Village Family Clinic & Wellness Center

Review finds APRNs may outperform physicians | National Nursing News

2011-07-29T09:01:00.000-07:00

Review finds APRNs may outperform physicians | National Nursing News

AANP Conference

2011-06-27T14:27:00.000-07:00

http://www.lvrj.com/news/sebelius-addresses-5-600-124408819.html

Awesome conference! The lecture where I presented our clinic model received a standing ovation; there are many NPs who are just getting the state authority to practice independently. As you can see from the link above, the federal government is very enthusiastic about NPs. Thanks for your patience while I was gone, and thanks to Lisa for taking over so I could go.

WORKLOAD!

2011-06-01T16:37:00.000-07:00

I am so happy to report that the clinic is doing great! I am busier than ever though and trying figure out ways to get out of here on time for dinner.

You may not know this but many of the tasks I provide are not covered by your insurance. Phone calls and emails along with many other duties are considered non-covered benefits. Many providers have chosen to have a yearly non-covered benefits fee of between $100 to $300 per patient, and others have chosen to charge fees for certain services; for now, I fall into the latter category and will post fees for extra work on my website in the next few months.

If any of the next 3 items are completed during an office visit, the fee will be waived, otherwise the fee is $30.

Referral letters and insurance pre-authorization for specialists visits
Letters for school, work, jury duty, etc.
Form completion, including medication pre-authorization, FMLA / short-term disability, DOT physical, sports physical, etc.

I will offer the following services on a fee-for-service basis:

Virtual visits -- if any email request will take longer than 10 minutes or require a treatment plan / prescription, you will be sent a virtual visit form ($30)
Phone consult -- this is if you want to speak to me on the phone for medical advice that normally would be discussed at a proper visit ($30 per 15 minutes)
After-hours phone calls (anytime other than 9am to 5pm on Monday to Friday) -- calling after hours for medical advice and treatment, and keeping you out of Urgent Care or the ER ($40)

So why, you might ask, am I doing this? I know it is hard to believe but there are patients who consistently use the "free" services and don't come in for a visit, and that is not in my business plan. I do always reserve the right to waive the charge, but I just want the policy out there if I need to use it. Would love feedback from all of you! -- Kristina

Call to Action

2011-01-25T14:43:00.000-08:00

Many of you already know that I belong to a non-profit organization called Ideal Medical Practices, IMP for short (http://www.idealhealthnetwork.org/). The IMP clinic model is designed to enhance provider-patient relationships, increase face-to-face time with providers and patients, reduce the workload in primary care, and instill patients with a sense of responsibility for their health and their health care dollars. An excerpt from the website is below:

The goal of an Ideal Medical Practice is Ideal care for patients in balanced, ethical and sustainable practices.

Ideal health care rests on a foundation of effective primary care.

Effective primary care is based on excellence in access, relationship over time, comprehensive services, and care coordination.
Ideal care is defined through patient experience.
- “I can get care when and how I need it”
- “I have a PCP who knows me as a person”
- “My PCP takes care of the bulk of my health care needs”
- “My PCP coordinates any and all care I need”
Balanced, ethical and sustainable practices are defined through Primary Care Provider/PCP experience.

“I am free to do what is best for my patient”
“I have the funding and autonomy I need”
“I have the time I need”
“I know my patients and can communicate with them effectively”
“I have the tools, and technology I need”

Briefly, I want to address the above statement because some of the goals are being met, but all the goals are attainable and necessary for our health care system to survive and thrive. I will use Village Family Clinic as the example; I think we do a pretty good job with items #1 and #2, mostly because those are the items over which the provider and patient have control. #3 is where the health care system has control and causes providers the most trouble.

