Med Monthly February 2015

Med Monthly February 2015

TRIFECTA FOR BECOMING THE MODERN (AND SUCCESSFUL) DENTIST pg. 36

Don’t Let Social be a Dilemma

Make it a Smart Dental Marketing Choice pg. 40

Dental Coding ICD-10 CM

Time to Prepare Your Practice Now! pg. 32

the

Modern Dentist issue

Bringing Technology into the Dental Office pg. 28

ATTRACTING IDEAL NEW PATIENTS TO YOUR PRACTICE

contents

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features

28 BRINGING TECHNOLOGY INTO THE DENTAL OFFICE 32 DENTAL CODING ICD-10 CM: Time to Prepare Your Practice Now! 36 TRIFECTA FOR BECOMING THE MODERN (AND SUCCESSFUL) DENTIST 40 DON’T LET SOCIAL BE A DILEMMA: Make It a Smart Dental Marketing Choice

insight 6

ADVANCED MEDICAL IMAGING FOR THE MODERN DENTIST

8

EARLY BLOOD GLUCOSE CONTROL LENGTHENS LIFE IN PEOPLE WITH TYPE 1 DIABETES

practice tips 10 DAILY SCORECARD CAN TRANSFORM MEDICAL PRACTICES/CLINICS 12 SERVICE WITH A SMILE 14 ATTRACTING IDEAL NEW PATIENTS TO YOUR PRACTICE

40

DON’T LET SOCIAL BE A DILEMMA:

research and technology 18 MEDICAL RADIATION DETECTION: Seven Trends We’re Watching 21 TURKISH LIFE SCIENCES INDUSTRY FUELLED

BY FAVORABLE INVESTMENT CLIMATE AND HEALTHCARE REFORMS

legal 22 EFFECTS OF THE NEW FEDERAL SPENDING PACKAGE ON THE HEALTH SECTOR 24 AFFORDABLE CARE ACT CHALLENGES AND TRENDS FOR 2015 & BEYOND 26 FDA IS EXPLORING OPTIONS FOR REGULATING NEXT GENERATION SEQUENCING DIAGNOSTIC TESTS

healthy living 44 SPICED SWEET POTATO HUMMUS MAKE IT A SMART DENTAL MARKETING CHOICE

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

Call us today at 919-833-3836 x141

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

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

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Med Monthly February 2015 Publisher Creative Director Contributors

Philip Driver Thomas Hibbard Ashley Acornley, MS, RD, LDN. Naren Arulrajah Terri Bradley Ellen J. Flannery Vishal Gandhi, BSEE, MBA Barbara Hales, M.D. Eric A. Klein Marina Liem M.D. Audrey Christie McLaughlin, RN Cynthia A. Moore Denise Price Thomas Beverly Thurmond, D.D.S.

contributors Terri Bradley is a speaker, consultant, and medical coding expert. She is certified by the American Institute of Healthcare Compliance, Inc., as an ICD-10-CM Certified Trainer.

She keeps her finger on the pulse of policy updates and changes in the insurance industry as she works with OMS offices daily. Terri is a member of the Academy of Dental Management Consultants and the Medical Group Management Association.

Vishal Gandhi, BSEE, MBA is the founder and CEO ClinicSpectrum Inc. He is a well-known and widely respected authority on the “nitty-gritty” of medical practice workflow and technology. His Hybrid Workflow Model is quickly becoming a new healthcare industry standard model for combining human and computer workflow, to maximize revenue and minimize cost and he has appeared in prominent health IT publications.

Barbara Hales, M.D.

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 skilled expert in promoting your health services. As seen on NBC, CBS,ABC and FOX network affiliates as well as Newsweek, Dr. Hales writes all the content you need to promote your medical services. Her latest book is on the best seller list and she can do the same for you. Check out her site at www.TheWriteTreatment.com

Marina Liem M.D. is a board-certified diagnostic radiologist with a subspecialty in Neuroradiology. She has been practicing clinical radiology in community hospitals and outpatient centers in Florida, Pennsylvania and New Jersey and is also currently a freelance medical writer.

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 WWW.MEDMONTHLY.COM |5

insight

ADVANCED MEDICAL IMAGING FOR THE MODERN DENTIST

By Marina Liem M.D.

When the routine office dental X-rays show an unexpected or puzzling finding or do not provide a ready answer for a patient’s symptoms, today’s dentist has an array of medical imaging modalities at his/her disposal for diagnosis.

Anatomically, the teeth are rooted in the maxillary and mandibular facial bones. The curved shape of the maxilla and mandible are challenging for routine radiographs because overlapping structures result in difficult visualization and inconsistent reproducibility.

By flattening out the curvature of the mandible, the 6 | FEBRUARY 2015

Panorex (panoramic) radiograph is the best X-ray view of the mandible to demonstrate fractures, bone lesions, temporomandibular joint (TMJ) dislocation and dentition.

Cross-sectional imaging modalities of computed tomography (CT) and magnetic resonance imaging (MRI) have significantly advanced dental imaging because of superior contrast resolution and unlimited capability for multiplanar reconstructions. There are distinct differences and advantages between the two modalities. CT has superior contrast resolution for bone and calcium and MRI for soft tissues. Helical or multidetector CT (MDCT)

rapidly acquires an entire imaging data volume by multiple detectors spiraling around the body and generates highly detailed reconstructions in any plane. CT data acquisition is typically completed in 30 seconds or less within a breath hold and therefore, MDCT is suitable for the majority of patients including uncooperative patients and pediatric patients. Ionizing radiation in MDCT and magnetically induced spinning hydrogen protons in MRI constitute the physical basis for imaging. Therefore, radiation exposure is a concern for MDCT and safety of ferromagnetic devices, implants or foreign objects within a patient is a concern and possibly a contraindication for MRI. Dental abnormalities are often incidentally demonstrated on MDCT of facial bones, paranasal sinuses and neck. Dental caries are seen as small round holes in the tooth enamel. Untreated periodontal disease progressing to periapical abscess appear as a small lucency at the tooth root. Supernumerary and impacted teeth and retained roots from tooth extraction are easily demonstrated.

Odontogenic infection is the most common cause of upper neck infection. Abscess in the cheek and under the tongue or mandible manifests as a fluid collection with a defined wall. Ludwig angina is cellulitis at the floor of the mouth causing airway narrowing and constitutes an emergency because of the risk of asphyxiation. Mandibular osteomyelitis (bone infection) may result from untreated infections and complicated or unrecognized fractures.

Jaw osteonecrosis (cellular bone death) is a complication of chronic osteomyelitis related to odontogenic infection, radiation therapy for head and neck cancer and more recently, IV bisphosphonate therapy for bone metastases.

Both osteomyelitis and osteonecrosis are demonstrated as lytic (decreased bone density) destructive areas on MDCT. Endodontic dental implants have become widespread by significantly improving masticatory function and facial aesthetics. These screw-type devices anchor teeth replacement appliances in the edentulous portions of the jaw. Bone absorption and consequent thinning of the maxillary and mandibular alveolar ridges is a sequela of edentulism and osteoporosis that may preclude proper implant placement and increase complications. MDCT is essential for dental implant pre-surgical planning.

Specialized reconstruction software generates curved coronal (panoramic) and cross-sectional planes for tooth mapping and evaluation of bone mineralization, alveolar ridge height and width and location of anatomic structures such as the maxillary sinus floor and mandibular nerve canal.

TMJ’s are hinge and glide joints that open and close the jaw by articulation between the mandibular condyle and glenoid fossa of the temporal bones. The bowtie shaped articular disc sitting on top of the mandibular condyle cushions the condyle as it moves forward with the condyle during jaw opening. TMJ internal derangement is a

common mechanical disorder in the general population.

Internal derangement is defined as abnormal position of the articular disc relative to the condyle and has a variety of causes including trauma, malocclusion, bruxism, stress and bone abnormalities. MRI is the only imaging modality that directly visualizes the disc and is therefore the reference standard for internal derangement. The disc shape and its position relative to the condyle is evaluated in the closed and open mouth positions. If the disc is displaced in the closed mouth position, it may or may not relocate (“recapture”) in the open mouth position. An audible click with or without jaw pain typically accompanies disc recapture in open mouth position. Non-recapture of the disc in the open mouth position signifies a more advanced stage with limited range of motion and no audible click.

A stuck disc stays in a static position on closed and open mouth because of adhesions. Less common etiologies for TMJ disorders include inflammatory arthritis, osteoarthritis, crystalline deposition, trauma, and condylar anomalies.

Motor vehicle accidents and assaults are the most common causes of mandibular fractures. Because of lateral pterygoid muscle retraction, fracture displacement is usually medial or inward. Condylar fractures account for up to half of all mandibular fractures. TMJ dislocation may be traumatic or nontraumatic from yawning, eating, dental treatment and oral intubation. MDCT multiplanar and 3D reconstructions are invaluable for fracture reduction and facial reconstruction planning.

In summary, the cross sectional modalities of MDCT and MRI greatly expand the elucidation of dental related anatomy and pathology. The acquisition and expert interpretations of these studies by radiologists are instrumental in the service of modern dentists and their patients. Radiologists are key team players in maximizing medical imaging for improving patients’ dental health.  REFERENCES: Steinklein J, Nguyen V. Dental anatomy and pathology encountered on routine CT of the head and neck. American Journal of Radiology 2013; 201:843-853. doi:10.2214/ AJR.12.9616.

Petscavage-Thomas J, Walker E. Unlocking the jaw: advanced imaging of the temporomandibular joint.

American Journal of Radiology 2014; 203:1047-1058. doi:10.2214/AJR.13.12177.

Kaplan P, Helms C. Current status of temporomandibular joint imaging for the diagnosis of internal derangements.

American Journal of Radiology 1989; 152:697-705.

Lomasney L, Steinberg M. Computerized imaging before patients undergo dental implantation. American Journal of Radiology 1999; 172:1439-1446.

