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Welcome to Healthcare Redefined: Advocating for Aging Adults and Their Families, where we empower families to navigate the complexities of aging and healthcare. Presented by Your Nurse Advocate Consulting, we share real stories, expert advice, and practical tools to help you and your loved ones confidently navigate aging with dignity.
We explore topics like creating collaborative care plans, demystifying Medicare, handling healthcare crises, and preparing for the future. Join us as we transform uncertainty into understanding.
Pam Dunwald: [00:00:00] Welcome to Healthcare Redefined: Advocating for Aging Adults and Their Families. Hi, I'm Pam.
Linda Kritikos: [00:00:05] And I'm Linda. We're registered nurses and board-certified patient advocates.
Pam Dunwald: [00:00:10] You know, each week we help family caregivers feel less overwhelmed and more confident one step at a time.
Linda Kritikos: [00:00:18] Well, this month's theme is preparing for the New Family Caregiver, and today's episode is a must-listen if you've ever thought 'I'm doing everything. Surely there's more support out there'.
Pam Dunwald: [00:00:30] You know this is episode ten, How to Get More Help from Your Clinic: A New Caregiver's Guide, and we're interviewing an RN that we both know very well, Viki Droegkamp.
Linda Kritikos: [00:00:40] Viki is going to walk us through how to take full advantage of the services your primary care clinic may offer.
Pam Dunwald: [00:00:48] You know every clinic is a little different, so what one clinic offers another clinic might not offer. But in general, we're going to cover the resources that can make caregiving easier for you, like care coordination, medication help, referrals, and possibly some social work support.
Linda Kritikos: [00:01:09] And those things are really important. And we're going to talk about how to use online tools such as MyChart to stay organized and in the loop.
Pam Dunwald: [00:01:18] You know, so if you're wondering how your primary care clinic can make your life easier, this episode is for you.
Linda Kritikos: [00:01:26] So let's jump right on in there and get with our guest.
Pam Dunwald: [00:01:30] Okay. You know, let's set the stage here. So kind of a quick caregiver reality check. You shouldn't have to coordinate everything alone. And we also want to clarify, too, that this is the primary care clinic. This is where your regular doctor, your preferred provider, is. And this should be the hub for coordinating all the care, not just going in for annual visits. And you know, last thing, last thing I want to mention is, you know, services do vary by clinic, but we're going to talk about some that are more common options that you should at least ask about.
Linda Kritikos: [00:02:08] So Viki, I'd really like to start with the first question for you on who is the best point person for care coordination in your clinic or in most clinics that you're aware of.
Viki Droegkamp: [00:02:22] At most clinics, when you call the clinic directly, usually at my organization, we call it a PSR, Patient Service Representative. And even though they manage check-ins and whatnot at the clinic, they can do everything from like answering questions, scheduling appointments, pending lab orders, things like that. So by just directly contacting the clinic, they can usually either help you themselves or they can connect you with a nurse or whatnot that can better serve you.
Linda Kritikos: [00:02:50] So basically calling the clinic and saying, you know, can I speak to the care coordinator or someone who can coordinate my schedule or my appointments. Would that be correct?
Pam Dunwald: [00:03:01] Yeah. Or Viki, would this be someone who's generally answering the phone at the clinic when you call?
Viki Droegkamp: [00:03:06] Yeah. They're first point of contact when you call, when a patient calls the clinic, they're the first ones to answer. So then they can figure out if either they can help you or they can direct your call to somebody that can.
Linda Kritikos: [00:03:17] Okay. Are there like nurse care managers, care coordinators or case managers on site that can help with coordination of care or with specific questions that individuals may have regarding appointments or treatment regimens?
Viki Droegkamp: [00:03:32] Yes, we do, but they're spread out. They cover multiple clinics in our area. So it might take a little bit to get a hold of them. But it is very possible. We also have social workers too, that can help you as well.
Pam Dunwald: [00:03:45] Okay. So how would I message the team? I mean, would it be better to call them or would it be better to use like the MyChart or an email system to get them to answer me quickly? And if I do call, usually, what is the turnaround time for a response?
Viki Droegkamp: [00:04:03] So it depends on if the patient is an established patient with the clinic or not. If they are established, MyChart would probably be the best option. If they're not established, then they can call the clinic and talk about next steps, and can have somebody connect with them to help them. And then turnaround time for MyChart, we typically say if you send a message, we as nurses have around 72 hours to send a response. It depends on, we have frontline people that identify if it's a high priority or not. So we handle those high-priority messages first.
Linda Kritikos: [00:04:35] Okay. Okay. So what would be the best way to handle a request like a refill for medication? Because I can tell you just from personal experience with my own parents, they wait until they have one pill left to call for a referral. So what's the best way to request for those refills or forms or referrals? And what is the turnaround time on things like that?
Viki Droegkamp: [00:04:58] Yeah. So for MyChart, that is probably the best option to request a refill. Now, if you request the refill through MyChart, there's no need for you to send an additional message. That kind of just clogs up our portal. If a lot of people don't realize that medical assistants and nurses can refill medications per protocol. So if it's a standard med and it's not a controlled med, we can fill that, refill that. And typically we have around 48 hours to 72 hours to refill it. Now, if it is a controlled, we have to send that request specifically to the doctor. And then they have to look at things like the PDMP and whatnot, which is like the controlled substance database, at least for Wisconsin, to make sure everything's up to date. And then those turnarounds can be like a week because there's more involved. Yeah.
Pam Dunwald: [00:05:46] So Viki, for our listeners that may not understand that, could you give some examples of what controlled substances would be?
Viki Droegkamp: [00:05:53] Yeah. So controlled substances are those stimulants for ADHD. So the Vyvanses, and the Adderalls. Otherwise, for like more like geriatric populations who are in chronic pain, they might have like Gabapentin, which give or take depending on the clinic, that may or may not be a controlled for nerve pain. Otherwise, like the Oxycodones or the Percocets or Xanax, those are all controlled medications. So then there's more strict rules.
