Med Monthly December 2012

Med Monthly 5

DECEMBER 2012

TIPS FOR DOCTORS WHO NEGOTIATE REIMBURSEMENT RATES WITH INSURANCE COMPANIES

CONSUMER TIPS

to Navigate New ‘Summary of Benefits and Coverage’ Forms pg. 44

pg. 48

12 Ways

to Supercharge Your Practice

Part 1 of 2

pg. 18

HEALTH CARE PROVIDERS AND THE AFFORDABLE CARE ACT pg. 50

the

health e insuranc issue

contents features 44 5 CONSUMER TIPS TO NAVIGATE NEW ‘SUMMARY OF BENEFITS AND COVERAGE’ FORMS

52

Featured Artist: Emily Weinstein

48 TIPS FOR DOCTORS WHO NEGOTIATE REIMBURSEMENT RATES WITH INSURANCE COMPANIES

practice tips

50 HEALTH CARE PROVIDERS AND THE AFFORDABLE CARE ACT

22 CHANCE TO AVOID A 1.5% REDUCTION OF ALL MEDICARE PAYMENTS IN 2013

insight

24 PA WORKFORCE VOLUME STRIVES TO MEET PATIENT DEMAND

10 IS YOUR MEMORY PLAYING TRICKS ON YOU? Check your medicine cabinet!

research and technology

12 ELDER CARE:

Doctors connect to patients in an mHealth world

How to Help Your Parents Manage

18 12 WAYS TO SUPERCHARGE YOUR PRACTICE

26 YOU IMAGINE - PART 2

30 HEALTH IT - Best Practices to Minimize Cash

14 HIGH-DOSE FLU VACCINE COVERED

BY MEDICARE

international 16 UNIVERSAL HEALTH COVERAGE: Health without boundaries - An example from India

78

Top 9 Holiday Health Tips

Flow Disruptions Resulting from ICD-10 Implementation

32 EVERYTHING ELSE IS SMART NOW...WHY NOT YOUR PILLS?

legal 34 WHAT YOU NEED TO KNOW ABOUT HEALTH SAVINGS ACCOUNTS 38 COMMUNITY HEALTH CENTERS AND THE AFFORDABLE CARE ACT 42 PREPARING FOR HEALTH CARE REFORM An Agent’s Perspective

the arts 52 WHEN PAINT IS DANGEROUS

healthy living 52 FESTIVE HONEY ROASTED BAKED PEARS

in every issue 4 editor’s letter 8 news briefs

60 resource guide 78 top 9 list

editor’s letter It is well known that health care in America is going through a radical change. Med Monthly’s December issue tackles this complex subject, from insurance companies’ responsibility to make the information digestible to the changing legal requirements for practices. We also delve into how doctors and practice managers can be more pro-active to increase physician reimbursement from health plans. The modifications to the health care systems are broken down for our readers so practices, physicians and patients alike can understand the new system.

Health insurance companies are obligated to answer basic questions regarding the new policies for the consumer. The article “5 consumer Tips to Navigate the New ‘Summary of Benefits and Coverage’ Forms Benefits” has selected the most pressing of concerns. These include: the out of pocket upper limit per year that a patient has to spend, their deductible, and the co-pay for in-network and out-of-network providers.

Joe Gupton from Jones Insurance writes about “Preparing for Health Care Reform – An Agent’s Perspective”. With the understanding that the Affordable Care Act’s goal is to assist financially disadvantaged people and reduce costs from unpaid emergency room costs, companies must adjust to the new requirements. Finding a trustworthy agent is key for a company to adapt to be governmentally compliant.

Another article explores how a practice can increase their bottom line as these changes take place. The “Tips for Doctors who Negotiate Reimbursement Rates with Insurance Companies” encourages practice owners to negotiate physician reimbursement. That is, by being proactive, doctors can discuss with health insurance companies ways to make their compensation higher. One solution is a ‘pay-for-performance arrangement’. This new managed care and cooperation can be a win-win situation.

While the changes in the health care system seem daunting, Med Monthly hopes that its implications and ramifications can be more easily understood by both the consumer and practice owner.

Hold onto your seats – next month’s theme is “Sex in the Practice”.

Ashley Austin Managing Editor

4 | DECEMBER 2012

Med Monthly December 2012 Publisher Philip Driver Managing Editor Ashley Austin Creative Director Thomas Hibbard Contributors Ashley Acornley, MS, RD, LDN Simi Botic Jennifer B. Daknis, AIF® Joe Gupton Anuradha Katyal Laura Masske Ed Rabinowitz Frank J. Rosello Lisa P. Shock, MHS, PA-C Cara Tannenbaum, MD, MSc Merle Turner, D.O. Emily Weinstein 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 Ashley Acornley, RD, LDN holds a BS in Nutritional Sciences with a minor in Kinesiology from Penn State University. She completed her Dietetic Internship at Meredith College and recently completed her Master’s Degree in Nutrition. She is also an AFAA certified personal trainer. Her blog can be found at: ashleyfreshfromthefarm.wordpress.com

Simi Botic is an associate in Dinsmore’s Columbus office focusing her practice on healthcare law. Learn more about Simi at www.dinsmore.com.

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

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

Merle Turner, D.O. is a family practice physician and founder and medical director of Warner Family Practice in Chandler, AZ. He previously served as the chairman of the department of family medicine and chief of staff at Tempe St. Luke’s Hospital, as well as the president of Vista Del Sol Healthcare Medical Group.

MEDMONTHLY.COM |5

designer's thoughts

From the Drawing Board Technology is a reality and is always moving quickly forward.

And it’s no different in health care, technology is in constant change in the medical arena.

In the “Research and Technology” section of this month’s magazine, the article “Everything Else is Smart Now…Why Not Your Pills?” we shed light on ICT (Ingestible Capsule Technology), a smart pill that contains a miniaturized microelectronic system allowing doctors to collect diagnostic and bio-medical information on patients simply by having them swallow the pill.

The second part of Laura Maaske’s article “Doctors Connect to Patients in an mHealth World” discusses how the iPad and other mobile devices have improved the relationship between patient and doctor. With the new mobile device apps available, physicians can give their patients immediate information at their office or bedside, saving the doctor time and bringing the patient the answers they seek. “Doctors say they enjoy being able to show patients the visual evidence of their medical conditions easily. It’s a situation where the human interaction is key and where the technology is making the experience better without dominating the human interaction.”

And in “News Briefs” we report on a new 3D Optical Microscope from Bruker that is easy to operate and very affordable.

The new features and capabilities enable greater convenience and productivity in a host of markets, ranging from ophthalmics and medical device implants to precision machining and semiconductor manufacturing.

Our goal each month is to provide the most current information on new technology and practices, assisting the health care community to stay fluent with new tools as they become available, while remaining cost effective.

Thomas Hibbard Creative Director

6 | DECEMBER 2012

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news briefs

Bruker Releases New Benchmark 3D Optical Microscope System Bruker announced the launch of the ContourGT-I 3D Optical Microscope to enhance R&D productivity and maximize manufacturing throughput for industrial applications.

The ContourGT-I has been optimized to accelerate and simplify measurement setup and feature-tracking and is the world’s first bench top profiling system to incorporate Bruker’s proprietary tip/tilt head design, along with fully automated functionality, including turret, lenses, and illumination. In addition, the system has been designed from top to bottom for maximum vibration stability and robustness, including a space efficient yet stable footprint with fully integrated air isolation. This combination of features and capabilities enables greater convenience and productivity in a host of markets, ranging from ophthalmics and medical device implants to precision machining and semiconductor manufacturing.

“Based on over three decades of surface metrology and imaging excellence, customers know they can count on our 3D optical microscopes to provide the best Z-axis resolution, independent of magnification, as well as the fastest measurements with the largest fields of view on the most difficult surface geometries,” said Mark R. Munch, Ph.D., President of the Bruker Nano Surfaces Division.

“By adopting automation and tip/tilt head designs from our high-volume floor-mounted systems, the bench top ContourGT-I now offers these capabilities to industries that previously may not have considered 3D optical microscopes as affordable or easy to operate.”

Source: http://www.pressreleasepoint.com/bruker-releases-newbenchmark-3d-optical-microscopesystem 8 | DECEMBER 2012

University Researchers Confirm Link Between Insomnia and Hot Flashes A team of researchers at the Stanford University School of Medicine in California recently embarked upon a study to help determine the causes of insomnia among premenopausal and postmenopausal women. The team conducted phone interviews with 982 women and gathered information about their sleep history, frequency of hot flashes, and overall health. They found that 51% of postmenopausal women suffer with hot flashes and that 79% of premenopausal women have them. Among the women with the most intense hot flashes (based on their severity and frequency), 81% of them experienced sleeplessness and insomnia.

The lead researcher said: “In this paper, we have observed without any doubt and in a significant way that hot flashes are associated with insomnia. This is the first observational study showing the link between insomnia and hot flashes while controlling for other factors that could account for insomnia in women.”

Night sweats and hot flashes have become a form of insomnia in which a woman can wake up drenched in sweat and unable to sleep. Regarding mineral deficiency at the time of menopause, the pioneering nutritionist Adelle Davis says in her book ‘Let’s Get Well’ that: “The amount of calcium in a woman’s blood parallels the activity of the ovaries. During the menopause, the lack of ovarian hormones (estrogen and progesterone) can cause severe calcium deficiency symptoms to occur, including irritability, hot flashes, night sweats, leg cramps, and insomnia. These problems can be easily overcome if the intakes of calcium, magnesium, and vitamin D are all generously increased and are well absorbed.”

Calcium is directly related to our cycles of sleep. In one study published in the European Neurology Journal, researchers found that calcium levels in the body are higher during some of the deepest levels of sleep, such as the rapid eye movement (REM) phase. The study concluded that disturbances in sleep, especially the absence of REM deep sleep or disturbed REM sleep, are related to a calcium deficiency. Restoration to the normal course of sleep was achieved following the normalization of the blood calcium level.

The research study above shows a definite link between hot flashes and insomnia. The lead researcher suggests that if a woman can address and remedy her hot flashes, she will also likely improve her insomnia.

Source: http://www.pressreleasepoint.com/university-researchers-confirm-linkbetween-insomnia-and-hot-flashes

Olea Medical Launches Olea Sphere™ Medical Imaging Enterprise Software Package in the U.S Olea Medical received the FDA 510(k) clearance to market the Olea package in the US earlier this year.

Olea Sphere™ is an image processing software package intended for picture archive, post-processing and communication. It helps standardize both viewing and analysis capabilities of functional and dynamic imaging datasets acquired with MRI and CT across vendors. It features innovative image viewing and analysis, processing of perfusion weighted image post-processing, permeability computation, as well as diffusion weighted image/tensor image post-processing, fiber tracking post-processing, and longitudinal analysis of multiple time points.

It is compliant with the DICOM standard and Windows, Macintosh or Linux operating systems. It runs on any standard off-the-shelf workstation or it can be used through a thin deployment with a server. The DWI Module is used to visualize local water diffusion properties from the analysis of diffusion-weighted MRI data. The Fiber Tracking feature utilizes the directional dependency of the diffusion to display different structures within anatomic areas of interest. The perfusion analysis module is used for visualization and analysis of dynamic imaging data, showing properties of changes in contrast over time. Both DSC and DCE MRI perfusion sequences are supported to cover full body analysis.

“In neuro-oncology, the role of imaging is to assess the nature and extent of disease, however the information provided with structural imaging is limited, particularly when acquired during the course of patient therapy. Advanced information from perfusion, permeability and diffusion tensor tractography imaging assists in determining lesion grade and extent, differentiation of treatment related changes from viable tumor and serves as a guide to the appropriate lesion resection trajectory. To be valid in practice, an advanced rendering engine must be reliable, accurate and be science-based. To be integral to the clinical process it must be fast, easy to use and accessible enterprise-wide” said Lawrence Tanenbaum, MD, Associate Professor of Radiology at The Mount Sinai Hospital, New York. “Olea Sphere™ meets these lofty requirements and more than satisfies our everyday advanced neuroimaging needs”, he added.

“The launching of Olea Sphere is a major milestone in the development of the company. During the past years, Olea Medical has gained recognition from neuroradiologists for our expertise in neuro-imaging. With Olea Sphere™ we are now covering the full body, regardless of the modality employed for image acquisition.

This is a tremendously important development, especially for oncology but also for hepatic disorders or kidney dysfunction,” says Fayçal Djeridane, president and CEO of Olea Medical. “Also, Olea Sphere™ has been specifically designed to incorporate future innovative modules, to cover various modalities, such as spectroscopy or ASL. Olea Sphere™ shows Olea Medical’s commitment to providing a widely SOON accessible, complete package of simple, safe, fast COMING THLY and accurate tools for full-body image postMED MON IN processing in order to help doctors improve coming the diagnosis and follow-up process for paIn the up , Med 2013 issue tients’ benefit”, he added.

January sex ports on re ly th n o M ractice Source: http://www.newswiretoday.com/ and the p news/120050/

Bacterial protein in house dust spurs asthma according to NIH study A bacterial protein in common house dust may worsen allergic responses to indoor allergens, according to research conducted by the National Institutes of Health and Duke University.

The finding is the first to document the presence of the protein flagellin in house dust, bolstering the link between allergic asthma and the environment.

“Most people with asthma have allergic asthma, resulting largely from allergic responses to inhaled substances,” said the paper’s corresponding author Donald Cook, Ph.D., an NIEHS scientist. “Although flagellin is not an allergen, it can boost allergic responses to true allergens.”

After inhaling house dust, test mice that were able to respond to flagellin displayed all of the common symptoms of allergic asthma, including more mucous production, airway obstruction, and airway inflammation.

However, mice lacking a gene that detects the presence of flagellin had reduced levels of these symptoms.

In addition to the mouse study, the research team also determined that people with asthma have higher levels of antibodies against flagellin in their blood than do non-asthmatic subjects, which provides more evidence of a link between environmental factors and allergic asthma in humans.

Source: http://www.nih.gov/ news/health/oct2012/niehs-15. htm MEDMONTHLY.COM |9

insight

Is your memory playing tricks on you?

Check your

MEDICINE

CABINET!

By Cara Tannenbaum, MD, MSc Institut universitaire de gériatrie de Montréal (IUGM) Common medication to treat insomnia, anxiety, itching or allergies can have a negative impact on memory or concentration in the elderly, according to Dr. Cara Tannenbaum, Research Chair at the Institut universitaire de gériatrie de Montréal (IUGM, Montreal Geriatric University Institute) and Associate Professor of Medicine and Pharmacy at the University of Montreal (UdeM). Up to ninety percent of people over the age of 65 take at least one prescription medication. Eighteen percent of people in this age group complain of memory problems and are found to have mild cognitive deficits. Research suggests there may be a link between the two.

