Office Policies and Medical Home Agreement

Affordable Quality Care

 

Principles of Medical Home

The American Academy of Pediatrics introduced the medical home concept in 1967, initially referring to a central location for archiving the medical records of a child. In its 2002 policy statement, the AAP expanded the medical home concept to include operational characteristics.

In February 2007, the AAP, the American Academy of Family Physicians, the American Osteopathic Association and the American College of Physicians used this concept to develop a set of joint principles. These principles address the medical home partnership, in which access is facilitated to specialty care, educational services, out-of-home care, family support, and other public and private community services important to the overall health of the patient.

As identified by the patient centered Medical Home Collaborative and adopted by OHCA and Affordable Quality Care, the principles of a Medical Home are as follows:

• Personal HealthCare Provider: Each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.
• HealthCare Provider Directed Care: The personal healthcare provider leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of the patients.
• Whole Person Orientation: The person healthcare provider is responsible for providing for all the patient's health care needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life; acute care; chronic care; preventative services; end of life care.
• Care is coordinated and/or integrated across all elements of the complex health care system (e.g. subspecialty care, hospitals, home health agencies, nursing homes) and the patient's community (e.g. family, public and private community-based services). Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.
• Quality and safety are hallmarks of the medical home.
• Enhanced access to care is available through systems such as open scheduling, expanded hours and new options for communication between parties, their personal physician, and practice staff.

 

Patient Information and Responsibilities for Medical Home Agreement

As a Sooner Care member, there are rules you must follow

It is your responsibility to:

• Be aware of your personal healthcare provider's office hours so you will know when you can be seen.
• Call for an appointment as early as possible.
• Keep your appointments.
• You may have to wait up to three (3) weeks to be seen for checkups and shots.
• Even if you have an appointment, you may have to wait past that time to see your personal healthcare provider. You should ask to reschedule if you cannot wait.
• If you cannot keep your appointment, you must call the provider's office at least 24 hours before your appointment. Your provider may ask to dismiss you as a patient if you continually miss appointments.

When you call your personal healthcare provider you should always:

• Tell the staff why you need an appointment.
• Have your medical ID card available for every call, every time.
• Call your personal healthcare provider's office if your problem gets worse before your scheduled visit. Ask to speak to the nurse. Tell the nurse what symptoms you have and ask if you should be seen sooner because of them.

 

Medical Home Agreement

During your visit with your personal healthcare provider you should always:

• Give staff the information they need to help you. This includes telling them about your symptoms.
• Tell your personal healthcare provider your medical history.
• Take shot records to personal healthcare provider's appointment.
• Inform your personal healthcare provider of all prescription drugs, over-the-counter medications, and herbal supplements you are taking.
• Inform your personal healthcare provider of any medical equipment you are using.
• Inform your personal healthcare provider of any other health care appointments.
• Follow the treatment plans and guidelines that your personal healthcare provider gives you.

Please also keep in mind:

• Your personal healthcare provider will refer you to a specialist as needed. You will get a referral only if indicated by our personal healthcare provider. The specialist must be a SoonerCare provider.
• You must get a referral BEFORE you go to a specialist.
• Do not ask your personal healthcare provider for a referral AFTER you have seen a specialist.
• If you personal healthcare provider gives you a referral for services that is not covered under SoonerCare, you will have to pay for it.
• If you do not keep your appointment, the specialist may not give you another one.
• Your personal healthcare provider will not give a prescription he/she does not determine is needed.
• SoonerCare allows unlimited personal healthcare provider visits monthly.
• SoonerCare limits specialty visits to 4 times per month.

After hours coverage:

• If you have an urgent medical need, please call 405-217-9997 (Affordable Quality Care's main phone number). You mut leave your name and phone number and a brief message. The phone system will page the personal healtchare provider on call for the evening or weekend who will return your call within 15 minutes. The AQC healthcare providers will NOT return calls requesting appointments, referrals, paper work, lab results or other routing office matters.
• You may also call the Patient Advice Line for SoonerCare at 800-530-3002 after 5pm weekdays or anytime on the weekends and holidays.
• If you think you have a true medical emergency, go to the nearest emergency room or call 911 (or your local emergency number).

Affordable Quality Care Policies

• You should always expect provider and staff to treat you professionally and repectfully. It is also expected that you and your family members will treat the providers and their office staff respectfully and will refrain from using rude, offensive or threatening behavior. You may call the SoonerCare Helpline to report complaints or concerns regarding any AQC provider or staff members.
• We see patients primarily by appointment but will see walk-ins if the time and schedule allows.
• Insurances we accept are: Medicaid, Medicare, O-EPIC, Tri-Care, HealthChoice, United Healthcare, Cigna
• We accept cash, check and credit cards.
• All payment except insurance payments are due PRIOR to services being rendered.
• All patients with insurance must pay co-pays PRIOR to being seen or having other services provided.
• All routine medication refills, questions about labs and x-rays, referral needs must be taken care of during regular business hours. We will not return calls for these after hours. We may access your prescription history database to verify information about what prescriptions you've had filled or check dosages that you may not remember.
• This is a nurse practitioner family practice clinic and as such can provide healthcare to all ages from birth through the elder years. Our role and scope of practice includes care for minor acute illnesses, stable chronic conditions, patient education, health and wellness care, and referrals to specialists if so needed. We can order and interpret tests, write prescriptions, oversee or manage your case if other healthcare providers are involved.
• We reserve the right to dismess any patient from our services who we feel is outside our scope of practice.
• Our goal is to provide top quality medical care for your entire family at a price that is reasonable for most members of the community. However, we are a business, not a charity and so must keep our prices at a level to pay ourselves a reasonable salary and pay our expenses. From time to time as our costs of doing business increase we will find it necessary to raise our prices.
• We will not prescribe narcotics for long-term use for any patient for any condition.

Office No-Show Policy

If you have two "no-shows" within a 6-month period, you will no longer be allowed to schedule an appointment. You must be seen as a walk-in. As a walk-in, you will not have the priviledge of an appointment time, nor will you get to choose the provider to see you. Please respect our time and cancel your appointment if you are unable to come at your scheduled time. The goal of this policy will enable us to continue offering same-day appointments.

 

Prescription Refill Requests

For any prescription refill requests we ask you call your pharmacy and request your refills through them. The pharmacy will in turn send the request directly to your provider electronically. This saves time for both you as a patient and our office as a provider.

Prescription Medications

Nurse Practitioners cannot legally prescribe: Ritalin, Metadate, Methylin, Adderall, Concerta, Dexedrine, Focaline, Percocet, and Oxycontin. If you need these medications, then you must see a physician and not a nurse practitioner.

It is the policy of Affordable Quality Care that all the staff work within their scope of practice. In order to do this we do not prescribe narcotics for chronic pain. This includes, but is not limited to: Lortab, any medication with Codeine, Demerol, Fentanyl and Morphine. If you need these medications, then you must see a physician and not a nurse practitioner.