May 12, 2008
New family medical practice is opening in Frisco
By AMBERLY DYER
It seems that a community of health and wellness is springing up in Frisco.
A new family medical practice opens this month, joining nearby
providers of dental, mental health, chiropractic, and alternative
health, as well as the Dare County Health Department, which will
relocate to the new county satellite building in Frisco later this
Alexis Hodges, known to most people as “Alex,” is opening
Hatteras Island Family Medicine. The grand opening is Saturday, May 17,
from 2 until 5 p.m. at the office, located at the corner of Highway 12
and Water Association Road.
Hodges will be working as a family nurse practitioner, having completed
her master’s of science in nursing (MSN) with a concentration as
a family nurse practitioner (FNP) in 2007. She completed the
degree almost entirely online through East Carolina University.
“When I completed the program last year, I knew I wanted to
practice to serve the needs I saw on the island,” she says.
According to the American Academy of Nurse Practitioners, these
providers are trained to give much of the same care as
physicians. Nurse practitioners, however, focus on “care
and cure.” This means that they promote disease prevention
and wellness, rather than the illness-based model used by many doctors.
“I am more medically oriented than most nurse
practitioners,” notes Hodges. However, she also has a strong
interest in health promotion and prevention.
For many residents, nurse practitioners are familiar in multiple
provider offices. "The best examples for people are Katie
Williams and Carey [LeSieur]," explains Hodges.
However, what can be perplexing to some is that Hodges will be practicing in a solo provider practice.
North Carolina licenses nurse practitioners as independent
providers. This means that they can diagnose patients, write
prescriptions, order diagnostic tests (labs, radiology exams, etc.),
and plan patient treatment. Nurse practitioners are overseen by
both the North Carolina Medical Board and the Board of Nursing.
Because the medical training is less extensive than a physician (about
three years of post-graduate work compared to seven years for a
physician), nurse practitioners have a "supervising physician," who
acts as a mentor, consultant, and guide through more complex
cases. The physician carries a portion of responsibility that
quality care is being given through the providers he or she supervises.
Dr. Al Hodges, Alex's husband and a family physician at HealthEast
Family Care, will act as Alex's supervising physician. The Board
of Nursing requires that all nurse practitioners entering into a new
collaborative practice agreement with a physician must have the
supervising physician review and sign each case for the first six
months of the agreement. After this initial period, the
supervisor is available for consultation and review of cases.
“I think because we have that [marital] relationship, it will
work really well for my patients. Al will have a more hands on
role than many nurse practitioners, and I welcome that," reflects
This marital relationship has made some people curious about Al
Hodges’ staying at HealthEast Family Care when Alex's practice
opens. Rest assured, Hodges will still be seeing patients in Avon
and Hatteras. He is working in a different model of care, and he
has many patients, particularly those with insurance such as Medicare
and Medicaid, whom he will continue to serve.
A Different Kind of Medical Practice
In assessing the community’s medical needs, Hodges noted the
large number of people without medical insurance or with high
deductible health plans. Often these families will not seek
medical care until a critical need arises. Many people also avoid
preventive care visits if the cost is prohibitive.
Hodges also knew that the medical model of care in the United States is business driven and dominated by health insurers.
“Part of the reason I’m doing this is because I have seen
my husband and his colleagues negotiating care with insurance
companies,” she explains.
To avoid this quagmire, Hodges declined all insurance
contracting. This means she is also not a Medicare, Medicaid, or
North Carolina Health Choice provider.
Hodges says she does not need to pay staff to spend time on the
telephone arguing with insurers about medical care or billing
issues. She and her staff can focus on medical care.
This model is effective. Hodges set up her practice similarly to
a physician in Apex, charging an affordable flat-rate for all care
provided. Office visits will be $45 or $25 for a camp or sports
physical, significantly lower than nearly all other providers.
She said a prospective patient put the price in perspective for her.
“One night of tips will pay for an office visit,” the
prospective patient told her.
Payment is expected at the time of service. If a patient has insurance
and wants to file for reimbursement, they will be given a completed
HCFA 1500 claim form, where they will add policy information
before submitting to the insurance company.
Hodges points out that most insurers will pay for services ordered by a non-participating provider, such as diagnostic tests.
She does note, however, that because of the out-of-pocket expenses of
her practice, patients with Medicare, Medicaid, or NC Health Choice
will probably be best served by a provider contracted with these
Labs will also be available at a reduced rate. For example, a
strep test will be $25. Labs and tests, including pap smears,
will be sent to either LabCorp or East Carolina University for
To help keep costs affordable, Hodges will not have x-ray capability, which is common for family practices in many areas.