"I am free to do what is best for my patient" -- Many patients are dealing with high deductible insurances (or no insurance) and cannot always financially afford the best evaluation or treatment. And anyone who has ever waited for a referral to a specialist or pre-authorization for tests or medication knows that the provider does not make the final decision with respect to care.
"I have the funding and autonomy I need" -- Third party payers (ie -- insurance companies) are the "elephant" in the exam room, due to some of the issues from the last statement, taking away autonomy by creating barriers to increase provider workload and increase patient expense, thus discouraging both from the proper care. I understand that most systems need checks and balances to control quality and cost, but I do 6-8 hours of uncompensated work per week because of these barriers. As far as funding, let's just say there is a reason that doctors are choosing specialties over primary care by a 50 to 1 margin.
"I have the time I need" -- With the IMP model, I have enough time with patients because I decreased my clinic expenses, so I can generate less revenue and still keep the doors open. Our medical system financially rewards the providers that see the most patients, and not the providers that give the best quality care.
"I know my patients and can communicate with them effectively" -- This one is no problem, right? Have I mentioned that I LOVE EMAIL! But the privacy police will be after me to comply in the next few years -- the only solution will be a securepatient portal that either you, I or all of us will have to pay for.
"I have the tools and technology I need" -- Finally most clinics are embracing technology, and that has created competitive prices for electronic health records/systems. This has also created programs that are completely different and cannot "talk" to each other and work together. It is inexcusable that we cannot communicate securely with specialists and hospitals when we can do it with the pharmacies through e-prescribing. I still get almost all patient information from outside the clinic by fax -- talk about not secure; if you are one number off, then your neighbor gets the test results.

Well, there are no perfect solutions, but it is a fact that health care systems with strong primary care as a base have healthier patient populations (Davis, Commonwealth Fund 2007, Wasson, JACM 2006, Moore, JACM 2006). In October 2011, I am going to Washington DC with IMP as the nurse practitioner liaison. We will be advocating for improvements in primary care, and the "hook" is "Primary Care can thrive on $1 a day."

What does that mean for us? If your health care provider (me) was paid $365 per year for each patient (which is about as much as everyone pays per month for insurance), I could make a living with a patient panel of 600 people. I currently have 1200 patients to do the same thing. Obviously this is way oversimplified because some patients need more or less care, but the concept is the same: 80-90% of health care could be done for 1/12 of the price. Hmmmm -- I see that as pleasing to both sides of the aisle in DC.

If any of you have stories about our health care system that I can share with the congressional members in October, please email them to me in the form of a letter. I will take them with me and you will be heard. Thanks!

Kristina

KG and VFC published online!

2011-01-03T21:43:00.000-08:00

Here is a link to an article about Village Family Clinic and the technology used to accomplish successful patient care.

http://amazingcharts.com/why-us/hear-what-users-say/kristina-garrido-case-study/

SECOND YEAR ANNIVERSARY!

2011-01-01T10:48:00.000-08:00

It is our 2nd anniversary with many positive changes for the next year. Now that we are open 6 days a week (with the addition of Lisa Garcia, ARNP) there will be plenty of convenient appointments for everyone. Also, I am on the board of Ideal Medical Practices, a non-profit dedicated to saving primary care by encouraging and educating small practices about their business and latest technology. I hope to help other doctors and nurse practitioners to practice medicine without getting on the "hamster wheel."

I appreciate your continued patronage and support -- I could not have done it without you! -- KG

It’s time to collaborate—not compete—with NPs — The Journal of Family Practice

2010-12-07T14:03:00.000-08:00

It’s time to collaborate—not compete—with NPs — The Journal of Family Practice

All the Best

2010-12-01T18:50:00.000-08:00

Going on the second year in solo practice and very thankful for all of you -- have a wonderful, healthy holiday season!

HIPPA laws and VFC

2010-12-01T18:46:00.000-08:00

Just so you know -- new rules are coming that will regulate email and privacy even more. It may be required that we log in to a secure server to communicate by email. This will not be free for you or me, but I do not think it will be prohibitively expensive, and may offer opportunities for virtual visits. These are the current rules on emails from Health and Human Services (HHS):

Does the HIPAA Privacy Rule permit health care providers to use e-mail to discuss health issues and treatment with their patients?

Answer:

Yes. The Privacy Rule allows covered health care providers to communicate electronically, such as through e-mail, with their patients, provided they apply reasonable safeguards when doing so. See 45 C.F.R. § 164.530(c). For example, certain precautions may need to be taken when using e-mail to avoid unintentional disclosures, such as checking the e-mail address for accuracy before sending, or sending an e-mail alert to the patient for address confirmation prior to sending the message. Further, while the Privacy Rule does not prohibit the use of unencrypted e-mail for treatment-related communications between health care providers and patients, other safeguards should be applied to reasonably protect privacy, such as limiting the amount or type of information disclosed through the unencrypted e-mail. In addition, covered entities will want to ensure that any transmission of electronic protected health information is in compliance with the HIPAA Security Rule requirements at 45 C.F.R. Part 164, Subpart C.

