Med Monthly April 2013

Med Monthly APRIL 2013

Free Samples to Patients and Office Calls to Physicians

STILL MAJOR PART OF PHARMACEUTICAL ADVERTISING pg. 10

POINT OF CARE DISPENSING –

How It Can Benefit Your Practice pg. 42

Prevention Efforts FOCUSED ON YOUTH

REDUCE

Prescription Abuse

Into Adulthood pg. 44

the

tions Prescrip

issue

ARE E-PRESCRIPTIONS RIGHT FOR YOUR PRACTICE?

Pg. 48

contents

features

51

42 POINT OF CARE DISPENSING: How It Can Benefit Your Practice 44 PREVENTION EFFORTS FOCUSED ON YOUTH REDUCE PRESCRIPTION ABUSE INTO ADULTHOOD 48 ARE E-PRESCRIPTIONS RIGHT FOR YOUR PRACTICE?

insight 10 OFFICE CALLS TO PHYSICIANS STILL MAJOR PART OF PHARMACEUTICAL ADVERTISING 12 GLOBAL SURVEY SHEDS LIGHT ON PATIENT SAFETY CHALLENGES IN NURSING

RETIRED CLINICAL PHARMACIST FINDS HIS MONTANA MUSE

international 24 EUROPEAN MOLECULAR BIOLOGY LABORATORY: Innovative Strategy Pinpoints Genes Underlying Cardiovascular Disease Risk

research and technology 26 EHR TECHNOLOGY ADVANCEMENTS: Moving Health Care Forward 28 YOU IMAGINE - Dental Apps That Kick, Part 2

16 THE PHYSICIANS FOUNDATION AWARDS MORE THAN $1.5 MILLION IN PHYSICIAN LEADERSHIP GRANTS

34 TRINSIC ANIMATION PRESENTS FLOCKING IN THE MEDICAL ANIMATION CONTEXT

practice tips

legal

18 NEW IN-OFFICE SOLUTION ENABLES PHYSICIANS TO CAPTURE PATIENT REVIEWS AT THE POINT OF SERVICE

36 FEDERAL LEGISLATION TO PREVENT PRESCRIPTION DRUG ABUSE INTRODUCED TO SENATE

20 PA PRESCRIBER CREDENTIALING AND PRESCRIBING: Medicaid Changes in NC 22 MEDICAL PRACTICE MARKETING: Implement Pricing Programs and Promotions the Right Way!

22

MEDICAL PRACTICE MARKETING:

38 DOCTORS CAUTION AGAINST PRESCRIBING ATTENTION-BOOSTING DRUGS TO HEALTHY KIDS 40 SEQUESTER WILL HIT EHR INCENTIVE PROGRAM

the art 51 DREW BODNER: Retired Clinical Pharmacist Finds His Montana Muse

healthy living 54 STRAWBERRY SPINACH SALAD

in every issue Implement Pricing Programs and Promotions the RIGHT WAY!

4 editor’s letter 8 news briefs

60 resource guide 76 top 9 list

editor’s letter

April’s issue of Med Monthly discusses prescription drugs.

From finding new ways to reduce errors in prescribing to increasing revenue by distributing medications directly from a practice, our articles shed new light on this area of medicine.

We also delve into the growing problem of prescription drug abuse among teens.

Our feature from the National Institutes of Health, “Prevention Efforts Focused on Youth Reduce Prescription Abuse Into Adulthood,” focuses on reducing prescription drug abuse among teens. Prescription and over the counter medicines are the number one way twelfth graders get high. The NIH’s studies show that middle and high school students are developmentally predisposed for addictive behavior, and that preventative efforts decrease long term risk factors.

If one electronic devise could save 7,000 lives a year in the US, would you consider using it in your practice? Thomas Hibbard’s “Are E-Prescriptions Right For Your Practice?” describes a system that would give medical staff the ability to send their prescriptions electronically. Everyone knows that most doctors’ handwriting is almost impossible to read; E-prescriptions reduces human error in filling prescriptions and provides other benefits such as increased adherence (which improves patient safety) and billions in savings over the next 10 years.

An even better way to handle prescriptions is Point of Care Pharmaceutical Dispensing. A practice can fill many prescriptions within its office with an average of $10 profit per bottle.

The reduction in staff time in contacting pharmacies is estimated to add $25,000 a year to the bottom line. Jeff Bugonian, author of “Point of Care Dispensing – How It Can Benefit Your Practice” discusses this very viable way to improve profits and increase patient compliance.

So enjoy our insight into how prescription drugs can affect your practice, patients and those who the drugs were not intended.

We look forward to Med Monthly’s May issue which pertains to “Your Practice Staff ”.

Ashley Austin Managing Editor

4 | APRIL 2013

Med Monthly April 2013

Publisher Philip Driver Managing Editor Ashley Austin Creative Director Thomas Hibbard Contributors Ashley Acornley, MS, RD, LDN Jeff Bugonian Joseph Conn Thomas Hibbard Laura Masske Frank J. Rosello Lisa Shock Marlee Ward Jessica Zigmond

contributors Ashley Acornley, RD, LDN holds a BS in Nutritional Sciences with a minor in Kinesiology from Penn State University. She completed her Dietetic Internship at Meredith College and recently completed her Master’s Degree in Nutrition. She is also an AFAA certified personal trainer. Her blog can be found at: ashleyfreshfromthefarm.wordpress.com

Laura Maaske is a medical illustrator with a Master's of Science degree in Biomedical Visualization from the University of Toronto. She launched Medimagery in 1997, specializing in the creation of patient education materials, interactive media, e-books, cellular and molecular illustrations, and design of medical education materials. For more information, please visit Medimagery.com, send a note to Laura@medimagery.com or call 262.308.1300.

Frank J. Rosello

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 medmonthly.com/writers-guidelines

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

Environmental Intelligence, LLC, is a complete, full-service healthcare IT solution provider. With a team having more than 10 years of proven clinical expertise in delivering end-to-end health IT solutions, Environmental Intelligence provides medical practices and facilities onsite expert IT consulting, installation, and implementation that is focused on physicians, their patients, and the quality of their care.

Lisa P. Shock, MHS, PA-C is a PA who has practiced in primary care and geriatrics. She enjoys parttime clinical practice and is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering services to help implement and improve the utilization of PAs and NPs in the health care system. Contact her with questions at lisa@pushpa.biz

MEDMONTHLY.COM |5

designer's thoughts From the Drawing Board Winston Churchill once said “Criticism may not be agreeable, but it is necessary. It fulfills the same function as pain in the human body. It calls attention to an unhealthy state of things.”

This applies to our first tech article on recording software for medical practices.

Imagine being able to have your patients review their office visit before they leave your practice. Digital Assent introduces the ReviewCatcher, the health care industry’s first in-office solution for capturing electronic ratings and reviews from patients. “We developed ReviewCatcher in direct response to requests from our physician customers,” said Andrew Ibbotson, founder and CEO of Digital Assent. “Every physician we work with is concerned about their online reputation, but they feel powerless in their ability to protect and proactively grow their online reputation. By creating an easy-to-use review capture solution, we enable physicians to privately capture feedback from patients before they leave the office.”

In the “Research and Technology” section of this month’s magazine, Trinsic Animation announces its new flocking technology for use in medical applications that records movement of large groups of individual cells including the flow of red blood cells through the circulatory system, stem cells as they move towards an attractant, RNA strand movement, and brain cell axon behavior. The applications for this technology are endless and exciting for future health care research.

Laura Maaske’s “YOU IMAGINE: Dental Apps That Kick” is the second part of her article exploring mobile apps for dentistry for both patients and dentists. In this issue she concludes her study of dental apps, with apps for dentists for easier record keeping, less paperwork, and the ability to transport dental charts electronically. She also discusses apps for patients who want to do some self exploring on dental questions, in terms they can understand and the ability to visually see the results of select dental procedures.

Tim O’Reilly, founder of O’Reilly Media states, “What new technology does is create new opportunities to do a job that customers want done.” Med Monthly will continue keeping you informed each month on what’s new in medical technology to assist in recognizing new and profitable health care opportunities for you and your patients.

Thomas Hibbard Creative Director

6 | APRIL 2013

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news briefs

PEOPLE WITH MEDICARE SAVE $5 BILLION ON PRESCRIPTION DRUGS BECAUSE OF HEALTH CARE LAW Health and Human Services Secretary Kathleen Sebelius announced that savings on prescription drugs made possible by the Affordable Care Act reached $5.1 billion. More than 5.8 million people with Medicare have benefited from the assistance the health care law provides with the Medicare prescription drug coverage gap known as the donut hole. In the first 10 months of 2012 alone, almost 2.8 million individuals have saved an average of $677 on prescription drugs. During the same period, about 23.4 million people with original Medicare received one or more preventive services at no cost to them, with 2.5 million having received an Annual Wellness Visit.

“The health care law is saving money for people with Medicare,” Secretary Sebelius said. “Everyone with Medicare should look at their health and drug plan options for additional value before the Medicare open enrollment period ends this week.”

For 2013 the health care law provides people with Medicare in the donut hole with greater savings, as discounts rise to 53 percent of the cost of brand name drugs and 21 percent of the cost of generic drugs. Savings on Medicare coverage of prescription drugs will gradually increase until 2020, when the donut hole will be closed.

Because of the health care law, people with Medicare can be healthier with free access (no deductible or co-pay) to many preventive services. Before 2011, people with Medicare had to pay part of the cost for many preventive services. Cost is no SOON longer a barrier for seniors who want to COMING stay healthy and treat problems early. In ONTHLY IN MED M 2011, an estimated 32.5 million people coming with original Medicare or Medicare In the up d issue, Me Advantage received one or more free May 2013 ill theme w preventive benefits.

Monthly’s ractice The Centers for Medicare & Medicaid be Your P Services (CMS) encourages people with Staff Medicare to enroll in high quality plans and get the most value for their premiums. Medicare health and prescription drug plans with 5 star ratings may continuously market and enroll beneficiaries throughout 2013. Medicare beneficiaries in consistently low performing plans (those receiving less than 3 star ratings for at least the past three years) have been notified about their plan’s poor performance and how they can switch to a higher quality plan.

CMS announced that individuals with Medicare who are affected by Hurricane Sandy and unable to make a plan selection by Dec. 7, 2012, can still enroll in health and prescription drug coverage for 2013 by calling 1-800-MEDICARE anytime, 24 hours a day, seven days a week.

People who are satisfied that their current coverage under original Medicare or a Medicare health or drug plan meets their needs for next year, do not need to take any action to continue their current coverage.  Source: http://www.hhs.gov/news/ press/2012pres/12/20121203a.html 8 | APRIL 2013

GOT DRUGS: NATIONAL TAKE-BACK INITIATIVE DEA Upcoming Take-Back Day — April 27, 2013 (10:00AM - 2:00PM) The Drug Enforcement Administration (DEA) has scheduled another National Prescription Drug Take-Back Day which will take place on Saturday, April 27, 2013, from 10:00 a.m. to 2:00 p.m. This is a great opportunity for those who missed the previous events, or who have subsequently accumulated unwanted, unused prescription drugs, to safely dispose of those medications.

In the four previous Take-Back events, DEA in conjunction with our state, local, and tribal law enforcement partners have collected more than 2 million pounds (1,018 tons) of prescription medications were removed from circulation.

The National Prescription Drug Take-Back Day aims to provide a safe, convenient, and responsible means of disposal, while also educating the general public about the potential for abuse of these medications.

Shortly after DEA’s first Take-Back Day event two years ago, Congress passed, and President Obama signed, the Secure and Responsible Drug Disposal Act of 2010, which amended the Controlled Substances Act (CSA), allowing DEA to develop permanent, ongoing, and responsible methods for disposal. Prior to the passage of the Disposal Act, the CSA provided no legal means for transferring possession of controlled substance medications from users to other individuals for disposal. On December 21, 2012, DEA published in the Federal Register a Notice of Proposed Rulemaking for Disposal of Controlled Substances. These regulations would implement the Secure and Responsible Drug Disposal Act of 2010 (Pub. L. 111-273) by expanding the options available to collect controlled substances from ultimate users for purposes of disposal to include: Take-Back events, mail-back programs, and collection receptacle locations.

However, until these regulations become permanent, DEA will continue to hold Take-Back Days.  http://www.deadiversion.usdoj.gov/drug_disposal/takeback/

Sequestration Cuts Cause Real Pain for Patients, Physicians “Our lawmakers have failed to act, and Medicare patients and physicians will now feel real pain in the form of new cuts that come at an already difficult time for the nation’s economy. A report released jointly by the American Medical Association, the American Hospital Association and the American Nurses Association found up to 766,000 health care and related jobs could be lost by 2021 as a result of the two percent cut in Medicare resulting from sequestration.

“The across-the-board cut will hit physicians particularly hard because of the fundamentally flawed Medicare physician payment system. Since 2001 Medicare payments for physician services have only increased by four percent, while the cost of caring for patients has gone up by more than 20 percent. A two percent cut widens the already enormous gap between what Medicare pays and the actual cost of caring for seniors.

“Physicians continue to face drastic cuts from the SGR, and an additional two percent cut coming from sequestration further threatens access to care for patients and prevents needed improvements in Medicare. Creating a larger gap between Medicare payment rates and the cost of delivering care will stifle innovation, reduce access to care and increase dysfunction within the Medicare program. At the same time that Medicare physician payment rates have been frozen, physicians need to make investments in their practices to help design, lead and adopt new models of care delivery that can increase quality and reduce costs now and in the future.

Further cuts are counterproductive and stifle important progress while placing an unsustainable burden on physician practices.” 

Source: http://www.ama-assn.org/ama/pub/ news/news/2013-03-01-statement-on-sequestration-cuts.page

MEDMONTHLY.COM |9

insight

Despite Improvement, Distribution of Free Samples to Patients and Office Calls to Physicians

STILL MAJOR PART OF

PHARMACEUTICAL ADVERTISING

10 | APRIL 2013

T

he pharmaceutical industry has pulled back on marketing to physicians and consumers, yet some enduring patterns persist.

According to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health, advertising peaked in 2004, with industry promotion to physicians declining nearly 25 percent by 2010, to $27.7 billion or 9 percent of sales. Similar declines were seen in direct-toconsumer advertising, which remains concentrated among a small number of products. The number of products promoted to providers peaked at over 3,000 in 2004, and declined by approximately 20 percent by 2010. Despite these changes, there was little change in the split of marketing between primary care physicians and specialists, and the proportion of all promotion taking place in physicians’ offices also remains unchanged. Free samples and physician detailing accounted for over 70 percent of promotional expenditures in 2010, with the remainder comprised by consumer advertising as well as physician marketing through journal ads, e-promotion and sponsored conferences and meetings. The results are featured in the February 2013 issue of the open-access journal PLOS ONE. “There have been important changes in the pharmaceutical marketplace during the past decade, including changes in the types of therapies being brought to market as well as an overall aging of the drugs with FDA approval,” said G. Caleb Alexander, MD, MS, senior author of the study and an associate professor with the Bloomberg School’s Department of Epidemiology and co-director of the Johns Hopkins Center for Drug Safety & Effectiveness. “Since pharmaceutical promotion can influence demand for drugs and affect physician prescribing, it is important to know how drugs are being marketed and promoted.”