WWW.MEDMONTHLY.COM | 7

insight

Early Blood Glucose Control Lengthens Life in People With Type 1 Diabetes

People with type 1 diabetes who intensively control their blood glucose (blood sugar) early in their disease are likely to live longer than those who do not, according to research funded by the National Institutes of Health.

The findings are the latest results of the Diabetes Control and Complications Trial (DCCT) and its follow-up, the Epidemiology of Diabetes Control and Complications (EDIC) study. Results were published online Jan. 6 in the Journal of the American Medical Association .

“The outlook for people with type 1 diabetes continues to improve,” said Catherine Cowie, Ph.D., of NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the primary funder of the study. “These results show that by tightly controlling their blood glucose, people with type 1 diabetes can live longer.”

Type 1 diabetes typically occurs in younger people and was formerly called juvenile-onset diabetes. In type 1 diabetes, the body does not make insulin, and people with type 1 need to take daily insulin to live.

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Beginning in 1983, the DCCT/EDIC study enrolled 1,441 people between ages 13 and 39 with recent-onset type 1 diabetes. In the DCCT, half were assigned at random to intensive blood glucose control designed to keep blood glucose as close to normal as safely possible, and half to the conventional treatment at the time. Both groups were similar in age. The DCCT ended in 1993 when the intensive control group was found to have substantially less eye, nerve and kidney disease. All participants were taught intensive blood glucose control and followed during the ongoing EDIC. Blood glucose control has been similar in both groups since DCCT ended.

Researchers found 107 deaths among DCCT/EDIC participants, who were followed an average of 27 years from enrollment. There were 64 deaths in the group that had initially received standard treatment and 43 deaths in the intensive treatment group, a 33 percent reduction in deaths. The most common causes of death – not all necessarily related to diabetes – were cardiovascular

diseases (22 percent), cancer (20 percent), acute diabetes complications – where blood glucose became dangerously high or low (18 percent) – and accidents/suicide (17 percent).

More people in the conventional treatment group than the intervention group died from diabetic kidney disease (six vs. one). The study also found that higher average glucose levels and increased protein in the urine – a marker of diabetic kidney disease –were the major risk factors for death.

“These results build on earlier studies, which suggested that increased protein in the urine largely accounts for shorter lifespans for people with type 1 diabetes,” said the study’s lead author, Trevor Orchard, M.D., a professor at the University of Pittsburgh Graduate School of Public Health. “These results further emphasize the importance of good early glucose control, as this reduces the risk for increased protein in the urine in general, as well as diabetic kidney disease.”

Since the 1993 publication of the findings, the DCCT intensive treatment has become standard practice for type 1 diabetes. The new findings show that reductions in diabetes complications resulting from tight glucose control translate into longer lifespans.

“Thanks to the findings over the years from the landmark DCCT/EDIC study, millions of people with diabetes may prevent or delay debilitating and often fatal

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complications from the disease,” said NIDDK Director Griffin P. Rodgers, M.D. “NIH’s mission is to help improve lives through biomedical research. These kinds of results provide hard evidence that what we do helps people live longer, healthier lives.”

Diabetes affects more than 29 million Americans, most of whom have type 2 diabetes, often associated with overweight or obesity. Another NIH study found that in older adults with longstanding type 2 diabetes and high cardiovascular disease risk, very intensive glucose control to near normal levels actually increased mortality.

In contrast, the DCCT/EDIC studied intensive glucose control in younger people with type 1 diabetes earlier in the course of their disease and found intensive control had a prolonged benefit in reducing mortality. Find more information on diabetes at www.diabetes.niddk.nih.gov.  About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Source: http://www.nih.gov/news/health/jan2015/niddk-06. htm

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practice tips

Daily Scorecard Can Transform Medical Practices/Clinics

In this article, I would like to highlight how a “Daily Scorecard” can transform any Medical Practice. We all know that in sports, a scorecard is a sheet, or a book in which scores are entered. In business terms scorecard means a statistical record used to measure an achievement or progress towards a particular goal.

We have often heard about “Balanced Scorecard” in the corporate world. The balanced scorecard is a strategic planning and management process that is used extensively in business and industry, government, and nonprofit organizations worldwide to align business activities to the vision and strategy of the organization, improve internal and external communications, and monitor organizational performance against strategic goals.

Taking the concept of a scorecard and introducing it in Medical Practice under “Daily Scorecard” can bind all the team members of a practice into one common string. Let’s look at some of the possible daily scorecard items for a practice.

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Daily number of appointments scheduled and seen.

This provides a complete analysis of NO SHOW ratio.

So if a provider complains that he/she was very slow, the scheduling team knows what to do. It also helps in forward thinking for practice’s workflow planning.

Daily number of patients’ who paid their outstanding balances from the total, who have some kind of balance towards co-insurance/deductible or non-covered charges.

This provides an indirect audit on the financial counselor within a practice or front desk team member. No one likes to have bad looking numbers on the scorecard, so it brings a sense of accountability among the team members to outperform day-by-day.

in a busy practice. Patient wait time is a big topic for discussion in workflow planning and patient satisfaction survey. We have seen an increased number of technology initiatives to calculate patients’ wait time in reception, exam room, triage and face-to-face time with physicians.

A simple scorecard can provide an accurate insight into providers’ performance and keep them focused on their core objective.

Daily number of claims billed.

By Vishal Gandhi, BSEE, MBA Founder and CEO

It is necessary to have insurance claims billed out in timely manner. This scorecard can provide a pace of billing.

Practice sees 150 patients daily however claims going out daily are not keeping up with this pace or claims billed out are sporadic, it would obviously create a disruptive cash flow for the practice. This serves as an immediate audit on the billing team members and provides possible statistical cash flow predictions for the accounting team based on procedure/payer mix.

Daily $$ amount posted.

Payment posting is one of the most neglected functions in a Medical Practice. It is very important that payment posting is kept in pace with daily cash flow. It is a first and fundamental step in wholesome Revenue Cycle Management and Planning. If money is not posted in a timely manner, you can’t balance bill secondary or patients.

It creates a work queue for AR follow up / Denials Team.

Daily number of denials worked on (or) outstanding claims followed up.

Daily number of patients’ scheduled and eligibility checked.

Affordable Care Act has created thousands of insurance patients’ in the past several years; it has also given a way to increased patients’ responsibility. Eligibility Verification is such a crucial part in workflow planning for Medical Practices. This scorecard serves as a quick tally between patients’ scheduled and eligibility checked. Any performance less than 100% shouldn’t be acceptable unless a known factor exists. A known factor could be patients’ who have been seen regularly in practice for their risk management.

Daily number of patients’ seen by providers with ratio of number-of-patients to workhours.

It is often observed that patient flow is a big problem

Healthcare is the only services industry where you are paid after services are rendered. Most service industries in the country charges their fees upfront. It is essential in a Medical Practice Workflow planning that Denied or Outstanding Claims are followed up periodically or promptly. This is a time consuming process and each claim can take up to 30 minutes or more. The scorecard helps a practice to establish a bench mark and dig into reasons for denials proactively.

We all agree that numbers have power. A series of numbers put together convey a whole story about any business or organization. Daily Scorecard turns out to be a simple but powerful tool in building an effective accountability into the practice. It keeps everyone connected towards one common goal “Recognition, Recommendation and Revenue”.  https://www.linkedin.com/pulse/daily-scorecard-cantransform-medical-practices-vishal-gandhi

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practice tips

Service with a

By Denise Price Thomas

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What a beautiful sunny day it was and what a smooth enjoyable flight it had been. Around midnight in my hotel room, I was putting the finishing touches on my presentation entitled “The Importance of a Smile” for the next day’s conference. I had based my talk on personal experiences and a career in healthcare (35 + years) along with practice assessments and my experiences as an “Undercover Patient.” Let’s just say I’m an expert, I know a smile when I see one! In fact, one practice calls me “The Queen of Smiles”, which I take as a compliment.

I know how it feels to receive a smile and to share one. And the best part is they’re free!

I have a habit of reviewing and revising almost every presentation based upon those last minute vibes.

I was to arrive at 8 am the following morning, check in, meet the committee members involved with the conference and return to speak for an afternoon session. Once those finishing touches were applied, it was time for a warm shower and my warm pajamas. While brushing my teeth, I noticed something unusual. My first thought was “POPCORN?!? When did I have POPCORN?” I looked into the mirror and confirmed that my left lateral incisor “had left the building” and so I cried myself to sleep.

The next morning I tried sticking gum in that space, but that didn’t work.

So I practiced smiling in the mirror without showing any of my teeth. If I was very careful introducing myself, shaking hands on the other side (the side that no one could see the gap) it might just work. I met the committee, checked in for the conference and I was all set.

Back in my room, I was able to make some calls. I called my local dentist to see if he would know anyone close by, but he didn’t. I asked the hotel concierge and fortunately he knew a local and reputable dentist. I nervously made the call which was answered

by a beautiful smile. She listened and did not rush me as I babbled with anxiousness and fear. I explained the details and she asked me how long it would take to get there. I had no idea of the distance, I told her where I was and she said they would wait on me to get there. The “limo” (thanks again to the concierge) arrived and I was on my way. I didn’t want to talk to the limo driver, but I didn’t want him to think I was “stuck up”. So I held my hand over my mouth and explained. He was very understanding and made me smile, in spite of my awareness.

When he pulled into the parking lot, there were no cars! I was a bit concerned over that. He was able to pull right up to the door and I felt like a movie star, I just didn’t look like one!

I walked into the office and a beautiful young lady with a smile greeted me saying, “Great, you made it! We’ve been looking forward to meeting you!”

I smiled, mouth closed and hand over my mouth. I had tears all over again.

This was a Friday morning and little did I know that their office is closed on Fridays. However they were there to meet their contractor who is building their new home. He had already left but the husband/wife dental team waited for me.

