Med Monthly February 2017

PHYSICIAN SOLUTIONS PRESENTS

Med Monthly MAGAZINE

February 2017

Patient Centered Medicine –

The Promise of Quality Care pg. 28

Does Telemedicine Have a Role in Primary Care?

the

tive Preventa e Medicin issue

pg. 32

Pharmacy Intervention Established to Aid Against Antibiotic Resistant Bacteria pg. 26

Preventative Healthcare for Your Patients:

3 Top Secrets of the Antioxidant Tester pg. 22

contents

features

22 PREVENTATIVE HEALTHCARE FOR YOUR PATIENTS: 3 Top Secrets of the Antioxidant Tester 26 PREVENTATIVE MEDICINE: Pharmacy Intervention Established to Aid Against Antibiotic Resistant Bacteria

28

28 PATIENT CENTERED MEDICINE – The Promise of Quality Care 32 DOES TELEMEDICINE HAVE A ROLE IN PRIMARY CARE? THE FUTURE OF THE AFFORDABLE CARE ACT

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PATIENT CENTERED MEDICINE – The Promise of Quality Care

practice tips 6

HEARING LOSS PREVALENCE DECLINING IN U.S. ADULTS AGED 20 TO 69 YEARS

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THE FUTURE OF THE AFFORDABLE CARE ACT

14 WOMEN WITH HIGH-RISK CONGENITAL HEART DISEASE CAN HAVE SUCCESSFUL PREGNANCIES

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Med Monthly February 2017 Publisher Creative Director Contributors

Philip Driver Thomas Hibbard Naren Arulrajah Matthew J. Goldman Jordan E. Grushkin Nick Hernandez, MBA, FACHE Yolanda Goff, BS, CHC Carrie Noriega, MD Ken Yood

contributors 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. If you have questions about marketing your practice online, call Naren direct at 877-249-9666.

Nick Hernandez, MBA, FACHE is the CEO and founder of ABISA, a consultancy specializing in solo and small group practice management. He has consulted with clients in multiple countries and has over 20 years of leadership and operations experience.

Visit www.abisallc.com for more information.

Carrie Noriega, MD

Med Monthly is a national monthly magazine committed to providing insights about the health care profession focusing on practical advice for physicians and practices. We are currently accepting articles to be considered for publication. For more information on writing for Med Monthly, please email us at medmedia9@gmail.com.

is a board certified obstetrician/ gynecologist who has worked in both private practice in the US and a socialized medical system.

As an adventure racer and endurance mountain bike racer, she has developed a special interest in promoting health and wellness through science and medicine.

P.O. Box 99488 Raleigh, NC 27624 medmedia9@gmail.com Online 24/7 at medmonthly.com

MED MONTHLY MAGAZINE |5

practice tips

Hearing Loss Prevalence Declining in U.S. Adults Aged 20 to 69 Years 22|| DECEMBER 2013 6 FEBRUARY 2017

H

earing loss among U.S. adults aged 20 to 69 has declined over the last decade, even as the number of older Americans continues to grow. These findings, published today in JAMA Otolaryngology–Head & Neck Surgery, also confirm that hearing loss is strongly associated with age and other demographic factors such as sex, race/ethnicity, and education.

Noise exposure, which is potentially preventable, was also significant but less strongly associated after adjustment for other factors. The research was supported by the National Institute on Deafness and Other Communication Disorders (NIDCD), part of the National Institutes of Health, and the National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention.

To examine hearing loss trends over time in adults aged 20 to 69, researchers compared hearing health data collected as part of the National Health and Nutrition Examination Survey (NHANES) (link is external) over two time periods: 2011–2012 and 1999–2004. NHANES is a nationally representative health interview and examination survey of U.S. adults. NHANES participants listened to tones of various frequencies that were presented at different loudness levels. The researchers defined hearing loss as an average hearing threshold in at least one ear that was greater than 25 decibels in loudness (about as loud as rustling leaves). Data were also age- and sex-adjusted to reduce the effects of demographic differences across the two time periods.

The researchers found that the overall annual prevalence of hearing loss dropped slightly, from 16 percent to 14 percent, or 28 million adults, in the 1999–2004 period versus 27.7 million in the 2011–2012 period. This decline in absolute numbers was observed despite an increase in the population generally, and in the relative number of adults aged 50 to 69 in the more recent time period.

The new results are consistent with previous findings showing improvements in hearing over time, when researchers compared NHANES data from 1999 to 2004 with data from 1959 to 1962.

“Our findings show a promising trend of better hearing among adults that spans more than half a century,” said Howard J. Hoffman, M.A., first author on the paper and director of the NIDCD’s Epidemiology and Statistics Program. “The decline in hearing loss rates among adults under age 70 suggests that age-related hearing loss may be delayed until later in life. This is good news because for those who do develop hearing loss, they will have experienced more quality years of life with better hearing than earlier generations.”

The researchers do not know the reason why hearing loss prevalence is declining but speculate possible factors could include fewer manufacturing jobs, increased use of hearing protectors, less smoking, and advances in health including better medical care to manage risk factors associated with hearing loss.

Researchers found that age was the strongest predictor of hearing loss, with the greatest amount of hearing loss in the oldest age group surveyed (aged 60 to 69). Across all ages, men were about twice as likely as women to have hearing loss. In addition, lower education level and heavy use of firearms were associated with hearing loss. Non-Hispanic white adults were more likely to have hearing loss than adults in other ethnic groups, with non-Hispanic black adults having the lowest risk.

The researchers also found that age- and sex-adjusted hearing loss declined over the years for the averaged high frequencies (3–6 kilohertz) in both ears, and for speech frequencies (0.5–4 kilohertz) in one ear. People aged 70 and above, although not studied in this report, have the highest prevalence of hearing loss of any age group, according to the authors.

“Despite the benefits from the apparent delayed start of hearing loss, there will be an increased need for affordable hearing health care as the numbers of adults aged 70 and older continue to grow,” said NIDCD Director James F. Battey, Jr., M.D., Ph.D. “NIDCD continues to prioritize research on hearing health care for adults, including approaches to make treatment more accessible and affordable to improve the quality of life for the millions of Americans with hearing loss.”  Source: https://www.nih.gov/news-events/news-releases/hearing-loss-prevalence-declining-us-adultsaged-20-69-years MED MONTHLY MAGAZINE

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practice tips

The Future of the Affordable Care Act

By Ken Yood, Matthew J. Goldman and Jordan E. Grushkin Sheppard, Mullin, Richter & Hampton LLP Part I: How We Got Here: President Obama to Obamacare to President-elect Trump One thing that has become clear since the election of Donald Trump is that efforts to repeal or amend the Affordable Care Act (ACA) will be a high priority legislative item for next year’s Congress and the incoming Administration. But to have a better grasp of what the future of health care might look like under the Trump Administration, it is important to understand how the current healthcare landscape came to be. This first post in our blog series, Very Opaque to Slightly Transparent: Shedding Light on the Future of Healthcare, takes us on a brief stroll down memory lane of how and why the ACA became enacted, and how it has helped lead to the developments and trends we have seen in the healthcare industry.

The healthcare landscape prior to the enactment of the ACA was not entirely different to what it is today.

