Telemedicine

Let's change our thinking and remove barriers using technology. Face to face appointments can be augmented using the options below.

  1. Text - this is for simple questions that can be answered in a couple sentences. For example, “How is my thyroid level? Do I stay on the same dose or increase?” 

  2. Email - this is probably the most common method. Email is for more complex questions and answers take up to a couple paragraphs. For example “What about Vitamin D in the event I get Covid 19 infection?”  Then I can email about the available research. From here we can go to a phone or video visit if the question is more complicated. If you need a physical visit, may order appropriate medications, lab tests or imaging and give advice prior to coming in. 

  3. Phone: ideally this will be scheduled. Sometimes you can get me, but often I am working. This contact method is best for more complicated conditions where I need a more thorough history and you need detailed instructions about what to do. We can then determine if a video or physical visit is necessary. 

  4. Video: this also needs to be scheduled, and works for moderate to complicated issues where something needs to be visualized and I can observe how you sit, stand, walk, see joint swelling, small lacerations, rashes, etc.. 

  5. Using telemedicine, we may order tests first and then have the exam, increasing time efficiency and minimizing disruptions to your schedule. Here are just a few examples of what can be handled - labs results, diagnostic testing results, mental health, new symptoms, chronic headaches, allergies, hypertension, diabetes, rashes/skin lesions, back pain, upper respiratory tract infections (colds, sinusitis), UTI (urinary tract infection), hypertension (if you have a reliable b/p cuff), allergy symptoms, nausea/vomiting/diarrhea, heartburn. 

Appointment Tips

1. Write down all questions, concerns and goals. Then arrange the most important issues at the top. 

2. Have there been any medication changes or other changes in your health such as a surgery, new symptoms, etc. 

3. Avoid tobacco and caffeine for several hours prior to the appointment.

4. During the pandemic, avoid bringing others if possible. 

5. If you have known exposure to someone with Covid 19, fever, cough, shortness of breath, body aches, recent sense of smell/taste loss then let's order a diagnostic test first. 

6. Remember to turn phone volume off. 

 
 

Services

  1. Diagnostic evaluations, management chronic conditions, preventive medicine, smoking cessation, weight loss counseling, stress reduction, sleep hygiene and behavioral health. 

  2. Telemedicine: contact via text, email, phone or two way video - insurers traditionally required face to face only as a way to get the care you need, but this is inefficient and sometimes unnecessary. The lack of telemedicine is saving your insurance money at expense of you health and peace of mind. Fewer barriers to medical care when you need it is a mark of quality - this helps get things going before the visit, which typical insurance clinics can’t provide and can help to avoid ER and urgent care visits. Simple issues can be resolved without an appointment and further disruption to your schedule. Since the Covid - 19 pandemic, insurers have loosened paid for telemedicine services, but for how long and will they rely on doctors who don’t know you personally. 

  3. One cash pay non-DPC doctor visit pays for as many visits as you need for 3 months. If you pay my cash price, you may be able to get partial reimbursement from your insurer, but not Medicare.

  4. Incredible personal attention - the better we know each other, the better and more efficient your care is. Constantly changing between providers is exhausting and breaks continuity of care. When there is a health concern, you need your doctor, not just any doctor. 

  5. 24/7 extended availability- care when you need it. Care weeks later is a “day late and a dollar short”. 

  6. Technical expertise - internal medicine knowledge and skills 

  7. Extra benefits of annual physicals, skin biopsies, simple laceration repair and more. EKGs available in the future. 

  8. Medication management and minimization,  and low cost prescription drug dispensary in the clinic. For some patients, we may be able to avoid the pharmacy altogether. 

  9. If cash paying, you have access to low-cost lab tests at cash prices from the major national lab, Quest Diagnostics. The same goes for imaging tests and pharmaceuticals. We have some common, basic medications on hand you will leave with from the appointment. 

  10. Medical advice based on you as a person and lifestyle counseling for stress reduction, exercise, diet, anxiety and depression. Most insurance physicians only have the time to scratch the surface, if at all. This is why many perceive we are treating the symptoms and ignoring the underlying causes. 

  11. Preventive care - we have the time to go over everything and accurately determine those services that are more likely than not to benefit you. Not everything advertised as “prevention” or “wellness” necessarily makes sense for you.

  12. Mental health - There is no clear separation between the brain, mind and body. With a little more thought, even the environment impacts our functioning at the genetic level, so called epigenetics. Check out the Dr. Jud Brewer app “unwinding anxiety”. 

  13. Coordination of care - most primary care providers are simply too overburdened to follow up with specialists, imaging and blood tests in the necessary detail and then personally communicate the interpretation to you.  The EMR system used ensures results from specialists, labs and imaging are seen right away and the results communicated to you ASAP. 

  14. Cognitive Behavioral Therapy and mindfulness - unwinding anxiety app - anxiety can be perpetuated as a habit. “Because I worried, I came up with a solution” - worry is a behavior. Eventually the sense of control is realized to not be working and then they get into a positive feedback loop. 

  15. What’s not covered - Costs due to hospitalization, ER visits, specialist consultations, surgeries, medications and labs are not included. Essentially, those services I am not able to provide directly are not covered. DPC is not insurance

 

Ascent Internal Medicine

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Contact

Phone: 541 771-2932

Address: 354 NE Greenwood Ave., #113

Bend, OR 97701

Email: contact@ascentinternalmedicine.com

This practice does not constitute insurance, and billing occurs at the end of the month. This practice provides only the limited scope of primary care as specified in the retainer medical agreement. Specialty and/or hospital care, pharmaceuticals, vision, dental and testing (labs that are not included, X-ray, Ultrasound, etc.) are not covered by your fee and are your financial responsibility. Labs ordered through Quest are billed at my cost and are paid to Ascent Internal Medicine. You can contact consumer advocates at the Department of Consumer and Business Services at (888) 977-4894, dcbs.insmail@state.or.us, or Oregon Insurance Division.

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