Med Monthly February 2013

Med Monthly FEBRUARY 2013

ENT TIPS FOR COLD AND FLU SEASON Maybe it’s not a cold: Knowing the difference between sinusitis and cold symptoms pg. 46

LIVES COULD BE SAVED BY DRUGS THAT LIMIT EXCESS MUCUS pg. 44

ENT Undercover

pg. 10

MEDICAL DEVICES

POWERED

BY THE EAR ITSELF pg. 50

the

ENT issue

contents features 44 LIVES COULD BE SAVED BY DRUGS THAT LIMIT EXCESS MUCUS 46 ENT TIPS FOR COLD AND FLU SEASON 50 MEDICAL DEVICES POWERED BY THE EAR ITSELF

insight 10 ENT UNDERCOVER 12 MORE DOCTORS, HOSPITALS PARTNER TO COORDINATE CARE FOR PEOPLE WITH MEDICARE 14 INCREASING VITAMIN C INTAKE: Solutions for Difficult Medical Problems

international 16 PROMISE OF COST AND CLINICAL BENEFITS FUELS ADOPTION OF HEALTH CARE IT PROFESSIONAL SERVICES IN EUROPE

practice tips 18 NEW STUDY REVEALS SUBSTANTIAL GAPS BETWEEN PHYSICIAN SATISFACTION AND ORGANIZATIONAL PERFORMANCE 22 THERE IS NO SUCH THING AS A 10-MINUTE OFFICE VISIT 24 WHY SMALL PRACTICES ARE STRUGGLING

52

Quintessential Renaissance Man

research and technology 32 CHICAGO ENT HEAD AND NECK SURGEONS USING VELSCOPE VX TO ENHANCE ORAL CANCER SURGERY SUCCESS RATE 34 YOU IMAGINE - What’s So Good About This App?

legal 39 BAYER SETTLES 3,490 YAZ AND YASMIN LAWSUITS 40 HOBBY LOBBY: GO AHEAD AND FINE US, WE WON’T COMPLY WITH ‘MORNING-AFTER’ MANDATE 42 CENTER FOR HEALTH & PHARMACEUTICAL LAW & POLICY INTRODUCES FIRST EDITION OF PHARMACEUTICAL AND MEDICAL DEVICE COMPLIANCE MANUAL

the arts

And What Can Be Done

52 QUINTESSENTIAL RENAISSANCE MAN

research and technology

healthy living

28 DRUG-RESISTANT MELANOMA TUMORS SHRINK WHEN THERAPY IS INTERRUPTED

54 DARK CHOCOLATE BREAKFAST MUFFINS

30 EHR TECHNOLOGY – Best Practices to Insure Effective EHR Implementation

in every issue 4 editor’s letter 8 news briefs

60 resource guide 76 top 9 list

editor’s letter

February’s edition of Med Monthly focuses on Ear, Nose and Throat issues. We explore new drugs that can improve respiratory conditions as well as medical devises that use biological activity to power hearing aids. Also, tips are given to determine whether you have a virus or bacterial infection.

There has been a breakthrough for common respiratory killers that thus far have had no effective treatments such as asthma and chronic obstructive pulmonary disease (COPD). Julia Strait’s article “Lives Could be Saved by Drugs that Limit Excess Mucus” discusses how a team of doctors created a drug that binds to the enzyme MAPK14 to inhibit viral infections and allergies.

The article “Medical Devices Powered by the Ear Itself ” elaborates on an exciting new apparatus that has been developed to improve hearing. The device uses the inner ear’s natural electrical activity to power the battery. This “natural battery” also can be used to normalize balance impairments.

Who hasn’t had a stuffy nose, sneezing and a sore throat and wondered is this a cold or do I have the flu? The cold obviously just needs to run its course, while an infection requires an antibiotic. “ENT Tips for Cold and Flu Season” has a list of symptoms that will help you determine whether medication is necessary.

The subject of ENT is one that affects us all in one way or another. Understanding new advances enables us to ask the most useful questions and get the best care. Stay warm and healthy this winter!

Ashley Austin Managing Editor

4 | FEBRUARY 2013

Med Monthly February 2013

Publisher Philip Driver Managing Editor Ashley Austin Creative Director Thomas Hibbard Contributors Ashley Acornley, MS, RD, LDN Becket Adams Jason Bardi Larry Hardestry Laura Masske Frank J. Rosello Robert Sayre Julia Evangelou Strait Denise Price Thomas Mary Pat Whaley, FACMPE

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

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

Rob Sayre

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 marketing adviser and business coach specializing in providing solutions to companies of every description through improved performance and increased human effectiveness. Linkedin: www.linkedin.com/pub/rob-sayre/2/977/355/

Denise Price Thomas retired in 2009 as a surgical practice administrator where she was employed for 32 years. She is certified in healthcare management through Pfeiffer College. Speaking invitations have taken her from NC to SC, Georgia, Florida, Chicago, Alaska and more. Website: www.denisepricethomas.com

Mary Pat Whaley, FACMPE is board certified in health care management and a Fellow in the American College of Medical Practice Executives. She has worked in health care and health care management for 25 years.

She can be contacted at marypatwhaley@gmail.com MEDMONTHLY.COM |5

designer's thoughts

From the Drawing Board Technology is change. Change; we might not like it, we might even fear it, but we can’t stop it from happening. Albert Einstein stated, “The world as we have created it is a process of our thinking. It cannot be changed without changing our thinking.” In this issue we explore in more depth medical changes that will alter our way of thinking.

Laura Maaske concludes her “YOU IMAGINE” series with “What’s So Good About This App?” exploring what makes a mobile app effective and gives it longevity. She states, “We want these tools to be fun, interesting, engaging, incorporated fully into our health care plan, socially connected to other people and to our physician, and most of all, effective in the intended function for each app.”

In the “Research and Technology” section of this month’s magazine, the article “Chicago ENT Head and Neck Surgeons Using VELscope Vx to Enhance Oral Cancer Surgery Success Rate” informs the reader about new technology by LED Medical Diagnostics Inc. that helps surgeons see cancerous and precancerous tissue more effectively. “The VELscope Vx may significantly enhance our ability to see the entire cancerous or precancerous lesion that needs to be excised, allowing us to minimize risk of additional unnecessary surgery.”

Frank J. Rosello’s “EHR Technology – Best Practices to Insure Effective EHR Implementation” reports on how to smoothly transition from paper based records to electronic medical records (EHR) within a practice. He shares five essential tips to assist in achieving this nearly impossible task as painlessly as possible.

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 | FEBRUARY 2013

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news briefs

NIH study suggests gene variation m Patients who have inherited a specific common genetic variant develop bladder cancer tumors that strongly express a protein known as prostate stem cell antigen (PSCA), which is also expressed in many pancreatic and prostate tumors, according to research at the National Institutes of Health.

A therapy targeting the PSCA protein on the tumor cell surface is under evaluation in clinical trials for prostate and pancreatic cancer. The researchers hope that this therapy will be tested in bladder cancer patients with the genetic variant, which could help to reduce potentially harmful side-effects, lower costs, and improve treatment efficacy.

Every gene contains a very long string of DNA components termed nucleotides (referenced commonly as T, C, G or A). A single letter variation in the string of letters can lead to changes in cell development, resulting in cancer.

In a previous study, the researchers identified a variant located in the PSCA gene on chromosome 8 as associated with bladder cancer susceptibility. The gene determines whether the corresponding protein is expressed in bladder tumor tissue. In the latest report, they found that the ‘T’ nucleotide that comprises a gene variant called rs2294008 is a strong predictor of PSCA protein expression. The variant results in increased delivery of the protein to the cell surface, where it is involved in signaling and promotes tumor growth. The study by scientists from the National Cancer Institute (NCI), part of the National Institutes of Health, appeared in the Journal of the National Cancer Institute on Jan. 3, 2013.

“We’ve been pursuing this mechanism for some time now. It started with our early results from the initial genome-wide association study that revealed a marker in the PSCA gene related to bladder cancer risk.

Research Shows Vitamin C and Minerals Cool Off Hot Flashes Up to 80% of women experience hot flashes and night sweats as part of their menopause symtoms. One natural remedy proven in a research study to relieve hot flashes may come as a surprise to some, as it is such a well-known, widely used vitamin with many benefits. It’s the famous vitamin C. The study was called “Non-Hormonal Control of Vaso-Motor Flushing in Menopausal Patients”, published in the journal: “Chicago Medicine.” Vasomotor refers to the nerves and muscles causing blood vessels to constrict (narrow) or dilate (open). Extensive research indicates that vitamin C strengthens blood vessel membranes and acts as a potent antioxidant. Antioxidants protect our tissues from deterioration and may help slow the aging process.

In the vitamin C study, A total of 94 patients were studied, all of who had reached menopause. They were given 200 milligrams of vitamin C and 200 milligrams of bioflavonoids (the substance contained in the inside of orange peels) six times daily. Therefore each subject received 1200 mg of both the bioflavonoids and vitamin C each day. The results were that 67% of the subjects reported complete relief from hot flashes and 21% reported partial relief, giving this combination an overall 88% success rate.

Mineral deficiency can also be a factor in contributing to menopause symptoms such as hot flashes and night sweats.

The pioneering nutritionist Adelle Davis writes of this in her book “Let’s Eat Right to Keep Fit”. Davis says, “The amount of calcium in a woman’s blood parallels the activity of the ova8 | FEBRUARY 2013

ries. During the menopause, the lack of ovarian hormones can cause severe calcium deficiency symptoms to occur, including irritability, hot flashes, night sweats, leg cramps, and insomnia.

These problems can be easily overcome if the intakes of calcium, magnesium, and vitamin D are all generously increased and are well absorbed.”

Jobee Knight, a nutritional researcher and founder of www.

NutritionBreakthroughs.com in Glendale, CA., is someone who fought her own menopausal battle against sleeplessness and insomnia. She decided to put her background to use by searching out effective natural insomnia remedies for relaxation and deeper sleep. The result was Sleep Minerals II, a natural insomnia remedy that contains highly absorbable forms of calcium and magnesium, combined with vitamin D and zinc.

The ingredients are formulated in a softgel with healthy oils, making them more quickly absorbable than tablets or capsules and providing a deeper, longer-lasting sleep.

Anita L. of New Caney, Texas says: “I was having hot flashes every 30 minutes to an hour through the night and was so miserable. After about two weeks of taking the Sleep Minerals, I noticed an incredible difference with my sleep. I have much less interruption from flashes, I’m sleeping much better and I’m a lot more comfortable.”

Source: http://www.pressreleasepoint.com/research-shows-vitamin-c-and-minerals-cool-hot-flashes

may shape bladder cancer treatment This latest work reveals how a specific letter change in DNA influences protein expression at the cell sur face. The big payoff is that a simple genetic test can determine which patients could benefit from anti-PSCA therapy,” said Ludmila Prokunina-Olsson, Ph.D., NCI Division of Cancer Epidemiology and Genetics, and senior author of this publication.

In 2012 in the United States alone, there were an estimated 73,510 new cases of bladder cancer and 14,880 deaths. The recurrence rate of bladder cancer is between 50 and 70 percent, and patients require life-long surveillance and treatment, making it an expensive cancer to live with and a major economic burden on the health care system and patients. Up to 75 percent of bladder cancer patients carry this genetic variant.

“This is one of the first studies to show direct clinical implications of a genetic variant identified through genome-wide association studies for common cancers,” said Stephen J. Chanock, M.D., acting co-director for the NCI Center for Cancer Genomics.

The scientists note that additional work is needed to develop alternative drugs targeting PSCA, and to evaluate drug delivery methods, such as systemic delivery for advanced muscle-invasive tumors and local, inter-bladder delivery in the case of non-muscle invasive tumors. Anti-PSCA therapy is likely to be effective only against tumors that express PSCA. A genetic test for the “T” nucleotide of this genetic variant can identify bladder cancer patients who could benefit from this treatment.

Source: http://www.nih.gov/news/health/dec2012/nci-26.htm

Overview on U.S. Medical Devices Market for Cosmetic Surgery in 2012

SOON COMING ONTHLY IN MED M

coming In the up Med 13 issue, March 20 ill theme w Monthly’s al Trials be Clinic

As per the reports, the U.S. market in 2012 for cosmetic surgery, facial aesthetics and medical laser devices was valued over $3 billion, with an increase of almost 10% from the preceding year.

In 2012, the U.S. market for cosmetic surgery, facial aesthetic and medical laser devices is composed of the botulinum toxin A market, dermal filler market, augmentation and reconstructive implant market, fat-reduction device market, and aesthetic laser and light device market. Because of augmentation and reconstructive implant market, there was a growth in this market.

According to the reports, in 2012, the top three contributors were the botulinum toxin A market, augmentation and reconstructive implant market, and dermal filler market. The growth in this market is mainly due to mainstream media influence on public perception of the importance of youthful appearance and beauty, and other contributing factors such as the aging population and obesity in the U.S. Inquire About This Report: U.S. Cosmetic Surgery, Facial Aesthetics and Medical Laser Devices Market Source: http://www.pressreleasepoint.com/overview-us-medicaldevices-market-2012 MEDMONTHLY.COM |9 MEDMONTHLY.COM |9

insight

ENT UNDERCOVER

By Denise Price Thomas

‘‘

“I have a friend who is aging and having some difficulty hearing.

