Med Monthly August 2012

Med Monthly AUGUST 2012

STAGING YOUR PRACTICE FOR SUCCESS

STAGING WITH DESIGN IN MIND Interior design tips on how to stage your practice

TOP HEALTHCARE DESIGN FIRMS

THE

BOTTOM

LINE

p. 44

PLUS DOES YOUR PRACTICE RADIATE SUCCESS? p. 40

contents features 34 STAGING WITH DESIGN IN MIND

Interior design principles for your practice

36 A LOOK INTO THE NRCME

The importance of becoming a certified medical examiner

40 WHAT DOES YOUR PRACTICE SAY? Does your practice radiate success?

42 THE BOTTOM LINE

The facility's roll in office economics

78

Top 9 Healthcare Design Firms in US

Artist Feature: Ako Jacintho A Giving Heart

research and technology

48

10 CANCER KILLING VIRUS USES BLOOD STREAM 12 FCC BROADBAND & NEW ERA OF TELEMEDICINE Decision implicates wireless healthcare monitoring

practice tips 15 HOW TO INCREASE YOUR PATIENT SATISFACTION 16 STAGING YOUR PRACTICE FOR SUCCESS Incorporating PAs & NPs into clinical care teams 18 9 WAYS TO MAXIMIZE MEDICARE PAYMENTS 22 EHR ADOPTION AND USABILITY 5 critical elements every physician should consider

legal 24 OCR RELEASES PROTOCOL FOR HIPAA AUDITS 28 PHYSICIANS' REACTIONS TO THE ACA 30 MA HOUSE PASSES COST CONTAINMENT BILL

the kitchen 32 GUILTLESS SUMMER APPETIZERS

the arts 48 A GIVING HEART

in every issue 4 editor’s letter 8 news briefs Randall Children’s Hospital at Legacy Emanuel, Portland, Oregon, ZGR Architects LLP

56 resource guide 78 top 9 list

COVER PHOTO COURTESY HOLLAND MEDICAL EYE CENTER, DALY CITY, CA

editor’s letter

Greetings Medical Professionals!

Image is everything, especially in the healthcare industry, and setting up your practice so that it radiates success is the key to boosting your image and increasing your patient volume and revenue.

Think of your medical practice the same way that you would your home. Impress your patients, just as you would your house guests, as soon as they step through your door with areas that are immaculately clean and beautifully decorated. It is sure to leave a lasting impression and increase the likelihood of wanting to return to your practice.

This month is packed with articles that will help you stage your practice for success. Bethany Houston, our Creative Director, has prepared a set of guidelines to follow when considering how to best accommodate your patients while they are in your practice. Richard Haines, a medical office architect who has been an expert in his field for over 30 years, has sent an article that explains the importance of efficiency in the design and gives specific strategies that will streamline operations and get your patients flowing through your practice as smoothly as possible. There are also lists of simple, but effective measures that you can take to enhance the aesthetics and level of patient comfort in your practice.

Thank you to all of our readers for your continued support and loyalty to our publication. I hope you enjoy our August issue.

Leigh Ann Simpson Managing Editor

4 | AUGUST 2012

Med Monthly July 2012 Publisher Philip Driver Managing Editor Leigh Ann Simpson Creative Director Bethany Houston Contributors Ashley Acornley, MS, RD, LDN Taylor Arnold Catherine Paddock, PhD David C. Daisher Lawrence Earl, MD Richard C. Haines, Jr. George K. Atanasov Julie Cox John O. Chesley Michele M. Garvin Deborah Gers Timothy M. McCrystal Frank J. Rosello Lisa P. Shock, MHS, PA-C Mary Pat Whaley, FACMPE

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 Frank J. Rosello is CEO & Co-Founder of Environmental Intelligence LLC, a Complete Outsourced Health IT Company providing End-to-End meaningful physician workflows consulting, integration, and implementation in EHR, Image Management Systems, and Practice Management to private and public practices and facilities and dedicated Health IT professionals. Visit Frank's website: http://www.goeillc.com

Lawrence Earl, MD has owned and/or operated over two dozen medical centers over the past 27 years, including several DOT examination clinics in NJ and PA. After selling his last centers to Concentra in 2010, he spent about a year training and mentoring physicians, nurse practitioners and PAs at Concentra. Recently he consulted on the NRCME training program requirements for NADME.org, the National Academy of DOT Medical Examiners.

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

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

Taylor Arnold is a freelance writer and editor whose work has appeared in Best Self, Atlanta's Finest, Points North, Lifestyles, Atlanta INtown, Jezebel and others. She also keeps a blog on skirt.com where she writes original essays about the twentysomething experience. In her spare time she illustrates custom greeting cards, save-the-dates and invitations.

MEDMONTHLY.COM |5

designer's thoughts

Hello Medical Professionals!

Given my creative tendencies, I was greatly looking forward to this month’s issue. With a retail background, I come from a land where poster placement and merchandise floor sets are a vital aspect of generating revenue and profitability. Ensuring that your practice is reflecting your professionalism and good taste is one of the most important business endeavors in which you can partake.

However, while a store's layout might display its merchandise with finesse, without the salespeople operating the procedure, it does little good. One thing all practices and businesses should most assuredly put into place is the importance of keeping your staff informed and valued. Since these smiling faces will be the shining beacons in your practice, treating them with respect and courtesy while they operate your business is the best way you can stage your practice for success.

In addition to minor details such as placing orchids on your counter or ensuring your doorknobs are clean, a major way to ensure your practice radiates patient care and success is through establishing solid financial and professional principles throughout your business. Beauty is only skin-deep, and an elegantly designed practice is only as successful as the fiscal prudence you apply to your enterprise.

I hope you enjoy this month’s issue, as it will sure be the first of many successful, en pointe editions that Med Monthly has to offer you. Stay educated, informed, and innovative, medical professionals!

Bethany Houston Creative Director

6 | AUGUST 2012

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news briefs

CMS Proposes Policy and Payment Changes for Outpatient Care in Hospitals and Ambulatory Surgical Centers The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule that would update payment policies and payment rates for services furnished to Medicare beneficiaries in hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) beginning Jan. 1, 2013. The proposals would affect HOPDs in more than 4,000 hospitals, including general acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, longterm acute care hospitals, children’s hospitals, and cancer hospitals, and approximately 5000 Medicare-participating ASCs. N O “The policies and payment rates included in the proposed rule are intended O S COMING to ensure that beneficiaries have access to high quality care in the outpatient THLY N O M setting,” said Jonathan Blum, CMS deputy administrator and director of the D IN ME agency’s Center for Medicare. coming p u e th In CMS is proposing to increase HOPD payment rates by 2.1 percent. The sue, er 2012 is increase is based on the projected hospital market basket—an inflation rate for Septemb in ly hones th n o M goods and services used by hospitals—of 3.0 percent less statutory reductions d Me ovative n in r, la u totaling 0.9 percent, including an adjustment for economy-wide productivon pop cross the a ls a ity. MS is also proposing to increase ASC payment rates by 1.3 percent – the it p s ho projected rate of inflation of 2.2 percent minus an adjustment required by law nation. for improvements in productivity of 0.9 percent. Medicare uses the consumer price index for urban consumers (CPI-U) as Fifteen-Year-Old Creates Non-Invasive the inflation rate for ASCs. CMS is asking Pancreatic Cancer Detection Tool for public comment on potential data that Jack Andraka, 15, of received the Gordon E. Medicare could collect Crownsville, Md. was Moore Award, named in to develop an inflaawarded first place for his honor of Intel co-founder tion index that would new method to detect and retired chairman and explicitly measure ASC pancreatic cancer at this CEO of $75,000. cost growth. year's Intel International Sci"We congratulate Jack Based on the proence and Engineering Fair, on his success here at the posed updates and a program of Society for Intel International Science other policies in the Science & the Public. Based and Engineering Fair," said proposed rule, CMS on diabetic test paper, Jack Elizabeth Marincola, presiprojects that total created a simple dip-stick dent of Society for Science payments to hospitals sensor to test blood or urine & the Public. "He and all the under the Outpatient to determine whether or other finalists here this week Prospective Payment not a patient has earlyfurther demonstrate how a System (OPPS) in stage pancreatic cancer. background of STEM [scicalendar year 2013 will His study resulted in over ence, technology, engibe approximately $48.1 90 percent accuracy and neering, and math] educabillion. CMS also projshowed his patent-pending tion creates the breeding ects that payments to sensor to be 28 times faster, ground for creativity and ASCs under the ASC 28 times less expensive and ingenuity that will help solve Payment System will over 100 times more sensithe pressing issues of the be approximately $4.1 tive than current tests. Jack future."  billion.  Photo courtesy of Intel 8 | AUGUST 2012

HHS Announces 89 New Accountable Care Organizations

FDA Introduces New Safety Measures for Extended-Release and Long-Acting Opioid Medications The U.S. Food and Drug Administration (FDA) recently approved a risk evaluation and mitigation strategy (REMS) for extended-release (ER) and long-acting (LA) opioids, highly potent drugs approved for moderate to severe, persistent pain that requires treatment for an extended period.

The REMS is part of a federal initiative to address the prescription drug abuse, misuse, and overdose epidemic.

The REMS introduces new safety measures designed to reduce risks and improve the safe use of ER/LA opioids, while ensuring access to needed medications for patients in pain.

“Misprescribing, misuse, and abuse of extended-release and long-acting opioids are a critical and growing public health challenge,” said FDA Commissioner Margaret A. Hamburg, MD. “The FDA’s goal with this REMS approval is to ensure that health care professionals are educated on how to safely prescribe opioids and that patients know how to safely use these drugs.”

The new ER/LA opioid REMS will affect more than 20 companies that manufacture these opioid analgesics.

Under the new REMS, companies will be required to make education programs available to prescribers based on an FDA Blueprint. It is expected that companies will meet this obligation by providing educational grants to continuing education (CE) providers, who will develop and deliver the training.

The REMS also will require companies to make available FDA-approved patient education materials on the safe use of these drugs. The companies will be required to perform periodic assessments of the implementation of the REMS and the success of the program in meeting its goals. The FDA will review these assessments and may require additional elements to achieve the goals of the program. 

Health and Human Services (HHS) Secretary Kathleen Sebelius recently announced today, that as of July 1, 89 new Accountable Care Organizations (ACOs) began serving 1.2 million people with Medicare in 40 states and Washington, D.C. ACOs are organizations formed by groups of doctors and other health care providers that have agreed to work together to coordinate care for people with Medicare.

These 89 new ACOs have entered into agreements with CMS, taking responsibility for the quality of care they provide to people with Medicare in return for the opportunity to share in savings realized through high-quality, well-coordinated care.

“Better coordinated care is good for patients and it saves money,” said Secretary Sebelius.

“We applaud every one of these doctors, hospitals, health centers and others for working together to ensure millions of people with Medicare get better, more patient-centered, coordinated care.”

Participation in an ACO is purely voluntary for providers. The Medicare Shared Savings Program (MSSP), and other initiatives related to ACOs, is made possible by the 2010 Affordable Care Act. Federal savings from this initiative could be up to $940 million over four years.

The selected ACOs operate in a wide range of areas of the country and almost half are physician-driven organizations serving fewer than 10,000 beneficiaries, demonstrating that smaller organizations are interested in operating as ACOs. Their models for coordinating care and improving quality vary in response to the needs of the beneficiaries in the areas they are serving.

Beginning this year, new ACO applications will be accepted annually. The application period for organizations that wish to participate in the MSSP beginning in January 2013 is from Aug. 1 through Sept. 6, 2012. More information, including application requirements, is available at http://www.cms.gov/Medicare/Medicare-Feefor-Service-Payment/sharedsavingsprogram/Application.html To learn more about the ACOs announced today, visit: http://www.cms.gov/apps/media/ fact_sheets.asp  MEDMONTHLY.COM |9

research & technology

Cancer Killing Virus Hitches a Ride on Blood Stream

By Catherine Haddock, PhD

S

cientists have discovered when a cancer-killing virus is injected in the bloodstream it hitches a ride on blood cells and evades attack from the immune system, allowing it to reach cancer tumors, and start destroying cancer cells. They suggest this means it may be possible to use promising "viral therapy" during routine outpatient sessions, like chemotherapy, to treat a wide range of cancers.

Certain viruses, like the reovirus, that causes colds and mild stomach upsets, prefer to attack cancer cells.

They also stimulate the immune system to attack tumors.

Using these "oncolytic" viruses to kill cancer is a fairly new approach that is currently being tested. Trials

10 | AUGUST 2012

are currently under way to test "viral therapy" as an approach to treat cancer in human patients.

But the challenge is how to get the viruses into tumors without alerting the immune system to destroy them.

One way is to inject them into the tumors, but this is technically difficult and particularly so for tumors that are deep inside the body, such as in the lungs, stomach, liver and pancreas.

Another way could be to inject the virus into the bloodstream; however, scientists have assumed this would not be feasible because the virus would likely be spotted and destroyed by the immune system before it could reach the tumor.

But when a group of scientists decided to test this by injecting the

virus into the bloodstream of patients with advanced colorectal cancer, they found the virus was able to evade the immune system by "going under cover" and hitching a ride on red blood cells.