I was taken immediately to the dental chair. “OK, let’s see what’s going on here” the dentist said. I watched closely for his reaction as I opened my mouth and he acted as if it were nothing, putting my mind at ease.

“Don’t you worry, this isn’t a problem.

I’ll have you looking like Hollywood when you leave” he said. I felt such comfort, because I knew I was in the right place. He was kind, very patient with me, told me exactly what he could do and said he would get me “up and running my mouth in no time”.

As the work began, I couldn’t help but reflect upon the importance of a smile, a real smile. The smiling concierge who offered compassion and assistance, while detecting my urgency.

The smile from the limo driver who offered humor to relieve my stress.

The smile from the dentist and his wife who greeted me with assurance they could “fix me”. Their smiles were genuine even after waiting on me to arrive.

The dentist was as good as his word, restoring my smile, and had me back to the conference on time. I was able to speak at the conference, pronouncing my words perfectly, well, as perfect as a Southern girl could pronounce them. The title “The Importance of a Smile” had even more significance than ever! On that day and every day, I am reminded of “the smile”. It costs nothing to give away yet the rewards are innumerable!

I knew that I was in a caring place with caring people from the first moment I entered that dental office.

There was never a need for anyone to apologize for anything. Both the dentist and his dental assistant had been alert, attentive, professional and caring beyond measure.

In my profession, I address the good, the bad and the “oh my goodness!” as an “Undercover Patient”, however this time it was for real. I was not an “Undercover Patient”, I was a real patient.

What I did not hear, see or miss was: • Personal conversations • A complaining staff • Lack of accountability What I did hear, see, appreciate and will always remember: • Concerned and caring professionals • A clean and inviting environment • 100% Accountability

These are qualities that cost you nothing. These are provided free to your patients and will be appreciated and remembered, bringing you more return business to your dental practice and also bringing you new patients by word-of-mouth. 

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practice tips

Attracting Ideal New Patients to Your Practice

by Audrey Christie McLaughlin, RN www.physicianspracticeexpert.com

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T

here are many ways to “stage a practice for success”. Some are practical, some are legally required, and some are just plain smart business.

From the smart business angle, one of the key factors to focus on is attracting new ideal patients.

What is an ideal patient?

Have you interpreted your professional obligation as an obligation to market to, see, and treat virtually anyone who can use their telephone and present their body in your office?

I would like you to consider that this type of thinking leads to requiring escalating numbers of patients in order to grow your practice, which no doubt leaves you overworked and stressed.

I am not suggesting that if you have the capacity to serve those seeking care, you deny them access based on a social standard or profile because that would be wrong and unethical.

What I want you to do is to simply identify characteristics of those patients you especially enjoy serving and make a specific effort to attract and retain those patients. Again, this does NOT mean to turn away patients that are not your “ideal patients.”

What types of patients and clients do you enjoy serving?

What are their common denominators? Health attitudes?

Income? Occupation? Hobbies? Lifestyle? Personal habits?

Age? Cash? Insurance? Condition?

Every practice and practitioner will have a different set of qualifiers that creates their ideal patient. There are a few qualities that universally go on all ideal patient profiles. All ideal patients are patients: • You enjoy working with • That need your help • Who will happily pay what you are worth (privately, via insurance, or a combination) • That will get great results from the services you can/do offer Now taking a look at just that short list of criteria, can you imagine what it would be like to have a practice full of these types of patients?

How do you discover your ideal patient?

You start with categorizing your current patients so you can see what your ideal patients have in common, then creating your ideal patient client profile, identifying who they are, what their issues tend to be, and how to identify their biggest problems. Then, you look at obstacles and challenges that you have the solutions for (or can create solutions for) and where to find them.

Again, knowing your ideal patient is so important; it is the foundation of creating a successful (and personally fulfilling) practice. Without knowing this you won’t have a clear picture on the best way to talk to your ideal patients,

so that they listen and be engaged. You won’t know what to do for them, you won’t know what products and services to create for them and you won’t know where to reach them.

Step 1: Categorizing your current patients The best place to begin to find your ideal patient is to start with what you have. You may have hundreds or even thousands of patients that have been through your doors over the years. Pick a random day’s patients load, maybe two days: one you remember as a great day and one you remember as a so-so or bad day.

Categorize your patients into categories ranging from best patients to worst patients and include a category for so-so patients.

Once you have everyone sorted out, gather your good patients and search for common threads. Why did they come to you? Are they all professionals? Blue-collar?

Single? Young? Old? Married? Moms? Do they all have a particular health concern? What is their insurance? What are their health attitudes?

There are no specific rules here, and after analyzing these patients you may discover that the unique factors in your ideal patient transcend age, sex, income, occupation, and other qualifiers: Your ideal patient maybe an attitudinal description.

One of my clients is a young family practice physician, and she enjoys working with young executives who are busy, on a tight schedule, and travel frequently. She caters to these executives locally and provides telemedical care for established patients while they are traveling. She has identified her ideal patient as an age range, income level, and lifestyle and is now catering to them.

Once you have all of the common threads sorted out, begin to create your ideal patient profile based on these traits. This profile will serve as a guide for you to speak to and find your ideal patients in your marketing efforts. Then begin to transform your practice physically in your office amenities and offer established and new services to meet the needs of your ideal patient.

In my previous example, my client who serves busy executives made sure her waiting room had free wireless Internet. She also offers these executives “walk-in” hours that our slightly earlier and slightly later than typical office hours. Her practice has coffee, tea, and bottled water available. She offers established patients telemedicine appointments when they are traveling.

Step 2: Find where your ideal patients hang out, and be present there.

Start by taking a look at the common threads you found in your favorite patients to get ideas on where in your community you can begin to build a presence. For moms, perhaps it is at schools or gyms with childcare? For continued on page 16 WWW.MEDMONTHLY.COM | 15

continued from page 15

business professionals, perhaps it is at Starbucks, chamber meetings or at large cubicle-filled corporations? If you are targeting seniors, maybe it is the local health fair?

One of my clients, a dermatologist, performed simple skin cancer screenings in a “feet on the ground” type of marketing plan for a large executive sales firm. She performed one afternoon of 31 exams and yielded 25 new ideal patients for her practice.

In addition to “feet on the ground” type initiatives or getting out in your community, you also want to look at online to determine where these patients are hanging out digitally. Since it simply isn’t possible to go through all of the places your ideal patient is collecting in droves in your community, closely examine a few places that you will need to be present online. This includes social media, websites, blogging, and stay-in-touch marketing vehicles.

Going back to my family practice client that works with executives, she used her stay in touch tactic to let her established patients know that she would be able to see them for telemedicine visits as they traveled. The work she did, literally staged her practice for success.

To sum it up, discovering and marketing your ideal patient is key to staging your practice for success by growing a successful and personally fulfilling practice. 

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research & technology

Medical Radiation Detection: Seven Trends We’re Watching

18 | FEBRUARY 2015

A

mong the various markets for radiation detection equipment, by far the largest is medical and healthcare applications, accounting for two-thirds of this sector. On the one hand it’s a relatively established end market with clearly addressable usage cases. On the other hand, growth rates aren’t as high as in other sectors such as domestic security or certain industrial processes, which require (often specialized) environmental monitoring capabilities.

Nevertheless, we see the medical and healthcare sector remaining a primary revenue generator for suppliers of radiation detection technologies. The market for X-ray imaging systems continues to be very strong for detecting low to high-energy photons coming out of tissues or bones (biological samples), especially in developing nations where these tests are cost-effective, efficient and quick.

We envision growth mainly will be for X-ray and for neutron systems. Gamma ray imaging has long been used in medical applications -- apart from nuclear imaging systems, no other modality including radiology can aid in identifying malignancy -- but we see more broadly its use in radiography as diminishing.

Application Opportunities for Radiation Detection First, let’s look at some specific usage trends we see as positive for radiation detection systems:

Smaller and Portable:

Device characteristics are moving towards smaller systems with embedded electronics that will eventually improve the portability and handiness of devices. This is in line with the worldwide trend to bring both diagnostic and therapeutic equipment closer to the patient.

The overall trend of “universality” -- mobility of a system between rooms and setups, including wireless capabilities, and in varying cassettes sizes -- was a prominent theme at the December 2014 annual meeting of the Radiological Society of North America (RSNA). We agree that this is a key pathway for suppliers to invest in, transporting some more advanced X-ray applications to more portable formats.

Another important micro-trend in this area is the introduction of smaller and lighter format detectors for easier imaging of smaller anatomies. In the U.S., companies such as Carestream and Fujifilm Medical Systems have received FDA clearance for wireless detectors and new contrast agents (gadolinium, and cesium detectors respectively).

Digital Radiography vs. X-ray:

Digital radiography (DR), a form of 2-dimensional X-ray imaging using digital sensors, continues to replace X-ray film technology owing to its better results and

possibility of storing electronic data. DR is the next-level technological advancement poised to take center stage in all applications of non-destructive radiographic testing. It will play a vital role in shaping the market for radiography in the healthcare sector, becoming a natural choice for hospitals and clinics which boast of faster and improved response.

NanoMarkets believes DR’s technological advantages are its primary market growth drivers: The advent of new technologies is encouraging hospitals and other medical establishments to shift to digital X-ray systems. These medical centers are continuously adapting to provide better services for their patients. The growing number of medical facilities in developed and emerging economies is complementing the growth of radiographic testing.

Technological advances in automation, growing aging population, and need for improved and faster imaging methods for higher patient throughput which are not offered by either CR or films Less radiation exposure to patient as well as radiologists is stressed by DR manufacturers, particularly in new markets.

Universal growth in medical structure owing to aging populations, growing incidences of chronic disease like tuberculosis, pneumonia and gastrointestinal disorders, in both developed and developing countries.

Advanced applications, such as dual energy subtraction, could provide a clinical reason for choosing digital over conventional radiography by providing better image quality.