Dr. Tannenbaum recently led a team of international researchers to investigate which medications are most likely to affect amnestic (memory) or non-amnestic (attention, concentration, performance) brain functions. After analyzing the results from 162 experiments on medications with potential to bind to cholinergic, histamine, GABAergic or opioid receptors in the brain, Dr. Tannenbaum concluded that the episodic use of several medications can cause amnestic or non-amnestic 10 | DECEMBER 2012

deficits. This potential cause is often overlooked in persons who are otherwise in good health.

The 68 trials on benzodiazepines (which are often used to treat anxiety and insomnia) that were analyzed showed that these drugs consistently lead to impairments in memory and concentration, with a clear doseresponse relationship. The 12 tests on antihistamines and the 15 tests on tricyclic antidepressants showed deficits in attention and information processing. The findings support the recommendation issued in the Revised Beers Criteria published in the spring of 2012 by the American Geriatrics Society that all sleeping pills, first generation antihistamines and tricyclic antidepressants should be avoided at all costs in seniors.

Dr. Tannenbaum believes in the importance of communicating this knowledge to patients: “Seniors can play an important role in reducing the risks associated with these medications. Patients need this information so that they are more comfortable talking to their doctors and pharmacists about safer pharmacological or nonpharmacological treatment options,” she explained. She also points out that

each case must be addressed on an individual basis: “Despite the known risks, it may be better for some patients to continue their medication instead of having to live with intolerable symptoms. Each individual has a right to make an informed choice based on preference and a thorough understanding of the effects the medications may have on their memory and function.”

Research summary

MEDLINE and EMBASE were searched for randomized, doubleblind, placebo-controlled trials of adults without underlying central nervous system disorders who underwent detailed neuropsychological testing prior to and after oral administration of drugs affecting cholinergic, histaminergic, GABAergic or opioid receptor pathways. Seventy-eight studies were identified, reporting 162 trials testing medication from the four targeted drug classes. Two investigators independently appraised study quality and extracted relevant data on the occurrence of amnestic, non-amnestic or combined cognitive deficits induced by each drug class. Only trials using

‘‘

“Patients need this information so that they are more comfortable talking to their doctors and pharmacists about safer pharmacological or nonpharmacological treatment options.”

validated neuropsychological tests were included. Quality of the evidence for each drug class was assessed based on consistency of results across trials and the presence of a dose-response gradient. This research was conducted in collaboration with researchers at the University of Sydney, the University of Calgary and the University of Iowa College of Public Health. 

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Cara Tannenbaum, MD, MSc, is a geriatrician and researcher in the health promotion, health care services and intervention unit at the Institut universitaire de gériatrie de Montréal (IUGM). She is also the inaugural Michel-Saucier Endowed Chair in Geriatric Pharmacology, Health and Aging from the Faculty of Pharmacy at the Université de Montréal and an Associate Professor of Medicine at the Université de Montréal. She leads a program of research in epidemiologic and clinical geriatric health. Her clinical practice aims to improve medical care for older people.

Source: Institut universitaire de gériatrie de Montréal-Université de Montréal

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insight

Elder Care:

How to Help Your Parents Manage

By Jennifer B. Daknis, AIF速 Sigmon Daknis Wealth Management 12 | DECEMBER 2012

It’s a decision most adults dread: having to take over the financial and day-to-day living decisions for parents who can no longer manage on their own. When caring for your parents, you may need to plan on three levels: managing finances, making health care decisions, and making sure their daily household needs are met. Finding qualified experts who can advise you in these areas may make it easier to manage the situation.

Managing Finances If your parents currently are able to communicate, try to initiate a conversation about how they would like their money to be managed.

Rather than telling them what to do, be clear that you would like to help and to make sure that their wishes are met. Access to bank and brokerage statements, insurance policies, and other financial documents may help you to safeguard your parents’ assets.

If your parents work with a financial advisor, try to arrange a joint meeting where all parties can review

the situation. If you pay your parents’ bills and manage their checkbook, arranging for direct deposit of Social Security or pension benefits, as well as electronic delivery of recurring bills, could expedite the process.

Arranging for Health Care If your parents are mentally competent, ask them about consulting a lawyer who can draft a health care proxy, a legal document designating you (or another person) to make decisions about medical care when they are no longer able to do so. If your parents have opinions about end-of-life care, their wishes can be incorporated into a living will, another legal document.

Even without these documents, the medical establishment is likely to look to you or other siblings to make decisions about health care, which could include arranging for long-term care or making end-of-life decisions.

As part of this process, determine the type of medical insurance that your parents have and what it covers.

Overseeing Daily Living If your parents are able to remain in their home, you may need to consider helping them to manage medication, to conduct daily tasks such as bathing or meal preparation, and to make arrangements for assistance with household chores. A visiting nurse and home care agency may provide assistance in these areas.

You may want to consider consulting a Professional Geriatric Care Manager, a professional who may help arrange for home care, provide crisis intervention, and help you identify solutions to potential problems. You can learn more at www.caremanager.org.

Managing a parent’s affairs can be complicated, but arranging for support from qualified people may help you care for parents in a way that meets their needs and does not create too much stress on you.  Jennifer B. Daknis is a Registered Representative with and, securities are offered through LPL Financial, Member FINRA/SIPC.

insight

High-Dose Flu Vaccine Covered by Medicare

By Merle Turner, D.O. Warner Family Practice

T

his is a tricky time of year for physicians as we continue to encourage our patients to get vaccinated against influenza and also begin to think about ordering our vaccine supply for the next influenza season.

Importantly, it is not too late to vaccinate. Once administered, the influenza vaccine takes about two weeks to build full immunity AND typically influenza does not peak until February – so there is still plenty of time to protect our patients against influenza this flu season – especially our most vulnerable elderly patients.

Two years ago, the FDA approved the higher dose influenza vaccine for adults age 65 and older. It was designed to address age-related decline in immune response among those 65 and older by increasing the amount of antigen (x4) as the standard vaccine.

This high dose influenza vaccine is important because according to the Centers for Medicare and Medicaid Services (CMS), pneumonia and influenza are the fifth leading cause of deaths in older adults. Medicare Part B pays for one influenza vaccine each year with no copayment or deductible applied. Medicare generally pays for one pneumonia vaccination for all Medicare beneficiaries per lifetime.

Despite full coverage for both the pneumonia and the high-dose influenza vaccine, rates of immunization in the senior population remain suboptimal, particularly in minority populations. This could be due in part to lack of

14 | DECEMBER 2012

education about Medicare benefits, so we must let patients know: first, these vaccines are important and, second, they are covered by Medicare.

It is also important to remind elderly patients to get their flu vaccine as part of a scheduled visit. Providers are unable to bill Medicare for an office visit when the only reason for the visit is a vaccine. If the office visit is for a medical reason covered under Medicare, the vaccine given in conjunction with that visit will be covered. Additionally, some Medicare Advantage plans limit the number of contracted providers for their Medicare members, which may eliminate some of the more convenient vaccine locations for seniors to receive their flu vaccine – such as supermarket pharmacies. Knowing all this, we can take the necessary steps to help elderly patients receive their annual flu vaccine, while still complying with Medicare policies.

To find out more about this issue, visit: http://www.cms. gov/AdultImmunizations/02_Providerresources.asp.  Merle Turner, D.O. serves as a member of the American Osteopathic Association, the Arizona Osteopathic Association, the Arizona Academy of Family Practice, the Arizona State Society of the American College of Osteopathic Family Physicians and the American Osteopathic Board of General Practitioners. Dr. Turner graduated from Anderson University in 1969 and the Kansas City College of Osteopathic Medicine in 1975.

international

Universal Health Coverage:

Health Without Boundaries-

An Example From India

By Anuradha Katyal Research Associate Administrative Staff College of India Hyderabad, India

16| DECEMBER 2012

The inception of the concept of Universal Health coverage occurred with the ideas of Otto von Bismarck in 1883. Since then many countries from both the developing and developed have embraced the idea. So what is it that developing countries should do to ensure that each citizen achieves their right to health?

When I think about the country I grew in I have very mixed memories about the health care system. I, on one hand, think of the dispensary where my grandmother took me for a tooth extraction when I was five in a small town in India. It was an unhygienic dispensary with almost negligible sterilization, swarming with patients and no fees for treatment. In contrast, I also think of a state of art hospital with cutting edge technology and well furnished wards, with well groomed staff and very high fees for service. Access of equity has hence been questioned from time to time in not just India, but many developing nations.

In 2010 WHO published its World Health Report highlighting this major problem. It said that millions of people cannot use health services because they have to pay at the time they receive them. Many of those who use services suffer financial hardship, or are even impoverished, making payment difficult. Those who cannot pay are left with two options. One, live with the disease, become morbid or even die. Or two, access medical attention at a public health care facility in the absence of quality and universal precautions for health care.

Andhra Pradesh is one of the 28 states of India. Known as the country ‘rice bowl’, this state has a high literacy rate (nearly 70%), a high GDP (3rd richest in India) and has emerged as a new IT hub. In 2004, the government of Andhra Pradesh launched many health care reforms. Many new initiatives were taken and funds were allocated to support their activities and ensure sustainability. The government lay emphasis on ‘accountability, transparency and decentralization’

‘‘

“While the government may have a noble intention to evade of the burden of expenditure, what still lacks is an attempt to strengthen primary care.”

in planning these initiatives. The government also wanted to ensure a revolutionary scheme that would bring back to power and popularity. Hence, the Rajiv Aarogyasri Health Insurance scheme was launched in 2007. The objective of this scheme is to provide quality tertiary care by improving the infrastructure in the network hospitals and providing financial support to those facing catastrophic health needs, i.e. the ones recognized as below the poverty line by the government.

This scheme provides an insurance coverage for 200,000 Indian rupees (~US$ 4000) per year to insured families, for 942 costly medical procedures. It is a good example of a public–private partnership, because it has brought together a health insurance company, private and public hospitals, and the state’s department of health.

The scheme is not just about providing financial coverage. The families are also provided free transport, free food, free follow-up appointments and a one year supply of medication. The government describes this as a ‘cashless’ scheme, since the families at no point have to pay out of pocket. In order to get empanelled into the scheme the private hospitals need to fulfil very strict criteria. In India, every BPL family holds a ration card (white card), which is complemented by a Rajiv Aarogyasri Health Card.

The card contains complete family data and is similar to a swipe card used for debit transactions.

There have been quite a few efforts

to launch comparable schemes in other states but the Aarogyasri Scheme has proven to be different in many ways, including the proper usage of technology, hence maintaining and managing a huge database of beneficiaries; taking photographic evidence at each point, proper training of staff to make database entries and making this data open to public viewing.

Nevertheless, the scheme has been accused of bad governance and malpractices. Leaving the fraud aside even if we believe that the government is not corrupt and there are no fraudulent practices, there are many other issues that need to be addressed. While the government may have a noble intention to evade of the burden of expenditure, what still lacks is an attempt to strengthen primary care. A study has shown a reduction in out-patient expenditures.

This actually poses a different series of questions. Are people accessing in-patient care even for diseases which could be treated conservatively or are physicians inducing the demand? Has the government attempted to reduce the burden of disease? Shouldn’t the weak primary care system be strengthened as opposed to secondary or tertiary care? And above all, despite pregnancy being a major expense for out of pocket expenditure, why has it not been covered under the scheme?

Despite the need for evaluating these few questions, Rajiv Aarogyasri has paved the future for many such schemes in India. It makes one think, even in a corrupt world, noble intentions exist and can be made to work.  Anuradha Katyal is a Research Associate at the Administrative Staff College of India, Hyderabad, India. She has a Bachelors in Dental Surgery and a Masters in Healthcare Management.

She is currently working on a project evaluating the Rajiv Aarogyasri Health Insurance scheme, together with the Indian School of Business and ACCESS Health International.

MEDMONTHLY.COM |17

practice tips

12 Ways to Supercharge Your Practice Part 1 of 2

By Mary Pat Whaley, FACMPE

There are 12 very actionable ways to make positive improvements in your practice. In this issue we’ll present the first 6 and will continue and complete the final 6 ways in our January 2013 issue. After reading through all twelve ways next month, rank them in order of importance and priority for your group. Bring them to your strategic planning meetings and discuss ways to implement them, or use them as a springboard for other ideas to improve your practice and gain a competitive edge.

18 | DECEMBER 2012

#1 Create a Practice Dashboard

You’ve probably heard the adage “You can’t manage what you can’t measure!” The Dashboard is a way to capture key pieces of data in your practice and demonstrate your management skills to your stakeholders.

A Practice Dashboard is a onepage look at the key indicators being monitored that are necessary for the practice to thrive financially. As an administrator, I have typically presented the Dashboard Report (sometimes called a Snapshot Report) to the physicians at the monthly meeting. The Dashboard keeps the physicians operating at a high level and usually keeps them from descending into the deep detail that can derail a monthly meeting like nobody’s business!

What should be included in my Practice Dashboard?

• Gross charges, collections and adjustments for the month and year-to-date (YTD) and the same month last year and YTD last year.

• Aged Accounts Receivable (typically written A/R) • Collection % - how much of what you can collect, do you collect?

• New patient referral breakdown by type (referred by doctor, patient, employee, website, direct mail, TV, radio, yellow pages, etc.)

• Cumulative money turned over to third-party collectors and money collected by the outside firm • Status of any loans (remaining principal) or line of credit outstanding • Sales and returns if you are selling anything in the practice – medication, vitamins, supplements, books, beauty products, etc.

• Appointments – % of appointments filled, % of noshows, % of appointments booked the same day or the day before.

• Money collected at check-in and check-out versus what should have been collected

#2 Stop Sending Patient Statements

Today the process of sending statements to patients is largely outsourced along with electronic claims, but it’s not very electronic.

If we can get paid by insurance companies electronically, why not get paid by patients electronically? I suggest that the practice of sending patient statements is not only resourceintensive, but it is also a 20th century business practice unsuited for a 21st century business. Why do practices insist on clinging to an outdated method of billing?

Setting up a statement-free practice is relatively easy

Use an online payment system that allows electronic payment plans.

An electronic payment plan enables a practice to enter a payment plan once, and have the system draft the credit/ debit card appropriately without staff management. It should also be able to send a receipt to the patient’s email, or to send a message to the patient to pick up the receipt through a secure portal.

Load your contract allowables into your practice management system.

If your system doesn’t have that capability, create a cheat sheet of your top codes for each contracted payer, so your check-out staff can calculate what the patient owes. There are also systems that can put together your contract information and the patient information into an estimate of what the patient owes for you.

Get online eligibility access that includes information about the patients’ benefits, deductibles, co-pays and co-insurance. This is available through your practice management system, your clearinghouse, or from a separate system that reads from your appointment schedule.

Practices that offer procedures or surgery should employ a financial counselor to sit down with patients and talk through financial responsibility and set up payment plans.

Coach staff on talking to patients about money. Teach them to become comfortable with collections.