The study, led by researchers from the University of Leeds and The Institute of Cancer Research (ICR) in the UK, reveals how the "hitch-hiking" virus is shielded from antibodies in the bloodstream that might otherwise neutralize its anti-cancer properties.

The team writes about its work in a paper published online in Science Translational Medicine on 13 June.

The study participants were 10 patients with advanced colorectal cancer that had spread to the liver and who were scheduled to undergo surgery on the secondary tumors in their livers.

In the weeks leading up to their surgery, all patients received up to five doses of the reovirus as outpatients.

From blood samples taken shortly

after treatment, the researchers found that the active virus associated with blood cells. Later samples showed the virus was no longer in the blood cells and had quickly cleared from the system.

When the researchers examined samples of liver tissue removed during surgery up to four weeks later, they found "viral factories" and active virus in the tumor samples but not in normal tissue samples. This confirmed the virus had travelled specifically to the tumor after being injected into the bloodstream.

Professor Alan Melcher of the University of Leeds, and Dr Kevin Harrington from The Institute of Cancer Research and The Royal Marsden NHS

Foundation Trust, jointly led the study.

Melcher told the press: "It seems that reovirus is even cleverer than we had thought. By piggybacking on blood cells, the virus is managing to hide from the body's natural immune response and reach its target intact. This could be hugely significant for the uptake of viral therapies like this in clinical practice."

Harrington commented that: "Viral treatments like reovirus are showing real promise in patient trials.

This study gives us the very good news that it should be possible to deliver these treatments with a simple injection into the bloodstream," he added.

He said if these treatments could only be delivered by injecting into the

tumor, they would have limited use, but discovering that the virus "can hitch a ride on blood cells will potentially make them relevant to a broad range of cancers".

"We also confirmed that reovirus was specifically targeting cancer cells and leaving normal cells alone, which we hope should mean fewer side-effects for patients," said Harrington.

Funds from Cancer Research UK, Leeds Experimental Cancer Medicine Centre, University of Leeds, The Institute of Cancer Research, Leeds Cancer Vaccine Appeal, and the Rays of Hope Appeal, paid for the study. *Reprinted from Mecial News Today 

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research & technology

FCC Broadband Vote Ushers in a New Era for Telemedicine Decision implicates extraordinary possibilities for wireless healthcare monitoring devices

By Frank J. Rosello, CEO and Co-Founder of Environmental Intelligence, LLC

12 | AUGUST 2012

T

he Federal Communication Commission (FCC) recently voted to allow the healthcare industry to use protected broadband space to develop and deploy mobile body area networks (MBAN). MBANs will set aside broadband spectrum for wireless healthcare monitoring devices that is free of transmission interference from Wi-Fi and other highpowered consumer devices including smart phones and tablets. The FCC’s action makes the United States the first country in the world to devote broadband spectrum to healthcare.

The FCC’s action was not decided in a vacuum as the ruling represents an important objective met in the commission’s comprehensive National Broadband Plan. In the healthcare space, the FCC’s National Broadband Plan is expected to serve as a driver for both innovation and connectivity, which are two key elements needed to lowering healthcare costs and improving patient care. The FCC worked closely with the Food and

FAST FACT:

Wireless monitors increase patient mobility, comfort and potential outcome.

Drug Administration (FDA), which has regulatory control over mobile medical devices, to streamline the approval process for medical devices that will use the wireless spectrum. As a result of this ruling, the FCC has allocated 40 MHz of spectrum for use by MBAN devices on a shared, secondary basis. This allocation provides a spectrum band for short-range medical technologies to facilitate very reliable low-power operation.

At present, telemedicine combines the use of traditional telecommunications and information technologies in order to provide clinical healthcare to patients at a distance. Telemedicine monitoring helps physicians improve clinical care to patients while also reducing the need for hospitalization and visits to the emergency room. This technology helps eliminate barriers and improve access to healthcare especially in rural communities where medical facilities are not readily available.

While telemedicine is recognized to be very beneficial to patients, especially those living in rural areas throughout the United States, a significant challenge to implementing MBANs in those communities is the lack of access to broadband services. The FCC cites that an estimated 18 million Americans currently live in areas without broadband access. The expectation shared by many stakeholders in the healthcare industry is that the FCC ruling should serve as the catalyst to close the broadband connectivity gap for healthcare providers while

‘‘

"While telemedicine is recognized to be very beneficial to patients, especially those living in rural areas throughout the United States, a significant challenge to implementing MBANs in those communities is the lack of access to broadband services."

aligning the commission’s efforts with the emerging meaningful use criteria and patient-centered coordinated care models. Without a shadow of a doubt, health information technology will not reach its true potential without full access to broadband services.

As the FCC works with broadband providers to expand coverage in rural areas throughout the country, the benefits of wireless monitoring and telemedicine via MBANs to patients and clinicians are significant. Many inpatient and telemedicine monitors today require connecting patients to devices using cables. The elimination of those wires could increase a patient’s mobility which will help contribute to improved patient outcomes and enhance their overall comfort. Small sensors could collect real-time clinical information such as temperature, blood glucose and respiratory function, and aggregate it using a nearby device for local processing and forwarding to continued on page 14 MEDMONTHLY.COM |13

continued from page 13

centralized displays and electronic health records. By eliminating the cables that restrict a patient to their hospital bed or home, experts say the devices could transform the way a patient’s health is monitored.

With MBANs, patients can stay connected to their clinicians at all times allowing for the continuous monitoring of vital signs even before they reach a hospital, while being moved from unit to unit, and even after they are discharged from the hospital. This technology is essential to reducing the costs of

healthcare, and giving patients and their providers an uninterrupted portal through which to share information.

Additional benefits of MBANs to patients in the hospital may include: • Increased Flexibility: Clinicians will have the ability to quickly add or remove sensors for different physiological parameters as medical conditions warrant.

• Ease of Transporting Patients: No longer will there be a need to disconnect and reconnect wires prior to transporting a patient.

• Early Detection of Health

Issues: Clinicians can catch issues before a patient's condition becomes critical, thus improving patient outcomes and potentially avoiding the need for acute interventional measures.

• Infection Control: By eliminating monitoring wires, MBANs could help reduce the risk of infection and the need for wire and sensor cleaning procedures.

In conclusion, mobile body area networks are the future for inpatient monitoring, telemedicine technologies, and represent an exciting next big step for healthcare in the United States. 

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practice tips

Staging Your Practice for

Patient Satisfaction Sixteen tips on how to treat your patients with exceptional care

C

ustomer service is paramount when it comes to attracting and retaining patients. The following is a list of simple ideas to enhance your patients’ experiences that can be easily implemented in any practice to help stage it for success.

1. Have a patient information brochure that describes your practice’s services, providers, and policies on medication refills, after-hours services, filing insurance, filling out forms, and making payments.

2. Have multiple ways for patients to complete their registration information – forms mailed to them, online completion, completion in the practice at a computer kiosk, completion at the practice with personal help, or pre-registration by phone.

3. Place tablets and pens in the waiting area so patients can write down questions for their provider while they are waiting.

4. Have computers in the waiting area for patients to use. Have Wi-fi for patients to use their own computers while waiting. Have instructions available for using the Internet to look up medical information and provide a written list of medical websites that your providers recommend. Place this information on your website.

5. Have a water fountain with cups in the reception area.

6. If you have a television in the reception area, make sure patients can change the channel or the volume.

7. Have an annual open house or patient appreciation day and do blood pressure checks or home safety checklists. Serve healthy snacks and visit with your patients.

8. If you give out wrapped candies, make sure to supply sugar-free candies as well as regular.

9. Have multiple ways for patients to complete their registration information – forms mailed to them, online completion, completion in the practice at a computer kiosk, completion at the practice with personal help, or pre-registration by phone.

10. If your parking lot is shared with other businesses, make sure there are parking spaces marked specifically for your patients.

11. Use wayfinding systems to help patients navigate around your practice. Many patients will not read signs, but will identify symbols or pictures if you explain the system. Use themes for providers or services to help patients find their way when coming out of the bathroom or lab. Carpet or tile designs and art pieces can also be used creatively to direct patients in and out.

12. If you have a choice, front-load your practice space with patient rooms and leave the furthest rooms for non-patient activities such as offices and staff rooms.

13. Validate parking for patients if they have to pay to park to come to your practice.

14. Ask patients to rate your service – have forms in the exam rooms and in the waiting room and in new patient packets and on your website.

15. If your practice is near a shopping or eating area, give patients a pager to buzz or ring when it is time to see the provider.

16. Have a blanket warmer to give patients who are sick, or have come in on a gurney a warm blanket.  MEDMONTHLY.COM |15

practice tips

Staging your Practice for Success – Incorporating PAs and NPs into Clinical Care Teams Why moving into an electronic payment system benefits the practice and the patient.

By Lisa P. Shock, MHS, PA-C

your practice.

Medical board rules vary slightly from state to state, but for the most part, PAs and NPs can perform many tasks traditionally reserved for physicians. These services often include: • Physical exams • Patient histories • Health screenings and preventive care • Assisting with surgeries, ER, and long-term care • Issuing prescription orders • Chronic disease management • And much more…

Consider these statistics:

I

n this time of health care reform, medical practices and health systems must find ways to provide high quality health care services while remaining cost effective. The health care system is facing a shortage of primary care clinicians. This is critical when looking at health reform and examining the concept of increasing numbers of patients seeking access to medical care under a reformed system. Currently, there is a shortage of primary care physicians and the American Academy of Family Physicians predicts that, if current trends continue, the shortage of primary care physicians will reach 40,000 within 10 years.

Utilization of PAs and NPs may be

16 | AUGUST 2012

part of the solution. Studies suggest that the addition of a PA or NP to a medical practice may offer enhanced patient satisfaction, improved physician work-life balance, improved revenues and greater access to care for patients.

PAs and NPs are found in every medical specialty and in every health care setting. When you incorporate a midlevel practitioner into your team and utilize them effectively, your practice will accommodate more patients. In addition, you will reduce patient waiting time, increase patient satisfaction levels, and improve overall practice efficiency. All of this adds up to more potential revenue for

■The typical PA brings in revenue of $231,000 with an average salary of $84,000 ■An average PA or NP can boost a practice’s bottom line by $30,000 or more ■Training costs for PAs are onefifth of an allopathic physician By hiring a PA or NP, your practice will be more efficient. This will result in improved access to high quality health care and improved patient satisfaction.

Utiization of PAs and NPs is common across all medical specialties. Changes in medical resident workforce requirements as well as changing third party payor reimbursement models have encouraged the exploration of new ways of achieving high quality patient care across all specialties. In 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted limitations on

total hours worked by residents in both inpatient and outpatient settings. This mandate to limit work by training residents has created a need to fill patient care hours. PAs have no such work restrictions and since they are an affordable alternative, have been utilized in greater numbers, especially in the inpatient setting.

Traditionally physician-centered subspecialties, such as radiation oncology have recently increased utilization of non-physician providers. Studies have examined the implementation and development of non-physician practitioner roles, such as the advanced practice nurse (APN) and physician assistant (PA), and have emphasized that the non-physician practitioner is not a replacement or substitute for either a resident or a radiation oncologist.

Instead, their role is a complementary one. The non-physician practitioner can assist in the diagnostic work-up of patients, manage symptoms, provide education to patients and families, and assist them in coping. Providing these valued services facilitates the physician’s

ability to focus on the technical aspects of prescribing radiotherapy, thereby promoting quality patient care and increasing utilization and cost-effectiveness.

Real Practices, Real Data: A Proven Success Case Study Utilization Solutions in Healthcare, Inc. (USH) staffed and implemented a midlevel provider into a single physician surgical subspecialty practice in 2010. This resulted in increased patient access to care, improved efficiency, and, surprisingly, practice sustainability when the physician faced a personal crisis and was forced to limit his work hours over several month’s time in 2011. The $2.1 million in annual practice charges was sustained when the midlevel provider effectively absorbed the practice workflow. This led to an averted loss of tens of thousands of dollars for the organization and, now that the physician is back to full scheduling capacity, opens up several

new opportunities for patient outreach and practice growth. Analysis of practice revenues also revealed a greater than $50,000 profit generated by utilizing the midlevel within the same time frame.

Click here to download your complimentary copy of the case study. https://lpshock.infusionsoft.com/ app/form/d4fc9ad829c28d0cdd08be0e417bba53 About the author: Lisa P. Shock, MHS, PA-C, is a seasoned PA who has practiced in primary care and geriatrics since her days at the Duke PA program in the late 90s. She enjoys part time clinical primary care practice and is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering a wide range of services to help implement and improve upon the utilization of PAs in the health care system. Contact her with questions at lisa@pushpa.biz 

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practice tips

Nine Ways to Maximize your

By Mary Pat Whaley, FACMPE

M

edicare has so many programs that have the potential to increase or decrease your payments that practices need a list to keep them straight.

Here’s your list with information on which programs are mutually exclusive and which can be combined.

1

Electronic Health Records (EHR) Incentive Program • You must be an eligible provider to

18 | AUGUST 2012

participate.

• You must be the owner of the EHR, although you do not need to have paid for the EHR. • The EHR must be certified.

