WEBVTT 1 00:00:12.210 --> 00:00:20.440 Quality Insights: Well, good morning, everyone, and welcome to Today's Webinar coffee and prevention with Dr. Penson, Medicare's Annual. Wellness visit. 2 00:00:20.640 --> 00:00:26.669 Quality Insights: We're going to get started in just a few minutes. But first we want to go over a few housekeeping items 3 00:00:26.900 --> 00:00:31.020 Quality Insights: first. All participants entered Today's Webinar in listen only mode. 4 00:00:31.050 --> 00:00:47.619 Quality Insights: If you have a question or a comment during the call Today we just ask that you please type that into either the Q. A. Feature or the chat box. Both of those are located at the bottom of your zoom window. You may need to hover your mouse around the bottom of the window to get those icons to appear if you don't see them. 5 00:00:47.900 --> 00:00:59.509 Quality Insights: And at the end of today's program, you're going to be directed to an evaluation and some reflective questions. Once you complete those, you'll be presented with a certificate for you to fill out and print as your proof of Webinar completion. 6 00:00:59.790 --> 00:01:09.120 Quality Insights: And even if you don't need the continuing education credits. We hope that you still complete the evaluation because it helps. Tell us how we did, and it can help shape our future programming. 7 00:01:10.060 --> 00:01:14.289 Quality Insights: So I just want to go over a couple of housekeeping items and slides 8 00:01:14.460 --> 00:01:17.750 Quality Insights: first to talk about continuing education credits. 9 00:01:17.810 --> 00:01:26.440 Quality Insights: So to obtain the contact hours for today. Participants must watch the Webinar today either live or the recorded version that will be posted later 10 00:01:26.490 --> 00:01:29.729 Quality Insights: and complete. The evaluation with the reflective questions 11 00:01:30.070 --> 00:01:32.800 Quality Insights: regarding the continuing education credits 12 00:01:32.820 --> 00:01:41.330 Quality Insights: in support of improving patient care. This activity has been planned and implemented by quality insights and Cmc institute for academic medicine. 13 00:01:41.490 --> 00:01:57.239 Quality Insights: cmc institute for Academic medicine is jointly accredited by the Accreditation Council for continuing Medical Education, the Accreditation Council from pharmacy, education, and the American nurses credentialing Center to provide continuing education for the health care team 14 00:01:57.340 --> 00:02:08.850 Quality Insights: so specifically for today positions. The Cmc Institute for Academic Medicine designates this live activity for a maximum of 1 h for am a pra category one credits 15 00:02:08.910 --> 00:02:16.529 Quality Insights: physicians. Should only Clinton excuse me. Positions should only claim credit commensurate with the extent of their participation in the activity. 16 00:02:16.680 --> 00:02:30.670 Quality Insights: and for nurses. The Cmc. Institute of Academic Medicine as an approved provider for continuing nursing education by the American nurses. Credentialing Centers Commission on accreditation this offering has been approved for one contact hour for nursing 17 00:02:31.650 --> 00:02:42.140 Quality Insights: Cynthia Pins and Md. And other planners for this educational activity have no relevant disclosures, and the expiration for this material is January, 18 of 2025. 18 00:02:44.490 --> 00:02:58.959 Quality Insights: So after this course, learners will be able to identify annual wellness, visit components, state who can conduct an annual wellness, visit and describe annual wellness, visit assessments for nursing home residents. 19 00:03:00.390 --> 00:03:08.739 Quality Insights: We have a lot of excellent information to deliver today. So without further ado, i'd like to introduce our guest speaker today. Dr. Cindy Pinson. 20 00:03:09.030 --> 00:03:16.650 Quality Insights: Dr. Pinson was born and raised in China until the age of 18. She came to study abroad in the Us. In 1,987. 21 00:03:16.810 --> 00:03:31.760 Quality Insights: She graduated Magna cum laude from Marshall University in 1,992, and she earned her Md. Degree from Marshall University, Jones, C. Edwards School of Medicine in 1,996 and went on to be trained with the department of family and community health. At Marshall 22 00:03:32.120 --> 00:03:35.239 Quality Insights: she founded travel and D in 2,005, 23 00:03:35.270 --> 00:03:41.399 Quality Insights: and for the following 13 years travel Md. Became the largest house call practice for the tri-state area 24 00:03:41.780 --> 00:03:48.460 Quality Insights: travel. Md. Joined Caval Huntington Hospital and Martial Health in March in February of 2,018, 25 00:03:48.550 --> 00:03:52.360 Quality Insights: and Dr. Penson, is the medical director of multiple, skilled. 26 00:03:52.450 --> 00:03:58.920 Quality Insights: multiple, local, skilled nursing facilities, as well as for the division of cable Huntington Hospital, home care, medicine. 27 00:03:59.180 --> 00:04:05.730 Quality Insights: She visits patients and skilled nursing facilities, assistant living living facilities, and private homes. 28 00:04:06.000 --> 00:04:12.490 Quality Insights: She was selected as the house called Doctor of the Year, in 2,013, by the American Academy of Home Care Medicine. 29 00:04:12.670 --> 00:04:16.499 Quality Insights: She's an assistant professor at the Department of Family and Community Health. 30 00:04:16.700 --> 00:04:23.370 Quality Insights: and she teaches geriatric practice to medical students, resident doctors, nursing staff, and other professionals. 31 00:04:23.690 --> 00:04:33.579 Quality Insights: She is the chairperson of the post acute care work group of the Mhc Aco, leading the collaborative effort to improve communication between all care settings. 32 00:04:33.850 --> 00:04:40.739 Quality Insights: She has 4 children. She's active in the Faith community and volunteers her time in recovery programs 33 00:04:41.020 --> 00:04:46.570 Quality Insights: so welcome Dr. Penson. I am very excited to turn things over to you this morning. 34 00:04:47.080 --> 00:04:48.389 Dr. Cynthia Pinson: Thank you very much. 35 00:04:48.920 --> 00:04:50.849 Dr. Cynthia Pinson: We'll get right home to it 36 00:04:58.880 --> 00:04:59.750 Dr. Cynthia Pinson: all right. 37 00:05:02.350 --> 00:05:04.550 Dr. Cynthia Pinson: so we will 38 00:05:07.280 --> 00:05:14.470 Dr. Cynthia Pinson: start. Well. Thank you. When Baby asked me to do this, and I thought to myself, she must really hate me, because this is 39 00:05:14.550 --> 00:05:32.069 Dr. Cynthia Pinson: such a big topic, and honestly, compared to everything I do every day is a very boring subject, but I will try to make it interesting for you. So just hang in there. There's really a lot of material, but none of these things are anything that's different from what we do every day, and I think most of you have done a. 40 00:05:32.080 --> 00:05:36.880 Dr. Cynthia Pinson: Wv. Visits, and are probably quite good at it. So I appreciate you still paying attention 41 00:05:37.220 --> 00:05:56.029 Dr. Cynthia Pinson: if you are Star or Fan, or have ever watched our wars, and you know that Yoda has the same? He says, do or do not. There is no trial which means you gotta go all the way. So my subtitle for this lecture. But this talk is, do or do not. There is no choice, because there really isn't, you gotta do it on those things 42 00:05:56.610 --> 00:05:57.380 Dr. Cynthia Pinson: all right. 43 00:05:57.830 --> 00:06:00.529 Dr. Cynthia Pinson: So here's our friend Yoga. Okay. 44 00:06:01.030 --> 00:06:07.049 Dr. Cynthia Pinson: looks of this thing. There are definitely times that this is what I look like underneath my my smiles. 45 00:06:07.150 --> 00:06:08.020 Dr. Cynthia Pinson: All right. 46 00:06:08.400 --> 00:06:19.180 Dr. Cynthia Pinson: So like any good story. We're going to talk about the who, the what in the where, and why, and how, and because it is medicine we're going to talk about the cost and reimbursement 47 00:06:19.440 --> 00:06:20.350 Dr. Cynthia Pinson: all right. 48 00:06:20.390 --> 00:06:24.220 Dr. Cynthia Pinson: and but the bulk of the top is going to be on the what. 49 00:06:24.540 --> 00:06:26.140 Dr. Cynthia Pinson: So you know that that 50 00:06:26.200 --> 00:06:30.920 Dr. Cynthia Pinson: the thing. We got to push through a lot of slides on that, but afterwards it's just smooth sailing. 51 00:06:31.910 --> 00:06:32.740 Dr. Cynthia Pinson: all right. 52 00:06:34.090 --> 00:06:40.270 Dr. Cynthia Pinson: Starvator says, who is going to need the annual bonus exam, and who is going to do it? 53 00:06:40.370 --> 00:06:41.090 Dr. Cynthia Pinson: Well. 54 00:06:42.760 --> 00:06:43.650 Dr. Cynthia Pinson: So 55 00:06:43.690 --> 00:06:44.780 Dr. Cynthia Pinson: who needs it? 56 00:06:44.920 --> 00:06:52.939 Dr. Cynthia Pinson: You know that's basically. Everyone. So either your Medicare or you're not. So it's almost 50 50, and most of the markets. 57 00:06:53.210 --> 00:06:56.380 Dr. Cynthia Pinson: and Medicare makes all the rules, but managed care 58 00:06:56.640 --> 00:06:57.909 Dr. Cynthia Pinson: who takes 59 00:06:58.250 --> 00:07:16.060 Dr. Cynthia Pinson: over in a way with their self risk for Medicare. They are required to do as well. Now who can do it, or it's you because you're here. Either you are a physician, a nurse practitioner, or a physician or assistant. You're doing this now. In some other 60 00:07:16.070 --> 00:07:30.629 Dr. Cynthia Pinson: areas of practice a Dietitian can do it or certified health educator can do this, or a team that's led by a physician can do it. That's not common here. I've never seen this done before, and I think the building will be a little bit tricky. 