I recently started what I thought was going to be my dream job- Working in an urgent care with another provider with me as the clinic is typically busy.
The reality is I’m often alone and see 35-50 patients in a day with limited support staff. Door to discharge target time is 1 hour.
Our medical director has recently made a point of training the new hires on a variety of topics, including ‘limited primary care’ to limit referrals
Long story short: the expectation is that we are to diagnose/treat/follow-up/manage new diabetes, hypertension, and lipids in the urgent care. Including giving insulin in the clinic and initiating regimens, dosing clonidine and starting them on one ore more antihypertensive. And ordering all the initial diagnostics.
My concerns are that the charting system is not set up for primary care documentation, we don’t have consistent schedules, and patients cannot schedule appointments. Labs are reviewed and dealt with by whomever is on the day that they result in the system and providers often work in multiple locations in the network.
I’m new to urgent care, so I’m not sure how other clinics work. Is this consistent with where others work- providing some primary care services-but not others, managing another provider’s primary care labs, etc?
We did back to school and sports physicals which we had no business doing. Parents would literally lie on the forms stating no problems but the nurse from the school would call to clarify saying that last year Susie had asthma and a peanut allergy. Or a Bill who tore his hamstring last year wants to play football again but his Pediatrician wouldn't clear him so they came to us. So sketchy.
We had an agreement with some insurance providers that patients would come to our Urgent Care for physicals and yearly exams, including bloodwork. It was only two specific insurances and we would only see maybe 2 or 3 a week. Those patients faced the same problem - they didn't see the same provider and the providers all had an ER background so their mentality was more patch up and go rather than chronic management.
I liked Urgent Care but it didn't come without it's problems. We were across the street from the hospital so a lot of people having MIs and strokes would come to us hoping to avoid the ER. All we could do was stabilize and transport.
Djmatte- I think you are absolutely right about the money..... we were also told we have to check in EVERYONE, even if we know we can’t treat them in the clinic and then bill them for a visit even though we are sending them to the ER- because ‘it’s the law’. I worked in the ER and am very familiar with EMTALA- but as far as I knew it only applied to emergency departments?? And what law says that if a patient is even greeted by a provider we must legally bill them for services?
For example our policy is age 2 and up- but a stable 6 month old with a fever comes in- or a patient with an open fracture - things that you can immediately tell cannot be treated and safely sent along to the appropriate place- are to be checked in, wait to see the provider, and then told we don’t have the resources to treat them.
Is this the same in your urgent care?
We have recently changed our policy on this. We now triage patients before they are registered. If they classify as a level 2 or sometimes 3 we bring them immediately back. Also, if they present with something we cannot treat it is the expectation the provider does a quick assessment to make sure they are capable of self transport. However, currently we aren't charging them for the visit if we are just asking questions and calling for transport or sending them to the ED by private vehicle. We felt it was risky to send them without the provider actually looking at them first. So far this hasn't delayed any patients from getting appropriate care or generated unnecessary billing. We probably could still bill since we are doing an assessment on them but it doesn't seem like the right thing to do since we have no intention of treating.
I agree we do not want to charge patients knowing they will need to go to an ER although if they are seeing a practitioner.....and you are assessing them and giving them advice to go to ER ...there isn't any documentation of this and becomes a liability issue
Djmatte- I think you are absolutely right about the money..... we were also told we have to check in EVERYONE, even if we know we can’t treat them in the clinic and then bill them for a visit even though we are sending them to the ER- because ‘it’s the law’. I worked in the ER and am very familiar with EMTALA- but as far as I knew it only applied to emergency departments?? And what law says that if a patient is even greeted by a provider we must legally bill them for services?
For example our policy is age 2 and up- but a stable 6 month old with a fever comes in- or a patient with an open fracture - things that you can immediately tell cannot be treated and safely sent along to the appropriate place- are to be checked in, wait to see the provider, and then told we don’t have the resources to treat them.
Is this the same in your urgent care?
Everyone gets checked in, however, the provider can decide to not charge them. We would triage a child with a Fx and send them out if we can't treat them. EMTALA only applies to ERs (not free standing urgent cares) but I'm not sure if it applies to Urgent Cares connected to an ER. Urgent Cares make a lot of money and there is so much competition out there.
I agree we do not want to charge patients knowing they will need to go to an ER although if they are seeing a practitioner.....and you are assessing them and giving them advice to go to ER ...there isn't any documentation of this and becomes a liability issue
I recently started what I thought was going to be my dream job- Working in an urgent care with another provider with me as the clinic is typically busy.
The reality is I’m often alone and see 35-50 patients in a day with limited support staff. Door to discharge target time is 1 hour.
Our medical director has recently made a point of training the new hires on a variety of topics, including ‘limited primary care’ to limit referrals
Long story short: the expectation is that we are to diagnose/treat/follow-up/manage new diabetes, hypertension, and lipids in the urgent care. Including giving insulin in the clinic and initiating regimens, dosing clonidine and starting them on one ore more antihypertensive. And ordering all the initial diagnostics.
My concerns are that the charting system is not set up for primary care documentation, we don’t have consistent schedules, and patients cannot schedule appointments. Labs are reviewed and dealt with by whomever is on the day that they result in the system and providers often work in multiple locations in the network.
I’m new to urgent care, so I’m not sure how other clinics work. Is this consistent with where others work- providing some primary care services-but not others, managing another provider’s primary care labs, etc?
If "door to discharge time" were expected to be one hour in our UC, they would need to get us 2 more providers, more lab staff, 2 more Xray techs with more equipement, etc, etc. I have heard there are states going to "Primary Urgent Care" but we don't do it. We do not provide refills or manage chronic illnesses. We hand our patients a list of primary care providers and they can make an appt. We are already overloaded with acute patients.
DowntheRiver
983 Posts
I used to work Urgent Care as a RN.
We did back to school and sports physicals which we had no business doing. Parents would literally lie on the forms stating no problems but the nurse from the school would call to clarify saying that last year Susie had asthma and a peanut allergy. Or a Bill who tore his hamstring last year wants to play football again but his Pediatrician wouldn't clear him so they came to us. So sketchy.
We had an agreement with some insurance providers that patients would come to our Urgent Care for physicals and yearly exams, including bloodwork. It was only two specific insurances and we would only see maybe 2 or 3 a week. Those patients faced the same problem - they didn't see the same provider and the providers all had an ER background so their mentality was more patch up and go rather than chronic management.
I liked Urgent Care but it didn't come without it's problems. We were across the street from the hospital so a lot of people having MIs and strokes would come to us hoping to avoid the ER. All we could do was stabilize and transport.