First Quarter 2014

D.C. Healthy Families/D.C. Healthcare Alliance

MedStar Family Choice does not deny claims when a member presents an ID card that does not reflect your office as the primary care provider (PCP). This is to prevent participating PCP offices from turning members

away when they are active MedStar Family Choice members on the date of service. When this happens, please ask the member to update his/her ID card information prior to his/her next appointment. Changing a member’s PCP is relatively simple. Please follow these instructions if your office is not printed on the card as the member’s PCP:

• Always verify through IVR that the member is an eligible MedStar Family Choice member on the DOS. Call 202-906-8319 (inside the D.C. Metro area) or 866-752-9233 (outside the D.C. Metro area).

• See the patient if he/she is active. Do not reschedule the appointment.

• Ask the member to call his/her member services at 888-404-3549 to request a new member card reflecting his/her correct PCP name prior to the next scheduled appointment. You may allow the patient to call from your office while he/she is waiting to be seen.

• Follow current authorization procedures if applicable. A list of services requiring prior authorization is available at MedStarFamilyChoice.com or can be obtained by calling MedStar Family Choice Provider Relations.

Please keep in mind the importance of current PCP information in regards to member ID cards. This information is used to create member rosters that are mailed monthly to PCP offices. These rosters are used by MedStar Family Choice to send member information to provider offices, as well as when making outreach attempts for members. If the roster is inaccurate, the PCP on file may consequently receive member mailings that go into the member’s chart, as well as telephone calls regarding the specific member that is not actively under their care. MedStar Family Choice rosters are also used by the vaccines for children nurses who supply vaccines to pediatric offices for members enrolled in the District of Columbia Healthy Families and Healthcare Alliance. As a result, pediatric offices may not be adequately stocked with vaccines for their members. If you need further assistance regarding the member’s benefits, call our Outreach department at 855-210-6203 for the member’s ID number and effective date.

MedStar Family Choice District of Columbia Healthy Families and Healthcare Alliance Membership Cards

Provider Newsletter

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Mammogram/PAP Test ProgramThe MedStar Family Choice Mammogram and Pap Test program was developed to encourage our members to obtain their annual mammogram and Pap test. The goal is to attempt to contact every female member missing a mammogram or Pap Smear test, and educate the member about the importance of being compliant.

The outreach coordinator attempts to contact every female member 40 and older who is in need of a mammogram and women 18 and older who need a Pap test. If the contact is successful, the member is educated about the importance of receiving these services and assisted with scheduling their appointments as needed. If the contact is unsuccessful, a minimum of three attempts are made via telephone/mail to contact the member.

Because these tests are so important, MedStar Family Choice will give the member a $25 gift card for having a Pap smear and a $25 gift card for having a mammogram. To be eligible for the gift cards, the member must receive the Pap test and the mammogram before Dec. 31, 2014.

For more information, please direct members to their wellness and preventative coordinator, Regina, at 202-243-5484 or 855-210-6203.

Access and Availability StandardsMedStar Family Choice providers must offer hours of operation to MedStar Family Choice members that are no less in number or scope than the hours of operation offered to commercial or other Medicaid patients. Regulations require providers to adhere to the following guidelines for appointment scheduling:

Within 48 hours of discharge

• High-risk newborns

Within 30 days of request

• Initial appointment to new members 21 years and older

• Well–child appointments

• Routine and preventative primary care

• Routine specialist follow-up

• Lab and X-ray

Within 10 days of request

• Initial assessment of pregnant and postpartum women

• Family planning service request

Providers must also maintain:

• 24-hour phone coverage/urgent care appointments within 24 hours

• Office hours for MedStar Family Choice members must be equivalent to the office hours offered to commercial or other Medicaid patients.

• Member’s waiting room time should be no longer than 45 minutes, and emergency cases should be seen immediately.

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EPSDT (HealthCheck) ProvidersHealthCheck/primary care providers seeing patients under the age of 21 are required to complete the District’s HealthCheck Provider Training within 30 days of joining the plan network and every two years after the initial training. Providers who are not up to date on their training may not be recredentialed with the health plan. This program is accessible online at DCHealthCheck.net and requires a provider’s NPI to log-in. The training program is free for participating plan providers who are due to receive the training. Upon completion of the online training module, providers receive five free continuing medical education (CME) credits.