Alexander, along with colleagues from the University of Chicago, the University of Pittsburgh, Massachusetts Institute of Technology and the National Bureau of Economic Research, analyzed annual data from 2001 through 2010 to examine inflation-adjusted total promotion spending for the pharmaceutical industry as a whole and for top-selling and top-promoted therapies. Expenditures were also broken down by type of promotion and, for physician detailing, by specialty.

The authors were surprised to find that, despite anecdotal reports and calls from professional societies, there was no substantial change in the amount of overall proportion of promotion taking place in physicians’ offices.

Lead author Rachel Kornfield describes, “There has been growing concern about the conflicts of interest introduced by physicians’ relationships with pharmaceutical companies, but the data show that physician detailing and the distribution of free samples is still the dominant form of drug promotion.”

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In addition, despite enthusiasm and publicity regarding new forms of marketing via the Internet and other electronic media, these channels accounted for a very small amount of overall marketing spending to providers - less than 2 percent over the decade examined. The authors found that the majority of marketing and promotion still takes place as it has in the past - through the distribution of free samples to patients and office calls to physicians.  Source: http://www.medicalnewstoday.com/releases/257198.php

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insight

12 | APRIL 2013

Global Survey Sheds Light on Patient Safety Challenges In Nursing

• Survey of 900 nurses in the U.S., UK and China by GE Healthcare and the American Nurses Association finds many nurses have witnessed errors and few call their own hospitals safe.

• Survey shows nurses feel responsible for patient safety, but heavy workload and poor communication increases risks.

• Non-punitive culture and access to technology for recording errors are highlighted as potential solutions.

When it comes to addressing patient safety issues within a hospital, nurses want to make a difference and they assign themselves great responsibility for safe outcomes. However, the question remains whether hospitals are doing everything they can in terms of keeping patients safe. According to a recent survey of nurses in the U.S., UK and China by GE Healthcare and the American Nurses Association, many nurses have witnessed errors and few call their own hospitals safe.

“Our goal in initiating this survey with the ANA was to get to the root causes of what is driving patient safety issues in today’s hospital, by surveying those who know the hospital best – nurses,” said Rob Reilly, Chief Marketing Officer, GE Healthcare, USCAN. “It is clear from the results of this survey that nurses place much of the responsibility of patient safety on their own shoulders. However, with the challenges facing today’s hospital, it is almost impossible for a nurse to shoulder this entire burden, and this survey provides valuable information on how we can work to improve the situation.”

Nurses cited workload, too many patients, time pressure and fatigue as factors leading to compromised safety. Additionally, nurses addressed access to technology, hospital culture and communication as the main barriers to patient safety.

Access to Technology 59% of nurses agree that although patient safety data is collected and reported, there is no followup or feedback given to the nurses. Three quarters (74%) of nurses name “technology/software” as a patient safety initiative that exists in their hospital and an additional 23% would like to see this in their health system. Nurses see technological innovation as key to identifying early warning signs of patient risk and alerting staff (68%) as well as improving the effectiveness of communication with regards to patient information in the hospital setting (67%).

“Through the survey we found a lot of information about the challenges facing today’s nurses including workloads, too many patients, time pressure, less than ideal nurse ratios and fatigue, but what we were also able to identify is some potential areas for improvement, with one significant area being technology to report errors,” said Reilly. “This survey is only one small part of the picture, and our efforts are one small part of a solution that involves continued on page 14 MEDMONTHLY.COM |13

continued from page 13

participation from the individual hospital on up to national programs like the Partnership for Patients. GE and ANA are committed to helping healthcare systems tackle some of their toughest challenges, including addressing patient safety concerns through innovative technologies, partnerships and cultural education.”

Culture According to the survey, nurses see themselves as having by far the most responsibility for patient safety (90%), over physicians (69%) or patient safety officers (60%). Nearly all (95%) nurses believe that it is extremely or very important that hospital leadership make patient safety a priority in creating an effective patient safety culture. The vast majority of nurses (85%) agree that their hospital has a patient safety culture, and 94% report that their hospitals have programs in place that promote patient safety.

Having a culture where nurses are not penalized for reporting errors or near misses is seen as important by 90% of nurses. However, 59% agree that nurses often hold back in reporting patient errors in fear of punishment [67% US, 62% UK, 49% China], and 62% agree that nurses often hold back in reporting near misses for that reason [69% US, 65% UK, 54% China].

However, it is questionable if these programs are meeting their objectives; only 41% of nurses describe the hospital they work in as “safe” and fewer than 6 in 10 (57%) believe the patient safety programs in their hospital are effective, resulting in a great opportunity for improvement in patient safety procedures.

Communication Among the most important aspects of creating an effective patient safety 14 | APRIL 2013

culture are communication with the patient and effective communication with the physicians. However, just 4 in 10 (37%) rate their hospital as excellent at communication with the patient and 31% say their hospital is excellent at communication between staff. Further, 33% name “poor communication among nurses at handoff ” as something that has increased the risk of patient safety incidences in their hospital in the past 12 months, and 31% say “poor communication with doctors” has also increased the risk of patient safety incidents.

“It’s no surprise that communication is a challenge for nurses today, given heavy patient loads and the time that they are able to spend on patient care is constantly decreasing,” said Cheryl Peterson, MSN, RN, director of nursing practice & policy of ANA. “Where we can help is increasing the quality of communication, and arming nurses and front-line staff with the information they need to effectively communicate on behalf of the patient.”  About the GE Healthcare Patient Safety Survey The GE Healthcare Patient Safety Study was conducted by research firm Edelman Berland as an online survey among a total of 900 practicing registered nurses (500 in the United States, 200 in the United Kingdom, and 200 in China). The survey took an average of 27 minutes to complete in the U.S., 30 minutes in the UK and 34 minutes in China. Total as represented in this study includes respondents from the U.S., UK and China, and the U.S. is weighted down so that each of the three countries is represented equally within that total. The margin of error is +/- 5 percent with a 95 percent confidence level.

Edelman Berland also conducted 14 in-depth interviews with nurses from a wide spectrum of facilities,

organizations and fields with similarly varied backgrounds with patient, teaching and administrative responsibilities. Interviews lasted between half an hour and an hour and were conducted between October 12 and November 4, 2011 in the U.S., the UK and China. Subjects were recruited with the assistance of GE, the American Nursing Association and the Royal College of Nurses.

About GE Healthcare GE Healthcare provides transformational medical technologies and services to meet the demand for increased access, enhanced quality and more affordable healthcare around the world. GE (NYSE: GE) works on things that matter - great people and technologies taking on tough challenges.

From medical imaging, software & IT, patient monitoring and diagnostics to drug discovery, biopharmaceutical manufacturing technologies and performance improvement solutions, GE Healthcare helps medical professionals deliver great healthcare to their patients. For more information about GE Healthcare, visit our website at www.gehealthcare.com.

About American Nurses Association The American Nurses Association (ANA) is the only full-service professional organization representing the interests of the nation’s 3.1 million registered nurses through its constituent and state nurses associations and its organizational affiliates. The ANA advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.

Source: http://www.pressreleasepoint. com/global-survey-sheds-light-patientsafety-challenges-nursing

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MEDMONTHLY.COM |15

insight

THE PHYSICIANS FOUNDATION Awards More Than $1.5 Million in Physician Leadership Grants

Funds Provide Management Skills Necessary to Navigate Ongoing Regulatory and Administrative Changes Within U.S. Health Care System

The Physicians Foundation, a nonprofit organization that seeks to advance the work of practicing physicians and help facilitate the delivery of health care to patients, has recently awarded more than $1.5 million in grants designed to foster physician leadership skills.

16 | APRIL 2013

The 17 grants, awarded to health care organizations and medical society foundations across the country, aim to create resources and programs to train physicians and medical professionals in leadership, business management, communication and interdisciplinary collaboration.

“In today’s challenging health care environment, it is imperative that medical practices remain viable so that doctors can continue to provide the highest quality of care possible to patients,” said Dr. Alan Plummer, Physicians Foundation Vice President and chairman of the Grants committee. “The Foundation is committed to equipping physicians with the necessary leadership skills to practice medicine successfully amidst ongoing regulatory and administrative changes, and we are pleased to fund so many organizations that share that same goal.”

Examples of the grants awarded by The Physicians Foundation include:

• Institute for Medical Quality: Stepping Up to Leadership Expansion – Physician leadership program that teaches effective communication, legal knowledge and management skills to physicians, chiefs of staff, department chairs and committee members. The grant will assist in expanding the California program to Texas and Washington, D.C. • North Carolina Medical Society Foundation: Kanof Institute for Physician Leadership – Leadership training organization that offers educational courses in leadership fundamentals, health care management and clinical quality, including a focus on performance improvement and team-based care.

• The Daniel Hanley Center for Health Leadership – Statewide initiative to expand physician leadership capacity in Maine by supporting three state medical societies in establishing leadership programs. The grant will also assist

in creating physician leadership case studies that can be used by other societies to advance program development in other states.

“There is a considerable need today for practicing physicians to effectively lead and oversee all elements of care, including clinical and operational responsibilities,” said Jill Silverman, president and CEO of the Institute for Medical Quality. “This grant support from The Physicians Foundation allows our organization to continue offering physicians in a multitude of practice arrangements the knowledge, confidence and non-medical leadership skills required to succeed in today’s health care environment.”

Since 2010, The Physicians Foundation has awarded 35 leadership grants across more than 20 states, totaling approximately $2.75 million.  Source: http://www. physiciansfoundation.org/news/thephysicians-foundation-awards-morethan-1.5-million-in-physician-leaders

MEDMONTHLY.COM |17

practice tips

New In-Office Solution Enables Physicians to Capture Patient Reviews at the Point of Service Digital Assent Revolutionizes Physician Ratings With ReviewCatcherTM

18 | APRIL 2013

Atlanta-based Digital Assent today announced the launch of ReviewCatcherTM, the healthcare industry’s first in-office solution for capturing electronic ratings and reviews from patients. Attendees of the 2013 American Academy of Dermatology (AAD) conference in Miami are the first to experience ReviewCatcher, the newest product offered by the fast-growing healthcare media and marketing company. ReviewCatcher helps physicians grow their online reputation and attract new patients.

Digital Assent is best known for its PatientPad® solution - a tablet-based practice marketing and patient engagement solution that is transforming the patient experience at doctors’ offices throughout the United States. ReviewCatcher is an innovative solution to a previously difficult-to-address problem. It is available as a standalone solution or as an add-on service to the PatientPad system.

“We developed ReviewCatcher in direct response to requests from our physician customers,” said Andrew Ibbotson, founder and CEO of Digital Assent. “Every physician we work with is concerned about their online reputation, but they feel powerless in their ability to protect and proactively grow their online reputation.”

“After speaking with a number of our physician customers about their concerns, we realized that we were in the perfect position to address this issue,” said CTO and co-founder Tim Collins. “PatientPad is used by patients throughout the patient visit. By creating an easy-to-use review capture solution for the PatientPad, we enable physicians to privately capture feedback from patients before they leave the office.”

“In addition to collecting positive reviews from satisfied patients, another major benefit of capturing real-time feedback from patients is that it gives office administrators the opportunity to resolve issues immediately, before the patient has the chance to post a negative review online,” commented Ed Zunzunegui, vice president of customer support for Digital Assent.

ReviewCatcher provides a simple user interface that lets patients quickly leave a 1 to 5-star rating and brief review. All patient reviews are delivered to designated office staff in real-time and selected testimonials can be automatically displayed on the office’s PatientPads and practice website to help promote those services.

In order to help physicians grow their online reputation, the ReviewCatcher system can be configured to send patients a confirmation email thanking them for their feedback and encouraging them to share their review on popular ratings websites like Yelp, Yahoo!

Local, Google+, Citysearch, Healthgrades, Vitals and RealSelf. Since the review has already been written, it

takes very little effort for patients to share their review online.

To learn more about ReviewCatcher, please visit http://www.GetReviewCatcher.com.  About Digital Assent Digital Assent is a healthcare media and marketing company that helps physicians and brands more effectively engage patients at the point of care. The company’s award-winning PatientPad® technology is transforming the patient experience at doctor’s offices throughout the United States. Upon arrival, each patient is given their own PatientPad® tablet to check-in for their appointment. Patients then hold on to the PatientPad® to learn more about their visit, explore relevant health information and share their feedback before they leave.

Digital Assent’s rapidly growing PatientPad® Network now spans every major metropolitan market in the country. For more information about Digital Assent, please visit www.DigitalAssent.com.

Source: http://globenewswire.com/news-relea se/2013/03/04/528037/10024003/en/Digital-AssentRevolutionizes-Physician-Ratings-With-ReviewCatcherTM.html

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Editorial Calendar: May 2013 - Your Practice Staff l June 2013 - Dermatology MEDMONTHLY.COM |19

practice tips

PA Prescriber Credentialing and Prescribing – Medicaid Changes in NC

By Lisa P. Shock, MHS, PA-C President/CEO Utilization Solutions in Healthcare, Inc. 20 | APRIL 2013

‘‘

The North Carolina Academy of Physician Assistants (NCAPA) continues its discussions with the Division of Medical Assistance (DMA) regarding Medicaid enrollment applications for physician assistants (PAs). Meetings also continue with health policy advisors for the NC House of Representatives.

T

he Division of Medical Assistance (DMA) put forth information in their clinical policies that Physician Assistants would be required to enroll with North Carolina Medicaid effective November 1, 2011. All services rendered by Physician Assistants were to be filed to Medicaid with their NPI as the rendering (or attending) provider. Physician Assistants would therefore not be allowed to bill “incident to” the physician after December 31, 2011.

Implementation of this rule and credentialing of Physician Assistants in NC has been a topic of debate.

It is the position of the North Carolina Academy of Physician Assistants (NCAPA) and the North Carolina Medical Society (NCMS) that such requirements, when made outside the rulemaking process, are not enforceable. Experts representing NCAPA and NCMS believe that PAs are already enrolled with Medicaid as a rendering provider, however they are not credentialed. NCAPA, supported by the NC Medical Society, continues discussions with the DMA and the NC Department of Justice to ensure requirements are reflected in agency rules before they are announced and enforced.

Credentialing is not the only confusing issue.