Pam Dunwald: [00:06:23] All right. So let's talk a little bit about some of the core clinic services that caregivers often don't realize that they can use. So at your clinic, do you have like a triage nurse or if you are having some kind of illness or ailment, I mean, is it worth calling the clinic before you go to urgent care or something like that?
Viki Droegkamp: [00:06:46] For sure. So a lot of people are unaware that in most provider schedules throughout the week, they have acute spots and then they have TCM appointments, which I'm sure we're going to talk about later, but they can fit you in even if your provider seems very busy throughout the week for those things that are acute. So whether like you're having the flu or Covid, maybe those things that you've been having symptoms for a week or so, and you're stable and you just need like a minor test, whether it's like a Covid test or flu test, you can go to your primary care provider and get those tests completed and then get treatment if needed. So as long as you're stable and you've had symptoms for a couple days, and it's not life-threatening, maybe if you don't, if it doesn't require imaging, then you can go to your primary care provider. But if it's a little bit more serious, like a sprain or whatnot of an ankle, then you could go to urgent care. You could go there for like UTIs as well. But if it is like shortness of breath, confusion, stroke-like symptoms, you know, blurred vision, slurred speech, then that's the time that would warrant the E.R. if it's critical and you cannot wait.
Pam Dunwald: [00:08:01] And I'm sure this triage person, if someone called in with symptoms that if they thought it was something that needed to go to urgent care, they would just recommend them, that they would go.
Viki Droegkamp: [00:08:10] Yeah. So I work as a triage nurse as well. I kind of switch roles. So we have protocols depending on the patient's main symptoms. And then we'll go through and ask them a series of questions and based off of their responses, helps determine if they need to see their primary in 24 hours, if they need to go to urgent care, or if they need to go to the E.R.. So it gives us recommendations on what they can do or should do.
Pam Dunwald: [00:08:32] Perfect. What about those post-hospital questions? Linda and I ran into a potential client that was set up for wound care from the nursing home. Ended up they hooked him up with a provider that wasn't covered under their insurance, so he went without wound care. What about these post-hospitalization questions that could come up? Is, the clinic an appropriate place for you to try and figure those things out?
Viki Droegkamp: [00:08:59] For sure. So we have, so there's a difference between ER follow-up and then a TCM or Transitional Care Management appointment. Those are usually if somebody is admitted to the hospital and they stay for more than 24 hours, then they require like a TCM in usually 7 to 14 days post-discharge from the hospital, whereas an ER follow-up is just if they were in the ER for a couple hours, they were discharged, then they could make an ER follow-up appointment. However, we do recommend the TCM and the ER follow-ups and at that time the provider can look at the medications that were prescribed in the hospital, determine if they need refills, provided they can see how well the person is recovering. And then they can also decide next steps like if additional wound care orders are needed, or if additional referrals are needed to help with their treatment plan. So we do recommend those follow-ups, and they are very helpful, especially to loop your primary provider in, who has probably seen you for many years.
Pam Dunwald: [00:09:57] Gotcha. That's a great comment. Moving on to medication support. So we talked, Linda talked a little bit about what's the refill process? So I don't want to go over that again. But how does the clinics handle like if you're, like for example, we have a client who uses a medication Trelegy, which is very expensive for her COPD. How does that work with prior authorization? Does the clinic help with that?
Viki Droegkamp: [00:10:20] For sure. So I've seen it where on both sides of it, where we sometimes will tell the patient to contact their insurance, and we'll give them a list of medications that would work for their condition. And then they could ask the insurance company which ones would be covered with their diagnoses. Or we have resources specifically for DME supplies, it's called Parachute, that can help us, we just fill out a few questions regarding the patient, and then it tells us what medications and what supplies are covered through their insurance. So it's one of two ways, really. And then once we figure out what may or may not be covered, we can just initiate a prior auth, depending on which is basically seeing if the insurance company will cover it. So, if they don't we'll just find a comparable medication and then we'll retry the whole process again. Depending on the medication though, the time for it to get approved or denied can vary. Usually at the beginning of the year, everybody's trying to get their medications approved. So, specifically like weight loss drugs, those are anywhere from like 7 to 8 weeks turn around for prior auth. But we do assist with them. We, at least at my clinic, we're very accommodating. If something's denied or if you need an alternative, we will usually handle that. I don't know if that helps you.
Pam Dunwald: [00:11:44] Gotcha. And that's great because that really kind of leads into the last part of that medication question I was going to have is, you know, we run into now that the new anticoagulant medications, you know, like the new medications that are very costly for that. So if say, for example, they don't approve one, I mean, is it pretty common for the doctor, okay, well maybe we'll switch and use a different one. And I mean, is that, are the doctors pretty accommodating for that?
Viki Droegkamp: [00:12:12] They are because they want their patients on these medications. So there's usually an equivalent or an alternative medication. So if we need to go down the list and keep prescribing different meds and initiating prior auth until one's approved, we'll do that.
Pam Dunwald: [00:12:25] You know, and and I don't think a lot of people understand too, like the Eliquis comes to mind. And what's, Viki what's the other one, Eliquis and...
Viki Droegkamp: [00:12:34] Coumadin. Warfarin.
Pam Dunwald: [00:12:35] No. That's, Linda, help me out here. Yeah, it's the other one, the, uh, Eliquis and.
Viki Droegkamp: [00:12:42] Lovenox.
Pam Dunwald: [00:12:43] No, it's the other new oral one that doesn't need any blood work. Eliquis. And I'm really drawing a blank there. Well, anyway, there are two of the newer ones, so they're still under patent, so there's no generic, and so, but sometimes the clinics will cover one of them and not the other. So that's, it's good to know that you can reach out to your physician, because I know sometimes too, that, you know, sometimes the generic is less expensive than the trade name. So how does the clinic, I mean, is does the clinic normally use a generic or how does it work?
Viki Droegkamp: [00:13:18] It totally depends on the availability and then patient's preferred pharmacy as well. Some do, a lot of the geriatric population, they do mail orders. So that reflects the quantity that we order. We can't order anything less than a 90-day supply at a time for most of them to have full insurance benefits.
Pam Dunwald: [00:13:39] Yes, I was just going to say it just popped in my mind that it was the Xarelto and the Eliquis. So those were the two. So thanks, Linda, for reminding me on that.
