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Concussion Management in the Urgent Care: Better Medicine & Better Business

Posted By Amanda Mannina, Monday, July 31, 2017
Updated: Friday, August 11, 2017

In 2015, the movie Concussion was released, which brought Dr. Bennet Omalu's findings on the risks of chronic traumatic encephalopathy (CTE) to the masses.  Since then, The New York Times, The Wall Street Journal and countless other media publications have frequently reported stories about deaths surrounding contact sports - and it's no secret that parents and coaches alike agree that the prevention of long-term damage begins early on in an athlete's life. Many parents of youth athletes state that they are worried about the risk of their children sustaining long-term damage; conversely, momsTEAM recently polled 20,000 of these parents and found that 75% would rather hear less about the “bad news,” and more about solutions that are available.

As one of the first acting points of entry into the American Medical system, Urgent Care agrees with those parents. To ensure that concussion testing protocols are properly researched, maintained, implemented and updated, they have chosen to partner with SportGait, who shares a common goal: To shift the focus away from fear and worry, and more towards effective solutions to brain injury management.

Basics of Concussion Care

While there is no set definition for concussion, each definition indicates that the initiating mechanism is blunt force trauma that can result in a physiological alteration to the brain’s functioning. Depending upon which brain systems are affected in a case, different cognitive, affective, or behavioral symptoms may manifest. Importantly, these areas of functioning are not always affected equally, and the likelihood of convergence decreases with milder cases.

  

There are currently 1.7 million recorded cases of concussion (sometimes referred to as mild traumatic brain injury or mTBI) in America every year. However, the actual number of cases is likely to be much higher. One of the reasons the statistics likely underestimate the extent of the problem is that people self-select for services and treatment based on the perceived severity of their symptoms, the anticipated cost of seeing a professional, and a lack of awareness about what treatment solutions are available.  Put simply, when people don’t believe the signs indicate an emergency situation, scheduling a doctor’s visit doesn’t seem worth the effort.

The Urgent Care setting, however, is perfectly suited to accommodate these people, so long as the practice uses a clinically acceptable concussion management system.  Urgent Cares are convenient, inexpensive and typically more efficient than hospitals when it comes to concussion care.  There has already been a shift in society to utilize urgent cares as the entry point into the American medical system since the Affordable Care Act was passed.

“I am convinced that Urgent Care is an appropriate environment for concussion management… athletic clubs want to partner with urgent care clinics.  This is what we are doing in our own local market with youth clubs, specifically soccer and hockey.  Not only do we have the direct benefit of serving the community by providing a concussion management pathway from baseline to diagnosis to recovery, but providing this critical need for athletes is a true differentiator for us in this crowded space.” – Dale Key, CEO of Medac Health

In a landmark paper published in Science in 1989, Dawes Faust and Meehl demonstrated that by using actuarial formulas one could always out-predict clinical judgment in a wide range of disciplines, including medicine. This was demonstrated even in such tasks as reading an x-ray. The key to improving the accuracy of diagnostic judgments was complete standardization of the steps in the decision-making process. This is in effect, the benefit of standardization in any test. Test-retest reliability reflects the extent to which an instrument is standardized, since high-retest reliability isn’t possible without standardization.  A test-retest reliability of 0.70 is the minimum for an assessment to be considered clinically acceptable.

“You have to have a standardized protocol for dealing with potential mTBI cases regardless of the cause… Many practices, schools and athletic clubs are attempting to do the right thing by adopting a system, but those systems fall short of the absolute minimum requirements of an effective system in that they lack basic reliability in assessment (not consistent in what they measure).” – Dr. Len Lecci, co-founder of MARS Memory-Health Network

As stated before, symptoms can present themselves cognitively, affectively, and/or behaviorally. In many instances, mTBIs result in normal brain imaging, despite the reporting of symptoms such as headaches, sleep disturbance, fatigue, emotional problems, sensitivity to light and noise, dizziness, depression, anxiety, poor concentration, and memory problems; most of which are subjectively reported and not quantified by a health-care provider (Gresham & Brodie, 2012). To increase the likelihood of detecting concussion indicators, focus on different aspects of functioning with a multi-modal system – that which employs at least two different methods of testing – that has high test-retest reliability, validity and sensitivity.

