Med Monthly February 2014

Med Monthly FEBRUARY 2014

the

Launching Your Practice’s New Med Spa Services pg. 44

’s Med Spa issue

Medical Spas Vs. Day Spas

Are They So Different? pg. 42

Top 10 Practices of Successful Medical Spas pg. 40

Blogging is a Cost-Effective Way to Promote Your Med Spa pg. 50

Adding Cosmetic Services to Your Medical Practice pg. 48

contents

14

features

PHYSICIAN ENGAGEMENT: A $100,000 Per Month Question

40 TOP 10 PRACTICES OF SUCCESSFUL MEDICAL SPAS 42 MEDICAL SPAS VS. DAY SPAS: Are They So Different?

44 LAUNCHING YOUR PRACTICE’S NEW MED SPA SERVICES 48 ADDING COSMETIC SERVICES TO YOUR MEDICAL PRACTICE 50 BLOGGING IS A COST-EFFECTIVE WAY TO PROMOTE YOUR MED SPA

insight 10 MEDICAL SPAS – A Booming Industry

international 24 INDIAN HEALTHCARE INDUSTRY: Foreign Investment Overview

research and technology 26 REVISED AUTISM SCREENING TOOL OFFERS MORE PRECISE ASSESSMENT

12 TIPS FOR LIVING WITH ARTHRITIS

28 2014 PQRS FOR LONG TERM CARE PHYSICIANS: Beatings Will Continue Until Morale Improves

practice tips

30 SPINAL CORD INJURY

14 PHYSICIAN ENGAGEMENT: A $100,000 Per Month Question

legal

18 HOW TO USE SOCIAL MEDIA FOR DOCTORS

32 COURT CHALLENGES THREATEN ACA PREMIUM TAX CREDITS

20 SMART HIRING IN HEALTHCARE

34 CMS AND OIG EXTEND EHR STARK LAW EXCEPTION

2014 PQRS FOR LONG TERM CARE PHYSICIANS: BEATINGS WILL CONTINUE UNTIL MORALE IMPROVES

28

36 A LOOK AHEAD: Top 5 Health Law Issues for 2014

the arts 52 FOLLOWING HIS BLISS: Jeff Brown – Artist, Physician

healthy living 54 OVEN BAKED SWEET POTATO FRIES

in every issue 4 editor’s letter 8 news briefs

60 resource guide 78 top 9 list

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

Call us today at 919-833-3836 x141

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

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editor’s letter

Medical Spa markets reached $2 billion in 2013. Medicine is moving away from simply taking care of illnesses to a pursuit of one’s wellbeing. How do these cosmetic procedures generate profit for your business? February’s issue of MedMonthly discusses the way that your Med Spa or a even a traditional practice can significantly increase revenue with elective treatments.

Karen Albright, owner of BodyLase Skin Spa, wrote the feature “Top 10 Practices of Successful Medical Spas”. Her number one suggestion is investing the proper amount of capital. The underestimation of money allocation is the biggest reason med spas fail. Other suggestions include hiring qualified, professional consultants that are well versed in this field.

If you already own a practice and are thinking about introducing cosmetic services, this is an excellent way to generate cash flow.

Since these treatments are not covered by insurance, it is just that, cash. Audrey McLaughlin’s article “Adding Cosmetic Services to your Medical Practice” gives reasons why this may be a direction your practice wants to go. First of all, the profit margin for these treatments is much higher than a regular office visit. Also, the initial cost to add cosmetic procedures is small, as drug companies often will provide samples and training.

All the features agree on one point: marketing is the major key to success. Marie Klee chose a less obvious way to promote services: blogging. In her “Blogging is a Cost-Effective Way to Promote Your Med Spa”, Marie tells you how to make blogging work for you. She said to start by doing some homework to find out which blogger would be best suited to represent your spa.

Then invite them for a complimentary day of treatments. When they write about their experience, the likelihood for new clients will be increased and “your ranking in Google will improve, increasing traffic to your website.”

The market for cosmetic treatments increased by 18% last year.

The profit margin is high. People pay cash. As long as you do the proper research and market your services wisely botox, juvederm and laser treatments might be a good way to increase your bottom line.

Next month’s issue covers locum tenens and travel nurses.

Ashley Austin Managing Editor

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Med Monthly February 2014 Publisher Philip Driver Managing Editor Ashley Austin Creative Director Thomas Hibbard Contributors Ashley Acornley, MS, RD, LDN Karen Albright Rod Baird Jennifer R. Breuer Jeff Brown, M.D. Lauren D’Agostino Michelle Durner, CHBME Jeffrey T. Ganiban Lori Gertz Barbara Hales, M.D. Marie Klee Audrey McLaughlin Dr. Pankaj Mohane Meghan O’Connor J. Peter Rich Nisha Salim Robert Stark, MD Daniel J. Whitlock, MD, MBA

Med Monthly is a national monthly magazine committed to providing insights about the health care profession, current events, what’s working and what’s not in the health care industry, as well as practical advice for physicians and practices.

We are currently accepting articles to be considered for publication. For more information on writing for Med Monthly, check out our writer’s guidelines at medmonthly.com/writers-guidelines P.O. Box 99488 Raleigh, NC 27624 medmedia9@gmail.com Online 24/7 at medmonthly.com

contributors Karen Albright owns and operates BodyLase Skin Spa, www.getbodylase.com, an award-winning medical spa that has been serving the Research Triangle area of North Carolina for over 11 years, with her husband, Daniel Albright, MD a board-certified surgeon. She is also the CEO of Medspa Consulting Group, a consulting business dedicated to ensuring the success of physicians starting or expanding new medical spas.

Rod Baird is Founder and President of Geriatric Practice Management (GPM) in Asheville, NC. Since 1977, he’s led provider and management organizations that deliver care to Medicare and Medicaid beneficiaries.

Programs he’s overseen include home health, personal care, hospice, rehabilitation hospitals, adult and psych daycare, alcohol/drug rehabilitation, industrial medicine and primary care practices.

Lori Gertz is the chief genius at her 15 year old strategic marketing company, Freakin’ Genius Marketing. Her intense focus on brand building is further strengthened by her uncanny ability to weave points-ofdifference through all of the tactical solutions, most specifically 1:1 marketing solutions. Her bestselling book on grassroots marketing techniques, Be the News: A Guide to Going Viral With Your Human Interest Story is available on Amazon.

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

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

WWW.MEDMONTHLY.COM |5

designer's thoughts From the Drawing Board Med Monthly’s “Research and Technology” section for February covers participating in the Physician Quality Reporting System to avoid reduction in Medicare Part B payments, spinal cord injury studies to improve the quality of life in patients suffering chronic pain, and a new Autism screening tool for a more precise assessment in children for an earlier diagnosis.

In Rod Baird’s article, “2014 PQRS for Long Term Care Physicians: Beatings Will Continue Until Morale Improves”, he shares how failing to satisfy the minimum participation requirements of the Physician Quality Reporting System in 2014 could reduce Medicare Part B payments in 2016 by -3.5%. He has provided several recommendations and strategies to avoid these penalties.

In “Spinal Cord Injury”, a new study by the Department of Violence and Injury Prevention and Disability, WHO, reports the survival rates are worse in low-income and middle-income countries suffering spinal cord injuries. They stress “Spinal cord injury is preventable, survivable, and need not preclude good health and social inclusion.” With 20-30% of people with chronic spinal pain showing clinically significant signs of depression, it is a medical concern that needs to be addressed through education and supplying adequate medical care and rehabilitation.

The Modified Checklist for Autism in Toddlers is a free, two-step screening tool used to detect children likely to have autism. As reported in “Revised Autism Screening Tool Offers More Precise Assessment” by the National Institutes of Health (NIH), it is intended for use at regular well-child checkups for children 16 to 30 months old. Using the revised tool, health care providers can focus energy where it is needed most and will reduce the number of families who need to go through additional testing.

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

Thomas Hibbard Creative Director

6 | FEBRUARY 2014

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news briefs

Studies Show Calcium Helps Sleep and Remedies Insomnia Warm milk has long been a highly recommended folk remedy for insomnia. Regarding this, William Sears, M.D. says: “Calcium helps the brain use the amino acid tryptophan to manufacture the sleep-inducing substance melatonin. This explains why dairy products, which contain both tryptophan and calcium, are one of the top sleep-inducing foods.”

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

In another report called “The Nutritional Relationships of Magnesium”, the author notes that the type of insomnia associated with a calcium deficiency causes difficulty with falling asleep. This same study says that: “Muscle cramps associated with calcium deficiency often occur at night and without exertion. Such cramps usually involve the calves and thighs, but not the hands or feet.”

Regarding magnesium, this study notes that the “Classical sign of magnesium deficiency is insomnia characterized

by falling asleep easily but awakening frequently throughout the night, with individuals finding themselves tired even after several hours of sleep.”

One natural insomnia remedy showing good results is Sleep Minerals II from Nutrition Breakthroughs. This natural sleep aid contains powerful forms of calcium and magnesium, the best known minerals for relaxation and sleep, as well as for restless leg syndrome, stomach health, teenage insomnia, and menopause insomnia. The ingredients are formulated in a softgel with healthy oils, making them more quickly absorbable than tablets or capsules and providing a deeper, longer-lasting sleep.

Kimberly B. of Troy, Michigan says: “I have been taking Sleep Minerals II for about a month now. I have tried everything out there and this supplement is amazing. I have suffered with insomnia for 2 1/2 years. I have also had restless leg syndrome my entire life and this is the first relief I’ve ever had...gone for a month now.”

Make good use of natural minerals as the first line of defense against insomnia. For more information on Sleep Minerals II, visit this page: http://www.nutritionbreakthroughs.com/html/sleep_remedy_for_insomnia_help. html  Source: http://www.pressreleasepoint.com/studies-showcalcium-helps-sleep-and-remedies-insomnia

SOON COMING NTHLY O IN MED M

coming In the up Med 14 issue, March 20 l be theme wil Monthly’s nens/ Locum Te rses Travel Nu

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GE Healthcare Centricity Practice Solution and Centricity EMR Receive 2014 Edition Meaningful Use Certification GE Healthcare today announced that Centricity Practice Solution 12.0 and Centricity EMR 9.8 have been certified as solutions that eligible healthcare professionals can use to attest for the Meaningful Use 2014 measures.

Under the HITECH Act of 2009, providers demonstrating meaningful use of a certified electronic health record (EHR) solution can receive financial incentives from the Medicare and Medicaid programs. To date, more than 12,170 Eligible Professionals (EPs) have successfully attested for Meaningful Use through GE Centricity Solutions.

“GE Healthcare was a great partner in helping us attest for Meaningful Use Stage 1,” said Tracie Keopplin, Physicians Medical Center, McMinnville, OR. “We look forward to implementing their 2014 Edition certified product, which we will use for Meaningful Use Stage 2. We expect that this will enable us to further enhance the coordination of care across our community.”

Centricity Practice Solution 12.0 and Centricity EMR 9.8 are compliant with the Office of National Coordinator (ONC) 2014 Edition criteria. In accordance with the applicable Eligible Professional certification criteria, adopted by the Secretary of Health and Human Services, Centricity Practice Solution 12.0 received certifications for both Complete and Modular EHR on 11/27/2013 and Centricity EMR 9.8 received certifications for Complete EHR on 11/27/2013 and Modular EHR on 12/2/2013 from the Certification Commission for Health Information Technology (CCHIT®), an ONC Authorized Certification Body (ACB).

The ONC 2014 Edition criteria support both Stage 1 and Stage 2 meaningful use measures required to qualify eligible professionals and hospitals for Medicare and Medicaid HIT incentive payments.

GE Healthcare certified EHR solutions for EPs are used across a wide range of healthcare delivery organizations, from small and large physician practices, to Federally Qualified Health Centers and Community Health Centers, to multi-specialty clinics with hundreds of providers.

“We are thrilled to achieve ONC HIT Certification supporting Meaningful Use 2014 measures, and we look forward to seeing our customers use Centricity Practice Solution and Centricity EMR to successfully attest in the coming year,” said Jan De Witte, President and CEO, GE Healthcare IT and Performance Solutions. “ONC HIT 2014 certification should help our customers recoup a portion of the financial investment they made implementing EMRs over the past decade. More importantly, we expect our ONC HIT 2014 certification to benefit patients by offering them enhanced access to their health information, helping to protect privacy, and enabling better sharing of health information to improve care coordination.”  Source: http://www.newswiretoday.com/news/137323/

PJITAW PERSONALIZED JUST IN TIME AIRWAY DEVELOPED A UNIQUE ALGORITHM TO HELP PREDICT APNEA EVENTS PJITAW is a young start-up that aims to convert all non-compliant sleep apnea patients into compliant patients as well as make sleep apnea treatment more comfortable to compliant patients and naive patients.

Today the majority of patients diagnosed with sleep apnea refuses the gold treatment standard of CPAP. PJITAW invented a unique algorithm that may predict an apnea/hypopnea event before it actually occur.

The ability to predict an apnea event will lead to more comfortable treatment’s solutions.

Part of PJITAW treatment’s IP will use this new algorithm to provide a unique, physiological solution to the patients using an advanced CPAP flow generator to improve compliance among CPAP users.

The same is true for HGNS treatment that does not work efficiently today as it awakens most patients that receive current solution. Use of PJITAW prediction algorithm will provide a much more comfortable solution to the patients receiving HGNS treatment and thus improve compliance.

In essence, PJITAW IP allows for much better control of treatment application and thus allow application of force in just the right value for just the right duration, which will result in much higher compliance.

The company states that this novel IP will allow change of treatment methodology in the entire sleep apnea market both for CPAP treatment application and for HGNS treatment application. Allowing many millions of noncompliant diagnosed patients to start receiving treatment and improve current treatment received by current users.