Viki Droegkamp: [00:13:48] Yeah. So it depends on availability, pharmacy, whether it's like a mail order or not. So it depends on a lot of factors. But a lot of providers are accommodating. And they have done peer-to-peers with insurance companies. They've talked to insurance companies to appeal decisions if medications were denied. They've written letters, things like that, to get meds that were previously denied covered if it's absolutely needed. So I've seen them go above and beyond and do a lot more than what we ever, like we think a provider would do in regards to medications.
Pam Dunwald: [00:14:24] Mhm. So would it behoove us to share with our audience that if they have any questions or that I mean, should, would it be prudent for them to ask if they could order the generic?
Viki Droegkamp: [00:14:35] Yeah. If that is, yes, they can absolutely ask if that is, if a generic is available on that, there is actually in the MAR, the Medical Administration Record in EPIC that we use, there is a note to pharmacy that we can put in and we can say like dispense as insurance preferred, which is usually the generic, but if they don't want generic, if they want name brand only or whatnot, we can say only name brand and then we can switch the pharmacy.
Linda Kritikos: [00:15:01] Yeah, I've seen that actually with a couple of my clients that it's right there that they can check a box saying okay to use generic or they'll say no generic. You cannot use generic, must use brand name.
Viki Droegkamp: [00:15:15] Because they have different fillers.
Pam Dunwald: [00:15:16] Yes.
Viki Droegkamp: [00:15:17] So it really depends on the pharmacy, the med, the patient, a lot of things go into it, but it is, we are able to order both.
Pam Dunwald: [00:15:25] Gotcha. All right. Let's move on to referrals and care navigation. We basically touched on, and I know we'll talk about it a little bit more about the transitional care nurses, but how does it work if you, if the primary care provider recommends maybe a specialist or X-rays, whether it's therapy, home health, walkers or oxygen, does the clinic usually take control and manage that?
Viki Droegkamp: [00:15:50] Yep. So we can put in the order either the nurse or the provider or the nurse can, with the provider's order like verbal order, so we put in like a service to, whether it's a service to ophthalmology, service to cardiology, whatever it may be. So we put in that referral, and then we, how my clinic does it, is we have a CRS or a Certified Referral Specialist for each clinic. So we just route that order or referral to her, and then she'll reach out to the patient to get them scheduled with any of the specialty providers. So I'm not sure how every clinic does this, but that's how my clinic does it. So we contact the patient to schedule.
Pam Dunwald: [00:16:32] Gotcha. So to take that one step further, when you're looking at, you know, what companies to use or, you know, maybe a home care agency does the clinic, I mean, are they going to check to see who your insurance, you know, is a preferred provider for?
Viki Droegkamp: [00:16:48] Yes, they will. And then with my organization, they actually have their own home health company within it. So that is majority of the time what they recommend, because that's covered if they have like the same organization provider. However, we do have other partnerships with other outside home agencies that they'll work with as well. So, yes, they do contact insurance to see which one's covered.
Pam Dunwald: [00:17:13] All right. And now let's move on to the last portion of what I wanted to talk about. Or actually we have a couple more things, but what about chronic condition management, such as diabetes, congestive heart failure? I mean, do you have certain programs or even though that there may be specialists involved with diabetes or congestive heart failure, how does the primary care clinic, you know, support these chronic diseases?
Viki Droegkamp: [00:17:39] Yeah, so specifically with diabetes, we have a diabetes educator that offers group and individualized sessions. Depends on how new the patient is to the diagnosis, even if it's a chronic diagnosis as well. They can get referrals put in to attend these educational groups to learn more about it. And then just in regards to like managing it, we have appropriate follow-ups with the patient, and we can adjust medications, things like that. So there are plenty of educational things that are offered.
Pam Dunwald: [00:18:10] And so, does the primary care provider, are they the ones that usually order the routine labs? I mean, who kind of keeps all these balls in the air even when they're seeing specialists?
Viki Droegkamp: [00:18:21] Typically it is the primary care provider. Now with I know specifically United Healthcare, I think it's just this year we've seen an uptick in they every specialist a patient sees, starting this year we need a brand new referral for that year. So if they've seen the cardiologist for ten years, previously one referral would be good, would have been okay. Now, every year that they're continuing to go to the cardiologist they need a referral. And that's specifically with United HealthCare, I'm not sure if it's with other insurance companies as well, but it's I know United HealthCare specifically requires all referrals to come from the primary care. So I'm not sure if that's every insurance, but most of those labs and everything, pre-op appointments, things like that and labs and referrals come from the primary care.
Pam Dunwald: [00:19:12] You know. And I'm just going to throw a plug in there. And Linda, you know, if you have anything you want to add here, I just want to say how important it is for you to be familiar with your insurance, because whether any of us like it or not, the insurance companies are driving much of the health care system. And so if you're not sure what your insurance company will approve or what their process is for you to get the health care that you need, you really do need to become an advocate for yourself. You know, I mean, obviously, you know, Linda and I, our services help or your clinic can help, but you really need to have a consumer awareness of what your insurance company will, you know, what their processes are to get approval for anything that you need from your primary care doctor or from a specialist.
Viki Droegkamp: [00:20:00] Yeah.
Linda Kritikos: [00:20:01] And most insurance companies will send, most insurance companies will send their consumers their benefit package or benefit handbook. The problem is a lot of people don't take the time to read it or read the fine print. And a lot of the language may be very confusing for people because a lot of it is set in medical terms. So they really need to look at that. And if they have questions, they really should contact their insurance company to make sure that they understand what is allowed under their plan, so they're not blindsided. Now, there is a transparency act that's out there with hospitals and clinics, and that to basically tell you what it's going to cost for certain procedures or an ER visit or for certain tests. But that really hasn't hit home to a lot of consumers yet. So I really think that, you know, making sure that you're aware of what you are actually able to get paid for under your insurance and what they'll cover is really important. So it makes Viki's job probably a lot easier if the consumer does know what the insurance is going to cover.
