Med Monthly January 2017

PHYSICIAN SOLUTIONS PRESENTS

Med Monthly MAGAZINE

January 2017

Repealing and Replacing the ACA: Five Developments Likely to Occur in the Years Ahead

the

Politics & ctice Your Pra

pg. 22

issue

Politics and Your Practice:

Don’t Alienate Half of Your Patients Before They Walk Through the Door pg. 26

Healthcare in 2017 for All? Will Trumpcare Stump Obamacare? pg. 28

A NEW YEAR FOR HEALTHCARE IN AMERICA

contents

features

22 REPEALING AND REPLACING THE ACA: Five Developments Likely to Occur in the Years Ahead 26 POLITICS AND YOUR PRACTICE: Don’t Alienate Half of Your Patients Before They Walk Through the Door 28 HEALTHCARE IN 2017 FOR ALL? Will Trumpcare Stump Obamacare?

14

22

REPEALING AND REPLACING THE ACA

practice tips 6

NATIONAL GROUPS CALL ON CONGRESS TO PROTECT OUR CARE

8

2016 PHYSICIAN SOLUTIONS/ MED MONTHLY COVER REVIEW

10 HELP PREVENT OVERUSE OF ANTIBIOTICS THE REASON MANY MEDICAL PRACTICE CHANGE INITIATIVES FAIL

12 PROS AND CONS OF OFFERING DENTAL IMPLANT TREATMENTS 14 THE REASON MANY MEDICAL PRACTICE CHANGE INITIATIVES FAIL

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Physician Solutions, Inc. Medical & Dental Staffing

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

Physician Solutions

THE DECISION IS YOURS Physician Solutions, Inc. P.O. Box 98313 Raleigh, NC 27624 phone: 919-845-0054 fax: 919-845-1947 www.physiciansolutions.com physiciansolutions@gmail.com

Scan this QR code with your smartphone to learn more.

Med Monthly January 2017 Publisher Creative Director Contributors

Philip Driver Thomas Hibbard Naren Arulrajah Dr. Justin Clemens Ahmed Ezzeldin DDS Barbara Hales, M.D. Nick Hernandez, MBA, FACHE Denise Price Thomas Richard J Zall

contributors Naren Arulrajah is President and CEO of Ekwa Marketing, a complete Internet marketing company which focuses on SEO, social media, marketing education and the online reputations of Dentists and Physicians. If you have questions about marketing your practice online, call Naren direct at 877-249-9666.

Ahmed Ezzeldin, DDS is a practicing dentist in Gainesville, Virginia. When he is not doing dentistry, Dr. Ezzeldin enjoys staying active by running, biking, reading social psychology books, and listening to podcasts.

Nick Hernandez, MBA, FACHE

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

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

Visit www.abisallc.com for more information.

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

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

MED MONTHLY MAGAZINE |5

practice tips

National Groups Call on Congress to Protect Our Care, Announce New Coalition to Fight Health Care Repeal

A group of the nation’s most prominent health care and social and economic justice groups called on President-elect Trump and Congress to stop their reckless sprint to repeal the Affordable Care Act (ACA) and show how they will provide more affordable and meaningful care, coverage, and consumer protections than the law currently provides. The Protect Our Care Coalition members, including the Asian & Pacific Is6

| JANUARY 2017

lander American Health Forum, Center for American Progress, Center on Budget and Policy Priorities, Center for Community Change, Center for Law and Social Policy, Community Catalyst, Doctors for America, Families USA, MomsRising, NAACP, National Council of La Raza, National Health Law Program, National Latina Institute for Reproductive Health, National Partnership for Women & Families, National Urban

‘‘

“Repeal and Delay” is no better than repeal. American families deserve to know what will happen to them before Congress acts.

League, National Women’s Law Center, SEIU, Voices for Progress, and Young Invincibles, issued the following joint statement: “Repealing the ACA could harm millions, double the number of uninsured by 2019, and throw the U.S. health care system into disarray, according to a recent study from the Urban Institute. It could take affordable health care coverage away from 30 million peo-

ple, including children and working families covered under the ACA’s Medicaid expansion.

“Millions could face higher premiums and out-ofpocket costs, and the availability of adequate, affordable coverage for people with pre-existing conditions like cancer, diabetes, and heart disease could be jeopardized. Women could also be denied coverage and charged higher premiums just because of their gender.

These people deserve an answer from Congress – not a bait and switch.

“The nation’s hospitals have said repeal would cause economic damage that ‘…will adversely impact patients’ access to care, decimate hospitals’ and health systems’ ability to provide services, weaken local economies…and result in massive job losses.’ And state and local governments could be left holding the bag for the cost of care for those who lose coverage.

“Despite this, some in Congress are rushing forward to repeal the ACA with no guarantee that people in America will have comparable protections restored.

This so called ‘Repeal and Delay’ strategy is irresponsible. It would cause significant immediate harm in 2017 by throwing 4.3 million Americans off of coverage, according to the Urban Institute.

“In these uncertain times, working people in America value the safety and security of health coverage more than ever. Before any repeal vote, they deserve to know what is in a replacement plan and see proof that it will provide better, more affordable care, coverage, and consumer protections than the ACA. “Repeal and Delay” is no better than repeal. American families deserve to know what will happen to them before Congress acts.

