July 2002
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July 2002
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The Women’s Group signed a contract with PacifiCare during the first week of June. We cannot schedule PacifiCare patients yet, but can put you on a waiting list until PacifiCare finishes their paperwork. We are looking forward to seeing our PacifiCare friends again! We have had a web page for three years. We
would like to make it more useful to our patients. If you have any suggestions
we’d love to hear them! You can email Bob Blackburn at:
http://www.thewomensgroup. com
Dr James Delaney I think almost everyone knows that I have been talking about retiring for over two years and because I have set previous dates for retiring but still kept working, many people have doubted that I was serious about taking the step. I have enjoyed almost all of my many years in practice and especially appreciated the confidence and trust my many patients have shown to me by allowing me to care for them. But the time has come. I have decided it is in both the patients and my best interests to stop practicing medicine. I don’t believe I have lost any of my surgical skill or my medical judgment but I want to stop before I get to the point where a diminution in either my skill or judgment might harm someone. And besides there are a lot of other things I would like to do that I have not had the time or freedom to do before now. Lois has suggested that a brief summary of the highlights of my career might be of some interest so she invited me to do this little sketch. I have been in private practice in the Denver metropolitan area for 30 years. Before that I taught at the CU Medical School for 4 years. I have admitted patients to every hospital in the area except Valley View( North Suburban) and National Jewish. I was always in solo practice until I joined The Women's Group 2 years ago. I have seen many changes in 30 years. The cesarean rate has gone from 3% to 20% and operative vaginal deliveries, which were common, have almost disappeared. I have seen the development of Neonatologists and Perinatologists and fetal monitoring. Ultrasound technology was in its infancy when I started. Most women delivered under general anesthesia or spinal anesthesia when I started. A woman would only receive conduction anesthesia( epidural) if her obstetrician was able to do it. I did a lot of the things we now refer out or seek consultation for. If a baby needed resuscitation, the obstetrician did it or it didn’t get done. For many years I took care of all the pregnant kidney transplant patients and the vast majority of insulin dependant pregnant diabetics. I also had a fairly large and successful infertility practice before the inception of assisted reproductive technology. Among my more memorable patients were the Miller quintuplets. They were the first quints to be born in the State. They are now 17 and are all healthy teenagers. The last two years with the Women's Group have been great. For the first time in my professional life I have been able to turn off my pager and take extended time off. I haven’t had to worry about billing and collections. All I have had to do is help care for some wonderful patients. Will I miss medicine? No. Will I miss the patients? Yes. In some ways it doesn’t seem like 30 years and in others it seems like forever. I have enough other work and plans to last a life time so I will not be bored. Gail & I hope to do dome volunteer medical work but the medical liability problem limits our ability to work in the United States and there are fewer & fewer places in the world with a need for care where it is somewhat safe for us to travel to. But we will find ways to contribute to different communities in different but meaningful ways. God has blessed me and my family and as most of the labor & delivery nurses would say my patients too. If you see me on the street or anywhere please stop and greet me or at least wave. Thanks to everyone who has made my professional life so rich. And a special thank you to Lois McLauchlan and all the office staff who have helped me so much during my time with The Women’s Group. Jim
Patient Satisfaction Survey Results in Changes at TWG Many thanks to all the patients who participated in our patient satisfaction survey. We mailed 650 forms and received 300 replies. Such a high response rate shows that you value our relationship and we deeply appreciate that. While the overall scores for your visits were very high, we know that in some areas you would like us to improve Parking: The number one complaint was the parking. The Arapahoe County Planning Office tells us that the building has the required parking according to code. We will continue to work with our property management company to come up with some remedy if possible. Scheduling: We are taking a closer look at how we schedule. We now are scheduling appointments out a full three months. Once the schedule is out, we do not change it unless a provider has an emergency. We are working hard to reserve enough slots for last minute problem visits and necessary follow-up appointments. It would help tremendously if you plan to schedule your annual exam far in advance, and call at least 48 hours in advance if you cannot make your appointment. Volunteer to be put on the cancellation list if you wish a sooner appointment and have some flexibility in you own schedule. Phone System: We improved our opening selections. You can bypass the first message to reach a receptionist by pressing 0. Check-in Process: We increased the staffing level and training of our receptionists. Wait in Reception and Exam Rooms: Your time is valuable and we want to make your visits as short as needed to provide the best possible care. We believe that we spend more time with our patients than the average office. We do not routinely double-book. Our providers do not routinely see patients in the office on call days then reschedule appointments when deliveries occur. Three problems do come up. Sometimes the provider will spend more time than was scheduled with a patient who needs unexpected extra help. Sometimes a provider will need to spend unexpected time on the phone to manage a patient in the hospital. Sometimes we run out of saved emergency time slots and a patient will call with an emergency and need to be seen. When these problems occur, we do not cut short subsequent visits to "make up" the time. To handle these problems, extra time slots have been created morning and afternoon, to allow the providers to catch up as needed. We are reserving "emergency" appointment times, and have developed and tested a log to track the times as patients move through the office. This information will be used to improve the allotted times for visits and to optimize the catch up time slots. The quest is to reduce routine waits and the number of delays in our schedule. As a result of the satisfaction surveys, we are all more conscious of your need to be seen in a timely manner and have committed to improve our performance. If your provider is running late due to an unexpected problem or emergency, our expectation is that you will be told why you are waiting, and be given the option of seeing another provider or re-scheduling. You should also be given the option of waiting in the reception room or the exam room if you chose to wait. We want to leave every single patient feeling appreciated and well cared for after her visit. When we fail, please let us know what happened by either: 1) filling out a suggestion form that is at the reception desk, 2) calling our manager, Janelle True at 303-948-3211.
