One key benefit of Generations Premium? -- Time with your doctor!

Tuesday, 25 April, 2017

When you first heard about Generations Family Practices' new service, Generations Premium, you may have thought to yourself - "Why would I be interested?" Well, to be would get more quality time with your family physician. Current policies only allow doctors a certain visit length with their patients before they are no longer reimbursed by the insurance companies. Generations Premium, as a service, by-passes that restriction, increasing your visit from ~15 minutes to an hour plus (if needed). The end result is a better diagnosis, plan-of-care and patient/physician relationship.

Take a moment to read the below blog shared from Kaiser Health News about this subject. If you have questions, please call us. We'd love to hear from you!

"15-Minute Visits Take Toll on Doctor-Patient Relationship"

[This Kaiser Health News story was produced in collaboration with USA Today.]

Joan Eisenstodt didn’t have a stopwatch when she went to see an ear-nose-and-throat specialist recently, but she is certain the physician was not in the exam room with her for more than three or four minutes.

“He looked up my nose, said it was inflamed, told me to see the nurse for a prescription and was gone,” said the 66-year-old Washington, D.C., consultant, who was suffering from an acute sinus infection.

When she started protesting the doctor’s choice of medication, “He just cut me off totally,” she said. “I’ve never been in and out from a visit faster.”

These days, stories like Eisenstodt’s are increasingly common. Patients – and physicians – say they feel the time crunch as never before as doctors rush through appointments as if on roller skates to see more patients and perform more procedures to make up for flat or declining reimbursements. 

It’s not unusual for primary care doctors’ appointments to be scheduled at 15-minute intervals. Some physicians who work for hospitals say they’ve been asked to see patients every 11 minutes. 

And the problem may worsen as millions of consumers who gained health coverage through the Affordable Care Act begin to seek care — some of whom may have seen doctors rarely, if at all, and have a slew of untreated problems.

“Doctors have one eye on the patient and one eye on the clock,” said David J. Rothman, who studies the history of medicine at Columbia University’s College of Physicians and Surgeons.

By all accounts, short visits take a toll on the doctor-patient relationship, which is considered a key ingredient of good care, and may represent a missed opportunity for getting patients more actively involved in their own health. There is less of a dialogue between patient and doctor, studies show, increasing the odds patients will leave the office frustrated.

Shorter visits also increase the likelihood the patient will leave with a prescription for medication, rather than for behavioral change -- like trying to lose a few pounds, or going to the gym.

Physicians don’t like to be rushed either, but for primary care physicians, time is, quite literally, money. Unlike specialists, they don’t do procedures like biopsies or colonoscopies, which generate revenue, but instead, are still paid mostly per visit, with only minor adjustments for those that go longer.

And many doctors may face greater financial pressure as many insurers offering new plans through the health law’s exchanges pay them even less, offering instead to send them large numbers of patients. 

This fee-for-service payment model, which still dominates U.S. health care, rewards doctors who see patients in bulk, said Dr. Reid B. Blackwelder, president of the American Academy of Family Physicians, who practices in Kingsport, Tenn.

“Doctors are thinking, ‘I have to meet my bottom line, pay my overhead, pay my staff and keep my doors open. So it’s a hamster wheel, and they’re seeing more and more patients ... And what ends up happening is the 15-minute visit,” he said.

Struggling For Control

Dr. Richard J. Baron, president of the American Board of Internal Medicine, said that patients and physicians often wrangle over control of that visit – a “struggle for control” over the allocation of time

Sometimes the struggle is overt – as when a patients pulls out a long list of complaints as soon as the doctors comes in.

Sometimes, it’s more subtle. When Judy Weinstein went to see her doctor in Manhattan recently, she knew she would get only 20 minutes with him – even though it was an annual physical, and she had waited nine months for the appointment.

So when the doctor asked if he could have a medical student shadow him, she put her foot down.

“I said, ‘Y’know, I would prefer not. I get 20 minutes of your divided attention as it is – it’s never undivided, ever – and I need to not have any distractions. I need you focused on me.’“

How did visits get so truncated? No one knows exactly why 15 minutes became the norm, but many experts trace the time crunch back to Medicare’s 1992 adoption of a byzantine formula that relies on “relative value units,” or RVUs, to calculate doctors’ fees.

If you must know, the actual formula is: (Work RVU x Geographic Index + Practice Expenses RVU x Geographic Index + Liability Insurance RVU x Geographic Index) x Medicare Conversion Factor.