People pay their bills via their credit/debit card routinely – this is not new or unusual for the majority of people. The ability to “set it and forget it” via electronic payment plans simplifies the payment system and speeds up cash flow. The ability to adjust a patient plan once insurance pays means no waiting to refund the patient or collect the remaining dollars. Your staff will still have to post the payments into the practice management system (although a few have integrated posting), but eliminating statements will save your practice money and time.

#3 When Do You Think

About Customer Service in Your Practice?

The problem with not thinking about customer service every day is that customer service is a day-to-day relationship. If you wait until you recognize the signs of things heading in the wrong direction, it could be too late. Just like other relationships, customer service in your practice needs consistent attention and creativity to keep things fresh and in the forefront of everyone’s mind. Just like other relationships, customer service is a living thing that needs care and feeding.

Customer Service is:

- Seeing people as individuals and remembering something about each one of them (yes, you probably will have to note it in the computer) continued on page 20 MEDMONTHLY.COM |19

continued from page 19

- Setting the practice thermostats to a comfortable level for the patients, not the staff. If you can’t get the thermostat to cooperate, tell every patient that the office is chilly and to bring a sweater or jacket. Buy a new or refurbished blanket warmer.

Everyone loves a warm blanket, especially when they are partially undressed!

- Inviting patients to roundtables to tell you what they like and don’t like about your practice. Don’t forget to invite patients who are really upset with the practice – they will give you the best information and can become your greatest advocates – if you are willing to listen.

- Telling patients when they call for their first appointment what the routine wait time is (be honest).

If the doctor always runs late, tell them how to plan for that.

Some patients are willing to wait and some patients either won’t wait, or can’t wait – try to align expectations early on.

Excellent customer service means patients will feel good about coming back, they may tell 3 or more people about their experience and they might even give your practice a very good review on Twitter, Facebook, Yelp, Angie’s List, and 1 or 2 other rating sites.

Customer Service is WHATEVER MAKES PEOPLE FEEL BETTER.

It is anything from saying “I’m sorry we didn’t do the best that we could have for you,” to providing a drink or a place to have a private conversation. We don’t have to be perfect, we just have to have the desire to provide the perfect experience for each patient. Compassion is having no preconceptions about the other person and being willing to serve the other person’s needs regardless of your own 20 | DECEMBER 2012

feelings about the person. It is taking “you” out of the equation.

#4 Consider Running an Urgent Care Within Your Practice

Many stakeholders are questioning what the advent of insurance for all Americans in 2014 will mean for patients whom have not had access to a medical home and coordinated care. The primary care physician is the de facto center of the ACO model, and the hub of care coordination. The influx of patients being encouraged (and hopefully wanting) to abandon the ED for a practice with expanded hours may overwhelm primary caregivers who do not have the potential to provide care seven days per week.

Challenges of Urgent Care

For many patients, going to the ED is a community norm, and one that may be difficult to redirect. The marketing budget for the Urgent Care may need to be significant to overcome long-standing community routines and to educate patients about the new Urgent Care.

For the practice operating Urgent Care hours at the same location as non-urgent care services, patients may find it frustrating to understand when the practice is a practice and when it is an urgent care. Patients may also resent that an appointment at 4:30 p.m. has a co-pay of $25 and walking in for service at 5:00 may require a $50 copay.

Other models of care that practices should contemplate, as adjuncts to face-to-face care, are a robust nurse triage program, telemedicine, and virtual visits.

Statistics on Urgent Care in America*

• Number of Urgent Care Centers in the U.S. 8,700

• Number of visits per center per week 342 • Ownership 50 percent physicians/ physician group, 13.5 percent corporation, 7.7 percent hospital • Comparative Visit Fees Urgent Care Center $156, Primary Care Physician Clinic $166, Emergency Room $414

#5 Create a Patient Advisory Board

Call it an Advisory Board, a Focus Group, a Patient Board or Patient Council. Whatever you choose to call the group of patients you meet with regularly, you need to have a group of patients you meet with regularly.

How do you start an Advisory Board?

• Budget. Have name tags made for Board members. Have lunch (nothing fancy) at every meeting.

When they leave the Advisory Board, present them with a plaque and a gift. Have a special thank you lunch (fancy) once a year for the Advisory Board.

• Have the staff keep a continuous list of patients they think would be good for the Advisory Board.

Naysayers, Question Askers and Perpetual Devil’s Advocates are all good choices. That one patient (or two) you couldn’t do anything right for. Don’t forget parents or children of patients, caregivers and spouses.

• Set a standing meeting date and time for the Advisory Board. The third Thursday of every month at noon. The first Tuesday of every month. Send invitations and/or emails for each meeting.

• Take minutes and keep an issues log. Get answers for questions.

Provide Board members with written records of the meetings.

*Courtesy of Urgent Care Association of Americas Urgent Care Industry Information Kit, 2011 (www.ucaoa.org)

‘‘

“We don’t have to be perfect, we just have to have the desire to provide the perfect experience for each patient”

• Invite staff members to attend on a rotating basis. Make sure staff have the opportunity the introduce themselves (everyone should introduce themselves at every meeting) and tell what they do in the practice.

• Experiment with physician attendance and gauge if the physicians’ presence is detrimental to open communication. You may be able to introduce a physician into the group after the Board has meet several times and everyone feels comfortable.

• You may get to a point when all the pithy issues have been addressed and the conversation doesn’t fill the Board meeting agenda. This is the time to start introducing short programs on new practice services, new physicians, or special topics you want the Board’s input on.

What is the right size for an Advisory Board?

Start with 12 people. Not everyone will come to every meeting, and some will probably drop off due to other commitments. If you target 12 people, have 10 stick with it and 8 people attend most meetings, it will be about right. If it isn’t, you can expand or shrink the number by inviting more people, or not filling vacant spots.

Don’t forget to set a service term that you can exercise if you need to.

#6 Use Remote Employees

If you can’t find the right part-time or full-time employees, maybe you’re not looking in the right places. One of the great things about business today is that a portion of your workforce can be anywhere. Your best employees may not live in your town, your state or your time zone.

Many employers can’t handle offsite employees, but study after study shows that both employers and employees win when employees work from home. Slaughter Development notes: “The real reason why telecommuting makes people more productive and more satisfied is this: outside of the office, employees are automatically in control their environment and workflow. There is no better way to build satisfaction than to give people authority and responsibility, and no better way to destroy productivity than to require people to work in environments and structures which do not leverage their expertise.”

What are other positives about remote employees?

• Employees spend less money and have less non-productive time (e.g. commuting), get more sleep and have a better life-work balance working from home, so they feel they win as employees.

• Not having to provide office space for employees means freeing up space to become revenueproducing. “Given that it costs more than $15,000 per year to provide an employee with 200 square feet of cubicle, the savings would be so great, in fact, that companies would still come out thousands of dollars ahead after springing for workers’ broadband and VoIP expenses.” (Wired Magazine) • Having employees work from home means staff can be scheduled to cover early or late shifts without the safety concerns of working in

an empty building.

• Remote employees can be parttime or prn and have floating hours to help cover busy times of the year, medical leaves and unexpected shortages.

• Not being exposed to office germs, office politics and negative behavior reduces stress and absenteeism and increases loyalty and retention.

• Telecommuting is green.

What are the negatives about remote employees?

• Some managers have no experience managing a remote workforce and may find it uncomfortable managing staff they cannot see.

• If the employee hasn’t worked from home before, s/he may experience feelings of being isolated and out of the loop.

• Most employers will choose to supply remote workers with computers, and therefore must to take responsibility for maintaining and repairing offsite computers.

• Communication with remote employees must be very strong and very consistent. Managers must pick up the phone, have Skype talks and video conferences.

• Remote employees will need performance standards just as onsite employees do, but their standards may be more production-oriented than timeoriented.

What are the medical practice positions that lend themselves to remote employees?

• transcription • coding and billing • nurse triage • scheduling • any task that does not require faceto-face time with patients 

The final 6 of the 12 ways to supercharge your practice will be presented in next month’s issue of Med Monthly.

MEDMONTHLY.COM |21

practice tips

Physicians, Don’t Have Money To Burn?

Another Chance To Avoid a 1.5% Reduction of All Medicare Payments In 2013

The Centers for Medicare and Medicaid Services (CMS) just announced that the Quality Reporting Communication Support Page (where you go to apply for one of the four hardship exemptions from the 2013 1.5% Medicare payment reduction) is re-open November 1, 2012 through January 31, 2013 for Medicare 2013 Electronic Prescribing (eRx) Payment Adjustment Hardship Exemption Requests.

22 | DECEMBER 2012

B

eginning November 1, 2012, CMS has reopened the Quality Reporting Communication Support Page to allow individual eligible professionals and CMS-selected group practices the opportunity to request a significant hardship exemption for the 2013 eRx payment adjustment. Significant hardship request should be submitted via the Quality Reporting Communication Support Page (Communication Support Page) on or between November 1, 2012 and January 31, 2012. CMS will review these requests on a case-by-case basis. All decisions on significant hardship exemption requests will be final.

Important — Please note that this is for the 2013 eRx payment adjustment only. Hardship exemption requests for the 2014 payment adjustment will be accepted during a separate time frame later in calendar year 2013.

Are You Already Exempt From the 2013 1.5% Payment Cut? The 2013 eRx payment adjustment only applies to certain individual eligible professionals. CMS will automatically exclude those individual eligible professionals who meet the following criteria: l The

eligible professional was a successful electronic prescriber during the 2011 (yes, 2011!) eRx 12- month reporting period (January 1, 2011 through December 31, 2011). l The eligible professional is not an MD, DO, podiatrist, Nurse Practitioner, or Physician Assistant by June 30, 2012, based on primary taxonomy code in the National Plan and Provider Enumeration System (NPPES). l The eligible professional does not have at least 100 Medicare Physician Fee Schedule (MPFS) cases containing an encounter code in the measures denominator for dates of service from January 1, 2012 through June 30, 2012. l The eligible professional does not have 10% or more of their MPFS allowable charges (per TIN) for encounter codes in the measures denominator for dates of service from January 1, 2012 through June 30, 2012. l The eligible professional does not have prescribing privileges and reported G8644 on a billable Medicare Part B service at least once on a claim between January 1, 2012 and June 30, 2012.

Avoiding the 2013 eRx Payment Adjustment Through Hardship Exemptions CMS may exempt individual eligible professionals and group practices participating in eRx GPRO from

the 2013 eRx payment adjustment if it is determined that compliance with the requirements for becoming a successful electronic prescriber would result in a significant hardship.

Significant Hardships The significant hardship categories are as follows: l The

eligible professional is unable to electronically prescribe due to local, state, or federal law, or regulation l The eligible professional has or will prescribe fewer than 100 prescriptions during a 6-month reporting period (January 1 through June 30, 2012) l The eligible professional practices in a rural area without sufficient high-speed Internet access l The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing

Submitting a Significant Hardship Request To request a significant hardship, individual eligible professionals and group practices participating in eRx GPRO must submit their significant hardship exemption requests through the Quality Reporting Communication Support Page (Communication Support Page) on or between November 1, 2012 and December 31, 2012.

Significant hardships associated with one of the four above reasons may be submitted ONLY via the Communication Support Page.

For more information on how to navigate the Communication Support Page, please reference the following documents: l Quality Reporting Communication Support Page

User Guide l Tips for Using the Quality Reporting Communication Support Page

For additional information and resources, please visit the E-Prescribing Incentive Program web page.

If you have questions regarding the eRx Incentive Program, eRx payment adjustments, or need assistance submitting a hardship exemption request, please contact the QualityNet Help Desk at 866-288-8912 (TTY 877715-6222) or via qnetsupport@sdps.org. They are available Monday through Friday from 7am to 7pm CST.  http://www.managemypractice.com/physicians-getanother-chance-for-2013-erx-hardship-exemption-startingnovember-1/ MEDMONTHLY.COM |23

practice tips

Physician Assistant Workforce Volume Strives to Meet Patient Demand

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

24 |DECEMBER 2012

In 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 Association of American Medical Colleges estimates that by 2020, the country will face a shortage of 90,000 physicians.

Increasingly informed patients and a cost-conscious marketplace are demanding new models of care that utilize all providers to their fullest potential in order to increase access to care and demonstrate improved health outcomes. Utilization of physician assistants (PAs) may be part of the delivery solution. Studies suggest that the addition of a PA to a medical practice may offer enhanced patient satisfaction, improved physician worklife balance, improved revenues and greater access to care for patients.

According to the American Academy of Physician Assistants (AAPA) there are 86,500 certified physician assistants practicing medicine nationwide. This is an increase of more than 100 percent over the last 10 years.

Many successful Accountable Care Organization (ACO) models are embracing a shift from volumebased reimbursement to value based reimbursement and the formation of population health management hubs.

With the development of these new structured organizations, PAs and NPs will also act as extenders to support the primary care physician within the medical home model.

Accrediting bodies such as (NCQA) and the Utilization Review Accreditation Commission (URAC) support the concept of the patient centered medical home (PCMH) as a proven model for delivering high

‘‘

“Currently, there is a shortage of primary care physicians and the Association of American Medical Colleges estimates that by 2020, the country will face a shortage of 90,000 physicians.”

quality, cost-effective patient care and encourage the inclusion of Physician Assistants. Nationally AAPA supports the fundamental premise that standards used to define the PCHM and newer care delivery models are not limited to physicians.

Approximately 35,000 PAs practice in primary care of all PAs nationwide.

Many PAs will practice in health care PCMHs, lead patient care teams and participate in and be an integral component of quality performance reporting.

By integrating the care delivery system and restructuring the delivery of primary care services across settings from outpatient to hospital, populations and conditions may be managed more efficiently. A team approach to care delivery will help to improve patient satisfaction and improve quality care for chronic diseases.

Utilization of PAs in the PCMH model may exist in several ways. In some settings, PAs may be focused on acute care or on management of chronic conditions, while in other communities, PAs may maintain their own panels of patients alongside physicians, and in rural communities, PAs may practice alone with a physician located off site. Optimal utilization supports the patient to choose a PA as a primary care

provider, ensuring and increasing access to care while the physician maintains oversight of the PA scope of practice. This utilization model allows for continuity of care, fosters patient/provider relationships, and underscores chronic disease management efforts for challenging care conditions including diabetes and asthma. Ultimately, the role of the PA within the PCMH will depend on the clinical setting, patient population, clinical competency and experience, and the professional relationship between the PA and the physician(s).