As is the case now, a majority of Americans prior to 8

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the ACA secured healthcare coverage through their employers, while certain government programs, including Medicare, Medicaid and the Children’s Health Insurance Program (CHIP), provided coverage for seniors and certain poor adults and children.

Nevertheless, many Americans grappled with certain inadequacies of the system in place at the time. Generally speaking, insurers had the ability in most states to deny coverage for those with pre-existing conditions, as well as the ability to stop coverage once individuals reached annual or lifetime limits. These practices made it extremely difficult for individuals with poor health histories to obtain adequate health insurance.

Further, because Medicaid and CHIP only provided coverage to certain categories of low-asset people (e.g., children, pregnant women and people with disabilities), many Americans found themselves too poor to afford health insurance, but not poor enough or otherwise eligible to qualify for government health-

care benefits. All told, prior to the passage of the ACA, some 45 million Americans lacked health insurance, while tens of millions of others found themselves underinsured. Moreover, health insurance was getting more expensive while incomes for many middle- and low-income families failed to keep up.

Healthcare reform was a major topic during the presidential election of 2008, and following the election, it became a top legislative priority for President Obama and the Democratic-controlled 111th Congress. Many healthcare proposals were debated, ranging from a single-payor, Medicare-for-all-type system, to other more modest proposals, but when dust finally settled in March of 2010, what emerged and was signed into law was the ACA. While the ACA contains an enormous amount of provisions, there are certain core features aimed at addressing the aforementioned problems of the American healthcare system. For example: • To help sicker patients obtain insurance, the ACA requires insurers to offer insurance to any applicant without looking into one’s underlying health status, and eliminates annual and lifetime coverage caps; • To help insurers absorb the risk of taking on sicker patients, the ACA generally requires all individuals to obtain health insurance, and to assist with that, the law creates insurance marketplaces to purchase insurance and provides subsidies to help make insurance more affordable; • The law also provides states with additional federal funding to expand their Medicaid programs to cover more individuals; and • The law contains certain payment incentives to providers to develop systems of coordinated, high quality and efficient care to patients.

While the debate about the efficacy of the ACA continues amongst legislators, economists and healthcare policy analysts, in the years since the ACA’s enactment, there have been some striking developments in the American healthcare system. Some 20 million people have obtained health insurance through ACA programs, and the uninsured rate is now under 9% nationwide, a record low, and down from the 16% right before the passage of the ACA. And while the savings envisioned by many of the payment incentive provisions of the ACA have, by and large, yet to be realized, the industry has seen a large movement in recent years towards providers assuming global risk

and investing in population health management. We have also seen a clear trend towards consolidation and convergence on both the payor side and the provider side in the shadow of the ACA. Part 2: Implications of Partial Obamacare Repeal In Part I, we discussed what the healthcare landscape looked like before the Affordable Care Act (ACA), how the law emerged from the healthcare reform policy debates and some of the major industry developments that have occurred since the law’s enactment. Beyond some of those changes, another significant development during the same time period has been the continued effort by many Republican members of Congress to repeal the ACA, an effort that has been stymied by President Obama and Democrats in Congress. With Donald Trump in office, Republicans have perhaps their best opportunity to put that effort into law, though Democrats may still be able to prevent a full repeal of the ACA. This begs an obvious question: what if Republicans are only able to repeal certain portions of the law, while leaving in place other significant provisions? What would this mean for the healthcare industry? This Part II of our blog series takes a look at some of the implications of a partial ACA repeal.

As a result of the 2016 presidential election, Republicans will soon have control of the Presidency, the House of Representatives and the Senate for the first time since the ACA’s enactment. Nevertheless, in order to pass an ACA repeal bill over an almost-certain filibuster threat from Senate Democrats, Republicans may need to use a process known as budget reconciliation, which only requires a simple majority, but only can be used to pass provisions directly affecting the budget. In fact, budget reconciliation was the legislative tool used by Senate Republicans in 2015 in a failed effort to roll back significant portions of the ACA. Accordingly, we look to the “Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015” (“Reconciliation Act”) to predict what a partial repeal scenario might look like.

Legislation modeled on the Reconciliation Act would get rid of the premium and cost-sharing subsidies that currently exist in the ACA exchanges and help millions of eligible Americans afford health continued on page 10 MED MONTHLY MAGAZINE

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insurance. The expansion of Medicaid, along with the individual mandate – which takes the form of tax penalties for those who fail to maintain insurance coverage – would go by the wayside. Other taxes designed to fund ACA programs would also be eliminated. What would remain, however, are those provisions that cannot reasonably be repealed through the budget reconciliation process: the requirement that insurers not discriminate against individuals with pre-existing conditions, the prohibition on lifetime and annual caps, the ability of children to stay on their parents’ plans until age 26, various changes to Medicare and other provisions that do not directly impact the budget.

If such a bill were enacted under President Trump, the insurance market would be left with the more popular but expensive elements of the ACA, but without the funding mechanisms to offset such costs.

The likely result would be the dreaded “death spiral” scenario, in which adverse selection (i.e., healthy Americans dropping coverage while sicker Americans seek or maintain insurance) leads to significant premium increases, causing further declines in coverage nationwide. Under such circumstances, one could expect to see less preventative care with a concomitant increase in patients presenting in the ER. It may be a good time to be an emergency medicine group!

At the same time, cuts to Medicaid could seriously harm hospitals, providers and other participants in the healthcare space whose business models depend on the expanded Medicaid dollars available to states under the ACA. A failure to adapt quickly could be cataclysmic for such businesses.

Even in the midst of such uncertainty, however, the move towards population health management initiatives and the assumption of financial risk by providers is likely to continue. Although such developments were perhaps hastened – or at least shone brighter – in the post-ACA healthcare landscape, there is some consensus (to the extent there is concensus on anything healthcare related) around the idea that they make fundamental economic sense for all participants.

Data shows that managed care, when done right, can improve health outcomes, reduce unnecessary costs and richly reward both providers and health plans.

Similarly, one can reasonably expect further consolidation in the marketplace. In light of the consolida22 || DECEMBER 10 FEBRUARY2013 2017

tion that has occurred to date, principles of inertia and competition should drive continuation of this trend.

While the partial repeal scenario explored in this post is a definite possibility, it would be foolish to take anything for granted. Given the uncertainty engendered by the political and economic dynamics at play, all we can do is speculate. Which is exactly what we will do next, in which consider another plausible scenario – full repeal and replacement of the ACA. Part 3: Exploring “Repeal and Replace” In Part II, Very Opaque to Slightly Transparent: Shedding Light on the Future of Healthcare, we considered potential healthcare market consequences of a partial repeal of the Affordable Care Act (ACA). In this Part III, we explore several potential “repeal and replace” scenarios that could unfold under the Trump Administration.

Tom Price Plan Tom Price, President Trump’s nominee to lead the Department of Health and Human Services, unveiled in 2015 the “Empowering Patients First Act” – legislation that would fully repeal the ACA and replace it with a comprehensive healthcare reform package.

Among the core tenets of the Price plan are: • Individuals who purchase health insurance through the individual market would be granted refundable tax credits for purchasing health insurance ranging from $1,200 to $3,000, depending on their age, although these tax credits would not be available to those receiving federal or other benefits, including Medicare, Medicaid, SCHIP and TRICARE. Similarly, individuals in employer subsidized group plans would be ineligible.