“The Protect Our Care Coalition will pool resources and work together to ensure people in America understand the damage of repealing the ACA. Congress should not take away the promise of future coverage without simultaneously voting on a plan that guarantees people will have health and financial security.”

The coalition has designated Leslie Dach as the Campaign Director, who will manage the work between the member groups and implementation at the state level. Additional organizations are expected to join.  Source: http://www.pressreleasepoint.com/nationalgroups-call-congress-protect-our-care-announce-newcoalition-fight-health-care-repeal

MED MONTHLY MAGAZINE

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practice tips

2016 Physician Solutions/Med Monthly Cover Review

22|| DECEMBER 2013 8 JANUARY 2017

It has been another fantastic year at Med Monthly and the cover art has been exceptional. We started the year out as Physician Solutions magazine and in September went back to being Med Monthly magazine, as requested by our contributors and readers.

Please feel free to click on the cover art to view to that month’s issue online.

Topics Featured in 2016 January – eHealth and Your Patients February – Practice Options; Closing, Expanding, Selling March – ICD-10 Medical Coding April – Using PAs/NPs Effectively May – Women’s Health June – Checking Your Patient In & Out July – How Do You Cope With Stress, Doctor?

August – Positioning Your Practice for Success September – Social Media and Your Practice October – Income Resources to Consider November – Doctor-Patient Relationship, Boundary Crossings December – Practice Management

Feature Topics for 2017 January – Politics & Your Practice February – Preventive Medicine March – Locum Tenens April – Spring Cleaning Your Practice May – Checking In & Checking Out June – Making Your Practice More Valuable July – Selling Your Practice August – Clinical Trials & Your Practice September – The New “Medical Billing” October – Practices Going Paperless November – Your Practice Staff December – Modern Medical Lobby

MED MONTHLY MAGAZINE

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practice tips

HELP PREVENT OVERUSE OF ANTIBIOTICS Antibiotics are among the most commonly prescribed drugs used in human medicine, and chances are you and your family members have taken them multiple times. These vital drugs help fight life-threatening bacterial diseases and are generally safe when appropriately prescribed. But overuse and misuse of antibiotics can reduce their benefit and contribute to the rise of drug-resistant bacteria, which kill thousands of Americans every year. The Tennessee Department of Health encourages Tennesseans to learn about proper prescribing and use of these medications.

“Antibiotics are critical to our ability to fight some serious diseases, but increasingly they are less effective because we are overusing these powerful medicines in both humans and animals,” said TDH Commissioner John Dreyzehner, MD, MPH. “Each of us has a responsibility as patients to know that taking and prescribing them is not to be done lightly. In addition to the growing threat of resistance, these drugs can also cause very serious side effects, more than we once knew, and that means we have to ask our health care provider how to use them the right way and to prescribe them only when they are really needed.”

“As we approach the cold and flu season, our concern about misuse of antibiotics increases,’’ said TDH State Epidemiologist Tim Jones, MD. “To help stay healthy this winter, and to reduce the misuse of antibiotics, we urge all Tennesseans six months of age and older to get a flu shot.”

Antibiotics only combat bacterial infections, not viruses. Sinus infections, sore throats and ear infections are usually caused by viruses and antibiotics are 10

| JANUARY 2017

rarely recommended. Research shows up to 50 percent of all antibiotics prescribed for people are not needed or are not optimally effective as prescribed. Taking antibiotics if you don’t really need them, or not taking them as prescribed, can contribute to the emergence and spread of antibiotic-resistant infections. Patients should ask their healthcare providers several key questions about an antibiotic prescription before taking it: • Why do I need it?

• What kind of infection do I have? Is this the best drug for it?

• How long should I take it?

• Will I get better without it?

• What are the side effects?

• Will it interact with other medications?

• How and when should I take it? ‘’Antibiotic resistance rates in Tennessee are among the highest in the nation,’’ said TDH Antimicrobial Resistance Program Director Marion Kainer, MD, MPH. ‘’We urge healthcare providers and patients to learn about the proper use of antibiotics and take steps to help reduce antibiotic resistance rates in our state.’’

There are more than 140,000 emergency department visits for reactions to antibiotics each year.

Antibiotics taken for the wrong reason are more likely to cause harm than good. Talk with your healthcare provider about whether antibiotics are right for you. If you are prescribed antibiotics, take as instructed and do not stop early, even if you are feeling better.

Source: http://www.pressreleasepoint.com/help-prevent-overuse-antibiotics

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practice tips

Pros and Cons of Offering Dental Implant Treatments

22 || DECEMBER 12 JANUARY 2013 2017

By Ahmed Ezzeldin DDS, Easy Dental Care and Dr. Justin Clemens

‘‘

“You need to consider your level of surgical experience. Implant treatment is a surgical procedure. Sharpen your surgical skills before introducing implants into your practice.”

Dental implant treatment is one of the biggest billing procedures in dentistry. However, one often fails to realize the steady cash flow of big dollars going out of your office due to the costly overhead such as the surgical setup, drill cost, implants cost (which is gigantic) and hours of staff time.

