Office Policies
Narcotic Prescriptions
Every day, we read about the ravages of painkiller 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 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. 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.
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.
Pap Smear Recommendation
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!
Tele-health and Insurance
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. Insurance companies 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.
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 medical 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. - social determinant of health
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.
