SocialMedicine Posted February 28, 2014 Share Posted February 28, 2014 I will admit the title is a bit sensationalist. However, I constantly see patients who "just last week went to urgent care" for this or that. I am evaluating much fewer URI, UTI, etc. I live in a large urban setting keep in mind. This change in healthcare (destructive innovation some would call it) may not be appreciated in less dense regions. The urgent care centers around me are often part of large hospitals or commercial chains with big money backing. They are advertising, smart marketing campaigns, and open long hours/weekends. This has influenced the volume of many small primary care/pediatric offices in my region (this is anecdotal I do not have data). How will primary care evolve in response to this change ? I look forward to a sore throat visit .... because I can spend more time with complicated diabetic or HIV patient. Will I only be evaluating chronic illness as opposed to acute in the future ? I could see that being draining in several ways. I hope PA's in professional associations and academic settings are thinking about this. It would be wise for us to be aware of this changes. Any predictions or ideas? Or is my concern more nonsense on my part like many feel the PA saturation concerns I have are :). Link to comment Share on other sites More sharing options...
Z PA-C Posted February 28, 2014 Share Posted February 28, 2014 Using my insurance as an example I would rather pay a $25 copay to see a PCP than a $100 copay to go to an UC. Link to comment Share on other sites More sharing options...
AREID Posted February 28, 2014 Share Posted February 28, 2014 Interesting. My friend just got obamacrarw and went to the ED. She had a 2nd degree burn, nothing bad by any means. She decided to go to the ED because it was FREE and had a copay with her PCP. ED saw her right away too... Sent from my iPhone using Tapatalk Link to comment Share on other sites More sharing options...
SocialMedicine Posted February 28, 2014 Author Share Posted February 28, 2014 Not all plans have different payment structure for PCP and UC. Especially that large a different. And I am talking about urgent care not a center which is categorized as an ER which charges ER rates. Many of these have popped up as well and have surprised/ruined a patient when the bill comes. Link to comment Share on other sites More sharing options...
Z PA-C Posted February 28, 2014 Share Posted February 28, 2014 My copay is $500 for ER. Maybe I should look into getting Obamacare. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 28, 2014 Moderator Share Posted February 28, 2014 I work some shifts at our affiliated urgent care. we are seeing huge volumes this year because we accept medicaid and only one other practice in town does and they have a 3 month wait for new patients and a 5 week wait for established pts. ACA coverage is like an ATM card that you can only use at ERs and urgent cares right now. there needs to be some teeth behind it so that pcps will take and be reimbursed appropriately for seeing these folks. the acuity is going way up too. for example I saw a diabetic the other day off meds for > 1 yr due to loss of job/no insurance/etc. Huge diabetic foot infection which had been brewing for months. fever/leukocytosis/poor renal function/etc...admitted and lost several toes.... Link to comment Share on other sites More sharing options...
ToppDog Posted February 28, 2014 Share Posted February 28, 2014 Primary Care can easily adapt (& has for many years) to Urgent Care. One of my first jobs in civilian healthcare was at a Family Practice clinic in a rural area where the docs also took turns manning an urgent care clinic that they also owned. Eventually they combined the two into a single office space in a newer building that also incorporated a Pediatrics clinic. One side of the office was the urgent care space, & the other side was the family practice space, with shared lab & x-ray facilities. Obvious advantages included your patients returning to your urgent care facility, combined medical records, shared staffing, reduction in overhead, & simply the convenience of having everything in a single place. I have also worked at other clinics that operated as both a primary care clinic & an urgent care facility, with providers that had regularly scheduled days & would take appointments, along with taking patients on a walk in basis, with corresponding billing. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 28, 2014 Moderator Share Posted February 28, 2014 yup, accessibility is key. if your pcp accepts your insurance and can see you on a same day basis, pts will go there. if you schedule a week out they will go elsewhere for urgent issues. Link to comment Share on other sites More sharing options...
LKPAC Posted February 28, 2014 Share Posted February 28, 2014 Interesting. My friend just got obamacrarw and went to the ED. She had a 2nd degree burn, nothing bad by any means. She decided to go to the ED because it was FREE and had a copay with her PCP. ED saw her right away too... This is part of what's wrong with ObamaCare. Instead of a $120 bill at a primary care office, people go the ER where the bill is $1000 or more for the same care! How is this controlling medical costs? Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted February 28, 2014 Share Posted February 28, 2014 Depends on coverage. Some have lower ED co-pay. Some carriers as noted discount UC, especially if in network. Truthfully , how many pt.'s do you run across that have a clue how their plan works? Link to comment Share on other sites More sharing options...