Viki Droegkamp: [00:21:08] Yeah, we are willing to contact insurance. I know our clinic is, the nurses, because we have like provider lines that we can contact insurance through, and it's a lot less of a wait time when we call them versus, you know, our patients. So we are able to do it. It just depends on the individual clinic. But another thing is just like it depends on if you're Medicare or if you're Medicare Advantage plan as well. Because if you're Medicare Advantage, they can cover labs anytime throughout the year. And then if you're just straight Medicare, it has to be exactly 365 days after certain labs, otherwise they're not covering it. And then another big confusion is there's Medicare wellness visits that are recommended, that are covered every year. And those are different than physicals. Most of the time those are in place of physicals. So that is another thing that most patients, when they're on Medicare, they get confused about because they think they're coming in for a physical. And it's really just like a welcome to Medicare or a Medicare subsequent visit, which just is like a hearing and a vision test on your first one. And then following subsequent visits are just like a little memory test. So, yeah.
Pam Dunwald: [00:22:20] And, you know, that's really important because I want to stress because a lot of consumers, you know, when they go to those Medicare annual, you know, checkups, they they say, well, they didn't listen to my lungs or they didn't do this or they didn't do that. And so that's not really what the purpose is of those visits is it?
Viki Droegkamp: [00:22:37] Yes.
Pam Dunwald: [00:22:38] So that's we just want to make sure that we clear that up because a lot of, you know, people will complain about that, but it's because they don't understand the purpose of that Medicare annual wellness visit. So yeah Viki let's move on to vaccines. So how does your clinic or how do clinics usually, I mean do they keep track of vaccines, do they recommend, how does that work? How does someone know when they're due for a vaccine?
Viki Droegkamp: [00:23:00] Yep. So in Wisconsin we have the WIR or the Wisconsin Immunization Record. So as long as you've gotten your vaccines in Wisconsin and you're from Wisconsin, we can see that. If it was in a different state, we have a harder time of seeing that. So we just ask that you bring in a record of it, depending on what state you're in and what state you're seeing your PCP and your primary care provider so we can update that specific record. And then in regards to when you come for an appointment at least how we get the charts ready when we pre-chart on a patient prior to seeing them, we have care gaps that come up. And this basically notifies the care team like this patient is due for their mammogram or their colonoscopy or like this vaccine. And if they're, usually if they're on Medicare, we just recommend they go to the pharmacy for all their vaccines because they're covered there for sure, where they might not be covered in the primary care office. So it depends on what the vaccine is. Covid and flu, I know, are covered in at least my clinic setting, but if it's RSV, TDAP, or pneumonia, those are not pneumococcal vaccines. Those are not covered for those that are Medicare in my clinic. So we just recommend that everybody that's on Medicare goes to the pharmacy just to prevent any possible, you know, insurance not covering it. But yes, as long as our health record or the patient's health record is updated, we can see when their last times they had vaccines were and then what are recommended.
Pam Dunwald: [00:24:30] Gotcha. So then just as a side note if someone's moving or they're, you know, moving to another state or maybe they're traveling and it may come up as far as vaccines, they really should keep a record of that with them.
Viki Droegkamp: [00:24:46] For sure. Yeah. Because at least in Wisconsin, the only records that we can update with the verbal without any proof is the Covid and the flu vaccine. Anything else we cannot take a verbal for, we need actual documentation that the person received it in order to update their record.
Pam Dunwald: [00:25:02] Perfect. All right. So let's move on to my last topic for this segment of the podcast. And and that's going to be looking at forms and documentation. What, how does the clinic help when you have family members that say, we're talking about family caregivers, so FMLA may come into question or disability, or they need a note for work or for school paperwork, that's needed for assisted living or driving concerns, what are some of those forms and how does the clinic help in that with that type of documentation?
Viki Droegkamp: [00:25:37] Yeah. So if the patient is relatively close to the clinic and they're able to, we prefer them to just drop them off at reception. We'll have the nurses and the provider look at it. We'll see if it's something that we can accommodate them for. And then we will either fill it out or ask that they come in for an appointment. If it needs more documentation, such as like a disability parking sticker, things like that, we do ask that we see the piece or the form prior to just saying yes or no we'll fill it out because it really depends on what the form says. If you do not live close to the clinic, you are able to attach documents on MyChart and you can just send it to us and we can look at them and print them off that way. Once the forms are completed, we can upload those to the patients portal and they have access to them that they can print off. Otherwise, we can just print off a copy if it needs a doctor's signature, and we can put it up at reception, and then patients can come pick it up as long as they just show an ID. So it really depends on what the form is. We are very accommodating on most forms. If it is something that requires more assessment, then we'll just ask the patient to come in for a visit.
Pam Dunwald: [00:26:46] All right.
Viki Droegkamp: [00:26:47] And help complete them.
Pam Dunwald: [00:26:48] On this topic too, what is the clinic's role? This comes up a lot with Linda and I with our our aging clients. What's the clinic or the primary care provider's role when it comes to driving? How does that work?
Viki Droegkamp: [00:27:02] Driving as what? What do you mean?
Pam Dunwald: [00:27:04] Well, I'm sorry. Maybe, like, if it's time to maybe take away their driving privileges. What kind of things do the primary care physician do? Do they communicate with the DMV? How might that work?
Viki Droegkamp: [00:27:15] Yeah. So they typically, if it is a concern more... so most of the time it's usually a family member that will send us a message in MyChart that says that they're concerned about their mom or their father driving. And then we can bring them in for a visit. We can do, like, a vision test or whatnot. We can assess their needs to see if they do, in fact, need to maybe lose their license. And then that can be a conversation that the provider and the child can have with their mom or dad or whoever the patient is, if that's what they want. So as long as the child, so yes. So if the doctor does feel like the person should not drive and they're not giving up their license willingly, they can contact the DMV and the DMV can require them to come do like another vision test or whatnot, or they could just simply revoke their license if there's enough medical documentation, if they had like a stroke with significant symptoms or delays or whatnot, and they harmed themselves or others, we can take their license.
