Med Monthly August 2014

Med Monthly August 2014

Concierge Medicine Will Get Massive Boost From Obamacare pg. 44

IS CONCIERGE MEDICINE THE CORRECT CHOICE FOR YOU?

the

e Concierg e Medicin issue

pg. 40

The Pros and Cons of Concierge Medicine-Practices pg. 42

contents

features

40 IS CONCIERGE MEDICINE THE CORRECT CHOICE FOR YOU? 42 THE PROS AND CONS OF CONCIERGE MEDICINE-PRACTICES 44 CONCIERGE MEDICINE WILL GET MASSIVE BOOST FROM OBAMACARE

insight 10 ENCOURAGING MEDICAL STUDENTS TO PURSUE FAMILY MEDICINE

THE GROWING BUSINESS OF URGENT CARE

12

research and technology 26 FDA UPDATES FISH CONSUMPTION RECOMMENDATIONS

12 THE GROWING BUSINESS OF URGENT CARE

28 PRE-DIABETES LABEL ‘UNHELPFUL’ AND ‘UNNECESSARY’

14 ANGRY MEDICINE: Why Anger is a Healthcare Issue

30 HYPERTHERMIA: Too Hot for Your Health

practice tips

legal

18 ARE YOU OUT-OF-TOUCH WITH WHAT PATIENTS WANT?

32 OFFICE FOR CIVIL RIGHTS (OCR) OFFERS “LESSONS LEARNED” REGARDING HIPAA COMPLIANCE

20 A THREE-STEP APPROACH TO PEDIATRIC RASHES

34 CLOSELY HELD CORPORATIONS CAN BE EXEMPT FROM ACA CONTRACEPTION PROVISIONS BASED ON RELIGIOUS 22 HIRING HELP: Adding New Team Members OBJECTIONS to Your Practice 38 HEALTH PLANS MUST CERTIFY ABILITY TO CONDUCT ELECTRONIC TRANSACTIONS

international

the arts 24 GOVERNMENT SUPPORT FOR IMPROVED DISEASE MANAGEMENT FUELS THE INDONE48 MEDICINE CURES THE BODY, BUT ART HEALS SIAN INFECTIOUS DISEASE IVD MARKET THE SPIRIT: The Creative Center at University Settlement CONCIERGE MEDICINE WILL GET MASSIVE BOOST healthy living FROM OBAMACARE 52 HEIRLOOM TOMATO SALAD WITH ROSEMARY

44

in every issue 4 editor’s letter 8 news briefs

58 resource guide 78 top 9 list

January 1, 2014 begins the attestation period for Stage 2 Meaningful Use. If you are a member of the North Carolina Medical Society, you have access to the resources provided for our members to help your practice achieve Meaningful Use in 2014.

Call us today at 919-833-3836 x141

Providing Jobs, Services, Vendors, and CME www.ncmedsoc.org

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editor’s letter It’s commonly known that the Affordable Care Act will provide millions of uninsured Americans health care coverage. This means that there will be a huge influx of people wanting medical care. Physicians will be forced to reduce the amount of time per patient to make ends meet. Med Monthly explains a viable alternative: concierge medicine.

What is concierge medicine? According to Paul Hsieh, MD, in his feature Is Concierge Medicine the Correct Choice for You? says that patients can pay a monthly fee for medical services.

These can be as low as $4-5 a day. The benefits include “same day appointments, 24/7 access to their doctor, e-mail consultations, and longer appointment times.” By spending more time with patients and reducing the wait time for an appointment, doctors are more likely to make the correct diagnosis and head off future ailments. Furthermore, the doctors who use this model have greater job satisfaction.

In The Pros and Cons of Concierge Medicine-Practices, we can read about more specifics of this growing form of medicine.

At one time the idea of concierge medicine was restricted to wealthy individuals. Now the prices have dramatically dropped. In the wake of healthcare changes, doctors are finding more patients in the middle class. These types of practices are steadily increasing, with about 25% more clinics added per year. Concierge practices do not accept insurance which decreases the administrative time and cost, therefore increasing the bottom line. Unfortunately, some insurance policies do not have a concierge clause, so it is recommended that patients buy the cheapest insurance with the highest deductibles. The fact remains that most people with normal insurance pay around 12% less, as the primary care doctors have decreased rates with specialists and do not charge extra for things like blood work and x-rays.

Dike Drummond, MD, in his article Concierge Medicine Will Get Massive Boost From Obamacare writes that since more people will have insurance, there will be a shortage of doctors.

Therefore, he believes there will be an increase in Concierge Clinics. Dr. Drummond’s thought is that both patients and doctors will be concerned that there is a lack of a personal relationship due to shorter appointment times. Also, more NPs and PAs will be treating patients, leaving the most complicated procedures only for the doctors.

As either a patient or doctor, it is clear that these types of clinics are on the rise and are a viable option to the current practices with the older business model. We look forward to September’s issue where features on medical billing options will help physicians determine the feasibility of change.

Ashley Austin Managing Editor 4 | AUGUST 2014

Med Monthly August 2014 Publisher Philip Driver Managing Editor Ashley Austin Creative Director Thomas Hibbard Contributors Ashley Acornley, MS, RD, LDN. Tricia Maddrey Baker Tina Bell Dike Drummond, M.D. Amy Gordon Barbara Hales, M.D. Emily M. Hord Paul Hsieh, M.D. Laura E. Marusinec, M.D. Ashley McCarthy Audrey Christie McLaughlin, RN Amy N. Moore Susan M. Nash Carrie A. Noriega, M.D. Deb Wood, PhD

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

contributors Tina Bell

is the co-founder of UrgentCareSuccess (www.UrgentCareSuccess.com), an urgent care consulting firm and online educational resource provider for urgent care owners. She has served as the chief brand officer for HealthCARE Express since 2008, where she oversees marketing strategy and development for the company’s growing urgent care and occupational medicine business.

Laura E. Marusinec, M.D. is a board-certified pediatrician at Children’s Hospital of Wisconsin Urgent Care with experience in general pediatrics, pediatric dermatology, and pediatric urgent care. She has supported an electronic health record implementation and optimization and is pursuing further medical writing education and opportunities.

Audrey McLaughlin, RN is a physicians practice expert, medical practice business strategist & marketing specialist. She uses her more than 12 years of diverse medical industry experience to help physicians, practice owners and managers to breathe new life into their practices.

Carrie Noriega, M.D. is a board certified obstetrician/ gynecologist who has worked in both private practice in the US and a socialized medical system.

As an adventure racer and endurance mountain bike racer, she has developed a special interest in promoting health and wellness through science and medicine.

Deb Wood, PhD is a senior consultant for Workplace Behavioral Solutions, Inc. and its Midwest EAP Solutions and Physician Wellness Services divisions, where she does counseling, speaking, and training and development. She specializes in the areas of team building, stress management and change in organizations, and also does critical incident stress debriefings.

She is a certified couple’s communication facilitator, a Certified Employee Assistance Professional and has her PhD in counseling from Capella University.

WWW.MEDMONTHLY.COM |5

designer's thoughts

From the Drawing Board In the “Research and Technology” section of the August Med Monthly we have articles on new FDA recommendations on fish consumption, insights and advice on the overuse of the label “pre-diabetic”, and advice on heat-related illness for older adults.

FDA Updates Fish Consumption Recommendations: A Brief Review of the Research by Carrie A. Noriega, MD reports the U.S. Food and Drug Administration has announced it is updating the recommendation for fish consumption by pregnant/breastfeeding women and young children. They hope this new recommendation will bring more public awareness to the health benefits of eating fish in pregnancy, during lactation, and in early childhood after discovering the numbers in current fish consumption while pregnancy are down.

In the article Pre-Diabetes Label ‘Unhelpful’ and ‘Unnecessary’ researchers from UCL and the Mayo Clinic considered whether a diagnosis of pre-diabetes carried any health benefits such as improved diabetes prevention. “Pre-diabetes is an artificial category with virtually zero clinical relevance,” says lead author John S Yudkin, Emeritus Professor of Medicine at UCL. “We need to stop looking at this as a clinical problem with pharmaceutical solutions and focus on improving public health.”

The article Hyperthermia: Too Hot for Your Health shares concerns by the National Institutes of Health (NIH) on dealing with the dangers of hyperthermia, especially in older adults and people with chronic medical conditions. The article also includes health tips to prevent, and to deal with, heat related illnesses in the elderly provided by the National Institute on Aging (NIA).

Med Monthly will continue to report on the latest medical research and technology. If there are topics or insights on advances in medical technology you would like to share with us for future issues, please contact us at medmedia9@gmail.com.

Thomas Hibbard Creative Director

6 | AUGUST 2014

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news briefs

New Report Shows High-Value Provider Networks Maximize Quality, Affordability for Consumers High-value provider networks are part of a broad array of strategies health plans use to maximize health care affordability and quality, and a new analysis from actuarial firm Milliman for America’s Health Insurance Plans (AHIP) offers additional insight into how health plans develop these networks to improve care delivery and value. The report finds that high-value provider networks allow for more affordable coverage options with 5% to 20% lower premiums compared to broader network plans, while placing an emphasis on the quality and effectiveness of providers.

“High-value provider networks are an important option that families and individuals can select for access to affordable, high-quality care,” AHIP President and CEO Karen Ignagni said. “By partnering with providers to improve care delivery, health plans ensure patients get the best value for their health care dollars.”

To achieve high quality and cost-effective care, health plans’ high-value network designs are focused on delivering care through more efficient treatment protocols, which resulting in the elimination of wasteful spending. In that regard, these initiatives address the cost and quality challenges in a comprehensive way—not simply though implementing smaller or narrower provider networks.

While health plans continue to offer broader coverage options, creating high-value networks—or contracting with a select number of providers who meet quality, cost, and effectiveness metrics—is one way health plans

address the wide variation in the price of services and care delivery. In addition, the report highlights that highvalue provider networks are “specifically geared toward providing personal and comprehensive care to patients in an environment where providers effectively communicate and coordinate with each other regarding the best treatment for the patient.”

The key findings of the report include: • The use of high-value provider networks can help reduce premiums and promote more affordable coverage options for consumers—with premium reductions of 5% to 20% or more when compared with broad network plans.

• High-value networks are developed through a deliberative evolution process considering more than just fee levels.

• Active cooperation and collaboration—between the health plan and participating providers—is a hallmark of successful high-value networks plans.

• Performance on quality measures is the key part of the criteria used for provider selection and inclusion in a plan’s network.

• Integration of the value network into plan designs is being used to improve the efficiency of care management and quality of care.  Source: http://www.pressreleasepoint.com/new-reportshows-high-value-provider-networks-maximize-qualityaffordability-consumers

SOON COMING NTHLY O IN MED M

coming In the up sue, er 2014 is Septemb me will thly’s the Med Mon al be Medic tions Billing Op

8 | AUGUST 2014

Sleep Apnea Market is in Need of Finer, Ergonomic Treatments The increasingly sedentary lifestyle and late work habits of people are leading to more cases of obstructive sleep apnea (OSA). The resulting lack of quality sleep can cause hypertension, heart failure, stroke, and reduced performance in everyday activities. The large cohort of undiagnosed people with OSA across the globe makes this a highly attractive market for investments.

New analysis from Frost & Sullivan finds that the time is ripe for stakeholders to integrate their efforts and develop a standard platform to diagnose and treat sleep apneic patients.

“Current treatments for sleep apnea include surgery to correct static obstructions, the use of continuous positive airway pressure (CPAP) devices to supply air, and other devices that help keep the airway open,” said Technical Insights Team Leader Saju John Mathew. “There are also over 30 different drugs in the market that address OSA issues by increasing the tone of the upper airways and ventilator drive.”

A key challenge facing the market is the lack of qualified personnel, such as pulmonologists and otolaryngologists, to diagnose sleep apnea in a timely manner. In addition, poor compliance with CPAP devices even though it is safer and more effective than any other surgical therapy has resulted in sleep apnea and its associated illnesses recurring among patients.

The development of finer and ergonomic CPAP devices will help increase patient ability to adhere to sleep therapy. The market is also seeing a rise in newer technologies that replace elaborate practices, target patient comfort to improve compliance, and help drive acceptance of sleep monitoring devices. This includes mandibular repositioning devices, which are cheaper than CPAP devices and more effective than tongue retaining devices; neuromodulators that are being developed with increasingly smaller footprints resulting in small incisions.

Widespread acceptance of these technologies among patients, who have become more aware and open to try different treatments, will eventually lead to a drop in equipment prices, making new technology platforms and products affordable. Evolving technologies will also influence patient preferences for products, treatment modalities, and diagnostic locations.

“As such, the global sleep apnea treatment market is expected to shift to home-based diagnostics for early identification and treatment of patients as well as portable devices that can reduce sleep apnea with minimal inconvenience,” noted Mathew. 

Holistic Approach Was Found Effective for Well-Rounded Recovery in Substance Abuse Facility Many studies have proven that these holistic approaches are very helpful to Substance abuse.

Substance Abuse Recovery has considered this kind of treatment in their program which they found very useful and practical. It can be a very important component to fight addiction and alcoholism, particularly if balanced with a professional and fact-based treatment plan.

This kind of program focuses on treating the whole being of a person to help him/her feel better. A healthy diet, exercising, doing yoga, and therapy talks are a few of the things that they used, along with medication, to help speed up recovery. Clients are taken to the gym daily to improve their physical health. Daily exercise has been found to help with mood and confidence. It also improves your sleep, and boosts your brain power. They also implemented a yoga session to increase their concentration and patience which helps in their sense of control, especially when their clients cannot sleep, craving, and agitating.

This treatment program also promotes relaxation through massage, along with physical and psychological health.

Clients will also experience therapy talks. These talks will help clients to know the skills necessary to stop using drugs or alcohol and help them realize the damage that addiction has done in their lives.

This kind of approach will help clients realize that they are not alone. Families are encouraged to join in some treatment activities. Involving families in these activities can help patients stay motivated.

They also created healthy meal plans for their clients as a part of their treatment program. Eating healthy has a direct effect on people. Having the right nutrition can help their clients improve their mood and boost immune system. By having these approaches on addiction rehabilitation, Substance Abuse Recovery’s goal is to help clients experience a new and complete recovery.  Source: http://www.newswiretoday.com/ news/144412/

Source: http://www.newswiretoday.com/news/143498/ WWW.MEDMONTHLY.COM |9

insight

Encouraging Medical Students to Pursue Family Medicine:

HOW YOU CAN HELP

By Tricia Maddrey Baker Executive Director Pitt County Medical Society

10 | AUGUST 2014

W

e have all read the reports: one third of all currently practicing primary care physicians in the US will retire in the next ten years. By the year 2020, the US will be short 24,000 to 200,000 family medicine physicians, depending on the study. Graduate Medical Training reports a continuing decline for the number of residents choosing family medicine, with the reported ratios of PCPs to Specialists at 30% to 70%, and declining each year.

What exactly causes medical students to choose any other specialty than Primary Care? Is it the long hours or working conditions? Is it the lack of prestige for this choice, “My daughter, the surgeon,” sounds sexier than “she’s a doctor.” Or is the issue the differential between the specialist and the PCP income?

As our County Medical Society examined this issue, one fact glared brightest. The high cost of education means that the debt for early career physicians is higher than ever before, and students worry about repayment.

We looked at the local school of Medicine, where the annual tuition is, by design, the lowest in the nation, and saw that the cumulative impact of four years would be over $140,000. By contrast, each year of Medical School at Duke University is near $82,000, and other state medical schools around $45,000 annually. An Ivy League undergraduate education now costs over $60,000 each year, so that indebtedness from eight years of school could be as high as $500,000 before the student works one day. If the post-residency/fellowship physician wishes to purchase a home, the physician could be nearly one million dollars in debt before starting to earn income!

In addition, the youngest generation of university graduates is entrepreneurial, with over one third having started a business before completing their senior year. When the potential primary care physician looks at working in a stand-alone practice and sees the actual reimbursement rates and cost of practicing medicine in 2014, this student is driven towards specialties with stronger income potential. Currently, specialists are earning twice that of employed primary care physicians, with independent PCP providers earning much less.

Confronted with these projections, the Board of Directors of Pitt County Medical Society in Greenville, NC decided to take action. Last fall, the Society initiated a new scholarship for the Brody School of Medicine at East Carolina University. The announcement and first commitments came from the annual dinner, and the next event was a Founders’ Circle reception this spring, where the first recipient was introduced. Immediately there were twenty donors, and the donor list continues to grow through group communications and direct ask.

Organizing a scholarship is fairly straightforward. Your first task is to inspire your friends, colleagues, and other interested parties to join with you. When you communicate your own passion and commitment, you will generate passion and dedication in your favorite people, and they will become your ambassadors to their colleagues as well.

Here are the decisions to make:.

1. Which 501(c )3 will administer your scholarship? (Universities will set up a fund for your donations by request; each has different guidelines, but they can design the scholarship for you.)

2. For how many years do you want to support a student? Is it for one year or renewable throughout the scheduled education?

3. What will be the criteria for selecting the recipient (please remember EEOC requirements)?

4. How often do you want to give the scholarship?

5. Do you want to have a minimum donation level, or a “naming rights” level?

The Foundation or other agency that administers your scholarship will know how to screen and choose applicants based on your selected criteria. They will also send acknowledgement letters for tax purposes, but you and your group will also send short notes of thanks to the donors.