Revised CMS 1500 Paper Claim Form Version 02/12 The National Uniform Claim Committee (NUCC) maintains the CMS-1500 paper claim form and makes updates according to healthcare industry requirements. NUCC recently announced that the healthcare industry will transition to a revised version of the CMS-1500 paper claim form.

Effective April 1, 2014, providers should begin submitting the updated forms for all MedStar Family Choice product lines, D.C. Healthy Families and D.C. Healthcare Alliance. The revised form includes the following functionality: indicators for differentiating between ICD-9-CM and ICD-10-CM diagnosis codes, expansion of the number of possible diagnosis codes to 12 and qualifiers to identify the provider role as ordering, referring or supervising. Additional changes were also made. Please refer to the NUCC website at NUCC.org for additional information and instructions on completing the form. Please note that claims received after April 15, 2014 on the old claim form may be denied.

Denial For Timely FilingA clean claim must be received by MedStar Family Choice within 180 days (six months) from the date of service. After 180 days, any claim submitted will be denied as untimely, and the claim will not be paid. If the claim is first submitted to another insurance carrier (commercial, Medicaid fee-for-service, etc.), claims must be submitted within 180 days (six months) from the date of the explanation of benefits (EOB) of the primary carrier. It is always required that the provider submit that EOB with the claim once they receive it. If a member has Medicare as a primary carrier, then the timely filing must occur within 18 months from the date of the Medicare EOB. When a claim is submitted, please retain the EOB as your proof of timely filing. It is critical for providers to retain their EOB since this is the only acceptable proof that a claim has been filed. MedStar Family Choice does not accept billing system print outs as proof that a claim was filed in a timely manner. Providers should make every effort to submit their claims as soon as possible. This allows providers additional time to submit corrected new claims within the six month timeframe.

District of Columbia Healthy Families and Alliance Transition PlanThe transition plan implemented on July 1, 2013 for MedStar Family Choice District of Columbia Healthy Families and D.C. Health Care Alliance recipient’s, remains in effect until further notice. Visit MedStarFamilyChoice.com for details and updates.

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The MedStar Family Choice claims look up website allows providers to check the status of a claim. In order to check claims status online, providers should go to MedStarFamilyChoice.com and click on the Go to online claims look up icon under For Physicians. This quick link will take you directly to the online claims page where you can register and/or sign on and look up a claims status. A new feature for claims look up is that each office will initially register for a master account and then register all other users in their office as subaccounts. Subaccounts will allow multiple users to share the same web portal access without sharing the same username and password. The employee who is registered as the master account holder will be responsible for activating and deactivating employee log ins. Prior to registering, verify that your computer is currently using either a Windows or Apple operating system that includes a supported web browser:

• Microsoft Internet Explorer 7, 8 or 9

• Mozilla Firefox 3.6 x or later

• Google Chrome 11.0 x or later

• Apple Safari 5.0.1 or later

Once your computer is set up, registration can begin. All identifying information needed for registration must exactly match the information in our database. Therefore, we recommend that offices have an EOB to refer to for accurate data input of the provider name, ID and address information. At this time, users will have the option to register as a:

• Facility: This option allows access to provider information associated with that medical facility, ie users will only be able to view the facility charge.

• Payee: This option allows access to all providers and locations associated with the payee. This is the recommended option if offices wish to view all professional claims billed from multiple office locations, as well as professional charges related to facilities that are associated with the payee’s information.

• Location: This option allows access to provider information for one physical location.

• Provider: This option allows access to only the provider’s information, ie the provider’s name used for the initial registration.

After registration is complete, users can set up subaccounts for other employees. To set up subaccounts:

• Click on the Setup > Subaccounts tab.

• Click Create New Subaccount.

• In the Create Subaccount window, enter the name and email address of the new user. (System-generated messages, such as password reset messages, are sent to the email address that you enter for this user. Users can change their name and email address later on the My Profile tab, once they log in.)

• Enter an initial username and password for the user. (Users can change their passwords later on the Change Password tab once they log in.)

• Click Save. The new account is created and added to the Subaccounts tab, where it can be edited, locked or unlocked. The subaccount user has the same web portal access as its master account, including access to patient rosters, billed amount lists and attached documents. For additional help, providers can contact the Claims department at 800-261-3371 and/or MedStar Family Choice Provider Relations at 855-210-6203 to request on-site assistance.