61 00:07:31.350 --> 00:07:34.009 Dr. Cynthia Pinson: so we just stick with what we know. So that's just you 62 00:07:34.300 --> 00:07:53.730 Dr. Cynthia Pinson: all right. This is a very busy slide. There are actually busier slice in this I just simplified it, and you have to remember these wordings are written by lawyers. So although you master English, and you can't read this, but you don't really understand the content that is normal. It's okay. 63 00:07:55.720 --> 00:07:56.470 Dr. Cynthia Pinson: But 64 00:07:56.640 --> 00:08:09.100 Dr. Cynthia Pinson: this is really for your reference. Later, there are 3 columns here. The good thing about this is the very left column tells you what the welcome to Medicare visit requires. Not that's the first 65 00:08:09.410 --> 00:08:12.000 Dr. Cynthia Pinson: visit that you get to Bill 66 00:08:12.180 --> 00:08:17.229 Dr. Cynthia Pinson: for someone that just started getting their Medicare be coverage. 67 00:08:17.380 --> 00:08:36.649 Dr. Cynthia Pinson: pay part b coverage, and then the middle part is the very first annual honest visit that you get to do. And this is what entails, and the next one is your subsequent follow up Visit now, for all in 10 purposes. If you look at it, they're really about the same when it's update once we view whatever. 68 00:08:36.659 --> 00:08:43.660 Dr. Cynthia Pinson: So in this talk I do not distinguish between the 2 of them, because they are really the same, and the amount of work is the same. 69 00:08:44.970 --> 00:08:46.420 Dr. Cynthia Pinson: So life is struggle. 70 00:08:46.550 --> 00:08:49.840 Dr. Cynthia Pinson: The practice of medicine is even more of a struggle. 71 00:08:51.570 --> 00:08:53.499 Dr. Cynthia Pinson: just a lot to do so 72 00:08:55.100 --> 00:08:57.999 Dr. Cynthia Pinson: So the what this I told you this is the bulk 73 00:08:58.080 --> 00:09:00.710 Dr. Cynthia Pinson: of what needs to happen for this visit. 74 00:09:00.830 --> 00:09:07.049 Dr. Cynthia Pinson: whether you're practicing in like a home setting or clinic, or nursing homes, or whatever 75 00:09:07.230 --> 00:09:09.739 Dr. Cynthia Pinson: everything is really the same. But 76 00:09:09.830 --> 00:09:19.870 Dr. Cynthia Pinson: what's different in different setting is the amount of information that's already available to you. That's already in your Ehr, or even ehr of 77 00:09:20.200 --> 00:09:23.150 Dr. Cynthia Pinson: the facility you are working, and 78 00:09:23.270 --> 00:09:25.110 Dr. Cynthia Pinson: that's vastly different. 79 00:09:26.780 --> 00:09:29.419 Dr. Cynthia Pinson: So when you think about 80 00:09:29.450 --> 00:09:31.169 Dr. Cynthia Pinson: annual wellness, visit 81 00:09:31.410 --> 00:09:32.590 Dr. Cynthia Pinson: well really 82 00:09:32.620 --> 00:09:34.320 Dr. Cynthia Pinson: has to happen here 83 00:09:34.570 --> 00:09:43.040 Dr. Cynthia Pinson: is that there is a certain amount of money allotted to a patient to take care of their medical expense for the year; that same. 84 00:09:43.700 --> 00:09:50.290 Dr. Cynthia Pinson: So in this visit you're trying to identify the things that's going to cause you money 85 00:09:50.480 --> 00:09:52.469 Dr. Cynthia Pinson: now and later. 86 00:09:52.800 --> 00:10:04.529 Dr. Cynthia Pinson: right. If this person has high risk for fall. You want to identify that you want to treat, that you want to make that better to prevent that fall. That, you see is coming because that fall. 87 00:10:04.780 --> 00:10:18.710 Dr. Cynthia Pinson: It's some costs a lot of money. If she or he has a hip fracture, goes to the hospital and stays there and gets pneumonia, and uti gets a fully it goes to rehab at, You know one of the nursing homes and then cannot go home anymore. 88 00:10:18.950 --> 00:10:35.480 Dr. Cynthia Pinson: Right? So that's what you want to prevent. That's really what this is all about you on the identify what is going to happen to these people later for side for side. You got to identify what is going to happen to them and address those problems ahead of time to prevent that huge cost later. 89 00:10:35.880 --> 00:10:36.670 Dr. Cynthia Pinson: All right. 90 00:10:36.720 --> 00:10:38.820 Dr. Cynthia Pinson: So nothing is free. 91 00:10:39.050 --> 00:10:44.119 Dr. Cynthia Pinson: Even addressing all these problems. It is not free. What's going to cost you is time. 92 00:10:44.210 --> 00:10:45.699 Dr. Cynthia Pinson: if you think about that. 93 00:10:45.740 --> 00:10:51.130 Dr. Cynthia Pinson: to address all these problems in a practice that's usually busy. 94 00:10:51.230 --> 00:11:00.519 Dr. Cynthia Pinson: It is things you don't even really talk about with your patient on a one on basis, on the day to day basis. You really don't talk about these things. You talk about their diabetes, or have 95 00:11:00.690 --> 00:11:04.380 Dr. Cynthia Pinson: hypertension, or their toenail herds or their knee herds 96 00:11:04.420 --> 00:11:11.140 Dr. Cynthia Pinson: whatever. But some of these questions we're going to address you. Don't like to get a chance to talk about it. Okay, but 97 00:11:11.390 --> 00:11:22.700 Dr. Cynthia Pinson: that's why. Awb pays very well, because it's paying for you to spend that time. It could take up to an hour, sometimes more, to address everything else that you don't get to talk about usually. 98 00:11:22.960 --> 00:11:25.029 Dr. Cynthia Pinson: and that's why it's only one time I care 99 00:11:26.000 --> 00:11:26.770 Dr. Cynthia Pinson: all right. 100 00:11:27.020 --> 00:11:28.140 Dr. Cynthia Pinson: So the 101 00:11:28.180 --> 00:11:31.190 Dr. Cynthia Pinson: that's overall. And all of these things we're going to touch later. 102 00:11:32.770 --> 00:11:33.790 Dr. Cynthia Pinson: So what 103 00:11:34.060 --> 00:11:34.990 Dr. Cynthia Pinson: This is 104 00:11:35.030 --> 00:11:41.409 Dr. Cynthia Pinson: not hard, because this is already in it. Hopefully, all of your charts. You already have 105 00:11:41.530 --> 00:11:49.099 Dr. Cynthia Pinson: their family history, you know, who has had cancer, who has a father that died at age 36, on massive party tag. 106 00:11:49.330 --> 00:11:55.349 Dr. Cynthia Pinson: So some of these things applies to the patient that you're that's in front of you right now. 107 00:11:55.490 --> 00:12:06.120 Dr. Cynthia Pinson: and their past medical history. One surgery they've already had, and what are their exposure to to medications well prescribed and not prescribed. 108 00:12:06.190 --> 00:12:07.949 Dr. Cynthia Pinson: So these things at a minimum 109 00:12:08.010 --> 00:12:10.839 Dr. Cynthia Pinson: to already being a chart. So thank goodness for that. 110 00:12:12.150 --> 00:12:19.069 Dr. Cynthia Pinson: Who are their providers? Who is there? A cardiologist who is your pulmonologist? Who is there a cancer doctor? 111 00:12:19.660 --> 00:12:23.360 Dr. Cynthia Pinson: And the suppliers well, who gives their Cp. 112 00:12:23.430 --> 00:12:26.519 Dr. Cynthia Pinson: Although there's very limited 113 00:12:26.610 --> 00:12:30.050 Dr. Cynthia Pinson: suppliers now. But these are things that that's necessary 114 00:12:31.070 --> 00:12:32.040 Dr. Cynthia Pinson: measures. 115 00:12:33.260 --> 00:12:38.100 Dr. Cynthia Pinson: A Wb Doesn't include and doesn't require a physical exam. 116 00:12:38.450 --> 00:12:48.879 Dr. Cynthia Pinson: So all right, You can save like 5 min in your time, but it does require some measurements, and luckily this measurements are already done for us usually by our nursing stack. 117 00:12:48.960 --> 00:12:51.170 Dr. Cynthia Pinson: If these are normal stuff, hide and wait. 118 00:12:51.230 --> 00:12:53.679 Dr. Cynthia Pinson: You know how how are you? 119 00:12:53.730 --> 00:13:03.909 Dr. Cynthia Pinson: How big are you? You know how, how, what's your blood pressure? That type, stuff or other things that you feel is permanent to finish your your assessment. 120 00:13:04.780 --> 00:13:05.450 Dr. Cynthia Pinson: Yeah. 121 00:13:05.680 --> 00:13:11.680 Dr. Cynthia Pinson: this is the part I like to do the most to detect any cognitive impairment the patient may have 122 00:13:11.730 --> 00:13:23.519 Dr. Cynthia Pinson: it. It is important in my line of work, because I, you know, really only see older people, and I do have some younger people, but these younger people have some other kind of impairment already that makes them disabled. 123 00:13:23.720 --> 00:13:29.589 Dr. Cynthia Pinson: all right. So they maybe at the nursing home. They may be kind of let me at home with their caregivers. 124 00:13:29.810 --> 00:13:31.300 so 125 00:13:31.710 --> 00:13:41.449 Dr. Cynthia Pinson: the cognitive test we are going to discuss later. But it's important to do this exam, because people can walk around with mild 126 00:13:41.700 --> 00:13:48.709 Dr. Cynthia Pinson: dementia or some kind of cognitive deficit for a long time before even their closest loved ones notice. 127 00:13:48.850 --> 00:13:55.560 Dr. Cynthia Pinson: So I feel if you detect this early and deliver that, and use to them in a compassionate way. 128 00:13:56.090 --> 00:13:58.389 Dr. Cynthia Pinson: This gives them a chance to go and 129 00:13:58.830 --> 00:14:04.780 Dr. Cynthia Pinson: understand the disease, progress themselves, to set their affairs in place, and to have that 130 00:14:05.280 --> 00:14:07.600 Dr. Cynthia Pinson: discussion about advanced care planning 131 00:14:07.860 --> 00:14:13.490 Dr. Cynthia Pinson: while they're still with it while they are still thinking in the correct way, because there's definitely a way 132 00:14:13.880 --> 00:14:18.769 Dr. Cynthia Pinson: that people start thinking later when they have called to the impairment what they can't really think 133 00:14:18.900 --> 00:14:22.259 Dr. Cynthia Pinson: correctly, and they can come to a rational decision anymore. 