Med Monthly December 2013

Med Monthly DECEMBER 2013

the

Do Your Homework Before Selling Your Practice

our Selling Y Practice

issue

pg. 48

TIPS ON

SELLING YOUR PRACTICE Considering Your Practice Options?

Sell to Another MD or Group Partner Buy-In Sell to a Hospital Find a Young MD or PA to Take Over the Practice Re-Locate the Practice Convert to Another Practice Model Or Should I Close the Practice

Find Your Answers in This Month’s Med Monthly

pg. 42

5 Factors

to Consider Before Selling Your Medical Practice pg. 46

contents

TIPS ON SELLING YOUR PRACTICE

42

features

42 TIPS ON SELLING YOUR PRACTICE 46 5 FACTORS TO CONSIDER BEFORE SELLING YOUR MEDICAL PRACTICE 48 DO YOUR HOMEWORK WHEN SELLING YOUR PRACTICE

insight 10 LIVING LONGER WITH PALLIATIVE CARE 12 FIVE TIPS FOR ADDRESSING DISRUPTIVE PHYSICIAN BEHAVIOR 14 WHY ZEN WORKS IN WEBSITE DESIGN 16 OFF THE BEATEN PATH: The Country Doctor Museum

28 EXAMINING THE FUTURE OF ON-DEMAND MOBILE PERSONAL HEALTH RECORDS 30 GENE HASTENS KIDNEY DISEASE PROGRESSION IN AFRICAN-AMERICANS

practice tips 20 GET PATIENTS CLAMORING FOR YOUR SERVICES 22 DECLARE YOUR MEDICAL PRACTICE A DRAMA FREE ZONE 24 WHEN LIFE IMPACTS WORK: Finding Work/Life Balance DECLARE YOUR MEDICAL PRACTICE A DRAMA FREE ZONE

research and technology

22

32 FDA APPROVES MEDICAL DEVICE TO TREAT EPILEPSY

legal 34 HHS ANNOUNCES THAT ACA EXCHANGE PLANS ARE NOT “FEDERAL HEALTH CARE PROGRAMS” 36 IRS ANNOUNCES MODIFICATION TO “USE- IT-OR-LOSE-IT” RULE FOR HEALTH CARE FLEXIBLE SPENDING ACCOUNTS 38 TOP TEN WAYS TO SURVIVE IN THE FEDERAL HEALTH CARE POLICY ENVIRONMENT

the arts 50 2013 MED MONTHLY COVER REVIEW

healthy living 52

HOLIDAY KALE SALAD

in every issue 4 editor’s letter 8 news briefs

60 resource guide 78 top 9 list

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

Call us today at 919-833-3836 x141

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

HELPING YOU WITH REAL ESTATE, SO YOU CAN FOCUS ON HELPING OTHERS.

York Properties Broker Team

We understand that most physicians cannot take valuable time away from seeing patients and managing their day-to-day operations of their practice to think about real estate. For over 100 years we have been helping clients find the best real estate solutions in the Triangle. Our combination of energetic young leaders, wisdom of established team members, and full range of real estate services have provided our healthcare clients with peace of mind, ideas and solutions.

www.yorkproperties.com RALEIGH Headquarters & Property Management (919) 821-1350 Commercial Sales & Leasing (919) 821-7177 MOREHEAD CITY (252) 247-5772

BROKERAGE LEASING PROPERTY MANAGEMENT INVESTMENT SECURITY MAINTENANCE LANDSCAPING

editor’s letter

Your practice could be your most valued asset, but do you know what yours is worth? When you start considering your practice options as retirement age creeps up on you or unforeseen circumstances become reality, what are your options? Med Monthly’s December issue enumerates key points for you to consider before putting your practice on the market. So where do you begin?

Practice choices will change depending on who you are talking with. Your banker, CPA, attorney and certainly your medical colleagues all have different opinions. Regardless of the path you take, remember that confidentiality is critical. If your patients or staff believes the office may close or if you are thinking of selling, they may preempt you and leave, thereby reducing the value of your practice. The first thing to do is to compile all your financial and medical data. Make sure you have your financial data in order. It’s important to have on hand your patient demographics and all the contracts associated with your business. Among other things, make sure you also know what financing structure you are comfortable with when considering a sale or merger. Philip Driver, in “Tips on Selling Your Practice” elaborates on what steps to consider when decision time approaches.

The Med Monthly staff writers have collaborated on an article entitled, “Do Your Homework When Selling Your Practice”.

How do you go about marketing your practice and who do you think might be a potential buyer? In the 1990s hospitals bought an enormous number of private practices. They overpaid and did not consider how many patients were already being admitted to the hospital, so the revenue sometimes did not offset the debt. Lesson learned. Twenty years later hospitals are again purchasing medical practices and groups. George Chapman writes about, “5 Factors to Consider Before Selling Your Medical Practice” addressing this trend.

Your practice is important to you, your family and, yes, your patients and employees. There is a great deal to consider when you’re thinking about selling your practice. I hope this issue will give you food for thought. The next Med Monthly will mark a new year. The January issue’s theme is Your Practice Website.

Ashley Austin Managing Editor

4 | DECEMBER 2013

Med Monthly December 2013 Publisher Philip Driver Managing Editor Ashley Austin Creative Director Thomas Hibbard Staff Illustrator, Writer and Journalist Laura Maaske Contributors Ashley Acornley, MS, RD, LDN Annie Anderson Theresa C. Carnegie George Chapman Philip Driver Liz Ferron, MSW, LICSW Lori Gertz Eric W. Gregory Barbara Hales, M.D. Audrey McLaughlin, RN Helen McNeal Ilisa Halpern Paul, MPP Douglas Swill Nili S. Yolin

contributors George Chapman is a health care management consultant and for more than 30 years has advised Syracuse hospitals, private medical groups, community health centers and allied health professionals. He has diversified experience in operations, management, payer negotiations, practice valuations, mergers, hospital joint ventures, and business strategies. His goal is to assist clients to maximize resources and increase profitability.

Contact him at gwc@chapmanconsulting.com or call 315-234-8177.

Liz Ferron, MSW, LICSW is a Senior Consultant and Manager of Clinical Services with Workplace Behavioral Solutions, Inc. and its Midwest EAP Solutions and Physician Wellness Services divisions. She has been with the company for over 10 years, and has been in the employee assistance field for over 20 years. She has served three terms as President of the Minnesota Employee Assistance Program Administrators and Counselors (MEAPAC), and is a former adjunct faculty member at the College of St. Benedict. Liz has her MSW degree from the University of Minnesota and is a Licensed Independent Clinical Social Worker.

Audrey McLaughlin, RN 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

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

Helen McNeal is the Executive Director of the California State University Institute for Palliative Care at CSUSM. Prior to joining CSUSM, Helen served as Vice President of San Diego Hospice and The Institute for Palliative Medicine (SDHIPM) where she was responsible for all of the operations of The Institute for Palliative Medicine (IPM). She is also the co-author of Module IV: Palliative Care of A Comprehensive Guide to the Care of Persons Living with HIV/AIDS.

WWW.MEDMONTHLY.COM |5

designer's thoughts From the Drawing Board In the Research & Technology section of this month’s Med Monthly we cover vital information on several topics. We report on medical regulations and obstacles that must be considered when developing new technology, health research studies to improve determining the chances of kidney disease in individuals, and a new breakthrough medical device to help patients dealing with epilepsy.

In the “Research and Technology” section of this month’s magazine, the article “Examining the Future of On-Demand Mobile Personal Health Records”, Frost & Sullivan examines the challenges and multiple platforms of interoperability that must be mastered before a true on-demand mobile personal health record (PHR) can be introduced to the public. Concerns include the fact that patients do not own their health information because it is stored within the EHR system and is the property of providers, hospitals and health systems.

The Chronic Renal Insufficiency Cohort (CRIC) Study and the African American Study of Kidney Disease and Hypertension (AASK) published joint results reporting a gene variant common in African-Americans predicts that people with that gene who also have chronic kidney disease (CKD) are twice as likely to progress to kidney failure as African-Americans without the high-risk gene and white people with CKD. The article “Gene Hastens Kidney Disease Progression in African-Americans” reports this finding indicates that different treatment strategies should be studied, so that one day kidney failure among people with this genetic risk may be delayed or prevented.

“FDA Approves Medical Device to Treat Epilepsy” reports on a new device for epilepsy patients who have not responded well to medications, approved by the Food and Drug Administration, to assist in reduction in the frequency of seizures. Implanted within the skull under the scalp, these neurostimulators provide electrical stimulation when activity within the brain indicates an approaching seizure before the patient experiences any symptoms.

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

Thomas Hibbard Creative Director

6 | DECEMBER 2013

Internal Medicine Practice Wilmington, North Carolina Newly listed Internal Medicine practice in the beautiful city of Wilmington, NC. With Gross revenues over $400,000, 18 to 22 patients per day, this practice is ready for the physician that enjoys beach life. The medical office is located in a brick wrapped condo and is highly visible. This well appointed practice has a solid patient base and is offered for $168,000.

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

news briefs

Sensogram Technologies Unveiled A Swiss-Made New Product for Patient Vitals Mobile Monitoring A breakthrough technology implemented in a tiny mobile device allowing to monitor patient’s vital signs and other biomedical parameters remotely and continuously, giving the user a freedom and a choice of the lifestyle, while giving the doctor the full pattern of changes and trends of vital signs and other monitored parameters.

Being in high demand by the medical, wellness, and sports communities, the first products - Sensogram and SensoTRACK have been successfully demonstrated at the WMTF 2013 in Lucern by the team of Sensogram Technologies AG. World novelty at the World Medtech Forum, Lucerne 2013: Sensogram Technologies AG presents its non-invasive device for continuous measurement of blood pressure, respiration rate and other vital parameters.

At the World Medtech Forum in Lucerne (WMTF 2013) this year, Berne-based Sensogram Technologies AG successfully demonstrated its new product for remote patient monitoring.

This unique device allows monitoring patients’ blood pressure, respiration rate, oxygen saturation, heart rate and other biomedical parameters remotely and continuously.

Doctors or nurses can remotely set the thresholds of required monitoring parameters allowing patients to be monitored while enjoying the freedom of the chosen lifestyle.

The breakthrough medical technology for cuff-less measurement of blood pressure and other vital functions is a result of five years of international research and development.

Sensogram products are designed, integrated and manufactured in Switzerland. This has made Sensogram one of the leading Swiss companies in the increasingly popular field of remote patient monitoring. Sensogram EC-200 has been qualified as a Class 1 non-invasive medical device and it is currently being tested for a CE mark and FDA 510(k) certification.

“A unique blend of expertise in micro-technology and cardiology is critical to the success of Sensogram.

Our entire team is proud to offer an affordable and very convenient device, which allows medical consultants to administer their patients worldwide. With the Sensogram technology nurses can intervene in case of need being it emergency or instant consultation,” said the founder and CEO Dr. Vahram Mouradian in an interview.

“I am glad that we could persuade Sensogram to choose Switzerland for their international headquarters,” said Patrick Roth, CCMT Switzerland General Manager.

8 | DECEMBER 2013

“Breakthrough technologies like Sensogram is offering can help improve the quality of medical care and therapy at no additional cost.”

The fact that Sensogram Technologies AG has based its production in Switzerland is yet another recognition of Swiss quality and competitiveness,” continued Mr. Roth.

SensoTRACK™ activity and performance monitor, the first product of Sensogram Technologies AG, will roll out in the European markets in early 2014.  Source: http://www.newswiretoday.com/news/135800/

SOON COMING NTHLY O IN MED M

coming In the up e, Med 2014 issu January l be theme wil Monthly’s site tice Web Your Prac

Study Shows Exercise Reduces Hot Flashes and Menopause Symptoms - from Nutrition Breakthroughs Exercise may be one of the most effective ways to reduce both hot flashes as well as heart trouble in menopausal women. From a recent issue of the Annals of Behavioral Medicine comes a study from kinesiologist Steriani Elavsky. Kinesiology is the study of human movement and motion. The study included 164 menopausal women in their 50’s who were experiencing hot flashes and insomnia and who were somewhat non-active. They were put into three different groups – walkers, yoga-doers and sedentary non-exercisers, and were studied for four months.

The women who walked regularly or took yoga classes reported their stress and tension were reduced, as well as having betterment in their quality of life. Women who walked derived the most benefit in terms of menopause symptom improvements, but yoga was also beneficial.

Elavsky concluded: “We found a significant association between changes in cardiorespiratory (heart and lung) fitness and changes in menopausal symptoms. Women who experienced decreases in menopausal symptoms in the study also experienced improvements in all positive mental health and quality-of-life outcomes.”

This health news is provided by http://www.NutritionBreakthroughs.com.

Since 2001 Nutrition Breakthroughs has been providing natural health articles and effective natural remedies. Their mission is to provide nutritional supplements that get results, and therefore help people to avoid harmful drugs and their side effects. Since 2009, their natural sleep remedy Sleep Minerals II has been keeping that promise -- by soothing even the worst insomnia and helping everyone from teenagers to seniors to get a good night’s sleep.

