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

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

All the Best

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

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

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!

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

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!

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...

KG

NPs ROCK!

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

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

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

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

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!

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

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!

Great view from PBS Frontline

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

IMPORTANT ANNOUNCEMENT

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

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