Med Monthly January 2015

Med Monthly January 2015

the

Coping With S tress issue

A Doctor’s Self-Worth pg. 38

3 PHASES TO HEAL CHRONIC STRESS pg. 36

The BID Team Huddle A Key Step to Taking Your Practice Back

pg. 32

Provider Stress & How to Handle it pg. 16

The Art of Medicine

Medical Illustration for Effective Communication

pg. 40

contents

features

32 THE BID TEAM HUDDLE: A Key Step to Taking Your Practice Back 36 3 PHASES TO HEAL CHRONIC STRESS 38 A DOCTOR’S SELF-WORTH

insight 6

8 TIPS TO RELIEVE STRESS

8 ARE YOU AN AUTHORITY? Answer YES With Article Marketing

practice tips 10 ANCILLARY SERVICES REQUIRE PRACTICES TO MARKET 12 IDEAL MEDICAL PRACTICE WORKFLOW: 8 Key Steps to Maximize Reimbursement 16 ‘TWAS THE SEASON: Provider Stress & How to Handle it

research and technology 18 NEW WHO GUIDE TO PREVENT AND CONTROL CERVICAL CANCER 20 SOPHISTICATED HIV DIAGNOSTICS ADAPTED FOR REMOTE AREAS 24 NEW DRUG THERAPY A SAFE, EFFECTIVE OPTION FOR ELDERLY PATIENTS WITH ACUTE MYELOID LEUKEMIA

6

8 TIPS TO RELIEVE STRESS

Cover illustration: Right popliteal fossa demonstrating sciatic, tibial, and peroneal nerves in relationship to popliteal vessels and muscles; book illustration (An Introductory Curriculum to Ultrasound-Guided Regional Anesthesia, Pollard & Chan, 2009); © 2009 Kryski Biomedia.

legal 26 HHS RELEASES GUIDANCE REGARDING APPLICATION OF HIPAA PRIVACY RULE IN EMERGENCY SITUATIONS 28 CMS GRANTS FIRST WAIVER OF STARK LAW EXPANSION RESTRICTIONS Are More Ahead?

30 JUSTICE DEPARTMENT ANNOUNCES RECOVERY OF NEARLY $6 BILLION FROM FALSE CLAIMS ACT CASES IN FISCAL YEAR 2014

the arts 40 THE ART OF MEDICINE: Medical Illustration for Effective Communication

healthy living 44 CRANBERRY MANDARIN SALAD

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

Call us today at 919-833-3836 x141

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

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

York Properties Broker Team

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

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This option also includes a brief practice consultation to explain the benefits of marketing through the Medical Practice Listings website.

Professional Listing In addtion to the benefits in the standard listing our Professional Listing affords you access to services provided by our expert legal and marketing team and a Bizscore Practice Valuation. This valuation compares your practice with other practices in your area, provides projections and determines what your practice is worth.

Visit us today at www.medicalpracticelistings.com to learn more.

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Med Monthly January 2015 Publisher Creative Director Contributors

Philip Driver Thomas Hibbard Ashley Acornley, MS, RD, LDN. Nidhi Behl Vats Michael R. Bertoncini Dike Drummond, M.D. Starla Fitch, M.D. Vishal Gandhi, BSEE, MBA Barbara Hales, M.D. Paige M. Jennings Eric A. Klein Diana Kryski, MScBMC Audrey Christie McLaughlin, RN Angela Savitri, OTR/L, RYT Lisa P. Shock, MHS, PA-C

contributors Starla Fitch, M.D. is a board certified practicing oculoplastic surgeon in Atlanta and is the creator of lovemedicineagain. com, an online community and other health care professionals who want to reconnect with their passion for the practice. Dr. Fitch’s new book, Remedy for Burnout: 7 Prescriptions Doctors Use to Find Meaning in Medicine, has been named #1 Amazon International Bestseller, #1 Hottest Release, and Amazon Editors’ Best Books for 2014.

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

Barbara Hales, M.D.

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

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

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

Angela Savitri, OTR/L, RYT helps high-achieving women be free of burnout and chronic stress.

She is an Integrative Health Coach and combines principles of behavioral science, mindfulness, and embodiment in her 90-Day Freedom from Chronic Stress Program. www. freedomfromchronicstress.com.

Lisa P. Shock, MHS, PA-C is a PA who has practiced in primary care and geriatrics. She enjoys parttime clinical practice and is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering services to help implement and improve the utilization of PAs and NPs in the health care system. Contact her with questions at lisa@pushpa.biz WWW.MEDMONTHLY.COM |5

insight

8 Tips to Relieve Stress

By Nidhi Behl Vats Freelance Medical Writer

“Nothing is impossible” is a popular saying that very few can actually implement in their daily lives. When talking about stress, one has to realize it is a daily pressure we exert upon ourselves. It can be desired or undesired stress and 90% of the time it is undesirable. Stress is so much a part of our lives that most of the time, we don’t even realize that we are feeling pressure and that it is completely unavoidable.

So why are we unable to generate daily solutions for this anxiety?

The definition of stress is “A state of mental or emotional strain or tension resulting from adverse or demanding circumstances.” Each individual handles strain differently, but let’s list some universal tips when dealing with stress to assist in times of unwanted tension.

1. Identify stress:

You get stress from tense situations. Once you are experiencing stress, it is important to identify this additional worry. Evaluate if this is desirable stress or should you just absorb the crux of this situation and move on.

2. Types of stress:

Is it desirable and undesirable stress? Are you in the habit of generating stress and anxiety over every small matter? If this is your habit, please remember every problem has a solution. With this in mind remember not every matter is worth generating too much of your time, energy and efforts. It’s important to understand whether what you are facing is a real problem worthy of the 6

| JANUARY 2015

additional hassle. As the saying goes, “Don’t sweat the small stuff.”

3. Trust yourself:

When you are caught in a truly tense situation and you are unable to find a solution, tons of negative thoughts flow through your mind. If you trust your instincts you can stop these negative thoughts and realize alternate solutions to your problem. You only need to have faith in yourself and you will come out of difficult situations with flying colors.

4. You can’t control everything:

It’s untrue to think we can handle every situation. To think we can is a stimulus for extra, avoidable anxiety.

Not everything will work out according to our plans.

Remember everyone has their own set of priorities and will work towards their own goals. So know when to release some control and situations will be less worrisome.

5. Get your thoughts right:

Be positive, calm and composed in stressful situations.

You are bound to make errors while under pressure if negativity sets in. Negativity uses more of your energy and generates more harmful effects to your body.

6. Detoxify your mind:

It is important to detoxify your brain during times of stress. Meditation is a great tool to bring you back to tranquillity. Sit quiet for a brief period and be introspective.

Allow yourself to reflect on what mistakes you have made and how you can resolve them. Gradually this process can

become your habit and you can prevent your mind from receiving negative thoughts early in the stress process.

Detoxification is a process where you heal yourself from all the hurt and imbalance. Detoxification is a permanent change which reflects on your personality. The person who detoxifies on a regular basis will be a more balanced, mature and controlled person in all situations.

The one stop solution for your website content, online PR and brand marketing needs.

7. Spend time doing things you enjoy:

Yes, it is not too easy to bring into practice, but it is equally vital. You will be happy only when you do what you wish to do. So take some time out for yourself and do activities that you love most or have always thought about doing.

8. Avoidable creating stressful situations if you are able:

If you are late, stop wasting time thinking how to blame others for the situation. Instead, think of what change in habit you should implement, so the situation does not arise again. If you have an important meeting, plan well and prepare thoroughly. When you are confident you have done all you can to be ready, relax and release all unnecessary anxiety.

Following these suggestions on a daily basis will allow you to lead a less stress filled life and will assist you when the pressures of life are unavoidable. 

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Nidhi Behl Vats Strategist, Content Developer, and Social Media Marketer

Freelance, expert medical writer who also covers such topics as travel, wellness, parenting, food, lifestyle, fashion, living abroad, self healing and grooming, women and social issues Email Nidhi Behl Vats at nidhibehl5@gmail.com or visit her on the web at http://about.me/behlnidhi

Located on NC’s Beautiful Coast, Morehead City

insight

ARE YOU AN AUTHORITY?

Answer YES with Article Marketing

By Barbara Hales, M.D. www.thewritetreatment.com

If you are involved with research or ongoing studies, then publishing your results in various professional journals is a natural progression of your ongoing process.

But what if you’re not? How do you get published without having to become the next Isaac Asimov or Robin Cook?

The answer is article marketing or put another way, publishing articles. While they may not be read by professionals in your field, quite frankly, it’s not the other professionals that you are trying to attract as paying patients in your practice.

Why should you spend time publishing articles? Simple!

It is free content for your readers and E-zine directories and free exposure for you, which gets you visibility and publicity, setting yourself up as an authority in the field and the one that prospective patients/clients should see rather than your competition.

Publishing articles creates great traffic to your website and is more effective than many forms of advertising… at NO cost! In addition, you will be amassing a list of published work that you’ve authored!

Think about what you can explain or teach your viewer in three to five short steps. You are doing it many times each day in your medical practice. Perhaps you may be saying to yourself that everyone knows the information that you would be teaching.

But the fact is that even though it may be second nature to you, many people do NOT know the information and would be grateful to have you explain it to them!

Once you learn the formula for article writing, you will be able to easily reproduce it over and over again.

8 | JANUARY 2015

Structure

There are six basic steps for your template- the basis for which you are going to construct each of your articles.

• First Paragraph-identify the problem that your reader is struggling with.

• Second Paragraph-Discuss possible solutions to the problem • Third Paragraph- Suggest your solution • Fourth-8th Paragraph- Your solution in 5 simple steps.

The solution poses and answers questions that your reader may have in a persuasive manner • Ninth Paragraph- Recap your argument • Tenth Paragraph- Suggest a call to action or step that your reader should take This template is easy and effective, providing the form that you will use time and again.

Score your articles with Flesch-Kincaid (F-K)

The Flesch-Kincaid score designates the ease and grade level a person would need to have achieved in order to understand the way in which you have presented information within your article.