After interest has been assessed, each $10,000 given through the scholarship will reduce the impact of the loan by nearly $27,000 over a maximum-term loan. You may add to your criteria that the student expresses an interest in family medicine, depending on the guidelines of the foundation at the chosen university. Please also consider mentoring the students you choose.

Of course you should have fundraising events, but for this purpose, think small in numbers and large in dollars! Arrange to have several intimate gatherings, preparing the attendees to think about their commitment to the future of medicine in your state or location. Be sure that those who present are passionate about medicine and about shepherding the future generations of physicians.

You have the power to change the future, by making it possible for students to become the next generation of doctors.

As a personal note, if you are shy about asking your friends to support your cause, just remember: you already have 10 friends who would give you $100 or $1000 if you requested it, without any explanation or promises.

Won’t these same friends give you this much or more with the cause where your passion thrives?  WWW.MEDMONTHLY.COM |11

insight

The Growing Business of Urgent Care

By Tina Bell Co-founder UrgentCareSuccess

A decade ago, going to see a doctor for minor injuries and illnesses meant patients had to either schedule an appointment or sit in a waiting room as a primary care physician attempted to fit them into an already overbooked schedule for a same day visit. As the American culture has shifted to a society of convenience, so too has the way patients expect to receive medical care. This shift, coupled with the nationwide shortage in primary care physicians and overcrowded emergency departments, has led the boom for urgent care centers now popping up across the country.

According to the American Academy of Urgent Care Medicine, there are approximately 9,300 walk-in, stand-alone urgent care centers in the United States. The academy estimates 12 | AUGUST 2014

there are over 20,000 physicians practicing Urgent Care Medicine today, despite the industry not yet being listed as a true specialty.

Urgent Care: A Changing Business Opportunity The growth in the urgent care specialty is fueled right now through a mixture of five models: Independently Owned, Private Equity, Franchise, Health Plan Owned, and Hospital Owned. Each of these models has a different reason for getting into the business of urgent care, and as they have found success in the business, the face of the industry has slowly started to change.

While the majority of urgent care centers are still owned by physicians or physician groups, that model is on

the decline as private equity groups, health plans, hospitals, and chains are slowly buying up the smaller urgent care businesses or consolidating them into national chains. Four years ago physicians accounted for over 50 percent of the ownership of urgent care centers. That number has now dwindled to around 35 percent.

A 2012 study completed by Health System Change found the primary reason health plans are delving into the urgent care market is a desire to steer patients away from costly emergency room visits. The largest urgent care provider in the country right now, Concentra, is owned by Humana. Blue Cross Blue Shield of North Carolina made an investment in 2012 in FastMed to provide urgent care access to their patients throughout the state.

That same year, Dignity Health bought U.S. HealthWorks and WellPoint invested into Physicians Immediate Care.

Many hospitals and larger health systems have broken into the urgent care market, too, seeing it as a way to drive patient volume and also alleviate the strain on their emergency departments. According to Beckers Hospital Review, the five largest health system urgent care operators include Aurora Urgent Care (37 Clinics), Intermountain InstaCare (24 clinics), Carolinas HealthCare Urgent Care (22 clinics), Florida Hospital CentraCare (20 clinics), and St. John Providence Urgent Care (18 clinics). Overall, 25 percent of urgent cares nationwide are owned by a hospital. This is a huge shift from just four years ago, when hospitals owned less than 7 percent of the urgent care centers nationwide.

Doctors Express was the urgent care industry’s first attempt at offering a franchise model. The model offered land developers and investors a turnkey opportunity to get into the urgent care industry. In 2013, Doctors Express was acquired by American Family Care but still operates as a franchise model.

Same Day Care with a Retail Model Urgent care centers are often confused with retail clinics and standalone emergency rooms. The difference is unlike retail clinics, which usually only have a few rooms and are run by a midlevel, urgent care centers tend to be run by physicians, have multiple rooms, and offer onsite lab and x-rays. Urgent care centers differ from standalone emergency rooms in that they are not typically setup to handle trauma patients or to admit patients into hospitals. Additionally, the cost to be seen at an urgent care center is substantially cheaper than the cost of a visit to a standalone emergency room, but it is often times more expensive than a visit to a retail clinic.

Because urgent care centers require top-of-mind-awareness to be successful, they tend to follow a business model similar to big box retailers. Centers are located in high traffic areas with convenient access points. They are open with extended hours, and unlike primary care offices, they utilize multiple marketing channels to reach their patient base.

The urgent care center model focuses on providing quality medical care coupled with a customer service centered patient experience. It is not uncommon for urgent care centers to provide extra amenities to patients like coffee bars, entertainment in waiting and exam rooms, and followup phone calls to ensure a patient was satisfied with their visit. Additionally, recognizing the changes coming to reimbursements with the Affordable Care Act, many urgent care centers have started adding cash only services, personal injury services, and occupational medicine into their practice scope.

While the urgent care industry has experienced rapid growth over the past decade, most urgent care executives do not anticipate that growth to stop anytime soon. Urgent care is still a growing business with an estimated 50-100 new centers opening each year across the country.  Tina Bell is the co-founder of UrgentCareSuccess (www.UrgentCareSuccess.com), an urgent care consulting firm and online educational resource provider for urgent care owners. She has served as the chief brand officer for HealthCARE Express since 2008, where she oversees marketing strategy and development for the company’s growing urgent care and occupational medicine business.

She regularly presents at industry conferences like the Urgent Care Success Summit, the Medical Marketing Conference, and the Urgent Care Association of America’s conference.

She can be reached at info@urgentcaresuccess.com.

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insight

Angry Medicine:

Why Anger is a Healthcare Issue

By Deb Wood, PhD Senior Consultant Physician Wellness Services (a division of Workplace Behavioral Solutions, Inc.)

14

| AUGUST 2014

W

hile anger is a completely normal emotion, the way a doctor expresses it—as well as the intensity and frequency with which it erupts—can have a dramatic impact on

several factors.

According to Vanderbilt University research, unprofessional behaviors are associated with everything from poor adherence to practice guidelines, loss of patients, low staff morale and turnover to medical errors, adverse outcomes and malpractice suits.

The Hidden Costs of Physician Anger Another reason for concern about physicians with anger issues is that they’re putting a valuable asset (their own health) at risk: • In addition to being associated with habits that increase the likelihood of developing heart disease (including smoking, low levels of physical activity and excessive use of alcohol), anger also produces direct biological effects on the heart and arteries by triggering the release of adrenaline, cortisol and other stress hormones associated with the body’s “fight or flight” response.

• High levels of stress hormones contribute to cardiovascular disease in several ways. Not only do they constrict blood vessels and boost blood pressure, they also enhance the clotting potential of the blood, increasing the likelihood that blockages will form in the heart’s arteries.

• In a 10-year study of healthy veterans at Duke University, men who reported higher levels of anger, hostility and depression showed a steady increase in their levels of C3, a marker of the inflammatory process thought to contribute to the development and progression of heart disease.

What Causes Anger?

Anger is one of the most complex human emotions. Many times anger is an appropriate response to a situational trigger—which can be expressed in either an appropriate or inappropriate manner. Physiological changes associated with anger include elevated heart rate, blood pressure and adrenaline.

Some people anger more easily than others, some are born that way and some develop it over time. There’s evidence that some children are born irritable and touchy and are perceived that way from an early age. Family background can also play a role—people who are easily angered often come from families that are disruptive, chaotic and not skilled at emotional communications.

Common mental or behavioral health issues that may result in increased irritability or difficulty managing anger include: • • • •

Untreated depression or anxiety Bipolar disorder Chemical dependency ADD or ADHD

Less common and more serious psychiatric disorders associated with anger include borderline, oppositional defiant or antisocial personality disorders, and schizophrenia.

In cases where anger is a manifestation of more serious underlying mental health issues such as depression, anxiety and personality styles, exploring opportunities for assessment and support is key in addressing these situations effectively.

Normal Versus Pathological Anger Typically, “normal” anger and “pathological” anger are differentiated by a variety of factors and the relative degree to which those factors come into play, including: • Pervasiveness: Is it a single, isolated incident or is there anger about a great many things and with a great many people?

• Duration: Is the anger over once expressed, or is there brooding after the fact about the person or event that triggered the anger?

• Communication: Is the anger expressed constructively or does it involve sarcasm, insults, threats or shouting?

• Physicality: Is there an attempt to physically intimidate or injure the person perceived as triggering the anger?

Are things thrown or broken in a rage?

“For the most part, anger disorders cannot be blamed on bad neurology, genes or biochemistry. They arise from a failure to recognize and consciously address anger as it arises, before it becomes pathological and dangerous,” said Dr. Stephen A. Diamond, PhD in a 2009 article on anger disorders published in Psychology Today.

What Makes Physicians Angry?

With physicians, the most common “triggers” for anger include: • • • •

Getting behind schedule Medical complications Unexpected additions to the schedule Nurses or other staff who are not as driven as they are — or who can’t seem to “read their minds” continued on page 16 WWW.MEDMONTHLY.COM | 15

Organizational Toxicity:

continued from page 15

• Perceived obstacles to providing patient care — “hoops they have to jump through” to get treatments approved • Outdated or inefficient systems and processes • Charting in general, and electronic records in recent years • Uncooperative patients • Hurt or resentment over real or perceived slights Regardless of the trigger, a doctor who responds with verbal or physical attacks has an anger management problem and so, by extension, does the organization employing him or her.

‘‘

“For the most part, anger disorders cannot be blamed on bad neurology, genes or biochemistry. They arise from a failure to recognize and consciously address anger as it arises, before it becomes pathological and dangerous.”

Dr. Stephen A. Diamond, PhD

Change Contributes to Anger, Too It’s hard to ignore that many doctors are angry, frustrated and apprehensive about the future of their medical practices. In fact, the majority of the 2400 physicians who responded to a 2010 survey by Merritt Hawkins on behalf of The Physicians Foundation expressed fairly high levels of concern about healthcare reform, and subsequent studies have echoed those results.

Uncertainty about the future is adding stress to already stressful careers. Many physicians are experiencing genuine emotional pain about the direction their careers are taking, perceived ingratitude and a diminished level of respect either for themselves specifically or physicians in general. While many have turned to employment by health systems to eliminate at least some of this uncertainty, some challenges remain—and new ones have been added.

While physicians are typically more gifted than the general population at managing their emotional responses to extremely challenging work situations, the passage of the reform law after years of declining income and autonomy has resulted in a perfect storm of physician discontent and “organizational toxicity” in many healthcare settings.

16

| AUGUST 2014

Healthcare Organizations Aren’t Immune When the majority of physicians in a healthcare organization are experiencing widespread, intense and energy-sapping negative emotions at the same time, healthcare organizations may start to see their physicians distancing themselves from their patients, co-workers and the healthcare organizations who employ them. Feeling that nobody cares about them, they’re less inclined to care about their work.

While administrators don’t have to agree or sympathize with all of their physicians’ concerns, it’s important to address the emotional overload before productivity and patient safety suffer. The goal is not just to retain physicians, but also to keep them engaged and healthy.

Who’s Handling the Toxicity?

Don’t Overload Your Circuit Breakers Despite training them to treat every conceivable disease during medical school, very little time is spent teaching physicians how to self-soothe or manage their anger.

Chances are most organizations have several physicians who not only lend a sympathetic ear to their colleagues, but are naturally inclined to see the positive side of an issue, e.g., “More people will have insurance and get care” than the negative “The newly insured will overwhelm our capacity.” They enjoy practicing medicine and serve as a reminder to others why they entered the profession. In leadership research by Peter J. Frost, PhD, they’re called “toxin handlers.”

In his book “Toxic Emotions at Work and What You Can Do About Them,” Frost delves into how toxin handlers alleviate organizational pain in a variety of ways. In formal and informal meetings with individuals and groups, they: • • • • •

Listen empathetically Suggest solutions Work behind the scenes to prevent pain Carry the confidences shared by others Reframe difficult messages

While toxin handlers often act as circuit breakers, over time and without organizational assistance they can be overwhelmed and develop toxic attitudes themselves.

That’s why it’s sometimes good for organizations to look externally for more resources. Physician peer coaches can take on the role of circuit breakers—and also sidestep the collegiality and confidentiality concerns that some physicians might have regarding sharing their thoughts with someone that they might work with side by side in other contexts.

Preventive Medicine:

Relaxation Techniques and Practicing SelfCare There are other steps that physicians can take to stop anger before it escalates into something toxic that affects their career and patient safety.

Even though making time for meditation and other relaxation techniques may seem like adding another item to an already overloaded to-do list, most physicians find the time they invest in self-care actually makes them more productive throughout the day. Here are a few highly effective relaxation techniques: • Deep breathing engages the abdominal muscles.

Breathe in through your nose and let your abdomen expand fully. Push in your abdomen to expel your breath. Release your abdomen and let the air rush back in.

The belly, lower ribcage and lower back all expand on inhalation, drawing the diaphragm down deeper into the abdomen, and retract on exhalation, allowing the diaphragm to move fully upward toward the heart.

• Progressive Calming: Using the breathing technique described above, in a seated position or lying down, start at the top of your head and work your way down your body, concentrating on one part at the time and consciously let go of tension in your scalp, eyes, cheeks, chin, neck, shoulders, arms, chest, back, pelvis, hips, thighs, calves, ankles, feet and toes.

• Guided Imagery & Meditation: Using either a CD or your own imagery, imagine yourself in a favorite, peaceful place. This is usually most effective if you begin with deep breathing or progressive calming and then let yourself go into a meditative state.

• Group Meditation: Joining or starting a meditation group ensures you’ll make time for meditation on a regular basis and actually sit still long enough (10 to 20 minutes) to experience some of the benefits.

Getting started is hard for almost everyone — you can often learn useful techniques from more experienced practitioners.

There’s no one right way to relax. Find the method that works for you—and if that method stops working over time, try something new. 

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practice tips

Are You Out-Of-Touch With What Patients Want?

By Barbara Hales, M.D. www.thewritetreatment.com

Do you use email to communicate with your patients?

No? Most don’t. But what you may not know is that this is what the public actually wants!

Catalyst Healthcare Research reported in their latest survey that 93% of adults want to have email communication with their doctor.

A look at traditional vs. online means of communication with physicians was addressed in the new study performed

by Catalyst Healthcare Research (CHR). Results revealed 18 | AUGUST 2014

that most people would select a physician who offered communication with email and 25% feel strongly enough to exercise this option despite a charge of $25.00 with each communication.

Study Findings The survey found that: • 84% of respondents in the Baby Boomer group used the Internet to obtain medical or drug information

• 62% of respondents in the Generation Y group searched for physician information online • 46% of respondents in the Generation X group were interested in viewing lab results online.

• 44% of respondents were interested in paying medical bills online, including 55% of both the Generation Y and Generation X groups • 41% of respondents in the Generation Y group looked for medical procedure costs online The survey also found that: • 57% were interested in dialing a number that offers a call-back feature • 30% desired a 24-hour phone number • 14% of respondents were interested in a video chat program, such as Skype

Discussion of Results The founder and President of CHR, Dan Prince pointed out that: “It’s not surprising that consumers want digital access to things like test results and making a doctor’s appointment. The Internet is quick and convenient and it’s in the best interest of health systems, hospitals, and physician practices to embrace online options for their patients’ healthcare needs. As healthcare changes, it’s crucial that providers stay relevant.”

This study comes on the heels of one done from December 2013 to February 2014, where 433 respondents were asked about which technological devices they use as well as their choice of communication with their physician.

Baby Boomers are the most active online of any group with a surprising 84% using the Internet to seek information about a medical condition, medication or solution to their health condition.

Baby Boomers represent a huge consumer group for American healthcare. It makes sense, then, to determine how health providers and medical facilities can serve them.

According to the last national study, What’s Reasonable?

Patient and Clinical Perspectives in Provision of Service, performed by CHR, feedback reflects a failure of many doctors to meet the huge expectations that Baby Boomers expect in consulting with physicians.

In this survey, Mr. Prince stated: “We found that Baby Boomers share a set of expectations. They overwhelmingly agree that doctors and doctors’ offices should be performing certain actions such as providing appointments when they want them, calling them back with test results, and seeing them within 15 minutes of their appointment times. However, it seems that many doctors have a hard time doing these things on a consistent basis, leading to patient discontent with many aspects of the

physician visit,” said Dan Prince, President of Catalyst Healthcare Research, the sponsor of the study.

Baby Boomers were chosen for the study subjects because they epitomize a major segment of society.

Prince emphasizes now that: “Baby Boomers are and will continue to be a huge consumer of healthcare in the United States, so they are an important group of people to listen to when it comes to figuring out how providers and health systems can better serve patients. “In this new study, we are able to see how their views compare to other important groups, including the digital savvy ‘millennia’s’.”

With 9 out of 10 patients clamoring for a specific service, wouldn’t you like to be the physician that offers it? Are you staying relevant?  About TheWriteTreatment.com The Write Treatment, LLC has helped promote medical practices and health professionals with fresh website content, blogs, newsletters, email campaigns and social marketing.

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WWW.MEDMONTHLY.COM | 19

practice tips

A Three-Step Approach to Pediatric Rashes

By Laura E. Marusinec, MD, Urgent Care Pediatrician Children’s Hospital of Wisconsin

O

ne thing that parents and many physicians have in common is their dislike, even fear of, rashes and skin conditions. As a pediatrician with experience with pediatric dermatology, when I am working with other providers and a patient presents with a rash, they are usually relieved that I am there to take on the problem. Rashes can be mysterious at times. They don’t always fit into an easy diagnosis. Often, they don’t appear the way that they are “supposed to”.