Note that an individual has the right under the Privacy Rule to request and have a covered health care provider communicate with him or her by alternative means or at alternative locations, if reasonable. See 45 C.F.R. § 164.522(b). For example, a health care provider should accommodate an individual’s request to receive appointment reminders via e-mail, rather than on a postcard, if e-mail is a reasonable, alternative means for that provider to communicate with the patient. By the same token, however, if the use of unencrypted e-mail is unacceptable to a patient who requests confidential communications, other means of communicating with the patient, such as by more secure electronic methods, or by mail or telephone, should be offered and accommodated.

Patients may initiate communications with a provider using e-mail. If this situation occurs, the health care provider can assume (unless the patient has explicitly stated otherwise) that e-mail communications are acceptable to the individual. If the provider feels the patient may not be aware of the possible risks of using unencrypted e-mail, or has concerns about potential liability, the provider can alert the patient of those risks, and let the patient decide whether to continue e-mail communications.

NPR Talk of the Nation -- About Nurse Practitioners

2010-11-17T12:40:00.000-08:00

This is a long interview but very positive for nurse practitioners, especially those in solo practice.

http://www.npr.org/2010/11/16/131361359/role-of-nurses-in-primary-care-may-expand

Lisa had the baby!

2010-11-07T21:03:00.000-08:00

Kelton was born on September 28 -- mom and baby are doing great and Lisa says hubby Chad is ready to do some father-son bonding and she is ready to work Fridays and Saturdays in December. Here is a little more information about your new nurse practitioner (from the website):

"Lisa Garcia graduated with her Bachelor of Science in Clinical Laboratory Science from Brigham Young University. She began a Master’s degree in Pathology at Indiana University before deciding that while she loved the things she learned working in a medical laboratory, she wanted something more. She was thrilled when she learned about Nurse Practitioners and their unique role in healthcare, and immediately began a Family Nurse Practitioner program at Seattle University. Lisa enjoys the opportunity to teach her patients and enable them to improve their health. Lisa is excited to join Kristina at Village Family Clinic. She interned with Kristina during her time as a student, and enjoys the warm and caring environment that Kristina has created. She likes the opportunity to spend time with each patient, focusing on health and wellness. She also appreciates the kindness and welcome that Kristina’s patients showed her during her internship!

Lisa and her husband Chad have lived in the Seattle area for 3 years, and love the green trees, mountains, and variety of community activities. They have one son, Kelton. In her free time, Lisa enjoys reading, spending time outdoors, and scrapbooking."

Fall at VFC

2010-11-07T20:55:00.000-08:00

New Hours and New Provider!

This fall brings about some wonderful changes for the clinic starting with the addition of Lisa Garcia, ARNP. Many of you met Lisa while she did her internship for Seattle University’s nurse practitioner program. Well, she has now graduated and passed her boards, but she still has one more thing to do – have a baby! After she becomes a mommy, she will work Fridays and Saturdays, hopefully by the beginning of December. This means that the clinic hours are changing to:

Monday, Tuesday, Thursday and Friday – 9am to 5pm
Wednesday and Saturday – 9am to 1pm

Flu vaccine Saturdays – October 16 and November 6
The schedules are open on AppointmentQuest for children and adults. The schedules are separate because I will give the kid vaccines, and Prevention MD will provide the adult vaccines. I will charge insurances for the kid vaccines, and just like at the pharmacies and grocery stores, Prevention MD will charge $25-30 at the time of service for the adult vaccine (with a RN administering the shots). Sign up now so there will be vaccines available for everyone.

Policy Alert
Now that Michele and I have figured out the billing (as much as possible), I wanted to focus on two policies that will effect most of you.
COPAYS -- For those of you who have a copay, we are required by contract with the insurance companies to collect the copay before submitting the remainder of the bill to the insurance company. When we do not collect your copay at the time of service, we must bill the remainder after the insurance reimbursement. Honestly, it is a book-keeping hassle, and one for which we will charge a $10 administrative fee. Now I recognize that life happens and you forget your wallet or your teenager comes in without you, so our solution is sending a PayPal bill immediately after the visit. If you pay the copay within 48 hours, you will not be charged the $10 administrative fee.
DEDUCTIBLES -- For those of you who have deductibles with your insurance, I want to offer a 25% discount off the charge if you pay at the time of service. Often this will save you about $5-10, and depending on how much you come in, that may add up quickly. By law I must charge the same amount to individuals and insurance companies, but if any of those can pay on the same day, they will get the discount (no way will an insurance company pay me same day). Examples would be – if the charge for a 15 minute appointment is $100, same day payment is $75; if the charge for a 30 minute appointment is $150, same day payment is $112.50. We will still submit it to your insurance company so your get credit for the deductible. This hopefully will save you some money and it helps the clinic’s cash flow when the deductibles reset in January.