134 00:14:22.300 --> 00:14:31.000 Dr. Cynthia Pinson: So do this for them for a favor. So while they're still rational, they can walk away from you and start making some plans for their life and their death. 135 00:14:31.890 --> 00:14:34.120 Dr. Cynthia Pinson: And you know there are treatment options as well. 136 00:14:35.310 --> 00:14:36.089 Dr. Cynthia Pinson: All right. 137 00:14:36.110 --> 00:14:44.470 Dr. Cynthia Pinson: So the 3 things we are commonly used, and maybe you guys use some other tools. But these are the 3 things that we use commonly in our practice. 138 00:14:44.480 --> 00:15:02.439 Dr. Cynthia Pinson: So meaningco is very simple. It's the one with the 3 words, you know apple table and penny, and then you make them draw clock with the time 10 after 11 on it, and then come back and tell us what the 3 words are. This takes 3 min to do it's a very, very short test and a very good test. 139 00:15:02.450 --> 00:15:08.500 Dr. Cynthia Pinson: It's a good screening test when they don't score 5 out of 5, because you know 3 words. 140 00:15:09.030 --> 00:15:19.669 Dr. Cynthia Pinson: but drawing and the time, so there are 5 points. So if they don't get a perfect 5, you don't have to ask some more questions. Kind of they are, which part of missing. 141 00:15:19.690 --> 00:15:21.339 Dr. Cynthia Pinson: and if they get 142 00:15:21.450 --> 00:15:34.619 Dr. Cynthia Pinson: like 3 out of 5, you're really all online. They are to do more test, and they they only get one or 2 out of 5. Most likely this person has a pretty advanced impairment, and really needs to be addressed. 143 00:15:35.190 --> 00:15:36.270 Dr. Cynthia Pinson: So the next 144 00:15:36.350 --> 00:15:51.849 Dr. Cynthia Pinson: 2 tests slums takes 8 min to do. The many mental takes 7 min to do. Slams is what I like to do best is the same. Louis University, and one of the smartest speech therapist introduced this to me, and 145 00:15:52.040 --> 00:15:59.179 Dr. Cynthia Pinson: it's more just like a memory. Test it. Really test your concentration, your 146 00:15:59.190 --> 00:16:12.049 Dr. Cynthia Pinson: visual spatial, and you know, story recall. And there's a lot of math in there. So this test is very good, and it gives you a scoring right here at the bottom, so it's very simple to administer 147 00:16:14.670 --> 00:16:20.189 Dr. Cynthia Pinson: right. The many mental status exams what I was trained in when I was in the school. 148 00:16:20.410 --> 00:16:22.089 Dr. Cynthia Pinson: Not a bad test, but I 149 00:16:22.240 --> 00:16:26.790 Dr. Cynthia Pinson: really not done this test since I started loving all the slums. 150 00:16:28.600 --> 00:16:29.520 Dr. Cynthia Pinson: All right. 151 00:16:29.670 --> 00:16:37.679 Dr. Cynthia Pinson: So what to do next? You know you feel familiar with Star Wars, and I can Sky Walker turn bad in this movie. 152 00:16:37.860 --> 00:16:40.289 Dr. Cynthia Pinson: right? So look at his red eyes. 153 00:16:40.340 --> 00:16:51.389 Dr. Cynthia Pinson: You don't want your patients to get to that shape right with their mood disorder, and you don't want them to be so angry that they start really hating the world, and wants to destroy everyone in their path. 154 00:16:51.440 --> 00:16:55.530 Dr. Cynthia Pinson: So the way to do is, you know, Catch them early before they get this way. 155 00:16:55.650 --> 00:17:14.069 Dr. Cynthia Pinson: and there are depression tools to, you know. Depression. Only one of the new disorders, of course, but in your observation in your one-hour conversation with the patient, you probably will be able to pick up some of their mood disorders if it's obvious, but screening for depression is actually required. 156 00:17:15.470 --> 00:17:27.380 Dr. Cynthia Pinson: I like this one. So this is the geriatric depression scale. This is the short form. There is a long form. The short form has 15 questions. The long form has 30, for I will choose the 15, 157 00:17:27.450 --> 00:17:30.330 Dr. Cynthia Pinson: and it's very telltale. 158 00:17:30.450 --> 00:17:41.390 Dr. Cynthia Pinson: I am sometimes surprised actually, by the answers. There are some patients I feel like they are just like really depressed, and they are so unmotivated, and they don't do anything all day. 159 00:17:41.610 --> 00:17:43.780 Dr. Cynthia Pinson: and they completely come out with like 160 00:17:43.900 --> 00:17:48.229 Dr. Cynthia Pinson: no positive answers. I guess all good answers to everyone. 161 00:17:48.440 --> 00:17:57.479 Dr. Cynthia Pinson: And then there are some people that are just doing great. You feel like life is wonderful for them, and then they get like 11 positive answers out of 15. 162 00:17:57.580 --> 00:18:01.459 Dr. Cynthia Pinson: So it's really good to do this exercise. 163 00:18:01.570 --> 00:18:09.609 Dr. Cynthia Pinson: and I think in Appalachian. You know most patients. We we are women. So in that age group they are all about 164 00:18:09.710 --> 00:18:15.750 Dr. Cynthia Pinson: doing things that you like, and not to offend people, and not be a burden to other people. 165 00:18:15.780 --> 00:18:17.589 Dr. Cynthia Pinson: So what I tell them is. 166 00:18:17.720 --> 00:18:37.359 Dr. Cynthia Pinson: don't think too much, and you don't have to explain your answers to me or justify why you feel that way, or I apologize for thinking that way. It's just how you feel for the last week. You know just the first question I asked you. You just say yes or no, and that's it, whatever it comes to your mind for just say it, you don't have to apologize for it. 167 00:18:37.370 --> 00:18:40.459 Dr. Cynthia Pinson: So I seem to get more honest results that way. 168 00:18:43.590 --> 00:18:45.000 Dr. Cynthia Pinson: Functional abilities. 169 00:18:45.020 --> 00:18:49.229 Dr. Cynthia Pinson: So we're all about function, no abilities, because this 170 00:18:49.250 --> 00:19:01.509 Dr. Cynthia Pinson: people can live, you know to 90 and still play tennis, and people can live to 65. It's in no wheelchair it's all about functions right. So you want to kind of figure out where they are. 171 00:19:03.050 --> 00:19:08.539 Dr. Cynthia Pinson: All right. Let's top on the basics. On the left side of your screen is the a 172 00:19:08.820 --> 00:19:11.230 Dr. Cynthia Pinson: activities of daily living. 173 00:19:11.310 --> 00:19:14.079 Dr. Cynthia Pinson: my acronym for aviation 174 00:19:14.480 --> 00:19:21.060 Dr. Cynthia Pinson: right? Because I think if you can do some of these things, you're just that you ability that pretty soon 175 00:19:21.390 --> 00:19:27.730 Dr. Cynthia Pinson: d for dress e for eat. They don't have to meal prep. They just have to eat 176 00:19:28.050 --> 00:19:30.510 Dr. Cynthia Pinson: ambulation with us a 177 00:19:30.660 --> 00:19:31.850 Dr. Cynthia Pinson: toilet. 178 00:19:32.040 --> 00:19:37.889 Dr. Cynthia Pinson: You got one Pm. P. By yourself and clean it up. That's very important. That's very important. 179 00:19:37.930 --> 00:19:49.049 Dr. Cynthia Pinson: There are multiple patients we have had because of this one issue. They end up in a nursing home or having to have around the call care because they can't toilet themselves 180 00:19:49.240 --> 00:19:57.659 Dr. Cynthia Pinson: Right? You can't sit in your own thing all day waiting for your daughter to come home from work that is not sanitary right? 181 00:19:58.110 --> 00:20:03.819 Dr. Cynthia Pinson: And then age for hygiene, and you clean yourself up all right. So that's your very basics. 182 00:20:03.860 --> 00:20:04.820 Dr. Cynthia Pinson: only 5. 183 00:20:04.960 --> 00:20:11.039 Dr. Cynthia Pinson: If you cannot meet some of these, if you need help with 2 out of 5 days. You you're pretty impaired. 184 00:20:11.620 --> 00:20:23.170 Dr. Cynthia Pinson: all right, the iadl my acronym, for that is it from home. You know that, moody it. So it phone home. E stands for errands. Can you make a list 185 00:20:23.210 --> 00:20:24.110 Dr. Cynthia Pinson: and say. 186 00:20:24.250 --> 00:20:42.080 Dr. Cynthia Pinson: today, I gotta go to the bank. I gotta go visit Frank. I gotta go, you know. Take some soup to Suzy, and I gotta go to, you know grocery store. Can you make a plan and run all your errands in transportation. Oh, there is a title 187 00:20:42.090 --> 00:20:47.469 Dr. Cynthia Pinson: so can you drive yourself places? Can you get your cell phone, Point a. To Point B. 188 00:20:47.560 --> 00:21:04.479 Dr. Cynthia Pinson: If you're within walking distance of your groceries, or can you walk over there with a cart and bring on yourself back and fall? Can you call people internal emergency housekeeping. Can you keep your place a little bit neat and clean and free of clutter? 189 00:21:04.500 --> 00:21:09.080 Dr. Cynthia Pinson: Hmm. That's that's questionable. And N. Stands for that 190 00:21:09.210 --> 00:21:11.059 Dr. Cynthia Pinson: meals and money. 191 00:21:11.400 --> 00:21:16.659 Dr. Cynthia Pinson: Can you manage your medications? Take them on time, pick up the refill, call for a refill. 192 00:21:16.940 --> 00:21:22.460 Dr. Cynthia Pinson: Can you remember? Take your night medications at night and day medications in day 193 00:21:22.700 --> 00:21:35.920 Dr. Cynthia Pinson: meals. This involves meal. Prep. Not Tom out elaborate Thanksgiving dinner is just come out. Can you make a sandwich? Can you make some steady? Can you make food to feed yourself? It could be TV dinner. Can you pop something in the microwave 194 00:21:36.360 --> 00:21:39.059 Dr. Cynthia Pinson: and put just the right amount of time on it. So it doesn't 195 00:21:39.340 --> 00:21:40.800 Dr. Cynthia Pinson: Catch your house on fire 196 00:21:41.150 --> 00:21:43.850 Dr. Cynthia Pinson: or money. Can you manage your finance? 197 00:21:44.620 --> 00:21:45.870 Dr. Cynthia Pinson: These are basics 198 00:21:46.160 --> 00:21:46.890 Dr. Cynthia Pinson: alright. 199 00:21:48.220 --> 00:21:52.159 Dr. Cynthia Pinson: Full risk assessment. We will talk about that. There. 200 00:21:52.280 --> 00:22:15.130 Dr. Cynthia Pinson: There are a lot of reasons why people will fall. It's a very complicated process. Not always, you know, medication related, or whatever. But there's a risk scale so we can discuss later. Home. Safety is your home safe. Do you feel safe in your home? There are throw rocks everywhere, other clutters everywhere. That's usually what I see there. 201 00:22:15.140 --> 00:22:25.949 Dr. Cynthia Pinson: Things in your way. When you try to navigate between your chair to the bathroom you can not be removed hearing impairment. I don't really know 202 00:22:26.390 --> 00:22:36.209 Dr. Cynthia Pinson: how you cannot detect that like you speak to someone in a normal tone. You can detect that. I'm amazed how 203 00:22:36.650 --> 00:22:48.419 Dr. Cynthia Pinson: much better people got as we were wearing mask more and more in the beginning no one could understand, but at the end, you know, we were getting pretty good at speaking with a mask on, and patients were getting really good at hearing us 204 00:22:49.870 --> 00:22:50.630 Dr. Cynthia Pinson: all right. 205 00:22:50.940 --> 00:23:06.809 Dr. Cynthia Pinson: So after you've done all of that, you want to have a schedule, you know. You guys want to write it down. If they're in the office and office setting and in our zoom room, we just write it in our chart right? And and you have this in your mind already, as you'll be doing the the last 6 items. 206 00:23:06.840 --> 00:23:12.310 Dr. Cynthia Pinson: You know what they're gonna need, and you know their age, and you kind of know what their function level is, right. So there's a schedule 207 00:23:13.130 --> 00:23:14.749 Dr. Cynthia Pinson: so to do and not to do. It. 208 00:23:14.920 --> 00:23:16.749 Dr. Cynthia Pinson: Is this exact. 209 00:23:16.840 --> 00:23:35.970 Dr. Cynthia Pinson: not exactly exact, because there are different organizations that wants to do different things for people at different age. Now the Us. Pst. F our cheeks, gates. They always want to do things. A little bit later i'd save a little bit more money, money, and benefit most people. 210 00:23:35.980 --> 00:23:46.619 Dr. Cynthia Pinson: I'm not saying anything bad about them. I just find that they are always a little bit different from the specialty groups, such as the cancer association. They always want to do things a little bit earlier. 211 00:23:46.740 --> 00:23:49.580 Dr. Cynthia Pinson: Obviously they are made up for, you know, people that 212 00:23:49.810 --> 00:23:50.780 Dr. Cynthia Pinson: treat cancer. 213 00:23:51.050 --> 00:23:53.040 Dr. Cynthia Pinson: So. Colon Cancer 214 00:23:53.430 --> 00:23:55.209 Dr. Cynthia Pinson: 45 to 75 215 00:23:55.400 --> 00:23:59.210 Dr. Cynthia Pinson: years of age, maybe every 10 years. If everything's normal. 216 00:23:59.230 --> 00:24:02.410 Dr. Cynthia Pinson: Once in our past age of 75, 217 00:24:02.580 --> 00:24:05.999 Dr. Cynthia Pinson: you can just be like I really don't need to do that anymore. 218 00:24:06.020 --> 00:24:10.469 Dr. Cynthia Pinson: except if this person you're seeing is very functional. 219 00:24:10.680 --> 00:24:19.149 Dr. Cynthia Pinson: But he doesn't have a lot of things around with them, and looks like may live another 10 years. You can talk to them or the Mpoa and try to decide 220 00:24:19.230 --> 00:24:19.950 Dr. Cynthia Pinson: all right. 221 00:24:20.490 --> 00:24:21.280 Dr. Cynthia Pinson: But 222 00:24:21.300 --> 00:24:24.969 Dr. Cynthia Pinson: for breast cancer, basically a 70 223 00:24:25.080 --> 00:24:27.659 Dr. Cynthia Pinson: 4 is our last meal. Grant. 224 00:24:27.900 --> 00:24:44.900 Dr. Cynthia Pinson: Thank God, I am still looking forward to that. But after that, if someone's really functional like they are patients I have. They are in their nineties. They are still leading the choir, you know, conducting milical and driving themselves around, and. 225 00:24:45.100 --> 00:24:47.500 Dr. Cynthia Pinson: you know, going across the country with our son. 226 00:24:47.840 --> 00:25:00.060 Dr. Cynthia Pinson: So those kind of people it really is a discussion I have to with them every year. But if you think about my grand, you know what If this happens with you? Text something. What would you want to do? This is what's gonna happen if there's treatment. 227 00:25:00.100 --> 00:25:02.539 Dr. Cynthia Pinson: So that's kind of personalized. But 228 00:25:02.600 --> 00:25:05.050 Dr. Cynthia Pinson: the cut off is 74 229 00:25:05.740 --> 00:25:06.960 Dr. Cynthia Pinson: lung cancer 230 00:25:07.110 --> 00:25:09.219 Dr. Cynthia Pinson: in this area. 231 00:25:09.440 --> 00:25:16.809 Dr. Cynthia Pinson: Unfortunately, we have a lot of smokers. The only time they quit smoking for a lot of people is when they come to a nursing home. 232 00:25:17.120 --> 00:25:23.900 Dr. Cynthia Pinson: although in our Zoom Rooms do allow people to smoke. But it's so inconvenient. Most people just kind of face down and and quit. 233 00:25:24.040 --> 00:25:30.940 Dr. Cynthia Pinson: So these people, that, being a smoker from the age of 55 to 80, they are supposed to have an annual casket. 234 00:25:31.170 --> 00:25:31.900 Dr. Cynthia Pinson: right. 235 00:25:32.000 --> 00:25:39.329 Dr. Cynthia Pinson: or if they having a smoker and quit, but it's less than 15 years ago, less than 1 5 years ago. 236 00:25:39.790 --> 00:25:45.729 Dr. Cynthia Pinson: So that is discussion I have with them. Well, you're you know you're 60 years old now, and 237 00:25:45.790 --> 00:25:53.919 Dr. Cynthia Pinson: you, Haven't, had this done, and you having a smoker, and you continue to smoke, you know. There's a protocol for this type of caskets, and they can't be ordered. 238 00:25:54.170 --> 00:25:59.340 Dr. Cynthia Pinson: Once they reach the age of 80. We can stop talking about it, stop ordering it. 239 00:25:59.620 --> 00:26:04.489 Dr. Cynthia Pinson: and then, once they have quit smoking for 15 years. You can stop ordering 240 00:26:05.540 --> 00:26:07.259 Dr. Cynthia Pinson: cervical cancer screening. 241 00:26:07.310 --> 00:26:09.420 Dr. Cynthia Pinson: Older adults 242 00:26:09.470 --> 00:26:10.200 Dr. Cynthia Pinson: have 243 00:26:10.410 --> 00:26:11.920 Dr. Cynthia Pinson: sexual activities. 244 00:26:12.090 --> 00:26:16.839 Dr. Cynthia Pinson: whether you like it or not. Maybe 245 00:26:16.920 --> 00:26:21.370 Dr. Cynthia Pinson: too much information. But in nursing homes we find this in 246 00:26:21.540 --> 00:26:38.570 Dr. Cynthia Pinson: which is thing is hilarious when we do find it so. I mean, is there a chance of these women getting cervical? Cancer. Chances are no so lucky for us we can stop doing cervical cancer screening can imagine putting these people on a stir. Up. I'm not doing that. 247 00:26:38.580 --> 00:26:42.020 Dr. Cynthia Pinson: So it's h 65. You can kind of write them off. You don't have to do that. 248 00:26:42.370 --> 00:26:43.149 Dr. Cynthia Pinson: All right 249 00:26:43.850 --> 00:26:52.749 Dr. Cynthia Pinson: prostate cancer screening very sensitive topic for man. It's completely individual decision. There's no one's gonna say 250 00:26:53.510 --> 00:27:08.419 Dr. Cynthia Pinson: If someone says, I want a Psa, I want a screaming, and you discuss with them. They still wanted. You can't really say no to that. So you just order a psa every year. So they have some, you know, peace, peaceful, thinking that they are being screened for the 251 00:27:08.430 --> 00:27:17.629 Dr. Cynthia Pinson: once. They're 70 years old, though you can stop ordering that test. You can explain to them. It basically stops here, and no one recommends any further testing after that 252 00:27:18.440 --> 00:27:28.170 Dr. Cynthia Pinson: Also, Porosis. If you are 65 and older, your patient 65 older, you can start screening for it with a dice, scan you can do that for about 253 00:27:28.200 --> 00:27:35.259 Dr. Cynthia Pinson: 10 years out every couple of years it'll be 5 just depends on the finding. I' to say 75 You can stop doing it. 254 00:27:35.390 --> 00:27:43.669 Dr. Cynthia Pinson: and if someone that's younger than 65, but they have increased risk. Like as they said, Hello, you can start waiting for sooner 255 00:27:46.010 --> 00:28:02.670 Dr. Cynthia Pinson: I put over you on this picture here because he is just so handsome. So, for if he were smoker he is aged 65 to 75, because he is so handsome. You will not want to him to die of a ruptured, a triple? A. So you want to drink him for that. 256 00:28:02.700 --> 00:28:07.509 Dr. Cynthia Pinson: Okay, but that's about the only time you only do mail you don't scream for female 257 00:28:09.200 --> 00:28:09.960 Dr. Cynthia Pinson: all right. 258 00:28:12.350 --> 00:28:14.599 Dr. Cynthia Pinson: down to the last 2, 3 259 00:28:15.630 --> 00:28:17.040 Dr. Cynthia Pinson: in this one. 260 00:28:17.500 --> 00:28:18.269 Dr. Cynthia Pinson: All right. 261 00:28:19.290 --> 00:28:23.020 Dr. Cynthia Pinson: So once you figure out what their risk. Factors are 262 00:28:23.110 --> 00:28:39.209 Dr. Cynthia Pinson: by the risk factors. It's only cost a lot of money and lot of heartaches and lot of disability. You want to go ahead and address that some of these things you can address right the end, and some of these things are a little bit extensive that you may need to bring them back on a second look. 263 00:28:39.410 --> 00:28:43.629 Dr. Cynthia Pinson: as busy as we are. If I do, you detect things 264 00:28:43.650 --> 00:28:45.240 Dr. Cynthia Pinson: like depression. 265 00:28:45.460 --> 00:29:01.180 Dr. Cynthia Pinson: I will address it right there, and i'll show you how we can build for that, or if I detect a cognitive impairment, I still have time. I will kind of ease into that conversation, although that's usually a fairly difficult conversation if they Haven't really noticed. If the family Haven't noticed before 266 00:29:01.210 --> 00:29:03.370 Dr. Cynthia Pinson: you want to address them. 267 00:29:04.500 --> 00:29:07.650 Dr. Cynthia Pinson: discuss all the treatment options for everything that you detect 268 00:29:08.150 --> 00:29:11.200 Dr. Cynthia Pinson: and provide a personalized plan. 269 00:29:11.620 --> 00:29:12.500 Dr. Cynthia Pinson: So 270 00:29:12.560 --> 00:29:15.939 Dr. Cynthia Pinson: let's talk about these items. So if they. 271 00:29:15.990 --> 00:29:18.300 Dr. Cynthia Pinson: the score high on the fall risk 272 00:29:18.310 --> 00:29:42.280 Dr. Cynthia Pinson: assessment, you can say, Well, looks like it may help you to use. Okay, because you are. If your knee is bad it may help you to go to physical therapy, and you can do an injection you can refer to, or if your medication is a little too much, you can say, I will think that if you stop taking this this is that you'll follow. This will actually decrease. 273 00:29:42.380 --> 00:29:45.309 Dr. Cynthia Pinson: So these things can be addressed right there. Nutrition. 274 00:29:45.960 --> 00:30:03.250 Dr. Cynthia Pinson: Not a lot of people are now nourished in this area. But if you look at the out human, a lot of people actually have low help you in, so you can address that. There's registered dietitians that can talk to them about that, or they can just Google on healthy eating, you know. Just put them on a Mediterranean diet. 275 00:30:03.670 --> 00:30:09.469 Dr. Cynthia Pinson: Physical activities stay active. They don't necessarily have to join a a gym. 276 00:30:09.500 --> 00:30:22.639 Dr. Cynthia Pinson: but they need to get up out of their bed or their chair at least 3 times a day and just walk around the house in our zoom home. There are activities that we encourage everyone to go attend even chair activities where they raise their. 277 00:30:22.650 --> 00:30:38.920 Dr. Cynthia Pinson: you know arms, and they kick their list. They they do some stretching. Those are all very, very good. Tobacco. Use cessation that goes without saying. But you gotta catch them when they're ready to quit. No need to pound someone who really choice, and they're not ready to put you just going to waste your time 278 00:30:39.200 --> 00:30:40.360 Dr. Cynthia Pinson: we lost. 279 00:30:40.770 --> 00:30:45.910 Dr. Cynthia Pinson: Well, sensitive subject again is all you know. Approach. 280 00:30:46.020 --> 00:30:58.840 Dr. Cynthia Pinson: I tell my patients even just 5 to £10 away. Loss is going to help you so much, and decrease your risk for heart attacks and strokes. So those are obtainable goals, very, very small goals. 281 00:30:58.970 --> 00:31:00.810 Dr. Cynthia Pinson: and give that to them 282 00:31:00.840 --> 00:31:02.270 Dr. Cynthia Pinson: cognition. 283 00:31:02.280 --> 00:31:21.240 Dr. Cynthia Pinson: There are speech therapists, a special license in cognitive therapy, and they are very, very good, very knowledgeable, and very helpful people. I always refer my newly diagnosed patients to speech therapy, but they do so much more things that i'm not able to do, and don't even know how 284 00:31:22.750 --> 00:31:36.339 Dr. Cynthia Pinson: alright, advance, care, planning discussion at patients discretion. You know there's probably been only 2 patients. So when I approach this subject they go scared. They're like. Do you think i'm gonna die? Why are you talking to me about dying. 285 00:31:36.630 --> 00:31:38.160 Dr. Cynthia Pinson: but other than that. 286 00:31:39.040 --> 00:31:43.750 Dr. Cynthia Pinson: most people and families I talked to about this is very welcoming 287 00:31:43.830 --> 00:31:54.539 Dr. Cynthia Pinson: by who doesn't want to talk about how they want to die right? And it's more than that is. Talk about what your wishes are. What's your philosophy in life? How do you look at life. How you look at death. 288 00:31:54.560 --> 00:32:08.179 Dr. Cynthia Pinson: and who is going to make that decision for you when you are brain dead? People are very worried about that. Who is gonna take over there have been patients who told me. I'm not going to point my daughter, because I know she is going to change my post at us. 289 00:32:08.320 --> 00:32:14.790 Dr. Cynthia Pinson: I i'm a DNA, but I know she's on changing me to a full cold, because she rather me live on it's a vegetable that lose me. 290 00:32:15.120 --> 00:32:31.639 Dr. Cynthia Pinson: So there are people that really need to make a decision on this, and most people have living will, but they are not specifically written out, perhaps exactly how they want it, so they can write more. They can write more on like you, an attorney, or just themselves, and write on it. 291 00:32:31.650 --> 00:32:45.869 Dr. Cynthia Pinson: Good thing really good thing about skilled care facilities that we have social service on side. We can help them actually, with some of the stuff. Right, Mpos. At least, i'll point out how they're at least so someone can speak for them. 292 00:32:46.100 --> 00:33:04.779 Dr. Cynthia Pinson: I have very extensive conversations with all of my patients on this all the new ones that come in all the ones I see for any of this. So anytime that seems appropriate. I bring the subject up. I just want them to think about what they want when they are able to still think about it. 293 00:33:04.790 --> 00:33:08.650 Dr. Cynthia Pinson: And I want the children, or the caregivers and family to think about this 294 00:33:08.680 --> 00:33:17.359 Dr. Cynthia Pinson: while they are not in a crisis in an emotional, you know, downward state. I wanted to think about what they want for their loved ones based on 295 00:33:17.520 --> 00:33:33.900 Dr. Cynthia Pinson: who they were, which I don't usually know what their mother was like when she was young and healthy. I only know her as someone I was laying there after a hit fracture right most of the time. So I want them to kind of dig into and really think about their choices. And I also educate a lot People have very. 296 00:33:35.220 --> 00:33:44.900 Dr. Cynthia Pinson: I don't know magical thinking about Cprs, you know. There's Pop goes the we on like it's not like that. It's not the emergency room 297 00:33:45.050 --> 00:34:02.659 Dr. Cynthia Pinson: presentation in the in the shows. Actually, people don't just come back like that. They really don't, and I kind of tell them, and if I feel like they could tolerate more, i'll get a little more gruesome with it. I really try to drive this home, and I think this is a very, very important part of the conversation. 298 00:34:04.830 --> 00:34:14.569 Dr. Cynthia Pinson: All right, opioids. How can we go anywhere without talking about it? This is a top by itself. Probably. Take an hour, and Bd. Don't sign me up for that one. 299 00:34:14.780 --> 00:34:21.249 Dr. Cynthia Pinson: So review opioid, you know. Unfortunately, a lot of our people came from that 300 00:34:21.620 --> 00:34:27.789 Dr. Cynthia Pinson: stage where we were giving a lot of pay medications, whether they are purposely a 301 00:34:27.909 --> 00:34:32.169 Dr. Cynthia Pinson: dependent on it, or they are not purposefully dependent on. They take that 302 00:34:32.190 --> 00:34:43.389 Dr. Cynthia Pinson: by a lot of people actually still take opioids, and it's not good for them anymore. So evaluate They're paying what I started all this and what is bothering you now, have you tried anything else? 303 00:34:43.400 --> 00:34:55.559 Dr. Cynthia Pinson: If you need to go see the pain clinic for some interventions, they do all fancy things now that can prevent pain, you know, and then there's some. But there's other medications. So if all possible, get them off the opioid 304 00:34:55.860 --> 00:34:58.360 Dr. Cynthia Pinson: to the level of functioning right with Hubble function. 305 00:34:58.540 --> 00:35:18.000 Dr. Cynthia Pinson: I have a patient. She takes half a tablet of normal 5, twice a day. She was a a lot more when I inherited her. It's taken us years to get a doubt that you know I couldn't go down any further, but she couldn't do without them. She couldn't really function without them. But with just this 5 mill one per day, divided into 2 times a day. 306 00:35:18.010 --> 00:35:23.349 Dr. Cynthia Pinson: she's able to do all of her own stuff and stay independent. You know that's what I want for her. That's what she wants. 307 00:35:26.110 --> 00:35:31.050 Dr. Cynthia Pinson: That but not least screen for substance use disorders. 308 00:35:31.650 --> 00:35:34.189 Dr. Cynthia Pinson: Alcohol, maybe, is probably. 309 00:35:34.560 --> 00:35:49.499 Dr. Cynthia Pinson: I will think, for this population is very well used in knowing even things about that as being maybe overused. And then there are people that use other drugs as well. You will be surprised what drugs people use. So screen for that? 310 00:35:52.020 --> 00:35:52.720 Dr. Cynthia Pinson: All right. 311 00:35:53.950 --> 00:35:55.850 Dr. Cynthia Pinson: So that's all about the what? 312 00:35:58.030 --> 00:36:01.770 Dr. Cynthia Pinson: There are 2 questions. Should we look at the questions right now? 313 00:36:04.000 --> 00:36:09.939 Dr. Cynthia Pinson: Why do you only scream, man? For Aaa? I think the research says that people is more 314 00:36:10.980 --> 00:36:13.009 Dr. Cynthia Pinson: is less common in women. 315 00:36:14.320 --> 00:36:23.429 Dr. Cynthia Pinson: If the patient is positive on screening for depression. Must we treat or manage this as the awb, or can we reschedule a visit? You can do Either 316 00:36:23.600 --> 00:36:28.180 Dr. Cynthia Pinson: you can do either, and then there is a slide. Later i'll tell you how to do it during 317 00:36:29.080 --> 00:36:29.799 Dr. Cynthia Pinson: Okay. 318 00:36:30.490 --> 00:36:32.109 Dr. Cynthia Pinson: So when can you do it? 319 00:36:32.380 --> 00:36:40.919 Dr. Cynthia Pinson: It's not just any time you can do this awp visit, You know it sounds like so much fun. You want to do this. I can more more, 2, 3 times a year you can't. 320 00:36:41.060 --> 00:36:47.069 Dr. Cynthia Pinson: so you have to wait till the first 12 months of their initial enrollment is finished. 321 00:36:47.280 --> 00:36:52.290 Dr. Cynthia Pinson: Right? They're well countermatic here. There's a year. You have to wait for that to be done. 322 00:36:52.480 --> 00:37:09.810 Dr. Cynthia Pinson: and then you can do it if someone else already beat you to it within the 12 months period that you're allowed to do them like who is going to be to believe or not? People do because people are mobile, people move, and people will have insurance that change their primary care position. So maybe they were saying somewhere else. 323 00:37:09.910 --> 00:37:14.780 Dr. Cynthia Pinson: and then they had to see you. Now they you just had to figure out when they did that 324 00:37:15.090 --> 00:37:27.520 Dr. Cynthia Pinson: where they're on your schedule. That's how I usually do it. I open up my schedule, and I see that I got like 2 or 3, the scheduled, and I just do them. You know I am really a slave to my scheduler to my office. Whatever they say, you know I just do them. 325 00:37:29.190 --> 00:37:35.780 Dr. Cynthia Pinson: So this is a normal visit, so this one will answer one of your questions about the depression. 326 00:37:35.870 --> 00:37:49.190 Dr. Cynthia Pinson: So while you're doing this visit, you detect this person has depression, and you know that you're booked for the next 3 months, and you don't really want this patient to go away feeling this way for 3 more months 327 00:37:49.290 --> 00:37:50.730 Dr. Cynthia Pinson: and not be treated. 328 00:37:50.820 --> 00:37:53.100 Dr. Cynthia Pinson: You can treat them right then. 329 00:37:53.140 --> 00:38:06.060 Dr. Cynthia Pinson: you know, after you spent all this time with it, you might as well just do it. It literally takes like 5 min, some months to talk about it. Talk about the treatment options and the side effects. I'm going to see you more often, and you know what to expect and 330 00:38:06.570 --> 00:38:07.620 Dr. Cynthia Pinson: benefits 331 00:38:07.820 --> 00:38:09.789 Dr. Cynthia Pinson: in risk of treatment. 332 00:38:09.870 --> 00:38:15.319 Dr. Cynthia Pinson: So just do it. You can do it and bill for it because this is a problem focused 333 00:38:16.160 --> 00:38:30.640 Dr. Cynthia Pinson: Pro: a problem focused visit as well as a. W. We visit now as long as you do a modifier you can build for both codes at the same time, so we absolutely You can treat it right there. I always treat it right then. 334 00:38:30.650 --> 00:38:41.090 Dr. Cynthia Pinson: because I think, move this order and depression is such a terrible thing completely skills joy from your life, and I just can't stand for them to wait for me for my schedule to open up with them to come back all right 335 00:38:41.560 --> 00:38:50.859 Dr. Cynthia Pinson: after I treat them. I often do a very frequent follow up. I actually see these people like 2 weeks or 4 weeks intervals until I feel like they're in admission. Okay. 336 00:38:54.020 --> 00:38:55.160 that's a 337 00:38:55.930 --> 00:38:58.120 Dr. Cynthia Pinson: we'll. We'll come back to the question as well. 338 00:38:58.140 --> 00:39:13.909 Dr. Cynthia Pinson: Where can you do it? You literally can do this everywhere, anywhere, all the same time. Right? You can do it the clinic. You can do it in nursing homes. You can do it in the lobby of assist living. They refuse to go back to their room, you and go to patients home and do this. You can literally do this anywhere. 339 00:39:14.190 --> 00:39:15.029 Dr. Cynthia Pinson: Okay. 340 00:39:16.410 --> 00:39:17.579 Dr. Cynthia Pinson: why do you do it? 341 00:39:17.740 --> 00:39:24.120 Dr. Cynthia Pinson: You know this is the big thing. I have to think about this a lot. Sometimes when i'm really burn out my job. I'm thinking, Why am I doing this. 342 00:39:24.350 --> 00:39:31.649 Dr. Cynthia Pinson: you know, because I want to be like Princess Leia right? I want to be beautiful and nice and brave and fierce 343 00:39:31.660 --> 00:39:44.789 Dr. Cynthia Pinson: and kind of prickly sometimes, so I want to be like her. So I want to take care of my people because I want to be nice, and I want to be a good doctor. I want to keep them healthy as healthy as possible when there's all that healthy. 344 00:39:44.800 --> 00:39:52.400 Dr. Cynthia Pinson: you know, and when they're at this spectrum. Not being healthy, I want to discuss palliative care. I want to see what their ris is. Are they going to fall? Break their hip. 345 00:39:52.430 --> 00:39:55.689 Dr. Cynthia Pinson: and you know we're switching to value based 346 00:39:55.860 --> 00:40:11.340 Dr. Cynthia Pinson: models. If you don't understand what that is, that means before you come to see me, I collect $25 from me, right, you know, fee for service. If you don't come to see me, i'm sure $25. So more. People I see more volume. I see the more money I made. 347 00:40:11.370 --> 00:40:16.570 Dr. Cynthia Pinson: but in the value based model it's actually different. So i'm given 348 00:40:16.840 --> 00:40:19.750 Dr. Cynthia Pinson: $2,000 a year to manage a patient. 349 00:40:19.930 --> 00:40:36.249 Dr. Cynthia Pinson: So when I do really well for them they only cost me $1,500, so that $500 is my right to keep. This is simple. Of course the numbers are all completely fake. It's a lot bigger than that was probably like 2, 3 zero's behind it. 350 00:40:36.430 --> 00:40:37.109 Dr. Cynthia Pinson: But 351 00:40:37.130 --> 00:40:41.159 Dr. Cynthia Pinson: if I don't do a good job if they were diabetic. But I kind of 352 00:40:41.350 --> 00:40:50.590 Dr. Cynthia Pinson: didn't really address it, or they were, you know, depressed. I didn't really address it, or they are too much pedication. They are hired. I didn't really address it 353 00:40:50.660 --> 00:41:02.779 Dr. Cynthia Pinson: so, for patient has some Tommy. They go out and they do things they shouldn't do whatever, and then they have some event that's going to cost $20,000 for that year. 354 00:41:02.920 --> 00:41:04.879 Dr. Cynthia Pinson: Guess what? I only got 2,000, 355 00:41:04.990 --> 00:41:06.950 Dr. Cynthia Pinson: and now someone calls 20,000. 356 00:41:07.270 --> 00:41:13.629 Dr. Cynthia Pinson: Yeah, so that's value base. So I want to do really good job to keep the cost down. Not 357 00:41:13.930 --> 00:41:14.709 Dr. Cynthia Pinson: bye. 358 00:41:15.150 --> 00:41:27.349 Dr. Cynthia Pinson: not allowing to take this medicine, not to do the other test, no taking care of them. So things that will happen to them later. You know. Some people actually don't know what kills them, so I have to tell them you do this. I didn't want to kill you all right. 359 00:41:27.750 --> 00:41:28.949 Dr. Cynthia Pinson: so i'm an expert 360 00:41:29.030 --> 00:41:29.689 Dr. Cynthia Pinson: at that. 361 00:41:30.110 --> 00:41:39.910 Dr. Cynthia Pinson: So if I can prevent all of that. Then I can keep my calls down right, and I take better care of them. I'm hoping they will have a better quality plan than they have now. 362 00:41:39.950 --> 00:41:42.140 Dr. Cynthia Pinson: before they met me right. 363 00:41:42.280 --> 00:41:54.610 Dr. Cynthia Pinson: and then the personal engagement, you know. Once you spend an hour talking to people about everything, including their toenails and their cat as it are. They is their cat in the way, or who's walking a doll for you when you're using. Okay. 364 00:41:54.940 --> 00:42:03.419 Dr. Cynthia Pinson: they are engaged in investing you, because you have invested in them of the most precious thing on earth. Right now in the practice, medicine is time 365 00:42:03.590 --> 00:42:08.600 Dr. Cynthia Pinson: right? And they do feel bonded with you, and hopefully they'll listen to you better once they like you. 366 00:42:10.250 --> 00:42:20.100 Dr. Cynthia Pinson: But how do you do it? You really cannot do this alone. Before we had, Ehrs. It was on like printed paper with your check check check out list. 367 00:42:20.110 --> 00:42:44.509 Dr. Cynthia Pinson: And then I had a yacht system that doesn't really have any along this visit built in, so I have a template which I will show you. So I just roll everything out, and then, as i'm in front of that patient, I just go down my list one by one. Luckily most Ehr now has some kind of thing building. I'll show you one of those things to it's real team effort. The I don't know when these things are due. Someone out there makes a list. 368 00:42:44.520 --> 00:42:52.269 Dr. Cynthia Pinson: and they tell me what it is. And the thing is, you just got to do more of it. Do not be intimidated. Just keep doing them once you get better at them. Now it's a breeze. 369 00:42:53.230 --> 00:42:55.140 Dr. Cynthia Pinson: All right. Let me give you 370 00:42:56.420 --> 00:43:10.829 Dr. Cynthia Pinson: okay. How can we determine if a. W. Has already been performed by a person? Oh, you know what you don't have to ask your office manager, your coordinator, your aco. Someone up there knows you are not gonna to have access to any of that. 371 00:43:12.540 --> 00:43:13.250 Dr. Cynthia Pinson: All right. 372 00:43:13.820 --> 00:43:15.120 Oh. 373 00:43:20.710 --> 00:43:24.269 Dr. Cynthia Pinson: Template Wendy, one of the great J guys. 374 00:43:24.990 --> 00:43:30.070 Dr. Cynthia Pinson: this is what I made for the yeah that I had that didn't have anything built in for 375 00:43:30.360 --> 00:43:36.560 Dr. Cynthia Pinson: this pages for people. If you look at a more advanced age, you know, because I we we treat people that 376 00:43:36.570 --> 00:43:53.619 Dr. Cynthia Pinson: are all the same. You know Medicare Age group, but some people are more advanced in their disease with their age. Some people are not. This is what people that are more advanced. So the wordings are a little bit different. Of course I'm always trying to cut out a charting time. So, for instance, the memo i'd already put it, not recommended 377 00:43:53.650 --> 00:43:58.589 Dr. Cynthia Pinson: greater than the age of 75. So if this person's 76, you are covered, you don't have to change anything. 378 00:43:58.710 --> 00:44:04.510 Dr. Cynthia Pinson: but if there are 74, you need to go in there maybe change your wording a little bit to make documentation accurate. 379 00:44:05.550 --> 00:44:11.939 Dr. Cynthia Pinson: This one is for people that are a little bit younger. So the the if you see the wordings are a little bit different. 380 00:44:13.900 --> 00:44:16.930 Dr. Cynthia Pinson: and then this goes down everything that has to be covered. 381 00:44:17.000 --> 00:44:21.279 Dr. Cynthia Pinson: and I already put it in need to help with ads, because the majority of my people do it 382 00:44:21.340 --> 00:44:28.210 Dr. Cynthia Pinson: needed but you can just say no. Me doesn't need who needs no help. You can modify this to fit your need. 383 00:44:28.270 --> 00:44:36.599 Dr. Cynthia Pinson: So this is a vaccination, a record, the health care education. So I just go down the list for prevention. Okay, you need a okay, okay, you need Pt: referral 384 00:44:36.760 --> 00:44:43.940 Dr. Cynthia Pinson: and then depression. I roll all this out. Just so I know what the answers are and give them points at the end 385 00:44:44.020 --> 00:44:44.649 Dr. Cynthia Pinson: right 386 00:44:44.980 --> 00:44:49.090 Dr. Cynthia Pinson: cognitive. I put many there because that's the easiest to 387 00:44:49.390 --> 00:44:53.240 Dr. Cynthia Pinson: short one to do, and if this longer one i'll pull down my slums. 388 00:44:53.280 --> 00:44:54.080 Dr. Cynthia Pinson: Risk 389 00:44:54.210 --> 00:45:02.449 Dr. Cynthia Pinson: assessment for us. Okay, there are a ton of these, my Ehr currently has a different one. But this is the one I used when we didn't have it 390 00:45:02.660 --> 00:45:03.680 Dr. Cynthia Pinson: built in. 391 00:45:03.760 --> 00:45:10.829 Dr. Cynthia Pinson: So you just go through that and give them points, right? It's given points. Okay? Well almost till the end. So this is Luke Sky Walker. 392 00:45:11.180 --> 00:45:16.189 Dr. Cynthia Pinson: the planet of Hop, where it's just all Wintery, which is kind of where we are right now. 393 00:45:16.800 --> 00:45:24.219 Dr. Cynthia Pinson: Alright. So how can you talk about medicine without talking about cost right? So what is the cost to do? A Awb. 394 00:45:24.370 --> 00:45:26.360 Dr. Cynthia Pinson: It's actually 0 for your patients. 395 00:45:26.380 --> 00:45:33.509 Dr. Cynthia Pinson: They don't get any co-pays, and when you build that Acp code right here with a modifier 33. 396 00:45:33.620 --> 00:45:34.730 Dr. Cynthia Pinson: They get. Nope. 397 00:45:34.930 --> 00:45:37.939 Dr. Cynthia Pinson: No, okay for that, either. So it's completely free. 398 00:45:38.000 --> 00:45:39.669 Dr. Cynthia Pinson: Because why? Here for you. 399 00:45:40.130 --> 00:45:41.969 Dr. Cynthia Pinson: But you know that's your problem, right? 400 00:45:42.360 --> 00:45:45.830 Dr. Cynthia Pinson: All right. One heavy family. By the time you do all of this 401 00:45:45.880 --> 00:45:49.139 Dr. Cynthia Pinson: you have fulfilled all the requirements. 402 00:45:49.260 --> 00:45:51.850 Dr. Cynthia Pinson: I want to show you 403 00:45:52.090 --> 00:45:54.020 Dr. Cynthia Pinson: our current 404 00:45:56.210 --> 00:45:58.639 Dr. Cynthia Pinson: hard to help us to in there. But 405 00:45:58.790 --> 00:46:01.349 Dr. Cynthia Pinson: so my current, ehr 406 00:46:01.830 --> 00:46:10.989 Dr. Cynthia Pinson: has something built in, and I wonder if yours does, too, and it's really pretty cool of all the things I can complain about it. Look, Medicare Annual Wellness visit. 407 00:46:11.760 --> 00:46:14.390 Dr. Cynthia Pinson: So it's all built in. And look at all this. 408 00:46:15.700 --> 00:46:27.589 Dr. Cynthia Pinson: So basically you just kind of go down and just ask, where is your pain? Blah blah, blah and's care planning, you know. Do you have a living? Well, do you have this? Do you have that procedures? If this person doesn't, you just add them right. 409 00:46:27.630 --> 00:46:33.160 Dr. Cynthia Pinson: Oops, I don't really want to do that. Family history. Add them social history at them. Health risk, assessment. 410 00:46:33.340 --> 00:46:35.240 Dr. Cynthia Pinson: right? This is what we just talk about. 411 00:46:35.590 --> 00:46:38.220 Dr. Cynthia Pinson: What can you do for yourself? Boom, boom, boom. 412 00:46:38.600 --> 00:46:46.639 Dr. Cynthia Pinson: geriatric screening. They'll do it. Many call this here and there's multiple other things. We're hearing. 413 00:46:47.550 --> 00:46:49.359 Dr. Cynthia Pinson: Okay, Home Safety. 414 00:46:49.640 --> 00:46:53.690 Dr. Cynthia Pinson: The Fall Risk assessment functional assessment. Right? 415 00:46:54.970 --> 00:46:57.169 Dr. Cynthia Pinson: Look out that that's Als right. 416 00:46:57.350 --> 00:46:59.310 Dr. Cynthia Pinson: You're independent. 417 00:46:59.850 --> 00:47:01.499 Dr. Cynthia Pinson: are all here. 418 00:47:03.250 --> 00:47:23.020 Dr. Cynthia Pinson: So then you are saying, okay, this person is screening this person. Doesn't: this is up to date. That's not today. So you just quickly check all this, and at the end you say, okay, you need to have Colonel Cancer screening and blah blah blah you. So you just finish all that, and then that's the end of it. So of course, when you have a tool like this. 419 00:47:23.260 --> 00:47:29.000 Dr. Cynthia Pinson: it's kind of a no-brainer, and it's so much easier for you. You're not trying to memorize anything. I literally cannot 420 00:47:29.140 --> 00:47:32.139 Dr. Cynthia Pinson: memorize these things. If I did not help him. 421 00:47:32.470 --> 00:47:33.319 Okay. 422 00:47:33.570 --> 00:47:34.629 Dr. Cynthia Pinson: it's 9 423 00:47:35.190 --> 00:47:39.399 Dr. Cynthia Pinson: 18. I want to go ahead and stop sharing the screen. 424 00:47:41.550 --> 00:47:43.839 Dr. Cynthia Pinson: All right. So I'm finished. If you 425 00:47:44.530 --> 00:47:46.930 Dr. Cynthia Pinson: I have any other things, Valerie or 426 00:47:48.350 --> 00:47:51.470 Shirley Sullivan: Dr. Pennsylvania is another question. 427 00:47:51.530 --> 00:47:52.939 Shirley Sullivan: Okay. 428 00:47:53.140 --> 00:48:04.169 Shirley Sullivan: that says, when complete and an annual wellness visit in the home. Is this typical? A provider, a. P. Or is there a model where nurses complete the Hr. A. 429 00:48:05.110 --> 00:48:10.260 Dr. Cynthia Pinson: You know I don't. I know we don't use nurses for this, because the code 430 00:48:10.860 --> 00:48:19.029 Dr. Cynthia Pinson: to build that it is for a provider of some sort. So check with your administrator and your billing people about that. 431 00:48:19.250 --> 00:48:25.059 Dr. Cynthia Pinson: Our practice and the practice associated with us. We haven't really sent a nurse out to do that before. 432 00:48:25.100 --> 00:48:26.649 Dr. Cynthia Pinson: so 433 00:48:26.950 --> 00:48:30.279 Dr. Cynthia Pinson: they're completely capable, of course, of doing it. 434 00:48:30.380 --> 00:48:34.329 Dr. Cynthia Pinson: But I think you need to check on that. It really is on the building. 435 00:48:42.690 --> 00:48:43.799 Shirley Sullivan: Thank you 436 00:48:46.730 --> 00:48:55.419 Shirley Sullivan: another question: Does your Ehr automatically give you a depression screen and score, or do you manually have to add the results? 437 00:48:55.990 --> 00:48:59.409 Dr. Cynthia Pinson: Believe it or not, the system actually does use the score 438 00:49:00.550 --> 00:49:02.290 Dr. Cynthia Pinson: with all the faults that they have. 439 00:49:04.820 --> 00:49:13.290 Dr. Cynthia Pinson: And when I do this, if it's on paper like, if you don't have that, I I should just pull this up on my phone. I type in geriatric depression screening 440 00:49:13.340 --> 00:49:17.379 Dr. Cynthia Pinson: short form, and then that pops up Google. 441 00:49:17.410 --> 00:49:24.600 Dr. Cynthia Pinson: And then, as i'm asking them that. Of course I have a notebook always, so I only write down the answers that are positive. 442 00:49:25.710 --> 00:49:28.779 Dr. Cynthia Pinson: So at the end. That's how I score them. If I write down 5 443 00:49:28.930 --> 00:49:35.829 Dr. Cynthia Pinson: calls and answers like I was, if they said, you know, are are you feeling helpless? If they say yes, then I might 444 00:49:35.860 --> 00:49:37.700 Dr. Cynthia Pinson: that number of the question down. 445 00:49:38.240 --> 00:49:39.820 Dr. Cynthia Pinson: So that's how I explore. 446 00:49:42.580 --> 00:49:54.859 Shirley Sullivan: Thank you. And there's another question. If they are here to be seen for another problem like pain or uti, etc. Can an annual wellness visit be done the same day? 447 00:49:55.100 --> 00:50:08.469 Dr. Cynthia Pinson: So this is a reversal annual. Well, this is. It takes so much of your time. If someone is a walking for uti, they say, hey, I want my annual on this visit, or your office manager says, hey, this person has. I had to go and do it. Just say no. 448 00:50:08.480 --> 00:50:15.529 Dr. Cynthia Pinson: honestly, you're not doing a justice. The whole point of setting aside a whole hour to do this is, you can actually address everything 449 00:50:15.730 --> 00:50:24.489 Dr. Cynthia Pinson: so. But the reverse is okay, right. If they come in for the schedule and your longest, is it? While you're asking the question, I said, oh, by the way, i'm peeing blood. 450 00:50:24.690 --> 00:50:26.299 Dr. Cynthia Pinson: and it burns when I go. 451 00:50:26.540 --> 00:50:32.949 Dr. Cynthia Pinson: No-brainer treat it. That's not a problem. You just use your modifier you can build for the annual honest physical 452 00:50:33.000 --> 00:50:39.029 Dr. Cynthia Pinson: plus your face to face, visit code in the modifier 25 You get paid for all of it. 453 00:50:41.560 --> 00:50:49.250 Shirley Sullivan: Thank you. Another question. How do you address opioid? Use disorder? Do you use a screening tool? 454 00:50:51.000 --> 00:50:57.350 Dr. Cynthia Pinson: That entirely is Another hour of lecture was about given before. Yes, there are swinging tools 455 00:50:57.460 --> 00:51:00.810 Dr. Cynthia Pinson: for it, and it's very good tools. 456 00:51:03.120 --> 00:51:04.109 Shirley Sullivan: Thank you. 457 00:51:04.600 --> 00:51:06.920 Shirley Sullivan: And I think that's all the questions right now. 458 00:51:12.380 --> 00:51:21.810 Valerie Wood: We can give it maybe 10 s or 20 s. Is anyone else? Have any questions you can put in the Q. A. Or in the chat function. We'll just give it a moment. 459 00:51:21.990 --> 00:51:23.139 and then we can 460 00:51:23.270 --> 00:51:24.359 Valerie Wood: move on. 461 00:51:33.290 --> 00:51:35.900 Valerie Wood: Okay, if any other. Oh, wait to do it. Okay. 462 00:51:36.000 --> 00:51:37.589 Valerie Wood: A comment. 463 00:51:37.820 --> 00:51:41.509 Valerie Wood: Excellent presentation. Love. The Star Wars pictures and analogies. 464 00:51:42.490 --> 00:51:43.639 Dr. Cynthia Pinson: Thank you. 465 00:51:44.150 --> 00:51:48.730 Valerie Wood: And I second that. Thank you, Dr. Penson. It's very, very helpful information. 466 00:51:48.790 --> 00:51:51.799 Valerie Wood: and really appreciate your time today. 467 00:51:52.520 --> 00:51:56.039 Valerie Wood: Next next slide my team. 468 00:51:59.750 --> 00:52:04.509 Valerie Wood: Okay, if any other questions came, come up, be happy to address. We have about 8 min. 469 00:52:04.560 --> 00:52:09.750 Valerie Wood: and we have an annual wellness visit assessment, toolkit. I would like to 470 00:52:09.780 --> 00:52:15.850 Valerie Wood: briefly introduced. It was initially created in 2,017, but we're updating it this year 471 00:52:15.930 --> 00:52:32.420 Valerie Wood: to focus on assessments and to narrow it down from 80 some pages to make it a little bit more user friendly. So this is a provider facing compilation of resources, educational handouts for patients and links to relevant materials 472 00:52:32.500 --> 00:52:46.619 Valerie Wood: for all of the topics that Medicare recommends, and requires, such as anxiety, depression, mobility, self care, memory, medication in the topics. Dr. Pins, who went over. 473 00:52:46.650 --> 00:53:03.610 Valerie Wood: so it covers the overall scope and guidelines, but with an emphasis on assessment tools for each category. And if your Ehr does have this, that is wonderful, and we'll probably, you know, save a lot of time. But this assessment toolkit will also save time. 474 00:53:03.660 --> 00:53:12.539 Valerie Wood: and to help you find them, because it is difficult sometimes when you're Googling to narrow down, especially geriatric focused ones. 475 00:53:12.590 --> 00:53:14.569 Valerie Wood: So i'm going to share my screen 476 00:53:15.950 --> 00:53:18.730 Valerie Wood: and share our assessment toolkit just to show 477 00:53:18.770 --> 00:53:20.059 Valerie Wood: here what we have 478 00:53:22.140 --> 00:53:24.200 Valerie Wood: so assessment and resource toolkit. 479 00:53:24.390 --> 00:53:31.750 Valerie Wood: If you click on the link, it will take you to the part in the in the toolkit for that 480 00:53:31.790 --> 00:53:32.729 Valerie Wood: topic. 481 00:53:33.840 --> 00:53:35.699 Valerie Wood: So we have 482 00:53:36.600 --> 00:53:41.630 Valerie Wood: variety of topics. Flyers to send out in any of these 483 00:53:41.710 --> 00:53:49.000 Valerie Wood: any of these resources with an asterisk are available at the very bottom, and the appendix; otherwise there they will be found in links. 484 00:53:49.110 --> 00:53:53.609 Valerie Wood: So some of the screenings Dr. Penson mentioned some other ones. 485 00:53:53.700 --> 00:54:08.449 Valerie Wood: and some of these may be appropriate for referrals. If there are more extensive screenings and assessments, we have information on Covid and Mutations depression screening. There's you know, one specific to geriatrics. 486 00:54:08.470 --> 00:54:14.500 Valerie Wood: We have a very large amount of mobility and home safety screenings 487 00:54:15.360 --> 00:54:17.100 Valerie Wood: and memory assessments. 488 00:54:17.440 --> 00:54:21.930 Valerie Wood: And there's a little little bit on each topic at the top. 489 00:54:22.800 --> 00:54:41.690 Valerie Wood: and I just wanted to share this quote about diabetes. There's some chronic disease management information here. Patients with diabetes who participate in a free annual on this visit, covered by medicare are 36% less likely to meet major lower extremity amputations 490 00:54:41.910 --> 00:54:49.310 Valerie Wood: according to American diabetes scientific sessions. I just thought it was a really pertinent quote for the Webinar and included in the toolkit. 491 00:54:49.570 --> 00:54:53.840 Valerie Wood: So we have. We have some opioid 492 00:54:54.080 --> 00:54:55.820 Valerie Wood: resources as well. 493 00:54:55.870 --> 00:55:00.930 Valerie Wood: and and then our appendix that has all some of our 494 00:55:01.060 --> 00:55:02.580 Valerie Wood: resources to share. 495 00:55:03.650 --> 00:55:04.529 So 496 00:55:04.790 --> 00:55:23.289 Valerie Wood: kind of stop sharing, and this will be available in February's Newsletter. But if you would like it sooner by contact, information will be in the following slides, but it keep an eye out for it in our neighborhood. Buzz, Newsletter, if you're not receiving that also free, feel free to reach out and let us know that you'd like to receive that to stop sharing. 497 00:55:29.040 --> 00:55:31.790 Valerie Wood: And it looks like we do have another question 498 00:55:32.950 --> 00:55:41.990 Valerie Wood: when Medicare says to address at minimum and list several items, such as sexual health, etc. Does that mean we must address all of that? 499 00:55:46.420 --> 00:55:47.340 Valerie Wood: Oh, you're on me. 500 00:55:47.420 --> 00:55:51.900 Dr. Cynthia Pinson: Sorry, I mean, master or not. My, that's the question like, who is going to read your note? Right? 501 00:55:52.090 --> 00:56:00.099 Dr. Cynthia Pinson: So? Yes, you want to address at least all the ones that's mentioned, but truly is up to your toolkit. 502 00:56:00.190 --> 00:56:04.119 Dr. Cynthia Pinson: like. If it is built into all your questionnaires, you just ask them. 503 00:56:04.220 --> 00:56:14.570 Dr. Cynthia Pinson: But if you miss that You' on your question. You didn't ask them. I mean, it's okay to get missed. It like no one is who might touch you with a license right now. But you do want to address the minimal. All that? 504 00:56:20.430 --> 00:56:27.529 Valerie Wood: Okay. I don't see any other questions this time, and I can definitely share the tool kit with all attendees today 505 00:56:29.930 --> 00:56:32.000 Valerie Wood: because we have your contact information. 506 00:56:32.380 --> 00:56:45.819 Valerie Wood: And now here's our contact information. If there's any, follow up questions. If you're not already, you know in touch with somebody from quality insights. Please reach out, and we'd love to, you know. Have you a part 507 00:56:46.200 --> 00:56:47.560 Valerie Wood: of our organization 508 00:56:49.520 --> 00:56:51.350 Valerie Wood: and next slide, please. 509 00:56:56.560 --> 00:57:05.690 Quality Insights: I just wanted to thank everybody who was able to join us today. And please remember to complete the evaluation and the reflective questions. There is a link to that 510 00:57:05.700 --> 00:57:24.930 Quality Insights: on your screen right now. You can either scan the QR code with your smartphone, or I also provided a link in the chat that will go to that evaluation as well. And for those that haven't seen in the chat, I did type that slides in the recording of today's sharing call are going to be available on our website 511 00:57:24.940 --> 00:57:38.670 Quality Insights: after Today's Webinar. The link to that is also in the chat. It's quality insights.org forward, slash. Q. I. N. And specifically the slides and sharing of the slides, and the recording will be on the multimedia page. 512 00:57:43.350 --> 00:57:44.240 Right 513 00:57:45.210 --> 00:57:48.689 Quality Insights: well, not seeing any further questions. 514 00:57:48.950 --> 00:57:54.370 Quality Insights: Thanks. Everyone for attending Valerie. I don't know if you want to have any closing remarks. 515 00:57:56.100 --> 00:58:02.559 Valerie Wood: Thank you, Dr. Penson. I second the comments in the chat, great presentation, and educating. 516 00:58:02.650 --> 00:58:04.850 Dr. Cynthia Pinson: So thank you for your time. 517 00:58:05.030 --> 00:58:06.979 Dr. Cynthia Pinson: Thank you. Take care. 518 00:58:07.320 --> 00:58:09.270 Quality Insights: Thanks. Everyone have a great day.