Using broad legislative language to describe the primary providers of health care encourages flexibility and innovation as practices shift toward developing systems of care that focus on value and quality rather than volumes of patients. Population management of chronic diseases will meet the needs of patients and community through models like PCMH and utilization of PAs will be an essential part of the successful workforce solution.  References: http://www.smartmoney.com/plan/ health-care/your-surgeon-may-not-bea-doctor-1346970593986/ https://www.aapa.org/news_and_ publications/news/item.aspx?id=5187 http://www.ahrq.gov/research/ pcwork2.htm Lisa P. Shock, MHS, PA-C, is a seasoned PA who has worked with clients to expand care teams in both large and small settings. She enjoys part time clinical primary care practice and is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering a wide range of services to help implement and improve upon the utilization of PAs and NPs in the health care system. Contact her at lisa@pushpa.biz MEDMONTHLY.COM |25

research & technology

Doctors Connect to Patients In an mHealth World Part 2 of 2

By

YOU IMAGINE 26 | DECEMBER 2012

In my last article I wrote about the increasing trend for doctors and medical staff to be using mobile devices in the clinical setting, and how this has changed the clinical setting: allowing for easier information and access to records right at patient bedside. In this article, I’d like to explore this question from the point of view of the patient.

Has this clinical change impacted the patient’s experience?

Are patients happy with the changes?

How are patients using iPads and mobile devices?

What is available for them to use? How is this changing the relationship to their health? And how can it change their relationship to their health?

Patients prefer the iPad when communicating with their doctors The use of iPads in clinical situations sets a good trend for patients. Ferdinand Velasco, M.D., chief medical information officer at Texas Health, sees a change in the doctor-patient interaction from doctors who are often leaving patient rooms to access information at computer terminals, to doctors who are using iPads as an accessory and offering more engaged patient conversations.1 Los Angeles, CA: CedarsSinai Medical Center has adopted widespread use of mobile devices in their hospitals.2 Lahey Clinic in Burlington, Massachusetts, has, too.3 Those involved in these initiatives have been widely in favor of the changes: both patients and doctors.

Since it is the one-on-one relationship with a doctor that patients find most satisfying, patients in these settings experience what feels like less indifference.4 Patients feel as if they are spending a lot more time with their doctors because of mobile devices. Dr. Finkel, co-chair of Lahey’s medical device committee, said that much of the time a physician typically spends away from the patient but attending to their medical needs, such as consulting with other physicians, reviewing, and ordering tests, can now be spent with the patient attending to those same tasks. He says patients see their own x-rays and test results, they are a part of the decisions made on the team, and they feel more in control and more connected than with the traditional setup.

And doctors say they enjoy being able to show patients the visual evidence of their medical conditions easily. It’s a situation where the human interaction is key and where the technology is making the experience better without dominating the human interaction. Elderly patients, specifically, benefit from this situation

because physicians are sitting closer to them within good earshot, and pointing to data and visual details on their mobile devices so that understanding the medical details is easier. Even family members of the patients prefer this kind of interaction, as the mobile device is easily shared between people and passed around.

The readily available content and medical records makes viewing x-rays and ekgs more accessible for family members and everyone involved in the patient’s care.5 “I can do anything at the patient bedside that I can do at a physician station, which saves time in my day,” Henry J. Feldman, MD, chief information architect for Harvard Medical Faculty Physicians and a hospitalist at Boston’s Beth Israel Deaconess Medical Center.6

An effective tool This trend is extending beyond the hospital setting. More and more frequently, iPads are being offered to patients as they walk into their

‘‘

“And doctors say they enjoy being able to show patients the visual evidence of their medical conditions easily. It’s a situation where the human interaction is key and where the technology is making the experience better without dominating the human interaction.” continued on page 28 MEDMONTHLY.COM |27

continued from page 27

doctor’s office, where a dynamic eForm captures all information and signatures, and then transmits the data to an EMR or EHR system, places a copy to SharePoint or other collaboration platform, and e-mails a PDF copy to whomever requires a copy.

At the Duke Oncology clinic, patients access secure online Web portals to answer questions between visits. Three-quarters of breast-cancer patients reported that they were able to remember their symptoms more accurately, and one-third of them said the online questionnaire prompted them to bring up issues with their doctors. And the staff feels there is a sense of anonymity, which has led to greater honesty and accuracy among patients in answering questionnaires about alcohol, sex, anxiety, and depression.7 One particular example I found was a medical student, Ales Chamessian, who made it clear to me how personal and helpful the mobile device can be: “Our team cared for a newborn who was showing signs of what appeared to be benign neonatal sleep myoclonus. The baby’s mother was very disturbed by the sight of her new (and first) daughter contracting during her sleep.

When I was presenting this case on rounds, I pulled up a Youtube video of benign neonatal sleep myoclonus and showed it to the parents and the rest of my team. When the mom saw the video of someone else’s baby twitching like her own, she was reassured that her daughter’s condition was fairly common and of little concern. Likewise, the rest of my team, which included residents, medical students, nurses and attendings, got a better view of what benign sleep myoclonus looks like.”8

How convenient it is, for those who have watched the changes in medicine 28 | DECEMBER 2012

from the old paradigm to the new, simply to have medical and visual information so close at hand.

Is the iPad or smartphone secure?

With so many physicians enthusiastic about the use of iPads in the clinical setting, if there is reluctance among physicians about the mobile device, it has to do with security. Unless doctors are using encrypted apps that securely protect patient information, they can’t use the devices to communicate to or about patients’ personal medical information without violating the Health Insurance Portability & Accountability Act, or HIPAA. But on September 28, new legislation was announced to make the approval process simpler and more streamlined for the FDA. The Healthcare Innovation and Marketplace Technologies Act (HIMTA) will allow the formation of a special Office of Mobile Health at the FDA.9 This office will provide approval and recommendations for apps and offer a developer support program at the Department of Health and Human Services. Such support will give app developers understanding

about the privacy regulations, and acknowledgment as to whether they are following the privacy regulations required by HIPAA. While this effort to make apps secure is a hot topic in iPad technology, in the meantime, apps have are avoiding the issue by “dumbing down”. Apps do not include personal information or store data that might be associated with a particular patient. This may be unfortunate for the patient, according to Chris Wasden, Global Healthcare Innovation Leader for PricewaterhouseCoopers.10 But it is an issue which may, in the long run, find a good solution. For those app developers who have made special effort to comply with secure protocols and have been cleared by the FDA, it is easy enough to find them on iTunes by doing a search for “AirStrip”.

Meanwhile, AT&T is developing the mHealth Platform to help bridge the gap between health and mobility. The platform will allow users to aggregate date from their insurance company, various devices and applications, and doctor’s offices, and hold it in a secure form, allowing applications to track health information with a secure infrastructure while sharing date with friends, family, and their health care professionals. This will all

be integrated into one app platform, creating a powerfully useful tool for the consumer to authorize and offer to health care providers when needed. It also promises to make the use of this secure system easy for app developers.

Many of the apps available offer something interesting without the need to reference medical records.

But there is freedom for developers, in designing apps with this purpose in mind. Recently I was speaking with an orthodontist to design a toothbrushing app for children, and the question came up of being able to keep a tooth-brushing record that the child could share with the orthodontist.

Presently this is not something the orthodontist can offer, with the security concerns on iPad. And for those settings where EHR transfer is secure, according to the Manhattan Research Study, 63% of doctors are using them.11

It’s a future more patientfocused vision for medicine Technology changes rapidly. We have as our vision an ideal: a future where both doctors’ and patients’ needs are met. This technology, mobile devices, offers a step in a better direction. Mobile devices satisfy doctors because they are an immediate and rich source of information. They also satisfy patients because they offer a closer and more interactive experience with the health professional. The future looks promising to offer secure apps so that medical records can be transferred confidentially. And developers are eager to create new application models with new possibilities. In my last article I offered a review of medical apps. Next month I will explore health apps and offer a review for some of the apps available in this expanding field of mobile health. 

Can the iPad Cure What Ails Us?

By Tom Kaneshige. http://www.pcworld. com/article/229374/Can_the_iPad_ Cure_What_Ails_Us_.html 2 HC industry needs to put the iPad in context

By Brian Dolan. http://mobihealthnews. com/special-issue-ipad-in-healthcare/ 3 Have iPad—can travel. How tablets at the bedside save doctors an hour a day

By Bonnie Darves http://www. todayshospitalist.com/index. php?b=articles_read&cnt=1438 4 Trouble with the Caregiver – Patient Connection http://www.nurture.com/ category/report/.

5 See 4.

6 Today’s Hospitalist. Taking your tablet to work?

The benefits and challenges of mobile computing in the hospital http://www.todayshospitalist.com/index. php?b=articles_read&cnt=1511 7 The Economist Group. Saving Lives One iPad at a Time. http://www. economistgroup.com/leanback/newbusiness-models/saving-lives-one-ipadat-a-time/ 8 How a medical student uses an iPad for patient care and education. By Alex Chamessian. October 23, 2011 in TECH. http://www.kevinmd.com/blog/2011/10/ medical-student-ipad-patient-careeducation.html.

9 Who Should Regulate Medical Mobile Apps? FDA or Some Other HHS Agency?

By Carmelina G. Allis. Oct 4, 2012 in FADALAWBLOG. http://www. fdalawblog.net/fda_law_blog_hyman_ phelps/2012/10/who-should-regulatemedical-mobile-apps-fda-or-someother-hhs-agency.html 10 Mobile health is taking off but what’s still in its way? By Ki Mae Heussner.

Jul 10, 2012 in GigaOm. http://gigaom. com/2012/07/10/mobile-health-istaking-off-but-whats-still-in-its-way/ 11 Manhattan Research Physician Specialist Survey. “2012 Taking the Pulse” polling 3,015 U.S. practicing physicians in over 25 specialties. http:// manhattanresearch.com/News-andEvents/Press-Releases/physician-digitalmedia-adoption.

1

MEDMONTHLY.COM |29

research & technology

Health IT Best Practices to Minimize Cash Flow Disruptions Resulting from ICD-10 Implementation

by Frank J. Rosello, CEO, Environmental Intelligence LL

30 | DECEMBER 2012

In order for medical organizations to effectively mitigate the risks involved with ICD-10 implementation, it is imperative for them to include a thorough review of potential cash flow risks as part of their overall ICD-10 planning.

W

hen any business is involved with a major system conversion, at risk is the potential disruption to cash flow, resulting in a negative impact to the bottom line.

With the current 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) implementation deadline of October 1, 2013 quickly approaching, medical organizations need to be well prepared to handle the financial risks associated with this initiative. In order for medical organizations to effectively mitigate the risks involved with ICD-10 implementation, it is imperative for them to include a thorough review of potential cash flow risks as part of their overall ICD-10 planning.

A component of a sound holistic risk mitigation strategy includes providers understanding their current revenue stream and be able to forecast possible changes to cash flow before, during, and post ICD-10 implementation. Medical organizations who proactively engage in advanced planning to protect revenue loss will also experience the unique opportunity to evaluate and improve their overall business operations, maximize operational efficiency, enhance their revenue stream, and control costs on a global scale.

While it is expected that reimbursements will initially decline with ICD-10 conversion, providers should now be engaged in aggressively taking advantage of the time remaining to diagnose and put in place a risk mitigation plan that will address any cash flow fluctuations from moving to ICD-10. To help medical organizations and providers prepare to make the transition to ICD-10, consider the following nine best practice action items when preparing a risk mitigation plan: 1. Explore and determine budgeting avenues for additional cash reserves if material delays in

payment occur resulting from the transition to ICD-10.

2. Perform a comprehensive review of all managed care contracts to potentially negotiate protective language relevant to reimbursement in the event payment shifts occur that could have a negative impact to cash flow and subsequently the bottom line.

3. Conduct a series of financial modeling to better understand the financial implications of moving from ICD-9 to ICD-10 and forecast the revenue impact by provider or facility, line of business, and geography.

4. Proactively engage with highvolume payers to assess their readiness level to process claims in the ICD-10 compliant format.

5. Develop a strategic plan for the coding, billing and claim backlogs processes to minimize disruptions and maximize cash flow.

6. Conduct clinical documentation improvement reviews with all stakeholders using the ICD-10 code set.

7. Develop a strategy and process for managing claim denials pre and post ICD-10 implementation.

8. Review audits currently occurring that may be impacted in the future by compliant use of the ICD-10 code set.

9. Perform ICD-10 readiness level assessments of all external vendors who support the coding, billing, follow up, and denials functions As the United States moves closer towards the deadline for this important classification conversion, top priority for both payers and providers should be on what IT systems will require retooling, what workflows will require reengineering, and budgeting for any infrastructure investments. Medical organizations and providers who proactively develop strategic and risk mitigation plans will be best positioned to experience a smooth transition to ICD-10. 

Providing customized, simple

NUTRITION SOLUTIONS to

ENHANCE HEALTH and

OPTIMIZE SPORTS PERFORMANCE Tracy Owens, MPH, RD, CSSD, LDN Ashley Acornley, MS, RD, LDN 6200 Falls of Neuse Road, Suite 200 Raleigh, NC 27609 919-876-9779

Blue Cross Blue Shield of North Carolina and Cigna insurance provider.

MEDMONTHLY.COM |29

research & technology

Everything Else is Smart Now...

Why Not Your Pills?

You’ve heard of smart cars, smartphones and smart grids. What about smart pills?

They are not, unfortunately, pills that boost people’s smarts. They comprise a small diagnostic tool for health care professionals. Also called Ingestible Capsule Technology (ICT), a smart pill is a miniaturized microelectronic systems in a single chip enclosed in a small capsule that a patient can swallow. The tiny device then uses its diagnostic and bio-medical applications to collect information and transmit it to physicians and other specialists.

And it will soon be worth big money, according to new research.

According to a new market research report, “Smart Pill Technology Market (2012-2017)” published by MarketsandMarkets, the smart pill technology market is expected to grow at a compound annual growth rate (CAGR) of 17 percent, reaching $965 million by the year 2017. The rapid growth the market is attributed in part to the rising number of screening treatments 32| DECEMBER 2012

for gastrointestinal (GI) disorders as well as improved reimbursement coverage across both developing and developed nations.

Research has broken the smart pill market into subcategories, including capsule endoscopy (observing and collecting data from the patient’s digestive system), smart pills for drug delivery and patient monitoring smart pills, which deliver data about a patient’s condition to physicians or researchers.

The report identifies the potential market drivers and restraints to anticipate future technology trends, opportunities and overcoming the challenges. The market is segmented and revenue is forecasted on the basis of major regions such as North America, Europe, Asia-Pacific and Middle-east and Africa.  http://www.healthtechzone.com/topics/healthcare/ articles/2012/10/16/312097-everything-else-smartnowwhy-not-pills.htm

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What You Need to Know About Health Savings Accounts

Is a health saving account (“HSA”) right for you? Find out in this article which summarizes what a HSA is, who is eligible to establish one, types of expenses that can be paid with HSA funds, increases to HSA limits in 2013 and how health care reform changed the way HSAs are used.