If you write with multisyllabic words and erudite fashion, you will not be read. You might think that writing this way is impressive but if no one reads it or understands it, the purpose of writing the article is lost. Avoid technical words. Remember, this article is for a general audience, not the medical journals.

Consider writing your article for the 6th-8th-grade student level. If you don’t think that’s true, consider the

following publications and the reading level that they gear to: Reader’s Digest- written at 13-15 year old student level Time Magazine- the same 13-15 year old level

The F-K index is readily accessible. It’s bundled into many word processing programs such as Microsoft Office Word, WordPerfect, KWord, IBM Lotus Symphony. Now that you know what you’re looking for, you will easily be able to find it. (It may be under File (other option) on the word program of your computer.

LinkedIn has become a source for you to post your article for higher visibility.

Directories

You can combine articles to: • Make a free report (to capture names and emails for your database) • Create a PowerPoint presentation • Have as a source for a webinar • Read the articles into a recorder for a podcast or basis for video • Amass a series of articles for a digital book (when publishing to sites like Amazon, they provide an “about” page opportunity for you to increase circulation about yourself and even help promote the sale and distribution of your book) 

There are more than 1500 E-zines to choose from for your articles. They can be general or limited to a specific niche. Some require others to be original, first run drafts whereas others do not mind that the article has been published previously. Knowing this will allow you to submit to the first and get more mileage by resubmitting again to the latter.

The top Ten Article Directories List: 1. EzineArticles (ezine.com) 2. GoArticles 3. Articlesbase 4. Buzzle 5. Article Dashboard 6. Helium 7. ArticleSnatch 8. Article Alley 9. Amazines 10. SearchWarp Submission of your articles to these directories provides a learning experience to perfect your writing skills to your viewer market. If the format or rules are not adhered to, the directory will point out what needs to be revised prior to publication. By rewriting according to their suggestions, you are getting a lesson in honing your skills.

Byline

A byline can simply be the name of the author and the date along with the title of the article, giving the writer recognition. However, more valuable is the byline one finds at the end of an article. This is a short paragraph that not only credits the name of the articles” author, but also will provide a short bio linking one or two websites to the author of note. This is the “payoff ” for writing the articlegetting a link back to your site.

Hyperlinking back to your site is gold. In essence you are inviting your reader to get more information from you or get to know more of you by going to your website.

Recycle!

Places where you can take excerpts or pieces of your article include: • Practice Facebook page • Twitter • Forums • Chat rooms • Blogs • Guest blogs

Want articles published under your name but don’t have the time? Outsource it! I would be happy to discuss your needs with you. Contact Barbara@TheWriteTreatment.com

The Write Treatment

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

You’ve spent the time writing and publishing your articles but the fruits of your labor don’t have to end with the publication. Do it once and profit repeatedly!

WWW.MEDMONTHLY.COM | 9

practice tips

Ancillary Services Require Practices to Market

By Audrey Christie McLaughlin, RN

10

| JANUARY 2015

H

ave you been looking into the growing world of ancillary service opportunities? Most practices look for those avenues before looking into marketing for doctors. Ancillary services for medical practices come in all shapes and sizes, they are everywhere. You likely even have a few business cards on your desk from services that have been presented in your office.

As you may know, part of what we do is match physician practices to ancillary service companies so that the physician has a beneficial service or test to offer his patients and so that the ancillary service company has a sound partner. We have provided this service for about 5 years now and as the market evolves, so have the requirements for the practices.

Here is what you might find interesting…many companies are now requiring a few new things of their physician partners: 1. An up-to-date and professional web presence.

2. Good online reviews.

3. Routine email contact with your patient population.

4. Active social media accounts.

So now it seems that marketing for doctors is becoming more and more important, not just so that you can grow your practice in volume of your ideal patients but also so that you can bring them the additional services that provided great care for your patients and great revenue for your clinic.

the practice within a half hour. Companies want to partner with practices that are capitalizing on that trend.

• Social media is here to stay, ancillary service companies recognize that this is the most focused and strategic way to market and advertise your clinic.

What does this mean for your practice?

This simply means that you must get on board. You must begin to take your marketing and your customer service seriously. You must choose to be different to meet the needs of today’s patients. 

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.

Why do the ancillary service companies care?

Ancillary service companies are in the business of medicine, they want to work with as many patients as possible and the risk is in their court for investing in a practice. It has taken some time to get to this point, but the companies that require these items recognize: • Practices that don’t actively market to their patients run out of new patients to participate in ancillary services in about 24-30 months. Ancillary service companies are focused on long-term partnerships, especially those service companies that offer their assistance in a no-investment scenario. They recognize that long-term partnerships just can’t happen without marketing channels in place.

• Practices that don’t communicate with their patients via email aren’ t harnessing the best way to announce and continue to feed a new revenue stream.

• Practices that don’t have up-to-date, modern, welldesigned, patient attractive websites, simply are out of the loop in growing their practices into a business. Around 74% of internet searches landing on a physicians website end in a telephone call to WWW.MEDMONTHLY.COM | 11

practice tips

Ideal Medical Practice Workflow 8 Key Steps to Maximize Reimbursement

ClinicSpectrum would like to share with you our concept of “Ideal Practice Workflow” to increase your practice revenue and reduce costs.

“Workflow” is an engineering term meaning any series of steps, consuming resources, and achieving goals. More specifically, workflow is your organization’s series of steps, consuming your time, effort, and money, to achieve great clinical outcomes, satisfied patients, and maximum revenue and cost performance. In effect, workflow is the “user interface” between all the members of your team, between your team and your IT systems, and between your IT systems. The key to making everything work together, to achieve all three of your goals, is workflow, which is why we are absolutely fanatically obsessed with understanding, supporting, and improving your professional and practice workflow.

Let us analyze an ideal practice workflow and steps in engaging the patient effectively not only for clinical reasons but for financial reasons as well.

One! Appointment Call Received Workflow begins with the patient appointment. When 12

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a patient calls to make an appointment, certain key parameters are essential to obtain over the phone for the success of efficient management of clinical and financial workflows. Key parameters include: •

• • • •

Patient’s Demographics o Name o Phone numbers o Date-of-birth o Gender Insurance Company Name Insurance ID for Primary and secondary insurance Primary Physician if any Reason for visit

The above items are essential to obtain over the phone in order to determine eligibility of the patient and define a preliminary care plan for the patient at the time of service.

Patient information such as address, guarantor, work type, job and employer can be obtained when patient arrives in office.

This data drives and enables subsequent practice workflows.

By Vishal Gandhi, BSEE, MBA Founder and CEO

Two! Eligibility Team Verifies Benefits A back-office insurance eligibility team works on verifying eligibility of all patients depending upon his or her reason for the visit. Fast track or basic eligibility can often be verified using your Electronic Health Record/ Practice Management System (EHR/PMS) but certain visit types may require calling an insurance company representative to verify detailed benefits and authorization and/or referral requirements. We recommend detailed telephone verification for all new patients. For returning or existing patients, the practice may use online or EHR/PMS options.

Depending upon eligibility verification, the back-end eligibility team creates a financial plan, including patient responsibility, and communicates to front office team for further action.

Three! Patient Check-In/Out Upon patient arrival and check-in, information obtained during the phone call is double-checked, additional data is collected, and the patient is informed and educated.

• • • • • • • •

Verify date & time of last office visit.

Update demographic information.

Update email and cell phone number.

Activate patient portal and email brief video tutorials.

Addresses alerts for financial and insurance issues.

Collect patient co-insurance, co-pay, and deductible.

Schedule next appointment upon patient’s check-out.

Confirm tests, procedures, referrals, and authorizations.

Again, as noted in the previous section on patient checkin and check-out, these data and activities drive and enable successful execution of many subsequent workflows.

Four! Pre-Physician Patient Engagement Every minute a physician isn’t gathering information relevant to making future decisions (that no one else can gather), or actually making those decisions is a waste of a physician’s more valuable asset, his or her time, and directly reduces practice revenue. So far, we have covered the continued on page 14 WWW.MEDMONTHLY.COM | 13

continued from page 13

initial workflows of the patient calling for an appointment and checking in at the front desk. Just as those data and activities drive and enable important workflows, the data and activities of clinical assistants are even more important for great clinical outcomes, satisfied patients, and maximum revenue and cost performance.

Shifting as much work as possible, from the physician to the right nurse or physician/clinical assistant, can dramatically increase practice productivity. However, this is only practical if the right workflows are in place to make sure the work is done correctly and according to physician intentions.

Physicians should able to simply walk into an exam room, review patient information and decide whether tests and procedures completed by their clinical assistant team were truly necessary and if so, decide to bill them.

• • • • • • • •

Validate primary reason for visit.

Take detailed history.

Confirm current meds taken by patient.

Documents allergies and current vitals.

Review clinical alerts.

Preventive tests based on conditions and treatments.

Document test & procedure medical necessity.

Execute relevant clinical protocols.

This workflow plan removes gaps in care plan management and improves risk management. This workflow helps in increasing medically necessary tests and procedures to avoid unnecessary referral and hospitalizations. In a nutshell, this is what we call “Accountable Care” wherein the clinical team truly follows clinical guidelines to take care of patients.

Five! Do What You Do Best: See Patients!

The physician walks into the exam room with a strong preparation done by his clinical assistants. She or he reviews complete history, allergy, and reason for visit, and completed tests and procedures based on clinical protocol.

Physicians lose up to 40% productivity due to EHR “clickarrhea.” Therefore electronic chart is then completed through a hybrid workflow of dictation and/or Dragonbased speech recognition, and minimal EHR template clicks.

Six! Billing Team Generates Bill After the chart is completed, billing information is transferred through via the electronic superbill to the billing team. Many practices submit claims in random order, disrupting cash flow. The following cycle of billing workflow is key to predicting ultimate cash flow.

The billing team should submit claims daily to forecast 14

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daily and weekly cash flow. They can maintain a gap of four days from date of service, providing enough time for physicians to finish charts, however the cycle of billing must be kept intact. Identifying gaps in billing and engaging patients for financial purposes is essential to your practice’s financial health. The billing team must follow a strict (but well-thought out) financial protocol-driven workflow. This workflow includes: • Submit claims daily for at least one day of service minimum (though some short gaps are allowed).

