Med Monthly December 2011

Med Monthly December 2011

the

ICD-1O CODES

&

ary prcim are issue

what you need to know before the switch in 2013

THE ROLE OF PRIMARY CARE IN ACOs LAB EQUIPMENT should you purchase or lease

MEDICAL ARCHITECTS Take a look at these medical offices and

see how new digs could improve your practice

ALSO

DOES INTERNET MARKETING REALLY WORK?

A tasty fall treat!

contents

44

features 26 MEDICAL OFFICE ARCHITECTS Check out these amazing looking practices

30 SLEEP APNEA

Why you should screen for it in your practice

research and technology

32 THE ROLE OF PRIMARY CARE IN ACOs

8 MANAGING POST-OP PAIN

Patients are now becoming consumers

34 GET WELL ON THE FLY

10 BEING VAGUE IS DEADLY

Clinics in airports

your practice

36 ICD-10 CODING

12 CALL CENTERS

What’s changed since ICD-9

14 INTERNET MARKETING FOR DENTISTS 16 LAB EQUIPMENT SELECTION 20 IMPACT OF PHRs

legal 22 OIG WORK PLAN

finance 42 TIPS FOR THE MARKET SAVVY PHYSICIAN

the arts 42 SILK PAINTING

the kitchen 44 CURRIED BUTTERNUT SQUASH

in every issue

12

4 editor’s letter 52 classified listings

Call center labs

50 resource guide 60 top nine

COVER PHOTO COURTESY MMA MEDICAL ARCHITECTS

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publisher’s letter

D

ecember is a time for celebration, fellowship, reflection and hopefulness. Every year we inevitably face changes, challenges and frustrations; and even though 2011 has certainly had its fair share I’m happy with where this year has taken me. I am very excited to be the new managing editor here at Med Monthly and I look forward to providing our readers information that is encouraging, entertaining and thought-provoking.

Our December issue celebrates primary care. Primary care isn’t an easy field of medicine to work in. Often overworked and underpaid, they face some of the most difficult challenges in health care, and sadly are not always recognized for all they do. This month we have compiled some practical advice for the primary care provider in 2012. Robert Tennant discusses the new role of primary care in Accountable Care.

Suzanne Leder explains the importance of early preparation for the ICD-10 conversion. Kimberly Licata offers some legal tips to help physicians avoid being taken advantage of by 2012’s OIG Work Plan. Mary Pat Whaley shares how PHRs might be used in the future and Whitney Howell wrote our cover story on the growing trends in medical office architecture. All of our writers did an outstanding job, and I’d like to thank them for their hard work and for being so great to work with; it truly has been a joy.

As your new editor, I want to hear from you! Please send me your thoughts, interests, questions and concerns. Personally, I have a great deal of interest in health care innovation and I would love to hear from those of you who are seeking solutions instead of focusing on the problems in today’s difficult industry. I’d like to see this magazine be utilized as a networking and collaborative resource for health care professionals to exchange their ideas, successes and failures. That being said, I encourage you all to take advantage of our medical resource guide to connect and help each other overcome adversity, and learn to adapt to whatever trials the future may have in store.

Again, I am very blessed to have this opportunity. I wish all of you the happiest of holidays and I look forward to our success in 2012. Thank you again; I hope you enjoy our December issue.

Sincerely,

Leigh Ann Simpson Managing Editor

4 | DECEMBER 2011

contributors

Med Monthly December 2011

Publisher

Philip Driver

Managing Editor

Leigh Ann Simpson

Creative Director

Courtney Flaherty

Contributors

Marketing Manager

Mary Pat Whaley, FACMPE Kimberly Licata Libby Knollmeyer B.S., MT (ASCP) Paul V. Brown Jr. Edward Logan, D.D.S. Ashley Acornley, R.D., L.D.N. Robert Tennant Lisa Feierstien Daniel Del Gaizo, M.D. Suzanne Leger, BA, M. Phil., CPC, COBGC, Jennifer Daknis Whitney Howell Will O’Neil

Med Monthly is a national monthly magazine committed to providing insights about the health care profession, current events, what’s working and what’s not in the health care industry, as well as practical advice for physicians and practices.

We are currently accepting articles to be considered for publication. For more information on writing for Med Monthly, check out our writer’s guidelines at medmontly.com/writers-guidelines.

P.O. Box 99488 Raleigh, NC 27624 medmedia9@gmail.com Online 24/7 at medmonthly.com

Mary Pat Whaley, FACMPE is board certified in health care management and a Fellow in the American College of Medical Practice Executives. She has worked in health care and health care management for 25 years. She can be contacted at marypatwhaley@gmail.com.

Whitney Howell is a seasoned reporter, writer, freelancer and public relations specialist with a master’s degree in international print journalism from The American University in Washington, D.C. In her 10 years as a reporter she’s earned in-depth experience in covering health care, including academic medicine, health care reform, women’s health, pediatrics, radiology, and Medicare.

Elizabeth “Libby” Knollmeyer, B.S., MT (ASCP) has over 40 years experience in the laboratory industry. She specializes in financial, operational management and compliance issues for hospital and physician office laboratories. Libby has a wide variety of experience with her areas of special expertise including financial review and management, compliance and regulatory assistance and lab design. She can be reached at eknollmeyer@triad.rr.com.

Kimberly Licata is an attorney at Poyner Spruill, who practices health law and participates on the Firm’s Emerging Technologies and Privacy and Information Security teams. She may be reached at klicata@poynerspruill.com or 919-783-2949.

Edward Logan, D.D.S. is a general and cosmetic dentist practicing in O’Fallon, Missouri. Dr. Logan graduated from the University of Washington School of Dentistry. After years of learning the business side of dentistry, Dr. Logan decided to write a book. Dentistry’s Business Secrets was published late last year. You can read more articles by Dr. Logan at his website DentistrysBusinessSecrets.com.

MEDMONTHLY.COM |5

Our secret weapon against smoking?

Each other.

I first lit up a cigarette when I was 9. I started smoking at 16 and smoked for 15 years. When I wanted to quit, I found out the average person takes 3-4 efforts to quit because nicotine is so powerful. I learned that if you pick it up again, it’s part of a process. It’s not that you failed, that’s just how it works. When I finally quit, I had more weapons to help me — my pills, my support and my nurse practitioner to talk to. Now we have Tobacco Free Nurses to help, too.

Tobacco Free Nurses is a one-stop shop for all nurses, especially nurses who want to help their patients quit smoking and nurses who want to quit themselves. We are nurses who want to benefit nurses and patients, and promote a tobacco free society. Please visit our website or call for further information.

Toll Free: 877-203-4144 | www.tobaccofreenurses.org Support for the Initiative was provided by a grant from the Robert Wood Johnson Foundation in Princeton, New Jersey, to the School of Nursing, University of California, Los Angeles in partnership with American Association of Colleges of Nursing, American Nurses Foundation / American Nurses Association, and National Coalition of Ethnic Minority Nurse Associations.

Photo: Todd Pickering

— Maria, RN

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research & technology

By Daniel J. Del Gaizo, M.D.

Spinal epidurals are often used for total hip arthroplasty

Post-op pain management

Minimally Invasive Surgery

By Daniel Del Gaizo, M.D.

T

otal hip and knee arthroplasty (replacement) are two of the most successful surgeries in medicine. Both procedures have demonstrated reliable pain relief,

8 | DECEMBER 2011

to these excellent outcomes. Most recently, developments in post operative pain control have offered great promise in increasing patient comfort and satisfaction while facilitating accelerated rehabilitation and shorter hospital stays.

return of function, and satisfaction in greater than 90 percent of patients at 15 years follow-up. Numerous advances in component design and surgical technique have contributed

Currently, there is a lack of consensus within the orthopaedic community as to what exactly constitutes minimally invasive surgery (MIS) hip or knee arthroplasty. The accepted general principle behind MIS hip and knee arthroplasty is the utilization of

smaller incisions and muscle/tissue sparring approaches to decrease post operative pain and weakness. Several years ago, there was a proliferation in the incorporation of MIS techniques.

In retrospect, it is clear that some of the enthusiasm was excessive. In an attempt to perform hip and knee arthroplasty through very small incisions, there were instances of patients being placed at increased risk for component malposition, wound dehiscence, infections, iatrogenic fracture and neurological injury. Many surgeons questioned whether potential gains in early rehabilitation warranted these risks. Ultimately, as more data was collected, it was discovered that many of these techniques did offer benefit with minimal increased risk if performed by a well-trained, experienced surgeon.

An example of safely incorporating MIS techniques with total knee arthroplasty (TKA) is through the utilization of the mini mid-vastus approach. This approach allows for less muscle/tissue dissection with preservation of the quadriceps muscle function. The utilization of this approach has also demonstrated increased range of motion in the early post operative period and increased quadriceps strength when compared to traditional TKA. These benefits may persist greater than a year from surgery.

Anesthesia Traditionally, total joint replacement was performed under general endotracheal anesthesia (GETA). This has been abandoned by many total joint surgeons in favor of neuraxial and/or regional anesthesia, which have demonstrated improved pain control, minimized blood loss and decreased side effects and morbidity/ mortality.

For both hip and knee arthroplasty,

I have worked closely with my colleagues in our anesthesia department to develop protocols and maximize comfort while minimizing side effects such as; respiratory depression, confusion, nausea, and urinary retention.

For TKA, we are performing the surgery under spinal anesthesia placed in the preoperative holding area. This allows for excellent, predictable pain relief and muscle relaxation during surgery that will not be affected by the use of a tourniquet. After the spinal anesthesia, an indwelling femoral nerve catheter is placed. Upon completion of the surgery, the catheter is utilized for continuous infusion of local anesthetic to the femoral nerve. About 20 percent of patients will experience significant posterior knee pain despite the indwelling femoral nerve catheter. For these patients, a single shot sciatic nerve block is performed in the post anesthesia care unit (PACU). For TKA, the indwelling catheter remains until the morning of post operative day (POD) two. For partial knee replacements, the indwelling catheter is removed the morning of POD one.

Because the femoral nerve catheter can cause a variable degree of motor block, patients are counseled to avoid ambulation without assistance while the catheter is in place.

For total hip arthroplasty (THA), the procedure is performed after placement of a combined spinal epidural.

The epidural portion of the neuraxial anesthesia allows placement of an indwelling catheter that provides excellent pain relief after surgery. The catheter is removed the morning of POD one. Many anesthesiologists will often deliver narcotics to the epidural space, however, their usage can be minimized to avoid complications of nausea, pruritus, and urinary retention.

timodal pain control is the utilization of multiple agents that affect the pain pathway at different points via different mechanisms. This creates an overall effect of the “sum being greater than the parts.� Multimodal pain control facilitates administering smaller medication doses with the goal of remaining beneath the side effect threshold for each agent. This is particularly important in patients undergoing joint replacement who are often older and more susceptible to the side effects of nausea, confusion, and urinary retention.

Unless contraindicated, all of my patients receive a central acting pain reliever (acetaminophen), a non steroidal anti inflammatory, a peripheral nerve pain reliever (pregabalin), a controlled release long acting narcotic (Oxycontin) and a short acting narcotic (Oxycodone IR). The narcotic doses are determined preoperatively via a narcotic trial. The narcotic trial allows us to determine if a patient is overly sensitive to the narcotic medications we routinely prescribe. It is important to identify these reactions preoperatively instead of immediately after surgery when the patient is in a compromised physiologic state. Utilizing the above protocol, the patients rarely require intravenous narcotics.

By combining minimally invasive surgical technique, neuraxial/ regional anesthesia, and multimodal pain control agents our patients experience effective pain control and minimal side effects. This has facilitated accelerated early rehabilitation and shorter hospital stays. We now routinely are able to safely discharge our patients one or two days after THA and two to three days after TKA.

Multimodal Pain Control

For more information visit www. med.unc.edu/ortho/faculty/delgaizo

The general principal behind mul-

MEDMONTHLY.COM |9

research & technology

Kevin Campbell, M.D.

Doctor Says ‘Vague’ Can Be Deadly For Women Dangerous symptoms of Coronary Artery Disease OBs often overlook

By Paul V. Brown Jr.

10 | DECEMBER 2011

N

early 500,000 American women die of cardiovascular disease every year, the equivalent of one every minute of the day. Today, eight million women in the U.S. are living with heart disease. Since 1984, the number of female deaths from cardiovascular disease has exceeded that of males.

Studies show that women are underdiagnosed and undertreated for coronary artery disease (CAD), which can lead to sudden cardiac death (SCD).

Those tough statistics are part of a message that Kevin R. Campbell, a North Carolina cardiologist, tries to deliver regularly to fellow physicians across the nation at symposia that he presents, typically to a roomful of internists or fellow cardiologists.

Recently, he’s started going outside the conventional referral doctors, presenting his data to OB-GYNs. “The thought is that OB-GYN physicians are the primary care doctors for many women,” Campbell said recently.

“They (OB-GYNs) are the ones who must screen and refer at-risk women for evaluation for SCD and CAD. So I began teaching OB-GYNs how to screen patients quickly and to recognize warning signs.”

Those warning signs can differ drastically in women and men. Americans commonly are told to watch for chest pains, shortness of breath or pain radiating down the arm. But women also exhibit vague symptoms, such as anxiety or feelings of dread, Campbell tells his colleagues. Those symptoms must be taken seriously.

Campbell takes them seriously − and became active in women’s cardiac health − partly for personal reasons.

His 11-year-old daughter, Rebecca, was diagnosed with insulin-dependent diabetes at the age of 5. That puts her at risk for cardiac disease when she grows up. “It motivated me to make sure someone is there to treat my daughter,” he said in a recent interview.

Certified in cardiac electrophysiology – the diagnosis and treatment of electrical activities in the heart – Campbell also has professional reasons for his interest. He was part of a 2005-2007 study involving more than 13,000 patients at 217 hospitals that found that women and minorities were undertreated for cardiac disease and underserved in receiving implanted defibrillators. Such findings indicate that doctors should be screening women more aggressively for coronary artery disease.

national shows. Early next year, he has symposia scheduled in Phoenix, San Diego and Seattle.

Campbell practices at WHV-Wake Heart & Vascular, a decades-old cardiology practice based in Raleigh, N.C. The practice itself does pioneering work. One of its founders was among the first doctors in the nation to do cardiac catheterizations through a blood vessel in the wrist, a procedure called transradial access. Widely performed in Europe and Asia because it causes fewer medical complications, transradial is now gaining ground in the United States.

St. Jude Medical, a Saint Paul, Minn.-based company that makes cardiac, neurological and chronic pain treatment devices, lauds Campbell’s work with OB-GYNs and beyond.

“In addition to his efforts to provide hundreds of physicians with insights into risk factors and treatment options for female patients, Dr. Campbell

That is beginning to happen, he said.

As is the case with most medical issues, the best way to address sudden cardiac death is prevention. Campbell said women need to manage risk factors and modify their lifestyles through such simple actions as better diet and exercise.

If she is deemed at high risk, an implantable cardioverter defibrillator, or ICD, is the best available treatment, Campbell said. A regular part of his day is implanting the device in patients of both genders.

