Frequently Asked Questions:

1. Why is different from other medical practices I've used before?
2. Can I get better quality health care with ?
3. How can you treat me over the phone-or by email? How do you know you might not miss something?
4. What are Dr. Dappen's qualifications?
5. Why are there no other practices like ?
6. Do you accept my insurance?
7. Why should I pay out of pocket for medical services my insurance company could pay?
8. How are labs, X-rays, and referrals covered since you don't accept my insurance?
9. What happens if I need labs or X-rays?
10. How do I set up a physical exam?
11. Do you really do house calls?
12. Does protect my confidentiality?
13. Can you call in controlled substances?
14. What happens if I need help while I'm traveling?
15. Examples of real patients

Answers:

1. Why is different from other medical practices I've used before?

is a traditional medical practice. We offer personalized care of the highest quality and encourage you to be an active, educated participant in your own health care. is also a lot more. In addition to caring for patients of all ages, providing illness and wellness care, and attending to acute and chronic medical problems, the practice model provides innovative solutions to improve the three cornerstones of care: communication, quality of information and trusting relationships.

Communication: The traditional health-care model is “office centered” and makes the doctor available only after you have talked to numerous office staff. This model assumes that every medical question requires a face-to-face visit with a doctor.

At the doctor is available and paid to answer your phone calls or e-mails 24/7. In our model, you tell your story once, to your doctor. patients can usually get what they need through a phone call or email. When an office visit is needed we can arrange to see you, almost always on the same day (including evenings and weekends.)

Quality of information: Medical information is vast, complex, and constantly changing. Traditional practices use the “Hippocratic Method” of information retrieval (i.e. information is limited to what your doctor recalls from memory.) This method hasn't changed in thousands of years and ignores the availability of powerful information technologies.

At , your board-certified doctor is constantly connected to information technologies that allow him to:

• Instantly review and update your electronic medical record.
• Rapidly search medical databases, libraries, and journals to help diagnose unusual problems or investigate the most up-to-date information about a particular malady.
• Immediately order or review tests and x-rays, or call your prescriptions to a pharmacy.
• Send relevant medical articles and recommendations to your email box.

See what a difference it makes when the information of thousands of doctors is at your doctor's finger tips!

Trusting Relationships: In the current system, doctors have become the reluctant employees of insurance companies. Insurance adds layers of bureaucracy and regulations to health-care, resulting in less convenient care, sky-rocketing costs, and frequent conflicts of interest between what is best for the patient and what is profitable for the system.

At , we have no contractual arrangements with insurance companies so we can focus solely on the needs of the patient. We have found creative ways to work with your insurance while offering you the highest quality care for a fraction of what traditional practices charge.

To see how patients respond to the model, check out what others are saying.

2. Can I get better-quality health care with ?

YES! The Institute of Medicine's recent book, " Crossing the Quality Chasm: A New Health System for the 21st Century, " highlights many areas where the traditional model is failing. addresses these shortcomings. Examine the difference.

10 Criteria for Better Health Care Delivery*

Criteria	Practice	Traditional Practice
1. Patients should receive care whenever they need it and in many forms, including over the Internet and by telephone.	Excellent	Poor
2. The system of care should be able to respond to individual patient choices and preferences.	Very Good	Poor
3. Patients should be given all of the relevant information and control over their medical decisions.	Excellent	Poor
4. Patients should have unfettered access to their own medical information and to clinical knowledge.	Excellent	Poor
5. Patients should receive care based on the best available scientific knowledge.	Exellent	Fair
6. Patients should be safe from injuries caused by errors.	Very good - Focus on patient care	Fair - Distracted by insurance demands
7. The health care system should make information available to patients and their families so they can make informed decisions when selecting a health plan, hospital or clinical practice. Rather than reacting to events, the system should anticipate patient needs.	Fair	Fair
9. The system should not waste resources or patient time.	Very good	Poor
10. Clinicians and institutions should collaborate and communicate to ensure an exchange of information and coordination of care.	Very good - Full utilization of electronic communications	Fair - Different forms of communication not integrated

*Institute of Medicine Criteria, from "Crossing the Quality Chasm: A New Health System for the 21st Century," http://www.ama-assn.org/amednews/2001/03/19/prl10319.htm

3. How can you treat me over the phone or by-email? How do you know you might not miss something?

Dr. Dappen feels strongly about getting you the best health care possible and is ready to see you at any time—days, nights, and weekends, at his office or at your home. At the same time, we won't pretend you need an office visit when it adds nothing to your care.