Online Claims Look-Up Registration

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Language Assistance Services for Our MembersUnder federal law Section 601 of Title VI of the Civil Rights Act of 1964, providers of healthcare services who receive federal financial payment through the Medicaid program are responsible to make language service arrangements to facilitate the provision of health care upon the request of their Medicaid patients who are limited English proficient (LEP), low literacy proficient (LLP) or sensory impaired. MedStar Family Choice knows that culturally and linguistically competent care is imperative to help people get the care they need. To support providers and members in meeting their language assistance need, MedStar Family Choice will provide telephonic interpretation services and/or professional on-site interpreters.

Please contact our Care Management department to schedule telephonic translation services or call Provider Relations to coordinate an in-office interpreter. Please note that Provider Relations will need no less than five business days prior to a member’s appointment to coordinate an on-site interpreter unless the visit is urgent.

Care Management and Provider Relations can be reached at 855-210-6203. In addition, MedStar Family Choice is contracted with La Clínica del Pueblo, available by calling 202-462-4788, to perform interpretation services for MedStar Family Choice members. Providers may contact La Clínica del Pueblo directly for these services. Providers who are interested in learning more about cultural diversity and literacy can take online training courses. For example, ThinkCulturalHealth.org provides training, as well as free CME credits, for completing education modules on this topic.

Balance Billing for MedStar D.C. Healthy Families and D.C. Healthcare Alliance Members is Prohibited.As a reminder, it’s prohibited under both District of Columbia and Federal Medicaid law for MedStar Family Choice participating providers to directly bill MedStar D.C. Healthy Families and D.C. Healthcare Alliance members for medically necessary covered services under any circumstances. Balance billing members for medically necessary services is considered a violation of both District of Columbia and Federal Medicaid laws.

All payments from MedStar Family Choice to participating providers must be accepted as payment in full for services rendered.

Providers are encouraged to utilize the claims appeals processes to resolve any outstanding claims payment issues. Claims appeals must be submitted within 90 business days of the denial letter date (EOB). Claims appeals must be submitted in writing with a copy of the claim, a copy of the explanation of benefits and any supporting documentation to:

MedStar Family Choice Attn: Appeals Department 901 D St., SW, Suite 1050 Washington, DC 20024

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Equal Access to AppointmentsThere are several federal laws that protect Medicaid recipients from discrimination. The national law that protects Medicaid recipients from being denied services because of “race, color or national origin” is Title VI of the Civil Rights Act of 1964. Title VI laws are enforced by the Office for Civil Rights (OCR). Other laws enforced by the OCR include the Age Discrimination Act of 1975, the Rehabilitation Act of 1973 and Title II of the Americans with Disabilities Act of 1990.

As described within these laws, Medicaid recipients:

• Must not be discriminated against in the provision of healthcare services.

• Are entitled to receive care without regard to race, age, gender, color, sexual orientation, national origin, religion, physical or mental disability, or type of illness/condition.

An example of discrimination includes offering fewer hours to Medicaid recipients than to commercial members and/or designating different office hours for Medicaid patients. Providers must provide the same access standards for all patients, regardless of the payor source. Services may not be denied or performed in a different manner and members may not be subjected to segregation or separate treatment based on these factors. In accordance with Title VI of the Civil Rights Act, MedStar Family Choice provides translation services and performs site visits to confirm handicap accessibility. Providers must ensure that patients with impairments or who require an interpreter are provided with these services as needed. Providers can contact MedStar Family Choice for assistance. Please report MedStar Family Choice equal access or discrimination concerns to our Provider Relations department at 855-210-6203. More information regarding these laws can be found at HHS.gov/OCR or you can call the U.S. Department of Health and Human Services Office for Civil Rights hotline at 800-368-1019.

Update to the MedStar Family Choice Formulary District of Columbia Healthy Families

Updates are available quarterly at MedStarFamilyChoice.com and more frequently on eProcrates. Paper booklets of the 2014 formulary have been mailed. If you have not received a copy or would like additional copies, please contact your Provider Relations representative. Details of the prior authorization criteria are available on the MedStar Family Choice website with the other pharmacy protocols. Contact Provider Relations at 855-210-6203 if your office does not have access to the Internet and you would like copies of this information.

Contact UsOn July 1, 2013, our telephone options changed.