A wonderful pediatric dermatologist, when faced with a rash that didn’t have an easily determined diagnosis, would often give the same speech. He would tell the family that the cause of the rash was unknown, but there were basically only three things we could do for a rash: “Leave it alone, cut it out, or rub a cream on it.” He would then make his recommendation for treatment, and the family would usually leave satisfied. Now, there are actually many more things you can do to diagnose or treat a rash. You can obtain lab tests, prescribe systemic medications, apply a chemical, or even perform a laser or light treatment. But that isn’t really the point. The point is that it isn’t always important to know the specific name or even cause of the rash, as long as you provide an effective treatment. And many times the treatment is doing nothing.

Seeing that this dermatologist, who practiced in a tertiary care pediatric dermatology department, didn’t always know the diagnoses and didn’t always do a lot to determine it, relieved a lot of my own anxiety when faced with an unknown rash. If the expert didn’t know or need to know, then surely I didn’t always have to. In time, I developed my own three-step approach to rashes.

1. First, if I can give the rash a specific diagnosis or a name, then everyone is happy. A rash with a name is a little less mysterious. It is something that can be defined and, therefore, usually treated. I provide the

20 | AUGUST 2014

family with the name of the condition and encourage them to look it up. Even better, I will often show the family a picture of the rash in the office. Once they see it, they can see that I actually do know what I’m talking about. We will then discuss treatment options, and the visit should be a success.

2. If I am unable to uncover the specific cause of the rash, my next goal is to determine if the rash is dangerous or not. Unlike adults , who may have a fairly high incidence of serious skin conditions or malignancies, most rashes in children are not dangerous. They may be unsightly, itchy, or annoying, but they are usually pretty harmless. There are a few things that I need to look for such as serious infections, malignancies, allergic reactions, or rashes that are a sign of an underlying serious medical condition. Once I inform the family that their child’s rash is not one that worries me, most of the anxiety about the rash is relieved.

3. Finally, if I cannot determine the name or cause of the rash, and I do not find it to be dangerous, I try to give the family a treatment plan that will make the rash go away or at least relieve the symptoms until it goes away on its own. Many pediatric rashes will resolve with time. Even without a specific diagnosis, I can often tell enough about the rash to know which treatments may be effective. For example, many rashes are the result of inflammation or dermatitis; irritation; bacterial, viral, or fungal infection; or contact or allergic reactions. I then tailor the treatment to the most likely cause. If I feel that further evaluation or treatment is required, or the rash does not respond to treatment, I will refer the patient to a pediatric dermatologist where, often, the treatment is still to “Leave it alone, cut it out, or rub a cream on it”! 

WWW.MEDMONTHLY.COM | 19

practice tips

Hiring Help: Adding New Team Members to Your Practice

by Audrey McLaughlin, RN

www.physicianspracticeexpert.com

22 | AUGUST 2014

Hiring a new team member or members can be a bit overwhelming. There are so many “what ifs?” Often times, especially in smaller clinics, office managers and physicians don’t really know what to look for our how to “test” candidates to see if they may be a good fit. It is important to remember you don’t want to hire the best of a bunch of so-so candidates. You should only be adding extraordinary people to your clinic.

The big trick is finding and recognizing them when you have them. Here is an overview of the system we use with our clients to ensure optimal hiring: 1. Make a list. Write a detailed list of skills, experience, AND personality skills you need your new employee to have. Ask for others input, sleep on it, try to nail it down perfectly.

2. Write out detailed instructions on how the candidates need to apply. This will be the first “test” for applicants. It is important to have detailoriented people who can follow instructions, and making prospective employees follow instructions will immediately will serve to weed out certain candidates.

Points to consider for detailed instructions: a. A particular e-mail address for submitting applications/resume b. A certain subject line (e.g., when hiring internally we often use “MSG LLC Join Team” as the required subject line) c. A document detailing their particular experience related to the required skill set in lieu of just a resume and cover letter d. A deadline date and time to have submitted applications 3. Determine where you should place ads for optimal candidates. Some suggestions include your website/ blog, Facebook, or Twitter accounts. Be sure look for referrals from personal networks, LinkedIn, other offices for recommendations, or advertisements in newspapers, trade organizations, magazines, Craigslist, and online job sites (Yahoo, CareerBuilder, etc.). Ask any current exceptional team members/employees if they know of anyone who would be interested and encourage them to apply.

4. Start sorting. Once you receive applications, I advise clients to sort their incoming applicants into three main categories. a. NO: These applicants didn’t meet your skill requirements or didn’t follow your instructions for applying down to the letter. Regardless of the skills and experience if the applicant did not follow the submission instructions, we advise our clients to weed them out immediately. b. MAYBE: These applicants have all of the skills you need, and followed the instructions, but may be lacking in some areas such as personality and

experience, or vice versa. (Remember, skills can be learned!) c. YES: These people have all of the skills, apparent personality, experience, and followed your instructions perfectly.

5. Contact all of the candidates from the YES category.

You should talk to at least five and as many as seven people. If you must reach into the MAYBE category to do so, that is OK, but also consider casting a larger net for applicants. Never reach into the NO category.

6. Narrow it down. Ideally, you will narrow down your list to five or fewer candidates. Bring them in for interviews; introduce them to current team members (gauge their opinions as well). Don’t skimp on calling all of their references, or performing background checks.

7. Keep weeding. If a clear front runner hasn’t emerged, then give the top two to three another detailed assignment. Someone will make a mistake in it and automatically weed themselves out, or you will get a little deeper insight into who will work best for your office. You could even consider having the candidates each come in for a half day or full day trial run.

Welcome to your newest perfect fit for a team member!



WWW.MEDMONTHLY.COM | 23

international

Government Support for Improved Disease Management Fuels the Indonesian Infectious Disease IVD Market

24 | AUGUST 2014

‘‘

The infectious disease market is one of the largest segments of “Furthermore, the rise in private the in-vitro diagnostics (IVD) market in Indonesia, accounting funding has paved the way for for approximately 62 percent of the innovations in the Indonesia’s total market. Increased incidence infectious disease IVD market. of infectious diseases such as Manufacturers are already hepatitis C, HIV, TB, malaria and dengue have spurred the developing analyzers to meet endgovernment to invest strongly in user budgets, test volumes, desired primary healthcare system, public breadth of test panels, and levels of hospital reforms, promotion of automation.”

IVD-related technology innovation among local participants, and - Sanjeev Kumar improved reimbursement policy, Healthcare Research Analyst, Frost & Sullivan thus creating a favorable climate for market participants.

New analysis from Frost & Sullivan, Indonesian Infectious Disease IVD Market, finds that the market earned revenues of $38.6 million revenue in 2013, which is expected to reach $59.9 million in 2017. The market is segmented into immunochemistry testing, microbiology testing, and molecular diagnostics testing. Among these, the molecular diagnostics segment, which includes virology, bacteriology, molecular blood donor screening and genetic testing, is expected to grow the fastest.

Despite the strong government backing, Indonesia’s infectious disease IVD market is battling a shortage of skilled healthcare workers and laboratory facilities. This issue hampers the accurate identification, diagnosis and reporting of infectious diseases in the country.

The market is further pegged back by the long turnaround times of tests and high level of investments needed. These challenges, however, are opportunities for companies in the opposite ends of the spectrum.

“The domestic participants in the low-end market will have an edge due to their competitive pricing and faster turnaround time,” explains Frost & Sullivan Healthcare Research Analyst Sanjeev Kumar. “Meanwhile, multinational companies (MNCs) in the high-end market can meet various end-user demands by offering improved localized service.”

This scenario is ideal to foster partnerships between multinational companies and local participants. Collaborations between the two will create a symbiotic ecosystem, wherein local companies will gain access to capital, technology and intellectual property, and MNCs will benefit from the market reach of the domestic companies.

“Furthermore, the rise in private funding has paved the way for innovations in the Indonesia’s infectious disease IVD market,” noted Kumar. “Manufacturers are already developing analyzers to meet end-user budgets, test volumes, desired breadth of test panels, and levels of automation.”

The adoption of new technologies will go a long way in enhancing the patient care. For instance, highly automated analyzers with automated sample-handling features and sophisticated informatics will improve throughput and eventually, diagnostic results.

If you are interested in more information on this study, please send an email to Donna Jeremiah, Corporate Communications, at djeremiah[.]frost.com, with your full name, company name, job title, telephone number, company email address, company website, city, state and country.

Indonesian Infectious Disease IVD Market is part of the Life Sciences (lifesciences.frost. com) Growth Partnership Service program. Frost & Sullivan’s related studies include: Pulse of Telehealth 2013, the Global Emerging Interventional Cardiac Devices Market, Disinfection and Sterilization Equipment Market Trends in Asia-Pacific, and the Accountable Care Team: A Guide for Care Delivery Transformation. All studies included in subscriptions provide detailed market opportunities and industry trends evaluated following extensive interviews with market participants.  Source: http://www.newswiretoday.com/news/144105/ WWW.MEDMONTHLY.COM | 25

research & technology

FDA Updates Fish Consumption Recommendations: A Brief Review of the Research

By Carrie A. Noriega, MD The FDA/EPA recently announced it is updating the recommendation for fish consumption by pregnant, breastfeeding women and young children. The previous recommendation issued in 2004 encouraged pregnant women and young children to eat up to 12 ounces of low mercury fish per week. The new recommendation is placing an emphasis on a minimum of 8 ounces of fish per week with the maximum amount of fish still at 12 ounces per week, which correlates to 2-3 servings per week.

So what prompted the change to the previous recommendation? The FDA did an extensive review of the literature in 2009 looking at the risks from methylmercury, the type of mercury found in fish, compared to the benefits 26 |AUGUST 2014

of nutrients from fish in the diet. They started looking at several studies from Japan and Iraq that evaluated patients poisoned by high levels of methylmercury from contaminated sources. The studies showed these patients suffered from various neurological symptoms including paresthesia, ataxia, visual effects, and difficulties with speech and hearing. The symptoms ranged from mild to severe depending on the patient’s level of methylmercury exposure. Unborn babies and young children were found to be more sensitive to the effects of methylmercury poisoning than adults. The effects included congenital cerebral palsy, mental retardation, primitive reflex, deformities of the limbs, and disturbances in physical

development and nutrition. These studies showed a clear risk from extremely high exposure to methylmercury, but this isn’t necessarily the exposure the average person receives while eating fish in a regular diet.

To determine the lowest amount of methylmercury exposure that could be consumed in the diet and still be deemed safe, the FDA examined island populations that had a high level of fish consumption in their regular diet. The analysis of these studies began to show that consuming certain types of fish high in methylmercury had a negative impact on the performance of children on various neurodevelopment tests. While consuming diets high in fish that contained low amounts of methylmercury had a positive effect on the neurodevelopmental testing of children, although this benefit seemed to plateau with higher levels of fish intake. These effects appeared to be especially prominent in the fetus and young child.

Unfortunately, these studies did not indicate the ideal amount of fish that should be consumed to maximize the neurodevelopmental benefit, but they did allow researchers to extrapolate the beneficial effects of fish to omega-3 DHA. Studies, which specifically looked at fish consumption during pregnancy, were then reviewed. Four particular studies were done in the United States that looked at the benefits of following the previous FDA recommendation of eating up to three servings of fish per week during pregnancy. These studies found that the most benefit from fish, especially fish low in mercury, occurred when a minimum of two servings per week was consumed on a regular basis. Children whose mothers ate fish in pregnancy were more likely to meet developmental milestones, less likely to have IQ’s in the bottom 25th percentile, and performed better on development tests.

They did find that a higher consumption of fish, and thus mercury, lowered these beneficial effects but this did not occur in people who ate less than the recommended three servings of low mercury fish per week.

Only four studies have been done in children looking at the benefits from the nutrients in fish versus the effects of methylmercury. Overall, they show a benefit in neurological development scores and IQ testing in children that eat fish compared to children that don’t eat fish but no specific amount of fish consumption was studied. No studies have been done that look at the effects on the infant from breastfeeding mothers who consume fish in their diet.

From the evidence in this extensive review, the FDA/ EPA released its newest recommendations for consumption of fish by young children and women who are pregnant or lactating. They recommend these populations should do the following: - Consume a minimum of 8 ounces and up to a maximum of 12 ounces of low mercury fish per week,

which includes shrimp, Pollock, salmon, canned light tuna, tilapia, catfish, and cod - Avoid fish with the highest levels of mercury including tilefish from the Gulf of Mexico, shark, swordfish, and king mackerel - Limit the consumption of white (albacore) tuna to no more than 6 ounces per week - If eating fish caught from local rivers and lakes follow local fish advisories or consume no more than 6 ounces per week and 1-3 ounces for children Despite the new recommendation to encourage more fish consumption in pregnancy, the FDA found that current fish consumption in pregnancy is rather dismal.

A poll of 1000 pregnant women showed 20% of pregnant women ate no fish in the last month, 50% ate less than 2 ounces per week, and 75% ate less than 4 ounces per week.

The FDA is hoping this new recommendation will bring more public awareness to the health benefits of eating fish in pregnancy, during lactation, and in early childhood. As the research clearly indicates the developing neurological system of infants and young children benefit greatly from the nutrients in low mercury fish.  Reference: www.Fda.gov

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research & technology

28 | AUGUST 2014

Labeling people with moderately high blood sugar as pre-diabetic is a drastically premature measure with no medical value and huge financial and social costs, say researchers from UCL and the Mayo Clinic, Minnesota.

The analysis, published in the BMJ, considered whether a diagnosis of prediabetes carried any health benefits such as improved diabetes prevention.

The authors showed that treatments to reduce blood sugar only delayed the onset of type 2 diabetes by a few years, and found no evidence of long-term health benefits.

Type 2 diabetes is typically diagnosed with a blood test that measures levels of haemoglobin A1c, which indicates average blood sugar level over the last three months.

People with an A1c over 6.5% can be diagnosed with diabetes but the latest guidelines from the American Diabetes Association (ADA) define anyone with an A1c between 5.7% and 6.4% as having pre-diabetes.

If the ADA guidelines were adopted worldwide, a third of the UK adult population and more than half of adults in China would be diagnosed with pre-diabetes. The latest study questions the logic of putting a label on such huge sections of the population, as it could create significant burdens on healthcare systems without conferring any health benefits.

Previous research has shown that type 2 diabetes treatments can do more harm than good for people with A1c levels around 6.5%, let alone people below this level.

3.2 million people in the UK are currently diagnosed with type 2 diabetes, but approximately 16 million would fall into the ADA’s pre-diabetes category. There is a condition known as impaired glucose tolerance (IGT) that affects around 3.7 million adults in the UK (8%). People with IGT are at high risk of diabetes, but the test is more time-consuming than a simple A1c blood test. There is evidence to suggest that interventions can delay the progression of IGT into diabetes, but the ADA category of pre-diabetes also includes another 12 million people who are at a much lower risk of

progressing to diabetes, for whom any benefit from treatment is unknown.

The World Health Organisation (WHO) has stated that “use of ‘prediabetes’ is discouraged to avoid any stigma associated with the word diabetes and the fact that many people do not progress to diabetes as the term implies.” Guidance from the UK National Institute for Health and Care Excellence (NICE) broadly aligns with the WHO statement, looking to “move away from describing ‘pre-diabetes’ as a separate condition”. So in the way of official authoritative organizations, ADA is pretty much on its own in using this term. Yet it has caught on heavily in the global scientific literature and because of ethnic differences in A1c levels, it may be an even less valid category in other countries and demographics.

“Pre-diabetes is an artificial category with virtually zero clinical relevance,” says lead author John S Yudkin, Emeritus Professor of Medicine at UCL. “There is no proven benefit of giving diabetes treatment drugs to people in this category before they develop diabetes, particularly since many of them would not go on to develop diabetes anyway.

“Sensibly, the WHO and NICE and the International Diabetes Federation do not recognize pre-diabetes at present but I am concerned about the rising influence of the term. It has been used in many scientific papers across the world, and has been applied to a third of adults in the UK and half of those in China. We need to stop looking at this as a clinical problem with pharmaceutical solutions and focus on improving public health. The whole population would benefit from a more healthy diet and more physical activity, so it makes no sense to single out so many people and tell them that they have a disease.”

Previous studies have tested the effectiveness of giving people with IGT

a drug called metformin, which is used to lower blood sugar in people with diabetes. The drug reduced the risk of developing diabetes by 31% over 2.8 years, probably by delaying its onset rather than by completely halting its development. But people who go on to develop diabetes are often treated with metformin anyway and there is no evidence of long-term benefits to starting the treatment early.

“The ADA recommends treating pre-diabetes with metformin, but the majority of people would receive absolutely no benefit,” explains Professor Yudkin. “There are significant financial, social and emotional costs involved with labeling and treating people in this way. And a range of newer and more expensive drugs are being explored as treatments for ‘pre-diabetes.’ The main beneficiaries of such recommendations would be the drug manufacturers, whose available market suddenly leaps to include significant swathes of the population. This is particularly true in emerging economies such as China and India, where regulating the healthcare market is a significant challenge.”