Let’s start with the hard cost. Your drill and implant system will be one of the most expensive investments when you decide to offer this procedure in your clinic. Many general dentists think they will get around this by purchasing Low-Bob’s Dental Implants because they are just like the real thing. They even have matching parts. The problem is, they aren’t and a specialist can tell. “So what?” you may ask. “I’m placing them, not a specialist.” Well, if an implant procedure goes wrong (likely if you’re not a specialist), you’ll need to refer the case to a specialist, but he isn’t going to know Low-Bob’s Dental Implant Company and he sure as heck isn’t going to “try out” your new kit on this new patient for the first time. This is why you want to stick to a major vendor that a specialist uses.

Next are the hours of staff time required. Labor is THE greatest cost to a practice. Most likely, when you start into placing implants, there will be a tremendous amount of treatment planning time as you learn new imaging systems and technology. Your surgical time will not be all “slam dunk” cases and you most likely will have a decent amount of post-operative time. This, of course, will get better as time goes on. Make sure you have the financial means to shoulder the burden of this slow time in your practice while you adjust to the learning curve. As for billing, if you are not a specialist, it is not right to charge the same as a specialist. You are not on their fee schedule.

Then there’s training cost. If you were trained in the military, a general practice residency or AEGD, you probably just need some refresher continuing education and you are good to go. If not, you may choose to go to an outside continuing education course. Now consider the cost of having to leave your office for weeks or months on end to learn dental implants.

This can cost tens of thousands of dollars. Maybe you plan to be a weekend warrior where you go to courses only on the weekends. The tuition is still about the same, but you don’t leave your practice for weeks on end.

Another option is doing a year-long implant residency. This is one where you do nothing but implant training.

Financial costs aside, you also need to consider your level of surgical experience. Implant treatment is a surgical procedure. Sharpen your surgical skills before introducing implants into your practice. You may want to start extracting the broken down molars that you normally send out and lay some flaps with them. Get out some sutures and practice.

In summary, dental implant treatment is an excellent addition to your dental practice, but not when you are still a newbie. Your debt must be under control. You must have time to spare in your schedule and your surgical skills must be on point. From there, proceed forward with the proper training and implementation of implant dentistry into your practice. Get really good at it. Your patient deserves the best so you must practice to the standard of care of a specialist if you are doing procedures usually reserved for specialists.  MED MONTHLY MAGAZINE

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practice tips

The Reason Many Medical Practice Change Initiatives Fail Good is rarely good enough, and opportunities for improvement are never lacking. Unfortunately, the success rate of major change initiatives in medical practices is often low due to poor management of the change.

Physician leaders and practice managers should expect and accept disruption and resistance to change, and never lose sight of the fact that costs are high when change efforts go wrong.

The consequences of poorly executed change are not only financial costs, but also lost opportunity, wasted resources, confusion, and diminished morale.

Here are three major areas to 14

| JANUARY 2017

focus on to help with your change management efforts.

Clarify Direction As the saying goes, “culture is everything.� To effectively manage change, you must consider your practice culture, and thus clarify how the change relates to your practice culture, vision, and goals.

Communication is paramount when trying to raise the level of understanding of why the change is taking place. Employees should be told why the change is taking place, what the change will mean for them, when the change will be happening, how the change will be carried out, what support will be

available to help them adjust to the change, and what will be expected of employees as a result of the change.

Over-communicate your goals, direction, and expectations. It’s not enough to send out an e-mail addressing those points. Communication should be regular and should continue over an extended period of time.

Invite and Acknowledge Concerns Make change a part of your business and an expectation among staff and providers. Many members of your practice are innovative and eager to contribute their insights

By Nick Hernandez, MBA, FACHE CEO and Founder of ABISA

and suggestions for improvement.

Treat them as a natural part of the process and address resistance by asking for input.

Work with all staff to measure “real” vs. “perceived” disruption.

The path of rolling out change is immeasurably smoother if these people are tapped early for input on issues that will affect their jobs.

The goal is to quickly get employees through the denial and resistance stages and on to the commitment phase where you get the buy-in from staff.

Develop Commitment Work on developing commitment from the staff and avoid

demanding compliance. People respond to calls to action that engage their hearts as well as their minds, making them feel as if they’re part of something consequential, so make the rational and emotional case for change together.

Their full-hearted engagement can smooth the way for complex change initiatives, whereas their resistance will make implementation an ongoing challenge. Address any reservations and give some consideration to possibly rewarding initiative. You must either build commitment or prepare for the consequences.

Medical practices must constantly change in order to survive

in today’s competitive healthcare arena. Practices should never settle for something that is considered completed; all things can improve with change.

Managing change in an already busy practice environment, however, can be challenging and you may want to consider bringing someone in to help structure the rollout of a project and guide you through key change initiative milestones. When employees who have endured real upheaval and put in significant extra hours for an initiative that was announced with great fanfare see it simply fizzle out, cynicism sets in. 

