Re: Refills between appointments counterproductive - Activate those patients

[Guest guest]

Pam,

I very much agree with you regarding waste of time issues like rx refills. I like your information sheet also.

My other issue is with mail order rx requests. I do not mind printing out these during an appointment, but invariably they "get new insurance" or just decide to go on a mail order plan between appointments.

I am considering charging a processing fee for filling mail order requests when they are not part of a visit, especially when local meds have been called in already as part of a previous visit.

With 1,000+ patients, I do not feel I can make everyone come in for an extra appointment for this and maintain my open access, but I am tired of saving the patient/insurance company's money at my expense.

I would like to hear feedback on this issue.

Thanks,

, M.D.

Durango, CO

Refills between appointments counterproductive - Activate those patients

I know many of you may disagree but I think it is a total waste of my time to deal with refills between appointments. 30% of all calls to medical offices are about refills. 20% are second calls becausethe first call never got returned (and some of these are return refillphone calls you can bet). I bypass the entire mess by making surepatients have enough meds till next visit and pharmacists automaticallytell pts "no" when they ask for a refill. Slowly I am training everyone.This is part of my "iron fist in velvet glove' routine.Here is something I wrote up for patients. What do y'all think?Refill Request Information SheetPamela L. Wible, MD1) What's the deal with refills? Refills are granted at the time of your office visit and not in between visits. Please DO NOT have your pharmacist call the office asking for a refill. When you are running low on your medication it is a reminderthat you are probably due for an office visit. I prescribe enough medication to last until your next office visit.2) How much medication can I get at the time of my appointment?If you have no issues and you are stable on your medication you can usually get a year supply (thyroid and birth control pills usually). If you have an ongoing medical issue that is stable you can often get a 3-6 month supply (high blood pressure pills, for example). If you have issues that are not under control then you usually need to return every 1-3 months for medication and evaluation (diabetes, for example). Some people who have dangerously out of control issues have to come back in 1-2 weeks. So the moral of the story is to get your health issues under control and make sure you ask for your refills at the time of your office visit so you are not surprised when the pharmacist says "Sorry, you have run out of medication."3) Why can't I just call when I'm on my last pill like at other doctor's offices?The average office is inundated with refill requests and they often need to hire lots of staff to handle the sheer volume of refill requests. Thirty percent of the phone calls to the average office are related to refill requests. Another 20% of calls are second calls in the same day from the same person who did not get their call returned. "It's 4:45 and nobody called me back! I just took my last pill! Help!" 4) Why is it my responsibility to keep track of my medication?Your physician usually has over 2500 patients to keep track of at the average office. I have approximately 350. Either way it is impossible for physicians to keep track of your medication. It is also hard on the pharmacists if you wait till the last minute to ask for a refill. Please keep track of your medication so you can ask in advance of using your last pill. It is best to schedule an appointment while you still have a week's supply left.5) Anything else I can do to make things easier?If you take a look at your prescriptions and try to get them renewed on the same cycle such as every 3,6,9 or 12 months then you will have them all in sequence and easy to remember the renewal date on all of them. Ask each time you go to the pharmacy to make sure you know when you will run out. Keep that list in your wallet so you will know when you come to your appointments.6) What if I'm in a pinch? Are there exceptions?Pharmacists will usually give you a 3 day supply to tide you over in an emergency. I make exceptions for situations in which you have had an emergency or are out of town. I also do not hold patients with traumatic brain injury or dementia to the same standards as those with normal cerebral function.

No virus found in this incoming message.Checked by AVG Free Edition. Version: 7.5.472 / Virus Database: 269.8.7/830 - Release Date: 6/3/2007 12:47 PM

[Guest guest]

Pam,

I very much agree with you regarding waste of time issues like rx refills. I like your information sheet also.

My other issue is with mail order rx requests. I do not mind printing out these during an appointment, but invariably they "get new insurance" or just decide to go on a mail order plan between appointments.

I am considering charging a processing fee for filling mail order requests when they are not part of a visit, especially when local meds have been called in already as part of a previous visit.

With 1,000+ patients, I do not feel I can make everyone come in for an extra appointment for this and maintain my open access, but I am tired of saving the patient/insurance company's money at my expense.

I would like to hear feedback on this issue.

Thanks,

, M.D.

