/submit-an-article www.jucm.com JUCM The Journal of Urgent Care Medicine | April 2018 3 JUCM EDITOR-IN-CHIEF Elisabeth L. Scheufele, MD, MS, FAAP ™ Lee A. Resnick, MD, FAAFP Physician, Massachusetts General Hospital Chief Medical and Operating Officer, Chelsea Urgent Care Physician Informaticist WellStreet Urgent Care EDITOR-IN-CHIEF Assistant Clinical Professor, Case Western Laurel Stoimenoff Lee A. Resnick, MD, FAAFP [email protected] Reserve University, CEO, Urgent Care Association of America Department of Family Medicine MANAGING EDITOR Joseph Toscano, MD Harris Fleming [email protected] JUCM EDITORIAL BOARD Chief, Emergency Medicine Medical Director, Occupational Medicine ASSOCIATE EDITOR, PRACTICE MANAGEMENT Alan A. Ayers, MBA, MAcc San Ramon Regional Medical Center Alan A. Ayers, MBA, MAcc CEO, Velocity Urgent Care Board Member, Board of Certification in ASSOCIATE EDITOR, CLINICAL Michael B. Weinstock, MD Jasmeet Singh Bhogal, MD Urgent Care Medicine CONTRIBUTING EDITORS Medical Director, VirtuaExpress Urgent Care Janet Williams, MD, FACEP Glenn Harnett, MD President, College of Urgent Care Medicine Medical Director, Rochester Regional Health David E. Stern, MD, CPC Tom Charland Immediate Care ART DIRECTOR CEO, Merchant Medicine LLC Tom DePrenda JUCM ADVISORY BOARD [email protected] Jeffrey P. Collins, MD, MA Chief Medical Officer, Kenneth V. Iserson, MD, MBA, FACEP, MD Now Urgent Care FAAEM Board of Trustees, Urgent Care Foundation The University of Arizona 185 State Route 17, Mahwah, NJ 07430 Tracey Quail Davidoff, MD Peter Rosen, MD PUBLISHER Rochester Regional Health/ Harvard Medical School Stuart Williams [email protected] • (201) 529-4004 Immediate Care Martin A.