She decided to get a hearing aid. She was pleasantly surprised at what she could hear once she had her new hearing aid. In fact, she decided not to tell anyone in her family about it. Since then, she has changed her Last Will and Testament four times!”

Gladys Friday

Health Care Comedienne, Denise Price Thomas’ alter ego 10 | FEBRUARY 2013

A

s an Undercover Patient, I begin my assessment in the lobby of a practice or hospital using all my senses. Since this is the ENT issue of Med Monthly, I’ll narrow my observations down to those three senses.

Ears:

I understand the reason we have two ears and only one mouth, therefore I am reminded to listen twice as much as I speak. Unfortunately, patients overhear the bad as well as the good. Imagine being a patient and hearing screams from the room across the hall followed by a conversation that a child was accidentally given ears drops in her eyes! This happened as I sat in an exam room, waiting to see a physician. Would YOU want to continue waiting for your turn?

While in the exam room or lobby, I would much rather hear conversations about new in-house procedures, what physicians are doing for the community and why the employee of the month was nominated.

Nose:

After 34+ years in a health care career, I tend to be a bit “nosey”

as an “Undercover Patient” asking questions and finding out all sorts of things the hospital or practice may or may not know about physicians, employees and more. Once I asked about a particular procedure and the appointment scheduler told me the physician was new to this procedure, only returning recently from a seminar on it. The scheduler continued, telling me they had just hired a new nurse to assist him with this procedure and had turned an exam room into the procedure room. Although I enjoy hearing about the continuing education, I became a little reluctant to be scheduled as the first patient. (nosey, yes: guinea pig, no) Employees should be kept informed and educated on what’s new, but should be educated about what is appropriate and inappropriate to share with the patient.

It’s helpful to provide your staff with a script to guide them in explaining topics to patients.

Throat:

“What does he think he is doing?

He made me so mad I could SCREAM! I hate working with him!” It seems that “Voice Art” has become a lost art.

We should always choose our words

carefully. When patients overhear comments such as these spoken while they wait for their appointment, their imagination will conclude the remarks must be about their physician. As humans, we will continue to make mistakes, however words spoken by us are our choice.

Communication, both verbal and non-verbal in health care is very important in how the public perceives your practice.

Health care professionals should allow their heart to guide them by listening to each patient with a desire to hear their story, looking them in the eye and connecting the dots before choosing their words. Using these senses will help to build patient/ physician relationships even stronger.

These are windows to a heart filled with compassion. When kind, positive and encouraging words become the normal spoken throughout the facility, you become part of creating an environment in which your patients will be happy, employees will have more of a team approach and physicians will be able to take care of their patients.  www.denisepricethomas.com

We may not always know what others are hearing around us.

Perhaps we should come back to our senses: EARS We can use our EARS to hear what is being said throughout our facility. It’s much easier to prevent problems than to correct them. Listen for good news and acknowledge it when we hear it.

NOSE We should be “NOSEY” and ask our patients their opinion of our facility. KNOW what their perception is and always have a plan of action and a desire to improve.

THROAT Start each day off right. Acknowledge every person in a cheerful and professional tone. Speaking kind and encouraging words to those around us helps to create a most positive working environment MEDMONTHLY.COM |11

insight

More Doctors, Hospitals Partner to Coordinate Care For People With Medicare Providers Form 106 New

Accountable Care

Organizations Doctors and health care providers have formed 106 new Accountable Care Organizations (ACOs) in Medicare, ensuring as many as 4 million Medicare beneficiaries now have access to high-quality, coordinated care across the United States, Health and Human Services (HHS) Secretary Kathleen Sebelius announced today.

Doctors and health care providers can establish ACOs in order to work together to provide higher-quality care to their patients. Since passage of the Affordable Care Act, more than 250 Accountable Care Organizations have been established. Beneficiaries using ACOs always have the freedom to choose doctors inside or outside of the ACO. ACOs share with Medicare any savings generated from lowering the growth in health care costs, while meeting standards for quality of care.

“Accountable Care Organizations save money for Medicare and deliver higher-quality care to people with Medicare,” Secretary Sebelius said. “Thanks to the Affordable Care Act, more doctors and hospitals are working together to give people with Medicare the highquality care they expect and deserve.”

ACOs must meet quality standards to ensure that savings are achieved through improving care coordination and providing care that is appropriate, safe, and timely.

The Centers for Medicare & Medicaid Services (CMS) has 12 | FEBRUARY 2013

established 33 quality measures on care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and patient and caregiver experience of care. Federal savings from this initiative could be up to $940 million over the next four years.

The new ACOs include a diverse cross-section of physician practices across the country. Roughly half of all ACOs are physician-led organizations that serve fewer than 10,000 beneficiaries. Approximately 20 percent of ACOs include community health centers, rural health centers and critical access hospitals that serve low-income and rural communities.

The group announced today also includes 15 Advance Payment Model ACOs, physician-based or rural providers who would benefit from greater access to capital to invest in staff, electronic health record systems, or other infrastructure required to improve care coordination.

Medicare will recoup advance payments over time through future shared savings. In addition to these ACOs, last year CMS launched the Pioneer ACO program for large provider groups able to take greater financial responsibility for the costs and care of their patients over time. In total, Medicare’s ACO partners will serve more than 4 million beneficiaries nationwide.

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insight

Increasing Vitamin C Intake:

Solutions for Difficult Medical Problems The non-profit Vitamin C Foundation sponsors an online forum with topics covering a wide variety of difficult medical questions.

Outstanding medical doctors, chiropractors and naturopaths routinely volunteer their time expressing their opinions and suggesting nutritional solutions to these unusual health issues.

All responses are debated at the forum, and the public is free to join. Foundation Co-Foundation Owen Fonorow, author of the book Practicing Medicine Without a License, the Story of the Linus Pauling Therapy for Heart Disease states, “It is really amazing the number of people who have reported excellent results, even cures. More often than not, they ask us questions after failing to find 14 | FEBRUARY 2013

relief from their conventional medical doctor. These cases stand for the world to read as topics at our forum.”

It is not surprising that increasing vitamin C intake is the most frequent recommendation made at the forum.

Human beings are one of only a few species that cannot make their own vitamin C. They must therefore get this essential nutrient entirely from the diet. The Vitamin C Foundation believes that if human beings consumed the amount of vitamin C produced by other mammals in their own bodies, adjusted for body weight, the cost of medical care would decrease dramatically. This amount ranges from an estimated 300 mg in domestic cats to over 19,000 mg daily in mice.

The vitamin C Foundation’s

recommended daily allowance of vitamin C is 3000 mg (1500 mg twice daily) for people in ordinary good health. The recommended amount varies with illness; viral infections such as mononucleosis require more than 200,000 mg daily The Foundation believes that roughly 75% of all human illness stems from the inadequate daily intake of vitamin C. We estimate that perhaps another 15% is caused by a deficiency in other nutrients. Finding the optimal vitamin C intake for an individual can be challenging. A good heuristic is the dosage recommended by the late twice-Nobel prizewinner Linus Pauling.

Linus Pauling consumed 18,000 mg (9000 mg, twice daily) of vitamin C as ascorbic acid. Pauling calculated that a mammal of his body weight produces on average 9000 mg daily. This finding, combined with his experiments that showed roughly half the vitamin C taken by mouth is lost and does not enter the blood stream, caused him to double the 9000 mg amount.

A 100-year-old, retired physics professor, Theodore P. Jorgensen, with a Ph.D. from Harvard, spent the war years working on the Manhattan Project. He wrote to us. “A free supply of vitamin C to every person would lower the cost of health care in a major way. It is virtually impossible for any person to obtain optimal vitamin C per day from ordinary or casual ways.

This also indicates that human beings are living with dangerously low levels of vitamin C The above information gives some idea of the reason our cost of health care is so high and our average age of death is so low. This problem is a national disgrace and should be attacked on a national basis.

Any practical approach to the vitamin C problem would require the whole prestige and authority of the federal government.”  Source: http://www.pressreleasepoint. com/solutions-difficult-medicalproblems

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international

Promise of Cost and Clinical Benefits Fuels Adoption of Health Care IT Professional Services in Europe Frost & Sullivan News Release The need to enhance health care delivery is driving the market for IT professional services in Europe. Adoption levels are, however, being hampered by budget cuts and end user reluctance to invest in such services. These trends have triggered several changes in the market, including consolidation and the adoption of inorganic growth models.

New analysis from Frost & Sullivan (healthcare.frost. com), Analysis of the European Healthcare IT Professional Services Market, finds that the market earned revenues of $1.58 billion in 2011 and estimates this to reach $1.93 billion in 2017. The research covers consulting, training, integration and implementation as well as support and maintenance services.

“Hospitals are now increasingly dependent on IT solutions to support their day-to-day, reduce human errors, limit operational costs and stay ahead in terms of technology,” noted Frost & Sullivan Research Analyst Somsainathan C.K. “As the penetration of health care IT rises, hospitals are investing in professional services to optimize the use of these solutions.”

Hospitals, now more than ever before, are recognizing the importance of using the right communication and technology solutions. They are turning to health care IT professionals to select the models best suited to their needs.

The demand to update existing technology to boost efficiency and lower costs is further driving the growth of IT professional services in health care. This will have a beneficial impact on the training segment, in particular; when a new technology is acquired, hospital staff needs to be trained to use the upgraded version.

A major, and continuing, challenge for market participants remain shrinking health care budgets. These have adversely affected the revenues and the margins 16| FEBRUARY 2013

earned by industry participants.

“Lower cash inflows have motivated hospital CIOs to revisit investments into IT solutions and services,” cautioned Somsainathan. “Simultaneously, the market is being negatively affected by certain pre-conceived end user notions. For instance, some IT services, especially training and consulting, are perceived as adding very limited value to existing IT infrastructure and solutions.”

The need, therefore, is for cost-effective solutions that promote clinical and cost efficiencies. Service providers, on their part, will have to place cost optimization on the top of their agendas.

“Newer architecture and delivery models, such as cloud services, will revive the market for health care IT professional services in the near future, as more and more hospitals are looking to improve their technology set up,” concluded Somsainathan. “Ultimately, the need to reduce costs through the effective use of technology and the optimum utilization of financial resources will help in improving the penetration rate of IT professional services in Europe”.

Analysis of the European Healthcare IT Professional Services Market is part of the Connected Health Growth Partnership Service programme, which also includes research in the following markets: Data Management Systems for Patient Monitoring Markets in Europe, European Market for non- Invasive Blood Pressure Monitors, European Telemetry Equipment Market and, European Pulse Oximetry Market. All research included in subscriptions provide detailed market opportunities and industry trends that have been evaluated following extensive interviews with market participants.  http://www.newswiretoday.com/news/122872/

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practice tips

New Study of Health Care Organizational Culture Reveals Substantial Gaps Between Physician Satisfaction and Organizational Performance Physician Wellness Services and Cejka Search study helps to show impact of organizational culture on physician engagement, recruitment and retention.

18 | FEBRUARY 2013

A

new Physician Wellness Services and Cejka Search study found substantial gaps between physicians’ satisfaction and experience with key cultural attributes in their health care organizations. The study explored the influence of 14 cultural attributes on physicians’ overall satisfaction, and their perceptions about their organization’s performance related to those cultural attributes.

A companion study of hospital administrators found that while they have a reasonably good sense of what is important to physicians’ satisfaction in terms of organizational culture, administrators consistently feel their organizations perform better with regard to cultural attributes than physicians think the organizations perform.

“The study clearly shows areas of disconnect between what physicians look for and what they find – and what organizations think they provide,” said Dan Whitlock, M.D., Physician Wellness Services consulting physician. “In our work with physicians and health care organizations, we find that this often leads to dissatisfaction, frustration and cynicism, sometimes with behavioral impacts. At a time when physician engagement is of paramount importance and health care organizations seek to promote satisfaction and loyalty, closing these organizational culture gaps can have a strong positive impact.”

“Cultural fit is a determining factor in a physician’s decision to join – or leave – a practice,” said David Cornett, Senior Executive Vice President of Cejka Search. “Because turnover and prolonged physician vacancy can cost a practice as much as $100,000 per month, organizations can achieve significant returns by investing in the assessment and cultivation of cultural fit.”

“I just switched organizations for all the reasons your survey is focusing on,” said a physician respondent.

“Thanks for helping me see the words and themes which prompted me to seek out a new job and my subsequent satisfaction with my new organization.”

High/Low Ranking Attributes and Gap Areas

A patient-centered care focus is by far the most important cultural attribute to physicians, the study found. This attribute also had one of the smallest gaps between physicians’ expectations and how well they believe their organizations address the attribute, indicating greater congruence on this important core attribute.

The highest-ranked cultural attributes for physicians are respectful communication, a team-focused environment, and supportive management regarding errors and mistakes. However, their satisfaction scores indicate that all of the attributes surveyed were important to them.

Physicians’ average scores regarding the importance of all but one attribute fell into the uppermost quartile of the 10-point Likert scoring scale.

Transparent communication, collaborative leadership style, and organizational adaption to change are attributes with the biggest gaps between what physicians consider to be important and what they perceive their organizations to be delivering.

The gap between importance and organizations’ delivery is smaller on cultural attributes such as clear mission and values, and objective performance evaluations. But notably, these are attributes that physicians rank as having lower influence on their job satisfaction.

