Northern Virginia Endocrinologists

We are moving on July 27, 2012!  See "News" below.

NOTICE: The information in this web site is provided for current and prospective patients of Northern Virginia Endocrinologists. Any clinical information reflects the guidelines of Northern Virginia Endocrinologists for care of our patients, and should not be used by any other individuals for treating any health problems.

 

Prescription Refills

Please try to keep all your prescriptions up to date during your office visits. This will require some effort on your part.  Monitor your prescription status: if there are no more refills, provide your pharmacy your written Rx before it is needed.  Otherwise, the pharmacy may contact us for refills.  As this is duplication of our efforts (providing you written Rx and providing the pharmacy renewal authorization) you may be charged for that duplication.  As we provide some one hundred thousand Rx's per year, the majority for non prescription items, we simply cannot possibly respond to between-visit refill requests for even a tiny fraction of them.  If your prescription has expired, you are likely due for an office visit.  In order to minimize errors and maximize efficiency, we communicate with pharmacies only by fax. As our physicians are not in each office each day, allow two working days for refills. Finally, with the exception of very expensive medications such as growth hormone, our written prescription is the only authorization for medication or supplies which we will provide; we will not respond to requests from pharmacies or insurers for "letters of necessity": our prescription is our letter of necessity!  

Patients with diabetes please note that all diabetes supplies other than Humalog/Novolog/Apidra and Lantus/Levemir insulins and Glucagon are non-prescription items. We are happy to provide prescriptions at office visits so that your insurer will help pay for your supplies. 

There will be a $15 charge for faxed-in prescriptions.   

Frequently, your insurance company will request that your medication be changed to a similar but different medication. We are sympathetic to the goal of saving money, and we will consider such substitutions at the time of your next office visit. However, we generally will not honor such requests between office visits, for the following reasons.

That having been said, we may approve substitution of brands of the same medication, when we know the brands to be comparable. Usually this does not include thyroid hormone.


Insurance

Insurance coverage for your care is a constant source of frustration and confusion for you, our doctors, and our staff. The rules change so fast and are so complicated that you cannot expect us to be "right" all the time, and we realize that you cannot always understand your coverage thoroughly.

If you require a referral from your PCP for payment for your visit, please understand that obtaining this referral is your responsibility, not ours. If you arrive for an appointment without a referral, you will have to try to arrange it from our office. If you cannot, you may have to choose between leaving without being seen or paying out-of-pocket for your visit.  If you elect to leave without being seen, you will be charged a missed appointment fee.

Insurance companies are requiring more and more "preauthorizations" for tests and medications that we order.  While we are sympathetic to your financial concerns, we do not consider it our mission to apportion costs between our patients and third party payers.  In fact, such efforts distract us from our true mission, that of providing quality medical care to patients with endocrine problems.  Insurers do not pay us for such authorization services, and we reserve the right to pass our costs on to our patients.  Keep in mind that for relatively inexpensive items such as certain diabetes supplies, our costs for insurance authorization may exceed your savings. 


As of  05/03/12 , we participate in the following plans: 

Aetna   
Anthem (BC/BS of VA) 

Carefirst (BC/BS of DC) (effective 9/1/09)

Cigna  (Not Great West, even though Cigna has purchased it and has added its name to the Great West insurance card.)

Coventry/First Health

Kaiser 

NCPPO
PHCS  

United including Alliance, MDIPA,  Optimum Choice and MAMSI

Medicare--Current patients only:  On 1/1/10, Medicare stopped paying for consultations in order to free funds to raise compensation of primary care physicians.  Since Medicare no longer pays for consultations, we can no longer offer this service to Medicare patients.  This includes patients previously seen in our practice but more than two years ago.  Unfortunately, since we still participate in Medicare--to continue seeing our existing Medicare patients and to provide hospital consultation--the law does not allow us to collect our consultation fee directly from patients.   

While we understand that Medicare cannot pay for everything and has to make choices, we are disturbed by a system that prevents Medicare patients from contracting privately to obtain consultative services.          

 

Reports and Preauthorizations

To allow us to continue participating with insurers, we are required to accept ever-declining reimbursement rates. Accordingly, we can no longer afford to provide certain services gratis, such as preparation of reports, and we must charge our patients for time spent in providing these services.