• You can choose to participate in Medicare (federally administered) or Medicaid (state administered) program.

• You must register for the programs.

• You must attest or document that you have adopted, implemented, upgraded or demonstrate meaningful use.

• Eligible professionals choosing to participate the Medicare program can each earn up to $44K over 5 years, and eligible professionals choosing to participate in the Medicaid program can each earn up to $63,750 over 6 years.

2

ePrescribing Incentive Program • Eligible professionals do not need to register for the program.

• You can participate in one of three ways: via submitting codes on claim

Medicare Payments forms, via an EHR or via a registry • Each professional needs to report 10 eRx events for Medicare patients for dates of service before June 30, 2012 OR apply for one of five exclusions or four exemptions.

• EPs who are successful e-prescribers can qualify to earn an incentive payment based on a percentage of their total estimated Medicare PFS allowed charges processed not later than 2 months after the end of the reporting period. For reporting year 2012, EPs who are successful e-prescribers can qualify to earn an incentive payment equal to 1.0 percent of allowed charges.

For reporting year 2013, EPs can qualify to earn an incentive payment of 0.5 percent of allowed charges. EPs who were not successful e-prescribers in 2011 and do not qualify for a hardship exception will be subject to a payment adjustment equal to 1.0 percent of their Medicare PFS allowed charges.

The payment adjustment increases to 1.5 percent in 2013 and 2.0 percent in 2014.

3

Physician Quality Reporting System (PQRS) • Originally called PQRI (Physician Quality Reporting Initiative) is the basis for pay-for-performance models.

• Physicians may report individually or practices may choose a set of three measures that relate to the type of patients they see. Measures are performed and modifiers are attached to claims.

• Bonuses are available until 2014;

starting in 2015 practices not participating in PQRS will receive a negative payment adjustment.

• For reporting years 2012 through 2014, EPs who satisfactorily report Physician Quality Reporting System measures will earn an incentive payment equal to 0.5 percent of allowed charges. Additionally, for reporting years 2011 through 2014, EPs who satisfactorily report Physician Quality Reporting System measures can qualify to earn an additional 0.5 percent incentive payment by, more frequently than is required to qualify for or maintain board certification status, participating in a maintenance of certification program and successfully completing a qualified maintenance of certification program practice assessment. Beginning in 2015, EPs who do not satisfactorily report under the Physician Quality Reporting System will be subject to a payment adjustment equal to 1.5 percent of their Medicare PFS allowed charges. The payment adjustment increases to 2.0 percent in 2016 and beyond.

4

Medicare Wellness Visits • Many practices are losing money due to the confusion over what Medicare pays for and what Medicare doesn’t pay for. Medicare introduced three new visits in 2010 and many providers continue to have trouble understanding and providing them correctly.

• The “Welcome to Medicare” visit is technically called the “Initial Patient Physical Examination” (IPPE), but to everyone’s dismay, it is not a physical

examination at all, with the exception of basic visits such as height, weight, BMI, blood pressure and pulse, and the potential for an EKG and an Abdominal Aortic Aneurysm screening. The Annual Wellness Visit (AWV) and the Subsequent Annual Wellness Visit are not physical examinations either, yet almost ALL patients believe that Medicare now gives free annual physicals.

• Practices must train all staff and physicians to use the correct terminology first. I suggest everyone stop using the phrases “annual physical” or “complete physical” with Medicare patients.

Patients can request and receive: • A Welcome to Medicare Visit with no exam (no deductible, no co-insurance) • A first annual Wellness Visit with no exam (no deductible, no co-insurance) ontinued on page 20

FAST FACT

EPs who were not successful e-prescribers in 2011 and do not qualify for a hardship exception will be subject to a payment adjustment equal to 1.0 percent of their Medicare PFS allowed charges. The payment adjustment increases to 1.5 percent in 2013 and 2.0 percent in 2014.

MEDMONTHLY.COM |19

continued from page 19

5

• A Subsequent Annual Wellness Visit with no exam every year thereafter (no deductible, no co-insurance) • What patients think they want is either a preventive visit, which Medicare will NOT pay for, or a standard Evaluation & Management (E/M) visit, which their deductible and co-insurance will apply to.

• The only way the practice can win is by driving home to patients what Medicare does pay for and doesn’t pay for and making sure your documentation matches the code you submit to Medicare.

The ABN (Advance Beneficiary Notice) • Many practices miss revenue when they provide services to Medicare patients that are statutorily excluded from Medicare benefits.

• These may be services that do not meet the Medicare definition of medical necessity or are provided at more frequent intervals than Medicare approves.

• Identifying these non-covered services is the hard thing, however, unless your EMR can alert you to a service

that will not be paid by Medicare, and if the patient requests the service and signs an ABN prior to the provision of the service In this case, the practice may collect the full fee from the patient.

6

Primary Care Incentive Payment Program (PCIP) • Eligible Providers (Clinical Nurse Specialists, Nurse Practitioners, Physician Assistants, and Physicians who have their primary specialty designation in family medicine, internal medicine, geriatric medicine or pediatric

What Medicare Bonus or Incentive Programs Can Be Claimed Together?

• PQRS can claimed with eRx. • PQRS can be claimed with EHR. • HPSA and PCIP are automatic and are not affected by any other programs • EHR and eRx can both be claimed but you cannot earn both an eRx incentive and an EHR incentive in the same year if you elect to receive the EHR incentive payment through Medicare. NOTE: Just because you cannot claim the eRx bonus in conjunction with EHR incentive, you must still continue to ePrescribe to avoid the eRx penalty!

20| AUGUST 2012

medicine) can receive a 10 percent incentive payment for services under Part B. • The PCIP program, which was created by the Patient Protection and Affordable Care Act, requires Medicare to pay primary care providers, whose primary care billings comprise at least 60 percent of their total Medicare allowed charges, a quarterly 10-percent bonus from Jan. 1, 2011, until the end of December 2015.

• Eligible primary care physicians furnishing a primary care service in a Health Professional Shortage Area (HPSA) area may receive both a HPSA

7

and a PCIP payment.

Section 5501 (b)(4) expands bonus payments for general surgeons in HPSAs. Effective January 1, 2011 through December 31, 2015, physicians serving in designated HPSAs will receive an additional 10 percent bonus for major surgical procedures with a 10 or 90 day global period.

• Payments are automatic; there is no need to register or report anything on the claim form.

• If services are provided in ZIP code areas that do not fall entirely within a full county HPSA or partial county HPSA, the AQ modifier must be entered on the claim to receive the bonus.

9

HPSA (Health Professional NEW! Comprehensive Primary Care Initiative Shortage Area) (CPCi) • Medicare makes bonus payments annually of 10 percent to physicians who provide medical care services in geographic areas that lack sufficient health care providers to meet the needs of the population.

• Payments are automatic; there is no need to register or report anything on the claim for • If services are provided in ZIP code areas that do not fall entirely within a full county HPSA or partial county HPSA, the AQ modifier must be entered on the claim to receive the bonus.

8

HPSA (Health Professional Shortage Area ) Surgical Incentive Payment (HSIP) • The Affordable Care Act of 2010,

• Payment model per beneficiary per month (PBPM) for care management of Medicaid and Medicare patients • Markets in Arkansas, Colorado, New jersey, New York, Ohio/Kentucky, Oklahoma and Oregon for Medicaid patients • Arkansas, Colorado, Ohio and Oregon are the four states for Medicaid pilots.

• Multiple payers, including CMS, will be paying a monthly care management fee to support the five primary care functions of: • Risk-stratified care management • Access and continuity • Planned care for chronic care & preventive care • Patient & caregiver engagement • Coordination of care across the medical neighborhood.  MEDMONTHLY.COM |41

practice tips

EHR Adoption and Usability The critical five elements every physician should consider

By Frank J. Rosello, CEO and Co-Founder of Environmental Intelligence, LLC

I

n October of 2011, the Centers for Medicare and Medicaid Services (CMS) reported that 100,000 physicians and hospitals had registered for the Medicare or Medicaid electronic health record (EHR) incentive program.

This resulted in more than $850 million in EHR incentives being paid through September 30, 2011. While these statistics may look impressive, consider the fact that there are approximately 500,000 total eligible providers and 5,100 hospitals throughout the United States. With such a low market penetration, the data suggests that the U.S. healthcare system still has a long way to go in achieving 100 percent adoption of EHR technology.

Currently, there are several factors that negatively impact EHR adoption, but dissatisfaction with usability is surfacing with greater frequency. While effective implementation and training

22| AUGUST 2012

plans affect EHR adoption rates as well, poor usability negatively impacts practice productivity, user satisfaction and error rates. EHR usability is typically associated with user satisfaction, but usability is actually more aligned with physician and patient workflow integration. Physicians and practice administrators place a significant amount of attention on the number of keystrokes, clicks and screens. But what many fail to consider in assessing usability is how and when patient data is presented, which ensures the EHR platform provides physicians with the right information at the right time.

So what determines if a particular EHR platform is useable?

Before answering this question, it is important to note and recognize that the perfect EHR platform does not exist in the marketplace. And instead of physicians seeking the perfect template

allowing for every patient visit to be recorded, their time is better spent looking for the template that fits the majority patients they see. It is suffice to say that there is no 100 percent solution.

However, here are five elements every physician and practice administrator should consider when evaluating EHR usability: 1. Physician and Patient Workflow Support: The EHR platform should support both physician and patient workflows. The technology should be broader than any single user or patient, and should be flexible enough to support the entire operation from top to bottom. When evaluating EHR platforms during the selection process, a best practice is to present the vendor with three clinical scenarios: • The most common patient scenario at the practice. • The most challenging patient

scenario.

• The patient scenario with the most number of interactions among the staff.

Simply using these examples in the early assessment phase will significantly help in understanding how the EHR platform will support core workflows.

2. Degree of Difficulty: To insure the EHR platform won’t require substantial changes to existing practice workflows and processes, physicians should pay particular attention to how they interact with nurses and staff when using the EHR in a demo environment.

This goes for encounters with patients in the office, on the telephone, and with how incoming documentation is handled. A good best practice is for the physician and their team to visit a practice that is using the prospective EHR

solution and see it in full operation.

This experience will help to identify any changes the physician and their staff should consider for their own unique needs.

3. Flexibility: EHR usability is all about integrating the EHR into a physician’s practice day in and day out. EHR usability can be complicated so the way a physician uses the technology will evolve as they become more comfortable with improvements in workflow and overall operational efficiencies.

4. Efficiency: An EHR is designed to save time and improve physician and patient workflows. Several EHR platforms do a good job of allowing a physician and staff to easily work on the same computer. This functionality keeps an active patient record online,

allowing for the physician and staff to work concurrently on parallel paths.

5. Effectiveness: Another key element of assessing an EHR platform’s usability is in how it streamlines workflows. Until now, the outcome of EHR adoption has been focused around managing patient volumes, procedures, etc. As healthcare evolves to a more value-based and consumer directed environment, it is critical for physicians to choose an EHR platform that improves overall workflows while keeping patients connected their doctor.

When it comes to determining EHR platform usability, it’s a process that is ultimately driven by the medical professional and their patient. As with any business, the customer is always right, and EHR technology is no different. 

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legal

OCR Releases Protocol for HIPAA Privacy, Security and Breach Notification Audits

By John O. Chesley, Michele M. Garvin, Deborah Gersh and Timothy M. McCrystal, Attorneys at Law, Ropes & Gray LLP, New York, N.Y.

O

n June 26, 2012, the Department of Health and Human Services (HHS) Office for Civil Rights (OCR) posted on its website the protocol it developed to serve as a guideline for the recently-implemented Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliance audits. Mandated by the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was enacted as part of the American Recovery and Reinvestment Act of 2009, these audits

24 | AUGUST 2012

are conducted as part of the new OCR HIPAA Audit program (the “Audit program�). Launched in late 2011, the Audit program is intended to assess covered entities’ compliance with the HIPAA Privacy, Security, and Breach Notification Rules. The Audit program signals a major shift in HIPAA enforcement, ushering in a new era of proactive oversight and enforcement, and a departure from the largely reactive and complaint-based enforcement activity of the past.

On June 10, 2011, HHS awarded KPMG a $9.2 million contract to

develop a comprehensive and focused audit protocol for the Audit program and to conduct the audits on behalf of OCR. For the pilot of the Audit program, OCR initially aimed to audit 150 entities by the end of 2012, but has since revised its estimate and decreased the total number of audits to 115. OCR implemented the Audit program pilot in three steps. First, OCR and KPMG worked to develop an initial audit protocol in late 2011, as well as develop the sample of audit targets.

OCR and KPMG then used an initial test phase to refine the audit protocol by auditing 20 covered entities from late 2011 to mid-2012. From there, OCR and KPMG stated that they planned to refine the audit protocol, and move on to audit the remaining 95 covered entities. The long-awaited audit protocol provides insights into what HIPAA requirements the auditors scrutinize during these audits, and how they ultimately assess compliance with such requirements.

The Audit program analyzes key processes, controls, and policies of selected covered entities, and the protocol offers a detailed breakdown of the audit procedures used to assess these processes, controls, and policies. The audit protocol is comprised of modules representing separate elements of the HIPAA Security, Privacy, and Breach Notification Rule requirements. The protocol: (1) outlines the established performance criteria, or requirements, which are drawn from the HIPAA regulations; (2) provides a high-level summary name for each key activity; and (3) details the audit procedures used to assess compliance with each requirement.