Durango, CO

Refills between appointments counterproductive - Activate those patients

I know many of you may disagree but I think it is a total waste of my time to deal with refills between appointments. 30% of all calls to medical offices are about refills. 20% are second calls becausethe first call never got returned (and some of these are return refillphone calls you can bet). I bypass the entire mess by making surepatients have enough meds till next visit and pharmacists automaticallytell pts "no" when they ask for a refill. Slowly I am training everyone.This is part of my "iron fist in velvet glove' routine.Here is something I wrote up for patients. What do y'all think?Refill Request Information SheetPamela L. Wible, MD1) What's the deal with refills? Refills are granted at the time of your office visit and not in between visits. Please DO NOT have your pharmacist call the office asking for a refill. When you are running low on your medication it is a reminderthat you are probably due for an office visit. I prescribe enough medication to last until your next office visit.2) How much medication can I get at the time of my appointment?If you have no issues and you are stable on your medication you can usually get a year supply (thyroid and birth control pills usually). If you have an ongoing medical issue that is stable you can often get a 3-6 month supply (high blood pressure pills, for example). If you have issues that are not under control then you usually need to return every 1-3 months for medication and evaluation (diabetes, for example). Some people who have dangerously out of control issues have to come back in 1-2 weeks. So the moral of the story is to get your health issues under control and make sure you ask for your refills at the time of your office visit so you are not surprised when the pharmacist says "Sorry, you have run out of medication."3) Why can't I just call when I'm on my last pill like at other doctor's offices?The average office is inundated with refill requests and they often need to hire lots of staff to handle the sheer volume of refill requests. Thirty percent of the phone calls to the average office are related to refill requests. Another 20% of calls are second calls in the same day from the same person who did not get their call returned. "It's 4:45 and nobody called me back! I just took my last pill! Help!" 4) Why is it my responsibility to keep track of my medication?Your physician usually has over 2500 patients to keep track of at the average office. I have approximately 350. Either way it is impossible for physicians to keep track of your medication. It is also hard on the pharmacists if you wait till the last minute to ask for a refill. Please keep track of your medication so you can ask in advance of using your last pill. It is best to schedule an appointment while you still have a week's supply left.5) Anything else I can do to make things easier?If you take a look at your prescriptions and try to get them renewed on the same cycle such as every 3,6,9 or 12 months then you will have them all in sequence and easy to remember the renewal date on all of them. Ask each time you go to the pharmacy to make sure you know when you will run out. Keep that list in your wallet so you will know when you come to your appointments.6) What if I'm in a pinch? Are there exceptions?Pharmacists will usually give you a 3 day supply to tide you over in an emergency. I make exceptions for situations in which you have had an emergency or are out of town. I also do not hold patients with traumatic brain injury or dementia to the same standards as those with normal cerebral function.

No virus found in this incoming message.Checked by AVG Free Edition. Version: 7.5.472 / Virus Database: 269.8.7/830 - Release Date: 6/3/2007 12:47 PM

[Guest guest]

Pamela,

I was wondering how you accomplished the impossible regarding refills. Have you

been giving that note out for awhile? I think that it is a pretty good note.

What do you do about the folks that have no sympathy about the need for extra

staff and wasted time regarding refills. I guess they are probably going to the

wrong doctor if they don't understand the staffing issue and overhead. I

finally had to discharge a patient that refused to come in for a visit

regarding her lorazepam for sleep pills, but wanted them renewed for a year at a

time. I hadn't started them and not much else worked for sleep or rather after

trying other things she was unwilling to try to anything new. I suppose the

iron and velvet technique would have told her that I just don't like to

prescribe that she would need to go elsewhere if unwilling to try to switch or

to try something else. What is the general consensus regarding how long one

refills scheduled drugs?

Kathy Broman MD

Mason City, IA

>I know many of you may disagree but I think it is a total waste

>of my time to deal with refills between appointments. 30% of all

>calls to medical offices are about refills. 20% are second calls because

>the first call never got returned (and some of these are return refill

>phone calls you can bet). I bypass the entire mess by making sure

>patients have enough meds till next visit and pharmacists automatically

>tell pts " no " when they ask for a refill. Slowly I am training everyone.

>This is part of my " iron fist in velvet glove' routine.

>

>Here is something I wrote up for patients. What do y'all think?

>

>

>Refill Request Information Sheet

>Pamela L. Wible, MD

>

>1) What's the deal with refills?

>Refills are granted at the time of your office visit and not in between

>visits. Please DO NOT have your pharmacist call the office asking for

>a refill. When you are running low on your medication it is a reminder

>that you are probably due for an office visit. I prescribe enough

>medication to last until your next office visit.

>

>2) How much medication can I get at the time of my appointment?

>If you have no issues and you are stable on your medication you can

>usually get a year supply (thyroid and birth control pills usually). If you

>have an ongoing medical issue that is stable you can often get a 3-6

>month supply (high blood pressure pills, for example). If you have

>issues that are not under control then you usually need to return every

>1-3 months for medication and evaluation (diabetes, for example).

