OFFICE UPDATE
August 16, 2023


Maria graduated form high school!

FLU SHOT CLINICS
Drive in flu shot clinics are set for Friday, October 13 and Friday November 3. You do need an appointment for each person. Please call to schedule.  We will be recommending updated Covid boosters this fall when they come out, but we do not have any information about that just yet!

STAFFING UPDATES
We are pleased to welcome Karie Shelton, PA-C to our practice as a per diem provider.  She comes to us after taking some time to raise her family after being trained in Arizona. Please welcome her if you get the chance!

Due to a shortage of appointments, we will be instituting a $25 fee for missed appointments. Please give us 24 hours notice if you need to reschedule appointments so your spot can be used for other people needing evaluation.

One of the changes in health care advanced by the Covid pandemic was insurance coverage of tele-health visits.  Insurance companies have continued paying for VIDEO visits for many health issues and have also begun paying for health care management via phone calls or portal messages to the office. For example if you call with urinary symptoms, have tests ordered and managed by the office and medication ordered, our office will bill a phone or portal health management code.  This would also happen if you submit photos on the portal of rashes or other physical findings that are reviewed and managed by a provider.  Theses charges will vary by the length of time spent on the complaint by our office, but you will see them reflected in your bills.  Calls for refills, following up on recent visits or general questions will not be charged for, but if there is any testing, medications given or decision making by providers on new complaints, there will be a charge put through.

CHECK OUT THE NEW TAB ON OUR PAGE DR. PETER'S BOOK INFORMATION FOR THE LATEST AND GREATEST FROM OUR OFFICE AUTHOR


Infectious Disease Update:  As you know there is a lot of Covid, Flu and RSV going around our schools and communities. Though we have enjoyed fewer febrile illnesses during Covid times due to mask wearing, we are now catching up with those infections!  We recommend supportive care at home for mild infections. If you are having high fevers and significant symptoms, please take a covid test at home and call our office for further direction.

If you do test positive for Covid, please call the office and speak to a nurse. Some patients will qualify for antiviral medication which may help you heal a bit faster, with fewer complications.
We give our highest recommendation to our patients to seek out Covid Vaccines. If you haven't received your bivalent booster yet, please call to schedule one. It should be at least 2 months following your last booster or 3 months following infection with covid.  Please work to get your loved ones vaccinated. 

Masks are now optional for healthy patients and required for anyone with symptoms of illness.  Please be kind to anyone who chooses to wear a mask.  At this time our office staff will wear masks when they have direct patient contact.  

REFERRALS and OFFICE ASSISTANCE:  Please be aware that referrals to specialists are taking months in general.  Our office like most businesses, has had some decreased staffing during this pandemic. Please be patient if things aren't processed quite as quickly as usual. Our staff has been working very hard with an increased case load.  We are forever grateful to them for their support during this difficult time!

INTEGRATED HEALTH CARE:  Our office is pleased to partner with Rutland Mental Health and the Community Health Team to provide our patients with support for Mind and Body Care and Wellness.  This team approach helps us bridge the gap between medical and mental health. This support may include referrals for counseling, case management, social work consultation or assistance with advanced directives.  We are so fortunate to have this community support for our patients!

Our practice is currently CLOSED to new patients!

VeggieVanGo
The Vermont Foodbank's VeggieVanGo events promote health for Vermonters and provide an opportunity for participants to bring home fresh produce.  They distribute free boxes of fresh fruits and vegetables at locations around the state.  Individuals and families do not need to register, for more information about these events please visit vtfoodbank.org


CORONAVIRUS UPDATE

Remember that this virus is spread through aerosolized particles. The louder someone speaks, laughs, or sings the more particles they push into the air and the farther they travel. A facial covering on them will limit this projection of particles, and a facial covering on you will limit what you take in.  If you stand 6 feet or greater apart, this will also limit the amount of particles you ingest. The lower your exposure to these particles, the lower your viral load will be, the fewer symptoms you will have, etc.  Let's all pitch into help keep our most vulnerable safe!

VIDEO-VISITS (TELE-HEALTH) 
We can now offer our patients Video-visits for some acute and follow up appointments. All you will need is either a cell phone with wi-fi or computer internet. You see us while we see you, and we will update your chart accordingly.  These visits would not always be appropriate depending on the nature of the medical problems being evaluated, but they would be sufficient for many.  Most insurances including Medicare, Medicaid,  BlueCross plans, and MVP will cover these tele-health visits similar to in person visits, with applicable copays and deductibles.  If you are interested in seeing if you qualify for one of these visits, please call us and discuss with staff. To prepare for one of these visits, it would be very helpful for you to check a home blood pressure, heart rate, temperature and weight before we get on the phone with you.  If you don't have access to this info, that is ok too.