• People with pre-existing conditions could not be denied coverage if they maintain “continuous coverage” for 18 months before choosing a new policy. However, if an individual ceases to maintain such coverage, insurers can (i) impose preexisting condition exclusions for up to 18 months, and (ii) raise premiums up to 50% for up to three years. In addition, some federal funds would be available to the states to partially offset the cost of state-sponsored high-risk pools.

• The amount of money that companies would be permitted to deduct from their taxes for employee health insurance expenses would be capped at

‘‘

Another common element of the plans discussed is medical malpractice liability reform. Such reforms, proponents argue, would reduce the practice of “defensive medicine” and reduce costs associated with medical malpractice coverage, resulting in overall healthcare cost savings.

$20,000 for a family health insurance plan and $8,000 for an individual insurance plan.

• The Secretary of Health and Human Services would collaborate with various physician/medical organizations to develop clinical guidelines for the evaluation and/or treatment of medical conditions. Such clinical guidelines would provide a safe harbor for medical malpractice defendants who adhered to the guidelines absent clear and convincing evidence establishing liability otherwise.

In addition, the Secretary may award grants to states for the development and implementation of administrative healthcare tribunals.

• The use of health savings accounts (HSAs) – a mechanism that permits people to contribute pre-tax dollars to accounts dedicated to covering healthcare expenditures – would be incentivized in a number of ways (e.g., availability of a onetime $1,000 tax credit, increase in the allowable HSA contribution limits, ability to roll over an HSA to a surviving spouse and/or other family members).

• Insurers licensed to sell policies in one state would

be permitted to sell such products in other states.

• The expanded Medicaid coverage under the ACA would be eliminated.

Paul Ryan Plan Paul Ryan, Speaker of the U.S. House of Representatives, also has a widely discussed ACA replacement plan. Titled “A Better Way,” Paul Ryan’s proposal – which is a more of a set of guiding principles than fully developed legislation – has many elements in common with Tom Price’s plan. In particular: • Refundable tax credits of an indeterminate amount (but scaling up with age) would be available to individuals buying insurance plans in markets regulated by the states, not the federal government.

• Insurers would be permitted to sell plans across state lines.

• Insurers would not be permitted to discriminate against individuals with pre-existing conditions so long as such individuals maintain continuous covcontinued on page 12

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erage. A one-time open enrollment period would be available for individuals to join the health care market if they are uninsured, regardless of how healthy they are.

• The plan would promote wider use of HSAs. • States would be able to choose whether to accept federal Medicaid funding as a block grant or a per capita cap, with federal funding based on 2016 spending adjusted based on general inflation.

• The plan would encourage employers to support and adopt wellness programs.

• Changes to medical liability laws would limit the amount of money plaintiffs could recover in malpractice lawsuits.

• The government would fund, to some degree, high-risk insurance pools for the sick.

• Tax breaks on employer-based premiums would capped.

Richard Burr, Orrin Hatch and Fred Upton Plan Senators Richard Burr and Orrin Hatch, together with Representative Fred Upton, have also proposed a comprehensive replacement for the ACA. The “Patient Choice, Affordability, Responsibility and Em-

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powerment Act,” also known as the “Patient CARE Act,” has a number notable provisions, many of which align with the Price and Ryan proposals. Specifically: • Insurers would not be permitted to discriminate against individuals with pre-existing conditions as long as such individuals maintain continuous coverage, and there would be a one-time open enrollment period to enable individuals to obtain insurance, regardless of how healthy they are.

• Americans would be permitted to purchase coverage across state lines.

• Individuals who do not receive employer-sponsored coverage through a large employer (e.g., small business employees or unemployed individuals) would be eligible to receive an age-adjusted, advanceable, refundable tax credit, which would also be scaled to income relative to the federal poverty level.

• Reforms would help to expand eligibility for and the use of HSAs. • States would be allowed to utilize default enrollment – e.g., states could create a default enrollment option with premiums equal to the value of the tax credit so that the individual assigned to the plan would not be charged any additional premium. However, individuals would be able to switch plans or opt-out of coverage altogether.

• States could leverage high-risk pools with targeted federal funding.

• Medical liability reforms would place caps on non-economic damages and limitations on attorneys’ fees. In addition, states could elect to establish “health courts” presided over by judges with health care expertise.

• States would receive capped allotment federal Medicaid grants.

• Employers’ deductions for employee health insurance expenses would be capped at $30,000 for a family health insurance plan and $12,000 for an individual plan.

Healthcare Market Impact As outlined above, many of the Republican ACA replacement proposals have common elements. While it is impossible to forecast with any certainty the full effect of any replacement legislation, one can surmise the potential consequences of healthcare legislation modeled off of the above proposals.

One commonality among the plans described above is the enactment of changes to how the federal government funds state Medicaid programs.1 Generally speaking, Republican healthcare proposals would replace existing federal Medicaid funding structures and move towards block grants or per capita caps. On the one hand, proponents of such a shift in methodology contend that block grants and/or per capita caps would provide states with financial predictability and flexibility in designing and operating their programs in ways that improve the quality of care offered to beneficiaries and reduce costs. On the other hand, critics worry that such a shift could result in insufficient funding, which would force states to take steps to limit enrollment, reduce covered benefits, increase state revenue, and/or lower provider payments. Depending on funding levels and the political tendencies of state legislatures, providers in certain jurisdictions could be at risk for reduced Medicaid revenue.

The proposals described above also would permit insurers to sell insurance plans across state lines.

Those in favor of such an idea believe that it would encourage competition by allowing consumers to shop for cheaper insurance policies while simultaneously simplifying operations for insurers. Opponents of such an approach fear a “race to the bottom,” in which insurers seek to locate to states with the least stringent regulations and sick people are priced out of coverage.

Regardless of the impact on consumers, such a policy shift could prove to be a boon to companies wishing to enter the health insurance space, as the high costs and regulatory burdens that provide a barrier to entry, at least to some degree, theoretically would be reduced.

Another common element of the plans discussed above is medical malpractice liability reform. Such reforms, proponents argue, would reduce the practice of “defensive medicine” and reduce costs associated with medical malpractice coverage, resulting in overall healthcare cost savings. While the plaintiffs’ bar would certainly not welcome malpractice liability reform, and some consumers (or victims of professional negligence) would likely take umbrage as well, providers could potentially see cost savings and, all things being equal, increased profit margins as the cost of professional liability coverage decreases (though detractors may disagree).

As noted in the last installment in this series, barring a massive shift in the composition of legislature (e.g., Senate Republicans obtaining a filibusterproof majority in 2018), the buy-in of Congressional Democrats almost certainly will be required to pass legislation to replace the ACA. Consequently, the Republican proposals discussed herein are likely to undergo substantial modification if they are to attract the requisite Democratic support. Nonetheless, healthcare market participants looking to plan for the future could be well-served by understanding the general principles underpinning Republican healthcare reform proposals.  [1] Although the Empowering Patients First Act does not directly provide for Medicaid block grants or per capita caps, Tom Price’s proposed 2016 budget contemplates such block grants.