Treatment by phone is not new. In fact, phone medicine is a tradition as old as the phone itself and is practiced throughout the country during non-business hours. Nor is phone care substandard. In fact, studies have shown that 60-80% of visits to a family doctor's office are unnecessary. Patients often need to speak to a doctor though a physical exam isn't needed.

Unfortunately, insurance companies do not reimburse doctors for phone care, so doctors must get patients into the office in order to stay in business. Consequently clinical staff are assigned to the phones and they decide how long your medical problem can wait before you are seen by a doctor. Making the doctor available to talk to you at any time avoids delays and saves money without sacrificing quality of care.

4. What are Dr. Dappen's qualifications?

Click here for Dr. Dappen's credentials.

5. Why are there no other practices like ?

First, phone calls cannot generate the revenue of office visits. The fact that phone calls are free means that doctors find someone else to answer the phones and instruct employees to schedule office visits for patients wishing to talk to the doctor.

Second, most medical offices lack our ability to immediately access your medical files when you call. Not all decisions require a complete medical record, but physicians often cannot remember the relevant past details of your medical story without having your chart.

Third, insurance companies today only pay for office visits. Most doctors must focus on how insurance companies will pay them if they are to stay in business, so they stay in the office and off the phone.

Fourth, in a traditional office, a large and expensive bureaucracy surrounds the doctor. Medical bureaucracy consumes 15% of the US Gross National Product, meaning that there are powerful financial interests invested in maintaining the status quo even where it is inconvenient and expensive.

6. Do you accept my insurance?

No, not directly. However, our phone and e-mail services frequently cost no more than an insurance co-pay and you are charged only for the time your doctor spends working for you.

Also, can work with your insurance in some cases. If you're in doubt about what your insurance covers, call the number on your insurance card and ask specifically, "What are my costs if I see an out-of-network provider?" and, "As long as I go to an in-network lab or x-ray department, does it make any difference which doctor orders the tests that I need?"

Some general information about insurance:

-HMO Insurance including Kaiser - For this group we can best address straightforward, uncomplicated problems where you need advice or it's obvious that you need a medication and inconvenient to go through the traditional system. Also, some conditions aren't covered by traditional insurance plans (i.e. travel, obesity, smoking cessation) and can out-compete other providers in terms of access, convenience, quality, and price in these areas.

-PPO Insurance - Labs, x-rays, medications, and referrals are covered by your PPO health plan and face-to-face office visits are partially reimbursed. People choosing PPO plans do so because they want to be in better control of their health care. and Dr. Dappen fit this demand perfectly.

-No insurance, high-deducible coverage or flexible/medical/health savings accounts - If you are the one paying your health care bills, then there is no other practice which can compete with on price, convenience, access, quality of information and overall care. Our knowledge about the pricing of medical services is growing. We can pass this knowledge directly to our patients. Most clinical practices don't deal with these questions in a systematic way and don't concern themselves with pricing.

-Medicare - You can order all your labs and x-rays and they are covered by Medicare. You are charged for the time it takes the doctor to order the test and get the results back to you, usually 10-15 minutes of time.

Paradoxically, can be more convenient and offer better care by not being a preferred provider.

7. Why should I pay out-of-pocket for medical services that insurance could pay?

Because we can often provide a superior service at a competitive price. If you take into account the hidden costs associated with your health insurance, you will see that is extremely cost-effective. Besides, with , you get:

• Unlimited access to convenient health care.
• A quick response and adequate time with a doctor.
• Good information about your health issues.
• To choose a doctor based on something other than whether he or she is covered by your insurance plan.
• A doctor who works for you, not your insurance.
• Transparent, fair pricing of all medical charges.
• Truly confidential health care - it is between you and you doctor.

When you include the full cost of your insurance - co-pays, gas, mileage, non-covered medical expenses, and time off work, using is frequently less costly than going through your insurance, and that assumes that you're still paying insurance premiums while using !

8. How are labs, x-rays, prescriptions, and referrals covered since you don't accept my insurance?

For HMO patients: Prescriptions are still covered, irrespective of the prescribing doctor. Some HMO plans will also allow “out-of-network” doctors to order labs and x-rays. Call your insurance to find out if your plan covers this service.