Logically, the cost-associated problem of DR is encouraging companies to look out for cost-effective solutions. Manufacturers have come up with a way out wherein analog X-ray systems can be turned into digital systems at a relatively cheaper price using retrofit kits, comprising a high-density solid scan system or flat-panel detectors.

Given the scale of X-ray radiography, NanoMarkets believes that DR will rule the charts in developed nations, while the market in developing countries is constricted by cost issues. Firms are coming with distinctive products in lieu of complete DR systems.

The Rise of 3D:

As part of the progression to digital imaging, NanoMarkets anticipates greater demand in 3D pixilated images taken from machines directly, while digitization of 2D information will decline.

3D-DEXA (dual-energy X-ray absorptiometry) allows a 3D model of the femur bone to be constructed from 2D images taken with a DEXA bone densitometer during routine femur exams. This provides key information about continued on page 20 WWW.MEDMONTHLY.COM | 19

continued from page 19

the bone status, including bone geometry, cortical bone thickness and bone mineral density in lower dose levels than CT scanners. The 3D analysis will be highly useful for physicians in understanding multiple components of femurs and this technology can be extended to other important bones of the body.

There is particular excitement over 3D mammography, or breast tomosynthesis, in which X-ray machines take pictures of thin slices of the breast from different angles and the overall image is reconstructed with computer software. (This process is similar to how a CT scanner produces images of structures inside the body.) Encouraging results continue to emerge about 3D mammography; results of several studies throughout 2014 suggest far better detection success not just with 3D mammography technology but using both digital mammography and tomosynthesis.

Cost issues associated with 3D will be weighed in the near future, but not in the long run -- especially for 3D tomography, owing to the high-volume rise in breast analysis for general checkups and cancer screening.

Hologic was the first company to receive FDA approval (in 2011) for 3D breast tomosynthesis, and received another FDA approval in 2013 for a “low-dose version.” Recently (Sept. 2014) GE also received the FDA’s nod for its lowdose 3D system.

Slicing and Dicing:

One of the biggest trends in CT technology is shifting towards multidetector CTs (MDCT), in which a twodimensional (2D) array of detector elements replaces the linear array of detector elements used in typical conventional and helical scanners. This 2D detector array permits CT scanners to acquire multiple slices or sections simultaneously and greatly increases the speed of image acquisition.

Image reconstruction in MDCT is more complicated than that in a single section. Nonetheless, the development of MDCT has resulted in the development of highresolution applications such as CT angiography and colonoscopy. MDCT offer substantial improvement in volume coverage and scan speed with efficient use of X-ray tube which are replacing a single row of detectors.

Technology Opportunities for Radiation Detection Here’s a snapshot of what we see as the leading technology trends:

More Combinatorial Diagnosis:

The development of efficient combinatorial diagnosis and easier accessibility to healthcare procedures 20 | FEBRUARY 2015

throughout the world continues to result in greater utilization of radiation detection systems. The market for detectors has also benefited from advancements in the science of radiology and from better understanding of device and diagnostic systems by medical professionals.

An increasing number of clinical applications are being based on multimodal imaging systems (MIS) including anatomical (CT, MRI) and functional (PET, SPECT) techniques to provide complex information in a single image.

NanoMarkets believes that these next-generation systems will play a vital role in the diagnostic industry.

Though, at present they have a small market size but with continual advancements and lowering of prices, reasonable opportunities are possible with both SPECT and PET combinations. Most of this equipment is utilized for highly sophisticated and complex detection in specialized fields.

Improved Components and Materials:

Scintillators (CsI, GOS, ceramic, CdWO4, and Cs(Tl)), semiconductors (s-Si, a-Se) and photodiodes (Si) will continue to rule the medical detectors industry. New developments in ceramic scintillators, YAP(Yb3+) (i.e., YAlO3), YAG, and LuAPare are fascinating, which are not only efficient but also quicker in response. Semiconductor integration technology is supporting enhanced image quality details and process speed for X-ray CT. NanoMarkets also expects some important developments in the nanomaterials space that could lead to a new class of radiation detector. Nanoparticles’ small sizes and thus larger collective surface areas translate to significantly improved detection efficiency. Metal organic frameworks (MOFs), nanophotonics, quantum dots, and nanocomposites with polymeric matrices are being studied by various research institutes with radiation detection in mind. The size of this market opportunity will depend heavily on how cost effective such novel nanomaterials can be made in the context of medical radiation detection.

Complex Software and Advanced Algorithms:

New algorithms and software for separating analysis radiation from the background noise are entering the market. This is especially relevant in medical/healthcare with the rise of 3D imaging and reconstruction; examples include dual-energy X-ray absorpitometry (DEXA) for bone densitometry and positron emission tomography (PET) image reconstruction in oncology.

What we expect to emerge from these trends are smart detector devices for healthcare where both imaging and electronics reading will be able to distinguish noise from signals.  Source: http://www.pressreleasepoint.com/medicalradiation-detection-seven-trends-we-re-watching

research & technology

Turkish Life Sciences Industry Fuelled by Favorable Investment Climate and Healthcare Reforms

Big pharmaceutical companies and foreign investors are flocking to Turkey to capitalize on its encouraging economic policies. The establishment of technology development zones that exempt pharmaceutical entrepreneurs and academics from income taxes until 2023 has played a particularly crucial role in driving R&D activity in the nation’s life sciences industry.

New analysis from Frost & Sullivan, 2014 Life Sciences Outlook in Turkey, finds that the market earned revenues of $14.53 billion in 2013. The study covers pharmaceuticals and clinical diagnostics. The pharmaceutical segment was valued at $14.04 billion in 2013 and is estimated to reach approximately $21.65 billion in 2018 at a compound annual growth rate (CAGR) of 9.1 percent. The clinical diagnostics segment accounted for the rest of the total life sciences market revenues in 2013 and is forecasted to hit $0.70 billion in 2018 at a CAGR of 7.4 percent.

“Biologics, oncology drugs and blood-based products are expected to support the development of the life sciences market in a big way,” said Frost & Sullivan Healthcare Senior Research Analyst Aiswariya Chidambaram. “The biologics segment, which accounted for

11 percent of the total Turkish pharmaceutical market in 2012, is poised to expand at a CAGR of 15 percent between 2013 and 2018. On the other hand, the oncology segment will witness strategic investments including certain tax allowances, customs duty exemption and valueadded tax exemption worth more than $9 billion.”

The Healthcare Transformation Program designed to improve healthcare services and access will remain instrumental to boosting spending across these segments. The strategic objectives of the program, along with rapid economic growth will ensure that Turkey’s life sciences market progresses faster than mature markets in the United States, Japan and Europe.

However, price ceilings that do not exceed 66 percent of drug reference prices and rigid reimbursement policies are adversely impacting foreign investors’ profits and overall market momentum. The lengthy drug approval process and poor patent protection are also dampening the investment spirit in the Turkish life sciences industry.

“With the reimbursement amount for prescription drugs having decreased at an average AGR of 7.1

percent between 2009 and 2012, companies are increasingly foraying into the over-the-counter segment with different product offerings,” noted Chidambaram. “This trend is expected to significantly boost domestic production and supply capacity.”

Eventually, Turkey will become the regional life sciences capital of the Middle East and North Africa. The country’s inviting investment scenario and pharmaceuticals export potential of nearly $300 billion to neighboring countries will help it quickly attain a strong status in the region.

2014 Life Sciences Outlook in Turkey is part of the Life Sciences Growth Partnership Service program. Frost & Sullivan’s related studies include: Next-generation Healthcare Global Advanced Medical Technologies 2014, Global Stem Cell Market, Global Infectious Disease Diagnostics Market, and Western European Biomarkers Market in Drug Discovery and Development.

All studies included in subscriptions provide detailed market opportunities and industry trends evaluated following extensive interviews with market participants.  Source: http://www.newswiretoday. com/news/149538/ WWW.MEDMONTHLY.COM | 21

legal

Effects of the New Federal Spending Package on the Health Sector

By Eric A. Klein Sheppard Mullin Richter & Hampton LLP

In mid-December, President Obama signed into law a $1.1 trillion spending bill known as the “Consolidated and Further Continuing Appropriations Act, 2015” or “Cromnibus.”1 This article explores provisions that relate to the health sector and Affordable Care Act (ACA) implementation.

22 | FEBRUARY 2015

Health IT The spending package allocates just over $60 million to the Office of the National Coordinator for Health Information Technology for the ongoing development and advancement of interoperable health IT. An emphasis on interoperability resounds as another provision limits aspects of Department of Defense and Department of Veterans Affairs spending until the department’s report on a plan to achieve electronic health record interoperability between them.

The Act allocates just over $14.9 million for health IT adoption (and other quality improvement measures) in rural hospitals. An additional $1 million is available to fund telehealth initiatives in rural areas.

Health Insurance Among other provisions affecting insurance, the Act mandates that the ACA’s risk corridor program be budget neutral. The program seeks to incentivize insurers to offer qualified health plans in the face of significant uncertainty by transferring funds from plans with lower than projected costs to those with allowable costs that are higher than anticipated. According to the spending package, the Centers for Medicare & Medicaid Services (CMS) may not apply resources from accounts funded by the Act towards risk corridor payments. This limits the agency to funding the program through collections.

While insurers may have depended on risk corridor payments in setting rates for 2014 and 2015, budget constraints should not come as a surprise. Department of Health & Human Services (HHS) guidance issued earlier in 2014 set forth that the program would be implemented “in a budget neutral manner.” While HHS anticipated that collections would be sufficient to cover expenditures, the department also stated that payments would be reduced pro rata to the extent of any shortfall.2 A second insurance-related provision amends section 833 of the Internal Revenue Code, which grants tax benefits to Blue Cross and Blue Shield plans, as well as certain other qualifying health care organizations. Section 833 benefits apply only to an organization with a medical loss ratio (MLR) of at least 85 percent. The IRS published final regulations in January 2014 providing that the MLR numerator—defined as the organization’s total premium revenue expended on reimbursement for clinical services provided to enrollees—does not include amounts spent on activities to improve health care quality. (The MLR denominator is an organization’s total premium revenue for a taxable year.)