And to all of my great patients -- HAPPY AUTUMN!

This is your head on STEROIDS!

2010-10-19T13:44:00.001-07:00

OUCH! After a night of wheezing and croup, my son got a hefty dose of steroids -- which made him crazy and he ran into the side of our chopping block.

So if I ever need to start you on steroids for inflammation, and I tell you to "use your superpowers for good" I really mean it...

NPs ROCK!

2010-10-14T08:15:00.000-07:00

Here are a couple of research studies telling you all something you probably know already... I have the best patients in the whole world!

http://news.opb.org/article/15435-survey-finds-patients-nurses-well-doctors/

http://nwhf.org/images/files/The_Nurse_in_Your_Future_-_Oregonian_-_Aschenbrener.pdf

IMP Camp 2010

2010-10-05T07:58:00.000-07:00

On the weekend of 10/1, I traveled to Denver for an Ideal Medical Practice (IMP) conference. This is a group of forward-thinking health care providers, including doctors and nurse practitioners, who work on real solutions to preserve solo practice primary care. I presented Village Family Clinic as an example of a successful, sustainable practice, and I was elected to the Board as the nurse practitioner liaison. For more information, here is the website -- http://www.idealhealthnetwork.org/patients

The Insurance Scheme

2010-09-22T11:37:00.000-07:00

Here is a book about what the insurance companies really do with your money.

http://www.bloomsburypress.com/books/catalog/deadly_spin_hc_816

2010-08-28T20:06:00.000-07:00

Here is a link to what my husband does while I am at work -- and he takes care of the kids so he is entitled to some time of his own...

http://www.npr.org/templates/story/story.php?storyId=129496479

I just think it is kind of cute and wanted to share because we love NPR.

HAIRCUT!

2010-08-20T13:38:00.000-07:00

Somebody cut his hair right down to the scalp -- he's tried it for weeks but he is a lefty and could not work the scissors until today...

Health Care Options

2010-07-17T13:32:00.000-07:00

Great NPR radio program about independent clinics who cut out the insurance companies in an effort to maintain relationships with patients, and not the money...

http://www.npr.org/templates/story/story.php?storyId=127777327

In October, I am invited to speak at a conference in Denver and present the medical care model of Village Family Clinic. With high technology and low overhead, the clinic is sustainable and successful. I believe that this type clinic will thrive with any type of health care reform, so I want to share it with other physicians and providers. Have a great summer!

2010-06-27T21:48:00.000-07:00

Great view from PBS Frontline

http://www.pbs.org/wgbh/pages/frontline/vaccines/view/

IMPORTANT ANNOUNCEMENT

2010-04-26T22:02:00.000-07:00

Kristina is going on vacation from May 12-16!

I know it is hard to believe that this work-a-holic is leaving the clinic for more than a day, but it is true! And I am leaving the kids home too… just me, hubby and Maui for our 10th anniversary.
So before some of you freak out wondering what you will do when I am gone, here is the plan:

• APPOINTMENTS -- If you need care when I am gone, go to an Urgent Care Center (Overlake, Multicare, MedCare, etc.). This is what most of you do on the weekends, so just think of this as a long weekend. Urgent care will charge you a regular co-pay, whereas an Emergency Room usually charges a lot more.

• CLINIC HOURS – The only services provided when I am out of the clinic are supplement sales and appointment scheduling, so hours will be limited on Thursday and Friday from 10am to 4pm, and the clinic will be closed on Wednesday and Saturday. Please email or call if you need to come in to see Michele or Jessie for something, so you can make sure they are in the clinic.

• EMAILS – I will not be answering emails on my vacation – my husband will push me in the volcano if I get near a computer while on the trip. If you email during that time, you will get an auto-response with this same information as this homepage and maybe a response from Michele or Jessie, if it is something they can help you with.

• REFILLS – Shake your medicine bottles people! I will refill the week before and the week after my vacation. If you run out and are on maintenance medications, pharmacies will give you a few days of medications so that you don’t go off your meds. Controlled substances are the exception however, and if you run out, you will need to go to Urgent Care to get a refill.