HIPAA Security, Privacy, and Breach Notification Rule Requirements The protocol directs auditors to conduct a comprehensive review of compliance with the HIPAA Security, Privacy, and Breach Notification Rule requirements, with very few regulatory requirements excluded from scrutiny.

The requirements for administrative, physical, and technical safeguards under the Security Rule are covered in great depth by the audit protocol, with 77 established performance criteria.

According to the protocol, auditors examine a broad array of key activities outlined in the Security Rule, including requirements for covered entities to: • conduct risk assessments, • develop and deploy an information system activity review process, • select a security official, and • evaluate existing security measures related to access controls.

For the Security Rule established performance criteria, the protocol also indicates whether the implementation specification is required, or simply “addressable” under the regulations. In cases where the implementation specification is addressable and the covered entity has chosen not to fully implement the specification, OCR states that entities must have documentation on what aspects of the specification they have chosen not to implement and their rationale for doing so.

The Privacy Rule requirements focus on several areas of compliance, including notice of privacy practices for protected health information (PHI), rights to request additional privacy protection for PHI, access of individuals to PHI, administrative requirements, uses and disclosures of PHI, amendment of PHI, and accounting of disclosures.

For these areas, covered entities must fulfill several key activities, including

obligations to: • obtain a valid authorization for the use or disclosure of PHI, • disclose PHI for health oversight activities, • comply with minimum necessary requirements for uses and disclosures of PHI, and • account for disclosures of PHI. Finally, the Breach Notification Rule requirements address several aspects of the breach notification process, which was also mandated as part of HITECH, including the requirements for covered entities to: • conduct a risk assessment of a breach, • provide a breach notification to individuals in a timely manner, and • when appropriate, issue a breach notification to the media and the HHS Secretary.

OCR noted that the combination of these multiple requirements may vary based on the type of covered entity selected for review. According to the information made available about the initial test phase of the Audit program, OCR is targeting a wide array of covered entities, including health plans, clearinghouses, and health care providers. Among the health care providers, OCR audited several types of providers, including physician practices, hospitals, a laboratory, a dental practice, a nursing and custodial facility, and a pharmacy. OCR officials have indicated that business associates may be included in future iterations of the Audit program.

Audit Procedures The audit procedures detailed in the protocol indicate that auditors utilize a wide array of methodologies to assess compliance with the established performance activities, including: • interviewing management, • collecting and reviewing policies and procedures,

• collecting and reviewing supporting documentation, and • directly observing the physical environment and covered entity practices.

At a high level, the audit protocol generally seeks to determine whether the covered entity has: drafted policies and procedures to address the requirements; implemented those policies and procedures (including communicated them to management and workforce members, and training relevant staff); updated the policies and procedures periodically to reflect changes to regulation, technology, etc.; and diligently documented its compliance decisions and activities.

Note that some audit procedures require the covered entity to produce extremely detailed supporting documentation and information. For instance, one of the audit procedures calls for auditors to obtain and review screenshots from systems to determine whether technical access capabilities, such as read-only, modify, or fullaccess, are defined. Another audit procedure calls for covered entities to provide evidence of approval or verification of workforce access to electronic protected health information (ePHI).

Yet another requires covered entities to produce risk assessment documentation of uses or disclosures of PHI that were not determined to be breaches.

Further, the protocol indicates that auditors are to assess compliance with each established performance criteria on using a combination of audit procedures. For instance, the protocol instructs auditors to utilize five different audit procedures when assessing the Security Rule requirement to conduct risk assessments: Established Performance Criteria 45 CFR §164.308(a)(1): Security Management Process §164.308(a) (1)(ii)(a) - Conduct an accurate and ontinued on page 30 MEDMONTHLY.COM |25

ontinued from page 29

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thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of electronic protected health information held by the covered entity.

Key Activity: Conduct Risk Assessment.

Audit Procedures • Inquire of management as to whether formal or informal policies or practices exist to conduct an accurate assessment of potential risks and vulnerabilities to the confidentiality, integrity, and availability of (“ePHI”).

• Obtain and review relevant documentation and evaluate the content relative to the specified criteria for an assessment of potential risks and vulnerabilities of ePHI. • [Determine if] covered entity risk assessment process or methodology considers the elements in the criteria and has been updated or maintained to reflect changes in the covered entity's environment.

• Determine if the covered entity risk assessment has been conducted on a periodic basis.

• Determine if the covered entity has identified all systems that contain, process, or transmit ePHI. With the auditors assessing a covered entity’s compliance with 175 total established performance criteria using several different methodologies for each requirement, it is clear that in order for a covered entity to have a successful outcome from these audits, a tremendous amount of investment in and commitment to ongoing compliance is required.

Assessing Audit Readiness and HIPAA Compliance The detailed audit protocol content clearly conveys OCR’s intent to

strictly enforce the requirements of the HIPAA Security, Privacy, and Breach Notification Rules. While OCR officials have stated that the audits are intended to serve as a “compliance improvement tool,” they have also been clear that enforcement actions may be taken if OCR finds a lack of compliance or cooperation with the audit. At the same time, OCR has continued to increase its enforcement activity and publicized many recent settlements and penalties which highlight the high-risk nature of this area of compliance.

Covered entities and business associates should proactively develop a work plan to review their operations in light of the specifications identified in the protocol. The detailed audit guidance can serve as a roadmap for compliance. Covered entities and business associates may assess current practices for each established performance criterion using OCR’s audit procedures in order to understand their current state of compliance. Such efforts may help reduce the risks of adverse findings in an actual audit, and reduce the likelihood of a breach or some other form of HIPAA violation.

For further information, please see Ropes & Gray’s February 2012 publication which provides a summary of the Audit program and a checklist that you and your organization may use as a starting point to assess HIPAA compliance and prepare for an audit.

Ropes and Gray’s health care privacy and data security attorneys continue to monitor developments with respect to the Audit program and evolving HIPAA regulations.

Deborah Gersh is a Chicago-based partner with Ropes & Gray LLP in the health care practice group. Timothy M. McCrystal and Michele Garvin are Boston-based partners in the firm’s health care practice group. John O. Chesley is a Silicon Valley-based partner in Ropes & Gray LLP’s health care practice group. 

By the numbers...

NPI and DEA numbers

What you need to know about the National Provider Identifier and the Drug Enforcement Administration numbers National Provider Identifier A National Provider Identifier (NPI) is a 10-digit identification number issued to health care providers in the United States. The number is issued by Centers for Medicare and Medicaid Services (CMS).

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

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

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

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

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

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

A DEA number is a series of numbers assigned to a health care provider allowing them to write prescriptions for controlled substances. Legally the DEA number is supposed to only be used for tracking controlled substances, however, the DEA number is often used by the industry as a general “prescriber” number that is a unique identifier for anyone who can prescribe medication.

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

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

legal

How Physicians are Reacting to the Affordable Care Act

By Taylor Arnold

M

uch has been said about the impact the Affordable Care Act will have on November’s presidential election, and even more has been made of effect this legislation will have on insurance companies, small businesses and individuals in this country. With so much buzz about higher premiums and cheaper prescription drug coverage, it’s easy to overlook the impact that health care reform will have on the medical professionals who provide this care. But our country’s physicians are facing an array of changes in hospitals and private practices alike, so it should come as no surprise that this legislation is getting mixed reactions from all sides of the medical community.

Under the new law, most Americans will be required to carry health insurance or pay a penalty beginning in 2014.

The law also guarantees that health insurance will be available to those who are already ill or need expensive care, ultimately helping many poor and middle-class people afford coverage. As a result, hospitals can expect an influx of approximately 32 million newly insured patients. So the question now is, how are physicians reacting to these changes?

The American Medical Association (AMA) responded to the Supreme Court’s June 28th ruling by saying, “The American Medical Association has long supported health insurance coverage for all, and we are pleased that this decision means millions of Americans can look forward to the coverage they need to get healthy and stay healthy.”

The American Academy of Family Physicians, the American Hospital Association and the American Nurse’s Association issued similar statements that were equally supportive of the decision. So it would seem that a majority of physicians and medical professionals in this country wholeheartedly support this new legislation.

While the AMA supports the Affordable Care Act, it’s important to note that the organization’s membership represents only 15 percent of practicing doctors in America.

So where do the other 75 percent stand on this issue?

According to a survey conducted by Kantar Health and Sermo, Inc. following the Supreme Court’s decision to uphold the Affordable Care Act, 71 percent of U.S. physicians want major changes to the law. Fifty-seven percent of the 1500 respondents said they would like to see the law re-

28| AUGUST 2012

pealed altogether, while 14 percent would keep the law but undertake major bipartisan revisions. Twenty-six percent favor keeping the law and "fine tuning" it over time.

That is not to say that these physicians are not in support of health care for all; they simply do not believe the government should have so much control over the health care system.

Furthermore, with 32 million additional patients to treat, many of these physicians will have to do more with less.

Because the Supreme Court’s decision gives states the option to extend Medicaid benefits to all non-Medicare individuals under the age of 65 with incomes up to 133 percent of the poverty level, Medicaid programs could potentially expand to hundreds of thousands more residents. As a result, Medicare reimbursements to doctors will be lower, causing some to stop taking on new Medicare patients altogether. Consequently, organizations like America’s Medical Society (AMS) are unveiling initiatives to help physicians preserve their independent practices and privately contract with patients for their medical treatment.

Then there is the issue of the ongoing physician shortage.

According to the American Association of Medical Colleges, “The United States already was struggling with a critical physician shortage and the problem will only be exacerbated as 32 million Americans acquire health care coverage, and an additional 36 million people enter Medicare.

Between now and 2015, the year after health care reforms are scheduled to take effect, the shortage of doctors across all specialties will quadruple.”

So the challenge now is accounting for the tens of millions of new people to come on to the health care rolls. Will there be enough doctors to take care of them? And are the country’s medical institutions capable of creating a system that does, in fact, offer health care for all?

Ultimately most physicians can agree that decreasing the number of uninsured is a step in the right direction. After all, it could mean a decline in the amount of free care that hospitals provide to uninsured patients, as these patients will soon have access to insurance. The test now is to see if this influx of insured patients reduces the amount of debt a hospital incurs when uninsured patients don’t pay.

In an ideal world, the Affordable Care Act will improve a hospital’s bottom line, and by extension, their physicians’

livelihood.

Not surprisingly, there is no widespread consensus as to how this decision will play out, but one thing’s for sure: the nation’s doctors and hospital administrators, like most Americans, just want to keep costs down and deliver the best outcome possible. Only time will tell if the Affordable Care Act will prompt significant improvements to the state of health care in this country.

References: 1. Affordable Care Act website. http://www.healthcare.gov/law/features/index.html. Accessed July 10, 2012.

2. The American Medical Association website. http://www.ama-assn.org/ama/pub/news/news/201206-28-supreme-court-health-care-reform-decision.page.

Accessed July 11, 2012.

3. American Academy of Family Physicians website. http:// www.aafp.org/online/en/home/publications/news/newsnow/government-medicine/20120628supremecourtruling. html. Accessed July 11, 2012.

4. American Hospital Association website. http://ahahealthreformlaw.wordpress.com. Accessed July 12, 2012.

5. American Nurse’s Association website. http://www. nursingworld.org/MainMenuCategories/Policy-Advocacy/ HealthSystemReform/Pres-Daley-Letter.html. Accessed July 12, 2012.

6. U.S. Politics Today (July 11, 2012). 71% of US Physicians Want Major Changes to Affordable Care Act [press release]. http://uspolitics.einnews.com/pr_news/104629089/71-ofus-physicians-want-major-changes-to-affordable-care-act.

Accessed July 12, 2012.

7. The Washington Times. Doctors vs. Obamacare: Can your physician simply ‘opt-out’?. http://communities.washingtontimes.com/neighborhood/medicine-and-politicsamerica/2012/jan/17/doctors-vs-obamacare-can-your-physician-simply-opt/. Published January 17, 2012. Accessed July 12, 2012.

8. American Association of Medical Colleges (September 30, 2010). AAMC Releases New Physician Shortage Estimates Post-Reform [press release]. https://www.aamc.org/newsroom/newsreleases/2010/150570/100930.html. Accessed July 12, 2012.

7"

Acknowledgements: Author has no relevant conflicts. 

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legal

MA House Passes Health Care Cost Containment Bill

By George K. Atanasov and Julie Cox Attorneys at Law, Mintz, Levin, Cohen, Ferris, Glorskey, Popeo, P.L.

T

he Massachusetts House overwhelmingly approved its version of legislation designed to cut the cost of medical care, passing the measure 148 -7 after a full day of debate on June 5th. After it initially released a bill on May 4th (see our prior alert), House leadership, including the original author, Representative Steven Walsh, accepted feedback and recommendations from various stakeholders. A minimally revised bill emerged from the House Ways & Means Committee on May 30th and House legislators then offered 275 amendments to that updated version.

One noteworthy provision included in the House Ways & Means Committee redraft bill would double the number of patients who can join an accountable care organization to 800,000, a change that would provide some relief for large networks.