The Act’s amendment aligns section 833’s MLR definition with that provided by section 2718 of the ACA, pursuant to which costs associated with activities

to improve health care quality may be counted in the numerator alongside medical claims. Examples of activities affected by the change include case management, care coordination, and care compliance initiatives, and investments in health information technology to support such initiatives. The provision is retroactively applied to taxable years beginning after December 31, 2009.

The Act does not address other controversial aspects of section 833, such as the scope of the benefits provided to nonprofit health plans, and whether there are possible means for an otherwise eligible organization to mitigate the consequences of having an insufficient MLR.

Medicare The spending package cuts appropriations for the Independent Payment Advisory Board (IPAB) by $10 million. While it has not yet been operationalized, IPAB is a 15-member panel created and empowered by the ACA to achieve cost savings in the Medicare system. The ACA appropriated $15 million a year for the entity. In addition, CMS is prohibited from using Medicare program funds for non-Medicare ACA activities.

Prevention and Public Health Finally, the Act places some restrictions and requirements on spending under the ACA’s Prevention and Public Health Fund. These provisions generally appear to address concerns over transparency. For example, HHS must establish a publicly accessible website to provide information regarding the use of available funding.  _______________ 1 The full text of the Act is available here.

2 Department of Health & Human Services. Risk Corridors and Budget Neutrality. Apr. 11, 2014.

Partner Eric Klein leads the 90+ attorney national healthcare practice, and is a partner in the Century City office, of Sheppard Mullin Richter & Hampton LLP, a full service AmLaw Global 100 law firm with offices throughout California, New York, Chicago, Washington, D.C., London, Brussels, Beijing, Seoul and Shanghai. With over twenty-six years of practical legal and business experience, his practice focuses on the healthcare, technology and related industries.

Known in the business community for his creative solutions and deal-making ability, Eric uses deep industry knowledge, entrepreneurial solutions, sophisticated negotiation skills and effective legal process to meet the complex business and legal needs of both established and emerging companies.

Copyright © 2014, Sheppard Mullin Richter & Hampton LLP. Source: http://www.natlawreview.com/article/effects-newfederal-spending-package-health-sector WWW.MEDMONTHLY.COM | 23

legal

Affordable Care Act Challenges and Trends for 2015 & Beyond

Going into 2015, one of the biggest challenges facing employers continues to be the implementation of the Affordable Care Act (“ACA”).

Applicable large employers need to make decisions regarding the measurement period that will be used for purposes of determining which employees are “full-time employees.” This determination is used for purposes of determining which employees must be offered coverage by the first day of the plan year beginning on or after January 1, 2015 in order to avoid the employer shared responsibility penalty. An applicable large employer also needs to determine which employees are full-time in order to comply with the employer reporting required by Section 6056 of the Internal Revenue Code of 1986, as amended (“Code”).

Reporting under Code Sections 6055 and 6056 is also a significant challenge, requiring each applicable large employer to collect detailed information about the group health plan coverage offered to and maintained by employees, their spouses and eligible dependents.

24 | FEBRUARY 2015

By Cynthia A. Moore Member Dickinson Wright PLLC

Employers should be establishing processes to track this data in 2015 to comply with the initial reporting required in January 2016, either internally or through service providers.

Looking into my crystal ball, trends related to group health plans include:

regarding whether an individual qualifies for premium subsidies if he or she purchases individual coverage on the federallyfacilitated Exchange and the U.S. Supreme Court has granted cert to decide this critical issue.

• Over time, as employees become familiar and comfortable with purchasing individual coverage on the Exchange, the take-up rate for COBRA continuation coverage will decline.

• Employers continue to wait for guidance from the IRS on the nondiscrimination rules that will apply to insured health plans. These rules could significantly affect the manner in which health insurance has traditionally been offered to different groups of employees (such as full-time vs. part-time) and the amount of employee contribution that are charged to different groups of employees.

• Smaller employers will consider self-funding in order to avoid certain fees assessed on health insurers and passed through to employers and certain other ACA mandates.

• The move toward high deductible health plans will continue as employers seek to minimize the possibility that their group health plan will trigger the “Cadillac tax.”

• Court decisions may continue to shape the implementation of the ACA. In particular, there are conflicting appellate decisions

Only time will tell if my predictions come true, but I am confident in saying that the challenges will continue into 2015 as employers struggle to comply with the ever-changing ACA landscape.  Source: http://www.natlawreview.com/ article/affordable-care-act-challengesand-trends-2015-beyond

WWW.MEDMONTHLY.COM | 31

legal

FDA Is Exploring Options for Regulating Next Generation Sequencing Diagnostic Tests

By Ellen J. Flannery Covington & Burling LLP

O

n December 29, 2014, FDA issued a public workshop notice and associated discussion paper entitled “Optimizing FDA’s Regulatory Oversight of Next Generation Sequencing Diagnostic Tests–Preliminary Discussion Paper.” The Discussion Paper describes opportunities and regulatory challenges presented by next-generation sequencing (NGS) tests, and requests public comment on possible new ap-

26 | FEBRUARY 2015

proaches to demonstrating analytical performance and clinical performance of NGS tests.

NGS, also called “high throughput sequencing,” refers to technologies that can perform sequencing of large segments of an individual’s DNA, and even the individual’s entire genome. A single NGS test can identify thousands or millions of genetic variants that an individual may have, in contrast to laboratory tests that identify a single or a

defined number of substances. The NGS test results can be used to diagnose or predict an individual’s risk of developing many different diseases or conditions.

NGS tests pose regulatory challenges to FDA, because they can “generate large amounts of data and consequently may have relatively broad or undefined intended uses or indications.” 79 Fed. Reg. 78092, 78093 (Dec. 29, 2014).

For purposes of considering the questions posed about possible new regulatory approaches for NGS tests, FDA’s Discussion Paper defines an NGS test as “a human DNA sequencing assay performed on a particular NGS instrument (e.g., MiSeqDx) with a workflow defined by standard operating procedures that specify all materials and procedures.” FDA’s definition covers the patient sample type through computational processing of sequencing data. It also includes “any portion of interpretation of the clinical meaning of individual variants identified in that patient that is performed within the test system (including software) rather than by a healthcare professional.”

FDA’s Discussion Paper describes how the agency applied a subset-based approach in authorizing, through the de novo process, the marketing of the MiSeqDx™ instrument (DEN130011) and Universal Kit sequencing reagents (DEN130042). Analytical test performance for the system was “demonstrated for a representative subset of types of variants in various sequence contexts.”

FDA intends to use this subset-based approach for other NGS platforms. But the agency is also considering whether a standards-based approach to FDA regulatory review of NGS tests would be valuable, and requests public feedback on this issue.

In evaluating in vitro diagnostic (IVD) devices, FDA reviews the clinical performance of the test — that is, whether the test results correctly identify the relevant disease or condition. This might be impractical for NGS tests because they detect rare variants, and because the rare mutations coexist with other possible causative variants. FDA is exploring the use of genetic databases that would provide information on genetic variants and their association with disease, including disclosing the strength of the evidence regarding the association.

FDA’s Discussion Paper focuses on two databases supported by the National Institutes of Health (NIH): ClinVar and ClinGen. ClinVar is a public database of reports of human variants and their relationship to phenotypes. ClinGen is a resource for expert evaluation of research data and genetic test results to determine which variants are most relevant to patient care. Important factors regarding these databases are that they are accessible to the public, transparent, and updated with new evidence curated by the scientific community. FDA is seeking public comment regarding whether other databases that meet these criteria could be used to support clinical claims for genetic and genomic tests.

FDA’s Discussion Paper also requests comment on whether and how to communicate to physicians information about genetic variants whose clinical significance is not well understood. In this regard, FDA is seeking to assure that test information will benefit medical decision-making while minimizing risks to patients.

The Discussion Paper lists ten specific questions regarding analytical performance, and eleven specific questions regarding clinical performance. The public can comment on these questions at the public workshop being held on February 20, 2015, and in written comments that should be submitted to the docket by March 20, 2015 (Docket No. FDA-2014-N-2214).  © 2015 Covington & Burling LLP Source: http://www.insidemedicaldevices.com/2015/01/09/fda-is-exploringoptions-for-regulating-next-generation-sequencing-diagnostic-tests/

Providing customized, simple

NUTRITION SOLUTIONS to

ENHANCE HEALTH and

OPTIMIZE SPORTS PERFORMANCE Tracy Owens, MPH, RD, CSSD, LDN Ashley Acornley, MS, RD, LDN 4030 Wake Forest Road, Suite 300 Raleigh, NC 27609 919-876-9779

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features

Bringing Technology into the Dental Office

By Beverly Thurmond, D.D.S.

28 | FEBRUARY 2015

Dr. Thurmond designs a crown using CEREC

A

fter relocating to Raleigh from New Mexico in 2009, I chose to purchase an existing dental practice from a retiring dentist. From the beginning I knew that upgrades and updates would be necessary to take the practice to the next level. This is where a motivated, eager and capable staff can be your best asset!

We began with the basics, installing an internet connected network of computers in each operatory and the front desk, that included Eaglesoft dental management software. Investing good money into old technology does not make good financial sense. So we transitioned from conventional film to digital x-rays. The new digital x-ray systems reduce radiation exposure by up to 80%, eliminate environmental waste (no processing solutions), allow immediate viewing and increase diagnostic efficiency.

Additionally, when a patient needs to be referred to a specialist sending digital x-rays via email saves time and money.