Ultimately, the largest gap – and the one that is most relevant to physicians in the long-term – is that between their satisfaction with their organization’s focus on an attribute and the ideal – a perfect 10 on a 10-point Likert scale. From that perspective, the gaps, ranging from 3.0 to 4.3 points, are considerable.

Influence of Cultural Fit on Recruitment and Retention

The study also found that administrators underrate the influence of organizational culture on physicians’ decisions to accept or leave jobs.

Most physician respondents agreed that expectations of cultural fit are a determining factor on whether or not to accept a practice opportunity, and at least half agreed that lack of cultural fit prompted them to leave.

Administrators felt cultural fit was a factor for physicians accepting or leaving a job about one-third of the time.

“Physician respondents said that cultural fit has prompted them to leave or decline a position to a higher degree than administrators estimated was the case,” Cornett noted. “This reveals a gap that organizations can fill by more objectively assessing cultural fit and engaging physicians in on-boarding and team-oriented activities that support a strong cultural fit. This is especially critical in the first three years of joining a practice, when recruits are highly vulnerable to turnover.”

Mind the Gap: An Rx for Some Cultural Health Improvements

“Administrators’ mistaken belief that their organizations are demonstrating competence when their physicians feel differently can lead to decreased efforts to create cultural congruence,” said Robert Stark, M.D., Physician Wellness Services consulting physician. “As more physicians become employed, consolidation continues, and work toward health care reform proceeds, physician engagement has become increasingly urgent while health care organizations work to develop models and systems to improve care and reduce costs.”

Dr. Whitlock stated there is tremendous opportunity for health continued on page 20 MEDMONTHLY.COM |19

continued from page 19

care organizations to understand how they can fully engage physicians – whether they are employed or independent – and create better retention and recruitment programs.

Physician Wellness Services and Cejka Search both have practices and programs that can assist organizations in closing the organizational culture gaps.

Several respondents indicated they were happy with their organizations and one respondent’s comment indicates the potential benefits of a healthy culture: “My organization’s cultural attributes are what has encouraged me to put off my retirement. It is a pleasure for me to work here.”

Organizations also should be mindful of cultural shifts over time due to staff and leadership changes,

as well as organizational and industry evolution, Dr. Stark added. As one physician respondent noted, “I joined my practice because of good cultural fit. The entire structure of the group has changed since joining six years ago. I’m completely unsatisfied with new structure.” 

About the Survey

The physician and administrator surveys were conducted in October 2012 by Physician Wellness Services and Cejka Search using a confidential online survey instrument, and collected responses from more than 2,200 physicians nationwide representing multiple specialties, and 123 administrators. Physician respondents closely reflected a demographic representation of the national physician population.

Based upon a review of the research on organizational culture attributes in

healthcare organizations, 14 cultural attributes were identified that were particularly relevant to physicians.

Respondents were asked to rate each of them based upon the importance of that attribute to their overall satisfaction; the degree to which they agreed their organization demonstrated that attribute; and their satisfaction with their organization’s focus with regard to that attribute.

The administrator survey mirrored the physician survey, asking administrators to assess how physicians would rate the 14 cultural attributes and their perceptions of their organization’s performance against those attributes.

For more information on the study, please visit http://www. physicianwellnessservices.com/news/ orgculturesurvey.php

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practice tips

THERE IS

NO SUCH THING AS A 10-MINUTE OFFICE VISIT By Mary Pat Whaley, FACMPE

22 | FEBRUARY 2013

‘‘

“But he only spent 10 minutes with me.”

I will never forget something a patient told me several years ago when I was covering the front desk in a practice I was managing. If you manage a practice and haven’t worked at your check-in and check-out desks recently, I highly recommend it.

An insured patient that I checked out was shocked when I said the charge for her visit was $100. She said, “But he was only in the room for ten minutes!” I was briefly at a loss for words. I recovered, we agreed on a payment plan for her co-pay, I made a note on her encounter form for the billing office and she left.

I’ve been thinking about our conversation, and thinking about what that $100 – actually the payer would probably only pay about $35 and with her co-pay, the grand total would be $55 – and what that $55 is supposed to cover…

1. First, we scheduled the appointment, which was a workin, so it took several people to take the message, pull the medical record (paper charts), call the patient to assess the problem, determine the need for the appointment and schedule it.

2. When the patient arrived, we checked to make sure her address and phone were the same, quickly checked her eligibility to make sure the insurance on file was still in force, and asked for a photo ID. An encounter form was generated at the nurse’s station to notify her of the patient’s arrival.

3. The nurse called her from the reception area, weighed her, and took her into an exam room to take her vitals, take a brief Chief Complaint and History of Present Illness, review the

medications she is taking and check to see if she needed any chronic medication refills while she was there.

4. The physician came in to see her, asked about any changes since she’d last been seen, reviewed her History of Present Illness and examined her. He talked to her about her illness and described a treatment plan for her upper respiratory infection given her chronic health problems.

5. He prescribed a medication for her problem, updated her medication list and made a copy for her to take with her.

6. He marked the encounter form with the level of service and her diagnoses and gave her the form to take to the check-out desk.

7. He refiled the medication reconciliation in the chart, finished documenting the visit, and placed the chart in the bin to be refiled. The chart was filed, and the encounter form was sent to the billing office.

8. At the billing office the charges and any payment was posted and the claim was filed. If there was no problem with the claim, it electronically passed through two scrubs and a final one at the payer.

9. If payment was not denied for any of a dozen reasons, the payment would arrive at the billing office and would be posted.

10. Since the patient did not pay her co-pay at the check-out desk, the patient balance is billed to the patient. If the patient pays on the very first statement, it has taken the practice from 45 to 60 days to

receive the complete payment of $55.

I know that patients often say “But he only spent 10 minutes with me.”

Checking back with the provider, I find it was typically longer. Patients tend to underestimate the time as it goes very fast.

The total visit encompassed the work of the phone operator, the medical records clerk, the triage nurse, the check-in person, the nurse, the doctor, the check-out person and the biller. It took 8 people, and at least 45 minutes of work to make that appointment happen. Plus, that visit had to help pay the expenses for the rent, the utilities, malpractice insurance, medical supplies, computers, phones and janitorial services.

The practice, the patients and the overseers of healthcare want each visit to be non-rationed, safe, high-quality, error-free, holistic, pleasant, clean, accurate, efficient and reimbursable.

It’s what we all want. And it isn’t cheap.

Even though health care and health care reimbursement have been sizzling hot topics in the past few years, most patients – already anxious and often sick – do not have a strong grasp of what actually goes into the services they receive. They see very little of the behind-the-scenes efforts. I don’t think the patient visit is necessarily the perfect time to educate patients on what goes into an office visit, but maybe each of us should be prepared to offer a meaningful answer when the patient says “But he only spent 10 minutes with me.”  Source: http://www.managemypractice. com/there-is-no-such-thing-as-a-10minute-office-visit-2/#more-12584 MEDMONTHLY.COM |23

practice tips

Why Small Practices Are Struggling And What Can Be Done

By Robert Sayre Marketing Adviser/Business Coach High Performance Network

Independent physician practices and small practices all face common issues these days as operating business units. Doctors from all walks of life are wrestling with common and sometimes what seem to be unsolvable challenges. There are six common factors that consistently impact the practice as a business. They are: • Revenue is squeezed • Overhead costs keep rising • Poor management skills • Lackluster marketing • Ineffective leadership and poor soft skills • Uncertainty about the future of health care 24 | FEBRUARY 2013

J

ed Constantz from Central New York Medical Support Services commented, “There are several factors affecting the short and longer-term viability of the independent practice. The first, and most obvious, is the lack of business savvy among those who make decisions regarding the business operations for the practice. Doctors should learn to appreciate the characteristics of a successful business operation and then make the connection between those and the operational characteristics of their own practice.”

Revenue is “Squeezed” When asked what are the key factors the companies you work with are facing, Gregg Seidner at Match One Staffing in New York City noted,” the number one factor is that the small practice must negotiate the rates they receive from the insurance companies they accept directly. As insurance companies are pressured to lower their payouts for various services, smaller practices are squeezed more. Larger practices with higher volumes can often negotiate higher rates. So, the revenue per patient for many small practices is going down.”

Cynthia Leckman noted, “When a physician hires the wrong fit, the ending result is lost revenue for the physician and the practice. This can range anywhere from 10% to 20% of the outstanding receivables”.

Overhead Costs Keep Rising When asked what the key positions his firm was placing were, Gregg Seidner’s immediate response was, “human resources positions are our largest placement category. This includes the roles of: l Handling benefits for employees l Employee requests for information, claims, problems with insurance, etc. l Talking directly with insurance

companies for employees and for patients l Handling disability claims and paperwork When half of your staff deals exclusively with insurance, billing and other administrative duties, which is the case in many practices, this overhead is a huge burden on the practice as a small business.

Poor Management Practice “Most physicians struggling with their business, it’s part of the challenge of doing business with them as a potential market. It’s part of what causes them to do damage to themselves,” explained Jed Constantz at Employer Health Care Advantage Solutions. “They are so used to being solely responsible in terms of patient care they have trouble behaving differently in terms of business relationships and shared decision making.”

Part of why costs keep rising and doctors are struggling is their management practices. Cynthia Leckman, who has managed practices for 25 years noted, “there are three key areas that contribute to practices struggling. l Billing “My experience in all practices, whether private sector or hospital employed, is inefficient billing operations can and will lead to the demise of the practice.

Unfortunately, in all of the practices I have consulted for, it is inaccurate with poor attention to detail in the claim billing and follow up with insurance companies as well as with resolving unpaid claims.” l Practice Manager’s

Knowledge

“It is essential that the practice manager is able to critically analyze and interpret all of the billing complexities. When a

practice manager has a limited knowledge of billing operations, this is when errors in billing as well as inefficient billing processes and systems are likely to be performed.

l Ineffective Scheduling

u Feedback and Communica-

tion Are the Keys

Effective scheduling will decrease doctor idle time and patient wait time. The doctor and his or her staff need to analyze the daily schedule for the types of appointments, time allotted and facts about the patient that could affect the visit and schedule. Delays in the schedule cause idle time for the doctor. u Idle Time Leads to

Interruptions, Killing Schedules

If a doctor has idle time, the tendency is to chat with staff during that time, attend to phone messages, see pharmaceutical reps, or complete charting. All of these variables factor into increasing patient wait time. Although some think the physician has many interruptions, typically this is not the case of the delayed doctor. u Sequence of Appointments Finally, the sequence of scheduling is important. I recommend that the first appointment of the day and after lunch be ones that are predictable in the length of time, i.e. only physicals or regularly performed procedures for established patients. This starts the morning and afternoon off on a positive note. u Try Team Huddles Dike Drummond shared a simple tool is to hold a ‘team huddle’ twice a day that continued on page 26 MEDMONTHLY.COM |25

continued from page 25

improves scheduling. This is just like a football team huddle except it includes the doctor and all the staff involved the patient flow for that half day.

Hold these 3 minute meetings once at the beginning of the day and another prior to the afternoon appointments.

Make sure your receptionist and the person who rooms your patients are there at a minimum with a copy of the schedule for that half day.”

Lackluster Marketing Like any other business, doctors and their practices need to bring in new patients on a regular basis.

Dr. Simon Sikorski , M.D. who had assembled case studies that do not break the bank suggests, “going with companies and plans that put the risk taking on the marketing company.

Compensating marketers on actual patients delivered is a new paradigm and one that the top firms can and do offer.”

Soft Skills Gaps Induce Stress, Sap Productivity and Impact Business I asked Dike Drummond, MD, what are some of the key areas that cause doctors to struggle in their practices?

“There are two key areas all physicians can improve in and if done consistently, will improve their personal experience of being a doctor, their practice as a business and their relationships with their staff and with their patients,” commented Dike Drummond, a former doctor turned coach and adviser.

“These are: l how they handle stress during the work day; l the leadership skills they use to coordinate the activities of the team involved in delivering their flavor of patient care.”

26 | FEBRUARY 2013

Stress Kills Business as Well “Doctors have to live with high levels of stress. They are seeing sick people, making medical diagnoses, sometimes very quickly. As the day goes on their stress load builds making them less effective in making decisions and actually being able to be present with their patients. A simple stress relieving technique is a single breath the doctor takes where you release any worry or stress you notice as you exhale.”

Leadership Skills Count Cynthia Leckman explained, “Leadership and the management by the physician are the leading contributing factors for why they are struggling with the business of their practice.

“During my work as a practice manager for 25 years as well as consulting for individual practices, I have seen wide pendulum swing from one extreme “bad practice” to another.

The top three “bad practices” include:” 1. Micromanaging 2. Undermanaging 3. Inefficient talent management process Dr. Drummond continued, “doctors also lead a team of nurses, nurse practitioners, receptionists, schedulers and others. We are conditioned by our medical education to be workaholics and we never get any training on leadership skills. The result is all doctors’ work too hard and their teams are usually ready, able and willing to share the load of patient care activities.

We have to remember that patient care is a team sport and our job is to coordinate the team ... not do all the work.”

Poor Employee Engagement By not listening to, barking orders and not respecting their staff, doctors

‘‘

“Leadership and the management by the physician are the leading contributing factors for why they are struggling with the business of their practice.”

as well as practice managers can unknowingly sabotage their practices.