The redraft also places the independent authority that would set guidelines and monitor compliance envisioned in the original legislation under the Executive Office of Health and Human Services. House leaders say the bill will save our state health care system $160 billion over the next 15 years.

This week the House disposed of

30 | AUGUST 2012

all 275 amendments in one day of debate but did not make significant changes to the provisions proposed in the original bill.

Highlights of the Floor Debate

• Adoption of an amendment that would have allowed small businesses to reduce their fair share assessments by excluding employees who have qualifying

‘‘

• Rejection of an amendment that would have eliminated the mandate in the bill that capped medical spending at a rate below the gross state product.

• Rejection of amendments that would have expanded the excise tax on cigarettes to other tobacco products, and eliminated the sales tax exemption on soda.

• Adoption of an amendment that would require accountable care organizations to serve children with specialty care needs.

• Rejection of amendments that would have eliminated the socalled luxury tax and the surcharge on providers and insurers.

"Lastly, rejection of an amendment that would have created a task force to review health care executives’ compensation and bonuses."

coverage from a spouse, parent, veterans’ plan, Medicare or Medicaid.

• Adoption of an amendment that includes accountable care organization in the listed entities, as it pertains to unfair methods of competition.

• Rejection of an amendment that would have required health plans to offer a basic health plan devoid of coverage mandates.

• Lastly, rejection of an amendment that would have created a task force to review health care executives’ compensation and bonuses.

The House and Senate bills (see our previous House and Senate alert) contain key differences, most notably over how much discretion and control the health care industry itself may have to contain costs.

The House favors more oversight, albeit with a limited number of appointed boards, whereas the Senate approach allows for more leeway in the development of solutions to reduce and control costs but arguably creates more bureaucracy to monitor it. Senate President Therese Murray has also been clear that she will not support a luxury tax on hospitals.

What’s Next?

The House and Senate will appoint a six member conference committee in the coming days to negotiate these legislative differences. Ultimately, the House and Senate must give an up-or-down vote on the conference committee’s report and deliver that final product to Governor Patrick prior to the conclusion of the current legislative session on July 31st.

ML Strategies will monitor the work of the conference committee and provide updates as the legislation progresses.

Please click on the links below to see copies of the House and Senate bills.

House Bill 4070 Senate Bill 2260 View ML Strategies professionals. www.mlstrategies.com Copyright © 2012 ML Strategies.

This communication may be considered attorney advertising under the rules of some states.

The information and materials contained herein have been provided as a service by the law firm of Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.; however, the information and materials do not, and are not intended to, constitute legal advice. Neither transmission nor receipt of such information and materials will create an attorney-client relationship between the sender and receiver. The hiring of an attorney is an important decision that should not be based solely upon advertisements or solicitations. Users are advised not to take, or refrain from taking, any action based upon the information and materials contained herein without consulting legal counsel engaged for a particular matter.

Furthermore, prior results do not guarantee a similar outcome.

1981 -0612 -NAT-MLS  MEDMONTHLY.COM |31

the kitchen

Guiltless Guacamole Ingredients: 4 ripe avocados 1 clove garlic, peeled and finely chopped ½ small sweet onion, finely chopped 1 fresh, hot jalapeno pepper, stemmed, seeded, and chopped ¼ cup sun-dried tomatoes, soft-

ened and finely chopped ¼ cup cilantro leaves, chopped ½ tsp salt, or to taste Fresh lime juice (about half of a lime) Instructions: Mix all ingredients together in either a food processor or using a mortar and pestle.

Pico de Gallo Salsa Ingredients: 4 medium tomatoes, diced ½ cup diced red onion ½ cup chopped green onions ½ cup chopped fresh cilantro 2 Tbsp. green jalapeno pepper, minced 2 Tbsp. fresh lemon juice (from half of a lemon)

32| AUGUST 2012

1 Tbsp. chili powder ¼ tsp. salt Instructions: Mix all ingredients together in a medium sized bowl. For best flavor, let salsa soak for 1 hour before serving.

Muy Caliente

By Ashley Acornley MS, RD, LDN

I hope everyone is having a safe and healthy summer so far! The summer barbeque season is in full gear, filled with burgers, buns, pasta salads, and cocktails galore. Try a healthy summer appetizer to start your picnic off right.

The two dips listed are great to dip whole wheat crackers, vegetables, or homemade pita chips into.

Both dips are filled with vitamins, minerals, and fiber to keep you satisfied for longer! Most importantly, they are great family-friendly options to include at your next summer get-together, for kids and adults alike!

MEDMONTHLY.COM |33

features

DESIGNING WITH SUCCESS IN MIND Eight interior design principles to consider when staging your practice

By Bethany Houston

What is your practice design saying about you?

N

ot only is it important to set up your practice financially for success, but it’s also vital to ensure that your office design reflects the exceptional care you provide to your patients. Holland Medical Eye Center, Daly City, CA (see left), does a fantastic job of designing their eye care center. While your practice may not be an optometry, use these eight design rules when staging your practice:

1. Think about your patients.

Before you even step into a fabric store or office furniture outlet, the most important place to start when designing your practice is to think about your patients and their needs. Is your practice a pediatric office? OB-GYN? Optometry? Catering your design to your clientele is the primary step in staging your practice for success.

2. Evoke emotions.

Once you have identified your patients and their needs, think about how you want them to feel when stepping into your office. If you’re an obgyn, you might want to portray a soft, feminine approach. If you’re a pediatrician, you’ll want children to have fun and feel comfortable. Ensure that your practice’s color palette evokes the right emotions. Neutral colors are great for soothing patients, and bright colors help keep children happy and playful. In the optometry reception

room example (see left), they wanted to maintain a cutting-edge and stylish appearance for their fashion-forward patients.

3. Be flexible.

So as to assist your practice when change comes about, set your larger furniture pieces as office staples.

Choose more subtle designs for reception desks and cabinetry, and ensure they are easily movable or transferable.

Keep your smaller elements (such as bookshelves, wall hangings, and light fixtures) for the “accessories” that define your overall look. This will allow you to adapt to the growth and success of your practice.

4. Do look down.

Every interior designer knows that the floor is not simply something people walk on; it is the fifth wall of the room. When reviewing your flooring options, consider something appealing and durable. Much like your larger pieces of furniture, choose carpet that is versatile but not boring.

5. Express yourself.

As the owner of your practice, you want to feel comfortable in the space you spend most of your time.

To ensure you are at home, allow the practice design to reflect yourself.

Display pieces of your favorite artist or choose a theme that centers around

your favorite hobby (sailing, anyone?).

Using these personal touches will allow the patient to feel more at ease in your practice and with you as their practitioner.

6. Accessorize, accessorize, accessorize.

Any fashion guru will tell you the importance of looking put together is all in the accessories. Interior design is no different! Using well-placed vases, plants and wall hangings can transform the way your practice is perceived and complete your look.

7. Clear away the clutter.

With hundreds of files, receipts, and samples, practices are notorious for appearing cluttered. Utilize shelving and cabinetry to keep your reception desk organized – this is where most of the clutter occurs, and it’s where most of the patients will be able to see!

8. Keep it germ-free.

Finally, the one place a patient should feel at ease about cleanliness is their doctor’s office. Since waiting rooms, bathrooms, countertops and doorknobs can be a breeding ground for germs, ensure that your staff is aware and proactive of your cleaning standards. Consider providing bottles of hand sanitizer in easy-to-reach locations for your patients’ convenience and assurance.  MEDMONTHLY.COM |35

features

NRCME: The National Registry

By Lawrence Earl, MD, Medical Director, National Academy of DOT Medical Examiners (NADME)

T

he National Registry of Certified Medical Examiners (National Registry) is a Federal program that establishes requirements for healthcare professionals that perform physical qualification examinations for truck and bus drivers. To become a certified medical examiner (ME) and be listed on the National Registry, healthcare professionals must complete training and testing on the Federal Motor Carrier Safety Administration’s (FMCSA) physical qualifications standards and guidelines.

FMCSA developed the National Registry of Certified Medical Examiners final rule as part of the agency's commitment to enhancing the medical oversight of interstate drivers, and preventing commercial vehicle-related crashes, injuries and fatalities. This rule addresses four National Transportation Safety Board (NTSB) recommendations on comprehensive training for medical examiners, and tracking of driver medical certificates.

All healthcare professionals who intend to perform physical examinations and issue medical certificates for commercial motor vehicle (CMV) drivers to meet the requirements of Section 391.41 of the Federal Motor Carrier Safety Regulations (FMCSRs) must be certified and listed on FMCSA’s National Registry by May 21, 2014. After this date, medical certificates for CMV drivers may only be issued by

36| AUGUST 2012

certified medical examiners listed on the national registry. In order to become certified, examiners must undergo training and pass a certification exam.

Currently, the only requirement to perform DOT exams is to be a li-

‘‘

"Medical examiners need to be knowledgeable of the specific physical and mental demands associated with operating a CMV." censed MD, DO, DC, NP or PA. Of the potential 400,000 pool of these professionals available, the FMCSA estimates 40,000 will be needed to serve over 6M commercial drivers.

Improper medical certification of drivers has led to an increase in crashes, with documented cases of drivers with serious disqualifying conditions having caused fatal and disabling accidents.

Longstanding studies reveal inadequacy of medical examiner’s understanding of the relationship between driver health and the performance of tasks of commercial driving.

Medical examiners need to be knowledgeable of the specific physical and mental demands associated with operating a CMV. This includes the requirements or standards of Section 391.43 as well as the medical advisory criteria and guidelines prepared by the FMCSA. The standards and guidelines aid the medical examiner in making the individual determination whether a driver should be issued a medical certificate, and to be proficient in following the medical protocols

of Certified Medical Examiners

necessary to adequately perform the medical examination.

The National Registry final rule addresses four NTSB recommendations on a comprehensive medical oversight program for interstate drivers that include the following elements: • Individuals performing medical examinations for drivers are qualified to do so and are educated about occupational issues for drivers (H01-017); • A tracking mechanism is

established that ensures that every prior application by an individual for medical certification is recorded and reviewed. (H-01-018); • Medical certification regulations are updated periodically to permit trained examiners to clearly determine whether drivers with common medical conditions should be issued a medical certificate. (H01-019); and • Individuals performing examinations have specific guidance and a readily identifiable source of

information for questions on such examinations (H-01-020).

In 2005 the SAFETEA-LU Act was passed, the Safe, Accountable, Flexible, Efficient Transportation Equity Act. It established the Medical Review Board (MRB) that advises FMCSA on medical concerns, including physical qualifications for drivers, medical standards and guidelines, the educational continued on page 42 MEDMONTHLY.COM |37

continued from page 41

curriculum for medical examiners, functional tests for drivers w/ disabilities, reviews all FMCSA medical standards and proposes new science-based standards and guidelines.

This law also directs FMCSA to remove from the registry the name of any medical examiner that fails to meet or maintain the qualifications and requirements established by the Secretary of Transportation for being listed in the registry and shall accept as valid only medical certificates issued by persons on the national registry of medical examiners.

NRCME training programs are required to cover 8 core curriculum topics: The eight topics are: 1. Background, rationale, mission and goals of the FMCSA medical examiner’s role in reducing crashes, injuries and fatalities involving commercial motor vehicles 2. Familiarization with the responsibilities and work environment of commercial motor vehicle (CMV) operations 3. Identification of the driver and obtaining, reviewing, and documenting driver medical history, including prescription and over-thecounter medications 4. Performing, reviewing and documenting the driver’s medical examination 5. Performing, obtaining and documenting diagnostic tests and obtaining additional testing or medical opinion from a medical specialist or treating physician 6. Informing and educating the driver about medications and nondisqualifying medical conditions that require remedial care 7. Determining driver certifica38 | AUGUST 2012

tion outcome and period for which certification should be valid 8. FMCSA reporting and documentation requirements After training, medical examiners would be required to provide FMCSA with their state medical license, business address and phone number, and medical examiner training provider. In addition, the applicant would provide several statements, including a statement that the applicant is capable and willing to comply with FMCSA requirements; that upon request he or she would provide copies of documents showing evidence of completion of training, States licenses, etc.; and an affirmation that all of the information provided is true.

The FMCSA will then issue an approval to take the certification exam. The computerized test consists of 120 multiple choice questions, will be proctored and have a 2 hr time limit. Pass/Fail results will be given immediately at the testing site, with the first tests expected to be given after August, 2012.

In addition to the initial certification test, medical examiners would be required to complete “refresher” CME training every 5 yrs, and to recertify by passing the medical examiner certification test every 10 years in order to remain listed on the registry. Classroom as well as online training will be acceptable.

Certified examiners will electronically send a monthly report of DOT exams to the FMCSA and will be required to have an electronic form of communication to receive updates to the

DOT medical exam, NRCME training, and changes in FMCSA policy.

Examiners will also be required to produce a copy of an exam within 48hrs upon FMCSA request, such as for investigation of improper certification of a CMV driver.

The FMCSA may remove an examiner from the NRCME if he/ she certifies a driver who fails to meet applicable standards or makes a false claim to have obtained the required training.

FMCSA will also monitor medical examiner performance and investigate any patterns of errors or improper certification of CMV drivers.