Pam Dunwald: [00:28:23] Yeah, I would say common for Linda and I too, it comes up frequently with clients that maybe have some form of dementia that they don't feel is significant. They say they can drive, but then there's cognitive issues on whether or not. So the doctors will look into that and make that determination. Okay. I think that's what I have for my section. Linda, do you have some questions for Viki?
Linda Kritikos: [00:28:43] Yeah, actually, I wanted to get in with Viki on discussing, you know, some tools that people can utilize to be able to have good communication with their primary care provider. And one of the biggest tools that I see is the MyChart tool that's used. And I think it's, personally I love it because it's it's right there, I can see things, I can see my lab results and you can see it in a way that's easily readable. And it's more said for people who are not medical professionals so you can easily determine what those test results are saying. And you have a way of communicating if you're not sure what it means on that email. So can you go through a little bit about how someone would get access to that or proxy access if their loved one is not able to actually understand or actually able to understand how to get into that system.
Viki Droegkamp: [00:29:43] Yeah. So when a patient comes for their appointment at least, so EPIC is the charting system that a lot of people use, it's what my clinic uses, so right next to their profile picture on their chart, it has a little circle and it says if it's blue it means they're not active on MyChart. If it's green, it means they're active. So if they're not active, while they're at their appointment, we can click on it and send a one-time code to either their cell phone or their email address that can help them get started with an account. And then if they are active or whatnot, we can have, there's within the MyChart when they're logged in, there is a like sidebar that says access proxy or get access or whatnot. And then they can add whether they're a minor or if they're like a geriatric patient, they can add whoever they need to be a proxy, and they can send MyChart messages on behalf of the patient.
Pam Dunwald: [00:30:40] So to be clear on that, Viki, so if they set up a proxy, I mean that the permission does that need to come from the actual patient?
Viki Droegkamp: [00:30:48] Yes. But it depends on if there's like a active power of attorney or not as well. So it depends on what the advanced directives and the power of attorney is too. So most of the time, yes. Unless they're deemed like, you know, incapacitated. Yes.
Linda Kritikos: [00:31:06] Incapacitated. Yeah. Because that's what I've seen also, I've seen that it can be deferred to them like at the doctor's office. They can say well no I want my daughter to have access. I don't want to deal with this. I don't know how to deal with it and I'm not dealing with it. So right then and there they've got that verbal consent to be able to do it. If under other circumstances I have had where they have asked for that healthcare power of attorney paperwork to be able to allow proxy access to this MyChart. But it's a great tool. So what are some of the things that they can people can find on the MyChart? I mean, I know what I see, but what are some of the in the bigger picture, what are some of the things that individuals can find on MyChart?
Viki Droegkamp: [00:31:49] So I think the biggest thing besides like the basic lab results and after visit summaries and diagnoses and things like that, medications, bills, like billing history, you can get educational pamphlets and things like that in regards to your conditions. There's videos, there's QR codes you can scan with, at least pediatric patients, there's games they can play kind of educating them on what they are diagnosed with. So there's just a lot of resources. But I think you can schedule appointments. The biggest one though, I think Linda, you already touched base on besides refills, requesting refills, is the MyChart messaging. So on there you can send a message to the patient's care team. And typically it's the nursing staff that responds to those unless it's something they cannot help with. Then we'll forward it to the provider to respond. But those are things where you can give us updates on like blood pressure readings or blood sugar readings, or if you've had a cough for a couple days and you're concerned about it, or if you have, I mean, if you have emergency symptoms, I wouldn't recommend using MyChart to update us like, oh, I have confusion or balance problems. We would most likely get ahold of you and triage you, but that's probably not a good way to use it. But yeah. Yeah.
Pam Dunwald: [00:33:11] You know, Viki, I just have one question on on that. Oftentimes what I've run across with a lot of our clients is they feel that they don't need any other information except what they get from their visit summary. Could you explain the difference between the visit summary and the actual doctor's note?
Viki Droegkamp: [00:33:31] Yeah, so at least I know on my personal MyChart, when you click on the AVS or the After Visit Summary, there's a down carrot and you can actually read progress notes. So I'm not sure if that's on everybody's MyChart, I'm sure it is. So you can read those to get more in depth about, so if you go in for a physical, it has every body system that they did an assessment on and their findings on it versus the after visit summary just addresses like your BMI, your most recent vital signs. So your blood pressure, your pulse ox, your height and your weight. Any lab tests that might have been ordered and then follow up recommendations. So it's very simplistic and it's a summary of everything they did. Whereas the doctor's notes go in depth, it talks about more medication changes, recommendations, things like that.
Pam Dunwald: [00:34:24] Yeah, and I've noticed on some other systems, I should say, is that oftentimes the quickest way that you may get to the doctor's note is actually to go to your past visits. And I see some other systems where you can click the actual doctor's note by going to your past appointment. So there's usually a couple of ways that you can access those doctor's notes. But just yeah, just wanted to say that there is a big difference between the after visit summary and the doctor's note.
Linda Kritikos: [00:34:56] And, you know, you can use those doctor notes as cues for questions for your next visit or for cues to, you know, finding out more information or to hand over to a specialist who you may be wanting to get a second opinion from. So those doctor's notes are very important. Sometimes though, and I have seen this in these doctor's notes, the the note is written with a lot of medical terminology, and unfortunately, a lot of the lay individuals that are getting this information don't have a good understanding of the terminology. So a lot of times their perception of what's written in those notes is maybe incorrect or not consistent or not concise. So if they don't understand what is on that doctor's note, they really do need to make a phone call and talk to the nurse, or talk to someone about what they don't understand. Make another appointment. Print that out. Write their questions next to it and say, what exactly does this mean for my follow up? What do I need to do to deal with this? And what exactly are you, and I've even had patients say, what exactly are you talking about? I don't understand any of this. So it's very, they're very good information. It's very good information. But you need to be able to understand what you're reading. And I did ask a provider at one point why when you go for these visits, why are you only giving a visit summary. And that was for the very reason they said, well, this is just a point in time. This visit summary is about this visit, this specific point in time. It doesn't deal with your whole health picture, the big umbrella. So if people want that big umbrella, as Pam said and you said, they really do need to dig in and look for those doctor's notes and that previous medical history. So what would you say about, what do you think, do you have a referral status in there? I mean, if they were referred to outpatient physical therapy or to an ophthalmologist or to a cardiologist. Would that show in the MyChart and it would give them the name and any information they need for further follow up with that?