Part 1 Source: http://www.sheppardhealthlaw. com/2016/11/articles/affordable-care-act-aca/part-ihow-we-got-here-president-obama-to-obamacare-topresident-elect-trump/ Part 2 Source: http://www.sheppardhealthlaw. com/2016/12/articles/affordable-care-act-aca/part2-implications-of-a-partial-obamacare-repeal/ Part 3 Source: http://www.sheppardhealthlaw. com/2016/12/articles/affordable-care-act-aca/part3-exploring-repeal-and-replace/ Reprinted with permission by Sheppard, Mullin, Richter & Hampton LLP MED MONTHLY MAGAZINE

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practice tips

Women with High-risk Congenital Heart Disease Can Have Successful Pregnancies

New recommendations from the American Heart Association provide guidance to women with complex congenital heart defects and their healthcare providers about managing successful pregnancies, childbirth and post-natal care.

Women with complex congenital heart disease were previously advised to not get pregnant because of the risk to their life,“Women with 14

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complex congenital heart disease were previously advised to not get pregnant because of the risk to their life,” said Mary M. Canobbio, R.N., M.N., chair of the writing committee for the new scientific statement published in the American Heart Association journal Circulation.

“Now scientific research demonstrates that with proper management in the hands of experienced

cardiologists and obstetricians, these women can have successful pregnancies,” said Canobbio, who is also a lecturer at UCLA School of Nursing in Los Angeles, California.

Complex congenital heart defects are serious abnormalities of the heart’s structure that are present at birth. People born with these conditions need immediate medical care soon after birth that continues

throughout their lives. While most female children born with congenital heart disease will reach childbearing age and will do well, their pregnancy in women with complex congenital heart disease carries a moderate to high risk for both the mother and her child.

Pre-pregnancy counseling is essential for women with complex congenital heart defects so that they

have a clear understanding of how their heart abnormalities could affect both their own health and the health of their child during a pregnancy.

Once pregnant, a delivery plan is also essential, Canobbio said, so the medical team can anticipate problems that could happen during and following delivery and be prepared.

The authors recommend that pregnant women deliver their babies at medical centers that have a cardiologist experienced in managing complex congenital heart disease, obstetricians trained in high-risk maternal-fetal medicine, cardiac anesthesia, and a cardiac surgical team.

After delivery, monitoring of the mother needs to continue, because the effects of pregnancy can linger with the woman for six weeks and as long as six months.

Complex congenital heart defects include: • single ventricle, in which a patient is born with only one of the two chambers that pump blood; • transposition of the great arteries, in which the position of the two main arteries leaving the heart are reversed; • pulmonary hypertension a type of high blood pressure that affects the arteries in the lungs; • Eisenmenger syndrome, a condition in which a hole exists between the heart’s two chambers, causing blood to flow from the left side of the heart to the right, leading to high blood pressure in the lungs (pulmonary hypertension); and • severe aortic stenosis, a critical narrowing of one of the valves on the left side of the heart.

“This scientific statement out-

‘‘

“Now scientific research demonstrates that with proper management in the hands of experienced cardiologists and obstetricians, these women can have successful pregnancies.”

lines the specific management for these high-risk patients,” Canobbio said. “What we know about the risks for these patients, what the potential complications are, what cardiologists, advanced practice nurses and other cardiac health providers should discuss in counseling these women, and once pregnant, recommendations in terms of the things we should be looking out for when caring these women.”

Co-authors are co-chair Carole A. Warnes, M.D.; Jamil Aboulhosn, M.D.; Heidi M. Connolly, M.D.; Amber Khanna, M.D.; Brian J. Koos, M.D., D.Phil.; Seema Mital, M.D.; Carl Rose, M.D.; Candice Silversides, M.D.; and Karen Stout, M.D.; on behalf of the American Heart Association Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Cardiovascular Disease in the Young; Council on Functional Genomics and Translational Biology; and Council on Quality of Care and Outcomes Research. Author disclosures are on the manuscript.  Source: http://www.pressreleasepoint.com/women-high-risk-congenital-heart-disease-can-have-successful-pregnancies MED MONTHLY MAGAZINE

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U.S. OPTICAL BOARDS Alaska P.O. Box 110806 Juneau, AK 99811 (907)465-5470 http://www.commerce.state.ak.us/dnn/ cbpl/ProfessionalLicensing/DispensingOpticians.aspx Arizona 1400 W. Washington, Rm. 230 Phoenix, AZ 85007 (602)542-3095 http://www.do.az.gov 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/

Idaho 450 W. State St., 10th Floor Boise , ID 83720 (208)334-5500 http://www.ironforidaho.net/

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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://tn.gov/health

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.njsop.org/aws/NJSOP/pt/sp/ home_page 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

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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 https://www.commerce.alaska.gov/web/ cbpl/ProfessionalLicensing/BoardofDentalExaminers.aspx Arizona 4205 N. 7th Ave. Suite 300 Phoenix, AZ 85103 (602)242-1492 http://azdentalboard.us/ Arkansas 101 E. Capitol Ave., Suite 111 Little Rock, AR 72201 (501)682-2085 http://www.asbde.org/ California 2005 Evergreen Street, Suite 1550Â Sacramento, CA 95815 877-729-7789 http://www.dbc.ca.gov/

Hawaii DCCA-PVL Att: Dental P.O. Box 3469 Honolulu, HI 96801 (808)586-3000 http://cca.hawaii.gov/pvl/boards/dentist/ Idaho P.O. Box 83720 Boise, ID 83720 (208)334-2369 http://isbd.idaho.gov/ Illinois 320 W. Washington St. Springfield, IL 62786 (217)785-0820 http://www.isds.org/LawsLegislation/ boardOfDentistry.asp 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 https://www.colorado.gov/pacific/dora/ Dental_Board

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/ 18

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

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Louisiana 365 Canal St., Suite 2680 New Orleans, LA 70130 (504)568-8574 http://dentistry.ky.gov/

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/about/ Michigan P.O. Box 30664 Lansing, MI 48909 (517)241-2650 http://www.michigan.gov/lara/0,4601,7154-72600_72603_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://njpublicsafety.com/ca/dentistry/

Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)783-7162 http://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Dentistry/ Pages/default.aspx#.VbkfjPlPVYU

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 New York 89 Washington Ave. Albany, NY 12234 (518)474-3817 http://www.op.nysed.gov/prof/dent/ North Carolina 507 Airport Blvd., Suite 105 Morrisville, NC 27560 (919)678-8223 http://www.ncdentalboard.org/ North Dakota P.O. Box 7246 Bismark, ND 58507 (701)258-8600 http://www.nddentalboard.org/

Rhode Island Dept. of Health Three Capitol Hill, Room 104 Providence, RI 02908 (401)222-2828 http://1.usa.gov/u66MaB South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4599 http://www.llr.state.sc.us/POL/Dentistry/ South Dakota P.O. Box 1079 105. S. Euclid Ave. Suite C Pierre, SC 57501 (605)224-1282 https://www.sdboardofdentistry.com/ Tennessee 227 French Landing, Suite 300 Nashville, TN 37243 (615)532-3202 http://tn.gov/health

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

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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://www.medlicense.com/alaskamedical-license.html 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 20

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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://www.maine.gov/md/

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/

Michigan Bureau of Health Professions P.O. Box 30670 Lansing, MI 48909 (517)335-0918 http://michigan.gov/lara/0,4601,7-15472600_72603_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 https://www.nebraska.gov/LISSearch/ search.cgi 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://www.medlicense.com/new-jerseymedical-license.html 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.pa.gov/ProfessionalLicensing/BoardsCommissions/Medicine/ Pages/default.aspx#.Vbkgf_lPVYU 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://tn.gov/health

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/

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features

Preventative Healthcare for Your Patients:

3 Top Secrets of the Antioxidant Tester

By Yolanda Goff, BS, CHC HealthCare Program Development HCPN Alliance The Antioxidant Tester is the Pharmanex® BioPhotonic Scanner and its Resonant Raman Spectroscopy.