The company is searching for a strategic partner to leverage its unique IP that will enable 15m diagnosed non compliant patients that currently refuse treatment to start receiving it and avoid the consequences of refusing treatment.  Source: http://www.newswiretoday.com/ news/137762/ WWW.MEDMONTHLY.COM |9

insight

Medical Spas - A Booming Industry

By Nisha Salim Freelance Writer NishaSalim.com

F

or an image-obsessed society that fights tooth and nail against aging, it should come as no surprise that the medical spa industry is booming. Affluent customers who demand the best, whether it is essential healthcare services or elective cosmetic enhancements, make a beeline to high-end med spas for chemical peels and Botox shots.

Hybrids of medical clinics and day spas, medical spas are popular all over the world. South-east Asian countries promote spa tourism as the perfect complement to a beach holiday or for sightseers to relax and rejuvenate before heading back home. Marketdata Enterprises, in their 127 page report on medical spas, reveals that 2100 spas now

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operate in the US, and the $1.94 billion industry is poised to hit $3.6 billion by 2016.

For many physicians who own their own medical practice, the idea of starting a spa is alluring because it allows generation of additional income with the ability to better manage work hours. But unfortunately, the highly consumer-oriented patient base of the medical spa industry is not what a typical physician may be used to. Day-to-day operations of a traditional medical clinic and spa differ from each other in many significant aspects. To open up a spa and be successful, it is important to be mindful of the different dynamics of marketing, customer service, and sales in each industry.

SO YOU WANT TO START A SPA Physicians who are interested in developing a successful medical spa will find the following tips useful.

Determine whether it is a feasible idea

Ask and answer difficult questions before you take the plunge. Why are you considering opening your own medical spa? Are your goals realistic? Do you have an already existing patient base which will easily convert to spa customers?

Do you want to open a new spa or integrate medical aesthetic services into your own practice? Do you have enough money to fund infrastructure for the spa and the working capital? Do you have the financial ability to wait for at least three years till you start seeing some return on your investment? Have you found the right location? Do you have access to the right demographic?

Seek professional advice

If you have decided that you would like to go ahead, you may want to engage the services of a consultant, an accountant, and a lawyer, right from the get go. The medical spa industry must comply with several legal and regulatory requirements. It is crucial that you choose the right legal structure to protect yourself against any possible regulatory or legal issues, and to ensure that the practice is set up to be compliant with the law. The International Association for Physicians in Aesthetic Medicine (IAPAM) helps by holding symposiums to educate and empower physicians who want to step into the spa industry.

Set up the infrastructure

Equipment for medical spa can be expensive. If you lease the equipment rather than buy, you will be able to regularly update to the latest models offering state-of-the-art facilities. Make sure that the equipment company also provides support in replacing and repairing items quickly, and will also help train your staff in operating and maintaining the machines.

Choose, train, and develop your staff members

Remember that the medical spa industry is highly service-oriented. It is important to choose friendly, service-minded people to staff your spas with.

You may consider hiring spa staff from your existing employees and training them, or recruiting people who have medical spa experience and will therefore need no further training. The compensation for medical spa staff is usually structured different than for staff at a traditional practice. Spa employees will be encouraged to offer better services if their incentives are tied to performance and customer satisfaction.

Promote your practice

You will need to allocate a good amount of marketing and advertising budget to promote your practice. It is necessary to have a well-designed professional website and an active social media presence. Don’t be shy to ask for testimonials from satisfied clients. If you have celebrities as clients, highlight them to bring in new customers.

Venturing into the medical spa industry can be very rewarding. But if you take a leap without planning or thinking through the legal and regulatory issues, it can end up being a disastrous affair. It isn’t possible to run a medical spa like you would run a clinic. Customers can be cranky, fussy and will demand to be pampered and well taken care of. Extensive marketing, client interest, and unparalleled customer service are required to run a successful medical spa.  Nisha Salim is a freelance writer specializing in the healthcare niche. She also blogs about content marketing and social media. Find her on Twitter @nocnoi.

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insight

Tips for Living with Arthritis By the Center for Disease Control (CDC)

A

rthritis is the most common cause of disability in the United States, disabling 8.6 million adults and limiting the activities of nearly 19 million adults in all. CDC’s Arthritis Program is currently working to improve the quality of life for people affected by arthritis by raising awareness about the disease and showing what they can do to management it themselves. Arthritis types include osteoarthritis, rheumatoid arthritis, gout, systemic lupus erythematosus (SLE or lupus), fibromyalgia, and childhood arthritis. The number of adults with doctor‐diagnosed arthritis is projected to increase from 46 million now to 67 million by 2030, and more than one‐third of these adults will have limited activity as a result.

In addition, a recent study indicated that some form of arthritis or other rheumatic condition affects 1 in every 250 children.

Can I prevent arthritis?

Maintaining an appropriate body weight has been shown to decrease the risk of developing osteoarthritis and gout. Protecting your joints from injuries or overuse can reduce the risk of osteoarthritis.

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| FEBRUARY 2014

Certain arthritis risk factors cannot be controlled such as: • Age: chances of developing arthritis increase with age.

• Gender: 60 percent of the people with arthritis are women. Gout is more common in men.

• Genetic: Specific genes are associated with a higher risk of certain types of arthritis.

What should I do if I think I have arthritis?

For people who suspect they may have a form of arthritis, it is helpful to see a doctor to find out what type of arthritis it is. Although there is no cure for most types of arthritis, early diagnosis and appropriate management are important, especially for inflammatory types of arthritis.

The sooner you know about your disease the sooner you can begin to make lifestyle changes that will make managing your disease easier.

What can I do on my own to help my arthritis?

The goal in managing arthritis is to control pain, minimize joint damage, and improve or maintain function and quality of life. Engaging

in physical activity or participating in self management education to learn techniques to reduce pain, move more easily, and use medicines appropriately are proven ways to help you improve your quality of life.

Many people with arthritis also have other chronic illnesses such as diabetes, high blood pressure, and heart disease, for which physical activity and maintaining a healthy weight are also recommended. It is especially important that people with arthritis include the recommended amounts of physical activity as a part of their lifestyle. Physical activity is one major, non‐pharmacological way to effectively reduce arthritis symptoms such as pain, fatigue, and stiffness.

Self-management Activities: • Learn Arthritis Management Strategies • Be Active • Watch your Weight • See your Doctor • Protect your Joints More information about specific programs that CDC has found to be effective in helping people with arthritis can be found at http://www. cdc.gov/arthritis/interventions.htm 

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.

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practice tips

Physician Engagement:

A $100,000 Per Month Question

By Robert Stark, MD and Daniel J. Whitlock, MD, MBA Physician Wellness Services

14 | FEBRUARY 2014

Feeling engaged is a prime driver of physicians’ satisfaction and dissatisfaction with their jobs. When physicians feel a lack of engagement—or are outright disengaged—it manifests itself in various ways, from feelings of hopelessness, anger or cynicism to, ultimately, leaving or wanting to leave their jobs.

That’s a matter of particular concern given that turnover and prolonged vacancies are key cost drivers—estimated to run as high as $100,000 per month when all costs and lost revenue are considered.

Engagement as a term is used a lot—but what does it really mean to physicians? Lacking specificity around this—and solid metrics—it’s nearly impossible for healthcare organizations to achieve an increase in engagement with their physician population. This formed the primary goal of the nationwide, multi-specialty survey that Physician Wellness Services conducted with Cejka Search in late 2013— to gain a better understanding of what physician engagement really means to physicians and the organizations that employ them. By understanding what engages physicians, it can assist healthcare organizations in making increased physician engagement actionable.

Administrators often see non-engaged physicians as difficult—and are frustrated by behaviors that range from passivity to selective noncompliance to active resistance.

Yet, without physician buy-in and active participation in new initiatives around quality, efficiency, patient satisfaction and related strategies, healthcare organizations can have little likelihood of success.

The 1,666 physician respondents confirmed (with a 99% confidence level and +/- 3% margin of error against the national active physician population) that engagement is extremely important to their job satisfaction. Based on a 10-point Likert scale ranging from 1 (unimportant) to 10 (very important), the average score was 8.0, with a quarter scoring 10, and two-thirds (66.2%) scoring it in the high range. Yet, the survey showed that their actual feelings of engagement were lower, with average scores of 7.7 for engagement with their work, and just 6.4 for engagement with their organizations.

What Does Engagement Really Mean to Physicians?

Asked to evaluate 15 elements of engagement that were presented in the survey, physicians generally felt that all of the elements of engagement were very important to feeling engaged, based upon average scores ranging from 7.9 to 9.2 on a 10-point Likert scale. These were well above the 3.0 to 7.0 point mid-range and all in the upper quartile.

Moreover, a 10 was the top score by far for all of these elements.

The top five elements of engagement in absolute terms were:

• Respect for my competency and skills (9.2 average score) • Feeling that my opinions and ideas are valued (9.1) • Good relationships with my physician colleagues (9.1) • Good work/life balance (9.1) • A voice in how my time is structured and used (9.0) The least important elements were participation in setting broader organizational goals and strategies (7.9 average score) and working for a leader in innovation and patient care (8.1), followed by alignment with the organization’s mission and goals (8.2). However, given how high these scores were, it underlines the fact that these elements are still important to physicians—and thus, should not be discounted.

Physician respondents gave universally lower marks for how well they felt these elements were true of their current practices, with average scores ranging from 5.8 to 8.0 with a majority in the 6 range.

The gaps between what was important to feeling engaged and what was true of their current practices ranged from .9 to 2.6 points. The largest gaps were: • Feeling that my opinions and ideas are valued (2.6 point gap) • A voice in clinical operations and processes (2.4) • A voice in how my time is structured and used (2.4) • Fair compensation for my work (2.4) • Good work/life balance (2.4) These are sizable gaps between what is important to physicians to feel engaged and what they perceive they are experiencing in their current practice—but even more so with the ideal of a 10 score which, given physicians’ importance scores for all elements, is a better reflection of their true expectations.

A companion survey of administrators showed they essentially understand the degree to which specific elements are important to physicians’ feelings of engagement, but tend to overstate how well their organizations are providing what physicians want.

Engagement Drives Career Decisions

The cost of overestimating physician satisfaction and not doing enough to engage physicians may ultimately be reflected in higher physician turnover, lower morale and ultimately, sub-optimal performance operationally and clinically as physicians feel less buy-in around key organizational initiatives.

A significant survey takeaway was that administrators often underestimate how large a role engagement plays in physicians’ decisions to accept a practice opportunities and/or leave a current job.

When asked how important a role engagement plays in continued on page 16 WWW.MEDMONTHLY.COM |15

continued from page 15

physicians’ decisions to accept a practice opportunity: • The average score for physicians was 7.3 • The average score for administrators was 6.9 The gap in scores was even greater when asked about the role engagement played in physicians’ decisions to leave a practice: • The average score for physicians was 6.3 • The average score for administrators was 5.4 The degree to which administrators underestimate the role that engagement plays for a physician making career decisions is troubling given the predicted shortage of physicians as boomer physicians retire.

Steps for Building Engagement Initiatives So, what can healthcare organizations do to build engagement with their physician population?

1. Begin by checking the pulse of their physicians around engagement. Ask them how engaged they’re currently feeling—and what the drivers of engagement are for them. An online survey is ideal, were it’s more likely to get a higher level of participation if responses can be collected anonymously.

It’s important to dig as deeply as possible into specifics. The goal is to try to learn as much as possible about what physicians find the most important—and where they see the gaps with what they are currently experiencing.

2. Sharing the results of the survey in forums that encourage discussion and interaction is critical-nothing will speak louder about an organization’s commitment to engagement than airing the results and listening to physician reactions. If possible, recruit a physician to serve as a champion or thought leader who can guide the process and encourage participation.

3. Once there is clear definition around what is important for physicians to feel engaged, develop a roadmap of what needs to change, then communicate and act on it. Make the plan as tangible as possible, and provide tools and resources to support those who are impacted. As tempting as it will be to create a quid pro quo between the elements to focus on and specific organizational goals and initiatives, organizations should resist the urge. Pressing another agenda may be counterproductive and undermine efforts to foster engagement.

Best Practices

• Ensure that physicians are involved in decision-making at every step, and if possible, leading key initiatives and activities.

• Provide training to leaders on how to identify and

16 | FEBRUARY 2014

address barriers effectively—both with physicians and senior administrators.

• Ensure that there are clear benchmarks and accountability around each initiative— everyone should know who is responsible, time frames, and how progress or success will be measured.

• Measure progress periodically and adjust tactics, as needed. Communicate results honestly and constructively Organizations with highly disengaged physicians may want to bring in outside objective outside parties to facilitate the launch of their next engagement initiatives.

The ideal is to create passion in our physicians for their practice setting and their health system. The most successful organizations will do this. Physicians can’t have passion without first having engagement. Engagement is fundamental!

This survey provides the framework for understanding physicians’ needs to develop the same passion they have for their patients, but this time for their organizations.

Engagement is the key to igniting a powerful synergy that will distinguish the great organizations from the merely good ones. 

The 15 Elements of Physician Engagement 1. Respect for my competency and skills 2. Feeling that my opinions and ideas are valued 3. Good relationships with my physician colleagues 4. Good work/life balance 5. A voice in how my time is structured and used 6. Fair compensation for my work 7. Good relationships with non-physician clinical staff 8. A broader sense of meaning in my work over and above my day to day duties 9. A voice in clinical operations and processes 10. Opportunities to expand my clinical skills and learn new skills 11. Opportunities for professional development and career advancement 12. Good relationships with administrators 13. Alignment with my organization’s mission and goals 14. Working for an organization that is a leader in innovation and patient care 15. Participation in setting broader organizational goals and strategies Note: In rank order of absolute scores to the question: What is important to feeling engaged?

Here are just a few of the many comments physician respondents to the surveys made regarding engagement: Being engaged, to me, means being part of the team. It means knowing the goals and direction of the organization as well as being a part of the process.

