Updated Controlled Drug Policy

Updated Controlled Drug Policy

Effective July 1, 2015

Applies to all patients taking controlled drugs on a regular basis, including:

  • Pain medications (excluding Ultram)
  • Stimulant medications (excluding ProVigil and NuVigil)
  • Benzodiazepine anxiety medications (Xanax, Valium, Ativan, Klonapin)

The previous policy will remain intact as written (see below).

Additionally, we will now require regular urine drug testing.  The testing will be done as follows:

  1. Urine drug testing will look for two abnormalities:
    1. Drugs not on patient list show up in the urine test (including illegal drugs).
    2. Drugs on the patient list do not show up in the urine.
  2. Patients at “low risk” will be required to get testing done every 6 months.  “Low risk” patients are those who:
    1. Have been with the practice more than a year without significant incident.
    2. Have never had abnormal urine drug screening.
  3. Patients who are “high risk” will be required to get tested every 3 months.
  4. Children on stimulant medications will be tested once during the school year.
  5. New patients will be tested prior to getting their first prescriptions.
  6. The in-office urine test costs $10 (which must be paid prior to getting prescription filled).
  7. A positive in-office test requires a confirmation test be sent to the laboratory.  There are two ways to pay for this test:
    1. Pay $60 up-front (the cash price for the test).
    2. Apply to insurance and accept billing from the lab (insurance is billed $137)
  8. Patients with unexplained abnormal tests will (at our discretion) either be:
    1. Required to undergo random urine testing over the next year
    2. Dismissed from the practice.
    3. Kept in the practice, but not prescribed any more controlled drugs.

Why are we drug testing?

The main reason we are doing this is to comply with state requirements for the prescription of these medications.  We don’t want to get in trouble with the state.  The second reason is to assure us that our patients are using the medications safely and responsibly.  

How will this work?

We will notify our patients when the test is due.  They must get tested prior to that medication being refilled.  If patients don’t get tested, they don’t get their refill.

Important advice

  • Don’t wait until last minute before getting refills if testing is due.
  • Be honest.  If you’ve not taken your medication, or if you’ve used an illegal drug, TELL US.
  • Understand that we will do our best to be reasonable with this policy.

Our previous controlled drug policy

All of these medications, because of their legal classification, have the following additional rules.  Failing to follow these rules will result (in most circumstances) in discharge from the practice. 

  1. Patients should never share medication with family members or friends.
  2. All patients taking these medications for more than short-term will be required to sign the “Controlled Drug Agreement” for our practice.
  3. Patients should not get medications of this class from other doctors unless it is clearly communicated to us and the other doctor that this has been done.
  4. Patients should not use illegal drugs while taking these medications.
  5. We will not refill these medications early for any reason (even medications lost or stolen are not refilled early).
  6. Refill of these medications will only occur after a person has filled out and submitted the “Controlled Medication Refill Request” form, online or on paper.
  7. All Category 2 drugs require patients to pick up the handwritten prescription in person.  All of these prescriptions can only be written as “Do Not Refill.”  We will only give these prescriptions to patients during regular office hours.
  8. Category 3 and 4 medications can be called in, but refills will only be called in during regular office hours.
  9. Should suspicion arise about the following of these rules, we reserve the right to do drug testing to see:
    1. If the drug is being taken as described
    2. If other drugs are being taken (including illegal) without our knowledge.
    3. We also will, should suspicion arise, check the state controlled drug registry, which records all filled prescriptions of these medications by patients.

 

Office Policies

I added a new menu at the top of the website regarding our office policies.  These policies include:

These policies detail how we run the office and what the boundaries of the relationships are between us and our patients.  

It's not the most exciting stuff, but it is really important.  I appreciate your feedback on this.

We've got Immunizations!

We are pleased to announce a new service: adult immunizations.  As opposed to last year (when we offered cash-only flu vaccines), we can now get them covered by patients with insurance (as long as the insurance company cooperates).   At the present time we have:

  • Flu shots (with 4 strains of virus)
  • High-dose flu shots (for adults over 65)
  • Zostavax (shingles vaccine) - for people 50+
  • Tetanus/diphtheria
  • Tetanus/diphtheria/pertussis (adds whooping cough protection)
  • Pneumovax (protects against a bacteria that causes a serious pneumonia and meningitis).

