Primary Care Physicians

Same day appointments

Dr. Sanders — Thu, 28 Jul 2011 11:00:50 +0000

Primary Care Physicians maintains 20% of each day’s schedule available for same day appointments. Every provider in the office has appointment slots to accommodate urgent same day access. We limit the use of those appointment slots for urgent needs or acute problems and not for chronic management. While we know patients are busy and pressed for time, we would like to have the ability to work a patient into the day’s schedule for a sore throat or headache or the high blood pressure identified at the dentist’s office. Getting a same day appointment for a camp physical or a 6-month follow up appointment for hypertension isn’t always possible. But we can likely see you tomorrow or later this same week.

By having same day appointments, we reduce the use of the emergency room for non-emergent care. We also reduce the splintering of care that happens when people go to walk-in clinics.

While a walk-in clinic may advertise that they take your insurance, if your insurance carrier hasn’t contracted with that specific clinic, you may receive a SIZABLE bill for services. Most patients must pay a percentage of care or may have a large deductible. Many diagnostic tests require prior authorization. Walk-in clinics do not have your active medication list and can prescribe drugs that interact with your daily medications. The walk-in clinic may be more convenient but they may be more expensive and create new problems.But in the atmosphere of defensive medicine, the walk-in clinic (and the emergency room) will often over test and order more diagnostic tests necessary to cover their liability. They don’t know you the way your family doctor knows you. They don’t have the time or philosophy that your family physicians has to know you and your medical issues.

Also, we often do not get records and have no knowledge of your illnesses and treatments.

It’s why we keep our daily schedules partially open. We want to take care of our patients and will make every effort to get you seen as soon as possible.

Legislative Changes

Dr. Sanders — Sun, 24 Jul 2011 15:07:58 +0000

Governor Rick Scott signed bills passed in the 2011 Legislative session that change medical practices. These laws went into effect July 1, 2011 and because of these new LAWS, the policies and procedures for how you may have received prescriptions or refills of certain medication has changed. This is the law and must be followed.

counterfeit-proof prescription paper must be used to prescribe any CONTROLLED SUBSTANCE. [see the list of controlled substances here]
new “standards of practice” for a controlled substance prescribing practitioner are expressly defined and require
- a complete medical history and physical exam
- a written individualized treatment plan
- a written controlled substance agreement
- regular, follow appointments at least every 3 months

While Primary Care Physicians is not, nor have we ever identified ourselves as pain management providers, our patients do occasionally have pain. We also prescribe other medications classified in the same category as opioid and pain medications, such as sleep aids, anxiety medications, medications of Attention Deficit Disorders and muscle relaxers. There is no denying that, as family physicians and primary care providers, that we use these medications in the care of our patients and their medical problems but the state legislature has left the language in these laws vague and broad. Primary Care Physicians has NEVER dispensed any controlled substances from the premises. We do not stock any injectible narcotics. We do not write these schedule and controlled substances for the majority of our patients. And while we treat pain that is associated with medical problems, as family physicians, our goal is to address the CAUSE and ORIGIN of pain and treat that. If no identifiable cause can be found, then our patients will be referred to the pain management specialists. More of our patients will be referred to the specialist because of these laws. The state is restricting the scope of the practice of medicine with regards to controlled substances and we will comply with the state laws. The treatment of pain and the chronic use of opioids and controlled substances will become a separate and distinct specialty of medicine and must be provided by the pain management specialist. We aren’t surgeons and could remove your tonsils or gallbladder. Likewise, we are not pain specialists and cannot manage your pain.

Florida has one of the highest rates of prescription drug abuse in the country, if not the world. In Broward County, there are more pain clinics than Burger Kings.

We must all do our part at limiting the flow of controlled substances onto the streets. And because of these new laws these are our new rules:

Before you can receive your next prescription, you must sign a controlled substance agreement. Refusal to sign this agreement will result in our INABILITY to write your prescription.
Any refills for controlled substances at your pharmacy will cancelled.
If you have not been seen since July 1, 2011, call and make an appointment for your headaches, arthritis, ADD, insomnia, anxiety or whatever condition you may take these controlled substances.
Random drug testing can be ordered.
You are required by the STATE to be seen in the office AT LEAST every three months.

If you want more information regarding these laws, read them here: www.doh.state.fl.us/mqa/osteopath/

Mandatory 90 Day prescriptions

Dr. Sanders — Wed, 20 Apr 2011 11:03:30 +0000

On April 5^th, CVS Caremark mailed letters to state of Florida employees on Blue Cross Blue Shield giving them notification that any chronic medications would now be filled ONLY through the CVS Caremark mail order process. This is MANDATORY. It is very likely that state of Florida employees received (by mail) prior warning that their medications must convert to 90-day quantities after the initial three month grace period, but we think it is likely that people discarded those envelopes unopened.

This creates dilemma on multiple levels.

1. You may be out of medication.

2. You could fill a bridge prescription at your local pharmacy but it will be at full cash cost. Your insurance co-pay will NOT apply to the filling of the local, 30-day prescription.

3. Your physician may not want to give 90 days of a medication. Maybe the dose is being adjusted. Maybe the medication has proven ineffective. Maybe the medication is a controlled substance.

Patients who take medications that are absolutely necessary to maintain their chronic disease states should NOT abruptly stop ANY medications. This includes blood pressure meds, asthma medication, antidepressants, diabetes medications, anti-coagulation drugs like Plavix or Coumadin. Stopping medications can increase your risk for adverse events. Abruptly stopping can also cause severe discontinuation syndromes. If you are uncertain if your medications fall into the ABSOLUTELY NECESSARY categories, please call the office @ 352.377.2022. Leave your message on the voice mail for your physicians medical assistant.

There are chronic medications that could be held temporarily without risk. This will save you the cost of paying CASH to fill a bridge 30-day prescription. You can hold lipid lowering drugs, hormone replacement therapies, osteoporosis treatments, reflux medications, anti-inflammatory drugs used for arthritis, sleep aids and most topical medications.

We at Primary Care Physicians understand that the changes to your insurance benefits are beyond your control. It is purely associated with the state of Florida diligently trying to maintain high quality medical insurance coverage for their employees while managing the ever escalating cost of that insurance. These changes to your prescription drug coverage is the state’s attempt to manage (and maybe lower) cost. We are proud to be Blue Cross Blue Shield providers and are very grateful that the state has continued to provide health insurance through a company with whom we are providers.

It is our mission as your primary care providers to collaborate with you and operate within your insurance coverage as much as possible, to be mindful of your out of pocket expenses and to also be mindful of the overall cost of delivering you the highest quality medical care. But please be aware…there are recommendations we will make….recommendations that are truly the best standard of care….that your insurance company may NOT consider necessary.

A patient has rights. And a patient has responsibilities. Know your rights. Know your responsibilities. Get online and verify the new benefit structure for your insurance plan. Services once covered may no longer be covered.