I. What is an HSA? A HSA “is a tax exempt trust or custodial account,” which is set up through a qualified HSA trustee or insurance company.1 HSAs first became available in 2004 through the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (“MMA”). 2 An HSA can be contributed to, by or on behalf of, “eligible individuals,” as defined below, and is used to pay for certain medical expenses for the 34 |DECEMBER 2012

eligible individuals, their spouses and their tax dependents. For eligible individuals, HSAs offer the following numerous benefits: • The funds contributed to an HSA are set aside tax-free to be used for qualified medical expenses; • employer contributions to an employee’s HSA are excluded from income and employment taxes 3; • an individual can claim an “above the line” tax deduction for any contribution made to the HSA4;

By Simi Botic Associate at Dinsmore Medical Office Today • an individual can decide exactly how much to set aside for medical expenses; • an individual can use the money in his or her HSA for a variety of health care expenses which health insurance plans may not cover, including dental expenses like cleanings and braces, vision care, and alternative treatments like acupuncture; • an individual’s contributions remain in his or her HSA from

year to year until they are used; • interest and other earnings in an HSA are tax free; distributions from an HSA may be tax free if used for a qualified medical expense; • an HSA is portable, so it travels with an individual as he or she changes employers or leaves the work force.5

II. Who is Eligible to Establish an HSA? You must be an eligible individual to qualify for an HSA. To be HSAeligible, an individual must meet the following four requirements: • An HSA is only available to an individual who is enrolled in a high-deductible health plan (“HDHP”)6 for the months in which contributions are made to the HSA.7 • An individual cannot have other health coverage, except for a few permitted “other health coverage”8 exceptions.9 • An individual cannot be enrolled in Medicare.10 • An individual cannot be claimed as a dependent on someone else’s tax return.11

III. Types of Expenses that can be Paid with HSA Funds HSA distributions are entirely voluntary, and HSA distributions are generally available without restriction.

This means, an individual can pay any expense with his or her HSA funds. Specifically, IRS Notice 2004-2 states “an individual is permitted to receive distributions from an HSA at any time.”12 While an individual can always access the funds in his or her HSA, the tax treatment of a distribution will depend on the timing of the distribution and whether any unreimbursed medical expenses can be used to offset the distribution.

An HSA distribution is excluded

from an individual’s gross income and tax-free if used for the qualified medical expenses of an account holder, his or her spouse, and tax dependents.

A “qualified medical expense” is an “expenditure for medical care, as defined by §213(d), for the account holder and his or her spouse or tax dependents, to the extent that such accounts are not reimbursed by insurance or otherwise.”13 Typically, a distribution to pay for insurance premiums is not tax-free.

If a distribution is made from an HSA for nonmedical expenses, those distributions will be included in an individual’s gross income and will be subject to an additional 20% tax (this 20% additional tax took effect beginning with the 2011 tax year. This is an increase from 10% that applied for tax years prior to 2011).14

IV. IRS Increases to HSA Limits in 2013 HSA contributions may be made by an HSA account holder, or other individuals including the account holder’s spouse, tax dependents and employer.15 The amount that can be contributed to an individual’s HSA depends on factors, including the type of HDHP coverage the person has, the individual’s age16 and date of eligibility.17, 18 Limits on HSA contributions apply to an individual account holder based on his or her taxable year. The same annual limits apply regardless of who makes an HSA contribution.19 Changes to these limits are around the corner as the IRS has announced increases to HSA account limits, effective in 2013. HSA limits will adjust each year for cost of living.

The current 2012 maximum contributions for HSAs are $3,100 for individuals and $6,250 for families.20 However, the maximum contributions for both individuals and families will be increasing slightly in 2013, according to the IRS.21 Under IRS Revenue Procedure 2012-36, the maximum contributions that can be

made to HSAs in 2013 will increase to $3,250 for employees with individual coverage and to $6,450 for employees with family coverage.22 It is important to note that HSA account fees are not treated as an HSA contribution, and therefore are not calculated in the maximum contribution.23 In addition to the rise in maximum contribution, the IRS has also announced a simultaneous rise in the minimum deductable for all HDHPs, which HSAs must be linked to.24 In 2013, the minimum deductible will rise from $1,200 to $1,250 for employees with individual coverage and from $2,400 to $2,500 for employees with family coverage.25 Finally, the maximum out-ofpocket expense, which includes but is not limited to an employee’s deductibles, will also rise in 2013.26 For employees with individual plans, the maximum out-of-pocket expense will rise from $6,050 to $6,250, and for employees with family plans it will increase from $12,100 to $12,500.27 No changes will be made to the HSA catch-up contributions.28 Therefore, the 2012 $1,000 HSA catchup contribution limit will carry-over to 2013.29 If HSA contributions exceed the limits imposed by law, an individual will be subject to an excise tax of 6% for each taxable year in which excess contributions are made.

V. How Health Care Reform Changes the Way HSAs are Used Health care reform, specifically the Patient Protection and Affordable Care Act (“ACA”)30 has changed the way HSA accounts are used in two ways.

Significantly, ACA has: (1) added a prescription requirement for the reimbursement of over-the-counter (“OTC”)31 medicines and drugs, other than insulin32; and (2) increased the amount of penalty for nonmedical continued on page 36 MEDMONTHLY.COM |35

continued from page 35

expense distributions from an HSA as more fully explained below.33 ACA establishes new restrictions on reimbursement for OTC34 drugs and medicines if purchased in tax years after December 31, 2010. According to these new restrictions, HSAs can only provide tax-free distributions for medicines and drugs if they are prescribed35, with the exception of insulin.36 This is true even if a prescription is not necessary to acquire the medicines or drugs. The new health care reform restrictions do not apply to OTC items that are not drugs or medicines (i.e. medical devices, equipment, crutches, blood sugar test kits and eyeglasses). Under ACA, if distributions are made from an HSA for nonmedical expenses, the distribution will be subject to a 20% tax.37 This increase applies to all distributions made for tax years after December 31, 2010. As previously discussed, this is an increase from 10% that applied for tax years prior to 2011.  See IRS Publication 969 (2011), Health Savings Accounts and Other Tax-Favored Health Plans.

2 Id. 3 See Code §§106(d), 3231(e)(11), 3306(b)(18), and 3401(a)(22).

4 See Code §62(a)(19).

5 See IRS Publication 969 (2011), Health Savings Accounts and Other Tax-Favored Health Plans.

6 An HDHP is a health insurance plan with high deductibles but lower premiums than traditional health insurance plans.

7 See IRS Publication 969 (2011), Health Savings Accounts and Other Tax-Favored Health Plans.

8 Generally, an HSA eligible individual cannot have other health coverage.

But, an individual can have additional insurance that provides benefits only for the following items: liabilities incurred under workers’ compensation laws, tort liabilities or liabilities related to ownership or use of property; a 1

36 |DECEMBER 2012

specific disease or illness; and a fixed amount per specified period for hospitalization. An individual may also have coverage for: accidents; disability; dental care; vision care; and long-term care.

9 Id. 10 Id. 11 Id. 12 Only reasonable restrictions on frequency or amount of distributions from an HSA are permissible by the IRS. 13 See Code §223(d)(2); IRS Notice 2004-2, 2004-2 I.R.B. 269, Q/A-26, See also IRS Notice 2004-50, 2004-33 I.R.B. 196, Q/As-26 and 028.

14 See Code §223(f)(2) and (4) as amended by PPACA, Pub. L. No. 111-148, §9004(a)(2010)(applicable to distributions made after December 31, 2010).

15 See IRS Notice 2004-50, 2004-33 I.R.B. 196, Q/A-28.

16 Known as “Catch-up Contribution.”

17 Known as “The Last-month Rule.”

18 See IRS Publication 969 (2011), Health Savings Accounts and Other Tax-Favored Health Plans.

19 See IRS Notice 2004-2, 2004-2 I.R.B. 269, Q/A-12 and IRS Notice 2004-50, 2004-33 I.R.B. 196, Q/A-28.

20 See Geiser, Jerry Workforce, Health Savings Account Contribution Caps to Rise Slightly in 2013, available at http://www.workforce.com/ article/20120427/NEWS01/120429965/ health-savings-account-contributioncaps-to-rise-slightly-in-2013 (April 27, 20 12).

21 Id. 22 Id. 23 See IRS Notice 2004-50, 2004-33 I.R.B. 196, Q/A-71.

24 See Geiser, Jerry Workforce, Health Savings Account Contribution Caps to Rise Slightly in 2013, available at http://www.workforce.com/ article/20120427/NEWS01/120429965/ health-savings-account-contributioncaps-to-rise-slightly-in-2013 (April 27, 2012).

25 Id.

Id. Id. 28 See Paton, Jenn, FosterThomas, Health Savings Account (HSA) Changes for 2013, available at http:// www.fosterthomas.com/blog/ bid/53573/Health-Savings-AccountHSA-Changes-for-2013 (May 24, 2012).

29 Id. 30 See Patient Protection and Affordable Care Act, Pub. L. No. 111148 (2010), as amended by Health Care and Educational Reconciliation Act of 2010, Pub. L. No. 111-152 (2010).

31 A “prescription drug” is defined as a “drug that can be obtained only by means of a physician’s prescription,” while “OTC” is a term used to describe “a drug that is sold lawfully without a prescription.” See U.S. National Library of Medicine, MEDLINEplus: Medical Dictionary (as visited Oct. 12, 2012).

32 Under the ACA, non-prescription insulin will still be considered qualified medical expenses, and therefore disbursements for insulin will be taxfree.

33 See Patient Protection and Affordable Care Act, Pub. L. No. 111148 (2010), as amended by Health Care and Educational Reconciliation Act of 2010, Pub. L. No. 111-152 (2010).

34 OTC drugs are not taken into account when determining an individual’s medical expense deduction under Code §213. See §213(b).

35 “Prescription” is defined as “a written or electronic order that satisfies the legal requirements for a prescription in the state in which the expense is incurred, including t hat it be issues by someone who is legally authorized to issue a prescription in that state.” See IRS Notice 2010-59, 2010-39 I.R.B. 396.

36 See Code §106(f), as added by ACA, Pub. L. No. 111-148 (2010).

37 Code §§ 223(f)(4)(A) and 220(f)(4) (A) as amended by ACA, Pub. L. No. 111-148(2010).

26 27

MEDMONTHLY.COM |37

legal

Community Health Centers and the Affordable Care Act: Increasing Access to Affordable, Cost Effective, High Quality Care For more than 40 years, community health centers have delivered comprehensive, high-quality preventive and primary health care to patients regardless of their ability to pay. During that time, community health centers have become the essential primary care medical home for millions of Americans including some of the nation’s most vulnerable populations. With a proven track record of success, community health centers have played an essential role in national recovery and reinvestment efforts and will play a key role in implementation of the Affordable Care Act. 38| DECEMBER 2012

The Affordable Care Act: The Essential Role of Community Health Centers The Affordable Care Act provides $11 billion to bolster and expand community health centers over 5 years. l $1.5 billion will support major construction and renovation projects at community health centers nationwide. l $9.5 billion will: u Create new community health center sites in medically under served areas; and

u Expand preventive and primary health care services, including oral health, behavioral health, pharmacy, and/or enabling services, at existing community health center sites. $250 million was made available to support the establishment of approximately 350 new community health center sites in fiscal year 2011.

The expansion of community health center sites and services will make affordable, cost-effective, high quality preventive and primary care services available to nearly twice as many

people regardless of their insurance status or ability to pay; and will create thousands of direct employment opportunities in many of the country’s most economically distressed, low income communities.

Community health centers are poised to play an essential role in the implementation of the Affordable Care Act. In particular, community health centers emphasize coordinated primary and preventive services or a “medical home” that promotes reductions in health disparities for low-income individuals, racial and ethnic minorities, rural communities and other underserved populations.

Community health centers place emphasis on the coordination and comprehensiveness of care, the ability to manage patients with multiple health care needs, and the use of key quality improvement practices, including health information technology. The community health center model also overcomes geographic, cultural, linguistic and other barriers through a teambased approach to care that includes physicians, nurse practitioners, physician assistants, nurses, dentists, dental hygienists, behavioral health care providers, case managers and health educators.

Delivery of Care: Increased Access to Health Services Rooted in a commitment to community-based, patient-centered care, community health centers continue to focus on comprehensive services that meet the varying needs of their patient populations including: chronic disease management, prevention and patient education activities, and outreach. Today, a network of more than 1,100 community health centers operate 8,100 service delivery sites that provide care to nearly 19.5 million patients in every State, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and the Pacific Basin. About half of

Community Health Centers Serve All Ages

Source: U.S. Department of Health and Human Services, Health Resources and Services Administration, Uniform Data System, 2009. all community health center grantees serve a critical need in rural America; the remainder are found in urban areas.

This network of community health centers has created one of the largest safety net systems of primary and preventive care in the country with a true national impact. l Community health centers, supported by the Health Resources and Services Administration (HRSA), treated 19.5 million people in 2010, more than half of whom were members of racial and ethnic minority groups.

Nearly forty percent had no health insurance; a third were children. l In 2009, one out of every 17 people living in the U.S. now relies on a HRSA-funded clinic for primary care. l Community health centers are an integral source of local employment and economic growth in many underserved and lowincome communities. Since the beginning of 2009, health centers have added more than 18,600

new full time positions in many of the nation’s most economically distressed communities. l In 2010, they employed more than 131,000 staff including 9,600 physicians, 6,400 nurse practitioners, physicians’ assistants, and certified nurse midwives, 11,400 nurses, 9,500 dental staff, 4,200 behavioral health staff, and more than 12,000 case managers, health education, outreach, and transportation staff.

Community health center quality of care equals and often surpasses that provided by other primary care providers. A programmatic emphasis on quality improvement as well as community-responsive and culturally appropriate care has also translated into impressive reductions in health disparities for community health center patients. Calendar Year 2009 Health Center Program data demonstrate that centers continue to provide high quality care and improve patient outcomes, while continued on page 40 MEDMONTHLY.COM |39

continued from page 39

reducing disparities, despite serving a population that is often sicker and more at risk than seen nationally: l Between 2008 and 2009, the percent of low birth weight babies decreased yet again, from 7.6 percent to 7.3 percent, which is lower than the most recent estimated national rate of 8.2 percent. In addition, the rate of entry into prenatal care in the first trimester increased from 65 percent to 67 percent. l 71 percent of community health center patients demonstrated control over their diabetes with a hemoglobin A1c (HbA1c) level less than or equal to 9. l 63 percent of hypertensive community health center patients have their blood pressure under control; an increase from 2008.

Community health centers also reduce costs to health systems; the community health center model of care has been shown to reduce the use of costlier providers of care, such as emergency departments (EDs) and hospitals. Community health centers continue to deliver high quality care efficiently and effectively at a total annual cost of $600 per patient in 2009.

Recovery and Reinvestment: Demonstrated Community Health Center Impact Enacted in 2009, the American Recovery and Reinvestment Act (ARRA) provided $2 billion for community-based grants to community health centers over a 2-year period; an unprecedented opportunity to serve more patients, retain existing and support new jobs, meet the significant increase in demand for primary health care services among the nation’s uninsured and underserved populations and address essential construction, renovation, equipment and health information technology systems

‘‘

With a proven track record of success, community health centers have played an essential role in national recovery and reinvestment efforts and will play a key role in implementation of the Affordable Care Act.

needs in community health centers.