Sadie D. from The Netherlands says: “I am ever so grateful that I discovered Sleep Minerals II after suffering with premenopause and now the real menopausal insomnia. I felt like I was slowly losing my mind due to the continual lack of sleep. I can’t express the relief of getting a good night’s sleep and being able to function properly.”  Source: http://www.pressreleasepoint.com/studyshows-exercise-reduces-hot-flashes-and-menopausesymptoms-nutrition-breakthroughs

STUDY SHOWS ADULTS HAD SIGNIFICANT WEIGHT LOSS THREE YEARS AFTER BARIATRIC SURGERY National Institutes of Health-funded researchers found that adults had significant weight loss three years after bariatric surgery, with the majority losing the most weight during the first year. A separate study in teens found few incidences of complications in the first 30 days after bariatric surgery. These studies are part of the Longitudinal Assessment of Bariatric Surgery (LABS) and TeenLABS. More than one-third of U.S. adults are obese, defined as having a body mass index or BMI of 30 or higher, and almost 17 percent of youth are also obese. Severe obesity is a BMI of 35 or more in adults and teens. BMI measures weight in relation to height.

Both studies are funded by the National Institute of Diabetes and Digestive and Kidney Diseases, part of NIH. The results appear online November 4 in the Journal of the American Medical Association (JAMA) and JAMA Pediatrics, respectively.

LABS found that adults who had either Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding had significant weight loss three years after surgery, with the majority losing the most weight during the first year. LABS is an ongoing study and its researchers will conduct longer-term follow up of participants’ health and weight status.

Teen-LABS found that 30 days after surgery shortterm complications were low, which researchers view as important information to help doctors and families better evaluate the risks and benefits of the procedure. Teen-LABS investigators will continue to follow participants to determine longer-term health and weight outcomes of bariatric surgery in teens.

NIH launched LABS and Teen-LABS in 2003 and 2007, respectively, to assess the short- and longer-term risks and benefits of bariatric surgery among adults and teens with severe obesity.

Source: http://www.nih.gov/news/health/ nov2013/niddk-04.htm WWW.MEDMONTHLY.COM |9

insight

Living Longer With

Palliative Care

By Helen McNeal Executive Director California State University Institute for Palliative Care

Through teamwork, palliative care professionals are helping patients with serious and chronic illnesses live longer and enjoy their lives more.

November was National Hospice & Palliative Care Month. It is estimated that 1.5 to 1.6 million patients in the United States received hospice or palliative care services in 2012.

Anecdotal accounts indicate that many more who would benefit by this care did not have access to it or had to wait so long that services were provided only during their final few days of life.

Considering that 90 percent of American adults live with a chronic illness before they die, this is an important issue. While some manage well on their own with minimal assistance from healthcare 10 | DECEMBER 2013

professionals and/or friends and family, others may need more handson care and supervision, particularly as their disease burden becomes heavier. We cannot forget that as the population ages, more people with multiple illnesses or conditions will require more supportive care.

Doctors, nurses, social workers, chaplains, and allied health professionals play vital role in educating the public about palliative care and the fact that it is much more than just hospice. Sharing the same philosophy and patient and familycentric approach, palliative care is the

broader umbrella of care for those with a serious or chronic illness and goes hand-in-hand with curative treatment.

Palliative Care is care that may be given while someone is receiving treatment that they hope will either cure them of their illness or prolong their life. Hospice on the other hand is the intensive end-of-life care offered to patients who are projected to have less than 6 months to live and who have elected to discontinue curative treatment.

The other role that health professionals, in particular physicians and nurses, play is in referring patients

to palliative care. When we explore the reasons why health professionals are not referring their patients to palliative care, many reasons surface.

Some of these reasons include the fact that services are not available in their area or that they are afraid of “losing” their patient. The first reason is valid; the second is not, as most palliative care is consultative. But the reason that is hardest to understand is when providers do not refer because they believe that a palliative care referral means giving up on life. In fact, the opposite is true.

As noted above, palliative care goes hand-in-hand with curative treatment. Most importantly, as an article, published in The New England Journal of Medicine (NEJM) in August 2010 highlighted, researchers have found what many had suspected for some time, that receiving palliative care actually helps patients to live longer.

The researchers evaluated the utility

of early palliative care for patients with metastatic non-small-cell lung cancer. Newly diagnosed patients were randomly assigned to either early palliative care in addition to standard cancer care or cancer care alone. The results showed that not only did the patients who received palliative care have a better quality of life; they also lived longer, with a median survival of 11.6 months compared with 8.9 months in the group that did not receive palliative care. Since this article was published, other smaller scale studies have duplicated these findings.

There are many benefits to the health care system of palliative care … it reduces readmissions, results in few admissions for futile care, and in general, reduces costs associated with serious illness and end of life care.

But, as important as reducing costs is, it pales besides the human imperative to enhance the quality of life of those

we care about. And, no one would disagree that enabling those we love and care for to live as long as possible with the highest quality of life possible is a higher order goal.

Palliative care is an approach that requires close teamwork from healthcare professionals, from nurses and physicians to social workers, pharmacists, dietitians, chaplains, counselors and many more. Thanks to this teamwork, the needs of the patient and family can be assessed, understood and addressed. And, thanks to this teamwork, palliative care professionals are helping patients with serious and chronic illnesses live longer and enjoy their lives more.

During National Hospice and Palliative Care month, isn’t it time that all of us who are health care professionals set aside our preconceptions and control issues, make the necessary referrals, acts as teams and focus on the best for patients and their families? 

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

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

We are offering this practice for $130,000 which includes all the medical equipment and furniture. The building is free standing and can be leased or purchased.

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

Medical Practice Listings Selling and buying made easy

MedicalPracticeListings.com | medlisting@gmail.com | 919-848-4202 WWW.MEDMONTHLY.COM |11

insight

By Nili S. Yolin Of Counsel Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C. 12| DECEMBER 2013

Five Tips for Addressing Disruptive Physician Behavior

R

ecently, a colleague and I spoke at the NAMSS 37th Educational Conference & Exhibition to nearly 200 medical directors, chief medical officers, and credentialing staff about what constitutes disruptive physician conduct in the hospital setting, and what hospitals can do to manage it. When a few audience members volunteered to describe their own experiences with disruptive physicians, it was readily apparent that the untenable situations they described were ones with which the rest of the audience could relate: a physician writes highly inappropriate notes in a medical record, a surgeon refuses to listen to a nurse in the OR, a nurse feels intimidated by a doctor who either berates or ignores him/her when he/she asks questions. Other factors with which the audience agreed was the fallout from disruptive behavior: low morale, poor patient satisfaction, high staff turnover, and medical errors or near misses. And finally, there was no question that everyone wanted to find the path of least resistance by avoiding the dreaded peer review hearing.

Perhaps the most fascinating revelation was how often the same physician who is described as obstreperous and threatening is also described as the most intelligent and charming – indeed, it is this precise dichotomy that likely causes a hospital to disregard or condone the physician’s behavior. But hospitals are obligated to create a work environment that promotes professionalism and a culture of safety for patients. This can be a difficult task, particularly when there is a staff physician who distracts colleagues and administrators from what is truly important: quality patient care. Below are five quick tips for proactively, rather than reactively, addressing disruptive and unprofessional physician conduct: 1. Adopt a Code of Conduct. Joint Commission Leadership Standards require hospitals to have a code of conduct that “defines acceptable and disruptive and inappropriate behaviors.” The code of conduct should identify what types of behavior are considered intolerable so that there is clear guidance – and managed expectations – about what conduct is and is not acceptable at the hospital.

2. Open the Lines of Communication. Nothing good ever comes out of first addressing a situation in an adversarial manner. Make sure the physician is spoken to informally – by the department chair, by the medical director, and if necessary, by the entire medical board. Having discussions in which the physician is advised of the inappropriate conduct and gently warned of the consequences of continuing such conduct can have a lasting impact and help avoid a peer review hearing.

3. Mentoring. Hospitals should have a system in place whereby physicians can seek mentoring from their peers, particularly when informal meetings fail to adjust the physician’s behavior. Mentoring can take place in or out of the hospital setting, but should be structured so that honest and objective feedback can be provided to the physician on issues ranging from the physician’s technical competence to staff relations and, of course, behavioral attitudes.

4. Performance Improvement Plans. The performance improvement plan (PIP) is an excellent tool for hospitals to communicate specific expectations to a physician in a manner that shows the hospital is invested in the physician’s success. The PIP sets forth the physician’s deficiency, identifies the hospital’s expectations for improvement, including a timeframe for resolving the deficiency, and notifies the physician of the consequences for non-compliance.

5. Referrals to Professional Organizations for Treatment. If the hospital does not think that a physician can be remediated with any of its own resources, referral for outside treatment should be considered. Options include everything from weekly psychiatric counseling to thirty-day inpatient programs, as well as anger management, emotional intelligence and behavioral modification courses.

There also are state medical society resources, such as the Committee for Physician Health in New York, that provide confidential, non-disciplinary assistance to physicians.

Because disruptive physicians often lack the self-awareness to realize their behavior needs improvement, they also tend to resist adversarial processes and the proposed sanctions that go along with them.

While there really is no easy way to address unprofessional behavior, doing nothing can be toxic for everyone involved. Hospitals need to ensure that they have a process in place for addressing disruptive behavior at the front end, and that each stage of remediation is documented. If and when that process fails, formal discipline, including probation, suspension and termination, will likely be necessary.  The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

Source: http://www.healthlawpolicymatters.com/ WWW.MEDMONTHLY.COM |13

insight

Why Zen Works in Website Design

By Lori Gertz Freakin’ Genius Marketing

Lori Gertz is the Chief Freakin’ Genius at Freakin’Genius Marketing specializing in website strategy, design, content development and deployment in a world of multitudes of devices. www.freakingeniusmarketing.com 14 | DECEMBER 2013

There’s hardly anything as corny as a marketing riddle, but here goes. Responsive web design isn’t a web site that gets you referrals nor is it a website that drives new patient traffic but both are outcomes of having a website that features responsive web design. So what is it? Did I get you curious?

Well first of all, let’s do an experiment. Pull your site up on your desktop or your laptop. I’m assuming you have a screen at least 12-15” wide. Can you see your whole page? Do you have to scroll down to see the content on your home page? How about your other pages? Can you see the tabs for your site’s main pages at both the top and the bottom of the site? Is the font crisp and clear? Is there reverse type? Do you have flashing elements loading?

Now, grab your phone. Whether it’s an android or an iPhone, you’ll note that the screen fits in the size of your palm. Now, pull up your website. What do you see? Are you looking at a 2X4 version of your whole home page in an unreadable font size? Or, are you looking at a miniscule piece of the left hand corner of your home page? Do you have to scroll down and across just to see the name of your business? Is the sunshine or the light above you making the screen so dark you can’t read the letters anyhow? Do you see funny shapes where the flash was unable to load?

Ok, ok…just to prove my point. If you’ve got one, pull out your ipad. Try the exercise again. What elements do you see in a warped presentation on that screen?

Websites that were designed as recently as three to five years ago were not designed as responsive. Yes, what I’m getting at is that they were designed for desktops and laptops. Where a mobile site was launched as a .mobi it was a separate site from the original site and even so, wasn’t a particularly intuitive design model.

With the popularity of multiple mobile devices of different shapes, sizes and resolutions comes the advent of responsive web design; really out of necessity rather than form. It originated because designers had to physically rewrite their sites to adapt to each new platform.

Specific phones and tablets needed uniquely formatted websites, and companies struggled to keep multiple sites

for their products working right. As a result, web design became time-consuming, costly, and just darned tedious.

Zen works across platforms! Responsive web design contains a set of techniques that adapt website features for each platform automatically, making the site functional, practical and user-friendly regardless of what device the user chooses to use to access it.

Responsive web is zen. Zen is simple. Zen works.

• Gives you increased flexibility Websites will be able to fit any screen size on any device, ensuring that brands can reach consumers effectively. That means people will be able to look you up anywhere. Even when they are waiting in their doctor’s office shopping for a new doctor that won’t keep them waiting so long.

• A better user/prospective patient experience; Reaching more people in more places.

The designs are highly adaptive and will optimize website content for each device in its own way. The site will look great, be intuitive, and be help your prospect find what they are looking for easily. A happy prospective patient is a happy long-term patient.

• Reducing your bounce rates In the past, bounce rates were high for mobile devices, largely due to functionality issues from websites that hadn’t been optimized for that particular device. They’ll find your site, no problem. No bouncing. Your site will come up under your domain name on any device. ANY DEVICE! For more information on cross-platform compatibility, AKA, a simple, zen design that is beautiful on any screen your patients and prospective patients use, contact a strategic website design company that knows a site can be beautiful and effective in today’s multi-screen world. 

Subscribe to receive Med Monthly e-news Click here to join our e-news subscribers and get current medical news as it happens Visit us online anytime at medmonthly.com WWW.MEDMONTHLY.COM |15

insight

Off the Beaten Path:

The Country Doctor Museum

By Annie Anderson Director & Head Curator, The Country Doctor Museum Located in the small, rural town of Bailey, North Carolina, about 45 minutes east of Raleigh, The Country Doctor Museum offers a unique experience where guests discover the challenges and triumphs of health care and medicine in early rural America.

Museum History & ECU Connections Inspired by the enthusiasm of Dr. Josephine E. Newell, a small group of determined women founded The Country 16| DECEMBER 2013

Doctor Museum in 1967 as a lasting tribute to rural physicians. Dr. Newell, herself the seventh in a line of country doctors, wished to honor the memory of these predecessors who faithfully served in rural communities like Bailey. Through the generosity of these early volunteers and supporters, the Museum opened in a re-constructed building made from two historic doctor’s offices and the collections grew steadily to encompass family medicine, nursing, pharmacy and dentistry.

