Tommy's graduation from Wake Forest, May 2018. L to R: Peter, Abby, Maria, Tommy, Lisa, Danny
FLU SHOT SEASON 2018
Adult flu shots are expected at the end of August, and children's vaccines are expected in September. New this year, after September 1, we will be having walk in
flu shots on Wednesday's after 9 AM,
adults only. If we run out of shots, I will post it here, so you may want to look here before you head to the office. We will have some high dose flu vaccines for patients over 65. Please call to set up nurse visits for children. If you have a regular appointment within the next couple of months, you can just get the vaccine at your appointment. If you can't drop by on a Wednesday for your flu shot, please call to schedule a nurse visit for other days during the week.
We are pleased to announce the recent hiring of Noah Wollenburg, PA
. Noah comes to us from the University of Wisconsin. He will be picking up Mondays/Tuesdays/Fridays as Kathy deRham, PA retires at the end of August. We extend a heart felt thank you to Kathy for more than ten years of service to our office. They will be hard (fancy) shoes to fill. Best wishes to Kathy and Noah in their new endeavors!
2018 HOLIDAY SCHEDULE
Just a reminder that our office will be closed for:
Thanksgiving, November 22rd
Friday, the day after Thanksgiving, November 23rd
Friday afternoon, December 14th, for a staff Christmas party
Monday, December 24th and Tuesday December 25th, for Christmas Eve and Christmas
Tuesday, January 1st for New Year's Day
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.
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!
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.
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 Phill Scott, Bernie Sanders, Peter Welch and Patrick Leahy. Everybody has to rant sometimes...
And this year's practice initiative includes developmental screening for our babies and toddlers. We started autism screenings at 18 and 24 month visits last year. We now will be asking parents to fill out screenings at home just prior to well child checks at 9 months, 15 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.
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.
WELL VISIT SCREENING
This will be a quick questionnaire filled out at all well visits age 13 on up to 99! All patients will be screened for depression and substance abuse at their recommended yearly physical.
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.
For those of you with teenagers who are patients here, when they come for their annual Well Child checks, yes, it is supposed to be annually, they will be given an Adolescent Questionnaire
to fill out. This survey 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 like 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.
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!
|Our privately owned family practice has been in operation since 1999. Clearly, much has changed in the Rutland medical community over the years, but we remain dedicated to the model of an independent medical practice. Though this idea may be old fashioned, we have advanced with the times in many important ways. We instituted an electronic medical record in 2009, and became a certified Medical Home in 2012. One of the many advancements we made in becoming a medical home was the initiation of a Patient Portal. This portal serves as an internet connection for our patients to get lab results, ask their providers questions, request appointments or print out a chart summary. Our patients range in age from newborns to 100 somethings. We provide acute care as needed during office hours, but emphasize preventive medicine to maximize our patients' overall health status. We are proud to care for as many as four generations of some Rutland area families.|
Thanks to our patients for voting us Rutland Herald's Best of the Best Doctors two years in a row!
|Drs. Peter and Lisa Hogenkamp
10 Commons Street
Phone: (802) 747-3359
Fax: (802) 786.5204
|Our office is open from 8:30AM to Noon and 1:00- 4:30PM Monday through Friday|
|We accept most major insurances.|
|We are affilliated with Rutland Regional Medical Center, Rutland, Vermont.|