Initially, in its December Medicaid Provider Bulletin, the Division of Medical Assistance (DMA) published the following information regarding prescribers who are not enrolled in Medicaid: The Affordable Care Act established a new rule that prohibits Medicaid programs from paying for prescriptions written by prescribers who are not enrolled in the Medicaid program. On January 1, 2013, pharmacy providers will begin to receive a message at point-of-sale for prescriptions written by prescribers not enrolled in the Medicaid program. This message will notify pharmacy providers that pharmacy claims written by non-enrolled prescribers will begin denying on April 1, 2013.

In both the December and February Medicaid Bulletins, DMA announced all Medicaid prescribers must be direct enrolled or their prescriptions would be rejected, effective April 1, 2013. DMA is under pressure to implement a related federal requirement that all Medicaid prescribers be enrolled by April 1.

The Division of Medical Assistance (DMA) has since changed their ruling. The Medicaid prescriber enrollment deadline of April 1 has been rescinded.

To date, no new deadline has been established.

The North Carolina Academy of Physician Assistants (NCAPA) continues its discussions with the Division of Medical Assistance (DMA) regarding Medicaid enrollment applications for physician assistants (PAs). Meetings also continue with health policy advisors for the NC House of Representatives.

The DMA has not established a new deadline specifically requiring PAs to direct enroll. Currently, it is NCAPA’s recommendation that PAs begin the enrollment and credentialing process.

Physician Assistants may enroll by completing the Medicaid provider enrollment application on www. nctracks.nc.gov.  Read more here: http://www.ncdhhs.gov/dma/bulletin/pa.htm http:/ncapaorg/?newsarticle=ncapa-recommendsmedicaid-enrollment About the Author:

Lisa P. Shock, MHS, PA-C, is a seasoned PA who has worked with clients to expand care teams in both large and small settings. She enjoys part time clinical primary care practice and is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering a wide range of services to help implement and improve upon the utilization of PAs and NPs in the health care system.

Contact her at lisa@pushpa.biz MEDMONTHLY.COM |21

practice tips

MEDICAL PRACTICE MARKETING:

IMPLEMENT PRICING PROGRAMS AND PROMOTIONS THE

RIGHT WAY!

By Marlee Ward Rx MD Marketing Solutions

22 | APRIL 2013

In the medical field it is NEVER profitable to compete on price. So, our first bit of advice is: Don’t compete on price! Price reduction alone is never a good strategy for improving profits.

Building a recognizable and reputable brand for your medical practice is always the most effective way to create long-term growth. Offer your patients products and services that provide exceptional value and meet their needs. People will justify the price of something if it meets their needs!

Unfortunately, not competing on price isn’t always an option. If you are in a hyper-competitive market, a slow economy, or trying to develop niche markets, implementing strategic pricing programs may be necessary.

The best way to choose a pricing strategy is to identify the purpose behind it and evaluate whether or not it fits into your medical marketing plan. Depending on your purpose, the following are effective ways to compete on price as a medical professional:

MONEY OFF NEXT PURCHASE A great way to encourage longterm patient loyalty is by offering a dollar amount off of your patient’s next purchase. For example, a dentist can offer $20.00 off a tooth whitening treatment when patients who come in for a routine cleaning schedule a whitening treatment within the next 30 days. This is an effective pricing strategy because it requires that a patient make a repeat visit and purchase. It also supports any medical marketing strategy designed to promote a specific product, protect market share, or maintain a healthy sales volume.

MULTIPLE PRODUCTS FOR THE SAME PRICE This is your everyday buy two get one free promotion. This type of pricing strategy is most effective when your two purchased products cover your cost of the free product. Patients

like these types of promotions because they feel compelled to “get their money’s worth” and take advantage of a limited offer. Use this type of pricing strategy to launch new products, develop niche markets or reward repeat patients.

REFERRAL PROGRAMS Offer your patients a gift card for new patient referrals. If you are an aesthetic practitioner who offers laser treatments in packages or provides services which require follow-up visits, your current patient base will be eager to refer patients and receive gift cards to use on their return visits. This builds patient loyalty, creates profit in mature markets, and will certainly attract patients.

PRACTICE MEMBERSHIP SPECIALS Costco, Sam’s Club, and CVS have built their brands on this pricing strategy. In the medical field, this pricing strategy best operates in the form of a point system similar to accruing frequently flyer miles. Look at a chiropractic practice for example.

A chiropractor can offer a free membership which allows patients to earn points for treatments they receive.

Once a patient has earned a certain number of points, they can then use those points to redeem specific treatments. Don’t let patients apply points to any and all treatments you offer. Identify which treatments are the lowest cost to you and let patient’s apply points to those treatments.

SPECIAL PAYMENT PLAN PROGRAMS No physician wants to go into the business of banking, so use this type of pricing strategy with caution. Payment plan programs are most effective when designated for specific types of procedures that are big ticket items.

Payment plan programs are simply

‘‘

Building a recognizable and reputable brand for your medical practice is always the most effective way to create long-term growth. Offer your patients products and services that provide exceptional value and meet their needs.

People will justify the price of something if it meets their needs!

installment plans that allow patients to pay for a procedure over time upfront. Practices that offer cosmetic procedures will find this pricing strategy most useful. For instance, a cosmetic surgeon may offer a payment plan for liposuction or breast augmentation to be paid in three installments with the third and last payment due on the procedure date.

This give people time to organize their resources for big ticket items and can help you attract patients who might otherwise not be able to afford your service.

No matter what pricing strategy you decide to use in your practice, be sure you don’t fall into a price war with your competitors. Price wars can devastate a practice and negatively affect your medical marketing efforts. Use pricing strategies to your advantage when you can, but focus on building a superior brand that will build patient loyalty and improve your profits long-term.  Rx MD Marketing Solutions, a health care marketing consulting firm. Learn more at http://rxmdmarketingsolutions. com MEDMONTHLY.COM |23

international

ZEROING IN ON HEART DISEASE European Molecular Biology Laboratory’s Innovative Strategy Pinpoints Genes Underlying Cardiovascular Disease Risk

S

tudies screening the genome of hundreds of thousands of individuals (known as Genome-wide association studies or GWAS) have linked more than 100 regions in the genome to the risk of developing cardiovascular disease. Researchers from the European Molecular Biology Laboratory (EMBL) and the University of Heidelberg, Germany, through the joint Molecular Medicine Partnership Unit (MMPU), are taking these results one step further by pinpointing the exact genes that could have a role in the onset of the disease. Their findings are published today in the Public Library of Science (PLoS) Genetics.

The scientists used a technology called “RNA interference” that can selectively decrease the level of expression of targeted genes. By observing what changes, if any, this decrease causes in cells, researchers can identify the function of the genes and, on a larger scale, objectively test the function of many genes in parallel.

Cholesterol levels in the blood are one of the main risk factors for cardiovascular disease. They are controlled by the amount of cholesterol that cells can take in thus removing it from the blood - and metabolize. The researchers used RNA interference to test the function of each of the genes within 56 regions previously identified by GWAS as being linked with cardiovascular disease. They selectively decreased their action and measured what, if any, changes this induced in cholesterol metabolism. From this they could deduce which of the genes are most likely to be involved in the onset of the disease.

24| APRIL 2013

“This is the first wide–scale RNA interference study that follows up on GWAS. It has proven its potential by narrowing down a large list of candidate genes to the few with an important function that we can now focus on in future in-depth studies,” explains Rainer Pepperkok at EMBL, who co-led the study with Heiko Runz at the University of Heidelberg.

“In principle, our approach can be applied to any disease that has an observable effect on cells”, adds Heiko Runz.

“The genes identified here may further our understanding of the mechanisms leading to cardiovascular disease and allow us to improve its prediction and diagnosis”.

In a nutshell: • Genome-wide association studies (GWAS) enable scientists to trace the origin of human diseases to distinct regions in the genome, but their resolution is limited • RNA interference is a powerful technology to test, in parallel, the function of many genes • The combination of these two approaches pinpoints what genes are the most important for the control of cholesterol levels, and thus likely to confer a risk for cardiovascular disease  Source: http://www.embl.de/aboutus/communication_ outreach/media_relations/2013/130228_Heidelberg1/index. html

research & technology

EHR Technology Advancements –

Moving Health Care Forward

by Frank J. Rosello, CEO, Environmental Intelligence LLC

26 | APRIL MARCH 2013 2013

T

echnology continues to improve practically all aspects of our lives – and health information technology is no different. Software and hardware developers are working fast to introduce new innovations and applications to electronic health records (EHR) technology that will dramatically improve the delivery of health care.

Recently the first iPad-native EHR platform gained ONC-ATCB certification qualifying it for Meaningful Use incentives. Then after just three short weeks after gaining certification, the same developer launched an iOS app to replace paperbased patient check-in. This new patient check-in app can be integrated into a medical practice as a stand-alone application as well as integrates with the iPad EHR platform. Many other top-rated EHR software developers are in the process of introducing similar iPad and tablet capability to their EHR platforms.

This new app digitizes the waiting room and eliminates significant barriers to mass adoption of patient check-in technology. The app is designed to be intuitive for both physician and patient users to create a better patient check-in experience.

The app features customizable templates that enable physicians to eliminate traditional paper forms and clipboards in the waiting room. The functionality of the app allows patients to: • Complete family medical history and demographic information.

• Snap a profile photo.

• Sign the required HIPPA consent form with digital signature.

• Complete insurance forms.

The information is then populated to the EHR platform providing accuracy, convenience, and a little more fun to a doctor’s visit. As a patient, imagine visiting a new doctor

prepared to complete several time consuming forms and instead being handed an iPad. This tool will also eliminate patients having to complete duplicate forms and will simplify the review of their information and make any necessary changes on the iPad. For the operations of the practice, entering insurance information alone takes a lot of time not to mention having to decipher patient’s handwriting that may lead to data input errors and inaccurate recorded health history.

People love gadgets and this technology will not only enhance the patient experience, it will save medical practices time and money too.

Another EHR innovation building momentum is medical speech recognition solutions. The technology is designed to help clinicians create medical notes directly into their EHR platform in real-time. With this real-time, voice-driven clinical documentation capability, clinicians will become empowered to capture a more complete patient story. This feature alone will enhance the patient experience and improve overall care, while enabling healthcare professionals to feel they are not sacrificing precious time.

Leveraging this technology is also saving medical practices money, particularly in smaller practices. A leading developer of this technology has validated that these practices are saving as much as $10,000 per clinician, per year in reduced medical transcription costs. The technology also helps decrease report turnaround time, improve the comprehensiveness of patient medical records, which leads to more accurate reimbursement.

With this improved speech recognition technology, the patient will feel they are being heard and the physician will be equipped with the information to provide better and efficient care. Now that’s a win-win.  MEDMONTHLY.COM |27

research & technology

YOU IMAGINE

Dental Apps That Kick Part 2 of 2

By

28 | APRIL 2013

FINDING AN APP FOR THAT Dental apps offer a promise for both dentists and patients. They can inform and educate, hold medical records, and they can change dental habits for the young and the old alike. They serve as a bridge between the dentist and the patient. What is being done to enhance this bridge? I have reviewed dozens of dental apps, spoken with dentists and developers about their plans, and I offer the insights of that exploration here. I want to be clear that I am in no way paid or compensated by any of the app developers I will be reviewing.

While iTunes doesn’t offer subcategories in Medical, dental apps came in four varieties. There are (1) apps that motivate kids to brush or visit the dentist. There are (2) apps dentists can use to to communicate with and educate patients about dental health and procedures. There are (3) apps that dentists use to hold medical records or reference data. And there are (4) apps patients can use to learn more on their own. I covered 1 and 2 in last month’s issue. In Part 2 of this issue I’ll focus on 3 and 4.

3. APPS FOR DENTISTS CDT Code Check Dentist will be looking to make paperwork more streamlined. CDT Code Check 2013 is a $19.99 app put out by the American Dental Association (http://www.ada.org/3827.aspx). It contains the complete listing for the CDT codes, and tracks changes in the codes as they occur. These codes can be searched by keyword, by code number, or by category. It is designed particularly for practitioners who travel between offices without a bulky code book and without internet connectivity. In addition to looking up claim codes, it is good for making claim forms.

continued on page 30 MEDMONTHLY.COM |29

continued from page 29

Smart Dental Chart Smart Dental Chart by Ashley Dental Partners Lite is a free app (limited) or paid app with a tap and drag dental chart that can be exported by email, picture save, or airprint. It includes an anatomy section with pop-out details. The Lite version offers primary teeth and a tooth missing function. The professional version includes the full range and costs $299.99.

These apps may be a beginning step. Are there any features or apps you see a need for that are not yet available?

30 | APRIL 2013

4. PATIENT SELF-EXPLORATION Orosphere Orosphere by Curve Technologies (http:// orasphere.com) is a free app with a limited but beautifully didactic set of educational videos to teach about the tooth. The free version includes a segment on tooth anatomy and one on root canals. ompleted, the app may be misleading.

continued on page 32 continued on page 34 MEDMONTHLY.COM |31

continued from page 31

Dental Expert and Pediatric Dental Expert Dental Expert and Pediatric Dental Expert are two free app for patients by Cosmetic Innovations, Inc (http://www. cosmeticinnovations.com). They includes an expansive collection of questions and answers related to dentistry. As a medical illustrator, I see a marked lack of visual interest in this app. And I wondered why the Smile Gallery in the adult app is offered as a section as it does little to explain or inform. But I enjoyed the thoroughly informative explanations offered in the Q & A and Myths v. Facts sections.

Exploring dental apps these past couple months, I was left with a sense that it is an area where some good efforts have been made, and where there is also great potential. These apps should offer a complete range of information, easy to access and navigate, 3D when necessary, and with complete text and narrative explanations. In the meantime, explore as you will and enjoy the many free choices available for mobile devices.  Medimagery Medical Illustration & Design info@medimagery.com http://www.medimagery.com/ http://www.linkedin.com/in/lauramaaske http://twitter.com/#!/Medimagery http://www.facebook.com/Medimagery http://www.facebook.com/laura.maaske http://medillsb.com/ArtistPortfolioThumbs.aspx?AID=4115 32 | APRIL 2013

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research & technology Imagine a flock of birds all taking flight at once or a shoal of sardines circling for safety in their mass numbers. Flocking is very helpful in the wilds of the world, but it is also very useful in the bread and butter aspects of animation.

Take into consideration the humble red blood cell as it travels along its circulatory route through the body. Deep in the bodies capillaries the cells are pressed single file and pretty much have to go where the direction of travel drives them.

Like military school students in a lunch line, they advance single file perfectly. But in larger veins and arteries, especially torturous anatomy or in varicose veins the red blood cells are so numerous that they roll and tumble to the beat of the body’s mighty pump. In cases like this, flocking behavior is ideal for allowing the cells to get through the turbulence but still have that nice random organic flow. Throw in all the other characters that inhabit the blood stream and one has an ideal use for flocking.