In 2003, The Country Doctor Museum was gifted to

East Carolina University’s Medical and Health Sciences Foundation and is currently managed by the William E. Laupus Health Sciences Library at ECU. The Museum’s scholarship, exhibits and programs have flourished under ECU’s stewardship. It enlightens students studying health care with the history of their chosen profession and offers practical, hands-on experiences for students of public history, artifact conservation and education.

The legacy of country doctors, as preserved by the Museum, shares a close affinity to the guiding principles of ECU’s Brody School of Medicine (BSOM) to increase the supply of primary care physicians in North Carolina and improve the health status of her citizens. The BSOM is the nation’s top ranked school for graduating family physicians. It is also in the top 10% of U.S. medical schools whose graduates go on to practice in rural and underserved communities. The Museum’s artifacts give evidence of the country doctor’s ingenuity, dedication and spirit. These traditions of innovation and commitment are carried on by modern medical school graduates.

Historical Collection The Museum’s collection illustrates a story of change and advancement in rural America’s medical history from the early 1800s through the WWII era. The first stop on a guest’s guided tour is the “Apothecary Room” featuring long-forgotten remedies, blood-letting instruments, and decorative show globes. Show globes (an early symbol of the pharmacy) were placed in the front windows or on counters of shops in the late 19th and early 20th centuries to inform customers that someone working in the store could compound medicine for them. Museum guests are

Apothecary Room

Dr. Newell starting the museum

also treated to a pill-rolling demonstration to explain how country doctors made their own medications.

Other exhibit highlights include Civil War era surgical instruments, prosthetic limbs and a country doctor’s financial ledger showing how the doctor accepted all sorts of items such as peaches, corn and ham, to settle his patients’ accounts. Many patients did not have cash to pay the doctor at the time of service so they paid on their account as they could afford to do so. The ledger documents the doctor’s close interaction with community members, especially during times of crisis, and reveals a dedication to meet the needs of the sick.

The Museum’s nursing history collection centers on 3-year diploma nursing programs that flourished throughout the country until the 1970s. Florence Nightingale lamps, student nurse uniforms and a variety of nursing caps help interpret the history of this storied profession. A late 19th century midwifery set harkens back to a time when trained and lay midwifes were critically important to the health of newborns and new mothers in rural communities.

In 2011, a turnof-the-century dental office collection was donated to the Museum to commemorate the work of rural dentists and to celebrate the opening of Ross Hall continued on page 18

History Alive

at ECU’s School of Dental Medicine. Dr. Milford, a dentist from Poolesville, Maryland, graduated from dental school in 1898 and acquired the “New Columbia Ritter Dental Chair” for his home office. His collection of examining instruments, amalgam supplies and a foot-pedal dental engine give clues to his daily work. Dr. Milford’s collection was brought to North Carolina by Dr. Roger Sears, the first dentist to open a practice in Kitty Hawk. Dr. Sears graciously donated the Milford collection to The Country Doctor Museum.

family’s kitchen table.

The Carriage House is also home to the museum’s polio display featuring an iron lung and other artifacts dating back to a time when this devastating disease crippled children and communities during summertime epidemics. Over the years visiting school children, not familiar with polio, have guessed the iron lung to be an incubator, washing machine or tanning bed. These students pay close attention when they discover that children and young adults had to live in these respirators years ago. The iron lung is a powerful teaching aid in educating a new generation about the dangers of old diseases.

Carriage House Surprises

Making a Difference

The Museum’s Carriage House is filled with country doctor’s buggies and antique cars that stand in quiet testament to the often difficult travels made by country doctors while making house calls. Stories from the past tell of country doctors who illuminated farmhouse windows with their vehicle headlights for surgeries performed on the

In addition to guided tours, The Country Doctor Museum also offers in-classroom visits to regional elementary schools, “House Calls in the School Halls.”

Students rotate through hands-on activity stations where they learn about stethoscopes, discovering artifacts, using mortar and pestles and the math behind pill rolling. The

continued from page 17

18| DECEMBER 2013

Museum’s annual autumn event, “History Alive” brings hundreds of visitors to Bailey for the day to enjoy activities and displays from area museums and historic sites, historical re-enactors and horse drawn carriage rides.

Recently, the Museum began hosting mobile health care units to make medical services more accessible. A mobile mammography unit visited to accommodate twenty women, many of whom had not previously undergone a mammogram. Additional site visits from organizations offering dental, kidney and health screening mobile units are planned for the coming year.

Plan Your Visit With admission, Museum guests receive a guided tour, usually lasting 45-60 minutes. Tours are offered every hour, on the hour from 10am-3pm, Tuesday through Saturday. Many guests stop for a tour while traveling along the nearby I-95 corridor, while others enjoy a daytrip to Bailey. Please call The Country Doctor Museum at 252-235-4165 or visit the Museum’s website, www. countrydoctormuseum.org for additional information. 

Annie Anderson started working at The Country Doctor Museum in 2003 when East Carolina University’s Laupus Library took over the management of the museum.

Since then, each day promises different adventures and challenges. Guests visit the museum from all over the world and having the opportunity to speak with them about their memories and experiences with special health care providers makes her job unique and rewarding. Annie has a BA in Anthropology, a MA in Museum Studies and she lives in Wake Forest, North Carolina, with her husband and two children.

Show Globe

Annie Anderson

WWW.MEDMONTHLY.COM | 19

practice tips

Get Patients Clamoring For Your Services

By Barbara Hales, M.D.

Recently there has been a lot written regarding social media, patient portals and patient engagement.

With meaningful use criteria including the ability to interact with patients online, health care providers and doctors have been seeking new interactive avenues, which includes various social media channels like Facebook, Twitter, YouTube, and Instagram.

Ironically, the most effective tool for spreading your message has been at your fingertips all along - your newsletters and email marketing.

Email Beats Facebook For Getting New Patients and Service Signups A recent survey by AW Pro Tools of 1,500 consumers nationwide demonstrated that one-third of respondents across all incomes were influenced by digital marketing tools when making online purchases. 13.8% said email influenced them, while 13.5% said Facebook did.

20 | DECEMBER 2013

Both those channels beat YouTube (3.5%) and Twitter (1.9%).

Knowing these results can help you decide where to allocate your time and marketing dollars.

“The winning strategies for entrepreneurs and Fortune 500 companies alike is to attract a base of raving fans that open, read, and click on the emails you send,” says Jack Born, CEO of AW Pro Tools. “Without a well thought-out email strategy, money spent on any advertising is going to be much less effective, especially if you want to attract highincome clients.”

Email marketing and newsletters is one of the best ways to keep in touch with your patients and clients, informing them about what is new in the practice, as well as attracting new ones.

Getting New Subscribers to Your List If you think that you can add all your patients to your Ezine or newsletter list without their consent, think

again!

Sending your electronic newsletters to “subscribers” who did not opt-in, is inviting those who did not request your Ezine to hit the delete button without ever opening the newsletter.

Worse yet, when your digital newsletter is reported as spam, since it wasn’t requested, your host server can shut you down.

Opt-In Process Opting-in is like raising your hand and saying, I want this; I want to participate. Regardless of whether you signed readers up or they signed up themselves, an opt-in process will ensure that the readers want to be there. When they have enrolled as subscribers, a confirmation is requested and when approved, you have them.

4 Benefits to Having an Opt-In Subscription Adopting a signup process for your newsletters has several advantages:

Your Valued Gift

1. Improve deliverability- your site will be white listed, ensuring that your delivery gets passed the spam filters. Your readers will look forward to opening up your regular newsletters and interested in what you have to say.

2. New Leads (prospective clients) will be genuine people more than likely and not made up names with fake email addresses.

3. Save Money- newsletters going out in the mail to the wrong address means throwing money out and increasing your expenses with no benefit. Ezines sent to “fake lists” cost you in terms of wasted time and marketing.

4. Separates the Real leads from the tire-kickers- by getting the prospective subscribers to go through the opt-in process, you can distinguish those who are truly interested, as opposed to those who are curious and just want to see your work on impulse.

Sure, your message has value, but unless your target market knows this, you will have no one interested in subscribing to your newsletter or Ezine.

Figure out what your market is interested in and provide it. Give a gift or an incentive, which is valued and considered helpful or beneficial such as: • Free Ebook or chapter of a book that you are promoting • Whitepaper, guide, tip sheet • Frequent Questions and Answers sheet Part of your opt-in process will consist of having prospective clients provide their email addresses to receive the bonuses they want.

Offer an Ezine or newsletter that has been circulated before so that a prospective reader can get a feel for your “voice”.

Most importantly, make sure that

the Ezine or newsletter delivers quality and helpful information every time the new one is issued.

This will turn your information into desired material that people look forward to with each delivery.

Important Information Don’t forget to put information about the daily operations of your office. Don’t assume that patients already know.

Information that should be included: • Office hours each day • How to contact you or your service when the office is closed • Telephone number • Office address The telephone number and address can be part of the newsletter banner so that it isn’t missed. Don’t make patients sift for this important data.

Don’t have time to write and spread your newsletter? This is no problem.

Outsource it! 

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practice tips

Declare Your Medical Practice a

DRAMA FREE ZONE

by Audrey McLaughlin, RN www.physicianspracticeexpert.com

One of my favorite topics in medicine is patient service, and this service goes beyond diagnosing and treating their clinical issues. Customer service is the new marketing, and poor customer/patient service reduces your ability to retain patients and have them refer their family and friends.

22 | DECEMBER 2013

O

ne important aspect of customer service is what I call the “family drama effect.”

Imagine you are a guest in a friend’s home for a Sunday afternoon barbeque. Everything seems to be going smoothly; you and several others are milling about the backyard, the host and their family relaxing with you. Out of the corner of your eye, you notice that the host’s oldest daughter is gesturing angrily and quietly mouthing words to the host. A quick glance at the host, his face is red with anger and embarrassment. Within seconds the host, hostess, and their family members are in an angry screaming match in front of everyone. Pretty tough to watch, are you uncomfortable yet?

What if a similar scenario played out in a more professional environment, say your clinic? Imagine being the patient, and having the office manager, nurse, and physician angrily argue over the upcoming schedule while you are all sitting in a small exam room. Pretty unbelievable? Has something similar happened in your clinic?

Recently this scenario played out right in front of me, while my history was being taken at a new physician’s office. I see and discuss less than desirable and even uncomfortable situations on a daily basis, but this one brought “uncomfortable” to a whole new level. I always see a look of intrigue and often field the question “how do we stack up?” on personal medical appointments when I answer the question “Ms. McLaughlin, what do you do for a living?” The look on this doctor’s face was priceless.

When these types of scenarios play out in a medical practice, I call it the “family drama effect.” For many of us, our job is where we spend eight or more hours per day most days. Your coworkers are effectively a second family, and over time this family can become a big dysfunctional and loving unit. Just as parents keep kids inline, it is important for the leaders in a work family to handle disagreements in a professional manner.

Disagreements must remain private and staff must be reminded that there is a professional code of conduct in front of patients. Airing your grievances is a demonstration of poor customer service (among many other issues), and in this social media age could lead to reputation damaging if a patient in my situation takes to Facebook or Twitter to complain.

It is entirely possible that the patients or families in the exam rooms on either side of me did take to social media or begin texting and relaying the story as it unfolded.

What if someone caught a quick video snippet when the argument continued all the way to the reception desk?

There could be huge repercussions on a number of levels. It is the reality we face today.

Here are five simple strategies for reducing or removing the “family drama effect” in your clinic:

1. Start with leadership.

As a leader in your medical practice, you must start with yourself. Periodically do a self-check up and be honest with yourself about your culpability in the culture of your practice. Take action to stop if you find you may be contributing to workplace drama.

2. Diagnose the issues.

Diagnosis can be difficult, sometimes it can be challenging to separate fact from opinion. It often comes down to he-said/she-said, do your best to strip the judgment and get down to the real issue. Once that issue is uncovered, shift focus on the next action that needs to be taken. For example: This afternoon’s clinic is overbooked. Rather than focusing on who is to blame, encourage staff to seek out the solution for the issue.

3. Begin treatment immediately.

Drama breeds more drama, make resolution to any problem a priority (i.e. seek solutions). Once the issue is handled, ask any involved employees to write down 10 good qualities about each other and discuss them.

4. Implement a No Gossip Policy.

Many times before and after a dramatic event between coworkers you know the rumor mill is churning up gossip. If you have an office gossip policy you should be reminding your staff about the policy. If you don’t have an official “no gossip policy,” get one.

5. Have regular staff check-ups (staff meetings).

Prevention is often the best medicine and that is true for the “family drama effect” also. Hold regular staff meetings and include reminders of personal behavior policy and the policy for handling disagreements.

Also include the opportunity for staff to bring up any pending issues. (Don’t forget to add a bit of teambuilding fun to your meetings, people that have fun together have less tension.)

Disagreements will happen in a work environment, drama should not. If disagreements do get dramatic, it is imperative to keep all drama away from patients and guests. Airing your dramatic office issues in front of your patients and guests is a fast way to scare away your patients and earn a poor reputation in your community.  Audrey is a mentor to business owners, medical providers, managers, and leaders. She transforms clinics, offices, small businesses, hospitals and healthcare organizations into places employees want to be and customers/clients/patients want to return to and recommend to their friends. Her newsletter, Physicians Practice Expert goes out weekly. If you are ready for big transformations, signup for your complimentary subscription at www.physicianspracticeexpert.com.