Now that the big “sciency” words are out of the way, let’s examine the technology that’s making a difference in the lives of doctors and their patients. We’ll be using Antioxidant Tester and BioPhotonic Scanner interchangeably.

Dr. Oz states the Scanner is a nutritional lie detector. But what does the Antioxidant Tester actually do 22

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and how long has it been available to doctors?

The Antioxidant Tester was invented at the University of Utah in 2001. It measures 18 different carotenoid antioxidants with a 30 second scan of the hand using Raman Spectroscopy. It provides a score, like 31,000, which indicates how much antioxidant protection a person has.

My introduction to the Scanner was in 2006. At that time I was taking vitamins, felt healthy, and thought my antioxidant score would be in the 40,000 range,

instead of at 26,000. I knew a little about antioxidants and knew they benefited the body, yet at 26,000, I did not have enough antioxidant protection to be healthy.

What I didn’t know then that I know now is that one’s Bio-score is directly related to how long one will live. Dr. Richard Cutler of the National Institute of Health stated, “The amount of antioxidants you maintain in your body is directly proportional to how long you will live.”

The U. S. Health Care System is in a crisis. Nutrition is hardly spoken of with patients and when it is, how do you as a physician know if your patient is compliant? Now there’s a way for physicians, nurses and allied medical clinicians to help their patients become more compliant to eating well for their health.

A weak or unhealthy immune system is the cause of autoimmune diseases and disorders.

Most common types of localized autoimmune disorders: l Multiple

sclerosis 1 Diabetes Mellitus l Ulcerative colitis l Crohn’s disease l Addison’s disease (adrenal) Autoimmune hepatitis (liver) l Hashimoto’s Disease (lowered thyroid function) l Celiac disease (GI tract) l Raynaud’s phenomenon l Graves’ disease (thyroid) l Guillain-Barre syndrome (central nervous system) l Type

Most common types of systemic autoimmune diseases: l Polymyalgia

Rheumatica (large muscle groups) l Rheumatoid arthritis l Scleroderma l Lupus l Sjogren’s syndrome l Systemic Sclerosis l Temporal Arteritis / Giant Cell (head & neck arteries)

As a recovering pharmaceutical representative, and in my tenth year with Pharmanex, I now get to work with preventive health care. I’m more excited than ever to share this amazing technology that’s measurable and changes lives.

I’d like to share the 3 secrets of using the Antioxidant Tester:

The first secret is your patients become more compliant with eating well for their health. This measuring device gives the patient an immediate result after their antioxidant test is completed. The testing is in Units of a thousand. The higher one’s Units the better, the healthier the person, i.e., as with the table below.

When people hear and see their number they become more aware and desire to eat better to improve their score. On the day the BioPhotonic Scanner was presented on the Dr. Oz Show he stated that his audience represented “America”, and 93% of his audience tested in the WEAK and POOR areas… That’s a D and F. What does that mean to your patient?

A+ 60,000 – 100,000 OPTIMAL Everyone is advised to strive for this level and above.

The higher your score the more able your body is to fight off disease and reduce the levels of oxidative stress and other risk factors that may happen in the body of those with lower scores. You will live a longer healthier life.

A 50,000 – 59,000 The higher your score the more able your body is to fight off disease and have low/managed oxidative stress levels and above average intake of fresh fruits and vegetables. Your lifestyle choices are lower exposures to sun pollution or smoke exposure. You will live a longer healthier life.

B 40,000 – 49,000 Healthy diets start here, but may not be enough for long-term disease prevention. At this level you are making positive lifestyle choices but need to get to the blue zone for maximum protection against disease.

C 30,000 – 39,000 People in this category are typically eating 3 -5 servings of fruits and/or vegetables per day, may or may not be supplementing or it could be an issue of absorbability.

This level is not sufficient for long-term protection. continued on page 24

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continued from page 23

D 20,000 – 29,000 People in this category are eating 1 -2 fruits or vegetables daily and are not supplementing or they are having gastrointestinal issues stopping nutritional absorption.

F 10,000 – 19,000 High oxidative stress leads to a low scan score and greatly reduces the bodies’ ability to fight disease. Half the US population scores in this range. The people who score in this range do not eat enough fresh fruit and vegetables, and/or the body is not absorbing their foods and nutritional support. This low of a scan needs immediate attention.

The second secret is this program integrates seamlessly and smoothly on top of any office existing protocol, adding up to $50,000 to any practice’s bottom line. It’s a proven cash-based model that’s been successfully implemented for over 10+ years into doctor’s offices across the U. S. It works because of the value and nature of Raman Spectroscopy, the validity of the

Pharmanex Antioxidant Test and how it’s used in the medical doctor’s office.

Doctors now have a measuring tool that validates nutritional levels in the body, and there is sciencebased nutritional therapy to support the clinician helping the patient to raise their Bio-score.

The third secret is that this is exclusive-patented technology that Lester Packer, Ph.D., UC Berkeley, “Father of antioxidants - coined the term antioxidants”, stated that the measurement of skin carotenoids by the Pharmanex® BioPhotonic Scanner is a convenient and useful indication of the body’s overall antioxidant status, and it’s available to test your patients in less than a minute. So what does this mean for you doctor?

Doctor’s who have implemented the Antioxidant Tester are seeing the patients numbers improve on many levels including potassium, WBC, PSA, hematocrit, glucose, cholesterol, LDL, CRP, A1C and antioxidants. This is a very effective tool for identifying your practice as proactive and cutting edge. 

Pharmanex® BioPhotonic Scanner (The Antioxidant Tester) If you are interested in: l HELPING

YOUR PATIENTS BECOME MORE COMPLIANT WITH EATING WELL FOR THEIR HEALTH

l ADDING

$50,000 TO YOUR PRACTICE WITHOUT INCREASING STAFF

l HAVING

YOUR PRACTICE BE IDENTIFIED AS PROACTIVE AND CUTTING EDGE WITH

EXCLUSIVE-PATENTED TECHNOLOGY We are 100% transparent. We have a spreadsheet for you to see the data. Our team is Healthcare Professionals Network Alliance (HCPN), we are a group of professionals made up of doctors, nurses, allied medical clinicians, businessmen and businesswomen who are dedicated and focused on helping healthcare professionals make a difference in the health of their patients.

Our Antioxidant Tester / Nutritional Therapy program is a complete turnkey program for your practice.

You rent the Tester with or without use of the company’s flagship products that are in the Physician’s Desk Reference.

We have over 4000 BioPhotonic Scanners in use worldwide and over 1000 being used in the healthcare industry.

