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What is the cost of treating compartment syndrome?

Compartment syndrome is a serious medical condition that requires prompt diagnosis and treatment. However, the costs associated with managing this condition can vary widely depending on the severity and chosen treatment approach. This comprehensive guide aims to demystify the expenses related to treating compartment syndrome, from initial diagnosis to long-term care. We'll explore the various severity levels of the condition, outline diagnostic procedures, and detail treatment options along with their associated costs and time frames. Whether you're seeking the most affordable care, the quickest resolution, or a balance of both, this article will provide you with the information needed to make informed decisions about compartment syndrome treatment. By the end, you'll have a clear understanding of the potential expenses involved and strategies for optimizing your care plan based on your individual needs and circumstances.
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Written by Andrew Le, MD.
Medically reviewed by
Last updated September 25, 2024

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Severity Levels of Compartment Syndrome

Compartment syndrome can vary in severity, with acute cases being the most critical and requiring immediate medical attention. Understanding the different severity levels is crucial for proper diagnosis and treatment.

Acute Compartment Syndrome

Acute compartment syndrome is the most severe form of the condition and requires immediate medical intervention to prevent permanent tissue damage or loss of limb function.

Symptoms

The classic signs of acute compartment syndrome are often referred to as the "5 P's":

  • Pain (severe and out of proportion to the injury)
  • Pallor (pale skin in the affected area)
  • Paresthesia (numbness or tingling sensation)
  • Paralysis (weakness or inability to move the affected limb)
  • Pulselessness (diminished or absent pulse in the affected limb)

Risk Factors

Acute compartment syndrome is often associated with:

  • Traumatic injuries, such as fractures or crush injuries
  • Severe burns
  • Tight casts or bandages

Diagnosis

Due to the urgent nature of acute compartment syndrome, diagnosis must be made quickly and accurately. An emergency room visit is required for proper evaluation and treatment.

Imaging and Laboratory Tests

To confirm the diagnosis and assess the severity of acute compartment syndrome, the following tests may be performed:

  • CT scan: Provides detailed images of the affected area
  • MRI: Offers high-resolution images to evaluate soft tissue damage
  • Intracompartmental pressure measurement: Directly measures pressure within the muscle compartment

Treatments

The primary treatment for acute compartment syndrome is an emergency surgical procedure called a fasciotomy. This involves:

  • Making incisions to release pressure in the affected compartment
  • Decompressing the muscles and restoring blood flow
  • Potentially leaving the incision open for a period to allow for swelling

Prompt treatment is crucial, as delays can lead to permanent muscle damage, loss of limb function, or in severe cases, amputation.

Summary Table: Severity Levels

Severity LevelCharacteristicsDiagnosisLabs/ImagingTreatment
Acute Compartment SyndromeSevere pain, pallor, paresthesia, paralysis, pulselessnessEmergency room visit requiredCT scan, MRI, intracompartmental pressure measurementEmergency fasciotomy

In summary, acute compartment syndrome is a medical emergency that requires immediate diagnosis and surgical intervention. The costs associated with treatment can be significant due to the urgent nature of care and the potential for extended hospital stays and rehabilitation. However, the focus in these cases is on preserving limb function and preventing long-term complications, which ultimately can lead to better outcomes and potentially lower long-term healthcare costs.

Getting a Diagnosis

Getting an accurate diagnosis for compartment syndrome is crucial for proper treatment. The method of diagnosis can vary depending on the severity of symptoms and the urgency of the situation. Here are the primary options for obtaining a diagnosis:

Self-diagnosis

While self-diagnosis is not recommended for compartment syndrome due to its potential severity, it's important to be aware of the symptoms. If you suspect compartment syndrome, seek immediate medical attention.

  • Cost: $0
  • Time: Immediate
  • Appropriate for: Initial symptom recognition only

Virtual doctor consultation

Virtual consultations offer a quick and convenient way to get an initial assessment from a healthcare professional.

