Itâ€™s in an Urgent Care clinics best interest to provide proficient treatment for work related…
I came out of ER residency in 1986 and started my urgent care center in 1987. It was second nature back then to treat both illnesses andÂ injuries. Lacerations, eye injuries, smashed fingertips, shoulder dislocations, and fracture care were standard fare. I hired our first PA in 1995 and the second a few years later.
At first, patients resisted saying â€œwhen can I see a real doctor?â€. Despite the fact that my PA colleagues were outstanding in every way and treated everything I treated. Fast forward to the last 10 years when there has been nothing short of a sea change in provider hiring driven by the lack of available physicians, their cost, and the relative availability of APPâ€™s. And I would venture to say that a meaningful percentage ofÂ UC profitabilityÂ was derived directly from this process.
Meanwhile, APP training is simply not the same as a 3- or 5-year residency training program. How could it be? I must admit, I should have seen the implications for injury treatment coming long ago.
Lacking initial injury training and how to follow them up has resulted in the expected, many more referrals out to ortho/optho/ER.
To provide a few examples:
- What used to be a â€œroutine tuft fractureâ€ has become an â€œopen and comminuted distal phalanx fractureâ€ and is referred.
- What used to be a routine fingertip infection with I&D is now a â€œhigh risk felonâ€ and referred.
- What used to be a â€œroutine corneal FBâ€ has become something for an ophthalmologist to remove (remember when plant nurses removed these?).
- What used to be â€œsmall avulsion fractureâ€ is now in need of a â€œpinâ€, in some cases the fragment is so small, a pin wouldnâ€™t fit through it anyway!
- What used to be a routine â€œmetatarsal fractureâ€ with boot and crutches gets referred so the orthopedic surgeon can do almost nothing and collect the â€œglobal feeâ€.
I can tell you that the lack of training and experience on the part of any provider leads toÂ fearÂ which leads to excessive referrals. In many cases, those referrals are just going to APPs at the ortho office, or worse yet, going to the â€œOrtho Urgent Careâ€. What a defeat that is!Â
We are now at grave risk of losing injury care altogether! If you think this is not true then why are payers wanting to pay for â€œtriage onlyâ€ or telling groups that â€œyou donâ€™t treat injuriesâ€ you just â€œrefer themâ€. Then offering low ball case rates that further dis-incentivize injury care and procedures. This is a downward spiral!
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