MED MONTHLY MAGAZINE

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Physician Solutions, Inc. Medical & Dental Staffing The fastest way to be $200K in debt is to open your own practice The fastest way to make $100K is to choose

Physician Solutions

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

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

U.S. OPTICAL BOARDS Alaska P.O. Box 110806 Juneau, AK 99811 (907)465-5470 http://www.commerce.state.ak.us/dnn/ cbpl/ProfessionalLicensing/DispensingOpticians.aspx Arizona 1400 W. Washington, Rm. 230 Phoenix, AZ 85007 (602)542-3095 http://www.do.az.gov Arkansas P.O. Box 627 Helena, AR 72342 (870)572-2847 California 2005 Evergreen St., Ste. 1200 Sacramento, CA 95815 (916)263-2382 http://www.optometry.ca.gov/ Colorado 1560 Broadway St. #1310 Denver, CO 80202 (303)894-7750 http://www.dora.state.co.us/optometry/ Connecticut 410 Capitol Ave., MS #12APP P.O. Box 340308 Hartford, CT 06134 (860)509-7603 ext. 4 http://www.ct.gov/dph/cwp/view. asp?a=3121&q=427586 Florida 4052 Bald Cypress Way, Bin C08 Tallahassee, FL 32399 (850)245-4474 http://www.pof.org/opticianry-board/ Georgia 237 Coliseum Dr. Macon, GA 31217 (478)207-1671 http://sos.ga.gov/index.php/licensing/ plb/20 Hawaii P.O. Box 3469 Honolulu, HI 96801 (808)586-2704 http://hawaii.gov/dcca/pvl/programs/ dispensingoptician/

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

Oregon 3218 Pringle Rd. SE Ste. 270 Salem, OR 97302 (503)373-7721 http://www.oregonobo.org/optque.htm

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

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

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

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

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

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

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

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

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U.S. DENTAL BOARDS Alabama Alabama Board of Dental Examiners 5346 Stadium Trace Pkwy., Ste. 112 Hoover, AL 35244 (205) 985-7267 http://www.dentalboard.org/ Alaska P.O. Box 110806 Juneau, AK 99811-0806 (907)465-2542 https://www.commerce.alaska.gov/web/ cbpl/ProfessionalLicensing/BoardofDentalExaminers.aspx Arizona 4205 N. 7th Ave. Suite 300 Phoenix, AZ 85103 (602)242-1492 http://azdentalboard.us/ Arkansas 101 E. Capitol Ave., Suite 111 Little Rock, AR 72201 (501)682-2085 http://www.asbde.org/ California 2005 Evergreen Street, Suite 1550Â Sacramento, CA 95815 877-729-7789 http://www.dbc.ca.gov/

Hawaii DCCA-PVL Att: Dental P.O. Box 3469 Honolulu, HI 96801 (808)586-3000 http://cca.hawaii.gov/pvl/boards/dentist/ Idaho P.O. Box 83720 Boise, ID 83720 (208)334-2369 http://isbd.idaho.gov/ Illinois 320 W. Washington St. Springfield, IL 62786 (217)785-0820 http://www.isds.org/LawsLegislation/ boardOfDentistry.asp Indiana 402 W. Washington St., Room W072 Indianapolis, IN 46204 (317)232-2980 http://www.in.gov/pla/dental.htm

Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7800 https://www.colorado.gov/pacific/dora/ Dental_Board

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

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

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

Delaware Cannon Building, Suite 203 861 Solver Lake Blvd.

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

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

Florida 4052 Bald Cypress Way Bin C-08 Tallahassee, FL 32399 (850)245-4474 http://floridasdentistry.gov/ 18

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

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

Maine 143 State House Station 161 Capitol St. Augusta, ME 04333 (207)287-3333 http://www.mainedental.org/ Maryland 55 Wade Ave. Catonsville, Maryland 21228 (410)402-8500 http://dhmh.state.md.us/dental/ Massachusetts 1000 Washington St., Suite 710 Boston, MA 02118 (617)727-1944 http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/dhpl/ dentist/about/ Michigan P.O. Box 30664 Lansing, MI 48909 (517)241-2650 http://www.michigan.gov/lara/0,4601,7154-72600_72603_27529_27533---,00. html Minnesota 2829 University Ave., SE. Suite 450 Minneapolis, MN 55414 (612)617-2250 http://www.dentalboard.state.mn.us/ Mississippi 600 E. Amite St., Suite 100 Jackson, MS 39201 (601)944-9622 http://bit.ly/uuXKxl Missouri 3605 Missouri Blvd.

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

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

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

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

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

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

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

New Jersey P.O Box 45005 Newark, NJ 07101 (973)504-6405 http://njpublicsafety.com/ca/dentistry/

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

New Mexico Toney Anaya Building 2550 Cerrillos Rd. Santa Fe, NM 87505 (505)476-4680 http://www.rld.state.nm.us/boards/Dental_Health_Care.aspx New York 89 Washington Ave. Albany, NY 12234 (518)474-3817 http://www.op.nysed.gov/prof/dent/ North Carolina 507 Airport Blvd., Suite 105 Morrisville, NC 27560 (919)678-8223 http://www.ncdentalboard.org/ North Dakota P.O. Box 7246 Bismark, ND 58507 (701)258-8600 http://www.nddentalboard.org/

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

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

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U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (334)242-4116 http://www.albme.org/ Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 http://www.medlicense.com/alaskamedical-license.html Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 (480)551-2700 http://www.azmd.gov Arkansas 1401 West Capitol Ave., Suite 340 Little Rock, AR 72201 (501)296-1802 http://www.armedicalboard.org/ California 2005 Evergreen St., Suite 1200 Sacramento, CA 95815 (916)263-2382 http://www.mbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7690 http://www.dora.state.co.us/medical/ Connecticut 401 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/cwp/view. asp?a=3143&q=388902 Delaware Division of Professional Regulation Cannon Building 861 Silver Lake Blvd., Suite 203 Dover, DE 19904 (302)744-4500 http://dpr.delaware.gov/ District of Columbia 899 North Capitol St., NE Washington, DC 20002 (202)442-5955 http://doh.dc.gov/bomed 20

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Florida 2585 Merchants Row Blvd.