  1. Teladoc:
    • General Medical Visits:
      • With Insurance: As low as $0 per visit, depending on your benefits.
      • Without Insurance: $89 per visit.
    • Therapy Visits:
      • With Insurance: $0-$119 per visit.
    • Psychiatry Visits:
      • First-time Visit: $0-$299.
      • Subsequent Visits: $0-$129.
  2. MDLive:
    • Therapy:
      • Initial and Follow-Up Sessions: $108 per session for uninsured patients. Costs may be lower if covered by insurance.
    • Psychiatry:
      • Initial Session: $248 for uninsured patients.
      • Follow-Up Sessions: $108 per session for uninsured patients. Costs may be lower if covered by insurance.
    • Other Services:
      • Urgent Care: $0 to $82.
      • Primary Care: As low as $0 (depending on insurance plans).
      • Dermatology: $0 to $95.
  3. OptimalMD:
    • Cost: Free with OptimalMD membership ($47/month for the entire family)
    • Time: Usually same-day appointment, 15-30 minutes

In-person doctor visit

For a more thorough examination, especially if symptoms are concerning, an in-person visit may be necessary.

  1. Primary Care Physician (PCP):
    • Average Cost: $171
    • Range: $150 to $300
    • Variation by City: Costs can vary by location, with cities like New York averaging $149 and Los Angeles averaging $190.
  2. Urgent Care Center:
    • Average cost: $100 to $150
    • Note: This cost can vary depending on factors such as insurance coverage, the specific services needed, and the location of the urgent care center.
  3. OptimalMD:
    • Cost: Heavily discounted with OptimalMD membership
    • Time: 1-3 days for appointment, 30-60 minutes for visit

Emergency room visit

For severe symptoms or suspected acute compartment syndrome, immediate emergency care is crucial.

  • Average Total Cost: As of 2024, approximately $2,715
  • Insured Patients: For insured patients, the average cost can be lower, but still significant. In 2019, the average cost for an insured patient was around $1,082.
  • Out-of-Pocket Costs: For patients with private insurance, the out-of-pocket cost for an emergency department visit averages around $646.
  • Time: Immediate attention, several hours for full evaluation
  • OptimalMD: Emergency care is not covered under the OptimalMD membership plan.

Summary Table: Assessment Options

ModalityAppropriate Severity Level(s)Price Without InsurancePrice With InsuranceEfficiency
Self-diagnosisInitial symptom recognition only$0$0Immediate
Teladoc Virtual ConsultationMild to Moderate$89As low as $0Same day, 15-30 min
MDLive Virtual ConsultationMild to Moderate$82-$108$0-$82Same day, 15-30 min
OptimalMD Virtual ConsultationMild to ModerateFree with $47/month membershipN/ASame day, 15-30 min
Primary Care Physician VisitMild to Severe$150-$300 (avg. $171)Copay (varies)1-3 days wait, 30-60 min visit

This table provides a quick overview of the diagnosis options, their appropriate use cases, costs, and efficiency. It's important to note that while cost is a factor, the severity of symptoms should be the primary consideration when choosing a diagnosis method for compartment syndrome.

Imaging and Laboratory Tests

Imaging and laboratory tests play a crucial role in diagnosing and assessing the severity of compartment syndrome. The choice of test depends on the suspected severity and the healthcare provider's assessment. Here's a breakdown of common tests, their costs, and efficiency:

Physical examination

A physical examination is typically the first step in diagnosing compartment syndrome.

  • Cost: Included in the doctor visit fee (see Section II for pricing)
  • Time: 10-15 minutes
  • Appropriate for: All severity levels
  • OptimalMD option: Free with OptimalMD membership

Intracompartmental pressure measurement

This test directly measures the pressure within the affected compartment.

  • Cost:
    • Cash price: $200 - $500
    • With insurance: $50 - $150 (after deductible)
    • With discount card: $150 - $400
  • Time: 30 minutes, immediate results
  • Appropriate for: Suspected acute compartment syndrome
  • OptimalMD option: Heavily discounted with OptimalMD membership

Ultrasound

Ultrasound can be used to assess blood flow and tissue damage in the affected area.

  • Cost:
    • Cash price: $250 - $500
    • With insurance: $50 - $150 (after deductible)
    • With discount card: $200 - $400
  • Time: 30 minutes, immediate results
  • Appropriate for: All severity levels
  • OptimalMD option: Heavily discounted with OptimalMD membership

CT scan

CT scans provide detailed images of the affected area and can help assess the extent of tissue damage.

