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 month.

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.


Nurse Practitioners

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 Hodges.

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 government insurers.

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 processing.

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 the Internet.

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 advises. 

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 future.”

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 hand-crafted items.

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.

Gillikin agrees. 

“I like the idea of the family-oriented practice.  Anyone can feel comfortable coming here.”


Patient Care


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 this service. 

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.


New Beginnings


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



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