>Some people who have dangerously out of control issues have to

>come back in 1-2 weeks. So the moral of the story is to get your

>health issues under control and make sure you ask for your refills

>at the time of your office visit so you are not surprised when the

>pharmacist says " Sorry, you have run out of medication. "

>

>3) Why can't I just call when I'm on my last pill like at other doctor's

offices?

>The average office is inundated with refill requests and they often

>need to hire lots of staff to handle the sheer volume of refill requests.

>Thirty percent of the phone calls to the average office are related to

>refill requests. Another 20% of calls are second calls in the same day

>from the same person who did not get their call returned. " It's 4:45

>and nobody called me back! I just took my last pill! Help! "

>

>4) Why is it my responsibility to keep track of my medication?

>Your physician usually has over 2500 patients to keep track of at the

>average office. I have approximately 350. Either way it is impossible

>for physicians to keep track of your medication. It is also hard on the

>pharmacists if you wait till the last minute to ask for a refill. Please

>keep track of your medication so you can ask in advance of using

>your last pill. It is best to schedule an appointment while you still

>have a week's supply left.

>

>5) Anything else I can do to make things easier?

>If you take a look at your prescriptions and try to get them renewed

>on the same cycle such as every 3,6,9 or 12 months then you will have

>them all in sequence and easy to remember the renewal date on all of

>them. Ask each time you go to the pharmacy to make sure you know

>when you will run out. Keep that list in your wallet so you will know

>when you come to your appointments.

>

>6) What if I'm in a pinch? Are there exceptions?

>Pharmacists will usually give you a 3 day supply to tide you over in an

>emergency. I make exceptions for situations in which you have had an

>emergency or are out of town. I also do not hold patients with traumatic

>brain injury or dementia to the same standards as those with normal

>cerebral function.

>

>

>

>

>

>

>

>

>

[Guest guest]

Pamela,

I was wondering how you accomplished the impossible regarding refills. Have you

been giving that note out for awhile? I think that it is a pretty good note.

What do you do about the folks that have no sympathy about the need for extra

staff and wasted time regarding refills. I guess they are probably going to the

wrong doctor if they don't understand the staffing issue and overhead. I

finally had to discharge a patient that refused to come in for a visit

regarding her lorazepam for sleep pills, but wanted them renewed for a year at a

time. I hadn't started them and not much else worked for sleep or rather after

trying other things she was unwilling to try to anything new. I suppose the

iron and velvet technique would have told her that I just don't like to

prescribe that she would need to go elsewhere if unwilling to try to switch or

to try something else. What is the general consensus regarding how long one

refills scheduled drugs?

Kathy Broman MD

Mason City, IA

>I know many of you may disagree but I think it is a total waste

>of my time to deal with refills between appointments. 30% of all

>calls to medical offices are about refills. 20% are second calls because

>the first call never got returned (and some of these are return refill

>phone calls you can bet). I bypass the entire mess by making sure

>patients have enough meds till next visit and pharmacists automatically

>tell pts " no " when they ask for a refill. Slowly I am training everyone.

>This is part of my " iron fist in velvet glove' routine.

>

>Here is something I wrote up for patients. What do y'all think?

>

>

>Refill Request Information Sheet

>Pamela L. Wible, MD

>

>1) What's the deal with refills?

>Refills are granted at the time of your office visit and not in between

>visits. Please DO NOT have your pharmacist call the office asking for

>a refill. When you are running low on your medication it is a reminder

>that you are probably due for an office visit. I prescribe enough

>medication to last until your next office visit.

>

>2) How much medication can I get at the time of my appointment?

>If you have no issues and you are stable on your medication you can

>usually get a year supply (thyroid and birth control pills usually). If you

>have an ongoing medical issue that is stable you can often get a 3-6

>month supply (high blood pressure pills, for example). If you have

>issues that are not under control then you usually need to return every

>1-3 months for medication and evaluation (diabetes, for example).

>Some people who have dangerously out of control issues have to

>come back in 1-2 weeks. So the moral of the story is to get your

>health issues under control and make sure you ask for your refills

>at the time of your office visit so you are not surprised when the

>pharmacist says " Sorry, you have run out of medication. "

>

>3) Why can't I just call when I'm on my last pill like at other doctor's

offices?

>The average office is inundated with refill requests and they often

>need to hire lots of staff to handle the sheer volume of refill requests.

>Thirty percent of the phone calls to the average office are related to

>refill requests. Another 20% of calls are second calls in the same day

>from the same person who did not get their call returned. " It's 4:45

>and nobody called me back! I just took my last pill! Help! "

>

>4) Why is it my responsibility to keep track of my medication?