Role Definition and Certification of Nurse Practitioners by Barb Ferris RNC, NP, MS The Women’s Health Nurse Practitioner is a specialist in the field of women's health. Practitioners are licensed as registered nurses in the states in which they practice. Nurse Practitioners function as advanced practice registered nurses and, thus, are subject to the rules and regulations of the practice act of the state in which they are licensed. The WHNP is prepared through a formal course of academic and clinical study to deliver health care to women throughout the life span, with an emphasis on reproductive-gynecologic and well-woman health. The practitioner is able to provide comprehensive health care in a variety of settings including but not limited to private care, acute care and community based settings. Comprehensive health care includes wellness promotion and provision of primary care. The nurse practitioner collaborates with a multidisciplinary health care team to provide comprehensive care that is coordinated around the patient’s needs. Nurse practitioners are responsible and accountable to the outcomes of their practice in accordance with law and professional standards of practice The WHNP is an advanced practice nurse and, therefore, should attain and maintain national certification. Certification provides evidence to the client and the community that the individual an achieved knowledge beyond basic nursing. Rickie Guida and Barbara Ferris, the Nurse Practitioners, at the Women’s Group have both been certified as WHNPs by a national Certification board. They have completed additional education to achieve prescriptive authority. They also participate in continuing education programs on a regular basis to remain current in the rapidly changing world of women’s health care.
Clinical Updates from the Providers Rubella vaccine-Women who were non immune to Rubella per prenatal lab work and who delivered at Swedish Medical Center between December and April did not receive Rubella vaccine due to a shortage of supply at that time. We have a list of all patients needing vaccine and will call you when the vaccine is available. Comprehensive lab panels - Patients often ask for a list of lab tests to be done as a routine at the time of the annual checkup. Please know that this is not necessary. When there are no symptoms or risk factors, abnormal results are likely to be false alarms. There can be risk in doing follow up tests to determine if there may really be a problem. If you do have certain symptoms or risk factors, the providers will not hesitate to order relevant tests or referrals. It is recommended to have pap smears regularly. Despite some recent controversy, it is still strongly recommended by experts to have mammogram by age of 40, then every 1 to 2 years through your 40’s, then yearly (to expedite readings, please be sure the past two previous films are available). A fasting (12 hours of nothing but water) cholesterol is recommended every 5 years. Colon cancer screening should be started by age 50. Blood pressure should be taken during every annual exam. Birth Control - Did you know there are a few new birth control options? One is “Mirena”, a type of IUD. It is good for 5 years and has the added benefit of decreasing the heaviness and duration of the periods after 6 months of use. Another new method is the transdermal (skin) patch called ”Ortho Evra”. A fresh patch is applied each week for three weeks, followed by a week off. It is very comparable to the pill hormonally, but is easier to remember. The other two additions also resemble the pill hormonally. “Lunelle” is a monthly injection, and NuvaRing is a flexible 2-inch diameter ring placed vaginally once a month. Let us know if you are interested in learning more to determine if these new methods may be right for you!
