Take advantage of e-prescribing for prescription refills

Prescription refills! How can something so necessary generate so much frustration?

You got all the original prescriptions written at the same time — but after a while, somehow, the refills are all coming due at different times, and they don’t coincide with your follow up office visits. So now you need to contact the doctors’ office for a refill. That means going through the phone menu. Then you have to either carefully recite your name/date of birth/contact phone number/prescription name/dose/instructions/pharmacy information to a staff member, or you have to talk to a voice mailbox and remember not to leave any of those critical details out of your message. Then you have to wait for someone at the doctors’ office to check your chart, authorize the refills,  call your pharmacy, and read the information to the phamacist or the pharmacy voice mailbox. And then you have to wait for the pharmacy to actually fill your prescription.

And guess what? You doctor isn’t exactly in love with the process, either. It requires a lot of valuable time from skilled staff members providing this free courtesy service — and doing it with minimal risk of irrgular hthe risk of medical errors. It ties up phone lines and personnel who are also handling sick calls. Multiple people have to “touch” your refill request, creating a risk of human error each time.


Fortunately, our office has electronic prescribing.  Although we’ve had some technical problems while upgrading our server, we’re now fully operational again.

E-prescribing reduces a lot of the wait-time involving telephone calls to request refills, it reduces a lot of the potential for errors when people are passing messages from one to the other, and at each step, it reproduces the exact information about medications that often have similar sounding names and complicated dosage forms.

If your pharmacy is set up for e-prescribing — and almost all of them are now — the process is more like this:

  • You call your pharmacist to have your routine refills ready for you to pick up.
  • Your pharmacist notices you don’t have any refills on some/all medications.
  • The pharmacist sends a refill request via a secure internet information exchange, in our case, via SureScripts.
  • You refill request appears on the queue for your doctor/nurse/PA on our computer system within minutes. Because it is linked to your previous prescription, the drug description and dosage information is automatically identical to your previous prescription.
  • The doctors’ office computer flags any discrepancies in the request: For instance, if the pharmacy requests a refill on a drug that was supposed to be discontinued, or it requests a refill for a dose that was changed, that request will be flagged for special review and manual matching. Prescriptions that are identical to our records will be matched automatically.
  • The prescriber clicks the drug in the queue to refill it, making any changes in instruction, number of pills, etc.
  • The prescriber hits “save” and “send.” The refill again goes through the secure clearinghouse. It comes to the pharmacy linked to the actual original script so the pharmacist can see any changes.
  • Your pharmacy proceeds to refill your drug, then you pick it up or get delivery.

Notice that most of the steps than involved time and effort on your part are eliminated. Also, a computer is much better at doing error checking for routine tasks, because computers don’t get bored or rushed. This system only requires humans to review things that are not routine, so they don’t lose their edge doing those reviews all day.


If you’ve been calling the office and leaving messages for refills, try e-prescribing and see if it makes life a little less annoying.

Also, if you’re getting 30 day supplies of medications, ask you doctor and pharmacist about getting 90 day supplies of your generic drugs. Besides eliminating 2/3 of the trips to a pharmacy to pick up your pills, your insurer will usually charge less than a full 3 times the copay of a 30 day supply — you save money. And if you are on a plan that puts a limit on the number of prescriptions you can receive a month, you may be able to increase your 6-prescription-a-month limit as high as 18 prescriptions a month by staggering the requests into different months.


A stroke is a “brain attack”

“She had a stroke.”

Everyone has heard the term “stroke,” and they’re pretty clear that it’s a bad event.

But surprisingly few people actually know much about what it’s like to have a stroke. While they’re usually pretty good at calling 911 if someone is having chest pain due to a heart attack, they may not even notice when someone is having a stroke. They frequently don’t even notice it when they’re having a stroke themselves.

It’s not surprising, actually. A stroke is sudden brain injury due to blood clotting or bleeding inside the head. The brain does a lot of different things, so there are a lot of different types of strokes. And the brain itself doesn’t feel pain, so strokes usually don’t hurt (unless there is so much pressure from bleeding that the brain is swelling against the skull around it). Strokes often occur during sleep, so they’re already hours old when the victim wakes up. A stroke is a very quiet catastrophe.

