As a practice matures and evolves, decisions are made and changes are instituted to assure that the quality of care delivered is not compromised. Most of our decisions are driven by factors (medical, regulatory, legal) that are out of our control. There are two significant changes that we have had to make to our laboratory ordering process.
First, we now have preferred laboratories that have partnered with us. The results are expected to be sent to us electronically, which should cut down on the time from the blood drawing and the results being available to us. The information on the preferred labs is located at: http://www.dssurgery.com/lab. Needless to say, there are no financial incentives for us. You should also check with one of the labs as well as your insurance company to make sure that they are a contracted facility, and that the order is covered under your policy. It is your responsibility to make sure that your insurance company will pay for the labs ordered. We are not in any way responsible for verification of benefits the laboratory services that we order.
Secondly, we have had to institute the way we order our yearly lab work.
As most of you are aware it is critical that weight loss surgical patient's have continuous yearly follow-up care and monitoring. The close and detailed surveys of the laboratory studies are even more important within the first 3-5 years. With majority of the patients, most laboratories have stabilized and normalized it in that time frame. This is why it is critical that the patient’s continue to have yearly follow up care, not only by doing their scheduled laboratory studies, but also by yearly exam.
As a part of our commitment to quality patient care, we provide comprehensive two-year follow-up to the patient's having Duodenal Switch or Revisions with us. This includes ordering the laboratory studies, review and interpretation of the results, as well as office visits-as frequently as required or deemed necessary.
After the initial two years, patients continue to get request letters, and in some cases, patients continue to follow up with us in the office for an office visit. In overwhelming number of cases, however, patients started taking their laboratory studies to their primary care physicians for interpretation-, which was not ordered by them.
The standard of care would require that the physician ordering the labs would evaluate the patient and recommend treatment as necessary based on the evaluation and the results of the studies.
What does this all mean? Every single patient will get his or her lab request letters starting this month. If your surgery was more that 5 years ago, then this will be the last year that you get a letter from us, unless you contact us and request that a follow up office visit, and continuation of your laboratory draws on a year by year basis. This will be done based on our evaluation weather or not just ordering laboratory studies will be adequate or not. In some cases we may require that you either see us for a follow up visit, or see your primary care and have them order the studies.
We will continue providing the lab request letters to all out patients for the first five years after surgery. Thereafter, we will continue to monitor if the patient contacts our office for follow up care and lab order requests.
This is to assure that we are not ordering tests on patients who will not follow up with us.
Over the years, patients have also requested that medication be prescribed solely based on lab results when they have not been seen in our office for years. We will not prescribe any medication to any patient if we have not seen them recently. Exception would be for patients, or conditions that the treating we have a first hand knowledge of are not new findings based on a patients long-term condition. There are cases when a patient calls our office 8 years after their surgery asking for Flagyl, for gas, when they were seen in our office last 5 years ago. W will not prescribe this medication, for this patient.
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