>Your physician usually has over 2500 patients to keep track of at the

>average office. I have approximately 350. Either way it is impossible

>for physicians to keep track of your medication. It is also hard on the

>pharmacists if you wait till the last minute to ask for a refill. Please

>keep track of your medication so you can ask in advance of using

>your last pill. It is best to schedule an appointment while you still

>have a week's supply left.

>

>5) Anything else I can do to make things easier?

>If you take a look at your prescriptions and try to get them renewed

>on the same cycle such as every 3,6,9 or 12 months then you will have

>them all in sequence and easy to remember the renewal date on all of

>them. Ask each time you go to the pharmacy to make sure you know

>when you will run out. Keep that list in your wallet so you will know

>when you come to your appointments.

>

>6) What if I'm in a pinch? Are there exceptions?

>Pharmacists will usually give you a 3 day supply to tide you over in an

>emergency. I make exceptions for situations in which you have had an

>emergency or are out of town. I also do not hold patients with traumatic

>brain injury or dementia to the same standards as those with normal

>cerebral function.

>

>

>

>

>

>

>

>

>

[Guest guest]

-

patients want to do good. They will meet your expectations if you set them

high so tell them what you want and require and try not to make any

exceptions. Once they learn how you work it gets easier so maybe

requiring appoitments or doing something that works for you like a

paperwork fee. They can drop off the form that they need with $30

and you'll do it within 24 hours. THik of something easy...and lucrative!

Do not work for free!

Do not let patients beg you for things between appoitments!

Pamela

>

> Pam,

> I very much agree with you regarding waste of time issues like rx refills. I

like your

information sheet also.

>

> My other issue is with mail order rx requests. I do not mind printing out

these during

an appointment, but invariably they " get new insurance " or just decide to go on

a mail

order plan between appointments.

>

> I am considering charging a processing fee for filling mail order requests

when they are

not part of a visit, especially when local meds have been called in already as

part of a

previous visit.

>

> With 1,000+ patients, I do not feel I can make everyone come in for an extra

appointment for this and maintain my open access, but I am tired of saving the

patient/

insurance company's money at my expense.

>

> I would like to hear feedback on this issue.

>

> Thanks,

>

> , M.D.

> Durango, CO

> Refills between appointments

counterproductive -

Activate those patients

>

>

> I know many of you may disagree but I think it is a total waste

> of my time to deal with refills between appointments. 30% of all

> calls to medical offices are about refills. 20% are second calls because

> the first call never got returned (and some of these are return refill

> phone calls you can bet). I bypass the entire mess by making sure

> patients have enough meds till next visit and pharmacists automatically

> tell pts " no " when they ask for a refill. Slowly I am training everyone.

> This is part of my " iron fist in velvet glove' routine.

>

> Here is something I wrote up for patients. What do y'all think?

>

> Refill Request Information Sheet

> Pamela L. Wible, MD

>

> 1) What's the deal with refills?

> Refills are granted at the time of your office visit and not in between

> visits. Please DO NOT have your pharmacist call the office asking for

> a refill. When you are running low on your medication it is a reminder

> that you are probably due for an office visit. I prescribe enough

> medication to last until your next office visit.

>

> 2) How much medication can I get at the time of my appointment?

> If you have no issues and you are stable on your medication you can

> usually get a year supply (thyroid and birth control pills usually). If you

> have an ongoing medical issue that is stable you can often get a 3-6

> month supply (high blood pressure pills, for example). If you have

> issues that are not under control then you usually need to return every

> 1-3 months for medication and evaluation (diabetes, for example).

> Some people who have dangerously out of control issues have to

> come back in 1-2 weeks. So the moral of the story is to get your

> health issues under control and make sure you ask for your refills

> at the time of your office visit so you are not surprised when the

> pharmacist says " Sorry, you have run out of medication. "

>

> 3) Why can't I just call when I'm on my last pill like at other doctor's

offices?

> The average office is inundated with refill requests and they often

> need to hire lots of staff to handle the sheer volume of refill requests.

> Thirty percent of the phone calls to the average office are related to

> refill requests. Another 20% of calls are second calls in the same day

> from the same person who did not get their call returned. " It's 4:45

> and nobody called me back! I just took my last pill! Help! "

>

> 4) Why is it my responsibility to keep track of my medication?

> Your physician usually has over 2500 patients to keep track of at the

> average office. I have approximately 350. Either way it is impossible

> for physicians to keep track of your medication. It is also hard on the

> pharmacists if you wait till the last minute to ask for a refill. Please

> keep track of your medication so you can ask in advance of using

> your last pill. It is best to schedule an appointment while you still

> have a week's supply left.