In the office we will check your insurance and see if it covers the vaccine.  If it does, the company which has enabled us to do this (VaxCare) will file insurance and collect payment.  They will also notify us if there is an additional amount to bill after insurance.  For those without insurance (or with insurance which does not cover adequately), we can collect a discounted cash-pay price.  The prices are:

  • Flu - $20
  • High-dose Flu - $30
  • Zostavax - $170
  • Td - Tetanus/Diphtheria - $20
  • Tdap - Tetanus/Diphtheria/Pertussis - $35
  • Pneumovax - $75

Who should Get Vaccinated?

Are you a candidate for these immunizations?  Here are the criteria for giving these vaccines:

  • Flu - Anyone can get it (if they want to avoid getting sick), but certain high-risk people are especially protected:
    • eople over age 65 (who should get the high-dose vaccine)
    • Diabetics
    • People with asthma, COPD, or other chronic lung conditions
    • People with significant heart, neurologic, or kidney conditions
    • People who are immunosuppressed (via medication or disease)
    • Pregnant women
    • Children between 6 months and 4 years of age (see below for discussion of childhood vaccines)
    • Health care workers
  • neumovax - is a 1-time vaccine recommended for high-risk adults as described above.  The only exception to this is an adult over 65 who had a pneumovax before age 65, who should get a repeat immunization (as long as it has been more than 7 years since the first one).  There is a childhood version of pneumovax (Prevnar), which also reduces risk of pneumonia and meningitis in children, but we do not offer that yet.
  • Tetanus - Adults who should get at least a Td every 10 years.  People with "dirty" wounds for whom tetanus vaccine status is unsure should also get vaccinated.  Because pertussis (whooping cough) immunity has dropped and the disease has become more of a problem, Tdap is recommended in:
    • dults who have not gotten the pertussis vaccine.
    • Women who are pregnant (during each pregnancy)
  • ostavax - this vaccine may not make lengthen your life, but avoiding an shingles outbreak can significantly improve your quality of life.  The big problem with this vaccine is that it may not be covered by insurance and is expensive.  The good news is that we can check your insurance coverage and you can make weigh the cost versus the benefit.

What about Children?

We are able to give influenza shots to children, but insurance may be tricky for this.  We are working with VaxCare to get the full array of immunizations for children without requiring parents to pay up front and file their own insurance.  Additionally, those without insurance to cover vaccines are likely eligible for the Vaccines for Children program to cover the vaccine.  We hope to allow all of these services for our patients by the end of the year.  In the mean-time, we do recommend you keep your children up to date by going to the local health department.

What do I need to do?

If you are one of our patients, let us know by emailing us (info@doctorlamberts.org), sending a Twistle message, or calling the office.  If you aren't one of our patients and want to be (and live in our area), sign up here.

She Rocks

I've made it to six months in the practice.  OK, it's actually seven now, but I got busy.  Things are going really well, and I am excited about changes coming soon.   

But something big happened today that I have to crow about: I got the framed version of the picture my daughter drew for me!  It's of our cat, Zander, although we just call him "cat" or "kitty."  Here he is relaxed as only cats can relax.  It's obvious that my older son Jonathan is not here, as he doesn't ever allow the cat to reach such states of relaxation.   

Anyway, Elizabeth's off at college now.  She attended the local fine arts school, and we are quite proud.  Obviously with this kind of talent, she chose the logical major in college: geology. 

Don't ask me.  She just likes rocks.  I guess it makes sense, though.  She rocks. 

Thanks, Elizabeth. 

Opening Tuesday

Well, it finally is on us.  The opening day of my practice will "officially" be next Tuesday.  What does that mean?  It means that we are finally going to use patients as guinea pigs, testing what I thought would work, and seeing if I was right.  Really, the first week or two will be all about making things work well, and not about getting to see as many patients as possible.  Sorry.  We will be reaching out to people out there who have signed up already and bring them in for an initial visit in the office.

