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Free blood pressure checks


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Nice service for your clinic to offer, or a liability?

Today’s debate with others.  I say no free checks, because they ultimately end with the patient asking, “Is that high, normal, low?” ... usually followed by them wanting to know what the medical assistant would do about it.  I consider that medical advice, and a recipe for disaster.  I am certainly not walking out front to have a conversation with you over what you should do about it either.  That’s called a “patient encounter”.

Sign in, pay your copay, get it checked, and I will address the numbers, along with making some chart notes.

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Interesting concept...When I functioned as a MA in Urgent Care we had different "nursing" services that the MAs performed where the provider is never involved. One was blood pressure checks. The patient would pay a "small" fee and the MA brought them back to check their blood pressure. However, we were never allowed to say "your blood pressure is high etc" because that would prompt "so what do I do now"...

we would say OFF the bat that "your blood pressure is within normal range" or "your blood pressure is elevated above what is considered within normal range, do you have access to a primary care provider...if not, we can provide a list for you so you can make an appointment" or "we can have the in house provider see you, would you like to be taken back to see them?" But here is the catch, if they say yes, that'll have to pay another fee lol.

Anything that is said beyond those lines were considered giving medical advice and we as MAs cannot do that and it now becomes a liability.

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Have an approved handout with the guidelines and directions for the patient. Inform MA to tell patient if they fall in the abnormal range, they should make an appointment to see the provider, and that is all that said MA can do. That's what we do for promotions like "women's health month" where they have free BP screenings.

If the reading is high, perhaps you could have the MA give them a screening form to fill out and have their BP read serially (however you want to do this) that way the serial BPs will be done when they come to see you.

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We do free BP checks, but only for patients who are established with a provider within our clinic.  If a provider then talks with the patient it is considered an encounter and billed.  Usually, it's someone whose BP was a bit high at a visit, so we have them come back once or twice to ensure they truly have HTN - especially as you're supposed to have more than once measure before diagnosing with HTN.

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On 4/11/2018 at 0:18 PM, MidwesternTexan said:

Otherwise, Pts should go to the Walgreens, Walmarts, that have those B/P machines- for free.

They do keep them calibrated.  Most of them even will state if high, normal, etc.

If all they want is a free b/p- that's my advice.

Oh, heck no.  Those are one-size-fits-noone-well, and I have on a couple of occasions spot-checked them for accuracy, with disappointing results.  I have yet to see a public/OTC BP machine that does a really decent job.  The hospital ones with variable size cuff attachments do well, but the drugstore ones are just not good enough to recommend.

Do your fire departments do free BP checks?  I send my people there for human-performed BP checks between visits.  Otherwise, that sounds like a 99211 to me.

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Pardon my naivete, but my only prior experience that was really relevant to BP was EMS, and then we only really cared if it was very high or very low. It wasn't uncommon to ballpark the number by 5 or 10 mmHg depending on the quality of the read and the situation as a whole. In my time in a free clinic (basically a GP) after seeing maybe 50-75 regular patients, only one was chronically hypertensive. 

As a whole, my impression of the "free BP check" scenario, would be to intercept a critical condition. For the vast majority of patients I've encountered "lose 20lbs," "stop smoking," or "stop drinking 2 liters of coffee a day," would bring them into a normal range. For those who were truly hypertensive, now you're talking about long term management with complete history etc etc. If it is a regular patient, department store wrist cuffs are "good enough." In my experience checking their accuracy for my parents, + or - 5 mmHg compared to manual; which unless I've missed something is well within normal daily variation and therefore expected error.

On top of that, a spot check is kind of arbitrary; I recall a dentist appointment I had where an exceptionally cute hygienist took my BP and it was something like 150/90; my resting BP is otherwise ~110/70.

So the question I have is "why bother?" Either you're trying to find a needle in a haystack of someone who truly requires medical intervention (possibly urgently) which is fine but perhaps not the most efficient allocation of resources, or it just sounds like a ethically fuzzy way of convincing people to make an appointment and drum up business "we accept all credit" used car salesman style.

Any clarification is appreciated. 