Another great place to put flocking to use in a medical animation is, believe it or not, on the two dimensional surface of a slide. Imagine a slide surface covered from end to end with simple stem cells. Place an attractant at one end of those cells and they hurl themselves toward it (in cellular time that is) as they collide and twist toward their destination. But watch them carefully, they don’t take the most direct path since they need to interact with the thousands of other cells all striving for the same goal. A flow begins to take place, and it looks identical to a large mass of birds changing direction in midair.

Other exceptional uses could include brain cell axon behavior, RNA strand movement and even the humble particle that is so often used in many method of action medical animations.

Imagine a simple cytokine, being released from a macrophage in some kind of auto immune reaction. Thousands of particles are being released, and each cytokine is destine for a matching receptor on a nearby cell. What might look like a random path when first released, if the camera is pulled back to reveal them in mass,a perfect venue for flocking behavior is seen to direct them in a more natural way towards the cells in question. As the tiny cytokines begin to group, they begin to take on an elegant wispy feel that could resemble vapor.

To really give a medical animation a true sense of organics, try flocking. One won’t be disappointed.  Trinsic animation is a full featured medical animation studio that specializes in biotech, pharmaceutical and medical device animations. Trinsic Animation is passionate about medical animation. Every project is approached with the scientific accuracy and the creative beauty that a medical animation need to become a success.

Source: http://www.pressreleasepoint.com/trinsic-animationpresents-flocking-medical-animation-context 34 | APRIL 2013

Trinsic Anim in the Medi

mation Presents Flocking ical Animation Context

Flocking, as you know, is most easily described when discussing the group activities of birds or in the shoaling behavior of fish. In a nutshell it is the interaction of a group of many independent organisms to move as one.

MEDMONTHLY.COM |35

legal

Federal Legislation to Prevent Prescription Drug Abuse Introduced to Senate

National Association of Boards of Pharmacy

36 |APRIL 2013

A

imed to address prescription drug misuse, addiction, and overdose deaths, the Prescription Drug Abuse Prevention and Treatment Act (SB 348) was reintroduced in the United States Senate by Senator Jay Rockefeller (D-WV) and Representative Nick Rahall (D-WV). The bill includes a number of provisions aimed to prevent diversion and abuse and foster safe use of prescription drugs. Under the law, health care providers would be required to complete new training before obtaining a license to prescribe certain prescription pain killers. The implementation of consumer education on safe medication use would also be required. The bill also includes provisions for increased funding of state prescription monitoring programs.

The following is a press release from the office of Senator Rockefeller: Senator Jay Rockefeller and U.S. Rep. Nick Rahall announced they have introduced companion legislation to combat the growing prescription drug abuse epidemic. Senator Joe Manchin cosponsored the Senate bill.

In the last decade, West Virginia has experienced a tragic increase in deaths and overdoses from prescription drugs. West Virginia has one of the highest rates of drug overdose deaths in the country, and nine out of ten drug-related deaths in the state result from the misuse and abuse of prescription drugs, especially opioid painkillers.

“I’ve reached out to West Virginians – health care providers, schools, pharmacists – asking for new ideas on how to reduce prescription drug abuse. This legislation reflects that real, on-the-ground feedback from West Virginia. And it addresses a complex problem in an equally intricate way,” Rockefeller said. “Prescription drug abuse is ripping our communities at the seams – so we need a broad, no-

holds-barred approach to tackling it.

That’s what this legislation offers.”

“The prescription drug abuse epidemic is hitting southern West Virginia hard and taking a heavy toll on our families and communities, as well as our businesses and workforce. We must do more at the Federal level to increase patient awareness and better train health care providers in order to prevent and treat pill abuse. These are straightforward and necessary policy changes that need to take effect and I will press hard for action in the House of Representatives,” said Rahall, who is a co-chairman of the Congressional Prescription Drug Abuse Caucus.

“Drug addiction hurts more than just the person abusing drugs; it destroys lives, tears families apart and hurts communities’ abilities to create and keep good jobs,” Manchin said. “To fight our state’s drug abuse epidemic, we need to take a positive step toward combating this escalating problem in our state and across our country. Too many families and communities have been torn apart by drug abuse and my heart goes out to them.

They need to know that I am determined to do everything I can to curb drug abuse.”

Through a multifaceted approach to addressing the unsafe use of prescription pain killers, the Prescription Drug Abuse Prevention and Treatment Act, which Rockefeller and Rahall first introduced in 2011, would help decrease the number of opioid and methadonerelated deaths in West Virginia and nationwide through: • New training requirements for health care professionals before they can be licensed to prescribe these drugs; • Consumer education on the safe use of painkillers and preventing diversion and abuse; • Basic clinical standards for safe use and dosage of pain medications, including methadone; • Increased federal support for state prescription drug monitoring programs; and

‘‘

“Under the law, health care providers would be required to complete new training before obtaining a license to prescribe certain prescription pain killers. The implementation of consumer education on safe medication use would also be required.”

• Comprehensive reporting of opioid-related deaths to help guide solutions.

On February 21, Rockefeller joined a roundtable discussion Rahall was hosting at Marshall University’s Forensic Science Center on efforts to address the public health and safety challenges of prescription drug abuse and trafficking in West Virginia. Speaking with them was White House Office of National Drug Control Policy (ONDCP) Director Gil Kerlikowske, who joined Rockefeller in the state two years ago for a discussion on this growing epidemic.  Sources: http://www.rockefeller.senate.gov/public/index.cfm/pressreleases?ID=de0d54d4-63ff-4f30-92e3a39d11e5b877 http://www.nabp.net/news/federallegislation-to-prevent-prescriptiondrug-abuse-introduced-to-senate MEDMONTHLY.COM |37

legal

Doctors Caution Against Prescribing Attention-Boosting Drugs to Healthy Kids Ethical, Legal, Social, And Neurodevelopmental Implications 38| APRIL 2013

The American Academy of Neurology (AAN), the world’s largest professional association of neurologists, is releasing a position paper on how the practice of prescribing drugs to boost cognitive function, or memory and thinking abilities, in healthy children and teens is misguided. The statement is published in the March 13, 2013, online issue of Neurology, the medical journal of the American Academy of Neurology.

This growing trend, in which teens use “study drugs” before tests and parents request ADHD drugs for kids who don’t meet the criteria for the disorder, has made headlines recently in the United States. The Academy has spent the past several years analyzing all of the available research and ethical issues to develop this official position paper.

“Doctors caring for children and teens have a professional obligation to always protect the best interests of the child, to protect vulnerable populations, and prevent the misuse of medication,” said author William Graf, MD, of Yale University in New Haven, Conn., and a member of the American Academy of Neurology. “The practice of prescribing these drugs, called neuroenhancements, for healthy students is not justifiable.”

The statement provides evidence that points to dozens of ethical, legal, social and developmental reasons why prescribing mind-enhancing drugs, such as those for ADHD, for healthy people is viewed differently in children and adolescents than it would be in functional, independent adults with full decision-making capacities.

The Academy has a separate position statement that addresses the use of neuroenhancements in adults.

The article notes many reasons against prescribing neuroenhancement including: the child’s best interest; the long-term health and safety of neuroenhancements, which has not been studied in children; kids and

teens may lack complete decisionmaking capacities while their cognitive skills, emotional abilities and mature judgments are still developing; maintaining doctor-patient trust; and the risks of over-medication and dependency.

“The physician should talk to the child about the request, as it may reflect other medical, social or psychological motivations such as anxiety, depression or insomnia. There are alternatives to neuroenhancements available, including maintaining good sleep, nutrition, study habits and exercise regimens,” said Graf.

View the full statement at: http:// neurology.org/lookup/doi/10.1212/ WNL.0b013e318289703b. View the AAN’s full statement on neuroenhancements and adults at: http://www.neurology.org/ content/early/2009/09/23/ WNL.0b013e3181beecfe.full.pdf The American Academy of Neurology, an association of more than 25,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, brain injury, Parkinson’s disease and epilepsy.  For more information about the American Academy of Neurology, visit http://www.aan.com or find us on Facebook, Twitter, Google+ and YouTube.

Source: http://www.newswise.com/ articles/view/600016/?sc=rsmn&utm_ source=feedburner&utm_ medium=feed&utm_campaign=Fee d%3A+NewswiseMednews+%28Ne wswise%3A+MedNews%29&utm_ content=FeedBurner

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legal

Sequester Will Hit EHR Incentive Program

The fiscal trap that members of Congress and the president set for themselves will punch a 2% hole in one of the federal electronic healthrecord incentive payment programs under the American Recovery and Reinvestment Act, a federal official has confirmed.

The cuts, called the sequester, include an across-the-board reduction in Medicare payments. EHR incentive payments distributed under Medicaid won’t be affected.

On March 1, President Barack Obama signed an order for sequestration that set in motion automatic federal budget cuts required by the Budget Control Act of 2011, the legislative effort passed by Congress with cuts promoted at the time to be so draconian that they would compel both Republicans and Democrats to reach a budget compromise.

That didn’t happen, and now, Medicare providers should expect cuts 40 | APRIL 2013

in payments for services provided on or after April 1.

Most hospitals participate in both the Medicare and Medicaid portions of the EHR incentive payment program, but 181 are listed as “Medicare only” providers on the latest CMS report on program expenditures.

On average, these Medicare-only hospitals have been paid $1.87 million each, which means a 2% cut would amount to about $37,500 for similarly compensated hospitals once the cuts are applied.

The cut would amount to a few hundred dollars for physicians and other “eligible professionals.” The top EHR incentive payment for them under Medicare is now $18,000, so the 2% reduction would cost them $360.

In an address to the Federation of American Hospitals on Tuesday, Acting CMS Administrator Marilyn Tavenner touched on the EHR incentive payment program, noting

By Joseph Conn and Jessica Zigmond ModernHealthCare.com

the CMS this year will “spend a lot of time around education and around the audit process.”

Tavenner, who spoke at the HIMSS conference in New Orleans, said “We are fully committed to the program” but will be “pausing and reflecting” on problem areas, such as appropriate coding levels, “and trying to increase the education; make sure we have the vendors on board.” She said there also will be “some small targeted audits to make sure it’s being done appropriately.”  Source: http://www.modernhealthcare. com/article/20130305/NEWS/3030 59943?AllowView=VW8xUmo5Q2 1TcWJOb1gzb0tNN3RLZ0h0MWg 5SVgra3NZRzROR3l0WWRMWGJ WLzBFRWxiNUtpQzMyWmVvNT NrWUpiaWk=&utm_source=link20130305-NEWS-303059943&utm_ medium=email&utm_campaign=am

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features

Point Of Care Dispensing – How It Can Benefit Your Practice

By Jeff Bugonian, CPht and Dispensing Consultant for MedX Sales 42 | APRIL 2013

T

here is a misconception in the United States that every physician is making too much money or that all physicians are rich. “M.D.” does not stand for “Many Dollars” unless you are speaking of the dollars it takes to operate a practice. Just think of where the income from your practice is spent: employee salaries, employee benefits, office supplies, medical supplies, office equipment, maintenance, malpractice insurance, EMR, etc…And then there are the repayment of tuition loans.

In order for most physicians to take home $100,000 per year, the practice likely needs to gross around 1 million dollars. Additionally, as expenses increase and reimbursements continue to decrease, the financial outlook does not look good.

With that in mind, many physicians are looking for ways to decrease business expenses and increase revenue. Physicians are outsourcing collections, joining a physician’s buying group or hiring a practice management consultant to combat this ever growing problem. Physicians are also looking at ancillary services to improve profits. One very simple ancillary service that physicians can take advantage of today is Point of Care (POC) Pharmaceutical Dispensing.

‘‘

Physicians are also looking at ancillary services to improve profits.

One very simple ancillary service that physicians can take advantage of today is Point of Care(POC) Pharmaceutical Dispensing.

“But I am not a pharmacist”, you may think. That may be true, but you do not need to be a pharmacist.

Forty-three states allow physicians to dispense pharmaceuticals to their patients with few, if any, restrictions.

The only states that restrict dispensing to such an extent that it becomes problematic are New York, New Jersey, Massachusetts, Texas, Montana, Wyoming and Utah. Most other states specifically mention physician dispensing as an allowable practice in their regulations and laws. Since it is legally allowable, it is highly probable that it will not result in an increase to your malpractice insurance.

So how can POC Dispensing help your practice?

Let’s look at 2 ways – time and money – and they are closely linked.

First of all think about your time. How much time per day do you or your staff spend on the phone with pharmacies?

You probably get several calls per day to clarify prescriptions or get them changed. If you spend 1 hour per day on the phone instead of seeing patients you may be conservatively losing $100.

That is over $25,000 per year.

How can POC Dispensing increase your revenue?

Simply by filling the prescription utilizing pre-packaged medications instead of having your patient go to a pharmacy. The average physician sees 100 patients per week. Most of those visits will result in writing at least 1 prescription. Presently, you do not make any money on that prescription.

POC Dispensing may allow you to fill that prescription and make an average profit of $10 for each bottle dispensed.

This could increase your income by over $50,000 per year. And it only takes a minute or two to dispense since the bottles are prepackaged and sealed, there is no pill counting. It works best with generic, acute-care meds such as antibiotics and pain control.

If you treat Worker’s Comp (WC) patients and your state recognizes physician dispensing, you can earn substantially more income from dispensing. If you practice Occupational Health or another modality such as Orthopedics, Pain Management or Neurology and you treat Worker’s Comp patients, you could be losing $100,000 or more per year.

Which practice types does this work especially well with?

In addition to the Occupational Health and Orthopedic practices mentioned you can add Family Practice, Oral Surgery, Urgent Care and Podiatry. There is also a medical practice model that is gaining popularity which is based on membership. This Concierge model typically limits the number of patients and has them pay a monthly fee for physician services. Since these patients are normally uninsured, POC dispensing is a great fit.

As you see, Point of Care Dispensing can significantly improve your practice’s financial health.

How can it help the patient?

It will be beneficial to your patients because it will assure compliance.

Many paper prescriptions go unfilled simply because the patient does not feel that they have the time to wait for an hour or more at the pharmacy.

Those patients that do wait may spend the entire time impulse shopping at a large retailer that has a pharmacy.

Many of your patients would rather get the medication from you even if it means bypassing a $4 bottle cost. In the end, your patients will walk away happier and more compliant.  If you would like to contact the author for more specific information or to add this service to your practice please contact him through his website: www. medxdrdispensing.com, or email at jeffbugonian@medxscripts.com.