>

> 5) Anything else I can do to make things easier?

> If you take a look at your prescriptions and try to get them renewed

> on the same cycle such as every 3,6,9 or 12 months then you will have

> them all in sequence and easy to remember the renewal date on all of

> them. Ask each time you go to the pharmacy to make sure you know

> when you will run out. Keep that list in your wallet so you will know

> when you come to your appointments.

>

> 6) What if I'm in a pinch? Are there exceptions?

> Pharmacists will usually give you a 3 day supply to tide you over in an

> emergency. I make exceptions for situations in which you have had an

> emergency or are out of town. I also do not hold patients with traumatic

> brain injury or dementia to the same standards as those with normal

> cerebral function.

>

>

>

>

>

>

>

----------------------------------------------------------------------------

--

>

>

> No virus found in this incoming message.

> Checked by AVG Free Edition.

> Version: 7.5.472 / Virus Database: 269.8.7/830 - Release Date: 6/3/2007

12:47 PM

>

[Guest guest]

-

patients want to do good. They will meet your expectations if you set them

high so tell them what you want and require and try not to make any

exceptions. Once they learn how you work it gets easier so maybe

requiring appoitments or doing something that works for you like a

paperwork fee. They can drop off the form that they need with $30

and you'll do it within 24 hours. THik of something easy...and lucrative!

Do not work for free!

Do not let patients beg you for things between appoitments!

Pamela

>

> Pam,

> I very much agree with you regarding waste of time issues like rx refills. I

like your

information sheet also.

>

> My other issue is with mail order rx requests. I do not mind printing out

these during

an appointment, but invariably they " get new insurance " or just decide to go on

a mail

order plan between appointments.

>

> I am considering charging a processing fee for filling mail order requests

when they are

not part of a visit, especially when local meds have been called in already as

part of a

previous visit.

>

> With 1,000+ patients, I do not feel I can make everyone come in for an extra

appointment for this and maintain my open access, but I am tired of saving the

patient/

insurance company's money at my expense.

>

> I would like to hear feedback on this issue.

>

> Thanks,

>

> , M.D.

> Durango, CO

> Refills between appointments

counterproductive -

Activate those patients

>

>

> I know many of you may disagree but I think it is a total waste

> of my time to deal with refills between appointments. 30% of all

> calls to medical offices are about refills. 20% are second calls because

> the first call never got returned (and some of these are return refill

> phone calls you can bet). I bypass the entire mess by making sure

> patients have enough meds till next visit and pharmacists automatically

> tell pts " no " when they ask for a refill. Slowly I am training everyone.

> This is part of my " iron fist in velvet glove' routine.

>

> Here is something I wrote up for patients. What do y'all think?

>

> Refill Request Information Sheet

> Pamela L. Wible, MD

>

> 1) What's the deal with refills?

> Refills are granted at the time of your office visit and not in between

> visits. Please DO NOT have your pharmacist call the office asking for

> a refill. When you are running low on your medication it is a reminder

> that you are probably due for an office visit. I prescribe enough

> medication to last until your next office visit.

>

> 2) How much medication can I get at the time of my appointment?

> If you have no issues and you are stable on your medication you can

> usually get a year supply (thyroid and birth control pills usually). If you

> have an ongoing medical issue that is stable you can often get a 3-6

> month supply (high blood pressure pills, for example). If you have

> issues that are not under control then you usually need to return every

> 1-3 months for medication and evaluation (diabetes, for example).

> Some people who have dangerously out of control issues have to

> come back in 1-2 weeks. So the moral of the story is to get your

> health issues under control and make sure you ask for your refills

> at the time of your office visit so you are not surprised when the

> pharmacist says " Sorry, you have run out of medication. "

>

> 3) Why can't I just call when I'm on my last pill like at other doctor's

offices?

> The average office is inundated with refill requests and they often

> need to hire lots of staff to handle the sheer volume of refill requests.

> Thirty percent of the phone calls to the average office are related to

> refill requests. Another 20% of calls are second calls in the same day

> from the same person who did not get their call returned. " It's 4:45

> and nobody called me back! I just took my last pill! Help! "

>

> 4) Why is it my responsibility to keep track of my medication?

> Your physician usually has over 2500 patients to keep track of at the

> average office. I have approximately 350. Either way it is impossible

> for physicians to keep track of your medication. It is also hard on the

> pharmacists if you wait till the last minute to ask for a refill. Please

> keep track of your medication so you can ask in advance of using

> your last pill. It is best to schedule an appointment while you still

> have a week's supply left.

>

> 5) Anything else I can do to make things easier?