[Engagement is] critical to the success and satisfaction physicians will experience as we go through the changes we will encounter in medicine in the next several years. Those systems whose physicians are fully engaged will succeed at the highest levels.

For many institutions, including mine, engagement is just a concept administrators use to proceed with the difficult, undesirable, but necessary task of working with physicians on running a hospital. They cite it when they want something, ignore it when it will make proceeding more laborious. An administrator who wants you engaged wants something from you, frequently for free.

Many hospital admins seem to think they can demand engagement. In my experience it is a function of mutual respect, good communication and a mission that at its heart supports good patient care. No substitutes exist.

Engagement is about control: control over time, the direction of my career, the number and type of patients I see, the midlevel staff and support staff that I work with. Engagement is a kind of part ownership.

Robert Stark, MD is a consulting physician for Physician Wellness Services, is medical director of the Cardiac Prevention Program at Greenwich Hospital. A board-certified internist and cardiologist, he practices in Greenwich, CT and is also a clinical assistant professor of medicine at New York Medical College.

Daniel J. Whitlock, MD, MBA joined Physician Wellness Services as a consulting physician to continue pursuing his interests in understanding and preventing physician stress and burnout. In his previous role as vice president of medical affairs at CentraCare Health System in St. Cloud, MN, he partnered with Physician Wellness Services to implement a supportive program for medical staff physicians and their families.

WWW.MEDMONTHLY.COM |17

practice tips

By Barbara Hales, M.D. www.thewritetreatment.com Despite the encouragement of open communication between patients and their physicians, establishment of patient portals and studies showing a great desire of patients to seek open communication with their doctors, misconceptions about social media and the Internet abound.

Use of social media n the medical community smacks of fear. You feel it and hear that in hospitals and medical meetings. Maybe even you feel hesitant to participate in social media.

That would be a BIG mistake!

Social media has changed the way we live and do business.

18 | FEBRUARY 2014

Lesson#1

Facebook has more than 1 billion users. More than 300,000 businesses are on Facebook. Research studies show that 79% of adults in the U.S. use social media.

The lesson? It’s time for you to have a Facebook page for your practice and your patients.

Lesson#2

Social media does have a purpose. It’s to: • Educate your viewers and fans • Engage your readers and patients • Clear up any misunderstandings • Let patients know about new techniques and solutions The material you post is for your reader, not for you.

That’s why it’s called YOUTube and not I-tube.

Lesson #3

Have a strategy instead of posting haphazardly. Posts should have a call-to-action (telling the readers what you would like them to do like clicking a button, or entering their email address to receive a free report) Posts should have fresh content. Old, stale content gives no reason for the reader to return and it also reflects on how current you may be in other areas of your business/ practice.

Lesson #4

Calmly sit down and list 7-10 keywords that describe you and your practice. Hint- what would someone type into the box when they are doing a Google search to find you?

Now, publish articles, blog posts and talk in forums/chat rooms about topics that include and stress those keywords.

When someone hears the words or phrases, they should immediately associate them with you.

Social media is most effective when combining it with other marketing plans like lectures, webinars, blogging and networking.

Lesson #5

Think of the questions that your patients ask. You hear many of these same questions throughout your day while consulting and examining patients. Make up a FAQ (frequently asked question) sheet with answers for people to request (thereby giving you their email address) Write a blog post of 400 words three times a week that each covers one question and answer in greater depth.

But keep your blog friendly, not clinical. Let your personality shine through.

Lesson #9

Be mindful of HIPAA and have a policy in your office that reflects it.

It is illegal to release patient information without express consent of that patient…but there is no need to! You can impart information without answering questions about a specific patient. If someone feels that they need to get personal, have them make an appointment.

Have a waiver on your site that states: • Privacy and security is secured • The site is not monitored 24 hours a day and so if it is an emergency, they need to go to the ER or contact you directly.

• Post clearly that the advice on the site is for educational and informational purposes only and not a treatment for a specific patient • No personal photographs are to be posted

Lesson #10

Communication is what it’s all about. If people share of themselves, they do not want to be ignored. They want the ability to engage with you as well as others on the site.

If posting and engagement is too time-consuming for you, outsource it to someone that will perform this function.

It will be well worth it for you! 

The Write Treatment

Lesson #6

Install a plug in on your blog post. Each time you publish a post, it will automatically appear on numerous sites simultaneously, cutting work time down considerably.

(Google +, twitter, LinkedIn, Facebook) Have share buttons so that those enjoying your post can forward it to their friends and family, thereby giving you more exposure.

Lesson #7

Implement an analytic tool that will allow you to see when and where your readers come to spend time on your site. You will also see by the time on the page whether or not the topic was of interest to your viewers so that you can frequent that topic again. Google Analytics is quite user friendly and has many good features.

Lesson #8

Share a story to illustrate a point and use descriptive words for your readers to imagine. (* don’t use a story about a real patient!) People relate to stories and remember them far longer than any advice you impart.

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

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

Barbara@TheWriteTreatment.com 516-647-3002

WWW.MEDMONTHLY.COM | 19

practice tips

SMART HIRING IN HEALTHCARE

By Michelle Durner, CHBME Applied Medical Systems, Inc.

20 | FEBRUARY 2014

Employees are one of the most important parts of any practice. They are the first faces that a patient sees when they walk through the door and can make a lasting impression when the patient leaves. They can be a huge asset, however, they can also be your biggest liability. You hire employees to be the face of your practice and the front line of customer service to your patients. They handle your money and are empowered to make decisions on your behalf. Would you trust the future of your practice with just anybody? More importantly, what steps have you taken to ensure that you haven’t already?

Just as there are rules governing every aspect of healthcare, there are rules and guidelines surrounding the employment process. Many who try to circumvent the process find it can result in a situation that quickly becomes costly, not only in terms of money, but also in terms of lost productivity by other staff members, low morale, legal ramifications, and more.

It’s worth the time and expense to develop a hiring plan and follow it. A successful hiring plan is comprised of many aspects but the most common are as follows: 1. Create the Position/Job Description. You won’t know the type of employee you are looking to hire without fully understanding what role you want them to play in your practice. The skillset required for a nurse is vastly different than that of a receptionist. To understand that role and to set the stage for a successful recruiting process, you should create a job description. Be sure that you create the complete job description. Most small medical practices have roles that overlap and you should consider that when hiring. For example, hiring for a medical biller position that will also include direct contact with patients will be different than one with no face-to-face contact.

2. Determine your compensation package. You can waste a good deal of time and effort if you don’t determine the salary range before beginning the recruitment process. You should know what competing practices pay for similar positions so that you are prepared to offer a competitive package to the right candidate.

If you are unsure of the going compensation for certain positions, you should talk to peers, go to websites such as www.salary.com, contact a staffing agency or look in trade publications which typically publish annual wage surveys.

3. Advertise. Now that you know what you are looking for and how much you are willing to pay for it, you are now ready to post your position. Ads can be expensive so consider other options such as Craig’s List, member associations, or try to hire from within. Please note, hiring from within can be an excellent option, except when it’s not. Make sure anyone that you are promoting possesses all of the skills that you have outlined in your job description. If not, and you promote someone that is not suitable for the job, it can have devastating effects on every aspect of your practice, including the overall employee morale.

4. Screen the respondents. As resumes are received and reviewed, determine which respondents best fit your job description. Next, you want to conduct phone screens as the initial contact. As you speak with each individual, make certain that what you have available, in terms of the job and the compensation, aligns with what the individual is looking for. In addition to qualifications and cost, it is imperative to make sure that the potential employee is a good fit with the current atmosphere of your practice. Employees in a medical office tend to be a tight-knit bunch, so be careful not to “stir the pot”, unless that is what you intend to do. Invite those who are qualified for the position and “pass” the criteria of your phone screen in for an in-person interview. Consider who it is important to involve in this process. It shouldn’t just be the direct supervisor.

5. Check out what you are “buying”. When candidates arrive for their interview, have them complete a job application. People can and will say anything on their resumes and you don’t have much recourse. If a new hire is found to have falsified information on your application, however, you have more available options. For the interview, have a standard set of questions pertinent to the job that you are hiring for. This same set of questions should be used for each candidate. If testing would be appropriate, you can do this while the candidate is on site. Finally, when you find the perfect fit, you will want to check references. Dig and talk to previous supervisors and others who can truly attest to the continued on page 22 WWW.MEDMONTHLY.COM | 21

continued from page 21

qualifications of the person you are considering to join your team. Finally, a background check is an easy and inexpensive way to further protect yourself from unknown liabilities. People pay to get inspections and reports before making a major purchase, shouldn’t you do the same before investing in your next hire?

If your practice files claims to any federally funded healthcare programs such and Medicare and Medicaid, you will also need to check the employee against the OIG Exclusions List, http://exclusions.oig.hhs.gov/, to ensure that they are not a sanctioned individual.

Anyone who hires an individual on the list may be subject to civil monetary penalties. In addition to checking the list at hire, you should develop a process to check existing employees against the list on a regular basis.

6. Prepare a formal offer letter. When you are ready to make an offer, you can speak to the candidate verbally but you will also want to prepare a formal offer letter. Include information that outlines exactly what you are offering - position, wages, start date, etc. Align expectations first thing.

7. Onboarding. Research shows that a strong, well delivered on-boarding process leads to more positive outcomes for new employees such as higher job satisfaction, better job performance, greater organizational commitment, stress reduction and lower turnover.

There are three areas of the onboarding process that are critical.

The first is that of New Hire Paperwork. Be sure to include paperwork required by federal and state law along with those specific to your office. The integrity of your employment recordkeeping is as important as the proper maintenance of tax files and bank records. Know what you are legally required to maintain and report. The I-9 is a federal form that’s a crucial part of new hire paperwork. It is an Employment Eligibility Verification Form required to be completed and maintained on file by ALL employers to verify an employee’s identity, and establish that workers’ eligibility to work in the United States.

And as an employer in the healthcare industry, you should strongly consider having all employees sign a confidentiality agreement.

New Hire Orientation allows employees to get started on the right foot by providing new hires with a solid orientation and welcome process. If possible, have the employee start on a date and time that is not extremely busy. Give them time to interact with your current employees and make sure that they see the entire workflow of the practice, not just the small 22 | FEBRUARY 2014

portion that they will be doing. In addition, some states have laws specific to certain information that must be communicated. Know the requirements of your state.

Training is important to allow the new employee to perform their duties in alignment with your organization’s protocol. In the training process, you should educate and communicate. No employee wants to fail. Help to ensure they are successful by spending the appropriate amount of time getting them acclimated to your office. Even if you are extremely busy, and any extra time spent training is an inconvenience, the effort will be rewarded over time. An employee that has not been trained properly is YOUR responsibility and will be extremely costly in the long run, especially if you have to begin the hiring process again. Some of the different formats for training are job shadowing/on-the-job-training, mentoring, formalized training through presentations, online/computer-based learning, and manuals.

You should determine which communications methodology, protocols and vehicles work for your practice.

Finally, all employees should receive formalized HIPAA training as part of the onboarding process, and then annually thereafter, to minimize your liability as a health care provider. Not only is HIPAA training a required element of HIPAA Compliance, it also mitigates your liability as a health care provider.

If you made it to the end of this article you might be overwhelmed by the amount of work required to have an effective hiring process. Don’t be. Take it one step at a time and be diligent in your efforts. If you do so, not only will your employees be successful in their positions, but you will reap the rewards in terms of culture, decreased hiring costs, decreased turnover and decreased liability. 

Michelle L. Durner, CHBME is the President of Applied Medical Systems, Inc. – a Durham, NC-based company which provides medical billing, coding, practice management, and consulting services to start-up practices, hospitals, private practices, and emergency physician groups across the nation. To contact Michelle or to learn more about Applied Medical Systems, visit www.appliedmedicalsystems.com

international

By Dr Pankaj Mohane Bionorr Health Care Pvt Ltd pmsnetwork@gmail.com The Indian healthcare industry was estimated at USD 40 billion in 2010 is expected to reach USD 280 billion by 2020. Large investments by private sector players are likely to contribute significantly to the development of India’s hospital industry, which comprises around 80% of the total market, according to the report ‘Indian Hospital Services Market Outlook’ by consultancy RNCOS. As per estimates by ratings agency Fitch, the sector is poised to grow to USD 100 billion by the year 2015 and further to USD 275.6 billion by 2020.

The Indian healthcare sector comprises the sub-sectors of hospitals, medical infrastructure, medical devices, clinical trials, outsourcing, telemedicine, health insurance and medical equipment. India presently has 0.5 million doctors, 0.9 million nurses and around 1.37 million beds, and has the highest number of medical and nursing colleges, at 303 and 3,904, respectively. In addition, the cost of medical treatment in India is one-tenth that compared to costs in the US and Europe.

The total FDI inflow into India in the hospitals and diagnostics sector for the period April 2000–April 2011 was USD 1 billion, according to the Department for Industrial 24 | FEBRUARY 2014

Policy and Promotion (DIPP), which is part of the Ministry of Commerce and Industry and which is responsible for formulating the FDI policy in the country.

Policy For Promotion

Various policy and promotion initiatives undertaken by the government for the healthcare sector include: .• Automatic FDI: India’s foreign investment policy is very liberal for hospitals. Since January 2000, FDI is permitted up to 100% under the automatic route for the hospitals sector in India. Approval from the Foreign Investment Promotion Board (FIPB) is required only for foreign investors with prior technical collaboration, but allowed up to 100%.

• Priority status: The government also allots priority to proposals of greater social relevance such as hospitals, life saving drugs and equipment.

• National Urban Health Mission (NUHM): This mission was set up in 2005 to address the healthcare needs of slum dwellers across urban India; there are nearly 4.26 crore slum dwellers spread across 640 towns and cities in India.