Your HCPN Representative helps with the integration, and training for all the staff. We recommend our healthcare professionals attend a corporate training. Our most successful practices have attended the training. Trainings are available each month, so attending is made easy for any practice within the first 60days of integrating your HCPN Antioxidant / Nutritional Therapy program.

We invite you to register for our webinar now at www.yolandagoff.com/hcpn-webinar

24

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What’s your practice worth?

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

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

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

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

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

919.846.4747 bizscorevaluation.com

features

Preventative Medicine:

Pharmacy Intervention Established to Aid Against Antibiotic Resistant Bacteria

By Nick Hernandez, MBA, FACHE CEO and Founder of ABISA Preventable chronic illnesses take an enormous toll on our nation’s health and on our wallets. It has been estimated that almost half of the U.S. population currently has a chronic disease and with these patients being the most frequent users of our healthcare system, the costs are staggering. Some studies show that nearly two out of every five deaths in America are associated with preventable risk factors, including smoking, poor diet, lack of physical activity, and alcohol use.

Included in the discussion of preventive medicine should be should be an analysis of antibiotic resistant bacteria and also the critical role of pharmacy interventions.

Antibiotic Resistant Bacteria Trends Antibiotic medications have made a major contribution to human health. Many diseases that once killed people can now be treated effectively with antibiotics, but some bacteria have become resistant to commonly used antibiotics. Antibiotic resistant bacteria are bacteria that are not controlled or killed by antibiotics; they are able 26

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to survive and even multiply in the presence of an antibiotic.

Antibiotic resistance refers specifically to the resistance to antibiotics that occurs in common bacteria that cause infections. Antimicrobial resistance is a broader term, encompassing resistance to drugs to treat infections caused by other microbes as well, such as parasites (e.g. malaria), viruses (e.g. HIV) and fungi. Most infection-causing bacteria can become resistant to at least some antibiotics.

Bacteria that are resistant to many antibiotics are known as multiresistant organisms.

The World Health Organization (WHO) declares that antibiotic resistance is one of the biggest threats to global health today.

When infections can no longer be treated by first-line antibiotics, more expensive medicines must be used. A longer duration of illness and treatment, often in hospitals, increases health care costs as well as the economic burdens. Scientists have found that antibiotic resistant bacteria can spread from person to person in the community or from patient to patient in hospital.

According to WHO, in the European Union alone, drugresistant bacteria are estimated to cause 25,000 deaths and cost more than US $1.5 billion every year in healthcare expenses and productivity losses. In the United States, the Centers for Disease Control and Prevention (CDC) as found an ever-increasing number of cases related to drug-resistant bacteria.

Here are some recent facts published by the CDC: 154 million prescriptions for antibiotics are written in U.S. doctor’s offices and emergency departments each year.

2 million illnesses are related to drug-resistant bacteria every year.

23,000 deaths annually are linked to drug-resistant bacteria.

70% of prescriptions are considered necessary although improvements in selection, dose and duration are still needed.

44% of outpatient antibiotic prescriptions are written to treat patients with acute respiratory conditions (e.g. sinus infections, middle ear infections, pharyngitis,

viral upper respiratory infections, bronchitis, bronchiolitis, asthma, allergies, influenza, and pneumonia). The CDC estimates that 50% of these outpatient prescriptions are unnecessary.

30% of antibiotics prescribed are unnecessary. The CDC estimates that one in three prescriptions (or 47 million annually) are inappropriate.

In the United States, the government has put forth a “National Action Plan for Combating Antibiotic Resistant Bacteria” which aims to reduce inappropriate outpatient antibiotic use by 50% by 2020. They note that this would require the elimination of 15% of all antibiotic prescriptions.

Pharmacy Interventions Ask any physician about a key patient health issue as it pertains to medication and they will tell you it is patient compliance. Simply put, many patients do a poor job at actually taking their medications as prescribed. Community pharmacists have long been able to help reduce hospitalizations and total medical costs commonly associated with non–adherence to medications. In the peer-reviewed journal Population Health Management, Walgreens has recently published a study examining just how these pharmacy interventions can lead to improved medication adherence.

The Walgreens research examined data from over 72,000 patients who initiated therapy within 16 drug classes used to treat common chronic conditions, over a sixmonth period in 2013. The study, “Improving Medication Adherence and Health Care Outcomes in a Commercial Population Through

a Community Pharmacy”, also compared Walgreens patients with those using other pharmacies. The study’s author, Michael Taitel, PhD, noted: “These findings clearly illustrate that the combination of pharmacist counseling, medication therapy management, refill reminders and telephonic and digital pharmacy interventions, tailored to patients’ needs, drive better adherence. Further, this improvement in adherence results in fewer hospitalizations and emergency room visits, ultimately benefiting payers by lowering the overall cost of care.”

Here are some highlights of the study: • Patients eligible for Walgreens pharmacy interventions experienced a 3% greater medication adherence.

• Walgreens community pharmacy patients had 1.8% fewer hospital admissions.

• Overall, Walgreens new-totherapy patients had 3% lower total healthcare costs then comparable non-Walgreens patients.

• Walgreens community pharmacy patients had 2.7% fewer emergency room (ER) visits.

• On a per patient basis, those in the Walgreens intervention group incurred lower total healthcare costs, including pharmacy (-$92), outpatient (-$120), ER expenditures (-$38), and total health care costs (-$226) over a 6-month period.

Walgreens states that their interventions include pharmacy-based patient counseling, medication therapy management (MTM), and online and digital refill reminders.

For new-to-therapy patients, these programs included pharmacist calls and consultations; and for those continuing therapy, included MTM consultations, automated reminders, pickup reminders, late-to-fill reminders and face-to-face consultations.

Another study in Progressive Cardiovascular Disease showed that only about 50 percent of patients with chronic conditions take their medications as prescribed by their physicians.

Walgreens Chief Medical Officer, Dr. Harry Leider, comments on the recent Walgreens research: “Patients receiving a new chronic diagnosis and medication therapy are at very high risk for nonadherence to medication, and this important study demonstrates how a diverse set of pharmacy and digital interventions improves care while reducing total healthcare costs.”

When treating patients suffering with multiple chronic conditions and treated by a disparate team of providers, the resulting potential drug interactions provide a new and distinct challenge. Beyond medication protocol adherence, trend analysis of the effects of the pharmacological mix can now be measured in real time. Consequently, some have argued that perhaps the “gate keeper” professional should be a pharmacist rather than a PCP, given the enhanced role of medications treating patients today.  Nick Hernandez, MBA, FACHE, is CEO and founder of ABISA, an independent consultancy specializing in strategic growth initiatives (www. abisallc.com).

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features

Patient Centered Medicine –

The Promise of Quality Care

By Naren Arulrajah Ekwa Marketing

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The rise in chronic disease among populations and the rising cost of health care are driving forces behind the growing trend of patient-centered care in the U.S. It is not just the healthcare fraternity, but also a new breed of an empowered patient base and their families that are realizing the huge benefits of taking an active part in the healthcare process.

Under patient centered medicine, each patient is treated as a unique individual and as such is provided with customized healthcare options based on their needs.