Campbell’s educational work is gaining wider recognition. This fall, for instance, he presented four programs in Los Angeles, including one for OBGYNs at the request of Dr. John Kennedy. A fellow cardiologist, Kennedy is a consultant for the television show “The Doctors” and has appeared on that show and “Dr. Oz,” another popular health and medicine show. Campbell may be featured soon in separate

has been a great partner with St. Jude Medical in developing a program that finds common ground between OB-GYN and cardiology,” said Amy Jo Meyer, a St. Jude spokeswoman. “As women often use an OB-GYN as their primary care physician, increasing awareness and providing simple tools for diagnosis of heart failure or other heart diseases to this group of physicians is an important key to improving women’s cardiac care.”

The best outcome in Campbell’s mind is that the word gets out to more than just the doctors who attend his symposia.

“We have to teach women to empower themselves and work hard with their physician to lower their own risk,” he said.

Paul V. Brown Jr. spent 30 years as a newspaper writer and editor. He now owns a media relations company and is a freelance journalist.

Unfortunately, its motor is inside playing video games.

Kids spend several hours a day playing video games and less than 15 minutes in P.E. Most can’t do two push-ups.

Many are obese, and nearly half exhibit risk factors of heart disease. The American Council on Exercise and major medical organizations consider this situation a national health risk. Continuing budget cutbacks have forced many schools to drop P.E.—in fact, 49 states no longer even require it daily.

You can help. Dust off that bike. Get out the skates.

Swim with your kids. Play catch. Show them exercise is fun and promotes a long, healthy life. And call ACE. Find out more on how you can get these young engines fired up. Then maybe the video games will get dusty.

A Public Service Message brought to you by the American Council on Exercise, a not-for-profit organization committed to the promotion of safe and effective exercise

American Council on Exercise

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ACE Certified: The Mark of Quality Look for the ACE symbol of excellence in fitness training and education.

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your practice

CALL CENTERS Your practice can be more productive

By Whitney L.J. Howell

12 | DECEMBER 2011

E

verywhere you look, the recent economic downturn has forced budget cuts. Health care is no different – and it’s likely that your practice or hospital has also been obliged to trim its spending. There are, however, ways to work within your means and still meet the necessary patient care and safety standards.

One hospital system, the University of Iowa Hospitals and Clinics, found its answer in a pathology lab call center.

Manned by official lab staff, the call center gives its health system physicians immediate access to expert pathology information without pulling lab scientists away from their duties.

“Asking a scientist to leave his or her work when a call came in left whatever sample was being analyzed just sitting on the table,” says Sue Zaleski, pathology lab manager. “Dedicating people and a space to answering calls helps with efficiency, quality control, and error prevention.”

So, in 2005, with support of her administration, Zaleski launched the call center in a room adjacent to the lab.

She hired a telemarketing professional to structure the center and train the scientists to focus on customer service.

Merging telemarketing expertise with the intricacies of a highly technical environment is the bedrock of why the call center has been so successful, she says.

Each day, 10 certified lab scientists field, on average, more than 150 calls from health care provider offices. The questions vary widely, including inquiries about which type of blood draw is best for a particular test or how to transport certain samples.

The scientists rotate through the call center on a schedule, and these shifts are an added responsibility on top of their work with analyzing samples.

Zaleski says she has been surprised by how much taking on call center duties has improved her lab scientists’ job

satisfaction.

“The scientists love it when their turn for the rotation comes around,” she says. “It gives them a nice break – the call center is quiet. They can sit down for a few hours, and they get to pair their research skills with their technical knowledge to help people.”

While the scientists enjoy a break from their regular routine, the benefit to the University comes from the increased efficiency in analyzing samples, she says. There’s no cost savings, but boosting the number of samples scrutinized daily is an improvement in lab productivity.

The call center is also valuable because it allows the scientists to focus their attention and speak directly with providers. This is particularly important with urgent requests about highpriority samples. Under federal health care regulations, certified lab scientists can only provide critical value notifications to licensed care providers. The call center’s single focus has helped the lab truncate its response time on high-priority samples to less than 15 minutes.

Fielding calls from health care providers also gives the lab scientists an opportunity to share their pathology knowledge one-on-one. Not only can they pull from their own extensive knowledge, but they have access to an arsenal of research sources that can augment the answers they provide.

Thanks to the telemarketing professional, each scientist has received extensive customer service training, including how to speak articulately and with empathy, listen closely to the caller and master the available reference materials to find information quickly.

Despite being in operation for a few years, Zaleski says the health care providers who contact the call center haven’t offered much feedback. At first, the silence bugged her, but she now says it’s not a negative sign. “We were initially deflated because no one gave

us any idea of what their experience with the call center had been,” she says.

“But we soon realized that when you do something well, especially for a group as busy as health care providers are, you don’t leave much of an impression.

It’s when you do things poorly that you hear about it. So, we’re taking no reaction as a good thing.”

That doesn’t mean the call center isn’t keeping track of its own performance.

Each call is recorded to keep tabs on how long it lasts, the number of times the caller is transferred, and how long it takes the scientist to supply an answer.

The audio files are also used to protect the scientists who speak with providers.

They can support the accuracy of provided information or reveal if a caller demonstrated problematic behavior, Zaleski says.

Sue Zaleski, pathology lab manager at University of Iowa Hospitals and Clinics and developer of pathology lab call center.

If you’re considering a lab call center to increase productivity and smooth communication between your health care providers and the pathology scientists, there are a few points to remember, Zaleski says. First, take a look at your certified lab staff and how they go about their daily work. What do they do with their existing resources? How would the additional responsibility of working in a call center affect their current responsibilities and job satisfaction? If all signs point to the need for a call center, take the idea to your administration and get proper buy-in from facility leaders. Ultimately, the longterm impact for your institution could be very positive.

MEDMONTHLY.COM |13

your practice

Does Internet Marketing Really Work for Dentists?

What techniques should you use in your practice

By Edward M. Logan, D.D.S.

O

ver the past decade, the Internet has revolutionized dental practice marketing. An ADA study from 1999 reported the percentages of patients finding a new dentist by referral source. The study indicated that 55 percent of new patients to a practice were referred by other patients. The next largest source of referral was direct mail marketing, which came in at 12 percent. There was no mention of the Internet as responsible for providing any new patient flow. Let’s contrast those figures with the present. My practice referral source statistics consistently point to Internet marketing as the leading source of new patients to my practice. Well over 50 percent of my new patients report first finding my practice on the Internet, and it is not uncommon for new patients to inform

14 | DECEMBER 2011

us that they made an appointment simply because our website was the first they encountered when searching online. Even during these years of economic downturn, my new patient numbers have not dropped off because of my efforts to keep my practice website at the top of Google searches for a dentist in my area.

This is not to say that I do not continue to strive for patient to patient referral sources, as the referring patient can still be considered the best patients to have. However, we cannot neglect the overwhelming tendency for patients to search for their doctors online. If we do, we will miss out on the huge numbers of new patients that our practices could be caring for simply by establishing a highly visible online presence.

It has been estimated that less than

35 percent of dentists don’t even own a website, and this says nothing about how many of those sites are actually optimized for the greatest search engine ranking and visibility. There are a diversity of reasons offered as to why the overwhelming majority of dentists still remain on the sidelines with respect to the greatest marketing opportunity available to their practices.

The most frequently expressed roadblock to Internet marketing adoption is that the majority of dentists simply do not know where to start. Another thought often articulated by dentists is the intimidation factor, fearing that they may be taken for a ride by their website designer. Many dentists feel the cost is too high and they do not value Internet marketing for what it is really worth.

In my practice, we have compiled a list of questions to ask a web designer before having them create your website that represents you to the world. Some of these important questions are listed below:  What techniques will be employed to ensure your website will have good visibility in online searches?  What does the designer do to stay abreast of the latest trends in SEO?  Will the site be designed with a Content Management System (CMS) that will facilitate your own additions? This is beneficial in allowing you to make simple updates to your website without paying a web designer for each change or requiring you to learn complicated coding.  Does the designer provide a contract with a completion date and payment agreement?  Under the arrangement, who owns the domain name and website?

To learn more visit www.DentistrysBusinessSecrets.com.

MEDMONTHLY.COM |15

your practice

Purchasing vs. Leasing Lab Equipment and Consumables Probably one of the more important business decisions you will make revolves around the purchases of your most important tools of the trade and whether you should purchase or rent

By Libby Knollmeyer B.S., MT (ASCP)

16 | DECEMBER 2011

T

he selection and acquisition of equipment and consumables for the laboratory is one of the major responsibilities of the lab manager. Although the means of acquisition is not always left to the manager to decide, it is still necessary to understand the various options available: 1) cash purchase, 2) lease, and 3) reagent rental. All have pros and cons attached to them, but to understand which might best suit the laboratory’s needs, it is necessary to understand what each is.

Purchase is accomplished by offering money and obtaining ownership of the product. The money can be from liquid cash assets of the lab or practice, or by borrowing money from a financial institution, whether by a loan or a line of credit. The end result is outright ownership of the goods after all loans have been repaid. Outright purchase usually carries the lowest interest rate for a loan, but the capital equipment must be depreciated over a period of time, generally five years for laboratory equipment, and appears on the balance sheet as a long term debt. If assets are

HELPFUL LAB TIP liquidated in order to purchase capital equipment, the loss of capital gains for those assets must be factored in against the lower interest rate available for a loan versus a lease.

A lease can be one of two types: fair market value (FMV) or capital. In a FMV lease, at the end of the lease ownership is dependent on the lessee paying a “fair market value” for the commodity, generally 10% - 15% of the retail price of the goods. A capital lease is also sometimes referred to as a “dollar buy-out lease” because at the end of the term of the lease, the lessee can purchase the commodity for $1.00.

As one would expect, the interest rate on a FMV lease is less than on a capital lease. Ownership is optional at the end of the lease period, but is generally a given for a capital lease because there would be no reason to opt for a capital lease with the higher interest rate if ownership at the end of the lease was not desired. Capital leases can be deducted for tax purposes like purchases. One of the most attractive options for leasing capital equipment is there is no capital outlay required to acquire the equipment. Another is that service can be added to the lease payment as an interest-free “pass through” whereby the leasing agency passes the service payment on to the contracted service provider on a monthly basis, eliminating the large service contract which would otherwise come due annually after the warranty has elapsed.

And, unlike a purchase, a lease can be considered a tax-deductible overhead expense.

A reagent rental agreement is arranged by the manufacturer or distributor of the equipment being acquired. The cost is usually based on a cost per reportable test (CPR), but sometimes is based on total test count. The difference is that in a CPR arrangement, calibrations and controls are not counted in the pricing

structure, while in a total test count arrangement, all tests are counted and charged. The price paid per test covers the cost of the instrument, service, reagents, and consumables for the term of the agreement, but there is no ownership at the end of the agreement.

This option, like leasing, offers the use of capital equipment, reagents, and consumables without capital outlay.

It also eliminates the need to contract for service annually after the warranty has elapsed because service is covered in the CPR. For labs with very large volumes, highly competitive CPR rates can be negotiated, making this an attractive option for reference labs. However, the CPR is calculated to cover the cost of the equipment and service in addition to reagents and consumables, so at the end of the term of the agreement, the instrument has essentially been paid for but there is no ownership. If the reagent rental agreement is renewed without renegotiating the terms, the equipment could be paid for more than once without ever achieving ownership. Successful reagent rental arrangements require the lab operator to have an accurate estimate of test volumes over the length of the agreement. Failure to estimate correctly could mean paying for tests which are never run, or losing the lower cost per test advantage which generally accompanies growth. However, for small labs with no capital funds available for instrument purchases, this option might allow the lab to do in-house testing which otherwise might not be available.

Which option will be used to acquire capital equipment is always a financial decision, and often not left to the laboratory manager but made instead by the practice administrator, or hospital or reference lab CFO. But the lab manager can add significant insight into the selection of financial methods. The information that should directly affect the decision and can

Like leasing a car, the lab should know what the component costs are for leasing equipment and should know whether or not they want to own the equipment at the end of the lease term. best be provided by the lab manager is whether or not ownership is desired (a function of how rapidly the technology is changing), and whether or not service is included or will be charged in addition.

Ownership can be a two-sided coin. Where technology is volatile and rapidly changing, ownership of highly technical equipment can be a burden.

If the technology is going to evolve and change to the extent that the equipment is out of date by the end of the term of the loan or lease, ownership is not always desirable, unless the dated equipment could be used as a backup instrument. That being said, if the technological changes are not going to affect the way the lab operates or the tests that can be offered, then the volatility is not a factor and ownership would be preferable.

Service contracts are expensive (generally about 10 percent of the retail purchase price of the instrument) so if leasing provides additional warranties or field service offered by the lessor, a lease can be a more attractive option than purchase. In reagent rental agreements, service is provided as part of the cost per reportable test.

Other considerations that will affect the choice of purchase, lease, or reagent rental are cash flow and the need to achieve the lowest outflow of cash, the flexibility of leasing terms and their ability to meet the lessee’s needs, and whether or not the balance sheet for the organization strongly prefers not showing debt (an operating lease is not considered a long term debt).

Ken Lee, Partner in Hatteras Venture Capital, believes the message MEDMONTHLY.COM |17

should be that leasing is a better choice in some circumstances, especially where cash flow is an issue, technological advances are rapid and constant upgrading is necessary, extended warranties are offered, and the balance sheet strongly prefers showing no debt.

Dan Melamedorf of Baytree Leasing believes leasing offers a number of advantages over a loan for purchase, including being tax deductible as an overhead expense, not showing up as a long term debt on the balance sheet, an immediate write-off of the dollars spent, eliminating the need to depreciate the equipment over 5 years or more, flexibility, virtual 100% financing options available, and the variety of leasing products available offering customized solutions to the needs of the corporation.

Emmett Kane, Kane Healthcare Solutions, LLC, believes that reagent rental is the best option if the platform

Careers Customer Service Day-to-Day Operations

is a closed system where the reagents, parts, and consumables are proprietary and alternatives are not available or possible. “Know the component cost breakdown for equipment, service, reagents, parts, consumables, and the cost of money,” he cautions, “and include language in the agreement that protects your costs in the event any component or individual test on the platform menu either temporarily or permanently cannot be performed.”

For leasing Emmett believes like leasing a car, the lab should know what the component costs are for leasing equipment and should know whether or not they want to own the equipment at the end of the lease term.

Mary Pat Whaley, Practice Administrator for a bariatric surgery clinic in Cary, NC, says that her ideas of how best to obtain capital equipment have changed over time. Where ownership was once her primary goal, her goal

now is to acquire equipment “with the least amount of pain,” whether the “pain” is cash outlay or maintenance and service. “Put all the pieces together to determine the return on investment (ROI) before making the decision as to how a piece of equipment is to be acquired,” she recommends.

In the end, whether to purchase, lease, or arrange a reagent rental agreement will depend on the specific needs of the organization, its cash on hand, the cost of money, and the way the organization manages its accounting. But the informed laboratory manager can assist in the selection of an option for acquiring capital equipment by providing valuable information as to the rate of change in the technology involved, accurate estimation of test volumes, and comparison of the options presented to her by the vendor.

