Is this common?

[Monte]

I work in an urgent care in New England; it's solo practice with pt load ranging from 28-55 daily, 35 or so average.. already seeing into the 50s this Fall.

It's staffed with 1 Provider, 1 x-ray tech and 1 MA or LPN typically (Total of 3 people). Some days, they staff 1 LPN with 1 MA that makes the total 4.

I'm 2 years out of PA school, been working urgent care for about 7 months now. What I'm wondering.. is if this situation with the below happenings is common practice or not.

 

- 1 MA or LPN working.. this creates a near-daily stress on everyone at the clinic where there isn't enough help for myself or patient rooming. On days where there isn't a nurse, I'm expected to do TB tests and any injections because they don't allow the MA to do injections.

- No front desk staff.. the x-ray tech is responsible for the front desk (checking people in, answering the constant phone calls, etc.) When they are busy with x-ray, there is literally nobody at the front desk, causing back-up and chaos often.

- With the previous, I very often am being asked by the nurse and tech to answer the phone, run urine dips, do TB tests etc. because they are so busy. I am definitely a team player, but most of the time I say no because it just gets the clinic even further behind.

-At my previous review, I've been told that the vast majority of my visits should be level 4s. This includes 5 minute UTI or Strep workups.. My work has already lost a lawsuit last year for overcoding.

 

Is any of this common? I've expressed my feelings to management but nobody truly cares at corporate ($$$$$)

Thanks for any input!

 

 

[LKPAC]

Not an ideal work condition.  They need 2 MA/LPNs at all times, plus the xray tech.  When the tech is taking an xray, an MA goes up front to registration.  They are not saving money by using a PAs valuable time doing MA work.  They need to make you more efficient so you can see more patients.  They are being penny wise, but pound foolish.

[Reality Check 2]

Money Mill

Pressure everyone into doing more than they should at the risk of errors and patient harm.

I have been in a similar situation in years past and would RUN, not walk, to a real job.

Nothing is worth perpetuating that kind of abuse to all involved.

[Monte]

Hello LKPAC, that's what I thought..

I've mentioned it several times to the manager who visits every so often, but since I've been working they staff an MA plus LPN probably around 30% of the time.

 

Reality check 2, I do 100% agree.. thanks for confirming this with me.

I've only stayed this long because I'm waiting to reach the 1 year mark on my resume for future ER/UC positions.

Edited October 11, 2019 by Monte

[thinkertdm]

I found this on the aafp website:

Rules of thumb for 99214

Think 99214 in any of the following situations:

• If the patient has a new complaint with a potential for significant morbidity if untreated or misdiagnosed,

• If the patient has three or more old problems,

• If the patient has a new problem that requires a prescription,

• If the patient has three stable problems that require medication refills, or one stable problem and one inadequately controlled problem that requires medication refills or adjustments.

https://www.aafp.org/fpm/1999/0700/p32.html

 

even a viral uri can be a 99214, if you prescribe tessalon perles and write something like “history and physical exam suggestive of a viral etiology; while the differential includes x,y,z I have a low suspicion for strep, mono as there was no fever or lad; etc.  today I prescribed tessalon perles and cautioned about...”. You reviewed prior medical records.  If they have diabetes, write that you cautioned it might cause a slight elevation in his blood sugars,.  

[rev ronin]

5 hours ago, thinkertdm said:

I found this on the aafp website:

Rules of thumb for 99214

Think 99214 in any of the following situations:

• If the patient has a new complaint with a potential for significant morbidity if untreated or misdiagnosed,

• If the patient has three or more old problems,

• If the patient has a new problem that requires a prescription,

• If the patient has three stable problems that require medication refills, or one stable problem and one inadequately controlled problem that requires medication refills or adjustments.

https://www.aafp.org/fpm/1999/0700/p32.html

 

even a viral uri can be a 99214, if you prescribe tessalon perles and write something like “history and physical exam suggestive of a viral etiology; while the differential includes x,y,z I have a low suspicion for strep, mono as there was no fever or lad; etc.  today I prescribed tessalon perles and cautioned about...”. You reviewed prior medical records.  If they have diabetes, write that you cautioned it might cause a slight elevation in his blood sugars,.  

Or back pain for which you start cyclobenzaprine.  Or UTI that you start Bactrim.  Or strep for which you start Pen VK. 

Also note that you can use 1995 or 1997 guidelines... https://emuniversity.com/Page5.html

[thinkertdm]

The beauty of templates...guide you through a 99213 vs 99214.  It’s all on how you document.  I spent an hour talking to a patient about their back pain, surgeries, pain treatment options...lots of ways to code it, I suppose, but I put it down as 99215, “greater than 50% of this 60 minute visit was spent in a face to face discussion and coordination of care”.

[Boatswain2PA]

8 hours ago, Monte said:

I work in an urgent care in New England; it's solo practice with pt load ranging from 28-55 daily, 35 or so average.. already seeing into the 50s this Fall.

This is corporate UC today.  So, to answer your question....yes this is common.  It also sounds like an absolutely terrible place to practice.

[Monte]

Thanks for the responses in regards to billing; the information above will help me going forward. 

In the end I think what bothers me most is the understaffing. Everyone at my clinic feels dread each morning which creates a terrible environment. I do like urgent care.. the fast-paced nature and 3 12s a week is amazing.. just need to find that gem job that at least staffs 4 people in the building and shows a little more appreciation for workers.

[Cideous]

This is extremely common, and I have worked in many just like it.  Virtually all UC clinics are like this in the corporate world and now most private UC's are like this as well.  They have adopted the corporate mindset to compete.

Also, your lucky the only lawsuit that they have faced was for billing.  Seeing that kind of volume, being that shorthanded....uggh.  What a nightmare of liability.

 

Ok here is a tip....admittedly somewhat cheesy, but we're all friends here sooo....  

Corporate UC's are constantly opening new clinics....constantly.  Look for one of these and try and get hired on at THAT location.  Every new UC clinic I have ever worked at has taken a minimum of 1-2 years to heat up.  You literally buy yourself a year or two of not getting killed.  Then, once it enters into the "unreasonable" volume stage and they don't support it?  Move on.  Like I said, cheesy but effective.

[Monte]

18 minutes ago, Cideous said:

Ok here is a tip....admittedly somewhat cheesy, but we're all friends here sooo....  

Corporate UC's are constantly opening new clinics....constantly.  Look for one of these and try and get hired on at THAT location.  Every new UC clinic I have ever worked at has taken a minimum of 1-2 years to heat up.  You literally buy yourself a year or two of not getting killed.  Then, once it enters into the "unreasonable" volume stage and they don't support it?  Move on.  Like I said, cheesy but effective.

Haha, I like that.. The staff at my urgent care even said that the location I'm at is on it's 2nd year, and that the first year was dead.

Are urgent cares more in rural areas any better?