This behavior will cause their employees to shut down and not offer solutions they know would potentially improve productivity or processes.

These employees interact more often with the patients, who are the key stakeholders of the physician’s revenue base. The staff of a practice reflects the culture of the practice. They are the first impression the patient has regarding the practice.

Uncertain Future of the Health Care Industry Gregg Seidner observed, “with the Affordable Care Act, or Obama Care, the outcomes or results of this are still largely unclear. The stated intention of the Act was to; include more people in the pool and to provide more preventative services. In theory, this would reduce costs for the patient.

But, we really don’t know what the outcomes will be.”

And Dike Drummond also noted, “there is a great deal of uncertainty in health care in the US. Many doctors are opting to join larger practices or hospitals, in the hopes of reducing their stress and handing off the management tasks and business issues to someone else so they can “just see patients.  Source: High Performance Network at http://www.highperformancenetwork. net/

What’s your practice worth?

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research & technology

DRUG-RESISTANT MELANOMA TUMORS SHRINK WHEN THERAPY IS INTERRUPTED ‘Intermittent Dosing’ Strategy in Lab Mice Suggests Simple Way to Help People With Late-Stage Melanoma

By Jason Bardi Senior Public Information Representative University of California, San Francisco (UCSF)

28 | FEBRUARY 2013

Researchers in California and Switzerland have discovered that melanomas that develop resistance to the anti-cancer drug vemurafenib (marketed as Zelboraf), also develop addiction to the drug, an observation that may have important implications for the lives of patients with late-stage disease.

The team, based at UCSF, the Novartis Institutes for Biomedical Research (NIBR) in Emeryville, Calif., and University Hospital Zurich, found that one mechanism by which melanoma cells become resistant to vemurafenib also renders them “addicted” to the drug. As a result, the melanoma cells nefariously use vemurafenib to spur the growth of rapidly progressing, deadly and drugresistant tumors.

As described in the journal Nature, the team built upon this basic discovery and showed that adjusting the dosing of the drug and introducing an on-again, off-again treatment schedule prolonged the life of mice with melanoma.

“Remarkably, intermittent dosing with vemurafenib prolonged the lives of mice with drug-resistant melanoma tumors,” said co-lead researcher Martin McMahon, PhD, the Efim Guzik Distinguished Professor of Cancer Biology in the UCSF Helen Diller Family Comprehensive Cancer Center.

It is therefore possible that a similar approach may extend the effectiveness of the drug for people – an idea that awaits testing in clinical trials.

Investigated through a publicprivate partnership, the research was spearheaded by the study’s first author Meghna Das Thakur, PhD, a Novartis Presidential Postdoctoral Fellow, who was co-mentored by McMahon at UCSF and Darrin Stuart, PhD at NIBR. McMahon is supported by the Melanoma Research Alliance, the National Cancer Institute and the UCSF Helen Diller Family Comprehensive Cancer Center, which

is one of the country’s leading research and clinical care centers, and is the only comprehensive cancer center in the San Francisco Bay Area.

Melanoma: A Deadly Form of Skin Cancer Melanoma is the most aggressive type of skin cancer, and in 2012 alone, an estimated 76,250 people in the United States were newly diagnosed with it. Some 9,180 people died last year from the disease, according to the National Cancer Institute.

As with all forms of cancer, melanoma starts with normal cells in the body that accumulate mutations and undergo transformations that cause them to grow aberrantly and metastasize. One of the most common mutations in melanoma occurs in a gene called BRAF, and more than half of all people with melanoma express mutated BRAF. In 2011, the U.S. Food and Drug Administration (FDA) approved the drug vemurafenib for patients who have late-stage melanoma with mutations in BRAF after clinical trials showed a significant increase in survival for such patients when taking the drug. The drug’s benefits do not last forever, though, and while their tumors may initially shrink, most people on vemurafenib suffer cancer recurrence in the long run with a lethal, drug-resistant form of melanoma.

In the laboratory, the same phenomenon can be observed in mice. When small melanoma tumor fragments are implanted in mice, the tumors will initially shrink in response to drug, but eventually the mice will cease to respond to the drug and their tumors will re-emerge in a resistant form.

Targeting the Mechanism of Resistance Working with such laboratory models, the UCSF and NIBR research

teams were able to determine the mechanism of resistance. They discovered that when melanoma cells are subjected to vemurafenib, they become resistant by making more of the BRAF protein – the very target of the drug itself.

The idea for intermittent dosing came directly from this insight. If by becoming resistant to vemurafenib’s anti-cancer potency, melanoma also becomes addicted to it, Das Thakur and her colleagues reasoned, then drug-resistant tumors may shrink when the vemurafenib is removed.

That’s exactly what they observed.

The team discovered that when they stopped administering the drug to mice with resurgent, resistant tumors, the tumors once again shrank. In addition, mice continuously treated with vemurafenib all died of drugresistant disease within about 100 days, whereas all the mice treated with vemurafenib but with regular “drug holidays” all lived past 100 days.

“Vemurafenib has revolutionized treatment of a specific subset of melanoma expressing mutated BRAF, but its long-term effectiveness is diminished by the development of drug resistance,” said McMahon, the Efim Guzik Distinguished Professor of Cancer Biology in the UCSF Helen Diller Family Comprehensive Cancer Center. “By seeking to understand the mechanisms of drug resistance, we have also found a way to enhance the durability of the drug response via intermittent dosing.”

The article, “Modeling vemurafenib resistance in melanoma reveals a strategy to forestall drug resistance” is authored by Meghna Das Thakur, Fernando Salangsang, Allison S. Landman, William R. Sellers, Nancy K. Pryer, Mitchell P. Levesque, Reinhard Dummer, Martin McMahon and Darrin Stuart. It appears in the Jan. 9, issue of the journal Nature.  Source: http://www.ucsf.edu/ news/2013/01/13389/drug-resistantmelanoma-tumors-shrink-when-therapyinterrupted MEDMONTHLY.COM |29

research & technology

EHR

Technology

BEST PRACTICES to Insure Effective EHR Implementation

by Frank J. Rosello, CEO, Environmental Intelligence LLC 30 | FEBRUARY 2013

T

he movement to transition the United States health care system from paper based patient medical records to electronic medical records (EHR) continues to grow at a steady pace. As more private and public medical practices, hospitals and clinics make the leap to implement EHR technology or upgrade their existing EHR platforms, the more knowledge is gained around effective EHR implementation strategies.

Let’s face it, change is a hard thing to embrace. But when you add the complexities of federal health care regulations and compliance requirements to the mix, EHR adoption and implementation for many is still viewed as a near impossible task. Essentially, many view making this step as not being worth the hassle regardless of how big the government incentive or disincentive.

Even the potential negative financial impact for those providers and medical facilities that choose not implement EHR technology and achieve Meaningful Use is not moving decision makers to action.

To help medical practices and facilities avoid the most prevalent EHR implementation mistakes, consider the following five best practices that work for any size practice: 1) Prepare for the challenge to successfully implement an EHR.

‘‘

Essentially, many view making this step as not being worth the hassle regardless of how big the government incentive or disincentive.

The process to implement the technology will bring stress and anxiety to everyone involved over a period of several months. EHR systems are very sophisticated and full of features and functionality that will bring efficiency to workflows, but it is impossible to take advantage of its full capability in first few weeks after going live.

Be patient and make sure your EHR vendor develops a robust implementation plan free of any shortcuts.

2) Embrace change as an opportunity to evaluate and improve the physician and patient workflows of your practice. Most medical practices have yet to optimize the day-to-day processes of the operation. Leverage EHR implementation as an opportunity to discover new efficiencies in your workflow. A perception exists with many physicians and practice administrators that EHR technology serves as a catalyst to solve issues in workflow. In fact, the opposite is true - EHR technology will only make existing workflow problems more severe.

3) Training, training, and more training. Operating a medical practice is complicated – Especially, when you step back and think about the necessary compliance tasks, proper coding, and patient documentation required. Also, consider the fact that different people learn and grasp new concepts in different ways. Don’t allow the EHR vendor you select to convince you that an EHR conversion is as easy as plug and play. To insure everyone on the team is ready, schedule time outside of operating hours and have your team practice scenarios on the EHR platform that will take place when you go live. Yes, you will most likely have to budget for

additional labor costs, but the return on investment will make any additional expense worth it. One last note, assign an EHR champion or champions to coach and check on teammates at thirty, sixty, and ninety days post your go-live day. This best practice will go a long way to support those teammates that need additional help and aid in capturing ideas to further improve workflows.

4) Don’t leave out your nursing staff from participating in the EHR selection process.

Physicians are either the owners, practice leaders, or the key decision makers, but they are not exclusive users of the EHR. In fact, a recent study found that nurses account for almost seventy-five percent of the use of the patient chart, while physicians complete the remaining twentyfive percent. You will know you are on the right path towards a successful EHR implementation when nurses are consistently assisting the physician during the integration of the EHR into clinical workflows.

5) Recognize that physicians do not all practice medicine the same way. The absolute worst thing a practice can do is force all physicians to use the system in the same manner. The good thing is that most EHR systems provide several ways to accomplish the same task. While this fact may add to the complexity of training, the benefit is that each physician will have the opportunity to choose which approach will work best for them and their style.

Taking this approach will help with coping with the stress that comes with change resulting in faster physician adoption and buy-in.

Leveraging these best practices will dramatically improve your chances of experiencing a rewarding and highly successful EHR implementation.  MEDMONTHLY.COM |31

research & technology

Chicago ENT Head and Neck Surgeons Using VELscope Vx to Enhance Oral Cancer Surgery Success Rate

Technology Helps Surgeons See Cancerous and Precancerous Tissue Not Apparent to the Naked Eye LED Medical Diagnostics Inc. (TSX VENTURE:LMD) subsidiary LED Dental announced today that its VELscope Vx enhanced oral assessment device will now be used by Chicago Otolaryngology Associates for oral mucosal abnormality assessment and when performing surgery on oral cancer patients.

According to Chicago Otolaryngology Associates’ Howard Kotler, MD, FACS, “We pride ourselves on embracing state-ofthe-art technologies that allow us to provide the best patient care possible.

The VELscope Vx may significantly enhance our ability to see the entire cancerous or precancerous lesion that needs to be excised, allowing us to minimize risk of additional unnecessary surgery.”

The VELscope Vx’s fluorescence visualization technology is the first approved by the FDA and Health Canada to help surgeons determine the surgical margins when excising cancerous and precancerous tissues.

The technology is also approved to 32 | FEBRUARY 2013

help dental and medical professionals discover cancerous and precancerous tissue that might not be apparent to the unaided eye.

The vast majority of the nearly 12,000 VELscope devices in use around the world are used by dental practices. Typically, when a suspicious lesion is detected by a dentist, the patient is referred to an oral surgeon or a periodontist for a surgical biopsy, which is then evaluated by an oral pathologist. If the biopsy sample is determined to be cancerous or precancerous, the patient is usually referred to an ENT head and neck surgeon for consultation and likely excision. VELscope technology was developed to address the problem of detecting all abnormal tissue, including that beneath the surface, as well as making it possible for dentists to discover early stage oral cancer, which requires less invasive treatment and has a significantly higher chance of survival than when the disease is detected in late stages.

“We applaud Dr. Kotler and

Chicago Otolaryngology Associates for being one of the first Otolaryngology practices in the U.S. to incorporate VELscope’s potentially life-saving technology,” said Peter Whitehead, founder and CEO of LED Dental and its parent, LED Medical Diagnostics Inc. (TSX VENTURE:LMD).

Robert Cartagena, chief operating officer of VELscope Vx distributor DenMat Holdings, LLC, added, “We encourage Chicago-area dental practices, particularly those using VELscope technology, to consider Chicago Otolaryngology Associates when referring any patients who have a suspicious abnormality.” He noted that Chicago Otolaryngology Associates, which is based in Chicago’s Mercy Hospital and Medical Center, offers the convenience of a central Metro Chicago location.  Source: http://www.marketwire.com/ press-release/chicago-ent-head-necksurgeons-using-velscope-vx-enhanceoral-cancer-surgery-success-tsx-venturelmd-1743950.htm

“Training Wheels in Heels” Denise Price Thomas Trainer for Health Care Professionals Focusing on Exceptional Customer Service, Effective Communication & Exemplary Compassion 34+ year career in health care and certified in health care management Undercover Patient Providing Insight to Your Practice Through the “Eyes of a Patient” Conference Speaker Presenting also as “Gladys Friday”, Health Care Comedienne

Home Grown/Nationally Known www.denisepricethomas.com denisepricethomas@gmail.com 704-747-8699

MEDMONTHLY.COM |39

research & technology

YOU IMAGINE What’s So Good About This App?

By

34| FEBRUARY 2013

It is now within reach of a physician who has a need to be met, to seek a small developer and developer and request that an app of his or her own be developed. So, for this final part in my “You Imagine” series, I want to ask what makes a good and effective health app on any mobile device.

With over 17,000 health and medical apps available in iTunes, and with an average price at around $2.00, iTunes “Health” and “Medical” categories are two of the fastest growing sectors of app development. There are health games that offer, for example, quizzes to assess calorie content of various foods. There are GPS apps, order tracking apps, weight management apps, pedometers, diabetes regulating apps, and calorie counting apps, just to name a few. These apps might be associated with push notifications that offer users reminders to take meds or other health interactions.