To date, this $2 billion investment in community health centers has resulted in major increases in access to care while supporting the long term capacity of community health centers to serve even more patients through facility and technology expansions and upgrades, including: l The establishment of 127 new community health center sites. l Preventive and primary health care services for more than 4.3 million additional patients, about 50% who are uninsured; l In 2009, community health centers hired 10,000 additional staff, and overall provided employment opportunities for more than 123,000 people in many of the nation’s most economically distressed communities; and The construction, repair and renovation of more than 1,600 community health center sites nationwide, including the addition of electronic health records systems in more than 350 community health centers.  http://www.healthcare.gov/news/ factsheets/2010/08/increasing-access. html

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MEDMONTHLY.COM |41

legal

Preparing for Health Care Reform An Agent’s Perspective

By Joe Gupton, CWCS, EmployeeSync Specialist, Jones Insurance

42| DECEMBER 2012

W

ith the elections over, we now have a very clear image of the future of health insurance in the U.S.. The intent of PPACA is clearly a good idea because there is a need for an initiative to help truly disadvantaged families and individuals struggling with chronic disease. Furthermore, the idea that by helping these Americans, the $49 billion in unpaid and unrecoverable costs that hospitals incur annually could be lowered by this same act. Unfortunately, along with the good intentions of this legislation come some major challenges.

Some businesses for example will now be held responsible for providing and administering medical insurance plans for their employees. Additionally, these plans will be subject to increasingly intense governmental scrutiny. Considering these circumstances, the roles of health insurance brokers and agents will now be more important than ever.

With the pending changes, agents will need to reevaluate their business model and decide if they will fight harder to prosper in an increasingly difficult market or gradually lose their books of business to more qualified and pro-active agencies. We have already seen the commissions paid by health insurance carriers fall and are very aware that the same insurance companies will soon create on-line “pick-your-own” health plans for individuals which require very little help from a professional. Small employers will also have access to S.H.O.P. exchanges (Small-business Health Option Programs) and may decide that the additional fees to hire a licensed agent seem unnecessary or unaffordable. The most significant challenge that agents face will be maintaining large employers (over 50 full time equivalent employees) as clients because those organizations will be evaluating the cost per service provider ever more closely.

Owners and executives of 50-plus employee groups need to embrace the idea of a 3 year plan regarding the

management of their benefits package and must now take a very subjective look at what their current agent is suggesting. As any trusted advisor should, a benefits broker will need to present a complete understanding of how reform will impact each client’s unique business, as well as a specific strategy for achieving long term goals.

The January 1st, 2014 deadline for implementation of health care reform is approaching quickly and the concept of picking major medical plans from a spreadsheet once a year is now an invalid solution. So what does all this mean to insurance agencies and the broker community?

First of all, we must make our clients aware of the reality of the new legislation. The reality for some businesses is that they are not even subject to the mandate, or that they already provide adequate and affordable coverage by the new governmental standards. These groups will only need guidance on how to gradually adapt to the requirements in the coming years and advise on how to “future-proof ” their compliant status.

Other groups who are not offering any health coverage or have non-compliant plans will need to hear the honest truth and prepare to make a significant change to the way they operate.

As agents, we must also be ready to offer businesses help in establishing wellness plans that result in lower utilization of, and dependence on, health insurance as a means of health care. After all, health care and medical insurance are two separate and different components of “reform”.

Health care is effectively maintaining one’s physical wellbeing which includes doctor’s visits, prescriptions and major medical care for chronic disease, terminal illness and accidents. Health insurance on the other hand, is a viable way to cover the financial costs associated with that care. Employees and employers must be aware of the difference in the two and, at the same time, the direct correlation of both components. That means that

‘‘

“The most significant challenge that agents face will be maintaining large employers (over 50 full time equivalent employees) as clients because those organizations will be evaluating the cost per service provider ever more closely.”

significant investments must be made to educate employees, measure and track improvements in employees’ health, and help those with chronic diseases, weight management and unhealthy lifestyle issues. Ultimately, agents must be poised to handle these tasks for their clients and in turn use the results to actively fine tune their insurance purchases to be as cost effective as possible.

Agents who intend to remain in the health insurance and group benefits business will have to work harder, learn more, and re-invest a larger portion of their earnings in value added services in order to remain useful advisors for their clients. The complex role of compliance auditor, human resources support, wellness coordinator, and contract negotiator that agents play, has now become more complicated and is more crucial than ever. Business owners will have to rely more and more on their broker’s advice in the coming years and the consequences of poor recommendations could be financially catastrophic.  MEDMONTHLY.COM |43

5 features

Consumer Tips to Na New ‘Summary of Be and Coverage’ Forms

44 | DECEMBER 2012

avigate enefits eHealthInsurance, America’s first and largest private health insurance exchange, released its top five tips to help consumers navigate the new “Summary of Benefits and Coverage” (SBC) forms in accordance with provisions of the 2010 Affordable Care Act (ACA). Many consumers will come into contact with these new forms for the first time as they review and compare health insurance plans during this year’s open enrollment season.

H

ealth insurance companies are required to make copies of the new Summary of Benefits and Coverage forms available to consumers for each health insurance plan they sell beginning September 23, 2012. The intent of the new forms is to provide consumers with a standardized, easy-to-understand description of how benefits and costs are balanced by each health insurance plan, and to help consumers make informed purchasing and enrollment decisions.

“Translating health insurance terminology into language the average person can understand helps consumers make the right coverage decisions for their personal needs.” said Gary Matalucci, eHealthInsurance, Vice President of Customer Care.

The new Summary of Benefits and Coverage forms answer basic consumer questions (like “What is the overall deductible?” or “Does this plan use a network of providers?”) and explain why answers to these questions matter. They describe “common medical events” (such as visiting a doctor’s office, needing prescription drugs, or staying overnight in the hospital) and explain how much a patient may be required to pay for these services. The forms also provide a list of medical services excluded from coverage, and an estimate of the total patient responsibility for medical bills incurred in case of pregnancy and delivery, or for the management of Type 2 diabetes.

The final template for the Summary of Benefits and Coverage forms produced by the U.S. Department of Health and Human Services is six pages long and it’s recommended that health insurance consumers review the whole form before making a final plan selection. The highlights and tips provided below were selected to provide a summary guide to items of special consumer concern.

Top Five Things to Look for on the New Summary of Benefits and Coverage Forms: 1. The Maximum Out-of-pocket Limit. What would happen if you became seriously ill or suffered an accident and suddenly found yourself facing serious hospital bills? The maximum out-of-pocket limit (MOOP) describes the upper limit of your personal financial exposure per year under a particular plan. Once you reach your maximum out-of-pocket limit, the health insurance company picks up all bills for most covered, medically necessary expenses. A typical MOOP ranges between $5,000 and $7,500. Be sure that, if the worst happened, you could afford your MOOP. Note that the maximum out-of-pocket limit does not include your monthly premiums. To find a plan’s MOOP on the new Summary of Benefits and Coverage form, look under “Important Questions” and find the question: “Is there an out-ofpocket limit on my expenses?”

2. The Deductible. The deductible is an amount you must pay out-of-pocket each year for specified medical services before the health insurance company steps in to provide coverage. Monthly premiums and copayments do not apply toward the deductible. Not all medical care is subject to the deductible, however. Many preventive care services, for example, are covered by most plans even before you meet your deductible. Some health insurance plans may also have more than one deductible. For example, some may have separate deductibles for in-network and out-of-network physicians. Others may have a separate deductible for prescription drugs. The new Summary of Benefits and Coverage form addresses deductibles in the “Important Questions” section. continued on page 46 MEDMONTHLY.COM |45

continued from page 45

3. The Cost of a Doctor’s Office Visit When Ill. Since many people only see the doctor when sick, it’s important to understand your level of coverage for these visits. When reviewing the new Summary of Benefits and Coverage form, you will find this addressed in the section describing coverage for common medical events. Make sure you understand what your copayment is when visiting an in-network or out-of-network physician, and whether your doctor’s office visit is subject to your annual deductible.

4. The Network of Providers. Many health insurance plans – especially HMOs and PPOs – contract with medical provider networks to negotiate discounted charges for patient care. It’s important to know if the plan you’re considering restricts your access to doctors, and whether or not your preferred doctor is covered by the plan. Under the “Important Questions” section of the new Summary of Benefits and Coverage form, you’ll find information about provider networks and covered doctors. If there are differences in coverage between in-network and out-of-network providers, these differences should be described in the “Common Medical Events” section of the form.

46| DECEMBER 2012

5. Coverage for Prescription Drugs. In order to pick up a prescription drug from the pharmacy, most health insurance plan members are required to make a copayment or pay a percentage of the drug’s total cost. Some health insurance plans may have a separate deductible for prescription drugs. Many, however, have different coverage tiers for different kinds of drugs. Make sure you understand how much you’ll be required to pay for generic drugs, preferred brandname drugs, and other drugs, before you enroll in a plan. Information about prescription drug coverage is found in the new Summary of Benefits and Coverage forms in the section describing common medical events.

There is a great deal of complexity to health insurance coverage and many consumers will not readily understand how to judge between two different plans.

It’s recommended that consumers considering their health insurance alternatives work with their employer’s Human Resources department or contact a licensed health insurance agent, like eHealthInsurance.com, for personal assistance and advice.  Reprinted courtesy of eHealthInsurance http://news.ehealthinsurance.com/pr/ehi/health-insuranceopen-enrollment-238927.aspx

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TIPS FOR DOCTORS WHO NEGOTIATE REIMBURSEMENT RATES WITH INSURANCE COMPANIES

by Ed Rabinowitz 48 |DECEMBER 2012

When it comes to negotiating fees with health plans, practices and physicians have more leverage than they realize. The problem, says John Schmitt, a managed care expert with EthosPartners Healthcare Management Group, is that practices often don’t even try. “Groups negotiate an agreement with a payer and then, for whatever reason, just file it away. Most medical groups do not have a good, proactive methodology for negotiating for physician reimbursement,” Schmitt says.

Schmitt says the adversarial fee negotiating environment that has existed between physicians and health plans is changing to a more cooperative partnership between payers and providers. As an example, Schmitt points to a Michigan-based orthopedic group whose contracts he helped renegotiate. He contacted the medical director of the group’s largest payer and indicated the group wanted to renegotiate its contract and fee schedule, and suggested talking about

‘‘

“Health plans are saying, ‘Let’s see if we can’t be better business partners not only for our sake, but for the sake of the patients and the community as well.’ It’s a new era of managed care, which is really what it should have been when it kicked off twenty years ago.”

a pay-for-performance arrangement.

Not only was the medical director receptive, he arranged to meet with members of the orthopedic group to further discuss the arrangement.

“What used to be a poker game is now transparent,” Schmitt says. “The realization is, we all have an economic problem with respect to medical costs. But the doctors have the clinical solutions to those economic problems.

Health plans are saying, ‘Let’s see if we can’t be better business partners not only for our sake, but for the sake of the patients and the community as well.’ It’s a new era of managed care, which is really what it should have been when it kicked off twenty years ago.”

Using leverage Taylor Moorehead, a partner with Zotec Partners, a leading medical billing company, suggests there are several ways physicians can begin renegotiating fees with health plans.

If a physician is hospital-based, he or she has a little more leverage. For example, the physician is performing services at a hospital and being paid the health plans’ usual, customary rates for that location. The physician asks for an increase, and the health plan says no, so the physician cancels his or her contract and begins working noncontracted with the plan, knowing that the plan’s patients are going to come to the hospital regardless of whether he’s contracted with the payor or not.

But now, the physician begins billing the patient for 100 percent of their fee schedule. The health plan will pay what it believes is appropriate, and the balance is owed by the patient.

“Now, the patient becomes the physician’s advocate,” Moorehead says.

“The patient is subject to paying a lot more money out of pocket, which is upsetting. They complain to the hospital, the hospital complains to the doctor, and the doctor complains to the carrier. Ultimately, it ends up in the lap of the carrier. So, if you can go non-contracted for a period of time,

applying the pressure to the payer, the payer will bend and give you a better rate.”

Building the business case Negotiating is a bit more difficult for office-based physicians, who rely on the carrier to direct its members to the physician’s practice. In those circumstances, where there isn’t as much leverage, building a business case is critical. That means shifting your strategy from reactive to proactive. “If you sit around and wait, you’re never going to get increases,” says John Haresch, MD, who runs One Family Doctor, a micropractice based in Kill Devil Hills, NC. “I’ve had some success at it, but not enough to make it easy.”

Haresch begins by sending a letter to the carrier outlining his case. He points out that costs are going up while the carrier’s reimbursement level is not. More importantly, he supplies data in support of the way he runs his practice— one physician who spends more time with his patients. He tells the carrier, “If you want full, patientcentered, medical home stuff that’s being proven out in studies, here’s the level of payment I need. Now, tell me what level of service you’re prepared to pay for.”

It’s challenging, says Haresch, and sometimes frustrating. What keeps him going? “There’s the underlying, altruistic part that if we can keep the reimbursement going, keep the practice going, and keep finding ways to improve the quality of care, it’s good for people—and that’s why I originally got into all of this. It’s just the right thing to do.”  Ed Rabinowitz is a healthcare writer and reporter.

Source: http://www.kevinmd.com/ blog/2010/01/tips-doctors-negotiatereimbursement-rates-insurancecompanies.html kevinmd.com MEDMONTHLY.COM | 49

features Reprinted from

HealthCare.gov

T

he Affordable Care Act makes investments to help raise the quality of care, while giving Americans – and their health care providers – more control over their health care. It puts patients’ relationships with their doctors and nurses ahead of insurance company profits and paperwork, and gives health care providers incentives to better coordinate care. The Affordable Care Act also ensures that millions of Americans will have access to affordable insurance – giving them access to the quality care you deliver.

What Does the Affordable Care Act Mean for Doctors, Nurses, and Other Health Care Providers?

For health care providers, health reform is designed to make our health care system stronger and make it work better for you and your patients: • Expanded coverage and consumer protections will offer security. As health care 50 |DECEMBER 2012

providers, you experience the impact of uninsured patients and uncompensated care first-hand.

Under the Affordable Care Act, more than 32 million uninsured Americans will have increased access to affordable, quality health coverage options, such as those through the new Health Insurance Exchanges, which will provide essential benefits and impose limits on cost sharing.

With better access to health coverage, fewer Americans will need to delay or avoid seeking the care they need because they can’t afford it. This will lower the burden of uncompensated care on physicians, hospitals, and the rest of the system.

• Reduced paperwork and administrative simplification will bring down the cost of care.

New rules will simplify paperwork and lessen administrative hassle to allow you to focus on caring for your patients instead of dealing with insurance company bureaucracy. This comes alongside investments in electronic health record adoption that will bring

doctors’ offices and hospitals into the 21st century.