“Healthy diet and physical activity remain the best ways to prevent and to tackle diabetes,” says co-author Victor Montori, Professor of Medicine at the Mayo Clinic, Rochester, Minnesota, USA. “Unlike drugs they are associated with incredibly positive effects in other aspects of life. We need to keep making efforts to increase the overall health of the population, by measures involving public policy rather than by labeling large sub-sections of the population as having an illness. This is a not a problem to be solved at the bedside or in the doctor’s surgery, but rather by communities committed to the health of their citizens.”  Source: http://www.pressreleasepoint. com/pre-diabetes-label-unhelpful-andunnecessary WWW.MEDMONTHLY.COM | 29

research & technology

HYPERTHERMIA:

Too Hot for Your Health

NIH provides advice on heat-related illness for older adults 30 | AUGUST 2014

During the summer, it is important for everyone, especially older adults and people with chronic medical conditions, to be aware of the dangers of hyperthermia. The National Institute on Aging (NIA), part of the NIH, has some tips to help mitigate some of the dangers.

Hyperthermia is an abnormally high body temperature caused by a failure of the heat-regulating mechanisms in the body to deal with the heat coming from the environment. Heat stroke, heat syncope (sudden dizziness after prolonged exposure to the heat), heat cramps, heat exhaustion and heat fatigue are common forms of hyperthermia. People can be at increased risk for these conditions, depending on the combination of outside temperature, their general health and individual lifestyle.

Older people, particularly those with chronic medical conditions, should stay indoors, preferably with air conditioning or at least a fan and air circulation, on hot and humid days, especially when an air pollution alert is in effect. Living in housing without air conditioning, not drinking enough fluids, not understanding how to respond to the weather conditions, lack of mobility and access to transportation, overdressing and visiting overcrowded places are all lifestyle factors that can increase the risk for hyperthermia.

People without air conditioners should go to places that do have air conditioning, such as senior centers, shopping malls, movie theaters and libraries. Cooling centers, which may be set up by local public health agencies, religious groups and social service organizations in many communities, are another option.

The risk for hyperthermia may increase from: • Age-related changes to the skin such as poor blood circulation and inefficient sweat glands • Alcohol use

• Being substantially overweight or underweight • Dehydration • Heart, lung and kidney diseases, as well as any illness that causes general weakness or fever • High blood pressure or other health conditions that require changes in diet. For example, people on salt-restricted diets may be at increased risk. However, salt pills should not be used without first consulting a physician.

• Reduced perspiration,caused by medications such as diuretics, sedatives, tranquilizers and certain heart and blood pressure drugs • Use of multiple medications. It is important, however, to continue to take prescribed medication and discuss possible problems with a physician.

Heat stroke is a life-threatening form of hyperthermia. It occurs when the body is overwhelmed by heat and is unable to control its temperature. Heat stroke occurs when someone’s body temperature increases significantly (above 104 degrees Fahrenheit) and shows symptoms of the following: strong rapid pulse, lack of sweating, dry flushed skin, mental status changes (like combativeness or confusion), staggering, faintness or coma. Seek immediate emergency medical attention for a person with any of these symptoms, especially an older adult.

If you suspect someone is suffering from a heat-related illness: • Get the person out of the heat and into a shady, air-conditioned or other cool place. Urge the person to lie down.

• If you suspect heat stroke, call 911.

• Apply a cold, wet cloth to the wrists, neck, armpits and/or groin.

These are places where blood passes close to the surface of the skin, and the cold cloths can help cool the blood.

• Help the individual to bathe or sponge off with cool water.

• If the person can swallow safely, offer fluids such as water or fruit and vegetable juices, but avoid alcohol and caffeine.

The Low Income Home Energy Assistance Program (LIHEAP) within the Administration for Children and Families in the U.S. Department of Health and Human Services helps eligible households pay for home cooling and heating costs. People interested in applying for assistance should contact their local or state LIHEAP agency or go to http://www. acf.hhs.gov/programs/ocs/liheap .

For a free copy of the NIA’s AgePage on hyperthermia in English or in Spanish, contact the NIA Information Center at 1-800-222-2225 or go to http://www.nia.nih.gov/health/ publication/hyperthermia-too-hotyour-health or http://www.nia.nih.gov/ espanol/publicaciones/hipertermia (Spanish).

The NIA leads the federal effort supporting and conducting research on aging and the medical, social, and behavioral issues of older people. The Institute’s broad scientific program seeks to understand the nature of aging and to extend the healthy, active years of life. For more information on research, health and aging, go to http://www.nia.nih.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 www.nih.gov.

Source: http://www.nih.gov/news/ health/jul2014/nia-02.htm

WWW.MEDMONTHLY.COM | 31

legal

Office for Civil Rights (OCR) Offers “Lessons Learned” Regarding Health Insurance Portability and Accountability Act (HIPAA) Compliance

By Emily M. Hord McBrayer, McGinnis, Leslie and Kirkland, PLLC Two recent reports issued by the HHS Office for Civil Rights (“OCR”), pursuant to the HITECH Act, reveal some interesting information about HIPAA data breaches. The Annual Report to Congress on Breaches of Unsecured Protection Information (“Breach Report”) and the Annual Report to Congress on HIPAA Privacy, Security, and Breach Notification Rule Compliance (“Compliance Report”) should remind covered entities and their business associates about the many risks associated with HIPAA and the importance of compliance.

The Breach Report describes the types and numbers of reported breaches for a two year period (2011 and 2012) and provides some cumulative data on breaches reported after the breach notification requirements went into effect.

During this two year period, the OCR received reports of 458 big HIPAA breaches affecting 500 or more individuals and a staggering 46,899 small HIPAA breaches affecting less than 500 individuals. OCR investigated all of the 458 large HIPAA breaches and investigated a number of the smaller HIPAA breaches.

Interestingly, OCR imposed its first Resolution Agreement for a small breach, which affected 441 individuals, after the theft of an employee laptop at Hospice of North Idaho in December 2012. For the larger breaches, OCR has entered into Resolution Agreements with seven (7) of the covered entities. The Breach Report revealed that: Under these agreements, the covered entities have agreed to pay more than $8 million Nearly two (2) million individuals were affected by these breaches; 32 | AUGUST 2014

Four (4) of these cases involved the theft of laptops or other electronic devices containing unsecured ePHI and the number one cause of security breaches in both years was theft; and, In addition to the settlements, OCR has entered into corrective action plans (“CAPs”) that require specific corrective actions on the part of the covered entities.

Breach Report, p. 20 As the Breach Report points out, CAPs can require a variety of corrective actions, including: Revising policies and procedures; Training or retraining workforce members who handle PHI; Conducting and documenting a risk assessment; Changing passwords; Adopting encryption technologies; or, Performing a new risk assessment, among other things.

Breach Report, p. 20-24.

Because investigations and the subsequent agreements, settlements, and corrective actions can be costly to finances and reputations, the Breach Report concludes with a “Lessons Learned” section meant to help covered entities avoid some of the more common type of breaches.  Source: http://www.natlawreview.com/article/office-civilrights-ocr-offers-lessons-learned-regarding-health-insuranceportabilit

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legal

Closely Held Corporations Can Be Exempt from ACA Contraception Provisions Based on Religious Objections

By Amy Gordon Ashley McCarthy Susan M. Nash McDermott Will & Emery

34 | AUGUST 2014

Background The Patient Protection and Affordable Care Act (ACA) requires certain employers to cover women’s preventive health care under their nongrandfathered group health plans at no cost to employees. The U.S. Department of Health and Human Services (HHS) promulgated regulations defining the scope of services that must be offered to comply with this preventive health care requirement. These regulations require covered group health plans to offer the 20 contraceptive devices approved by the U.S. Food and Drug Administration (FDA) in order to comply with the women’s provisions of the preventive care mandate under the ACA (Contraception Mandate).

The Supreme Court of the United States (the Court) case was brought by three plaintiffs: Hobby Lobby, a family-owned, for-profit corporation, a religious book store owned by the family that owns Hobby Lobby and Conestoga Wood Specialties Corp., another closely held family-owned, for-profit corporation. The families who own these businesses are devoutly religious and argued that compliance with the Contraception Mandate substantially burdened their exercise of religion. Thus, these families filed lawsuits in federal court seeking a judicial order that their businesses did not need to comply with a portion of the Contraception Mandate.

Specifically, the business owners objected to being required by the government to provide four of the 20 FDA-approved contraceptive devices: two forms of emergency contraception colloquially known as “morning after” pills and two intrauterine devices. The business owners did not object to the 16 other contraceptive devices, because those devices work by preventing fertilization. The four contraceptive devices at issue in Burwell v. Hobby Lobby Inc., however, work by preventing further development of an already fertilized egg. Plaintiffs argued that because these contraceptive

devices act on already fertilized eggs, they violate the plaintiffs’ Christian belief that life begins at conception.

The claims that the Court considered in Hobby Lobby began at the district court level as separate cases. In both cases, the district courts rejected the plaintiffs’ arguments. On appeal, however, the reviewing courts reached different conclusions. The U.S. Court of Appeals for the Third Circuit affirmed the district court, holding that because for-profit corporations cannot engage in religious exercise in the first place, it would be impossible for government action to impede corporate religious exercise. The U.S. Court of Appeals for the Tenth Circuit, on the other hand, reversed the lower court decision, holding that for-profit corporations are indeed “persons” capable of religious exercise.

The ACA’s Contraception Mandate, according to the Tenth Circuit, violated the businesses’ religious freedom.

The Supreme Court agreed to review both cases to settle the dispute between the Third and Tenth Circuits.

The Court’s opinion is summarized below. View the full decision here.

The Majority Opinion in Hobby Lobby Justice Alito delivered the Court’s majority opinion, in which Chief Justice Roberts and Justices Scalia, Kennedy and Thomas joined. The Court held that requiring the plaintiffs, which are closely held for-profit corporations, to comply with the Contraception Mandate violates the Religious Freedom Restoration Act of 1993 (RFRA). The Court relied solely on RFRA for its conclusion that the Contraception Mandate violated plaintiffs’ religious freedom, and did not engage in First Amendment analysis in reaching its decision. Ironically, the actual decision did not limit the ruling to the four contraceptive devices originally at issue. The actual holding was broader and applied to the entire ACA Contraception Mandate.

RFRA prohibits the federal government from taking any action that substantially burdens the exercise of religion, unless that action constitutes the least restrictive means of serving a compelling government interest.

Do For-Profit Corporations Exercise Religion?

Before the Court could consider whether the Contraception Mandate violated RFRA, it had to decide whether RFRA applied at all to forprofit corporations. The government had taken the position, with which several lower courts had agreed, that for-profit corporations do not have standing to bring claims under RFRA because it only protects persons who exercise religion, and for-profit corporations are incapable of meeting that definition because they are not persons and do not exercise religion (i.e., a corporation cannot pray or attend church). The Court rejected this argument and concluded that nothing in RFRA suggests that closely held corporations were to be excluded from its scope. The Court further concluded that the word “person” includes not only a nonprofit corporation, but also a for-profit corporation. The majority emphasized that its Hobby Lobby holding is limited to closely held corporations, suggesting thatHobby Lobby might not apply generally to publicly traded public corporations. Nevertheless, under Hobby Lobby, closely held for-profit corporations now have clear standing to bring claims under RFRA.

Does the Contraception Mandate Impose a “Substantial Burden” on Hobby Lobby’s Religious Exercise?

The Court agreed with the plaintiffs that the Contraception Mandate imposes a substantial burden on their exercise of religion. In reaching this continued on page 36 WWW.MEDMONTHLY.COM | 35

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conclusion, the Court noted that the Contraception Mandate left plaintiffs with three choices. First, they could violate their religious belief that life begins at conception by providing the contraceptive devices at issue in Hobby Lobby. Second, they could exclude the objectionable contraceptive devices from their group health coverage, in which case they would have to pay an ACA penalty equal to $100 per day per affected individual (or approximately $475 million per year in Hobby Lobby’s case). Third, they could stop providing group health coverage to their employees altogether. However, if they chose this route and at least one of their full-time employees received subsidized coverage on an ACA Health Insurance Marketplace Exchange, they would be required to pay an ACA tax for failing to provide coverage to their full-time employees of $2,000 per full-time employee, minus 30 full-time employees. This penalty would be approximately $26 million per year in Hobby Lobby’s case, significantly less than the penalty for offering group health coverage that does not provide morning after pills and intrauterine devices at no cost to employees, but still significant. To the Court, this trio of alternatives imposed a substantial burden on plaintiffs’ ability to exercise their religion. Essentially, the government presented plaintiffs with a choice between violating their religious beliefs on the one hand and paying millions of dollars in annual Internal Revenue Service penalties on the other hand.

Does the Contraception Mandate further a “compelling governmental interest” and, if so, is it the “least restrictive means” of doing so?

The Court declined to rule on whether the Contraception Mandate furthers a “compelling governmental interest,” though the majority hinted 36 | AUGUST 2014

that it had doubts about whether the government could satisfy this requirement by noting that it seemed odd the government was claiming a compelling interest in ensuring employers provide free access to all 20 FDA-approved contraceptive devices, given that the government itself had exempted religious nonprofit organizations, group health plans of employers with under 50 employees and grandfathered health plans from satisfying the Contraception Mandate—the latter for no apparent reason except administrative convenience. Rather, the Court focused its inquiry on whether the Contraception Mandate is the “least restrictive means” that the government could have chosen to serve its compelling interest in providing women with free access to contraception, assuming that it has such a compelling interest. The “least restrictive means” test is one of the most demanding standards in constitutional jurisprudence, and the Court concluded that the government failed to satisfy that demanding test in Hobby Lobby. The government “has not shown,” wrote the Court, “that it lacks other means of achieving its desired goal without imposing a substantial burden on the exercise of religion by the objecting parties in these cases.”

The Court gave examples of less restrictive means the government could utilize, such as the government itself providing contraception to women who are unable to obtain it through employer-sponsored health insurance policies due to their employers’ religious objections. Most compelling was the fact that the government had already established an accommodation for the religious nonprofit organizations that the government exempted from the Contraception Mandate. HHS regulations completely exempt a certain narrow set of religious employers from the Contraceptive Mandate, and for nonprofit religious organizations, the government

‘‘

“Ironically, the actual decision did not limit the ruling to the four contraceptive devices originally at issue. The actual holding was broader and applied to the entire ACA Contraception Mandate.”

provides an accommodation by requiring those entities to certify their religious objections to their insurance issuer or third-party administrator.

The insurance issuer or third-party administrator then excludes the objectionable contraceptive services from the employer’s group health plan and assumes the cost and responsibility of providing those contraceptive services directly to any employees who request them without imposing any cost-sharing requirements on the employer, its insurance plan or its employee beneficiaries. According to the Court, it would be permissible under RFRA for the Court to extend this same approach to for-profit corporations that harbor religious objections to the Contraception Mandate. The Court however failed to include any procedure on how a religious forprofit company would raise a similar objection as a religious nonprofit organization in this instance. In addition to this case, in other currently pending cases, this accommodation is being challenged by other religious organizations who believe the request for the accommodation itself is a violation of their religious beliefs.

The Hobby Lobby Holding In light of the foregoing analysis, the Court held that the Contraception Mandate, as applied to closely held corporations, violates RFRA. Because the Court was able to adjudicate the

claim under RFRA, the Court did not assess the plaintiffs’ First Amendment claims.

The Court dismissed the concern raised in Justice Ginsburg’s dissent (as well as in media accounts of the Hobby Lobby decision), that Hobby Lobby could encourage businesses to identify religious beliefs as a pretext for engaging in deleterious conduct, such as discriminatory hiring practices, by observing, “The Government has a compelling interest in providing an equal opportunity to participate in the workforce without regard to race, and prohibitions on racial discrimination are precisely tailored to achieve that critical goal.”

Several commentators have noted that the Court’s reference to racial discrimination seemed misplaced and perhaps ominous for advocates of laws prohibiting discrimination on the basis of sexual orientation. After all, these commentators note, the vast majority of contemporary business owners’ claims that non-discrimination rules infringe religious freedom involve sexual orientation, not race. Yet the Court made the presumably conscious decision to omit any reference to sexual orientation.

The Court also dismissed the dissent’s prediction that Hobby Lobby will invite both closely held and public corporations of all sizes to seek regulatory exemptions on religious grounds. On this point, the Court observed, “it seems unlikely that … corporate giants … will often assert RFRA claims” and “numerous practical restraints” would likely prevent that from occurring.

What It All Means For the business owners who filed the Hobby Lobby case, the Court’s decision means that the government cannot require them to comply with the Contraception Mandate. These companies can now offer group health coverage that does not include contraception without having to pay any penalties or taxes under the ACA.

It remains to be seen whether the Obama administration will take action to ensure that if a woman’s employer does not offer the comprehensive panoply of FDA-approved contraceptive devices, she will still have free access to those devices. For example, will the government accept the Court’s invitation to directly provide contraceptive devices to women affected by Hobby Lobby?

Or will the government extend to for-profit corporations its existing accommodation for religious nonprofit organizations, under which the employer certifies its religious beliefs to an insurance issuer or third-party administrator, who in turn provides the contraceptive services at issue to plan participants? Another open question is who will actually pay for these contraceptive devices as it is established that it will not be the religious employer or the woman seeking the contraception. Will forprofit corporations be able to challenge other aspects of the ACA on religious grounds? All of that remains to be seen in the wake of Hobby Lobby.