Viki Droegkamp: [00:37:07] Yeah. It should, if a referral is placed at that visit, it should come up in the MyChart as like needing an appointment or schedule an appointment. Most hospital systems and organizations, they'll reach out to you if it's a specialized visit, but if they don't, it should pop up as like a task not completed. Or it might look different for each person, but it should show up if a referral is placed with the phone number that they can call to schedule.
Linda Kritikos: [00:37:35] Okay, so can you give us an example of some of the educational handouts that someone may find on a MyChart?
Viki Droegkamp: [00:37:41] Yeah. So for cholesterol, it would tell you healthy diets to follow if you want to lower your cholesterol levels. In regards to diabetes, it would tell you same similar things for dietary restrictions that you might need to start following, exercise recommendations. It could also teach you the importance of checking your blood sugar, you know, twice a day, three times a day, depending on what the doctor recommends. It could also, you know, teach you like breast exams. It can teach, there's a wide variety of resources on MyChart, so. And if you need more, they can just send a message and we can get them more.
Linda Kritikos: [00:38:24] So what would your recommendation be to someone who is a caregiver who is using MyChart in regards to communication? What would you recommend in how they verbiage their messages, you know, and what they put in those messages?
Viki Droegkamp: [00:38:40] So I would just keep them short. As a person that responds to these messages every day, I really do not love reading paragraphs. So just like short, sweet and then always have the ask in there as well. What are you asking for? Are you asking for a repeat lipid panel or a cholesterol panel? Or are you looking for an appointment for a, you know, acute problem that just started like, I don't know, UTI symptoms? Like tell us what you're asking for. Most of the times we will give you what you're asking for, but just, you know, give us some background and then why you're asking what you're asking. But I think one of the biggest mistakes is that, like caregivers usually, so if it's kids, they're usually taking care of mom and dad, and they'll be asking about mom under dad's chart. We're not supposed to be typically responding to another patient's concerns, even though they might be married or whatnot, because every message that a patient or their proxy sends is documented as a different encounter, whether it's a telephone encounter or e-advice encounter, a MyChart encounter. So we just don't want to get patients mixed up, if that makes sense within one patient in one chart.
Linda Kritikos: [00:39:54] That does make sense. So can you tell us what, when would be considered an urgent issue, where they should call you, or what would be a non-urgent issue? Can you give us an example of what that would mean for like a message?
Viki Droegkamp: [00:40:07] Yes. So non-urgent would be like Covid symptoms as long as you're not having, you know, extreme like shortness of breath or things like that, if you're just having, you know, some general body aches and, I don't know, stuffy nose or fever. Those things that could wait a day or two to be seen or addressed. Where a urgent issue would be like my lips are swelling or shortness of breath.
Linda Kritikos: [00:40:36] I can't breathe.
Viki Droegkamp: [00:40:37] What?
Linda Kritikos: [00:40:38] I can't breathe.
Viki Droegkamp: [00:40:39] I can't breathe. Like those things you should just go to the ER. But if, you know, we do have some of those patients that are a little more stubborn that would like us to tell them to go to the ER before they'll go to the ER. So, you know. Those life-threatening, urgent, I can't wait, not stable, you know, balance difficulties. Slurred speech. Those things.
Linda Kritikos: [00:40:59] So a fall if, if a someone called about their dad and said you know my dad just fell, that would be, that would rectify like an urgent call. You wouldn't want a message on that. You would actually want to call on that.
Viki Droegkamp: [00:41:12] Correct. Especially if they're on blood thinners as well. Whether or not they hit their head, that could be a critical fall. So we'd recommend them calling. Now, if it was just a little like, maybe slip on the ice and there's no physical, you know, they just got up and there's no physical.
Pam Dunwald: [00:41:29] Injuries.
Viki Droegkamp: [00:41:30] Injury, maybe that could be like urgent care.
Linda Kritikos: [00:41:33] Okay. Okay.
Viki Droegkamp: [00:41:34] Mhm.
Linda Kritikos: [00:41:35] All right. That's basically what I have. Pam?
Pam Dunwald: [00:41:38] Yeah. We're going to move on to maybe some other resources that the clinic might have. So Viki, I know we talked a little bit about this beforehand. So you mentioned that you had a social worker that covers multiple clinics. I know sometimes, I know in our area each, of the clinics have a social worker. What are some of the types of things that the social worker might help a patient with at the clinic?
Viki Droegkamp: [00:42:01] So they can help those that are unhoused or facing homelessness, those that are on a fixed income that might have difficulty, you know, paying for their prescribed prescriptions. They can also help, you know, finding like whether if they're like homebound and they need like mobile wound care, they could help set that up. They can also help with like, mental health concerns. Basically they're just your support system or person to help you. They can help you with a lot of things. More so.
Pam Dunwald: [00:42:36] So they basically will help, like with a lot of community resources like care support groups, things like that. Okay. So would the social worker, so what happened, would you utilize a social worker say, if a family member calls you and says, you know what, I'm burned out. I can't do this. You need to put my mom or dad in a nursing home. I can't do this anymore. So would they assist with trying to find placement for a loved one?
Viki Droegkamp: [00:43:03] They can. Yes they can, first, usually it's like respite. So care 72 hours whatnot just to give the caregiver a break. And then if they need to find permanent placement they will help with that as well. Whether it's memory care, assisted living, things like that.
Pam Dunwald: [00:43:19] So, and one of the reasons why I bring that up is oftentimes, and Linda and I have both worked in the ER, and you know, oftentimes a family member will come in and drop a loved one off. And there's really not anything wrong with them, but they say I just can't do it anymore. So what you're saying is they really should reach out to their clinic for some help.
Viki Droegkamp: [00:43:37] Correct. Yes. For sure.