> If you take a look at your prescriptions and try to get them renewed

> on the same cycle such as every 3,6,9 or 12 months then you will have

> them all in sequence and easy to remember the renewal date on all of

> them. Ask each time you go to the pharmacy to make sure you know

> when you will run out. Keep that list in your wallet so you will know

> when you come to your appointments.

>

> 6) What if I'm in a pinch? Are there exceptions?

> Pharmacists will usually give you a 3 day supply to tide you over in an

> emergency. I make exceptions for situations in which you have had an

> emergency or are out of town. I also do not hold patients with traumatic

> brain injury or dementia to the same standards as those with normal

> cerebral function.

>

>

>

>

>

>

>

----------------------------------------------------------------------------

--

>

>

> No virus found in this incoming message.

> Checked by AVG Free Edition.

> Version: 7.5.472 / Virus Database: 269.8.7/830 - Release Date: 6/3/2007

12:47 PM

>

[Guest guest]

Hi Kathy and Lou,

Lou. Coool! I'm winning you over. You never elaborated on the

negative side of your " mixed feelings " on this topic. Please

tell me more....

Kathy, I have only been using this form for one day! I have not

even sent it out yet. I have mostly solved this problem. I used to get

many calls per day for refill requets from pharmacies. Now I get a

few per week. I even have my answering machine say at the end of

the message " Remember refill requets and referrals and granted

during office visists only. " Every once in a while I get a pharmacy calling

saying " this is our third message for Dr. Wible on this refill " so I guess

they did not listen to my message!!!!!

So for the few times this keeps happening and instead of just deleting

the pharmacy msgs as soon as I hear the word refill (it feels soooooooo

good to do that!! - I keep thinking " didn'y you listen to my outgoing msg? " )

I decided to call the few pharmacies who are repeat offenders who can't

" get " my message and they put a BIG " NO to all REFILLS " next to my name in

the computer. For my few remaining pts who do this I wrote the handout

to actually *help* them get it and so they can make the most of their visits.

I really want to get patients activated so they can be prepared and on task

during their office visits.

Kathy, I've never had anyone leave my practice over my refill policy or

my other iron fist policies such as $50 fee for no show/cancellations

<24 hours.

scheduled drug refills I do 1-3 month supply depending on my trust

for the patient. One woman just loves to see me every month and has

less than optimal cerebral function so she always gets into trouble if

she does not come in monthly. One gal I give a 3 month supply of ritalin

and see her 4 x per year. Ahhhh, the art of medical practice...

Weed out the people who dod not respect you. It's OK!

We deserve to be happy too!

Pamela

> >I know many of you may disagree but I think it is a total waste

> >of my time to deal with refills between appointments. 30% of all

> >calls to medical offices are about refills. 20% are second calls because

> >the first call never got returned (and some of these are return refill

> >phone calls you can bet). I bypass the entire mess by making sure

> >patients have enough meds till next visit and pharmacists automatically

> >tell pts " no " when they ask for a refill. Slowly I am training everyone.

> >This is part of my " iron fist in velvet glove' routine.

> >

> >Here is something I wrote up for patients. What do y'all think?

> >

> >

> >Refill Request Information Sheet

> >Pamela L. Wible, MD

> >

> >1) What's the deal with refills?

> >Refills are granted at the time of your office visit and not in between

> >visits. Please DO NOT have your pharmacist call the office asking for

> >a refill. When you are running low on your medication it is a reminder

> >that you are probably due for an office visit. I prescribe enough

> >medication to last until your next office visit.

> >

> >2) How much medication can I get at the time of my appointment?

> >If you have no issues and you are stable on your medication you can

> >usually get a year supply (thyroid and birth control pills usually). If you

> >have an ongoing medical issue that is stable you can often get a 3-6

> >month supply (high blood pressure pills, for example). If you have

> >issues that are not under control then you usually need to return every

> >1-3 months for medication and evaluation (diabetes, for example).

> >Some people who have dangerously out of control issues have to

> >come back in 1-2 weeks. So the moral of the story is to get your

> >health issues under control and make sure you ask for your refills

> >at the time of your office visit so you are not surprised when the

> >pharmacist says " Sorry, you have run out of medication. "

> >

> >3) Why can't I just call when I'm on my last pill like at other doctor's

offices?

> >The average office is inundated with refill requests and they often

> >need to hire lots of staff to handle the sheer volume of refill requests.

> >Thirty percent of the phone calls to the average office are related to

> >refill requests. Another 20% of calls are second calls in the same day

> >from the same person who did not get their call returned. " It's 4:45

> >and nobody called me back! I just took my last pill! Help! "

> >

> >4) Why is it my responsibility to keep track of my medication?