The sensitivity of a test will determine how long after the injury the assessment can detect symptoms.  Unfortunately, many commonly used concussion assessments are only sensitive enough to detect symptoms within the first 48 hours to a week post injury.

How to Implement Concussion Care into Your Practice

Two assessments which Urgent Cares should use, in addition to a standard vital sign examination, are neurocognitive and neuromotor exams.  SportGait’s Concussion Management System uses these types of assessments with special sensor technology to check for cognitive and physical signs of concussion that may be too subtle for the naked eye.  Providers can use a verbal assessment to determine if the patient is experiencing any emotional or sleep-related symptoms.

SportGait uses industry validated tests, so each assessment has normative data to allow for valid comparisons.  Normative data is helpful for providers who may not have access to a patient’s baseline information, assuming the patient ever received a baseline examination.  By using tests with normative data, providers can detect signs of a possible concussion by comparing a patient’s test results to those typical of other patients their age.

Urgent Cares should also consider making education a primary part of their protocol.  Physical therapist Olga Dreeben summarized many of the benefits for providers in Patient Education in Rehabilitation:

-        Patient education programs attract patients to the provider and increase their satisfaction with their care;

-        These programs can also decrease the provider’s liability;

-        Patient education promotes patient-centered care and increases adherence to medication and treatments;

-        An increase in compliance leads to a more efficient and cost-effective healthcare delivery system; and

-  Educating patients ensures continuity of care and reduces complications related to the illness

Differentiate Yourself from Competitors

Urgent Care operators can benefit from the increased number of families entering their facilities, or who are at least exposed to the center’s name and location.  SportGait has helped Urgent Cares do the following:

-  Advertise Urgent Care as an alternative to the emergency department; market your practice as less expensive, equally convenient (open nights/weekends and walk-ins accepted), and more efficient.

- Form partnerships and/or sponsorships with schools or club athletic leagues

-  Curate information for an Urgent Care’s website and/or social media pages:

o   What can cause a concussion

o   Indicators someone may have sustained a concussion

o   What to do if you suspect one: when to go to an ER vs Urgent Care

o   Activities/sports with a high risk of concussion

o   Risks of concussions going untreated

o   How to ‘treat’ a concussion

-       Display educational handouts or brochures at the check-in desk and patient rooms.

-       Utilize email or mailing address lists by sending announcements about their new concussion system. You should include information about concussions so they know the signs – most patients never see a doctor because they don’t even know they have a concussion.

-       Produce collateral for current and prospective OCCMED customers to inform and upsell them on the new offering.

See examples of marketing collateral that SportGait gives to providers who use our Concussion Management System.

 

How Does Concussion Care Help My Urgent Care Business?

The vast majority of sports-related concussions (SRC) occur in a medically unsupervised environment where doctors are unavailable, resulting in either no treatment, self-treatment, or overuse of emergency departments. By offering concussion management services to athletic clubs, Urgent Cares can build relationships with coaches, athletic directors and trainers, and offer pre-participation physicals and post-concussion care -- as well as management of other sports-related injuries -- to drive incremental volume. The initial visit may be limited to athletes, but providers will likely see these same patients return for other urgent care issues and encourage their friends and families to do the same.

Niche services, like concussion management, with cash payment or membership models drive value fastest since they increase revenue and decrease costs simultaneously. SportGait has found that these services are perfect for Urgent Cares with occupational medicine contracts. In Occupational Health, brain injuries are common among factory and construction workers, firefighters, police officers, loading dock workers, delivery drivers. For example - SFM, a worker’s compensation insurer covering the Midwest, reports a 48% increase in reported concussions that caused employees to lose time from work in the last two years. 

“With the recent updates to protocol, urgent cares can benefit in two ways: better medicine, and better business. It’s good to see payors, patients and providers squarely aligned.” – Chris Newton, CEO of SportGait

The future of concussion care hinges primarily around consistently maintained protocols along with innovative and progressive test/re-test development, which starts with the relationship between medical practitioner and patient.

The SportGait protocol is reimbursable by insurance payers. Providers looking to offer a Safe-to-Safe continuum of care to an underserved market can learn more about SportGait and our Concussion Management System by contacting us at info@sportgait.com.

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