• Post daily payments and bill balances to insurer or patients. Don’t wait for the end of the month.

• Process denials within 72 hours. Keep them in work queue for follow up in 6-7 weeks.

• Communicate to patients about high deductible, coordination of benefits, and health plan questionnaires.

• Audit outstanding claims monthly and create action plans for follow up within six weeks.

Seven! Operations Team Finds Cost Reductions The operations team, usually comprised of an office manager and key physicians in a practice, continually identify the use of technology or outsourcing to reduce costs. This team will conduct monthly meetings.

In our hybrid workflow model, tasks delegated to backoffice team members result in savings of up to 30% or more.

Eligibility Verification With high deductibles on the rise, proper eligibility verification is more crucial than ever. While about 60% of verifications may be completed online, detailed verifications for various procedures, and more specific templates customized to specialty, require a live representative call. Hybrid workflow allows a collaborative verification effort resulting in cost savings and decreased risk of claim denials.

Appointment Confirmation Using a hybrid workflow model and outsourcing various tasks a practice can reduce significant operational cost all while becoming more efficient. Our automated engine schedules appointment confirmation calls, text messages, and email notifications, while the back-office team provides appointment confirmation for high value procedures through live representative calls.

Scanning and Indexing EHR document management modules can receive in-bound faxes and compile scanned images, however those documents may accumulate over time and still

must be indexed to the patient’s chart. This can be a timeconsuming task. An outsourced back-office team can reduce the cost of indexing by 40% or more. The average cost of indexing per page or file done in-house is 50 cents.

Outsourced it costs 10 to 25 cents per image or file.

Evidence-based recalls, diagnostic tests and procedures, and annual wellness visits contribute to better patient care and risk management. This can increase revenue ten percent, or more, through additional opportunities for visits and in-office procedures.

Eight! Generate Clinical Reminders

The Ideal Medical Practice Workflow S.Y.S.T.E.M.

The clinical reminders team data mines the EHR/PMS to identify patients for practice growth and required visits in office. They send reminders to patients through the patient portal, email, SMS, automated calls and live representative calls. The clinical reminders team encourages medication adherence and compliance for outside tests and referrals for patients.

Pre-visit preparations, to be completed 24-hours before patient’s arrival by outsourced back office clinical reminders team, include: • • • • • •

Look at problem list.

Last test and procedures.

Last lab results.

Last annual well visit.

Identify plan of care.

List clinically necessary procedures based on current problem list and previous assessment.

The above workflow plan can take a practice to next level in managing revenue, cost, and risk, making them truly accountable to you. After all, your system of carefully calibrated and systematically improved workflows should Save You Substantial Time, Effort, and Money.

With our innovative Hybrid Workflow Model, ClinicSpectrum helps medical practices, billing companies and other healthcare facilities reduce operational costs and increase revenue. Our Hybrid Workflow Model combines the best collaborative efforts to create efficiency in your organization.  The complete White Paper can be downloaded along with informative graphics from our website at http://www. clinicspectrum.com/White_Paper.aspx

WWW.MEDMONTHLY.COM | 15

practice tips

‘Twas the Season:

Provider Stress & How to Handle it

By Lisa P. Shock, MHS, PA-C President/CEO Utilization Solutions in Healthcare, Inc. 16

| JANUARY 2015

It was that time of year again – the holiday season. Managing work-life balance is a great challenge for many in the health professions, and the added stress of the holidays could have been the tipping point. Physician Assistants (PAs) and Nurse Practitioners (NPs) are patients too. One study from the Stress in America survey suggests that patients are not receiving what they need from their health care providers to manage stress and address lifestyle and behavior changes that would improve their individual health.

PAs and NPs are estimated to do about 85% of the work a physician would otherwise provide in the primary care setting. It has been discussed by many sources that the population of patients being managed is sicker and more complex than seen in the past.

Nationwide, hospitals and health systems are moving toward using more PAs and NPs and there is a much greater emphasis on team based care. Many colleagues are reporting increased stress and the research indicates that more than 2/3 of US adults with high stress report that their stress has indeed increased in the last year. Growing concerns about physician shortages are increasing reliance on PAs and NPs to fill the gaps. Increasing capacity of the health system to meet the growing numbers of patients seeking care is critical and necessary.

How is a busy clinician to cope?

‘‘

“Long work hours, decreased sleep and fatigue all contribute to poor self-care and increased provider stress.

The old saying, “Healer Heal Thyself” rings true.”

One handout from the California Department of Public Health details the key elements of stress management for health care professionals. Long work hours, decreased sleep and fatigue all contribute to poor self-care and increased provider stress. The old saying, “Healer Heal Thyself ” rings true. It is critically important to remain in contact with loved ones and participate in relaxing and enjoyable activities. Taking regularly scheduled breaks from direct patient care allows the mind to clear and refresh. Establishing a place to talk with colleagues and clear communication is important for stress moderation.

Keeping a sense of perspective, and trying to stay positive is an opportunity to refocus. Try to remember the big picture. We have great jobs with tremendous responsibility. It’s a privilege and an honor to be allowed to care for patients and we can sometimes make a huge difference.  References: http://www.apa.org/monitor/2013/04/health-care.aspx http://www.bepreparedcalifornia.ca.gov/Partners/HealthcareProviders/ ForHealthcareProviders/PracticeGuidelinesandFactSheets/ mentalhealth/Pages/StressManagementforHealthCareProviders.aspx http://www.kevinmd.com/blog/2013/01/dealing-psychological-stressdoctor.html About the Author: Lisa P. Shock, MHS, PA-C, is a seasoned PA who has worked with clients to expand care teams in both large and small settings. She enjoys part time clinical practice and is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering a wide range of services to help implement and improve upon the utilization of PAs and NPs in the health care system. Contact her at lisa@pushpa.biz WWW.MEDMONTHLY.COM | 17

research & technology

New WHO Guide to Prevent and Control Cervical Cancer

New guidance from WHO aims to help countries better prevent and control cervical cancer. The disease is one of the world’s deadliest – but most easily preventable – forms of cancer for women, responsible for more than 270 000 deaths annually, 85% of which occur in developing countries.

The new “Comprehensive cervical cancer control: a guide to essential practice” will be launched at the World Cancer Leaders’ Summit in Melbourne, Australia on 3 December 2014.

The main elements in the new guidance are: 18 | JANUARY 2015

Vaccinate 9 to 13-year-old girls with two doses of HPV vaccine to prevent infection with the Human papillomavirus (HPV), the virus responsible for most cases of cervical cancer. The reduced, 2-dose schedule has been shown to be as effective as the current 3-dose schedule.

The change will make it easier to administer the vaccine.

In addition, it reduces the cost, which is particularly important for low- and middle-income countries where national health budgets are constrained but where the need for HPV vaccine is the greatest. Today, girls in more than 55 countries are protected by routine administration of

HPV vaccine. Encouragingly, a growing number of lowand middle-income countries are introducing HPV vaccine in the routine schedule, with support from the GAVI Alliance.

Use HPV tests to screen women for cervical cancer prevention. With HPV testing, the frequency of screening will decrease. Once a woman has been screened negative, she should not be rescreened for at least 5 years, but should be rescreened within 10. This represents a major cost saving for health systems, in comparison with other types of tests.

Communicate more widely. Instead of focusing mostly on encouraging the screening of women aged over 29, the guide recommends communicating with a wider audience: adolescents, parents, educators, leaders and people working at all levels of the health system, to reach women throughout their lives.

Dr Nathalie Broutet, a leading WHO expert on cervical cancer prevention and control, says: “WHO’s updated cervical cancer guidance can be the difference between life and death for girls and women worldwide. There are no magic bullets, but the combination of more effective and affordable tools to prevent and treat cervical cancer will help release the strain on stretched health budgets, especially in low-income countries, and contribute drastically to the elimination of cervical cancer.”

An estimated one million-plus women worldwide are currently living with cervical cancer. Many have no access to health services for prevention, curative treatment or palliative care.

Addressing Inequities Cervical cancer rates have fallen in much of the developed world during the past 30 years, largely due to screening and treatment programs. During the same time, however, rates in most developing countries have risen or remain unchanged, often due to limited access to health services, lack of awareness and absence of screening and treatment programmes. Rural and poorer women living in developed countries are at increased risk of invasive cervical cancer. The new guidance highlights the importance of addressing gender discrimination and other inequities in relation to a range of other social factors (such as wealth, class, education, religion and ethnicity), in the design of health policies and programmes.

“Unless we address gender inequality and ensure women’s right to health, the number of women dying from cervical cancer will continue to rise,” says Dr Marleen Temmerman, Director of WHO’s Department of Reproductive Health and Research.

Editor’s Note: About the Guide The new WHO guidance provides a comprehensive cervical cancer control and prevention approach for

governments and healthcare providers. Also known as the “Pink Book,” it underlines recent developments in technology and strategy for improving women’s access to health services to prevent and control cervical cancer.

The guidance identifies key opportunities and ages throughout a woman’s life when cervical control and prevention can be put into action, especially for: • Primary prevention: human papillomavirus (HPV) vaccination targets girls aged 9 to 13 years, aiming to reach them before they become sexually active.

• Secondary prevention: access to technology for women over 30 years of age, such as VIA (visual inspection of the cervix with acetic acid) or HPV testing for screening, followed by treatment of detected precancerous lesions, which may develop into cervical cancer.

• Tertiary prevention: access to cancer treatment and management for women of any age, including surgery, chemotherapy and radiotherapy.

• When curative treatment is no longer an option, access to palliative care is crucial.

A variety of health services and programmes are needed to implement the different elements of these recommendations. The guidance underlines the importance of collaboration between sectors, between health programmes, and between professionals working at all levels of the health service, for the success of cervical cancer prevention.

The guidelines also show how cervical prevention and control can be integrated into existing health care delivery systems, including for family planning, postpartum care and HIV/AIDS. The delivery of vaccinations to adolescents for example, opens the door to reaching them with additional health information, sexual education and advice about healthy life styles.