> >Your physician usually has over 2500 patients to keep track of at the

> >average office. I have approximately 350. Either way it is impossible

> >for physicians to keep track of your medication. It is also hard on the

> >pharmacists if you wait till the last minute to ask for a refill. Please

> >keep track of your medication so you can ask in advance of using

> >your last pill. It is best to schedule an appointment while you still

> >have a week's supply left.

> >

> >5) Anything else I can do to make things easier?

> >If you take a look at your prescriptions and try to get them renewed

> >on the same cycle such as every 3,6,9 or 12 months then you will have

> >them all in sequence and easy to remember the renewal date on all of

> >them. Ask each time you go to the pharmacy to make sure you know

> >when you will run out. Keep that list in your wallet so you will know

> >when you come to your appointments.

> >

> >6) What if I'm in a pinch? Are there exceptions?

> >Pharmacists will usually give you a 3 day supply to tide you over in an

> >emergency. I make exceptions for situations in which you have had an

> >emergency or are out of town. I also do not hold patients with traumatic

> >brain injury or dementia to the same standards as those with normal

> >cerebral function.

> >

> >

> >

> >

> >

> >

> >

> >

> >

>

[Guest guest]

As a person who has discovered at the last minute that I need a refill for my medication, I am sympathetic to people who forget to plan ahead. We ask people to have their pharmacist fax a refill request. If they are due for their appointment I will give them a 2 week supply. That means that they will have to pay an extra co-pay for the month. This is a pretty good incentive for people to minimize those last minute requests. If 14 days later I get a second refill request from the pharmacy the next refill is just for 7 days. I am a little concerned about just saying no to refills because then are out of their meds for a few days until they can see me. Larry Lindeman MDI know many of you may disagree but I think it is a total waste of my time to deal with refills between appointments. 30% of all calls to medical offices are about refills. 20% are second calls becausethe first call never got returned (and some of these are return refillphone calls you can bet). I bypass the entire mess by making surepatients have enough meds till next visit and pharmacists automaticallytell pts "no" when they ask for a refill. Slowly I am training everyone.This is part of my "iron fist in velvet glove' routine.Here is something I wrote up for patients. What do y'all think?Refill Request Information SheetPamela L. Wible, MD1) What's the deal with refills? Refills are granted at the time of your office visit and not in between visits. Please DO NOT have your pharmacist call the office asking for a refill. When you are running low on your medication it is a reminderthat you are probably due for an office visit. I prescribe enough medication to last until your next office visit.2) How much medication can I get at the time of my appointment?If you have no issues and you are stable on your medication you can usually get a year supply (thyroid and birth control pills usually). If you have an ongoing medical issue that is stable you can often get a 3-6 month supply (high blood pressure pills, for example). If you have issues that are not under control then you usually need to return every 1-3 months for medication and evaluation (diabetes, for example). Some people who have dangerously out of control issues have to come back in 1-2 weeks. So the moral of the story is to get your health issues under control and make sure you ask for your refills at the time of your office visit so you are not surprised when the pharmacist says "Sorry, you have run out of medication."3) Why can't I just call when I'm on my last pill like at other doctor's offices?The average office is inundated with refill requests and they often need to hire lots of staff to handle the sheer volume of refill requests. Thirty percent of the phone calls to the average office are related to refill requests. Another 20% of calls are second calls in the same day from the same person who did not get their call returned. "It's 4:45 and nobody called me back! I just took my last pill! Help!" 4) Why is it my responsibility to keep track of my medication?Your physician usually has over 2500 patients to keep track of at the average office. I have approximately 350. Either way it is impossible for physicians to keep track of your medication. It is also hard on the pharmacists if you wait till the last minute to ask for a refill. Please keep track of your medication so you can ask in advance of using your last pill. It is best to schedule an appointment while you still have a week's supply left.5) Anything else I can do to make things easier?If you take a look at your prescriptions and try to get them renewed on the same cycle such as every 3,6,9 or 12 months then you will have them all in sequence and easy to remember the renewal date on all of them. Ask each time you go to the pharmacy to make sure you know when you will run out. Keep that list in your wallet so you will know when you come to your appointments.6) What if I'm in a pinch? Are there exceptions?Pharmacists will usually give you a 3 day supply to tide you over in an emergency. I make exceptions for situations in which you have had an emergency or are out of town. I also do not hold patients with traumatic brain injury or dementia to the same standards as those with normal cerebral function.

[Guest guest]

Oh,

Pam, I sooooo wish I was where you are….