That was a switch for Medicare, which had previously paid physicians based on prevailing or so-called usual and customary fees. But runaway inflation and widespread inequities dictated a change. RVUs were supposed to take into account the physician’s effort and cost of running a practice, not necessarily how much time he or she spent with patients. 

The typical office visit for a primary care patient was pegged at 1.3 RVUs, and the American Medical Association coding guidelines for that type of visit suggested a 15-minute consult.

Private insurers, in turn, piggybacked on Medicare’s fee schedule, said Princeton health economist Uwe Reinhardt. Then, in the 1990s, he said, “managed care came in and hit doctors with brutal force.”

Doctors who participated in managed care networks had to give insurers discounts on their rates; in exchange, the insurers promised to steer ever more patients their way.

To avoid income cuts, Reinhardt said, “doctors had to see more patients – instead of doing three an hour, they did four.”

Rushed Doctors Listen Less

How doctors structure the precious 15-minute visit varies – often quite dramatically.  Generally, they start by asking the patient how they are and why they came in, trying to zero in on the “chief complaint” -- the medical term for the patient’s primary reason for the visit.

But most patients have more than one issue to discuss, said Dr. Alex Lickerman, an internist who has taught medical students at University of Chicago and is director of the university's Student Health and Counseling Services.

“The patient is thinking: ‘I’m taking the afternoon off work for this appointment. I’ve waited three months for it. I’ve got a list of things to discuss.’

“The doctor is thinking, ‘I’ve got 15 minutes.’ There is almost a built-in tension,” Lickerman said.

Studies show that doctors’ visits have actually not gotten shorter on average in recent decades. The mean time spent with a physician across specialties was 20.8 minutes in 2010, the latest year available, up from 16.3 minutes in 1991-1992 and 18.9 minutes in 2000, according to the National Center for Health Statistics; that includes visits with internists, family docs and pediatricians, which all increased by about two and a half minutes. 

In 1992, most visits – about 70 percent -- lasted 15 minutes or less; by 2010, only half of doctor visits were that short (the data is from the National Ambulatory Medical Care Survey, an annual nationally representative sample survey of visits to physicians).

This doesn’t necessarily mean the patient experience is improving. Medical schools drill students in the art of taking a careful medical history, but studies have found doctors often fall short in the listening department. It turns out they have a bad habit of interrupting.

A 1999 study of 29 family physician practices found that doctors let patients speak for only 23 seconds before redirecting them; only one in four patients got to finish their statement. A University of South Carolina study in 2001 found primary care patients were interrupted after 12 seconds, if not by the health care provider then by a beeper or a knock on the door.

Yet making the patient feel they have been heard may be one of the most important elements of doctoring, Lickerman said.

“People feel dissatisfied when they don’t get a chance to say what they have to say,” he said. “I will sometimes boast that I can make people feel they ‘got their money’s worth’ in five minutes. It’s not the actual time or lack of time people are complaining about – it’s how that time felt.”

Fee Increase Notice from Generations

Tuesday, 25 April, 2017

As you probably know, healthcare has, and will continue to change.


Reimbursement by insurance companies and Medicare has not kept up with the cost of running a medical office. Governmental and insurance regulations have reached into just about every facet of care. Unfortunately, we are not compensated for providing many of these services.


In fact, our office has been paying to provide these services. We can no longer afford to do this. Just like you, we pay rent, utility bills, insurance premiums and so forth. Our average provider compensation is among the lowest in the area. Therefore:


Starting May 1, 2014, requests for completion of several types of forms and correspondence will incur fees.


Examples include:

  • disability forms
  • letters /correspondence requested from patients, insurance companies or third parties
  • prior authorizations required by your insurance company for medications, imaging, genetic testing, etc.


Charges for these services will range from $25 for a basic form, and vary depending on the amount of time required by the provider to complete the request.


Examples of these fees would be:

  • a prior authorization would be $25 dollars
  • a typical 2-page report to an employer or attorney requiring 15 minutes of provider preparation time would be $75 dollars.

Fees are strictly based on the amount of time required to fulfill your requests.


These charges will be waived for Generations Premium members.


In an effort to provide you with financially viable quality of care, we thank you in advance for understanding the necessity of adding these charges.

Coping Strategies for Busy Professionals

Tuesday, 25 April, 2017

The boss is requiring you to stay late to finish a project. Dinner needs to be made. The kids have to be shuttled around to after-school activites. There will never be more hours in the day, and your career and family responsibilities will always be demanding. It may seem that there’s nothing you can do about stress. But you have more control than you might think. In fact, the simple realization that you’re in control of your life is the foundation of stress management. Managing stress is all about taking charge: of your thoughts, emotions, schedule, and the way you deal with problems. Here are some coping strategies to help.