• Tough new consumer protections will hold health insurers more accountable for treating patients and providers fairly. By eliminating many of the worst insurance industry practices, the Act will free you and your patients to focus on what really counts – taking care of the illnesses and injuries that affect them.

Insurers won’t be able to cancel coverage because a patient made an unintentional mistake on his or her application for coverage.

They won’t be able to set annual or lifetime limits on benefits that leave patients without coverage when they need it most. And they won’t be able to exclude millions of Americans from coverage because of a pre-existing medical condition. Patients will have new rights to choose their primary care professionals – including pediatricians – and to file appeals when insurers deny claims. Finally, insurers will be required to spend a minimum amount of premium dollars on

patient care, reducing their ability to make excessive profits and pay unreasonably high salaries.

• Medicare will be stronger and offer new benefits. The Act preserves the guaranteed benefits under Medicare, makes recommended preventive services available with no cost-sharing, and provides an annual wellness visit. It closes the Medicare Part D prescription drug program “donut hole” over time, beginning with a $250 rebate to seniors who reach that limit in 2010. By lowering cost-sharing, the Act empowers providers, who will have to worry less about patients being unable to afford needed treatments.

• New investments in prevention and public health will support your efforts to help patients live healthier lives. In addition to expanded access to preventive services, the Affordable Care Act will give states and local communities new resources to address the nation’s mounting health problems, such as the increase in chronic diseases, or in conditions linked to obesity. This will strengthen provider efforts to help patients make healthy choices like losing weight or quitting smoking.

• Health care providers will help drive improvements to health care delivery. New models of patient-centered, coordinated care will give you and your patients more control over how care is delivered. Investments in medical homes and other advanced care coordination and disease management models will help you ensure that your patients receive seamless, efficient care. Providers who provide high-quality services will be rewarded based on standards that they help develop, based on solid medical evidence.

And Medicare will pay bonuses to qualified primary care doctors and general surgeons, particularly

those who practice in underserved areas.

Of course, none of these changes can happen without highly trained and dedicated health care professionals – and independent experts are already projecting that, unless we take action, we will see a shortfall in primary care providers. For that reason, the Affordable Care Act will make an unprecedented investment in workforce development: • Strengthening and growing our health care workforce. Combined with the earlier investments made by the American Recovery and Reinvestment Act of 2009, the provisions of the Affordable Care Act will support the training and development of more than 16,000 new primary care providers over the next five years.

• Investing in community health centers and new clinical settings.

In addition to new resources to build new and expand existing community health centers, the Affordable Care Act will establish new nurse-managed health clinics to train nurse practitioners and operate in underserved communities.

• Loan forgiveness and scholarships. The National Health Service Corps will be expanded in order to repay student loans and provide scholarships for even more primary care physicians, physician assistants and nurse practitioners willing to work in underserved areas.

Talking to Your Patients About Health Reform When patients have questions about their care or coverage, they often turn to one of their most trusted sources: the men and women who care for them when they are sick or injured.

Your patients are likely to have a lot of

questions about how health reform will affect them. Here are a few key things about the new law to remind patients about: • Greater insurance security for families. The Affordable Care Act will help to ensure that patients will have choices among quality, affordable health coverage options, even when they lose their job, switch jobs, move or get sick.

In fact, through the creation of Health Insurance Exchanges, millions of Americans will have the same choice of health plans as their member of Congress.

• Protecting patients when they get sick. For policies issued or renewed on or after September 23, 2010, insurance companies are now prohibited from dropping patients from coverage when they get sick just because of an unintentional mistake on a form, and can no longer be able to deny coverage to children based on preexisting conditions. The new law also eliminates lifetime coverage limits and, by 2014, will phase out annual limits that adversely affect the sickest patients with the highest costs.

• Preventive care leads to better health. For plan years beginning on or after September 23, 2010, the law now requires health plans and health insurance policies to cover certain recommended preventive services at no charge to patients.

And Medicare patients are now eligible for an annual wellness exam and certain preventive services with no cost-sharing.

You can download consumerfriendly brochures and posters to share important benefits of the law with your patients.  http://www.healthcare.gov/news/ factsheets/2010/07/health-careproviders.html MEDMONTHLY.COM | 51

the arts

When Paint is Dangerous

By Emily Weinstein Featured Artist

Above: Durham Tech 50th Anniversary Mural 10’ x 64’ Mineral coating on cement panels

A

few years ago I became incoherent, unable to string a sentence together. The villain in this drama turned out to be paint. Oil paints are my preferred medium, but after a winter of painting inside and using oil paints exclusively, I encountered a terrifying condition. A fellow artist noticed my inability to communicate fluently and suspected what was probably causing my aphasia, as she had had the same experience. She suggested a naturopathic practitioner who ultimately prescribed mega-doses of vitamin C, Lipotropic Complex, and a suspension of painting with oils for a while.

Within months I was back to myself.

Nowadays when the weather turns cold, I paint primarily with acrylics or mineral coating. In creating a mural in public, particularly when children are involved, I have always used less toxic paints.

It was a great relief that my friend recognized my need for help. In my state of mind I had no idea where to turn or the strength to figure anything out. I was in my mid-forties when this occurred and it was frightening to think I perhaps had an early onset of 52| DECEMBER 2012

Alzheimer’s, or perhaps a stroke? One might wonder why hadn’t anyone else noticed something was wrong with me? Well, I had kept this fearful state to myself as it had been progressing into a vague depression that didn’t lend itself to being with people. Also, remarkably, my clients were still getting their commissioned artwork in a timely manner. Since age three I’ve been drawing, so even when not in top form, as a creature of long-realized habit, I’m either in the studio working on a series or out in the field on a mural site. Certainly there are days when what I produce astounds and other days that are less inspired.

What likely added to my condition prior to diagnosis and cure is that the new home I’d design-built was being freshly painted that winter. Standard latex paint emits gasses for weeks after being applied; with windows closed the curing paint could certainly have contributed to making the air toxic.

Presently on the market, water-based paints are made with considerably less VOC’s (volatile organic compounds), and many of the higher end brands report zero VOC’s. Having used the new “healthy” paint, I strongly

recommend it over the old standard as well as to have all windows open, for maximum ventilation when applying paint and during the drying and curing process.

For the past 35 years of painting public murals, I’ve used acrylics exclusively. No oils as the fumes become an issue when working inside and too dangerous when working with children. Most recently I completed a 10 x 64 foot mural using mineral coating imported from Europe, known for never fading, peeling or outgassing, but, oh my, is it hard to paint with! Mineral coating has the consistency of ground-up chalk mixed with water. Using it won’t kill you, but it will surely try one’s patience because the colors change as they dry.

However, the end results are beautiful, and happily, after many months of painting the 50th Anniversary Mural for Durham Tech, pictured above, I experienced no fallout. To view a video about this mural, please follow this link: http://www.youtube.com/ watch?v=2emnjs3cdx4 The safest way to use oils is of course, painting outside, en plein aire, communing with nature, landscape

painting. In tribute to the pursuit of healthy practices, I teach my students to use vegetable oil to clean brushes, then wipe on old phone books, dip in Murphy Oil soap, rinse off before reshaping.

I can’t imagine a time when I won’t be painting, but after marrying at the young age of 54, wondering where my life had gone, I began my limitededition 25-year Handmade Book Series. Each year I design a 6 x 6 inch structure encapsulating my year in art along with its most notable events, and then make no more than 75 signed and numbered copies. The first year focuses on all my art leading up to the wedding while the 2nd volume describes my actual creation of a mural from A to Z. My most recent project, the 3rd year, is a triptych with images of 60 works of art ranging from 3 x 3 inches to 3 x 3 feet. I will be 80 years old when this series is complete, and so far, since I’m determined that making my book series won’t poison me, I just might make my goal. 

Above: Two Moon Pond 10” x 10” Oil on wood - To date Weinstein has painted over 300 moon paintings of which 72 are featured in Moon Book, published by Discovery Press. Sizes range from 6 inches to 8 feet.

Above: Rails to Trails 14” x 6” Oil on wood - From Weinstein’s book, Saving Magic Places, published by Beaux Soleil Publishers which features many of her landscapes.

Visit Emily Eve Weinstein’s website at Weinsteinart.com. Her most current painting series have not been posted yet, but her four art gift books are listed along with many landscapes and moon paintings.

Please feel free to phone her with any questions or suggestions at 919-402-0160.

At Left: Daffadill 32” x 16” Wood, latex, acrylic, UV protectant, primer on roofing felt - show cased in Volume III of the 25-year Handmade Book Series MEDMONTHLY.COM |53

healthy living

Festive Honey Roasted Baked Pears

By Ashley Acornley MS, RD, LDN

When people think of holiday desserts, they often think of a plethora of homemade cakes, traditional cookies, and delectable pies. Although all of these desserts are truly delicious, they can pack quite a large calorie punch in our diets. The average American consumes an excess of 3,000 calories on Thanksgiving and Christmas, and gains a total of 10 pounds each year throughout the holiday season. Instead of providing plenty of sugar and fat laden goodies at the dinner table, why not try a fruit-based dessert? This recipe for honey-roasted pears is a baked dish that infuses flavors of honey, balsamic vinegar, and pepper. If desired, the baked fruit can be served warm with a scoop of vanilla ice cream and sauce drizzled on top. This dessert is a perfect option for doctors to suggest to their patients who struggle with obesity, diabetes, high cholesterol, or hypertension. Try this delicious recipe for under 200 calories this holiday season!

Nutritional Facts:

Calories: 198 Fat: 3g Saturated fat: 2g Monounsaturated fat: 1g Polyunsaturated fat: 0g Protein: 2g Carbohydrates: 42g Fiber: 3g Cholesterol: 9mg Iron: 0mg Sodium: 26mg Calcium: 61mg

Prep Time: 10 minutes Cook Time: 25 minutes Yield: 10 servings

(serving size is equivalent to 1/2 pear with 1/4 cup ice cream and 1/8 cup sauce) 54 | DECEMBER 2012

Ingredients

Directions

2 tablespoons unsalted butter, melted 5 firm-ripe pears, halved lengthwise (leave stems intact), and cored 3 tablespoons balsamic vinegar 2/3 cup honey Freshly ground black pepper (as needed) 2 1/2 cups low-fat or slow-churned ice cream

1. Preheat oven to 400째. Pour butter into a large baking pan. Tilt pan to coat with the butter. Arrange pears in one layer, cut sides down. Roast 20-25 minutes or until tender when pierced with a knife.

2. Combine vinegar and honey. Spoon mixture over pears, and bake 5 minutes more. Arrange pear halves on each of 10 dessert plates. Spoon pan juices over top, add pepper and 1/4 cup ice cream; serve.

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

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

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

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

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

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

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

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

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

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

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

MEDMONTHLY.COM |55

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

Dover, DE 19904 (302)744-4500 http://1.usa.gov/t0mbWZ Florida 4052 Bald Cypress Way Bin C-08 Tallahassee, FL 32399 (850)245-4474 http://bit.ly/w1m4MI 56 | DECEMBER 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 http://www.mass.gov/eohhs/provider/ licensing/occupational/dentist/ Michigan P.O. Box 30664 Lansing, MI 48909 (517)241-2650 http://www.michigan.gov/lara/0,4601,7154-35299_28150_27529_27533---,00. html Minnesota 2829 University Ave., SE. Suite 450 Minneapolis, MN 55414 (612)617-2250 http://www.dentalboard.state.mn.us/ Mississippi 600 E. Amite St., Suite 100 Jackson, MS 39201 (601)944-9622 http://bit.ly/uuXKxl Missouri 3605 Missouri Blvd.

P.O. Box 1367 Jefferson City, MO 65102 (573)751-0040 http://pr.mo.gov/dental.asp Montana P.O. Box 200113 Helena, MT 59620 (406)444-2511 http://bsd.dli.mt.gov/license/bsd_ boards/den_board/board_page.asp

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

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

Texas 333 Guadeloupe St. Suite 3-800 Austin, TX 78701 (512)463-6400 http://www.tsbde.state.tx.us/

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

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

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

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

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

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

North Dakota P.O. Box 7246 Bismark, ND 58507 (701)258-8600 http://www.nddentalboard.org/

Tennessee 227 French Landing, Suite 300 Nashville, TN 37243 (615)532-3202 http://health.state.tn.us/boards/dentistry/

Virginia Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4538 http://www.dhp.virginia.gov/dentistry Washington 310 Israel Rd. SE P.O. Box 47865 Olympia, WA 98504 (360)236-4700 http://www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/Dentist.aspx West Virginia 1319 Robert C. Byrd Dr. P.O. Box 1447 Crab Orchard, WV 25827 1-877-914-8266 http://www.wvdentalboard.org/ Wisconsin P.O. Box 8935 Madison, WI 53708 1(877)617-1565 http://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 |57

U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (334)242-4116 http://www.albme.org/ Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 http://bit.ly/zZ455T Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 (480)551-2700 http://www.azmd.gov Arkansas 1401 West Capitol Ave., Suite 340 Little Rock, AR 72201 (501)296-1802 http://www.armedicalboard.org/ California 2005 Evergreen St., Suite 1200 Sacramento, CA 95815 (916)263-2382 http://www.mbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7690 http://www.dora.state.co.us/medical/ Connecticut 401 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/site/default.asp Delaware Division of Professional Regulation Cannon Building 861 Silver Lake Blvd., Suite 203 Dover, DE 19904 (302)744-4500 http://dpr.delaware.gov/ District of Columbia 899 North Capitol St., NE Washington, DC 20002 (202)442-5955 http://www.dchealth.dc.gov/doh 58 | DECEMBER 2012

Florida 2585 Merchants Row Blvd.

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

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

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

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

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

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

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

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

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

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

Indiana 402 W. Washington St. #W072 Indianapolis, IN 46204 (317)233-0800 http://www.in.gov/pla/ Iowa 400 SW 8th St., Suite C Des Moines, IA 50309 (515)281-6641 http://medicalboard.iowa.gov/ Kansas 800 SW Jackson, Lower Level, Suite A Topeka, KS 66612 (785)296-7413 http://www.ksbha.org/ Kentucky 310 Whittington Pkwy., Suite 1B Louisville, KY 40222 (502)429-7150 http://kbml.ky.gov/default.htm

Minnesota University Park Plaza 2829 University Ave. SE, Suite 500 Minneapolis, MN 55414 (612)617-2130 http://bit.ly/pAFXGq Mississippi 1867 Crane Ridge Drive, Suite 200-B Jackson, MS 39216 (601)987-3079 http://www.msbml.state.ms.us/ Missouri Missouri Division of Professional Registration 3605 Missouri Blvd.