More broadly, Hobby Lobby now stands for the proposition that closely held for-profit corporations have standing to bring claims under RFRA. It is expected that a growing number of corporate litigants will bring RFRA claims arguing that government rules or regulations impinge on their religious freedom. Whether the courts hearing these claims will apply Hobby Lobby beyond its specific facts is unclear, though the Court certainly gave lower courts ample bases via which to distinguish future claims from Hobby Lobby by emphasizing the intended limits of the Hobby Lobby holding (i.e., that the holding only applies to the plaintiffs, family-owned corporations that have ascertainably infused their businesses with their religious beliefs).  Source: http://www.natlawreview. com/article/closely-held-corporationscan-be-exempt-aca-contraceptionprovisions-based-religio-0

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Health Plans Must Certify Ability to Conduct Electronic Transactions

By Amy N. Moore, Partner Covington & Burling LLP

By December 31, 2015, group health plans must complete a testing process and certify that they are able to conduct electronic transactions in accordance with uniform standards and operating rules. Plans must also ensure that third-party administrators and other outside vendors are in compliance with the electronic transaction rules if the vendors conduct transactions on the plans’ behalf.

December 2015 might seem a long way off to group health plan sponsors and administrators focused on ACA’s shared responsibility rules. Plan sponsors should bear in mind, though, that compliance with the certification requirements for electronic transactions can involve significant lead time. Failure to comply carries substantial penalties. Accordingly, group health plan sponsors that have not already addressed the electronic transaction rules might wish to develop a timetable for compliance.

Uniform Standards for Electronic Transactions

The Health Insurance Portability and Accountability Act (HIPAA) required the Department of Health and Human Services to establish uniform standards for electronic data transmission between group health plans and health care providers such as doctors, pharmacies, and hospitals. Once HHS establishes a standard for a particular transaction, the parties must conform to the standard when they conduct the transaction electronically.

Starting in 2011, HHS must also adopt a single set of operating rules for each standard transaction. The operating rules provide additional guidelines for conducting the transaction electronically. For example, the operating rules might specify the transmission method or define the circumstances in which the plan must provide particular data. When the operating rules for a transaction become effective, the parties must also comply with the operating rules when they conduct that transaction electronically.

Most employer group health plans with 50 or more participants (and smaller plans administered by outside vendors) are subject to the electronic transaction standards.

38 | AUGUST 2014

Self-insured plans must have the ability to transmit and receive information electronically for any standard transaction, either directly or through a business partner.

Insured plans generally rely on the insurer to satisfy these requirements.

As we explained in an earlier post, here, each group health plan must also obtain a unique health plan identifying number (HPID) this fall and must use the HPID in standard transactions. HHS will use the HPID to track which plans have met the certification requirement.

ACA Imposes a Certification Requirement

Although HHS published the first set of electronic transaction standards more than a decade ago, the health care industry has—as HHS puts it—“experienced difficulty transitioning to [the standards] by the regulatory compliance dates.” In order to ensure that plan sponsors take the electronic transaction standards seriously, the Affordable Care Act created a new enforcement structure.

Under the ACA regime, group health plans must file statements with HHS certifying their compliance with the electronic transaction standards. ACA also requires HHS to conduct periodic audits of health plans and their service-providers, and establishes a penalty (up to $40 per covered life) for failure to satisfy the certification requirement.

The first compliance statement must certify that the group health plan complies with the standards and operating rules for the following electronic transactions: 1. Eligibility for a health plan; 2. Health care claim status; and 3. Health care electronic funds transfers and remittance advice.

HHS has issued a proposed rule explaining how a plan must provide the first certification of compliance.

Although the statutory deadline for the first certification was the end of 2013, HHS has extended the deadline to December 31, 2015.

ACA requires health plans to provide a second

certification of compliance for the following electronic transactions: health care claims or equivalent encounter information; enrollment and disenrollment in a health plan; health plan premium payments; health claims attachments; and referral certification and authorization.

Although the statutory deadline for the second certification is the end of 2015, HHS has not yet published operating rules for these transactions (and has not even published the standard for health claims attachments). HHS has said that it will explain the requirements for the second certification in future regulations. It seems reasonable to expect that HHS will also extend the 2015 compliance deadline for the second certification, although HHS has not yet announced an extension.

Certifying Compliance with Electronic Transaction Rules

ACA requires a group health plan to demonstrate that it conducts the covered electronic transactions in a manner that fully complies with regulations. The plan must also provide documentation showing that it has completed endto-end testing with its transaction partners, such as doctors and hospitals.

HHS’s proposed regulation describes two ways in which a group health plan can satisfy these requirements.

Both options will be administered by the Committee on Operating Rules for Information Exchange (CORE) of the Council for Affordable Quality Healthcare (CAQH), a nonprofit organization that works with industry stakeholders to implement the electronic transaction rules.

Under the first option, a group health plan will obtain a “Phase III CORE Seal,” which confirms that the health plan has successfully completed certification testing with an independent CORE-authorized testing vendor for each of the electronic transactions covered by the initial certification of compliance. CAQH CORE charges a fee based on “net annual revenue,” capped at $18,000, for the Phase III Core Seal.

Under the second option, a group health plan will obtain a “HIPAA Credential.” Although CAQH CORE is still developing the HIPAA Credential, current indications are that the credential will be less expensive and easier to obtain than the Phase III CORE Seal. Unlike the Phase III Core Seal, the HIPAA Credential does not require the health plan to test with an independent CORE-authorized testing vendor. Instead, the health plan must certify that it has “successfully tested” the covered electronic transactions with at least three providers that collectively account for at least 30% of the plan’s transactions. The HIPAA Credential does not require a specific approach to external testing with providers (whereas the Phase III CORE Seal does require plans to meet a uniform testing standard). The maximum fee for the HIPAA Credential is expected to be approximately $4,000. (Additional information about the HIPAA Credential and draft application forms are available

on CAQH CORE’s website, here.)

In addition to documenting the fact that it has obtained a Phase III Core Seal or HIPAA Credential, the group health plan must notify HHS of its number of covered lives on the date when it submits the documentation.

Commenters on the proposed regulation have noted that it is impossible to conduct an accurate headcount in real time, and have requested that plans be permitted to provide the number of covered lives as of an earlier date, such as the first day of the plan year.

Certifying Compliance with Privacy and Security Requirements

In order to obtain a Phase III CORE Seal, a group health plan representative must attest that the plan complies with HIPAA’s privacy and security provisions. In the preamble to the proposed regulation, HHS states that the same attestation will be required for the HIPAA Credential.

Consistent with this statement, CAQH CORE’s draft application forms for the HIPAA Credential include an attestation that the plan “is and shall remain” in compliance with the privacy and security requirements). Accordingly, although the first certification of compliance nominally relates only to the covered electronic transactions, the group health plan must be able to confirm that it is (and will remain) in compliance with a broad array of statutory and regulatory requirements—many of which have nothing to do with electronic transactions—in order to provide the necessary attestation.

Certifying Compliance by Business Associates

To the extent that a group health plan conducts standard transactions through business associates—such as claims administrators, pharmacy benefit managers, or COBRA administrators—the group health plan must require the business associates (and their agents and subcontractors) to comply with the standards and operating rules for electronic transactions. The group health plan’s certification to HHS that it complies with the electronic transaction rules includes a certification that it has met this requirement with respect to its business associates.

Group health plan sponsors should consider whether they need to amend their business associate agreements or other agreements with third-party administrators in order to address ongoing compliance with the electronic transaction standards and operating rules. All HIPAA business associate agreements must be amended no later than September 22, 2014, to comply with the requirements of the final HITECH omnibus regulation; plan sponsors executing amended agreements might wish to include provisions concerning electronic transactions.  Source: http://www.insidecompensation.com/2014/07/15/ health-plans-must-certify-ability-to-conduct-electronictransactions/ WWW.MEDMONTHLY.COM | 39

features

Is Concierge Medicine the Correct Choice For You?

By Paul Hsieh, M.D. Physician and Co-founder of Freedom and Individual Rights in Medicine (FIRM)

As the ObamaCare law is phased in, health policy experts predict a growing physician shortage. Although ObamaCare did not create this shortage, it will worsen the problem.

Many doctors are responding to the new law by retiring early or reducing their hours in what the American 40 | AUGUST 2014

Medical Association describes as a “silent exodus.� The Wall Street Journal reports an expected shortfall of 60,000 physicians in 2015 and 90,000 by 2020 (roughly 10-15% of practicing physicians), even as millions of newlyinsured patients enter the system. As a result, patients will endure longer waits

for doctor appointments. Meanwhile because of declining reimbursements, primary care physicians be forced see as many patients as possible each day in hurried 10-15 minute appointments, simply to make ends meet.

In response to this frustrating situation, more doctors are seeking

an alternative practice model. They are establishing “concierge” or “direct pay” practices, where patients pay a monthly or annual fee for enhanced services, including same day appointments, 24/7 access to their doctor, e-mail consultations, and longer appointment times. Instead of the usual rushed 10-15 minute appointments, these doctors typically offer 45-60 minute visits allowing them to really delve into their patients’ problems and craft individualized treatment and prevention plans.

The Indianapolis Business Journal described how concierge medicine helped patient Dale Sventeck. Sventeck suffered from a “frozen shoulder” which severely limited his range of motion. Most doctors he saw simply wanted to schedule him for an MRI study and surgery. But concierge physician Kevin Logan was able to take the time to diagnose that Sventeck’s problem was caused by the mercury in his dental fillings. Dr. Logan advised Sventeck to remove the fillings. One month later, his shoulder was back to normal.

To make such time to see their patients, most concierge physicians carry a smaller patient load — typically 300-400 patients — rather than the usual 2000-2500 patients. Yet some patients have both practical and ethical concerns about the “direct pay” or concierge model. For patients interested in this option, here are a few key considerations:

1) Concierge medicine can be surprisingly affordable.

Although some of the early concierge services were targeted at the wealthy, nowadays the annual fee amounts to roughly $4-5 per day — the cost of a daily latte at Starbucks.

This is within the means of many middle class families. Many middle class patients gladly choose to take more frugal vacations or drive less expensive cars in order to enjoy this service. The well-regarded One Medical Group (based in New York

‘‘

“I truly believe this is a better way to practice primary care medicine.”

Dr. Floyd Russak

and San Francisco) is even more affordable, charging members only $200 per year.

2) Choice is good.

We regard it as perfectly acceptable that some people can afford to pay more to drive a nicer car or live in a larger house. Similarly, some parents choose to pay extra to send their kids to private schools over public schools. We should similarly respect the prerogative of those who wish to pay more for a more comprehensive doctor’s appointment. Patients have the right to spend their own money for their own medical benefit according to their best judgment.

3) Concierge medicine benefits both physicians and patients.

Concierge physicians routinely report greater job satisfaction, because they can practice the way they were trained — taking the time to really talk to their patients and use their skills to their fullest extent.

Dr. Floyd Russak, the head of my county medical society, explained his reasons for switching to a concierge practice: “It is morally wrong to practice inferior care… [I]t is just not practical to provide good care to patients in the current reimbursement model without maintaining a full-time practice of nearly 2000 patients, which requires 10-15 minute appointments to see everyone. Good care requires time, and with the overhead of a primary care practice running $200K/year per physician, time and reimbursement are at odds with each other…

I now practice a much more rewarding style of Internal Medicine, where I have time for the vastly improved care that comes with longer appointments and following my own patients wherever needed, including the hospital, office, home or rehab.

Being on call all the time is not easy, but with only 300 patients, there are very few calls and most are appropriate and timely. I truly believe this is a better way to practice primary care medicine.”

A recent study published by the concierge medical group MDVIP in the peer-reviewed American Journal of Managed Care showed that their approach to primary care saved $2,551 per patient due to decreased hospitalizations, and resulted in a 72-79% reduction in hospital readmissions for serious illnesses.

The number of concierge physicians is still relatively small (4,400 in 2012), but has increased 30% over the past year. As ObamaCare unfolds, Forbes’ Bruce Japsen reports that as many as 10% of physicians are considering switching to a concierge practice. Those physicians will be able to practice according to their best medical conscience, while being appropriately compensated. Their patients will receive high-quality care at a fair price. Both parties win.

Over the next decade, we will likely see the evolution of primary care delivery into two tracks. Some patients receive high-quality care from happy, motivated concierge doctors, whereas others will have to make do with rushed “assembly line” care from overworked providers trying to get their patients in and out the door as quickly as possible.

Which track do you want? If you don’t choose, the choice will be made for you. And you might not like what you’ll get.  Originally appeared in Forbes.com (3/27/2013): http://www.forbes.com/ sites/paulhsieh/2013/03/27/is-conciergemedicine-the-correct-choice-for-you/ WWW.MEDMONTHLY.COM | 41

features

The Pros and Cons of Concierge Medicine-Practices More practices are catering to the middle class, with the goal of providing affordable care

When Samir Qamar practiced concierge medicine at Pebble Beach Resorts in Monterey, Calif., the hotel’s “A-list clientele” paid $550 to see him and as much as $30,000 a month to keep him on retainer.

But last year, Dr. Qamar decided to abandon VIP medicine and pursue a no-frills version of his practice, charging just $59 for monthly membership to his MedLion clinics (16 locations in five states) and $10 a visit—and never billing insurance.

Dr. Qamar is part of a new and growing generation of concierge doctors who, in this era of health reform, see more opportunity in the middle class than they do in the jet set. The trend has bifurcated the retainer medicine industry: On one end, patients pay thousands of dollars a month for lavish celebrity-type treatment at traditional concierge practices. On the other, pared-down clinics charge roughly $50 to $100 a month for basic primary-care medicine, more accessible doctors, and yes, money savings for those looking to reduce their health spending.

Of the estimated 5,500 concierge practices nationwide, about two-thirds charge less than $135 a month on average, up from 49% three years ago, according to Concierge 42 | AUGUST 2014

Medicine Today, a trade publication that also runs a research collective for the industry. Inexpensive practices are driving growth in concierge medicine, which is adding offices at a rate of about 25% a year, says the American Academy of Private Physicians.

Unlike high-end concierge practices, which typically bill insurers for medical services on top of collecting retainer fees, the lower-end outfits usually don’t accept insurance.

Instead, they charge patients directly for treatment along with membership, often posting menu-style prices for services and requiring payment up front, which is why it is called “direct primary care.” Eliminating insurance billing cuts 40% of the practices’ overhead expenses, enabling them to keep fees low, doctors say.

On the cusp of the Affordable Care Act mandating most Americans to have health insurance next year, a rise in doctors who don’t take insurance might seem paradoxical.

But health-care experts say the two forces go hand in hand, as patients may find concierge doctors more accessible, especially if traditional doctors get flooded with more patients. Also fueling the trend is a little-known clause tucked into the health-care law that allows direct primary-

care to count as ACA-compliant insurance, as long as it is bundled with a “wraparound” catastrophic medical policy to cover emergencies.

“All of a sudden our market went from the uninsured to everybody,” Dr. Qamar says.

Think this type of medicine might be right for you? Here are some issues to consider: The ACA already requires me to buy health insurance.

Why would I need this, too? While some insurers are developing special health plans around concierge practices, most patients who see concierge doctors pay for it on top of their regular insurance. The rationale: Many of the new health plans have high deductibles that most members will never hit, meaning patients will still be paying thousands of dollars out-of-pocket anyway—possibly even more than what they’d spend on concierge medicine. People with deductibles of $5,000 or more should think about how many times a year they typically see the doctor and for what, keeping in mind that annual checkups are free under the ACA. If doctor visits typically cost $150 and the patient has six appointments a year, a concierge practice offering the same services for $40 or $50 a month might be cheaper.

The recognition of concierge medicine in the law has spurred a few insurance companies, including Cigna Corp., to build new employee health plans around the model.

Travel company Expedia Inc., EXPE +0.72% for one, has added a concierge clinic run by Seattle-based Qliance Medical Group to its Bellevue, Wash., headquarters. Some practices are working with insurers on bundled products for the individual insurance market, as well, all designed to cost roughly the same as traditional insurance, or less. “I would never be a person who recommends coverage on top of coverage for the sake of increased coverage, but as we move forward, it becomes much more of a puzzle than it used to be,” says Tracy Keiser, chief executive and founder of the Keiser Group, a benefits-design firm developing wraparound policies to complement MedLion.

What if my insurance doesn’t have a concierge option?

Since most large insurers have yet to build plans around concierge practices, people might feel that the retainers are redundant next to their insurance plan, says Erika Bliss, CEO of Qliance, which received funding from Amazon. com Inc. AMZN +1.50% CEO Jeff Bezos and whose 8,500 patients pay between $54 and $94 a month depending on age. Dr. Bliss, who championed the concierge clause in the ACA, says it’s “a shame” more insurance companies haven’t embraced it yet, because people compelled by law to buy traditional coverage might find concierge unaffordable now.

Direct primary-care doctors say that a patient’s best bet is to select a high-deductible policy with minimal premiums for emergencies, and put the money they save up front toward the concierge retainer. High-deductible plans are often paired with health savings account. The

IRS, however, doesn’t recognize direct primary-care fees as eligible HSA expenses, so patients might not be able to spend pretax dollars at the clinics.