Article reprinted from ADVANCE magazine

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About the expert Mary Pat Whaley, FACMPE, is board certified in health-care management and a fellow in the American College of Medical Practice Executives. She has worked in health care and health-care management for over 25 years. Mary Pat is also a well-respected author and highly sought-out speaker consultant.

18| DECEMBERand 2011

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your practice

By the numbers...

NPI and DEA numbers

What you need to know about the National Provider Identifier and the Drug Enforcement Administration numbers Staff reports

National Provider Identifier A National Provider Identifier or NPI, is a 10-digit identification number issued to health care providers in the United States. The number is issued by Centers for Medicare and Medicaid Services (CMS).

The NPI began replacing the unique provider identification number (UPIN) in 2006 as the required identifier for Medicare services and other payers, including commercial health care insurers. The change to the NPI was mandated as part of the Administrative Simplifications portion of the Health Insurance Portability and Accountability Act of 1996, and the first numbers were issued in October of 2006.

The NPI was proposed as an eight-position alphanumeric identifier. However, many stakeholders preferred a 10-position numeric identifier with a check digit in the last position to help detect keying errors.

The NPI contains no embedded intelligence; that is it contains no information about the health care provider, such as the type or location.

All individual HIPAA covered health care providers (physicians, physician assistants, nurse practitioners, dentists, chiropractors, physical therapist, athletic trainers, etc.) or organizations (hospitals, home health care agencies, nursing homes, residential treatment centers, group practices, laboratories, pharmacies, medical equipment companies, etc.) must obtain an NPI for use in all HIPAA standard transactions, even if a billing agency prepares the transaction. Once assigned, a provider’s NPI is permanent and remains with the provider regardless of job or location changes.

More information regarding NPI numbers can be found at http://nppes.cms.hhs.gov.

DEA Number The Drug Enforcement Administration (DEA) is a U.S. Department of Justice law enforcement agency tasked with enforcing the Controlled Substances Act of 1970. It shares concurrent jurisdiction with the Federal Bureau of Investigation in narcotics enforcement matters.

A DEA number is a series of numbers assigned to a health care provider (such as a medical practitioner, dentist, veterinarian) allowing them to write prescriptions for controlled substances. Legally the DEA number is solely to be used for tracking controlled substances. The DEA number, however, is often used by the industry as a general “prescriber� number that is a unique identifier for anyone who can prescribe medication.

A valid DEA number consists of two letters, six numbers, and a one check digit.

More information regarding DEA numbers can be found at www.deanumber.com.

MEDMONTHLY.COM |19

your practice

The Personal Health Record is Alive and Well!

Meet Zweena, a personal health record solution

By Mary Pat Whaley, FACMPE

A

personal health record (PHR) is an individual electronic health record that is stored securely on the Internet so it can be accessed by medical providers and caregivers who have permission.

PHRs allow the storage of all critical health history information in one place. In the event of an emergency, the patient, caregiver or family member can give providers access to health information. By having the most current information always available, duplicate or unnecessary tests can be avoided as can possible drug interactions. This benefit is achieved without having to rely on the memory or incomplete records of

20| DECEMBER 2011

the patient. PHRs also allow patients, caregivers or third-party vendors to update information regularly over the Internet so that new data can always be accessed by stakeholders.

Although Personal Health Records have been around for more than 10

years, they have gained little traction.

Amidst a health care environment that is increasingly supportive of the empowered patient, most patients have neither the time nor the knowledge to enter their own records into a PHR. Many PHRs can interface with

an individual hospital or physician’s EHR system, but most are unable to share information bi-directionally with more than one entity or flow seamlessly into a Health Information Exchange (HIE).

With that being said, PHRs could be poised to make a big impact on the future of the delivery of health services. Today’s providers are shifting their focus from individual visits to entire episodes of care across the care continuum, which has the potential to benefit from digitized patient records. As more providers convert to electronic medical records, one of the next steps towards fulfilling the Meaningful Use criteria needed to receive Federal incentive payments is to achieve Enterprise Integration with their electronic records, defined by the HITECH act as: “the electronic linkage of health care providers, health plans, the government, and other interested parties, to enable the electronic exchange and use of health information among all the components in the health care infrastructure in accordance with applicable law” In short, health care providers have to adopt systems that can then interface with other providers to share patient data, and collect public health data for comparative effectiveness research.

Although the death of Google Health this year has led many to speculate that the PHR is an idea too far ahead of its time, Zweena is challenging that notion.

Zweena (www.zweenahealth.com)

‘‘

The electronic linkage of health care providers, health plans, the government, and other interested parties, to enable the electronic exchange and use of health information among all the components in the health care infrastructure in accordance with applicable law” is a personal health record management solution, as opposed to a standalone PHR. Zweena overcomes the traditional downfall of PHRs by taking care of everything for the patient and bridging the (huge) gap between health care providers and patients.

Upon request by the patient, Zweena contacts the patient’s care providers, requesting their records and entering

the record information into the PHR properly. The patient record, accessible via Microsoft Healthvault, is then available for easy exchange with hospitals, physician offices, continuing care communities, family members and others permissioned by the patient.

Zweena is involved in a fascinating pilot program starting October 2011. Virtua Hospital in southern New Jersey has contracted with Zweena to provide ALL residents in a three-county area a free PHR with all the heavy lifting done by Zweena.

This three-year agreement will be a tremendous test of the concept of the personal health record and the improvement of health and health care for these communities.

Zweena CEO John Phelan comments, “Most of us only think about our health and our medical records when we are reacting to a health crisis. By then, it is too late to harness the power of our assembled health information. Zweena gives all of us an opportunity to use the information we have today and be more proactive and engaged with our own health information and the information for those we love and care for.”

Article first published as, “The Personal Health Record (PHR) is Alive and Well!

Meet Zweena.” on Technorati.

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legal

OIG 2012 Work Plan

new concerns. Be aware of these initiatives and address applicable initiatives in your compliance program and/or policies and procedures. Further safeguard your practice by seeking appropriate advice if you determine that one or more of these initiatives could affect your practice. The following article briefly summarizes the portions of the FY 2012 Work Plan that affect physicians.

New Initiatives in the FY 2012 Work Plan

Physicians take note of the fraud and abuse initiatives focused on your practice

By Kimberly Licata

22| DECEMBER 2011

E

ach year in October, the United States Department of Health and Human Services, Office of the Inspector General (OIG) releases a work plan to identify its priorities for the coming fiscal year. The OIG Work Plan traditionally gives providers valuable insight into arrangements or activities that the OIG believes are sensitive to fraud and abuse. Each year, the OIG Work Plan includes some initiatives from the prior year(s) along with

High Cumulative Part B Payments: The OIG will review payment systems controls that identify high cumulative Medicare Part B payments to physicians and suppliers to determine whether these controls are in place to identify such payments and assess their effectiveness. The OIG’s prior work has concluded that unusually high Medicare payments may indicate incorrect billing or fraud and abuse.

Physician-Owned Distributors of Spinal Implants: The OIG will determine the extent to which physicianowned distributors (PODs) provide spinal implants purchased by hospitals and whether PODs are associated with high use of spinal implants. The

OIG WORK PLAN TIP Work Plan notes that Congress has expressed concern that PODs could create conflicts of interest and safety concerns for patients.

Incident-To Services: The OIG will review physician billing for incidentto services to determine whether payment for such services has a higher error rate than that for non-incident-to services. The OIG will assess CMS’s ability to monitor incident-to services. The OIG expresses concern that the incident-to services may be performed by unqualified individuals, may expose beneficiaries to care that does not meet professional standards of quality, and may be vulnerable to overutilization.

Impact of Opting Out of Medicare: Motivated by a growing number of physicians opting out of Medicare, the OIG will review the extent of opting out and determine whether these physicians are submitting claims to Medicare. The OIG will examine whether particular areas of the country have seen higher opt out rates and any potential impact on beneficiaries.

Evaluation and Management Services: Use of Modifiers During the Global Surgery Period: The OIG will review the appropriateness of the use of certain claims modifier codes during the global surgery period and determine whether Medicare payments for claims where modifiers were used during the global surgery period were in compliance with Medicare requirements. Prior OIG review indicates that improper use of modifiers during this time resulted in improper payments for Evaluation and Management (E/M) services that were otherwise included in the global payment.

Physician-Administered Drugs and Biologicals: The OIG launches a new initiative to compare Medicare and Medicaid payments for commonly

used physician-administered drugs and biologicals to assess current reimbursement of ASP plus 6 percent and opportunities for savings through changes to Part B.

Continuing Initiatives in the FY 2012 Work Plan Compliance with Assignment Rules: The OIG remains interested in the extent to which providers comply with assignment rules and the extent to which beneficiaries may be being inappropriately billed in excess of Medicare-allowed amounts.

Place-of-Service Errors: The OIG continues to review physician coding of Medicare Part B claims for services performed in ambulatory surgery centers (ASCs) and hospital outpatient departments to confirm proper place-of-service coding (and associated level of reimbursement).

Evaluation and Management Services: Coding of Claims, During Global Surgery Periods, and Improper Payments: The OIG will continue to review trends in coding of claims for E/M services, including an ongoing initiative relate to E/M services provided during global surgery periods (and therefore, they should be billed and reimbursed as part of the global surgery fee). Last year’s Work Plan included the OIG’s first year of reviewing E/M claims to determine whether coding patterns vary by provider type; this initiative is continued in 2012.

Also new in 2011, and continued in 2012, is the OIG’s review of potentially inappropriate payments for E/M services.

Medicare Payments for Part B Imaging Services: The OIG continues to assess whether Medicare payments for Part B imaging services reflect expenses incurred and whether utilization rates reflect industry practices.

The OIG is particularly interested in

Virtually all physicians are affected by one or more of these initiatives. The government has had tremendous financial success in aggressively pursuing fraud and abuse initiatives. With the changes in health care reform that broaden the government’s power and reduce the level of intent necessary to find a provider has committed fraud and abuse, physicians must make themselves aware of the government’s plans.

the practice expense component and equipment utilization rate.

Excessive Payments for Diagnostic Radiology: The OIG continues to review high-cost diagnostic radiology tests to assess medical necessity and to deny payment (or request a refund for overpayment) for the unnecessary tests. The OIG also continues to assess ordering patterns by primary care physicians versus specialists for the same treatment.

Medicare Payments for Sleep Testing and Appropriateness of Medicare Payments for Polysomnography: The OIG continues its interest in the appropriateness of Medicare payments for sleep test procedures, including payments to physicians and independent diagnostic testing facilities for these tests. Unnecessary tests are not covered and subject a provider to refund any overpayment.

Laboratory Part B Payments for Glycated Hemoglobin A1C Tests and Trends in Laboratory Utilization: The OIG continues last year’s initiative into reviewing the number and types of laboratory tests ordered by physicians and examining how physician specialty, diagnosis, and geographic difference in the practice of medicine affect laboratory test ordering.

Comprehensive Outpatient RehabiliMEDMONTHLY.COM |23

OIG WORK PLAN TIP Be aware of these initiatives and address applicable initiatives in your compliance program and/or policies and procedures. Further safeguard your practice by seeking appropriate advice if you determine that one or more of these initiatives could affect your practice. tation Facilities (CORFs): The OIG is concerned about “potentially inappropriate” lease arrangements between physician landlords and CORFs. Expect the OIG to perform site visits and reviews of associated arrangements.

Medicare Payments for Part V Claims with G Modifiers: Previously, the OIG investigated use of the GY modifier, and this year, the OIG will review Medicare payments made from 2002 to 2010 for claims on which providers used certain G modifiers that indicate that Medicare denial was expected. The OIG will identify

24| DECEMBER 2011

atypically high billers who are using these modifiers. A recent OIG review identified $4 million in potentially inappropriate payments for pressurereducing support surface claims billed with G modifiers, indicating the provider’s expectation that Medicare would (but did not) deny these claims as not reasonable and necessary.

Payments for Services Ordered or Referred by Excluded Providers: The OIG’s review of payments for services ordered or referred by excluded providers continues. This initiative also examines CMS’s oversight mechanisms to identify and prevent improper payments for services based on orders or referrals by excluded providers.

Error-Prone Providers under Medicare Parts A and B: The OIG will continue to target error-prone providers through reviews of sampled claims submitted by the top error-prone providers to (in)validate claims and request refunds for projected over-

payments.

Virtually all physicians are affected by one or more of these initiatives.

The government has had tremendous financial success in aggressively pursuing fraud and abuse initiatives.

With the changes in health care reform that broaden the government’s power and reduce the level of intent necessary to find a provider has committed fraud and abuse, physicians must make themselves aware of the government’s plans. Assess your current practices to determine whether these are reasonable and sufficient to protect against the OIG’s concerns.

Remember these are the areas that the OIG sees as easy targets for recouping valuable cash and overpayments from providers. You never want to be an easy target when prevention is a phone call (or policy review) away!

Editor’s Note: These comments are not intended to establish an attorney-client relationship and are not intended to be legal advice.

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feature

MEDICAL OFFICE ARCHITECT

S

By Whitney L.J. Howell

tep inside an office in a long-standing San Francisco financial building, and you’ll see smooth, heavy timber columns and exposed wood joists. The brick walls are accented by modern colors, and three large lamps strike a dramatic image over a wood veneer reception desk.

26| DECEMBER 2011

With this sleek appearance, any visitor would be forgiven for assuming he or she had entered the headquarters of a progressive venture capital firm. But this is, in fact, the home for One Medical Group, a patient-centric, primary care medical office that offers longer, same-day appointments.

“There’s been so much buzz in San Francisco about One Medical Group,” said Justin Martinkovic, principal and co-founder of MMA Medical Architects, a San Francisco-based architectural firm that specializes in designing modern medical offices for all specialties.

“People have been known to walk in and think they’re in the wrong space. It’s just not what you expect a doctor’s office to look like.”

And, that’s exactly the intent, he says.

For so long, medical offices have been seen as sterile, functional spaces. Today, however, the health care environment is shifting toward boosting patient satisfaction, and your reimbursement rates will soon be tied to how happy your patients are with the time they spend

‘‘

ONE MEDICAL GROUP

Contemporary colors and bricks walls create a relaxing loftlike lobby for this One Medical Group office.

We’ve detected a pattern among doctors who are more concerned with how they are perceived and the image they project. They want to distinguish themselves while still showing patients they have a high level of competency.”

with you. The impact on your bottom line has prompted many of you to search out innovative ways to set yourselves apart from your competitors.

This is where firms like MMA Medical can help. Over the past decade, they’ve redesigned nearly 50 medical offices.

“We’ve detected a pattern among doctors who are more concerned with how they are perceived and the image they project,” Martinkovic says. “They want to distinguish themselves while still showing patients they have a high level of competency.”

Through a collaborative process, MMA Medical work closely with their doctor-clients to design a welcoming space to not only make

“There’s been so much buzz in San Francisco about One Medical Group,” said Justin Martinkovic, principal and co-founder of MMA Medical Architects, a San Francisco-based architectural firm that specializes in designing modern medical offices for all specialties. “People have been known to walk in and think they’re in the wrong space. It’s just not what you expect a doctor’s office to look like.”

MEDMONTHLY.COM |27

existing patients feel more at home, but to also help attract a new, broader clientele.