• Rise in funding for the sector: The government has increased the plan allocation for public health spending to USD 5.96 billion in 2011–12 from USD 4.97 billion in 2010–11. Further, the Ministry of Health and Family Welfare has decided to increase health expenditure to 2.5% of GDP by the end of the 12th Five-Year Plan, from the current 1.4%.

• Encouraging policies: The government is also encouraging the growth of this market through policies such as a reduction in import duties on medical equipment, higher depreciation on life-saving medical equipment (40%, up from 25%), and a number of other tax incentives.

• Reduction in customs duty: Customs duty on lifesaving equipment has been reduced to 5% from 25%, and is exempted from countervailing duty. Import duty on medical equipment has been reduced to 7.5%.

Major Players

Many foreign players have entered the Indian healthcare market due to the large market. Some of these foreign players are Pacific Healthcare of Singapore, which is a JV with Vital Healthcare in Hyderabad; Columbia Asia Group, a Seattle-based hospital services company; Wockhardt Hospitals; Steris, a US-based medical equipment company that has set up a wholly-owned arm in India; and Amcare Labs, an affiliate of Johns Hopkins International of the US, which has set up a diagnostic laboratory in Hyderabad through a JV with the Apollo Group.

Besides hospitals, foreign players have also evinced interest in establishing research and development (R&D) centers in India; for example, Abbot Laboratories has announced plans to set up an R&D centre in collaboration with Syngene, a contract research subsidiary of Biocon Ltd., to develop nutrition products in India; US pharma company Merck, which is known as MSD outside of the US and Canada, plans to set up a laboratory in New Delhi for developing vaccines at an estimated cost of USD 133.93 million.

In addition, India is now acknowledged as the premier destination for medical tourism, owing to cheaper costs and treatments in the country. According to industry estimates, the market size of medical tourism in India is growing at over 25% annually at over USD 2.5 billion.

The segment’s growing business potential prompted the ITC Group to set up the 58-room Fortune Park Lake City business hotel at the Jupiter LifeLine Hospitals complex in Thane, near Mumbai, to serve medical tourists. Most international patients are from Africa, SAARC and West Asia. Patients requiring higher-end tertiary care are now coming to India for cardiology, orthopaedics, neurology, oncology and organ transplants. Affordability of treatment is a big pull factor — treatment in India costs just 10% to 20% of what it costs abroad.

Domestic hospitals have a long-standing reputation in the healthcare sector; some of the prominent private Indian hospital chains that offer world-class medical treatment include Max Healthcare, Fortis, Escorts Healthcare, Moolchand Hospital, Manipal Group of Hospitals, Woodlands Multispeciality Hospital, Anandlok Hospital, Jitendra Narayan Ray Sishu Seva Bhavan and General Hospital, Apollo Group of Hospitals, Sarvodaya Hospital, Suguna Ramaiah Hospital, Chinmaya Mission Hospital, Manipal Hospitals, Narayana Hrudayalaya, CSI Kalyani General Hospital, KHM Hospitals, Kumaran Hospitals, P. D. Hinduja National Hospital, Joy Hospital, Sir H. N. Hospital and Research Centre, Sowmya Hospital, etc.

Sector Outlook

The main areas where a number of market opportunities exist for both domestic and foreign players in the Indian healthcare domain include medical tourism, healthcare insurance, telemedicine and medical equipment.

The main drivers of growth in the healthcare sector are India’s booming population; growing middle class; increasing purchasing power; growth in infectious, chronic degenerative and lifestyle diseases; and rising awareness of personal healthcare.

Some of the advantages and opportunity areas for further growth of the sector are: • A low-cost destination: India provides best-in-class treatment, in some cases at less than one-tenth the cost incurred in the US and Europe.

• Rising medical tourism: The main factors contributing to rising medical tourism in India are presence of a well-educated, English-speaking medical staff, as well as state-of-the art private hospitals and diagnostic facilities.

• Growing economy: With a growing middle class, and rising health awareness and purchasing power, the healthcare insurance sector is poised for strong growth in coming years in India.

• Telemedicine: Growth in the telemedicine subsector is taking place due to the need for specialist doctors in rural areas, as most of them live in urban or semi-urban centers of India. Rural areas, roughly with a population of 700 million, can be provided healthcare facilities through telemedicine, with remote diagnosis, and monitoring and treatment of patients via videoconferencing.

• Healthcare infrastructure: Growth in Indian healthcare infrastructure is accompanied by strong demand for medical equipment such as x-ray machines, CT scanners and electrocardiographs, highlighting an opportunity for global players making quality products in this space.

• Rising population: In 2011, India’s population was 1.21 billion and by 2030, India is expected to surpass China as the world’s most populous nation.  WWW.MEDMONTHLY.COM | 25

research & technology

Revised Autism Screening Tool Offers More Precise Assessment

An updated screening tool that physicians administer to parents to help determine if a very young child has autism has been shown to be much more accurate than earlier versions at identifying children who could benefit from further evaluation, according to researchers supported by the National Institutes of Health.

The Modified Checklist for Autism in Toddlers — Revised, with FollowUp (M-CHAT–R/F) — is a free, two-step screening tool used to detect children likely to have autism. It is intended for use at regular well-child checkups for children 16 to 30 months old. With the M-CHAT-R/F, health care providers can classify a child’s risk of having autism as low, medium or high, on the basis of parents’ answers 26 | FEBRUARY 2014

to 20 questions.

“This checklist can more accurately identify children likely to have autism so they can get the treatment and support they need,” said Alice Kau, Ph.D., of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the NIH institute that funded the study. “Given that the typical autism diagnosis occurs at age 4, it also offers the possibility of detecting autism much earlier — during regular doctor’s visits when a child is 18 months or 2 years old. And earlier intervention has been shown to improve outcomes for children with autism.”

A score in the high-risk range warrants a referral for further evaluation for possible autism. For

a child determined to be at medium risk, M-CHAT R/F includes a followup questionnaire used soon after the original evaluation to obtain additional information needed to more definitively classify the child as either high risk or low risk.

Based on the M-CHAT-R/F classifications, the researchers found that a smaller proportion of children received a medium- or high-risk assessment (7 percent) than with earlier versions of the checklist (9 percent). However, more total cases of autism were detected with the revised checklist than with earlier versions (67 cases per 10,000 screened vs 45 cases per 10,000 screened).

Of the more than 16,000 children evaluated with the screening tool, 93

Testing during routine checkups indicates earlier diagnosis possible

percent of the children screened were considered low-risk, 6 percent were in the medium-risk range and 1 percent were considered high-risk.

Of all the children who determined by the test to be at risk after the M-CHAT-R/F follow-up, 95 percent were eventually found to have some form of developmental delay, including more than 47 percent with autism spectrum disorder.

First author Diana L. Robins, Ph.D., of Georgia State University (GSU), in Atlanta, conducted the research with GSU colleague Karís Casagrande, and Marianne Barton, Ph.D., ChiMing Chen, Ph.D., Thyde DumontMathieu, M.D., M.P.H., and Deborah Fein, Ph.D., all of the University of Connecticut in Storrs. Dr. Fein was the

study’s senior author.

The findings appear in Pediatrics.

The researchers updated an earlier version of the autism screening tool, adding examples, rephrasing some questions and dropping others that previously did not elicit strong responses. Using the revised tool, the researchers worked with health care providers to screen more than 15,000 toddlers considered at low risk for autism.

“Earlier tools cast a wider net, but these refinements will allow health care providers to focus energy where it is needed most and will reduce the number of families who go through additional testing but which ultimately do not need treatment interventions,” said Dr. Fein.

The free autism screening tool is available online in more than 45 languages.

This study was supported by NIH grant number R01HD039961.  About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit the Institute’s website at http://www.nichd.nih.gov/.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih. gov.

Source: http://www.nih.gov/news/ health/dec2013/nichd-23.htm

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research & technology

2014 PQRS for Long Term Care Physicians:

BEATINGS WILL CONTINUE UNTIL MORALE IMPROVES

By Rod Baird Geriatric Practice Management

According to CMS, only 25% of eligible professionals participate in Physician Quality Reporting System (PQRS). CMS has a strategy to improve this dismal level of enthusiasm to 40% – triple the number of Quality Measures required for successful participation. Here is the quote from the Final 2014 Physicians Fee Schedule (emphasis added): For the commenters who urge us not to raise the satisfactory reporting criteria for the PQRS until participation in PQRS increases, we understand that, as discussed in this final rule below and in the 2011 PQRS and eRx Reporting Experience, participation in the PQRS has fluctuated around 25 percent among those eligible to participate in the PQRS. Indeed, it is one of our major goals to increase participation in the PQRS. While increasing the satisfactory reporting threshold for the 2014 PQRS incentive may deter or discourage some eligible professionals from participating, we believe that this increase to the satisfactory reporting threshold will not significantly deter eligible professionals from participating in the PQRS. Providers who fail to satisfy minimum participation requirements in 2014 will suffer Medicare Part B payment 28 | FEBRUARY 2014

reductions in 2016. The magnitude of those reductions depends on group size. l

All eligible providers are subject to a 1.5% penalty if they fail to meet minimum participation levels. The minimum reporting level for LTC is satisfactorily reporting on three individual measures for 50% of eligible patients. l Providers wishing to achieve the +0.5% incentive for successful reporting must report on nine PQRS measures for 50% of eligible patients across three domains of care, or on one measures group. l If you work in a medical group with 10 or more providers you are subject to an additional penalty of 2.0% under Value Based Purchasing (VBP) if you (or your group) don’t report at least three PQRS measures for 50% of eligible patients. This VBP penalty will apply to every eligible provider in 2015 under the current rules. l The two penalties for nonparticipation are additive; that means large groups will have their 2016 Medicare Part B reimbursement cut -3.5%in 2016 if they

fail to satisfy the 2014 PQRS and VBP reporting requirements.

Let’s assume you become more motivated to participate, now that it is up to three times more difficult to succeed (nine measures vs. three measures prior to 2014). What strategy should you employ?

Last month, CMS conducted a national call to review the 2014 Medicare Physician Fee Schedule. You can view the slide deck for the call here. The call covered many of the 2014 changes that affect EHR and Quality Reporting.

Starting on Slide 45, CMS lists the reporting options available for individuals and groups to satisfactorily report PQRS. I count 26 different choices to report. The best option depends on whether you are simply avoiding the -2% penalty, or trying to achieve the +0.5% incentive payment.

Obviously larger groups have a compelling imperative to avoid the cumulative 3.5% reduction in 2016 payments.

Basic recommendations to avoid penalties Select at least three 2014 PQRS measures to use for the year. t We’ve prepared a list of all 2014 PQRS measures that apply to typical LTPAC CPT code families (90791, 90792, 99304-99310, 99324-99334). That list of codes based on CMS tables is available here. n The individual measures are listed by PQRS number, which is how CMS published the tables.

You can find the individual measures, and measures groups, with full descriptions on the CMS PQRS website. l Read each measure and determine how you are supposed to document satisfactory participation. Many definitions have changed from 2013 to 2014, so pay attention to verify that past documentation strategies are still compliant. l Validate how to report results (claims, registry, etc.).

A significant reporting change in 2014 states that all measures groups are only reportable by a qualified registry. l Train clinical and office staff on documentation and reporting. l Track your progress throughout the year (CMS promises to provide tools by mid-year to verify your status if using claims based reporting. Registries provide the ability to validate data prior to submission in early 2015). l

Recommended strategy for both avoiding penalties and earning 0.5% incentive (not using a 2014 certified EHR product) l

Follow the basic recommendation (above). Select three individual measures for your group to implement.

Select an appropriate measures group that applies to LTPAC patients. t Report on this measures group for each eligible professional. This requires a threshold of 20 patients or 80% of all eligible patients seen by the provider. t In past years we’ve recommended the CAD measures group for PCPs working in LTPAC. Because staff members are familiar with the measures, we will continue with this measures group. This is a list of 2014 measures groups that apply to 99304-99310: n Hypertension n Parkinson’s disease n Dementia n Coronary artery disease n Heart failure n Chronic kidney disease n Diabetes l

Strategy for groups using a 2014 certified ambulatory EHR and reporting PQRS by use of the EHR’s eCQMs It is critical to verify your EHR is up to date and using 2014 eCQMs. There are several versions of CQMs available, so check with your vendor that the ones you are going to use are certified for 2014 PQRS reporting. t WARNING: An eCQM is eligible for use as a PQRS measure, but an individual PQRS measure is not an eCQM. l Each EHR is certified for a minimum of nine eCQMs. t eCQMs are reported to CMS through your vendor or a special type of registry. t eCQMs don’t use CPT codes or CPT II codes as part of their definition. This is what prevents them from being reported like traditional PQRS measures. l EHRs can also include PQRS measures which are reported on claims or via registry. l Plan your reporting strategy. You have to report on at least 50% of all eligible patients for the year. t If you don’t start using your 2014 EHR early in the year, you may miss hitting the 50% threshold. That is particularly problematic for the influenza measure, which only counts patients seen from Oct. 1, 2013 through March 31, 2014. t Meaningful Use only requires reporting for 90 consecutive days during the year. That is a different threshold than PQRS. l Remember that you have to have at least one patient in the eCQM, and you have to demonstrate satisfactory performance on one patient to use it as a PQRS measure.  l

Source: http://ltcmanagement.com/index.php/pqrs/56-pub WWW.MEDMONTHLY.COM | 29

research & technology

Spinal Cord Injury: as many as 500,000 people suffer each year

Survival rates worse in low-income and middle-income countries

30 | FEBRUARY 2014

As many as 500 000 people suffer a spinal cord injury each year. People with spinal cord injuries are 2 to 5 times more likely to die prematurely, with worse survival rates in low- and middle-income countries. The new WHO report, “International perspectives on spinal cord injuries”, summarizes the best available evidence on the causes, prevention, care and lived experience of people with spinal cord injury.