We also added a Schick intraoral camera in the operatory which adds digital photos of a patient’s tooth or tissue into their permanent record. This “wow” feature can make a problem crystal clear to the patient and encourage them to take ownership and action. Intraoral photos are very helpful when submitting pre-authorizations for dental treatment. For example, a tooth fracture that runs mesial to distal cannot be seen on an x-ray but it is clearly visible in a photo. Most insurance companies appreciate the additional information and documentation to assess the medical necessity of the proposed treatment.

Implementing technology requires adequate space, so we relocated to a newly renovated space that will support our growth for years to come. As part of this growth an additional monitor was added in each operatory. Patients are excited to conveniently view their x-rays on a 14” dedicated computer monitor used for patient education and not on a 1.5” piece of film held up to a light source.

To prepare for HITECH Act compliance due by 2015, we have implemented electronic patient charts, claims submission and referrals when sending a patient continued on page 30 MEDMONTHLY.COM |29

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to a specialist. For instance, when we receive patient information from another provider, the documents are not printed, but imported into the patient’s digital file cabinet.

These “e-tools” increase efficiency, reduce errors, and allow for faster reimbursement.

Another important technology is the use of third-party software to handle patient communications. Using email and text messages to remind patients of their appointments has reduced overhead, no-shows and late cancellations.

We use this service to track recalls; patients due for an appointment but not scheduled. These patients receive a combination of email, text and postcards as reminders.

In the near future, our patients will be able to access their account, patient chart and even make payments through a secure internet portal.

In 2011 we brought in CEREC CAD-CAM technology to our office. CEREC (Chairside Economical Restoration of Esthetic Ceramics) was first introduced in 1985. It is a dental restoration product that allows a dental practitioner to produce ceramic dental restorations using computer assisted technologies, including 3D photography and CAD/CAM. This replaces the use of messy impression materials and physical stone models. It is possible to design inlays, onlays, veneers, and crowns on the computer, articulate the restoration with adjacent and opposing teeth, and then mill and cement the final restoration in a single appointment. Patients appreciate the single visit appointment. It reduces their time off from work and reduces anesthetic use. If needed, the scans can be e-mailed to the lab for the fabrication of custom abutments used with implants and implant 30 | FEBRUARY 2015

crowns. Initial training classes are required for the doctor and dental assistant(s) to introduce the techniques and tools.

As new releases of the software and improvements in the technology are available, continuing education training is a must for the doctor and dental assistant(s).

As with any new technology, there is a learning curve for the implementation into the actual schedule. The process must flow from doctor to assistant and back, letting each do their assigned tasks to achieve the final product. Implementing the steps understandably takes much longer initially, so extra time must be built into the schedule to allow for this to occur.

Another time saving tool that we have introduced is the SonicFill™ by Kerr Dental.

It is a sonic-activated bulk fill composite delivery system. Kerr’s sonic activation allows for a rapid flow of composite material into the cavity for effortless placement and excellent adaptation. This has become an incredibly efficient method for using tooth-colored restorative materials. Previously we used an incremental fill technique done by hand, effective, but much more time consuming.

It is truly amazing the number of innovations that have been introduced into the dental field in the past 15-20 years and it seems that many more advancements are on the horizon. It is easy to get overwhelmed or over extend your budget when trying to keep up with the latest and greatest.

Each segment of technology implemented must benefit the office, make fiscal sense and contribute to a patient’s oral health in a positive way. Over the last 4 years, we have fast tracked the adoption of new and efficient technology into our dental practice and haven’t looked back!  An assistant loads the CEREC milling unit.

features

Dental Coding ICD-10 CM

Time to Prepare Your Practice Now!

By Terri Bradley Terri Bradley Consulting, LLC

32 | FEBRUARY 2015

Tick-tock, tick-tock, tick-tock. Hear that? It’s the sound of time passing. On October 1, 2015, the United States will implement a new, updated diagnosis code set. ICD-10 CM (International Classification of Disease, Volume 10) will become the new code set for all medical claims submitted with a date of service after October 1, 2015.

You may be thinking, I don’t submit medical claims, so I don’t have to know about this. As a dental office you may not submit medical claims often, but I can guarantee you, there will be times when it will benefit both you and your patients if you submit some services to medical carriers.

For example, did you know that many patients have coverage for dental-related trauma under their medical plans? If you can get some claims paid under a medical plan rather than using dental benefits, you may be saving patients money and saving their benefits so they can use those benefits for other procedures in your practice.

What does all this have to do with ICD-10 CM? One of

the biggest differences between a medical claim form and a dental claim form is the required reporting of diagnosis codes. Medical insurance carriers pay their claims based on medical necessity. It becomes our job to provide the carrier with the reason or medical necessity for the procedure. We do this by using diagnosis codes. I teach my clients that diagnosis codes help us tell the story to the insurance carrier. We are not making up a story to get a claim paid; we are telling the story of why the procedure was performed by using codes. No narratives, no extra paperwork, just one claim form submitted one time. How cool is that?

We are currently using ICD-9 CM here in the U.S. How we use the codes, how we look them up, and their purpose, will remain the same as we move to ICD-10 CM. What will be very different are the way the codes will look and the number of codes we will have to submit come next October.

A COMPARISON OF THE TWO CODE SETS ICD-9

ICD-10

3-5 characters in length

3-7 characters in length

Approximately 14,000 codes

Approximately 69,000 codes

First character may be alpha (E, V) or numeric Characters 2-5 are numeric

First character is alpha Characters 2-7 are alpha or numeric

Limited space for new codes

Flexible for adding new codes

Lacks laterality

Has laterality

Difficult to analyze due to nonspecific codes

Specificity improves coding accuracy and depth of data for analysis

Codes are non-specific and do not adequately define diagnoses needed for medical research

Details improve the accuracy of data used in medical research

Does not support interoperability because it is not used in other countries

Supports interoperability and the exchange of health care data between other countries and the United States continued on page 34

WWW.MEDMONTHLY.COM | 33

continued from page 33

As you can see, the number of codes will increase significantly, as will the specificity of the codes. A mapping has been created to help map us from ICD-9 CM to ICD10 CM and back from ICD-10 CM to ICD-9 CM. These mappings are called General Equivalency Mappings, or GEMS. While these are great tools to start with, GEMS are not a replacement of learning ICD-10 CM. For some codes in ICD-9 CM, there is only one code in ICD-10 CM, and for other codes in ICD-9 CM, there are multiple code choices in ICD-10 CM. You can easily see the level of specificity that is going to be required as we move toward next October. Remember, this is big! The diagnosis code we put on a medical claim form has to be supported by the documentation in the patient record. We cannot put a code on a claim form just to get the claim paid; it has to be supported by the information in the record!

I mentioned earlier that dental offices can often submit a claim to a medical carrier for dental services related to trauma for patients. Let’s take a look at a scenario and how that will look as of October 2015.

Imagine your patient is a 12-year-old boy who fell in his yard while riding his bike. When he fell, he landed on a tree root and cut his lower lip. He is in your office and you are preparing a claim form to send to his medical insurance carrier. Here are the IDC-10 CM diagnosis codes that will have to be listed on the claim form in order to tell the story to the insurance carrier: • S01.541A Puncture wound with foreign body of lip, initial encounter • V18.0xxA Pedal cycle driver injured in non-collision transport accident in non-traffic accident • Y92.017 Garden or yard in single-family (private) house as place of occurrence for external cause • Y93.55 Activity, bike riding • Y99.8 Other external cause status (includes leisure activity) Wow! That’s a lot of information and we haven’t even reported a procedure code yet! Take a step back and look at all that was accomplished by reporting diagnosis codes.

Didn’t we tell the entire story to the medical carrier – who got hurt, how the injury happened, when it happened, what the person was doing at the time of the injury, and why the person was doing it. I think this is fascinating and awesome, and when done correctly, it can save a lot of grief and paperwork when dealing with medical insurance carriers.

My intention is not to scare you. To be honest, I was somewhat afraid of ICD-10 CM before I became acquainted with it and learned how to use it. Now I’m a raving fan. The level of specificity in the code set actually makes our jobs easier because there is literally a code for everything. No more guessing, and no more listing of 34

| FEBRUARY 2015

unspecified codes. Once I got over the new look, I was a fan.

I hope this article plants the seed for you to start the learning process. Become acquainted with the codes and learn how they’re to be used in your dental practice. We’re not able to use these codes until next October, but we don’t want to wait until next September to prepare for them.

Start learning now so you won’t be overwhelmed next fall.

We’re here to help you with this transition. If you need training on this new code set, please do not hesitate to reach out to me.  Terri Bradley’s extensive hands-on experience, including management of a multi-doctor oral and maxillofacial surgery practice, laid the foundation for her current success as a speaker, consultant, and medical coding expert. She is certified by the American Institute of Healthcare Compliance, Inc., as an ICD-10-CM Certified Trainer. She keeps her finger on the pulse of policy updates and changes in the insurance industry as she works with OMS offices daily. Terri is a member of the Academy of Dental Management Consultants and the Medical Group Management Association. She has a B.S. in Healthcare Administration.

Source: http://www.dentistryiq.com/articles/2014/11/dentalcoding-icd-10-cm-time-to-prepare-your-office-now.html

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features

Trifecta for Becoming the Modern (and Successful)

DENTIST

By Barbara Hales, M.D. www.thewritetreatment.com 36 | FEBRUARY 2015

Y

ou’d like to overhear your patients and friends boast that you’re the best dentist ever. Of course this is invaluable as word-of-mouth advertising has always been the most effective way to garner new patients and build a successful practice.

But why would you be considered the best? Usually this earned perception is achieved because you have dialed into the 3 channels of the modern dentist. Incorporating them all into your practice completes the circle of success.

TRIFECTA OF MODERN DENTISTRY

Modern Equipment

Patient Education Effective Marketing

Modern Equipment The following equipment will make you both modern and special by identifying oral health issues in exceptionally early stages, making treatment less complex.