How It Works Doctors are often very particular, Martinkovic says. They come to the firm with a clear idea that they want – something. This is where the interview process truly begins. A design team sits down with the physician and runs through a litany of questions.

What are your priorities? What is the culture of your office? What specific needs do your staff have? What is the ultimate goal of this redesign? These conversations help the team suss out any space or capital investment challenges.

“The initial interviews are our most intense interaction with the doctors.

Through our conversation, we find out what they want and what their routine is,” Martinkovic says. “It’s also a chance for them to really identify what systems they have in place that they like and that work well and what things they need to shed.”

During the next three phases – schematic design, design development, and construction – doctors watch their original office spaces transform into more efficient, patient-focused, streamlined medical facilities.

Team members usually present three or four potential designs, and doctors have the final word on which features they want to include, which materials they want to use, and which contractors will do the work.

Beyond that, they 28| DECEMBER 2011

can be as involved or as laissez-faire as they choose.

What Changes You Can Expect At every turn, the health care system is revamping how you practice medicine – the biggest change being the push toward increased health information technology adoption. With the expanding use of digital tools has come a greater need for you to be mobile with laptops, iPads, or tablets.

MMA Medical’s latest design efforts focus on accommodating those needs and making the most efficient use of your space. For example, at Golden Gate Ob/Gyn in San Francisco, most of the private offices have been eliminated. Instead, the design team created work stations – 2 ft x 2 ft spaces with a spot to plug in their laptop and printer – where multiple providers can transfer notes from their mobile devices and input data into patient charts.

Design teams have also made

changes to take advantage of cloudcomputing. Electronic records once meant you had dedicated space for your system server. Keeping your records in the ether means architects have two options: they can either slice the space devoted to your back-up system to a small closet or move it offsite completely.

“By using the work stations, moving away from private offices, and devoting less space to housing technological equipment, we’re able to focus on patient areas,” Martinkovic says.

“Waiting rooms are getting elaborate designs, and it’s all enhancing the patient experience.”

The days of worn upholstery and sliding windows that separate receptionist from patient are gone. Doctors are now looking to infuse part of their personality into the office design, and patients are beginning to expect spaces that are more relaxing and less intimidating.

It’s an added plus, he says, when the design can play off of the doctor’s

specialty, as it did with Holland Medical Eye Center in Daly City, Calif.

The retail space is often integral to an optometrist’s office, so the architects mimicked the look and feel of glasses when designing the curvature of the walls and desks and orchestrating the lighting so it reflected off surfaces as it does off spectacles.

Healthy Design for the Health Care Provider Your initial capital investment might be higher, but perhaps one of the biggest benefits that comes with modernizing your office space is the opportunity to go green. Although medical offices are considered to be places that promote health, they have historically been constructed out of “sick” materials, Martinkovic says.

“If you’re going to be charged with keeping people healthy, then a good step is to remove as many toxic pollutants as you can from your office,” he says. “We can also take things a step further and increase an office’s energy efficiency.”

Vinyl flooring, because it is constructed from harmful petrochemicals, is a major culprit in releasing toxins into your office, he says. Any new design should offer you one of three choices for flooring: wood, linoleum, or cork. When properly cleaned and sealed, wood is very resilient.

Linoleum is inexpensive and safer than vinyl because it is made from non-toxic linseed oil. Cork can also be easily cleaned and is softer to stand on during an eight-hour day.

In addition, MMA Medical redesigns only use low VOC (volatile organic compound) paints. Removing the VOCs eliminates the chemicals that could induce breathing problems, headache, burning and watery eyes, or nausea in your patients.

Green design can also lower your utility bills. Energy-efficient lights,

A suspended orange acrylic panel hovers above the optometry check-in desk

such as LED or fluorescent lighting, and an energy-efficient HVAC system can reduce your electricity consumption. Martinkovic says designers also build in low-flow water systems to control the amount of water medical offices use each day.

Things to Consider Giving your office a facelift can be exciting and revitalizing for both you and your staff. But there are many things to consider before you jump in, Martinkovic says.

First, have a frank discussion with your design team about your budget, what the design and construction will cost, and how long it will take. Be prepared for a four-to-six month process.

If you haven’t re-outfitted your office before, you could be in for sticker shock. The cost to you will vary by what features you select and by your regional location.

Second, identify your new location and how it will affect your existing and new clients. In this process, you should also determine who your ideal patient is. That model can help you decide which design features will be most appealing to your clientele, he says.

Last, think through the image you want to portray.

“Consider your office to be your suit,” Martinkovic says. “It’s the first impression your patients have of your practice and who you are as a physician.”

MEDMONTHLY.COM |29

feature

Sleep Apnea Screening Saves Lives and Reduces Health Care Costs

By Lisa Feierstien

A

s a primary care physician, it’s now more important than ever to screen your patients for sleep apnea. Many symptoms of sleep apnea may be mistaken for other problems such as morning headaches, excessive daytime sleepiness, snoring, depression, difficulty sleeping, nighttime urination, and/or erectile dysfunction. Diagnosing sleep apnea will improve patient outcomes if they have type II diabetes, or are likely to develop cardiovascular disease or hypertension. Sleep apnea treatment can improve blood pressure, weight control, blood sugar, and can lower the risk for diabetes, stroke, obesity and heart attack. Screening is recommended by the JNC7 protocols, the IDF (International Diabetes Federation) and the AHA (American Heart Association).

Screening for sleep apnea in your office through several quick and free screening tools is the first step in treating more complex diseases to save and improve patients’ lives.

30| DECEMBER 2011

The Dangers of Sleep Apnea Obstructive sleep apnea is disruptive, dangerous and under-diagnosed. Of the 20 million people in the U.S.

who suffer from sleep apnea, approximately 75 percent remain undiagnosed and untreated. Untreated sleep apnea is related to several comorbidities such as

CPAP machines are often used to treat patients with sleep apnea

hypertension, diabetes and cardiovascular disease; sleep apnea sufferers also increase their risk of heart attack, stroke and kidney disease.

Hypertension Recent studies reveal that if one can manage their obstructive sleep apnea one can also manage their hypertension. Approximately 35 percent of all people with hypertension also have sleep apnea. That percentage increases to 80 percent for those who take four or more medications for their blood pressure. One out of three Americans has hypertension, which is defined by having one or both numbers over 139/89. Being over 45 for males and over 55 for females increases ones risk of hypertension, as does a poor diet with high salt content, in addition to lack of exercise, genetics, smoking, racial factors, high cholesterol, diabetes, alcohol and sleep apnea. Being overweight can be a factor for developing sleep apnea, which can then lead one to develop hypertension as well.

Diabetes People with sleep apnea are more than twice as likely to have diabetes as those who don’t. A high bodymass index or BMI, a measurement that considers both height and weight, is a risk factor for both sleep apnea and diabetes. In addition, 50 percent of men with type II diabetes have sleep apnea, compared to an estimated 4 percent of middle-aged men overall. Several recent studies have suggested that insulin sensitivity—the body’s ability to respond to insulin—decreases as sleep apnea severity increases.

The literature also supports the fact that 80 percent of all diabetes suf-

ferers die of cardiovascular disease.

Therefore, you can help a diabetic patient who suffers from cardiovascular disease by helping their sleep apnea.

This association is so dramatic that the IDF developed a very important consensus statement highlighting the connection between sleep apnea and diabetes. The statement urges healthcare professionals to adopt new clinical practices to ensure that patients with either sleep apnea or diabetes should be evaluated for the other condition.

Heart Disease Over five million Americans have heart disease according to the AHA, and of these heart disease patients 76 percent have sleep disorder breathing problems. Sleep apnea has been noted in 49 percent of atrial fibrillation (abnormal heart rhythms) patients and 30 percent of cardiovascular patients.

Scientists are still researching the exact link between sleep apnea and cardiovascular disease (CVD), and with regular CPAP therapy one can help reduce the risk of this blood vessel damage by allowing the person to sleep with normal oxygen and carbon dioxide exchange. With less toxicity in the blood, the heart grows and remains healthy.

Virend Somers, chair of the joint statement writing committee for Circulation, the American Heart Association’s publication, says, “There have been a number of studies on sleep apnea in the last decade, and those looking at cardiovascular diseases and their associations with sleep apnea are especially compelling….Diagnosing and treating sleep apnea may prove to be an important opportunity to advance our efforts at preventing and

treating heart disease.”

Offer Your Patients a Sleep Screening Today Usually blood pressure falls when you sleep, but if you have sleep apnea, it will not because the blood vessel walls become damaged due to the many pauses in breathing, which also inhibits the necessary amount of oxygen flow that helps repair the cells.

Without oxygen the heart also won’t function optimally—a lethal combination if the sleep apnea sufferer also has a heart condition.

Offering a 10 second sleep screening for your patients will enable you to properly diagnose your patient so they can be properly treated for their sleep apnea and their comorbidities.

If the patient checks positive in their sleep apnea screening, then you can refer them for a diagnostic overnight sleep study, a polysomnogram. If they do have sleep apnea, then they will be treated with the gold standard, the CPAP (continuous positive airway pressure) machine. The devices and masks keep getting smaller, quieter and more sophisticated. It is a noninvasive option that treats other conditions at the same time. Sleep apnea treatment reduces health care costs by reducing the need for medications and other interventions. Furthermore, the medical equipment provider will ensure compliance and educational support so the sleep apnea can be successfully managed.

Discuss sleep with your patients and how the lack of it is connected to disease. Sleep apnea control leads to comorbidity control which leads to smoother, easier patient encounters and healthier patients—this can all be accomplished once the patient steps into your primary care office.

MEDMONTHLY.COM |31

feature accountable care and how primary care plays a role in each.

Focusing on Prevention

Soon patients will be paying for improved health, not just a single service.

The Role of Primary Care in Accountable Care

By Robert C. Tennant

A

colleague and I recently presented a workshop on moving towards accountable care. Participants included large and small health systems, physician groups and even a couple of specialty care groups. The discussions were interesting; the tone varying from, ‘this is great’ to ‘this is never going to work.’

However, we all left the room wondering how the health care delivery system

32| DECEMBER 2011

is going to find a way to cut costs and increase quality of care. The quest for a solution is well underway and will affect patients, employers, payers and caregivers to one degree or another. The primary care arena will be affected the most and in some ways, the whole idea of accountable care arguably hinges on primary care. The following sections highlight the shifts that are likely to occur during the transition toward

According to a 2007 study by the Milken Institute, preventable chronic diseases have a $1 trillion annual impact on our economy. This astounding figure indicates there is no shortage of patients with health problems. One might say that the U.S. healthcare basin is overflowing, and the solution is not a bigger basin. Rather, the solution is reducing the flow, which has lead to a greater focus, largely by payers, on the prevention of diseases and adverse events that can lead to hospitalization and expensive procedures.

In order for prevention to have a significant affect on health care costs and quality, primary care physicians are going to have to identify at risk patients and managing their care to a greater degree than ever before. Additionally, they are going to have to work with caregivers to start engaging these patients outside of face-to-face office visits. The idea is not just about prevention, of course, but ultimately about promotion of a healthier patient.

Getting Paid for Value Escalating costs are a big driver behind health reform, which almost surely is going to significantly change how physicians get paid. Payment incentives are being realigned to help obtain health care quality goals. Under the traditional fee for service payment model, physicians get paid for providing more services. Payers have been changing that model slightly by incenting primary care physicians to provide certain services under pay for performance programs mostly aimed at chronic disease management. But even incenting for certain services does not measure quality nor does it necessarily lead to or incent toward a healthier patient. The accountable care movement takes payment reform a step further by measuring outcomes and incenting for

value (value = outcomes compared to cost). In other words, we are moving from paying for services, to paying for certain services, to paying for improving the health of the patient.

Again, primary care is key, as they are the ‘medical home,’ main point of contact and overseer of the patient’s health as care is delivered across the continuum.

As the shift toward value takes place, primary care providers will be asked to do more for their patients and will be paid accordingly. Specifically primary care givers will need to increase their level of delivery by diagnosing and caring for a broader range of problems and performing related procedures in the primary care office setting.

Digitizing Health Information Rarely is there an accountable care conversation without discussion of how a significant technology infrastructure must be built to support the transition to an accountable care delivery system.

Whether we are talking about cost savings, prevention of adverse patient events or improving the health of the entire patient population, having the right information available at the point of care in a form that can be analyzed to measure our success is critical.

Primary care is the point of entry for much of the data flowing into the accountable care delivery system. In fact, 22 of the 33 quality measures relating to Accountable Care Organizations (ACO) require data from the ambulatory setting with the significant focus being on primary care. In order for the right data to flow into the system, appropriate use of an Electronic Health Record (EHR) system is critical. But simple EHR use and appropriate use of EHR required to drive accountable care is not one in the same. According to a 2009 National Ambulatory Medical Care survey, 50 percent of physicians have an EHR but only about 10 percent of physicians are using their EHR in a fully functional way. In other words, ‘nurse only’ use of

an EHR or using an EHR as a glorified word processor will not meet the needs of accountable care. The federal ‘meaningful use’ program is a step in the right direction and one way for physicians to help offset costs.

Health information exchange between physicians, hospitals and other caregivers starts with primary care.

The primary care physician is a digital gatekeeper of who, in the end, is likely to take responsibility for validating a patient’s key medical information such as active problems, allergies and medications. Information technology is necessary to have the electronic chart established and maintained in order for any kind of information exchange to be useful. Primary care physicians and other clinical staff must embrace and promote the use of EHR in their office and, ideally, champion for use outside the walls of their office.

Patients Becoming Consumers Patients are not just people ‘treated and released’ anymore and understandably so. High deductible insurance plans with out of pocket expenses of thousands of dollars per year are one driver of the patients’ desire to understand what they are paying for and to have a say in what they buy. In some ways this is perhaps frightening to physicians, but there is potential good. Primary care physicians are often blamed when a patient fails to follow their plan of care. This is frustrating for care providers and costly in terms of staff time.

The positive side of patients becoming consumers is that healthy consumers need and want to be empowered, and an empowered consumer is likely a necessary step toward becoming an accountable patient. As a primary care physician, your relationship with the patient is shifting from a one-way ‘treat and release’ relationship to a two-way give and take relationship with them.

Embracing this shift and developing a new way of relating to patients more as consumers is crucial.

New Roles for Primary Care Physicians Because of the previous four shifts, new roles are being created and existing roles are changing. If you have begun a program of prevention and disease management, you may have adopted new roles such as ‘care managers’ designed to handle new tasks that were formerly not performed by anyone. If you have implemented an EHR then you may have noticed a need to shift some of your work to nurses or midlevel clinical staff in order to maintain your patient visit volume. Perhaps you have already begun to perform more procedures in house or to handle more complex issues before referring to a specialist – this also begs for additional roles and a change in the physician role.

The burden of work is increasing for primary care and new roles are required to get the work done. A physician simply cannot and should not be managing things that do not require a physician’s level of engagement. The idea of releasing control and delegating work can be frightening but it is the way of the future. I often hear nurses and mid-level care providers express that they feel they are under utilized and wish they were doing more. The shift to accountable care is an opportunity for physicians to let go and delegate to these care managers, nurses and mid-level providers, bringing more opportunity and job satisfaction to all involved.