How Do the New HIPPA Regulations Affect Your Patient Rights?

Tuesday, 25 April, 2017

The U.S Department of Health & Human Services (HHS) recently adopted new rules, which make changes to existing privacy, security and breach notification requirements in what is often referred to as the final "HIPAA Omnibus Rule." These new rules stem from changes made under the Health Information Technology for Economic and Clinical Health (HITECH) Act which is part of the same law that created the Electronic Health Records (EHRs) Incentive Program under Medicare and Medicaid.

Generations Family Practice has updated its HIPAA policies and procedures and implemented the changes required by these regulations. These new rules mandate that we update our Business Associate Agreements (BAAs) and patients’ Notices of Privacy Practices (NPPs). It also reinforces the importance of the encryption of electronic protected health information.

Generations Family Practice has, for many years, been ahead of the curve in implementing EHR systems and the security required to keep our patients medical data secure. The HIPAA Privacy Rule provides federal protections for personal health information held by physicians and gives patients an array of rights with respect to that information. The Privacy Rule balances the rights of patients with the needs of physicians and others who need access to patient information (such as other doctors and insurance companies).

Under HIPAA, physicians are required to control the ways in which they use and disclose patients' protected health information.

The HHS Office of Civil Rights (OCR) oversees compliance with the HIPAA Privacy requirements. Earlier this year, OCR published an omnibus final rule that covers changes to the HIPAA rule which included the final regulations on notifications associated with the breach of patient information that has not been encrypted; modifications to the HIPAA rule regarding privacy protections for genetic information as required by the Genetic Information Nondiscrimination Act (GINA); and additional changes to the HIPAA privacy, security, and enforcement rules. The compliance date for the final Omnibus rule was September 23, 2013.

The key new provisions in the HIPAA omnibus rule cover:

  • Extending the applicability of certain of the Privacy and Security Rules’ requirements to the Business Associate (BA) of Covered Entities (CE);
  • Requiring CEs and BAs to provide for notification of breaches of unsecured Protected Health Information (PHI);
  • Establishing new limitations on the use and disclosure of PHI for marketing and fundraising purposes;
  • Limiting circumstances on the sale of PHI;
  • Requiring the consideration of a limited data set as the minimum necessary amount of information for a particular use, disclosure, or request of PHI;
  • Expanding individuals’ rights to obtain restrictions on certain disclosures of PHI to health plans; and
  • Strengthening enforcement provisions.

You can read Generations Family Practice various HIPAA policies and procedures, as well as a detailed explanation of your rights as a patient clicking here.

Connect with Your Family This Fall

Tuesday, 25 April, 2017

Connect with Your Family This Fall With A Healthy Dose Of Technology

You might have seen the studies: The average teen sends 50+ text messages a day. Women are more likely to log onto Pinterest, and men to Google+. And only about 30 percent of people over age 70 even use the internet.

Since different generations prefer different technologies, is there a rift in communication between them? Not necessarily. Perhaps surprisingly, young people who spend the most time with technology also spend more time doing physical activities, enjoying hobbies, and hanging out with their parents, according to the Kaiser Family Foundation.

Since technology is an important part of the lives of many of us—no matter what our age—don’t fight it. Instead, put technology to work for you to bring different generations together.

Family time, tech time

Look for ways to engage all ages in your family this spring.

  • Get outdoors, tech in hand. Web-based tools use GPS to map, find and create outdoor trails. Log onto a website like Or download the app. With your family, take a virtual look at area walks, hikes or even a paddle, and then get out and do it for real. With a smart phone, you can pull up your route in real-time to show your progress. Once back at home, you can see your trip online and even name it in honor of your family.
  • Make family meals a priority. Studies show that kids who eat meals with their families feel better about themselves and the future, for example. They are also less likely to try risky activities like drugs and fighting.  To get tech in the mix, help your children search the internet for healthy recipes that use their favorite foods. Use the search words, “eat right nutrition tips” to reach some great resources of the American Dietetics Association. Look for picnic items for the warmer days ahead, and a nice warm soup for the chillier days of late winter.
  • Have a relative who isn’t so tech savvy? Here’s a great chance for you to set up cross-generational connections. Have a younger relative teach the older relative how to use e-mail, find a good health website or use a webcam. Then when they’re apart, they can still connect.
  • While out on a walk, during a drive or over dinner, talk about technology.
    • Discuss each person’s favorite technology item, including those they own and ones they would like to have.
    • Discuss what kind of software application, or “app,” each person like to invent, and what they would need to do it.
    • What websites are their favorites?

