Partnering With Your Doctor to MakeTheRightCall

My patient, Jackie, hadn't seen a physician in years but was excited to tell me her daughter had recently helped her sign up for health insurance. 

‘Not bad at all,’ she said, ‘took about 20 minutes.’ 

She came to our free health clinic this Saturday morning just to ‘get her diabetes under control’ until she could establish a primary care doctor of her own closer to her home.  Because of her previous lack of insurance, she had gone without insulin, cancer screenings and illness and wellness care.  She was optimistic now and felt ready to make big changes in her life.

Jackie had the orange, “Your guide to Make the Right Call” info-graphic sheet in her hands.

“I was reading this”, she said as she pointed to the sheet.  “My daughter could have used this last week” 
she sighed.   “She took her son to the Emergency Room last week for a sore throat.   They waited almost 
4 hours!   They have new insurance too.  It was around dinnertime and my daughter didn't think her 
doctor’s office would be open.  Come to find out that office has evening hours.”

Jackie and I reviewed the info-graphic together.  Along with the symptoms listed I wanted to make sure Jackie, with diabetic medications now in hand, knew what warning signs to watch for if her blood glucose 
got too low.  She was going to check her finger-sticks in the morning before breakfast and one to two 
hours after beginning a meal.  We talked about the clinic hours and the best way to reach the clinic.  
We talked about symptoms based on her risk factors for other emergencies, when to call 911 and when 
an urgent care facility may be an appropriate option. 

Jackie will be seeing her new family physician soon.  She plans to find out what the office hours are and 
how best to reach her doctor on weekends and evenings. Jackie will also ask if the practice is affiliated with 
an urgent care clinic.  She knew that many free standing urgent care clinics wouldn't have access to her medication list and medical history and that she’d have to bring those along if she went.

As more patients are able to get a primary care physician, some for the very first time, understanding what kinds of emergencies might require a 911 call and when to call the primary care office is important.  

I know that Jackie will Make the Right Call.  I encourage others to discuss this info-graphic with your own doctor, so you can be prepared to do the same.

Barbara Tobias, M.D.
University of Cincinnati, College of Medicine
Department of Family and Community Medicine

Urgent Care vs. the Emergency Room: Where Should You Take Your Child?

Author:  Rima Rusnak, M.D.
Medical Director of the Urgent Care Centers at Cincinnati Children’s Hospital Medical Center

Imagine this: It’s a Monday evening and your daughter has not been feeling well all afternoon. You were hoping that she would be okay until tomorrow so you could get her in to see her pediatrician, but she only seems to be getting worse. Will she be okay if you wait until tomorrow to see a doctor? Should you take her to an Urgent Care, or maybe even to the Emergency Room? 

If at any time you just aren't sure where to go, often the best way to decide is to call your physician; he or she will direct you to the appropriate level of care. If you feel like you don’t have time to wait for a call-back from the physician on call, you should call 911 for help and a ride to the ER.

Here’s some information that may help you decide what to do and where to go if you find yourself in a similar situation. We will first review common emergencies and then discuss urgent (not emergent) medical concerns.

First, life-threatening emergencies should be handled in the Emergency Room (ER), and a call to 911 is the best way to get there. Please don’t try to take your critically ill child to the ER yourself. 

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Life-threatening emergencies include (but are not limited to):

• Breathing difficulties (including severe asthma attacks where the child is wheezing too much to count to ten or a baby is wheezing too much to drink or nurse)
• Severe trauma
• Seizures
• Allergic reactions with breathing problems, swelling, and/or vomiting
• Head injuries with loss of consciousness
• Neck injuries 

If your child’s injury or illness is not life-threatening, but needs emergent attention, your child should 
be seen in the ER, but does not necessarily need to go by ambulance.

Here are some emergent types of patients or situations that should be seen in the ER:

• Very young, un-immunized infants (<2 months of age) with fever or illness such as vomiting or diarrhea.  These patients should go to the ER because they will need testing that cannot be offered at an Urgent Care.
• Children with extensive chronic medical problems. 
• If your child has chronic medical problems, you should have a plan in place with his or her care providers that details exactly what you should do if you need help urgently.
• Psychiatric or social service problems. 
• Reproductive care or sexually transmitted infections.  Patients seeking this type of care should contact their physician’s office, or Planned Parenthood. If there is urgent need for this type of care, one of the ERs will be most appropriate.
• Emergency dental treatment. 
• Severe abdominal pain concerning for appendicitis. Lower right abdominal pain can be a sign of appendicitis.  