A global opportunity to improve women’s health: Implementing cervical cancer prevention and control programmes supports the UN Secretary-General’s 2010 Global Strategy for Women’s and Children’s Health.

Cervical cancer was identified in the 2011 Political Declaration of the High-level Meeting of the UN General Assembly on the Prevention and Control of Noncommunicable Diseases.

The 2013 World Health Assembly identified cervical cancer as among the priority interventions in the action plan for the prevention and control of NCDs 2013-2020, which was agreed by Member States, committing them to including cervical cancer and other NCD interventions in national health plans.  Source: http://www.pressreleasepoint.com/new-who-guideprevent-and-control-cervical-cancer

WWW.MEDMONTHLY.COM | 19

research & technology

Sophisticated HIV Diagnostics Adapted for Remote Areas New tool is low-cost, with no electricity needed

20 | JANUARY 2015

Diagnosing HIV and other infectious diseases presents unique challenges in remote locations that lack electric power, refrigeration, and appropriately trained health care staff. To address these issues, researchers funded by the National Institutes of Health have developed a low-cost, electricity-free device capable of detecting the DNA of infectious pathogens, including HIV-1. The device uses a small scale chemical reaction, rather than electric power, to provide the heat needed to amplify and detect the DNA or RNA of pathogens present in blood samples obtained from potentially infected individuals.

“This highly creative technical solution brings sophisticated molecular diagnostics to underserved populations and represents a potentially groundbreaking advance in global health care for HIV as well as tuberculosis and malaria, which remain significant health challenges in many remote areas,” said Roderic Pettigrew, Ph.D., M.D., director of the National Institute of Biomedical Imaging and Bioengineering (NIBIB) at NIH. The work was performed by a team at the Seattle-based international non-profit PATH, led by Paul LaBarre, senior technical officer, and is reported in the Nov. 26 issue of PLOS ONE. The core technology they developed and continue to improve is a system known as NINA, for non-instrumental nucleic acid amplification. The goal is to expand access to accurate diagnostics wherever they are needed, especially those areas that lack reliable electricity.

Early on-site diagnosis allows immediate treatment Thermal imaging of the NINA device was used to assess heat losses and compare insulating materials. Credit: Paul LaBarre, PATH. LaBarre explains the problem their research endeavors to address. “In low-resource settings, the lack of on-site molecular diagnostic testing is a barrier to the control of infectious diseases. The need to transport the samples from local sites to a distant central diagnostic facility results in delays, lost results, and increased costs.” One of the biggest problems, he says, is loss to follow-up, where individuals who have provided samples may fail to return to the local clinic, and therefore will not receive treatment if their test result indicates they are infected. Given these significant impediments to effective disease control, the goal of the NINA technology is to enable on-site point of care (POC) testing and subsequent treatment regardless of the available infrastructure.

A critical feature of the nucleic acid test is the ability to detect infection at very early stages. The currently available test sold over the counter is antibody-based, and cannot detect HIV until antibodies to the pathogen are produced by the body, which can take as long as several months after infection. The PATH method can detect HIV in the early stage of the disease, when the patient can be most

infectious. Early detection is essential for POC medicine, where the goal is to diagnose infection and begin treatment in a single visit to the local clinic. For testing babies born to HIV-positive mothers, a nucleic acid-based test must be used because the mother’s antibodies in the baby’s blood can result in false positives.

Addressing the challenge one idea at a time The amplification process involves extracting nucleic acids from an individual’s blood sample, mixing it with a nucleic acid segment from the pathogen of interest, and using constant temperature heat in a process that makes many copies of (amplifies) pathogen nucleic acids present in the blood sample. The results of the test are highly accurate and easily visualized with a simple dipstick that reveals a colored band indicating the presence of the pathogen nucleic acids.

PATH incorporated user-experience feedback from product concept testing in India, Zambia, and Kenya. Here a health care worker in Zambia walks through the steps of using a NINA prototype. Credit: Paul LaBarre, PATH. LaBarre and his team are developing the NINA system using an inexpensive insulated thermos where the source of heat is the chemical reaction. The newest version of the incubator produces heat using magnesium iron alloy (MgFe). MgFe was chosen because it costs just $0.06 per reaction and can be supplied in a self-contained packet. To start the heat-producing reaction, a technician simply adds saline solution to the packet at the bottom of the thermos.

In this study, the researchers engineered each component of the incubator for maximum performance, ensuring that the amplification reaction that takes place in tiny test tubes maintains a constant temperature. To achieve this, the group identified a special compound that can store and regulate the heat created by the chemical reaction and can also be easily configured to the tubeholder design, guaranteeing uniform heating on each tube’s surface. When designing the main body of the device, the research team used a thermal imaging camera to assess the performance of inexpensive materials, and eventually chose a reusable thermos and cover that minimize system heat loss.

Another critical factor is the setting in which the incubator must operate. Although a sophisticated diagnostic laboratory would have equipment operating at room temperature in a controlled environment, the device must operate in extreme ambient temperatures. The reaction inside the incubator must maintain a temperature of 140 degrees Fahrenheit for one hour. Therefore, the research team checked the ability of the NINA incubator to function properly over a range of ambient temperatures.

The device maintained the required 140 degrees when continued on page 22 WWW.MEDMONTHLY.COM | 21

continued from page 21

tested in environments ranging from 50 to 90 degrees.

The group demonstrated that their amplification system provides sensitive and repeatable detection of HIV-1 in just 80 minutes. They are now working to pair their amplification system with a simple technique for preparing nucleic acids from blood samples in the field. LaBarre explains: “To complete this low-resource setting diagnostic, one remaining need is the integration of a simple method for isolating nucleic acids from patient blood samples before amplification. Current methods are expensive and technically difficult. Fortunately, there are several methods we are testing that look promising.”

Identifying high-performance, yet inexpensive materials Cut-away view of the reusable NINA device showing relative location of insulation, heat source, phase change material, and samples. Credit: Paul LaBarre, PATH. Because the NINA system can quickly determine whether an individual has an infectious disease, it is a critical technology that will enable POC health services, which combine testing and treatment in a single visit.

This is an essential step toward the control and eventual eradication of infectious diseases across regions of small,

22 | JANUARY 2015

isolated villages.

This work was supported by NIH through the National Institute of Biomedical Imaging and Bioengineering under award number R01EB012641 and the National Institute of Allergy and Infectious Diseases under award number R01AI097038.

NIBIB’s mission is to improve health by leading the development and accelerating the application of biomedical technologies. The Institute is committed to integrating the physical and engineering sciences with the life sciences to advance basic research and medical care. NIBIB supports emerging technology research and development within its internal laboratories and through grants, collaborations, and training. More information is available at the NIBIB website: http://www.nibib.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/dec2014/nibib-01. htm

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research & technology

New Drug Therapy A Safe, Effective Option for Elderly Patients with Acute Myeloid Leukemia

Seventy percent of elderly patients with acute myeloid leukemia (AML) who were treated with a combination of drugs aimed to make chemotherapy treatments effective and less toxic achieved remission or a slowing of disease progression, according to research at the University of Pittsburgh Cancer Institute (UPCI), partner with UPMC CancerCenter. The findings were presented Sunday at the 56th American Society of Hematology Annual Meeting in San Francisco.

The research is important because most elderly patients diagnosed with AML can’t tolerate the aggressive chemotherapy needed and tend to have more aggressive disease than younger patients, making prognosis poor. So researchers, led by UPCI’s Annie Im, M.D., an assistant professor of medicine in Pitt’s Division of Hematology/ Oncology, examined whether an epigenetic strategy using the drugs decitabine followed by cytarabine would help make other treatments more tolerable by reactivating genes that had previously been silenced by the malignancy.

“Outcomes are really poor in elderly patients who have AML because the only therapies we have are often too toxic to offer as treatment options, and the unmet need for 24 | JANUARY 2015

novel therapies is dire,” Dr. Im said. “But we have shown that using this therapy in this patient population is safe and effective.”

In the study, 23 patients were evaluated after receiving what’s called an induction therapy of decitabine intravenously for five days followed by a standard dose of cytarabine intravenously for five days. Fourteen patients had complete remission and five patients had a complete remission with delayed bone marrow recovery. All patients except for two received two cycles of induction.

Researchers believe the drugs work because they help reactivate genes that had been silenced by the malignancy.

In addition, evidence suggests that epigenetic priming by decitabine enhances the efficacy of cytarabine. The next phase of the trial will examine overall survival and the rate of adverse events, and include epigenetic correlative studies.  Source: http://www.pressreleasepoint.com/new-drugtherapy-safe-effective-option-elderly-patients-acute-myeloidleukemia

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legal

HHS Releases Guidance Regarding Application of HIPAA Privacy Rule in Emergency Situations

By Paige M. Jennings Associate Covington & Burling LLP 26 | JANUARY 2015

In response to the recent Ebola outbreak and other events, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) has released guidance regarding the use and sharing of patient information in emergency situations. The guidance emphasizes that HIPAA requirements are not suspended during an emergency.

However, the Privacy Rule includes several provisions that affect the use and disclosure of patient information in emergencies. Additionally, the Secretary of HHS may temporarily waive certain Privacy Rule provisions during emergencies, such as sanctions or penalties against providers that fail to comply with particular requirements. OCR has created an interactive, online decision-support tool to assist covered entities, business associates, and others in determining how information may be accessed, used, or disclosed consistent with the HIPAA Privacy Rule in emergency situations.

In general, the HIPAA Privacy Rule prohibits covered entities (CEs) from disclosing protected health information (PHI) without written patient authorization. However, the Rule contains numerous exceptions. Most notably, a CE may use and disclose PHI for its own “treatment, payment, or health care operations,” and for the treatment activities of another health care provider.

“Treatment” includes the coordination of health care services by one or more providers, including consultation between providers and patient referrals for treatment.

After giving the individual a chance to agree or object, CEs may use or disclose PHI in certain situations, including: To the individual’s family, friends, or others involved in the individual’s care if the PHI is directly related to the person’s involvement with the individual’s care.

• To family, friends, or others involved in the individual’s care, or to disaster relief organizations such as the American Red Cross, to notify or assist in the notification of the individual’s location, general condition, or death.