OUR OFFICE:
We will still be having our office hours as scheduled, however we will be taking many precautions to eliminate transmission of germs. 
Staff will be masked with direct patient contact to minimize transmission of anything to our patients. 

2023 HOLIDAY SCHEDULE
Just a reminder that our office will be closed for:
New Year's Day
Presidents' Day, Monday February 20
Memorial Day, Monday, May 29
Juneteenth, Monday, June 19
July 4th, Tuesday, July 4
Labor Day, Monday, September 4
Indigenous People's Day, Monday, October 9
Thanksgiving, November 23
Thanksgiving Friday, November 24
Friday afternoon, December 15th, for a staff Christmas party
Christmas Holiday, Monday, December 25 

COMPLETE PHYSICAL EXAMS/ WELL CHILD VISITS
Most insurances will now cover annual physicals without a copay. We encourage all of our patients to take advantage of this "free" benefit each year. The point of this exam is to review your medical history, medications, and risk factors, to determine what testing, vaccines or treatments you would benefit from. Please be aware that we need to review these issues with you to be able to bill this code. If you are scheduled for a physical, but you come in with acute or chronic complaints that require a significant portion of the visit, we may need to reschedule your physical and tend to the acute problem. Some patients prefer for us to try and do both the well visit and manage ongoing problems at the same visit.  We will try to squeeze that in whenever possible, but keep in mind, we do have other patients on the schedule behind you!  If we are able to cover the requirements of a well exam, and manage acute or chronic problems  requiring referrals, extra blood tests, and/or medicinal management, you may incur an extra visit code along with the "free" physical code.  If you have any questions about your bill, please call and ask to speak with Marsha.

WELL VISIT SCREENINGS
All patients will be screened for depression and substance abuse at their recommended yearly physical.  For those of you with teenagers who are patients here, when they come for their annual Well Child Check (yes, it is supposed to be annually) they will be given an Adolescent Questionnaire to fill out.  This includes questions about risk factors in teens like substance use, sexual activity, signs of depression or anxiety, exposure to dangerous situations, etc.  We encourage you to encourage them to fill it out honestly and independently.  The more people teenagers feel they can confide in, the more likely they will be to seek out help when they are put into sticky situations.  Please allow us to try to build a rapport with your teen.

DEVELOPMENTAL SCREENING
And this year's practice initiative includes developmental screening for our babies and toddlers.  We will be asking parents to fill out screenings at home just prior to well child checks at 9 months, 18 months and 30 months.  These screenings can be picked up at our office, sent to you in snail mail, or sent over the portal.  They do take 10-15 minutes to fill out as you need to test the baby's ability to do a few age appropriate activities.  These screenings will assist us in identifying any areas of development in which your child may need some extra help.  We do have screenings that you can opt to do at any age from 2 months to 5 years.  If you are interested in doing them at any of these other ages, just let us know a few days before their Well Child Checks and we can forward the screens to you.  They are very educational for caretakers and show each milestone with pictures and descriptions. 


HYPERTENSION PROJECT
For those of you that read these updates, you know we always have a quality improvement project each year.  This year's winner is improving control of our patients' blood pressures.  If you have a blood pressure greater than 140/90, we will be trying to work with you on lifestyle modifications like decreasing salt, losing weight, exercising and decreasing alcohol.  If that's not enough, then we will be tweaking meds to try to get you to goal.  We highly encourage our patients with increased blood pressures to invest in an automatic home blood pressure cuff that fits your upper arm.  You can then take your BP away from the office and bring us readings.  We feel more confident making treatment decisions based on more than just the one blood pressure reading we get at your visit.  For those of you who simply cannot afford a cuff, we do have some loaners available at the office.  Let your provider know and they can set up a nurse visit for you to receive the cuff and teaching needed to use it.  If you are interested in this, please call and ask to be put on the attendance list.  We would love to see everyone with Hypertension checking their pressures at home! 

NARCOTIC PRESCRIPTIONS
Every day, we read about the ravages of pain killer addiction on our society and in our homes.  The state of Vermont has taken some strong steps to curb the way these medications are prescribed so as to limit addiction potential and to decrease the supply of them on the street.  Those of you on chronic painkillers will see changes in some protocols which will include written narcotic prescription agreements, mandatory urine drug testing, mandatory pain clinic consultations on at least a yearly basis, and at least quarterly visits in our office with your primary provider.  The state is also putting strict limits on the number of pain pills that providers can give out for acute, new onset pain.  All of these changes are best practices and will encourage all of us to use safer modalities in the treatment of pain.  More information is available at the end of this update.