For PPO and POS patients: The costs of labs, X-rays and prescriptions should be completely covered under your insurance agreement as long as they are arranged at an "in-network" facility. Additionally, many referrals do not need authorizing paperwork - you can see anyone you like if you or a doctor decides a specialist or specific procedure is necessary.

For Medicare patients: The actual labs, x-rays and medicines are covered if arranges them for you. You are, however, responsible for the time spends with you.

For out-of-pocket, high-deductible and flexible/medical/health savings accounts patients: We are the best value available for people who have no insurance or who pay high deductibles because we have redesigned our practice to keep health care affordable. We also specialize in keeping lab and prescription costs down for those who are paying their own bills. This is something that most doctors within the traditional insurance world don't ever have to master.

9. What happens if I need labs/ X-rays?

We have working relationships with different x-ray centers and labs and can immediately fax an order to the lab or radiology center that's most convenient for you. Once you get the test done, we'll get the results promptly and call you back to review the findings.

For those with PPO insurance, these tests don't need to be ordered exclusively by a preferred provider, so you get a lot more flexibility without worrying about the lab or x-ray testing bills. For those without insurance, we can direct you to the lowest-cost centers as necessary. The fee charges to set this up usually costs you $35.00 or less under plan A - more inexpensive and involving less time and hassel than with any other medical practice we know.

10. How do I set up a physical exam?

Physical exams are done at just as they would be at any other medical practice. Since more than 50% of the physical consists of reviewing your medical history and lab work, we suggest that most people start by calling the doctor and covering this information over the phone. This saves time and money and any needed labs can be ordered so that they are available for review at the time of your visit. The time required for a physical (including preliminary calls) is usually around 30 minutes.

Women might also prefer to schedule a well-woman/PAP physical exam with our nurse practitioner, Valerie Tinley FNP.

11. Do you really do house calls?

Yes! If your problem requires a face-to-face visit and you cannot come to us, then we can come to you. We usually are able to provide same-day service. We reserve the right to deny this service to those living especially far away and cannot guarantee that we will be able to provide a house call at unusual hours. House visits are easiest to arrange for non-urgent problems. We will typically travel within five miles of the office, although there are cases where we can travel twice this distance.

Due to Virginia medical licensing restrictions we are unable to make house calls to Washington DC or Maryland.

There are additional “distance” charges added to the bill for visits further than 5 miles away. Click here for more information about house call pricing.

12. Security and confidentiality issues:

We now have a page devoted to security and confidentiality issues. Please go to http://www.doctokr.com/security/ for more information.

13. Can you call in controlled substances?

Yes, but not in all cases. Some substances, like Percocet or Ritalin, require a hand-written prescription and we NEVER call in controlled substances for people who are not already patients. Also, new members who join hoping that we will manage their chronic pain should be aware that we are not a chronic pain clinic and do not provide this service. The misuse of controlled substances is a real problem and we have found the prescription of controlled substances is best managed when trusting doctor/patient relationships have been established over time.

14. What happens if I need help while I'm traveling?

Just call or email your doctor! This is one of the major benefits of being a patient.

No matter where you're located - at home, the office, or travelling anywhere within the US - you can reach your doctor or nurse practitioner. If you're sick or having a medical question, pick up the phone (toll free 1-888-) or drop us an email for non confidential/non urgent questions. If we can make a clear diagnosis, we're able to call in medications to any pharmacy in the country. We can also send you supporting articles or medical documents, and we can let you know if a problem might need to be seen right away by a local doctor. We can even arrange treatment in other countries.

Furthermore, many of the necessary travel vaccines can be given at the clinic. If you are a PPO member using , you should keep in mind that most Insurance companies will not pay for travel advice or vaccines. In the area of travel medicine, we can be more efficient and cost effective than almost any other medical practice. Having a supply of emergency medications while travelling is always a good idea, especially in third world countries or remote areas, and we would like to help you put your travel first aid kit together.

15) Real life examples

Patient #1 called because he was traveling outside the U.S. to a malaria zone and wanted advice. The doctor referred to the CDC travel web site for up-to-date information about malaria and other endemic diseases and recommended vaccines for the patient. Malaria medicine and back-up antibiotics were called-in to a nearby pharmacy and the patient was sent to Public Health Services for some needed, hard-to-get vaccines. The patient also received detailed health travel information in his e-mail box.