• PHONE CALLS – When you call the clinic, the phone message will tell you that I am not in the continental U.S. and therefore will not be responding to your phone call until the following week. Most insurance companies have a nurse helpline that you can access for questions or when deciding if you need further care. And if you absolutely, positively have to talk to me, my cell phone number will be in the email response and on the voice mail; I actually have to provide 24/7 coverage by contract with most insurance companies (or I would not even take my cell phone with me). I cannot guarantee that I will answer your call right away, but I will call you back. And it better be good…

Please let me know if you have any questions or concerns in the meantime, and thanks for understanding that I need a break. -- Kristina

March 2010

2010-03-10T21:12:00.000-08:00

I promise to give a detailed account of the cleanse that I did -- it was great! Very hard though, and I think there are some things to make it easier -- more info in the next few weeks... you all have kept me very busy in the last month!

I want to blog today about how disgusted I am with pharmaceuticals. In the last few days, the FDA and Merck have admitted that they knew Fosamax, the drug used for patients with osteoporosis, did not build quality bone in people who took it for more than 5 years, and the fracture risk has actually increased because the bone is more brittle than real bone created with good calcium, magnesium and vitamin D. And let me just mention here that calcium carbonate (Caltrate, Tums, etc) and magnesium oxide are basically rocks and not effectively absorbed into the body. After hearing about the Fosamax, I immediately called my mom and told her to stop taking it, and get herself some calcium citrate, magnesium malate, and vitamin D3 in the proper amounts. Bone is a living part of the body that needs to break down and build back the right way.

The more I study functional medicine the more I want to treat patients as dynamic systems that change, repair and function in natural ways. Irritable bowel syndrome, reflux disease, migraines and hormonal imbalances can all be treated with natural substances that assist your body with the healing process and do not change the way your body works.

The problem is daily life -- a patient sent me this link that I found very interesting:

http://www.msnbc.msn.com/id/35315651/ns/health-diet_and_nutrition

Basically, it really does not matter what I give you as far as vitamins, medications, and herbs, if you do not "walk the walk" and clean up your habits, your quality of life will eventually diminish and disease will be present. The cleanse or detoxification starts the process, and then you can change your habits and health.

Now don't get me wrong -- medications have their place, but with every other patient taking Prilosec or something similar, and changing the way their digestive system works (sometimes irreversibly), I start to take notice. So I hope to have the time in all your appointments to present all the options for treatment.

Off the soapbox now -- and back to work!

KG

HAPPY NEW YEAR -- January 2010

2009-12-31T20:18:00.000-08:00

I hope that you all had a wonderful holiday season – I know I did. This was the first time since my kids were born that I made it home early enough to enjoy Christmas Eve. I was able to wrap presents, have dinner and spend time with my family. It was pretty great…

My husband and I are doing a New Year’s Detox with Thorne MediClear. Basically, we are trying it out to see how difficult it is to maintain while taking care of a busy family, and if it improves our overall health. If anyone is interested or would like more information on MediClear, please email me and I can send you a PDF of information. As a thank you for your patronage in the last year, there will be a 20% discount on the MediClear program and any additional products that complement your particular health issues. I will keep you posted on how we are doing with the detox…

One year in business and still very happy with my choice to go it on my own. I hope you are too, but I want to know what you think. This is your “medical home” and so I will be checking with you periodically to see how I can improve things to the best of my ability.
For that reason, I have created a short survey that I would love for you all to take. Thank you in advance for your feedback and here’s to another great year!

-- Kristina

To take the survey, follow this link:
http://www.surveymonkey.com/s/FRLSY7L

Christmas Morning

2009-12-25T07:32:00.000-08:00

I am the first one awake because I am so excited about this Christmas. Yesterday, I realized that it was the first time in 10 years that I was home in time on Christmas Eve to wrap all the presents, enjoy dinner, and be with my family...usually I had to choose - now I could do it all!

It was an amazing year of change, and I am reflecting upon it while gazing at the tree, making cinnamon rolls, and blogging. I could not help myself -- you all are a part of my family too...

Must go now -- I think I hear some little footsteps on the stairs...

Merry Christmas!