For more information, visit www. healthdirections.com Robert C. Tennant is a Managing Associate with Health Directions, a national health care consulting firm. He has more than twenty years of experience leading business development software and IT infrastructure deployments, and has dedicated ten years exclusively to health care information technology and health information exchange in the physician practice, hospital and payer settings.

MEDMONTHLY.COM |33

feature

34| DECEMBER 2011

By Leigh Ann Simpson

W

hen considering the demands of their hectic schedule, the average American usually finds that they have very little time for them to be sick, much less see a doctor. Job security has become such a rare commodity that many workers feel that taking time away from their job to seek medical care when they’re sick is a luxury they simply can’t afford.

Inconvenient access to health care is especially problematic for the nearly 300,000 Americans who claim to live in airports and find it nearly impossible to make an appointment to see their local primary care physician.

Recognizing these issues as an opportunity to improve, the Metropolitan Nashville International Airport Authority joined forces with the Tennessee based company, CareHere, to open a health care clinic and wellness store inside the Nashville International Airport (BNA) last August.

CareHere BNA provides routine and emergency health care delivery to the 9 million travelers passing through its terminals every year and the 5,000 individuals who are employed by BNA. Unlike the handful of other airport medical clinics in major hubs throughout the country, CareHere BNA is not subsidized by a hospital or airport – it’s the first of its kind.

“We wanted an airport clinic that was a self-sustaining business model,” says Rebecca Ramsey, Metropolitan Nashville Airport Authority assistant director of properties.

The 1,110-square foot clinic has

three examination rooms efficiently designed to maximize space, allowing them to serve, on average, 200 patients a month. This facility has the same state of the art same medical equipment that you would expect to see in a traditional primary care practice and lab equipment that is used for employment services, such as drug screenings.

“Convenience and saving time away from work for basic health care issues are great benefits for airport employers and employees alike,” says Ramsey, “immunizations fall squarely in that category. In early October, the clinic was administering about nine flu shots per day. Travel-related shots are also offered, with Vitamin B-12 injections and hepatitis vaccines being the most sought after.”

CareHere’s hours of operation are from 7:00 a.m. to 6:00 p.m., Sunday through Friday, and from 8:00 a.m. to 3:00 p.m. on Saturday. The clinic is always staffed with either a nurse practitioner or a physician, and because all of their medical records are electronic, staff members have the ability to employ telemedicine to consult a physician via the internet when there is not one on duty.

In addition to providing convenience, the price of services at CareHere BNA is very reasonable for both employees and travelers. Employers’ plans usually cover the majority of expenses; employees usually have no co-payment expenses and no deductable. Passengers using the airport clinic can pay with cash or use their health insurance plans.

The retail wellness store inside CareHere BNA caters to the needs of travelers, with an inventory that ranges from organic snacks, to beauty products and over-the-counter medications.

Over the past seven years, CareHere has cultivated a unique approach to health care delivery by offering basic and chronic care management for employees that is near or inside the businesses where they work. In addition to their ideal location, the clinics promote wellness and provide preventative care to help employees stay healthy and efficient. The company owns and operates over 100 workplace health care clinics that service the employees of major corporations, manufacturers, businesses and government agencies throughout the country.

CareHere is also a pioneer of in-flight telemedicine which assists air passengers in need of medical attention. With the help of several airlines, they have developed a model that will ensure that passengers can receive medical care while in the air, if needed, until the plane can land and emergency health care services on the ground can take over.

“If we can be successful with telemedicine, that opens up opportunities for people who are chronically ill and afraid to fly” says Ernie Clevenger, CareHere company president.

Clevenger says that the technology exists to make this happen, but the ongoing debate with airlines over what level of care can be administered during flight has delayed this initiative.

MEDMONTHLY.COM |35

feature

7 Reasons You Need Exposure to ICD-10-CM Now Good news: Here’s what you won’t have to re-learn

By Suzanne Leder, BA, M. Phil., CPC, COBGC, certified AHIMA ICD-10 trainer, and executive editor at The Coding Institute

36| DECEMBER 2011

I

f you’ve been avoiding the prospect of diving into ICD-10-CM, it’s time to face the music. The good news is it’s probably a lot less scary than you think.

Taking small steps now to accustom yourself to ICD-10-CM means that you’ll be ahead of the game before October 1, 2013 hits. Remember, you won’t have any grace period.

Use these seven questions and answers — and the examples that follow — to set your training in motion:

1

Why Should I Learn ICD-10 Now?

The shift from ICD-9 to ICD-10 will not be simple.

Productivity in your practice will be an issue prior to, and after implementation. In other words, it will take longer for your coding specialist to code your claims in ICD-10 until she is finished with the learning curve. Imagine too that you’re going to have to spend more time clarifying your documentation, so that she can get to that ultra specific code.

You’ll probably see an increase in billing inquiries from payers. Your practice will also encounter an increased number of adjustments and pended or suspended claims. That’s why getting a jump start is such a wise decision. The more you can streamline this, the more you can assist your practice’s bottom line.

2

Who Else is Using ICD-10?

Obviously, adoption here in the US has been slow, but other countries around the world have already been using it.

Countries that have adopted ICD-10: • • • • • • •

Australia (since 1998) Canada (since 2000) France (since 2005) Germany Korea Sweden Thailand

3

Why is ICD-9-CM Changing?

Frankly, ICD-9-CM is running out of room.

The first digit of an ICD-9-CM code is a number, which limits code options from 0-9. For instance, the code for osteoporosis is 733.01 right now. The “7” is the first digit. In ICD-9-CM, we can only go from 0-9. In ICD-10-CM, you’ll report M81.0 for osteoporosis.

The “M” is the first digit, meaning that we can go from A-Z before even tapping into numbers.

Also new for ICD-10-CM is the expansion of 5 digits to 7 digits. Look at this seven digit example. ‘Abrasion of unspecified hand; initial encounter’ will be S60.519A. ‘Abrasion of unspecified hand; subsequent encounter’ will be S60.519D.

For instance: Right now, if a patient has severe sepsis with shock, you would report 995.92 (Severe sepsis) and 785.52 (Septic shock). For ICD-10, you’ll have a consolidated code: R65.21 (Severe sepsis with shock).

We’re going to have expanded injury codes which will allow your claim to describe the injuries as well as the external causes of injuries.

Also, here’s something great for providers seeing ob patients, Leder says: “We’ll have new codes that will need to specify trimester.”

In addition, we’ll have expanded alcohol and substance abuse options as well as more options for post-operative complications.

5

What’s So Great About ICD-10-CM?

What’s the Difference Between ICD-9-CM and ICD-10-CM Besides More Room and Greater Specificity?

You will encounter other advantages to ICD-10-CM, besides it having more room for growth. Here are a few to consider: • More information relevant to ambulatory and managed care • Combo codes for diagnosis/symptoms (example: R65.21, Severe sepsis with shock) • Expanded injury codes • Trimester info • Expanded alcohol/substance abuse codes • Expanded post-op complication codes • We’re going to have more info relevant to ambulatory and managed care.

• We’re going to have combo codes for diagnoses/symptoms — and here’s the benefit: It’ll reduce the number of diagnosis codes you have to report to describe a specific condition.

First off, the ICD-10 manual will be different from the ICD-9 one. With ICD-10, you’ll have three volumes rather than two: Volume I: Tabular Listing, Volume II: Instructional Manual, and Volume III: Alphabetic Index.

Also different under ICD-10, you’ll search under alphanumeric categories rather than numeric categories.

ICD-10 has twice as many categories as ICD-9.

You’ll have to reacquaint yourself with the chapters, as they have been rearranged. Some of the titles will change. The conditions have been regrouped. Also, you’ll have to get to know some minor changes to the coding rules for mortality.

For bilateral sites, you’ll find a final character in the codes in which ICD10 specifies if one side or both sides.

For instance, right side is always “1.”

Left side is always character “2.” Bilat-

4

38| DECEMBER 2011

eral is always “3.” For instance, if your physician sees a patient for a follow-up visit where he examines an abscess of a bursa on the right wrist. You would report M71.031. Notice how the last digit is “1.” If this was for the left wrist, you would’ve reported M71.032.

6

What Do I Not Have to Re-Learn for ICD-10-CM?

Before you get too overwhelmed, you should know that some things will remain similar. In other words, you won’t have to re-learn these coding conventions.

• • • • • • • •

Indented format Rubric system Index Tabular convention Includes notes Inclusion terms Exceptions Neoplasm table

7

What Should I Do to Start Preparing for ICD-10-CM?

To prepare for ICD-10, doctors will need to look at the codes they use most frequently in their offices and create new job aids or superbills for those procedures. Look at those codes that you see most commonly in your practice and concentrate on knowing how to code those appropriately.

Strategy: Use your list of the top diagnoses that your practice sees to find the corresponding ICD-10 codes, and you’ve got your cheat sheet. Then, ensure that your coders are trained, that your claims are form 5010 compliant, and that your claim submission system supplier is ICD-10-ready. In addition, if you have an electronic medical record or you plan to get one, make sure it can handle ICD-10. If you’re start-

ing to bring in an EMR, you want to convert to ICD-10 first, not bring one in under ICD-9 and then convert.

The bottom line is that physicians should tighten up their documentation. As is the case under ICD-9,

coders will not be able to glean ICD-10 codes from a physician’s documentation if it isn’t thorough, so physicians should take the opportunity to improve their documentation skills.

Coders cannot code what’s not in the

medical record. As there are more opportunities for coders to pick from a list, they’re going to be coming back to physicians early on to say “Wait, I need more definition to help me pick A or B.”

3 Examples Show You How ICD-10-CM Works Anatomy skills key to ICD-10-CM coding success.

So now that you’ve had an ICD-10-CM overview, have a look at some specific examples to help you apply the fundamentals.

Example 1: The physician sees a Medicare patient with osteoporosis who has a pathological humerus fracture.

ICD-9: You would report 733.11 (Pathological fracture of humerus) and 733.01 (Senile osteoporosis).

ICD-10: You would report M80.021D (Subsequent encounter for fracture with routine healing, postmenopausal osteoporosis with current pathologic fracture, right humerus).

So this is a situation where ICD10 consolidates these codes.

Example 2: A patient presents to your office with a prolapse of the anterior vaginal wall, which is commonly called a cystocele.

ICD-9: You would report 618.01 (Prolapse of vaginal walls without mention of uterine prolapse; cystocele, midline) or 618.02 (… cystocele, lateral).

ICD-10: When your diagnosis

code system changes: Code 618.01 will become N81.10 (Cystocele, unspecified) or N81.11 (Cystocele, midline).

Code 618.02 will become N81.12 (Cystocele, lateral).

Those are different looking codes, but their definitions are similar.

Example 3: The physician treats a patient for a lower back pressure ulcer.

ICD-9: You should report 707.03 (Pressure ulcer; lower back) and an additional code from 707.20-707.25 (Pressure ulcer stages …) to identify the pressure ulcer stage: • 707.20 -- Pressure ulcer, unspecified stage • 707.21 -- Pressure ulcer stage I • 707.22 -- Pressure ulcer stage II • 707.23 -- Pressure ulcer stage III • 707.24 -- Pressure ulcer stage IV • 707.25 -- Pressure ulcer, unstageable.

Note: If you look at those definitions, you’ll see how the descriptor specifies the stage.

ICD-10: You don’t have enough information. The physician needs to document whether the ulcer is on the left or right. The coding specialist will report a single code. Some options will be (but are not limited to):

• L89.131 (Pressure ulcer of right lower back, stage I) • L89.141 (Pressure ulcer of left lower back, stage I).

Bottom line: You’ll need additional anatomic details when you start using ICD-10 in 2013.

For instance, for the same lower back pressure ulcer, choosing the proper ICD-10 code will depend on whether the ulcer is on the left or right. Did your physician probably already document this? Yes. That information didn’t matter for ICD-9.

But ICD-10 will allow you to be more specific.

Also, note that rather than using two codes as you do under ICD-9, a single ICD-10 code will represent both the anatomic location and the stage, such as L89.131 (Pressure ulcer of right lower back, stage I) or L89.141 (Pressure ulcer of left lower back, stage I).

MEDMONTHLY.COM |39

finance

Intra-Year Declines vs.

Calendar Returns Tips for the Market Savvy Physician

By Jennifer Daknis

N

o matter how many market “corrections,” or sharp declines you see, they are never easy. Occasionally, and we’ll venture to say this summer’s decline will be viewed in the future as one of those times, corrections take on a life of their own and morph into a full blown panic.

“Panics,” if we may coin the term, are far from fun for investors. They are also far from rational. They represent the point at which people will sell all their investments, at any price. The operative word being “any.” Panics come up every now and again for various reasons, without much consistency, rhyme or reason as to why. They just happen.

There is no value a panicked investor won’t take for their investments. Panicked investors lose.

The best protection against panic is an asset allocation suited to your goals, tolerance for risk, and time horizon.

That being said, whether you have a little or a lot invested in the greatest companies in this country and the world, it is easy to forget what is normal fluctuation for stock investments. Just understanding this concept might lend comfort when the next panic attack occurs.

Please note the chart below which shows the S&P 500 (without dividends)

40| DECEMBER 2011

Source: Standard and Poor’s, FactSet, J.P. Morgan Asset Management.

For illustrative purposes only. Standard and Poor’s 500 Index is an unmanaged index which cannot be invested into directly.

from 1980 to 2010 indicated by the bars and numbers directly above them. For example, in 2010 the S&P 500 gained 13 percent (15.1 percent including dividends). What’s interesting here is the number by the dot below. If you looked at your stock accounts daily (which I don’t recommend because it will drive you crazy), the lower number by the dot indicates the amount of decline you experienced, or had to suffer through, at some point during that year.

So using 2010 as an example again, you experienced a decline of 16 percent (from April 23 to July 5) even though your full year gain was 13 percent (again, 15.1 percent including dividends). The numbers were even more extreme in 2009. You had to suffer through a decline of 28 percent during the first part of that year, but if you were able to hang in there, your annual gain was 23 percent.

In fact, the average annual decline of 14.3 percent over the past 31 years

makes the 2011 “peak to trough” decline of 17 percent at the time of this writing almost average.

Interesting note: The S&P 500 finished in positive territory in 24 of those 31 years in spite of an average 14.3 percent annual decline.

Of course, the past doesn’t necessarily equal the future and past performance can’t guarantee future results, but then again, nothing guarantees future results.

We just wouldn’t bet against it.

Editor’s note: Securities offered through LPL Financial, Member FINRA/SIPC. This article is not intended to provide specific investment advice.

Stephen E. Sigmon and Jennifer B. Daknis are financial advisors with Sigmon Daknis Wealth Management, with securities offered through LPL Financial.

Sigmon Daknis Wealth Management serves both individual and corporate clients. They can be reached via phone at 757.223.5902 (Newport News office) or 757.258.1063 (Williamsburg office).

What’s your practice worth?

When most doctors are asked what their practice is worth, the answer is usually, “I don’t know.”

Doctors can tell you what their practices made or lost last year, but few actually know what it’s worth.

In today’s world, expenses are rising and profits are being squeezed. A BizScore Performance Review will provide details regarding liquidity, profits & profit margins, sales, borrowing and assets.