Males are most at risk of spinal cord injury between the ages of 20-29 years and 70 years and older, while females are most at risk between the ages of 15-19 years and 60 years and older. Studies report male to female ratios of at least 2:1 among adults.

Causes: 90% traumatic

Up to 90% of spinal cord injury cases are due to traumatic causes such as road traffic crashes, falls and violence. Variations exist across regions. For example, road traffic accidents are the main contributor to spinal cord injury in the African Region (nearly 70% of cases) and the Western Pacific Region (55% of cases) and falls the leading cause in the South-East Asia and Eastern Mediterranean Regions (40% of cases). Non-traumatic spinal cord injury results from conditions such as tumors, spina bifida, and tuberculosis. A third of non-traumatic spinal cord injury is linked to tuberculosis in sub-Saharan Africa.

Consequences of spinal cord injury

Most people with spinal cord injury experience chronic pain, and an estimated 20-30% show clinically significant signs of depression. People with spinal cord injury also risk developing secondary conditions that can be debilitating and even life-threatening, such as deep vein thrombosis, urinary tract infections, pressure ulcers and respiratory complications.

Spinal cord injury is associated with lower rates of school enrollment and economic participation. Children with spinal cord injury are less likely than their peers to start school, and once enrolled, less likely to advance.

Adults with spinal cord injury face similar barriers to socio-economic participation, with a global unemployment rate of more than 60%. Spinal cord injury carries substantial individual and societal costs.

Many of the consequences associated with spinal cord injury do not result from the condition itself, but from inadequate medical care and rehabilitation services, and from barriers in the physical, social and policy environments that exclude people with spinal cord injury from participation in their communities.

Full Implementation of the Convention on the Rights of Persons with Disabilities is urgently required to address these gaps and barriers.

“Spinal cord injury is a medically complex and lifedisrupting condition,” notes Dr Etienne Krug, Director

of the Department of Violence and Injury Prevention and Disability, WHO. “However, spinal cord injury is preventable, survivable, and need not preclude good health and social inclusion.”

Essential health measures

Essential measures for improving the survival, health and participation of people with spinal cord injury include: • timely, appropriate pre-hospital management: quick recognition of suspected spinal cord injury, rapid evaluation and initiation of injury management, including immobilization of the spine; • acute care appropriate to the level and severity of injury, degree of instability and presence of neural compression; • access to ongoing health care, health education and products such as catheters to reduce risk of secondary conditions and improve quality of life; • access to skilled rehabilitation and mental health services to maximize functioning, independence, overall well-being and community integration; • access to appropriate assistive devices that can enable people to perform everyday activities, reducing functional limitations and dependency; and • specialized knowledge and skills among providers of medical care and rehabilitation services.

Essential social and economic measures

Essential measures to secure the right to education and economic participation include legislation, policy and programs that promote: • physically accessible homes, schools, workplaces, hospitals and transportation; • inclusive education; • elimination of discrimination in employment and educational settings; • vocational rehabilitation to optimize the chance of employment; • micro-finance and other forms of self-employment benefits to support alternative forms of economic selfsufficiency; • access to social support payments that do not act as disincentive to return to work; and • correct understanding of spinal cord injury and positive attitudes towards people living with it.

“International perspectives on spinal cord injuries” was developed in association with the International Spinal Cord Society and Swiss Paraplegic Research, and launched on the occasion of the International Day of Persons with Disabilities on 3 December 2013.  Source: http://www.pressreleasepoint.com/spinal-cordinjury-many-500-000-people-suffer-each-year WWW.MEDMONTHLY.COM | 31

legal

Court Challenges Threaten ACA Premium Tax Credits in State With Federal Facilitated Exchanges

By Lauren D’Agostino and J. Peter Rich McDermott Will & Emery

32 | FEBRUARY 2014

Two federal district court judges will likely rule in early 2014 on pending challenges to the availability of premium tax credits under the Patient Protection and Affordable Care Act of 2010 (ACA). The plaintiffs in both cases argue that the ACA’s plain language does not permit residents of states with a federally facilitated exchange, 33 states plus Washington, D.C., to obtain such credits. The government counters that the legislative history, structure and purpose of the ACA mandates that premium tax credits be available nationwide.

Premium tax credits under the Patient Protection and Affordable Care Act of 2010 (ACA) could be unavailable to residents of states with a federally facilitated exchange (FFE), depending on the outcome of four cases pending in federal trial courts.

In the two most prominent of these federal cases, Halbig v. Sebelius in Washington, D.C. and King v. Sebelius in Virginia, the plaintiffs’ challenge to a May 2012 Internal Revenue Service (IRS) rule is based upon an apparent conflict with the “plain language” of the ACA. The IRS rule provides that effective January 1, 2014, the health insurance premium tax credit will be available to taxpayers whether they obtain coverage through a state-based exchange or an FFE. The plaintiffs in both cases maintain that the ACA, by its very terms, does not permit tax credits to be available to taxpayers obtaining coverage through the FFE. Instead, the plaintiffs point out that section 1401(a) of the ACA (which enacted Internal Revenue Code section 36B(b)(2)(A)) provides that such tax credits are available only to taxpayers “enrolled in through an exchange established by the State under 1311 of the [ACA].” (emphasis added). Section § 1311 provides for the establishment of health benefit exchanges by states, as opposed to section 1321 of the ACA, which governs when the state fails to establish

an exchange and thus the federal government must establish a fallback FFE. The plaintiffs argue Congress intended a deliberate “carrot and stick” approach to implementing exchanges under the ACA—with the carrot being that residents in states that establish an exchange can access premium tax credits and the stick being that residents in states that fail to do so will not have access to such tax credits.

In response, the federal government has vigorously defended the IRS rule by asserting that the plaintiffs’ reading of the provision is inconsistent with the legislative history, structure and purpose of the ACA. The government has argued that premium tax credits are a critical component to the ACA and were assumed to be available nationwide. The government has noted that other statutory provisions, such as the Health Care and Education Reconciliation Act of 2010 section 1004’s reporting requirement imposed on FFE and state-based exchanges, would be rendered superfluous if the plaintiffs’ argument was to prevail.

Furthermore, the government has argued that section 1321 of the ACA gives the U.S. Secretary of Health and Human Services the authority to establish and operate an exchange within a state and thus, in effect, step into the shoes of states that do not establish their own exchanges.

Therefore, it would be unreasonable to conclude that the same premium tax credits would be unavailable to residents merely because they are enrolled in an FFE rather than a statebased exchange. In response to the Halbig case, the government has also questioned the appropriateness of the relief sought—nationwide cancellation of the IRS rule, as opposed to a tax refund for those affected—and asserted procedural bars relating to standing and the Anti-Injunction Act. Because the FFE will operate in 33 states (plus the District of Columbia) in 2014, the ability of residents of those states to obtain premium tax credits is likely to

have a profound impact on insureds, insurers and providers.

Both Judge Friedman and Judge Spencer anticipate issuing decisions in early 2014, which will likely propel these cases to the U.S. Courts of Appeals in the District of Columbia and the Fourth Circuit, respectively, before randomly selected, threejudge panels. Either side will be able to ask for expedited hearings and, perhaps, for interim relief pending a final decision. If a split between these federal appellate courts occurs, the Supreme Court of the United States likely will be required to make the final decision.

The IRS rule is being challenged in two other federal cases as well.

First, State of Oklahoma ex rel. Pruitt v. Sebelius, brought by Oklahoma Attorney General Scott Pruitt, revives an earlier challenge to the ACA and seeks declaratory and injunctive relief on behalf of individuals and employers in Oklahoma. Second, in October 2013, Indiana and 15 of its public school districts sued the IRS, challenging its use of federal tax subsidies and penalties to implement the ACA. There is no doubt that the ACA would be seriously undermined if the courts were to rule in favor of the plaintiffs and hold that there are no federal tax credits available to those who purchase coverage on the FFE. Therefore, just as Supreme Court strove to find a way to uphold the ACA as a whole against a constitutional challenge, it would be unsurprising if the federal courts, and ultimately the highest court, accept the government’s argument that Congress intended to make these tax subsidies available to all otherwise eligible—notwithstanding the flawed statutory language to the contrary.  Source: http://www.mwe.com/CourtChallenges-Threaten-ACA-PremiumTax-Credits-in-State-with-FederalFacilitated-Exchanges-01-02-2014/ WWW.MEDMONTHLY.COM |33

legal

Center Medicare and Medicaid Services (CMS), Office of Inspector General (OIG) Extend Electronic Health Records (EHR) Stark Law Exception, Anti-Kickback Safe Harbor Through 2021

December 27, 2013, the Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) will publish final rules that extend through December 31, 2021 the existing Stark Law Exception (42 CFR 411.357(w)) and Anti-Kickback Statute Safe Harbor (42 CFR 1001.952(y)) applicable to the donation of electronic health records (EHR) items and services. December 31, 2021 is the last year of the Medicaid Meaningful Use incentive payments.

By Jennifer R. Breuer and Jeffrey T. Ganiban Drinker Biddle & Reath LLP 34 | FEBRUARY 2014

In the Final Rule, CMS and OIG also: • Update the provisions under which EHR software is deemed interoperable; • Remove the requirement relating to e-prescribing from the Exception and Safe Harbor • Limit the scope of protected donors to exclude laboratory companies; and • Clarify the condition that prohibits a donor from limiting or restricting the use, compatibility or interoperability of donated EMR items and services

Interoperability

The final rules require the donated EHR technology to be “interoperable” as of the date it is donated. Such technology will be deemed to be interoperable if it has been certified by a certification body authorized by the Office of the National Coordinator for Health Information Technology (ONC) to an edition of the EHR certification criteria identified in the then-applicable 45 CFR part 170 (i.e., the HITECH Act’s definition of “Certified EHR”).

This will require donated software to be “as interoperable as feasible given the prevailing state of technology at the time they are provided to the recipient.” For example, in 2013, the HITECH Act’s definition of “Certified EHR” permits certification pursuant to either the 2011 or 2014 editions of the EHR certification requirements; in 2014, the HITECH Act requires certification pursuant to the 2014 edition only.

E-prescribing

CMS and OIG have concluded that there are sufficient alternative policies driving the adoption of electronic prescribing such that it need not be included in the Exception and Safe Harbor. Thus, under the final rules, an EHR is no longer required to have electronic prescribing capability in order to be subsidized.

Permissible Donors

In the proposed rules, CMS and OIG identified concerns of potentially abusive practices stemming from the donation of EHR software that seemed to provide for the interoperable exchange of information, but instead led to data and referral “lock-in” between the donor and the referral source. OIG and CMS specifically referred to EHR items and services donated by ancillary service providers and suppliers, i.e., those do not have a direct primary patient care relationship, as subject to this concern. In the proposed rules, CMS and OIG sought comments on whether to limit the list of permissible donors of EHR items and services to hospitals, group practices, Prescription Drug Plan sponsors and Medicare Advantage organizations – or others with front-line patient care responsibilities. In light of the comments received, in the final rules, CMS and OIG specifically exclude laboratories from the list of permissible donors. Otherwise, the universe of protected donors remains the same.

Restrictions

In the proposed rules, CMS and OIG also requested comments on “new and modified conditions” that would prevent EHR donations from becoming a method for locking-in referrals (generally, to the donor), and instead encourage the free exchange of data. CMS and OIG do not adopt any such additional conditions in the final rules, but clarify that neither a donor “nor any person on the donor’s behalf may take any action to limit or restrict the use, compatibility or interoperability of the donated items or services with other electronic prescribing or other EHR systems, including but not limited to health information technology applications, products or services.” This expanded language is meant to clarify that neither donors nor recipients may limit interoperability and that donated EHRs must be interoperable both with other EHRs and with health information exchanges and other forms of technology.

To view the CMS final rule, click here. To view the OIG final rule, click here.  Source: http://www.natlawreview.com/article/centermedicare-and-medicaid-services-cms-office-inspectorgeneral-oig-extend-electr

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Editorial Calendar: March - Locum Tenens/Travel Nurses l April - Staging Your Practice for Success

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legal

A Look Ahead:

Top 5 Health Law Issues for 2014

By Meghan C. O’Connor von Briesen & Roper, S.C.

36 | FEBRUARY 2014

F

rom Affordable Care Act implementation to the continued transition to quality and evidence-based medicine, we expect to see a host of new regulatory and industry changes in 2014. Moreover, federal and state governments will continue to ramp up detection and enforcement of fraud, abuse, and other laws. These changes provide ample opportunities for lawyers to represent and counsel health care industry clients.

In addition to health lawyers, these changes and new opportunities will also affect lawyers who practice in other areas, including business, antitrust, technology, employee benefits, and elder law. Below is an overview of five hot issues in health care law that practitioners – new and seasoned – should monitor in 2014.

1. Affordable Care Act Implementation

Exchanges and the Individual Market. As millions of Americans obtain insurance on the individual market through Exchanges (a.k.a. the “Marketplace”), the ACA individual mandate and the individual insurance market will create a host of issues for health lawyers in 2014. Beginning early in the year, health lawyers will be called on to address coverage, enrollment, and compliance issues.

Attorneys and firms looking to expand their ACA practice should consider employee benefits regulations and related legal issues as ACA implementation continues and employers look for help understanding and complying with coverage requirements and pay or play rules.

Medicaid. The ACA’s expansion of Medicaid will also bring increased attention to the Medicaid program in 2014. Attorneys should be prepared to see increased scrutiny of program integrity in the coming year, including inspector general attention at the state and federal levels (e.g., program audits). Attorneys may be called upon to address these and other Medicaid issues in 2014, including issues with eligibility, covered benefits, and movement between Exchanges and Medicaid.

Tax Exemption. Section 501(r) of the Internal Revenue Code, introduced as part of the ACA, requires, among other things, that tax-exempt hospitals conduct a community health needs assessment and adopt a written financial assistance policy.