Some have questioned why I have to see them in the office for the first visit, and the truth is, I don't.  I just think it's better to actually see someone at some point in time if I am taking care of them.  If people are healthy and without problems, I am Ok with temporarily accepting them into the practice without having them physically at the office.  Still, there are a lot of things that can only be done in person, so I will eventually require your physical presence in my office.  After that, the goal is to keep you healthy and away from the office.  Sounds good?

2013-02-02 10.30.56 pm.jpg

One feature I've been working on and will continue working on is "My Health Guide," which is a guide to help my patients deal with medical problems and questions they have.  This will aways be a "work in progress," as I will always have more to write.  But as of now I have about 50 articles I've written (many of them podcasts I recorded as well) on subjects ranging from ear infections to hospice.  I also have places on that site where you can fill out information to get in touch with me about medical problems and/or questions you are having.  It's going to be a pretty neat site when all is said and done, but I just don't know when saying and doing will be finished.

So, let the fun begin this week!  I look forward to seeing some of you, and will eventually have a "grand opening" and a ribbon-cutting so you all can come and see what cool stuff we are doing (and how great the office looks...despite the enormous ramp out front).

2 Weeks and Counting?

It looks like I will "officially" open my office on February 4th.  If it doesn't, expect to hear a very loud noise coming from Martinez.  It's been a very long wait to see this through, and I hope there will be no more delays.

Here are a couple of new developments to fill you in on:

  1. I hired Jamie - Jamie Franks, my nurse at Evans Medical Group for the past few years has agreed to join me in my new practice!  This is great news for both me and my patients who are following me.  She already knows my quirks (it's actually easier to keep track of the parts of me that aren't quirks), and knows my patients.  It is a great comfort to have her with me.
  2. Beginning the process - I sent out emails to people who made it to the waiting list for the practice.  Some have signed up since then, and I will work on getting back to everyone so they know they are on the list, but if you think you are on the list but didn't get a recent email, please contact me.  The next step will be to pre-register those folks at the front of the line and bring them in to gather their information.  Once this is done and the contracts are signed, then (and only then) are they "officially" my patients.  (Click here to see the details of the contract).
  3. More discounts coming - I am negotiating a deal with a local lab to get significant discounts on tests for patients who need them.  A CBC costs around $5, as does a Basic Chemistry Panel.  I plan on offering a big list of discounted tests that anyone can take advantage of if they choose.  I am also negotiating discounts with radiology services and am looking into having generic drugs I can dispense from the office at a deep discount as well.  I will do all I can to make the monthly payment a very, very good investment.

Update for January 9

The past month (two, actually) has been tough.  Despite the fact that I've been working hard, the progress has been excruciatingly slow.  As impatient as my patients are for me to start, I am doubly so.  On top of the delays, I haven't been able to get a good idea of meeting deadlines.

Fortunately, that has recently changed.  I can give report several fronts.

The first (obvious) update is the unveiling my new website!  Besides the spiffy new look, I have put a lot of content up.  Be sure to look around, click on links, and learn about what's up with the practice!

The second update is on the building, and the news is not quite as good.  As of now, the opening date of my office is still unclear.  Apparently, doing any construction work on a medical office draws in building inspectors like cats to a can of tuna.  Inspectors mean delays, and delays mean a frustrated doctor.  

So here's where things stand:

  • The office should open somewhere between the last week of January and the 1st week of February, although that is still not entirely clear.
  • Once the opening date is firm, I will start communicating with patients about their status.  

Let me reiterate that until my office opens:

  •  I can't give any medical care to anyone.
  • If you have prescriptions due or medical questions, you need to get them handled somewhere else.  
  • Even when my office is accepting patients, I can't do anything for you until you are notified, registered, and I've filled out your initial intake.

I am sorry for all of the trouble this has caused for many of you.  I really, really want to get things going and show you just how much better health care can be.  The only silver lining in this is that I've been able to put a lot more work into giving some really great services from the day I open my doors.