If your child does not have an emergent problem (but still needs to be seen quickly), and your pediatrician’s office is closed, Urgent Care is most likely the place to go.  It is helpful to remember that going to Urgent Care is similar to going to your physician’s office, with a few added services. 

Here are some of the most common things we examine and treat at Urgent Care:

• Simple lacerations (which may require stitches) and wounds
• Fractures and injuries to arms, legs, fingers and toes (bone not sticking out of skin)
• Ear aches
• Runny noses
• Cough 
• Fevers (fever at or above 100.4 in children under 2 months of age and very high fever in children under 6 months of age should go to the ER)
• Common pediatric illnesses such as mild asthma attacks (cough and mild wheezing), stomach flu, diarrhea, vomiting, rashes, and strep throat
• Minor burns

Pediatric urgent care/emergency physicians can often stitch up a 2 year old without sedation; pediatric facilities have the right tools and correctly trained people to keep the experience from being traumatic for kids. 

Cincinnati Children’s Hospital Medical Center has two Emergency Departments (Burnet Campus [Main] and Liberty Township) and four Urgent Care locations (Mason, Anderson and Green Township, and Burnet [Main] Campus). 

For more information on Cincinnati Children’s Emergency Departments and Urgent Cares, click here 



Rima Rusnak, MD

Debunking Myths about the Emergency Department

Debunking Common Myths about the Emergency Department

Overuse of the Emergency Department is a problem in Cincinnati and nationwide.  In North Carolina, Natania Barron of Blue Cross, Blue Shield put together a list of "myth-busters".  People who know the facts are more likely to “Make the Right Call".

Myth #1: The uninsured are to blame for unnecessary ER visits.  

Fact: Contrary to popular belief, it’s not the uninsured who make up the majority of these “ER overusers.” Increasingly, it’s people with insurance. In fact, according to CDC data, Medicare beneficiaries are the most likely to visit the ER — and those without insurance are no more likely to visit the ER compared to those with private insurance.  

Myth #2: Going to the ER is “free” if you can’t pay. 

Fact: This is a classic example of consumers being shielded from the true cost of health care. While it’s true that out-of-pocket costs can be as low as zero for the uninsured or the cost of a copayment for insured patients, we know that the average trip to the emergency room really costs an average of about $1,500. Those ER costs pile up and are part of the reason that health care costs have been rising so much faster than inflation and salaries for the past decade.

Myth #3: I can’t tell if it’s an emergency, so the ER is the best way to go. 

Fact: This is a tough one, but it comes down to education and availability. Researchers have concluded that more than half of all ER visits are not serious enough to require a visit to the ER and could be treated at a doctor’s office or urgent care center at much lower costs. That makes a big impact on the cost of health care for you and everyone around you, whether or not you’re using the ER incorrectly. Of course there are always situations that absolutely require an ER visit—but it’s important to know the difference. Not just for your health, but for your checkbook, too.

Myth #4: You’ll get help quicker in the ER. 

Fact: Nationally, the average ER patient wait time is four hours. That’s a long time, especially if you compare that to other care options like a primary care physician's office or urgent care centers where the average wait time can be much shorter.

Myth #5: Ambulance rides are free. 

Well, in some places, they used to be. But that’s no longer the case. The New York Times recently wrote a piece about the skyrocketing charges for ambulance rides, including the story of an insured woman who was charged over $1,700 for an ambulance ride to the ER. 

Click here to read the full article.  

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Your Doctor’s Office is Talking About You

We often talk about our patients when they aren’t around. We discuss their diabetes goals for example. Patients with diabetes need to achieve five goals to reduce their risk for complications and every patient is likely to have different motivations for reaching those goals.

At regular staff meetings, my team of caregivers will create action plans to improve the care that we give to our diabetic patients using what we know about what motivates them. Do they want to spend more time with grandchildren, write the great American novel or travel? What steps can they take now to improve or maintain their health and make those dreams real?