WWW.MEDMONTHLY.COM |23

practice tips

When Life Impacts Work:

Finding Work/ Life Balance

By Liz Ferron, MSW, LICSW Physician Wellness Services

24 | DECEMBER 2013

The cost of replacing a physician is estimated at anywhere from $150,000 to $1,000,000 and a nurse $40,000 to $60,000—but how does one calculate the cost of a physician or nurse who’s physically present in the exam room but mentally miles away?

Personal problems—from marital or relationship issues, to children in crisis or elderly parents in need of care, to financial investments gone bad— often have impact the quality and quantity of patient care that a physician or nurse is able to offer.

Heathcare providers tend to believe that they are immune to stress. The reality is they are often unaware of the toll that personal stress is taking on themselves and their work. It’s important for healthcare organizations to take steps to help their providers recognize when this is happening—and for physicians and nurses to become more self-aware about how their personal struggles may be impacting their work and job performance.

Common Stresses, Uncommon Costs

All employers pay a toll for distracted employees: • Relationship-related stress costs employers about $300 billion annually (Velasquez-Manoff, 2005) • A 2010 MetLife Caregiving Cost Study estimated that that an employee caring for an elderly parent costs his or her employer 8% more per year in increased healthcare costs alone, not counting absenteeism, presenteeism and work interruption-related costs.1 • Employees dealing with major financial problems cost businesses an estimated $15,000 per affected employee per year2 These are average costs at healthcare organizations, considerations such as the potential cost in dollar and human terms of adverse events make the cost of normal life distractions exponentially higher. Given the stress

of their profession, physicians and nurses also experience more stress in their personal lives. For example, various studies have shown that the rate of divorce among physicians is estimated to be 10-20% higher than in the general population, and even higher for nurses.

Clearly, it benefits healthcare organizations to intervene quickly and compassionately when they see that a physician’s or nurse’s personal problems are beginning to affect onthe-job performance. Sometimes, relatively simple steps can be taken to help the provider and ameliorate the effects in their work.

Extreme Distractibility: A Case in Point

A primary care physician referred to us had been going through a particularly difficult divorce while at the same time struggling with an adolescent daughter who’d been in and out of treatment for a variety of behavioral health issues.

He was so concerned about his daughter that he dropped everything to accept cell phone calls from her and her siblings, no matter what he was doing. Patient feedback about the distractions was reaching not just his colleagues, but also the organization’s CEO. In addition to distracted patient care and disruptions in the schedule, the physician had also fallen deeply behind in case management and record keeping. The organization was concerned, but very much wanted to retain the physician, whose contributions were highly valued and whose performance, until recently, had been above reproach. Working with the physician and referring practice, a thorough evaluation of the situation resulted in a performance improvement plan for the distracted doctor that included: • An agreement that his cell phone wouldn’t be taken into the exam room • A temporary reduction in administrative duties and clinical

load to give him time to catch up on his cases and medical records • A therapist to help the physician work through his marital and parenting issues • A physician peer coach to work with the physician on more effective ways to balance his work and life issues • An evaluation and coordination of the family counseling and behavioral health resources being provided to the physician’s family (at the request of the physician and with full permissions) In this instance, the physician was unaware of how his behavior was affecting patients, colleagues and staff.

He actually appreciated the heads up and the support the organization was willing to extend. The referring organization was able to see immediate and noticeable improvement and was kept apprised of the physician’s progress on a regular basis for a year, at which time it was agreed by all parties that the performance issue had been resolved and the ongoing family issues were being appropriately handled.

Clear Performance Issues, No Clear Cause

In smaller practices or medical groups, colleagues often know the underlying causes of a change in behavior: “He’s going through a divorce,” or, “Her father’s in the hospital.” However, staff at a hospital may have no idea why a surgeon suddenly becomes bullying or dismissive every time he or she makes rounds, or a nurse who is normally impeccable in her charting starts to forget things.

Ruling out mental health and substance abuse issues, or medical problems, when there are clear performance problems is critical in any workplace, but especially in healthcare settings. Once other causes are ruled out, it’s important that organizations delve for potential underlying issues in an employee’s personal life that might continued on page 26 WWW.MEDMONTHLY.COM |25

continued from page 25

be impacting what is being observed in the workplace.

Sometimes this can be a challenge.

While a provider may be struggling with a personal issue, most healthcare organizations also struggle to balance compassion and respect for privacy with concern about how a their behavior will affect not only patient care, but also the organization’s liability and bottom line. Healthcare organizations can provide physicians and nurses the help they need to become or remain productive without getting into the nitty-gritty details of the their personal lives in a variety of ways.

Restoring Work/Life Balance: Ways Healthcare Organizations Can Help Providers

A 2010 article in American Medical News stated, “An unmanageable work schedule and out-of-control home life can lead to depression, poor performance at work, conflict with family and a feeling of burnout that can lead physicians to question whether to stay in medicine at all.” A 2006 paper in Research in Nursing & Health found “52% of nurses reported episodic family interference with work, and 11% reported chronic family interference with work.”

The reality is that ensuring a healthy work/life balance for physicians and nurses increases physician retention and productivity, improves patient care and reduces risk.

Sometimes it’s a matter of freeing up time so that physicians and nurses can attend to personal issues on their own time and at a more realistic pace: • Offering flexible hours and, for physicians, a period of no call or reduced call • Offering concierge-type services to assist with daily tasks, especially those that must be done during normal business hours that make it especially difficult for healthcare 26 | DECEMBER 2013

providers • Encouraging use of EAP services, which can provide confidential assistance and resources around family and relationship issues, financial struggles and legal problems • Allowing temporary changes in work schedules, practice assignments or duties

conversations regarding conflict. Addressing conflict and moving beyond it can make an enormous difference in your feelings and perceptions.

• Set regular times to get together with family and friends, and stick to them.

• Find time for regularly scheduled family meetings and meals together. Everyone may have to give a little to make this happen, but it will be worth it.

• Give people the benefit of a doubt and avoid jumping to conclusions. Work on identifying obstacles to trust.

• Be open to reasonable feedback.

• Ask for help and delegate responsibilities and duties when possible.

3. Better self-care--practicing good self-care establishes a solid foundation for coping. Some ways to do this include: • Build “down” time in schedules to take restorative breaks throughout the day.

• Enroll in a yoga, Pilates, or mindfulness meditation class to reduce stress.

• Read fiction, write in a journal, or meditate.

• Identify more ways to integrate exercise into daily life.

• Improve nutrition by sitting down to breakfast, taking a break for lunch, bringing healthy snacks to work, and being there for family dinners.

• Take care of mental and emotional needs. Acknowledge losses and take time to grieve.

• Identify workplace and personal challenges that create stress, and develop an action plan for addressing or coping with them. 

Helping Providers Help Themselves

Having organizations assist in making accommodations for providers is one approach to helping them more effectively address personal issues.

However, a longer-term approach is equally helpful in encouraging physicians and nurses to take a more constructive approach to dealing with problems in their personal lives.

There are three major areas where taking a different approach can make a big difference in approaching personal issues—and preventing them from spilling over into the work sphere to begin with: 1. Better time management—this can be a challenge due to many demands that may seem conflicting. Here are some ways to manage time more effectively: • Sit down with spouses or partners to discuss and negotiate relationship expectations.

• Better align priorities and values between home and work.

• Look for areas where limits can be set on boundaries and time—both at home and work—and stick to them.

• Seek mentors who model good time management and ask for their advice and guidance.

2. Stronger relationships— relationship problems can be a great drain on both time and emotional energy. Some ways to strengthen relationships both at work and at home include: • Engage in necessary

“The MetLife Study of Working Caregivers and Employer Health Care Costs,” February, 2010 2 Journal of Employee Assistance, 1st Quarter, 2009, January 1, 2009 1

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research & technology

Examining the Future of On-Demand Mobile Personal Health Records

By Frost & Sullivan

28 | DECEMBER 2013

Governments and increasingly technology-savvy healthcare consumers are demanding better quality care, cost containment, and improved access, fuelling development in mobile connectivity that provides on-demand access and ownership for all personal health information. True integration of health information, however, will require data to be collected along an ever-extending care continuum that currently includes providers, hospitals, physician specialty groups, imaging centers, laboratories, payers, government entities that oversee healthcare entitlements, and patients using personal health devices. The challenge lies in the fact that these stakeholders have historically operated independently, deploying unique IT infrastructures and fragmented patient record systems.

Frost & Sullivan’s new white paper, Moving Beyond the Limitations of Fragmented Solutions, examines the challenges and multiple platforms of interoperability that must be mastered before a true on-demand mobile personal health record (PHR) can be introduced.

Ownership of personal health data is still a very undetermined element of ongoing healthcare reform in the U.S., as attempts encouraging patients to keep their health information up-to-date and physically own the digital files has been met with a tepid response. Historically, doctor’s offices and hospitals have taken both control and responsibility of health records. Despite the apathetic response, as our healthcare system transitions to electronic health records (EHR), consumers are demanding digital access to personal health information.

Because America is an increasingly mobile society, any ownership of health data on the part of healthcare consumers must include remote, on-demand access to all health related information.

“Two realities have emerged from widespread EHR deployment,” noted Frost & Sullivan Connected Health Senior Industry Analyst Patrick Riley. “Firstly, the host of available EHR systems lack interoperability and cannot communicate with one another, therefore failing to reach the goal of creating seamless, universal and secure access to individual health information. Secondly, the end user, or patient, does not own his or her health information, as this data is stored within the IT protocols of the EHR system, proprietary to providers, hospitals and health systems.”

Frost & Sullivan analysis has revealed an emerging leader in integration server capability that can address these concerns. CORAnet Solutions, Inc. is a seasoned healthcare information company that is the first to provide a true mobile system for PHR access. The solution integrates patient data from various sources and offers it on a mobile device in a user-friendly and secure format.

It enables patients to update their information, allows access even without network coverage, permits the transfer of medical images, and facilitates ondemand mobile access to limited, life-saving individual patient information in emergency situations.

“After conducting both primary and secondary research analyzing mobile healthcare technology companies and their capabilities, Frost & Sullivan is able to validate its assessment of CORAnet and the company’s leadership, history and current offerings in the on-demand mobile health technology industry,” said Riley.

Moving Beyond the Limitations of Fragmented Solutions is part of Frost & Sullivan’s Connected Health Growth Partnership Service program. To access this white paper or for more information, please email Jennifer Carson, Corporate Communications, at jennifer.carson@frost.com, with your full name, company name, job title, telephone number, company email address, company website, city, state and country.

Source: http://www.newswiretoday.com/news/135351/

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research & technology

Gene Hastens Kidney Disease Progression in African-Americans A gene variant common in AfricanAmericans predicts that people with that gene who also have chronic kidney disease (CKD) are twice as likely to progress to kidney failure as African-Americans without the highrisk gene and white people with CKD. People with the high-risk gene also tend to lose kidney function at twice the rate of those without the gene, according to the research, which was funded by the National Institutes of 30 | DECEMBER 2013

Health.

Investigators from the Chronic Renal Insufficiency Cohort (CRIC) Study and the African American Study of Kidney Disease and Hypertension (AASK) published joint results online in the New England Journal of Medicineat http://www.nejm.org , which will appear in the Dec. 5, 2013 print issue.

The impact of the gene variant — known as APOL1 — on risk for

and rate of CKD progression was consistent in both studies, regardless of whether patients maintained good blood pressure control or had diabetes.

High blood pressure and diabetes are major risk factors for CKD and its progression to kidney failure.

“We now know that the APOL1 gene variant is independently associated with a more aggressive course of disease. This finding tells us that different treatment strategies

should be studied, so that we may one day delay or prevent kidney failure among people with this genetic risk,” said Paul Kimmel, M.D., director of the Kidney Translational Genetics Program at the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

“Now that the importance of the gene is known, clinicians could potentially genotype — or map the genes — of African-Americans with CKD to assess their risk for disease progression,” said Afshin Parsa, M.D., a nephrologist at the University of Maryland School of Medicine in Baltimore and a CRIC Study investigator. “This discovery provides direct evidence that AfricanAmericans with established CKD and the APOL1 risk gene variant experience a faster decline in kidney function compared to their white counterparts, irrespective in most cases of what caused their kidney disease.”

Parsa and Linda Kao, Ph.D., a geneticist from the Johns Hopkins Bloomberg School of Public Health in Baltimore and the AASK Study Group, co-led the research.

The discovery builds on landmark 2008 research by NIH kidney specialist Dr. Jeffrey Kopp and others, led by Dr. Martin Pollak at The Laboratory of Inherited Kidney Disease at Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, which found the APOL1 gene variant to be a risk factor for kidney disease that wasn’t associated with diabetes.

An estimated 20 million or more American adults have CKD, and over 400,000 people in the United States and 2 million worldwide depend on dialysis to treat kidney failure.

Although exceedingly rare in white people, the APOL1 gene variant is found in 13 to15 percent of AfricanAmericans. Some have speculated that it evolved to protect against one of the two forms of African sleeping sickness, a lethal parasitic disease transmitted by the tsetse fly.