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On ‎4‎/‎15‎/‎2018 at 7:48 PM, rev ronin said:

Oh, heck no.  Those are one-size-fits-noone-well, and I have on a couple of occasions spot-checked them for accuracy, with disappointing results.  I have yet to see a public/OTC BP machine that does a really decent job.  The hospital ones with variable size cuff attachments do well, but the drugstore ones are just not good enough to recommend.

Do your fire departments do free BP checks?  I send my people there for human-performed BP checks between visits.  Otherwise, that sounds like a 99211 to me.

OK, noted

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I've done them in the past for another employer and I presented them with a sheet of paper spelling out the ranges and that if abnormal they need to follow up with their primary care provider.  If in the severe range (>180/110) and neuro sx then you start walking a really fine line since urgent neuro assessment is indicated.

All this  being said, myself and the other provider were volunteered to do just this in the next couple of weeks.  Again, non-medical folks making medical decisions.  No one has bothered to ask the question "What if we find someone with abnormally high blood pressure and they're sx.?"

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I'll probably catch flak for this but I'm a medic, (Starting PA school in august) I do "I just wanted to be 'checked out'" calls all the time.  I have no problem saying yeah, your BP is good, or its a little high or a little low and then rattling off a few reasons why it may be. Then go through the PTs meds with them, daily routine, Intake/Output, diet, etc etc and make suggestions about all these things but always end my statements/assessments with "I'm NOT A DOCTOR, your should see your PCP, or we can transport you to the ED to see a doctor there, they can tell you much better than I can about what may be causing xyz symptom and you can call us back at any time"  I see it as a service to the community of extremely poor, disenfranchised, un-educated PTs who may not have insurance or transportation or for whatever reason refuse to or can't get to a PCP. Many times it's just settling somebody's self diagnosis anxiety. Obviously if I see something way off or c/o dizziness, HA, nausea, syncope I will very strongly recommend they get transported and document the hell out of it if they refuse transport.

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I'll probably catch flak for this but I'm a medic, (Starting PA school in august) I do "I just wanted to be 'checked out'" calls all the time.  I have no problem saying yeah, your BP is good, or its a little high or a little low and then rattling off a few reasons why it may be. Then go through the PTs meds with them, daily routine, Intake/Output, diet, etc etc and make suggestions about all these things but always end my statements/assessments with "I'm NOT A DOCTOR, your should see your PCP, or we can transport you to the ED to see a doctor there, they can tell you much better than I can about what may be causing xyz symptom and you can call us back at any time"  I see it as a service to the community of extremely poor, disenfranchised, un-educated PTs who may not have insurance or transportation or for whatever reason refuse to or can't get to a PCP. Many times it's just settling somebody's self diagnosis anxiety. Obviously if I see something way off or c/o dizziness, HA, nausea, syncope I will very strongly recommend they get transported and document the hell out of it if they refuse transport.

The key to your phrase is "document it".  In our EMR if this isn't an established patient then I don't have the means to create a patient note since they aren't in the system.  If in the office and they have "severe HTN" as noted above then our SP has given us (or at least me) the OK to initiate therapy and he'll see them in office in a couple of days to pick up the ball and run with it (remember, I'm not the PCP for my folks, thank goodness).  I will give them one of my "snot/cough" sheets and note at the top the BP readings (pulse rate included) and Mr. Stick Man to show how it was obtained. 

Addendum: Boy, did I open a can of worms this morning. Made mention of fact that I didn’t want to not have the ability to document an interaction in a patient record that we haven’t seen previously and I’m told that we won’t be interpreting values but instead will just hand them an approved AHA handout and tell them to see their PCP if abnormal. If they don’t have a PCP then refer them to SP’s network. Okay. So they walk away, they have an acute event, put two and two together, and then decide to look for someone to blame. Guess who has NO record of the interaction and as a licensed HCP did not provide standard of care information?

 

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Very true, I never considered the fact that you wouldn't have a way to document.  I've got a long way to go to learn "office" medicine compared to what I do now.  Good luck with that, I wish there was an established protocol for this type of thing, I feel like "health screenings" at no cost/low cost would be a great way to open up dialogue with people who need care and improve the public's opinion of healthcare but with the risk to the provider it seems nearly impossible.  I wouldn't even mind doing the charts if it meant we could get 1-2 people out of 10 on the right track to preventative care.

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