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Questions have come up about ultrasound use in urgent care. Adoption in most clinics has been slow although some make the case.
Ultrasound used to be relegated to radiology and ob/gyn offices. The machines were cumbersome, expensive, and they required some expertise to use. As technology has progressed, however, the machines have gotten smaller, cheaper and easier to use.
The newest versions of handheld devices weigh less than a pound and are comparable to a smart phone, in terms of ease of use and size, said Nico Forte, Senior Commercial Marketing Manager with Konica Minolta Medical Imaging USA, Inc. Because of this, more clinicians are using ultrasound, and Forte expects to see that number continue to climb.
It’s not been heavily adopted in urgent care centers yet, but Forte thinks it’s just a matter of time before every clinician across the country has some type of ultrasound machine in his or her offices.
“In essence, the technology of ultrasound is becoming more democratic and the tools that were reserved for radiology are now being made available to others,” he said. “I’m sure at some point there was only one stethoscope in a hospital, now every clinician carries their own. I think the same thing will happen with ultrasound. It’s just a matter of time.”
Handheld ultrasound devices are on the market starting around $8,000 new; and quality used devices are available starting at $2,500, according to a May 2014 article in the Journal of Urgent Care Medicine. Essentially anyone in the urgent care setting can use an ultrasound (even though the purchase must be made by an MD).
The JUCM article makes a case for ultrasound use in urgent care for help diagnosing soft tissue infection. “This technology brings added benefit to patient care, with minimal provider education necessary for implementation, and therefore, should be considered for integration.”
Here are a few clinical applications to consider about adopting ultrasound at your practice.
Nurses in a variety of medical settings already use the machines frequently for bladder checks and IV access. Clinical applications include cardiac, abdomen, obstetric, and thoracic ultrasound.
Training can be provided in a variety of ways, including online courses, DVD and educational materials, and hands-on training at annual conferences. More information can be found the American Institute of Ultrasound in Medicine website: aium.org.
When using a handheld or portable ultrasound device as an extension of the patient’s physical exam, it would be considered part of the E/M or office visit. It would not be appropriate to bill separately. This can pose a problem for urgent care getting paid for this service, especially if the center has flat-rate contracts.
However, there are several billing codes that may be used when certain requirements are met, such as chest (76604), retroperitoneal (76775), abdominal (76705), and pelvic (76857). Clinics using PV Billing submitted for payment using these codes about 60 times in the past six months.
Urgent care may provide imaging services upon referral by primary care physicians and other providers in the community. This may provide opportunity to convert these patients into urgent care patients when needed, and it can help build a trusted relationship for primary care physician referrals to urgent care.
First Stop Urgent Care in Louisville, Kentucky, recently added a Phillips 5500 ultrasound machine. The clinic advertises its ability to perform ultrasound for abdominal, breast, carotid Doppler, pelvic, scrotal, thyroid, and upper and lower extremities.
“We are providing our patients with the assurance that these studies are being conducted with some of the best equipment available,” the center’s website touts. First Stop positions itself as a partner for primary care physicians, promising to perform exams and deliver the results to the ordering physician within 24 hours.
There are still some unknowns surrounding the overall practicality and value of ultrasound machines for use in an urgent care center. The use of the technology is not widespread yet in urgent care, but some are making a case for it.
Forte said the greatest value for ultrasound use is in evaluating patient conditions “in that gray area.” For a patient who is presenting with symptoms that aren’t clearly serious, but still raise questions.
“What if I could take a small device and within five minutes get a better look at what’s going on inside? Would that help them better understand what’s going on with a patient?” Forte argues: Yes.