Commercial drivers will access the National Registry database to select only certified examiners as of May 21, 2014 It would wise for medical examiners to seek training and certification early, don't wait for the May 21, 2014 deadline. Once certified, you can promote this to your motor carrier clients and prospects to become the preferred DOT examiners in your area.

Lawrence Earl, nadme.org, lar. earl@gmail.com 

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features

Does your Practice Radiate Patient Care and Success ...or Something Else?

By Leigh Ann Simpson

I

mage is everything when it comes to success, especially for a medical practice. When was the last time you asked yourself; what image does my practice reflect to my patients? Are they impressed?

Are they uncomfortable? Annoyed?

Bored? In this article we’ll discuss staging techniques for your medical practice to leave your patients with a favorable impression, and more importantly, returning and recommending you to other potential patents. Let’s start with the basics:

The exterior The exterior of your practice is obviously the first thing that your patients see when they arrive. If they see a dirty or trashy parking lot, or worse no parking, they are immediately turned off and inconvenienced. Make sure that you have designated parking (in an area that is frequently cleared of trash) that provides easy access to your entrance.

Treat the exterior of your practice as you would your home. Keep all bushes and all other flora wellmanicured and the entrance swept.

When was the last time you had an exterior painted? A dilapidated paint job is a sure sign of neglect and carelessness, which is the last impression you want to give your patients.

40 | AUGUST 2012

The waiting room

progressive physician.

Careful staging of the waiting room in your practice is absolutely paramount and should be carefully assessed from a patient’s point of view. Consider this; your patients have come to you most likely because they aren’t feeling well. Why make the dreaded waiting process any worse than what it has to be? Instead of your typical rows of chairs that are only positioned upright (and usually uncomfortable) why not have several types of seating; chaise lounges, sofas, plush arm chairs, kids’ chairs. You may even consider having movable furniture in case you have a family wanting to group together and converse, or seating that can be conformed to be more comfortable for a patient that may be in pain. Keep in mind how frequent this furniture is used so it must be durable, but one must never forget the element of style! The furniture pieces preferably should be matched according to design and color.

A large majority of your patients are tech savvy and will want to be able to access the internet with mobile devices while waiting for their appointment. Having free Wi-Fi in your practice will serve as a convenience that will be well appreciated, and will also boost your image as a technologically

Complementing aesthetics Think about how a beautiful view can lift your spirits to truly support a healing environment, be sure to consider providing access to nature.

For example, a water feature can have a calming effect and can subtly help you to relax. Lighting, direct or indirect, can completely influence the mood of a room and therefore your patient so make sure that the tone is set to maximize their comfort and sooth their spirit. People also like to be visually stimulated.

An accent wall or a fun wallcovering can add interest to the space.

Ceilings are often ignored, yet with bulkheads and accent paint, you can really change the feel of the space.

Last but not least, don’t underestimate the power of art in a space. Art can add a warm, non-institutional feel to the room, give people something to ponder, or help take the edge off a stressful situation.

Remember that although products are consumed, environments are experienced. Through careful planning and improving the environment that patients and visitors spend time in, you are able to help ensure that guests leave with a favorable impression of your facility and an overall positive experience.

features

THE BOTTOM LINE The Facility's Role in Office Economics The object of medical practice is to deliver services in a timely manner. To prosper in the current environment, clinicians must stress productivity and efficiency. This article discusses the impact of office space configuration on these factors. Not only is profitability increased, satisfaction improves as providers can spend more face-to-face time with patients, and waits are reduced.

By Richard C. Haines, Jr.

42 | AUGUST 2012

Y

ou practice medicine. Your ability to do this relies on your ability to run a "profitable" business.

Often, in medicine profitability is treated as a dirty word, but consider what happens if you are not profitable: • You cannot stay in business and are therefore not able to make your knowledge, skills, and intellect available to your patient community.

• You cannot support your family.

• You don't have the discretionary income to buy equipment to serve your patients.

• Having a profit is fundamental to the well being of your patients and your family.

Look at the profit and loss statement of your practice, or any business for that matter. They all break down into the same categories. We refer to this as the Fundamental Equation:

Income - Expense = Net Income The object of any business is to drive up net income. This can be done in two basic ways: increase income or decrease expenses-or both. To understand how you can influence these variables in the interest of your practice, a couple of definitions are in order: productive is the ability to produce, be generative, creative; efficient is functioning effectively with the least waste (of time or effort).

It is important to recognize the fundamental difference between productivity and efficiency. Each plays a role in maximizing net income.

To drive up income, productivity comes into play. It is necessary either continued on page 46 MEDMONTHLY.COM |43

continued from page 45 to add new capability or to increase the volume of: physician production, billable tasks/tests, and ancillary services.

To drive down expenses, efficiency comes into play. It is necessary to lower: salaries, rent, equipment costs, and consumable costs.

It is difficult to drive up productivity without looking at ways to be more efficient. Helping the doctor be more efficient frees up time to see more patients, thus increasing that doctor's productivity.

Efficiency by itself does not necessarily increase productivity. Helping a billing clerk be more efficient does not raise the practice's productivity base-it does not generate more revenue. It is desirable, however, to help that billing clerk to be as efficient as possibleperhaps getting the job done with one less billing clerk (thus holding down expenses and increasing net income).

Help the staff be more efficient by giving them the communications systems they need. This will allow more work to be done better by fewer people.

It is important to be critical of how your practice does things. It needs to drive up income by helping the doctor be more productive by being more efficient. This may require the addition of staff. While the expense side of the practice may go up, if it is outdistanced by the increase in the income side, then the addition of staff is warranted.

Use communications systems.

Nothing gets done while staff is walking around the office. Help the staff be more efficient by giving them the communications systems they need.

This will allow more work to be done better by fewer people. Be critical 44 | AUGUST 2012

of new equipment purchases. If the doctor uses the equipment, then the income side may go up if it helps the doctor be more efficient. If the increase in income exceeds the carrying cost of the equipment, then the addition of

‘‘

"Be as efficient within the exam as possible.

Pivot, do not walk. Have whatever is needed for the exam at your fingertips."

the equipment is a good idea. It may be important to the practice, however, to add a particular piece of equipment because it is required to maintain the state of the art of the medical practice.

Not all equipment can be strictly costaccounted.

Equipment that is not used by the physician but issued by the staff is effective to the practice only to the extent that it helps to lower the expense side of the fundamental equation. It can do this by driving down the cost of the personnel required to use the equipment, by lowering the equipment cost to the practice, or taking up less space.

Keep in mind that the latest gizmo that tantalized you in the exhibit section of the meeting that you recently attended may not be a valid purchase.

You must consider the possible revenue that the equipment/service will generate, the expenses involved, its obsolescence, the need to depreciate it rapidly (note that the current tax code allows the first $100,000 of equipment purchases to be depreciated in the first year) ... and you must keep in mind the space needs for the "machine" and supplies and possibly more waiting space.

The fundamental equation for your practice drives what you do and how you do it. The remainder of this article discusses specifically how space impacts both the income and expense side of the fundamental equation.

Your workspace is fundamental in helping both productivity and efficiency.

Be as efficient within the exam as possible. Pivot, do not walk. Have whatever is needed for the exam at your fingertips.

The proper level of office space will help raise income- by helping the doctor be more efficient. It will also help to lower expenses by helping the staff do their work more effectively.

Let's start by looking at the role your facility can play in helping raise income. (In discussing this, the role of space in housing new services will be ignored).

Raising Income In terms of direct practice support, the only way space can raise income is by helping the doctor be more efficient.

The doctor generates revenue only at

the patient's side. The more easily doctors can do this, the more patients they can see in a given unit of time, and the greater the fees that can be generated.

The organization and juxtaposition of space can engineer out the "road bumps" in a physician's daily routine.

Step 1. Be as efficient within the exam as possible. Pivot, do not walk.

Have whatever is needed for the exam at your fingertips. Eliminate reasons to have to leave the exam room in midprocess. Doctors are generally taught to practice medicine right-handed.

Respect that. Use it to simplify your exam process.

Step 2. Assemble your exam rooms into as tight a grouping as possible.

Prior to doing this you need to determine the number of exam rooms you need.

Step 3. Add a doctor's station to your exam complement. This way, if the doctor needs an outside resource will lie seeing patients (phone, coffee, x-ray, viewbox, etc.), tl1e doctor does not have to leave the exam area.

Step 4. If you use your personal office for patient management (i.e., getting a history), then put it within your exam complement. (If you do not use your personal office for patient interaction, put itout of the way-or eliminate it altogether).

Step 5. If the doctor gives samples to the patient (the doctor, not the nurse), then put the samples somewhere within the doctor's exam area-perhaps in the doctor's station.

When taken together, these planning concepts will save the doctor many steps and much effort throughout the day. This can translate into

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continued on page 48 MEDMONTHLY.COM |45

Example of how Haines arranges an efficient, well-kept exam room

more patients-or getting home earlier.

Lowering Expenses The facility can hold down expenses in two ways: getting the job done in fewer square feet; and getting the job done with fewer staff members. Let's look at each of these opportunities.

Fewer Square Feet. This can be done by building only what is really necessary and by using space efficiently when it is built.

Use the space you build intensively.

If each doctor is in the office only some of the time, then organize the doctor access schedule to minimize peaks and valleys. If a four-doctor group averages six half-days per doctor per week in the clinic, then all the doctors' needs can be met with no more than three doctors in the office at once. Build for three, not four.

46 | AUGUST 2012

If each doctor is in the office only some of the time, then organize the doctor access schedule to minimize peaks and valleys.

For many practices the doctor's personal office is a "vestigial organ." If it is a place to gather junk and plop mail, consider developing a "bullpen" where all the doctor shave a dedicated work area within a larger room.

Organize your hallways so they are double-loaded. Approximately 25 to 30 percent of your entire office space is consumed by hallways. Double-loading means putting rooms on both sides of the hallway, not just one.

Fewer Staff Space can help you operate with fewer staff members-or at least keep from adding more staff. How? By keeping the staff from excess walking.

Nothing constructive gets done while walking, so keep it to a minimum.

When the staff is walking, they are not near their workstations and therefore inaccessible to their colleagues (and doctors).

To eliminate excess walking, consider the following: • Break up waiting rooms so patients wait nearer their doctor, and thus the nurse can get them into an exam room more quickly. Try to gauge the optimal waiting space that you will need. Keep in mind that exam rooms can serve as waiting space. Still, it is better to err on the side of slightly excess space rather than be short and have folks stand in the hall even temporarily.

• Have the nurse station at the front of the doctor/patient hall, so the staff has easy supervision of the exam hall.

• Use sub-waiting areas to hold patients between one service in the

office (such as the exam) and another such as an x-ray).If your staff does diagnostic tests, have enough diagnostic rooms so the staff does not have to wait for one test to finish before the next can begin.

• Make sure all staff members have a place of their own to work. Jumping around the office looking for an empty chair wastes time.

• Also consider outsourcing certain functions such as billing; this is a common practice in many offices. If you consider the costs of space in addition to personnel and equipment, you may find that the price per bill may be lower by using an outside service than by doing it in-house. Keep in mind, though, that you may have better

control of your collection procedures by keeping this service in the office.

The same calculation applies to other services such as laboratory and x-ray.

The cost of space must be entered into your calculations of profitability.

Other improvements, such as communications systems, will help the staff be more efficient, but the suggestions in this section are spatial concepts that will assist staff with their job performance.

There are added benefits to optimal space configuration: • Increased patient and, ultimately, provider satisfaction. The clinician can spend more time in face-to-face interactions.

• Improvement in billing in the

evaluation/management codes that are based on time standards.

• Reduction in waiting times, the greatest source of frustration for patients.

In conclusion, these space issues will help you run a more profitable practice. The key is to have the space work for you, not the other way around.

Reprinted with permission from The Journal of Medical Practice Management, Volume 20, Number 6, pages 305-307, Copyright 2005, Greenbranch Publishing, PO Box 208, Phoenix, MD, 21131 (800) 933-3711, www.greenbranch.com. For a free sample issue of the JMPM, please send an email to info@greenbranch.com 

Example of how Haines maintains an organized, staff-friendly office area MEDMONTHLY.COM |47

the arts

Ako Jacintho has been expressing his experiences in life and healthcare through abstract painting for over ten years.

O

riginally Cape-Verdean American, Ako Jacintho, MD, lived the early part of his years on the east coast, attending Brown University for his undergrad and University of Massachusetts Medical School for his MD. Throughout his younger days, he first began to experiment with art through creative collage making. After moving to San Francisco in 1998 to complete his residency, Ako was influenced by the open and expressive culture of the city by the bay. Teaching himself to paint, he was intrigued by the story-telling quality of art and began to use his residency and daily encounters in the medical field to inspire his work. “I really strive to see the connection between my emotional view point and my art,” reflects Ako. Art is more than a form of expression for Ako, however.

“In addition to painting, I have found passion in the healing sciences. I believe art is a form of healing, both for the doer and the viewer. This is the idea that binds my two passions,” says Ako. Being a self-taught abstract painter, he has studied contemporary artists and their color combinations and forms for inspiration. Primarily using oil paint and large canvases, Ako has been able to reflect his work as a physician into his art. His pieces are often about sickness, recovery, loss and triumph, fear and struggle and finally, acceptance and celebration. He also has explored depicting organ systems and disease processes in his figurative pieces.