Out three signature sections include:  Performance review  Valuation  Projections

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919.846.4747 bizscorevaluation.com

the arts

One Brush Stroke at a Time Healing patients through art

By Leigh Ann Simpson

42| DECEMBER 2011

T

hroughout the centuries, nature has served as one of the greatest sources of artistic inspiration on earth. Mankind’s adoration of art that depicts the beauty of nature is universal, but could there be benefits, outside of the obvious aesthetic pleasure, that explain our inherent attraction?

Surmounting evidence suggests the presence of naturally inspired art in medical facilities can provide a number of health benefits that can increase the rate of patient recovery. Several clinical studies indicate that such an environment can reduce stress and anxiety during treatment, lower blood pressure and even increase a patient’s tolerance of pain.

Silk paintings not only epitomize the type of art that can be used to produce health benefits, they also provide a unique way of increasing patient and family satisfaction. The use of vivid color in the floral designs of these paintings is abstract, yet soothing; warming the uninviting, bare walls often found in a medical facility. Over the past few years, this ancient art form has made its way into hospital hallways and waiting rooms across Europe, and is now increasing in popularity among U.S. medical facilities.

Julie Jennings is a master of the craft, and has been creating beautiful silk paintings for nearly 30 years. Her extraordinary work with orchids on silk has captivated thousands of art and orchid enthusiasts, and is frequently showcased in exhibitions across the country.

Julie also teaches her techniques and says that she witnesses the healing power of this art form in her classes all the time.

Julie is not a licensed therapist and has no formal medical training; however, the

majority of her students suffer from a variety of medical issues. Individuals who are battling cancer, enduring painful physical therapy, dealing with the loss of a child and countless others all sign up to take Julie’s class hoping to receive additional comfort during their recovery.

“I don’t advertise my classes as therapy, but the response rate I get suggests otherwise,” Jennings says. “It is incredible the number of individuals that are drawn to the art who are recovering in either a physical way or emotional.”

Each new class of students begins like any normal art class, however, over the course of several weeks; their issues emerge and the students begin to create an unexpected fellowship that ultimately helps them all through their healing processes, Jennings says.

“It is most rewarding to know that my artwork and classes are providing comfort to those who need it most,” she says. “I enjoy sharing my art, but more importantly I enjoy touching the soul, wounded as so many of them are.”

Julie’s work is currently being displayed in the Smithsonian Gardens and the Daniel Stowe Botanical Gardens in Charlotte, N.C. To find out more about Julie Jennings and her silk paintings visit: http://silksynergy.com/index.htm.

Julie Jennings has been painting on silk for over 30 years. Her work is colorful and vibrant yet calming.

MEDMONTHLY.COM |43

the kitchen

A tasty fall treat

By Ashley Acornley, R.D., L.D.N

T

his is a rich, nutritious, and crowd-pleasing fall side dish, and would be a sweet and spicy addition to any holiday meal. Almost every ingredient in this recipe has powerful antioxidant properties, especially the garlic, cinnamon, curry powder, and cranberries. This recipe is also filled with heart healthy fats.

WITH CURRIED BUTTERNUT SQUASH CONUT CRANBERRIES AND TOASTED CO Serves 6 Ingredients: l) 1 large butternut squash (2# tota 2 cloves garlic, minced peeled and 1 1-inch piece of fresh ginger, grated 3 Tbsp. 100% pure maple syrup 1 tsp. ground cinnamon

1 tsp. curry powder 2 tsp. chili powder Pinch of salt and pepper d 3 Tbsp. unsweetened shredde coconut, lightly toasted 2 Tbsp. dried cranberries

Preparation:

Fahrenheit.

Preheat oven to 375 degrees 1-2 inch pieces. into p Cut and peel squash, cho onut and aining ingredients except coc rem add Place in a large bowl and cranberries; toss well to coat. ng once or le dish and bake for 1 hour, stirri Pour into a large glass cassero twice. dried cranberries before serving.

Top with toasted coconut and

44 | DECEMBER 2011

NUTRITION FACTS Per ½ cup serving: 178 calories, 9g fat (5g mono, 1g poly, 2g saturated) 0mg cholesterol, 2g protein, 27mg carbohydrates, 1g fiber, 17mg sodium

needs.

MEDMONTHLY.COM |45

U.S. DENTAL BOARDS Alabama Alabama Board of Dental Examiners 5346 Stadium Trace Pkwy, Ste. 112 Hoover, AL 35244 (205) 985-7267 http://www.dentalboard.org/ Alaska P.O. Box 110806 Juneau, AK 99811-0806 (907)465-2542 http://bit.ly/uaqEO8 Arizona 4205 N. 7th Ave. Suite 300 Phoenix, AZ 85103 (602)242-1492 http://azdentalboard.us/ Arkansas 101 E. Capitol Ave. Suite 111 Little Rock, AR 72201 (501)682-2085 http://www.asbde.org/ California 2005 Evergreen Street, Suite 1550Â Sacramento, CA 95815 877-729-7789 http://www.dbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7800 http://www.dora.state.co.us/dental/ Connecticut 410 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/site/default.asp Delaware Cannon Building, Suite 203 861 Solver Lake Blvd.

Dover, DE 19904 (302)744-4500 http://1.usa.gov/t0mbWZ Florida 4052 Bald Cypress Way Bin C-08 Tallahassee, FL 32399 (850)245-4474 http://bit.ly/w1m4MI

46| DECEMBER 2011

Georgia 237 Coliseum Drive Macon, GA 31217 (478)207-2440 http://sos.georgia.gov/plb/dentistry/ Hawaii DCCA-PVL Att: Dental P.O. Box 3469 Honolulu, HI 96801 (808)586-3000 http://1.usa.gov/s5Ry9i Idaho P.O. Box 83720 Boise, ID 83720 (208)334-2369 http://isbd.idaho.gov/ Illinois 320 W. Washington St. Springfield, IL 62786 (217)785-0820 http://bit.ly/svi6Od Indiana 402 W. Washington St. Room W072 Indianapolis, IN 46204 (317)232-2980 http://www.in.gov/pla/dental.htm Iowa 400 SW 8th St. Suite D Des Moines, IA 50309 (515)281-5157 http://www.state.ia.us/dentalboard/ Kansas 900 SW Jackson Room 564-S Topeka, KS 66612 (785)296-6400 http://www.accesskansas.org/kdb/ Kentucky 312 Whittington Parkway, Suite 101 Louisville, KY 40222 (502)429-7280 http://dentistry.ky.gov/ Louisiana 365 Canal St. Suite 2680 New Orleans, LA 70130 (504)568-8574 http://www.lsbd.org/

Maine 143 State House Station 161 Capitol St. Augusta, ME 04333 (207)287-3333 http://www.mainedental.org/ Maryland 55 Wade Ave. Catonsville, Maryland 21228 (410)402-8500 http://dhmh.state.md.us/dental/ Massachusetts 1000 Washington St. Suite 710 Boston, MA 02118 (617)727-1944 www.mass.gov Michigan P.O. Box 30664 Lansing, MI 48909 (517)241-2650 www.michigan.gov Minnesota 2829 University Ave., SE. Suite 450 Minneapolis, MN 55414 (612)617-2250 http://www.dentalboard.state.mn.us/ Mississippi 600 E. Amite St. Suite 100 Jackson, MS 39201 (601)944-9622 http://bit.ly/uuXKxl Missouri 3605 Missouri Blvd.

P.O. Box 1367 Jefferson City, MO 65102 (573)751-0040 http://pr.mo.gov/dental.asp Montana P.O. Box 200113 Helena, MT 59620 (406)444-2511 http://mt.gov/ Nebraska 301 Centennial Mall South Lincoln, NE 68509 (402)471-3121 http://bit.ly/uBEqwK

Nevada 6010 S. Rainbow Blvd. Suite A-1 Las Vegas, NV 89118 (702)486-7044 http://www.nvdentalboard.nv.gov/

Oklahoma 201 N.E. 38th Terr. #2 Oklahoma City, OK 73105 (405)524-9037 http://www.dentist.state.ok.us/

New Hampshire 2 Industrial Park Dr. Concord, NH 03301 (603)271-4561 http://www.nh.gov/dental/

Oregon 1600 SW 4th Ave. Suite 770 Portland, OR 97201 (971)673-3200 http://www.oregon.gov/Dentistry/

New Jersey P.O Box 45005 Newark, NJ 07101 (973)504-6405 http://bit.ly/uO2tLg

Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)783-7162 http://bit.ly/s5oYiS

New Mexico Toney Anaya Building 2550 Cerrillos Rd. Santa Fe, NM 87505 (505)476-4680 http://bit.ly/vCnCP4

Rhode Island Dept. of Health Three Capitol Hill, Room 104 Providence, RI 02908 (401)222-2828 http://1.usa.gov/u66MaB

New York 89 Washington Ave. Albany, NY 12234 (518)474-3817 http://www.op.nysed.gov/prof/dent/

South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4599 http://www.llr.state.sc.us/POL/Dentistry/

North Carolina 507 Airport Blvd. Suite 105 Morrisville, NC 27560 (919)678-8223 http://www.ncdentalboard.org/

South Dakota P.O. Box 1079 105. S. Euclid Ave. Suite C Pierre, SC 57501 (605)224-1282 https://www.sdboardofdentistry.com/

North Dakota P.O. Box 7246 Bismark, ND 58507 (701)258-8600 http://www.nddentalboard.org/ Ohio Riffe Center 77 S. High St. 17th Floor Columbus, OH 43215 (614)466-2580 http://www.dental.ohio.gov/

Tennessee 227 French Landing, Suite 300 Nashville, TN 37243 (615)532-3202 http://health.state.tn.us/boards/dentistry/ Texas 333 Guadeloupe St. Suite 3-800 Austin, TX 78701 (512)463-6400 http://www.tsbde.state.tx.us/

Utah 160 E. 300 South Salt Lake City, UT 84111 (801)530-6628 http://www.dopl.utah.gov/licensing/ dentistry.html Vermont National Life Building North FL2 Montpelier, VT 05620 (802)828-1505 http://www.vtprofessionals.org/opr1/ dentists/ Virginia Perimeter Center 9960 Maryland Dr. Suite 300 Henrico, VA 23233 (804)367-4538 http://www.dhp.state.va.us/dentistry/ default.htm Washington 310 Israel Rd. SE P.O. Box 47865 Olympia, WA 98504 (360)236-4700 http://1.usa.gov/tKBFHT West Virginia 1319 Robert C. Byrd Dr. P.O. Box 1447 Crab Orchard, WV 25827 1-877-914-8266 http://www.wvdentalboard.org/ Wisconsin P.O. Box 8935 Madison, WI 53708 1-877-617-1565 http://bit.ly/sEhr0Q Wyoming 1800 Carey Ave. 4th Floor Cheyenne, WY 82002 (307)777-6529 http://plboards.state.wy.us/dental/index. asp

U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 334-242-4116 http://www.albme.org/

Florida 2585 Merchants Row Blvd.

Tallahassee, FL 32399 850-245-4444 http://www.doh.state.fl.us/

Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 907-269-8163 http://www.commerce.state.ak.us/occ/ pmed.htm

Georgia 2 Peachtree Street NW, 36th Floor Atlanta, GA 30303 404-656-3913 http://medicalboard.georgia.gov/portal/ site/GCMB/

Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 480-551-2700 http://www.azmd.gov

Hawaii DCCA-PVL P.O. Box 3469 Honolulu, HI 96801 808-587-3295 http://hawaii.gov/dcca/pvl/boards/medical/

Arkansas 1401 West Capitol Ave., Suite 340 Little Rock, AR 72201 501-296-1802 http://www.armedicalboard.org/ California 2005 Evergreen St., Suite 1200 Sacramento, CA 95815 916-263-2382 http://www.mbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 303-894-7690 http://www.dora.state.co.us/medical/ Connecticut 401 Capitol Ave. Hartford, CT 06134 860-509-8000 http://www.ct.gov/dph/site/default.asp Delaware Division of Professional Regulation Cannon Building 861 Silver Lake Blvd., Suite 203 Dover, DE 19904 302-744-4500 http://dpr.delaware.gov/ District of Columbia 899 North Capitol St., NE Washington, DC 20002 202-442-5955 http://www.dchealth.dc.gov/doh 48| DECEMBER 2011

Idaho Idaho Board of Medicine P.O. Box 83720 Boise, Idaho 83720 208-327-7000 http://bit.ly/orPmFU Illinois 320 West Washington St. Springfield, IL 62786 217-785 -0820 http://www.idfpr.com/ Indiana 402 W. Washington St. #W072 Indianapolis, IN 46204 317-233-0800 http://www.in.gov/pla/ Iowa 400 SW 8th St., Suite C Des Moines, IA 50309 515-281-6641 http://medicalboard.iowa.gov/ Kansas 800 SW Jackson, Lower Level, Suite A Topeka, KS 66612 785-296-7413 http://www.ksbha.org/ Kentucky 310 Whittington Pkwy., Suite 1B Louisville, KY 40222 502-429-7150 http://kbml.ky.gov/default.htm

Louisiana LSBME P.O. Box 30250 New Orleans, LA 70190 504-568-6820 http://www.lsbme.la.gov/ Maine 161 Capitol Street 137 State House Station Augusta, ME 04333 207-287-3601 http://www.docboard.org/me/me_ home.htm Maryland 4201 Patterson Ave. Baltimore, MD 21215 (410)764-4777 http://www.mbp.state.md.us/ Massachusetts 200 Harvard Mill Sq., Suite 330 Wakefield, MA 01880 781-876-8200 http://www.mass.gov Michigan Bureau of Health Professions P.O. Box 30670 Lansing, MI 48909 517-335-0918 http://www.michigan.gov/lara Minnesota University Park Plaza 2829 University Ave. SE, Suite 500 Minneapolis, MN 55414 612-617-2130 http://bit.ly/pAFXGq Mississippi 1867 Crane Ridge Drive, Suite 200-B Jackson, MS 39216 601-987-3079 http://www.msbml.state.ms.us/ Missouri Missouri Division of Professional Registration 3605 Missouri Blvd.