  • Cost:
    • Cash price: $450 - $850
    • With insurance: $100 - $300 (after deductible)
    • With discount card: $350 - $700
  • Time: 30 minutes, results within 24 hours
  • Appropriate for: Moderate to severe cases
  • OptimalMD option: Heavily discounted with OptimalMD membership

MRI

MRI provides the most detailed images of soft tissues and can be crucial in assessing severe compartment syndrome.

  • Cost:
    • Cash price: $400 - $3,000 (varies widely based on body part and contrast use)
    • With insurance: $100 - $500 (after deductible)
    • With discount card: $300 - $2,500
  • Time: 30-60 minutes, results within 24-48 hours
  • Appropriate for: Severe cases or when other imaging is inconclusive
  • OptimalMD option: Heavily discounted with OptimalMD membership

Summary Table: Diagnostics

ModalityAppropriate Severity Level(s)Price without InsurancePrice with InsuranceEfficiency
Physical ExaminationAllIncluded in visitIncluded in visit10-15 minutes, immediate
Intracompartmental Pressure MeasurementSuspected acute$200 - $500$50 - $15030 minutes, immediate results
UltrasoundAll$250 - $500$50 - $15030 minutes, immediate results
CT ScanModerate to severe$450 - $850$100 - $30030 minutes, results in 24 hours
MRISevere or inconclusive cases$400 - $3,000$100 - $50030-60 minutes, results in 24-48 hours

Note: All tests are either free or heavily discounted with OptimalMD membership ($47/month for the entire family).

Prescription Medications

When it comes to treating compartment syndrome, prescription medications play a crucial role in managing pain and reducing inflammation. The choice of medication often depends on the severity of the condition and the individual patient's needs. Let's explore the various options available, along with their costs and suppliers.

Pain Management

1. Opioids

Opioids are often prescribed for severe pain associated with acute compartment syndrome. Common options include:

  • Oxycodone (generic available)
    • Brand name: OxyContin
    • Cash price: Approximately $13 for 20 tablets (5mg)
    • With insurance: Copay varies, typically $10-$30 for a 30-day supply
    • With discount card: Can reduce price by 10-20%
    • Free with OptimalMD membership
  • Hydrocodone (generic available)
    • Brand name: Vicodin
    • Cash price: Approximately $24.56 for 12 tablets (5-325mg)
    • With insurance: Copay varies, typically $5-$20 for a 30-day supply
    • With discount card: Can reduce price to around $10 for 12 tablets
    • Free with OptimalMD membership

2. NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

NSAIDs are often prescribed for mild to moderate pain and inflammation. Common options include:

  • Celecoxib (generic available)
    • Brand name: Celebrex
    • Cash price: Approximately $216 for 30 capsules (200mg)
    • With insurance: Copay varies, typically $15-$50 for a 30-day supply
    • With discount card: Can reduce price to as low as $8.81 for 30 capsules
    • Free with OptimalMD membership
  • Meloxicam (generic available)
    • Brand name: Mobic
    • Cash price: Approximately $130-$145 for 30 tablets (15mg)
    • With insurance: Copay varies, typically $5-$25 for a 30-day supply
    • With discount card: Can reduce price to as low as $3 for 30 tablets
    • Free with OptimalMD membership

Muscle Relaxants

Muscle relaxants can help alleviate muscle spasms and tension associated with compartment syndrome. Common options include:

  • Cyclobenzaprine
    • Brand name: Flexeril
    • Cash price: Approximately $20-$54 for 30 tablets (10mg)
    • With insurance: Copay varies, typically $10-$30 for a 30-day supply
    • With discount card: Can reduce price to as low as $3-$4.48 for 30 tablets
    • Free with OptimalMD membership
  • Methocarbamol
    • Brand name: Robaxin
    • Cash price: Approximately $10-$14 for 30 tablets (500mg)
    • With insurance: Copay varies, typically $5-$20 for a 30-day supply
    • With discount card: Can reduce price to as low as $3 for 30 tablets
    • Free with OptimalMD membership

It's important to note that the effectiveness of these medications can vary from person to person, and the choice of medication should be made in consultation with a healthcare provider. Additionally, the duration of treatment and dosage will depend on the severity of the compartment syndrome and the individual patient's response to the medication.