• As part of a facility directory. Thus,

although health care providers may not affirmatively report to the media information about an identifiable individual without written consent, if asked about a patient by name, the provider may release limited directory information to confirm that the individual is a patient and provide general information about the patient’s condition (i.e., stable or critical).

• In the above situations, CEs must generally give the identified individual an opportunity to object to the use or disclosure. In emergencies, or if the individual is incapacitated or not present, the CE may use or disclose the PHI if it determines that doing so is in the individual’s best interests.

CEs may use or disclose PHI without written patient authorization and without giving the individual an opportunity to agree or object in the following situations: • For public health activities to public health authorities authorized to receive the information, such as the Centers for Disease Control and Prevention. Thus, CEs may report actual or suspected cases of communicable diseases such as Ebola to these authorities.

• To persons who may have been exposed to a communicable disease or otherwise at risk of contracting or spreading the disease if the CE is authorized by law to notify the person.

• If “necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.”

A business associate (BA) of a covered entity may make the above disclosures on behalf of the CE or another BA to the extent authorized by the BA agreement.

In all cases, CEs and BAs must limit the use or disclosure of PHI to the “minimum necessary” to accomplish the intended purpose.  Source: http://www.insideprivacy.com/ health-privacy/hhs-releases-guidanceregarding-application-of-hipaa-privacyrule-in-emergency-situations/ WWW.MEDMONTHLY.COM | 27

legal

CMS Grants First Waiver of Stark Law Expansion Restrictions -

Are More Ahead?

By Eric A. Klein Sheppard Mullin Richter & Hampton LLP Are changes to the landscape of physician hospital ownership ahead?

The Affordable Care Act amended the federal Stark Law to eliminate the “whole hospital exception” that permitted self-referrals provided the referring physician was authorized to practice at the hospital and the ownership or investment interest was in the hospital itself (as opposed to a subdivision). An exception, albeit a limited one, was created for existing hospitals. Such physician-owned hospitals are restricted, absent waiver authority from CMS, from expanding capacity in terms of the number of operating rooms, procedure rooms, and beds for which the facility was licensed as of March 23, 2010. In order to obtain a waiver of this rule, a hospital must qualify as an “applicable hospital” or a “high Medicaid facility.”

28 | JANUARY 2015

The first application for a waiver, submitted by Texas-based Lake Pointe Medical Center in November 2013 on the premise that it is a high Medicaid facility, was approved by CMS late last month.1 The request was granted based on the following three criteria: • The hospital is not the sole hospital in its county; • Medicaid patients comprised a greater percentage of total admissions, for each of the three most recent fiscal years for which data were available, than such percentage for any other hospital located in the county;2 and • The hospital certified that it does not discriminate against beneficiaries of federal health care programs.

Additionally, the scope of the request—to add 36 beds—did not violate a statutory ceiling prohibiting expansion greater than 200 percent of the hospital’s baseline capacity.

Lake Pointe Medical Center makes for an interesting test case. There is only one other hospital in the county, and while Lake Pointe Medical Center had a higher percentage of admissions attributable to Medicaid patients, the difference between the facilities seems fairly minimal: 1.01%, 2.35%, and .96% in 2011, 2010, and 2009, respectively. Notably, CMS received a comment urging it to consider data from 2012 and alleging that Lake Pointe Medical Center did not have the higher Medicaid percentage that year, but declined to do so because the source contained information from 5,941 hospitals as opposed to the 6,100-hospital minimum required by regulation.

For entities that have been waiting to see how the waiver process rolls out, this instance seems to suggest that consideration of the criteria is straightforward—strictly limited to a binary analysis provided for by regulation. So, what now? Will this stimulate or discourage more requests?

Moreover, for how long will Lake Pointe Medical Center’s experience remain relevant? Back in July, CMS issued a proposed rule to permit consideration of supplemental and internal data to verify waiver requirements—a modification that could conceivably muddy the analysis and allow for (or even necessitate) greater discretion.3  _______________ Lake Pointe Medical Center’s exception request is available here. CMS’ final notice of approval is available here.

2 Regulations require that applicants use CMS Healthcare Cost Report Information System. See 42 C.F.R. § 411.362.

3 The proposed rule is available here.

1

Copyright © 2014, Sheppard Mullin Richter & Hampton LLP. Eric A. Klein leads the 90+ attorney national healthcare practice, and is a partner in the Century City office, of Sheppard Mullin Richter & Hampton LLP, a full service AmLaw Global 100 law firm with offices throughout California, New York, Chicago, Washington DC, Europe and Asia. With over twenty-six years of practical legal and business experience, his practice focuses on the healthcare, technology and related industries. Known in the business community for his creative solutions and deal-making ability, Eric uses deep industry knowledge, entrepreneurial solutions, sophisticated negotiation skills and effective legal process to meet the complex business and legal needs of both established and emerging companies.

Source: http://www.natlawreview.com/article/cms-grants-first-waiver-starklaw-expansion-restrictions-are-more-ahead

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legal

Justice Department Announces Recovery of Nearly $6 Billion From False Claims Act Cases in Fiscal Year 2014

By Michael R. Bertoncini Jackson Lewis P.C.

The Justice Department announced that it secured a record $5.69 billion in settlements and judgments from civil cases involving fraud against the government in the fiscal year ending September 30, 2014 (“FY2014”).

This marks the first time the Justice Department recovered more than $5 billion in these cases, bringing the total recoveries under the False Claims Act (“FCA”) to $22.75 billion since January 2009.

The FCA is a federal law prohibiting individuals and institutions from knowingly submitting or causing to be submitted, false or fraudulent claims to the federal government. Most FCA cases are filed under the FCA’s whistleblower, or qui tam, provisions, which allow private citizens to file lawsuits on behalf of the federal government. If they prevail, they can receive up to 30% of the recovery. Qui tam actions often are filed by current or former employees of the companies they accuse of making false claims.

Of the $5.69 billion recovered by the Justice Department in FY2014, nearly $3 billion was related to qui tam lawsuits. During that period, $435 million was paid to individuals who brought qui tam claims.

The Justice Department reported that in FY2014, it recovered a record 30 | JANUARY 2015

$3.1 billion from banks and other financial institutions involved in making false claims for federally insured mortgages and loans. The Justice Department cited several individual settlements for hundreds of millions of dollars involving major financial institutions.

Health care fraud also continued to account for a large percentage of the FCA recoveries, totaling $2.3 million of the FY2014 FCA recoveries.

This marked the fifth straight year in which the Justice Department recovered more than $2 billion in health care fraud cases. The Justice Department attributes this high rate of recovery in part to the Health Care Fraud Prevention and Enforcement Action Team (“HEAT”), which is an interagency task force coordinating the efforts of the Justice Department and the Department of Health and Human Services.

The Justice Department noted that the pharmaceutical industry accounted for a substantial part of the $2.3 billion in health care fraud recoveries in FY2014. The Justice Department also cited large recoveries in cases involving hospitals and home health service providers.

While the lion’s share of the FY2014 FCA recoveries related to mortgage,

housing and health care fraud, the Justice Department also stated that it continued to aggressively pursue fraud in government procurement and other federal programs, citing multiple eightfigure settlements.

It is clear that FCA claims remain a high priority for the Justice Department. In addition, for those companies involved in the health care industry, it is expected that HEAT will continue to aggressively pursue claims of health care fraud.

In this environment of multi-million dollar recoveries by both the federal government and individuals filing qui tam actions, one of the most important steps a company can take is to work with counsel to develop and implement a robust compliance program.  © 2014 Jackson Lewis P.C. Reprinted with permission. Originally published at www.jacksonlewis.com. Jackson Lewis P.C. is a national workplace law firm with offices nationwide.

Source: http://www. corporatecomplianceadvisor. com/2014/12/justice-departmentannounces-recovery-of-nearly-6-billionfrom-false-claims-act-cases-in-fiscalyear-2014/

WWW.MEDMONTHLY.COM | 35

features

The BID Team Huddle – A Key Step to Taking Your Practice Back

By Dike Drummond, M.D. CEO of TheHappyMD.com

32 | JANUARY 2015

Time after time, physician surveys show we are overwhelmed with the non-clinical tasks of the average practice day. Instead of taking care of patients, we become trapped in the quicksand of EMR, filing papers, patient flow and putting out fires that seem to come out of nowhere. There is a way to minimize all of this and begin taking your practice back -- something that only takes five minutes twice a day. In fact, I bet you have even heard of this tool: the team huddle.

A crisp BID team huddle stops fires before they start, gets all team members on the same page and sets you up for success rather than struggle. You will save at least three to five minutes of work time for every minute you devote to the huddle – and it will get home sooner as a result.

As a physician coach working with burned out doctors, I have taught the following huddle system to hundreds of doctors and it is routinely cited as a major piece of their recovery. Let me share with you the basics and then some additional “power tips” to help you take your personal care delivery team to a whole new level of performance.

BID Huddle Basics A typical doctor’s day is split into halves, with a morning and afternoon clinic. (Note: go ahead and adjust the following structure to suit your needs if your day is scheduled differently.) The huddle is performed BID before each clinic. Here are the steps: • Give yourself at least 15 minutes between the start of your huddle and your first scheduled patient. So if your first patient is at 9 a.m., schedule your huddle at 8:45 a.m. If any quick action steps come up in the huddle, you have time to complete them.

• The huddle consists of everyone on your patient flow team. You, your nurse/MA/roomer, your receptionist and anyone else on the team that comes in contact with the patient during their time in the office or hospital.

Have someone bring a copy of the half day’s schedule to a stand up meeting of this team.

• The huddle is a stand up meeting. Do not make your people come to your office and kowtow to you while you sit behind your desk … please. Start a five minute timer. It usually won’t take that long. Starting the timer keeps everyone on point.

• Go over the half day schedule as a team. Share information on who needs special accommodations.

There is always someone scheduled to go in the wrong room or missing a piece of equipment. If you do procedures, are they set up correctly? Are all the office systems and supplies functioning normally? If the hot water is out or computers are down, now is when the whole team needs to know!

‘‘

“A crisp BID team huddle stops fires before they start, gets all team members on the same page and sets you up for success rather than struggle.”