According to Float Mobile Research, almost 80% of Americans want to use mobile apps to assist in their health decisions, and 40% of physicians believe that the mobile apps can reduce their patients’ need for office visits1. But which ones do people enjoy, which ones do people learn something from, which ones do people keep, and which ones effectively achieve their goals?

devices. For people who own smartphones and tablets, social media and texting are preferred ways of passing information because they are personal. The tendency we have to check our devices and to check-in means that physician offices might reach their patients most effectively by tapping into this preference.

Mayo Clinic cancer patient educator Sarah Christensen, whose newsletter “Living with Cancer” has over 60,000 subscribers, has learned from the experience of bringing resources to patients via iPad that social media is the key to reaching her patients2. She says this recognition of the social nature of the search for health and wellbeing, is the key to reaching people, and it breaks people from the limits of geography.

Some of the apps making great effort to offer an interesting and socially integrated experience include Runtastic (http://www.runtastic.com/), which manages exercise routines and aims to make it fun.

1. I LIKE THIS APP Apps should be sociable, personal, engaging, interesting, and fun.

To like an app, even for adults, it must be fun, personal, or interesting. Its visual appeal must grab our interest from the beginning, and not disappoint. A health app can not be overly complicated to use, and it must meet our expectations seamlessly as we begin to click and navigate through it. Because we are social creatures and find greater meaning in our personal ties, a health app must also connect us to friends, family, and our physician and healthcare providers. Certainly, it might also venture to introduce us to others who share our health concerns and our same health circumstances.

Pricewaterhouse Coopers Managing Director, Christopher Wasden, speaking at the Healthcare Information and Management Systems Society’s annual conference 2012, offered suggested that interoperability, or networking, is a great area of opportunity in the health app playing field. This potential has been slow to implement because, as my own clients express, there is concern about patient privacy. As security protocols are being addressed for electronic medical records (EMRs), and as the FDA regulations become clear to developers, patient privacy will be maintained while allowing patients to share personal data with exactly those they intend to.

Wasden’s suggestion that social networking is a key point to one of the most exciting capabilities of mobile

2. I’VE LEARNED FROM THIS APP Apps should be intelligent and supportive of our learning needs, offering compiled health behaviors and even offering marketing informatics.

Certainly, apps can offer medical information in layer upon layer of complexity. But this alone is not always strong enough or useful enough insight; nor motivating for all. We want an app to be intelligent, to adjust to our behaviors and to offer something new from the outside world. Apps should be smart enough to suggest and make health suggestions that are unique and specific to our needs, strengths, weaknesses, and to our unique pattern of health choices. continued on page 36 MEDMONTHLY.COM |35

continued from page 35

Apps should work with the lifestyle and needs of both the doctor and the patient. iPads and iPhones prove their usefulness in a variety of new ways by the innate hardware features that complement such engaging software capabilities: functions like recording, light, and camera capabilities; or by offering the option to record specific data through devices such as attached stethoscopes, lenses, to be used for recording data. Using an iPad to record data, heart sounds, and integrate resources is a powerful step in the direction. Dr. Ariel Soffer is a South Florida cardiologist who developed an app allowing patients to take a photo of their veins and send the photo to for feedback3. It’s a simple idea, but powerful, time saving, and it efficiently integrates the health care system without violating strict patient privacy laws.

The app should be flexible and allow for different learning styles. People differ in which method of presentation reaches them best.4 It might offer information in different formats: visual, text, and audio, for example.

It might offer linear approach for some, and a linked approach for those who like to choose their own path towards knowledge5.

3. I’VE KEPT THIS APP Apps should be integrated to the health care system, and integrated into our lives so that we return to them again and again.

In Tom Myers’ review article, What makes an effective Health App6, he says, “A good indicator of usefulness of an 36 | FEBRUARY 2013

application are retention figures. That is how long does the app stay on the users device.”

This is quite a demand for an app. Even for my kids, the best shelf life for any single game has been months. And there have been a few games, as well that have remained on the iPad for a year now, which are only opened once a month. I would suggest that an app that is retained longest is not necessarily achieving its goals any more than one which is held onto for a couple of months. My children throw away a game when they have mastered it. And this is a good sign that they have moved on to something of a greater or different challenge.

I would suggest that, specifically, apps with short term goals, such as those teaching anatomy or physical therapy exercises would not need a long retention cycle.

But those intended to be incorporated into a patient’s long-term health care plan should be capable to collect data of different types, or to access wide knowledge. But app retention would not be the sole factor to consider in determining the usefulness of a health app.

Larklife (http://lark.com/) is one example of an app that is well incorporated into the user’s lifestyle. Lark offers daytime and night-time wristbands to monitor patients sleeping and waking activity. It logs this data into the mobile device.

4. THIS APP CHANGED ME Apps should have goals, directed for outcomes. They should change a behavior or health outcome the user desires changed, and by be implemented into the health care plan.

Any health app should be designed with a goal in mind.

Often this goal is some health outcome. Alain Labrique, director of the Johns Hopkins Global Health Initiative, and many before him in the field of interactivity research, suggests that apps are more effective when they engage the users in a responsive way. Some send reminders to keep patients, particularly with those whose medical conditions need monitoring, on their medical or prescription regimens. This goes beyond simply social connectedness as discussed above.

Labrique believes apps that are designed well to engage and offer reminders can tip bad behaviors in favor of good choices, and that sharing information with one’s health care provider, or with others who experience the same health issues, is a more effective approach to keep a patient’s health on track. The simple reminders and tracking of choices can help people to be aware and to take control in a more active way. Labrique believes these apps increase a person’s tendency to think about their health, and that this is an advantage over the fairly infrequent reminders that health care providers offer during doctor visits.7 Christopher Wasden also suggests that apps be designed with a target in mind for changed behavior: to be focused on some particular outcome. Wasden’s fifth key to success for a mobile app is that it be socially integrated. Good behaviors require friends for support. And finally, Wasden suggests that a good app is fun and engaging: visually dynamic and interesting to use.

Some apps specifically might be working on these types of changes. Few have been tested for outcomes. One example of a tested mobile health effort involved a study of 204 participants aiming to improve their diet. Participants used mobile devices with remote coaches. As a result of these mobile health interventions, participants were doing better at the end of the study: eating more vegetables and fruits, engaging in less sedentary leisure activities, and decreasing their fat intake.8 This understanding of effectiveness will be the next place to be moving, in the exploration of mobile devices and the implementation of health apps into our everyday lives. One app making great strides in this endeavor include, RunKeeper, which offers rigorous personal training, heart graphs, location tracking to monitor exercise patterns, and goal-setting strategies. Keas, Retrofit, Beeminder, and Lift are other apps which focus on goalsetting. These are all robust apps and time will tell which strategies work best. continued on page 38 MEDMONTHLY.COM |37

continued from page 37

It is a continued marvel for those of us who grew up in a world where even clunky computers were a novelty, that we can hold so much power in the palm of our hands. But our expectations for these devices soar beyond our imaginations. We want these tools to be fun, interesting, engaging, incorporated fully into our health care plan, socially connected to other people and to our physician, and most of all, effective in the intended function for each app. Maybe, we would even like an app to change our lives!  Mobile Apps: 10,000 Ways to Improve Your Health … and Counting Nick Martin, Vice President of Innovation, Research and Development at UnitedHealth Group http://www.fahp.net/assets/ newsletterandwidgetarticles/May/2012%2004%20mobile%20health%20 apps%20_matthew%20yi_.pdf 2 Using iPads in Patient Education: Realities and Lessons from the Front Lines of Healthcare. Posted on August 20, 2012. Susan Collins, MS, CHES, RD, SurroundHealth. http://blog.surroundhealth.net/2012/08/20/using-ipads-in-patienteducation/ 3 New apps a shot in the arm for doctor-patient communication. August 27, 2012. Nicole Brochu, Staff writer. http://articles.sun-sentinel.com/2012-08-27/health/fl-doctor-smartphoneapps-20120823_1_health-apps-new-apps-smartphone 4 Enhance Patient Compliance. Targeting Different Learning Styles. Volume 16 - Issue 8 - August 2003. http://www.podiatrytoday.com/article/1852 5 Learning Styles: Understanding Your Learning Preference http://www.mindtools.com/mnemlsty.html 6 Microlab Devices. “What makes an effective health App – Webinar Review” http://www.microlabdevices.com/what-makes-an-effectivehealth-app-webinar-review/ 7 Hopkins Researchers Aim to Uncover which Mobile Health Applications Work. By Meredith Cohn, The Baltimore Sun. March 14, 2012 http://www.baltimoresun.com/health/bs-hs-mobile-healthapps-20120314,0,2590424.story?page=1 8 Multiple Behavior Changes in Diet and Activity: A Randomized Controlled Trial Using Mobile Technology. Original Investigation | May 28, 2012. Bonnie Spring, PhD; Kristin Schneider, PhD; H. Gene McFadden, BS; Jocelyn Vaughn, MA; Andrea T. Kozak, PhD; Malaina Smith, BA; Arlen C. Moller, PhD; Leonard H. Epstein, PhD; Andrew DeMott, BA; Donald Hedeker, PhD; Juned Siddique, DrPH; Donald M. Lloyd-Jones, MD. Arch Intern Med. 2012;172(10):789-796. doi:10.1001/archinternmed.2012.1044. c Original Investigation | May 28, 2012 1

Medimagery Medical Illustration & Design info@medimagery.com http://www.medimagery.com/ http://www.linkedin.com/in/lauramaaske http://twitter.com/#!/Medimagery http://www.facebook.com/Medimagery http://www.facebook.com/laura.maaske http://medillsb.com/ArtistPortfolioThumbs.aspx?AID=4115 38 |FEBRUARY 2013

legal

Bayer Settles 3,490 Yaz and Yasmin Lawsuits With More Than 8,000 Remaining

B

ayer has spent about $750 million to settle 3,490 lawsuits, half of the cases lodged

by Yasmin™ and YAZ™ oral contraceptives plaintiffs suffering from deep vein thrombosis or pulmonary embolism, according to the company’s third quarter stockholder report. But settling the Yasmin™ and YAZ™ lawsuits is far from over. An estimated 3,800 more suits alleging deep vein thrombosis or pulmonary embolisms remain to be settled, which may bring the total cost of the litigation up to $1.5 billion. And Bayer has yet to address almost 5,000 more suits claiming Yasmin™ and YAZ™ caused other injuries including gall bladder problems and sudden death. More than 12,000 suits have been lodged against Bayer, with more being lodged daily, surpassing asbestos as the largest pending litigation in the United States.

Even when the settlement amounts have been established, payout can take months if not years.

The German chemical and pharmaceutical company Bayer— famous for its 1897 invention of aspirin—brought the oral

contraceptives YAZ™ to the market in 2001 and Yasmin™ in 2006. YAZ™, Yasmin™, the generic formulation called Ocella, and a newly approved hormonal product for menopause called Angeliq, contain drospirenone, a synthetic form of progestin.

Drospirenone increases levels of potassium in the blood, a condition called hyperkalemia, which if unchecked, leads to heart rhythm disturbances. This slowing down of the flow of blood through the heart can cause blood clots to form, leading to heart attacks, pulmonary embolus (if the clot breaks off and travels to the lungs) or stroke (if the clot travels to the brain).

Thanks in part to multi-million dollar ad campaigns promoting the drugs to women under 35 as the birth control pill that also combated premenstrual depression and acne, YAZ™ became the top-selling birth control pill in the U.S., generating $1.58 billion in sales in 2010. YAZ™ and Yasmin™ were also marketed to reduce water retention and bloating often associated with premenstrual disorders.

Plaintiffs claim that Bayer knew, or should have known, of the risks associated with Yasmin™ and YAZ™, and should be held liable for having failed to disclose them or adequately warn users. Deaths reported related to YAZ™ and Yasmin™ included women of child-bearing age as well as some as young as 17. The cases seeking compensatory and punitive damages pending in U.S. federal courts have been consolidated in a multidistrict litigation (MDL) proceeding for common pre-trial management.

Attorneys representing plaintiffs in the Yaz and Yasmin cases, as well as plaintiffs themselves, should contact RD Legal at 1-800-565-5177 for more information about immediate postsettlement funding. Founded in 1997, RD Legal has established itself as one of the nation’s leading providers of lawsuit settlement funding to attorneys and plaintiffs. For more information about RD Legal, please visit http:// www.legalfunding.com.  Source: http://www.prnewswire.com/ news-releases/bayer-settles-3490-yazand-yasmin-lawsuits-with-more-than8000-remaining-179347771.html MEDMONTHLY.COM |39

legal

Hobby Lobby:

Go Ahead and Fine Us, We Won’t Comply With ‘Morning-After’ Mandate

By Becket Adams, Business Editor The Blaze An attorney for Hobby Lobby Stores said that the arts and crafts chain plans to defy a federal mandate requiring it to offer employees health coverage that includes access to the morning-after pill, despite risking potential fines of up to $1.3 million per day.

Hobby Lobby and religious book-seller Mardel Inc., which are owned by the same conservative Christian family, are suing to block part of the federal health care law that requires employee health-care plans to provide insurance coverage for the morning-after pill and similar emergency contraception pills.

The companies claim the mandate violates the religious beliefs of their owners. They say the morning-after pill is tantamount to abortion because it can prevent a fertilized egg from becoming implanted in a woman’s womb.