By Jennifer Brenton, MD Remember the standard advice, "take plenty of fluids" for a variety of ailments? Well, there are some excellent reasons for that! The standard recommendation is eight 8 ounce glasses of water each day. I tell people they can also substitute milk or juice for this, but water is the best. Here in Denver and the southwest, where it is dry, the reconunendation should be closer to 10 glasses each day. For pregnancy, exercise, time spent outdoors, breastfeeding, etc., more like 12-14 glasses each day. What most people do not realize is that the other "fluids" they are consuming (pop/soda, coffee, tea, alcoholic beverages) act like diuretics or "water pills" that are given to people with heart failure. The caffeine and alcohol in these drinks actually tell the kidneys to get rid of water; for every glass of pop, coffee, tea, or alcohol, a person actually voids (eliminated through the urine) that glass and potentially an additional one to two glasses of water depending on the amount of caffeine or alcohol present in each bevera Why all the fuss about water? 1) WEIGHT LOSS: Did you know that the chemical formula. for breaking down a fat cell actually requires a molecule of water? If the body does not feel it has enough for survival, it will not release that molecule. Thus, though you may be exercising, weight loss is extremely difficult if there is not adequate hydration. 2) VAGINAL DISCHARGE: The vagina is probably one of the last organs in the body to see water. Why? Because it is not a necessary organ for survival. The vagina is a self-cleansing organ. If there is inadequate hydration, certain bacteria normally present in the vagina will overgrow and create unpleasant, odorous, or thick discharge. Some of this can be treated with medication, but it is mostly cured with water (drinking it, that is). It always surprises my patients that I can tell their hydration status while performing their pap smear! 3) VAGINAL PAIN (E.G. WITH INTERCOURSE): Along the same lines, particularly for perimenopausal or postmenopausal women, adequate hydration helps to provide lubrication for intercourse as well as prevent small cracks in the vaginal mucosa called fissures, which can be extraordinarily painful. Estrogen cream occasionally helps in these instances, but water is an important addition to help prevent future occurrences. 4) CONSTIPATION: One way the body reclaims water from food is in the large intestine; if the body does not see much water, it will reclaim virtually all available water from the stool, creating very hard and painful bowel movements. Even addition of fiber will not necessarily help without water! (This can also be one possible source of chronic pelvic pain.) 5) SINUSITIS: The sinuses are encased in bone. In any other area of the body where there is a buildup of "pus" (abscess), we would surgically drain it because antibiotics do not penetrate to the center of an abscess to clear it. Outside of surgical drainage, water helps to clear the infection in the sinuses away, at the same time facilitating the action of the antibiotics to get to the areas it needs to in order to work. 6)URINARY TRACT PROBLEMS: The urinary tract needs excess water to help fight infection, prevent stones, and protect the cells of the bladder. If the cells of the bladder continue to see a very concentrated excess from soda pop, coffee, tea, or alcohol, over time it irritates these cells to the point where the urge to urinate is constant. 7) FATIGUE: Dehydration may be the number one cause of fatigue in the United States. Stimulants like caffeine not only dehydrate, they also contribute to fatigue once the "high" is over. 8) FLUID RETENTION: The body will retain fluid in the tissues if it is in a state of dehydration; thus, drinking less water or taking diuretics to help abdominal bloating or leg swelling at the end of the day actually increase the body's tendency to store water and thus increase the bloating and swelling! 9) SKIN: Beautiful skin starts with plenty of hydration - just ask your Dermatologist! 10) DYSMENORRHEA: Pain with menses is made worse by a state of dehydration as the uterus has an increased tendency to cramp (just as pregnant women have an increased tendency to have contractions when they are dehydrated!). It is difficult to keep up with 8-10 eight ounce glasses of water each day, but it is well worth it!
Hint#1: Copays for preventive visits may be less than for other types of services and may not be listed on your card. Check with customer service to clarify your benefit. Copays for specialist care (OBGYNs are considered to be specialists) may be higher than for primary care physicians (defined as pediatricians, internists, and family practice physicians). Hint#2: There are mail order prescription plans and discount coupons available for certain prescriptions that may not be covered by your plan. Ask your doctor for details when prescriptions are written. Hint #3: Some prescriptions are actually less expensive to pay for directly than to pay a copay to get. Ask your pharmacist, as they may not volunteer this information to you. If you have any questions, please call our billing manager, Jan Scott at 303-948-3205. For a current list of insurances, please visit our web site at thewomensgroup.com.
That Darn Paperwork - Why We Need It by Jan Scott Tired of being asked to fill out forms when you come into the office? Well, It is important to have your personal information updated for ease in the office contacting you regarding test results or appointment reminders, BUT that patient information sheet also serves as our permission to bill your insurance for your visit, as well as a release of medical information to the insurance company. Your insurance company requires the office to have a signature on file, which is no more than one year old. Every year or so, many of the insurance companies will do what is called a “chart audit” on their insured patients. During this audit, one of the things looked at is if a current signature is on file for claims reporting and release of medical information. This is just to keep us all “legal” and make sure nothing is being billed without your consent. The most important aspect of your patient information sheet is the insurance information. When we bill out an office visit to an old insurance carrier, there are two problems created - (1) payment of your claim is delayed because an incorrect insurance was billed and (2) you receive a notice from an incorrect insurance carrier stating your claim was denied (and you know, this will definitely cause anyone’s blood pressure to skyrocket to think we have to deal with our insurance!!). Often, when these notices are received, it is thought the current insurance has denied (which is a different can of worms). Next time the person at the front desk asks you to review the super bill to make sure everything is correct, please take a few minutes to really look over the information and MAKE SURE IT IS CORRECT. And, when that same person asks you to fill out new paperwork, please try to remember there is method to her madness.
by Doneise Roberts As our office continues to grow, we have expanded our reception area staff to be able to better serve our patients. Karen Osborne has rejoined our staff. She has been a valuable asset to our front receptionist area, and we are pleased to have her back on our staff. It is our desire to make the time our patients are in our office pleasant. We understand the paperwork at times may seem over whelming, however it is important for us to have our patient files current. If you are a new patient with us, we will automatically send out the paperwork. However, if you are an established patient with us, when you call to make an appointment please indicate if you may have had a change of address, phone numbers, employment, insurance, or name change, so we can send the paperwork to you ahead of time. This gives you the luxury of filling out the paperwork at your convenience and saves time when you arrive in our office for your scheduled appointment We are updating our "Heart Baby Board" and we need pictures of your new little ones. Please send them or bring them by our office so we can "show-off" your new addition to your family. |