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

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

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

Maine 161 Capitol Street 137 State House Station Augusta, ME 04333 (207)287-3601 http://www.maine.gov/md/

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

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

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

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

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

Michigan Bureau of Health Professions P.O. Box 30670 Lansing, MI 48909 (517)335-0918 http://michigan.gov/lara/0,4601,7-15472600_72603_27529_27541-58914--,00. html

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

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

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

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

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

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

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

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

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

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

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features

Repealing and Replacing the ACA: Five Developments Likely to Occur in the Years Ahead

By Richard J Zall Proskauer Rose LLP

*Krista White, a law clerk at Proskauer’s Health Care practice contributed to this article.

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| JANUARY 2017

O

n the back of the 2016 United States presidential election results, the health care industry ponders how a Republican president and Congress will transform the business environment. The health care industry has a number of important questions which need to be examined. We take this opportunity to look at key issues, including the meaning of “repeal and replace,” the future of Medicare and Medicaid, the rigor of antitrust enforcement, and the viability of insurance exchanges.

While industry observers have speculated about the future, the only thing one can say with authority is that the health care landscape in 2017 and beyond remains highly uncertain.

Following the President-Elect’s campaign refrain to “Repeal Obamacare,” the President-Elect and Republican Congressional leaders would indeed find it difficult to repeal the legislation wholesale without creating substantial disruption – both to the approximately 20 million people who gained insurance as a result of the ACA between 2010 and 2016,[1] as well as to the hospitals and insurance companies which have large stakes in the expanded health care coverage the ACA created. Adding to the uncertainty, the Democrats retain a sufficient number of seats in the Senate to filibuster a wholesale Obamacare repeal bill.

Notwithstanding the difficulty of predicting with certainty what will transpire, we believe there are five developments that are likely to occur in the years ahead: Reductions in Federal Subsidies, Changes to Medicaid

Funding and Contraction of Insurance Coverage Federal subsidies to individuals purchasing health insurance on the ACA health exchanges are likely to be reduced significantly by the next administration and Congress. Such a reduction would cause a dramatic shift in the health care landscape: the Department of Health and Human Services (HHS) estimates that 85% of all health exchange customers receive some sort of subsidy on the marketplace.[2] Both House Speaker Paul Ryan and nominee for HHS Secretary Tom Price have proposed to replace the subsidies with tax credit schemes based on age.[3] In place of subsidies, for those individuals not covered by their employer, Medicare, or Medicaid, Speaker Ryan’s plan proposes a fixed tax credit based on age as a proxy for need.[4] Under this scheme, older Americans would receive more support. Speaker Ryan’s plan envisions the credit being large enough to “purchase the typical pre-Obamacare health insurance plan,” reflecting the Speaker’s general desire to decrease costs of plans by eliminating mandated benefits, such as essential health benefits (EHBs). Representative Price’s plan proposes specific figures for the tax credits for each age group, ranging from $900 per year for individuals under age 18 to $3,000 per year for those over age 50.[5] Some believe the elimination of subsidies in favor of tax credits, however, could result in many consumers falling through the cracks and insurance companies receiving less revenue: The companies will no longer receive the billions of dollars in subsidies the government provided on behalf of qualified indi-

viduals. Moreover, many of those individuals do not earn enough income to benefit from a tax credit and therefore would not be able to afford an insurance plan.

Elimination of subsidies and the likely reduction in Medicaid funding will also affect the bottom line for hospitals. The ACA – through the subsidies and expanded Medicaid programs – ensured that a greater number of previously uninsured patients could obtain insurance and pay their hospital bills.

In fact, the HHS estimates that the ACA reduced uncompensated care costs by $7.4 billion in 2014.[6] In anticipation of this expanded coverage, the ACA provided for lower Disproportionate Share Hospital (DSH) payments to hospitals. The elimination of subsidized insurance coverage will likely increase the number of uninsured patients at hospitals, and, without an increase in DSH payments, more charity care provided by the hospitals.

Increased State Autonomy in Managing Medicaid Program Design Speaker Ryan’s plan emphasized that states should retain more regulatory control over Medicaid administration.[7] Both the PresidentElect and Speaker Ryan support block grants of Medicaid funding to states and greater flexibility for states to determine (and possibly narrow) Medicaid eligibility. It remains unclear whether block grants would reduce overall federal spending on state Medicaid programs.

Under current law, states are permitted to request Section 1115 waivers to modify their provision of Medicaid, which several states optcontinued on page 24 MED MONTHLY MAGAZINE

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continued from page 23

ed to do in exchange for expanding their Medicaid programs. Conservative policy favors modifying Medicaid to include prerequisites to coverage, such as cost-sharing measures and work requirements.