On Wednesday, Supreme Court Justice Sonia Sotomayor denied the companies’ request for an injunction while their lawsuit is pending, saying the stores failed to satisfy the demanding legal standard for blocking the requirement on an emergency basis. She said the companies may still 40| FEBRUARY 2013

challenge the regulations in the lower courts.

Kyle Duncan, who is representing Hobby Lobby on behalf of the Becket Fund for Religious Liberty, said in a statement posted on the group’s website that Hobby Lobby doesn’t intend to offer its employees insurance that would cover the drug while its lawsuit is pending.

“The company will continue to provide health insurance to all qualified employees,” Duncan said. “To remain true to their faith, it is not their intention, as a company, to pay for abortion-inducing drugs.”

In ruling against the companies last month, U.S. District Judge Joe Heaton said churches and other religious organizations have been granted constitutional protection from the birth-control provisions but that “Hobby Lobby and Mardel are not religious organizations.”  Source: http://www.theblaze.com/stories/2012/12/28/hobbylobby-go-ahead-and-fine-us-we-wont-comply-with-morningafter-mandate/

legal

SETON HALL LAW CENTER FOR HEALTH AND PHARMACEUTICAL LAW AND POLICY INTRODUCES

THE FIRST EDITION OF THE

PHARMACEUTICAL AND MEDICAL DEVICE COMPLIANCE MANUAL

42 |FEBRUARY 2013

The fight against fraud and abuse in health care programs, and the pharmaceutical and medical devices industry in particular, continues to grow. Since 1996 the federal government has strengthened its efforts to detect and prevent fraud and abuse in health care, and has recovered $18 billion since 1997.

These enforcement activities make a compliance program essential to protecting a company from running afoul of the myriad laws and regulations that have been enacted to combat fraud and waste.

The Seton Hall Law Center for Health & Pharmaceutical Law & Policy, American Health Lawyers Association (AHLA) and the Food and Drug Law Institute (FDLI) have released the first edition of the Pharmaceutical and Medical Device Compliance Manual. The Manual is a guide to deciphering the intricate web of federal and state laws and the practices of regulatory and enforcement authorities within the health care and life sciences arena, while also providing the practical skills needed to implement an effective compliance program.

Pharmaceutical and Medical Device Compliance Manual includes: In-depth coverage of the federal and state enforcement agencies l Federal Anti-Kickback Statute and False Claims Act details l Distinction between manufacturers’ lawful dissemination of scientific information and unlawful promotion of off-label use l Discussion of the Foreign Corrupt Practices Act and its extra-territorial reach l Coverage and reimbursement of prescription drugs and medical devices l Prescription drug price regulations l

Designed to aid health law attorneys, compliance professionals and others in the pharmaceutical and medical device field, the Manual

‘‘

Since 1996 the federal government has strengthened its efforts to detect and prevent fraud and abuse in health care, and has recovered $18 billion since 1997. These enforcement activities make a compliance program essential to protecting a company from running afoul of the myriad laws and regulations that have been enacted to combat fraud and waste.

explains the law in layman’s terms in addition to providing advice and guidelines on creating, managing, monitoring and auditing an effective compliance program, in essence, marrying legal expectations with the operational demands of business units.

The book was co-edited by Seton Hall Law Associate Dean Kathleen M. Boozang, J.D., LL.M., who founded the school’s Health Law program in 1990, ranked among the top 10 by U.S. News & World Report for the past 16 years; and by Simone Handler-Hutchinson, J.D. ‘93, Executive Director of the Center for Health & Pharmaceutical Law & Policy.

Dean Boozang notes: “Over the last two decades the trend in government oversight has resulted in a regulatory environment of increased accountability among organizations across a number of sectors, with the health and life sciences industries being the subject of particular attention – a trend that shows no sign of waning. We produced this manual for compliance officers, health and life sciences lawyers and their clients to enable them to build a framework for creating and sustaining an effective

compliance function.”

As co-editor, Ms. HandlerHutchinson said, “Each chapter was written by a leading regulatory official, practicing attorney, or health care consultant who has either shaped the policies as an official and/or counsel in the nation’s regulatory agencies, served as counsel to or built compliance functions within life science corporations. They offer first hand, in-depth compliance insight and actionable advice.”

The Pharmaceutical and Medical Device Compliance Manual is available as a softbound book and a variety of eBook formats; it may be ordered by visiting http://law.shu.edu/ compliancemanual.  The Seton Hall Law Center for Health & Pharmaceutical Law & Policy advances scholarship and recommendations for policy on the varied and complex issues that emerge within pharmaceutical and health law. Additionally, the Center is a leader in providing compliance training on the wide-ranging state, national and international mandates that apply to the safety, promotion and sale of drugs and devices. Seton Hall University School of Law, New Jersey’s only private law school and a leading law school in the New York metropolitan area, is dedicated to preparing students for the practice of law through excellence in scholarship and teaching with a strong focus on experiential learning. Founded in 1951, Seton Hall Law School is located in Newark and offers both day and evening degree programs. For more information visit law.shu.edu.

The American Health Lawyers Association (AHLA) is the nation’s largest nonpartisan educational organization devoted to legal issues in the health care field. The Association’s 11,000 members practice in a variety of settings in the health care community.

For information about our resources, publications, and educational offerings, visit www.healthlawyers.org.

Source: http://law.shu.edu/About/ News_Events/releases.cfm?id=320683 MEDMONTHLY.COM |43

features

Lives Could Be Saved

By Drugs That Limit Excess Mucus

By Julia Evangelou Strait Senior Medical Sciences Writer Washington University School of Medicine in St. Louis

44 | FEBRUARY 2013

R

espiratory conditions that restrict breathing such as asthma and chronic obstructive pulmonary disease (COPD) are common killers worldwide. But no effective treatments exist to address the major cause of death in these conditions - excess mucus production.

“There is good evidence that what kills people with severe COPD or asthma is mucus obstructing the airway,” says Michael J. Holtzman, MD, the Selma and Herman Seldin Professor of Medicine at Washington University School of Medicine in St. Louis. “It’s a huge unmet medical problem and is only increasing in this country and throughout the world.”

Now, Holtzman and his colleagues have described the molecular pathway responsible for excess mucus in airway cells and have used that information to design a series of new drugs that inhibit that pathway.

Their study appears online in the Journal of Clinical Investigation.

Chronic respiratory disease, especially COPD, is the third leading cause of death in the United States and worldwide. Smoking and exposure to pollution are major causes of these diseases. Related conditions that affect the respiratory airways, like asthma and bronchitis, are also among the most common causes of human disease in adults and children.

The morbidity and mortality from these conditions is closely linked to excess mucus production that blocks the airways and prevents normal breathing. However, there are no effective treatments to address the overproduction of airway mucus.

As part of the new research, the scientists discovered that a critical

‘‘

“The big killer is COPD, but other extra-mucus conditions can also be life threatening.”

signaling molecule, CLCA1, has a special role in the mucus pathway.

They showed that CLCA1 allows a protein known as IL-13 to turn on the major mucus gene in airway cells. The researchers also showed that CLCA1 needs help from an enzyme called MAPK13.

Although there were no existing drugs that acted against MAPK13, Holtzman says there were several that inhibit a similar enzyme known as MAPK14, which differs slightly in structure.

“We could take advantage of the MAPK14 inhibitors that were already known,” Holtzman says. “These drugs bind to a specific pocket in MAPK14 to block its activity. For MAPK13, that pocket itself has some obstructions making it more crowded and harder to access, so these older drugs can’t fit into the pocket to block activity.”

So Holtzman and his team built drugs with slimmer structures that could avoid the obstacles and better fit into the protein pocket of MAPK13.

“We sculpted the drugs so they’re better able to bind in the MAPK13 pocket,” Holtzman says. “And we showed that the new shape translates into more potent and effective blockade of MAPK13 activity. It’s drug discovery that takes advantage of biology and chemistry, and it takes a very special team to do that.”

Indeed, the results show that some of their newly designed MAPK13 inhibitors reduced mucus production in cultures of human airway cells by 100 fold.

Importantly, Holtzman says that this work had to be done in human cells because commonly used lab animals have different wiring for the mucus production circuit. For example, MAPK13 inhibitors were not effective in mice because other types of CLCA and MAPK proteins could continue to make excess mucus.

“We recognized that we had to work directly in human cells to figure out the control system,” Holtzman says.

“We then looked at lungs from patients

Michael Holtzman, MD, and his colleagues designed drugs (yellow) that bind with the MAPK13 enzyme (grey) to limit excess mucus production in airway cells.

According to Holtzman, the drugs could help patients with lifethreatening respiratory conditions including COPD and asthma. Work was done at Washington University School of Medicine in St. Louis.

with very severe COPD who were at the last resort of lung transplantation.

In these diseased lungs, we found too much mucus, too much CLCA1 and over-activated MAPK13. What we observed in isolated human cells translated to a devastating disease in real life.”

Beyond COPD and asthma, Holtzman also sees a possible role for MAPK13 inhibitors in related conditions with excess mucus production, like cystic fibrosis and even the common cold.

“The big killer is COPD,” Holtzman says. “But other extra-mucus conditions can also be life threatening.

And we know from our studies that respiratory viral infections and allergies are potent activators of this same pathway for mucus production.

Since the new inhibitors would be active in both the upper and lower airways, they could impact a wide set of respiratory illnesses.”  Source: https://news.wustl.edu/news/ Pages/24608.aspx MEDMONTHLY.COM |45

features

ENT TIPS FOR COLD AND FLU SEASON

Maybe it’s not a cold:

Knowing the difference between sinusitis and cold symptoms

The common cold

More than 200 different types of viruses can cause a cold. The three most frequent symptoms of a cold are nasal stuffiness, sneezing, and runny nose. Throat irritation is also often involved. Adults and older children with colds generally have minimal or no fever. Infants and toddlers often run a fever in the 100 to 102 degree range.

Depending on which virus is the culprit, the virus might also produce a headache, cough, postnasal drip, burning eyes, muscle aches, or a decreased appetite, but in a cold, the most prominent symptoms are in the nose.

Once you have “caught” a cold, the symptoms begin in one to five days. Usually irritation in the nose or a scratchy feeling in the throat is the first sign, followed within hours by sneezing and a watery nasal discharge.

SIGN/SYMPTOM Nasal Discharge Nasal Congestion Facial Pressure/ Pain/Fullness Duration of Illness Double-worsening* Fever Pain in Upper Teeth Bad Breath Coughing Sneezing

The entire cold is usually over all by itself in about seven days, with perhaps a few lingering symptoms (cough) for another week. If it lasts longer, consider another problem, such as a sinus infection or allergies.

Sinusitis

Acute bacterial sinusitis is an infection of the sinus cavities caused by bacteria.

It usually is preceded by a cold, allergy attack, or irritation by environmental pollutants. Unlike a cold or allergy, bacterial sinusitis requires a physician’s diagnosis and may require treatment with an antibiotic to cure the infection and prevent future complications.

Normally, mucus collecting in the sinuses drains into the nasal passages.

When you have a cold or allergy attack, your sinuses become inflamed and are unable to drain. This can lead to congestion and infection. Diagnosis of acute sinusitis usually is based on a

SINUSITIS

Allergies

Allergy symptoms appear when the immune system reacts to an allergic substance that has entered the body as though it was an unwelcome invader.

Many common substances can be

ALLERGY

continued on page 48

COLD

Cloudy or colored Often Often

Clear, thin, watery Sometimes Sometimes

Thick, whitish or thin Yes Sometimes

10 days or longer Sometimes Sometimes Sometimes Sometimes Sometimes No

Varies No No No No Sometimes Sometimes

Under 10 days No Sometimes No No Yes Yes

*Initial improvement followed by worsening within the first 10 days 46|FEBRUARY 2013

physical examination and a discussion of your symptoms.

When you have frequent sinusitis, or the infection lasts three months or more, it could be chronic sinusitis.

Symptoms of chronic sinusitis may be less severe than those of acute, however, untreated chronic sinusitis can cause damage to the sinuses and cheekbones that sometimes requires surgery to repair.

Ask your otolaryngologist if you believe you have a sinus infection (see sidebar at right). For more information on ear, nose, and throat winter health, visit www.entnet.org.

IS IT A SINUS INFECTION?

1. Facial pressure/pain/fullness? o yes o no 2. Nasal congestion or stuffiness? o yes o no 3. Cloudy or colored nasal discharge? o yes o no 4. Postnasal drip? o yes o no 5. Illness lasting 10 days or longer? o yes o no 6. Improvement followed by worsening? o yes o no If you answered “Yes” to three or more of the symptoms listed above, you may have an acute bacterial sinus infection.

An examination by an ear, nose, and throat specialist may be warranted.

By the American Academy of Otolaryngology – Head and Neck Surgery

MEDMONTHLY.COM |47

continued from page 46

allergens—pollens, food, mold, dust, feathers, animal dander, and chemicals When an allergen reenters the body, the immune system rapidly recognizes it, causing a series of reactions. It also causes the production of many inflammatory substances including histamine. Histamine produces common allergy symptoms such as itchy, watery eyes, nasal and sinus congestion, headaches, sneezing, scratchy throat, hives, or shortness of breath. Other less common symptoms are balance disturbances, skin irritations such as eczema, and even respiratory problems like asthma. For some allergy sufferers, symptoms may be seasonal, but for others it is a yearround discomfort.