Hospitals that do not meet the 501(r) requirements risk an excise tax, taxing of hospital revenue, and revocation of exempt status.

Proposed regulations outlining the 501(r) requirements were released in 2013, and final rules are expected in 2014.

2. Health Information Privacy and Security

This year is shaping up to be another big year for health information privacy and security and the Health Insurance Portability and Accountability Act (HIPAA), as providers, payers, and businesses that support the health care industry (including lawyers) adapt to new compliance requirements and increased liability under the Omnibus Rule regulatory scheme.

This is an area that will be important for health lawyers, as the Omnibus Rule outlines clear compliance requirements for lawyers providing legal services to providers and payers. (For more information on lawyers as business associates, see “Casting a Wider continued on page 38 WWW.MEDMONTHLY.COM | 37

continued from page 37

Net: Health Information Privacy is Not Just For Health Lawyers” in the September 2013 Wisconsin Lawyer).

Health lawyers are also awaiting the 2014 release of another major HIPAA rule – expected to outline requirements for tracking uses and disclosures of health information – as well as legislative changes in Wisconsin dealing with confidentiality of mental health records (an in-depth Wisconsin Lawyer article on this is forthcoming).

Lawyers that deal with health information should be familiar with HIPAA and other federal and state laws protecting the confidentiality of health information to address an increased emphasis on HIPAA audits, security, and technology issues in 2014.

3. Provider Reimbursement and Emphasis on Quality Care

Medicare Billing and Payment. As of this writing, Congress is still debating options for repealing the sustainable growth rate (SGR), which is part of a reimbursement formula used to calculate Medicare physician payments. For years, the SGR has resulted in cuts to physician payments. However, Congress has always used SGR “doc fixes” to extend and delay the cuts (most recently, on Dec. 18, 2013, a 23.7 percent cut set to take effect Jan. 1, 2014, was delayed until March).

However, bipartisan efforts in Congress may make 2014 the year of the SGR repeal. Health care attorneys should take note because the SGR repeal will mean significant changes in how Medicare physician reimbursement is calculated, and the wide-spread effect will touch any number of contractual arrangements that use Medicare reimbursement to set compensation terms.

Quality-based Reimbursement. We have seen a steady change from productivity-based compensation models, which pay for volume, to quality-based reimbursement models, and 2014 will continue this progression. Attorneys that represent physicians and physician practices should be prepared for the introduction (or addition) of quality metrics in physician compensation arrangements, as well as an increase in co-management arrangements and opportunities, which engage physicians in hospital management to better align physicians and hospitals.

Narrow Networks. With additional products available in the individual insurance market in 2014 and an increased focus on performance-based contracting, payers are tying rate increases to quality metrics and tightening provider networks. Attorneys representing physician groups may see an increase in narrow network products and, as a result, their clients’ exclusion from networks.

Changing reimbursement concepts are not new but some methodologies will affect physician behavior, require more patient engagement, and influence efficiency as 38 | FEBRUARY 2014

the industry demands accountable care and continues to introduce quality-based incentives.

4. Increased Joint Venture Activity and Market Consolidation

We expect to see increased joint venture activity and market consolidation in 2014. Increasing market share and patient population allows providers and payers to introduce and monitor their quality care initiatives to a broader base of patients and standardize care with the hope of better outcomes and efficiency. Attorneys representing parties in these transactions should be mindful of fair market value and other fraud and abuse requirements, leasing and construction considerations, and potential antitrust implications.

5. Government Enforcement

The health care industry has seen increased government scrutiny, including emphasis on payment, program integrity, and compliance. From Medicare and Medicaid compliance audits, Strike Teams, increased HIPAA penalties, overpayment recoupment, to fraud and abuse self-disclosures and intervening in whistleblower suits, the federal government is improving its enforcement mechanisms used against hospitals and providers. The federal agencies and their contractors have increased their damages and penalty recoveries over the last few years, and we expect this to continue in 2014.

The primary goal of the U.S. Department of Health and Human Services Office of Inspector General’s (OIG) strategic plan for 2014 to 2018 is fighting fraud, waste, and abuse. In order to achieve its goal, the OIG intends to build upon existing enforcement models, refine self-disclosure protocols, and use all appropriate means (including exclusions and debarments) to maximize recovery.

If you are new to health care, or if you want to expand your practice into health law, these areas of strict liability and increased enforcement will be fundamental to your practice in 2014. Understanding the complex regulations and strict liability statutes is fundamental to providing sound legal and business advice to health care clients.

Honorable Mentions

Retail health clinics and on-site health services, changes in medical malpractice standards, increased emphasis on post-acute care, non-physician health care professionals, and the corporate practice of medicine will also be hot topics in 2014.  This article was first published in WisBar Inside Track, Vol.6, No. 1, a State Bar of Wisconsin publication (Jan. 2, 2014).

Source: http://www.wisbar.org/NewsPublications/Pages/ General-Article.aspx?ArticleID=11262

features

Top 10 Practices of Successful Medical Spas

By Karen Albright Owner/Operater BodyLase Skin Spa www.getbodylase.com 40 | FEBRUARY 2014

As the baby boomers create an ever-increasing demand for minimally-invasive cosmetic services, the medical spa industry has become big business. Many med spas are experiencing great success; just as many, however, are floundering. What creates a successful medical spa and how can you ensure that your med spa thrives?

Here are ten “best practices” that will help ensure your med spa’s success.

1. Invest Sufficient Capital

Many med spa owners underestimate the amount of money it takes to start a medical spa. Significant capital is required to support your business in the early years as it makes its way to profitability. Under-capitalization is the number one reason medical spas fail.

2. Have Both Medical and Business Experience

Medical spas are complicated businesses. As a med spa owner, you face the daunting task of combining the practice of medicine with a sophisticated service business.

You must stay on top of the latest aesthetic medical technologies and simultaneously understand how to successfully operate a service business.

3. Hire Professional Expertise

Physicians were not taught how to run a business in medical school. Hire experienced, industry-specific, professional consultants to guide you. This will be some of the best money you ever spend.

4. Understand the Importance of Sales and Marketing

make adjustments quickly rather than waiting until the end of the year, when it may be too late.

8. Make it Easy for People to Do Business With You

Businesses that flourish and grow make it easy to do business with them. Strategies include: stay open during evening and weekend hours; offer payment plans such as CareCredit; make scheduling easy by offering online booking and/or ensuring your telephone is answered by the third ring. If doing business with your medical spa is difficult, your clients will take their business elsewhere.

9. Ensure Quality Treatments

Of utmost importance, you must ensure the safety of your patients. Because med spa treatments are “fun,” it is easy to forget that they are still medical treatments. If you delegate procedures to ancillary staff, make sure these individuals have excellent training, experience and proper medical oversight. Don’t cut corners when it comes to quality.

10. Have Integrity in Business Practices

Be kind to your vendors, your staff, and your clients.

They are hard-working individuals just like you and deserve your respect. Your reputation is one of your most important assets and word travels quickly. Remember karma is a boomerang. 

Advertise Your Webinar in Med Monthly

Do not underestimate the importance of sales and marketing in your medical spa. Your marketing program must be thought-out, well-executed, and consistent.

Without enough emphasis on sales and marketing, your phones won’t ring and your treatment rooms will be empty.

5. Control Your Overhead

Excessive overhead will ruin any business. Understand the difference between fixed and variable costs and try to keep your fixed costs as low as possible. When starting out, don’t overextend yourself by purchasing too many lasers or leasing too large a facility.

6. Have Persistence and Drive

Startup businesses require long hours of intense work and medical spas are no exception. You must have an incredible drive to succeed and considerable persistence to overcome the many hurdles faced by startups.

7. Set Financial Goals and Review Regularly Establish an annual budget for your business in which you project your revenues and expenses. Each month, sit down and compare your actual results to your budget projections. Did you hit your targets? If not, why not?

When you evaluate your numbers every month, you can

Contact us for more information at: 919.747.9031 medmedia9@gmail.com WWW.MEDMONTHLY.COM | 41

features

Medical Spas Vs. Day Spas (Are They So Different?)

By Barbara Hales, M.D. www.thewritetreatment.com Medicine is evolving beyond just treating illness to a quest for wellness; one of ideal health that combines balance of mind, body, spirit and emotions.

Gone are the days when doctors were just pill-pushers. Patients want much more like being treated, as a person, not a disease, and the physicians that cling to the past will be relegated to it!

We’ve come to recognize that when someone has a symptom, rather than just prescribing a medication like analgesics, all potential factors must be considered to relieve this. (That an imbalance in one body system will affect all others). Relief may include diet and lifestyle changes, decreasing stress, increasing self-esteem and making someone comfortable “in one’s own skin”.

42 | FEBRUARY 2014

Spas

Spas are delightful centers to relieve stress and relax both spirit and aching muscles. They offer aesthetic pleasures to boost self-esteem thereby changing our outlook on life and consequently our choices and actions.

If you are looking for a specific therapy, it helps to know what services are offered in both Medical Spas and Day Spas so that you can make the right choice.

Medical Spas

As implied by the name “medical spa”, physicians perform or supervise treatments, which may be done by nurses or licensed and trained aestheticians. Staff consists of doctors and medically trained employees, which are both insured.

The fundamental focus of a medical

spa is offering long-term solutions to a range of issues related to fat, cellulite, muscle, hair, unwanted capillaries, pigment, acne and wrinkles.

Sophisticated medical equipment may be utilized.

Staple services offered may include: • Liposuction • Acupuncture • Diets and diet supplements • Permanent hair removal • Laser skin therapy • Facial fillers • Photo facials Some of these services may be offered individually at the office of dermatologists, plastic surgeons, gynecologists, general practitioners, neurologists, general surgeons, and internists. This necessitates a person looking for these or multiple services

Services offered generally consist of: • Massage- Swedish, deep tissue, hot stone • Facials- seaweed masks, alpha hydroxyl acids, clay • Light based therapy (Limelight Facial, Cutera) for skin rejuvenation and decreasing pores, softening wrinkles and fine lines • Hair removal- usually waxing, occasionally with light or laser therapy • Lash enhancement- Latisse application Treatments may take 5-6 weeks to see results and are usually harmless.

Some also have skin filler injections and teeth whitening.

Hybrids- The best of both worlds

to make many inquiries and go to more than one place for the procedures sought.

Day Spas

Unlike having to spend long times in waiting rooms among patients suffering from various maladies in traditional doctor offices, day spas are typically more luxurious and elegant since the focus is on relaxation and feeling better.

On the other hand, most of these spas don’t require personnel to be medically licensed. Massage therapists are licensed however.

If you are looking to be pampered, relaxed or achieve temporary fixes, then a day spa is just the place for you but don’t expect permanent or complicated solutions in most cases.

There are day spas that bring in medical professionals to amass professional services in one location.

This is a win-win situation, which serves to: • Boost the reputation and credibility of the spa • Make the spa more effective • Increase the following of the physicians or health providers • Serve as an additional source of income for physicians • Serve as an alternate work location for physicians that may be reluctant to offer these services in their primary office for fear of credibility loss The treatments help empower individuals to take responsibility for well-being and arrive at ideal health.

Additional services offered besides massage, weight loss programs with nutritional guidance and manicure/ pedicures, many of which are FDA approved, include: • Acne and Scar treatment • Microdermabrasion • Facial fillers (Botox injections, Juvederm, Radiesse) • Chemical peels • Laser hair removal • Laser removal of capillaries and spider veins • Body contouring

• Treatment of hyperhidrosis • Teeth whitening • Chiropractic services

Which One is Best?

As with all facilities and professionals, there are those that are very good at their job and those that are incompetent.

While both environments can achieve desired results, the crucial aspect of choosing a facility is the expertise and credentials of those performing the therapies.

Look at the experience, and length of time that the practitioner has had honing the craft. A physician may be one who only completed a weekend course and then has embarked on treating others while an aesthetician may have been at it successfully for 2 decades.

There is a Medical Spa Society, which is a nonprofit organization, dedicated to educating both professionals and consumers, “improving professionalism in the medical spa industry” and providing more training.

Questions to ask: (or to prepare answers for) • Who will be performing the procedure?

• What is the training and licensing of the one performing the services?

• Is there a doctor on premises?

• What happens if something goes wrong?

• How am I monitored?

• What kind of equipment is used?

• How old is the equipment?

• What result can I hope to achieve?

• How many treatments will I need?

• How long will it take to achieve the desired goal?

Before undergoing any procedure, do your due diligence.

Get a referral from someone you respect, ask questions, and ask for recommendations and testimonials from people that have undergone the same procedure.  WWW.MEDMONTHLY.COM | 43

features

Launching Your Practice’s New Med Spa Services

How to define your new target markets and increase awareness of new services offered

By Lori Gertz Freakin’ Genius Marketing 44

| FEBRUARY 2014

You’re a physician with a healthy practice, but you’re interested in adding Med Spa services and products. You are suddenly looking at line extension marketing and increasing awareness. Two strategies for growing your practice you, perhaps, have never had to do.

As a medical professional, your practice is defined as a service business. Pretty clearly, service businesses are defined by the American Marketing Association as enterprises that are established and maintained for the purpose of providing services (rather than or in addition to products) to private and/or commercial customers. The AMA defines those services as “activities, benefits, or satisfactions which are offered for sale or are provided in connection with the sale of goods.”

Entrepreneurs engaged in medical-based service businesses must recognize how service marketing differs from product marketing, especially if their growth includes products. Service marketing can be far more challenging than the marketing of products because of these three distinctive characteristics of service offerings: 1) Services are intangible; 2) Services are perishable; 3) Services cannot be separated from the provider.

This all changes when you add a line extension that puts you into a product-driven market and has many aggressive competitors. That’s not to say that you don’t compete with other service providers, but at the risk of sounding silly, the points of difference are, well…they are entirely different.