The value of this new healthcare trend is now being recognized and embraced by leading healthcare organizations such as the American Academy of Family Physicians among others.

The Growing Importance of Implementing a Comprehensive Patient Centered Care Approach Miscommunication and rushed interactions between healthcare providers and the patient is one of the ills of the modern healthcare system. Healthcare quality delivery not only takes a hit, but more importantly it has led to a trust deficit between both the patient and the healthcare provider. Lack of education and awareness on the part of the patient limits participation in improving their own health. Even now, a significant majority of patients leave a doctor’s office without fully understanding their condition, the treatment options, as well as the approach suggested by the provider. This lack of communication can be hugely counter-productive to patient healthcare.

Under patient centered medicine the big area of focus is on equal participation and the forging of an open channel of communication between a patient and their healthcare provider. The patient has an equal opportunity to voice his concerns, seek better and more detailed information about their health condition. Patients with terminal illness also have the option to exercise their right to withdraw treatment if at any stage they feel that their treatment is not being addressed in a manner that aligns with their dignity and/or outweighs health benefits.

A personal and continuing relationship between the patient and the physician is also encouraged as a way of ensuring continuity so patients don’t wait till they face acute or an immediate healthcare risk before seeking medical help.

Another encouraging aspect of the patient-centered medicine approach is that it is considered to be an effective option for ensuring patients with chronic diseases have better control over their conditions. The rise in chronic conditions among adults across the U.S. is a worrisome factor because of the economics of rise in healthcare costs and impact on the economy. And although many chronic diseases are preventable, most patients either chose to ignore the importance of preventive medicine or are completely unaware of how they can take better control of their health.

However, with continuous care, a team based approach to patient health, and active patient participation, the dangers of chronic conditions can be effectively dealt with and in most cases avoided.

Benefits of Patient-Centered Medicine • The focus in patient centered care is on forging a proactive partnership between the patient and healthcare teams. continued on page 30

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continued from page 29

• Improved and open communication is encouraged between the patients and the physician.

• An active effort is made to understand not just the patient’s healthcare needs, but also to understand where they are coming from and to respect their decision making choices in improving their healthcare management.

• Medical decisions are based on and customized in keeping with the patient’s unique healthcare needs.

• Educating the patient and their families is a core aspect of patient centered medicine; every effort is made to keep the patient and their families completely aware of their health condition and their medication and treatment options at every stage.

• Each of the above mentioned steps help in building a strong trust component which is now being recognized as a critical aspect of delivering quality care to patients.

Information Technology Can Boost Patient Centered Medicine The prime focus of healthcare technologies is to enable patient care teams to keep a track of illnesses, to run important reports, and to effectively enhance care delivery across the healthcare organization. Increasingly information technology is proving to be a breakthrough aspect of ensuring success of patient centered medicine approach. Mobile devices in particular are proving to be highly effective means of ensuring patients have better control over their health.

Using technology tools such as email,

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| FEBRUARY 2017

video chat, and mobile apps, patients can benefit from better access to healthcare services.

Better use of remote patient monitoring systems on the other hand can help patient care teams continually monitor and collect medical and health data from patients enrolled in monitoring programs which again can lead to better health management. Understanding patient needs is integral to the patient centered medicine approach and the use of technology such as EHRs (Electronic Health Records) and patient management tools make it easy for patient care team members to quickly and easily access patient healthcare information so they have a better understanding of what the patient needs.

Conclusion Quality healthcare and delivery is steadily gaining prominence not only across the U.S., but also across the globe. There is a real and very immediate need for adopting a healthcare model that is open, quickly ac-

cessible, interactive, and focuses fairly and squarely on improving overall patient well-being. Patient centered medicine is one approach that can deliver on these goals effectively. By combining prevention, early and faster detection, better treatment options and greater patient education, patient centered medicine can be the healthcare model that completely addresses the needs of a patient based on their unique needs which in turn can lead to better health outcome.  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 140+ 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 855- 598-3320 to speak one-on-one with Naren.

MED MONTHLY MAGAZINE

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features

Does Telemedicine Have a Role in Primary Care?

By Carrie Noriega, MD Telemedicine is rapidly gaining in popularity for treating a variety of illnesses, thanks to faster internet connections, higher availability of smartphones, and improving insurance coverage. It is estimated that there are close to 200 telemedicine networks that service over 3,500 sites in the US. These networks are being utilized by a number of different entities including individual patients, hospital 32

| FEBRUARY 2017

networks, and non-governmental organizations (NGOs). It is estimated that over 1.2 million virtual visits were performed in 2016 in the US alone, which is a 20% increase over the previous year.1 Despite this rise in telemedicine, much of the care is being given by physicians who have no prior relationship to the patients they are treating. Most patients are using telemedicine to treat illnesses that

they would otherwise seek care for in an urgent care setting. For the most part, primary care physicians are not actively trying to establish long-term patient relationships via telemedicine. A recent poll of 1500 family physicians indicated that only 15% were using some type of telemedicine in their office practices.2 While the overwhelming majority of patients are still receiv-

ing their primary medical care in face-to-face interactions with their healthcare providers, a large number of patients are participating in telehealth in one form or another.

People who are emailing their doctors medical questions, checking their recent lab results via a patient portal, or participating in online support groups are all participating in telehealth. These types of encounters are increasing in the primary care setting as patient portals become more integrated with electronic medical records.

More prevention programs are being delivered through telemedicine and mostly target patients who are at risk for chronic diseases like diabetes, obesity, depression, and hypertension. Patients can access education programs or patient support groups that are run by nurses or trained personnel through patient portals to learn about the disease they are at risk for and healthy behaviors for reducing this risk. While one on one counseling with a physician is ideal, time constraints in present-day offices are making this more challenging to actually accomplish in a clinical setting. This is where these education programs can be used to provide valuable counseling for patients who might not otherwise receive it.

Telehealth systems can also be used to provide patients with reminders that certain preventative health services are due. These reminders can be about things such as the need for a vaccination, Pap test, or follow up blood pressure check. This service can be used in lieu of a phone call or mailed letter and will can a significant amount of staff time.

As the use of telemedicine increases, health systems are starting

to do more to attract patients to their clinics by launching telemedicine platforms. The ClickWell Care program was started at Stanford in 2014 to encourage 18 to 40 year olds to receive care from a primary care physician instead of urgent care clinics. The Stanford MyHealth mobile app was launched as part of the program and allows patients to make appointments, message their doctors, and access their medical records all from the convenience of their mobile device.3 The program also provides access to wellness coaches to help patients achieve their health goals. Patient satisfaction with the program has been high so far with strong patientphysician relationships being one of the key results of the program.3 While there are a number of important ways that telemedicine can be used in primary care clinics to improve patient care, actually implementing video based telemedicine systems is often difficult to accomplish in busy clinic settings.

Most clinics already have the basic infrastructure in place that is needed for this type of telemedicine but finding software that is encrypted and HIPAA compliant can be costly and time consuming. Time needs to be spent creating and implementing guidelines to establish exactly how the system will be used to interact with patients. Even after the telemedicine system is up and running, the mindset of practitioners has to change to allow patients less limited access to nurses and physicians.

This is often the most challenging part of successfully implementing telemedicine into clinical practice.