Over-the-counter medications and sinus pain: Know the facts!

Drugs for stuffy nose, sinus trouble, congestion and drainage, and the common cold constitute a large segment of the over-the-counter market for America’s pharmaceutical industry. Even though they do not cure allergies, sinusitis, colds, or the flu, they provide welcome relief for at least some of the discomforts of seasonal

allergies and upper respiratory infections. However, it’s essential for consumers to read the ingredient labels, evaluate their symptoms, and choose the most appropriate remedy.

Antihistamines - help dry up a runny nose and relieve sneezing. Avoid them during the congested phase of your cold because they can make mucus thicker and more difficult to drain. They are most helpful when symptoms are caused by an allergy.

Some older brands may cause you to be sleepy.

Decongestants - can help relieve sinus pressure and a stuffy nose, making it easier for you to breathe.

These will also dehydrate you! Take lots of fluids. Avoid at bedtime, since they are stimulants.

Pain Relievers - help relieve the pain associated with a sore throat, and headache, and can reduce a fever. These include acetaminophen (Tylenol), aspirin, ibuprofen (Advil, Motrin) and Naproxen (Aleve).

Always make sure to consult with your doctor about your prescription medications before you start taking an O-T-C product, as some can cause drug interactions.  *note – Information is for adults only.

MAINTAINING SINUS HEALTH Maintaining sinus health during the cold and flu season can help prevent a case of sinusitis. The American Academy of Otolaryngology—Head and Neck Surgery suggests the following ways to keep your sinuses clear: • Drink plenty of fluids to keep nasal discharge thin and keep your body hydrated.

• You may get some relief from your symptoms with a humidifier, particularly if air in your home is heated by a forced-air system.

• If you are going to fly during the holiday seasons, use a nasal spray decongestant before take-off to prevent blockage of the sinuses, allowing mucus to drain.

• Avoid smoking and drinking alcohol, as both can irritate your nasal passages.

• If you have allergies, try to avoid contact with things that trigger attacks. If you cannot, use over-the-counter or prescription antihistamines and/or a prescription nasal spray to control allergy attacks.

48 | FEBRUARY 2013

Symptoms of sinusitis: • symptoms of upper respiratory infection lasting 10 days or more • improvement followed by worsening within 10 days • facial pain, pressure, or fullness • nasal discharge that is cloudy or colored • nasal congestion or stuffiness • post-nasal drip • cough

At-home treatments for sinusitis: • nasal sprays that moisturize the nasal cavity, reduce dryness, and help clear thick or crusty mucus • humidification (moisturizing the air) of living spaces in dry climates will aid the movement of mucus through the sinuses

An otolaryngologist can: • determine if you have an infection requiring an appropriate antibiotic • discover if you require intensive medical treatment for a condition such as nasal obstructions, necessitating sinus surgery • Make treatment recom mendations and discuss long-term outcomes Source: http://www.entnet.org/ AboutUs/upload/Cold-Flu-SeasonNewsletter.pdf

features

Medical Devices

POWERED

by the Ear Itself

By Larry Hardesty, MIT News

For the first time, researchers power an implantable electronic device using an electrical potential - a natural battery deep in the inner ear.

50 | FEBRUARY 2013

D

eep in the inner ear of mammals is a natural battery — a chamber filled with ions that produces an electrical potential to drive neural signals. In today’s issue of the journal Nature Biotechnology, a team of researchers from MIT, the Massachusetts Eye and Ear Infirmary (MEEI) and the HarvardMIT Division of Health Sciences and Technology (HST) demonstrate for the first time that this battery could power implantable electronic devices without impairing hearing.

The devices could monitor biological activity in the ears of people with hearing or balance impairments, or responses to therapies. Eventually, they might even deliver therapies themselves.

In experiments, Konstantina Stankovic, an otologic surgeon at MEEI, and HST graduate student Andrew Lysaght implanted electrodes in the biological batteries in guinea pigs’ ears. Attached to the electrodes were low-power electronic devices developed by MIT’s Microsystems Technology Laboratories (MTL). After the implantation, the guinea pigs responded normally to hearing tests, and the devices were able to wirelessly transmit data about the chemical conditions of the ear to an external receiver.

“In the past, people have thought that the space where the high potential is located is inaccessible for implantable devices, because potentially it’s very dangerous if you encroach on it,” Stankovic says.

“We have known for 60 years that this battery exists and that it’s really important for normal hearing, but nobody has attempted to use this battery to power useful electronics.”

The ear converts a mechanical force — the vibration of the eardrum — into an electrochemical signal that can be processed by the brain; the biological battery is the source of that signal’s current. Located in the part of the ear called the cochlea, the battery chamber

is divided by a membrane, some of whose cells are specialized to pump ions. An imbalance of potassium and sodium ions on opposite sides of the membrane, together with the particular arrangement of the pumps, creates an electrical voltage.

Although the voltage is the highest in the body (outside of individual cells, at least), it’s still very low. Moreover, in order not to disrupt hearing, a device powered by the biological battery can harvest only a small fraction of its power. Low-power chips, however, are precisely the area of expertise of Anantha Chandrakasan’s group at MTL. The MTL researchers — Chandrakasan, who heads MIT’s Department of Electrical Engineering and Computer Science; his former graduate student Patrick Mercier, who’s now an assistant professor at the University of California at San Diego; and Saurav Bandyopadhyay, a graduate student in Chandrakasan’s group — equipped their chip with an ultralowpower radio transmitter: After all, an implantable medical monitor wouldn’t be much use if there were no way to retrieve its measurements.

But while the radio is much more efficient than those found in cellphones, it still couldn’t run directly on the biological battery. So the MTL chip also includes powerconversion circuitry — like that in the boxy converters at the ends of many electronic devices’ power cables — that gradually builds up charge in a capacitor. The voltage of the biological battery fluctuates, but it would take the control circuit somewhere between 40 seconds and four minutes to amass enough charge to power the radio. The frequency of the signal was thus itself an indication of the electrochemical properties of the inner ear.

To reduce its power consumption, the control circuit had to be drastically simplified, but like the radio, it still required a higher voltage than the biological battery could provide. Once

the control circuit was up and running, it could drive itself; the problem was getting it up and running.

The MTL researchers solve that problem with a one-time burst of radio waves. “In the very beginning, we need to kick-start it,” Chandrakasan says.

“Once we do that, we can be selfsustaining. The control runs off the output.”

Stankovic, who still maintains an affiliation with HST, and Lysaght implanted electrodes attached to the MTL chip on both sides of the membrane in the biological battery of each guinea pig’s ear. In the experiments, the chip itself remained outside the guinea pig’s body, but it’s small enough to nestle in the cavity of the middle ear.

Cliff Megerian, chairman of the otolaryngology department at Case Western Reserve University, says that he sees three possible applications of the researchers’ work: in cochlear implants, diagnostics and implantable hearing aids. “The fact that you can generate the power for a low voltage from the cochlea itself raises the possibility of using that as a power source to drive a cochlear implant,” Megerian says. “Imagine if we were able to measure that voltage in various disease states. There would potentially be a diagnostic algorithm for aberrations in that electrical output.”

“I’m not ready to say that the present iteration of this technology is ready,” Megerian cautions. But he adds that, “If we could tap into the natural power source of the cochlea, it could potentially be a driver behind the amplification technology of the future.”  The work was funded in part by the Focus Center Research Program, the National Institute on Deafness and Other Communication Disorders, and the Bertarelli Foundation.

Reprinted with permission of MIT News MEDMONTHLY.COM |51

the arts

By Thomas Hibbard Creative Director

G

Quintessential Renaissance Man

ary Bodner is interested in everything from architecture to art and for the past thirty years, he has practiced medicine in Atlanta, specializing in Obstetrics and Gynecology. Reaching the pinnacle of achievement in all of his fields of interest is an ongoing, lifetime project. He is the quintessential renaissance man.

Bodner was a sophomore studying architecture at Miami University of Ohio when his father suggested that a career in medicine would allow more financial security.

He heeded his father’s advice and attended Chicago Medical School, but earned his medical degree from Emory University School of Medicine.

For the last 30 years, Bodner has been the first face seen by hundreds of newborn babies. He also has earned the respect and trust of the women for whom he cares.

Throughout his life, Bodner was attracted to art. He tried his hand at making pottery, as well as painting with watercolors and drawing with pen and ink, without much success.

But several years ago, he studied artistic techniques under Phil Carpenter in classes at the Atlanta College of

52|FEBRUARY 2013

Art and Chastain Arts Center. “Phil is a great teacher, and oil painting just works for me,” Bodner says. “It is very forgiving, and the more you fix your mistakes, the richer your painting gets.”

Bodner participated in workshops with nationally acclaimed artist Robert Johnson at the Sara Britt Arts Center in Tuscaloosa, Ala., and studied under Sandy Grow in Atlanta. But he credits his wife, Melanie, and Anne Irwin, owner of Atlanta gallery Anne Irwin Fine Arts (which represents Bodner’s artwork), with positively affecting his artwork.

“My wife has a great eye and can ‘fix’ a painting pretty quickly,” he says. “Anne Irwin has directed me to be a more expressionistic painter, almost an abstract painter. She has encouraged me to try different styles and take risks in the creative process.”

Anne Irwin recalls the first time she spoke with Gary, “He called me, indentified himself and asked if I would represent his work. He said he chose me because my name sounded familiar. “It should,” I replied, “You delivered my son.”

Due to his enormous energy and passion for his art, Bodner finds time to paint early in the morning, and late in the evening and on weekends. He describes his work as strong and colorful with an expressionistic style.

“The power of juxtaposing or placing one color on top of another to create an image is what drives my paintings,” he says. “It is a great way to relieve stress. I can paint for three hours straight, and it feels like only 30 minutes have passed. Painting for me is hard work, but the last hour of a painting when I feel it all comes together is so gratifying.”

Primarily Bodner considers himself a colorist and is constantly looking for the interplay of colors on his canvases. He says he has been inspired by works of Cézanne, Van Gogh and Philip Johnson, architect. He also admires artist Henri Matisse because of his color palette and his interior landscapes. And it seems to be all about color for Bodner as well.

“I love painting and color, and one simple stroke of yellow next to a purple vase can change the entire painting because they are complimentary colors,” he says.

Having practiced medicine for 30 years and art for over ten years, a common assumption might be that Bodner would retire from medicine soon and take up painting full-time. But he says he has found the perfect mix with art and medicine.

“I feel I have the best of two worlds, and I feel that medicine and my art, like my colors, complement each other,” he says.

Several of Dr. Bodner’s paintings are featured at the Anne Irwin Fine Art gallery in their “Best in Show 2013” exhibit running through February 6th. 

To see more of Gary’s work, please visit Anne Irwin Fine Art’s Web site at www.anneirwinfineart.com MEDMONTHLY.COM |53

healthy living

Dark Chocolate Breakfast Muffins Ashley Acornley, MS, RD, LDN Nutritional Facts: Calories: 180 Fat: 6g Carbs: 28g Fiber: 3g Protein: 7g Cholesterol: 10mg Sodium: 280mg

In honor of Valentine’s Day, why not bake some delicious chocolate muffins for your sweetie this year? Chocolate typically has a bad reputation for contributing to an unhealthy diet and weight gain.

However, recent research has shown that dark chocolate (70% cocoa or greater) has heart healthy benefits….in moderation, of course! So, don’t be afraid to experiment with more chocolate in your diet. You can mix a little unsweetened cocoa powder into dry rubs, dressings, and sauces. Or, incorporate bits of bittersweet dark chocolate into a healthy trail mix snack. These dark chocolate muffins are great, because they are baked with whole wheat flour, yogurt, applesauce, and egg whites- a perfect breakfast or dessert option!

