Question for solo docs

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ateria radicularis magna

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Hey all,
If you prescribe medications and you have no partners, what do you do when you are on vacation?
Thank you!
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I don’t prescribe or do implants anymore for this reason. You could have a gentleman’s agreement with another solo doc to cover emergency calls
 
ateria radicularis magna said:
Hey all,
If you prescribe medications and you have no partners, what do you do when you are on vacation?
Thank you!
Click to expand...
I do not understand. You need an OV to Rx. So if you are not in office, you have no problem. Make sure patients who have upcoming Rx renewals are seen prior to you going on vacation. Same thing for holidays when office is closed.
 
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They should have 1 months of meds.
 
You have two options:

1. Squeeze the patients who need med refills in right before your vacation.
2. If that's not possible or undesireable, just give them 2 scripts at the office visit the month before and have them follow up in 2 months.

Either way, arrange for someone to cover emergency calls or you should be available by phone/EMR if needed.
 
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Because I'm solo I haven't a vacation longer than 5 business days
 
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i have only been out of the country once in the past 10 years.

the nurses put in to Epic the refills, puts it in the common "Provider Pool" (APP and myself) and when i feel like it, i get on and sign the ones not done by the APP electronically during vacation. 6 am before everyone is awake is a good time.

ive tried timing and having nurses and staff look ahead of time. that works for the most part but a few will slip through.

limit your opioid panel, then you dont have to worry too much about it too much...
 
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try to get anyone in before you leave. dont do any crazy procedures before you leave.
The gift of the pandemic is patients can be seen and eRX'd medications virtually. So if there is someone that slips through the crack, get on Doximity and video chat them and get on your emr and refill. 5min visit, 99214-95
 
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Those that are saying "make sure refills are done before you leave," are all your patients responsible enough where they make their appointments on time in order to refill their meds? I have some frantically calling the office for refills despite no-showing for their appropriately-scheduled time. I can't be the only one.
 
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Darkside_ said:
Those that are saying "make sure refills are done before you leave," are all your patients responsible enough where they make their appointments on time in order to refill their meds? I have some frantically calling the office for refills despite no-showing for their appropriately-scheduled time. I can't be the only one.
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You could make the argument that if they’re not responsible enough to make and keep appropriate appointments, they’re not responsible enough to be prescribed those medications.

Put it in your opioid contract and verbalize when initiating or taking over a script. It’s their responsibility to make appropriate appointments, scripts are only sent at office visits, and no bridge scripts will be called in. If they come in making a stink because they went through withdrawals because they didn’t listen, print off their signed contract and highlight the pertinent lines. As the kids say, they effed around and found out.
 
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unchockey21 said:
You could make the argument that if they’re not responsible enough to make and keep appropriate appointments, they’re not responsible enough to be prescribed those medications.

Put it in your opioid contract and verbalize when initiating or taking over a script. It’s their responsibility to make appropriate appointments, scripts are only sent at office visits, and no bridge scripts will be called in. If they come in making a stink because they went through withdrawals because they didn’t listen, print off their signed contract and highlight the pertinent lines. As the kids say, they effed around and found out.
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Technically it’s not a contract. It’s an agreement.
And as the recent case has shown, you can be sued and lose if they do something stupid because you didn’t refill. The lawyers will say you were out galavanting somewhere instead of tending to your withdrawing patient or some garbage like that.

Unless it’s a last minute vacation, your schedule should already be blocked in the emr so when the staff goes to make an appointment, they should schedule accordingly or at least ask you what to do.

Anything other than opioids, they can also ask their pcp to refill once.
 
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Im in the same boat as dr ice and pmrmd.

Work is way easier than kids. Still go on vaca..... but its not really a vaca
 
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Darkside_ said:
Those that are saying "make sure refills are done before you leave," are all your patients responsible enough where they make their appointments on time in order to refill their meds? I have some frantically calling the office for refills despite no-showing for their appropriately-scheduled time. I can't be the only one.
Click to expand...

Repeat after me: "Your failure to plan is not my emergency".

I'm happy to schedule the patient for first available office visit, and if otherwise compliant, will also send in Rx to last until that visit. If they're not otherwise compliant, will be glad to help by sending in clonidine/zofran until the scheduled visit.
 
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Tylenol #4 could be called in As a substitute without an in person visit as a bridge until you get back. If anything greater than that is required, call in clonidine in case they have any withdrawal with the recommendation for them to go to the ER for assessment.
 
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It isn't that uncommon for me to refill meds on vacation. I'm not sure why this is a big deal.

Any of yall in private practice? This is normal.

Edit - This includes opiates.
 
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myrandom2003 said:
Technically it’s not a contract. It’s an agreement.
And as the recent case has shown, you can be sued and lose if they do something stupid because you didn’t refill. The lawyers will say you were out galavanting somewhere instead of tending to your withdrawing patient or some garbage like that.

Unless it’s a last minute vacation, your schedule should already be blocked in the emr so when the staff goes to make an appointment, they should schedule accordingly or at least ask you what to do.

Anything other than opioids, they can also ask their pcp to refill once.
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I hear you and certainly agree with trying to do whatever you can on your end to minimize the impact. However, I don’t think that you can extrapolate that case to every situation involving an opioid refill, especially not knowing all of the details. Otherwise, where do you draw the line between accommodating someone out of fear of a lawsuit and just plain bad medicine?
 