Option 1 for outreach for eligibility verification and transportation assistance or fax to 202-243-5495

Option 2 for pharmacy, pre-authorizations, inpatient reviews, case management, and special needs, or fax to 202-243-5495

Option 3 for Member Services or denials and appeals

Option 4 for claims

Option 5 for Provider Relations or fax to 202-243-5496

Option 6 for dental, vision, substance abuse, or mental health

Option 7 for compliance

You may contact MedStar Family Choice at 855-210-6203, Monday through Friday between 8 a.m. and 5:30 p.m. Providers have the option to leave a message or send a fax after the normal business hours. However, any calls and faxes after normal business hours will be addressed the next business day.

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Advantica - MedStar Family Choice Vision Service ProviderAll vision services for MedStar Family Choice D.C. Healthy Families (all members) and D.C. Alliance (under the age of 21) are rendered by Advantica. Members may self-refer to Advantica for all routine vision services and may contact Advantica directly for routine vision care. No referrals are required.

Advantica also manages medical/surgical ophthalmology services. Providers wishing to provide services to MedStar Family Choice members for medical and surgical ophthalmology services must contact Advantica to become a credentialed provider and to obtain information on services requiring referral authorizations and to verify eligibility. Advantica is available Monday through Friday, 8 a.m. to 7 p.m., at 855-210-6203.

Acute BronchitisThe treatment of acute bronchitis presents a challenge for most clinicians. While viral etiologies are suspected in 90 percent of cases, patients often expect an antibiotic to be prescribed. Weighing the evidence against patient expectations can be exceedingly difficult. The National Committee for Quality Assurance (NCQA) has set forth stringent goals through Healthcare Effectiveness Data and Information Set (HEDIS) regarding this issue. They are measuring the percentage of adults (ages 18 to 64) with a diagnosis of acute bronchitis who were not dispensed an antibiotic prescription. The stated goal is avoidance of antibiotic treatment in adults with acute bronchitis. The purpose of this article is to lend support to practitioners in providing excellent evidenced-based care while still maintaining patient satisfaction.

(continued on back cover)

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It is a policy of MedStar Family Choice to protect patient privacy by means of an active confidentiality program, which includes limits on access to information, controlled circulation, and physical security of patient records and information. Further, it is MedStar Family Choice’s policy to safeguard all medical information, including the paper medical record and the computer-based patient record against loss, defacement, and tampering and from use by unauthorized individuals.

General Medical Record Policies

1. A medical record shall be constructed for each MedStar Family Choice member and maintained by the practitioner while the member is an active patient. If the member becomes an inactive patient, the medical record can be moved to storage. Current Maryland regulations require practitioners to keep the medical record for 10 years after the last visit if the member is 18 years old or above and for 10 years past the age of majority if the member was a child at the time of the last visit.

2. All medical records, X-ray films, tissue specimens, slides, and photographs are the property of the practitioner.

3. It is at the discretion of the practitioner’s office to determine the method of filing the medical records, i.e. alphabetical order, terminal digit order or number order. The record itself should be organized to allow for easy access to information. For example, the record may be organized with dividers to separate progress notes and laboratory reports. An organized, standard record format is available upon request to all practitioner offices.

4. All paper-based notes, reports, etc. in the medical record should be secured in the member’s folder or electronically attached to the member’s file/record.

5. A member’s medical record should be kept at each practitioner’s office. If the member becomes an inactive patient, the purged medical record may be kept off site. Records should be easily retrievable. All medical records, active and inactive, should be supplied within 30 days of a request. Urgent requests should be met according to the clinical situation.

6. Compliance with all federal, state and local regulations pertaining to medical records should be maintained.

7. All medical record information should be released only by properly trained personnel.

Confidentiality and Security of Medical Records and Information

1. All protected health information should be kept strictly confidential in compliance with HIPAA. Notices of Privacy Practices should be signed by the patient and filed in the record. Nonclinical information, such as patient identity and demographic information, should be recognized as sensitive for some individuals and increased confidentiality of this information should be available to any patient upon request.

2. All employees should be trained and oriented to confidentiality policies upon employment and required to sign a Confidentiality Pledge. Staff should receive annual retraining in member information confidentiality.

3. Access to computerized patient information should be controlled with appropriate security settings and passwords.

MedStar Family Choice Medical Record Documentation Standards

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(continued on page 10)

4. Service entities with which the practitioner office transacts business (e.g., medical transcription, off-site storage) should be required to adhere to confidentiality requirements.