Laboratory Work

The measurement of hormone levels in blood and urine is a crucial aspect of the specialty of Endocrinology. Our policy is to arrange for testing at the time of your office visits. Please do not call between visits to obtain authorization for lab tests; our experience is that these calls lead to confusion and wasted time and money.  

If you undergo testing ordered by another MD, interpretation of the results is between you and the ordering physician.  Please do not phone our doctors for our opinion; that creates avoidable conflicts.  We are always happy to respond to telephone calls from your other MD.  If you  prefer our direct opinion, please obtain a copy of the lab results and bring them to an appointment with us.  Never rely on your other doctor's office to send us the results;  in spite of the best intentions most such requests do not succeed, since medical offices are extremely busy.  It is much more reliable for you to secure a copy of the test results yourself to bring to our offices.

If one of our physicians needs to or promised to call you with results, please allow a week for all but the most urgent of results.  If you expected to hear from your physician and have not, please leave one message on your doctor's voice mail; do not call other staff.  Finally, if you wish hard copies of your results, please so advise your doctor or other staff at the time the tests are ordered, so that the lab can handle this request.  If a copy of results from an outside lab is requested but you do not receive it, please call the lab.  If you decide later that you would like a copy, please leave a message for the reception staff (see phone tree above), not your MD.

The Doctors

Dr. Peter Ross joined the practice in 1978. A graduate of Harvard University School of Medicine, he completed his fellowship in endocrinology at the National Institutes of Health.

Dr. Suzanne Rogacz joined us in 1988. A graduate of UNC School of Medicine, she completed her endocrinology fellowship at the Brigham and Women's Hospital (associated with Harvard, in Boston.)

Dr. Roy W. Langley joined us on October 1, 2004.  Dr. Langley left a brief career as an engineer to attend Loyola University School of Medicine.  He comes to us from Walter Reed Army Medical Center.  

Dr. Melissa J. Antonik joined our practice on September 1, 2009.  A graduate of Loyola University Stritch School of Medicine, Dr. Antonik completed her endocrinology fellowship at the Medical College of Wisconsin, Milwaukee.  

Drs. Ross, Rogacz, Langley, and Antonik and are board certified in Endocrinology. Dr. Ross holds  Georgetown University and VCU clinical faculty appointments at Inova Fairfax Hospital. Drs. Rogacz and Langley are also on the clinical staff of VCU.  



The Certified Diabetes Educators

Katharina Ewell, RN, joined our Fair Oaks Office in August of 2009.  As soon as she had sufficient practical experience caring for patients with diabetes she took and passed the examination to become a Certified Diabetic Educator.  Congratulations, Katie!


The Diabetes Page

SICK DAY RULES

Monitoring   Your main tool for controlling your diabetes through an illness is your blood glucose meter. Use it!

I.  Patients on only oral therapy: Continue to take your anti-diabetes pills through an illness, unless your blood glucose levels are under 80 mg/dl. Do not be overly concerned if you are unable to keep down a dose of your pill. Similarly, raising the dose of pills for unusually elevated glucose levels is not recommended, as such an increase is unlikely to work until after you have already recovered from your illness. Elevation of blood glucose into the 200's and even 300's for a day or two will cause you no harm. If this continues for more than a couple days, however, please call for an urgent appointment.

Drink plenty of fluids, if possible.  If your BS's are high, avoid fruit drinks or "real" sodas. 

 

II.  Insulin requiring patients

 

GENERAL GUIDELINES

GOAL: Prevent ketoacidosis due to dehydration or lack of insulin.

ALWAYS check glucose and ketones every four hours around the clock.

ALWAYS take some insulin. The dose may need to be adjusted due to the guidelines on other side of this page.

Drink extra fluids. If glucose levels are high, use non-calorie fluids. If this is a stomach or intestinal illness use clear liquids. If unable to eat normal diet, substitute liquids with sugar for your normal amount of carbohydrates/starches.

If vomiting, hold all liquids and solids for 2 hours. Then try 1 Tablespoon of clear liquid with sugar every 1/2 hour for 1 hour. If vomiting resumes, hold fluids for another 2 hours. If no vomiting, increase the amount of liquid by 1 Tablespoon every hour.

May use ibuprofen, tylenol, sugar free cough meds, and any medication prescribed by your primary physican. See primary physician for colds, urinary infections, virus infections, earaches, etc.