This is what we call a Patient Centered Medical Home (PCMH) model of care. I explain to model to my patients like this:

• My staff and I as your primary care physician work hard to know you and coordinate your care
• We make sure that you get the right care at the right time, without unnecessary duplication of services and without medical errors
• For example, at our practice we make referrals for you to see a specialist when you need one and we make sure that specialist has the information he or she needs to ensure you transition in care is smooth and coordinated 
• We track and support you when you obtain services outside our practice
• We follow-up with you within a few days of an emergency room visit or hospital discharge
• We communicate test results and care plans to you and your family
• We link you with community resources that might benefit you
• We provide you with a nurse care coordinator who is a point person that works with you and your family on a regular basis and is always available to answer questions even when I may not be

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When you are part of a PCMH, there is always a health care professional available to talk with you, 24 hours a day/7 days a week.

      PCMH practices use quality measures such as those found at YourHealthMatters.org as a tool in their quality improvement efforts. You can picture YourHealthMatters.org as a scorecard for entire clinical teams, not just physicians, grading the team’s ability to provide you with quality healthcare and good outcomes. Knowledge is power and YourHealthMatters.org helps us know where we need to improve. The “WE” is you, your doctor and our entire team, because a strong patient-health care team partnership means we do our part and you as a patient need to do yours.

      Here's the story of one of our patients, John M., a friendly 48-year-old.  He has been struggling with controlling his diabetes mellitus for several years.  He struggles with his busy lifestyle, demands at work, and financial constraints that prevent him from affording all of his medications.  When John joined our practice, we started to work with him using our PCMH strategy to not only help him control his diabetes, but also to help him to make positive changes on his own that would lead to better glucose control.  

      By working with our care coordinator in the office, he was able to become more consistent with monitoring of his sugars.  We used resources to help John have access to medications that he was previously unable to afford.  John worked with us to set realistic goals to incorporate diet, exercise and monitoring of his blood sugars into his busy lifestyle.   Happily, John has seen a significant improvement in his blood sugars, feels better and continues to stay motivated to control his health.

PCMHs are gaining in popularity as we transform health care in the United States. In fact, under this new model, our pay is tied to the quality of care we offer you and the outcomes you as a patient achieve working together with us to reach your health goals. We look forward to partnering with you, our patients!

Brian Peerless, MD 

Mercy Health – Blue Ash Family Medicine

20-Somethings: Young and Fit? Here Are 5 Reasons You STILL Need a Doctor

Younger adults are generally in better health than older people.  Plus, many people run, work out and try to keep themselves in better health.  So why is it that 20-somethings rely on emergency departments (EDs) for care far more than those in other age groups?

• Often these trips to the ED are not for emergency care. It’s because they don’t have a primary care physician and don’t know where else to turn when something comes up.
• Many young people don’t have a primary care physician (PCP) because they simply haven’t taken the time to choose one.
• Others don’t have a primary care physician because they don’t have insurance; perhaps they lost their insurance during the transition from their teen years to adulthood. 

You may have procrastinated with finding a primary care physician, but now is the time to choose one so that you can start getting preventive care that may help you avoid a serious medical issue.  

Here are 5 reasons having a PCP is important:

1. Preventive care helps you reach your personal best by:
• Setting a baseline for tracking your health over time.
• Catching problems before they become major issues.
• Getting on a path for lifelong health management.
2. Get personal medical advice for urgent medical issues:
• With a PCP, you’ll get medical advice when you need urgent medical attention.
• An ED doctor isn't familiar with you; your PCP knows you and your medical history.
3. Having a regular source of care correlates to better health:
• Having a PCP will keep you healthier.
• Studies show that adults who have established a relationship with a PCP have better health outcomes and better chronic disease management.
4. Get personal treatment from someone you know:
• You’ll get VIP treatment from someone who knows you.
•  Your PCP has an entire team that works to help keep you healthy and at your best
5. It’s a non-emergency care option that is far less costly than the ED:
• Do the math: Seeing a primary care physician is far less expensive than the cost of a trip to the emergency department.
•  Plus, you’ll save money over the long run. One national study showed that adults who had a primary care physician as their regular source of care had 33 percent lower costs of care.

So get running…to the doctor!

Having a PCP will help you be prepared to deal with any medical issue that may arise down the road. If you don’t have insurance, you may be able to find affordable health coverage options.  Remember, young adults can get coverage until the age of 26 through a parent’s insurance.  Finally, there is a trusted resource you can use to find a PCP. Visit YourHealthMatters.org to find a doctor near you.