PRESCRIPTION COSTS
Nobody knows what the future holds for our health care coverage in America, but I can tell you that one of our system's biggest problems is the cost of prescription medications.  Over the last ten years, we have made every effort to avoid brand name medications whenever possible.  I go days without prescribing anything but generic medications.  However, the pharmaceutical companies have caught onto this, and now are ratcheting up the costs of certain generic meds as seen with the Epi-pen debacle this past year.  Old-time medications can go from $4 to $100 in the blink of an eye.  Insurance plans will charge co-pays of $40 for a medicine that costs $2.  Patients need to know to check what medications their prescription plans will "cover", but you also need to compare that price to the price local pharmacies will charge if the prescription is not run through insurance.  For example, if I want Tetracycline for acne and use my "insurance"  it will cost $500 at all of the local pharmacies and my mail away plan.  However, if I use Goodrx, a coupon service independent of insurance companies, at the same local pharmacy, I could get that same medicine for $25.  Keep in mind that if I don't run this prescription through my insurance plan, it will not go toward my deductible.  However, I would rather save that $475 for something else!  Prices can also vary greatly from one pharmacy to the next.  So as a consumer, I highly encourage you to shop around for the best prices.  Go online, or call  and check to see what your insurance plan will charge for a particular medication that we want you to get.  Compare that price to the Goodrx (an app on your smart phone) prices available at your local pharmacies.  And then let us know where you want the prescription sent. I know, I know, it is much too complicated.  Complain to Phil Scott, Bernie Sanders, Peter Welch and Becca Balint.  Everybody has to rant sometimes...


BEST WAY TO DECREASE YOUR CHILD'S USE OF DRUGS AND ALCOHOL
Be clear with your child about your family's expectations and rules. Revisit the topic often. Have clear ramifications for breaking these rules and follow through with them.  Set a good example.  Show your child that you can spend time with family and friends without having to drink or use drugs.  Don't leave things you don't want them to use out in the open, and certainly don't involve them in getting drinks or drugs for you.  The same applies to cigarettes.  We can lecture our kids about many things, but an even more important motivator is setting a good example. 

TEACHING IN FAMILY MEDICINE
One thing we were very grateful for during our medical training was the willingness of physicians to let us tag along in their offices.  Students can read from books for as long as they want, but at some point, you just need to learn by DOING.  We, in turn, often have students tagging along with us.  They may be medical, nursing, physician assistant or nurse practitioner students.  They may be high school or intermediate school students who are trying to figure out what to do with their lives. These students may simply help put patients in rooms, or they may sit in on entire appointments with the providers. When we do have students with us, we will post a sign at our front check-in desk alerting you to who is there and in what capacity they are shadowing.  You, as our patients, always have the right to decline having students come into your appointments. We do request that you alert our front office staff before your appointment if you don't want to see the students, as face-to-face rejection is uncomfortable for everyone. 

NARCOTIC/CONTROLLED SUBSTANCES POLICIES (More info...)
If you have read over our patient policies, you will see that we try to be very careful in prescribing chronic narcotics.  There is a widespread problem of prescription drug abuse within our local community and across the country.  If you are prescribed any of these medications by our office, you must agree to abstain from any illegal drug use, take the medications according to the prescription, and comply with random urine drug testing at our office.  Failure to do so will result in the cessation of our prescribing these medications for you. 
We will be instituting similar parameters for ADD stimulant medications, benzodiazepine or sedative medications, and some sleeping medications.  There is widespread misuse of all of these medications, and we would like to do what we can to keep these medicines from being abused on the black market.  Therefore, even if you have been on these for many years, your provider may require a urine drug screen at any time.  This is to ensure that we are taking appropriate care of you and keeping potentially dangerous, addicting meds out of the hands of our children.  Please understand that if you are calling every month for a prescription refill, and we check a drug test that shows you have not in fact been taking this same medication, then it would appear to us that the medicine is being diverted to someone else that we did not prescribe it for.  If we find that you are using other illegal drugs like marijuana, cocaine, etc, or other controlled substances that we have NOT prescribed for you, then it would appear to us that you are not using these medications in a safe way.  Either of these situations would lead us to discontinue prescribing these medications for you.
Please call the office to request refills of controlled medicines one week ahead of time.  This will allow the request to be sent to your primary provider.  These refills must come from your primary provider unless he/she is out of the office for more than a week.  Please plan accordingly.
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The recommendations for PAP smears have been changing.  Today they are recommended starting at age 21 and every 3 yrs until 30. Then between 31-65, they can be every 3-5 years depending on the type of pap smear being done.  You are allowed to retire from pap smears over 65 as long as you have not had any significant pathology on any of your previous paps.  Our office is in the process of changing over to these policies, so we will discuss them with you at your upcoming appointments.  Please be advised, that we still recommend yearly physicals, but you just won't have to have the pap!

SURVEYS
Some of you may have received yet another survey to fill out for our office.  As a medical home, we are required to do them each year to keep abreast of how well we are meeting your needs as a primary care office. We do hope you will take a few moments to fill them out for us.  We do use the feedback from these to make changes in our processes as needed.