The CRIC study is one of the largest and longest ongoing studies of CKD epidemiology in the United States (ClinicalTrials.gov number: NCT00304148). It is supported under NIH grants U01DK060990, U01 DK60980, U01 DK60902, U01 DK61021, U01 DK61022, U01 DK60963, U01 DK61028 and U01 DK60984. CRIC recently embarked on an expansion to add more than 1,500 patients over the next five years, increasing the study’s total size to approximately 5,500.

AASK is the largest and longest completed study of chronic kidney disease (CKD) in African-Americans.

Beginning as a randomized clinical trial in 1995, the investigation was completed in 2007 as a cohort study.

The NIDDK, a component of the NIH, conducts and supports research on diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition and obesity; and kidney, urologic and hematologic diseases. Spanning the full spectrum of medicine and afflicting people of all ages and ethnic groups, these diseases encompass some of the most common, severe and disabling conditions affecting Americans. For more information about the NIDDK and its programs, see http://www.niddk.nih. gov.  About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih. gov.

Source: http://www.nih.gov/news/ health/nov2013/niddk-09.htm

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research & technology

FDA APPROVES MEDICAL DEVICE TO TREAT EPILEPSY

The U.S. Food and Drug Administration today approved a device to help reduce the frequency of seizures in epilepsy patients who have not responded well to medications.

The RNS Stimulator consists of a small neurostimulator implanted within the skull under the scalp. The neurostimulator is connected to one or two wires (called electrodes) that are placed where the seizures are suspected to originate within the brain or on the surface of the brain.

“The neurostimulator detects abnormal electrical activity in the brain and responds by delivering electrical stimulation intended to normalize brain activity before the patient experiences seizure symptoms,” said Christy Foreman, director of the Office of Device Evaluation in the FDA’s Center for Devices and Radiological Health.

Epilepsy produces seizures affecting varied mental and physical functions. Seizures happen when clusters of nerve cells in the brain signal abnormally, which may briefly alter a person’s consciousness, movements or actions. According to the Epilepsy Foundation, epilepsy affects nearly 3 million people in the United States and is the third most common neurological disorder, after Alzheimer’s disease and stroke. Approximately 40 percent of people with epilepsy are severely affected and continue to have seizures despite treatment.

The FDA’s approval is supported by a three-month randomized control trial of 191 patients with drug-resistant epilepsy.

The study showed that by three months after the implanted device was turned on (active use) patients 32 | DECEMBER 2013

experienced a nearly 38 percent reduction in the average number of seizures per month, compared to an approximately 17 percent reduction in the average number of seizures per month in patients who had the implanted device turned off. At the end of three months, the median reduction in seizures, which reflects a more typical patient experience, was 34 percent with active use and about 19 percent with the device turned off. During the trial, 29 percent of patients with an active device experienced at least a 50 percent reduction in the overall number of seizures, compared to 27 percent for those with the implanted device turned off.

During a two-year follow-up phase (unblinded), data demonstrated a persistent reduction in seizure frequency.

Patients with RNS Stimulators cannot undergo magnetic resonance imaging (MRI) procedures, nor can they undergo diathermy procedures, electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS). The energy created from these procedures can be sent through the neurostimulator and cause permanent brain damage, even if the device is turned off.

The most frequent adverse events reported were implant site infection and premature battery depletion.

The RNS Stimulator is manufactured by Neuropace, Inc. of Mountain View, Calif.  Source: http://www.pressreleasepoint.com/fda-approvesmedical-device-treat-epilepsy

legal

Health and Human Services (HHS) Announces That Affordable Care Act’s (ACA) Exchange Plans Are Not “Federal Health Care Programs”

By Theresa C. Carnegie Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.

In a surprising move, HHS Secretary Kathleen Sebelius announced that qualified health plans (QHPs) purchased through the Affordable Care Act’s (ACA) insurance exchanges are not “federal health care programs” for purposes of the federal anti-kickback statute.

In a letter to Rep. Jim McDermott (D-Wash), Sebelius states that this conclusion was based upon a careful review of the definition “federal health care program” in consultation with the Department of Justice and applies to: • State-based and federally-facilitated Marketplaces; • The cost-sharing reductions and advance payments of the premium tax credit; • Navigators for the federally-facilitated Marketplaces and other federally funded consumer assistance programs; 34 | DECEMBER 2013

• Consumer-oriented and operated health insurance plans; and • The risk adjustment, reinsurance, and risk corridors programs.

Sebelius notes that HHS “is taking strong measures to protect consumers and to ensure robust oversight of these critical Affordable Care Act programs” and refers to the (i) Program Integrity: Exchange, SHOP, Premium Stabilization programs and Market Standards proposed rule, and (ii) finalized first set of compliance standards from that proposed rule in the Program Integrity: Exchange, SHOP, and Eligibility Appeals rule, which include requirements for decertification of QHPs and the imposition of civil monetary penalties against non-compliant issuers. In

addition, ACA expressly provides that the False Claims Act applies to “any payments made through, or in connection with an Exchange if the payments include federal funds.”

Finally, the OIG has jurisdiction to audit and investigate HHS-administered programs and the “affairs of an Exchange.”

Prior to HHS’s announcement, there was considerable debate as to whether QHPs would fall within the definition of “federal health care program” and whether the financial relationships between plans and providers within the Exchanges would be subject to the restrictions of the federal anti-kickback statute. Sebelius’ letter opens the door for providers, such as hospitals, that are considering paying patient premiums or offering other patient assistance programs, and for the offer of drug copay coupons by pharmaceutical manufacturers within the Exchanges.

Drug copay coupons have been a hot button issue for many years. Manufacturers and certain patient support groups contend that copay coupons provide valuable assistant to individuals who need help affording their medications, while plans and pharmacy benefit managers counter that the coupons undermine the use of copayments to steer patients to lower cost generic drugs. The Pharmaceutical Care Management Association (PCMA) is concerned that Sebelius’ announcement may undermine cost controls within the Exchanges and has indicated that it plans to challenge the HHS determination. Therefore, it seems that despite the apparently clear guidance from HHS, the debate over copay coupons may rage on.  Source: http://www.natlawreview.com/article/health-andhuman-services-hhs-announces-affordable-care-act-s-acaexchange-plans-are

CMS Declares Third Party Payment of QHP Premiums Not OK

By Theresa C. Carnegie and Thomas S. Crane On the heels of HHS’s recent announcement that qualified health plans (QHPs) purchased through the Affordable Care Act (ACA) insurance exchanges are not “federal health care programs” for purposes of the federal anti-kickback statute, CMS has published a Q&A in which it states that it has “significant concerns” regarding the payment of QHP patient premiums or cost-sharing obligations by hospitals, health care providers, or other commercial entities.

HHS’s conclusion that the federal anti-kickback statute does not apply to QHPs appeared to open the door for the provision of premium and cost-sharing assistance and for the offer of pharmaceutical manufacturer drug coupons to QHP members. Now, HHS, citing its broad authority under ACA to establish standards with respect to the Exchanges and QHPs, is clarifying that it “discourages” the offer of premium and cost-sharing assistance and “intends to monitor this practice and to take appropriate action, if necessary.” It remains to be seen whether CMS will respond to the industry’s conclusion that drug manufacturer coupons are permissible within the Exchanges.

CMS may choose to make a distinction between payments made directly to QHPs (such as premium assistance) and other forms of patient assistance (such as drug coupons) that are offered directly to patients.

The full Q&A reads as follows: Q: Are third party payors permitted to make premium payments to health insurance issuers for qualified health plans on behalf of enrolled individuals?

A: The Department of Health and Human Services (HHS) has broad authority to regulate the Federal and State Marketplaces (e.g., section 1321(a) of the Affordable Care Act). It has been suggested that hospitals, other healthcare providers, and other commercial entities may be considering supporting premium payments and costsharing obligations with respect to qualified health plans purchased by patients in the Marketplaces. HHS has significant concerns with this practice because it could skew the insurance risk pool and create an unlevel field in the Marketplaces. HHS discourages this practice and encourages issuers to reject such third party payments. HHS intends to monitor this practice and to take appropriate action, if necessary.

Source: http://www.healthlawpolicymatters.com/2013/11/05/cms-third-party-payment-of-qhp-premiums-not-ok/ WWW.MEDMONTHLY.COM |35

legal

IRS Announces Modification to “Use-It-Or-Lose-It” Rule for Health Care Flexible Spending Accounts

By Eric W. Gregory, Esq. Dickinson Wright PLLC On October 31, 2013, the Internal Revenue Service (“IRS”) announced a modification to the “use-it-or-lose-it” rule that applies to health care Flexible Spending Arrangements (“FSAs”) under a cafeteria plan. Under the use-it-orlose-it rule, unused amounts in a participant’s health care FSA for a plan year not used to pay eligible medical expenses incurred during the plan year were required to be forfeited to the employer, unless the employer adopted the 2 1/2 month grace period. The grace period rules permit participants to use amounts remaining from the prior year to pay eligible medical expenses incurred during the first two months and 15 days immediately following the end of the plan year (March 15 for a calendar year plan).

36 | DECEMBER 2013

The New Carryover Provision Under the new rule, an employer, at its option, may permit a participant to carryover to the immediately following plan year up to $500 in unused amounts from a health care FSA. This carryover may be used to pay or reimburse medical expenses under a health care FSA incurred during the entire plan year to which it is carried over. The rule also provides that: • The carryover does not count against or otherwise affect the maximum payroll reduction limit for the plan year ($2,500 for 2014).

• Although the maximum unused amount allowed to be carried over to any plan year is $500, the plan may specify a lower amount.

• If a plan permits a carryover, the same dollar limit must apply to all plan participants.

• A plan that adopts the carryover provision is not permitted to provide the FSA grace period.

• The use of the carryover option does not affect the plan’s ability to provide for the payment of expenses incurred in one plan year during a permitted “runout” period at the beginning of the following year.

• A plan is not permitted to allow unused amounts related to an FSA to be cashed out to the participant or used for any other taxable or non-taxable benefit.

• A plan is permitted to treat reimbursements of all claims that are incurred in the current plan year as reimbursed first from unused amounts credited for the current plan year and, only after exhausting these amounts, as then reimbursed from unused amounts carried over from the previous year.

• Any carryover amount used to pay for eligible medical expenses in the current plan year will reduce the amounts available to pay claims during the run-out period from the prior plan year.

For example, Jane Smith participates in her employer’s FSA with a calendar plan year, a run-out period from January 1 to March 31, an open enrollment in November for making salary reductions for the following year and the $500 carryover.

In November 2014, Jane elects a salary reduction of $2,500 for 2015.

By December 31, 2014, she has $800 remaining from 2014. The plan may treat $500 of the unused $800 as available to pay 2015 expenses. Jane now has a total of $3,000 to spend in 2015. She is reimbursed for a $2,700 claim incurred in July 2015.

The plan treats the first $2,500 as reimbursed with 2015 contributions, and the remaining $200 of the claim as reimbursed with unused 2014 contributions (leaving $300 for any further 2015 expenses). If she submits no further claims in 2015, the remaining $300 is carried over to 2016.

Assume these same facts, except that Jane’s $2,700 expense is incurred and submitted in January 2015 (during the 2014 run-out period).

Jane is reimbursed for the claim first from 2015 contributions ($2,500) and then from 2014 contributions ($200). Since this claim was incurred during the run-out period, the 2014 run-out amount is reduced to $600 ($800 – $200). If on February 1, 2015 Jane receives a medical bill from 2014 for $700 and submits the expense, the plan may only reimburse her for $600 of the total $700 claim.

Next Steps An employer that wants to implement the new carryover option

must amend its cafeteria plan on or before the last day of the plan year from which amounts may be carried over and the amendment can be made effective retroactively to the first day of that plan year. For example, an employer can amend a calendar year plan on or before December 31, 2013 and have the carryover rule apply for 2013. The employer must notify participants of the new rule.

This increased flexibility will reduce a key barrier for many potential FSA users and may increase enrollment in FSA programs. Participants will no longer have to perfectly predict normally unpredictable health expenses a year in advance. Even though the carryover is limited to $500, the majority of forfeitures under the use-it-or-lose-it rule were less than $500.

Employers should carefully consider whether their employees would benefit from adopting the carryover rule instead of the grace period rule.

The carryover rule is limited to $500 but permits the $500 to be used to pay for eligible expenses during the entire year into which it was carried over. In contrast, the grace period rule permits the entire amount of unused dollars in a health care FSA to be used but only to pay expenses incurred during the first 2 1/2 months of the next year. Employers seeking to modify a 2013 plan that currently has a grace period should also carefully consider the ERISA implications of eliminating the availability of the grace period for 2013 contributions.  Source: http://www.dickinson-wright. com/~/media/Files/News/2013/11/ IRS%20ANNOUNCES%20 MODIFICATION%20TO%20USE-ITOR-LOSE-IT%20RULE%20FOR%20 HEALTH%20CARE%20FLEXIBLE%20 SPENDING%20ACCOUNTS.pdf

WWW.MEDMONTHLY.COM |37

legal

Top Ten Ways to Survive in the Federal Health Care Policy Environment

38 | DECEMBER 2013

By Douglas Swill Drinker Biddle & Reath, LLP Partner and Chair of the Health Care Group and

Ilisa Halpern Paul, MPP Drinker Biddle & Reath, LLP Managing Government Relations Director

Health care providers are facing the most dynamic and uncertain regulatory, legislative and fiscal environment in more than a generation. Increasingly, hospitals and health systems need to develop and maintain comprehensive government relations programs that address their site-specific or system-specific concerns. Federal government relations efforts are an integral component to health care providers’ business planning and strategic operations.