Thanks for waiting; I promise it will be worth the wait.

Time to Sign Up!

I've delayed this as long as possible, but can delay no more: it's time to open up the sign-up for the practice.  This has taken far longer than I anticipated, and I apologize for the wait.  Please understand the following:

  1. I will add new patients to my practice off of this list.
  2. Getting on this list does not obligate you to become my patient.
  3. Getting on this list does not mean I am your doctor.
  4. Getting on the list early will make it more likely you will get into the practice sooner, but there will be other criteria I will use to determine which patients to accept when.
  5. Please, please, please do not wait to get medical care because your name is on this list.  If you have chronic medical problems, get them taken care of.  If you are having a problem, get seen.  Don't wait for me to get care.
  6. Reread #5 to make sure you've gotten the message.
  7. I will begin to contact people as soon as everything is ready to start seeing patients.  This will be a process that will not happen at once.
  8. I will do my best to keep everyone on the list up-to-date with their status.
  9. If you aren't on this list, you can't become my patient.

There are two ways to sign up:

  1. Go to http://doctorlamberts.org/signup/ and fill in the form.
  2. Send a the following information to my office, at 119 Davis Road, Suite 4A, Martinez, GA 30907: Name: Address: Phone Numbers: Date of Birth: How many household members are signing up: Names and ages of family members: Were you a previous patient of mine?

Thanks again.  It's getting close, but there's a lot of work to do.

What it's Going to Cost

OK, I've told a bunch of folks already (and nobody punched me or fainted, which is a good sign), so I'll take this opportunity to announce the fee-schedule for my practice. The monthly fee is paid at the start of the month, giving access to care, communication tools, web content, etc.  There is no discount for paying a year in advance, it's confusing and it gives me one extra thing to keep track of, so I prefer a monthly fee.

The charges are:

  • Age 0-2: $40/month
  • 3-30: $30/month ($10/month if they are away in college)
  • 30-50 $40/month
  • 50-65 $50/month
  • 65+ $60/month

Family maximum will be $150/month

Registration fee is $50 for 0-30 years of age and $100 after that (will count as first month's payment). $200 Family maximum for registration.

I am really trying to keep it as affordable as possible, especially for families.  Registration IS NOT YET OPEN, but I promise I am getting there.

Newsletter for October 9

I sent out the following to everyone who signed up for the newsletter.  If you didn't get it, you either didn't sign up or it got sent to your spam.  Even though I'd love to treat the folks who followed the rules as an elite group, I will resist the temptation.  If you did get the newsletter you can consider yourself "elite" if that makes you happy. Here's what it said:

Hi!

Here's an update on how things stand with Dr. Rob Lamberts, LLC

1.  Video

Don't worry; I haven't forgotten about those of you who could not make it to the meeting on the 29th.  I am working to get the video recording of the talk put together with the slides.  It's a bit more complicated than I expected, but it should be up by the end of the week.

2.  Where will I be?

I am also hoping to nail down a location within the next 7-10 days.  It's important to me that this be done so I can make cards, brochures, and start working on it as soon as possible.  Thanks to everyone for your input on this!

3.  How much will I charge?

I want to be 100% sure of the numbers before publishing them, but I think I've got this figured out as well.  I have noticed hesitence on the part of the younger people and those with children, so I am doing what I can to keep that cost down.  Once I come up with a price list I will also open my "official" sign-up for the practice.  Those of you who filled out cards at the meeting on the 29th don't need to worry, as I've already got you on the list.

4.  When will I open up to start seeing new patients?

As soon as I can!  My hope is to start accepting patients as early as December 1 (no promises on this, though).  I will need to do the sign-up process in a slow and steady fashion (at least at the start) so I can be sure to meet people's needs and deliver on the service I want to give.  I ask you all to be patient in the process, as it is most important to me to do this well.  I want to exceed expectations, offering a truly new kind of care for anyone who is my patient, and one that is well worth the cost.