Digital X-rays – allows you to visualize an image of a tooth instantly and the high-resolution screen enables you to see dental problems easier and faster. Images can be made larger and clearer. Exposure to harmful radiation is kept to a minimum. l Intraoral cameras – comprise a series of tiny cameras that diverts digital images of teeth and interior mouth tissue to an LCD screen display for viewing by dentist and patient. These images can be enlarged by as much as 50 times so no lesion goes undetected. l Cosmetic imaging – incorporates software enabling a dentist to show how the teeth will appear after a procedure. This demonstrates size, shape and teeth color. l

Patient Education Patient education is important to inform patients about latest treatments, conditions and available options.

It’s also about convenience and communication with patients, families, referring physicians and caregivers. l

Newsletter – provides an opportunity to inform your reader about the latest in dentistry, while establishing you as an authority in your dental niche (i.e. cosmetic procedures, implants, orthodontics). Newsletters strengthen your brand. The best part- it enables you to amass names with email addresses for your database from website visitors, increasing your patient numbers and attracting more prospective patients. continued on page 38 WWW.MEDMONTHLY.COM | 37

continued from page 37

Blog – enables you to educate your viewer by publishing captivating content while letting your personality come through. Blog posts provide you with an opportunity to relate memorable stories that elicit emotions and drive home the point that you are trying to make. Bonus- it raises your search engine rankings to get you more visibility. l E-book – says to the patient, you are an authority in your field. While many dentists may practice like you, you’re the one who wrote the book! Patients are impressed with this. Content can be repurposed from your blog posts and newsletters. l Video – clips can be made for preoperative and postoperative instructions, about various office procedures, new equipment and devices and even office staff and office hours. They can be used for both internal viewing at the office or remotely through Vimeo and YouTube. If you are a “techie”, you can create these yourself but I would recommend outsourcing it for a more professional appearance. l Patient Portal – promotes improved dentist-patient relationships by supplying secure online access to the dentist or office from home or work. Patients can make appointments, view oral health records, or ask questions. l

your investment.

Don’t forget to include a map of the office (from Google maps) and Foursquare. More than 50 million people use Foursquare to find businesses and professional offices. l Social Media – enables you to stay in touch with your patients, former clients and prospective patients.

You can view trending topics in chat rooms, as offering solutions to problems that your target market is struggling with. Consider your practice demographics.

Are they more likely to be on Facebook (a professional Facebook page is invaluable), Twitter, Pinterest, YouTube, and Instagram? Whichever modalities your patients hang out on, is a good way for you to reach out to them.

The thing is, make sure that your posts are in sync with your professional niche and that you use your selected keywords. This will optimize your sight, get you found on searches and allow you to reap the rewards in your business strategies.

By incorporating each of the 3 tools within the “trifecta”, you will be well known as the “Modern Dentist” that everyone must see!

If you need help with any aspect of the mentioned strategies, contact me so that we can discuss your needs at Support@CompleteContentPackage.com. 

Effective Professional Marketing Even if you are the best dentist who ever lived and practiced, it won’t matter if no one knows about you.

Visibility is key to growing your practice and your brand.

In this market, you need a strategic plan to stand out from your competition and your colleagues.

Conversion Website – this goes beyond the simple SEO (search engine optimized) site. It is one that is easy to navigate, has contact information highly visible, gives premiums to amass lists and most importantly, spells out “calls-to-action”. These CTAs show people what you want them to do, not just view the site (e.g. sign up for newsletters and blogs, call for appointments, get Tip Sheets, go to a hyperlinked page, etc.) l Press Release – is among the cheapest form of effective advertising. Benefits of press release marketing include: links to your website with call to action, associates specific keywords to you and your practice, increases visibility, establishes credibility and provides entry into online news sites. Not only that, but also you now can be syndicated! l Local Listing – helps you get noticed by patients doing an online search for a dentist. Optimizing a Google+ site with videos, photos and offers will consistently outrank your peers. This is well worth

The Write Treatment

l

38

| FEBRUARY 2015

Ezines and NewslettersCost Effective Powerful Tools • Drive traffic to your business website • Build relationships between yourself and patients • Get new patients • Announce a new service or product • Give great impact Have you got a newsletter yet or want to spread a message?

Contact Barbara Hales, M.D. for a free consultation.

Barbara@TheWriteTreatment.com 516-647-3002

WWW.MEDMONTHLY.COM | 39

features

Don’t Let Social be a Dilemma –

L A T N E D T R A E SM C I A O T I H E C K G A M IN T E K R

By Naren Arulrajah MA President and CEO Ekwa Marketing

The new age digital landscape is dispersed, vibrant, and more diverse than before. If anything, this has made the market place more competitive and fragmented for dental practices. The challenge thus that most dental practices today face is to reach out and connect with a wider, yet scattered audience that is both demanding and entitled.

Nothing short of impressive marketing efforts will work in such an environment.

Marketing today is all about individualization. You are no longer connecting with a section or group of your target audience. It is safe to say that marketing strategies that celebrate the “individual” stand to win more traction! And this is where social comes in. Social media in a lot of ways helped demarcate traditional marketing from the new age digital marketing. In fact, in 2014 we saw social emerge as an absolutely elemental aspect of digital marketing as an increased number of dental practices decided to walk the social path.

40 | FEBRUARY 2015

Aligning with the Social Diversity • In 2014, 92% of internet users in the age group of 16-64 had an account on at least one social network.

• On an average, online adults today have accounts on at least 5.07 social networks.

• This figure is a little higher at 5.9 among those in the age group of 16-24.

Potential patients have strong expectations from your dental practice brand. Target audiences want to interact with your brand on a platform of their choice at a time that is most convenient to them. One of the best ways of meeting those expectations is by being in a place that provides you and your target audience with an active and effective means of both connecting and engaging with each other.

In other words - get your dental practice brand out there! Build a brand presence on several social media

transparency, and a commitment to customer service. Keep in mind that even if a section of your potential target audience might not actively comment or add likes and might actually just maintain “radio silence,” they’re still watching.

The one thing that brands often tend to ignore is that that today’s digital audience is not only intelligent, they are also highly perceptive.

They understand that social media often leaves brands susceptible and vulnerable to criticism. However, maintaining a social presence in spite of this, can win you respect and much required attention. Ask your readers for feedback, respond to their queries and concerns in a timely manner and they will respect you for it.

Meeting the Demands of your Social Audience

channels and connect with potential patients from a variety of different sections.

Social Highlights Human Values Social offers dental practices with a sure way of showcasing your brand’s dedication to accountability,

So you know your target audience is active in the social realm and they expect your practice brand to be active over possibly multiple social channels. The obvious question then to ask yourself is – what do they want from your dental practice brand?

Any item which has the potential to enrich the life of a reader is a winner on social networks. Your potential patients want things that are most relevant to them and when you deliver on this expectation, you can expect to be rewarded with brand advocates and tangible consumer goodwill. Remember your content needs to be entertainment rich and deliver obvious relevant value that is specific to the needs of your potential audience. Don’t make social about direct selling; any marketing that will come about will and should be delivered by your brand advocates.

At best, social should only be used to lightly touch upon your practice products and services.

Social highlights an environment that is highly personal and conversational and the last thing your audience wants to hear are sales pitches. continued on page 42 WWW.MEDMONTHLY.COM | 41

continued from page 41

Social as an Active Communication Platform In the 2014 State of Multichannel Customer Service Survey report 1,000 consumers were asked if they had at any point asked a customer service question over social media.

• 35% reported that they had.

• 51% of these respondents also said that receiving a response from the brand provided an improved view of the brand.

Consumer reliance on social media is also highlighted in the HubSpot report The Social Lifecycle: Consumer Insights to Improve Your Business, where 569 customers were questioned about social media presence for brands.

According to the report, • 50% respondents said they had complimented a brand in the past 5 months.

• 35% respondents had complained about a brand.

• 30% had actively requested support.

In fact, an increasing number of senior citizens (above the age of 60), today use social media as a way to communicate and connect with brands. They are using social to get guidance or to express their satisfaction and

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gratitude. What this indicates for dental practices is a clear opportunity to connect with a lucrative target audience that is keen on communicating over social networks.

Conclusion Smart social marketing simply translates into the following - use the comments, likes, criticism, and feedback earned over social to improve and better your dental practice brand image. Establish a responsive patient service channel, communicate in a timely manner and you can easily and quickly build credibility for your practice. And credibility is the cornerstone of a robust digital presence for dental practices in the ever vibrant world of social.  About the Author: Naren Arulrajah is President and CEO of Ekwa Marketing, a complete Internet marketing company which focuses on SEO, social media, marketing education and the online reputations of Dentists and Physicians.

With a team of 130+ full time marketers, www.ekwa.com helps doctors who know where they want to go, get there by dominating their market and growing their business significantly year after year. If you have questions about marketing your practice online, call Naren direct at 877-249-9666.

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healthy living

Spiced Sweet Potato Hummus (Adapted From Vegetarian Ventures)

By Ashley Acornley, MS, RD, LDN We all know hummus is usually made from chickpeas, but this recipe also contains the winter spud - - sweet potato! Sweet potatoes contain over 400% of your daily Vitamin A requirement, plenty of potassium, and are loaded with fiber. Hummus is usually used as a dip for vegetables or pita chips, but try adding this hummus to a healthy wrap or to top off a salad of fresh vegetables.

This delicious sweet potato hummus recipe is a great way to spice things up in your diet!

Ingredients:

• 1 Large sweet potato, cubed • 2 Cups cooked chickpeas • 4 Tablespoons tahini • 2 Tablespoons olive oil (you may need more if the hummus comes out thick) • 2 Garlic cloves, minced • Juice from 1/2 a lemon • 1 Tablespoon cumin • 1 Teaspoon sriracha • Dash of nutmeg • Dash of cinnamon • Salt/Pepper to taste

Preparation: Bring a large pot of water to a boil. Lower to medium low and add in the sweet potatoes. Cook until softened (about 10 to 15 minutes). Strain and let cool.