For example, Governor Mike Pence obtained a Section 1115 waiver to require Medicaid recipients in Indiana to pay premiums if their earnings fall above the federal poverty level. Other states may look to apply for Section 1115 waivers in the near future under what is likely to be a more flexible administration. President-Elect Trump’s recent appointment of health care consultant Seema Verma to head the Centers for Medicare & Medicaid Services foreshadows a continued trend toward greater utilization of such waivers: Verma co-designed Indiana’s Section 1115 waiver with Governor Pence.

Increased Emphasis on Marketplace Solutions and Consumer Choice Republicans and the PresidentElect have also favored a more consumer-based health care system, where the consumer can make decisions based on his or her needs.

Both strongly oppose the individual mandate and support greater expansion of existing health care financing options, such as health savings accounts (HSAs) and health flexible spending accounts (FSAs).

With consumer choice comes the consumer’s ability to choose not to buy insurance. The repeal of the individual and employer mandates – another likely action under the next administration – may, absent other action, render insurance companies the victims of adverse selection, 24

| JANUARY 2017

where healthy consumers choose not to purchase health insurance, leading to an increase in the proportion of unhealthy consumers covered. Further, Speaker Ryan’s plan would prohibit insurance companies from dropping patients simply because they are sick when they renew their plan.[8] PresidentElect Trump has stated he also would ban insurance companies from dropping current policyholders just because they are sick; but as for new enrollees, the PresidentElect and Speaker Ryan would put those individuals into high-risk pools. These pools could, in theory, provide an insurance option for high-risk individuals, but would require higher premiums and higher federal subsidies: Speaker Ryan’s plan promises $25 billion in federal subsidies for such pools.[9] It is also possible that the new administration will eliminate the federal operation of state exchanges, while still encouraging states to operate their own exchanges.

After all, the exchanges are the type of market-based mechanism that the Republican President-Elect and Congress typically support. At the same time, if subsidies are cut, insurance companies may decide to withdraw from the public exchang-

es, threatening the viability of the individual insurance marketplace platform. Several major insurers have already withdrawn from or scaled back their participation in the exchanges, leaving individual insurance-seekers with as little as one option on the exchange.

Potential Changes in the Shape of the Medicare Program Speaker Ryan and the Republican Party hope to change the current structure of Medicare to a system based on “premium support.” This plan allows private plans to compete with traditional fee-for-service (FFS) Medicare, building on the popularity of already privatized Medicare Advantage plans. Seniors would receive a voucher-like payment toward the plan of their choice – a voucher that may not cover the senior’s desired level of care. President-Elect Trump also favors “moderniz[ing] Medicare,” although he has not elaborated on a specific plan to do so.[10] In general, plans to change the structure of Medicare remain politically controversial and may not survive in their full proposed form.

Another target of Republican criticism has been the Center for

Medicare and Medicaid Innovation (CMMI), which oversees alternative payment and service delivery models that aim to reduce government program expenditures. While some supporters believe CMMI provides a platform for innovation and cost-effective market research, some Republicans claim that the Center oversteps its legislatively authorized role. The new administration could diminish the role of CMMI and decrease its federal funding.

New Rules for the Pharma and Medical Device Sector Deregulation of pharmaceutical products and medical devices is a likely possibility in 2017 and beyond. President-Elect Trump has stated that his administration will “[r]eform the Food and Drug Administration, to put greater focus on the need of patients for new and innovative medical products.”[11] Industry players may face shorter approval periods, which could allow for greater competition and innovation, but may also leave consumers exposed to dangerous products. Nevertheless, investors and lenders may begin to see companies more willing to take risks if the FDA loosens its standards and hastens its process. The 21st Century Cures Act, which passed in the House with overwhelming bipartisan support and is likely to do the same in the Senate, pushes for a modernization of the drug and medical device approval process.[12] The bill appropriates more than $6 billion in federal funds toward high-risk, high-reward biomedical research.

The past year has also seen bipartisan support for lowering prescription drug costs and limiting

drug price gouging. A bipartisan bill introduced in September 2016 proposes having drug companies report to HHS any price increases of 10% or more over a 12-month period.[13] Lastly, the medical device industry may benefit from repeal of the medical device tax imposed by the ACA. H.R. 3762, a wide-sweeping health care reform bill that passed through the House and Senate but was vetoed by President Obama earlier this year, proposed an elimination of the tax, a move also supported by President-Elect Trump.[14]  [1] “20 million people have gained

health insurance coverage because of the Affordable Care Act, new estimates show,” U.S. Dep’t of Health & Human Services, http://www.hhs.gov/about/ news/2016/03/03/20-million-peoplehave-gained-health-insurance-coveragebecause-affordable-care-act-new-estimates (March 3, 2016).

[2] “More Than 70 Percent of Consumers Can Find Marketplace Plans for Less than $75 Per Month,” U.S. Dep’t of Health & Human Services, http:// www.hhs.gov/about/news/2016/10/24/ more-70-percent-consumers-can-findmarketplace-plans-less-75-month.html (October 24, 2016) [3] “A Better Way: Health Care,” Office of the Speaker of the House, http:// abetterway.speaker.gov/_assets/pdf/ ABetterWay-HealthCare-PolicyPaper. pdf, p. 14 (June 22, 2016); Empowering Patients First Act of 2015, H.R. 2300, 114th Cong. § 36B (2015).