Kristina

October 25 Homepage -- H1N1 info

2009-11-12T22:18:00.000-08:00

October 25, 2009
Well, my daughter has influenza A, and there is really only one strain of influenza A in the public right now, H1N1. I want to document for everyone what I have done for Ila because it seems that many of us will get this flu before immunizations are available to the general public.
Friday night, 7pm – started with her lying on the couch, which she never does, and she said her body was hurting and cold. Took her temperature and it was 101.5. She looked flushed and sweaty. I also noted a dry, tight cough but no problems breathing. Gave her children’s ibuprofen and put her to bed. When I took her temperature 1 hour later, it had increased to 102, so I gave her Tylenol, and let her sleep with me. She slept 10 hours straight.
Saturday – She woke up shivering and sweaty. Fever was 102, and the dry cough is difficult for her to control. She did not complain about sore throat. Her nose was congested with occasional clear drainage. I gave her ibuprofen every 6 hours which kept the fever decreased to 100.5. She stayed on the couch all day, and I told her we would go to the clinic tomorrow if she woke up with a fever. She had a nice hot bath, which she said helped her feel better. I gave her some Triaminic night time medicine before bed for the cough.
Sunday – She woke up with 102.5 degree fever. I gave her some ibuprofen and within an hour the fever was down to 99.5. She told me that the dry cough kept her up all night. Took her to the clinic and the rapid flu test was positive for influenza A. The rest of her exam is normal. It is interesting that her cough increases with the fever and goes away when the fever is under control. I started her on Tamiflu, mostly because that is what I would do for everybody else (it is hard to be objective with your own kids and she was doing so well that I almost did not give it to her). She is on the couch now watching an old Looney Tunes Halloween special. She is eating, drinking and acting quite normal; just her energy level is decreased.
So we have quarantined her to the house and are hoping no one in the family gets this from her (I had the vaccine for health care workers 10 days ago, so I should be OK). The moral of the story: this is the flu, and like any other flu virus, you need to take care of yourself and protect others from getting it.
1. Push fluids – this can be ice chips, popsicles, jello – anything clear that turns into liquid. Dehydration is one of the reasons patients are admitted to the hospital with the flu.
2. Control the fever – use baths, cold drinks, ibuprofen and/or Tylenol.
3. Watch for respiratory symptoms – if you or your family member has a cough that develops into chest pressure/congestion, wheezing or difficulty taking a deep breath, they need medical evaluation immediately to check for pneumonia.
4. Stay home! If you want to get a flu test and Tamiflu, please email me.
Stay tuned for up-to-date information about the H1N1 vaccine – there will likely be widespread availability of the vaccine in November.

September 2009 Email/Homepage

2009-11-12T22:16:00.000-08:00

September 2009 Updates

First of all, thank you, thank you, and thank you! It was a wonderful summer with some 3 day mini vacations and more time with my family and friends. My children remember who I am and I am enjoying the practice of medicine again. The winter will be interesting because there will be some days where I have very few open appointments. Just email Michele or me for availabilities, and we will find a place for you and your family.

Due to the winter getting busier, I will be seasonally opening up some Wednesday afternoons. This means that from September to May, I will open up the online schedule for appointments on the Wednesdays I am in the clinic. If there are no appointments available and you need to be seen on Wednesday, email or call and we can make some arrangements to get you in. Also, please verify the date of the visit whenever you make an online appointment, as AppointmentQuest will find the first available 15 minute slot and it may not be on the day you want to see me.

Flu Shots

If you had to pick one year to get a flu shot, this is the one. It would help me out a lot if everybody received a shot or FluMist nasal spray, then if you get sick I know it is not that type of flu. Adults and kids over 12 years can get the vaccine through most grocery stores. I will only have vaccine for children less than 12 years old.

The first shipment of H1N1 flu vaccine will be delivered to the Health Departments for high-risk patients in October, and it will be available through some pharmacies for in November, as the mass vaccinations start. I will not be a H1N1 vaccine clinic, but I will keep the website updated on where you can get the vaccine, if you wish. The closest Health Department Immunization Clinic is Renton Public Health Center, 3001 NE 4th St.