• Share information on who is upset in the waiting room and why. Decide how you want your open appointments booked. Ask if there is anything else the team needs to know before you kick into the day.

That is your basic BID huddle structure. You are preplanning as a team, to ensure a smooth, efficient practice day. Don’t stop there. The huddle is the ideal forum for much higher level team building.

Huddle Power Tips The huddle is a perfect place to build your team’s morale and effectiveness. It only takes a few minutes to execute on these team building tools: • Ask everyone how they are doing today. If a team member has a sick child and might have to leave early, the sooner you are aware the better. Show interest. Get to know each other as people. You care about your team members. All it takes is a word or two here to show it.

• Take time to celebrate. “Who has something they want to celebrate or acknowledge themselves for … and it doesn’t have to be about work?” Give them an opportunity for a pat on the back. If someone’s son just became a state soccer champ or daughter just won a spelling bee, it feels really good to share it with your co-workers and see the smiles of congratulation all around. And it takes all of 15 seconds.

• Acknowledge all effort. Take a moment to publically thank one or more team members for their hard work in the previous days. Unless you plan to do this on purpose, sincere thanks from the leader is very rare on a medical team.

• Problem solve. Ask if there are any issues that need to be addressed. You can delegate action steps and report back on results at the next huddle. Example: “The new flu vaccine is in. Sarah, please check on the proper dose and report back to us in the next huddle.”

• Leverage the team. Ask if anyone has noticed a patient care activity that could be done more effectively by a continued on page 34 WWW.MEDMONTHLY.COM | 33

continued from page 33

different member of the team. Let them know you are open to new ideas and ways of dealing with the team’s tasks.

• Clear and center. End with a big breath to center everyone at the start of the day. You may even want to put your hands in the center and end with a cheer.

Your team will love it when the BID Huddle becomes a habit in your practice. If you miss a day, they will remind you and insist you huddle up. You will have less kerfuffles in the flow of your patients, fewer surprises, better team coordination, more engaged and happier staff and you will feel things just got noticeably smoother and easier.

Here is the big danger and one final Power Tip: The biggest obstacle to an effective BID Huddle is the physician.

Doctors often think they are too busy to huddle. These are usually the physicians who fly in at 9:05 a.m. for that 9 a.m. patient and are behind all day. Even more commonly, the doctor stops calling the huddle after the first week and it dies a slow and silent death. Don’t let this happen to you.

I also strongly advise you to take yourself out of the picture and delegate the calling of the huddle to one of your staff members. Tell them they are to call the huddle at 8:45 a.m. Let them know now there will be days when you, the doctor, will resist and they have your permission now to call you on it. Set yourself a penalty now if you fail to

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show for a team huddle, such as a $5 gift card for each team member. Hold yourself to these agreements.

There you have it. A well-performed BID huddle will save you three to five times the amount of time spent in the huddle and get everyone home earlier. Don’t start a half day in the clinic or hospital without it.  Dike Drummond MD is a family practice doctor, executive coach and author of “Stop Physician Burnout – what to do when working harder isn’t working.” His field-tested physician burnout prevention tools can be found on his website, www.TheHappyMD.com. He is an advisory team member for Physician Wellness Services, the only company providing healthcare organizations with comprehensive pathways to promote a healthy workplace experience. For more information, visit www.physicianwellnessservices.com.

Dike Drummond, M.D.

is CEO of TheHappyMD.com and author of the Burnout Prevention MATRIX Report containing over 117 ways to prevent physician burnout.

WWW.MEDMONTHLY.COM | 37

features

3 PHASES TO HEAL CHRONIC STRESS

By Angela Savitri, OTR/L, RYT

Freedom from Chronic Stress Coach www.freedomfromchronicstress.com

S

tress often receives a bad reputation, but it is critical to distinguish the effects of acute stress and chronic stress.

Acute stress, stress that last for a short period of time, is normal and a necessary function of biological existence. There is nothing inherently harmful with experiencing acute stress. Some studies show acute stress can increase a healthy immune response1 and when people are informed that stress symptoms – a racing heart, butterflies in the stomach, feelings of nervousness - are working in their favor, perceived negative symptoms of stress decrease2.

The effects of chronic stress, however, are harmful. Chronic stress happens with the perceived demands of life outweigh one’s available resources for a period of months to

36 | JANUARY 2015

years. It is chronic stress that wreaks havoc on the physical, mental, and emotional body, leaving those who experience it feelings of constant tension and susceptible to physical illness, insomnia, depression, anxiety, relationship problems, and career disruption.

There are many external conditions that contribute to chronic stress, often identified as caring for someone who is ill or caring for a child with special needs, managing a chronic illness, experiencing long-term financial strain, and/or traumas.

Although these conditions contribute to chronic stress, there is another group of high-performing professional adults who experience chronic stress from a demanding career combined with competing personal demands, ambition, high

expectations, perfectionist tendencies, and an overextended schedule.

In my work with high-achieving professional women, chronic stress symptoms show up as insomnia, a racing mind, exhaustion, reactivity, impatience, discontent, and feelings of disconnection from themselves and the ones they love. It is rarely their professional work that suffers, but symptoms first show up as a decrease in their own felt sense of well-being followed by relationship strain with a partner and/or children.

If the physical, emotional, and/or relationship problems get bad enough after goal-setting cycles and traditional self-care measures fail to provide relief, high-achieving women may seek counsel from a healthcare provider, therapist, or health coach.

Providers may offer advice to take

‘‘

It takes vulnerability, awareness, and self-reflection for high-achieving professionals to heal chronic stress.

little stressed but I feel fine.” These are words commonly heard after someone has received a stress-related health crisis wake-up call.

In order to heal chronic stress, it is imperative to develop body awareness to discern and honor the body’s sensations. The body is constantly providing sensation and feedback from internal and external stimuli, most of which goes unnoticed, ignored, or denied.

With so much cultural identity and emphasis placed on scholastic knowledge and external achievement, few have mastered the art of embodiment. What is it like to live and be in the body instead of the head?

Developing stress awareness through embodiment practices allows one to observe and respond to fluctuations in body temperature, tempo of mental activity, and constriction of muscle and breath patterns that alert one to their current stress state. In order to change any pattern that is causing harm, awareness must precede action.

Phase 2: Stress Regulation some time off, practice yoga, get a massage, or take warm baths. Although these are wonderful acts of self-care and temporarily reduce acute stress, these tactics do not resolve chronic stress. The belief that a vacation, taking a yoga class, or receiving a massage resolves chronic stress is a myth.

In my practice, I guide highachieving professional women through three phases to heal chronic stress.

These phases, when approached with compassion and gentleness, create a restored nervous system, resiliency to prevent harm from future stressors, and self-awareness to regulate emotions and activities without guilt or exhausting one’s resources.

Phase 1: Stress Awareness “It came out of nowhere…I don’t know how this happened…I’ve been a

Stress management is a popular term, but I prefer the term stress regulation. Stress management assumes that one needs to manage something – work, domestic responsibilities, relationship strain – outside of themself.

Healing from chronic stress is an inside job. Oftentimes, it is internal stressors like fear, guilt, perfectionism, high expectations, and/ or self-judgment that fuel the external circumstances high-achievers believe create their experience of stress.

By developing mindful awareness, the practice of paying attention to the present moment without judging it, high-achieving professionals learn to regulate their emotions, responses, and activities to maintain a personal well of energy that never runs on empty.

Stress regulation allows for ups and downs within safe parameters of enough activity for stimulation but not

so much activity to create overwhelm or exhaustion. Balance is never static.

Phase 3: Stress Shifting Managing stress as a consistent way of life is like managing misery. It sets the bar of what is possible very low and in turn, keeps one assuming that chronic stress is the norm.

Freedom from chronic stress happens when one shifts out of the ‘managing stress’ mindset and engages in activity and relationships that increase connection, love, and joy.

Love is humanity’s supreme emotion and governs the experience of contentment and peace needed to shift toward feeling light-hearted and connected. This is not romantic love, but rather a felt sense of warm connection with other humans, animals, and nature that evoke positive emotions.

Chronic stress is rooted in disconnection from the present moment, nature, and the experience of being alive. To heal chronic stress, one must decrease their stress muscle and flex their connection muscle. Slow down, pay attention, and connect.

It takes vulnerability, awareness, and self-reflection for high-achieving professionals to heal chronic stress. Approach the process with compassion; view it as a practice instead of a destination, and everyone can experience freedom from chronic stress.  1. Viswanathan, K. & Dhabhar, F. (2005) Stress-induced enhancement of leukocyte trafficking into sites of surgery or immune activation. Proceedings of the National Academy of Sciences of the United States of America, 102, 58085813. doi:10.1073/pnas.0501650102 2. Keller, A., Litzelman, K., Wisk, L.E., Maddox, T., Cheng, E.R., Creswell, P.D., & Witt W.P. (2012) Does the perception that stress affects health matter? The association with health and mortality. Health Psychology, 31(5), 677-684.

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features

A Doctor’s Self-Worth

By Starla Fitch, M.D.

38 | JANUARY 2015

A doctor’s self-worth can be tied up with a lot of issues.

• How well can we make a diagnosis?

• How elegantly can we perform the surgery?

• How happy are our patients? Our staffs? Our families?

• How many articles have we had published or how many lectures have we given?

The list goes on and on, doesn’t it?

For me, it’s a daily, sometimes hourly, battle to separate my self-worth from how I think other people perceive me.

We all want our patients (not to mention our staffs and our families) to be head over heels about us all the time.

We want to feel we have made a difference, performed at our absolute best. We want to feel we’ve been the perfect doctor, the perfect parent, the perfect perfect spouse.

Therein lies the rub. Perfection is the enemy of good.

In the OR, have you ever decided to tweak something a little bit, only to go from an “A-” outcome to a “C+,” all in the name of trying to be a little more perfect?

A study by the MacArthur Foundation showed good self- worth to be a strong predictor of good health and long life.1 So it seems likely that those who have a strong sense of self-worth would provide better health to others as well.

Those outside the medical profession are quick to say doctors have a skewed sense of increased self-worth and self-importance.