In order to thrive in today’s environment, providers must have tailored information, individualized political and policy analyses, and multi-faceted government relations programs that focus specifically on advancing their missions and promoting their operations.

To help guide you in evaluating your individual government relations efforts, we have developed the following recommendations for establishing an effective, comprehensive federal government relations program.

1. Undertake a strategic planning process. Taking the time to review the universe of policies and programs and assessing where those intersect with individual operations and service lines, finances, and goals allows providers to better prepare for the future, to take advantage of opportunities, and to blunt the potential adverse effects of threats or negative developments. Such a process need not be burdensome or lengthy, but should involve a comprehensive review of operations and an analysis of pending/anticipated policy changes along with an overlay of the current budgetary and political environments. The result should be a practical government relations work plan that includes specific goals, objectives, and tactics for the year ahead.

2. Secure organization-specific analyses of legislative and regulatory proposals and maintain a system to receive timely information specific to your organization. Providers often rely solely on the broad-based information reported in the media or what is provided to them from trade associations.

Though this information is useful, it may not address specifically how proposals or changes will affect their particular organizations, finances, or patients.

Individualized analyses and insight enable providers to respond appropriately to legislative and regulatory developments at the federal level.

3. Build and sustain relationships with local district and state officials as well as elected officials who represent the organization’s staff, leadership, and service areas. Extending outreach efforts beyond local and state officials to the largest cohort of elected officials relevant to your operations expands the group of policymakers willing to take action on your behalf. Such efforts should involve the following: • visiting Capitol Hill a few times a year in addition to trade association lobby days; • engaging policymakers at home through individual meetings at their offices; • attending town hall meetings and other community events; • hosting health fairs and other health education events; and • inviting Members of Congress and their staffers to tour your operations and facilities (while always being mindful of compliance with ethics and gift rules).

4. Establish relationships with other health policy thought leaders in Congress, principally those who serve on the committees with jurisdiction over health care: the Senate Finance Committee; the Senate Health, Education, Labor, and Pensions Committee; the House Energy and Commerce Committee; and the House Ways and Means Committee. continued on page 40 WWW.MEDMONTHLY.COM | 39

continued from page 39

Increasingly, health policy and payment decisions are made by those who serve on these powerful committees, often with little input from non-committee colleagues. Providers who do not have many — if any — contacts with elected officials on these committees can be at a disadvantage unless they reach out to these offices to tell their “story” and to establish relationships. These policymakers and their staffs are interested in learning about health care delivery challenges and innovations and about how their proposals would affect various communities and constituencies.

Offering to be a trusted resource will assist them and will also elevate your profile positively within Congress.

5. Reach out to and establish partnerships with federal agency officials, including political and career staff at the Centers for Medicare and Medicaid Services (CMS). Providers often avoid reaching out to regulators, as they may be considered adversaries. In our experience, federal agency officials are eager to work side-by-side with providers to identify and address challenges, to explore creative remedies, and to implement new efforts to achieve the triple aim of improving health outcomes, increasing health system efficiencies, and reducing costs. Taking the time to travel to Washington, D.C., and to Baltimore, where CMS is located, and to engage with agency staff can result in significant positive partnerships with agency officials and, in turn, can benefit your organization.

6. Develop and disseminate concise materials that educate federal policymakers about your organization/ institution and that illustrate your impact in the communities you serve. Developing institution-specific, tailored documents designed for a public policy audience, such as maps that show your institution’s operations and reach (e.g., service area, number of employees, number of patients served) overlain on Congressional district maps, helps personalize your impact for elected officials.

Members of Congress and staff have expressed “fatigue” at hearing the “no more cuts” message from providers; as such, presenting information and documentation illustrating how your organization contributes to the local economy and what you are doing proactively to reduce costs and improve care will resonate with policymakers in a meaningful way.

7. Deploy an interdisciplinary team of representatives from your organization to engage with federal policymakers. The provision of health care involves a team of physicians, nurses, physician assistants, social workers, care coordinators, and other providers. Policymakers appreciate meeting with all types and levels of providers so that they can gain a 360-degree understanding of health 40 | DECEMBER 2013

care in their districts and states. In addition to having in-house and/or external government relations consulting staff, we recommend training at least three clinical staff members to be spokespeople and advocates in the federal policymaking arena. These individuals, along with CEOs, CFOs, and COOs, can be highly effective advocates and can bring to life the work that your organization does for the community and can give policymakers first-hand insight into how their decisions impact the delivery of care.

8. Host a Congressional briefing to educate Congress about a particular issue or program. Congressional briefings are a terrific way to reach a broader audience within the Congress. If your organization is leading the way in care coordination, reducing readmissions, or some other cutting-edge health care issue, take the time to organize a briefing on Capitol Hill to educate your Congressional delegation, other Members of Congress, agency officials, and others in the health care community about your work.

9. Submit written comments to and weigh in with CMS on proposed rules and regulations. In addition to relying on trade associations to submit comments to CMS, it is increasingly important for individual hospitals and health systems also to take the time to tell the agency how its proposals will impact individual organizations, not just the industry at-large. Also, a policy change may affect your organization in such a way that you would want to highlight or emphasize your particular concerns, or take a slightly different position than that of your trade association. Taking the time to develop and submit written comments or seeking a meeting about your specific issues can help ensure that the agency understands your unique situation. When the agency issues its final rule, it must respond to all of the comments it receives, so your individual efforts could result in a specific change in your favor. Further, sharing your comment letters with your elected officials on Capitol Hill helps to educate them about the issues and can engage them to take action on your behalf.

10. Strategically utilize social media to connect with elected officials—increasingly, Members of Congress rely on social media, such as Twitter, to hear from and respond to constituents. We work with health care providers to create social media plans and best practices so they can utilize this mode of communication with federal policymakers in a way that is appropriate and effective.

Social media activity also helps generate additional positive media attention and public support.  Source: http://www.drinkerbiddle.com/resources/ publications/2013/Top-Ten-Ways-to-Survive-in-the-FederalHealth-Care-Policy-Environment

What’s your practice worth?

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

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

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

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

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

919.846.4747 bizscorevaluation.com

features

Tips on

Selling Your Practice

By Philip Driver CEO, Physician Solutions, Inc.

When you are ready to sell your practice or starting to review your options, here are some key points you need to address before talking to a potential buyer.

42

| DECEMBER 2013

10 KEY POINTS TO ADDRESS WHEN SELLING YOUR PRACTICE 1. Stage Your Practice to Sell: Before you start gathering your data, both financial and patient demographics, you must stage your practice for success. De-clutter your practice, organize every desk, the patient waiting room, exam rooms and keep your entire practice VERY clean.

Having an orchid displayed at your check-in window is an inexpensive way to up-sale your practice. Make sure your staff is well groomed and always greats every patient with a friendly smile. Suggesting or requiring your staff to wear lab coats or uniform tops will create a professional atmosphere. Create a positive atmosphere with the buying doctor and allow him to buy the practice instead of you selling it to him. The first impression is important, but rest assured when you are selling your practice that every visit by the potential buyer is extremely important. Your professional broker should orchestrate the practice visits while directing times and dates for every visit and, of course, the exchange of data.

2. Financial Data: Have your financials in order. You should have at least the past three years of tax returns and current profit and loss statements with balance sheets both in cash and accrual format. Make sure your statements are prepared in a good accounting format; Quick Books or statements from a reputable accounting or CPA firm.

You should identify your expense “add backs”. As you are determining the value of your practice there are certain logical add backs you are entitled to claim including personal expenses such as club memberships, car payments, health and life insurance as well as entertainment and travel expenses, to name a few. Adding back expenses also applies for one-time non-recurring cost such as EMR roll-out invoices or one time legal fees.

Your practice may be your most valuable asset, but do you know what yours is worth? Having a professional Valuation on your practice can also be a big help. There are a few specialized attorneys and CPAs that prepare valuations. We recommend BizScore Valuation because they have three sections: the Performance review, the Valuation Reports and the Projections section that provide 5 years of detailed estimates. You can view their corporate capabilities at www.bizscorevaluation.com 3. Patient Demographics: You must provide data regarding your patient demographics. Every buyer will be interested in your patient flow and how you track your patients on a daily and monthly basis. Have a detailed list of your CPT codes with charges for each procedure with any modifiers. You should be able to print this report from your electronic medical software. Make sure you are able to detail your routine charges like 99212 through 99215,

special procedures that may be specific to your practice and have your CPT codes with charges formatted for print and viewing. You may be able to separate pages by age, insurance payee, sex and type of medical issues they experience. (An example is the total number of Medicare patients or pediatric patients).

4. Contracts and Agreements: Organize all of your vendor contracts and have the details, account numbers, payment data, due dates and rents or mortgages that are due monthly, quarterly or annually. Include phone bills, utilities, pest control, copier payment or maintenance, insurance, payroll services, billing or accounting services, etc. Always review your contracts like telephone plans for the best short term and long term plans and cut out waste whenever possible.

5. Solve Problems: Make sure you identify any problems or potential problems before closing. Most issues can be resolved as most sellers and buyers are working toward a common goal, transferring ownership. If there are any pending law suits or employee issues, make the situation known and understand what your options are in finding resolutions. No one likes surprises and an unresolved issue can spoil your closing.

6. Identify Your Liabilities: In an asset sale, most buyers will not assume major liabilities of the practice.

Such liabilities may include bank loans, credit lines, and equipment leases. When estimating your net proceeds from the closing, you should consider carefully all of your outstanding liabilities and how much it will cost to satisfy this debt at or before closing. Your outstanding liabilities will determine what you will net from the sale.

7. Work with a Professional Broker: It is very hard to sell your home on your own and it is much harder selling your practice without professional guidance. I strongly suggest using an experienced practice broker in lieu of a business broker. An experienced medical practice broker knows how to write medical contracts, keep the respected medical boards informed and protect the interest of the selling doctor or practice owner depending on the state the practice is located in. Also, CONFIDENTIALITY is a very important issue. You must not place a sign in the yard of the practice saying “For Sale”. This would be very damaging and your employees as well as your patients will be concerned and may leave your practice. Business and Real Estate brokers are accustomed to putting their continued on page 44 WWW.MEDMONTHLY.COM |43

continued from page 43

sign on the building or business for sale. When working with a practice broker you will eliminate the problems inexperience may bring. If your practice broker has an attorney on staff, you will come out ahead. The staff attorney will be informed in the proper documentation needed and eliminate errors and missteps along the way.

If your broker doesn’t have a staff attorney, we strongly recommend you have your own attorney involved. Selling your practice is not easy and requires experienced and legal hands working on your behalf to make sure the ownership transition is smooth and legal.

8. Practice Financing: We recommend the buyer pay for the practice in full at closing. A cash transaction handled by an attorney, bank transfer of funds using an Escrow account is ideal. If the seller has to finance part of the sales price for the buyer, make sure you are dealing with a credit worthy buyer and we suggest you have collateral backing up your promissory note.

44 | DECEMBER 2013

9. Your practice Image: The very best way to create an image for your practice is with a professional web site.

Practices with really sharp informative web sites will fetch 20% more in price. Also your colleagues will be more comfortable referring patients to you if they and their patients can see you on-line.

10. Plan your sale: If you don’t have a plan for success, you automatically have a plan for failure. I have heard it said that every practice does one of two things - sells or closes from lack of preparation. Don’t wait until the last minute. When you start thinking about your practice options, talk to a medical practice broker. Discuss time lines and how long you may be on the market before a sale.

You need to think about the time you may be required to spend at the practice to help with a smooth ownership transition. Selling your practice is not hard, but you must have your numbers, both income and patient, available for the prospective buyer. Make the new owner comfortable with their findings. Then you can step back and take a deep breath. 

features

5 Factors to Consider Before Selling Your Medical Practice

As everyman-philosopher Yogi Berra supposedly said, “It seems like déjà vu all over again.” Hospitals are, once again, purchasing/operating medical groups. However, things are a bit different this time around.

In the 1990s, it was pretty much a one-way street, with hospitals aggressively pursuing medical groups.

Physicians, not necessarily looking to sell, couldn’t refuse the rather exorbitant offers being thrown at them. Most of the purchases occurred in urban areas among competing 46 | DECEMBER 2013

hospitals, to protect/increase market share, and most of the physicians involved were primary care. Many hospitals purchased their own attending practices (cannibalism) just to keep competitors from buying them.

The purchasing frenzy in the 1990s didn’t last long. Hospitals overpaid for the practices, didn’t have a good understanding of their operations and were not prepared to manage them properly. Most hospitals never recovered their large upfront investments and subsequent operating

losses. Losses were especially egregious when hospitals purchased practices (cannibalism) that were already admitting to the hospital. There was no new revenue to offset losses on the practice. Hard lessons were learned and most of the purchased groups were spun back off by the end of the decade. Twenty years later, things are very different.

First, hospitals, especially soleprovider hospitals, are purchasing certain medical groups primarily to preserve the viability and future

By George Chapman Health Care Management Consultant of both the hospital and certain specialties. (Market share may still be a consideration, but is beside the point.)

If hospitals don’t purchase certain groups and assume responsibility for them, the specialty will completely disappear from the community due to attrition. Rather than competing with them, hospitals have learned it is easier and smarter to start with their own attending physicians.