5. When medical records or radiology films and other patient identifiable information are to be destroyed, methods of disposal that ensure confidentiality should be used. Such methods include incineration and shredding.

6. Patient record-keeping area(s) should provide for physical security of patient records by means of stringent controls on circulation of the record. Medical record storage area(s) should be secured.

7. All requests (walk-ins, telephone, written) for patient and clinical information should be processed according to prescribed routines. Responses to routine requests should be fulfilled within 30 days. Urgent requests should be fulfilled according to the clinical situation.

8. All requests for health records or health information should be directed to appropriate staff who have received training. A properly completed and signed authorization should be required for release of all protected health information as required by law. Exceptions under the law include: release to another healthcare provider currently involved in

the care of the patient, release to another healthcare practitioner/provider for emergent situations, release for quality assurance and medical care evaluation, or release for research and education. Release for education and research is limited to MedStar Family Choice approved activities.

Medical Record Documentation Standards

The following standards correspond to the specific items on the MedStar Family Choice medical record evaluation tool, which is the instrument used by the QI Department reviewers to conduct and score the performance of offices and practitioners for compliance to the medical record documentation standards.

1. Biographical/personal data: Address, occupation (patients age 15 and older), employer (one parent’s employer for patient under age 15), home and work telephone, marital status (age 15 and older), and/or identification of parent or legal guardian on pediatric records should be documented.

2. Allergies and adverse reactions to medications prominently displayed: This information should be documented at the first visit. “No known allergies” (NKA) or “None” should be noted.

3. Completed problem list: Medical conditions of a chronic nature should be documented on a Problem List.

4. Completed medication list: Chronic, current and episodic medications should be listed on the medication list and/or in the progress notes at each visit. It should be accurate and up to date.

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5. Immunizations: Primary care practitioner medical records should contain evidence of immunization status for adults and children. Immunization flow sheets or a similar tool to summarize immunization information are recommended.

6. Growth chart: A completed, up-to-date growth chart should be in the record for pediatric patients from birth to 36 months. Head circumference should be measured and graphed until age 2.

7. Birth history documented: Primary care practitioner medical records should contain a perinatal history, including birth weight and length, any problems and resolutions for pediatric patients up to minimum of 6 years of age.

8. Lead blood level: Documentation of blood lead tests that is compliant with District, as well as federal, law.

9. BMI calculations and graphing: BMI calculations and graphing should be documented from ages 2 through 20 years of age in accordance with EPSDT requirements.

10. Family history documented: A family history should be documented.

11. Social history documented: a social history should be documented.

12. Smoking habits documented: Smoking status should be documented.

13. Documentation of alcohol use or substance abuse: A substance abuse history should be noted on all patients age 12 or older within the first three visits.

A comprehensive history or an addiction screening instrument, such as the Michigan Addiction Screening Test (MAST) or CAGE with results documented in the record, is recommended.

14. History and physical exam: A complete history and physical including a past medical history and review of systems is documented.

15. Detailed progress notes: At each visit, the entry into the medical record should document the reason for the visit, clinical findings and evaluation, and an assessment and plan, including tests, diagnostics, medication prescribed, therapeutic, and other regimes. A plan for a follow-up visit and the time interval should be noted, if indicated.

16. Unresolved problems from previous visits addressed: Unresolved problems from previous visits should be addressed in subsequent visits.

17. Lab and imaging studies reflect a practitioner’s review: All reports should be signed and dated indicating review by the practitioner. Entries into the medical record referencing results indicating review are acceptable.

(Documentation Standards continued from page 9)

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18. Abnormal findings are addressed with the patient: Consultation, abnormal lab and imaging study results should have an explicit notation in the record concerning follow-up plans and evidence that the results have been addressed with the patient.

19. Patient education documented: Documentation of patient education related to the diagnosis or treatment should be included. Anticipatory guidance as outlined by EPSDT should be reviewed at the age-appropriate visit.

20. Preventive services/risk screenings are documented: There should be evidence that preventive services and risk screening are performed in accordance with MedStar Family Choice preventive services recommendations. Pediatric preventive and risk screening should follow the EPSDT recommendation for the appropriate age.

21. Medical record entries are legible: All notations, including telephone encounters, should be legible, dated and signed by the person making the entry.

22. All medical record pages contain patient ID: Each page, front and back, should contain information to identify the sheet/ entry as part of a unique patient record.