48 | AUGUST 2012

His art has been displayed at St. Luke’s Hospital, San Francisco, CA, and he has donated several pieces to various charitable organizations centered on healthcare. Recently, Ako donated a piece to Visual AIDS, an organization that helps artists dealing with HIV/AIDS, where they hold yearly art auctions to benefit their clients. His work is also available for purchase and viewing through spring and fall open studios.

Ako is currently employed through the Haight Ashbury Free Clinic – Waldon House, where he is the only medical provider at the Mission St. office. The Haight Ashbury Free Clinic and Waldon House merged on July 1, 2011, and the joint healthcare clinic focuses on serving community healthcare, substance abuse treatment and mental health services to the less fortunate.

To see more about Ako’s work, visit his website: www.akojacintho. com  Ako Jacintho, MD, San Francisco, CA

A Giving Heart Ako Jacintho, MD, serves the Bay Area community in more ways than one

By Bethany Houston

MEDMONTHLY.COM |55

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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 www.vtprofessionals.org 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 www.doh.wa.gov

MEDMONTHLY.COM |51

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 52 | AUGUST 2012

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

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

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

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

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

Utah 160 E. 300 South Salt Lake City, UT 84111 (801)530-6628 http://1.usa.gov/xMVXWm

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

Vermont National Life Building North FL2 Montpelier, VT 05620 (802)828-1505 http://bit.ly/zSHgpa

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

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

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

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

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

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

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

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

Virginia Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4538 http://bit.ly/zDkIU2 Washington 310 Israel Rd. SE P.O. Box 47865 Olympia, WA 98504 (360)236-4700 http://1.usa.gov/tKBFHT West Virginia 1319 Robert C. Byrd Dr. P.O. Box 1447 Crab Orchard, WV 25827 1-877-914-8266 http://www.wvdentalboard.org/ Wisconsin P.O. Box 8935 Madison, WI 53708 1(877)617-1565 http://bit.ly/sEhr0Q Wyoming 1800 Carey Ave., 4th Floor Cheyenne, WY 82002 (307)777-6529 http://plboards.state.wy.us/dental/index.asp

MEDMONTHLY.COM |53

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

Florida 2585 Merchants Row Blvd.

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

Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 http://bit.ly/zZ455T

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

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

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

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

54 | AUGUST 2012

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

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

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

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

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

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

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

Nevada Board of Medical Examiners P.O. Box 7238 Reno, NV 89510 (775)688-2559 http://www.medboard.nv.gov/ New Hampshire New Hampshire State Board of Medicine 2 Industrial Park Dr. #8 Concord, NH 03301 (603)271-1203 http://www.nh.gov/medicine/ New Jersey P. O. Box 360 Trenton, NJ 08625 (609)292-7837 http://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/

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

Texas P.O. Box 2018 Austin, TX 78768 (512)305-7010 http://bit.ly/rFyCEW Utah P.O. Box 146741 Salt Lake City, UT 84114 (801)530-6628 http://www.dopl.utah.gov/ Vermont P.O. Box 70 Burlington, VT 05402 (802)657-4220 http://1.usa.gov/wMdnxh Virginia Virginia Dept. of Health Professions Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4400 http://1.usa.gov/xjfJXK Washington Public Health Systems Development Washington State Department of Health 101 Israel Rd. SE, MS 47890 Tumwater, WA 98501 (360)236-4085 http://www.doh.wa.gov/PHIP/default.htm 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/section. asp?linkid=6&locid=0 Wyoming 320 W. 25th St., Suite 200 Cheyenne, WY 82002 (307)778-7053 http://wyomedboard.state.wy.us/

MEDMONTHLY.COM |55

medical resource guide

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

ADVERTISING

Ajishra Technology Support

Sweans Technologies

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

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

Applied Medical Services

VIP Billing

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

Axiom Business Solutions 1-800-Urgent-Care

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

Find Urgent Care

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

www.medmedia9.com

Ring Ring LLC

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

ANSWERING SERVICES Corridor Medical Answering Service

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

Docs on Hold

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

BILLING & COLLECTION Advanced Physician Billing, LLC

PO Box 730 Fishers, IN 46038 (866)459-4579 www.advancedphysicianbillingllc.com 56| AUGUST 2012

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

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

MedMedia9

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

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

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

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

Marina Medical Billing Service

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

CAREER CONSULTING SEAK Non-Clinical Careers Conference Oct. 21-22, 2012 in Chicago, IL (508)457-1111 www.nonclinicalcareers.com

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

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

COMPUTER, SOFTWARE

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

American Medical Software

Mediserv

CDWG

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

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

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

Practice Velocity

Instant Medical History

1673 Belvidere Road Belvidere, IL 61008 (888)357-4209 www.practicevelocity.com

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

medical resource guide

CONSULTING SERVICES, PRACTICE MANAGEMENT

The Dental Box Company, Inc.

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

Manage My Practice

103 Carpenter Brook Dr. Cary, NC 27519 (919)370-0504 www.managemypractice.com

myEMRchoice.com

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

DESIGN SERVICES Taylor Made Illustrations

Taylor Arnold 912-398-3832 www.taylorarnolddesigns.com

Urgent Care America

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

ELECTRONIC MED. RECORDS ABELSoft

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

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

Utilization Solutions

Acentec, Inc

Medical Credentialing

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

www.pushpa.biz

(800) 4-THRIVE

www.medicalcredentially.org

Synapse Medical Management

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

DENTAL Biomet 3i

AdvanceMD

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

INSURANCE, MED. LIABILITY

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

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

Medical Protective

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

5814 Reed Rd. Fort Wayne, In 46835 (800)463-3776

CollaborateMD

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

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

DocuTAP

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

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

Dental Management Club

Integritas, Inc.

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

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

Aquesta Insurance Services, Inc.

Medical Practice Listings

service@pushpa.biz (919) 289-9126

FINANCIAL CONSULTANTS

MGIS, Inc.

www.mgis.com

Professional Medical Insurance Services

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

Wood Insurance Group

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

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

MEDMONTHLY.COM |57

medical resource guide

LOCUM TENENS

MEDICAL EQUIPMENT

MEDICAL PRACTICE VALUATIONS

ALLPRO Imaging Physician Solutions

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

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

Biosite, Inc

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

MEDICAL ART

www.artisanprinter.com Deborah Brenner 877 Island Ave #315 San Diego, CA 92101 (619)818-4714 www.deborahbrenner.com Martin Fried www.martindfriend.com Julie Jennings (678)772-0889 juliejenn@silksynergy.com http://silksynergy.com/ http://www.coroflot.com/naddie09 Ako Jacintho chuchinho58@gmail.com www.facebook.com/akojacintho www.akojacintho.com Marianne Mitchell (215)704-3188 http://www.mariannemitchell.com http://www.colordrop.blogspot.com Nicholas Down http://bit.ly/yHwxb0 Barry Hanshaw 18 Bay Path Drive Boylston MA 01505 508 - 869 - 6038 JHans76271@aol.com www.barryhanshaw.com Pia De Girolamo

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

www.biosite.com

www.cryopen.com

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

Dicom Solutions

www.dicomsolutions.com

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

www.thetps.com

MEDICAL MARKETING

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

MEDICAL RESEARCH Arup Laboratories

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

www.aruplab.com

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

www.crlcorp.com Sanofi US 55 Corporate Drive Bridgewater, NJ 08807 (800) 981-2491

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 PRACTICE SALES

www.sanofi.us Scynexis, Inc. 3501 C Tricenter Blvd.

Durham, NC 27713 (919) 933-4990 www.scynexis.com

MORTGAGE PROFESSIONAL SunTrust Mortgage, Inc.

www.piadegirolamo.com

Medical Practice Listings

8317 Six Forks Rd. Ste #205 Raleigh, NC 27624 (919)848-4202 www.medicalpracticelistings.com 58| AUGUST 2012

MEDICAL PUBLISHING Greenbranch Publishing

Carolina Liquid Chemistries, Inc.

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

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

Cryopen Brian Allen

BizScore

Nicholas Lay, Senior Loan Officer 910.368.8080 Cell nick.lay@SunTrust.com NMLSR# 659099 www.suntrust.com

medical resource guide

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

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

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

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

www.djoglobal.com

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

SUPPLIES, GENERAL

REAL ESTATE

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

BSN Medical 5825 Carnegie Boulevard Charlotte, NC 28209 (800)552-1157 www.bsnmedical.us CNF Medical 1100 Patterson Avenue Winston Salem, NC 27101 (877)631-3077 www.cnfmedical.com

www.expertmed.com

Gebauer Company

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

Scarguard

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

Manage My Practice is the go-to online source of technology, information and resources for

Is Your Practice Well Managed?

Take the Test and Find out...

practice management professionals, and it is visited by over 20,000 medical-practice managers and medical providers each month.

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❏ Yes ❏ No

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(919) 370-0504 or go online at ManageMyPractice.com

Careers | Customer Service | Day-to-Day Operations | Electronic Medical Records | Finance | Human Resources | Innovation | Leadership | Marketing | Medicare & Reimbursement | Social Media MEDMONTHLY.COM |59

CALLING ALL WRITERS

Are you educated in the medical and healthcare field and looking to showcase your exceptional writing skills?

To become a contributing writer in Med Monthly magazine, contact MedMedia9 at medmedia9@gmail.com

Med Monthly Not your father’s medical journal

Contact us: 919.747.9031 medmedia9@gmail.com medmonthly.com

classified listings

Classified To place a classified ad, call 919.747.9031

Physicians needed

Physicians needed

North Carolina

North Carolina (cont.)

Occupational Health Care Practice in Fayetteville North Carolina has two to five days of locums work per week.

Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 8450054, email: physiciansolutions@gmail.com Occupation Health Care Practice located in Greensboro, NC has an immediate opening for a primary care physician. This is 40 hours per week opportunity with a base salary of $135,000 plus incentives, professional liability insurance and an excellent CME, vacation and sick leave package. Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Family Practice physician opportunity in Raleigh, NC This is a locum’s position with three to four shifts per week requirement that will last for several months. You must be BC/BE and comfortable treating patients from one year of age to geriatrics. You will be surrounded by an exceptional, experienced staff with beautiful offices and accommodations. No call or hospital rounds. Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration.

Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Methadone Treatment Center located near Charlotte, NC has an opening for an experienced physician. You must be comfortable in the evaluation and treatment within the guidelines of a highly regulated environment.

Practice operating hours are 6 a.m. till 3 p.m. Monday through Friday. Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054,email: physiciansolutions@gmail.com Immediate Full-Time Opportunity for Board Certified occupational health care MD in Greensboro, NC. Excellent working environment, wage and professional liability insurance provided. Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

Cardiology Practice located in High Point, NC has an opening for a board certified cardiovascular physician. This established and beautiful facility offers the ideal setting for an enhanced lifestyle. There is no hospital call or invasive procedures. Look into joining this three physician facility and live the good life in one of North Carolina’s most beautiful cities. Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Board Certified Internal Medicine physician position is available in the Greensboro, NC area. This is an out-patient opportunity within a large established practice. The employment package contains salary plus incentives.

Please send a copy of your current CV, NC medical license, DEA certificate and NPI certificate with number along with your detailed work history and CME courses completed to: Physician Solutions, P.O. Box 98313, Raleigh, NC 27624. email: physiciansolutions@gmail.com or phone with any questions, PH: (919) 845-0054.

Family Practice physician is needed to cover several shifts per week in Rocky Mount, NC. This high profile practice treats pediatrics, women’s health and primary care patients of all ages. If you are available for 30 plus hours per week for the remainder of the year, this could be the perfect opportunity. Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, N.C. 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Health department in North Carolina seeks FP/GP/IM for June 30-Aug 10 Health Dept in North Carolina seeks physician for jail. Primarily will treat minor ailments, small trauma, and sutures. The dates the physician will need to cover are: 7/31/12, 8/3/12, 8/6/12, 8/8/12, 8//12, 8/13/12. Please send a copy of your current CV, NC medical license, DEA certificate and NPI certificate with number along with your detailed work history and CME courses completed to: Physician Solutions, P.O. Box 98313, Raleigh, NC 27624. email: physiciansolutions@gmail.com or phone with any questions, PH: (919) 845-0054.

MEDMONTHLY.COM |61

classified listings

Classified To place a classified ad, call 919.747.9031

Physicians needed

Physicians needed

North Carolina

North Carolina (cont.)

Sports Medicine center in Charlotte seeks FP/GP/IM immediately FT/PT to perm Doctor needed immediately in Charlotte Sports Medical Clinic to help decrease the risk of sports injuries by evaluating baseline and preexisting conditions to provide treatment and rehabilitation. 8a-5p M-F no call. Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

Fayetteville Health Dept seeks FP/GP/IM for June 30-Aug 10 County Health Dept seeks physician for jail for minor ailments, small trauma, and sutures. Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@ gmail.com

GP needed immediately for Cary center to treat knee related disorders A small practice in Cary is looking for a physician for 2 weeks in July and intermittently. The physician will need to be able to do injections for Non-Surgical knee pain and the injection is done via video Flouroscopy . 8a-5p.Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

Urgent care and occupational practice 30 minutes north of Greensboro, needs family practice doctor able to see all ages. Dates are Aug 13-17, likely further scheduling. 20-25 patients a day. Hours are 8:15 to 5:30. Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

GP/FP/IM needed for urgent care near Greensboro Aug 13-17

Charlotte Health Department Seeks On-going General Practitioners: • •

• • •

County Health Department seeks physicians immediately to work 8am-5pm in the following departments: Child Health FP or pediatrician needed for intermittent dates to do physicals, immunizations, vision and hearing screenings among other basic procedures.