P.O. Box 1335 Jefferson City, MO 65102 573-751-0293 http://pr.mo.gov/

Montana 301 S. Park Ave. #430 Helena, MT 59601 406-841-2300 http://bit.ly/obJm7J p

North Dakota 418 E. Broadway Ave., Suite 12 Bismarck, ND 58501 701-328-6500 http://www.ndbomex.com/

Nebraska Nebraska Department of Health and Human Services P.O. Box 95026 Lincoln, NE 68509 402-471-3121 http://www.hhs.state.ne.us/

Ohio 30 E. Broad St., 3rd Floor Columbus, OH 43215 614-466-3934 http://med.ohio.gov/

Nevada Board of Medical Examiners P.O. Box 7238 Reno, NV 89510 775-688-2559 http://www.medboard.nv.gov/ New Hampshire New Hampshire State Board of Medicine 2 Industrial Park Dr. #8 Concord, NH 03301 603-271-1203 http://www.nh.gov/medicine/ New Jersey P. O. Box 360 Trenton, NJ 08625 609-292-7837 http://www.state.nj.us/lps/ca/bme/index. html New Mexico 2055 S. Pacheco St. Building 400 Santa Fe, NM 87505 505-476-7220 http://www.nmmb.state.nm.us/ New York Office of the Professions State Education Building, 2nd Floor Albany, NY 12234 518-474-3817 http://www.op.nysed.gov/ North Carolina P.O. Box 20007 Raleigh, NC 27619 919-326-1100 http://www.ncmedboard.org/

Oklahoma P.O. Box 18256 Oklahoma City, OK 73154 405-962-1400 http://www.okmedicalboard.org/ Oregon 1500 SW 1st Ave., Suite 620 Portland, OR 97201 971-673-2700 http://www.oregon.gov/OMB/ Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 717-787-8503 http://bit.ly/havKVj

Texas P.O. Box 2018 Austin, TX 78768 512-305-7010 http://www.tmb.state.tx.us/agency/ contact.php Utah P.O. Box 146741 Salt Lake City, UT 84114 801-530-6628 http://www.dopl.utah.gov/ Vermont P.O. Box 70 Burlington, VT 05402 802-657-4220 http://healthvermont.gov/hc/med_ board/bmp.aspx Virginia Virginia Dept. of Health Professions Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 804)-367-4400 http://www.dhp.virginia.gov/About/ contact.htm

Rhode Island 3 Capitol Hill Providence, RI 02908 401-222-5960 http://www.health.ri.gov/partners/ boards/medicallicensureanddiscipline/

Washington Public Health Systems Development Washington State Department of Health 101 Israel Rd. SE, MS 47890 Tumwater, WA 98501 360-236-4085 http://www.doh.wa.gov/PHIP/default.htm

South Carolina P.O. Box 11289 Columbia, SC 29211 803-896-4500 http://www.llr.state.sc.us/pol/medical/

West Virginia 101 Dee Dr., Suite 103 Charleston, WV 25311 304-558-2921 http://www.wvbom.wv.gov/

South Dakota 101 N. Main Ave. Suite 301 Sioux Falls, SD 57104 605-367-7781 http://www.sdbmoe.gov/

Wisconsin P.O. Box 8935 Madison, WI 53708 877-617-1565 http://drl.wi.gov/section. asp?linkid=6&locid=0

Tennessee 425 5th Ave. North Cordell Hull Bldg. 3rd Floor Nashville, TN 37243 615-741-3111 http://health.state.tn.us/

Wyoming 320 W. 25th St., Suite 200 Cheyenne, WY 82002 307-778-7053 http://wyomedboard.state.wy.us/

medical resource guide

ADVERTISING 1-800-Urgent-Care

6881 Maple Creek Blvd Suite 100 West Bloomfield, MI 48322-4559 248-819-6838 www.ringringllc.com

Find Urgent Care

PO Box 15130 Scottsdale, AZ 85267 602-370-0303 www.findurgentcare.com

NextGen

Mediserv

6451 Brentwood Stair Rd. Ft. Worth, TX 76112 800-378-4134 www.mediservltd.com

Practice Velocity

1673 Belvidere Road Belvidere, IL 61008 888-357-4209 www.practicevelocity.com 501 Silverside Rd. Wilmington, DE 19809 302-351-3690

VIP Billing

PO Box 1350 Forney, TX 75126 214-499-3440 www.vipbilling.com

BILLING & COLLECTION Advanced Physician Billing, LLC

PO Box 730 Fishers, IN 46038 866-459-4579 www.advancedphysicianbillingllc.com

Ajishra Technology Support

3562 Habersham at Northlake, Bldg J Tucker, GA 30084 866-473-0011 www.ajishra.com

Applied Medical Services

4220 NC Hwy 55, Suite 130B Durham, NC 27713 919-477-5152 www.ams-nc.com

Axiom Business Solutions

4704 E. Trindle Rd. Mechanicsburg, PA 17050 866-517-0466 www.axiom-biz.com

Frost Arnett

480 James Robertson Parkway Nashville, TN 37219 800-264-7156 www.frostarnett.com

Horizon Billing Specialists

4635 44th St., Suite C150 Kentwood, MI 49512 800-378-9991 www.horizonbilling.com 50| DECEMBER 2011

Synapse Medical Management 18436 Hawthorne Blvd. #201 Torrance, CA 90504 310-895-7143 www.synapsemgmt.com

COMPUTER, SOFTWARE www.medisweans.com

www.medmedia9.com

www.nextgen.com

Sweans Technologies

MedMedia9

PO Box 98313 Raleigh, NC 27624 919-747-9031

200 Welsh Rd. Horsham, PA 19044 215-657-7010

CONSULTING SERVICES, PRACTICE MANAGEMENT

CDWG 300 N. Milwaukee Ave Vernon Hills, IL 60061 866-782-4239

Instant Medical History 4840 Forest Drive #349 Columbia, SC 29206 803-796-7980 www.medicalhistory.com

DENTAL Manage My Practice 103 Carpenter Brook Dr. Cary, NC 27519 919-234-4880 www.managemypractice.com

myEMRchoice.com 24 Cherry Lane Doylestown, PA 18901 888-348-1170 www.myemrchoice.com

Urgent Care America 17595 S. Tamiami Trail Fort Meyers, FL 33908 239-415-3222 www.urgentcareamerica.com

Medical Practice Listings 8317 Six Forks Rd. Suite #205 Raleigh, NC 27624 919-848-4202 www.medicalpracticelistings.com

Laboratory Management Resources 3729 Greene’s crossing Greensboro, NC 27410 336-288-9823 www.managemypractice.com

Biomet 3i

4555 Riverside Dr. Palm Beach Gardens, FL 33410 800-342-5454 www.biomet3i.com

Dental Management Club

4924 Balboa Blvd #460 Encino, CA 91316 www.dentalmanagementclub.com

The Dental Box Company, Inc. PO Box 101430 Pittsburgh, PA 15237 412-364-8712

www.thedentalbox.com

Dentistry’s Business Secrets

9016 Phoenix Parkway O’Fallon, MO 63368 636-561-5445 www.dentrysbusinesssecrets.com

Modern Dental Marketing Practices

504 N. Oak St. #6 Roanoke, TX 76262 940-395-5115 www.moderndentalmarketing.com

medical resource guide

ELECTRONIC MED. RECORDS ABELSoft 1207 Delaware Ave. #433 Buffalo, NY 14209 800-267-2235 www.abelmedicalsoftware.com

Carolina Liquid Chemistries, Inc.

Wood Insurance Group

4835 East Cactus Rd. #440 Scottsdale, AZ 85254-3544 602-230-8200 www.woodinsurancegroup.com

391 Technology Way Winston Salem, NC 27101 336-722-8910 www.carolinachemistries.com

Dicom Solutions

LOCUM TENENS

548 Wald Irvine, CA 92618 800-377-2617

www.dicomsolutions.com

Physician Solutions

Acentec, Inc 17815 Sky Park Circle , Suite J Irvine, CA 92614 949-474-7774 www.acentec.com

PO Box 98313 Raleigh, NC 27624 919-845-0054 www.physiciansolutions.com

MEDICAL ART

AdvanceMD 10011 S. Centennial Pkwy Sandy, UT 84070 800-825-0224 www.amdsoftware.com

CollaborateMD 201 E. Pine St. #1310 Orlando, FL 32801 888-348-8457 www.collaboratemd.com

Sigmon Daknis Wealth Management 701 Town Center Dr. Ste. #104 Newport News, VA 23606 757-223-5902 www.sigmondaknis.com

Deborah Brenner

877 Island Ave #315 San Diego, CA 92101 619-818-4714 www.deborahbrenner.com Martha Petty 316 Burlage Circle Chapel Hill, NC 27514 919-933-4920

INSURANCE, MED. LIABILITY Medical Protective 5814 Reed Rd. Fort Wayne, In 46835 800-463-3776

ALLPRO Imaging

1295 Walt Whitman Road Melville, NY 11747 888-862-4050 www.allproimaging.com

105 Windermere Ave. Ellington, CT 06029 860-875-2460

Professional Medical Insurance Services

16800 Greenspoint Park Drive Houston, TX 77060 877-583-5510 www.promedins.com

www.biosite.com

www.aruplab.com

Clinical Reference Laboratory 8433 Quivira Rd. Lenexa, KS 66215 800-445-6917

www.crlcorp.com

507 N. Lindsay St. 2nd Floor High Point, NC 27262 www.Petersmedicalresearch.com

PRACTICE VALUATIONS www.brymill.com

BizScore

Cryopen

800 Shoreline, #900 Corpus Christi, TX 78401 888-246-3928

500 Chipeta Way Salt Lake City, UT 84108 800-242-2787

Peters Medical Research

Brymill Cryogenic Systems www.mgis.com

8317 Six Forks Rd. Ste #205 Raleigh, NC 27624 919-848-4202 www.medicalpracticelistings.com

Arup Laboratories www.piccoloxpress.com

9975 Summers Ridge Road San Diego, CA 92121 858-805-8378

1849 W. North Temple Salt Lake City, UT 84116 800-969-6447

MEDICAL PRACTICE SALES

MEDICAL RESEARCH

Abaxis

Biosite, Inc

MGIS, Inc.

9115 Hague Rd. PO Box 50457 Indianapolis, IN 46250-0457 317-521-2000 www.roche-diagnostics.us

Medical Practice Listings

MEDICAL EQUIPMENT

3240 Whipple Road Union City, CA 94587 800-822-2947

524 Huffman Rd. Birmingham, AL 35215 866-324-9700 www.radicalradiology.com

Roche Diagnostics

www.marthapetty.com

FINANCIAL CONSULTANTS

Radical Radiology

www.cryopen.com

PO Box 99488 Raleigh, NC 27624 919-846-4747 www.bizscorevaluation.com MEDMONTHLY.COM |51

Buying or selling? We can help!

Listing Benefits • • • • •

Buying Benefits

Maintain confidentiality Professional representation National and regional marketing Maximize your practice value BizScore Valuation assessment

• Accurate practice pricing • Detailed reports and financials • Largest selection of health care facilities • Work one-on-one with an experienced team of qualified professionals

Medical Practice Listings Scan this QR code with your smartphone to learn more

A Philip Driver Company

medicalpracticelistings.com

classified listings

Classified To place a classified ad, call 919.747.9031

Physicians needed

Physicians needed

North Carolina

North Carolina (cont.)

Occupation Health Care Practice located in Greensboro, N.C. has an immediate opening for a primary care physician. This is 40 hours per week opportunity with a base salary of $135,000 plus incentives, professional liability insurance and an excellent CME, vacation and sick leave package. Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, E-mail: physiciansolutions@gmail.com

setting for an enhanced lifestyle. There is no hospital call or invasive procedures. Look into joining this three physician facility and live the good live in one of North Carolina’s most beautiful cities. Send copies of your CV, N.C. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, E-mail: physiciansolutions@gmail.com

Family Practice physician opportunity in Raleigh, N.C. This is a locum’s position with three to four shifts per week requirement that will last for several months. You must be BC/BE and comfortable treating patients from 1 year of age to geriatrics. You will be surrounded by an exceptional, experienced staff with beautiful offices and accommodations. No call or hospital rounds. Send copies of your CV, N.C. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, E-mail: physiciansolutions@gmail.com Methadone Treatment Center located near Charlotte, N.C. has an opening for an experienced physician.

You must be comfortable in the evaluation and treatment within the guidelines of a highly regulated environment. Practice operating hours are 6 a.m. till 3 p.m.

Monday through Friday. Send copies of your CV, N.C. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, E-mail: physiciansolutions@gmail.com Family Practice physician is needed to cover several shifts per week in Rocky Mount, N.C. This high profile practice treats pediatrics, women’s health and primary care patients of all ages. If you are available for 30 plus hours per week for the remainder of the year, this could be the perfect opportunity. Send copies of your CV, N.C. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, E-mail: physiciansolutions@gmail.com Cardiology practice located in High Point, N.C. has an opening for a Board Certified Cardiovascular physician.

This established and beautiful facility offers the ideal

Board Certified Internal Medicine Physician position is available in the Greensboro, N.C. area. This is an outpatient opportunity within a large established practice. The employment package contains salary plus incentives. Please send a copy of your current CV, N.C. medical license, DEA certificate and NPI certificate with number along with your detailed work history and CME courses completed to: Physician Solutions, P.O. Box 98313, Raleigh, NC 27624. Email: physiciansolutions@ gmail.com or phone with any questions, PH: (919) 8450054.

Locum Tenens opportunity for Primary Care MD in the Triad Area, N.C. This is a 40 hour per week on-going assignment in a fast pace established practice. You must be comfortable treating pediatrics to geriatrics. We pay top wage, provide professional liability insurance, lodging when necessary, mileage and exceptional opportunities. Please send a copy of your current CV, North Carolina medical license, DEA certificate and NPI certificate with number along with your detailed work history and CME courses completed to: Physician Solutions, P.O. Box 98313, Raleigh, NC 27624. E-mail: physiciansolutions@gmail.com or phone with any questions, PH: (919) 845-0054.

Internal Medicine practice located in High Point, N.C., has two full time positions available. This well-established practice treats private pay as well as Medicare/ Medicaid patients. There is no call or rounds associated with this opportunity. If you consider yourself a wellrounded IM physician and enjoy a team environment, this could be your job. You would be required to live in or around High Point and if relocating is required, a moving package will be extended as part of your salary and incentive package. BC/BE MD should forward your CV, and copy of your N.C. medical license to physiciansolutions@gmail.com View this and other exceptional physician opportunities at www.physiciansolutions.com or call (919) 845-0054 to discuss your availability and options.

MEDMONTHLY.COM |53

Hospice Practice Wanted Hospice Practice wanted in Raleigh/ Durham area of North Carolina.

Hospi

To find out more information call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com

EXCELLENT FAMILY PRACTICE FOR SALE North Carolina family practice located about 30 minutes from Lake Norman has everything going for it.

For more information call (919) 848-4202. To view other practice listings visit medicalpracticelistings.com

Gross revenues in 2010 were 1.5 million, and there is even more upside. The retiring physician is willing to continue to practice for several months while the new owner gets established.

Excellent medical equipment, staff and hospital near-by, you will be hard pressed to find a family practice turning out these numbers.

Listing price is $625,000.

54| DECEMBER 2011

e in Dall ce Practic

as, TX

We have a qualified buyer that is looking for an established hospice practice in the Dallas,Texas area.

To review your hospice practice options confidentially, contact Medical Practice Listings at 919-848-4202 or e-mail us at medlistings@gmail.com.

Medical Practice Listings has a qualified physician buyer that is ready to purchase. If you are considering your hospice practice options, contact us for a confidential discussion regarding your practice.

Medical Practice Listings

: d e t Wan

To view our national listings visit www.medicalpracticelistings.com

Wanted: Urgent Care Practice Urgent Care Practice wanted in North Carolina.

Qualified physician is seeking to purchase an established urgent care within 100 miles of Raleigh, North Carolina.

If you are considering retiring, relocations or closing your practice for personal reasons, contact us for a confidential discussion regarding your urgent care. You will receive cash at closing and not be required to carry a note.