Thank You

Yesterday was a big day.  A lot of my patients received a letter that probably shook them up - a letter I was very apprehensive about.  Not only am I leaving Evans Medical Group, but I am doing so fairly soon (and I will explain the reason for that soon).  I was afraid of the reaction I would get, given how important a primary care doctor is to many patients, and given the relationship I've built with people over the 18 years I've practiced. But the response was not only better than I expected, it was downright touching to me.  Yes, I am sure that there are people who are angry and very worried about how this will affect them, and there are people who are disappointed by this big disruption in their care.  But an overwhelming number of people expressed real happiness for me as a person, that I was making a change and doing what I thought was the right thing to do.  It is wonderfully encouraging to be supported in such a way by my patients.

Thank you for not only choosing to have me as your doctor, but for the fact that you see beyond the title to the person who sits on the other side of the stethoscope.  I am most fortunate to have such good people as my patients, and hope to show that gratitude by making my new practice that will exceed expectations.

Collaboration

Most patients have to figure out how a practice works and adapt themselves to it.  If the phones have voicemail, they need to figure out how to get through the voicemail maze.  If patients are rescheduled after showing up late, they need to adapt to that too.  Most of these rules are put there for a good reason, but the word "good" is usually from the doctor's perspective, not the patients'.  


I want to change that.  One of the advantages of starting from the ground up in a practice style that frees me from the rules that usually constrain a practice is that I can do whatever I want.  Or, more specifically, I can do what my patients want.  I'm not saying that I won't have say in the process; I plan on giving my patients - especially those who start out with me - a huge hand in voicing their opinions of how the practice can serve them best.  I am not worried that they will turn me into their own personal "doctor slave," since most of the folks who join me are doing so because they are fond enough of me that they are willing to take a risk on my dream.  I am also not worried that there will be bad ideas that make things worse.  None of us have done this before, and sometimes the only way to figure out if something works is to try it.  If it seems reasonable, then we'll try it.  If it is a bad idea, we will abandon it and see what we can learn from the "adventure."

This will be one of the big bonuses for those bold enough to be with me from the start: you will have a hand at shaping your own health care.  The reason I am doing this is not, however, just to be a nice guy and give up my usual "power," it is to hear ideas from the other side of things.  I'll listen to any suggestion and hold regular debriefing sessions for patients to see how things are going.  How will I get suggestions?  How will I hold debriefing sessions?  How often will they be?

I don't know.  I am open to suggestions.

Who is the Ideal Patient for Direct Care?

There are some people for which the business model of paying a predictable amount every month is very well suited.  The current payment system hurts people because it forces people to be seen for even small problems, and charges a premium amount to ensure collecting the contracted amounts.  It's complicated, and it is a bad system for both patients and doctors. Who is my new model best for?

  • People with no insurance.  This is a no-brainer, as the low monthly payment is far more palatable and less risky.
  • People with high-deductible insurance.  This is the same as the previous one, as for most people, high-deductible insurance is pretty much a guarantee of paying cash for most of your care (unless you are very unlikely).
  • People from far away.  If you have to drive 50 miles to come to a doctor you like, you will spend a lot of money on gas (not to mention the time spent) to go to and from the doctor.  Having a practice style which emphasizes electronic communication will cut way back on all of this.
  • People who are healthy and want to stay that way.  I will be very aggressive at trying to keep all of my patients up to date with their care plans, allowing them to have resources to keep well and keep away from care altogether.  Yes, I am trying to decrease use of health care, which is a unique position a primary care doctor can hold.

Are there more who it works for?  Perhaps people who are unable to transport easily, or those who have jobs where they can't leave work without causing lots of trouble?  Let me know what you think.

Where?

I am already wondering where my office will be.  Should I stay in Columbia county, or should I be closer to home and have a West Augusta office?  The truth is, it shouldn't matter as much to my patients where I am physically located, as I am trying to keep them all out of the office.  Because I am wanting to go with the subscription model, I have no motivation to bring people in to be seen, so I will be trying to make the location of the office totally unimportant. One of the main things I want is to be unique.  This practice will be unlike any others in the CSRA, so I want the whole experience to be unlike normal doctors' offices.  What does that mean?  I am happy to hear suggestions.