Makes: 12 muffins Serving Size: 1 muffin Prep Time: 15 minutes Cook Time: 20 minutes

Ingredients: Preparation:

1. Preheat oven to 325 F. Coat muffin pan with nonstick spray.

2. Combine flour, protein, salt, baking powder, baking soda, and cocoa powder in a mixing bowl.

3. In separate bowl, combine maple syrup, applesauce, milk, vanilla, egg whites, and yogurt.

4. Add wet ingredients to dry ingredients and stir well to combine.

5. Stir in chocolate pieces and walnuts.

6. Fill the muffin cups ¾ full with batter, and bake for 20 minutes.

54 | FEBRUARY 2013

1 cup whole wheat flour ½ cup chocolate whey protein powder ½ tsp salt 1 tsp baking powder 1 tsp baking soda 6 Tbsp. unsweetened cocoa ½ cup maple syrup ½ cup unsweetened applesauce ¾ cup skim milk 1 tsp vanilla 3 large egg whites ¾ cup coffee yogurt ½ cup 72% dark chocolate, chopped ½ cup walnuts, chopped

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/ MedicalLicensing.aspx

MEDMONTHLY.COM |55

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

Dover, DE 19904 (302)744-4500 http://1.usa.gov/t0mbWZ Florida 4052 Bald Cypress Way Bin C-08 Tallahassee, FL 32399 (850)245-4474 http://bit.ly/w1m4MI 56 | FEBRUARY 2013

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Texas 333 Guadeloupe St. Suite 3-800 Austin, TX 78701 (512)463-6400 http://www.tsbde.state.tx.us/ Utah 160 E. 300 South Salt Lake City, UT 84111 (801)530-6628 http://1.usa.gov/xMVXWm Vermont National Life Building North FL2 Montpelier, VT 05620 (802)828-1505 http://bit.ly/zSHgpa Virginia Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4538 http://www.dhp.virginia.gov/dentistry Washington 310 Israel Rd. SE P.O. Box 47865 Olympia, WA 98504 (360)236-4700 http://www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/Dentist.aspx West Virginia 1319 Robert C. Byrd Dr. P.O. Box 1447 Crab Orchard, WV 25827 1-877-914-8266 http://www.wvdentalboard.org/ Wisconsin P.O. Box 8935 Madison, WI 53708 1(877)617-1565 http://dsps.wi.gov/Default. aspx?Page=90c5523f-bab0-4a45-ab943d9f699d4eb5 Wyoming 1800 Carey Ave., 4th Floor Cheyenne, WY 82002 (307)777-6529 http://plboards.state.wy.us/dental/index.asp MEDMONTHLY.COM |57

U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (334)242-4116 http://www.albme.org/ Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 http://bit.ly/zZ455T Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 (480)551-2700 http://www.azmd.gov Arkansas 1401 West Capitol Ave., Suite 340 Little Rock, AR 72201 (501)296-1802 http://www.armedicalboard.org/ California 2005 Evergreen St., Suite 1200 Sacramento, CA 95815 (916)263-2382 http://www.mbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7690 http://www.dora.state.co.us/medical/ Connecticut 401 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/site/default.asp Delaware Division of Professional Regulation Cannon Building 861 Silver Lake Blvd., Suite 203 Dover, DE 19904 (302)744-4500 http://dpr.delaware.gov/ District of Columbia 899 North Capitol St., NE Washington, DC 20002 (202)442-5955 http://www.dchealth.dc.gov/doh 58| FEBRUARY 2013

Florida 2585 Merchants Row Blvd.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

MEDMONTHLY.COM |59

medical resource guide ACCOUNTING

Ajishra Technology Support

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

ADVERTISING

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

MedMedia9

www.medmedia9.com

Ring Ring LLC

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

ANSWERING SERVICES Corridor Medical Answering Service

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

Docs on Hold

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

BILLING & COLLECTION Advanced Physician Billing, LLC

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

60| FEBRUARY 2013

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

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

VIP Billing

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

Axiom Business Solutions

Find Urgent Care

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

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

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

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

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

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

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

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

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

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

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

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

COMPUTER, SOFTWARE American Medical Software

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

CDWG

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

Instant Medical History

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

medical resource guide CONSULTING SERVICES, PRACTICE MANAGEMENT

DENTAL Biomet 3i

Manage My Practice

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

Medical Credentialing

(800) 4-THRIVE www.medicalcredentialing.org

Medical Practice Listings

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

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

Dental Management Club

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

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

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

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

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

The Dental Box Company, Inc.

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

DIETICIAN

myEMRchoice.com

DocuTAP

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

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

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

ELECTRONIC MED. RECORDS

Synapse Medical Management

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

Urgent Care America

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

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

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

www.pushpa.biz

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

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

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

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

INSURANCE, MED. LIABILITY Aquesta Insurance Services, Inc.

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

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

Medical Protective

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

MEDMONTHLY.COM |61

medical resource guide INSURANCE, MED. LIABILITY

Nicholas Down Martin Fried

MGIS, Inc.

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

Professional Medical Insurance Services

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

Wood Insurance Group

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

LOCUM TENENS Physician Solutions

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

MEDICAL ARCHITECTS

Dicom Solutions http://bit.ly/yHwxb0

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

www.martindfried.com

www.dicomsolutions.com

Tarheel Physicians Supply

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

Ako Jacintho

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

Julie Jennings

(678)772-0889 juliejenn@silksynergy.com http://silksynergy.com/ http://www.coroflot.com/naddie09

MedImagery

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

www.thetps.com

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

MedMedia9

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

Laura Maask 262-308-1300 Laura@medimagery.com

www.medmedia9.com

medimagery.com

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

MEDICAL EQUIPMENT

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

MEDICAL PRACTICE SALES

MMA Medical Architects

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

ALLPRO Imaging

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

Biosite, Inc

MEDICAL ART Brian Allen

www.artisanprinter.com

Deborah Brenner

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

Pia De Girolamo

62| FEBRUARY 2013

www.piadegirolamo.com

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

www.biosite.com

Cryopen

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

Medical Practice Listings

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

MEDICAL PRACTICE VALUATIONS BizScore

www.cryopen.com

Carolina Liquid Chemistries, Inc.

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

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

medical resource guide

MEDICAL PUBLISHING

PRACTICE FINANCING Bank of America

Greenbranch Publishing

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

MEDICAL RESEARCH

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

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

Dermabond

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

DJO

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

REAL ESTATE

www.djoglobal.com

Arup Laboratories

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

www.aruplab.com

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

www.crlcorp.com

Sanofi US

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

Scynexis, Inc.

ExpertMed

York Properties, Inc.

www.sanofi.us

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

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

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

www.expertmed.com

Gebauer Company

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

Scarguard

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

WEBSITE DESIGN

SUPPLIES, GENERAL

3501 C Tricenter Blvd.

Durham, NC 27713 (919) 933-4990

MedMedia9 www.scynexis.com

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

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

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 MEDMONTHLY.COM |63

64| FEBRUARY 2013

classified listings

Classified To place a classified ad, call 919.747.9031

Physicians needed

Physicians needed

North Carolina

North Carolina (cont.)

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

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

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

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

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

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

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

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

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

continued on page 66

MEDMONTHLY.COM |65

classified listings

Classified

continued from page 65

To place a classified ad, call 919.747.9031

Physicians needed

Physicians needed

North Carolina (cont.)

South Carolina

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.

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.

Peds Clinic near Raleigh seeks Mid-Level Provider for on-going coverage 4x/wk Health Department pediatrics clinic 45 min from Raleigh needs coverage 4 days a week from January through June. Provider will see about 20 patients daily, hours are 8am-5pm with an hour for lunch.

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

FT Mid-Level Provider needed for Wilmington practice immediately Small private practice 45 minutes outside Wilmington seeks mid-level provider starting January. M-F 8:00-5:00, PT or FT. This practice also is looking for a PA permanently in April.

Accommodations, PLI, and mileage provided. Please contact Physician Solutions at 919-845-0054 or emailphysiciansolutions@gmail.com.

66| FEBRUARY 2013

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

Virginia Pediatric Locums Physician needed in Harrisonburg, Danville and Lynchburg, VA. These locum positions require 30 to 40 hours per week, on-going. If you are seeking a beautiful climate and flexibility with your schedule, please consider one of these opportunities. Send copies of your CV, VA. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Urgent Care opportunities throughout Virginia. We have contracts with numerous facilities and eight to 14-hour shifts are available. If you have experience treating patients from pediatrics to geriatrics, we welcome your inquires. Send copies of your CV, VA medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, E-mail: physiciansolutions@gmail.com

Classified To place a classified ad, call 919.747.9031

Practice wanted

Practice for sale

North Carolina

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.

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

Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or email: medlistings@gmail.com continued on page 69

Woman’s Practice in Raleigh, North Carolina.

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

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

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

medmonthly.com | 919.747.9031 MEDMONTHLY.COM |67

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

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

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

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

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

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

NC OPPORTUNITIES LOCUMS OR PERMANENT

PEDIATRICIAN

or family medicine doctor needed in

FAYETTEVILLE, NC

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

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

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

Comfortable seeing children. Needed immediately.

Call 919- 845-0054 or email: physiciansolutions@gmail.com www.physiciansolutions.com 68| FEBRUARY 2012

classified listings

Classified

continued from page 67

To place a classified ad, call 919.747.9031

Practice for sale

Practice for sale

North Carolina

North Carolina (con't)

Impressive Internal Medicine Practice in Durham, NC: The City of Medicine. Over 20 years serving the community, this practice is now listed for sale. There are four wellequipped exam rooms, new computer equipment and a solid patient following. The owner is retiring and willing to continue with the new owner for a few months to assist with a smooth transition. Contact Medical Practice Listings at (919) 848-4202 for more information. View additional listings at: www.medicalpracticelistings.com

Modern Vein Care Practice located in the mountains of NC. Booking seven to 10 procedures per day, you will find this impressive vein practice attractive in many ways.

Housed in the same practice building with an internal medicine, you will enjoy the referrals from this as well as other primary care and specialties in the community. We have this practice listed for $295,000 which includes charts, equipment and good will. Contact Medical Practice Listings at (919) 848-4202 for more information. View additional listings at www.medicalpracticelistings.com

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

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

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. 

CALLING ALL WRITERS

Editorial Calendar: March 2013 - Clinical Trials April 2013 - Prescriptions

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

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

Med Monthly

Contact us:

919.747.9031 medmedia9@gmail.com medmonthly.com

MEDMONTHLY.COM |69

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

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

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

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

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

List price: $435,000

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

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

Medvertising

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

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

Med Monthly 919.747.9031 | medmedia9@gmail.com | medmonthly.com

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

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

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

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

MODERN MED SPA AVAILABLE Located in beautiful coastal North Carolina

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

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

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

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

MedicalPracticeListings.com | medlisting@gmail.com | 919.848.4202

PRACTICE FOR SALE

OCCUPATIONAL HEALTH CARE PRACTICE FOR SALE Greensboro, North Carolina

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.

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

List Price: $150,000 | Established: 2007 | Location: Colorado For more information contact Dr. Jack McInroy at 303-929-2598 or Shrink1324@gmail.com 72| FEBRUARY 2012

To view more listings visit us online at 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 Gross Yearly Income: $335,000+ | List Price: $125,000

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

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

MEDMONTHLY.COM |73

MD STAFFING AGENCY FOR SALE IN NORTH CAROLINA

NC MedSpa For Sale

The perfect opportunity for anyone who wants to purchase an established business.

MedSpa Located in North Carolina We have recently listed a MedSpa in NC

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

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

Contact Medical Practice Listings today to discuss the practice details.

For more information call Medical Practice Listings at 919-848-4202 or e-mail medlistings@gmail.com Please direct all correspondence to driverphilip@gmail.com.

Only serious, qualified inquirers.

www.medicalpracticelistings.com

Unfortunately, its motor is inside playing video games.

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

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

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

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

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

American Council on Exercise

®

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

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

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DIEGO,

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92123

USA

WWW.ACEFITNESS.ORG

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

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

Contact us today to discuss your options confidentially.

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

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.

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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

Medical Practice Listings Buying and selling made easy

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

Call 919-848-4202 or email medlistings@gmail.com www.medicalpracticelistings.com MEDMONTHLY.COM |75

the top 1 AFFORDABILITY

The number one factor affecting doctors’ decisions when deciding on medical office space is affordability, including the decision to lease or buy.

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ANCILLARY SERVICES

After interviewing several doctors, the new buzz word is “Ancillary Services”. Traditionally, hospitals were the main benefactor of many of these services. Ancillary services include MRI’s, sleep labs, physical therapists, outpatient surgery centers, and imaging centers. Doctors are more recently looking for extra medical office space where they can install ancillary services and other diagnostic treatment areas.

EXCLUSIVITY

Willingness of the landlord to restrict leasing to other physicians of similar specialty in the same building is often requested. While many physicians view this as an important concession, it probably is not that important in the long run. This is more important in rural or less populated areas where a new hospital is being established.

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ACCESSIBILITY

Doctors are looking for access to major road arteries and highways so their patients can easily find them. After exiting the highway, doctors expect their patients to make less than two turns to find their offices. After all, as a patient they may not be feeling all that good in the first place. Why make their plight any more difficult if they can’t find their doctor?

Factors to Weigh When Choosing Medical Office Space

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GEOGRAPHIC LOCATION

In the past, doctors needed to be close to the hospital to round on large numbers of inpatients and perform inpatient surgeries. Now procedures are more frequently performed on an outpatient basis, and doctors can relocate their offices farther away from the hospital at usually lower lease rates.

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PARKING

Most professional office buildings have a parking ratio of two to three parking spaces per thousand square feet. With patients coming and going throughout the day, doctors need to have at least four to five parking spaces per thousand square feet to avoid overcrowding.

Since parking can be tight in the downtown corridor, doctors often shy away from downtown medical space.

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PROXIMITY TO OTHER PHYSICIANS

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In a medical office building, doctors are often looking for proximity to other physicians who could inter-refer to each other. For example, a family medicine physician will frequently refer patients to other medical specialties such as cardiology or orthopedics. With the right synergy, all of the doctors are inter-referring and enhancing their practices.

MODERN ARCHITECTURE FOR MIXED USE DEVELOPMENT

Often, physicians are now looking for mixed use development featuring more modern architecture. They want buildings that are appealing and inviting. Unless it is a very small practice, the old one story stucco flat roof office building is becoming a thing of the past.

SIGNAGE AND ZONING LAWS

Building monument or signage to distinguish your medical group or practice is an important feature. Local zoning laws often restrict the size and location of business signage in any given area, but often the developer can offer “top of building� signs for major anchor tenants.

Read more at: http://www.orlandomedicalnews.com/top-10-factors-that-doctors-weigh-when-choosing-medicaloffice-space-cms-830 MEDMONTHLY.COM | 77

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