CALL IF VOMITING PERSISTS FOR FOUR HOURS, or if glucose levels will not rise after treating with clear liquids with sugar, or if glucose levels remain above 300 and/or ketone levels do not decrease after taking extra insulin. Keep clear liquids with and without sugar, ketone strips, R insulin, broth, and sugar free cough meds on hand so they will be available on sick days.

INSULIN ADJUSTMENT

IF THERE IS NAUSEA OR VOMITING reduce your long acting insulin as follows:

Lantus by 10%; N or 70/30 by 25%

Use supplemental R insulin according to the chart below as needed every 4 hours around the clock (including the middle of the night) to bring down glucose and ketones. (Humalog or Novolog will work but are less efficient and more risky if patient nauseated or vomiting). Note that this extra insulin may be at a time different than a regular injection time. This amount is based on your total daily insulin dose. REMEMBER: IF YOU HAVE ARE STILL VOMITING AFTER 4 HOURS CALL THE PHYSICIAN ON CALL.

IF GLUCOSE IS:

AND KETONES ARE:

DO THE FOLLOWING:

YOUR DOSE OF R WOULD BE

79 or below

Negative to large

Omit R, Novolog or Humalog. Decrease N, L, U or Lantus by 10 %. Recheck in 3-4 hours.

  

80 to240

Negative

Take usual insulin dose if time to do so. Recheck in 3-4 hours.

  

80 to240

Trace or more

Take usual insulin dose if time to do so. Push extra calorie containing fluids. Recheck in 3-4 hours.

  

241-400

Negative

Take usual insulin dose if time to do so. Take extra R insulin in an amount equal to 5% of your total daily insulin dose. Extra R insulin should be taken every four hours around the clock as necessary and may be combined with usual dose or given separately

.

241-400

Trace or more

Take usual insulin dose if time to do so. Take extra R insulin in an amount equal to 10% of your total daily insulin dose. Extra R insulin should be taken every four hours around the clock as necessary and may be combined with usual dose or given separately.

  

401 and up

Negative

Take usual insulin dose if time to do so. Take extra R insulin in an amount equal to 10% of your total daily insulin dose. Extra R insulin should be taken every four hours around the clock as necessary and may be combined with usual dose or given separately

.

401 and up

Trace or more

Take usual insulin dose if time to do so. Take extra R insulin in an amount equal to 15% of your total daily insulin dose. Extra R insulin should be taken every four hours around the clock as necessary and may be combined with usual dose or given separately.

  

 


  The News:

Updated 05/03/2012

(CareFirst patients only):  Levemir substitution for Lantus

CareFirst recently struck a deal with NovoNordisk to obtain Levemir insulin more cheaply than Lantus.  The problem is that Levemir does not last as long in the body as Lantus, and most diabetic patients must take it twice a day.  There is no point in our trying to persuade CareFirst to keep you on Lantus.  We recommend that you make an appointment to initiate the change.  Meanwhile, if you will run out of Lantus before you can make an appointment, please pick up a sample of Lantus in our office, but call our nurses in advance.

We are moving!

Effective summer '12 we shall move into a single space at 3201 Jermantown Road, Oakton, 22124, Suite #250, almost exactly halfway between our two current offices.  This move will greatly simplify our practice but allow us to continue being  the consultants in endocrinology at Inova Fairfax and Inova Fair Oaks Hospitals.  Our newly renovated LEED Gold certified office building, Three Flint Hill, is less than a mile and one traffic light from the Route 123 exit from Route 66.  While we apologize to those patients who may have to drive a little farther to reach us, you should have a much easier time parking at our new place.

Useful Links:

We consider the following websites to be good sources of information for patients. However, Northern Virginia Endocrinologists does not necessarily monitor, endorse, or have any control over any of the content.

American Association of Clinical Endocrinologists
Endocrine Web
American Diabetes Association
 American Thyroid Association


NEW PATIENT PLACE

Here are some suggestions to help you get the most from your first visit to our practice:

NOTICE: As of August 14, 2006, we have our new patient forms available as a PDF file.  Adobe Reader

It is very helpful for us if you can "do the paper work" in advance of your visit.  Please click here to view and print our updated forms.  Please also read our Privacy Policy before your consultation.

If you have problems filling out these forms, you may want to come in 30 minutes before your visit. If you are not ready to be seen within 15-30 minutes of your appointment time, you may have to reschedule so that your physician does not become delayed for the remainder of the day. 

 Thank you!