Be conscious of turning technology off when it interferes with quality time. But you can also use it to engage your family and improve the quality of your time together.

Infographic: Signs of a Heart Attack in Men & Women

Tuesday, 25 April, 2017

The signs of a heart attack can vary greatly between men and women. So much so that they can be mistaken for less serious health issues - like a tummy ache. We created this infographic to help you know what to look for.

Signs of a Heart Attack in Men May Include:

  • Lightheadedness: You may feel dizzy or feel like you might pass out.
  • Anxiety: You may feel a sense of doom or feel like you're having a panic attack for no reason.
  • Shortness of Breath: You may pant for breath or try to take deep breaths. This often occurs BEFORE you develop chest discomfort.
  • Chest Discomfort or Pain - Upper Body Pain: This can feel like a tight ache, pressure, fullness or squeezing in the center of your chest lasting more than a few minutes. Pain or discomfort may spread beyond your chest to your shoulders, arms, back, neck, teeth or jaw.
  • Stomach Pain: Pain may extend downward into your abdominal area and may feel like heartburn.
  • Nausea and Vomiting: You may feel sick to your stomach or vomit.
  • Sweating: You may suddenly break into a sweat with cold, clammy skin.

Signs of a Heart Attack in Women May Include:

  • Lightheadedness: You may feel dizzy or feel like you might pass out.
  • Shortness of Breath: You may pant for breath or try to take deep breaths.This may occur with or without chest discomfort.
  • Chest Discomfort: Discomfort or presssure in the center of the chest. It often lasts more than a few minutes, or goes away and returns.
  • Upper Body Pain: Pain in one or both arms, upper back, neck, jaw or stomach.
  • Stomach Pain: Pain may extend downward into your abdominal area and may feel like heartburn.
  • Nausea and Vomiting: You may feel sick to your stomach or vomit.
  • Sweating: Paleness or you may suddenly break into a sweat with cold, clammy skin.
  • Inability to Sleep: You may experience insomnia. 
  • Unusual Fatigue: You may feel more tired than usual or for no apparent reason.

Schedule an Appointment Today

We offer a wide range of services listed here. Call us at 919-852-3999 or email us at with any questions or to schedule an appointment. We look forward to working with you!

Not-So-Summer-Fun: Summer Healthcare & Travel Vaccinations

Tuesday, 25 April, 2017

Summer is a time for playing outdoors, for traveling, for swimming and biking, for baseball games -- and for visits to the doctor. All this great weather and outdoor fun means an increased risk of illness and injury, from minor mishaps (like bee stings and sunburns) to real causes for concern (like sports injuries and accidents).

But summer healthcare concerns don’t have to ruin your fun! Come to Generations Family Practice for convenient medical care and thoughtful treatments from Cary’s favorite family doctors.

Our primary care capabilities includes comprehensive summer healthcare services, including:

At Generations Family Practice, our goal is to help you stay healthy and happy so you can enjoy all the best of summer -- whether you’re traveling abroad or staying home and soaking up the sunshine. Turn to our Cary, NC primary care physicians and pediatricians for travel shots, sunburn care, bee sting treatments and more!

So get outside and play this summer -- without the worry of summer healthcare concerns. At Generations Family Practice, our Cary, NC doctors are committed to convenient, thoughtful and patient-centered care. No matter what this summer brings you, you can count on Generations Family Practice for help you stay healthy!

Do You Know Your Car Seat Safety Requirements?

Tuesday, 25 April, 2017

The recommendations keep changing, but the goals are always the same...keeping our children safe. 

Did you know…Car safety seats reduce the risk of fatal injuries by 71% for infants and by 54% for children ages 1-4year? BUT these statistics are only accurate for properly installed car safety seats. 

Did you also know…70% of children are not properly restrained?

The nut and bolts…

  • Infants to 2 years old are best protected in a rear facing car seat in the back, middle seat or until they reach the car seat’s height/weight requirements.
  • 2 years old and older are safest in a 5-point forward harness until they reach the maximum height/weight allowed by the car seat.
  • Seat belt positioning boosters are used when your child outgrows the forward facing 5-point harness. 
  • Children may use the seat belt if they meet the following requirements…
  1. The child’s knees bend at the edge of the seat when their back is against the back of the seat. 
  2. The lap belt fits over the lap/thighs-not the abdomen. 
  3. The shoulder strap rests along the collar bone and shoulder-not the neck. 
  4. In general a child meets these criteria when they are 57in, between 80-100lbs, and between 8-10years.
  • Front seat? Back is always best…the latest recommendation is to wait until your child is 13 years old to be in the front seat.