In a large blender or with a food processor, blend all the ingredients together until a desired consistency is reached.

44

| FEBRUARY 2015

Nutrition Information:

Per 1/8 serving of this dish: Calories: 136 Carbs: 17g Sugar: 2g Fat: 6g Protein: 5g

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 http://www.ironforidaho.net/

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://www.opticiantraining.org/optician-training-kentucky/

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

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

South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4665 www.llr.state.sc.us

Nevada P.O. Box 70503 Reno, NV 89570 (775)853-1421 http://nvbdo.state.nv.us/

Tennessee Heritage Place Metro Center 227 French Landing, Ste. 300 Nashville, TN 37243 (615)253-6061 http://health.state.tn.us/boards/do/

Arkansas P.O. Box 627 Helena, AR 72342 (870)572-2847 California 2005 Evergreen St., Ste. 1200 Sacramento, CA 95815 (916)263-2382 http://www.optometry.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.ct.gov/dph/cwp/view. asp?a=3121&q=427586 Florida 4052 Bald Cypress Way, Bin C08 Tallahassee, FL 32399 (850)245-4474 http://www.pof.org/opticianry-board/ Georgia 237 Coliseum Dr. Macon, GA 31217 (478)207-1671 http://sos.ga.gov/index.php/licensing/ plb/20 Hawaii P.O. Box 3469 Honolulu, HI 96801 (808)586-2704 http://hawaii.gov/dcca/pvl/programs/ dispensingoptician/

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/

Texas P.O. Box 149347 Austin, TX 78714 (512)834-6661 http://www.tob.state.tx.us/ 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 http://www.dpor.virginia.gov/Boards/ HAS-Opticians/ Washington 300 SE Quince P.O. Box 47870 Olympia, WA 98504 (360)236-4947 http://www.doh.wa.gov/LicensesPermitsandCertificates/MedicalCommission. aspx

WWW.MEDMONTHLY.COM | 45

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://commerce.alaska.gov/dnn/cbpl/ ProfessionalLicensing/BoardofDentalExaminers.aspx Arizona 4205 N. 7th Ave. Suite 300 Phoenix, AZ 85103 (602)242-1492 http://azdentalboard.us/

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/

Arkansas 101 E. Capitol Ave., Suite 111 Little Rock, AR 72201 (501)682-2085 http://www.asbde.org/

Illinois 320 W. Washington St. Springfield, IL 62786 (217)785-0820 http://bit.ly/svi6Od

California 2005 Evergreen Street, Suite 1550Â Sacramento, CA 95815 877-729-7789 http://www.dbc.ca.gov/

Indiana 402 W. Washington St., Room W072 Indianapolis, IN 46204 (317)232-2980 http://www.in.gov/pla/dental.htm

Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7800 http://www.dora.state.co.us/dental/

Iowa 400 SW 8th St. Suite D Des Moines, IA 50309 (515)281-5157 http://www.state.ia.us/dentalboard/

Connecticut 410 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/cwp/view. asp?a=3143&q=388884

Kansas 900 SW Jackson Room 564-S Topeka, KS 66612 (785)296-6400 http://www.dental.ks.gov/

Delaware Cannon Building, Suite 203 861 Solver Lake Blvd.

Dover, DE 19904 (302)744-4500 http://1.usa.gov/t0mbWZ

Kentucky 312 Whittington Parkway, Suite 101 Louisville, KY 40222 (502)429-7280 http://dentistry.ky.gov/

Florida 4052 Bald Cypress Way Bin C-08 Tallahassee, FL 32399 (850)245-4474 http://floridasdentistry.gov/ 46

Georgia 237 Coliseum Drive Macon, GA 31217 (478)207-2440 https://gbd.georgia.gov/

| FEBRUARY 2015

Louisiana 365 Canal St., Suite 2680 New Orleans, LA 70130 (504)568-8574 http://www.lsbd.org/

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

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

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

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

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

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

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://governor.vermont.gov/boards_ and_commissions/dental_examiners Virginia Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4538 http://www.dhp.virginia.gov/dentistry Washington 310 Israel Rd. SE P.O. Box 47865 Olympia, WA 98504 (360)236-4700 http://www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/Dentist.aspx West Virginia 1319 Robert C. Byrd Dr. P.O. Box 1447 Crab Orchard, WV 25827 1-877-914-8266 http://www.wvdentalboard.org/ Wisconsin P.O. Box 8935 Madison, WI 53708 1(877)617-1565 http://dsps.wi.gov/Default. aspx?Page=90c5523f-bab0-4a45-ab943d9f699d4eb5 Wyoming 1800 Carey Ave., 4th Floor Cheyenne, WY 82002 (307)777-6529 http://plboards.state.wy.us/dental/index.asp

WWW.MEDMONTHLY.COM | 47

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://commerce.alaska.gov/dnn/cbpl/ ProfessionalLicensing/StateMedicalBoard.aspx 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/cwp/view. asp?a=3143&q=388902 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://doh.dc.gov/bomed 48 | FEBRUARY 2015

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/Pages/default.aspx

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

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

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

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

Texas P.O. Box 2018 Austin, TX 78768 (512)305-7010 http://www.tmb.state.tx.us/

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/licensing/physician_surgeon.html

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

Vermont P.O. Box 70 Burlington, VT 05402 (802)657-4220 http://1.usa.gov/wMdnxh Virginia Virginia Dept. of Health Professions Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4400 http://1.usa.gov/xjfJXK Washington Public Health Systems Development Washington State Department of Health 101 Israel Rd. SE, MS 47890 Tumwater, WA 98501 (360)236-4085 http://www.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://dsps.wi.gov/Boards-Councils/ Board-Pages/Medical-Examining-BoardMain-Page/ Wyoming 320 W. 25th St., Suite 200 Cheyenne, WY 82002 (307)778-7053 http://wyomedboard.state.wy.us/

WWW.MEDMONTHLY.COM | 49

medical resource guide ACCOUNTING

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

www.pushpa.biz

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

BILLING & COLLECTION

DENTAL Biomet 3i

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

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

CODING SPECIALISTS Place Your Ad Here

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

Urgent Care America

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

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

50 | FEBRUARY 2015

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

The Dental Box Company, Inc.

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

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

ELECTRONIC MED. RECORDS

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

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

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

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

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

LOCUM TENENS Physician Solutions

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

MEDICAL ARCHITECTS MMA Medical Architects

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

medical resource guide MEDICAL ART

MEDICAL PRACTICE SALES

Deborah Brenner

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

Medical Practice Listings

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

MedImagery

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

MEDICAL EQUIPMENT

MEDICAL PRACTICE VALUATIONS

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

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

www.assurepharma.com

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

www.thetps.com

Capri Health

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

REAL ESTATE York Properties, Inc. Headquarters & Property Management 1900 Cameron Street Raleigh, NC 27605 (919) 821-1350

BizScore

Assured Pharmaceuticals

PROFESSIONAL SPEAKER

MEDICAL RESEARCH

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

Scynexis, Inc.

3501 C Tricenter Blvd.

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

MEDICAL EQUIPMENT FINANCING Bank of America

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

SUPPLIES, GENERAL PRACTICE FINANCING Bank of America

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

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

www.bankofamerica.com/practicesolutions

MEDICAL MARKETING WhiteCoat Designs

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

WWW.MEDMONTHLY.COM | 51

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

Family Primary Care Practice

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

Family Practice/Primary Care

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

Med Spa

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

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

Practice Type: Internal Medicine

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

Dental Practices Place Your Ad Here

Optical Practices Place Your Ad Here

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

Considering your practice options? Call us today.

52 | FEBRUARY 2015

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

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

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

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

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

Medical Practice Listings Selling and buying made easy

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

“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

NC OPPORTUNITIES LOCUMS OR PERMANENT

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

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

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

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

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

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

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

Medical Practice Listings Selling and buying made easy

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

PEDIATRICIAN

or family medicine doctor needed in

FAYETTEVILLE, NC

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.

Comfortable seeing children. Needed immediately.

Call 919- 845-0054 or email: physiciansolutions@gmail.com www.physiciansolutions.com 54 | FEBRUARY 2015

List price: $435,000

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

Women’s Health Practice in Morehead City, NC

PEDIATRICIAN

OR FAMILY MEDICINE DOCTOR NEEDED IN

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

Credentialing at the hospital is necessary.

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

Medical Practice Listings Buying and selling made easy

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

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

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

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

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

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

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

Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624 PH: (919) 845-0054 | email: physiciansolutions@gmail.com WWW.MEDMONTHLY.COM | 55

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

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

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

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

Medical Practice Listings Buying and selling made easy

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

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

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

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

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

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

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

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

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

Contact Medical Practice Listings today to discuss the practice details.

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

www.medicalpracticelistings.com

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

Modern Med Spa Available

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

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

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

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

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

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

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

Contact: Cara or Philip at 919-848-4202

medlisting@gmail.com medicalpracticelistings.com

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

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

NC Opportunities DENTISTS AND HYGIENISTS

l One

Please direct all correspondence to driverphilip@gmail.com.

Only serious, qualified inquirers.

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

Call us today if you are available for a few days a month, on-going or for permanent placement. Please contact Physican Solutions at 919-845-0054 or physiciansolutions@gmail.com

Physician Solutions, Inc. Medical & Dental Staffing

The fastest way to be $200K in debt is to open your own practice The fastest way to make $100K is to choose

Physician Solutions

THE DECISION IS YOURS Physician Solutions, Inc. P.O. Box 98313 Raleigh, NC 27624 Scan this QR code with your smartphone to learn more.

phone: 919-845-0054 fax: 919-845-1947 www.physiciansolutions.com physiciansolutions@gmail.com