Cost for 15 minutes of phone and email consultation = $45.00 (Plan A) or $60.00 (Plan B)

Patient #2 twisted her ankle weeks ago and continued to limp because of pain and swelling that were gradually improving but had not gone away. Over the phone, the patient said that the skin around her ankle, leg and foot wasn't red or bruised, but that pressure on the ankle bone was very painful. The doctor, knowing that it was critical to determine if the ankle had been fractured, faxed in an order for an x-ray to a nearby radiology center. The patient got the x-ray at her convenience and the radiologists called Dr Dappen with results later that day. The doctor promptly relayed the results to the patient. The x-ray showed that the patient's ankle was not fractured, so Dr. Dappen emailed specific ankle strengthening exercises to the patient and advised that 2-3 more weeks of healing time could be expected.

Cost for 10 minutes of phone and email consultation = $30.00 (Plan A) or $40.00 (Plan B)

Patient #3 was on cholesterol-lowering drugs and needed routine follow-up blood tests to measure cholesterol and monitor potential side effects of the medicine. Dr. Dappen sent the patient an email reminder that it was time to recheck lab work, faxed the lab, then notified the patient that the tests had been ordered. The patient went to the lab at a convenient time. Within 36 hours the test results were back, the patient was called and the results reviewed.

Cost for 10-15 minutes of phone and email consultation = $30.00-$45.00 (Plan A) or $40.00-$60.00 (Plan B)

Patient #4 called Dr. Dappen at 7 AM with typical urinary tract infection (UTI) symptoms, including burning with urination and frequent urination with very little urine coming out. She had no fever, and was used to having a UTI 1-2 times a year. Upon talking over the phone, she and the doctor agreed that she was experiencing a normal UTI and the doctor immediately called a 24 hour pharmacy with a prescription for medicine that she could pick up within 30 minutes. Follow up recommendations were posted in her email box along with possible side effects of the antibiotics. She was feeling better in time for work that day.

Cost 5 minute phone conversation = $15.00 (Plan A) or $20.00 (Plan B)

Patient #5 had hypertension. He had been on blood pressure (BP) reducing medicines for about 6 months but had time constraints that made regular office visits difficult so he didn't know if his BP was well-controlled. The patient reviewed his medical history and medicines with the doctor and answered some lifestyle questions over the phone. The mandatory "1st office visit" wasn't initially necessary since this patient was well-known to the doctor. Dr Dappen insisted that home BP monitoring be done several times a week. Supporting information and a medical information release form were emailed to the patient and patient agreed to keep track of his BP for 4 weeks. An 10 minute Saturday office visit was scheduled so that home BP readings could be reviewed and compared with the doctor's readings. After that, the patient was able to use his home BP monitoring to recognize the effects of medications and stress, yet retained access to the physician for phone consultation and advice.

Cost 10 minute phone conversation + 10 minute office visit = $75.00 (Plan A) or $100.00(Plan B)

Patient #6 called on a Sunday with a sore, bumpy rash on her back that had appeared the day before. She didn't know the cause. The doctor scheduled an office visit for later that same day so that he could properly diagnose and treat the rash. It turned out that she had shingles.

Cost 5 minute phone call + 10 minute office visit = $59.00 (Plan A) or $78.00 (Plan B)

Patient #7 was a 48 year old rock climber who was travelling when he noticed a small scab on the back of his finger had become badly infected. When the affected finger began to stiffen, he called Dr. Dappen. The doctor called in antibiotics to an out-of-state pharmacy and advised that if warm soaks and antibiotics didn't make a difference within 36 hours, it needed to be seen for possible drainage. 36 hours Later, the patient and was advised to go to an urgent care center. The wound was drained and intravenous antibiotics were administered in addition to the ones that had been prescribed by Family Medicine.

Although this patient was unable to make it in to the office for treatment, lets compare his urgent care bill to charges for the same procedures.

Urgent Care Procedure	U.C. Price	Procedure	Our Price
Extended Office Visit	$110.00	10 Minute Phone Consult	$30.00
Incision & Drainage	$150.00	25 Minute Office Visit	$110.00
IV Placement	$150.00	IV Placement	$20.00
1 Gm Rocephin abx (Antibiotic)	$140.00	1Gm Rocephin abx (Antibiotic)	$90.00
Follow-up Care (Short Office Visit)	$80.00	Follow-up Care (5 Minute Phone Consult)	$15.00
TOTAL	$630.00	TOTAL	$265.00*

* This assumes that the patient is on Plan A. The Plan B total would be $281.00.

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