Need coverage July 12-13 & 20.

Employee Health GP/IM needed for physicals and sick visits for staff.

Family Planning FP sought for first time wellness check-ups; no follow-up appointments. Approx 20 patients per day.

Diabetes GP/FP needed for outpatient diabetic clinic. Approx 10 patients per day.

Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054,email: physiciansolutions@gmail.com

62| AUGUST 2012

Wanted: Classified ads

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

919.747.9031

Visit us online anytime at

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SOMETIMES, THE GAME THEY LOVE DOESN’T LOVE THEM BACK. More and more, young athletes are focusing on a single sport and training for that sport year-round — a practice that’s led to an increase in Overuse Injuries. Left untreated, overuse trauma to young shoulders, elbows, knees and wrists may require surgery and have lifelong consequences. For information on preventing and treating Overuse Injuries, visit these sites: orthoinfo.org

stopsportsinjuries.org

MEDMONTHLY.COM |61

Classified

To place a classified ad, call 919.747.9031

Physicians needed

Physicians needed

North Carolina (cont.)

Virginia

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

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

Locum Tenens Primary Care Physicians Needed If you would like the flexibility and exceptional pay associated with locums, we have immediate opportunities in family, urgent care, pediatric, occupational health and county health departments in NC and VA. Call today to discuss your options and see why Physician Solutions has been the premier physician staffing company on the eastern seaboard.

Call (919) 845-0054 or review our corporate capabilities at www.physiciansolutions.com Occupational Clinic in Greensboro NC seeks GP immediately PT General Practitioner needed for an occupational, urgent care and walk in clinic. The practice is located in Greensboro NC. Hours are 8a-5p. Approximately 20 patients/day.

Excellent staff. Outpatient only. No call or hospital duties. Please send a current CV to physiciansolutions@gmail.com or call (919) 845-0054 for details on this and other opportunities across the state.

Physicians Needed Immediately We have several immediate needs for physician coverage for various facilities in North Carolina for addiction medicine.

For immediate consideration please call or email us at physiciansolutions@gmail.com or call (919) 8450054. We can put you to work tomorrow! We have very competitive salaries, we pay for mileage, your accommodations if necessary. We look forward to hearing back from you.

64| AUGUST 2012

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

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

MEDICAL PRACTICE LISTINGS Are you looking to sell or buy a practice?

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

919.848.4202 medlistings@gmail.com | medicalpracticelistings.com We have in-house practice experts and an attorney ready to assist.

Comprehensive Neuro-OphthalmicPractice Practice Ophthalmic and Neuro-Ophthalmic

Pediatrics Practice Wanted

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

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

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.

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

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

Contact us today to discuss your options confidentially.

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

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

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ADULT & PEDIATRIC INTEGRATIVE MEDICINE PRACTICE FOR SALE

Med Monthly

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:

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

• • • • •

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

• • • • • •

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

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

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

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

Call us today to place your classified!

919.747.9031

Also available online 24/7

medmonthly.com

Does your Practice Accept Insurance?

We Can Help!

Call us at

1-855-4-THRIVE Visit us at

MedicalCredentialing.org

Also, ask us about Affordable Medical Billing!

62| JULY 2012

Unfortunately, its motor is inside playing video games.

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

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

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

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

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

American Council on Exercise

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

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

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

NC MedSpa For Sale MedSpa Located in North Carolina

TM

Wanted: Urgent Care Practice

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

Contact Medical Practice Listings today to discuss the practice details.

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

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

www.medicalpracticelistings.com

Call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com MEDMONTHLY.COM |67

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

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

Our Services: • Primary Health • Well Child Health Exams • Sport Physical • Adult Health Exams • Women’s Health Exams • Management of Contraception • DOT Health Exam • Treatment & Management of Medical Conditions • Counseling on Prevention of Preventable Diseases • Counseling on Mental Health • Minor surgical Procedures For more information call Medical Practice Listing at (919) 848-4202.

To view our other listings, visit medicalpracticelistings.com.

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

Live and work in one of the most healthy cities in the U.S. List Price: $150,000 | Established: 2007 | Location: Colorado For more information contact Dr. Jack McInroy at 303-929-2598 or Shrink1324@gmail.com 68| AUGUST 2012

Classified To place a classified ad, call 919.747.9031

Practice for sale

Practice for sale

North Carolina

North Carolina (con't)

Family Practice located in Hickory, NC. Well-established and a solid 40 to 55 patients split between an MD and physician assistant. Experienced staff and outstanding medical equipment. Gross revenues average $1,500,000 with strong profits. Monthly practice rent is only $3,000 and the utilities are very reasonable. The practice with all equipment, charts and good will are priced at $625,000.

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

Internal Medicine Practice located just outside Fayetteville, NC is now being offered. The owning physician is retiring and is willing to continue working for the new owner for a month or two assisting with a smooth transaction. The practice treats patients four and a half days per week with no call or hospital rounds. The schedule accommodates 35 patients per day. You will be hard pressed to find a more beautiful practice that is modern, tastefully decorated and well appointed with vibrant art work. The practice, patient charts, equipment and good will is being offered for $415,000 while the free standing building is being offered for $635,000. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or email: medlistings@gmail.com

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

Housed in the same practice building with an internal medicine, you will enjoy the referrals from this as well as other primary care and specialties in the community. We have this practice listed for $295,000 which includes charts, equipment and good will. Contact Medical Practice Listings at (919) 848-4202 for more information. View additional listings at www.medicalpracticelistings.com Primary Care Practice specializing in women’s care. The owning female physician is willing to continue with the practice for a reasonable time to assist with smooth ownership transfer. The patient load is 35 to 40 patients per day, however that could double with a second provider.

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

South Carolina Lucrative ENT Practice with room for growth, located three miles from the beach. Physician’s assistant, audiologist, esthetician and well-trained staff. Electronic medical records, mirror imaging system, established patient and referral base, hearing aids and balance testing, esthetic services and Candela laser. All aspects of otolaryngology, busy skin cancer practice, established referral base for reconstructive eyelid surgery, Botox and facial fillers. All new surgical equipment, image-guidance sinus surgery, balloon sinuplasty, nerve monitor for ear/parotid/thyroid surgery.

Room for establishing allergy, cosmetics, laryngology and trans-nasal esophagoscopy. All the organization is done; walk into a ready-made practice as your own boss and make the changes you want, when you want. Physician will to stay on for a smooth transition. Hospital support is also an option for up to a year. The listing price is $395,000 for the practice, charts, equipment and good will. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or email: medlistings@gmail.com

Washington Family Practice located in Bainbridge Island, WA has recently been listed. Solid patient following and cash flow makes this 17-year-old practice very attractive.

Contact Medical Practice Listings for more details. email: medlistings@gmail.com or (919) 848-4202.

MEDMONTHLY.COM |69

Buying or selling? We can help!

Listing Benefits • • • • •

Buying Benefits

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

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

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

A Philip Driver Company

medicalpracticelistings.com

: d e t n Wa Hospic

in Dalla e Practice

s, TX

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

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

To view our national listings visit www.medicalpracticelistings.com

Practice at the beach Plastic Surgery practice for sale with lucrative ENT specialty Myrtle Beach, South Carolina Practice for sale with room for growth, located only three miles from the beach. Physician’s assistant, audiologist, esthetician and well-trained staff. Electronic medical records, Mirror imaging system, established patient and referral base, hearing aids and balance testing, esthetic services and Candela laser. All aspects of Otolaryngology, busy skin cancer practice, established referral base for reconstructive eyelid surgery, Botox and facial fillers. All new surgical equipment, image-guidance sinus surgery, balloon sinuplasty, nerve monitor for ear/parotid/thyroid surgery. Room for establishing allergy, cosmetics, laryngology & trans-nasal esophagoscopy. Walk into a ready made practice as your own boss and make the changes you want, when you want. Physician will stay on for smooth transition. Hospital support also an option for up to a year. The listing price is $395,000.

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

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

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

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

Excellent medical equipment, staff and hospital nearby, you will be hard-pressed to find a family practice achieving these numbers.

Listing price is $625,000.

MEDMONTHLY.COM | 71

ADVERTISE YOUR PRACTICE BUILDING IN MED MONTHLY

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.

By placing a professional ad in Med Monthly, you're spending smart money and directing your marketing efforts toward qualified clients.

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

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

Listing Price: $430,000

medmonthly.com | 919.747.9031

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

MODERN MED SPA AVAILABLE Located in beautiful coastal North Carolina

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

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

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

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

MedicalPracticeListings.com | medlisting@gmail.com | 919.848.4202 72| AUGUST 2012

Primary Care Practice For Sale Wilmington, 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.

Contact Medical Practice Listings for more information.

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

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

Please direct all correspondence to mdstaffingforsale@gmail.com Only serious, qualified inquirers.

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

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

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

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

Call for pricing and details.

Call Medical Practice Listings at (919) 848-4202 for details and to view our other listings vist www.medicalpracticelistings.com MEDMONTHLY.COM |73

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

74| AUGUST 2012

NC OPPORTUNITIES

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.

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

List price: $435,000

For more information about Physician Solutions or to see all of our locums and permanent listings, please visit physiciansolutions.com

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

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

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

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

Medical Practice Listings Selling and buying made easy

MedicalPracticeListings.com | medlisting@gmail.com | 919.848.4202 MEDMONTHLY.COM |75

A New Book from Greenbranch Publishing www.greenbranch.com

31½ Essentials for Running Your Medical Practice Dr. John Guiliana and Dr. Hal Ornstein with Mark Terry

Enjoy new control of your practice, profits, people … and life

I

s there a formula for running a practice that focuses on healing while still letting you enjoy robust profitability and a personal life, too? Yes! In fact, there are 31 “essentials” — concrete solutions that have been tested, refined and proven to make a difference by highly successful practices. Now, with 31½ Essentials for Running Your Medical Practice. You can start using these same ideas to streamline your own practice, contain costs, defuse conflicts, boost reimbursement and increase physician, staff and patient satisfaction.

Selected Table Of Contents

Real-world success pearls that work for any healthcare practice

paperback, 159 pages, ISBN: 978-0-9827055-1-3 $69.95 plus $9.95 S&H

dedr ay!

OrT o

Developing a Budget • Hiring Your Staff • Leadership Skills • Marketing Your Practice • Writing Your Office Manual • Office Dynamics • Motivating Your Staff • The Paperless Office • Remote Access • E-prescribing • Billing • Practice Assessments • Controlling Overhead • Ancillary Services • In-office Dispensing • Patient Communication and Compliance • Plugging Revenue Leaks • Time Management • Bringing on Associates • Liability Coverage • Office Design • Dealing with Stress • Effective Patient Scheduling • Collections • Dealing with Difficult Patients • Balancing Your Personal and Professional Lives

Phone: 800.933.3711 • Fax: 410.329.1510 Web: www.greenbranch.com Email: info@greenbranch.com

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

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

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

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

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

Asking price: $385,000

To view more listings visit us online at medicalpracticelistings.com

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

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

To find out more information call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com MEDMONTHLY.COM |77

the top

Health

T

his month’s Top 9 Lists features influential and rule-breaking healthcare design firms across the nation. When it comes to these architecture experts, long gone are the days of plastic curtains and fluorescent lighting. Using industry-bending tactics and the most cutting-edge design teams, these firms conceptualize, develop and master the art and functionality of healthcare interior and exterior design.

Compiled by Bethany Houston

HDR, Inc.

Omaha, Nebraska www.hdrinc.com

Perkins + Will

Chicago, Illinois www.perkinswill.com

Arlington Free Clinic, courtesy of Perkins + Will

Cannon Design

New York, New York www.cannondesign.com

3

Page Southerland Page

Chickasaw Nation Medical Center, courtesy of PSPAE.com

78| AUGUST 2012

Houston, Texas www.pspaec.com

2

hcare Design Firms

5

Resource: Interior Design Magazine, Top 40 Firms in Healthcare Design, http://www.healthcarefineart.com/2008/02/top-40-healthca.html Randall Children’s Hospital at Legacy Emanuel, Portland, Oregon

Shepley Bulfinch Richardson & Abbott

Boston, Massachusetts www.shepleybulfinch.com

Smith Group JJR

Detroit, Michigan www.smithgroupjjr.com

7

ZGF Architects, LLC Portland, Oregon www.zgf.com

9

8

Gresham, Smith and Partners Nashville, Tennessee www.greshamsmith.com

Loeble, Schlossman & Hackl

Tampa General Hospital, courtesy of Gresham, Smith & Partners

Chicago, Illinois www.lshdesign.com

MEDMONTHLY.COM |79

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