Summary Table: Prescription Medications

MedicationSeverity LevelPrice without InsurancePrice with InsuranceEfficiency
OxycodoneSevere$13 for 20 tablets (5mg)$10-$30 copay (30-day supply)Rapid pain relief
HydrocodoneModerate to Severe$24.56 for 12 tablets (5-325mg)$5-$20 copay (30-day supply)Effective pain management
CelecoxibMild to Moderate$216 for 30 capsules (200mg)$15-$50 copay (30-day supply)Reduces inflammation and pain
MeloxicamMild to Moderate$130-$145 for 30 tablets (15mg)$5-$25 copay (30-day supply)Long-acting pain relief
CyclobenzaprineMild to Moderate$20-$54 for 30 tablets (10mg)$10-$30 copay (30-day supply)Relieves muscle spasms

Note: All medications listed are free with OptimalMD membership ($47/month for the entire family).

Over-the-Counter Treatments

Over-the-counter (OTC) treatments can be an important part of managing mild cases of compartment syndrome or providing initial relief while seeking medical attention for more severe cases. These treatments are generally more affordable and accessible than prescription options. Let's explore the main OTC options, their costs, and effectiveness.

Pain relievers

OTC pain relievers are often the first line of defense for managing pain associated with compartment syndrome. The two main types recommended are:

  1. Ibuprofen (e.g., Advil, generic available)

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can help reduce pain and inflammation.

  • Generic ibuprofen:
    • Walgreens: $3.99 for 20 tablets ($0.20 per tablet) to $24.99 for 300 tablets ($0.08 per tablet)
    • CVS: $9.49 for 100 tablets ($0.095 per tablet) to $29.79 for 1000 tablets ($0.03 per tablet)
  • Brand-name Advil:
    • Typically costs 20-30% more than generic options

Most insurance plans do not cover OTC medications, but some flexible spending accounts (FSAs) or health savings accounts (HSAs) may allow you to use pre-tax dollars for these purchases.

  1. Acetaminophen (e.g., Tylenol, generic available)

Acetaminophen is another common OTC pain reliever that can be effective for managing pain associated with compartment syndrome.

  • Generic acetaminophen:
    • 600 caplets for $14.65 ($0.02 per caplet)
    • 40 capsules for $14.59 ($0.36 per unit)
  • Brand-name Tylenol:
    • Typically costs 20-30% more than generic options

As with ibuprofen, most insurance plans don't cover OTC acetaminophen, but FSAs or HSAs may allow its purchase with pre-tax dollars.

Both ibuprofen and acetaminophen can provide relief within 20-30 minutes of taking them. They can be taken as needed, following the dosage instructions on the package.

Compression bandages

Compression bandages can help manage swelling and provide support to prevent the development of compartment syndrome. However, it's crucial to use them carefully and under medical supervision. Removal of compression dressings and seeking immediate evaluation is needed should compartment syndrome symptoms develop.

Based on information from Walgreens:

  • Compression bandages range from $5.99 to $9.99, depending on size and type.
  • The average price is around $7.79.

These bandages can be applied immediately and used continuously as needed. However, it's important to follow proper application techniques and consult with a healthcare professional, especially in cases of suspected compartment syndrome.

Summary Table: OTCs

ModalitySeverity LevelPrice without InsurancePrice with InsuranceEfficiency
Ibuprofen (generic)Mild$0.03 - $0.20 per tabletNot typically coveredEffects within 20-30 minutes
Acetaminophen (generic)Mild$0.02 - $0.36 per tabletNot typically coveredEffects within 20-30 minutes
Compression bandagesMild$5.99 - $9.99 per bandageNot typically coveredImmediate application, continuous use

Remember, while these OTC treatments can be helpful for mild symptoms or initial management, it's crucial to seek professional medical advice if you suspect compartment syndrome, especially in moderate to severe cases. These treatments should not replace proper medical evaluation and care.

Procedures

Compartment syndrome often requires surgical intervention, especially in severe cases. The two main procedures involved in treating compartment syndrome are fasciotomy and physical therapy. Let's explore each of these procedures, their costs, and the time involved.

Fasciotomy

Fasciotomy is a surgical procedure used to treat severe cases of compartment syndrome. It involves making incisions in the fascia to relieve pressure within the muscle compartment.