MEDMONTHLY.COM |43

features

Prevention Efforts Focused on Youth Reduce Prescription Abuse Into Adulthood

NIH-funded research shows effectiveness of community-based, substance abuse prevention interventions begun during middle school years

44 | APRIL 2013

M

iddle school students from combined research results of three ran- years of age, students across the three small towns and rural domized controlled trials of preventive studies showed reductions in risk — communities who received interventions – termed “universal” ranging from about 20 percent to as any of three communitybecause they target all youth regardless much as 65 percent — for prescription based prevention programs were less of risk for future substance abuse. All drug and opioid abuse, compared to likely to abuse prescription medicathree studies involved rural or smallstudents in the control groups. Imtions in late adolescence and young town students in grades six or seven, portantly, the interventions used had adulthood. The research, published who were randomly assigned to a con- previously been shown to reduce the today in the American Journal of Pub- trol condition (receiving no prevention likelihood of other substance use or lic Health, was funded by the National intervention) or to a family-focused other problem behaviors.

Institute on Drug Abuse (NIDA), the intervention alone or in combination “We could find no other randomNational Institute on Alcohol Abuse with a school-based intervention: ized, controlled studies where brief and Alcoholism, and the National • Study 1, begun in 1993, tested a community-based preventive intervenInstitute of Mental Health, all comfamily-focused intervention alone tions conducted during middle school ponents of the National Institutes of (22 schools). were associated with long-term reducHealth.

• Study 2, begun in 1997, tested a tions in prescription drug abuse -- six “Prescription medications are combined family-focused interven- to 14 years after initial program implebeneficial when used as prescribed to tion and a school-based life skills mentation,” said Dr. Richard Spoth, treat pain, anxiety, or ADHD,” said training program (24 schools). from the Partnerships in Prevention NIDA Director Dr. Nora D. Volkow.

• Study 3, begun in 2002, tested a de- Science Institute at Iowa State Uni“However, their abuse can have serious livery system for a family-focused versity and first author on the study. consequences, including addiction intervention and one of three “The intervention effects were compaor even death from overdose. We are school-based interventions selected rable or even stronger for participants especially concerned about prescripfrom a menu (28 schools). who had started misusing substances tion drug abuse among teens, who are All of these interventions addressed prior to the middle school intervendevelopmentally at an increased risk general risk and protective factors for tions, suggesting that these programs for addiction.” substance abuse rather than specifialso can be successful in higher-risk Prescription drug abuse — taking a cally targeting prescription drug abuse. groups.” medication without a prescription or In follow-up questionnaires and tele The study can be found at: http:// in a way (higher dose, snorted) or for phone interviews completed at 17-25 ajph.aphapublications.org/toc/ajph/0/0 reasons other than prescribed (to get high) — has Past Year’s Abuse of Pharmaceuticals Among 12th Graders become one of the most serious public health concerns in the United States. According to the 2012 Monitoring the Future survey of U.S. teen substance use, prescription and over-thecounter medications were among the top substances abused by 12th graders in the past year. In 2011, about 1.7 million people 12-25 years old, or more than 4,500 young people per day, abused a prescription drug for the first time, according to the latest National Survey on Drug Use and Health.

The article, by scientists at Iowa State University, Ames, and Penn State, University Park, presents the continued on page 46

MEDMONTHLY.COM |45

continued from page 45

For information on prescription drug abuse, go to: http://www.drugabuse.gov/publications/drugfacts/prescription-over-counter-medications.

The study was funded under grant numbers DA013709, DA10815, DA007029, AA14702 and MH49217.

The National Institute on Drug Abuse is a component of the National Institutes of Health, U.S. Department of Health and Human Services.

NIDA supports most of the world’s research on the health aspects of drug abuse and addiction. The Institute carries out a large variety of programs to inform policy and improve practice. Fact sheets on the health effects of drugs of abuse and information on NIDA research and other activities can be found on the NIDA home page at http://www.drugabuse.gov, which is now compatible with your smartphone, iPad or tablet. To order publications in English or Spanish, call NIDA’s DrugPubs research dissemination center at 1-877-NIDA-NIH or 240-645-0228 (TDD) or fax or email requests to 240-645-0227 or drugpubs@nida.nih.gov. Online ordering is available at http://drugpubs.drugabuse. gov. NIDA’s media guide can be found at http://drugabuse.gov/mediaguide/, and its new easy-to-read website can be found at http://www.easyread.drugabuse.gov.  About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases.

For more information about NIH and its programs, visit http://www.nih.gov.

Source: http://www.nih.gov/news/ health/feb2013/nida-14.htm 46 | APRIL 2013

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features

Are E-Prescriptions Right For Your Practice?

By Thomas Hibbard Creative Director, Med Monthly

48 | APRIL 2013

It is estimated that approximately 7,000 deaths occur each year in the United States due to medication errors.

These errors are predominately due to hand-writing illegibility, wrong dosing, missed drug-drug or drug-allergy reactions. With approximately 3 billion prescriptions written annually, which constitutes one of the largest paper-based processes in the United States, the writing of prescriptions can be streamlined and efficient by using an e-prescribing system.1 Electronic prescribing or e-prescribing (e-Rx) is the computerbased electronic transmission and filling of a medical prescription, taking the place of paper and faxed prescriptions. E-prescribing allows a physician, nurse practitioner, or physician assistant to electronically transmit a new prescription or renewal authorization to a local or mail-order pharmacy. It has the ability to send error-free, accurate, and understandable prescriptions electronically from the healthcare provider to the pharmacy.

E-prescribing is meant to reduce the risks associated with traditional prescription script writing. It is also one of the major reasons for the push for electronic health records (EHR).

Small and mid-size practices are leading the way, making up a sizeable chunk of the 58% of physicians using e-prescribing tools outside of the hospital.2

Do E-prescriptions Actually Improve Patient Health?

According to a study by Surescripts, e-prescribing is linked to an increase in first-fill medication adherence and health care savings that could lead to $140 to $240 billion in health care savings and improved health outcomes over the next ten years.

Physicians adopting e-prescribing wrote out nearly 40% of their prescriptions electronically. This resulted in a 10% increase in patient first-fill medication adherence, which

translates to fewer doctor visits and reduced risk of hospitalization.

When taking into account the 60/40 ratio of paper-to-electronic prescriptions, the study demonstrated prescription delivery rates rising to 81.8%, and 76.5% getting picked up.

This is encouraging, considering how many prescriptions never make it to a pharmacy counter.3

Benefits The benefits of e-prescribing to both patients and clinicians include: l Improving patient safety and quality of care - Illegibility from handwritten prescriptions is eliminated, decreasing the risk of medication errors while simultaneously decreasing risks related to liability. Oral miscommunications regarding prescriptions can be reduced, as e-prescribing should decrease the need for phone calls between prescribers and dispensers.

Electronic prescribing has the potential to eliminate most of these types of errors. Warning and alert systems are provided at the point of care. E-prescribing systems can enhance an overall medication management process through clinical decision support systems that can perform checks against the patient’s current medications for drug-drug interactions, drug-allergy interactions, diagnoses, body weight, age, drug appropriateness, and correct dosing. Based on these algorithms, the system can alert prescribers to contradictions, adverse reactions, duplicate therapies and flag lethal dosages and lethal combinations of drugs. l Reducing time spent on phone calls and call-backs to pharmacies - According to estimates, almost 30 percent of prescriptions require pharmacy callbacks. E-prescribing can significantly reduce the volume of pharmacy call-backs related to

‘‘

“E-prescriptions not only fulfill Meaningful Use requirements, but it’s clear that they help reduce or prevent errors.

They can aid in making your practice more organized and save your practice money.”

illegibility, mistaken prescription choices, formulary and pharmacy benefits, decreasing the amount of time wasted on the phone. This ultimately impacts office workflow efficiency and overall productivity in a positive manner. l Reducing time spent faxing prescriptions to pharmacies Both prescribers and pharmacists can save time and resources spent on faxing prescriptions through a reduction in labor costs, handling costs, and paper expenses waste due to unreliability. l Automating the prescription renewal request and authorization process With e-prescribing, renewal authorization can be an automated process that provides efficiencies for both the prescriber and pharmacist. With limited resource utilization and just a few clicks on behalf of the prescriber, they can complete a medication renewal task while enhancing continuous patient documentation. l Increasing patient convenience and medication compliance - It is estimated that 20% of paperbased prescription orders go unfilled by the patient, partly due to the hassle of dropping off a paper prescription and waiting for it to be filled. By eliminating or reducing this waiting period, e-prescribing may help reduce the continued on page 50 MEDMONTHLY.COM |49

continued from page 49

number of unfilled prescriptions and hence, increasing medication compliance. l Improving formulary adherence permits lower cost drug substitutions - By checking with the patient’s health plan or insurance coverage at the point of care, generic substitutions or lower cost therapeutic alternatives can be encouraged to help reduce patient costs. Lower costs may also help improve patient compliance. l Allowing greater prescriber mobility - Improved prescriber convenience can be achieved when using mobile devices that work on a wireless network, to write and renew prescriptions. Such mobile devices may include laptops, PDA’s, tablet computers, or mobile phones. This freedom of mobility allows prescribers to write/renew prescriptions anywhere, even when not in the office.

l

l

l

Challenges and Limitations Challenges and limitations that may hinder the widespread adoption of e-prescribing practices are: l Financial Cost and Return on Investment (ROI) - The costs associated with purchasing, implementing, training staff and maintaining such a system may be beyond the means of small clinical practices, and is noted to be one of the greatest implementation barriers. As a result, large urban areas (large practices) may see the greatest ROI when compared to those in rural or inner city locations (small practices). l Change Management - Many underestimate the challenges pertaining to change management when transitioning from paper-based prescriptions to e-prescribing. This is especially true in busy practices where health care providers and associated staff are accustomed to their 50| APRIL 2013

l

current management system.

Staff accustomed to certain work practices may have particular aversions to the technology, so it may be difficult to get everyone on board immediately when introducing such a dramatic change.

Hardware and Software Selection - Choosing the right hardware platform and software applications can be a rather daunting task for practices, especially in regards to small and busy settings. Initiatives must be put into place to allow for effective and strategic planning prior to adoption.

Integrity of data input - Accidental data entry errors such as selecting the wrong patient or clicking on the wrong choice in a menu of dosages may occur. Software vendors should continually review user feedback and follow best practices in user interface design.

Security and Privacy - As with many eHealth solutions, privacy of patient information stored in electronic format may lead to the possibility of novel errors, such as inadvertently divulging protected health information on the internet through inadequate security practices. Instances of negligence may also arise, where employees may forward prescriptions to organizations outside its intended use. Therefore, hospitals, practices and pharmacies should be protected with firewalls, use strict computer permission settings, and remain vigilant toward signs of an intrusion.

System Downtime - Periods of system downtime may arise, either due to network-related issues, hardware failure, or loss of electricity. The inability to use electronic prescribing when the system is not accessible is of great concern, and must be addressed with the discussion of fall-back procedures and mechanisms when such situations arise.4

How to Get Your Practice Started l

Purchase hardware such as desktop PC’s, laptops, pocket PC’s, tablet PC’s , PDA’s utilizing a wired or wireless network. l Install an internet connection; high speed is highly recommended. l Decide whether you wish to choose a stand-alone e-prescription software or a full EMR system which includes e-prescribing functionality. l Choose an e-prescribing software vendor. The e-prescribing vendor will need to utilize a company which supplies the electronic prescribing network (hub or gateway for transmissions).

There are several e-prescription networking companies. Among the industry leaders are SureScripts (http://surescripts.com/), RxHub (http://www.rxhub.net/index. html), and ProxyMed (http://www. proxymed.com/).

In Conclusion E-prescriptions not only fulfill Meaningful Use requirements, but it’s clear that they help reduce or prevent errors. They can aid in making your practice more organized and save your practice money. Furthermore, e-prescriptions assist your patients to adhere to their medication regimen, contributing to their improved health and satisfaction.  References: 1 http://www.emrconsultant.com/ education/e-prescribing 2 http://www.poweryourpractice.com/ do-eprescriptions-actually-improvepatient-health/ 3 http://www.poweryourpractice.com/ eprescribing-could-save-health-carebillions/ 4 http://en.wikipedia.org/wiki/ Electronic_prescribing

the arts

Retired Clinical Pharmacist Finds His Montana Muse

By Thomas Hibbard

Creative Director, Med Monthly

D

rew Bodner, RPh is a retired clinical pharmacist with a passion for art. He retired in 2003 after 39 years of continual employment at Shawnee Mission Medical Center in Johnson County, Kansas. He started the clinical program there for the Medical Surgical Unit. Bodner also worked in ICU and was the wound care pharmacist for SMMC. He still remains active, maintaining his Missouri and Kansas pharmacy licenses and continuing his APhA, MSHP, and KPha memberships, including helping to plan KPhA conferences.

His grandparents homesteaded in Montana in 1892 from what is now the Slovak Republic and he and his wife, Joanne, own a cattle ranch, the N Lazy J, there on a side hill of the Highwood Mountains where they go each summer.

With only 1200 people in the entire county and 60 miles between his home and the closest full line grocery store, life can be challenging. From his home he can see Glacier National Park 150 miles away because there is nothing but flat prairie between them.

Our Montana Home

Drew Bodner:

The beautiful Montana landscape is where he gets much of his inspiration and he has been a featured artist in Montana for the last 5 years. Even his company name, Montanamuses.com, reflects his love of the area. Bodner states, “My art is all about nature, even down to the wood grains I like to paint. And the Montana sunsets are great.”

His art roots go clear back to his grandparents and their homestead. They were frequently visited by C.M. Russell (Charlie Russell), a famous Montana artist of the Old American West, when he was passing through on horseback.

Bodner’s father painted many art pieces throughout his life imitating Charlie Russell’s style and subject matter and was quite an accomplished artist himself. Bodner believes that is why he became an artist and he still has over 30 of his father’s paintings.

Bodner started painting while wintering in Foley, Alabama at Paulette’s Palette and has painted in Florida, Alabama, New Mexico, Arizona, Oklahoma, and Arkansas.

When he’s in Montana he paints at the Mid-Montana State continued on page 52 MEDMONTHLY.COM |51

Every Picture Tells a Story...

As a young man, Bodner took a ride with his dad.

They stopped at a rock arch at the edge of the forest and his father took a picture of Bodner with Lonesome Charlie, his horse. It is the subject matter of the painting on the left.

The painting below is the watercolor he did from his friend’s childhood memory entitled.

“Waiting for My Coal Miner Husband.”

Resting With Lonesome Charlie

52| APRIL 2013

Waiting for My Coal Miner Husband

continued from page 51

Art Society and at Studio 706; when he’s in Kansas he’s a member at the Seniors’ Art Council. His recent works are in acrylic and watercolor, but he would love to get back into oils in the near future. His work is displayed at Prairie Collection in Stanford, Montana; Made in Montana in Great Falls, Montana; and a gallery in Raton, New Mexico. And his photograph entitled “Mama Owl” was recently juried into the Arti Gras show in Leawood, Kansas. And he also teaches art classes at a Kansas City inner-city grade school and tutors math.