References for more detailed information and free inspection locations:  (includes link to a free car seat check app)


(Written by Christine Macomber, MD, staff pediatrician at Generations Family Practice)

Preventive Care Visits at Generations Family Practice

Tuesday, 25 April, 2017

In this day and age of higher health insurance premiums with reduced benefits, it's important for patients to be informed consumers. With the onslaught of the HSA came higher costs to patients and an inkling of the real cost of healthcare.

It's important for patients to understand the difference between preventive care (i.e. a physical) and a regular office visit. Many HSA plans will cover a patient's preventive care in full, while regular office visits are subject to deductible.  What does this mean for the patient? You are entitled to a comprehensive medical exam and screening blood work. Unfortunately, given the higher costs to patients we oftentimes find patients schedule their physicals, but come in with a list of maladies. Time allotted for a yearly exam does not allow for the addition of sinus infections, abdominal pain, severe headaches, et cetera.

When issues arise during the course of the physical exam, or if the patient raises specific complaints in addition to the physical, this can result in an additional office visit charge.

In reviewing your lab results your provider may notice abnormal values, which may require further treatment or office visits. These cannot be viewed as an extension of your physical.

I liken this to six month check-ups at the dentist. While preventive care may be covered at 100%, any cavities or treatments required would fall outside the realm of preventive medicine.

I feel the pain of the costs of healthcare myself and empathize with many people less fortunate than myself. If you have any questions about the costs or the difference between a physical and an office visit, please do not hesitate to call and ask. We are here to help, but we are not able to retroactively change a visit type after the fact, so please ask beforehand if you are not sure.

Jennifer Sethi, Office Manager

Be of good cheer! Ways to beat those holiday blues

Tuesday, 25 April, 2017

With all the fall and winter holidays one after the other, the sight of all the changing decorations remind us that time is passing quickly. For many of us, the season of comfort and joy truly is that. But for many others, feeling sad during this time period is common. For many people, this time that others see as cheerful reminds us of sad events or losses from our childhoods, with our parents or grandparents, or the fantasy family we never had. And for everyone, during the last two months of the year, we all experience heightened stress due to money issues, lost love ones and unrealistic expectations magnified by the media surge.

To put some “comfort and joy” into your fall and winter, consider these tips:

Spend just the right amount of time with people you love. Many of us come from complicated families. Though we love them, visits with some of them can be stressful. If this is true for you, limit the amount of time for visits. All-day celebrations can be cut down to two hours. Or, you can visit those relatives at other times during the year when you feel less pressured by the season. Send those people cards, with the suggestion to get together another time.

Set financial goals. Your love for your family cannot be measured in dollars. If you cannot spend a lot on gifts due to your budget, don’t feel guilty. Spending more than you plan will make you feel guilty and stressed later. So instead, you may want to consider just sending a card with a nice note to some relatives. If you do give gifts, be sure to set a realistic budget and stick to it. Also, many families pick the names of just one relative, so each person only buys one gift. For a real twist on giving, get everybody on board to do a white elephant gift exchange. Or shop in consignment shops for beautiful presents that might even be new. Recycle gifts that you receive if they are sitting on your shelf, make cookies or a cake, or buy smaller specialty items like real maple syrup, which is always appreciated on holiday mornings, and always a treat.

Make a schedule so you do not feel rushed. Life today is lived in speed-up mode, and we feel pressed for time. This includes almost everyone: working people, mothers with little children, and people who are primary caregivers for the elderly. This is amplified during the month of November and December due to family obligations, holiday shopping and forced social engagements. To deal with the rush, setting specific times for shopping and visiting others is essential. Block out a period of time to shop and also to visit friends and family. Last minute shopping increases your stress levels. In addition, try to limit yourself to one social obligation every other day so these events will not feel overwhelming. This will also help children and older relatives  cope with the coming and going around family events. Schedule in the most important festivities that will help you see most of your loved ones at one time. Let go of those non-essential events that have more to do with strangers.

Set realistic expectations. Don't set yourself up for failure. Take time out for yourself by arranging to see those people who make you feel loved and supported. How you spend your time during the holiday season needs to reflect your own life and its constraints. You decide what is most important to you and focus on it. Life is not a dress rehearsal - it's the real thing.

Take a look at the following websites for more helpful suggestions:
University of Maryland School of Medicine:
Psychology Today magazine: