About Us   (Updated August 2023) 2

Hours of Operation and Contact Info 3

Background 4

Introduction and Overview 5

The FHP Geriatrics Difference 6

Expertise Matters 6

Reputation matters 7

Expectations Matter 7

New Patient Intake 8

Insurance 9

Workflow 10

Routine Visits 10

New symptoms and Urgent Visits 11

Telehealth 12

Labs 12

Radiology 13

Equipment 13

Paperwork and Forms to Fill 13

Specialist Network 13

Medical Cannabis 14

Communication 15

Staff Communication 15

Family Communication 16

Urine Testing for Confusion 17

Allied Services 19

Home Health and PT/OT/Speech Therapy 19

Hospice And Palliative care 20

References and Forms 20

 

 

About Us   (Updated Sept 2023)

Visiting Multi-Specialty Care for Senior Living

• Double Board-Certified, Physician-Led Primary, Palliative, Hospice Care

• Exclusive Network of Multispecialty Physicians

• Methodist, CHI St Luke’s, Memorial Hermann, HCA Hospital Privileges

• Mobile Lab and Radiology, 7 days a week

• Dedicated Family Hotline and Patient Portal

• Text notice several days and 30 minutes before visit

• Medical cannabis alternative to antipsychotics, benzos, opiates

 

Our Medical Expertise, Advanced Systems

• Active communication with family

• Trusted relationships with staff

     =   Care built around the values, needs, and Quality of Life of each patient

 

For the eldest, most complex, precious patients, 

Expertise and Relationships Matter

 

Make sure your residents’ provider is:

• Led by a native Texas, Double Board-Certified Doctor, 20+ years expericence

• Supervised by a Physician, active in care, focused on senior living, and 

           not distracted by clinic

• Affiliated at all area hospital systems, recognized for preventing readmission

• Have a Specialty Physician Network built for senior living

 

Don’t settle for care the way it is 

Leading facilities and families insist on FHP Geriatrics 

When getting to clinic becomes a challenge, primary care physicians trust us 

We provide care the way it should be

 

New patient registration and information available at Fhpgeriatrics.com

 

Hours of Operation and Contact Info

Team Text 832-356-7878 or Call 832-599-8336

Mon to Fri 8am to 4pm: for active response, Spruce Message or Team text 832-356-7878 

• Our whole team sees messages (We are all in front of computers) 

• Text @manager if no response after 1 hour, 

  • @urgent for serious or unstable issue 

• Text Supervisor or Provider directly if no response after 2 hours

• Any issue not life threatening is managed Mon to Fri 8am to 4pm

• SpruceHealth app is used for HIPAA protected messaging and video visits

Mon to Fri 4pm to 10pm, Sat, Sun 8am to 10pm, dangerous, urgent issues, CALL 832-859-8336 

Urgent issues 10pm to 8am, refer to ER or contact Methodist Virtual Urgent Care, 24/7 

And text us so we can follow up during regular hours

24/7 text 832-356-7878 to notify us of any and all non urgent issues, notify going/coming from ER/hospital

• REFILLS: Contact pharmacy for refill requests and plan refills at least 2 business days before running out 

• Unless urgent, routine orders, meds, labs are sent within 2 business days of visit

• If condition worsens or changes after hours, contact us, Methodist Virtual Urgent care, or refer to ER

• New Patient Registration and more info online at www.fhpgeriatrics.com

 

HotLine 832-599-8336: 

Monday to Friday, 9 AM to 5 PM, Call only, not for texting, 5pm to 10pm, life-threatening issues

We have dedicated staff making sure family members are connected to care.  

Also remind family we have a Patient Portal app so they may send secure messages, review our med list, and review labs. (If more than 1 person wishes, must share email/password).

 

 

With many years experience, we have found there are 2 issues late at night 

1. An after hours incident, and a person does resume their usual activity and behavior.

Text us ALWAYS so we can follow up in the morning if needed, 

and arrange in person or telehealth evaluation as soon as possible.

1. An after hours incident, and a person does not resume their usual activity and behavior, They should seek emergency care.  

Text us ALWAYS so we can connect with hospital and family, follow up closely

Palliative/Hospice Care:  Many of our patients are enrolled in our Palliative program.  

They are fragile, no longer wish for hospital evaluation, but are stable.  

If they decline or become unstable, we will trigger hospice services. 

After hours, if a person wishes to no longer go to a hospital, but not yet enrolled in hospice, 

we would still recommend emergency evaluation if a person is not already on hospice.  

This is necessary in order to stabilize the issue, make sure the person has a good plan and team in place to prevent suffering. Following stabilization, we can have a meaningful conversation during regular hours to review directives and have a good plan in place.

Email Address:   admin@fhpgeriatrics.com     Website: www.fhpgeriatrics.com

Hot Line to Call: 832-599-8336       Fax Number:  888-840-6973

Team Text Line: 832-356-7878 (add SpruceHealth app for HIPAA Secure)

Background

Dr. George Valdez, MD, MBA, is a native Houstonian.  He attended Bellaire High School, received Bachelor's of Science degree in Microbiology from Texas A&M, received the prestigious Buck Weirus Spirit Award, Medical Degree from University of Texas Medical Branch at Galveston, Family Medicine specialty from Dartmouth in New Hampshire, additional Board Certification in Hospice and Palliative Care, followed by a Masters in Business Administration from Florida International University.

 

“Dr. V” has practiced in the Houston area since 2002.  He was the Tomball High School team doctor for 15 years and ran a full scope family practice, caring for all ages and conditions. In 2015 he developed a separate team focused on the particular needs and challenges faced by those in Senior Living.  He continued to innovate systems of care to improve quality and safety for those most vulnerable.  The more attention he gave, the more he witnessed the disconnected care and overwhelming need.  

 

With a heart for the elderly, in 2019 he sold his successful practice to give full attention to seniors.  When the pandemic started in 2020, within one week his agile team was able to implement telemedicine at 70 facilities, and continued to guide them safely through that dangerous time. His team is built with Lean Six Sigma systems to continuously improve and constantly collaborate.  He appreciates the trust and respect placed in providing for the eldest, most complex, and most vulnerable.

 

Dr. Valdez enjoys spending time with his wife Diana and their 6 grown children.  His hobbies include lacrosse, scuba diving, billiards, and oil painting.  He serves on the Board of Directors for the nonprofit Tomagwa Clinic, as also on the United Way Elder Services Provider Network.

 

Introduction and Overview

Thank you for working with FHP Geriatrics.

Our operations, robust services and support, and improved outcomes and satisfaction are unmatched.  We are the first and only group with a visiting multispecialty alliance in the nation.  We have over 20 years of earned trust with placement agencies, primary care doctors, insurance companies, and families.  We don’t take that for granted.  We push ourselves to earn your trust, and your respect.  

 

Getting to know who we are and how we operate can be a challenge.  We are all busy, and often only have time for a brief introduction.  Even if you are already familiar with our team, chances are, there are still some things you aren’t yet aware of.  

 

Our sophisticated infrastructure is supported by strong relationships.  We develop and nurture meaningful relationships, not just with the patient, but with the families, and yiour facility staff members.  The more you get to know us and our systems, the better we communicate, and the more successfully we can keep your residents healthy and in place.  

 

Families come with complex dynamics, and high emotions. This is where we thrive. 

We are able to thoroughly assess a patient’s health, take a fresh look at the regimen, make meaningful changes, coordinate specialty care for a better decisions, navigate family dynamics, and bring order from chaos.  Families have more confidence in the residents' care, which makes the job of your staff easier.  Everyone is comforted knowing we are doing the heavy lifting.
 

We constantly evolve, grow, add new services and new partners.  The information in this binder may change.  We encourage you to follow us on Facebook.  Aside from referring families to fill out new patient info, check our website fhpgeriatrics.com periodically for service updates.  In the Staff Resources page, you will find updated info that can be printed and replace these pages.  We have the ability to send text blast to all family members to notify of new services or events.
 

When things don’t go right, it is almost always due to miscommunication or misunderstanding of expectations.  This binder is intended to be full of information to eliminate such issues, and we will continue to update it when a new issue or clarification is needed.  

 

Please have new staff that need to become familiar with our services review this information.   We also have an app available that provides up to date resources for family and staff members.

They will have access to this information and more to help them work more efficiently and effectively.

 

 

The FHP Geriatrics Difference

This section is lengthy, because staff members new to your facility need to understand we are very different, in many ways, and taking time to learn how to take advantage of those extras and differences can help us all be successful.

Expertise Matters

The senior living industry is used to a certain level of provider care.  We’ll call it checkers.  Residents move-in, a kind and friendly practitioner comes to take care of them, and as problems come up, services and care are triggered.

 

FHP Geriatrics brings innovative care.  The way it should be, not the way it is. 

We work smart, love what we do, and enjoy collaborating to bring better care to our seniors.

Our nurse practitioners have a large team working behind the scenes.  

Our team is trained in cross-directional relationships, using Lean Six Sigma principles.  

Our team members all know what each other’s job entails, constantly communicate with each other, and work with systems of high sophistication. 

 

We have administrators dedicated to facility staff,  utilizing artificial intelligence and a hive mentality to solve problems faster and smarter.  

 

We have administrators who are regularly and constantly reaching out to family to make sure they are aware of and included in their loved ones' care.

 

We use location-based scheduling software utilizing GPS technology to coordinate care in the field.  We have a staff member whose only job is tracking our nurse practitioners in the field.  Even when we are not scheduled to be at your facility on a given day, we are in most areas of town several times per week.  The sooner we are aware of an issue, the more effectively we can respond. We can direct our nurse practitioner to stop by and check out the issue in person, 

or quickly do a video telemedicine visit.  

 

While we all prefer in person, telemedicine can be the difference in avoiding the emergency room, or making more informed treatment decisions. Remember we were doing telemedicine two years before the pandemic, and operate at a very high skill level. 

 

We have Clinical staff with full medical school, graduate-level training, behind the scenes to analyze trends, reassess care plans, and proactively address problems before they happen.  

 

When hospitalizations occur, we have privileges at every hospital system in the area, and can follow the transitions of care effectively.  Our team was recently commended for their distinguished ability to prevent rehospitalization among our peers.

 

Multi specialty care is yet another added feature with our team. 

Most people don’t even realize we may be able to bring multi specialty care to seniors.  

We currently have 16 different specialties and are growing all the time.  

 

Dr. Valdez has physician to physician relationships, mutual respect, and has trained and collaborated with specialists so they can bring care to seniors addressing the unique challenges that are faced by this population.  

 

Most providers can do a simple referral to a specialist. Our team is the only one with relationships, mutual respect, communication, and the ability to coordinate and successfully implement the specialist plan, then continue to collaborate with them closely.  Big difference.

 

Many physicians are not actively involved in care, are not double board-certified, or are distracted by their own clinic or hospital work. 

 

Dr. V is an active supervising physician, interacting all day long, without distraction, to support the nurse practitioners and solving even the most complex issues with over 20 years of expertise.  

Reputation matters

We support your staff and make them look and feel more successful.  

Facilities may experience staff shortages, turnover, and other challenges.  

We provide consist care and support the family as we all work through challenges together.

Many senior living referral agencies prefer to send their clients to facilities where they know our team is in place.  

Expectations Matter

We strive to earn your trust and are honored to be a part of your residents’ care team. If you are aware that a family member has a complaint regarding our care or our care team, please bring it to our attention.  We operate with the same attitude as an airline.  We aim for 100% safety and have systems of continuous improvement.

 

The most common issue is miscommunication or misunderstanding of expectations.  If there is truly a service failure, or a fault in our systems, we will address the issue in a forthright manner, and improve our systems going forward.  

 

We will also extend the same courtesy to you.  If we are aware a family member is threatening to leave, move out, file a complaint, or otherwise unhappy, we will bring it to your attention.   

We have experience and resources we are able to engage to help solve problems together.

 

We do not bring complaints.  We work towards win-win solutions.  

We have resources to help educate staff, support your team, and constantly improve.  

There are occasions when systems or staff at a facility impair our ability to provide proper care.  If this is the case, we will communicate our concerns clearly and negotiate a resolution.  

Our team is held to a high level of integrity and professionalism.  

 

FHP Geriatrics is providing care the way it should be

New Patient Intake

Try to encourage family to use our online forms at www.fhpgeriatrics.com. 

They are built to pull more useful information from the family and trigger resources faster.

Please make sure a list of current medications is included if available.

You are welcome to text us at 832-356-7878 to confirm we have received.

We are in most areas every week, and usually visits are within a week.

 

Pre-Move In Visits: Does your incoming resident need a physician evaluation prior to move in?

No problem.  Have the family fill out our online or paper registration, and we’ll set up a telemedicine appointment wherever they’re at.  We’ll identify issues ahead of time, have paperwork ready, order TB testing, prescriptions all ready at the pharmacy, and home health orders already sent.  This makes for smoother and safer transition to your facility.  

Just let us know this is needed when submitting paperwork.

 

PPOC - Patient’s Plan of Care:  Need it in minutes, not days or weeks? 

Send us a blank copy of your form. We’ll turn it into a customized quick fill in app that you can transmit to us and have it signed and returned in moments.

 

Patients with Traditional Medicare or PPO Plans: We can confirm insurance quickly and most people are seen within a week.  If there is an urgent issue, and we’lve confirmed insurance, we can usually get things in motion sooner.

 

HMO and Advantage Plans:

We accept most plans except Cigna Health Springs and Humana Gold Advantage.

Don't worry if we're not in your plan's network.

For an Advantage Plan Insurance Plan specific to senior living, open enrollment any time of year, contact Lamart Clay 708-257-4132 or Derek Vogl  281-813-9586.  We aren't able to recommend a specific plan, but this plan has a network of specialists and therapy options aligned with ours.

For other plans, Medicare supplements, and drug plans of all types, contact Matt Gomez 832-421-1894.  Remember, you can choose any service or specialist when you have regular Medicare with a supplement.  Be sure to confirm the plan you choose has deductibles, medication coverage, therapy options, and a strong network of specialists that you prefer.  

​

If there are unstable issues during this process, please reach out, and we'll help solve the problems.  Medicare Advantage plans must have PCP listed as Dr. George Valdez,  Tax ID 26-084-9313 

 

We are happy to provide more printed copies of registration paperwork. Just text us!

You may also print our paper-based forms from our website.

Paperwork and additional supporting information may be emailed securely to

 admin@fhpgeriatrics.com, or faxed to 888-840-6973

 

Transitions of Care can be dangerous.  There are often unstable or unidentified issues.  

The more information we are given, the faster we will review, connect with family, and we can have support and refills and a plan in place before they even move in.  

We always take a fresh look at meds, get rid of unnecessary ones.

 

We build expert care around a patient’s priorities and values.  

We are able to access resources, therapy, labs, radiology, specialists, hospitals, and access resources that other providers are unable to.

 

We do the heavy-lifting for your staff, make families confident in your facility, and keep your residents at your facility longer.

Insurance 

INSURANCE ACCEPTED: 

• Medicare

• Blue cross blue shield texas

• Cigna 

• Aetna

• United

• United Optum 

• Wellmed

• Kelsy Seybold Kelseycare

• Wellcare/ Texan Plus (certain plans)

• Medicare

• Humana - Not after 2023

• Amerigroup

• Ambetter

• Bright Health

 

INSURANCE NOT ACCEPTED: 

• Humana Gold

• Kelsey Seybold (possibly soon)

• Cigna Health Springs (case by case basis)

• Devoted (case by case basis)

• Molina

• Medicaid as primary 

 

Some plans are great when going to a clinic isn’t an issue, but when it comes to in-home care, they are unable to provide the expertise, services, and resources that measure up to the standards of FHP Geriatrics. 

 

For an attorney who can assist with Long Term Care Medicaid benefits, 

Contact Benecia Flores, Attorney at Law, 281-607-2985

 

Workflow

Routine Visits

An NP is assigned to each facility.   We are in a given area every week.  Some areas we are present several times per week. The more patients we have at your facility, the more you will see us.  The more your staff engages with us, the more trust and stronger the relationship, communication lines, and they are better able to learn and access all of our benefits.  

 

We see a particular resident once per month, even when they are stable.  

Elderly patients may be less able or willing to share they are struggling, and get more sick more quickly.  Seeing a person regularly helps us to identify issues before they get out of control. 

 

We work with almost all of the major insurances including advantage plans.  Once verified, we typically see a patient within a week, but we can get things in place sooner if needed. The main delay keeping us from the first appointment is usually an Advantage or HMO plan that requires the patient or family member to have us assigned as the primary care provider.  We aren't allowed to initiate or accept care for the patient until this is complete.  If the family understands, and plans to make this happen, we can work with them to put things in place in the meantime.  

 

We get to know a particular person’s values and priorities. 

We get to know their family, look for unknown or unstable conditions, usually order routine bloodwork, then take a fresh look at their medications.  If a person hasn’t seen a cardiologist in the past year, even if they are towards the end of life and want no heroic measures, we encourage a visiting cardiology evaluation.  They can perform an ultrasound of the heart to look at the pump in valves, look at the peripheral vascular system, and help us make more informed decisions about the right medications, and have better conversations about prognosis.  

 

Innovations in medication and technology have escalated at a rapid pace in the last few years. Many issues that were not fixable or or difficult to fix, may now be addressed by Houston Medical Center level specialists who can maximize quality of life without being aggressive.  Aside from Cardiologist we have other specialists who can provide additional diagnosis and treatment options, with a lot less stress than working with traditional providers.  Making families aware that we have this capability is our usual challenge.  

 

Some groups may advertise nurse practitioner psychiatric services.  This certification is a 19 hour online training with no direct patient care. We work directly with board-certified psychiatrist physicians who have thousands of hours of training over several years, for complex conditions.

 

 

Families should not have the expectation that Dr Valdez sees their family member on a routine schedule.  He is present in all areas regularly, but shifts constantly to manage dangerous and urgent issues.  

 

They should have the expectation that he is always actively supervising.  

Less time spent on the road means he is more focused on collaboration, more effective in solving problems, coordinating with specialists and hospitals, and having those difficult conversations.

 

He applies 20 years of expertise, 2 board certifications, over 100,000 patient visits, to personally review every new patient history and clinical status.  He makes recommendations and arranges interventions as needed.  He accesses information from all hospital systems.  He leverages 20 years of relationships with specialists to access information, and expert opinions, faster.  

This sets us far apart from traditional NP-led groups.

New symptoms and Urgent Visits

The more your staff is aware how contact us, the better and faster we can solve problems.

Your staff knows a person’s behavior, eating and drinking habits, on a day to day basis.  

They are also the first to notice when these things are changing.  

Encourage them to not be afraid to give us notice at the first sign of changes.  

 

Also have them indicate whether they are giving us an FYI type of notice,

or if they need a particular response or urgent intervention.

 

We have the capacity to address issues quickly in person or through telemedicine.  

We have Lab and radiology services available seven days a week. 

While they can often respond quickly, response times may vary depending on conditions we cannot control.  If an issue is worsening or changing while we are waiting for response, please notify us and we will work to get the issue addressed using our best available resources.  

We also have a partnership with Dispatch Health, which can provide IV fluids, IV antibiotics, instant labs and other services which may help prevent hospitalization.

 

One common issue for a change in behavior is a urinary tract infection. 

If your facility is willing and able, we can provide urine analysis dipsticks.  

Your staff can perform this rapidly, text us with the result, and depending on the result, 

we can have the mobile lab company collect urine, 

or we may provide antibiotics sooner if the patient has significant symptoms.

 

The lab company sends a person to pick up the urine specimen and perform a culture. 

The testing they use is highly sensitive and sophisticated. Because of this it is important that the urine sample is collected properly. The lab company does not perform the actual collection.  Your staff must perform the collection, but the lab culture can provide materials and training on how to do it properly.  It does take some extra effort for your staff, but doing so helps keep residents from going to the hospital and declining faster.

Telehealth

We all prefer in-person visits, and our routine visits are in person.  

During the pandemic telemedicine visits kept us safe.  Now, we leverage technology to manage new symptoms more effectively, make better decisions than we used to.  We have time built into our day which usually allows for same-day add on visits.  Through video visits, we can remote control an exam, get a good idea how stable a person is, and what is the best initial approach.  

 

We are often able to avoid unnecessary emergency room visits, and select the right medicine faster. When needed, we can even include a family member who is unable to make it, or a family member who lives far away.  

If your staff has a phone with a camera, we can walk them through the process in seconds.

 

Dr. Valdez was an innovator in telehealth two years prior to the pandemic.  He was National Director of Information Technology for a large corporation as well.  When the pandemic arrived, we pivoted 70 facilities into telehealth within 1 week.  His team is able to examine more effectively that those with less experience.  He continues to innovate, and was the first physician in Texas to implement the Nonagon device.  

 

The Nonagon device has a stethoscope to listed to heart, lungs, and abdomen, otoscope to check ears and throat, thermometer to check temperature, and pulse oximeter to check oxygen level.  With it, there is almost nothing we can’t examine as well as in person.  It takes practice, but let us know if you would like to have one at your facility.

Labs

We have lab availability 7 days a week.  Urgent lab results may be available within 2-3 days, but if a person is declining, please notify us and they likely need to be sent to the Emergency Room.

After labs are collected, they are reviewed by our staff, interpreted based on the patient’s history and conditions, we may order medication changes, make new orders, and decide on the follow up plan.  Once this is done, you can expect a copy of this information for your knowledge and records.  Results are available to family members through our Patient Portal.  Labs may be requested on behalf of specialists, and shared with specialists upon request.

Radiology

We have x-rays and ultrasound availability 7 days a week.  Urgent results may be available within 1-2 days, but if a patient’s condition is declining, please notify us and they will likely need to be sent to the Emergency Room.

 

After the test is completed, the results are reviewed by our staff, interpreted based on the patient’s history and conditions, we may order medication changes, make new orders, and decide on the follow up plan.  Once this is done, you can expect a copy of this information for your knowledge and records.  Results are -not- available to family members through our Patient Portal.  Upon request, they may be emailed or printed out.  Radiology may be requested on behalf of specialists, and shared with specialists upon request.

Equipment

We use Century Orthotics for most Durable Medical Equipment due to reliable and efficient service.  Delays are usually related to insurance approval.  You may contact your insurance if delay is prolonged, or their service representative may be able to update you (713) 597-0923.

Paperwork and Forms to Fill

We regularly complete letters and Long Term Care forms so families may access insurance or VA benefits, as well as various financial documents.  This typically requires review of issues and requires 1 week turnaround.  Sending through our secure email is preferred: admin@fhpgeriatrics.com

Specialist Network

We may be able to bring Board-Certified Physicians to your Senior Living Facility.

This network is unique to patients of FHP Geriatrics.   

Specialist physicians prefer to work with respected physicians who will implement their consultation, collaborate doctor to doctor, and follow through with expertise. 

 

Dr. Valdez has over 20 years of experience, and has earned trust and respect with specialists. There are no other groups in the area which are led by a focused and organized physician, without distractions, at such a high level of trust.  

 

If a specialist does a consultation, and their plan is implemented by a group with less experience, there are more likely to be worse outcomes, which reflects badly on them.  

Remember, this is not a simple doctor-patient relationship.  

This is a Doctor - NP - Patient - Patient family - Facility staff - Insurance - Specialist relationship.

 

Our current specialties include:

Geriatrics Primary Care, Palliative Care, Dermatology, Rheumatology, Cardiology, 

Pain / Physiatry, Ophthalmology, Wound Care, Infectious Disease, Neurology, 

Psychiatry, Psychology (Counseling), Podiatry, Dentistry, Hematology/Oncology, 

Kidney/Nephrology, Endocrinology, Audiology, Integrative Medicine, General Surgery, End of Life Planning, and more added regularly.

 

Each specialist is independent and determines 

• The type of care they provide

• Where it is provided

• The area of service

• When they will be able to schedule

 

Some specialists need a small or large group in order to arrange a visit in person.  

Some provide care through telemedicine which is often more convenient and faster than clinic.  

Others we are able to facilitate clinic visits, sometimes months faster than routine methods.  

Once we have sent the referral, it is up to family members to contact the specialist to confirm.

If there are significant barriers to setting up, let us know and we’ll look into other options.

Medical Cannabis

Medical Marijuana for Quality of Life

Dr. Valdez is one of few physicians certified to prescribe medical marijuana under a Texas-approved Compassionate Use program.  He completed extensive training, certification courses, research, combined with over 20 years of experience and Board Certification in Palliative Care.

 

We work with facility staff and other physicians to educate on proper management, what to expect, and how to achieve the best outcomes.  It is indicated for Dementia, Parkinson's, Neuropathy, Cancer, PTSD, and more.  

 

We have found it especially helpful, often more effective, and safer than traditional medications for dementia-related behavior such as agitation, anxiety, insomnia, anorexia, and sadness.  We have been able to successfully reduce the need for antipsychotics, benzodiazepines, and opioid pain medications, while improving quality of life, sometimes quite dramatically.  

 

Dementia-related behaviors are often related to the person’s constant awareness that something is not right, but they can’t figure it out, creating a constant negative feedback.  Using precision dosing, the person is able to appreciate where they’re at.  

Of course there is no guarantee, but more often than not, there is a clear reduction in suffering and improvement in quality of life.

The workflow is different from usual prescription.  It is not covered by insurance or delivered by a pharmacy.  

• I consult with the patient and family, obtain certain demographic information, and send the prescription to the Texas Compassionate Use Registry.  

• The family calls the dispensary to confirm and obtain the medication (Their name is added to the registry to have permission to pick up)

• The family brings the medication to your facility, and we send orders to the facility on how it is to be dispensed.  It should be managed and counted like other controlled meds.

 

Like fine wine to complement a good meal, this small, controlled dosing, is a great addition to a traditional medication regimen.  Check out fhpgeriatrics.com>resources for more information and videos.

 

Communication

Let us know if there is any lack of clarity in communication or if orders need to be managed differently.  We are quite responsive, as well as agile, and we can adapt our workflow to accommodate challenges unique to your facility.  Please understand these ‘exceptions to the rule’ create more opportunity for miscommunication.

 

Let us know if you are having staffing issues and we can adjust to support your staff more effectively.  Remember we build relationships with families, extra trust, and when times are tough, we step up and work together.

 

We understand trust and respect are earned, and we appreciate the opportunity to work through any misunderstandings.

 

Please notify us if there are separate pharmacies for mail order and local prescriptions, and also if the pharmacy changes.

Staff Communication

832-356-7878.  It’s easy to remember, and you are reaching our entire team at the same time when you text.  Whatever the issue is, text us first to get the process started.  When you text that line, every staff member, every provider, even Dr. Valdez has access to the text.  Once we know who you are, how urgently issue is, and what is needed to solve it, the right person will interact and address it.  If you call, the line may be occupied, sending you to voicemail. 

Always Text First.

 

What if you prefer to text the NP directly and prefer to have their cell phone? It seems more personal, but it’s much less efficient.  Remember, that NP may be driving, likely is not in front of a computer, and may be off at the time.  Every NP has access to the Team Line, so you’ll still reach them.  If it’s urgent, just text that it’s urgent you get a call from them, and you will, but chances are, another person monitoring the line, able to instantly look at the patient’s chart, can give a faster and better response.

 

Your staff is on the front lines, doing the day to day care, and are often the first to notice a change in condition.  Please emphasize this with your staff regularly, and remind them to reach out to us at the first sign of change.  Let us know if it is mainly a ‘heads up’, or if it appears more urgent and need faster response.  Together, along with family, we keep residents from declining and going to the hospital.

 

After hours is the time when staff is most likely to forget to notify us of status changes, or when a resident has gone to the hospital, or returned from the hospital.  Please regularly remind them to inform us any time of day.  We will be able to follow up and follow through more effectively so residents are healthier and families are happier.

 

We manage routine issues during routine office hours.  After hours, we may give advice but we may not be in front of computers.  Make sure there are systems in place to notify us of refills during normal office hours and before they run out.  Medication accuracy is critical.  We request access to your eMAR so we can regularly reconcile meds.  The safest protocol is to have any medication from any specialist or hospital go through us first.  We generally have the most updated medication list and may be aware of a potential conflict or problem that they were not aware of.

 

We are able to order labs and radiology on behalf of specialists as well.  Often a patient sees one specilists who wants labs, and another specialist wants some of the same labs.  They almost never communicate with each other.  We are generally the main ones to ensure everyone knows what everyone else is doing.

 

Monday morning and Friday afternoon are our busiest times of call volume.  Our general expectation is to give a response to a request within an hour during working hours, but during these times there may be additional delay.

Family Communication

Family hotline is 832-599-8336, and is operated during routine office hours M-F 9am-4pm.

For after hours, life-threatening urgencies, please have your staff contact us.

 

Our separate family hotline functions to develop and maintain relationships with family. 

Our staff members for the hotline utilize protocols that are built to address their unique needs.  

 

We also have a patient portal that family members may access. 

They can send secure messages, review lab results, and review our list of medications.  

During transitions of care to emergency room or hospital, medication‘s are constantly changing.  

We value family members as a part of the care team, and appreciate their extra input.  

When family members come at you with a clinical concern, direct them to us. 

We will take care of it, while also working with your staff and getting their valuable input.  

Your staff is doing the day to day care, and knows a persons usual behavior. 

 

Please notify us if there are particularly unstable issues or challenging family dynamics.  We’re skilled in helping families feel more confident during the stressful transitions.

 

Each patient is generally seen once per month.  Some families feel their family member is stable and hesitate with this frequency.  We remind them the elderly get more sick, more quickly, and less able or willing to express themselves when they are declining.  We would be doing a poor job if we wait for problems to happen, because it is often too late. Waiting for problems may be fine for someone young, but by our team doing routine visits, we often catch issues before they become a dangerous problem. 

 

Family members know a person‘s behavior longer, and usually have a strong grasp on a persons values and priorities.  We have the medical expertise and systems.  We call the combination of facility staff, family members, and our team, the triple helix of awesomeness. We all work together to maximize outcomes and quality of life.

 

Urine Testing for Confusion

The reason for most urinary tract infections in this population, is not drinking enough fluids, not going to the bathroom often enough, or not getting changed often enough.  Many residents have a lack of mobility and/or lack of control of their urine.  Because of this, many people instinctively drink less fluids so they don’t have as many accidents, and don’t have to get up as often to go to the restroom.  In order to prevent hospitalization and worse, it is important to make sure your staff stays aware of how much a person is drinking. If they aren’t drinking enough, make sure there are plans to improve it, or let us know and we can help with intervention.

Make sure they go to the bathroom or that they get changed frequently enough. 

At your request, we provide urine testing strips to keep and check when there is a change in condition suspicious for UTI.  It may be an increased weakness, confusion, imbalance, fatigue, or other change in usual function.  

Text us about your concern at 832-356-7878, and we will approve using the urine strips.  Getting an accurate specimen is critical.  If a person isn't cleaned well prior to testing, we may get false positives, leading us to overuse antibiotics, the risk of antibiotic side effects, or not catching other illnesses that may be happening.  

Please take a picture with your phone 1 minute after dipping the strip in the urine. 

Text 832-356-7878 with the photo as well as the name of the person you were testing.  

If it is positive, carefully cover the sample bottle, or if contaminated, collect a clean catch in a few hours, stored in medical refrigerator.

We will likely go ahead and send antibiotics and send a request for the lab to collect formal culture to make sure we know the bacteria and correct antibiotic.  We may change the antibiotic a few days later based on the culture results.

The specimen collected for the lab must be collected as cleanly as possible.  

We understand it be challenging, but the PCR technology is obnoxiously sensitive.  

If bacteria from the outside are detected, we may inadvertently over-prescribe antibiotics, and may expose the person to potential side effects from antibiotics.  

Please review the info below with staff members, 

and confirm they demonstrate correct technique.

We don't assume it's clear when the antibiotic is finished.  Approximately 1 week after finishing, we request you retest the urine to confirm it's all clear.

Notify us if down to the last strip and we will provide more. You should also have sample collection cups, sanitary wipes, and collection containers to assist with collection if needed. 

Remember, urine infections are not a mysterious problem.

The majority of infections can be prevented by making sure residents drink 25 to 30 ounces of fluids in the morning and 25 to 30 ounces of fluids in the afternoon. You should also make sure they use the restroom about every two hours and if they are using adult diapers, that they are changed at least every four hours. 

Also let us know the associated symptoms.  If the resident has significant new and increased weakness, low blood pressure, high fevers, or other severe symptoms, infection may have already spread from the urine system into the kidneys and the bloodstream.  

Please send the resident directly to the emergency room. 

Text us which emergency room they were sent so we can make sure there is proper follow up.

 

Wash your hands before and after this procedure to prevent spreading infection to yourself or others. Use gloves when dealing with any type of bodily fluid. 

Diligence with making sure residents actually drink the fluids given, catching UTI's early, and treating properly, takes attention and effort, but helps keep your residents from ending up in the hospital or worse.

If a person refuses to drink, ask why, and possibly offer an alternative flavor. Sometimes it helps to acknowledge the fact they may have to get up to pee more often, or have more accidents, but it's better than going to the hospital, isn't it? Return an hour later to confirm fluid intake. If still not improving, let us and the family know.  Like a flower slowly wilting, it can be very subtle until it's too late. Know your residents and their usual intake and behavior well. Treat them as your own family you love.

If a person appears dehydrated, weak, blood pressure low, pulse high, and they refuse liquids, notify us, notify Dispatch Health who can come out with IV fluids, or send to ER if getting worse.

If positive, the cup should be labeled with the name of the resident, date collected, and kept in a bag, refrigerated if possible for up to 3 days, so it can be sent to the lab by us or home health, to find out which bacteria it is, and which medications it is sensitive to.

We understand the reality of collection may be difficult with someone who is poorly mobile or uncooperative, but it is important to try your best and let us know if the collection is probably contaminated.

 

Instructions for Collecting a Clean Catch Urine Sample

 

INSTRUCTIONS FOR FEMALES

1. Wash hands with soap and warm water.

2. Spread the labia (folds of skin) apart with one hand and wipe with the towelette provided.

Wipe from front to back.

3. Continue holding the labia apart. As you start to urinate, allow a small amount of urine

to fall into the toilet bowl. (This clears the urethra of contaminants) Do not touch the

inside of the cup.

4. After the urine stream is well established, urinate into the cup. Once an adequate amount

of urine fills the cup (the cup only needs to be half-full), remove the cup from the urine

stream.

5. Pass the remaining urine into the toilet.

6. Screw the lid on the cup tightly (do not touch the inside of the cup or lid). 

 

INSTRUCTIONS FOR MALES

1. Wash hands with soap and warm water.

2. If uncircumcised, retract foreskin.

3. Wipe the end of penis with towelette provided. As you start to urinate, allow a small

amount of urine to fall into the toilet bowl. (This clears the urethra of contaminants)

Do not touch the inside of the cup.

4. After the urine stream is well established, urinate into the cup. Once an adequate amount

of urine fills the cup (the cup only needs to be half-full), remove the cup from the urine

stream.

5. Pass the remaining urine into the toilet.

6. Screw the lid on the cup tightly

 

Allied Services

Home Health and PT/OT/Speech Therapy

We work with a large number and variety of home health and therapy companies.  

We will always approve care for patients who clearly need it. 

Please note we have contracted with a lab company.  

Labs are often done more quickly, and results are available for the family on the patient portal.  

Unless specified, do not have your staff collect labs that are ordered on a progress note.

 

Facility staff and family are encouraged to reach out to us when they are aware of a need.  

We work with many home health companies, however, we manage orders exclusively through

eSignatureOnline.com, Kinnser.net (877-399-6538) or Doctorsalliance.com (800-608-5368), or clinisign.com.  (772-403-1301).  Our NPI is 1215970876

Kinnser users, text us to notify Dr. V the first time in order to accept the collaborative invite.

 

There is no other option.  Unfortunately using other platforms creates more complexity and confusion in our workflow, leading to delays in patient care and reimbursement.   Digital platform orders are signed weekly, at most 2 weeks, with no driving, no lost papers, better response and efficiency for everyone.

 

We have a very clear, very efficient system of managing orders.

We do not respond to orders through phone, email, fax, papers, or folders.  We never refuse to sign orders, but we do insist that they are signed through one of these platforms.  Orders are typically signed on Thursdays.  Companies who insist on calling to remind us to sign orders tend to create further delays

 

In the recent past, Many companies would send faxes and bring papers for orders to sign.  

They had employees whose only job is tracking down orders from providers.  

This caused tremendous delays in care, rejections in their claims, and inefficiency for our staff.  

 

A few years ago, a company filed a formal complaint with the Medical Board regarding our digital platform-only policy.  The medical board responded with overwhelming support. 

 

Our policy improves care, reduces waste, reduces cost, and improves compliance.  We are not trying to be difficult.  Once your workflow is adapted, you will appreciate the improved efficiency. 

 

Hospice And Palliative care

Dr. Valdez is Board Certified in Hospice and Palliative care. There aren’t many hospice directors who are Board Certified.  Hospice will take over medical care, medical supplies and equipment, and hospice-related medications.  Expert nurses will visit often.  They do not hasten death, but give medications to allow nature to take its course while minimizing suffering.  It is a Medicare benefit. 

 

No matter what anyone tells you, it is intended for those who are actively declining and expected to pass in the next 6 months.  It is not intended for those who wish to continue aggressive treatments, go to the hospital if condition declines, or want to be resuscitated.

 

There is a hospice team who takes over all care, including a physician, nurses, social worker, chaplain, and volunteers.  They meet as a team usually every 2 weeks to discuss each person’s care.  Dr. Valdez is Board Certified in Hospice and Palliative Care and is Medical Director for certain hospice companies, depending on location. 

 

If a hospice is chosen that Dr. Valdez is not the medical director, it means he is unfamiliar with that team, does not attend their meetings, and for this reason, will turn over all primary care to that director, in order to avoid confusion.  Some representatives are not aware that he will only manage when he is attending their meetings.  Please contact us before enrolling at 832-599-8336 if you wish to confirm Dr. Valdez will to continue to manage all care.  This is a time of great stress and families may become upset if Dr. Valdez is no longer managing care.

References and Forms 

Please visit our website to print copies of DNR Forms, New Patient Paperwork, and more.  They are also digitized in our staff app for even faster completion.