The national average cost for a fasciotomy ranges from $4,665 to $8,580. However, this can vary significantly depending on the healthcare provider, location, and whether the procedure is performed in a hospital or outpatient setting. Let's look at some specific examples:

  • Mayo Clinic (Rochester, MN):
    • Cost varies; use their Cost Estimator Tool or call 833-479-5483 for a personalized estimate.
    • To get an estimate, you'll need to provide:
    • Description of the service or the CPT procedure code
    • Name of your insurance
    • Type of insurance
  • UCLA Health (Los Angeles, CA):
    • Cost varies; use their Patient Estimates tool or contact their Centralized Cash Pricing Unit at 424-259-8010 for a specific estimate.
    • Options for getting an estimate:
    • Use the Patient Estimates tool via myUCLAhealth account
    • Download the Charge Description Master (CDM) from UCLA Health's website
    • Email [email protected] for a pricing estimate
    • Call 424-259-8010 for urgent requests

For both providers, the cost can vary significantly based on individual circumstances, insurance coverage, and specific medical needs. Always check with your insurance provider to understand your coverage and out-of-pocket expenses.

Time: The fasciotomy procedure itself typically takes 1-2 hours. However, the total hospital stay can range from 3-7 days, depending on the severity of the condition and any complications. Full recovery and return to normal activities may take several weeks to months.

Physical Therapy

Physical therapy is often a crucial part of the recovery process after a fasciotomy or for managing less severe cases of compartment syndrome.

The national average cost for a physical therapy session ranges from $75 to $150 without insurance. With insurance, after meeting the deductible, co-payments typically range from $20 to $60 per session.

Let's look at some specific examples:

  • ATI Physical Therapy (Chicago, IL):
    • With insurance: $20 to $60 per session after deductible
    • Without insurance: $50 to $155 per session
    • Note: Initial evaluation may cost more
  • CORA Physical Therapy (Orlando, FL):
    • With insurance: $20 to $60 co-payment per session
    • Without insurance: $80 to $150 per session

Time: Physical therapy sessions typically last 30-60 minutes. The frequency and duration of therapy can vary greatly depending on the severity of the condition and individual progress. A typical course of physical therapy for compartment syndrome recovery might involve 2-3 sessions per week for 4-8 weeks, but this can be longer or shorter based on individual needs.

Summary Table: Procedures

ModalitySeverity LevelPrice Without InsurancePrice With InsuranceEfficiency
FasciotomySevere$4,665 - $8,580 (National Avg)Varies, typically 10-20% of total cost1-2 hours for surgery, 3-7 days hospital stay
Physical TherapyMild to Severe (post-surgery)$75 - $150 per session (National Avg)$20 - $60 co-pay per session30-60 min per session, 4-8 weeks of treatment

Note: Prices can vary significantly based on location, provider, and individual circumstances. Always consult with your healthcare provider and insurance company for accurate, personalized cost estimates.

Optimizing for Cost

When optimizing for cost in treating compartment syndrome, it's essential to balance affordability with proper care. Here are cost-effective strategies for each severity level:

Acute Compartment Syndrome

  • Prioritize immediate emergency room visit to prevent long-term complications
  • Choose generic pain medications when available
  • Opt for in-network hospitals and surgeons if possible for fasciotomy
  • Discuss payment plans or financial assistance programs with the hospital

Chronic Exertional Compartment Syndrome

  • Start with virtual doctor consultation for initial assessment
  • Use over-the-counter pain relievers and compression bandages as first-line treatment
  • Consider physical therapy as a non-surgical intervention
  • If surgery is necessary, explore outpatient fasciotomy options

General cost-saving tips:

  • Compare prices for imaging tests at different facilities
  • Ask about cash pay discounts for services
  • Utilize prescription discount programs for medications
  • Consider telemedicine follow-up appointments when appropriate
  • Explore preventive measures to avoid recurrence and additional treatment costs

By implementing these strategies, patients can work towards more affordable compartment syndrome care without compromising on the quality of treatment. It's important to remember that while cost is a significant factor, the primary goal should always be proper diagnosis and effective management of the condition to prevent long-term health consequences.

Optimizing for Efficiency

When dealing with compartment syndrome, time is often of the essence, particularly for acute cases. This section focuses on strategies to optimize the efficiency of diagnosis and treatment for each severity level.