So, up until considering the addition of non-medical procedures to your menu of offerings, such as those that are cosmetic or product related, you’ve probably never thought of how you compete for market-share in your local/regional markets. All of that changes when you offer a competitive service that’s outside the range of insurance-covered medical procedures and care.

Since 1996, there’s been tremendous expansion in the number of medical spas available to consumers. See, right there. Did you catch that? Your patient just turned into a consumer.

What’s important to realize is that everyone is opening Med Spas, from dentists to general physicians and internal physicians to OB/GYNs. And even though you may want to enter the market, how will your medical spa differentiate itself from the one down the hall or next door, or near the supermarket?

First things first: If you are considering adding Med Spa services, create a survey to give your new patients when they are filling out their health background forms asking whether they would be interested in receiving medical esthetic services, such as injectables, skin rejuvenation and laser hair removal from you. When asking them, be sure to list all the services that you are thinking of offering and don’t forget to ask them if they want to be included in the grand opening celebration and offers.

It’s imperative that you check out your state’s medical and cosmetology boards to make sure you are in complete compliance before you invest anything in overhead expenses or marketing dollars.

Many details and legalities must be considered, like making sure you have the right experience to determining the scope of practice for nurses and estheticians. Be cautious and invest time and money in knowing the legalities in your state. Smart money spent now saves headaches later.

Your second step is to develop a concept for your new line extension that is unique. If it isn’t something someone else has, even if only by the way you bundle, offer memberships instead of a la carte or exclusive products. It’s important to create a facility that will be easily separated from the competition. From the color you paint your walls and the décor you place in the waiting room to the retail product you offer for sale, you are establishing yourself as a unique facility. There needs to be consistency and professionalism.

• Make sure that you choose to offer a product line that supports its claims and is results oriented • Offer the most utilized treatments (botox, injectables, microdermabrasion, and skin rejuvenation treatments top the list) • Watch the trade magazines for new and updated technologies in skin care • If space allows, consider adding body contour devices Your third step is to create a unique personalized consultation process during which your potential customer is fully educated about the options that are really right for them, and why one service is recommended over another. After the consultation, clients should leave with a totally unique, personalized treatment plan listing all potential services—invasive and noninvasive— continued on page 46 WWW.MEDMONTHLY.COM |45

continued from page 45

from which they can benefit from. Also, the treatment plan should outline the financial aspect of the services recommended should be covered so your customer can make an informed decision on next steps to take.

Once patient interest has been researched, legal and medical details have been ironed out, a concept has been determined and the Med Spa’s grand opening has been arranged, it’s time for your marketing to kick in. Here are fifteen marketing tips and strategies that will help increase your Med Spa’s visibility without eating up your entire budget.

• Include a complete educational consultation to help patients understand the different available treatment options.

• Organize seasonal promotions to encourage clients to try different services.

• Organize weekly promotions to create excitement.

• Host educational evenings twice a year to introduce your patients to all the services you offer.

• Hold anniversary events every year and invite the local paper in order to make it a VIP event.

• Send birthday cards to your clients that include a gift certificate or discount on Med Spa services.

• Perform community service in your area to create branding while helping a good cause.

44 | FEBRUARY 2014

• Produce a loyalty program that offers Med Spa dollars and discounts.

• Create a Med Spa service menu and keep it visible for anyone and everyone to take.

• Direct mail to your clients twice a year to promote events and special promotions.

• Create an e-newsletter to educate your clients about your services and products.

• Make sure you dedicate virtual space to your new line extensions on your website and in social media. Offer incentives to “like” and “follow” your business online.

• Donate to different charity events.

• Participate in women’s trade events.

• Organize evenings of education in golf clubs and gyms.

• So many marketing tactics can be created without spending too much money; however, if you have the budget, you should seriously consider investing in a public relations firm that will prepare a yearly marketing plan for your Med Spa facility.

There are endless details involved in transitioning into or opening a Med Spa as a line extension to your medical practice. However, if you do your due diligence, research the market, consider your competition, stay visible in your community and exceed patients/customers’ expectations, you’ll be the proud owner of the most popular new Med Spa in town! 

Physician Solutions is now hiring primary care MD’s and PA’s in North Carolina, Virginia and South Carolina

If you are a well informed physician or mid-level, we could use your services from 2 to 5 days per week. Find out why dozens of doctors choose Physician Solutions.

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

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

features

SMETIC SERV O C G ICE N I D S D A TO YOUR MEDICAL PRACTICE

by Audrey McLaughlin, RN

www.physicianspracticeexpert.com 48 | FEBRUARY 2014

T

here are many opportunities on the market for physician offices to add revenue streams to their clinics. Some come in the form of adding ancillary services, adding additional providers, products, or even having an independent business unit operating right in your office. One of the most commonly utilized revenue stream is cosmetic treatments and products. Compared to the profit margin on a standard or even a new patient office visit, minor cosmetic treatments (cash paid, not billable to insurance) can substantially add revenue and new patients. There are a number of different types to implement.

The easiest to implement is Botox treatments (also a newer alternative, Dysport), It is a subcutaneous injection used to reduce fine lines and wrinkles best utilized in the upper 1/3 of the face. Training is minimal. Often times there are a couple hours of class time the manufacturer will provide to certify practitioners and even without cosmetic surgery fellowship training, the Botox technique can be very simple to perfect.

Some practices elect to charge by the unit, some elect to charge by the area, however I recommend charging a flat rate plus per unit cost. If there is a touch up needed at their two week follow up the client is only charged the per unit fee. There is very little up-front cost involved. Typically the drug company will provide samples to train with and to treat the office staff with, and then your staff becomes your walking and talking advertisements. Botox must be kept cold, so it ships fast. In most instances you could fill up a morning with Botox patients and only need to order the supplies only a few days in advance.

Once you have mastered the Botox/Dysport arena, you may be ready to move onto hyaluronic acid fillers for the lower 2/3 of the face (Restylane or Juvederm or the like).

These fillers are a bit more time consuming because they are a bit more labor and skill intensive than Botox, but in a similar manner the financial rewards for the clinic can be quite handsome. In the same manner as above, the drug companies will train practitioners and provide samples for office staff should they chose to be practice patients. There is little up-front cost and typically you can keep a couple on hand or order them a week or so prior to a patient being scheduled.

A third option or addition to your clinic’s revenue stream is to add laser treatments. These can be very popular for the non-invasive cosmetic procedure patient group, and again are cash pay procedures. Lasers can treat a variety of issues- veins, uneven skin tone, age spots, wrinkles, excessive hair, and the list goes on.

Depending on the route you take, there can be little up-front investment required. Lasers purchased out right are expensive, but there are a number of lease-to-own and other financing options available. In some metro areas there are even laser renting programs where you

can rent a laser by the day, week, or patient. Training is very important for laser work and most laser companies will train you on their specific units. One benefit here is that mid-levels, nurses, and techs can also perform these treatments on certain lasers, under the supervision of a physician.

There are a number of supplemental services that could be added to a practice expanding into the cosmetic market.

These additional services capture additional revenue, such as skin care consultations, facials, skin care products, waxing, etc. All of these fall under the cash pay umbrella, and will generate a nice add-on revenue stream.

Electing cosmetic treatments as your office’s additional revenue stream has great perks for the office staff and the potential for huge perks in profit as well. In some areas hard hit by tough economic times, cosmetic treatments have taken a hit, but in other markets they are flourishing.

Be sure to do your research for your specific area and even check with your current patients to see if this avenue would provide return on the time investment. If you are still unsure, start with Botox, and then once that is flourishing, poll your patients to ask about laser treatments before deciding to move on a laser purchase.

Finally, remember that marketing these services is one of the big keys to a successful minor-cosmetic or med-spa practice. 

WWW.MEDMONTHLY.COM | 49

features

BLOGGING

is a Cost-Effective Way to Promote

YOUR MED SPA

By Marie Klee Chief Editor Carrotstick.dk

Spending money on traditional marketing may no longer be the most effective method to promote your Med Spa. Have you ever considered using professional bloggers?

The influence of online blogs has increased during the last couple of years, and many people who already have experience promoting their ”product” through blogs agree that it is a very cost-effective method.

This is a guide on how to work with bloggers when you are trying to promote your Med Spa.

How Does It Work?

You invite a professional blogger to a entire day at your Med Spa. You give them a nice experience and a some 50 | FEBRUARY 2014

treatments that they might want to recommend on their blog. A well written blog with thousands of readers could supply your Med Spa with many future clients.

The Benefits of Blogging

Not only does the blog they write about your Med Spa directly increase the chances of you getting more clients, but another advantage is your ranking in Google will improve. This will increase the traffic to your website and further increase your potential of getting new clients.

Another benefit of using this way to promote your Med Spa is it will increase the number of the two types of clients you probably want more of – the younger generation and men.

We know that mature women are interested in Med Spa services, but now we can have these untapped segments start to join the dialogue about your business.

Finding the Right Bloggers to Work With

First, you need to do some research. You need to figure out which bloggers you want to work with and which segments you want to target.

What Makes a Blogger Suitable For Branding Your Med Spa? First keyword – Google. Go for the blogs that are the top searches in Google. You want to use keywords like ”beauty”, ”lifestyle”, ”health and beauty”, ”wellness” then add ”blog” and maybe your city or state. Since the competition in the Med Spa area is big, you want to focus on attracting especially the local audience. So finding bloggers within your area is crucial and increases your potential of new clients.

You have chosen your first keyword combination and typed it into the search bar. Check out the top blogs and write down which ones you like – judge by your first impression. Write down the blogs that have a layout that identifies with the qualities or philosphy of your Med Spa. Is the content on the website of good quality? Does the person behind the blog look friendly and presentable to you? Are there a lot of comments on the articles that they post?

Now, check out which of your favorite blogs has the most followers. You can either do that by finding their Facebook page or their Instagram profile – they usually link these on their blog. Read some of their posts where they have written about other products or services. After doing this, you might have a good idea of which bloggers you want to approach.

Approaching Your New Marketing Partner

First, you have to remember that bloggers are offered a lot of free things every day, so how you approach them is quite important. Being able to offer them a good deal is key, but you want to test them out first. Simply write them an honest e-mail saying that you are considering using bloggers to attract customers to your Med Spa, and the image of their particular blog identifies with the way you want to profile your business. Simply ask if they would be interested in a relaxing day at your Med Spa with some indulgences and different treatments, in exchange for an article/blog post and a reference to your website. Add a link to your website and ask them to check it out and get back to you if they are interested. Avoid contacting them again if they do not answer your e-mail. If they get back to you, you have a committed blogger who finds your offer appealing and who most likely will give your Med Spa a presentable reference.

Making a Deal

If the blogger says yes, you need to have them choose the treatments they are interested in. If you have certain treatments you want promote, you have to be careful about suggesting these. If the blogger has set his or her mind onto something particular, they will look much more forward to the experience – and the excitement is something they might write about on their blog before the actual experience.

Now you just need to settle a date for the treatment, or the consultation with them. Remember that it is important to initiate a relation with them, so they feel confident and comfortable in working with you. Write an e-mail a couple of days in advance to remind them of their appointment and to say that you look forward to meeting them. This also emphasizes your commitment to giving them a great experience, and will make them less prone to mention if there is something during their experience they did not enjoy so much.

Check Your Foundation

What do I mean by this? I am referring to your website.

Does it look professional enough? We judge the appearance of a website in less than a tenth of a second, so the first impression is truly important. Get some professional feedback on your website’s current appearance. Do this before you start your new alternative marketing method.

A well designed website that emphasizes a high quality practice will make potential clients want to visit your Med Spa - or at least make it part of their wish list.

Good luck and feel free to ask questions on mail@ marieklee.dk 

Marie Klee is a Danish freelance nutritionist. She writes articles about health, nutrition and wellness and also works as a corporate health strategist. She is chief editor on the Danish health website Carrotstick.dk. Carrotstick is a blog-like health forum that has a scientific approach to health, and commits to delivering high quality articles about food, nutrition and general health. Marie has a BA in Nutrition and Health from the Metropolitan University College in Copenhagen and has worked for many large corporations, and has improved the health of many people in both Denmark and the UK. Connect with Marie on LinkedIn. WWW.MEDMONTHLY.COM | 51

the arts

Following His Bliss:

Jeff Brown - Artist, Physician

52 | FEBRUARY 2014

This Ol’ House - 36” X 24”

I have had no formal artistic training. I did not come from an artsy family and I have no more inborn talent than you, dear reader. Yet I am preparing for a one-man show at a high-end gallery. How did this happen?

Initially, I casually visited the odd museum, gallery and street art fair, just as you do. But I noticed that I responded to certain works of art. Particularly modern oil paintings. After spending an increasing amount of time doing this and feeling more comfortable, I found myself saying “I bet that I can do this.”

Then my wife said, as wives sometimes do, “OK, Bozo, prove it.” So I bought some basic supplies, found a space and started with a wonderful piece of advice from an artist; “Just get some paint down on the canvas. You can always change or fix it.” In other words, painters paint.

Working off photos, ads and other artists’ work (“Good artists borrow and great artists steal.”), I started doing my versions of what I observed. Docs are trained observers, after all. Then I added jazz-like improvisational riffs to play off of, bend and distort well-known ideas and symbols. I love primary colors and iconic themes. I try to draw the observer into the frame to “see the story.” And the humor that I salt in when I can.

‘‘

Eden’s Garden 36” X 48”

“Art is the lie that tells the truth”

So I love to keep working, creating, learning and getting the paint on the canvas. I just feel a driving passion to do it. Joseph Campbell, the famous philosopher and teacher, was well-known for telling any who would listen, to “Follow your bliss.” I am lucky to have found oil painting and am grateful for the interest of others. Please see my work at jeffcontemporaryoils,com.  It’s About Time 46” X 46” WWW.MEDMONTHLY.COM | 53

healthy living

Oven Baked Sweet Potato Fries

By Ashley Acornley, MS, RD, LDN Sweet potatoes are a nutrient dense food that is often incorporated into festive meals, due to its naturally sweet flavor and smooth texture. Sweet potatoes are a good source of beta-carotene and blood sugar-regulating nutrients. Recent research has shown that a minimum of 3-5 grams of fat per meal significantly increases our uptake of beta-carotene from sweet potatoes. Coconut oil is reported to be anti inflammatory, and thought to support thyroid health. Sea salt is full of minerals that are needed for all cellular activity.

