Preemptive planner/frequent SDN spectator/excelling in 3rd year med school/happy 
/strong interest in 501c missionary ventures. Happiest with variety, abbreviated continuity of care, and definitive diagnoses. Still undecided about FP,Surgery, strong lean toward EM. That's me in short.
I have a few questions for you guys...
If I start an urgent care, assuming equipment is a non-issue, are there limitations as to what types of reimbursable services I can render as opposed to a "free-standing ED/level1/2?" eg. cardioversion, r/o brain bleeds w/ CT etc.
As I care greatly about continuity of care, if my wife opens a family practice next door and I recommend my urgent care patients there for follow up, chronic management, or in-house rx dispensing etc.., would that be a violation of Stark Laws?
***EDIT: more questions...
As the efficacy of educational advancement crawls forward (EMRAP, Larry Mellick youtube, etc), I'm trying to accelerate the experience attendings have with tens of thousands of patient encounters so as to improve my own clinical judgement at a faster pace. eg. not surely calling for a meningitis r/o with a 12/10 pain response for a kernig/brudzinski's test on my acutely ill teacher friend with sick contacts with 10/10 headache in moderate distress. Any resources or advice would be great.
Just want to ask how you guys feel about this. I understand that an important aspect of the ED is getting to the dispo and moving the people to where they need to go... but in many cases I've seen... working non-medicare patients come in and get a coded for a massive bill for r/o of insidious GI pathology, or a older patient with chronic pain gets full workup for pain / suspect mental status changes and they both get d/c'd without a definitive answer. My thinking is that if a patient's been in the ED for 9 hours and gets a level 5 for acute abdomen r/o and is now leaving, why not just throw in some fecal markers to see if you can tell him his 6 month bowel incontinence might be due to IBD or something other. Heard the justification that you don't want to tax hospital resources, deal with messing up the MDM with another test result, and patient expense etc... but the people are leaving with a massive bill and no answer. What do you attendings think about adding a few tests here and there for patient benefit? Or am I misguided and should just say, "follow up with your primary care and please return to the ED if your symptoms worsen."
I appreciate all the wisdom I've gleaned through the prior posts here, so in advance many thanks to all you docs for the insight.
/strong interest in 501c missionary ventures. Happiest with variety, abbreviated continuity of care, and definitive diagnoses. Still undecided about FP,Surgery, strong lean toward EM. That's me in short.I have a few questions for you guys...
If I start an urgent care, assuming equipment is a non-issue, are there limitations as to what types of reimbursable services I can render as opposed to a "free-standing ED/level1/2?" eg. cardioversion, r/o brain bleeds w/ CT etc.
As I care greatly about continuity of care, if my wife opens a family practice next door and I recommend my urgent care patients there for follow up, chronic management, or in-house rx dispensing etc.., would that be a violation of Stark Laws?
***EDIT: more questions...
As the efficacy of educational advancement crawls forward (EMRAP, Larry Mellick youtube, etc), I'm trying to accelerate the experience attendings have with tens of thousands of patient encounters so as to improve my own clinical judgement at a faster pace. eg. not surely calling for a meningitis r/o with a 12/10 pain response for a kernig/brudzinski's test on my acutely ill teacher friend with sick contacts with 10/10 headache in moderate distress. Any resources or advice would be great.
Just want to ask how you guys feel about this. I understand that an important aspect of the ED is getting to the dispo and moving the people to where they need to go... but in many cases I've seen... working non-medicare patients come in and get a coded for a massive bill for r/o of insidious GI pathology, or a older patient with chronic pain gets full workup for pain / suspect mental status changes and they both get d/c'd without a definitive answer. My thinking is that if a patient's been in the ED for 9 hours and gets a level 5 for acute abdomen r/o and is now leaving, why not just throw in some fecal markers to see if you can tell him his 6 month bowel incontinence might be due to IBD or something other. Heard the justification that you don't want to tax hospital resources, deal with messing up the MDM with another test result, and patient expense etc... but the people are leaving with a massive bill and no answer. What do you attendings think about adding a few tests here and there for patient benefit? Or am I misguided and should just say, "follow up with your primary care and please return to the ED if your symptoms worsen."
I appreciate all the wisdom I've gleaned through the prior posts here, so in advance many thanks to all you docs for the insight.
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