Health Care Reform

No matter what you think about health care reform, change is coming and it is important for us all to use our collective voices and votes. There is a great short film produced by an Emergency Room physician in Portland, OR that presents all sides of this complicated issue. It can be accessed through www.ourailinghealthcare.com. I would encourage you to familiarize yourself with this issue as it will not only dramatically affect us in our lifetime but will have a profound effect on generations to come. Send your opinions to our leaders – links are below.
President Obama -- http://www.whitehouse.gov/contact/
Office of the Surgeon General -- Phone: 301-443-4000/Fax: 301-443-3574
Senator Maria Cantwell -- http://cantwell.senate.gov/contact/ -- phone: 202-224-3441
Senator Patty Murray -- http://murray.senate.gov/email/index.cfm -- phone: 202-224-2621
Washington State Congressmen List -- http://www.house.gov/house/MemberWWW_by_State.shtml#wa

Health Notes

I am frequently asked about what I do to maximize my immune system and prevent illness, since I am exposed to sick people every day. Below is what I do for myself and my kids. We still get sick, but frequency and intensity of our illnesses have been decreased with this regimen. Keep in mind that I do not care if you buy these supplements from me or online; I just want you to have the right stuff. As I have told many of you, I am lucky enough NOT to only sell supplements for a living.

Daily Immune Supplements for Kristina
• Pharmax Liquid Multivitamin, 2 capfuls per day in 2 liters of water.
• Vitamin D 2000-4000iu per day.
• Pharmax HLC probiotics, 1-2 capsules per day.
• Thorne Green tea capsules, 1-2 per day.
• Thorne IM-Encap or Phytogen, 1-2 capsules twice a day
• Xymogen IgG Pure, 1-2 scoops per day.
• Xymogen IgG, 2 capsules twice a day (only if I start to feel sick)
Daily supplements for Ila and Kian (sometimes Kian won’t eat anything I give him)
• Multivitamins (gummy vits from Costco).
• Pharmax Probiotic straws, 1 straw every 2-3 days.
• Xymogen IgG Powder, 1 tsp per day OR 1 tsp twice a day when ill.
• Wise Women Herbals, Herbal CE 1, ½ tsp at night when exposed to illness or ill.
(of note, kids absorb Vitamin D better than adults, so no supplement is recommended)

Daily activity, even a 10 minute walk outside, helps the body to maintain balance and function appropriately. Vigorous activity, such as a hike in the middle of the winter, stimulates “leukocytosis” and increases the white blood cells in the body. And, for the last time, you really are what you eat, and although a twinkie can survive on the shelf, fresh and new, for many years, you cannot. As we age, our body’s response to the fuel we give it is amplified, so eat 5 servings of fruits and veges per day, cut down on simple carbs like sugar and white flour products, and eat lean proteins like chicken, turkey and fish. When possible, choose organic, locally grown food, as it really does make a difference in taste and residual free radicals from chemicals in the body. And it makes you feel good to buy food from your neighbors.

So it is not easy to stay healthy on a daily basis, but it pays off when you don’t have to check out for a week because of illness. I am here for you if you need me!

Kristina

June 2009 Email/Homepage

2009-11-12T22:15:00.000-08:00

June 2009
Hello to All, and I again extend my appreciation for your understanding in this transition. I would appreciate any feedback about the workings of the clinic – I still won’t hire someone to answer the phone, but you can share with me how much you hate voice mail, and I will listen…
Here is an article about the medical model I am striving to achieve… of note, many of these medical models have a membership fee and I do not plan to do that because you all have been good enough to come in for an appointment when you need me…
http://www.nytimes.com/2009/06/07/health/07health.html?emc=eta1
Everything has slowed down after cold and flu season, so if you have some little things that have been bothering you and have not made time for yourself, there are same day appointments available every week, and I am only booking out about one week for physical appointments.
One unfortunate business decision that I had to make this month was breaking off negotiations with Medicare. FYI – you don’t really negotiate with Medicare; it is more of a “take it or leave it” scenario, so I left it. Nurse practitioners get a 20% pay cut from the regular physician fee, and if you do not implement e-prescribing and a Medicare approved electronic medical record, you get another pay cut. So since I would actually be paying to see Medicare patients, I opted out of the system for 2 years. I am hoping things will change as more and more people appreciate nurse practitioners as an important part of the health care team. Medicare patients will privately contract with me on a fee-for-service basis with a discount for paying at time of service. I am having a meeting for any interested parties (even those close to Medicare enrollment) on Tuesday, June 9th at 5pm.
Now for the fun…
I am having an Open House on July 3rd from 4-9pm. It will correspond with Art Walk in the Village, and there will be art and hopefully some music. All children who are of walking age are welcome to come in at 1pm that day to paint a mural in my hallway. You can paint anything – handprints are accepted! The clinic will be open for walk-in/urgent appointments only from 9am to 1pm. Hope to see you there!
If you cannot make it to this Art Walk, I will have art at the clinic on August 7th and September 4th.
Have a great summer! I know I will!!
Kristina