“There’s no bad art. All art is good art. I find and encourage the good points in everyone’s art,” he shares.

Each of his paintings has a story. They bring back fond memories from the artist’s personal life or from the people who have shared their stories with him. A friend, a former grade school teacher in Hughesville who became a Sister of Charity in Leavenworth, told him of a tender remembrance of standing in front of her cabin in Ashland, Montana in 1925 with her mother and siblings waiting for their father to return from the coal mine. Bodner did the painting, “Waiting for My Coal Miner Husband”, from her description of her mother with her three children all under the age of 4; daughter on one side, young boy on other, small baby in her arms. The young boy in the image is of Drew, himself, at age four.

He shares, “Can you imagine the mother’s stress with those small children, at dusk, waiting for her husband to return from the coal mine. In those days, coal was mined for their own use. My friend is the young girl on the right side.

I took a painting of myself with the sheep in Montana as a little boy for the picture of the boy on the other side. Her parents went on to have many more children.”

“I paint these pictures and envision myself there. I can transport myself to another world and actually feel I’m there in what I am painting. That’s the fun of it and that’s what relieves stress. It’s just like magic.”

Mama Owl

Mama Owl lives on the N Lazy J and enjoys posing almost as much as watching her young. This is a excellent example of Bodner’s rendering of wood grains.

Besides his original paintings for sale, Bodner currently has a line of over 100 stationery cards, each card displaying an original piece of his art. 

Two watercolor paintings of Montana wagons near the Bodner homestead

Worn Out

Buckboardd

MEDMONTHLY.COM |55

healthy living

Strawberry Spinach Salad Goodbye winter; spring is finally here! Spring is my favorite time of the year, not only because of the warmer weather, but because there is an abundance of seasonal produce available starting in April! One of my favorite foods of the season is strawberries, they are very versatile in dishes and are chock full of nutrition. Strawberries are great for immunity because they are full of water, fiber, Vitamin C, and Vitamin A. Try this delicious recipe for a strawberry spinach salad - makes a great appetizer or light entrĂŠe.

Preparation: 1. In a large bowl, toss together the spinach, strawberries, almonds, and cheese crumbles.

2. In a medium bowl, whisk together the oil, vinegar, sugar, paprika, sesame seeds, and poppy seeds.

Pour over the spinach and strawberries, and toss to coat.

54| APRIL 2013

By Ashley Acornley, MS, RD, LDN Servings: 8 servings

Ingredients: 2 bunches or bags spinach, rinsed and torn into bite-size pieces 4 cups sliced strawberries 1/8 cup fat free feta cheese 1/8 cup sliced almonds 1/2 cup vegetable oil 1/4 cup white wine vinegar 1/2 cup white sugar 1/4 teaspoon paprika 2 tablespoons sesame seeds 1 tablespoon poppy seeds

U.S. OPTICAL BOARDS Alaska P.O. Box 110806 Juneau, AK 99811 (907)465-5470 http://www.dced.state.ak.us/occ/pdop.htm

Idaho 450 W. State St., 10th Floor Boise , ID 83720 (208)334-5500 www2.state.id.us/dhw

Oregon 3218 Pringle Rd. SE Ste. 270 Salem, OR 97302 (503)373-7721 www.obo.state.or.us

Arizona 1400 W. Washington, Rm. 230 Phoenix, AZ 85007 (602)542-3095 http://www.do.az.gov

Kentucky P.O. Box 1360 Frankfurt, KY 40602 (502)564-3296 http://bod.ky.gov

Arkansas P.O. Box 627 Helena, AR 72342 (870)572-2847

Massachusetts 239 Causeway St. Boston, MA 02114 (617)727-5339 http://1.usa.gov/zbJVt7

Rhode Island 3 Capitol Hill, Rm 104 Providence, RI 02908 (401)222-7883 http://sos.ri.gov/govdirectory/index.php? page=DetailDeptAgency&eid=260

California 2005 Evergreen St., Ste. 1200 Sacramento, CA 95815 (916)263-2382 www.medbd.ca.gov Colorado 1560 Broadway St. #1310 Denver, CO 80202 (303)894-7750 http://www.dora.state.co.us/optometry/ Connecticut 410 Capitol Ave., MS #12APP P.O. Box 340308 Hartford, CT 06134 (860)509-7603 ext. 4 http://www.dph.state.ct.us/ Florida 4052 Bald Cypress Way, Bin C08 Tallahassee, FL 32399 (850)245-4474 doh.state.fl.us Georgia 237 Coliseum Dr. Macon, GA 31217 (478)207-1671 www.sos.state.ga.us Hawaii P.O. Box 3469 Honolulu, HI 96801 (808)586-2704 optician@dcca.hawaii.gov

Nevada P.O. Box 70503 Reno, NV 89570 (775)853-1421 http://nvbdo.state.nv.us/ New Hampshire 129 Pleasant St. Concord, NH 03301 (603)271-5590 www.state.nh.us New Jersey P.O. Box 45011 Newark, NJ 07101 (973)504-6435 http://www.njconsumeraffairs.gov/ ophth/ New York 89 Washington Ave., 2nd Floor W. Albany, NY 12234 (518)402-5944 http://www.op.nysed.gov/prof/od/ North Carolina P.O. Box 25336 Raleigh, NC 27611 (919)733-9321 http://www.ncoptometry.org/ Ohio 77 S. High St. Columbus, OH 43266 (614)466-9707 http://optical.ohio.gov/

South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4665 www.llr.state.sc.us Tennessee Heritage Place Metro Center 227 French Landing, Ste. 300 Nashville, TN 37243 (615)253-6061 http://health.state.tn.us/boards/do/ Texas P.O. Box 149347 Austin, TX 78714 (512)834-6661 www.roatx.org Vermont National Life Bldg N FL. 2 Montpelier, VT 05620 (802)828-2191 http://vtprofessionals.org/opr1/ opticians/ Virginia 3600 W. Broad St. Richmond, VA 23230 (804)367-8500 www.state.va.us/licenses Washington 300 SE Quince P.O. Box 47870 Olympia, WA 98504 (360)236-4947 http://www.doh.wa.gov/LicensesPermitsand Certificates/ProfessionsNewReneworUpdate/DispensingOptician.aspx

MEDMONTHLY.COM |55

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 56 | APRIL 2013

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 http://www.mass.gov/eohhs/provider/ licensing/occupational/dentist/about/ Michigan P.O. Box 30664 Lansing, MI 48909 (517)241-2650 http://www.michigan.gov/lara/0,4601,7154-35299_28150_27529_27533---,00. html 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://bsd.dli.mt.gov/license/bsd_ boards/den_board/board_page.asp

Nebraska 301 Centennial Mall South Lincoln, NE 68509 (402)471-3121 http://dhhs.ne.gov/publichealth/Pages/ crl_medical_dent_hygiene_board.aspx

Ohio Riffe Center 77 S. High St.,17th Floor Columbus, OH 43215 (614)466-2580 http://www.dental.ohio.gov/

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://www.rld.state.nm.us/boards/Dental_Health_Care.aspx

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/

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://1.usa.gov/xMVXWm Vermont National Life Building North FL2 Montpelier, VT 05620 (802)828-1505 http://bit.ly/zSHgpa Virginia Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4538 http://www.dhp.virginia.gov/dentistry Washington 310 Israel Rd. SE P.O. Box 47865 Olympia, WA 98504 (360)236-4700 http://www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/Dentist.aspx 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://dsps.wi.gov/Default. aspx?Page=90c5523f-bab0-4a45-ab943d9f699d4eb5 Wyoming 1800 Carey Ave., 4th Floor Cheyenne, WY 82002 (307)777-6529 http://plboards.state.wy.us/dental/index.asp MEDMONTHLY.COM |57

U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (334)242-4116 http://www.albme.org/ Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 http://bit.ly/zZ455T Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 (480)551-2700 http://www.azmd.gov 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 58| APRIL 2013

Florida 2585 Merchants Row Blvd.

Tallahassee, FL 32399 (850)245-4444 http://www.stateofflorida.com/Portal/ DesktopDefault.aspx?tabid=115

Louisiana LSBME P.O. Box 30250 New Orleans, LA 70190 (504)568-6820 http://www.lsbme.la.gov/

Georgia 2 Peachtree Street NW, 36th Floor Atlanta, GA 30303 (404)656-3913 http://bit.ly/vPJQyG

Maine 161 Capitol Street 137 State House Station Augusta, ME 04333 (207)287-3601 http://bit.ly/hnrzp

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

Maryland 4201 Patterson Ave. Baltimore, MD 21215 (410)764-4777 http://www.mbp.state.md.us/

Idaho Idaho Board of Medicine P.O. Box 83720 Boise, Idaho 83720 (208)327-7000 http://bit.ly/orPmFU

Massachusetts 200 Harvard Mill Sq., Suite 330 Wakefield, MA 01880 (781)876-8200 http://www.mass.gov/eohhs/gov/departments/borim/

Illinois 320 West Washington St. Springfield, IL 62786 (217)785 -0820 http://www.idfpr.com/profs/info/Physicians.asp

Michigan Bureau of Health Professions P.O. Box 30670 Lansing, MI 48909 (517)335-0918 http://www.michigan.gov/lara/0,4601,7154-35299_28150_27529_27541-58914-,00.html

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

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/healingarts.asp

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/

Texas P.O. Box 2018 Austin, TX 78768 (512)305-7010 http://bit.ly/rFyCEW

Nebraska Nebraska Department of Health and Human Services P.O. Box 95026 Lincoln, NE 68509 (402)471-3121 http://www.mdpreferredservices.com/ state-licensing-boards/nebraska-boardof-medicine-and-surgery

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

Utah P.O. Box 146741 Salt Lake City, UT 84114 (801)530-6628 http://www.dopl.utah.gov/

Oklahoma P.O. Box 18256 Oklahoma City, OK 73154 (405)962-1400 http://www.okmedicalboard.org/

Vermont P.O. Box 70 Burlington, VT 05402 (802)657-4220 http://1.usa.gov/wMdnxh

Oregon 1500 SW 1st Ave., Suite 620 Portland, OR 97201 (971)673-2700 http://www.oregon.gov/OMB/

Virginia Virginia Dept. of Health Professions Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4400 http://1.usa.gov/xjfJXK

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://bit.ly/w5rc8J 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/

Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)787-8503 http://www.dos.state.pa.us/portal/server. pt/community/state_board_of_medicine/12512 Rhode Island 3 Capitol Hill Providence, RI 02908 (401)222-5960 http://1.usa.gov/xgocXV South Carolina P.O. Box 11289 Columbia, SC 29211 (803)896-4500 http://www.llr.state.sc.us/pol/medical/ South Dakota 101 N. Main Ave. Suite 301 Sioux Falls, SD 57104 (605)367-7781 http://www.sdbmoe.gov/ Tennessee 425 5th Ave. North Cordell Hull Bldg. 3rd Floor Nashville, TN 37243 (615)741-3111 http://health.state.tn.us/boards/me/

Washington Public Health Systems Development Washington State Department of Health 101 Israel Rd. SE, MS 47890 Tumwater, WA 98501 (360)236-4085 http://www.medlicense.com/washingtonmedicallicense.html West Virginia 101 Dee Dr., Suite 103 Charleston, WV 25311 (304)558-2921 http://www.wvbom.wv.gov/ Wisconsin P.O. Box 8935 Madison, WI 53708 (877)617-1565 http://drl.wi.gov/board_detail. asp?boardid=35&locid=0 Wyoming 320 W. 25th St., Suite 200 Cheyenne, WY 82002 (307)778-7053 http://wyomedboard.state.wy.us/

MEDMONTHLY.COM |59

medical resource guide ACCOUNTING

Ajishra Technology Support

Boyle CPA, PLLC 3716 National Drive, Suite 206 Raleigh, NC 27612 (919) 720-4970 www.boyle-cpa.com

ADVERTISING

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

MedMedia9

www.medmedia9.com

Ring Ring LLC

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

ANSWERING SERVICES Corridor Medical Answering Service

3088 Route 27, Suite 7 Kendall Park, NJ 08824 (866)447-5154 www.corridoranswering.net

Docs on Hold

14849 West 95th St. Lenexa, KS 66285 (913)559-3666 www.soundproductsinc.com

BILLING & COLLECTION Advanced Physician Billing, LLC

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

60| APRIL 2013

Applied Medical Services 4220 NC Hwy 55, Suite 130B Durham, NC 27713 (919)477-5152 www.ams-nc.com

Sweans Technologies 501 Silverside Rd. Wilmington, DE 19809 (302)351-3690 www.medisweans.com

VIP Billing

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

Axiom Business Solutions

Find Urgent Care

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

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

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

CAREER CONSULTING Doctor’s Crossing 4107 Medical Parkway, Suite 104 Austin, Texas 78756 (512)517-8545 http://doctorscrossing.com/

Gold Key Credit, Inc. PO Box 15670 Brooksville, FL 34604 888-717-9615 www.goldkeycreditinc.com

Horizon Billing Specialists 4635 44th St., Suite C150 Kentwood, MI 49512 (800)378-9991 www.horizonbilling.com

CODING SPECIALISTS The Coding Institute LLC 2222 Sedwick Drive Durham, NC 27713 (800)508-2582 http://www.codinginstitute.com/

Management Services On-Call 200 Timber Hill Place, Suite 221 Chapel Hill, NC 27514 (866)347-0001 www.msocgroup.com

Marina Medical Billing Service 18000 Studebaker Road 4th Floor Cerritos, CA 90703 (800)287-8166 www.marinabilling.com

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

COMPUTER, SOFTWARE American Medical Software

1180 Illinois 157 Edwardsville, IL 62025 (618) 692-1300 www.americanmedical.com

CDWG

300 N. Milwaukee Ave Vernon Hills, IL 60061 (866)782-4239 www.cdwg.com/

Instant Medical History

4840 Forest Drive #349 Columbia, SC 29206 (803)796-7980 www.medicalhistory.com

medical resource guide CONSULTING SERVICES, PRACTICE MANAGEMENT

DENTAL Biomet 3i

Medical Credentialing

(800) 4-THRIVE www.medicalcredentialing.org

Medical Practice Listings

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

myEMRchoice.com

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

Physician Wellness Services 5000 West 36th Street, Suite 240 Minneapolis, MN 55416 888.892.3861 www.physicianwellnessservices.com

Synapse Medical Management

18436 Hawthorne Blvd. #201 Torrance, CA 90504 (310)895-7143 www.synapsemgmt.com

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

DocuTAP 4701 W. Research Dr. #102 Sioux Falls, SD 57107-1312 (877)697-4696 www.docutap.com

Integritas, Inc. 2600 Garden Rd. #112 Monterey, CA 93940 (800)458-2486 www.integritas.com

The Dental Box Company, Inc.