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

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

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

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

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

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

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

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

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

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

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

Nevada Board of Medical Examiners P.O. Box 7238 Reno, NV 89510 (775)688-2559 http://www.medboard.nv.gov/ New Hampshire New Hampshire State Board of Medicine 2 Industrial Park Dr. #8 Concord, NH 03301 (603)271-1203 http://www.nh.gov/medicine/ New Jersey P. O. Box 360 Trenton, NJ 08625 (609)292-7837 http://bit.ly/w5rc8J New Mexico 2055 S. Pacheco St. Building 400 Santa Fe, NM 87505 (505)476-7220 http://www.nmmb.state.nm.us/ New York Office of the Professions State Education Building, 2nd Floor Albany, NY 12234 (518)474-3817 http://www.op.nysed.gov/ North Carolina P.O. Box 20007 Raleigh, NC 27619 (919)326-1100 http://www.ncmedboard.org/

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

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

MEDMONTHLY.COM |59

medical resource guide ACCOUNTING

Ajishra Technology Support

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

ADVERTISING

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

MedMedia9

www.medmedia9.com

Ring Ring LLC

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

ANSWERING SERVICES Corridor Medical Answering Service

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

Docs on Hold

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

BILLING & COLLECTION Advanced Physician Billing, LLC

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

60| DECEMBER 2012

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

Axiom Business Solutions

Find Urgent Care

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

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

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

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

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

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

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

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

VIP Billing

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

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

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

American Medical Software

Mediserv

CDWG

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

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

1180 Illinois 157 Edwardsville, IL 62025 (618) 692-1300 www.americanmedical.com 300 N. Milwaukee Ave Vernon Hills, IL 60061 (866)782-4239 www.cdwg.com/

Instant Medical History

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

medical resource guide CONSULTING SERVICES, PRACTICE MANAGEMENT

DENTAL Biomet 3i

Manage My Practice

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

Medical Credentialing

(800) 4-THRIVE www.medicalcredentialing.org

Medical Practice Listings

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

myEMRchoice.com

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

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

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

Dental Management Club

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

The Dental Box Company, Inc.

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

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

ELECTRONIC MED. RECORDS

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

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

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

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

INSURANCE, MED. LIABILITY

Synapse Medical Management

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

Urgent Care America

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

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

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

www.pushpa.biz

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

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

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

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

Aquesta Insurance Services, Inc.

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

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

Medical Protective

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

MGIS, Inc.

1849 W. North Temple Salt Lake City, UT 84116 (800)969-6447 www.mgis.com MEDMONTHLY.COM |61

medical resource guide INSURANCE, MED. LIABILITY 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

LOCUM TENENS

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

MEDICAL ARCHITECTS MMA Medical Architects

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

www.artisanprinter.com

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

Nicholas Down http://bit.ly/yHwxb0

62| DECEMBER 2012

chuchinho58@gmail.com www.facebook.com/akojacintho www.akojacintho.com

Julie Jennings

(678)772-0889 juliejenn@silksynergy.com http://silksynergy.com/ http://www.coroflot.com/naddie09 Laura Maask 262-308-1300 Laura@medimagery.com

www.martindfried.com

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

www.dicomsolutions.com

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

www.thetps.com

MEDICAL MARKETING MedMedia9

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

medimagery.com

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

WhiteCoat Designs Web, Print & Marketing Solutions for Doctors (919)714-9885 www.whitecoat-designs.com

MEDICAL PRACTICE SALES

Emily Eve Weinstein

919-402-0160 weinsteinart@gmail.com http://www.weinsteinart.com

MEDICAL EQUIPMENT

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

Deborah Brenner

Martin Fried

Ako Jacintho

ALLPRO Imaging

MEDICAL ART

Pia De Girolamo

18 Bay Path Drive Boylston MA 01505 508 - 869 - 6038 JHans76271@aol.com www.barryhanshaw.com

MedImagery

Physician Solutions

Brian Allen

Dicom Solutions

Barry Hanshaw

Medical Practice Listings

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

MEDICAL PRACTICE VALUATIONS BizScore

Biosite, Inc

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

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

www.bizscorevaluation.com

Cryopen

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

MEDICAL PUBLISHING www.cryopen.com

Carolina Liquid Chemistries, Inc.

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

Greenbranch Publishing

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

medical resource guide

MEDICAL RESEARCH

PRACTICE FINANCING Bank of America

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

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

REAL ESTATE

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

York Properties, Inc. www.crlcorp.com

Sanofi US

55 Corporate Drive Bridgewater, NJ 08807 (800) 981-2491 www.sanofi.us

Scynexis, Inc.

3501 C Tricenter Blvd.

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

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

STAFFING COMPANIES

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

Dermabond

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

DJO

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

ExpertMed

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

SunTrust Mortgage, Inc.

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

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

SUPPLIES, GENERAL BSN Medical

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

Additional Staffing Group, Inc.

MORTGAGE PROFESSIONAL

www.djoglobal.com

WEBSITE DESIGN MedMedia9

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

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

www.medmedia9.com

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 medmonthly.com MEDMONTHLY.COM |63

Medvertising

compound noun: 1. The action of calling attention to medical goods or services for sale. Exclusively refers to advertising in Med Monthly.

Come see why we’re not your father’s medical journal Scan this code with your smartphone or visit medmonthly.com

Med Monthly 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.)

GP Needed Immediately On-Going 3 Days Per Week at Occupational Clinic General Practictioner needed on-going 3 days per week at occupational clinic in Greensboro, NC. Numerous available shifts for October. Averages 25 patients per day with no call and shift hours from 8:30 am to 5:30 pm. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

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

3-5 days per week in Durham, NC Geriatric physician needed immediately 3-5 days per week, on-going at nursing home in Durham. Nursing home focuses on therapy and nursing after patients are released from the hospital. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com GP Needed Immediately On-Going 1-3 Days Per Week at Addictive Diease Clinics located in Charlotte, Hickory, Concord & Marion North Carolina General Practitioner with a knowledge or interest in addictive disease. Needed in October on-going 1-3 times per week. This clinic requires training so respond to post before October 1st. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Primary Care Physician in Northwest NC (multiple locations) Primary care physician needed immediately for ongoing coverage at one of the largest substance abuse treatment facilities in NC. Doctor will be responsible for new patient evaluations and supportive aftercare.

Counseling and therapy are combined with physician’s medical assessment and care for the treatment of adults, adolescents and families. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Pediatrician or Family Medicine Doctor in Fayetteville Comfortable with seeing children. Need is immediate - Full time ongoing for maternity leave. 8 am - 5 pm.

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

General Practitioner Needed in Greensboro Occupational health care clinic seeks general practitioner for disability physicals ongoing 1-3 days a week.

Adults only. 8 am-5 pm. No call required. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Pediatrician or Family Physician Needed Immediately at clinic in Roanoke Rapids, NC Pediatric clinic in Roanoke Rapids, NC seeks Peds physician or FP comfortable with children for 2-3 months/ on-going/full-time. The chosen physician will need to be credentialed through the hospital, please email your CV, medical license and DEA so we can fill this position immediately.

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

The practice is located in Greensboro NC. Hours are 8 am-5 pm. Approximately 20 patients/day. Excellent staff. Outpatient only.

continued on page 66

MEDMONTHLY.COM |65

classified listings

Classified

continued from page 65

To place a classified ad, call 919.747.9031

Physicians needed

Physicians needed

North Carolina (cont.)

Virginia

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

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

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

Child Health Clinic in Statesville, NC seeks pediatrician or Family Physician comfortable with peds for on-going, full-time shifts. Physician will work M-F 8 am - 5 pm, ongoing. Qualified physician will know EMR or Allscripts software. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

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

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

66| DECEMBER 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 North Carolina 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.

continued on page 69

Practice for Sale in Raleigh, NC

PEDIATRICIAN

or family medicine doctor needed in

FAYETTEVILLE, NC

Primary care practice specializing in women’s care Raleigh, North Carolina The owning physician is willing to continue with the practice for a reasonable time to assist with smooth ownership transfer. The patient load is 35 to 40 patients per day, however, that could double with a second provider. Exceptional cash flow and profit will surprise even the most optimistic practice seeker. This is a remarkable opportunity to purchase a well-established woman’s practice. Spacious practice with several well-appointed exam rooms and beautifully decorated throughout. New computers and medical management software add to this modern front desk environment.

List price: $435,000

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

Comfortable seeing children. Needed immediately.

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

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

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

• • • • • •

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

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

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

66| DECEMBER 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

classified listings

Classified

continued from page 66

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

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

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

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

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

THINKING ABOUT SELLING YOUR PRACTICE?

Medical Practice Listings can help you sell your practice online!

Now offering two types of listings to better serve all practice specialties and budgets.

Standard Listing The Standard Listing offers you the opportunity to gain national exposure by posting your listing on our website which is viewed daily by our network of professionals.

This option also includes a brief practice consultation to explain the benefits of marketing through the Medical Practice Listings website.

Professional Listing In addtion to the benefits in the standard listing our Professional Listing affords you access to services provided by our expert legal and marketing team and a Bizscore Practice Valuation. This valuation compares your practice with other practices in your area, provides projections and determines what your practice is worth.

Visit us today at www.medicalpracticelistings.com to learn more.

919.848.4202 | medicalpracticelistings.com

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

NC OPPORTUNITIES LOCUMS OR PERMANENT

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

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

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

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

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

medmonthly.com | 919.747.9031 MEDMONTHLY.COM |71

Woman’s Practice in Raleigh, North Carolina.

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

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

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

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

Medical Practice Listings; 919-848-4202

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

Unfortunately, its motor is inside playing video games.

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

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

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

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

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

American Council on Exercise

®

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

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

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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

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

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.

PEDIATRICIAN

OR FAMILY MEDICINE DOCTOR NEEDED IN

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

Credentialing at the hospital is necessary.

Asking price: $385,000

To view more listings visit us online at medicalpracticelistings.com

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

Wanted: Urgent Care Practice 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.

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

List Price: $150,000 | Established: 2007 | Location: Colorado For more information contact Dr. Jack McInroy at 303-929-2598 or Shrink1324@gmail.com

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

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

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

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

Listing Price: $430,000

Pediatrics Practice Wanted Pediatrics practice wanted in NC Considering your options regarding your pediatric practice? We can help.

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

Contact us today to discuss your options confidentially.

Call 919-848-4202 or email medlistings@gmail.com www.medicalpracticelistings.com 76| DECEMBER 2012

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

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

Contact Medical Practice Listings today to discuss the practice details.

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

www.medicalpracticelistings.com

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

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

Call us today to place your classified!

919.747.9031

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

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

Please direct all correspondence to driverphilip@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.

Also available online 24/7

medmonthly.com

Call Medical Practice Listings at (919) 848-4202 for details and to view our other listings vist www.medicalpracticelistings.com MEDMONTHLY.COM |77

the top In 1987, radio personality, Bob Rivers, recorded “The 12 Pains of Christmas” in which the litany of each “thing of Christmas that’s such a pain to me” includes finding a Christmas tree or a parking space, screaming children, facing the in-laws, rigging up the lights, and sending Christmas cards. It’s a popular song each holiday season and very funny, but also very true.

We hope following some of our holiday health tips can relieve some of your seasonal stress so you can enjoy the holiday and its indulgences without sacrificing your health goals in closing of the year.

1

EXERCISE EVERY DAY

Get out of the house for a walk to view the Christmas lights and decorations in the evening. Be sure to dress for the weather and take along a flashlight and/or reflective clothing to illuminate your path and make you visible to traffic. Be very careful in areas that are prone to freezing to avoid falls.

2

COMBINE SHOPPING AND WALKING

If the weather prevents you from walking outdoors, combine a holiday shopping trip with your exercise. Indoor malls are great places to walk, and many have walking clubs. If you are planning on shopping in a particular store, park near an entrance on the opposite end of the mall -even if time is short, you will still get some exercise.

Holiday

Health

3

Tips

REMEMBER TO TAKE YOUR MEDICATIONS

Holidays often disrupt routines and may cause you to forget your lifesaving medications. As you note social appointments, add a reminder to take your medications or order re-fills. If you are traveling, be sure to take enough medications with you in case of delays and have a copy of your prescriptions in case of loss.

EAT YOUR VEGETABLES AND SALAD FIRST

If you are at a party with a lot of tempting food, try to start with healthy vegetables and salads. These will fill you up and reduce the temptation to over-indulge on high-fat, highcalorie foods. Just a taste of your holiday favorites should then satisfy your taste buds.

5

DRINK MODERATELY

Drinking too much may not just mean a terrible hangover. Around this time of year, doctors report seeing a spike in erratic heartbeats— dubbed “holiday heart syndrome.” It is more common among people who usually aren’t heavy drinkers but drink in excess for a short time. Keep it on the rocks because melting ice dilutes a cocktail and creates more liquid. So order your drink on the rocks to try to avoid a quick buzz and sip it longer before a refill.

78 | DECEMBER 2012

6

KNOW YOUR FOOD INGREDIENTS

If you have food allergies, don't be afraid to ask about ingredients in dishes made by others. Be especially careful of home-baked goods if you have an allergy to tree nuts or peanuts. Those ingredients may not be obvious at first sight but can be deadly if you are affected by these types of allergies.

7

PRACTICE ALLERGY-FREE DECORATING

If you suffer from allergic rhinitis, the culprit may be your holiday decorations.

Decorations stored away all year can build up a coating of dust that can trigger allergies. You may also need to rethink Christmas tradition and substitute an artificial tree, as many people are allergic to real trees. The newer trees are very lifelike and safer (they don't dry out and become fire hazards).

8

MANAGE STRESS

The holidays don’t need to take a toll on your health. Keep a check on over-commitment and over-spending. Balance work, home, and play.

Get support from family and friends. Keep a relaxed and positive outlook. And make plans for January because if you have social events coming up with people you like, you’ll be upbeat about what’s to come, avoiding depression during the holidays.

9

GET A GOOD NIGHT'S SLEEP

Holiday celebrations can often disrupt regular sleep patterns. Try to get to sleep at the same time every night and avoid heavy foods and alcoholic beverages before bedtime. Take a nap if you feel the need during the day to help recharge your energy. AND DON’T TRY TO STAY AWAKE TO SEE SANTA!

Read more at: http://seniorhealth.about.com/od/prevention/tp/holiday_health.htm http://www.foxnews.com/health/2011/12/01/holiday-health-tips/ MEDMONTHLY.COM | 79

Physician Solutions MD STAFFING Locum tenens Nurses Front Desk and Office Staff Permanent placement When someone in your practice can’t work tomorrow, make us your Plan B With an extensive network of health care providers and over 20 years of experience in physician staffing, Physician Solutions is a leader in the industry. We specialize in primary care and place doctors, nurses and office staff, including front desk and billing, in family practices, urgent cares, internal medicine, pediatrics offices and occupational health facilities.

We’ve got you covered!

Short-term or long-term, Physician Solutions has you covered P.O. Box 98313, Raleigh, NC 27624 Scan this QR code with your smartphone to learn more.

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