Ingredients: 1 large sweet potato, peeled and cut into wedges 2 teaspoons organic coconut oil 1/4 teaspoon sea salt or trace mineral salt pinch of cayenne pepper

Preparation:

Nutritional Facts:

Serving per Recipe - 2 Serving Size: ½ sweet potato, sliced 122 calories 5 g fat 0 mg cholesterol 19 g carbohydrates; 2 g protein 3 g fiber 323 mg sodium 429 mg potassium

Preheat oven to 425°F. Toss sweet potato wedges with coconut oil and sea salt and spice. Spread the wedges out on a rimmed baking sheet. Bake until browned and tender, turning once, about 20 minutes total.

Culinary notes: Cut smaller and leave in oven longer if you want them crispier. Add garlic spice powder if desired.

54 | FEBRUARY 2014

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

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

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

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

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

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

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

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

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

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

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

WWW.MEDMONTHLY.COM | 55

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

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

| FEBRUARY 2014

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (334)242-4116 http://www.albme.org/ Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 http://bit.ly/zZ455T Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 (480)551-2700 http://www.azmd.gov Arkansas 1401 West Capitol Ave., Suite 340 Little Rock, AR 72201 (501)296-1802 http://www.armedicalboard.org/ California 2005 Evergreen St., Suite 1200 Sacramento, CA 95815 (916)263-2382 http://www.mbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7690 http://www.dora.state.co.us/medical/ Connecticut 401 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/site/default.asp Delaware Division of Professional Regulation Cannon Building 861 Silver Lake Blvd., Suite 203 Dover, DE 19904 (302)744-4500 http://dpr.delaware.gov/ District of Columbia 899 North Capitol St., NE Washington, DC 20002 (202)442-5955 http://www.dchealth.dc.gov/doh 58 | FEBRUARY 2014

Florida 2585 Merchants Row Blvd.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

WWW.MEDMONTHLY.COM | 59

medical resource guide Urgent Care & Occupational Medicine Consultant

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

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

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

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

ADVERTISING

www.pushpa.biz

MedMedia9

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

DENTAL www.medmedia9.com

BILLING & COLLECTION

Biomet 3i

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

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

CODING SPECIALISTS Place Your Ad Here

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

Urgent Care America

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

60 | FEBRUARY 2014

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

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

www.AccountingProfessionalsAgency.com

The Dental Box Company, Inc.

FINANCIAL CONSULTANTS

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

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

ELECTRONIC MED. RECORDS

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

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

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

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

LOCUM TENENS Physician Solutions

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

medical resource guide MEDICAL ARCHITECTS MMA Medical Architects

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

MEDICAL MARKETING

Bank of America

MedMedia9

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

WhiteCoat Designs

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

MEDICAL ART

PRACTICE FINANCING

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

REAL ESTATE

Deborah Brenner

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

MedImagery

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

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

MEDICAL PRACTICE SALES Medical Practice Listings

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

MEDICAL PRACTICE VALUATIONS

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

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

MEDICAL PUBLISHING www.thetps.com

MEDICAL EQUIPMENT FINANCING Bank of America

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

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

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

BizScore

www.assurepharma.com

York Properties, Inc.

MedMedia9

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

MEDICAL RESEARCH

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

Gebauer Company

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

WEBSITE DESIGN

Scynexis, Inc.

3501 C Tricenter Blvd.

Durham, NC 27713 (919) 933-4990

MedMedia9 www.scynexis.com

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

classified listings

Classified To place a classified ad, call 919.747.9031

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

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

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

62 | FEBRUARY 2014

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

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

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

Classified To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

continued on page 65 WWW.MEDMONTHLY.COM |63

Modern Med Spa Available

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

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

classified listings

Classified

continued from page 63

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

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

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

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

Family Practice 1 h SE of Raleigh seeks coverage.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

continued on page 66 WWW.MEDMONTHLY.COM | 65

classified listings

Classified

continued from page 65

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

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

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

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

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

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

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

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

General Practitioner/ Internal Medicine/ Family Physician opportunity available at a large substance abuse treatment facilitiy in Western NC. Doctor will be responsible for new patient evaluations and supportive aftercare. Counseling and therapy are combined with physician’s medical assessment and care for the treatment of adults, adolescents and families. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com. continued on page 68

PEDIATRICIAN

or family medicine doctor needed in

FAYETTEVILLE, NC

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

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

Comfortable seeing children. Needed immediately.

Call 919- 845-0054 or email: physiciansolutions@gmail.com www.physiciansolutions.com 66 | FEBRUARY 2014

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

Woman’s Practice in Raleigh, North Carolina.

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

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

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

Medical Practice Listings; 919-848-4202

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

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

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

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

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

Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624 PH: (919) 845-0054 | email: physiciansolutions@gmail.com WWW.MEDMONTHLY.COM | 67

classified listings

Classified

continued from page 66

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

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

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

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

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

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

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

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

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

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

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

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

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

68 | FEBRUARY 2014

NC OPPORTUNITIES LOCUMS OR PERMANENT

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

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

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

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 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 $38,000.

919.848.4202 medlisting@gmail.com medicalpracticelistings.com

Located on NC’s Beautiful Coast, Morehead City

classified listings

Classified

continued from page 68

To place a classified ad, call 919.747.9031

Physicians needed Virginia (cont.)

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

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

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

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

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

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

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

70 | FEBRUARY 2014

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

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

Practice wanted North Carolina Pediatric Practice Wanted in Raleigh, NC Medical Practice Listings has a qualified buyer for a pediatric practice in Raleigh, Cary or surrounding area. If you are retiring, relocating or considering your options as a pediatric practice owner, contact us and review your options. Medical Practice Listings is the leading seller of practices in the US. When you list with us, your practice receives exceptional national, regional and local exposure.

Contact us today at (919) 848-4202.

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

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

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

Classified To place a classified ad, call 919.747.9031

Practice for sale North Carolina (cont.)

Impressive Internal Medicine Practice in Durham, NC: The City of Medicine. Over 20 years serving the community, this practice is now listed for sale. There are four wellequipped exam rooms, new computer equipment and a solid patient following. The owner is retiring and willing to continue with the new owner for a few months to assist with a smooth transition. Contact Medical Practice Listings at (919) 848-4202 for more information. View additional listings at: www.medicalpracticelistings.com Primary Care Practice specializing in women’s care. The owning female physician is willing to continue with the practice for a reasonable time to assist with smooth ownership transfer. The patient load is 35 to 40 patients per day, however that could double with a second provider.

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

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

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

South Carolina Lucrative ENT Practice with room for growth, located three miles from the beach. Physician’s assistant, audiologist, esthetician and well-trained staff. Electronic medical records, mirror imaging system, established patient and referral base, hearing aids and balance testing, esthetic services and Candela laser. All aspects of otolaryngology, busy skin cancer practice, established referral base for reconstructive eyelid surgery, Botox and facial fillers. All new surgical equipment, image-guidance sinus surgery, balloon sinuplasty, nerve monitor for ear/parotid/thyroid surgery. Room for establishing allergy, cosmetics, laryngology and trans-nasal esophagoscopy. All the organization is done; walk into a ready-made practice as your own boss and make the changes you want, when you want. Physician will to stay on for a smooth transition. Hospital support is also an option for up to a year. The listing price is $395,000 for the practice, charts, equipment and good will. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or email: medlistings@gmail.com

Washington Family Practice located in Bainbridge Island, WA has recently been listed. Solid patient following and cash flow makes this 17-year-old practice very attractive. Contact Medical Practice Listings for more details. email: medlistings@gmail.com or (919) 848-4202. 

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Hospice Practice Wanted

NC MedSpa For Sale MedSpa Located in North Carolina

Hospice Practice wanted in Raleigh/ Durham area of 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.

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

Contact Medical Practice Listings today to discuss the practice details.

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

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

www.medicalpracticelistings.com

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

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

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

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

Medical Practice Listings Selling and buying made easy

MedicalPracticeListings.com | medlisting@gmail.com | 919-848-4202 72 | FEBRUARY 2014

Practice for Sale in Raleigh, NC Primary care practice specializing in women’s care Raleigh, North Carolina

PEDIATRICIAN

OR FAMILY MEDICINE DOCTOR NEEDED IN

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

Credentialing at the hospital is necessary.

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

List price: $435,000

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

Women’s Health Practice in Morehead City, NC

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

OCCUPATIONAL HEALTH CARE PRACTICE FOR SALE Greensboro, North Carolina

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

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

Asking price: $385,000

Medical Practice Listings Buying and selling made easy

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

To view more listings visit us online at medicalpracticelistings.com

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

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

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

Medical Practice Listings Selling and buying made easy

MedicalPracticeListings.com | medlisting@gmail.com | 919.848.4202

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

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

• • • • • •

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

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

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

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

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

Contact us today to discuss your options confidentially.

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

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

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

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

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

Primary Care Practice for Sale Hickory, North Carolina Established primary care practice in the beautiful foothills of North Carolina The owning physician is retiring, creating an excellent opportunity for a progressive buyer.

There are two full-time physician assistants that see the majority of the patients which averages between 45 to 65 per day.

There is lots of room to grow this already solid practice that has a yearly gross of $1,500,00.

You will be impressed with this modern and highly visible practice.

Call for pricing and details.

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

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

Woman's Practice A vailable for Sale Available for purchase is a beautiful boutique women’s Internal Medicine and Primary Care practice located in the Raleigh area of North Carolina.

The physician owner has truly found a niche specializing in women’s care. Enhanced with female-related outpatient procedures, the average patient per day is 40+. The owner of the practice is an Internal Medicine MD with a Nurse Practitioner working in the practice full time. Modern exam tables, instruments and medical furniture.

Gross Yearly Income: $585,000 | List Price: $365,000

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

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

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

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

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

medmonthly.com | 919.747.9031

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

Live and work in one of the most healthy cities in the U.S. List Price: $150,000 | Established: 2007 | Location: Colorado For more information contact Dr. Jack McInroy at 303-929-2598 or Shrink1324@gmail.com

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

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

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

Medical Practice Listings Buying and selling made easy

Primary Care Practice For Sale Wilmington, NC Established primary care on the coast of North Carolina’s beautiful beaches.

Fully staffed with MD’s and PA’s to treat both appointment and walk-in patients.

Excellent exam room layout, equipment and visibility.

Contact Medical Practice Listings for more information.

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

Medical Practice Listings 919.848.4202 | medlistings@gmail.com www.medicalpracticelistings.com

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

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

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

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

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

Medical Practice Listings Selling and buying made easy

MedicalPracticeListings.com | medlisting@gmail.com | 919-848-4202 WWW.MEDMONTHLY.COM | 77

the

top

While Med Spas do offer relaxing treatments, such as massages and body treatments, a majority of their services are related to enhancing their clients’ appearance. Here are the top 9 medical spa procedures.

1

BOTOX

2

LASER HAIR REMOVAL

This method works by emitting a gentle beam of light onto the desired area, removing unwanted hair. The light paralyzes the hair follicle and leaves the surrounding skin unharmed.

78

3

| FEBRUARY 2014

MESOTHERAPY

Crow’s feet and facial wrinkles in the forehead and between the eyes are treated with Botox injections, relaxing the muscles that produce facial expressions. The end result is muscles that no longer contract and cause wrinkles to relax and soften.

This is a procedure that targets problem areas with microinjections of conventional or homeopathic medicines, vitamins, minerals or amino acids, delivered directly into the middle layer of skin to treat conditions such as cellulite, wrinkles, and fat deposits.

Medical Spa Services

4

COLLAGEN COSMETIC FILLERS

Collagen is injected through a small needle directly into wrinkles, skin creases, or skin folds. The collagen plumps up the skin, smoothing out wrinkles and creases and correcting blemishes.

5

MICRODERMABRASION

This is another form of a facial peel that helps leave your skin smooth and rejuvenated. Aluminum oxide crystals are administered onto the skin surface under pressure, and then suctioned away. This process removes dead skin cells and cleans pores, leaving skin looking clean and refreshed.

6

LASER SKIN RESURFACING

Improve the appearance of fine lines, wrinkles, scars and discolored skin with the help of laser light.

There are several different kinds of lasers that work at various layers of the skin to treat acne scars, wrinkles and age-related skin discoloration.

7

CHEMICAL PEELS

Reduce the appearance of wrinkles of the effects of sun damage, acne scars, blemishes, or uneven skin pigmentation with a facial peel. The physician will apply a chemical solution, including glycolic acid, trichloroacetic acid, or phenol, producing a controlled wound.

Taking several days to heal, regenerated skin will emerge.

8

LASER BODY SCULPTING

Non-invasive techniques to help treat fat bulges and tighten skin producing less swelling and bleeding associated with laser body sculpting. The procedure takes less time than liposuction and the results are visible much faster.

9

ACUPUNCTURE

This traditional Chinese procedure works by inserting fine needles at key points of the body that relate to different organs to relieve muscular, neurological, and arthritic problems.

Some experts believe acupuncture can also balance your body’s energy, or Chi.

WWW.MEDMONTHLY.COM |

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It’s Time to Get Online!

Showcase your practice and develop the right image.

Our website packages are custom designed and affordable.

Scan this QR code with your smartphone to learn more.

Increase your patient volume and profitability with a website from

MedMedia9.

Visit us today at medmedia9.com to find out how we can make your practice grow. Click on the “Web Design” tab for more details and view the sample website.

Call MedMedia9 today at 919-747-9031.

M edM edia9

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