[4] “A Better Way: Health Care,” Office of the Speaker of the House, http://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-PolicyPaper.pdf, p. 14 (June 22, 2016).

[5] Empowering Patients First Act of 2015, H.R. 2300, 114th Cong. § 36B(b) (1) (2015).

[6] “Insurance Expansion, Hospital Uncompensated Care, and the Affordable Care Act,” U.S. Dep’t of Health & Human Services, https://aspe.hhs.gov/sites/ default/files/pdf/139226/ib_UncompensatedCare.pdf(March 23, 2015).

[7] “A Better Way: Health Care,” Office of the Speaker of the House, http://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-PolicyPaper.pdf, p. 12 (June 22, 2016).

[8] “A Better Way: Health Care,” Office of the Speaker of the House, http://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-PolicyPaper.pdf, p. 20 (June 22, 2016).

[9] “A Better Way: Health Care,” Office of the Speaker of the House, http://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-PolicyPaper.pdf, p. 21 (June 22, 2016); Karen Pollitz, “HighRisk Pools For Uninsurable Individuals,” Kaiser Family Foundation, http://kff. org/health-reform/issue-brief/highrisk-pools-for-uninsurable-individuals/ (August 1, 2016).

[10] Healthcare, President Elect Donald Trump, https://www.greatagain.gov/ policy/healthcare.html.

[11] Healthcare, President Elect Donald Trump, https://www.greatagain.gov/ policy/healthcare.html.

[12] 2 1st Century Cures Act, H.R. 6, 114th Cong. (2015).

[13] H.R. 6043, Fair Accountability and Innovative Research Drug Pricing Act of 2016, 114th Congress, 2nd Session (2016) [14] H.R. 3762, 114th Cong. (2015).

Source: http://www.natlawreview.com/ article/repealing-and-replacing-acafive-developments-likely-to-occur-yearsahead

Source: http://www.natlawreview. com/article/repealing-and-replacingaca-five-developments-likely-tooccur-years-ahead

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features

Politics and Your Practice: Don’t Alienate Half of Your Patients Before They Walk Through the Door

By Denise Price Thomas

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| JANUARY 2017

While contracted as an “Undercover Patient” for a Practice Assessment and arriving at the facility, the very first thing I noticed was a huge political sign just as I pulled into the parking lot. Now granted, the sign referred to my candidate of choice however, I’m certain not everyone agreed.

While sitting in their lobby, I witnessed patients checking in and a few began discussing the sign out front. One even expressed her opinion to all as if it were the gospel! Before I knew it, there were heated disputes filling the lobby with opinions from all over the board.

Because of the sign, this hot topic was fresh on their minds as they walked through the front door and it carried over until they exited that same door.

Physicians and staff reported that they had many discussions (some pretty heated) sometimes starting in triage and lasting all the way into the exam room.

Some employees were more opinionated than others, some were not voting for the candidate on the sign and they did not mind sharing this information. As if we need to invite more drama into the medical office?

The very first thing I recommended was for the sign to be taken down. I reminded the practice that they would be making some patients happy and some patients unhappy.

The sign had been approved to be placed there by one of the physicians. It was not the opinion of all the physicians, which posed a problem between physicians, as well as the staff and their patients.

I compared it with local elections and mentioned the fact that family members of the opposing candidate may also be patients there at the facility. I asked that they think about how they would feel being on the other side. I brought it even closer to home. I said, “Let’s say you pulled up to see your personal physician and there was a political sign that didn’t go along with your views. Would this bother you? The vote YES was unanimous.

Your medical practice should try to avoid political conversations altogether or at least express neutral views. Many experts say you should never, ever discuss politics in any office setting, because it can be a very sensitive topic. It touches on people’s world views, how they believe the world and country should run, and the way individual people should run their lives. That’s why it can be so easy to offend a patient and that is the last thing you want to be doing at your practice. Even if the conversation is low-key, you still

open yourself up to judgment when you voice your political views. You never really know where people stand. Patients might judge your whole practice based on something the candidate you’re supporting did.”

If politics must be discussed, remain neutral. If asked “What did you think about the debate last night?” reply “It was interesting.” Or simply redirect the conversation. “I feel so overwhelmed with all the election coverage, let’s talk about something else. Have you seen the latest Star Wars movie?”

Now, we all know that when given the choice, I hope we would vote for “Gladys Friday” and her large dose of Healthcare Humor. However, when it comes to real politics, I would suggest that before you open up your practice for a debate, you start by speaking with your staff. I think you will find that there are many different opinions among your own staff. Consider this when deciding if it is appropriate to share political views with your patients.

Many times we make decisions with the most sincere intentions. We just sometimes forget to think about it from both sides. 

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

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

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features

Healthcare in 2017 for All? Will Trumpcare Stump Obamacare?

By Naren Arulrajah Ekwa Marketing

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| JANUARY 2017

The real test of the Affordable Care Act (ACA) will take place in 2017. And while healthcare costs haven’t become unaffordable, as yet, how the system will change and impact healthcare practices and patients under President-elect Donald Trump is to be seen.