Even after an office sets up a video telemedicine system, receiving payment for the services provided by this system is proving to be a

complicated issue. Many employers and health plans are willing to pay for virtual urgent care visits but payment becomes more difficult when services are used to provide care for continuing issues. A number of states have passed laws that require health insurers to pay for services delivered virtually that they would pay for if the patient was seen in a clinic. However, the laws don’t require the reimbursement to be the same and actually receiving payment from insurers can be challenging.

There are certainly a number of benefits that telemedicine can offer in the primary care setting but there are still a number of hurdles to overcome before telemedicine has a major role in the primary care setting.  References: 1. American Telemedicine Association. About Telemedicine. http:// www.americantelemed.org/main/ about/about-telemedicine/telemedicine-faqs. Accessed January 4, 2017.

2. Beck M. How Telemedicine Is Transforming Health Care: The revolution is finally here—raising a host of questions for regulators, providers, insurers and patients. The Wall Street Journal. April 26, 2016. http://www.wsj.com/articles/howtelemedicine-is-transforming-healthcare-1466993402. Accessed January 4, 2017.

3. MacCormick H. ClickWell Care: An online primary care program designed to meet the needs of young patients. Scope Published by Stanford Medicine. February 22, 2016. http://scopeblog.stanford. edu/2016/02/22/clickwell-care-anonline-primary-care-program-designed-to-meet-the-needs-of-youngpatients/. Accessed January 9, 2017.

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Practices for Sale Medical Practices Pediatric Practice Near Raleigh, NC

Location: Minutes South of Raleigh, North Carolina List Price: $145,000 Gross Yearly Income: $350,000 Year Established: 1980(s) Average Patients per Day: 16-22 Total Exam Rooms: 5 Building Owned/Leased: Owned. Will sell or lease.

Contact: Philip or Wendy at (919) 848-4202

Urology Practice near Lake Norman, NC Location: Minutes from Charlotte, NC List Price: $165,000 Gross Yearly Income: $275,000 Year Established: 1980 Average Patients per Day: 12 to 15 Building Owned/Leased: Leased Contact: Philip or Wendy at (919) 848-4202

Primary Care specializing in Women’s Practice

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: Philip or Wendy at (919) 848-4202

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: Philip or Wendy at (919) 848-4202

Med Spa

Family Primary Care Practice

Practice Type: Mental Health, Neuropsychological and Psychological

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: Philip or Wendy at (919) 848-4202

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: Philip or Wendy at (919) 848-4202

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: Philip or Wendy at (919) 848-4202

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.

34

| FEBRUARY 2017

State of Cha-Ching.

Lindsay Gianni, Agent 12333 Strickland Road Suite 106 Raleigh, NC 27613 Bus: 919-329-2913 lindsay.gianni.f23o@statefarm.com

Get discounts up to 35% * Saving money is important.

That’s why you can count on me to get you all the discounts you deserve.

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

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

Listing Price: $430,000

*Discounts and their availability may vary by state and eligibility requirements.

For more information, please see or call a State Farm agent.

1101216.1 State Farm, Home Office, Bloomington, IL

Call 919-848-4202 or e-mail medlistings@gmail.com www.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 relocating and will assist as needed during the transition period. The gross receipts for the past three years average $650,000 and the list price was just reduced to $185,000. If you are looking to purchase a well equipped primary care practice, please contact us today.

919-848-4202 medlisting@gmail.com medicalpracticelistings.com

MED MONTHLY MAGAZINE

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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

Pediatric Practice Available Near Raleigh, NC

Pediatric practice located minutes south of Raleigh, North Carolina is now listed for sale. Located in an excellent area convenient to Raleigh, Cary, and Durham, it is surrounded by a strong health care community. This is a well established practice with a very solid patient base. The building is equipped with a private doctor’s office, five exam rooms, and an in-house lab.

Established: 1980s l Gross Yearly Income: $350,000 Average Patients per Day: 16 to 22 l List Price: $145,000

Call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com 36 | FEBRUARY 2017

We have several qualified MDs seeking established Urgent Care Practices in North Carolina.

Urgent Care Practices Wanted If you have an urgent care practice and would like to explore your selling options, please contact us. Your call will be handled confidentially and we always put together win-win solutions for the seller and buyer.

Call Medical Practice Listings today and ask for Philip Driver 919-848-4202.

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

l One

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

Please direct all correspondence to driverphilip@gmail.com.

Only serious, qualified inquirers.

PRIMARY CARE PRACTICE 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 Philip at 919-848-4202 to receive details and reasonable offers will be presented to the selling physician.

MedicalPracticeListings.com | medlisting@gmail.com | 919-848-4202 MED MONTHLY MAGAZINE

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Pediatrics Practice Wanted

Internal Medicine Practice in the Heart of Raleigh

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

This is a beautiful practice, well appointed with great street visibility, parking and a very strong patient following. There are 4 exam rooms and a procedure room. The lobby is very comfortable with hardwood floors and tastefully decorated.

The gross revenues are over $600,000 with a strong income after expenses.

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

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

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

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

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

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

MedicalPracticeListings.com | medlisting@gmail.com | 919-848-4202 38 | FEBRUARY 2017

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 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 is POISED FOR SUCCESS. 919.848.4202 medlisting@gmail.com medicalpracticelistings.com

Practice for Sale in Raleigh, NC

Urology Practice minutes from Lake Norman, North Carolina

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

List price: $435,000

Urology Practice minutes from Lake Norman is now listed for sale. This excellent located practice is convenient to Charlotte, Gastonia, Lincolnton and Hickory. With a solid patient base, procedures currently include; Adult & Pediatric Urology, Kidney Stones, Bladder Problems, Incontinence, Prostate Issues, Urinary Tract Infections, Wetting Problems, Erectile Dysfunction and related issues. Three exam rooms with two electronic tables and one flat exam table.

Established: 1980 l Gross Yearly Income: $275,000 Average Patients per Day: 12 to 15 l List Price: $165,000

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

Contact Philip or Danielle at 919-848-4202 or email medlistings@gmail.com MED MONTHLY MAGAZINE

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PEDIATRICIAN

or family medicine doctor needed in

FAYETTEVILLE, NC

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.

Comfortable seeing children. Needed immediately.

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

CALLING ALL WRITERS

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

Primary Care Practice For Sale in 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.

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

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

Contact us:

919-845-0054 medmedia9@gmail.com physiciansolutions.com

Editorial Calendar:

January - Politics & Your Practice February - Preventive Medicine 40 | FEBRUARY 2017

Medical Practice Listings

919.848.4202 | medlistings@gmail.com www.medicalpracticelistings.com

Located on NC’s Beautiful Coast,

Morehead City

Primary Care Specializing in Women’s Health Practice established in 2005, averaging over $540,000 the past 3 years. Free standing practice building for sale or lease. This practice has 5 well equipped exam rooms and is offered for $20,000.

919.848.4202 medlisting@gmail.com medicalpracticelistings.com

Discounts as big as a house.

Or condo.

Or apartment.

Lindsay Gianni, Agent 12333 Strickland Road Suite 106 Raleigh, NC 27613 Bus: 919-329-2913 lindsay.gianni.f23o@statefarm.com

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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 MED MONTHLY MAGAZINE

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

Scan this QR code with your smartphone to learn more.