Second, it is no longer a oneway street. In many cases, medical groups are initiating discussions

with hospitals. There are a variety of reasons for this, but the most common is the group can’t replace retiring partners and the remaining partners cannot handle the increased office workload, let alone the call schedule. In the current recruiting environment, hospitals and their attending physicians realize it is far better to cooperate than compete. A united recruiting and clinical front is much more appealing to a potential candidate.

Third, hospitals are doing their

homework this time around. Gone are the good old days when they made offers physicians couldn’t refuse. To avoid both Stark and IRS violations, hospitals pay for an independent evaluation of the practice, which includes a full operational assessment and a fair-market-value determination.

As a result, both parties have a better understanding of the finances and what they are getting themselves into, which ultimately lends itself to better decision making and a lasting relationship.

Fourth, hospitals are better at managing and operating medical groups. Typically, hospitals now employ a manager with a background in medical practice management.

Depending on the specific circumstances, the hospital will elect to directly employ the physician or indirectly employ the physician through a separate, captive PC. In either case, the hospital is ultimately responsible for the bottom line.

Physician compensation is generally a guaranteed base with an incentive clause.

Finally, unlike 20 years ago, both parties understand they need each other and are more likely to succeed as partners (clinically and financially) in a coordinated and integrated delivery system. Otherwise, both are doomed to fail and the biggest loser will be the community they serve. Declining physician reimbursement, difficulty recruiting, increasing patient loads, the inevitability of electronic medical records, and the worsening hassles of just operating a medical practice have all contributed to the selling of practices to hospitals. For some physicians, it is their only exit strategy.  Source: http://nyphysicianmagazine. com/?p=389 Reprinted with permission from New York Physician Magazine print edition.

Article originally appeared as “Should You Consider Selling Your Practice?”

Volume 1, Issue 6.

WWW.MEDMONTHLY.COM | 47

features

DO YOUR HOMEWORK WHEN SELLING YOUR PRACTICE

Med Monthly Staff

48 | DECEMBER 2013

Every physician and practice owner will sell their practice during their career or the practice will close. That’s just a fact.

Reasons for selling your practice: • Retirement • Partner Buy-in or Buy-out • Choosing to sell your practice to a hospital system and becoming an employed physician • Merging your practice with a larger practice • Death or disability • Divorce or identifying greener pastors • Family relocation issues

What are some considerations that you should take into account?

Check List When Selling Your Practice aDo you have a really sharp and informative website?

aDoes your practice show well?

aDo you need fresh paint,

carpet cleaned, landscaping, etc.?

• Patient well being - Will the purchasing physician continue to see my patients as I did. Will their quality of care be to the standard they are accustomed to when visiting the practice.

aAre your financials in order

• Employees – What will happen to your staff? Most employers are close to their employees and want to be sure that their staff will be taken care of in the future by the purchasing physician.

aIs your practice staff solid or

• What is your practice worth? If your operating agreement indicates the stock is worth $1, it may make negotiating the sale of that stock more challenging.

aDo you have any debt?

• How will you be paid? This sounds like a simple question, but can be complex in practice. Everyone wants to make sure that the value of their company is maximized and you get as much cash up front, without hamstringing the future capital of the practice.

• Cost of Tail policies if you carry any claims made insurance policies. Medical Professional Liability (medical malpractice) are commonly written on this type of insurance policy form.

The best tip is to do your homework.

If you have proper planning on the front end by drafting an operating agreement, buy/sell, stock repurchase, you will have an opportunity to exit your practice on excellent terms. The patient base and the medical community you have contributed to will be able to survive and thrive into the future, thanks to you doing the proper amount of homework during the sale of your practice. 

and can you put your hands on them? do you need to hire a new staff member?

Will your debt be paid off before closing or at closing?

aAre there any unresolved

situations; lawsuits, partner buy-in or buy-out problems?

aAre all of your taxes, interest and penalties paid?

aIs your practice building

leased or owned? Do you want to lease, sell or lease with an option?

aDo you have an attorney?

WWW.MEDMONTHLY.COM |49

the arts

2013 Med Monthly Cover Review

50

| DECEMBER 2013

It has been another great year at Med Monthly and the cover art has been exceptional. This is a gallery of our covers featured in 2013.

Please feel free to click on the cover art to view to that month’s issue online.

Featured Topics for 2013 January - Sex and the Practice February - ENT March - Clinical Trials April - Prescriptions May - Your Practice Staff June - Dermatology July - Procedures to Enhance Your Practice August - First Responders September - The Magic of Referrals October - Medical Research November - County Health Departments & Community Health Centers December - Selling Your Practice Laura Maaske, staff medical illustrator at Med Monthly, illustrated the fantastic cover art for our October and November issues, featured on the right of this page.

Look for more of Laura’s illustrations in Med Monthly in 2014.

WWW.MEDMONTHLY.COM | 51

healthy living

Holiday Kale Salad

By Ashley Acornley, MS, RD, LDN Happy holidays! The holiday season is notorious for an abundance of baked goods, treats, and homemade dishes. Often, we forget to include dishes that are rich in fruits, vegetables, and whole grains. During the holidays, I challenge you to try this festive holiday salad, filled with red and green goodness! This dish is also high in Vitamin C and Potassium to help increase immunity. Serve as a side dish to your traditional holiday meals.

52 | DECEMBER 2013

Ingredients: 2 cups fresh cranberries 4 cloves garlic, unpeeled 1 tablespoon olive oil Pinch, Salt and ground black pepper 1/3 cup olive oil 2-3 teaspoons finely shredded lemon peel 1/4 cup lemon juice 4 1/2 teaspoons Dijon mustard 4 cups chopped fresh kale 2 cups cooked wild rice, cooled 1 small bulb fennel, cored and shaved or cut into very thin wedges 1 cup chopped walnuts, toasted 1/2 cup thinly sliced red sweet pepper 1/2 cup thinly sliced red onion

Makes: 12 servings Prep Time: 25 mins Cook Time: 25 mins

Nutritional Facts:

Serving per Recipe - 12 Calories per serving: 187 Fat, total 14g Sat. fat 2g Carb. 14g Monosaturated fat 6g Polyunsaturated fat 6g Fiber 4g Sugar 2g Protein 4g

Preparation: 1. Preheat oven to 375 degrees F. Line a 15x10x1-inch baking pan with foil or parchment paper.

2. Place cranberries and garlic cloves on pan. Drizzle with 1 tablespoon of the olive oil; sprinkle with 1/4 teaspoon each salt and pepper. Roast, uncovered, 20 to 25 minutes or until garlic is softened and cranberries are browned at the edges and wrinkled. Cool slightly. Remove garlic peels. Chop garlic.

3. For dressing, in a screw-top jar combine garlic, remaining olive oil, lemon juice, mustard, and lemon peel. Cover and shake well. Season to taste with salt and ground black pepper.

4. In a large bowl combine cranberries, kale, wild rice, fennel, walnuts, sweet pepper, and onion. Pour dressing over salad; toss to coat. makes 9 cups (about 12 servings).

For more seasonal, local, and healthy cuisine recipes using produce commonly found in CSA (Community Supported Agriculture) boxes and at farmer’s markets, purchase Ashley Acornley’s book Fresh from the Farm Cookbook.

The cookbook is available in both electronic and printed form. For the electronic version, contact Ashley Acornley at ashleyk1010@gmail.com for more information. The printed version is available through LuLu at http:// www.lulu.com/shop/ashley-acornley/fresh-from-the-farm-cookbook/ hardcover/product-16266372.html WWW.MEDMONTHLY.COM | 53

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

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

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

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

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

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

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

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

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

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

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

WWW.MEDMONTHLY.COM |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 2013

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

Maine 143 State House Station 161 Capitol St. Augusta, ME 04333 (207)287-3333 http://www.mainedental.org/ Maryland 55 Wade Ave. Catonsville, Maryland 21228 (410)402-8500 http://dhmh.state.md.us/dental/ Massachusetts 1000 Washington St., Suite 710 Boston, MA 02118 (617)727-1944 http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/dhpl/ dentist/ Michigan P.O. Box 30664 Lansing, MI 48909 (517)241-2650 http://www.michigan.gov/lara/0,4601,7154-35299_28150_27529_27533---,00. html Minnesota 2829 University Ave., SE. Suite 450 Minneapolis, MN 55414 (612)617-2250 http://www.dentalboard.state.mn.us/ Mississippi 600 E. Amite St., Suite 100 Jackson, MS 39201 (601)944-9622 http://bit.ly/uuXKxl Missouri 3605 Missouri Blvd.

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

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

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

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

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

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

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

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

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

New Mexico Toney Anaya Building 2550 Cerrillos Rd. Santa Fe, NM 87505 (505)476-4680 http://www.rld.state.nm.us/boards/Dental_Health_Care.aspx

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

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

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

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

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

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

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

Texas 333 Guadeloupe St. Suite 3-800 Austin, TX 78701 (512)463-6400 http://www.tsbde.state.tx.us/ Utah 160 E. 300 South Salt Lake City, UT 84111 (801)530-6628 http://1.usa.gov/xMVXWm Vermont National Life Building North FL2 Montpelier, VT 05620 (802)828-1505 http://bit.ly/zSHgpa Virginia Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4538 http://www.dhp.virginia.gov/dentistry Washington 310 Israel Rd. SE P.O. Box 47865 Olympia, WA 98504 (360)236-4700 http://www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/Dentist.aspx West Virginia 1319 Robert C. Byrd Dr. P.O. Box 1447 Crab Orchard, WV 25827 1-877-914-8266 http://www.wvdentalboard.org/ Wisconsin P.O. Box 8935 Madison, WI 53708 1(877)617-1565 http://dsps.wi.gov/Default. aspx?Page=90c5523f-bab0-4a45-ab943d9f699d4eb5 Wyoming 1800 Carey Ave., 4th Floor Cheyenne, WY 82002 (307)777-6529 http://plboards.state.wy.us/dental/index.asp WWW.MEDMONTHLY.COM |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 2013

Florida 2585 Merchants Row Blvd.

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

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

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

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

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

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

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

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

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

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

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

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

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

Montana 301 S. Park Ave. #430 Helena, MT 59601 (406)841-2300 http://bsd.dli.mt.gov/license/bsd_ boards/med_board/board_page.asp Nebraska Nebraska Department of Health and Human Services P.O. Box 95026 Lincoln, NE 68509 (402)471-3121 http://www.mdpreferredservices.com/ state-licensing-boards/nebraska-boardof-medicine-and-surgery Nevada Board of Medical Examiners P.O. Box 7238 Reno, NV 89510 (775)688-2559 http://www.medboard.nv.gov/ New Hampshire New Hampshire State Board of Medicine 2 Industrial Park Dr. #8 Concord, NH 03301 (603)271-1203 http://www.nh.gov/medicine/ New Jersey P. O. Box 360 Trenton, NJ 08625 (609)292-7837 http://bit.ly/w5rc8J New Mexico 2055 S. Pacheco St. Building 400 Santa Fe, NM 87505 (505)476-7220 http://www.nmmb.state.nm.us/ New York Office of the Professions State Education Building, 2nd Floor Albany, NY 12234 (518)474-3817 http://www.op.nysed.gov/ North Carolina P.O. Box 20007 Raleigh, NC 27619 (919)326-1100 http://www.ncmedboard.org/

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

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

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

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

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

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

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

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

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

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

WWW.MEDMONTHLY.COM | 59

medical resource guide Urgent Care & Occupational Medicine Consultant

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

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

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

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

ADVERTISING

www.pushpa.biz

MedMedia9

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

DENTAL www.medmedia9.com

BILLING & COLLECTION

Biomet 3i

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

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

CODING SPECIALISTS Place Your Ad Here

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

Urgent Care America

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

60 | DECEMBER 2013

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

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

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

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

ELECTRONIC MED. RECORDS 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

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

medical resource guide MedMedia9

MEDICAL ART

PRACTICE FINANCING

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

Deborah Brenner

www.medmedia9.com

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

MedImagery

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

WhiteCoat Designs

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

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

www.assurepharma.com

MEDICAL PRACTICE SALES

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

MEDICAL PRACTICE VALUATIONS

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

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

Medical Practice Listings

MEDICAL EQUIPMENT

Bank of America

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

STAFFING COMPANIES

BizScore www.thetps.com

MEDICAL EQUIPMENT FINANCING Bank of America

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

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

Additional Staffing Group, Inc.

www.bizscorevaluation.com

MEDICAL PUBLISHING MedMedia9

www.medmedia9.com

MEDICAL RESEARCH

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

SUPPLIES, GENERAL CNF Medical

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

www.bankofamerica.com/practicesolutions

MEDICAL MARKETING

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

Scynexis, Inc.