How can this save me money? While traditional doctors charge for each treatment and test—which can add up to hundreds of dollars per visit—Qliance, MedLion and other clinics charge flat fees that generally include basic checkups, treatment of minor ailments and electrocardiograms, or EKGs. SignatureMD Inc., a somewhat higher-end concierge practice, includes in its $125 to $200 monthly retainer an “executive physical” that could cost $1,000 at a standard practice. Services like blood work, X-rays and vaccines can cost extra, but concierge doctors often negotiate with specialists and labs to secure discounts for patients who would otherwise pay out-ofpocket. Brian Forrest, who describes his $39-a-month Access Healthcare clinic in Apex, N.C., as “concierge-lite,” has obtained prostate-cancer tests for $5 from the same lab that would charge a Medicare patient at least $175, $350 mammograms for $80, and colonoscopies for $400 when the official rate is $2,000. “Sometimes, it might be cheaper for them to use their insurance, but in some cases it isn’t,” Dr. Forrest says.

Students at North Carolina State University who studied Dr. Forrest’s practice found that his patients with normal insurance spent 12% less out-of-pocket than had they gone to a regular doctor—partly because the longer visits kept them healthier, says Richard Kouri, director of N.C. State’s BioSciences Management Initiative.

If the concierge medicine is cheaper, do I still get VIP treatment? Because concierge doctors aren’t at the mercy of insurance companies, they say they take on fewer patients and spend more time with each, often guaranteeing appointments within 24 hours. They also don’t need patients to come into the office to get paid, so they can provide care via video, email and phone. One of the great conveniences that private physicians offer is virtual conversations, as in “text me a photo of your tick bite,” says Tom Blue, chief strategy officer for the American Academy of Private Physicians.

But the lower-cost concierge practices keep their rates low by focusing on simple services—you won’t find advanced medical technology, and you’ll have to go elsewhere (and pay extra) for screenings like MRIs. For Qliance patient Don MacPhee, 85, the appeal was getting to keep his doctor when he switched to the concierge model—well worth the $90 a month he and his wife each pay. But Mr. MacPhee also likes the longer appointments and says his wife, whom the doctor visited in a rehab facility after she broke her hip, “profited from” the extra attention: “We don’t consider this to be exorbitant.”  Source: http://online.wsj.com/news/articles/SB10001424052 702303471004579165470633112630 WWW.MEDMONTHLY.COM | 43

features

Concierge Medicine Will Get Massive Boost From Obamacare Written by Dike Drummond, M.D. CEO of TheHappyMD.com

The shortage of physicians caused by the implementation of the Affordable Care Act in the next five years will drive a massive increase in the popularity of Concierge Medicine in the US. As the typical healthcare organization adapts to the coming tidal wave of newly insured patients it will become very difficult for you to see your doctor when you are ill, impossible to see them for routine care and make the typical experience of getting a checkup feel like being dropped into a “patient mill”.

Five years from now, if you want to have a personal physician see you for all your healthcare needs, you will need to pay for the privilege.

One popular way to do this is “concierge medicine” where you pay a monthly or annual premium directly to your doctor and, in return, they become your own personal physician, 44 | AUGUST 2014

taking direct responsibility for your healthcare needs. The good news is that concierge medicine is no longer a privilege of the rich. Premiums are becoming much more affordable – as low as $200/year – and if you enjoy seeing “my doctor” and not being rushed, you will feel the additional money for a concierge medicine doctor is well spent.

Concierge medicine popularity will also be driven by the primary care doctors themselves. Those who want to continue to have a personal relationship with their patients will find it very difficult to be satisfied with the typical high volume practice.

Why Concierge Medicine and Why Now? The Association of American Medical Colleges estimates that there will be a shortage of 91,500 doctors

by 2020 as the Obamacare insurance coverage provisions are implemented and 30 million Americans become eligible for health insurance coverage.

This tidal wave of newly insured patients has to be served somehow and US Medical Schools and Residency Programs cannot supply anywhere near these numbers of new physicians in this short of a time frame. There is no hope whatsoever to cover the shortfall with newly minted US Residency graduates … none.

The Fork in the Road How will healthcare markets respond – especially with regards to primary care? As the shortage of primary care providers worsens it will literally create a fork in the road for patients and doctors, driving the structure of their practices into two completely different tracks.

- Each is a distinct and logical response to the massive patient overload - The two models produce dramatically different experiences for both the patients and doctors - And each will expose gaping holes in a physician’s medical education that must be addressed.

TRACK 1 – Volume Driven: Doctor as Apex of a Care Pyramid In the more traditional practice structure, the physician will be come the leader of a care team supervising a number of Nurse Practitioners and Physician Assistants who provide the majority of the hands-on care. The skill and experience of the physician will be saved for the more complicated and severe cases seen that day. The majority of the doctor’s activity will be devoted

to leading and coordinating the care provided by the pyramid of N.P’s and P.A.’s who are their direct reports.

This model is invisibly driven by a financial reality – the very high overhead of the practice. The only solution for these groups will be to maximize patient volume. All the front line providers will see 20-30 patients a day, most likely with 15 minute time slots for each visit. It will look and feel like a “patient mill” with everyone doing their best to maximize patient satisfaction and outcomes under extreme time pressure.

As a patient in this model you will only see your doctor on rare occasion and only when you are very ill. Your primary relationship with be with a P.A. or N.P. This may come as a bit of a shock if you are used to seeing “my doctor” whenever you are sick or need a routine checkup.

In 5 years we will learn to accept this as the “normal practice of medicine” in America. All corporate forces in healthcare are leading in this direction at the moment and it seems clear that volume driven care will become the new normal for the majority of patients and medical practices.

For the physician, the challenge of this model is the complete absence of functional leadership skills training in most medical school and residency programs. 30-50% of these physician’s time will likely be spend in leadership and management activities for which they are not prepared on graduation.

Office team leadership training should be a popular CME topic in the years ahead.

TRACK 2 – Service Driven: Concierge Medicine/ Direct Care Model As the typical patient begins to notice they are only seen by a physician on rare occasion, a certain percentage will become willing to pay for that privilege. I suspect this will quickly grow to a substantial wave of

new demand for concierge medicine services especially as premiums continue to fall and more concierge medicine practices are available.

The surplus of patients means a shortage of doctors. As the shortage worsens, a larger and larger segment of our population will become willing to pay to continue to see their doctor as they do today, especially if your alternative is the high volume patient mill practice I previously described.

The huge popularity of the concierge medicine model will have another important driving force – the doctors. The office duties of the physician here are exactly the opposite of those in the first example. Here the physician is often seeing less than 15 patients a day, providing direct patient care and continuing to have meaningful personal relationships with their patients. And the dramatically lower overhead of the concierge medicine model means they can make the same amount of income as the volume driven doctors without having to see all those patients or supervise a team of mid-level providers.

As a patient, you will continue to see your doctor whenever you are ill or in for routine care. The doctor will most likely be practicing solo in a small office and will have much more time available for your visit.

As a physician, the challenge of this model is the absence of business training – and specifically marketing training – in most medical education programs. The concierge medicine model is inherently entrepreneurial and will always involve a fairly sophisticated marketing program to be successful. For the first time the doctor must enroll their own patients who pay with their own money for this direct relationship. Acquiring these skills is not an insurmountable obstacle and I have yet to meet a newly board certified MD who understands the essentials of marketing. continued on page 46 WWW.MEDMONTHLY.COM | 45

continued from page 45

What’s a Patient to Do? If you would like to continue to have direct access to your doctor in the years ahead, I encourage you to investigate concierge medicine services in your area and ask your current doctor if they have considered a concierge medicine practice. If you google “concierge medicine (your city here)”, you will most likely find a practice nearby. They would be happy to meet you and introduce you to the practice at no charge.

$100.00 Off Your New Website!

What’s a Doctor to Do? If you are a primary care physician with 10 or more years of practice ahead of you, I suggest you look at the various concierge medicine business models and get ready to be met by the fork in the road.

Will you choose to lead a team or build your concierge medicine practice? If you are leaning in one direction or the other, I suggest you get started building your missing skill set – be that leadership or marketing. The wave of newly insured patients is coming.  Source: http://www.thehappymd.com/blog/ bid/285923/Concierge-Medicine-will-getMassive-Boost-from-Obamacare

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46 | AUGUST 2014

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the arts

Medicine Cures the Body, But Art Heals the Spirit : The Creative Center at University Settlement

By Thomas Hibbard Creative Director, Med Monthly

Artist-In-Residence Nikki Schiro helping patient create jewelry

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The Creative Center, founded in 1994 on the belief that “medicine cures the body, but art heals the spirit,” began as a series of free art workshops for women with cancer.

Twenty years later, with immeasurable recognition in the field of arts in healthcare and the nonprofit sector, The Creative Center is proud to have hospital artist-inresidence programs in more than 25 sites in New York area hospitals, as well as 60 sites across the US through a national replication, including Bellevue Hospital, Englewood Hospital, Mt. Sinai Medical Center, New York Presbyterian Hospital, St. Luke’s-Roosevelt, Terence Cardinal Cooke Healthcare Center, and Woodhull Hospital. They also offer free-of-charge art workshops every day of the week, a training program bringing The Creative Center’s proven approach to arts in healthcare around the country, and an online gallery representing professional artists living with illness.

In 2011, The Creative Center merged with and became a program of University Settlement, the oldest settlement house in the U.S., expanding into the growing field of “creative aging”. This merge puts into practice what recent research has shown; that arts activities and experiences provide not only opportunities for artistic and self expression, but also measurable health benefits to seniors at all stages in the aging continuum, enabling them to live better and healthier lives. The Creative Center is now integrated throughout University Settlement’s senior programming.

Robin Glazer, the Director of The Creative Center at University Settlement, states they have four major programs: the Art Workshop Program, the Arts-InResidence Program (AIR), the Training Institute, and the Art Gallery.

Art Workshop Program The Creative Center provides daily free-of-charge art Creative Center Art Workshop: Shoebox Portraits

Artwork created by a patient and his wife while receiving chemotherapy.

workshops to people with cancer and other chronic illnesses on a semester basis. Class curriculum covers a variety of mediums including photography, drawing, writing, painting, jewelry design, dance, acting, sculpting and is taught by professional artists and art educators.

Artist-In-Residence Program (AIR) The mission of The Creative Center’s Hospital Artist-InResidence Program is to bring artmaking experiences to patients, their families and staff in New York City area hospitals. Artists offer patients the opportunity to be absorbed in their own creative process as an antidote to the anxiety, pain and boredom that are often part of the hospital experience. The Creative Center’s Hospital Artistsin-Residence work at the bedside and in small group settings with men, women, and children – in oncology units, bone marrow transplant units, general medical/ surgical floors, intensive care/respiratory units, hospice and palliative care programs, pediatrics, cardiology, geriatrics and dementia, HIV/AIDS and outpatient clinics – offering their patients the opportunity to learn about and become absorbed in their own creative resources as they meet the continued on page 50 WWW.MEDMONTHLY.COM | 49

continued from page 49

challenges of diagnosis, treatment and survivorship.

The program enables hospitals to offer their patients a multitude of benefits: • • • • • • • • •

•

Relief from anxiety Distraction from pain Respite from boredom A safe outlet for their emotions Extended contact with a caring and supportive individual, which can augment the hospital’s patient support services The opportunity to engage in creative expression, which may lead to a new appreciation of their innate ability to express themselves through the arts An experience of mastery at a time when they have little control over their daily lives The discovery that their own creativity may augment their coping skills by accessing resources they did not realize they had Strengthened communication with the hospital staff, especially when patients’ artwork is displayed and the staff has the opportunity to interact with the patient as a creative and unique individual An enhanced perception of the hospital as a nurturing and healing environment, raising patient satisfaction

The following are some excerpts from AIR logs that reflect how effective the program is and how it touches the participants at very tumultuous time in their lives: Caring for the Caregiver: Staff Jewelry Workshop

“I commenced my morning with a new patient, a young with an eye patch. He spoke of being a pessimist but that he needed to be a pragmatist at this time. He was once a security guard but that now he’s just a landlord in a brownstone, living with his family. He chose a ceramic star ornament and was very specific of his design, blue border, white interior and then painted a sun on it with water underneath and birds. The water that he painted was turbulent. He asked me to paint the clouds and birds in light of his hands. I found that he has a rare cancer that has affected his vision and his hearing.”

“Although I had approached a new patient from Bangladesh who did not speak the language, he turned me down. However one of the nurses would not accept a ‘no’. She felt that he was harassing her too much with questions on his first day, so she “bullied” him in a nice way into making the ornament. We made the snowman pony bead ornament together. He and his family member got into counting the beads per row to get the image to come out right. It helped him to stop thinking of his chemo. At the end of our work together, I was able to get a smile out of him. His face had been riddled with terror in light of the fact that he cannot speak the language and that it’s his first day.”

“My last patient speaks Spanish. I asked her if she’d like to do an ornament. She chose a ceramic snowflake, painted it blue and white. I showed her how to paint brushstrokes in a manner that is impressionistic. She placed rhinestones and then varnished it. Not bad for a first timer. She stated that she had been waiting for hours to see the doctor.”

“Harry was in and wanted to make a Valentine’s card to go with the box that he made. He spent some time picking out colors and patterns and told me that he wanted to make a floral collage on the card. He seems to have many physical problems including a trache, which makes it a bit difficult to communicate. He also has a problem with his hands that make him unable to use them for very much, but making the card made him so happy. He had a twinkle in his eye when he said he would write a message in it at home.”

“Janet was in with her mom this time. She had been in the cardiac ICU apparently as a result of side effects from the chemo she was getting. She has a nine-month old baby and two school age children and is now awaiting a bone-marrow transplant. She decorated one of the huge heart boxes with an assortment of orange-candy patterned papers. She relishes doing these things and is very careful and competent at it”.

An evaluation study funded by the United Hospital Fund resulted in the publication of the Final Report: Satisfaction and Outcomes Assessment of the Hospital Artist-in-Residence Program of The Creative Center.

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Participants in Creative Aging Training Program learn techniques to bring art-making to people living with dementia.

Patients responded to open-ended questions to describe their experience. The most commonly used words were fun, interesting, enjoyable, and nice.

Here are some of the comments collected from patients: • The experience made me feel better.

• The artist was encouraging and helpful.

• The experience was good, even though I was in a depressed mood.

• I loved it even though my hands are shaky.

• It is a pleasure to come here for a creative experience - great assistance - all the materials were here for us.

• It was a great distraction from chemo.

• The artist inspired me and it was good to talk with her.

• The artist’s visit was the bright spot of my day.

• I appreciated the gift of humanity from the artist.

There were no negative comments recorded.

Training Institute Training in The Creative Center’s approach and methods is given to artists and administrators from healthcare institutions around the country. They come to New York and are given everything they need to create “best practice” arts programming in their healthcare facilities. They then return home to design and implement a program tailored to their sites.

The next training, funded by the National Endowment for the Arts, which has named The Creative Center a “Best Practice Site”, is scheduled for Sunday, March 15 through Friday, March 21, 2015. The focus will be on both arts-inhealthcare and creative aging. For more information, email info@thecreativecenter.org. Applications will be available on their website and by request in early fall, 2014.

Specific consulting is also available. Robin Glazer

has trained staff at numerous institutions including the University of Michigan Medical Center and the Kentucky Center for the Performing Arts.

Publications and DVDs The Creative Center has two books available for purchase on their website. Artist-In-Residence: The Creative Center’s Approach to Arts in Healthcare offers artists and healthcare professionals a unique look at artmaking with patients and caregivers in healthcare settings. Still Life: Documenting Cancer Survivorship shares the words and photographs of twenty-five cancer survivors as they learned the art and craft of documentary photography to convey their experiences in survivorship.

A DVD is also available entitled Hospital-In-Residence Training. It is a two disc set containing lectures from physicians, social workers, bereavement counselors, artists, art therapists, writers, artists-in-residence, and participants about what to expect in starting a hospital artist-inresidence program.

Art Gallery & Sales The Creative Center’s Art Gallery, a unique social enterprise, represents artists who are in treatment for, or survivors of, illness as well as their caregivers and those working in the healthcare field. Purchases of original art or reproduction rights helps support the mission of The Creative Center with 40% of art sales benefiting programs in public hospitals that can’t afford them.  The Creative Center at University Settlement Phone: 646-465-5313/5314 email: info@thecreativecenter.org Website: http://www.thecreativecenter.org WWW.MEDMONTHLY.COM | 51

healthy living

Heirloom Tomato Salad with Rosemary from AllRecipes.com

By Ashley Acornley, MS, RD, LDN

Ingredients:

1/4 cup extra virgin olive oil 2 tablespoons rice wine vinegar 1 sprig fresh rosemary, finely chopped 1/8 teaspoon dried oregano kosher salt to taste ground black pepper to taste 3 large heirloom tomatoes, quartered 3 small heirloom tomatoes, quartered

Nutritional Facts: Makes 4 servings Calories: 164 Fat: 14 g Fiber: 2.6 g Protein: 1.8 g Carbohydrates: 8.3 g Cholesterol: 0 mg Sodium: 110 mg

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Preparation: Whisk together the olive oil, rice wine vinegar, rosemary, and oregano in a large bowl. Add small and large tomatoes, and toss until evenly coated.

Cover and refrigerate until chilled, 10 to 15 minutes.

Season with salt and black pepper. Toss again before serving.