However, some types of strokes are much more common than others. Because of the way the blood vessels to the brain are arranged, the majority of strokes involve weakness or loss of feeling of one side of the body, and they often cause problems speaking (with or without problems understanding language or even symbols).

Health officials and stroke specialists around the English-speaking world are teaching people to remember the acronym “FAST.” It stands for

* twisted/asymmetric face
* weak arm
* impaired speech
* means you have very little time to act

Once upon a time, there wasn’t much you could do about a stroke. But that’s all changed. Getting the proper treatment can often prevent some or all of the permanent brain damage. But treatment works best when given immediately. Minutes count.

A stroke is a “brain attack” and needs the same rapid response as a heart attack.  In future posts, we’ll talk about the FAST signs in more detail.

Medicaid expansion coming to Pennsylvania

Low income working Pennsylvanians were initially shut out of the Affordable Care Act (“Obamacare”) benefits. Because they were working, often working multiple minimum wage jobs, they made too much money to qualify for traditional medical assistance.  But because their families were still below the poverty line despite working parents, they didn’t qualify for subsidized “affordable care.” It was even more frustrating because the cost of the expansion was covered by the federal government, not the state. PA federal income taxes flowed out of the state to pay for ACA benefits, but Pennsylvanians who needed them couldn’t get the help.

The Healthy PA program, an alternative to the medicaid expansion designed by the Corbett administration, went into effect January 1. Instead of simply expanding medicaid to everyone below the poverty line, it was a complicated assortment of benefits provided through a parallel system of private insurance plans. For instance, Independence Blue Cross has offered its Keystone First plan (formerly Keystone Mercy) for years, but the Healthy PA benefits went through a different plan called Keystone Connect. In effect, every insurer providing medicaid HMOs had to create a duplicate product to participate in Healthy PA.

Whether Healthy PA would have been adequate or not is hard to tell. Enrollees weren’t the only ones confused by the program. Many providers didn’t know whether they were enrolled in the special Healthy PA plans, either, nor what benefits patients were eligible for. Many doctors who participated in the private insurers’ regular medicaid products wrongly assumed they were automatically participating in their Healthy PA products. And many patients who had been receiving medicaid were pushed into Healthy PA, too, even though their incomes had not risen.

Fortunately, Gov. Wolf is doing away with the distinction. There will be a single medicaid system for everyone below the poverty line. PA taxpayers will no longer be subsidizing enrollees in other states while their own working poor are uninsured, and there will no longer be the massive expense of maintaining the dual systems. It’s unfortunate this wasn’t done in the first place, as setting up the failed system wasted a great deal of public and private money.

The timeline for the transition is explained at http://www.healthchoicespa.com/ . Anyone who applies for coverage through the Healthcare.gov website will automatically be referred for medical assistance if their income is low enough. Anyone currently in a Healthy PA plan will automatically be given full medicaid without having to reapply.

We’re happy to say that Urban Health Initiatives not only accepts Keystone First/Keystone Connect, Aetna Better Health,  United Healthcare Community Plan, Health Partners/Health Partners Essential and traditional medicaid, we welcome those plans. We also accept most employer health plans. We hope to make sure you don’t have to have a different doctor just because your insurance changes.

March 6, 2015 Schedule

The Philadelphia public and parochial schools are closed again Friday, 3/6/15, but UHI will be open.

We anticipate a lot of no shows and cancellations, however, due to difficulty traveling and parking, as well as due to the unanticipated need to be home with children who are off school. We expect to have room for add-ons and walk-ins if you are able to come in.  Appointment times will be fluid, and it will be better to come earlier in the day if possible, as many scheduled patients who do come may have difficulty arriving on time.

Weather Closure 3/5/2015

Due to the prediction of accumulating snow throughout the day on Thursday, March 5, 2015, Urban Health Initiatives will not be open. We will be contacting patients to reschedule them. We are very sorry for the inconvenience, but we don’t want any of you having to spend the night snowed in with us if things get bad!

Because of shared management, we follow the schedule of Spectrum Health Systems, which will be closed as well.

Calls to the office for emergencies will be paged to the physicians at their homes. Since there will not be any staff in the office, please wait for the following day for non-emergency calls, in order to avoid overloading the phone-forwarding line. Thank you.