New patient visits will be conducted by one of the physicians and a treatment plan well be generated. It may be necessary to have several visits in order to put a sustainable treatment in place. After this inauguration period, a patient will continue with periodic visits, conducted by other providers in the practice treatment team.
The two main types of continuing visits to the practice are medication oversight and prescription writing encounters, generally conducted by Advanced Practitioners, and physician oversight visits, which are not routine prescription-writing visits but are intended to provide periodic reviews and the overall diagnosis and treatment. Routine medication visits are generally conducted each two to three months. Oversight visits are conducted once or twice a year or if there is a change in the patient’s condition that requires a re-evaluation. However, there are other kinds of visits that are periodically needed, including the following:
- Insurance carrier generated opioid review visits. It is very clear that patients on LTOT and their providers are subjected to an intense degree of scrutiny and we periodically receive requests for prescription benefit providers to certify and justify our use of opioids and other controlled substances for an individual patient. Our policy is to conduct a brief visit with the patient in order for us to confirm benefit from the therapy and to assess possible attendant risks. Using the information from the visit, we can then respond to the carrier. These visits are NOT routine office visits and changes in the treatment plan will not be made.
- Pharmacy designation and change visits. Opioid prescribing and dispensing is becoming more complicated and difficult. We are now having to adjust to the changing pharmacy landscape in that some stores are no longer to accommodate patients on LTOT. In these circumstances, we need to have a discussion with the patient about any needed change in pharmacy. Our practice policies have changed to address some of these issues (see below). These visits are also NOT considered a routine follow up and no treatment plan changes will be made, other than necessary medication adjustments.
- Administrative (“Paperwork”) visits. Other than very simple one-page forms, a separate office visit is needed to complete various forms of documentation. Examples of more complicated form completion includes FLMA attestations, Disability reports and DMV physician attestations. It is critical that the posed questions be answered correctly and that there is no misunderstanding about the information being conveyed. This is also a visit conducted outside of medical/treatment plan visits.
- Urine Drug Screen (UDS)/Prescription Monitoring Program (PMP) oversight visits. If a review of shows that there is an aberrancy, the regulatory requirement is that the practice needs to take measures to address any potential problem. The patient will be contacted and there will be an assessment made as to why there were reported to be abnormal results. These visits do not occur unless an unexpected result surfaces. Patients are reminded to review their controlled substances agreements. It is absolute necessary, at the time of specimen collection, to notify the practice of all medicines that they may have previously taken. These are also not considered to be routine visits.
- Random Urine Drug Screen and Pill Count (“Random”) visits. Circumstances can arise where it is necessary for the practice to verify in real time that a patient is taking medicine properly and that they are correctly managing their controlled substances. If a patient is notified that such a visit is necessary, the need to present to the office THAT DAY. We understand that there may be situations in this is impossible, such as travel. However, other arrangements can be made, including performing a visual pill count using telemedicine, and having a UDS performed at a LabCorp facility that is proximate to the patient. Again, these alternatives have to be performed on the SAME day as the notification for the visit. These visits are not routine treatment plan review visit.
- Patient remote telemedicine (“Zoom”) visits. The Pandemic Crisis has demonstrated to us that these visits can be useful, although are not a complete substitution for the clinically more satisfying face-to-face visits. However, for the foreseeable future, these visits will continue to be part of routine medical practice. We have found them serviceable for routine oversight visits, but somewhat wanting for more critical encounters. Certainly, they are appropriate for the Insurance/Opioid, Pharmacy and Administrative visits described above. We expect to continue to use this type of visit depending on patient preference and regulatory requirements. PLEASE NOTE that the rules that surround telemedicine visits are changing rapidly. Circumstances may dictate certain parameters under which these visits can be conducted. These will be discussed with you by front desk personnel.
- Physician remote telemedicine visits. Another feature of the practice is the ability to perform remote face-to-face encounters through internet video and audio linkage, with the patient in the office and the provider off-site. A telemedicine exam room has been equipped with HIPPA compliant high-resolution audio/video, also employing a remote controllable pan/tilt camera. An office visit of this sort is conducted in the usual fashion, with a patient completing the pre-visit paper work, having vital signs taking and having a preliminary assessment done by nursing personnel. Applicable laws are such that a remote office visit is deemed to have taken place where the patient (not the provider) is located. This type of remote encounter may be necessary in some instances in conducting follow-up visits for established patients.
We have technology in place to perform remote face-to-face encounters through internet video and audio. Our telemedicine exam room has been equipped with HIPPA compliant high resolution audio/video, and employs a remote controllable pan/tilt camera. These visits begin with a patient completing pre-visit paper work, having vital signs taking and having a preliminary assessment done by nursing personnel. Applicable laws are such that a remote office visit is deemed to have taken place where the patient (not the provider) is located. This type of remote encounter may be necessary in some instances in conducting follow-up visits for established patients.