For those of us who live it daily, we know that most of the time we feel a strong sense of self is necessary, every day: • When we enter the emergency room to see a patient, not knowing what to expect • When we boldly begin a complicated case in the OR • When we deliver bad news to a patient about their pathology report Our patients expect us to be certain and secure in our approach, our knowledge, and our self-worth.

These traits are what make us good doctors.

I had the good fortune to interview Dr. David Olansky, a dermatologist specializing in Mohs surgery for cancer patients. He revealed his thoughts on self-worth.

Dr. Olansky comes from a family of physicians. He said there was no pressure for him to become a doctor; it was just understood. He did have a short-lived stint as a trombone player. Seriously. But medicine won out.

“I can’t imagine doing anything else. Medicine fits me to a T. That’s one of the keys to happiness, when you and something where your karma and your dharma meet together: what you’re supposed to do and what you are doing,” he said.

Dr. Olansky shared a defining moment in his youth during our interview. As a fourth-year medical student, he went with his father to see a patient in a nursing home. The patient’s husband met his dad at the door. When the man

saw his dad, it was “like a ton of bricks had been lifted off of him.”

Dr. Olansky said, “I realized no greater gift could have been given to that patient’s husband. He felt powerless before he saw my dad. It turned out to be an easy problem.

But it made me realize the power we have, and we don’t even realize it,” he said. “I see that every day. It’s a tremendous gift to be able to help patients, physically and emotionally.”

Dr. Olansky said his father taught him “to be authentic.”

He continued, “Be exactly who you are. The most important thing is to follow the Golden Rule. Treat other people as you would expect to be treated. Not everyone will like you, but you’ll be authentic and genuine.”

As I work with more and more doctors around the country, I am encouraged by what I am witnessing: • Doctors who completely left medicine then returned later, refreshed and recharged • Doctors who have slightly altered their original mode of practicing, discovered the parts of medicine they love most, then magnified them • Doctors who have added and subtracted from their recipes until the unique flavor of their practice is perfect for them My mission is to help those of you who are sitting on the edge to fall in love with medicine again.

I know you still have a tiny glimmer of hope in your hearts. You still believe there are subtle twists and changes that you can make to take the rough edges off. You believe there’s still hope. You believe you can make what you once considered an awesome job tolerable and—on a good day—a great way to earn a living again.

How do I know? Because I have been where you are.

I’ve stood right there, looked at my practice, and found a flicker of hope still burning.

I examined my hope with a magnifying glass and it caught fire.  Lipschitz, David, “Having High Self-Esteem is Essential to Good Health,” Creators.com. April 26, 2012.

1

Starla Fitch, MD, is a board certified practicing oculoplastic surgeon. Dr. Fitch is also an author, professional speaker, and certified life coach. She has a passion to help those in the medical field suffering from burnout. Her new book, Remedy for Burnout: 7 Prescriptions Doctors Use to Find Meaning in Medicine, is already an international best seller. She is also the creator of the online community lovemedicineagain. com, a place for doctors, doctors-in-training, nurses, and other health professionals to connect and remember why they went into medicine in the first place. You can also connect with Dr. Fitch on Facebook, Twitter, and LinkedIn.

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the arts

The Art of Medicine Medical Illustration for Effective Communication

John Doe: Concepts of Bone Flap Replacement Surgery; demonstrative evidence panel for personal injury case, © 2014 Kryski Biomedia.

W

hat is your vision for your career in medicine? What would you love to share with your community? Your knowledge, techniques, your research? These are indeed your biggest assets. Second in value to your ability to apply these yourself in your daily practice, is your ability to share them with oth-

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| JANUARY 2015

By Diana Kryski, MScBMC CCO, Medical Illustrator Kryski Biomedia ers: your patients, your students, your colleagues, the global community of health care professionals and researchers.

The effectiveness of this communication has a direct impact on what you are able to achieve and on your personal fulfillment. It also adds value to what you provide to your communities and institutions, and on your reputa-

tion as a whole. As we all know, your data, your experience, your words, descriptions and stories, speaking and demonstrating, are essential to the sharing of yourself in this way. And I’m sure we can all agree that adding images—or visuals of some sort—can help as well.

As students of anatomy we probably all (consciously or not) felt immense

gratitude for the illustrations in Netter and Grant’s, among other books.

The fact is, using effective visuals is critical to communicating (and as a student, absorbing) complex information efficiently. This is obvious when it comes to subject matter with physical attributes and spatial relationships, such as anatomy, but is also true of communicating data, temporal processes, and conceptual relationships, all of which are ubiquitous in science and medicine. If you’ve ever admired an excellent data visualization, a flawlessly designed biochemistry schematic, or a surgical technique crystallized in animation, then you know what I mean.

Whether you conduct and publish research, teach, develop online resources, or author books, the profile and perception of your work is either bolstered or blemished by its visual presentation (or lack thereof).

This is why I do what I do. I work with clients—physicians and health care providers, academics and medical researchers, hospital programs and departments—who are devoted to their message and their material, and who want to share it with others. I see the value in what they are sharing with the world, and I try my best to help them do it justice on a public stage.

How did this happen?

People often ask me how I knew I should become a medical illustrator. I think it was a combination of things.

I always had an interest in drawing and painting, and a good attention to detail. I started drawing in a realistic style before I was twelve and began selling my drawings and creating commissioned portraits at the age of fourteen.

I also always had an interest in medicine and in how the body works.

As a child, instead of asking for bedtime stories, I’d often say to my Dad, “Dad, let’s talk about bones.”

I wanted to understand what was hidden under our skin—what did it look like in there?! Well, now I know.

Course of the greater occipital nerve, posterior views; journal article illustration, © 2014 Kryski Biomedia.

Learning to communicate medical content using visuals With a degree in Visual Studies from the University of Toronto (U of T) and nine years of experience as an artist and illustrator, I attended the two-year Biomedical Communications (BMC) Master of Science program at U of T. There we studied human anatomy and embryology intensely with our fellow medical students. Four hours of human cadaver dissection and four hours of lecture every day. I loved it. Following this period, we took courses in neuroanatomy and pathology (supplementing my previous education in physiology, zoology, biology, anatomy and embryology, and comparative anatomy). And, of course, we made visuals and participated in critiques of those visuals.

My master’s research project involved the design, development and evaluation of an online, interactive, threedimensional model of the pterygopalatine fossa. This educational tool was created to aid medical students in understanding the complex spatial relationships and neurovascular anatomy of the fossa. You can check out the tool online at http://www.ppfstudy.com.

During this time, I was fortunate to work as a teacher’s assistant in the undergraduate Biomedical Communications program at the Institute of Communication and Culture at the University of Toronto Mississauga. There, I developed and delivered weekly technical skills tutorials for the course Visualization of Forensic Demonstrative Evidence, taught by Dr. Leila Lax. This continued on page 42 Lumbar spine, sacrum and pelvis; posterolateral view; book illustration, © 2009 Kryski Biomedia.

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Right peri-clavicular brachial plexus in relationship to structures around the clavicle, anterior view; book illustration, © 2009 Kryski Biomedia. continued from page 41

course aimed to prepare forensic anthropology students for producing their own clear and effective demonstrative evidence presentations when called to be expert witnesses in

their future careers.

After graduating from BMC with my master of science, I was hired as a full-time medicolegal illustrator at a studio in Toronto. On a daily basis, I reviewed personal injury plaintiffs’ medical files and imaging and then

produced detailed, anatomically accurate illustrations of their injuries, complications, and surgeries so that their medical case could be presented clearly in mediation and in court. After nearly four years as a medicolegal illustrator, I began to miss the variety and originality involved in creating other types of medical visuals, as well as the challenge of running a business.

Critical thinking about visuals

Emitted and reflected ultrasound energy encountering 22G needle oriented perpendicular and at 45 degrees to beam plane; book illustration, © 2009 Kryski Biomedia.

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During my time in Visual Studies, I created my own artwork but also took many art theory courses and participated in countless critiques.

In addition to practicing skills like draftsmanship and color theory, I also learned the value of critical thinking about a piece of art. Does this artwork do (to the viewer) what the artist intended? For example, does it make the viewer question something; does it make them feel an emotion (pity, delight, or awe); does it transport them? And then, “Is this what the artist wanted?” Art is created for a great number of purposes, and you really can’t generalize, but I think one

approach we can take to most art is to ask, “Does this do what the artist intended?” Of course, in the art world, answering this question requires some knowledge of the artist’s intentions, or at least an educated guess based on the context of the artwork’s creation and/ or presentation.

I bring the same approach to medical illustration, with often much more pragmatic ends. Does this illustration do what we want it to do? Does it communicate our salient points to the viewer? In the case of a magazine cover, does it attract the eye of passersby? In the case of a textbook, does it compete effectively with the competition’s book? In a poster or an advertisement, does it inspire fascination? In a study guide, is it easy to memorize?

Illustrating your science

As CCO (chief creative officer) and art director at my studio, Kryski Biomedia, I have the regular opportunity to think visually and critically about what we create. From textbooks to whiteboard videos, medicolegal posters to online learning tools, I encounter a variety of visual challenges. However, while the details—of both the subject matter and

‘‘

”The effectiveness of this communication has a direct impact on what you are able to achieve and on your personal fulfillment.

It also adds value to what you provide to your communities and institutions, and on your reputation as a whole.”

the techniques—are always changing, the skill we apply to them—the visual expertise, the originality, the research—are consistently effective.

In addition to the many researchers and doctors we’ve worked with on books and journal articles, as well as the law firms we’ve provided with medicolegal posters, some of the particularly fun and interesting jobs we’ve worked on include: a uniquely exquisite book, An Introductory Curriculum to Ultrasound-Guided Regional Anesthesia (Pollard & Chan, 2009); an online educational tool for patients considering postmastectomy breast reconstruction (Division of Plastic and Reconstructive Surgery, University Health Network (UHN), Toronto); and a series of six whiteboard “explainer” videos for the UHN’s Antimicrobial Stewardship Program. You can take a look at our website and portfolio at http://kryski. com. 