23. Coordination of care: The primary care practitioner (PCP) medical record should contain the member’s complete medical information. There should be documentation reflecting coordination and communication between healthcare providers and practitioners. The primary care practitioner medical record should contain:

a. All services that are directly provided by a PCP: The medical record documentation should reflect all services performed directly by the practitioner.

b. All ancillary services and diagnostic tests are ordered by the practitioner: All ancillary and diagnostic tests ordered should be noted in the record.

c. Reports for diagnostic and therapeutic services for which a member was referred by the practitioner, e.g., home health nurse, specialty physician, and PT reports: The medical record should contain reports for all diagnostic and therapeutic services for which a member was referred.

d. Reports from hospital-based services: The medical record should contain reports of services provided at hospitals, such as admission discharge summaries and Emergency department visits.

24. Outreach efforts documented by the provider when patients fail to keep appointments: Outreach attempts/and or referrals should be noted. Documentation should include the date of the missed appointment, actions taken to contact the patient (e.g., telephone, postcard, letter, email), number of contact attempts, reason for missed appointment, staff signature, and any follow-up appointments scheduled. A MedStar Family Choice Outreach Referral Form should be completed and submitted after the second missed appointment and a copy placed in the record.

25. Medical records are stored securely: Only authorized personnel have access to records.

26. Staff receives annual training in confidentiality of member information.

901 D St., SW Suite 1050 Washington, D.C. 20024 855-210-6203 PHONE

The MedStar Family Choice Newsletter is a publication of MedStar Family Choice.

Submit new items for the next issue to Ricardo L. Jones, MedStar Family Choice, at ricardo.l.jones@medstar.net.

Kenneth A. Samet, FACHE President and CEO, MedStar Health

Eric Wagner President, MedStar Family Choice

Ricardo L. Jones Editor

MedStarFamilyChoice.com

14-MFC-0383.042014

The most common viral infectious etiologies include adenovirus, coronavirus, influenza, metaneumovirus, parainfluenza, respiratory syncytial virus, and rhinovirus. The most common bacterial etiologies are Bordetalla pertussis, Chlamydia pneumonia and Mycoplasma pneumonia. Given that the vast majority of bronchitis cases are viral, it is reasonable to treat most symptomatically. However, there are certain instances in which antibiotics should be considered. If pertussis is suspected, a macrolide antibiotic will help lessen the risk of transmission (but will not lessen symptom duration). In addition, antibiotics should be considered in patients at high risk for pneumonia. Established risk factors for pneumonia include (but are not limited to) chronic lung disease, heart disease, immunosuppression, and age 65 or greater.

Practitioners aim to provide the best evidence-based care. Yet, it is not unreasonable to also aim for patient satisfaction. How might we allay patient apprehension about leaving the office without a plan for antibiotic therapy? Suggestions include:

• Explain the diagnosis. Inform patients that in 90 percent of cases, this illness is caused by a virus. Go further and explain that antibiotics do not treat viral infections.

• Briefly detail the potential side effects of antibiotics. Severe diarrhea (C. difficile), nausea and serious allergic reactions are just a few side effects that patients can easily comprehend.

• Anticipatory guidance is critical. Patients may believe that a cold should only last a few days. So, when the cough has persisted for a week, many think it is time to turn to antibiotics. Explain that the cough, congestion, rhinorrhea, etc. may last three weeks (sometimes longer).

• Offer symptomatic care. Patients may benefit from expectorants, mucolytics, antitussives, humidifiers at the bedside, etc. Use your best judgment with supportive measures, but keep in mind that the FDA issued a recommendation that children under the age of 2 not use cough and cold preparations due to the risk of serious side effects. Additionally, the American Academy of Pediatrics has stated that over-the-counter cough and cold medicines do not work for children younger than 6 years and in some cases may pose a health risk.

• Offer a script “to hold.” Patients often fear being trapped on a weekend without access to care other than an ED or urgent care visit. Offering a script to fill at a later time if symptoms progress or worsen might lessen anxiety.

It is definitely possible to provide excellent care while still maintaining a high level of patient satisfaction. Additional sources of excellent patient-centered information can be located at FamilyDoctor.org/FamilyDoctor/en/Diseases-Conditions/Acute-Bronchitis.html or via the Centers for Disease Control website at CDC.gov/GetSmart/Antibiotic-Use/URI/Bronchitis.html.

(Acute Bronchitis continued from page 7)