PO Box 101430 Pittsburgh, PA 15237 (412)364-8712 www.thedentalbox.com

DIETICIAN Triangle Nutrition Therapy 6200 Falls of Neuse Road, Suite 200 Raleigh, NC 27609 (919)876-9779 http://trianglediet.com/

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

Sigmon & Daknis Williamsburg, VA Office 325 McLaws Circle, Suite 2 Williamsburg, VA 23185 (757)258-1063 http://www.sigmondaknis.com/

ELECTRONIC MED. RECORDS

Urgent Care America

17595 S. Tamiami Trail Fort Meyers, FL 33908 (239)415-3222 www.urgentcareamerica.com

Urgent Care & Occupational Medicine Consultant Lawrence Earl, MD COO/CMO ASAP Urgentcare Medical Director, NADME.org 908-635-4775 (m) 866-405-4770 (f ) ASAP-Urgentcare.com UrgentCareMentor.com

Utilization Solutions service@pushpa.biz (919) 289-9126

www.pushpa.biz

ABELSoft 1207 Delaware Ave. #433 Buffalo, NY 14209 (800)267-2235 www.abelmedicalsoftware.com

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

AdvancedMD 10011 S. Centennial Pkwy Sandy, UT 84070 (800) 825-0224 www.advancedmd.com

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

INSURANCE, MED. LIABILITY Aquesta Insurance Services, Inc.

Michael W. Robertson 3807 Peachtree Avenue, #103 Wilmington, NC 28403 Work: (910) 794-6103 Cell: (910) 777-8918 www.aquestainsurance.com

Jones Insurance 820 Benson Rd. Garner, North Carolina 27529 (919) 772-0233 www.Jones-insurance.com

Medical Protective

5814 Reed Rd. Fort Wayne, In 46835 (800)463-3776 http://www.medpro.com/ medical-protective

MEDMONTHLY.COM |61

medical resource guide INSURANCE, MED. LIABILITY

Nicholas Down http://bit.ly/yHwxb0

Martin Fried

www.martindfried.com

MGIS, Inc.

1849 W. North Temple Salt Lake City, UT 84116 (800)969-6447 www.mgis.com

Professional Medical Insurance Services

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

Wood Insurance Group

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

Bank of America

Barry Hanshaw 18 Bay Path Drive Boylston MA 01505 508 - 869 - 6038 JHans76271@aol.com www.barryhanshaw.com Laura Maask 262-308-1300 Laura@medimagery.com

medimagery.com

Marianne Mitchell (215)704-3188 http://www.mariannemitchell.com http://www.colordrop.blogspot.com

MEDICAL EQUIPMENT Physician Solutions

MEDICAL ARCHITECTS MMA Medical Architects

520 Sutter Street San Francisco, CA 94115 (415) 346-9990 http://www.mmamedarc.com

MEDICAL ART Brian Allen

www.artisanprinter.com

Deborah Brenner

877 Island Ave #315 San Diego, CA 92101 (619)818-4714 www.deborahbrenner.com

Pia De Girolamo

62| APRIL 2013

www.piadegirolamo.com

ALLPRO Imaging

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

Biosite, Inc

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

MEDICAL MARKETING High Performance Network Robert Sayre Marketing Adviser/Business Coach http://www.linkedin.com/pub/robsayre/2/977/355/

MedMedia9

PO Box 98313 Raleigh, NC 27624 (919)747-9031 www.medmedia9.com WhiteCoat Designs Web, Print & Marketing Solutions for Doctors (919)714-9885 www.whitecoat-designs.com

www.biosite.com

MEDICAL PRACTICE SALES

Cryopen

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

www.cryopen.com

Carolina Liquid Chemistries, Inc.

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

www.dicomsolutions.com

Tarheel Physicians Supply 1934 Colwell Ave. Wilmington, NC 28403 (800)672-0441

Medical Practice Listings

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

MEDICAL PRACTICE VALUATIONS

Dicom Solutions 548 Wald Irvine, CA 92618 (800)377-2617

Mark MacKinnon, Regional Sales Manager 3801 Columbine Circle Charlotte, NC 28211 (704)995-9193 mark.mackinnon@bankofamerica.com www.bankofamerica.com/practicesolutions

MedImagery

LOCUM TENENS

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

MEDICAL EQUIPMENT FINANCING

www.thetps.com

BizScore

PO Box 99488 Raleigh, NC 27624 (919)846-4747 www.bizscorevaluation.com

medical resource guide

MEDICAL PUBLISHING

PRACTICE FINANCING Bank of America

Greenbranch Publishing

info@greenbranch.com 800-933-3711 www.greenbranch.com

MEDICAL RESEARCH

Mark MacKinnon, Regional Sales Manager 3801 Columbine Circle Charlotte, NC 28211 (704)995-9193 mark.mackinnon@bankofamerica.com www.bankofamerica.com/practicesolutions

CNF Medical 1100 Patterson Avenue Winston Salem, NC 27101 (877)631-3077 www.cnfmedical.com

Dermabond

Ethicon, Route 22 West Somerville, NJ 08876 (877)984-4266 www.dermabond.com

DJO

1430 Decision St. Vista, CA 92081 (760)727-1280

REAL ESTATE

www.djoglobal.com

Arup Laboratories

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

www.aruplab.com

Chimerix, Inc. 2505 Meridian Parkway, Suite 340 Durham, NC 27713 (919) 806-1074 www.chimerix.com Clinical Reference Laboratory 8433 Quivira Rd. Lenexa, KS 66215 (800)445-6917

www.crlcorp.com

Sanofi US

55 Corporate Drive Bridgewater, NJ 08807 (800) 981-2491

Scynexis, Inc.

ExpertMed

York Properties, Inc.

www.sanofi.us

Headquarters & Property Management 1900 Cameron Street Raleigh, NC 27605 (919) 821-1350 Commercial Sales & Leasing (919) 821-7177 www.yorkproperties.com

STAFFING COMPANIES Additional Staffing Group, Inc. 8319 Six Forks Rd, Suite 103 Raleigh, NC 27615 (919) 844-6601 Astaffinggroup.com

31778 Enterprise Dr. Livonia, MI 48150 (800)447-5050

www.expertmed.com

Gebauer Company

4444 East 153rd St. Cleveland, OH 44128-2955 (216)581-3030 www.gebauerspainease.com

Scarguard

15 Barstow Rd. Great Neck, NY 11021 (877)566-5935 www.scarguard.com

WEBSITE DESIGN

SUPPLIES, GENERAL

3501 C Tricenter Blvd.

Durham, NC 27713 (919) 933-4990

MedMedia9 www.scynexis.com

BSN Medical 5825 Carnegie Boulevard Charlotte, NC 28209 (800)552-1157 www.bsnmedical.us

PO Box 98313 Raleigh, NC 27624 (919)747-9031 www.medmedia9.com

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PRIMARY CARE PRACTICE - Hickory, North Carolina This is an outstanding opportunity to acquire one of the most organized and profitable primary care practices in the area. Grossing a million and a half yearly, the principal physician enjoys ordinary practice income of over $300,000 annually.

Hickory is located in the foot-hills of North Carolina and is surrounded by picturesque mountains, lakes, upscale shopping malls and the school systems are excellent. If you are looking for an established practice that runs like a well oiled machine, request more information.

The free standing building that houses this practice is available to purchase or rent with an option. There are 4 exam rooms with a well appointed procedure room. The owning physician works 4 to 5 days per week and there is a full time physician assistant staffed as well.

For the well qualified purchasing physician, the owner may consider some owner-financing. Call us today.

List price: $425,000 | Year Established: 2007 | Gross Yearly Income: $1,500,000

Medical Practice Listings Selling and buying made easy

MedicalPracticeListings.com | medlisting@gmail.com | 919-848-4202

NC OPPORTUNITIES

Woman’s Practice in Raleigh, North Carolina.

LOCUMS OR PERMANENT

Physician Solutions has immediate opportunities for psychiatrists throughout NC. Top wages, professional liability insurance and accommodations provided.

Call us today if you are available for a few days a month, on-going or for permanent placement.

Please contact Physican Solutions at 919-845-0054 or physiciansolutions@gmail.com For more information about Physician Solutions or to see all of our locums and permanent listings, please visit physiciansolutions.com

We have a established woman’s practice in the Raleigh North Carolina area that is available for purchase. Grossing a consistent $800,000.00 per year, the retained earnings are impressive to say the least. This is a two provider practice that see patients Monday through Friday from 8 till 6. This free standing practice is very visible and located in the heart of medical community. There are 7 well appointed exam rooms, recently upgraded computer (EMR), the carpet and paint have always been maintained. The all brick building can be leased or purchased.

Contact Cara or Philip for details regarding this very successful practice.

Medical Practice Listings; 919-848-4202 64| APRIL 2013

classified listings

Classified To place a classified ad, call 919.747.9031

Physicians needed

Physicians needed

North Carolina

North Carolina (cont.)

GP Needed Immediately On-Going 3 Days Per Week at Occupational Clinic . General Practictioner needed on-going 3 days per week at occupational clinic in Greensboro, NC. Numerous available shifts for October.

Averages 25 patients per day with no call and shift hours from 8:30 am to 5:30 pm. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

Immediate need for full time GP/FP for urgent cares in eastern NC. Urgent care centers from Raleigh to the eastern coast of NC seek immediate primary care physician. Full time opportunity with possibility for permanent placement. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

3-5 days per week in Durham, NC . Geriatric physician needed immediately 3-5 days per week, on-going at nursing home in Durham. Nursing home focuses on therapy and nursing after patients are released from the hospital. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com GP Needed Immediately On-Going 1-3 Days Per Week at Addictive Diease Clinics located in Charlotte, Hickory, Concord & Marion North Carolina. General Practitioner with a knowledge or interest in addictive disease.

Needed in October on-going 1-3 times per week. This clinic requires training so respond to post before October 1st. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Primary Care Physician in Northwest NC (multiple locations). Primary care physician needed immediately for ongoing coverage at one of the largest substance abuse treatment facilities in NC. Doctor will be responsible for new patient evaluations and supportive aftercare. Counseling and therapy are combined with physician’s medical assessment and care for the treatment of adults, adolescents and families. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Pediatrician or Family Medicine Doctor in Fayetteville Comfortable with seeing children. Need is immediate - Full time ongoing for maternity leave. 8 am - 5 pm.

Outpatient only. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

General Practitioner Needed in Greensboro. Occupational health care clinic seeks general practitioner for disability physicals ongoing 1-3 days a week. Adults only. 8 am-5 pm. No call required. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Pediatrician or Family Physician Needed Immediately at clinic in Roanoke Rapids, NC. Pediatric clinic in Roanoke Rapids, NC seeks Peds physician or FP comfortable with children for 2-3 months/on-going/full-time.

The chosen physician will need to be credentialed through the hospital, please email your CV, medical license and DEA so we can fill this position immediately.

County Health Department in Fayetteville, NC seeks GP/IM/FP Full-Time, On-Going Shifts. GP/IM/FP Needed Immediately at County Health Department in Fayetteville, NC. Approximately 20 patients per day with hours from 8 am -5 pm. Call or email for more information. 919-845-0054 physiciansolutions@gmail.com Occupational Clinic in Greensboro, NC seeks FP/GP for On-Going Shifts. Locum tenens position (4-5 days a week) available for an occupational, urgent care and walk in clinic. The practice is located in Greensboro NC. Hours are 8 am-5 pm. Approximately 20 patients/ day. Excellent staff. Outpatient only.

Diabetic Clinic 1 hour from Charlotte seeks FP/GP/ IM for On-Going Shifts.Primary care physician needed immediately for outpatient diabetic clinic one hour outside Charlotte, NC On-going. Hours are 8 am -5 pm with no call. Approximately 15-20 patients a day. continued on page 66 MEDMONTHLY.COM |65

classified listings

Classified

continued from page 65

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

Addictive Disease Clinic in Charlotte, NC and surrounding cities seeks GP/FP/IM for on-going shifts An addictive disease clinic with locations with locations in Charlotte, NC and surrounding cities seeks a GP with an interest in addictive medicine for on-going shifts. This clinic has 15-25 open shifts every month and we are looking to bring on a new doctor for consistent coverage. The average daily patient load is between 20 and 25 with shifts from 8 am - 5 pm and 6 am - 2 pm. If you are interested in this position please send us your CV and feel free to contact us via email or phone with questions or to learn about other positions.

Child Health Clinic in Statesville, NC seeks pediatrician or Family Physician comfortable with peds for on-going, full-time shifts. Physician will work M-F 8 am - 5 pm, ongoing. Qualified physician will know EMR or Allscripts software. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Peds Clinic near Raleigh seeks Mid-Level Provider for on-going coverage 4x/wk. Health Department pediatrics clinic 45 min from Raleigh needs coverage 4 days a week from January through June. Provider will see about 20 patients daily, hours are 8am-5pm with an hour for lunch.

Employee Health Clinic seeks Mid-Level Provider for FT on-going coverage near Charlotte. Health Department 45 minutes from Charlotte seeks on-going coverage for employee health clinic beginning in January. Provider will see about 20-24 patients daily, hours are 8am-5pm with an hour for lunch.

FT Mid-Level Provider needed for Wilmington practice immediately. Small private practice 45 minutes outside Wilmington seeks mid-level provider starting January.

M-F 8:00-5:00, PT or FT. This practice also is looking for a PA permanently in April. Accommodations, PLI, and mileage provided. Please contact Physician Solutions at 919-845-0054 or emailphysiciansolutions@gmail.com.

Clinic between Fayetteville and Wilmington seeks FP/ GP/IM Mar 22 FT ongoing. A small hospital’s outpatient clinic located within an hour of both Fayetteville and Wilmington seeks FP/GP/IM to work FT ongoing beginning March 22. Shifts can be either 8 or 12 hours. No call.

66| APRIL 2013

Clinic between Fayetteville and Wilmington seeks FP/ GP/IM Mar 22 FT ongoing. A small hospital’s outpatient clinic located within an hour of both Fayetteville and Wilmington seeks PA to work FT ongoing beginning March 22. Shifts can be either 8 or 12 hours. No call.

Employee Health Clinic seeks Mid-Level Provider for FT on-going coverage near Charlotte. Health Department 45 minutes from Charlotte seeks on-going coverage for employee health clinic beginning in March.

Provider will see about 20-24 patients daily, hours are 8am-5pm with an hour for lunch.

FT/PT Mid-Level Provider needed for Wilmington practice immediately. Small internal medicine private practice 45 minutes outside Wilmington seeks mid-level provider starting immediately. FT/PT. M-F 8:00-5:00.

Possible permanent placement.

Western North Carolina Health Department needs continuing physician coverage. County Health Department seeks coverage for their walk in clinic which sees all ages. Ongoing, 8am-5pm, no call. 35-40 patients a day. Well established clinic located in a beautiful area.