KMD16 Posted March 1, 2014 Share Posted March 1, 2014 Using my insurance as an example I would rather pay a $25 copay to see a PCP than a $100 copay to go to an UC. Shop around. Most UC charges copay at PCP rate. Free standing ED that are not affiliated to hospital staff by EP charge at ED copay rate. Link to comment Share on other sites More sharing options...
jdumoch Posted March 1, 2014 Share Posted March 1, 2014 I work at one of the biggest UC companies in the northeast.. we make it a point to stress that we are not taking patients away from primary care. to that end, on most patients beyond the typical cough/sore throat we tend to call the pmd to help develop a treatment plan and arrange follow up to ensure they return to their pmd after the UC visit. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 1, 2014 Moderator Share Posted March 1, 2014 speaking of sicker folks at UC after ACA may I present the following:63 yr old guy, smoked forever, has had progressive SOB x months and just got insurance.anyone care to interpret his cxr? click on it to make it full size. Link to comment Share on other sites More sharing options...
Acebecker Posted March 1, 2014 Share Posted March 1, 2014 That's impressive. What was the final diagnosis? Looks like severe atelectasis, but I can't tell if it's effusion or malignancy. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted March 1, 2014 Share Posted March 1, 2014 I thought this was a lat decub specifically looking for layering of effusion, which it doesn't, thus making it either a consolidated pleural mass or intraparenchymal density/consolidation. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 1, 2014 Moderator Share Posted March 1, 2014 it's not a lat film, it just posted that way. it's a large malignant pleural effusion. what didn't come out well in the pix unfortunately was all the 3 cm mets in the L lung fields. sent the guy to the hospital for CT and thoracentesis. he didn't go. wondering what his thought process was.......I called his listed phone # and it was disconnected.... Link to comment Share on other sites More sharing options...
primadonna22274 Posted March 1, 2014 Share Posted March 1, 2014 Even severe atelectasis and/or effusion you should see some lung markings. I'm betting on s/p lobectomy with new hilar mass on the right. Link to comment Share on other sites More sharing options...
primadonna22274 Posted March 1, 2014 Share Posted March 1, 2014 On second thought I can see total white-out with a 50% effusion...but you can only make the referral--you can't make him go. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 1, 2014 Moderator Share Posted March 1, 2014 On second thought I can see total white-out with a 50% effusion...but you can only make the referral--you can't make him go. yup, he adamantly refused an ambulance transfer....I'm guessing he never intended to go once I told him my suspicions and concerns... Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted March 1, 2014 Share Posted March 1, 2014 Should've known about the lat decub.. That's so "old school". Why do that when we can just scan him? Heck, I bet new grads aren't even told about it. Crap, where'd I set that Geritol bottle? Lawrence Welk is coming on.... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 1, 2014 Moderator Share Posted March 1, 2014 I remember ordering lat decubs but have not done one in a while. at my first job we also did 5 hr IVPs for kidney stone...,. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted March 1, 2014 Share Posted March 1, 2014 ^^ "Clink" as we tap our Geritol glasses together. Used to mix mine with my Zomax prescription and my sublingual squirt of Procardia (only the "geriatric" population will understand this reference). Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 1, 2014 Moderator Share Posted March 1, 2014 yup, we did procardia puncture and swallow as well....apparently that was a bad idea..... at my first job I had to move the suction cup around on the chest to get the different ekg leads, we had a hemoglobinometer, and I spun my own crits....we also had glass IV bottles...I probably still have some scars from cutting my fingers on the little metal tabs on them. Link to comment Share on other sites More sharing options...
JohnnyM2 Posted March 1, 2014 Share Posted March 1, 2014 Depends on coverage. Some have lower ED co-pay. Some carriers as noted discount UC, especially if in network. Truthfully , how many pt.'s do you run across that have a clue how their plan works? Healthcare will never be affordable as long patients are uninvolved in making cost decisions and have no idea how the system works. It was bad enough when insurance companies had total control; Now the government has it's foot on the throats of insurance companies, employers and individuals. This government can't produce a budget, can't stick to a budget, can't produce honest downstream cost estimates, can't produce jobs and economic growth, passes legislation full of pork and time bombs that no one reads before voting, exempts itself from its own bad law, and puts more time and effort into re-election than governing. Is it any wonder the entire healthcare system is being turned upside down with no real benefits to patients or the economy? Just sayin. Sent from my Kindle Fire HDX using Tapatalk 2 Link to comment Share on other sites More sharing options...
Corpsman2PA Posted March 1, 2014 Share Posted March 1, 2014 yup, we did procardia puncture and swallow as well....apparently that was a bad idea..... at my first job I had to move the suction cup around on the chest to get the different ekg leads, we had a hemoglobinometer, and I spun my own crits....we also had glass IV bottles...I probably still have some scars from cutting my fingers on the little metal tabs on them. Did you guys also use blood letting, leaches, frontal lobotomy and jugum's? :) Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.