3501 C Tricenter Blvd.

Durham, NC 27713 (919) 933-4990

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

Gebauer Company

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

WEBSITE DESIGN www.scynexis.com

MedMedia9

PO Box 98313 Raleigh, NC 27624 (919)747-9031 www.medmedia9.com WWW.MEDMONTHLY.COM | 61

classified listings

Classified To place a classified ad, call 919.747.9031

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

Averages 25 patients per day with no call and shift hours from 8:30 am to 5:30 pm. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com 3-5 days per week in Durham, NC . Geriatric physician needed immediately 3-5 days per week, on-going at nursing home in Durham. Nursing home focuses on therapy and nursing after patients are released from the hospital. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com GP Needed Immediately On-Going 1-3 Days Per Week at Addictive Disease Clinics located in Charlotte, Hickory, Concord & Marion North Carolina. General Practitioner with a knowledge or interest in addictive disease. Needed in October on-going 1-3 times per week. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Primary Care Physician in Northwest NC (multiple locations). Primary care physician needed immediately for ongoing coverage at one of the largest substance abuse treatment facilities in NC. Doctor will be responsible for new patient evaluations and supportive aftercare. Counseling and therapy are combined with physician’s medical assessment and care for the treatment of adults, adolescents and families. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Pediatrician or Family Medicine Doctor in Fayetteville Comfortable with seeing children. Need is immediate - Full time ongoing for maternity leave. 8 am - 5 pm.

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

62 | DECEMBER 2013

Immediate need for full time GP/FP for urgent cares in eastern NC. Urgent care centers from Raleigh to the eastern coast of NC seek immediate primary care physician. Full time opportunity with possibility for permanent placement. Physician Solutions, PH: (919) 845-0054, email: physiciansolutions@gmail.com General Practitioner Needed in Greensboro. Occupational health care clinic seeks general practitioner for disability physicals ongoing 1-3 days a week. Adults only. 8 am-5 pm. No call required. Please contact Physician Solutions at 919-845-0054 or email us at physiciansolutions@gmail.com.

Pediatrician or Family Physician Needed Immediately at clinic in Roanoke Rapids, NC. Pediatric clinic in Roanoke Rapids, NC seeks Peds physician or FP comfortable with children for 2-3 months/on-going/full-time.

The chosen physician will need to be credentialed through the hospital, please email your CV, medical license and DEA so we can fill this position immediately. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Occupational Clinic in Greensboro, NC seeks FP/GP for On-Going Shifts. Locum tenens position (4-5 days a week) available for an occupational, urgent care and walk in clinic. The practice is located in Greensboro NC. Hours are 8 am-5 pm. Approximately 20 patients/ day. Excellent staff. Outpatient only. physiciansolutions@gmail.com Diabetic Clinic 1 hour from Charlotte seeks FP/GP/ IM for On-Going Shifts.Primary care physician needed immediately for outpatient diabetic clinic one hour outside Charlotte, NC On-going. Hours are 8 am -5 pm with no call. Approximately 15-20 patients a day. Call or email for more information. 919-845-0054 physiciansolutions@gmail.com Clinic between Fayetteville and Wilmington seeks FP/ GP/IM Mar 22 FT ongoing. A small hospital’s outpatient clinic located within an hour of both Fayetteville and Wilmington seeks PA to work FT ongoing beginning March 22. Shifts can be either 8 or 12 hours. No call. email: physiciansolutions@gmail.com

Classified To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

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

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

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

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

Asheboro Family Practice and Urgent Care seeks GP for intermittent coverage. Family Practice and Urgent Care seeks general practitioner for intermittent days from 8a-8p. Provider will see about 35 patients with no call. Please contact Physician Solutions at 919-845-0054 or email us at physiciansolutions@gmail.com.

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

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

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

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

Peds Clinic near Raleigh seeks Mid-Level Provider for on-going coverage 4x/wk. Health Department pediatrics clinic 45 min from Raleigh needs coverage 4 days a week from January through June. Provider will see about 20 patients daily, hours are 8am-5pm with an hour for lunch. Please contact Physician Solutions at 919-8450054 or email: physiciansolutions@gmail.com.

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

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

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

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

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

Employee Health Clinic seeks Mid-Level Provider for FT on-going coverage near Charlotte. Practice 45 minutes from Charlotte seeks on-going coverage for employee health clinic beginning in March. Provider will see about 20-24 patients daily, hours are 8am-5pm with an hour for lunch. Please contact Physician Solutions at 919-845-0054 or email us at physiciansolutions@gmail.com.

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

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

continued on page 65 WWW.MEDMONTHLY.COM |63

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

classified listings

Classified

continued from page 63

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

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

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

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

Family Practice 1 h SE of Raleigh seeks coverage.

Goldsboro FP seeks MD for July 6-7 and intermittent shifts. 8-5p. Please contact Physician Solutions at 919845-0054 or email physiciansolutions@gmail.com.

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

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

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

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

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

Clinic between Fayetteville and Wilmington seeks FP/ GP/IM Mar 22 FT ongoing . A small hospital’s outpatient clinic located within an hour of both Fayetteville and Wilmington seeks PA to work FT ongoing beginning March 22. Shifts can be either 8 or 12 hours. No call. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Western North Carolina Clinic needs continuing physician coverage. Clinic seeks coverage for their walk in clinic which sees all ages. Ongoing, 8am-5pm, no call.

35-40 patients a day. Well established clinic located in a beautiful area. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

IM/FP/Peds opportunity in Fayetteville clinic immediately. Fayetteville clinic needs immediate coverage for the following clinics: adult health, women’s health and STD. No call 8a-5p.

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

Pediatrician Needed MD June-Aug, Burlington NC 3x week for 10 wks starting June 1st, 8-5 Mon-Fri Burlington, NC: located 1 hour west of Raleigh. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

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

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

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

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

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

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

continued on page 66 WWW.MEDMONTHLY.COM | 65

classified listings

Classified

continued from page 65

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

FULL TIME MD needed for Family Practice in Washington, N.C. Family Practitioner needed for FT MD June 15-Sept 1 on-going Mon- Fri 8-5, Washington, NC, 1 hour 45 minutes outside Raleigh. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

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

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

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

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

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

General Practitioner/ Internal Medicine/ Family Physician opportunity available at a large substance abuse treatment facilitiy in Western 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. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com. continued on page 68

Woman’s Practice in Raleigh, North Carolina.

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

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

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

66 | DECEMBER 2013

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

Primary Care Specializing in Women’s Health

Located on NC’s Beautiful Coast, Morehead City

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

919.848.4202 medlisting@gmail.com medicalpracticelistings.com

PEDIATRICIAN

or family medicine doctor needed in

FAYETTEVILLE, NC

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 Comfortable seeing children. Needed immediately.

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

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

classified listings

Classified

continued from page 66

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

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

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

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

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

Pediatrics Opportunity - Roanoke Rapids Area Northeastern North Carolina Pediatric Practice seeks on-going physician for full time coverage beginning mid-October through the end of the year. Practice sees about 16-25 patients a day, hours are 8:00-5:00 with negotiable call. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Family Practitioner Opportunity - Greenville area Immediate opportunity for a family practitioner for a practice about 20 miles east of Greenville. The hours will be 8:00am until 5:00pm. Must see all ages. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

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

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

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

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

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

Physicians needed Virginia Pediatric Locums Physician needed in Harrisonburg, Danville and Lynchburg, VA. These locum positions require 30 to 40 hours per week, on-going. If you are seeking a beautiful climate and flexibility with your schedule, please consider one of these opportunities. Send copies of your CV, VA. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com continued on page 70

68 | DECEMBER 2013

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

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

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.

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

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

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

classified listings

Classified

continued from page 68

To place a classified ad, call 919.747.9031

Physicians needed Virginia (cont.)

Urgent Care opportunities throughout Virginia. We have contracts with numerous facilities and eight to 14-hour shifts are available. If you have experience treating patients from pediatrics to geriatrics, we welcome your inquires. Send copies of your CV, VA medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, E-mail: physiciansolutions@gmail.com Virginia practice outside of Washington DC seeks IM doctor FT/PT now – June 1. IM physician needed immediately FT/PT for Virginia clinic near Washington DC. 8-5p Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

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

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

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

8a-5p ongoing full time or part time. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

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

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

70 | DECEMBER 2013

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

8a-5p ongoing full time or part time. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

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.

Practice for sale North Carolina Primary Care Practice Only Minutes East of Raleigh North Carolina. The retiring physician maintains a 5 day work week and has a solid base of patients that can easily be expanded. There are 6 fully equipped exam rooms, a large private doctor’s office, spacious business office, and patient friendly check in and out while the patient waiting room is generous overlooking manicured flowered grounds. This family practice is open Monday through Friday and treats 8 to a dozen patients per day. The Gross revenue is about $235,000 yearly. Contact Cara or Philip at 919 848 4202 or email: medlistings@gmail.com to receive details.

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

Classified To place a classified ad, call 919.747.9031

Practice for sale North Carolina (cont.)

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

Exceptional cash flow and profitable practice that will surprise even the most optimistic practice seeker. This is a remarkable opportunity to purchase a well-established woman’s practice. Spacious practice with several wellappointed exam rooms throughout. New computers and medical management software add to this modern front desk environment. This practice is being offered for $435,000. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or send an email to medlistings@gmail.com Internal Medicine Practice located just outside Fayetteville, NC is now being offered. The owning physician is retiring and is willing to continue working for the new owner for a month or two assisting with a smooth transaction. The practice treats patients four and a half days per week with no call or hospital rounds. The schedule accommodates 35 patients per day. You will be hard pressed to find a more beautiful practice that is modern, tastefully decorated and well appointed with vibrant art work. The practice, patient charts, equipment and good will is being offered for $415,000 while the free standing building is being offered for $635,000. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or email: medlistings@gmail.com

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

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. 

WWW.MEDMONTHLY.COM | 71

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

Advertise Your Webinar in Med Monthly

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.

Contact us for more information at: 919.747.9031 medmedia9@gmail.com

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

www.medicalpracticelistings.com

PEDIATRICIAN

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.

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.

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

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

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

PRACTICE FOR SALE

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

Asking price: $385,000

To view more listings visit us online at medicalpracticelistings.com

Unfortunately, its motor is inside playing video games.

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

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

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

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

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

American Council on Exercise

®

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

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

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

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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.

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

Live and work in one of the most healthy cities in the U.S. List Price: $150,000 | Established: 2007 | Location: Colorado

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

For more information contact Dr. Jack McInroy at 303-929-2598 or Shrink1324@gmail.com

Pediatrics Practice Wanted

Practice for Sale in Raleigh, NC

Pediatrics practice wanted in NC

Primary care practice specializing in women’s care

Considering your options regarding your pediatric practice? We can help.

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

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.

Contact us today to discuss your options confidentially.

Raleigh, North Carolina

List price: $435,000

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

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

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

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

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

Medical Practice Listings Selling and buying made easy

MedicalPracticeListings.com | medlisting@gmail.com | 919.848.4202

Women’s Health Practice in Morehead City, NC

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

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

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

Medical Practice Listings

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

Buying and selling made easy

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

Buying and selling made easy

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

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

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

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

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

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

Medical Practice Listings Selling and buying made easy

MedicalPracticeListings.com | medlisting@gmail.com | 919-848-4202 76 | DECEMBER 2013

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

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.

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

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

the top

Here are the top 9 sensible precautions to take to help prevent this being the holiday you’ll want to forget.

1 2

4

THE BIRD

Don’t wash your turkey before cooking. The majority of us do and that simply risks spreading harmful bacteria over counter tops. If you have bought a frozen bird, then make sure it is fully defrosted with no ice crystals inside. Cook it properly until none of the meat is pink and the juices run clear.

‘KID FRIENDLY’ HOLIDAY

Christmas offers a whole variety of choking hazards from Christmas tree bulbs to decorations to children. Make sure presents are appropriate for the age and watch out for small items that could be swallowed by toddlers.

3

NOT TO BE TAKEN LIGHTLY

It may look festive but dragging a tree – natural or artificial - into your living room and covering it with electric lights and tiny glass bulbs is asking for trouble. How many years have you been using those lights? Consider a new set and remember to turn them off at night.

OVEREATING

Let’s face it, most of us will eat too much during the holidays. That’s not a problem if it’s a one-time event, but two out of three adults are overweight or obese.

Christmas dinner can provide more calories than are needed in an entire day. Remove skin from turkey and eat slowly, chewing thoroughly, to help avoid overeating.

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| DECEMBER 2013

Holiday Health Risks

5

UP IN SMOKE

Candles flickering on the window ledge won’t seem such a good idea if your curtains are set ablaze. Candles cause more than a thousand house fires and several deaths every year. Decorations and Christmas cards can also be fire hazards. You are more 50% more likely to die in a house fire at Christmas than any other time.

6

MIND YOUR STEP

There are more accidental falls and traffic accidents in December with bad weather and short daylight hours both playing a part.

Snow and ice can be a lethal opponent to even the fittest individual and the best drivers.

8

7

HOLIDAY SPIRITS

Whereas eating too much will simply harm your own waistline, excess alcohol can ruin the lives of others.

Assaults - many fuelled by alcohol - and drunk driving both rise over Christmas and New Year.

There is also a rise in alcohol poisoning.

WINTER ILLNESSES

There are always more deaths in winter than other times of year, with causes such as respiratory and circulatory diseases, and infections like flu. There are five times as many emergency admissions for pneumonia in December compared to August.

There are things you can do to minimize some risks such as have a flu shot, stay warm and wash your hands regularly.

9

DEPRESSION

There’s only one thing worse than being surrounded by your relatives at Christmas and that’s not being surrounded by them. But research suggests there is a fall in suicides during the Christmas period followed by an increase just after the New Year. Of course loneliness is just one of many problems people face during the holiday season.

Others include mounting debt from holiday bills and marital breakdown, with more people considering ending their relationship in January than at any other time of year.

WWW.MEDMONTHLY.COM | 79

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