Asheboro Family Practice and Urgent Care seeks GP for intermittent coverage. Family Practice and Urgent Care seeks general practitioner for intermittent days beginning in March from 8a-8p. Provider will see about 35 patients with no call.

Greensboro occupational health care clinic seeks general practitioner for intermittent shifts. Primary care physicians needed for occupational medicine. Adults only. Hours are 8am-5pm. Large corporation, no call required.

IM/FP needed in Fayetteville health department immediately. Fayetteville health department needs coverage March through June full or part time. Clinics are adult health and women’s health. Adults only. No call 8a-5p.

Geriatric physician needed immediately 2 to 5 days per week, on-going eastern NC. Nursing homes in Durham, Fayetteville and Rocky Mount seek GP/IM/ FP with geriatric experience to work full or part time.

Nursing home focuses on therapy and nursing after patients are released from the hospital. 8a-5p, no call.

Classified To place a classified ad, call 919.747.9031

Physicians needed

Nurses needed

South Carolina

North Carolina

A family and urgent care in Little River, SC seeks an FP/EM physician for 1 to 2 days per week, on-going shifts. The practice is a one-physician facility and is looking for a physician to come in regularly. The practice is small and does not have a large patient load.

The qualified physician will have experience in Family or Emergency medicine. If you have any availability and a SC medical license contact us today and we will do our best to work around your schedule. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

Charlotte Occupational clinic seeks NP in March for ongoing coverage. Nurse practitioner needed in employee health clinic for large corporation in Charlotte.

8a-5p ongoing full time or part time.

Practice wanted North Carolina

Physicians needed Virginia 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, email: physiciansolutions@gmail.com 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 Practice Wanted in Raleigh, NC 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 US. When you list with us, your practice receives exceptional national, regional and local exposure.

Contact us today at (919) 848-4202.

Practice for sale North Carolina Family Practice located in Hickory, NC. Well-established and a solid 40 to 55 patients split between an MD 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 email: medlistings@gmail.com continued on page 69 MEDMONTHLY.COM |67

Adult & pediAtric integrAtive medicine prActice for sAle This Adult and Pediatric Integrative Medicine practice, located in Cary, NC, incorporates the latest conventional and natural therapies for the treatment and prevention of health problems not requiring surgical intervention. It currently provides the following therapeutic modalities: • • • • •

Conventional Medicine Natural and Holistic Medicine Natural Hormone Replacement Therapy Functional Medicine Nutritional Therapy

• • • • • •

Mind-Body Medicine Detoxification Supplements Optimal Weigh Program Preventive Care Wellness Program Diagnostic Testing

There is a Compounding Pharmacy located in the same suites with a consulting pharmacist working with this Integrative practice. Average Patients per Day: 12-20 Gross Yearly Income: $335,000+ | List Price: $125,000

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

FAMILY PRACTICE FOR SALE A beautiful practice located in Seattle, Washington This upscale primary care practice has a boutique look and feel while realizing consistent revenues and patient flow. You will be impressed with the well appointed layout, functionality as well as the organization of this true gem of a practice. Currently accepting over 20 insurance carriers including Aetna, Blue Cross and Blue Shield, Cigna, City of Seattle, Great West and United Healthcare. The astute physician considering this practice will be impressed with the comprehensive collection of computers, office furniture and medical equipment such as Welch Allyn Otoscope, Ritter Autoclave, Spirometer and Moore Medical Exam table.

Physician compensation is consistently in the $200,000 range with upside as you wish. Do not procrastinate; this practice will not be available for long.

List price: $255,000 | Year Established: 2007 | Gross Yearly Income: $380,000

Medical Practice Listings Selling and buying made easy

MedicalPracticeListings.com | medlisting@gmail.com | 919.848.4202

classified listings

Classified

continued from page 67

To place a classified ad, call 919.747.9031

Practice for sale

Practice for sale

North Carolina

North Carolina (con't)

Impressive Internal Medicine Practice in Durham, NC: The City of Medicine. Over 20 years serving the community, this practice is now listed for sale. There are four wellequipped 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 NC. 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

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 send an email to medlistings@gmail.com Internal Medicine Practice located just outside Fayetteville, NC 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 email: medlistings@gmail.com

South Carolina Lucrative ENT 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 you want. Physician will to stay on for a 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 email: medlistings@ gmail.com

Washington Family Practice located in Bainbridge Island, WA has recently been listed. Solid patient following and cash flow makes this 17-year-old practice very attractive. Contact Medical Practice Listings for more details. email: medlistings@gmail.com or (919) 848-4202. 

MEDMONTHLY.COM |69

PHYSICIANS NEEDED: Mental health facility in Eastern North Carolina seeks: PA/FT ongoing, start immediately Physician Assistant needed to work with physicians to provide primary care for resident patients. FT ongoing 8a-5p. Limited inpatient call is required. The position is responsible for performing history and physicals of patients on admission, annual physicals, dictate discharge summaries, sick call on unit assigned, suture minor lacerations, prescribe medications and order lab work. Works 8 hour shifts Monday through Friday with some extended work on rotating basis required. It is a 24 hour in-patient facility that serves adolescent, adult and geriatric patients.

FT ongoing Medical Director, start immediately The Director of Medical Services is responsible for ensuring all patients receive quality medical care. The director supervises medical physicians and physician extenders. The Director of Medical Services also provides guidance to the following service areas: Dental Clinic, X-Ray Department, Laboratory Services, Infection Control, Speech/Language Services, Employee Health,

Pharmacy Department, Physical Therapy and Telemedicine. The Medical Director reports directly to the Clinical Director. The position will manage and participate in direct patient care as required; maintain and participate in an on-call schedule ensuring that a physician is always available to hospitalized patients; and maintain privileges of medical staff.

Permanent Psychiatrist needed FT, start immediately An accredited State Psychiatric Hospital serving the eastern region of North Carolina, is recruiting for permanent full-time Psychiatrist. The 24 hour in-patient facility serves adolescent, adult and geriatric patients. The psychiatrist will serve as a team leader for multi-disciplinary team to ensure quality patient care/treatment. Responsibilities include:

evaluation of patient on admission and development of a comprehensive treatment plan, serve on medical staff committees, complete court papers, documentation of patient progress in medical record, education of patients/families, provision of educational groups for patients.

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 PH: (919) 845-0054 | email: physiciansolutions@gmail.com

Practice for Sale in Raleigh, NC Primary care practice specializing in women’s care Raleigh, North Carolina

Practice for Sale in South Denver Neurofeedback and Psychological Practice Located in South Denver, Colorado, this practice features high patient volume and high visibility on the internet. Established referral sources, owner (psychologist) has excellent reputation based on 30 years experience in Denver. Private pay and insurances, high-density traffic, beautifully decorated and furnished offices, 378 active and inactive clients, corporate clients, $14,000 physical assets, good parking, near bus and rapid transit housed in a well-maintained medical building.

Live and work in one of the most healthy cities in the U.S. List Price: $150,000 | Established: 2007 | Location: Colorado For more information contact Dr. Jack McInroy at 303-929-2598 or Shrink1324@gmail.com 70| APRIL 2013

The owning 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 profit 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 and beautifully decorated throughout. New computers and medical management software add to this modern front desk environment.

List price: $435,000

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

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

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.

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

PEDIATRICIAN

or family medicine doctor needed in

FAYETTEVILLE, NC

Comfortable seeing children. Needed immediately.

Call 919- 845-0054 or email: physiciansolutions@gmail.com www.physiciansolutions.com

Woman's Practice A vailable for Sale Available for purchase is a beautiful boutique women’s Internal Medicine and Primary Care practice located in the Raleigh area of North Carolina.

The physician owner has truly found a niche specializing in women’s care. Enhanced with female-related outpatient procedures, the average patient per day is 40+. The owner of the practice is an Internal Medicine MD with a Nurse Practitioner working in the practice full time. Modern exam tables, instruments and medical furniture.

Gross Yearly Income: $585,000 | List Price: $365,000

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

Pediatrics Practice Wanted Pediatrics practice wanted in NC 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.

Contact us today to discuss your options confidentially.

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

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

NC MedSpa For Sale MedSpa Located in North Carolina We have recently listed a MedSpa in NC 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.

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

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

Also available online 24/7

medmonthly.com

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

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

®

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

For more information, visit our website: www.ACEfitness.org

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A M E R I C A’ S A U T H O R I T Y O N F I T N E S S

Primary Care Practice for Sale Hickory, North Carolina Established primary care practice in the beautiful foothills of North Carolina The owning physician is retiring, creating an excellent opportunity for a progressive buyer.

There are two full-time physician assistants that see the majority of the patients which averages between 45 to 65 per day.

There is lots of room to grow this already solid practice that has a yearly gross of $1,500,00.

You will be impressed with this modern and highly visible practice.

Comprehensive Ophthalmic and Neuro-Ophthalmic Neuro-Ophthalmic Practice Raleigh North Carolina This is a great opportunity to purchase an established ophthalmic practice in the heart of Raleigh. Locate on a major road with established clients and plenty of room for growth; you will appreciate the upside this practice offers.

This practice performs comprehensive ophthalmic and neuro-ophthalmic exams with diagnosis and treatment of eye disease of all ages.

Surgical procedures include no stitch cataract surgery, laser treatment for glaucoma and diabetic eye disease. This practice offers state-of-the-art equipment and offer you the finest quality optical products with contact lens fitting and follow-up care & frames for all ages.

List Price: $75,000 | Gross Yearly Income: $310,000

Call for pricing and details.

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

Contact Cara or Philip 919-848-4202 for more information or visit MedicalPracticeListings.com

TM

Primary Care Practice For Sale Wilmington, NC

ADVERTISE YOUR PRACTICE BUILDING IN MED MONTHLY By placing a professional ad in Med Monthly, you're spending smart money and directing your marketing efforts toward qualified clients.

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.

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

Internal Medicine Practice for Sale Located in the heart of the medical community in Cary, North Carolina, this Internal Medicine practice is accepting most private and government insurance payments.

The average patients per day is 20-25+, and the gross yearly income is $555,000.

Listing Price: $430,000

Contact one of our advertising agents and find out how inexpensive yet powerful your ad in Med Monthly can be.

medmonthly.com | 919.747.9031 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 that are 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

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

To view more listings visit us online at medicalpracticelistings.com

MD STAFFING AGENCY FOR SALE IN NORTH CAROLINA The perfect opportunity for anyone who wants to purchase an established business.

PEDIATRICIAN

OR FAMILY MEDICINE DOCTOR NEEDED IN

ROANOKE RAPIDS, NC In mid December, a pediatrician or family medicine doctor comfortable with seeing children is needed full time in Roanoke Rapids (1 hour north of Raleigh, NC) until a permanent doctor can be found.

Credentialing at the hospital is necessary.

l One

of the oldest Locums companies l Large client list l Dozens of MDs under contract l Executive office setting l Modern computers and equipment l Revenue over a million per year l Retiring owner

Please direct all correspondence to driverphilip@gmail.com.

Only serious, qualified inquirers.

Call 919- 845-0054 or email: physiciansolutions@gmail.com www.physiciansolutions.com

MODERN MED SPA AVAILABLE Located in beautiful coastal North Carolina

Modern, well-appointed med spa is available in a picturesque part of the state. This practice is positioned in a highly traveled area with positive demographics adding to the business appeal and revenue stream. A sampling of the services and procedures offered are: BOTOX, facial therapy and treatments, laser hair removal, eye lash extensions and body waxing as well as a menu of anti-aging options.

If you are currently a med spa owner and looking to expand or considering this high profile med business, this is the perfect opportunity.

Highly profitable and organized, you will find this spa poised for success.

The qualified buyer can obtain detailed information by contacting Medical Practice Listings at 919-848-4202.

MedicalPracticeListings.com | medlisting@gmail.com | 919.848.4202

the top

1

MANAGING FINANCES WITH THE UNCERTAINTY OF MEDICARE REIMBURSEMENT RATES

The threat of a significant cut in Medicare reimbursement continues to plague physician practices and severely hinders their ability to properly plan and assess their financial situations.

2

PREPARING FOR REIMBURSEMENT MODELS THAT PUT GREATER FINANCIAL RISK ON PRACTICES

Physicians may soon be at financial risk as payers test and adopt new payment methods. These new payment methods require doctors to think in new ways and will challenge the information systems of even the most sophisticated feefor-service practice.

3

PREPARING FOR THE TRANSITION TO ICD-10

Planning and implementing ICD10-CM must include communication and significant collaboration on information technology, finance, education, and problem solving. The work necessary to implement ICD-10-CM and the resources required will depend on the size of the practice.

76 | APRIL 2013

4

Bigge

Medic DEALING WITH RISING OPERATING COSTS

The largest expense after real estate, equipment, and insurance is personnel, an area that managers constantly struggle with. Practices have to be able to provide good patient care without being overstaffed. Trying to hire dynamic employees who can do a little bit of everything seems to be the solution for many practices.

5 6

PARTICIPATING IN CMS’ ELECTRONIC HEALTH RECORD MEANINGFUL USE INCENTIVE PROGRAM

Frank Rosello, CEO at Environmental Intelligence LLC, has a very informative article on the current progress of the meaningful use Stage 2 being reviewed by CMS in the January issue of Med Monthly.

7

COLLECTING PAYMENT FROM HIGH-DEDUCTIBLE HEALTH PLANS AND/OR HEALTH SAVINGS ACCOUNT PATIENTS Health plan deductibles are rising, and patient self-pay of deductibles is typically difficult for doctors to collect, meaning that increasingly more doctors may lose money on patient deductibles.

MAINTAINING PHYSICIAN COMPENSATION LEVELS

There is rarely just one strategy to increase physician compensation. Most groups will use a combination of revenue enhancement and expense management options on an ongoing basis, tweaking and re-evaluating their strategy from year to year.

est Challenges Facing

cal Practices Today

8

MANAGING GROUP PRACTICE FINANCES

The healthcare environment is increasingly complex to navigate.

It’s now more important than ever for professional practice administrators, especially those who are board certified in medical practice management, to assist their practices in adapting to the arduous processes and regulations that govern our industry.

9

RECRUITING PHYSICIANS

Practices should implement a staff development plan to help them anticipate when physician job openings will occur and to help them schedule recruitment efforts accordingly. Intense competition means that starting the physician search without an adequate lead time could result in a long and detrimental physician vacancy gap.

MEDMONTHLY.COM | 77

It’s Time to Get Online!

M e dM ed i a9 medmedia9.com

Showcase your practice and develop the right image.

Our website package is custom designed and affordable.

Increase your patient volume and profitability with a website from MedMedia9.

Scan this QR code with your smartphone to learn more.

Visit us today at medmedia9.com to find out how we can make your practice grow. Click on the “Web Design” tab for more details and view the sample website.

Call MedMedia9 today at 919-747-9031.