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/LicensesPermitsandCertificates/MedicalCommission. aspx

WWW.MEDMONTHLY.COM | 53

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 54

| AUGUST 2014

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/gov/departments/dph/programs/hcq/dhpl/ dentist/ 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 WWW.MEDMONTHLY.COM | 55

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 56 | AUGUST 2014

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://bsd.dli.mt.gov/license/bsd_ boards/med_board/board_page.asp 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 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/

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

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

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/

WWW.MEDMONTHLY.COM | 57

medical resource guide Urgent Care & Occupational Medicine Consultant

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

Lawrence Earl, MD COO/CMO ASAP Urgentcare Medical Director, NADME.org 908-635-4775 (m) 866-405-4770 (f ) http://www.asap-urgentcare.com/ UrgentCareMentor.com

EQUIPMENT APPRAISER Brumbaugh Appraisals 8601 Six Forks Road, Suite 400, Raleigh, NC 27615 (919) 870-8258 www.brumbaughappraisals.com

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

ADVERTISING

www.pushpa.biz

MedMedia9

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

DENTAL www.medmedia9.com

BILLING & COLLECTION

Biomet 3i

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

Dental Management Club Applied Medical Systems, Inc. Billing - Coding - Practice Solutions 4220 NC Hwy 55, Suite 130B Durham, NC 27713 (800) 334-6606 www.ams-nc.com

CODING SPECIALISTS Place Your Ad Here

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

Urgent Care America

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

58 | AUGUST 2014

EXECUTIVE ACCOUNTING & FINANCE RECRUITER Accounting Professionals Agency, LLC Adrienne Aldridge, CPA, CGMA, FLMI President 1204 Benoit Place Apex, NC 27502 (919) 924-4476 aaldridge@AccountingProfessioinals Agency.com

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

www.AccountingProfessionalsAgency.com

The Dental Box Company, Inc.

FINANCIAL CONSULTANTS

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

DIETICIAN Triangle Nutrition Therapy 4030 Wake Forest Road, Suite 300 Raleigh, NC 27609 (919)876-9779 http://trianglediet.com/

ELECTRONIC MED. RECORDS

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

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

LOCUM TENENS Physician Solutions

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

medical resource guide MEDICAL ARCHITECTS MMA Medical Architects

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

MEDICAL MARKETING

Bank of America

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

MEDICAL ART Deborah Brenner

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

MedImagery

Laura Maaske 262-308-1300 Laura@medimagery.com http://www.medimagery.com

PRACTICE FINANCING

MEDICAL PRACTICE SALES Medical Practice Listings

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

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

PROFESSIONAL SPEAKER Capri Health

Angela Savitri, OTR/L, RYT, IHC, RCST速 919-673-2813 angela@caprihealth.com www.freedomfromchronicstress.com

REAL ESTATE York Properties, Inc.

MEDICAL EQUIPMENT Assured Pharmaceuticals Matthew Hall (704)419-3005 mhall@assuredpharma.com

MEDICAL PRACTICE VALUATIONS

Commercial Sales & Leasing (919) 821-7177 www.yorkproperties.com

BizScore

PO Box 99488 Raleigh, NC 27624 (919)846-4747

www.assurepharma.com

STAFFING COMPANIES

www.bizscorevaluation.com

Additional Staffing Group, Inc.

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

MEDICAL PUBLISHING www.thetps.com

MEDICAL EQUIPMENT FINANCING Bank of America

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

Headquarters & Property Management 1900 Cameron Street Raleigh, NC 27605 (919) 821-1350

MedMedia9

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

8319 Six Forks Rd, Suite 103 Raleigh, NC 27615 (919) 844-6601 Astaffinggroup.com

SUPPLIES, GENERAL www.medmedia9.com

MEDICAL RESEARCH

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

WEBSITE DESIGN

Scynexis, Inc.

3501 C Tricenter Blvd.

Durham, NC 27713 (919) 933-4990

MedMedia9 www.scynexis.com

PO Box 98313 Raleigh, NC 27624 (919)747-9031 www.medmedia9.com WWW.MEDMONTHLY.COM | 59

classified listings

Classified To place a classified ad, call 919.747.9031

Physicians needed North Carolina 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 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 Disease 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. 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

60 | AUGUST 2014

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, 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. Please contact Physician Solutions at 919-845-0054 or email us at 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. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: 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. physiciansolutions@gmail.com 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. Call or email for more information. 919-845-0054 physiciansolutions@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 PA to work FT ongoing beginning March 22. Shifts can be either 8 or 12 hours. No call. email: physiciansolutions@gmail.com

Classified 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.

Physician Solutions, PH: (919) 845-0054, email: physiciansolutions@gmail.com

Greensboro occupational health care clinic seeksgeneral practitioner for intermittent shifts. Primary care physicians needed for occupational medicine. Adults only. Hours are 8am-5pm. Large corporation, no call required. Please contact Physician Solutions at 919-8450054 or email: physiciansolutions@gmail.com.

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

Please contact Physician Solutions at 919-845-0054 or email: physiciansolutions@gmail.com.

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.

Please contact Physician Solutions at 919-845-0054 or email: physiciansolutions@gmail.com.

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

Nursing home in Durham seeks PT/FT NP/PA for immediate ongoing scheduling. Durham nursing home seeks part time or full time mid-level for ongoing locums.

Must have geriatric experience. 8-5p. Other facilities in Fayetteville and Rocky Mount. Please contact Physician Solutions at 919-845-0054 or email us at 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. Please contact Physician Solutions at 919-8450054 or email: physiciansolutions@gmail.com.

Fayetteville occupational health care clinic seeks GP for May. Primary care physicians needed for occupational medicine. Adults only. 8-5p. Large corporation, no call required. Intermittent dates in the future and second office in Greensboro with ongoing scheduling.

Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Employee Health Clinic seeks Mid-Level Provider for FT on-going coverage near Charlotte. Practice 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. Please contact Physician Solutions at 919-845-0054 or email us at physiciansolutions@gmail.com.

Nursing home in Durham seeks PT/FT Geriatrics doctor for immediate ongoing scheduling. Durham nursing home seeks part time or full time MD for ongoing locums. Must have geriatric experience. 8-5p. Other facilities in Fayetteville and Rocky Mount. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

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. Please contact Physician Solutions at 919-845-0054 or email us at physiciansolutions@gmail.com.

Family Practice 1 h SE of Raleigh seeks coverage.

Goldsboro FP seeks MD for July 6-7 and intermittent shifts. 8-5p. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com. continued on page 63 WWW.MEDMONTHLY.COM | 61

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

Women’s Health Practice in Morehead City, NC

PEDIATRICIAN

OR FAMILY MEDICINE DOCTOR NEEDED IN

ROANOKE RAPIDS, NC

Newly listed Primary Care specializing in Women’s care located in the beautiful coastal city of Morehead City. This spacious practice has 5 exam rooms with one electronic tilting exam table and 4 other Ritter exam tables. Excellent visibility and parking make this an ideal location to market and expand. This practice is fully equipped and is ready for a new owner that is ready to hit the ground running. The owning MD is retiring and will be accommodating during the transition period. This medical building is owned and is offered for sale, lease or lease to own. The gross receipts for the past 3 years exceed $540,000 per year. If you are looking to purchase an excellent practice located in a picturesque setting, please contact us today.

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.

Medical Practice Listings Buying and selling made easy

Call 919-848-4202 or email medlistings@gmail.com www.medicalpracticelistings.com 62 | AUGUST 2014

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

classified listings

Classified

continued from page 61

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

Pediatric clinic near Greensboro needs 10 weeks of 3 day a week coverage beginning June 1. Burlington pediatric clinic seeks coverage June 1 3 days a week for 10 weeks. 8-5p. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Greenville Clinic seeks GP. GP/IM needed for intermittent shifts. Must have experience or be willing to do pain management and trigger point injections. 8-5p.

Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Raleigh practice seeks BC FP for permanent placement in new facility summer 2013. Board Certified Family Practitioner sought for FT permanent placement in new clinic in Raleigh to start summer of 2013.

Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@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 PA to work FT ongoing beginning March 22. Shifts can be either 8 or 12 hours. No call. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Western North Carolina Clinic needs continuing physician coverage. Clinic 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. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

IM/FP/Peds opportunity in Fayetteville clinic immediately. Fayetteville clinic needs immediate coverage for the following clinics: adult health, women’s health and STD. No call 8a-5p. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Pediatrician, IM & FP needed, Fayetteville NC Urgent Need for immediate MDs - Pediatrics, Family Practice or Internal Medicine - PT/FT, 8-5 Mon-Fri. Ongoing. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Locum & Permanent MD Needed , Kinston NC Urgent Need for immediate MD placement, 8-5 MonFri. Must be able to do family planning & light maternity, Kinston, NC: 1.5 hours outside Raleigh. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

PT MD needed for Occupational practice, Greensboro NC. Urgent need for PT MD to do disability physicals 2-3 days weekly, 8-5, on-going scheduling.

Greensboro, NC. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Permanent PA or MD needed in Goldsboro, NC On-going permanent position Mon- Fri 8-5, Goldsboro, NC: 1 hour 10 minutes outside Raleigh. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Family Practice MD needed 2-3x/week, Goldsboro intermittent dates, 8-5p,Goldsboro, NC 1h SE of Raleigh. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Geriatric Experienced Mid Level or MD, Durham NC Must have geriatric experience, PT/FT, Locations in Durham, Rocky Mount & Fayetteville, NC. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Family Practitioner opportunity available one hour east of Charlotte Monday through Friday. The hours will be 8:00am until 5:00pm either full time or part time.

You will be seeing 15-20 new patients a day. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Immediate opportunity for a Primary Care Physician at a large practice located one hour south of Raleigh. The hours are from 8:00am until 5:00pm You will be treating generally 20-25 patients per day. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Family MD opportunity at an Urgent Care facility that sees all ages in the Jacksonville, NC area. This will be an ongoing schedule from 8:00am until 6:00pm 1-2 days a week, including weekend dates. You will treating generally 30-35 patients a day. There is potential for permanent placement. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com. continued on page 64 WWW.MEDMONTHLY.COM | 63

classified listings

Classified

continued from page 63

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

Primary care physician opportunity for busy occupational medicine practices near Greensboro/Fayetteville, NC. There are two locations with positions available within 15 minutes of Greensboro and Fayettteville. Your schedule will be from 8:00am until 5:00 pm either full time or part time, no call necessary. Patient treatment will consist of adults only in both facilities. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Family Physician opportunity for a leading medical practice in the Raleigh area. Must be able to start immediately and be comfortable with seeing all ages.

Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Primary Care Physician opportunity for a leading women’s practice in the Lenoir, NC area. Treating Physician must be comfortable with light OB and well women’s exams. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

General Practitioner/Internal Medicine Physician opportunity for intermittent shifts at a prominent practice in the Greenville, NC area. Treament schedule will be from 8:00am until 5:00pm. The practicing physician must have experience or be willing to perform pain management and trigger point injections. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Exceptional Family Physician opportunity at a practice in the Raleigh, NC area. Schedule will be ongoing Monday through Friday from 8:00am until 5:00pm. Must be comfortable with treating all ages. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Immediate Pediatrician opportunity at a small outpatient hospital. Located between Fayetteville and Wilmington, this facility requires someone for intermittent shifts. Please contact Physician Solutions at 919845-0054 or email physiciansolutions@gmail.com.

Pediatrics Opportunity - Roanoke Rapids Area Northeastern North Carolina Pediatric Practice seeks on-going physician for full time coverage beginning 64 | AUGUST 2014

mid-October through the end of the year. Practice sees about 16-25 patients a day, hours are 8:00-5:00 with negotiable call. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Primary Care Physician - Washington area Seeking a physician for a general primary care practice.

Treatment will include seeing 3-4 pediatric and about 10 adult patients per day. The hours are 8:00- 5:00pm M-F. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Family Physician –Williamston area Immediate opportunity at a developing family practice in the Williamston area. You will be treating 8-16 patients per day from 8:00-5:00 pm. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com. continued on page 66

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

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

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

Medical Practice Listings Buying and selling made easy

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

Eastern North Carolina Family Practice Available Well-appointed Eastern North Carolina Family Practice established in 2000 is for sale in Williamston, NC. This organized practice boasts a wide array of diagnostic equipment including a GE DEXA scanner with a new tube, GE case 8000 stress testing treadmill and controller and back up treadmill, Autoclave and full set of operating equipment, EKG-Ez EKG and much more.

The average number of patients seen daily is between 12 to 22.

The building is owned by MD and can be purchased or leased.

The owning physician is retiring and will assist as needed during the transition period. The gross receipts for the past three years are $650,000 and the list price was just reduced to $240,000.

If you are looking to purchase a well equipped primary care practice, please contact us today.

Contact: Cara or Philip at 919-848-4202

medlisting@gmail.com medicalpracticelistings.com

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

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

NC OPPORTUNITIES 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

Please direct all correspondence to driverphilip@gmail.com.

Only serious, qualified inquirers.

WWW.MEDMONTHLY.COM | 65

classified listings

Classified

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Physicians needed North Carolina (cont.)

MD Suboxone Duties Suboxone is a prescription medicine used for the maintence treatment of oproid dependence. Duties include opioid dependence recovery, rehabilitation, substance abuse and general Internal medicine. We have 4 practices to support with 3 to 5 day coverage. This means you have choices in the city you wish to practice. Slow to moderate patient pace with an exceptional staff and facility. Please contact Physician Solutions at; (919) 8450054 or Email; physiciansolutions@gmail.com Family Practice Opportunity, treating patients of all ages, looking for a FP or well informed Pediatric MD to work a full schedule Monday through Friday in Raleigh NC. This job is available immediately and is on-going contracted assignment. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@ gmail.com Methadone Treatment facility in the Western part of North Carolina has an immediate opening for a dependable MD. This is a highly regulated facility and the nursing staff performs most of the routine duties. The physicians that currently work in this environment really enjoy the work environment. We are accepting applications for this position and we will consider 3 to 5 shifts per weekly. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Physician Assistant to work primary care settings in North Carolina. We have 5 or 6 primary care practices that are looking for permanent or locum to perm PA’s.

Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Fayetteville area practice on-going physician for full time coverage. Practice sees about 16-25 patients a day, hours are 8:00-5:00 with negotiable call. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Pediatrician needed for permanent placement at Fayetteville area practice. Board Certified or Board Eligible. Practice sees about 16-25 patients a day, hours are 8:00-5:00 with negotiable call. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com

Winston Salem clinic seeks PA for FT ongoing locums position immediately. Average daily patient load is 25.

Primary care services as well as some pain management. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Chiropractic Clinic seeks mid-level provider in Greenville, NC for Monday and Tuesdays shifts beginning in April. No call required, 8-5. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Cardiology practice has immediate opportunity for full time mid-level or physician in Fayetteville area to provide primary care assistance for the practice. The position has the potential for permanent placement. No call required, 8-5 M-F. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Clinic seeks PA immediately 3 days per week ongoing in Rocky Mount. Small clinic in Rocky Mount seeks 2-3 days coverage a week immediately. Few peds, 8-5pm M-F days flexible. Temp to perm. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Occupational Therapist (OT) - 3 positions available in Eastern, NC. We have opportunities for 3 on-going Occupational Therapists. These positions are 40 hour per week temp status to permanent positions. Contact Ashley or Cara at; physiciansolutions@gmail.com or PH: (919) 845-0054 for more details.

Immediate opportunity for a Family or Internal Medicine MD to practice 3 to 5 days per week in Charlotte.

Light patient volume along with top wage make this a very attractive position. If you have 3 to 5 hour shifts you can work from Monday through Friday, we would like to discuss this upscale practice opportunity.

Contact Ashley or Cara; (919) 845-0054 or Email us at physiciansolutions@gmail.com Primary care practice in North Raleigh has an immediate opening for a well rounded Medical Doctor in Raleigh, NC. 3 to 5 days per week seeing 16 to 22 patients between the hours of 8-5. This is an on-going opportunity with some flexibility as there are two other providers as co-workers. Outpatient with no hospital duties makes this a very desirable locum’s job. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com

continued on page 69 66 | AUGUST 2014

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

Modern Med Spa Available

Located in beautiful coastal North Carolina Modern, well-appointed med spa is available in the eastern part of the state. This Spa specializes in BOTOX, facial therapy and treatments, laser hair removal, eye lash extensions and body waxing as well as a menu of anti-aging options. This impressive practice is perfect as-is and can accommodate additional services like; primary health or dermatology.

The Gross revenue is over $1,500.000 during 2012 with consistent high revenue numbers for the past several years. The average number of patients seen daily is between 26 and 32 with room for improvement. You will find this Med Spa to be in a highly visible location with upscale amenities. The building is leased and the lease can be assigned or restructured. Highly profitable and organized, this spa POISED FOR SUCCESS. 919.848.4202 medlisting@gmail.com medicalpracticelistings.com WWW.MEDMONTHLY.COM | 67

What’s your practice worth?

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

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

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

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

Scan this QR code with your smart phone to learn more.

919.846.4747 bizscorevaluation.com

classified listings

Classified

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Physicians needed North Carolina (cont.)

Family practice in Wake Forest, NC seeks 2 to 3 shifts per week from a Board Certified FP. There is one doctor and 2 PA’s already practicing here and the growth requires another provider. No call, no hospital and great colleagues and facility. Contact Ashley or Cara at; physiciansolutions@gmail.com or PH: (919) 845-0054 for more details.

