PracticeUpdate Dermatology February 2019

EDITOR’S PICKS 10

The Value of Urgent Care Dermatology International Journal of Dermatology Take-home message

COMMENT By Jeremy Jackson MD U rgent care dermatology clinics provide patients rapid access to dermatologists who are the most qualified to treat conditions of the skin. This article shows that there are several potential benefits to seeing patients in the setting of an urgent care dermatology clinic versus waiting for a general dermatology clinic appointment or being seen in an emergency room. These benefits include lower no-show rates compared with general derma- tology clinics, shorter wait times when compared with emergency room vis- its, and significantly decreased costs to the healthcare system when com- pared with emergency room visits. This study was performed at a tertiary care academic medical center where it is likely less difficult to implement than in a private practice setting. However, in the current healthcare environment, where quality measures and value are increasingly emphasized, this article supports the benefits of implementing urgent care dermatology clinics to pro- vide high-quality access to our patients. At the University of Mississippi, we have had a rapid access clinic (RAC) for a lit- tle over a year. There are barriers! The RAC must refer to "regular" clinics for follow-up care to keep openings avail- able for urgent and emergent patients. The RAC dermatologist loses continuity of care with many of these patients. Still, it has been a great success and won friends for our department, including emergency room personnel, primary care physicians, and private practicing dermatologists who often need to send patients "right now!!"

• The authors of this study from the University of Utah established an urgent care dermatology clinic which offered same-day dermatology (SDD) appointments to better serve patients with acute skin diseases who would otherwise have presented to their primary care doctor or the emergency department (ED) and to determine if urgent-care dermatology adds value to healthcare. Over the study period of 3 months, 542 patients were seen in SDD. Compared with similar patients from ED, patient encounters in SDD took less time (58 minutes in SDD vs 163 minutes in ED), and patients were charged less than half the cost of an ED visit. The no-show rate for SDD was less than half that of a general dermatology clinic (2.5% vs 5.7%, respectively). Patients in SDD were more likely to be insured by Medicaid or self-pay than those in a general dermatology clinic. • As wait times for dermatology appointments continue to increase, patients with acute skin problems often resort to visiting the ED, resulting in significant wait times, high costs, and treatment by a provider with no formal dermatology training. Urgent-care dermatology clinics can greatly increase the value of care for patients with acute skin issues through quality specialist care and lower costs compared with ED. Caitlyn T. Reed MD

Abstract OBJECTIVE To determine whether urgent care dermatology adds value (service + quality/cost) to healthcare. METHODS A retrospective cross-sectional chart review of dermatologic patients in three service settings was compared: an urgent care derma- tology clinic (same day dermatology [SDD]), the emergency department (ED), and a general dermatology clinic. Study period was July 1-Sep- tember 30, 2014, for ED and SDD patients and August 2014 for general dermatology patients. ED patients had diagnoses of dermatitis (629.9) or rash (782). Final diagnoses, visit length, and no-show rates were determined. Cost and charge data for patients seen in SDD versus the ED were provided by the university, without raw data available for publication. RESULTS For matched diagnoses, ED visits were 105 (95% CI: 68.7-152.4, P < 0.001) min- utes longer than SDD visits. Compared to SDD,

no-shows in the general dermatology clinic were 2.24 times more likely (95% CI: 1.0003-5.02, P = 0.045). The odds for an SDD patient to be diag- nosed with a code that was also seen in the ED was 13.0 (95% CI: 8.0-21.2, P < 0.01) times higher than the odds for the same diagnosis to be given to patients seen in the general derma- tology clinic. ED visits cost 25% more than SDD visits. Patient charges for an ED visit are 207% more than for an SDD visit. CONCLUSIONS Urgent care dermatology clinic adds value to the healthcare system by pro- viding quality care and excellent service at low cost. Dermatologists better utilize their skills by seeing acute, often-serious patients who would have otherwise been seen in the ED. The Value of Urgent Care Dermatology. Int J Dermatol 2019 Jan 01;58(1)80-85, J Sempler,

Dr. Jackson is an Assistant Professor of Dermatology at the University of Mississippi Medical Center in Jackson, Mississippi.

F Thomas, J Pettit, SZ Klein. www.practiceupdate.com/c/77694

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