I have had people leave because I wouldn’t

write off their deductible…or because I made them come in to change all

of their 15 prescriptions to the new formulary requirements….or because I

objected to having to fax their prescriptions to the mail order pharmacy rather

than give the patient a paper prescription to fill at the pharmacy of their choice….or

they called me from 700 miles away,

complained that they got burned in a campfire accident and wanted me to phone

in narcotics and antibiotics and I recommended that they be seen in there

nearest UTC or ER. If they bounce a

check, my bad check fee is a whopping five bucks, and I have had people refuse

to reschedule unless I agree to drop that charge. Just yesterday a lady emailed me from Boston (I’m in KY) with complaints of palpitations. I emailed back within the hour and said

that I could not safely evaluate her for such a potentially serious problem

over the phone….odds are I will never see her again.

Count your blessings. Not having a million other docs within 3

miles really makes a difference,

Annie

Re: Refills between appointments counterproductive - Activate those patients

Kathy, I've never had anyone leave my

practice over my refill policy or

my other iron fist policies such as $50 fee for no

show/cancellations

<24 hours.

scheduled drug refills I do 1-3 month supply depending

on my trust

for the patient. One woman just loves to see me every

month and has

less than optimal cerebral function so she always gets into trouble if

she does not come in monthly. One gal I give a 3 month supply of ritalin

and see her 4 x per year. Ahhhh, the art of medical practice...

Weed out the people who dod not respect you. It's OK!

We deserve to be happy too!

Pamela

> >I know many of you may disagree but I think it is a total waste

> >of my time to deal with refills between appointments. 30% of all

> >calls to medical offices are about refills. 20% are second calls

because

> >the first call never got returned (and some of these are return refill

> >phone calls you can bet). I bypass the entire mess by making sure

> >patients have enough meds till next visit and pharmacists

automatically

> >tell pts " no " when they ask for a refill. Slowly I am

training everyone.

> >This is part of my " iron fist in velvet glove' routine.

> >

> >Here is something I wrote up for patients. What do y'all think?

> >

> >

> >Refill Request Information Sheet

> >Pamela L. Wible, MD

> >

> >1) What's the deal with refills?

> >Refills are granted at the time of your office visit and not in

between

> >visits. Please DO NOT have your pharmacist call the office asking for

> >a refill. When you are running low on your medication it is a reminder

> >that you are probably due for an office visit. I prescribe enough

> >medication to last until your next office visit.

> >

> >2) How much medication can I get at the time of my appointment?

> >If you have no issues and you are stable on your medication you can

> >usually get a year supply (thyroid and birth control pills usually).

If you

> >have an ongoing medical issue that is stable you can often get a 3-6

> >month supply (high blood pressure pills, for example). If you have

> >issues that are not under control then you usually need to return

every

> >1-3 months for medication and evaluation (diabetes, for example).

> >Some people who have dangerously out of control issues have to

> >come back in 1-2 weeks. So the moral of the story is to get your

> >health issues under control and make sure you ask for your refills

> >at the time of your office visit so you are not surprised when the

> >pharmacist says " Sorry, you have run out of medication. "

> >

> >3) Why can't I just call when I'm on my last pill like at other

doctor's offices?

> >The average office is inundated with refill requests and they often

> >need to hire lots of staff to handle the sheer volume of refill

requests.

> >Thirty percent of the phone calls to the average office are related to

> >refill requests. Another 20% of calls are second calls in the same day

> >from the same person who did not get their call returned. " It's 4:45

> >and nobody called me back! I just took my last pill! Help! "

> >

> >4) Why is it my responsibility to keep track of my medication?

> >Your physician usually has over 2500 patients to keep track of at the

> >average office. I have approximately 350. Either way it is impossible

> >for physicians to keep track of your medication. It is also hard on

the

> >pharmacists if you wait till the last minute to ask for a refill.

Please

> >keep track of your medication so you can ask in advance of using

> >your last pill. It is best to schedule an appointment while you still

> >have a week's supply left.

> >

> >5) Anything else I can do to make things easier?

> >If you take a look at your prescriptions and try to get them renewed

> >on the same cycle such as every 3,6,9 or 12 months then you will have

> >them all in sequence and easy to remember the renewal date on all of

> >them. Ask each time you go to the pharmacy to make sure you know

> >when you will run out. Keep that list in your wallet so you will know

> >when you come to your appointments.

> >

> >6) What if I'm in a pinch? Are there exceptions?

> >Pharmacists will usually give you a 3 day supply to tide you over in

an

> >emergency. I make exceptions for situations in which you have had an

> >emergency or are out of town. I also do not hold patients with

traumatic

> >brain injury or dementia to the same standards as those with normal

> >cerebral function.

> >

> >

> >

> >

> >

> >

> >

> >

> >

>