Addictive medicine practice would like FP or IM physician to see 8 to 15 patients per day in Charlotte, NC. This position requires a solid level of Administrative writing skills for outlining patient protocol. The ideal doctor will have 2 to 4 shifts per week. Providers with Suboxone credentials can start within days. If you would like to obtain Suboxone certification, the process time is one to two weeks (on-line course). Call (919) 845-0054 or Email us at physiciansolutions@gmail.com Wilson, NC Urgent care treating 25 to 35 patients per day has an opportunity for a well qualified MD. The shifts are 10 hour days during the week and 6 to 8 hour shifts on the weekend. This allows you to work 3 to 4 days per week comfortably. You must be comfortable seeing children to geriatrics and basic suturing skills are required. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Walk-in primary care practice in Wilmington, NC would like to add 1 to 3 shifts per week for a primary care doctor. Heavy population of female patients and young adults are seen between 8 and 5 M-F. This is an ongoing locum opportunity. Contact Ashley or Cara; (919) 845-0054 or Email us at physiciansolutions@gmail.com On-going contract with an Assistive Living and Nursing Home organization in Raleigh, Durham, Greensboro, Charlotte, Wilmington, High Point, Greenville, Wilson, Asheboro, Rocky Mount, Asheville and Hillsboro. The mentioned cities are the major cities we need Geriatric MD’s to see patients. 6 to 8 doctors are required as this a long term locum opportunity. You will be paid hourly (no commissions or fee splits) plus mileage and lodging when necessary. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com PA opportunity in Raleigh, NC for long term locum opportunity. This large primary care practice would like to add one, possible two physician assistants. If you can provide 3 to 5 shifts per week, we would like to introduce you to this up-scale practice. No call, no hospital

and no pain management. This job starts May and is on-going. Call (919) 845-0054 or Email us at physiciansolutions@gmail.com Asheville, NC needs long term PA opportunity in this beautiful mountain city. This is a 40 hours per week on-going positions that can develop into permanent.

No call or hospital. This is a locum assignment for the serious PA to work with 3 MD’s and several other PA’s.

Primary care medicine at its best in this modern facility.

Contact Ashley or Cara; (919) 845-0054 or Email us at physiciansolutions@gmail.com Charlotte area pediatric practice seeks on-going mid-level for immediate coverage, 1-2 shifts per week.

Hours are 8:00-5:00 with no call. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com Vascular Surgeon needed for multi-practice specialty group located in Greensboro area to cover weekend shifts. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Family practice with Sports Medicine focus in Greensboro, NC seeks physician assistant, practice sees all ages. Must be familiar with electronic records. Practice sees 20-25 patients a day, hours are 8:00-5:00. Contact Ashley or Cara; (919) 845-0054 or Email us at physiciansolutions@gmail.com Family practice with busy allergy clinic in Rocky Mount, NC seeks full time physician assistant to join their practice. Clinic hours 8-5 with no call. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com Immediate opportunity for Physician Assistant with Fayetteville area family practice and Heart clinic. Practice is conveniently located with excellent support staff. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Immediate opportunity for Geriatrics or Family Physician with statewide practice. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Urgent Care with busy Occupational Medicine practice in Greensboro, NC seeks Internal Medicine Physician with North Carolina DOT Certification for intermittent shifts. All shifts are 8-5, with no call. Contact Ashley or Cara; (919) 845-0054 or Email us at physiciansolutions@gmail.com continued on page 70 WWW.MEDMONTHLY.COM | 69

classified listings

Classified

continued from page 69

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

Family Medicine Physicians needed for Fayetteville primary care clinic, physician will see all ages. Hours are 8-5 with no call. Contact Ashley or Cara; (919) 845-0054 or Email us at physiciansolutions@gmail.com

Urgent Care in Fayetteville, NC with busy Occupational Medicine practice seeks Internal Medicine Physician with North Carolina DOT Certification for intermittent shifts. All shifts are 8-5, with no call. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

Urgent Care with busy Occupational Medicine practice seeks Internal Medicine Physician with North Carolina DOT Certification for intermittent shifts. All shifts are 8-5, with no call. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

Pediatrician needed for practice one hour north of Raleigh, NC Mondays and Wednesdays on going. All shifts are 8-5 with no call. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com Family Physician needed to see all ages in Eastern North Carolina clinic. Flexible dates, and on-going opportunities available. Contact Ashley or Cara; (919) 845-0054 or Email us at physiciansolutions@gmail.com

Addictive medicine practice would like FP or IM physician to see 8 to 15 patients per day. This position requires a solid level of Administrative writing skills for outlining patient protocol. The ideal doctor will have 2 to 4 shifts per week. Providers with Suboxone credentials can start within days. If you would like to obtain Suboxone certification, the process time is one to two weeks (on-line course). Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com

Urgent Care in Greensboro, NC with busy Occupational Medicine practice seeks Physician Assistant with North Carolina DOT Certification for intermittent shifts. All shifts are 8-5, with no call. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com

Asheboro urgent care seeks FP/GP for ongoing shifts starting in July 2014. Week days are 8-8pm and weekends 9-6pm. There are two providers and usually 3 NPs. Average 60 patients per day. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com

Urgent Care with busy Occupational Medicine practice in Fayetteville, NC seeks Physician Assistant with North Carolina DOT Certification for intermittent shifts. All shifts are 8-5, with no call. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

Elizabeth City pediatrics clinic seeks physician Oct 1-31, M-F or 4 days a week ongoing. Hours are 8-5pm and average patient load is 25 per day. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 8450054, email: physiciansolutions@gmail.com

Multi-speciality practice seeks family physician to cover shifts from July 11-Sept 5 (3-5 days/week) in Carolina Beach. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com Family practice in Holly Springs seeks physician to cover intermittent shifts throughout the summer. Hours are 8-4p, practice sees 10-15 patients per day. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Primary care practice in North Raleigh has an immediate opening for a well rounded Medical Doctor. 3 to 5 days per week seeing 16 to 22 patients between the hours of 8-5. This is an on-going opportunity with some flexibility as there are two other providers. Outpatient with no hospital duties makes this a very desirable locum’s job. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com 70 | AUGUST 2014

Physicians needed South 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

Classified To place a classified ad, call 919.747.9031

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 Virginia practice outside of Washington DC seeks IM doctor FT/PT now – June 1. IM physician needed immediately FT/PT for Virginia clinic near Washington DC. 8-5p Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Nurse Practitioners needed North Carolina Permanent NP needed in Goldsboro, NC On-going permanent position Mon- Fri 8-5 Goldsboro, NC: 1hour 10 minutes outside Raleigh.

Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Permanent NP needed in Goldsboro, NC On-going permanent position Mon- Fri 8-5 Goldsboro, NC: 1hour 10 minutes outside Raleigh.

Please contact Physician Solutions at 919-845-0054 or 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. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Medical Marketing & Sales needed North Carolina Accounts Manager; Physician Solutions has an immediate opportunity for a professional to work from our North Raleigh corporate offices. Duties include; calling on developed practice accounts while developing new accounts. Recruiting physicians and overseeing all marketing and sales duties. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com WebSite Development and Hosting Sales; MedMedia9 is accepting applications for Sales Associates in all parts of North Carolina. We are looking for Independent Medical Sales Reps that are looking for a really solid product that is needed by 6 out of 10 practices, cost effective and will enhance their practice income while attracting new patients. Easy sales delivery by a confident professional. Please send your resume and contact information to; medmedia9@gmail.com or go to www.medmedia9.com the About Us tab and view the Reseller Application. We pay exceptional commissions and offer the best back office support. We welcome the opportunity to discuss our program with you. 

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. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

WWW.MEDMONTHLY.COM | 71

Practices for Sale Medical Practices Primary Care specializing in Women’s Practice Location: Morehead City, N.C. List Price: Just reduced to $20,000 or Best Offer Gross Yearly Income: $540,000 average for past 3 years Year Established: 2005 Average Patients per Day: 12 to 22 Building Owned/Leased: MD owned and can be leased or purchased Contact: Cara or Philip at 919-848-4202

Family Primary Care Practice

Location: Minutes East of Raleigh, North Carolina List Price: $15,000 or Best Offer Gross Yearly Income: $235,000 Average Patients per Day: 8 to 12 Total Exam Rooms: 6 Physician retiring, Beautiful practice Building Owned/Leased: Owned (For Sale or Lease) Contact: Cara or Philip 919-848-4202

Family Practice/Primary Care

Location: Hickory, North Carolina List Price: $425,000 Gross Yearly Income: $1,5000,000 Year Established: 2007 Average Patients Per Day: 24-35 Total Exam Rooms: 5 Building Owned/Leased: Lease or Purchase Contact: Cara or Philip at 919-848-4202

Med Spa

Location: Coastal North Carolina List Price: $550,000 Gross Yearly Income: $1,600,000.00 Year Established: 2005 Average Patients Per Day: 25 to 30 Total Exam Rooms: 4 Building Owned/Leased: Leased Contact: Cara or Philip at 919-848-4202

Practice Type: Mental Health, Neuropsychological and Psychological Location: Wilmington, NC List Price: $110,000 Gross Yearly Income: $144,000 Year Established: 2000 Average Patients Per Day: 8 Building Owned/Leased/Price: Owned Contact: Cara or Philip at 919-848-4202

Practice Type: Internal Medicine

Location: Wilmington, NC List Price: $85,000 Gross Yearly Income: $469,000 Year Established: 2000 Average Patients per Day: 25 Building Owned/Leased: Owned Contact: Cara or Philip at 919-848-4202

Dental Practices Place Your Ad Here

Optical Practices Place Your Ad Here

Special Listings Offer We are offering our “For Sale By Owner” package at a special rate. With a 6 month agreement, you receive 3 months free.

Considering your practice options? Call us today.

72 | AUGUST 2014

Internal Medicine Practice Wilmington, North Carolina Newly listed Internal Medicine practice in the beautiful city of Wilmington, NC. With Gross revenues over $400,000, 18 to 22 patients per day, this practice is ready for the physician that enjoys beach life. The medical office is located in a brick wrapped condo and is highly visible. This well appointed practice has a solid patient base and is offered for $85,000.

Medical Practice Listings l 919-848-4202 l medlisting@gmail.com l medicalpracticelistings.com

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

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.

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

Primary Care Practice For Sale

NC MedSpa For Sale MedSpa Located in North Carolina

Wilmington, NC

We have recently listed a MedSpa in NC

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.

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 for more information.

Contact Medical Practice Listings today to discuss the practice details.

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

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

www.medicalpracticelistings.com

3 OCCUPATIONAL THERAPISTS POSITIONS IN JACKSONVILLE, NC These positions are 40 hour per week temp status to permanent positions with the following qualifications required: l Have graduated from an accredited Occupational Therapist program with a Masters Degree and 1 year experience or a Bachelors Degree with 3 years experience in Occupational Therapy. Program must be accredited by the Accreditation Council for Occupational Therapy Education (ACOTE). l Possess and maintain a valid license or certificate to practice as an Occupational Therapist in any of the 50 states, District of Columbia, the Commonwealth of Puerto Rico, Guam or the US Virgin Islands. l Possess and Occupational Therapist Registered (OTR) certification by the National Board for Certification of Occupational Therapy (NBCOT). l Possess a minimum of one year experience as an Occupational Therapist, preferably working in the neurological based practice setting and with a familiarity of TBI specific patient care practice needs.

HOW TO APPLY: Send us your Resume/CV along with the following: available date to start, salary history, cover letter, eight hour shifts available per week. We will contact you by Email or phone to discuss our program. Make sure you provide your phone numbers and Email address.

Contact Ashley or Cara at: physiciansolutions@gmail.com or phone (919) 845-0054 for details

NC Opportunities DENTISTS AND HYGIENISTS

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 Physician Solutions has immediate opportunities for dentists and hygienists 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

Gross Yearly Income: $335,000+ | List Price: $125,000

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

PRIMARY CARE PRACTICE East of Raleigh, North Carolina We are offering a well established primary care practice only minutes east of Raleigh North Carolina. The retiring physician maintains a 5 day work week and has a solid base of patients that can easily be expanded. There are 6 fully equipped exam rooms, a large private doctor’s office, spacious business office, and patient friendly check in and out while the patient waiting room is generous overlooking manicured flowered grounds. This family practice is open Monday through Friday and treats 8 to a dozen patients per day.

Currently operating on paper charts, there is no EMR in place. The Gross revenue is about $235,000 yearly.

We are offering this practice for $50,000 which includes all the medical equipment and furniture. The building is free standing and can be leased or purchased.

Contact Cara or Philip at 919-848-4202 to receive details and reasonable offers will be presented to the selling physician.

Medical Practice Listings Selling and buying made easy

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

Would You Like to Become a MedMedia9 Sales Associate?

MedMedia9 is creating a national sales force to market our Medical Website Design and Hosting products. We are signing up a limited number of sales associates to provide us with medical practices that need and are ready to implement their Practice Website.

MedMedia9 designs and hosts websites exclusively to the medical community. Our websites are priced extremely competitively with excellent commissions and we are a ‘Made in the USA’ company. We only design and host websites for health care practices, including medical, dental and optical.

If you would like to have another exciting tool to offer your practice clients, this could be the perfect fit that is financially rewarding. Call us today at our corporate offices in Raleigh, North Carolina to request more information on becoming a MedMedia9 Sales Associate. www.medmedia9.com 919-747-9031 medmedia9@gmail.com

Contact Tom Hibbard, Creative Director or Philip Driver, CEO for additional details.

Primary Care Specializing in Women’s Health

Located on NC’s Beautiful Coast, Morehead City

Practice established in 2005, averaging over $540,000 the past 3 years. Free standing practice building for sale or lease. This practice has 5 well equipped exam rooms and is offered for $20,000.

919.848.4202 medlisting@gmail.com 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.

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 us today to discuss your options confidentially.

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

Call 919-848-4202 or email medlistings@gmail.com www.medicalpracticelistings.com WWW.MEDMONTHLY.COM | 77

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the top GOVERNMENT MANDATES

The requirement to use the ICD-10-CM coding system will probably have the greatest impact, for the simple reason that practices not using the new code set will no longer be reimbursed by third-party payers. Also 2014 is the last year in which doctors who have not previously participated in the government’s Meaningful Use (MU) incentive program to adopt electronic health record (EHR) systems can do so and avoid financial penalties beginning in 2015.

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UNCERTAINTY SURROUNDING HEALTH INSURANCE

The Affordable Care Act has caused many insurance companies to make drastic changes – dropping physicians from panels, causing patients to scramble for new plans and new doctors, and making the whole process of finding quality healthcare even more confusing and tedious.

Experts believe that the uncertainty surrounding health insurance will continue to fall on physicians – and that their patients will ultimately be the ones to suffer as a result.

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PAYMENT FOR MEDICAL SERVICES

Healthcare is in the midst of transformational change in the way it is financed. Fifteen of the 16 key provisions of the Affordable Care Act (ACA) will take effect in the end of 2014, and they will most definitely impact the numbers of patients seen and the way they pay for medical services.

High-deductible health plans will also pose business challenges for most practices and will require a more aggressive collection policy at the time of visit.

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STAFFING AND TRAINING

Flexibility and efficiency – these two qualities will be crucial for staff recruitment and training.

For many medical practices, survival in the changing healthcare landscape will require staff members to embrace a team-oriented culture and take on new roles within the practice.

Training will also be paramount for both current and new employees and practice owners should anticipate additional hours and costs required for staff training.

PRIMARY CARE’S CHANGING ROLE

The vision of the ACA is that primary care physicians will lead the delivery of medicine and coordinate care through the maze of specialists. The challenge for primary care practices will lie in conducting a thorough analysis of its organization, health information technology platform, procedures, and policies related to coordinating care across the medical neighborhood, examining access to the practice, supporting self-managed care, and utilizing risk-stratified care management principles to manage patient populations.

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Challenges Facing Physicians

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TECHNOLOGY COSTS

Practice owners can expect some big health information technology expenses, as ICD-10 goes live in October 2015, and continuing costs of electronic health records (EHR) systems and Health Insurance Portability and Accountability Act (HIPAA) compliance continue to be significant.

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PHYSICIAN BURNOUT

It’s getting harder for medical practitioners to keep their heads above water financially, and their love for practicing medicine seems to be fading. Physicians state there is “too much regulation.” More pointed to stress, uncertainty, and workload.

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CHANGING PATIENT POPULATIONS

Millions of Americans without health insurance now have it because of Medicaid expansion and other provisions of the Affordable Care Act (ACA). How many of these newly-insured individuals will try to see a primary care doctor in 2014 for the first time? These patients will present new challenges to physicians when it comes to both providing care and anticipating revenue.

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WORK-LIFE TIME BALANCE

There is no such thing as a 40-hour work week for physicians. More than 73% of physicians work more than 40 hours per week, and about 24% work more than 60 hours per week. The demands of the profession mean that for many physicians the work-life balance is tipped heavily toward work, and that’s unlikely to change in the near future. The unavoidable fact is that overworked physicians make for a poorer healthcare system. Fixing the issues of physician work-life balance is a major component to improving healthcare.

WWW.MEDMONTHLY.COM | 79

is now hiring primary care MD’s and PA’s in North Carolina, Virginia and South Carolina

Ongoing and intermittent shifts are available for both physicians and mid-levels as well as permanent placement.

Find out why providers choose Physician Solutions.

P.O. Box 98313, Raleigh, NC 27624 Scan this QR code with your smartphone to learn more.

phone: 919.845.0054 fax: 919.845.1947 e-mail: physiciansolutions@gmail.com www.physiciansolutions.com