Medical Practice Listings Buying and selling made easy

Call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com

Classified To place a classified ad, call 919.747.9031

Physicians needed

Practice sales

North Carolina (cont.)

North Carolina

Locum Tenens Primary Care Physicians Needed If you would like the flexibility and exceptional pay associated with locums, we have immediate opportunities in family, urgent care, pediatric, occupational health and county health departments in North Carolina and Virginia. Call today to discuss your options and see why Physician Solutions has been the premier physician staffing company on the Eastern seaboard. Call 919-845-0054 or review our corporate capabilities at www.physiciansolutions.com

Virginia

Urgent Care opportunities throughout Virginia. We have contracts with numerous facilities and eight to 14-hour shifts are available. If you have experience treating patients from Pediatrics to Geriatrics, we welcome your inquires. Send copies of your CV, Va. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, E-mail: physiciansolutions@gmail.com Pediatric Locums Physician needed in Harrisonburg, Danville and Lynchburg, Va. These locum positions require 30 to 40 hours per week, on-going. If you are seeking a beautiful climate and flexibility with your schedule, please consider one of these opportunities. Send copies of your CV, Va. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, E-mail: physiciansolutions@gmail.com

Impressive Internal Medicine Practice in Durham, N.C.: The City of Medicine. Over 20 years serving the community, this practice is now listed for sale. There are four well equipped exam rooms, new computer equipment and a solid patient following. The owner is retiring and willing to continue with the new owner for a few months to assist with a smooth transition. Contact Medical Practice Listings at (919) 848-4202 for more information. View additional listings at: www.medicalpracticelistings.com Modern Vein Care Practice located in the mountains of N.C. Booking seven to 10 procedures per day, you will find this impressive vein practice attractive in many ways.

Housed in the same practice building with an Internal Medicine, you will enjoy the referrals from this as well as other primary care and specialties in the community. We have this practice listed for $295,000 which includes charts, equipment and good will. Contact Medical Practice Listings at (919) 848-4202 for more information. View additional listings at: www.medicalpracticelistings.com Family Practice located in Hickory, N.C. Well established and a solid 40 to 55 patients split between an M.D. and physician assistant. Experienced staff and outstanding medical equipment. Gross revenues average $1,500,000 with strong profits. Monthly practice rent is only $3,000 and the utilities are very reasonable. The practice with all equipment, charts and good will are priced at $625,000.

Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or E-mail: medlistings@gmail.com

MEDICAL PRACTICE LISTINGS Are you looking to sell or buy a practice? We can help you!

View national practice listings by visiting our website or contact us for a confidential discussion regarding your practice options. We are always ready to assist you.

919.848.4202 medlistings@gmail.com | medicalpracticelistings.com in-house practice experts and attorney MEDMONTHLY.COM | 55

Classified To place a classified ad, call 919.747.9031

Practice for sale

Practice for sale

North Carolina (cont.)

South Carolina (cont.)

Internal Medicine Practice located just outside Fayetteville, N.C. is now being offered. The owning physician is retiring and is willing to continue working for the new owner for a month or two assisting with a smooth transaction.

The practice treats patients four and a half days per week with no call or hospital rounds. The schedule accommodates 35 patients per day. You will be hard pressed to find a more beautiful practice that is modern, tastefully decorated and well appointed with vibrant art work. The practice, patient charts, equipment and good will is being offered for $415,000 while the free standing building is being offered for $635,000. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or E-mail: medlistings@gmail.com

you want. Physician will to stay on for smooth transition.

Hospital support is also an option for up to a year. The listing price is $395,000 for the practice, charts, equipment and good will. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or E-mail: medlistings@gmail.com

Primary Care practice specializing in women’s care. The owning female physician is willing to continue with the practice for a reasonable time to assist with smooth ownership transfer. The patient load is 35 to 40 patients per day, however that could double with a second provider.

Exceptional cash flow and profitable practice that will surprise even the most optimistic practice seeker. This is a remarkable opportunity to purchase a well-established woman’s practice. Spacious practice with several wellappointed exam rooms throughout. New computers and medical management software add to this modern front desk environment. This practice is being offered for $435,000. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or E-mail: medlistings@ gmail.com

South Carolina Lucrative E.N.T. practice with room for growth, located three miles from the beach. Physician’s assistant, audiologist, esthetician and well-trained staff. Electronic medical records, mirror imaging system, established patient and referral base, hearing aids and balance testing, esthetic services and Candela laser. All aspects of otolaryngology, busy skin cancer practice, established referral base for reconstructive eyelid surgery, Botox and facial fillers. All new surgical equipment, image-guidance sinus surgery, balloon sinuplasty, nerve monitor for ear/parotid/ thyroid surgery. Room for establishing allergy, cosmetics, laryngology and trans-nasal esophagoscopy. All the organization is done; walk into a ready-made practice as your own boss and make the changes you want, when 56| DECEMBER 2011

Practice wanted North Carolina Pediatric Practice wanted in Raleigh, N.C. Medical Practice Listings has a qualified buyer for a Pediatric Practice in Raleigh, Cary or surrounding area. If you are retiring, relocating or considering your options as a pediatric practice owner, contact us and review your options. Medical Practice Listings is the leading seller of practices in the U.S. When you list with us, your practice receives exceptional national, regional and local exposure. Contact us today at (919) 848-4202.

Wanted: Classified ads for Med Monthly!

Call our Advertising Department today to find out about all the advertising opportunities available with Med Monthly.

919.747.9031 Visit us online anytime at

medmonthly.com

Pediatrics Practice For Sale Minneapolis, MN

Practice at the beach Plastic Surgery practice for sale with lucrative E.N.T. specialty Myrtle Beach, South Carolina Practice for sale with room for growth and located only three miles from the beach. Physician’s assistant, audiologist, esthetician and well-trained staff. Electronic medical records, Mirror imaging system, established patient and referral base, hearing aids and balance testing, esthetic services and Candela laser. All aspects of Otolaryngology, busy skin cancer practice, established referral base for reconstructive eyelid surgery, Botox and facial fillers. All new surgical equipment, image-guidance sinus surgery, balloon sinuplasty, nerve monitor for ear/parotid/thyroid surgery. Room for establishing Allergy, Cosmetics, Laryngology & Trans-nasal Esophagoscopy. All the organization is done, walk into a ready made practice as your own boss and make the changes you want, when you want. Physician will to stay on for smooth transition. Hospital support also an option for up to a year. The listing price is $395,000.

For more information call Medical Practice Listing at (919) 848-4202. To view our other listings, visit medicalpracticelistings.com.

MD STAFFING AGENCY FOR SALE Great opportunity for anyone who wants to purchase an established business.  One of the oldest Locums companies  Large client list  Dozens of MDs under contract  Executive office setting  Modern computers and equipment  Revenue over a million per year  Owner retiring  List price is over $2 million

Please direct all correspondence to mdstaffingforsale@gmail.com.

Only serious, qualified inquirers.

Located in the beautiful suburbs of Minneapolis, MN, this two year old pediatric practice is successful and growing steadily.

Averaging 14 patients per day and projected numbers top 35 per day within a short few months. Contracts have been established with Blue Cross Blue Shield of Minnesota, HealthPartners, Medica, PreferredOne, UCare, Minnesota Medicaid, and America’s PTO. Providers include one MD, one LPN and two CMAs. Fully equipped with modern computer networking in this 3,370 sq. foot leased medical space. Contact Medical Practice Listings for more information.

Medical Practice Listings 919.848.4202 | medlistings@gmail.com www.medicalpracticelistings.com

PRACTICE FOR SALE

OCCUPATIONAL HEALTH CARE PRACTICE FOR SALE Greensboro, North Carolina Well-established practice serving the Greensboro and High Point areas for over 15 years. Five exam rooms fully equipped, plus digital X-Ray. Extensive corporate accounts as well as walk-in traffic. Lab equipment includes CBC. The owning MD is retiring, creating an excellent opportunity for a MD to take over an existing patient base and treat 25 plus patients per day from day one. The practice space is 2,375 sq. feet. This is an exceptionally opportunity. Leased equipment includes: X-Ray $835 per month, copier $127 per month, and CBC $200 per month. Call Medical Practice Listings at (919) 848-4202 for more information.

Asking price: $385,000

To view more listings visit us online at medicalpracticelistings.com

MEDMONTHLY.COM |57

Primary Care Practice For Sale

Exceptional North Carolina Primary Care Practice for Sale

Medical Practice Listings

Established North Carolina Primary Care practice only 15 minutes from Fayetteville, 30 minutes from Pinehurst, 1 hour from Raleigh, 15 minutes from Lumberton and about an hour from Wilmington. The population within 1 hour of this beautiful practice is over one million. The owning physician is retiring and the new owner will benefit from his exceptional health care, loyal patient following, professional decorating, beautiful and modern free standing medical building with experienced staff. The gross revenue for 2010 is $856,000, and the practice is very profitable.

We have this practice listed for $415,000. Call today for more details and information regarding the medical building.

Our Services: • Primary Health • Well Child Health Exams • Sport Physical • Adult Health Exams • Women’s Health Exams • Management of Contraception • DOT Health Exam • Treatment & Management of Medical Conditions • Counseling on Prevention of Preventable Diseases • Counseling on Mental Health • Minor surgical Procedures

919.848.4202 | medlistings@gmail.com www.medicalpracticelistings.com

For more information call Medical Practice Listing at (919) 848-4202.

To view our other listings, visit medicalpracticelistings.com.

Wilmington, N.C. Established primary care on the coast of North Carolina’s beautiful beaches.

Fully staffed with MD’s and PA’s to treat both appointment and walk-in patients.

Excellent exam room layout, equipment and visibility.

Contact Medical Practice Listings for more information.

Private Medical and Mental Health Care Practice for Sale Coastal North Carolina, Minutes from Atlantic Beach

Established private internal medicine practice treating general as well as adolescent patients and licensed clinical psychologist’s combine for a high profile multi-disciplinary practice. The staff includes a medical doctor, physician assistant, three licensed clinical psychologists, and a complement of nurses and administrators. The internal medicine practice also uses locum physicians to treat primary care patients as needed.

Excellent gross income with solid profits are enjoyed in this evergrowing practice located in a bustling community with handsome demographics. Two all brick condominiums house these practices which are offered for lease or purchase.

This expanded services private health care facility has a solid following and all the tools necessary for enhanced services, income and expansion.

For more details which include a BizScore Practice Valuation, financial statements, patient demographics and furniture and equipment details, contact one of our professionals.

Medical Practice Listings PH: (919) 848-4202 Email: medlistings@gmail.com www.medicalpracticelistings.com 58| DECEMBER 2011

N.C. MedSpa For Sale MedSpa Located in North Carolina We have recently listed a MedSpa in N.C. This established practice has staff MDs, PAs and Nurses to assist patients. Some of the procedures performed include: Botox, Dysport, Restylane, Perian, Juvederm, Radiesse, IPL Photoreju Venation, Fractional Laser Resurfacing as well as customized facials. There are too many procedures to mention in this very upscale practice. The qualified buyer will be impressed with the $900,000 gross revenue. This is a new listing, and we are in the valuation process.

Med Monthly Med Monthly is the premier health care magazine for medical professionals.

By placing an ad in Med Monthly you’ll reach: family medicine, internal medicine, physician assistants and more!

Call us today to place your classified!

919.747.9031

Contact Medical Practice Listings today to discuss the practice details.

For more information call Medical Practice Listings at 919-848-4202 or e-mail medlistings@gmail.com.

Also available online 24/7

medmonthly.com

www.medicalpracticelistings.com

Pediatrics Practice Wanted

Practice for Sale in Raleigh, NC

Pediatrics Practice wanted in N.C.

Primary Care practice specializing in Women’s care

Considering your options regarding your Pediatric Practice? We can help.

Medical Practice Listings has a well qualified buyer for a Pediatric Practice anywhere in central North Carolina.

Raleigh, North Carolina The owning female physician is willing to continue with the practice for a reasonable time to assist with smooth ownership transfer. The patient load is 35 to 40 patients per day, however, that could double with a second provider. Exceptional cash flow and profitable practice that will surprise even the most optimistic practice seeker. This is a remarkable opportunity to purchase a well-established woman’s practice.

Spacious practice with several well-appointed exam rooms, tactful and well appointed throughout. New computers and medical management software add to this modern front desk environment.

Contact us today to discuss your options confidentially.

List price: $435,000.

Medical Practice Listings Call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com

Call Medical Practice Listings at (919) 848-4202 for details and view our other listings at www.medicalpracticelistings.com

MEDMONTHLY.COM |59

Attending a few continuing medical education seminars throughout the year can help you, and your staff, stay abreast of industry news and issues – not to mention allow you to take some time off from seeing patients!

December’s 9 List features a few of next year’s educational opportunities for primary care providers that offer quality instruction, plus travel perks.

NEW YORK CITY Primary Care Update: A Review of Common Clinical Problems. Dec. 29-31, 2012 at the in Westin Hotel in Times Square. http://bit.ly/rRiwdi

7

GREAT SMOKEY MOUNTAINS NATIONAL PARK Neurological Update and Managing Depression in a Primary Care Setting. July 19-20, 2012 at the Smokey Mountains Conference Center in Pigeon Forge, Tennessee http://bit.ly/sspKqG

Compiled by Leigh Ann Simpson

LAS VEGAS HIMSS12 Annual Conference & Exhibition. Feb. 20 – 24, 2012 at the Venetian Sands Expo Center www.himssconference. org/

2

SAN DIEGO 9th Annual Primary Care Summer Conference. Aug. 3-5, 2012 at the Hyatt Regency Mission Bay. http://bit.ly/unYSb9

3

KIAWAH ISLAND, SOUTH CAROLINA 20th Annual Primary Care Continuing Education. Conference July 2- 6, 2012 at the Kiawah Island Golf Resort. http://bit.ly/rY9Kq6

60 | DECEMBER 2011

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SAN JOSE, CALIFORNIA ATA 2012 - American Telemedicine International Meeting and Expo. April 29-May 1, 2012 at the San Jose McEnry Convention Center. http:// bit.ly/ndIUrr

FT. LAUDERDALE, FLORIDA 3rd Annual Health Care Reform Conference. Oct. 24-25 at the Westin Diplomatic Resort & Spa. www.healthcarereformconference.com/ SONOMA, CALIFORNIA Adult Infectious Diseases: Evidence Based Primary Prevention and Treatment.

Oct. 25-27, 2012 at the Fairmont Mission Inn Resort and Spa. http://bit.ly/rp59BU

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PARADISE ISLAND, BAHAMAS Women’s Health for the Primary Care Provider. March 12-14, 2012 at the Atlantis Resort http://bit.ly/vkURdu

PHOTO OF NYC COURTESY ANGELA POWELL. BAHAMAS: ROBERT LINDER,FLORIDA: GREGG STRATTON, SAN JOSE: CHRISTOPHER BRUNO, DICE: KATINKA KOBER

the top

CME seminars to look forward to in 2012

GROW YOUR PRACTICE

Let MedMedia9 expert designers create a website for your practce. Need more? We can also create print collateral to help your practice grow.

Scan this QR code with your smartphone to learn more.

MEDMEDIA9.COM | 919-747-9031

IMAGINE THAT!