MitchLevi said:
It isn't that uncommon for me to refill meds on vacation. I'm not sure why this is a big deal.

Any of yall in private practice? This is normal.

Edit - This includes opiates.
Click to expand...

In PP. I’m not sure about other states but Florida requires an in person office visit to prescribe opioids. Telehealth had been ok during the pandemic but that was stopped.
 
unchockey21 said:
In PP. I’m not sure about other states but Florida requires an in person office visit to prescribe opioids. Telehealth had been ok during the pandemic but that was stopped.
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Life happens to ppl on Norco BID.
 
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Get a PA.
Telemedicine is here until at least 12/23.
Get an emr system that you can use on vacation.
Verbal order to pharmacy , last resort .
Do CMEs on vacation and write stuff off…
 
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10KHertz said:
Get a PA.
Telemedicine is here until at least 12/23.
Get an emr system that you can use on vacation.
Verbal order to pharmacy , last resort .
Do CMEs on vacation and write stuff off…
Click to expand...

What do you write off when you do netCE while vacationing in Cabo?
 
There are build your own CME courses. You can select your location for your course and get some Amazon gift card money as well.
 
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Newbie question - how do you handle the tax deductions when doing one of these on a family vacation? Do you purchase your tickets and meals separately? Is only a portion of the hotel room deductible? Just hand a stack of receipts to your CPA and let them figure it out?
 
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Do cmes built around vacation...
Talk to your CPA regarding deductions. We all have different incomes , spouses on staff, tax risk, etc… enjoy life more
 
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How do you guys handle when your partner is out of town, and one of their pt calls in for a refill of their opioid? Apparently it has been standard practice with my current partner and my predecessor that they would just fill it for the full 30 days when one was on vacation. No calling in for an appt, no telemed visit, no exam, no short bridge course until the vacation is over. Basically they just write a short "note" saying they did not examine the pt but reviewed notes and it seems appropriate, no history of aberrancy, etc, even though they've never met them. I did it twice for him last vacation, but thinking of letting him know I'm not comfortable doing it anymore. I would never have him do it for me, because I always have my patients scheduled for an OV prior to a refill.
 
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SgtThunderfistMD said:
How do you guys handle when your partner is out of town, and one of their pt calls in for a refill of their opioid? Apparently it has been standard practice with my current partner and my predecessor that they would just fill it for the full 30 days when one was on vacation. No calling in for an appt, no telemed visit, no exam, no short bridge course until the vacation is over. Basically they just write a short "note" saying they did not examine the pt but reviewed notes and it seems appropriate, no history of aberrancy, etc, even though they've never met them. I did it twice for him last vacation, but thinking of letting him know I'm not comfortable doing it anymore. I would never have him do it for me, because I always have my patients scheduled for an OV prior to a refill.
Click to expand...
Bring them in for visit.
 
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MitchLevi said:
It isn't that uncommon for me to refill meds on vacation. I'm not sure why this is a big deal.

Any of yall in private practice? This is normal.

Edit - This includes opiates.
Click to expand...
I was planning to do this. Then I went to vacation in Costa Rica last summer and discovered that I couldn't log on to Athena from a foreign IP address. So rather unexpectedly, my partners ended up dealing with all of my messages. Will make sure that things are more squared away before I leave town again (especially if I leave the country)
 
difficult situation and something you definitely will want to square away with your partner.

he may be okay with you just writing for a 1 weeks worth until he gets back from vacation. thats what i would do.

esp since i have no empty slots,,,
 
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I think it depends on your office availability. However, there is likely no liability in what your partners are doing in the interest of continuity of care (assuming you're not making any changes of course). Alternatively you can do a telehealth appt or in office appt if you have the time.
 
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Ferrismonk said:
I think it depends on your office availability. However, there is likely no liability in what your partners are doing in the interest of continuity of care (assuming you're not making any changes of course). Alternatively you can do a telehealth appt or in office appt if you have the time.
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i would think the concern is liability for yourself. refilling a dangerous Rx without ever seeing the patient? what if something happened to that patient? I feel like lobelsteve would be licking his chops in court.
 
I know of a colleague who would regularly refill partner's scripts. One of the patients had an overdose and was referred to state medical board. The covering doc was cleared but had to hire a lawyer, come to a hearing, deal with all the stress, etc.
 
GoBeers said:
i would think the concern is liability for yourself. refilling a dangerous Rx without ever seeing the patient? what if something happened to that patient? I feel like lobelsteve would be licking his chops in court.
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I meant if he did what his partners are doing by just refilling the medication and leaving a note about the encounter in the chart.

You of course would need to document that you are prescribing the medication after a thorough review of records, reviewed the PDMP, chart shows no signs of aberrancy, UDS has been appropriate, etc. as well as the fact that you are only prescribing for continuity of care and to prevent unintentional withdrawal. Also document the patient will follow up with their usual provider at his/her next office visit.

I'm not saying it's the best care, but I doubt there is much liability in it.
 
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Work as hard as you can, fill up your schedule (enough for 1.5 people) and then hire a midlevel. Until then just jam pack your schedule before and after your 5 day (max # of days) vacation. You must have a "system" in place. Otherwise this dilemma will be eternal until the day you retire solo.
 
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