Acute Compartment Syndrome

For acute compartment syndrome, the most efficient approach is:

  1. Immediate emergency room visit
  2. Rapid physical examination and intracompartmental pressure measurement
  3. Emergency fasciotomy if diagnosed

This approach prioritizes quick compartment syndrome diagnosis and immediate intervention, potentially saving limb function and reducing long-term complications.

Chronic Exertional Compartment Syndrome

For chronic cases, efficiency can be balanced with thorough diagnosis:

  1. Virtual doctor consultation for initial assessment
  2. In-person follow-up with specialist if necessary
  3. Same-day imaging (preferably ultrasound or CT scan)
  4. Prompt initiation of conservative treatments or scheduling of fasciotomy if required

This strategy allows for swift progression from initial concerns to diagnosis and treatment initiation, minimizing delays in care.

General Efficiency Tips

  • Opt for virtual consultations when possible for initial assessments
  • Choose imaging methods with quick turnaround times (e.g., ultrasound over MRI)
  • Have a clear communication channel with your healthcare provider for prompt follow-ups
  • If prescribed medications, use pharmacy home delivery services to save time

By focusing on these efficiency-optimizing strategies, patients can ensure they receive timely care for compartment syndrome, potentially improving outcomes and reducing the risk of complications. Remember, while efficiency is crucial, it should not come at the expense of thorough and accurate diagnosis and treatment.

Balancing Cost and Efficiency

When balancing cost and efficiency in treating compartment syndrome, it's crucial to consider both factors while prioritizing patient safety and outcomes. For each severity level, consider the following approaches:

Mild Compartment Syndrome

  1. Start with a virtual doctor consultation for initial assessment
  2. If necessary, follow up with an in-person visit for physical examination
  3. Use over-the-counter pain relievers and compression bandages as first-line treatment
  4. Monitor symptoms closely and escalate care if needed

Moderate Compartment Syndrome

  1. Schedule an in-person doctor visit for prompt evaluation
  2. Undergo intracompartmental pressure measurement for accurate diagnosis
  3. Consider ultrasound imaging as a cost-effective alternative to CT or MRI
  4. Use generic prescription medications for pain management and muscle relaxation
  5. Begin physical therapy early to improve outcomes and reduce long-term costs

Severe Compartment Syndrome

  1. Seek immediate emergency room care
  2. Prioritize rapid diagnosis with intracompartmental pressure measurement
  3. Proceed with emergency fasciotomy if necessary
  4. Use a combination of generic prescription medications for post-operative pain management
  5. Engage in intensive physical therapy to optimize recovery and minimize long-term complications

By tailoring the approach to each severity level, patients can receive appropriate care while minimizing unnecessary expenses and time investments. Always consult with healthcare professionals to determine the best course of action for individual cases of compartment syndrome.

Conclusion

Treating compartment syndrome can vary significantly in cost and time depending on the severity of the condition and the chosen treatment approach. Early diagnosis and appropriate care are crucial for managing this potentially serious condition effectively.

Key takeaways from this guide include:

  1. The severity of compartment syndrome greatly influences the treatment path and associated costs.
  2. Diagnosis options range from self-assessment to emergency room visits, with varying costs and time investments.
  3. Imaging and laboratory tests play a critical role in confirming the diagnosis, with options like ultrasound and CT scans offering different cost and time trade-offs.
  4. Treatment options include both prescription and over-the-counter medications, as well as surgical procedures in severe cases.
  5. Balancing cost and efficiency in treatment often depends on the individual's specific situation, insurance coverage, and the urgency of their condition.

Remember that while cost is an important factor, the primary goal should always be to receive appropriate and timely care for compartment syndrome. Delaying treatment to save money could lead to more severe complications and higher long-term costs.

Patients are encouraged to discuss treatment options and their associated costs with healthcare providers to develop a plan that best suits their medical needs and financial situation. Additionally, exploring insurance coverage and potential financial assistance programs can help manage the costs associated with compartment syndrome treatment.

By understanding the various diagnostic and treatment options available, patients can make informed decisions about their care, optimizing both health outcomes and financial considerations in managing compartment syndrome.

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Jeff brings to Buoy over 20 years of clinical experience as a physician assistant in urgent care and internal medicine. He also has extensive experience in healthcare administration, most recently as developer and director of an urgent care center. While completing his doctorate in Health Sciences at A.T. Still University, Jeff studied population health, healthcare systems, and evidence-based medi...
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