Diana Kryski

is CCO and principal at Kryski Biomedia, a full-service illustration and animation studio north of Toronto, Canada, specializing in the communication of science and medicine. Ms. Kryski can be reached at 1-(888) 803-0008 or by email at diana@kryski.com.

Learn more at http://kryski.com.

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healthy living

Cranberry Mandarin Salad

By Ashley Acornley, MS, RD, LDN Citrus fruits often start lining the shelves in early Nutrition Information: winter, and are very versatile ingredients to use in dishes. The most convenient and delicious of these Per 1/8 serving of dish: Vitamin C-packed fruits are mandarin oranges.

Calories: 133 Vitamin C has been shown to boost the immune Carbs: 23g system – a very important quality for the cold and Sugar: 14g flu season! This cranberry and mandarin orange Fat: 5g salad is a great way to get in a serving of fruit and healthy omega-3 fats, from the walnuts! This dish Protein: 2g keeps well in the fridge and can even be served at a party. The orange juice and Ingredients: applesauce keep this dish light in added • 2 bags of fresh cranberries (24 oz) sugars, but still sweet.

• ¾ cup orange juice • ½ cup of applesauce (no sugar added) • ½ cup of water • 1 ¼ cup mandarin oranges slices or 11oz can, drained • ½ cup chopped walnuts *If cranberries are out of season at the time of making the dish, canned cranberry sauce works just as well. However, the sugar content may be different from the recipe listed.

Preparation: • Put cranberries, applesauce and water in a sauce pan and bring to a boil.

• Keep on medium heat, stirring constantly until the cranberries start to explode (about 10-15 minutes).

• Reduce to a simmer and pour the juice over the cranberry mixture.

• Simmer 10-15 minutes and remove from heat.

• Stir in mandarin oranges and walnuts.

• Cool completely and store in fridge at least 4 hours but preferably overnight before serving.

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

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

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

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

Kentucky P.O. Box 1360 Frankfurt, KY 40602 (502)564-3296 http://www.opticiantraining.org/optician-training-kentucky/

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

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

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

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

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

Arkansas P.O. Box 627 Helena, AR 72342 (870)572-2847 California 2005 Evergreen St., Ste. 1200 Sacramento, CA 95815 (916)263-2382 http://www.optometry.ca.gov/ Colorado 1560 Broadway St. #1310 Denver, CO 80202 (303)894-7750 http://www.dora.state.co.us/optometry/ Connecticut 410 Capitol Ave., MS #12APP P.O. Box 340308 Hartford, CT 06134 (860)509-7603 ext. 4 http://www.ct.gov/dph/cwp/view. asp?a=3121&q=427586 Florida 4052 Bald Cypress Way, Bin C08 Tallahassee, FL 32399 (850)245-4474 http://www.pof.org/opticianry-board/ Georgia 237 Coliseum Dr. Macon, GA 31217 (478)207-1671 http://sos.ga.gov/index.php/licensing/ plb/20 Hawaii P.O. Box 3469 Honolulu, HI 96801 (808)586-2704 http://hawaii.gov/dcca/pvl/programs/ dispensingoptician/

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

Texas P.O. Box 149347 Austin, TX 78714 (512)834-6661 http://www.tob.state.tx.us/ Vermont National Life Bldg N FL. 2 Montpelier, VT 05620 (802)828-2191 http://vtprofessionals.org/opr1/ opticians/ Virginia 3600 W. Broad St. Richmond, VA 23230 (804)367-8500 http://www.dpor.virginia.gov/Boards/ HAS-Opticians/ Washington 300 SE Quince P.O. Box 47870 Olympia, WA 98504 (360)236-4947 http://www.doh.wa.gov/LicensesPermitsandCertificates/MedicalCommission. aspx

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U.S. DENTAL BOARDS Alabama Alabama Board of Dental Examiners 5346 Stadium Trace Pkwy., Ste. 112 Hoover, AL 35244 (205) 985-7267 http://www.dentalboard.org/ Alaska P.O. Box 110806 Juneau, AK 99811-0806 (907)465-2542 http://commerce.alaska.gov/dnn/cbpl/ ProfessionalLicensing/BoardofDentalExaminers.aspx Arizona 4205 N. 7th Ave. Suite 300 Phoenix, AZ 85103 (602)242-1492 http://azdentalboard.us/

Hawaii DCCA-PVL Att: Dental P.O. Box 3469 Honolulu, HI 96801 (808)586-3000 http://1.usa.gov/s5Ry9i Idaho P.O. Box 83720 Boise, ID 83720 (208)334-2369 http://isbd.idaho.gov/

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

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

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

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

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

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

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

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

Delaware Cannon Building, Suite 203 861 Solver Lake Blvd.

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

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

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

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

| JANUARY 2015

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (334)242-4116 http://www.albme.org/ Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 http://commerce.alaska.gov/dnn/cbpl/ ProfessionalLicensing/StateMedicalBoard.aspx Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 (480)551-2700 http://www.azmd.gov Arkansas 1401 West Capitol Ave., Suite 340 Little Rock, AR 72201 (501)296-1802 http://www.armedicalboard.org/ California 2005 Evergreen St., Suite 1200 Sacramento, CA 95815 (916)263-2382 http://www.mbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7690 http://www.dora.state.co.us/medical/ Connecticut 401 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/cwp/view. asp?a=3143&q=388902 Delaware Division of Professional Regulation Cannon Building 861 Silver Lake Blvd., Suite 203 Dover, DE 19904 (302)744-4500 http://dpr.delaware.gov/ District of Columbia 899 North Capitol St., NE Washington, DC 20002 (202)442-5955 http://doh.dc.gov/bomed 48 | JANUARY 2015

Florida 2585 Merchants Row Blvd.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Oklahoma P.O. Box 18256 Oklahoma City, OK 73154 (405)962-1400 http://www.okmedicalboard.org/ Oregon 1500 SW 1st Ave., Suite 620 Portland, OR 97201 (971)673-2700 http://www.oregon.gov/OMB/ Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)787-8503 http://www.dos.state.pa.us/portal/server. pt/community/state_board_of_medicine/12512 Rhode Island 3 Capitol Hill Providence, RI 02908 (401)222-5960 http://1.usa.gov/xgocXV South Carolina P.O. Box 11289 Columbia, SC 29211 (803)896-4500 http://www.llr.state.sc.us/pol/medical/ South Dakota 101 N. Main Ave. Suite 301 Sioux Falls, SD 57104 (605)367-7781 http://www.sdbmoe.gov/ Tennessee 425 5th Ave. North Cordell Hull Bldg. 3rd Floor Nashville, TN 37243 (615)741-3111 http://health.state.tn.us/boards/me/

Vermont P.O. Box 70 Burlington, VT 05402 (802)657-4220 http://1.usa.gov/wMdnxh Virginia Virginia Dept. of Health Professions Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4400 http://1.usa.gov/xjfJXK Washington Public Health Systems Development Washington State Department of Health 101 Israel Rd. SE, MS 47890 Tumwater, WA 98501 (360)236-4085 http://www.medlicense.com/washingtonmedicallicense.html West Virginia 101 Dee Dr., Suite 103 Charleston, WV 25311 (304)558-2921 http://www.wvbom.wv.gov/ Wisconsin P.O. Box 8935 Madison, WI 53708 (877)617-1565 http://dsps.wi.gov/Boards-Councils/ Board-Pages/Medical-Examining-BoardMain-Page/ Wyoming 320 W. 25th St., Suite 200 Cheyenne, WY 82002 (307)778-7053 http://wyomedboard.state.wy.us/

WWW.MEDMONTHLY.COM | 49

medical resource guide ACCOUNTING

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

www.pushpa.biz

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

BILLING & COLLECTION

DENTAL Biomet 3i

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

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

CODING SPECIALISTS Place Your Ad Here

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

Urgent Care America

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

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

50 | JANUARY 2015

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

The Dental Box Company, Inc.

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

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

ELECTRONIC MED. RECORDS

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

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

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

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

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

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

LOCUM TENENS Physician Solutions

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

MEDICAL ARCHITECTS MMA Medical Architects

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

medical resource guide MEDICAL ART

MEDICAL PRACTICE SALES

Deborah Brenner

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

Medical Practice Listings

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

MedImagery

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

MEDICAL EQUIPMENT

MEDICAL PRACTICE VALUATIONS

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

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

www.assurepharma.com

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

www.thetps.com

Capri Health

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

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

BizScore

Assured Pharmaceuticals

PROFESSIONAL SPEAKER

MEDICAL RESEARCH

Commercial Sales & Leasing (919) 821-7177 www.yorkproperties.com

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

Scynexis, Inc.

3501 C Tricenter Blvd.

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

MEDICAL EQUIPMENT FINANCING Bank of America

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

SUPPLIES, GENERAL PRACTICE FINANCING Bank of America

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

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

www.bankofamerica.com/practicesolutions

MEDICAL MARKETING WhiteCoat Designs

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

WWW.MEDMONTHLY.COM | 51

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

Family Primary Care Practice

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

Family Practice/Primary Care

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

Med Spa

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

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

Practice Type: Internal Medicine

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

Dental Practices Place Your Ad Here

Optical Practices Place Your Ad Here

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

Considering your practice options? Call us today.

52 | JANUARY 2015

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

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

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

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

Medical Practice Listings Selling and buying made easy

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

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

List price: $435,000

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

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

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

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

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

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

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

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.

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

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

Women’s Health Practice in Morehead City, NC

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.

PEDIATRICIAN

or family medicine doctor needed in

FAYETTEVILLE, NC

Comfortable seeing children. Needed immediately.

Medical Practice Listings Buying and selling made easy

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

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

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 | 55

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

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.

Buying and selling made easy

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

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

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

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

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

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

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

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

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

Contact: Cara or Philip at 919-848-4202

medlisting@gmail.com medicalpracticelistings.com

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

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

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

Contact Medical Practice Listings today to discuss the practice details.

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

Only serious, qualified inquirers.

www.medicalpracticelistings.com

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

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

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

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

NC Opportunities DENTISTS AND HYGIENISTS

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.

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

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

Contact us today to discuss your options confidentially.

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

Physician Solutions, Inc. Medical & Dental Staffing

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

Physician Solutions

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

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