Pam Dunwald: [00:43:40] Do the social workers, as you mentioned, they help with maybe some finances if they're having trouble, you know, is when would a social worker step in as far as maybe not paying their medical bills versus working with the billing department? What would be the difference there?
Viki Droegkamp: [00:43:56] Well, you gotta ask for help. Like they're not going to typically reach out to you. You're going to have to, whether it's the caregiver or the patient, reach out to them. And as long as you reach out to them to let them know you're having financial concerns or what not, they can usually figure out some solutions, whether that's like Good RX coupons. Sometimes Good RX coupons are cheaper than using your insurance, depending on the medications. There's a lot of grants that they can help get for patients in regards to whether it's like medical supplies, like blood pressure monitoring, like cuffs or things like that. So I would say reach out to the social worker prior to having any like severe, like falling behind in paying your bills. They're more likely to be working with you prior to, you know, because it's really hard for them to recode. We've had patients try to ask us to recode visits, and obviously we can't do that most of the time because it's, you know, fraud. So. Yeah.
Pam Dunwald: [00:44:54] Right. Yeah. No. Exactly. Now in your, and we'll talk, we talked a little bit about this, in your system do they help with advanced directives at all?
Viki Droegkamp: [00:45:06] They can. But the biggest thing, we have packets. That's like one patients get annoyed with. If they don't have them done we ask them at every visit do you have them done? Will you bring us a copy? If not, we have folders of every single thing that they might need to fill out. And then we have people that they can call, such as the social worker, if they need more in depth, like answers to questions that they may have. So yes, they most definitely can help with that. But the biggest thing is you need to have people, like witnesses to sign them. And we've had a lot of patients need two signatures and they bring them in thinking like the nurses or the doctor could sign them and they can't. They could be like your neighbor. But we cannot sign those for you.
Pam Dunwald: [00:45:47] Yeah, that's.
Viki Droegkamp: [00:45:48] As a healthcare provider.
Pam Dunwald: [00:45:48] That is a really good point. And people need to understand that, you know, the witnesses, the social worker and, you know, I've seen instances where the social worker can sign, but a nurse or doctor cannot, and a family member cannot, especially those that may be mentioned on the advanced directives, they can't sign as a witness. And so I'd like to bring this up because a lot of people think that you have to go to an attorney, you know, and pay for the advanced directives. And it really can be, you know, a free or low cost option for you to be able to get help with these advanced directives. So what we try to do with these calls too, and these podcast episodes is to, you know, reduce barriers, you know, for everyone to be able to get help. So thank you for that, Viki. We talked about placement support. We talked about it going into nursing home. But obviously you could help also with assisted living or memory care or home care services. And I think we've talked a little bit about that. So does a family member need a referral to the clinic social worker? How would one get ahold of it or how do they ask for that?
Viki Droegkamp: [00:46:52] Typically, they can just call our clinic and ask the front desk for their number, or they can send like a secure chat to the nursing staff, and we can put in the referral for them like, it's not anything physical. It's not a physical referral that they need. As long as they're an established patient, they can just literally call the clinic and we can have them get ahold of them.
Pam Dunwald: [00:47:18] So before I move on to Linda, one last thing that kind of cropped up in my mind, how important it is for someone that, say, is moving, changing locations, how important or what kind of a priority is it for them to get set up with a primary care physician as soon as possible?
Viki Droegkamp: [00:47:36] It is very important. We want, you know, ERs are for those that are very sick and urgent cares are for people that have, you know, less severe symptoms but might not be able to wait a few days. But your primary care provider is the person, your go-to person. They can put in basic lab orders for you. Some of them might, you know, order a urine sample for you if you're having UTI symptoms without you even being seen, you can just come to the lab, provide the sample, they'll treat it without seeing you. So having that relationship with a primary care provider is very important, as they're going to be the one person that knows you the best. They can help you with the most resources, and hopefully they can just help prevent you from going to the ER. And they can, you know, treat symptoms before they get worse and progress.
Pam Dunwald: [00:48:26] Thank you for that. And just, yes. And just a side note to again check your insurance, make sure you're choosing a primary care provider that is in network with your insurance company. So with that I'm going to turn it over to you, Linda.
Linda Kritikos: [00:48:40] So, Viki, just to, you know, as we're getting closer to the end of this podcast, I just wanted to go through a couple things here in regards to some complex cases that the clinic may see where you may need to have help from other entities. So can you speak a little bit about what transitional care means and who would be, what do they look at in regards to transitional care?
Viki Droegkamp: [00:49:05] So transitional care meetings or TCMs are those that we typically recommend within 7 to 14 days of a hospital discharge just to prevent readmission. So in regards to that, they'll just discuss like meds that were prescribed, treatment that was provided, any follow up recommendations. But they also can mean, if you're transitioning from like not only the hospital to home or from home to assisted living or wherever you might go, they would provide you with the resources to set you up for success and not failure. Depending on the situation, but it's just a meeting with the provider to see what they can do to help you, you know, be set up.
Linda Kritikos: [00:49:49] So basically they can kind of help with post-discharge check ins, if there's any new or different symptoms that you may be having post-hospitalization, reconciling any meds that you may be looking at and maybe possibly even identify some red flags. So they're kind of like an extra set of eyes and ears, would you say?
Viki Droegkamp: [00:50:10] Mhm.
Pam Dunwald: [00:50:11] For the clinic?
Viki Droegkamp: [00:50:11] Yeah for sure.
Pam Dunwald: [00:50:12] Okay. So who would qualify for transitional care? Like is it something that's specifically like documented, like the primary care provider would say, you know, institute transitional care or have them see transitional care navigator. How does that work?
Viki Droegkamp: [00:50:28] It depends on the type of appointment. Like we use the TCM thing for, we mainly use it for those that are discharged after hospital stays. So most hospitals tell them like follow up with your PCP in two days. So that's when they would call us and we'd schedule that appointment. But if it was something more as like assisted living or memory care, usually then it's the family reaching out to us to tell us that they want to move forward with this, and then it's just them bringing their loved one in. And then it's kind of more just like mediating, you know, like, yeah.
Linda Kritikos: [00:51:07] So would you say that people who have multiple chronic conditions or are frequent fliers to the emergency room or have really complex medical histories or new diagnoses would qualify for this type of care?
