By Sean F.X. Dugan, Esq., and Michelle A. Frankel, Esq.
Monday, August 15, 2016
Medical care collaboration may be particularly important within pediatrics due to the inherent dependence of children on their caretakers. In this vein, pediatric care can be further complicated by the increased likelihood that the patient may be unable to communicate symptoms due to his or her age while also being prone to frequent injury or illness. For this reason, it is important to consider how the child’s pediatrician and urgent care center providers collaborate to deliver care.
The New York State Department of Health defines urgent care centers as “a source of outpatient diagnosis and treatment for ambulatory patients with non-life threatening or permanently disabling” acute illness or minor traumas. Some urgent care centers, such as PM Pediatrics and CityMD, specialize in providing pediatric care. Urgent care centers are beneficial to the child and parent, as they provide unscheduled medical care 24 hours per day or during extended hours.
The American Academy of Pediatrics has affirmed that urgent care centers should be used as a “safe, effective adjunct to, but not a replacement for, the medical home or emergency department.” It is imperative for parents and physicians to be mindful of this because varied understandings, definitions and service offerings associated with “urgent care” may create a tendency for parents to self-triage, pursuing the ease and cost efficiency associated with urgent care centers rather than seek potentially more appropriate care at their pediatrician’s office or an emergency room. Urgent care center providers can attempt to counteract this by being cognizant not to underdiagnose potentially significant conditions simply because the parents did not bring the child to the emergency room.
Urgent care center providers and primary care pediatricians can facilitate the provision of appropriate medical care by adhering to their respective scopes of practice and then coordinating care. The American Academy of Pediatrics promotes such collaboration and advises that urgent care centers should not routinely provide continuity care to children and should avoid appearing as a replacement for the primary care provider. Instead, urgent care centers should serve as referral centers for patients with acute health concerns.
Communication between the urgent care center provider and the child’s pediatrician is essential. The American Academy of Pediatrics recommends that urgent care centers have mechanisms in place to notify primary care physicians and ensure follow-up. Primary care physician referrals should be made by urgent care centers if a treating pediatrician is not identified. This type of coordinated care also requires seamless facilitation of shared medical records in compliance with the regulations of HIPAA. The child’s pediatrician may further promote coordinated care by choosing to be employed (part-time) by or affiliated with urgent care centers, which can promote patient care by enabling long-term physicians to have complete, unhindered access to patient records and presentation notifications.
Many models of care coordination have been developed to facilitate the provision of coordinated, quality health care. Such models may be particularly beneficial when treating pediatric patients with special health care needs, including those at increased risk for chronic physical, developmental, behavioral, or emotional conditions and who also require health and related services of a type or amount beyond that generally required by children. Pediatricians, emergency departments, and urgent care centers can collaborate to provide better patient care, as emphasized by the Urgent Care Association of America.