Dr. William Mase, Master of Public Health Program, Director and Assistant Professor of

University of Cincinnati College of Medicine Department of Environmental Health

Supporting Individuals Living With Developmental Disabilities To MakeTheRightCall

What if you are not prepared to make the right call?  What if you do not know the names of the medications you take or your medical history?  What if you depend on someone else to make nearly all of your medical decisions?  Adults with developmental disabilities are often confronted with this reality. Self-determination, choice, and advocacy are major themes in the services and supports provided to adults with developmental disabilities.  Individuals are provided training and assistance making decisions on which programs to attend, where to live, how to vote, and many other life decisions.  Unfortunately, there is not as much focus on health and wellness and taking control of health care decisions.  Most individuals living with a developmental disability rely on family members, guardians, or paid professional staff for support in making major life decisions. 

As a vocational and transitional employment service provider for adults living with developmental disabilities, Easter Seals TriState is in a unique position to help individuals learn how to be more involved in their health care decisions.  The individuals we serve spend more time with us than they do with most other people in their lives.  Easter Seals TriState’s Addressing Health Disparities project, made possible by a generous grant from Bethesda Inc., aims to use this time to assist individuals with overcoming barriers to becoming more engaged in their health care.  The materials provided by the MakeTheRightCall campaign gives us wonderful resources to provide education to people whose unique needs are often overlooked in the medical community.  For example, in addition to carrying identification, adults with disabilities should also have their doctor’s name and phone number listed and their caregiver should ask about physician after-hours procedures to be prepared in advance in case they need to contact the doctor.

Adults with developmental disabilities also face numerous challenges when seeking to obtain health care.  These challenges include attitudinal, physical, and communication barriers in addition to having low health literacy skills and a fear of examinations.  Obviously, these challenges make it difficult to establish a relationship with a primary care physician.  If you know or take care of an adult with a developmental disability, check out the “MaketheRightCall” campaign, including videos like this one to educate everyone on the importance of getting quality care in the appropriate location.  I also encourage you to contact Easter Seals at www.eastersealstristate.org to learn more about local programs and resources to support individuals with disabilities in our community. 

Jonathon Sherwood, M.Ed.

Project Director

Easter Seals TriState

Live Well with Diabetes: Pay Attention to Quality Goals and Measures

“Quality” health care has a wide variety of meanings.  To me, it used to have a very vague meaning. I felt good about my doctor if I thought I received a thorough examination, was treated politely by my doctor’s staff, and was able to schedule an appointment within a reasonable amount of time.  While these are important quality issues, receiving high quality “clinical” care is even more important.  In the last several years I’ve learned what high quality clinical care means.

Here’s what I’ve learned: Quality measures are a sort of scorecard for my physician and me. In other words, quality measures show me how often my doctor provides high quality care to me and to other patients with my condition.  These measures include the most important clinical tests, exams, and advice that will have the greatest impact on my health.  For example, I have diabetes. There are a set of goals for managing diabetes that have been documented by research and experience to lead to the best patient outcomes. So it’s important for my doctor and me to know what the goals are to ensure I get the exams and advice I need to stay healthy. 

The diabetes goals are called the “D5” and they include:

Goal #1: Keep blood pressure under 140/90 mmHg

Goal #2: Keep bad cholesterol (LDL) under 100mg/dl

Goal #3: Keep blood sugar (A1C) less than 8%

Goal #4: Be tobacco-free

Goal #5: Take aspirin daily as recommended

Why is the D5 important to me?

• I can use the D5 to evaluate the care I’m receiving from my doctor’s office. I can view how well my health care facility performs in the D5 categories compared to other facilities in my area by going to the yourhealthmatters.org website.

•  I need to do my part too and the D5 also helps me be accountable. For example, I have changed my diet and implemented regular exercise to maintain an optimum LDL cholesterol level.

• It makes it easier for me and my doctor to work together to set and achieve goals that will help better manage my diabetes. We recently set a goal to lower my hemoglobin A1C to 6.5. My doctor has made simple adjustments on my insulin pump and has me electronically submit weekly glucose logs between appointments to measure the effectiveness of the changes.

• When I achieve D5 success, I reduce my risk for complications such as heart attack, stroke and problems with my kidneys, eyes and nervous system.

All care is not the same. Hospitals and doctors differ in how well they provide appropriate care to patients. The quality of the care they provide influences my health. YourHealthMatters.org uses the D5 to evaluate the diabetes care that specific practices in Cincinnati provide. It explains it to me in a way I understand. You should search your doctor’s office to measure the quality of care of their patients compared to others in the area. These measurable resources are facts. You are empowered as a patient. Your part is to use it.

Raushanah Cole 
Health Care Consumer