Viki Droegkamp: [00:51:24] I think so, yeah.
Linda Kritikos: [00:51:26] Okay. All right. So do you specifically have like a complex care management model out of your clinic? Or have you seen that you know, within your system and you have to enroll in it?
Viki Droegkamp: [00:51:40] Honestly, I'm not quite familiar with that. I'm not sure.
Pam Dunwald: [00:51:44] And Linda, I can speak on that. I know with our clinic that feeds into our hospital in our area, that's one of the things that we've seen over the last five years or so really changes. They'll have nurses like, call people after, you know, a hospitalization because maybe they're at risk for not coming to their doctor appointment, their follow up appointment. But we see changes that they keep reducing the amount of clients they could see because they just don't have enough of these nurses to go around. So it's usually the most critical or the most at risk patients for readmission to the hospital that actually get this transitional care. So it's a great system, but it's not always foolproof. And so a lot of times that's why, you know, where Linda and I come in is we can help fill those gaps.
Linda Kritikos: [00:52:32] Yeah. Because I mean if you think about it there's a large population that has multiple chronic conditions and the follow up is very important. So having that ability to know that there's someone there, but I can see that where it's basically for individuals that are coming out of the hospitals because, you know, they they're given seven, eight, nine, twelve pages of discharge summary. And you know, if they're older and they're a poor historian and they're on multiple meds, they may or may not remember the things that they need to do to. So to have somebody call and check in on them to say, hey, you have a doctor's appointment, you remember that? And did you pick up that prescription? Because we're seeing it here that it wasn't picked up at the pharmacy. So I think those types of things for these complex cases are really, really important. And that is where Pam and I come in, because there isn't enough of those individuals. And because we're independent, we can totally look at things from outside of that system and see if there's other resources that are available for them. So, all right, well, let's wrap this up. Okay. I think we've been talking for a while, Viki.
Pam Dunwald: [00:53:44] Yes, yes. So, Viki, we're going to just shoot some last minute things at you as we wrap up this podcast episode. We hope that it's been so enlightening for especially our new caregivers and very eye opening for maybe those that have some experience. So is there one thing that you can think of that caregivers should ask their clinic this week?
Viki Droegkamp: [00:54:03] I, just generally speaking, like what resources that they can offer, because there's a lot that people are unaware of that clinics can do for them. But I think the biggest would just be like, who is the point of contact? Or who should I contact and how should I contact them if I need a question answered or whatnot. Because every clinic is different.
Linda Kritikos: [00:54:24] And then that leads me into my question. So what's the biggest MyChart proxy access mistake that you see individuals make in using those systems.
Viki Droegkamp: [00:54:35] Besides like asking about other patients within a certain, like asking about like somebody's wife in the husband's chart, besides that one, just sending paragraphs of things without a question or like, I don't know how to explain it. Like, yeah, just like sending a long thing and then saying you googled it. Like, that's not, a lot of people like Google their diagnoses. And that just, you know, instills more fear into them because it's not a provider telling them what is going on with them.
Linda Kritikos: [00:55:10] So keepin it short, sweet, to the point, with an ask.
Viki Droegkamp: [00:55:15] Yes, with an ask.
Pam Dunwald: [00:55:16] Yeah and don't ask Dr. Google.
Viki Droegkamp: [00:55:18] Yeah don't. And then usually wait for the provider to reach out in regards to test results. Because those get released to the patient before the team even sees them. So we are going to see them. We get a notification of when they're put in the chart, but it might be 10 p.m. on a Sunday. We're not going to see that until Monday the next day. So give us a little, give us like 24 hours to respond to you in regards to your test results.
Pam Dunwald: [00:55:42] You know, that's really, really, and I'm glad you brought that up, Viki, because that's a really good point to know that oftentimes you can see those labs. But I know when I look at, say, my own MyChart, it will say these labs have not been reviewed yet by your physician. So, you know, it's real important to make sure that when you're looking at those labs, you know, your doctor will answer it if there's something going on, good or bad, they're really good about that. But they may just not have seen them yet.
Linda Kritikos: [00:56:08] And, you know, if a caregiver is overwhelmed, what's the fastest way to get through to the clinic?
Viki Droegkamp: [00:56:14] Depends on the clinic. Probably just calling the clinic. My organization now switched over to Pact, which is a call center. So when you call the clinic directly, it routes you to like a nurse in Illinois, and then they can triage you or they can connect you to the clinic. So it's not great. We're still working through the kinks of that. So probably with my clinic MyChart is the best. If it's not urgent.
Pam Dunwald: [00:56:39] All right. So let's wrap this up. And so we want to make this practical for everyone. So your next step is to call your clinic and ask what supportive services are available, and who is the contact person. Who should you be reaching out. So that is the first thing that we want to bring home again about this episode.
Linda Kritikos: [00:56:57] And then the next thing is, is if you don't have access to MyChart, get that set up or ask the clinic to help you set that up, especially proxy access if you're managing care for a parent or a spouse, that's really important.
Pam Dunwald: [00:57:13] And you know, if this episode has helped you, you know, consider sharing it with a friend, a sibling, or a caregiver, or a coworker who's caregiving right now.
Linda Kritikos: [00:57:25] Yeah. Remember, caregivers don't get a handbook. And this is the kind of support that can make a really huge difference in the ability of caring for someone else, because it's a big undertaking. So we want to thank Viki very, very much for joining us today and sharing some of the best practices on how to best utilize your primary care clinic as a resource.
Pam Dunwald: [00:57:48] And, you know, also make sure you subscribe to Healthcare Redefined: Advocating for Aging Adults and Their Families so that you don't miss a single episode.
Linda Kritikos: [00:57:57] And if you have a minute, please leave us a review because it really helps us help more families find this podcast when they're searching for answers.
Pam Dunwald: [00:58:06] And we really want to thank you for being here with us today.
Linda Kritikos: [00:58:09] So you're not alone in this, and you don't have to figure it out all at once. We'll see you next time.
Pam Dunwald: [00:58:15] Take care.