But affordable does not mean rushed with lots of patients. Hodges is
setting up extended times for patient visits, so that wellness and
education can occur naturally and without a rush.
She wants a relationship with her patients, which can be seen in the
intensive hands-on care of the practice. Hodges will not only be
seeing patients, but she will also draw blood and other specimens as
needed. She will call patients with test results, so they can ask
her questions directly.
Accessibility to a provider is important to Hodges.
“If I’m available, I’ll take your call. If not,
you will get my personal voice mail, and I will call you back,”
she explains. While the office will have e-mail capability, she
is legally restricted from discussing specific medical questions via
Technology is an important piece of Hodges’ practice. The
office is fully wired for Internet service, and there are workstations
in each exam room. This configuration promotes a fully integrated
patient medical and administrative record.
“When I am speaking with a patient, I will be typing at the same
time. This may be a new experience for many people,” she
Hodges points out other technical advantages of the Internet, including
the ability to print prescriptions and patient education materials at
the end of the visit. She will also have photographic storage
available to facilitate documentation.
“We hope to be able to fax prescriptions directly to Beach
Pharmacy,” she notes. “We will work toward electronic
prescriptions with pharmacies up the beach [in Nags Head area] in the
While she is using technology to increase efficiency and improve
patient care, Hodges is keeping a homey feel to the office by adding
special touches from her family, such as a rocking chair and
In the same vein, Hodges hired Kim Gillikin to serve as her administrative assistant.
“One way I’m decreasing overhead is through Kim. Kim
is competent in office processes, but she is committed to a family and
kid-friendly environment,” she says.
“I like the idea of the family-oriented practice. Anyone can feel comfortable coming here.”
As a family nurse practitioner, Hodges will be able to treat all ages
and sexes. The office will handle acute needs, from fish hooks to
earaches to lacerations and more, as well as preventive care.
Women’s and children’s care is an important aspect to her
practice. “I feel that the two go hand in hand,” she says.
Hodges is promoting annual care to increase patient education and to
prevent complicated diseases. She has set up four appointment
slots at different times of the day for preventive physical exams.
She is also performing well-child visits and is very comfortable working with adolescents and young adults.
While Hodges will have some vaccines available – Gardasil,
tetanus, and a few others -- she will not routinely keep the vaccines
required for small children. This is, again, largely due to the
costs of maintaining the supply and the availability of other providers
in the area, such as the Health Department or HealthEast, to provide
At this time, Hodges is focusing on building her practice and providing
family medical care. She is not currently planning on providing
cosmetic services, such as Botox or laser treatments.
Although she is legally able to write many prescriptions, Hodges has
chosen not to obtain the additional license by the Drug Enforcement
Agency (DEA) to prescribe controlled substances.
Controlled substances vary from Tylenol or cough syrup with codeine to
highly potent pain medications, such as Percocet or Oxycotin. It
also includes anti-anxiety medications, such as valium, and stimulants,
such as Ritalin.
“I believe that there is a time and place for narcotics, but I do
not want it to be part of my practice,” Hodges
states. If she finds such medications may be necessary for
her patients, she will refer her patients for evaluation and
appropriate care. She will also work with patients to find
alternatives to controlled substances as appropriate.
Although she has worked in the medical community for 13 years on
Hatteras Island, Hodges is excited about the new opportunity to work
with families and individuals in the community. She feels greatly
supported by her extended family and her husband and children who have
helped in many ways to get her office set up and ready for patients.
In addition, the she feels that there is an outpouring of support by
the community. This only increases her commitment to the success
of the practice.
“This is not a whim. I’m here to stay,” she says with a smile.
FOR MORE INFORMATION
Hatteras Island Family Medicine is located on the corner of Highway 12
and Water Association Road in Frisco. Office hours are 8:30 a.m.
to 5:00 p.m. Monday through Thursday and 8:30 a.m. to 2:00 p.m. on
Friday. There is no weekend or after-hours care available.
Patients are encouraged to call 911 or to proceed to the Outer Banks
Hospital for emergencies.
Payment is due at the time of service. Master Card, Visa, check, and cash are accepted.
Appointments are preferred and may be made by calling (252)
995-3900. Work-in patients, including non-residents, are
welcome. However, please note that priority will be given to
scheduled patients. Hodges plans to have same-day appointments
available most days.
Although limited in Spanish proficiency, Hodges welcomes Latino
community members to her practice. She is unable to maintain a
telephone interpreter service, so bringing an interpreter will
facilitate the examination and discussions.
Information is also available at www.HIfamilymedicine.com