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Sample Focus

Coupeville Clinic Survey--Preliminary
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Hello:

You are invited to participate in our survey. The Coupeville Clinic is entering a new phase and we want to establish a Web presence to better serve our clients. Further, we are seeking input on various business options for our practice tailored to the financial needs of both our practice and you, our clients. Our goal is to reduce health care cost through innovation and greater efficiency. The questions in this survey are tailored to help us meet these objectives. It will take approximately 10 minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. You need only answer the questions you feel are appropriate. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.

Dan Fisher, MD
 
 
Demographic. Is your primary care provider Coupeville Clinic?
 
Yes
 
No
 
I am considering switching to Coupeville Clinic
 
 
 
Demographic. My age is:
 
<20
 
21-30
 
31-40
 
41-50
 
50-64
 
>65
 
 
 
Demographics. My health care needs are for (check all that apply):
 
Only myself
 
My family
 
I am the primary care giver and I am interested in health care for my ward(s)

 
 
 
If your personal medical records were available online how would you access them (check all that are applicable)?
 
Not at all, I don't use the Internet
 
From a desktop computer
 
From a laptop computer
 
From a tablet like iPad
 
From an Android smart phone
 
From an iPhone

 
 
Patient Portal Feature. Front Office. Please rank the following if they were available to you online.
Wouldn't use at all Not important Important Very important Must have
Initial Office Visit Pre-Registration and Forms
Appointment Requests
Patient Messaging (notices, newsletter, mass e-mail)
Patient Check-In (issues to be discussed, health and drug update)
 
 
Patient Portal Features. Back Office Solutions. Please rank the following if they were available to you online.
Wouldn't use at all Not important Important Very important Must have
Online Bill/Co-Pay & Budget Plans
Virtual Card Swipe
Ask a Biller
 
 
Patient Portal. Clinical Solutions. Please rank the following if they were available to you online.
Wouldn't use at all Not important Important Very important Must have
Lab Results and Reminders
Prescription Renewal and Refills including patient entered prescriptions from other providers
Vaccinaton record including patient entered data from other providers
Symptom Assessment (HPI-history of present illness/ROS-review of systems) through online database questionaire
Ask a Doctor
Virtual Office Visits
Referral Managment to Specialists
Personal Health Record
Post Consult Care & Maintenance Instructions
 
 
 
Comments/Suggestions about other online patient informaton and potential patient input to electronic health records:
   
 
 
There are three payment options that we are considering in the Coupeville Clinic.

Traditional Insurance with co-pay depending on plan. We accept Medicare, TRICARE, Group Health, Blue Cross, and most other major insurance plans for payment in full or part depending on the plan.

Direct Pay. The patient pays a fixed monthly stipend on a one year contract at a set amount starting at $59/mo. for individuals and $99/mo. for families with an increasing premium by age to a maximum individual payment of $89/mo. at age 65+ for level 1 care. Level 1 covers all office visits and remote hospital care coordination. Level 3 covers beside hospital coordination by your clinician and routine labs starting at $60/mo. and scaling to $165/mo. with age.

Patient Responsible Health Care. The patient is responsible for all cost associated with individual and family health care.

Not applicable. This plans is intriguing but I need more information. This plan is the one for me.
Traditonal Insurance
Direct Pay
Direct Pay with Employer Cost Share
Patient Responsible
 
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