April 2009 Email/Homepage

2009-11-12T22:09:00.000-08:00

April 2009
Well, I think we have made it through the worst of a late cold and flu season. Some of you people were really sick! I was able to accommodate most everyone with same day appointments during the busiest time of the year, so I think the clinic is at a good number of patients at this point. I am still not accepting any new patients or prior Issaquah Medical Group patients at this time.
One of the things that takes up about 1-2 hours per day is my extra work – emails, refills, referrals, FMLA paperwork, etc. I used to have 4 people on staff that helped with this work, and had to see 8-10 more patients per day to pay them. I get it all done eventually, but let me explain my process a little:
“A” list – all the patients that have gone out of their way to make an appointment. Obviously, when you are in front of me, you have my full attention and resources, and get immediate service.
“B” list –emails, refills, lab results, phone calls. These are usually completed in 48 hours.
“C” list – FMLA paperwork, medical records requests, billing questions, referrals. These are completed in one week unless I am having difficulty accessing information and I will at least give you an update.
None of this is difficult – just takes time. I share this with you because if you urgently need something on the B or C list to be done right away, you need to make an appointment. That is the only way I can guarantee immediate service. I do have part-time help in the morning, but all of the above duties are mine alone. I have the staff busy with many other tasks that make the clinic run. So we will never be answering the phone, but you will get a call back now when you leave a message!
After 3 months in business, I have finally carved out some time to write clinic policies. I really do not like formal policies, but they are an unfortunate necessity to protect against naughty clients. I have attached the policies. Included is the HIPAA policy (required by law and standard at all medical offices) and email policy. It is very important for everyone to read the email policy because, before your next visit, you will be asked to sign that you read and understood the privacy and email policies. Email has worked FABULOUSLY to communicate with patients and I can do 5-6 emails for every phone call, so I want to continue to communicate primarily by email.
There are some additions to the website as well – a page with health links and phone numbers to urgent care centers for those Sundays with sick kids. Please let me know if I can provide any additional information on the website. Thank you for your continuing support!
Kristina Garrido

January/February 2009 Email/Homepage

2009-11-12T22:08:00.000-08:00

Dear Patients and Friends,
What a whirlwind! Any of you who visited in January observed that I was leaving your insurance cards on the copier and forgetting co-pays, but I was open for business! Although I may have seemed a little discombobulated (one of my favorite words), I am SO HAPPY! I wanted to thank you all for your kindness and patience at this time. I have now hired front desk staff (Michele, Blake and Jesse) so things will be a bit smoother at your next visit…
I am still streamlining the process of lab notifications, so if anyone does not receive a result in a timely fashion – I apologize – email and remind me! For those who had trouble finding the place, we have changed the website map in an effort to help others. FYI – I am in Gilman Village, at the southwest end behind Sweet Additions. If you park in the Juniper Street lot at the southwest end, you will see the sign for Grimaldi’s Coffee Shop (the best coffee I’ve had since I lived in Seattle) and I am the “salmon” (pink) building next to them.
A few words about online scheduling…
It is going pretty well, and most are having no trouble. I have closed the enrollment due to overwhelming response (a blessing and a curse!), so if some of your family members have not signed up, they need to email me and I will make them an account. I just needed to put my “finger in the dike” for a bit, and then I can decide what a comfortable patient base is for the clinic.
So, making an appointment… many have emailed me that they are not able to make a same day/15minute appointment. Those appointments open up the day before so that there will be available slots for sick/injured people. If you try to make those appointments the week before, it will not work. My experience has been that if patients are thinking about the appointment a week ahead of time, they will need more than 15 minutes for the appointment. The 30 minute appointments are best for medication checks/refills/complicated disease management, and those can be scheduled months in advance. The software will generate a reminder 48 hours before the appointment so you can re-schedule if needed.
If I am completely out of same day appointments and you are in crisis or very ill, I will find a way to fit you into the schedule. I do show preference to my littlest patients, as they are the ones who get sick very fast and need care right away.
Of the 2-3 thousand patients that I regularly saw at my prior clinic, you all are the 700 patients that felt it was worth it to follow me to Village Family Clinic. You have made my dream come true… and the clinic is a welcoming, gentle place for healing… I am so happy to share it with you!
Kristina

2008-12-12T20:34:00.000-08:00

THE BEGINNING!

2008-11-07T07:31:00.000-08:00

Village Family Clinic & Wellness Center will be opening January 2, 2009.