For now there isn’t much clarity on Trump’s vision of healthcare for Americans. He has however, at numerous occasions mentioned the strong possibility of repealing the ACA and replacing it with a different healthcare policy. However, given the fact that repealing ACA completely at this stage might be extremely difficult, there is a very high possibility that the Trump administration might introduce crucial and impacting changes in specific areas of ACA. The Expiration of Two Programs As we step into 2017, two programs that will expire are “Risk corridors” and “re-insurance.” These programs contain true costs of health insurance which were subsidized with taxpayer money.

Under Risk corridors, insurance companies were paid in the event that their customers spent more on healthcare than the insured amount. Reinsurance on the other hand allows insurance companies to claim the bill from the federal government for costs incurred on expensive treatment for patients. In both these cases, insurance companies were allowed to list low premiums for their healthcare plans.

Essentially, both programs were meant to make the move to ACA healthcare system easy or more convenient. However, there is no denying that post-ACA, healthcare has become more expensive. Base premiums increased 41 percent in 2014. Authors of the ACA system created both these programs as a way of offsetting the impact of rise in premiums - until Jan. 1, 2017.

Post that date, premiums are set to increase.

Scattered Response from the Healthcare Sector Given the lack of clarity in Trump’s healthcare agenda, the response from the healthcare sector has been rather muted. Hospitals, private practices, and corporate clinics have undergone a lot of transition pain to get their systems up and ready to tackle ACA. Technological and IT changes apart, healthcare practices had to undergo specific changes in keeping with greater accountability and an improved system of patient care. This included working out new insurance programs, a change in billing systems, re-organizing their practice structure to service more patients.

So a lot of effort and pain has gone into getting on board with the ACA system. A repealing of the ACA will mean drastic and a complete overhaul of the healthcare system in its present form.

Unless Trump can specifically list out a system that shows clear and detailed advantages of introducing a completely new healthcontinued on page 30

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continued from page 29

care platform, repealing ACA does seem far-fetched. For most healthcare practices, it is a wait and watch game for now.

How will Trumpcare Impact Women In addition to contraception coverage, a number of voices have raised the impending risk of lower or no coverage for a number of other women’s health benefits.

Under the ACA, maternity care was to be included as an essential health benefit for women. Prior to the ACA implementation, individuals rarely purchased plans that covered both prenatal care and childbirth. However, ACA made that necessary.

Prior to ACA implementation, it was not uncommon for women to be charged higher rates compared to men for the same services. This was the case even with plans that did not include maternity coverage. ACA changed that.

ACA also introduced coverage for preventive services for women.

Specific preventive services such as breast and cervical cancer screening for BRCA 1 and 2 genetic mutations recommended by the U.S. Preventive Services Task Force had to be covered without deductibles or copayment. If the law is repealed, coverage of these kinds of services could change.

Coverage for contraception and other services endorsed by the Health Resources and Services Administration (HRSA) which includes contraceptives that are approved by the Food and Drug Administration (FDA) that most insurers are required to cover without charging women could be 30

| JANUARY 2017

eliminated. Coverage and support for other services such as yearly visits (at least once a year), counseling and screening for sexually transmitted infections, screening for gestational diabetes, support, counseling and supplies for breast-feeding as well as screening and counseling for domestic violence could be viewed differently by the Trump administration.

A number of services might be un-endorsed, or there could be a difference in opinion about implementing healthcare recommendations. Or, the new administration could simply go ahead and create a completely different set of rules.

A lot of consideration went into strengthening preventive services benefits for women. For example a directive for making it necessary for insurers to provide coverage for all contraceptive options (18 in total) helped in ensuring a stronger base for preventive care for women.

If these are un-endorsed, the implications can be wide and far reaching. At the moment, how the Trump administration will decide to look at these laws is not very clear.

Conclusion President-elect Donald Trump has been very vocal about changing the healthcare system for Americans.

His strongest attack on Obamacare came in the form of a completely repealing the system and replacing it with something bigger and better. Will he be successful in doing so or will he simply go ahead with changing specific laws under ACA will become clear only after he steps into office.  About the Author: Naren Arulrajah is President and CEO of Ekwa Marketing, a complete Internet marketing company which focuses on SEO, social media, marketing education and the online reputations of Dentists and Physicians. With a team of 140+ full time marketers, www.ekwa.com helps doctors who know where they want to go get there by dominating their market and growing their business significantly year after year. If you have questions about marketing your practice online, call 855- 598-3320 to speak one-on-one with Naren.

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Practices for Sale Medical Practices Pediatric Practice Near Raleigh, NC

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

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

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

Primary Care specializing in Women’s Practice

Family Practice/Primary Care

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

Location: Morehead City, N.C. List Price: Just reduced to $20,000 or Best Offer Gross Yearly Income: $540,000 average for past 3 years Year Established: 2005 Average Patients per Day: 12 to 22 Building Owned/Leased: MD owned and can be leased or purchased Contact: Philip or Wendy at (919) 848-4202

Med Spa

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Practice Type: Mental Health, Neuropsychological and Psychological

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

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

Location: Wilmington, NC List Price: $110,000 Gross Yearly Income: $144,000 Year Established: 2000 Average Patients Per Day: 8 Building Owned/Leased/Price: Owned Contact: Philip or Wendy at (919) 848-4202

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

Considering your practice options? Call us today.

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| JANUARY 2017

Located on NC’s Beautiful Coast,

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

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MED MONTHLY MAGAZINE

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MD STAFFING AGENCY FOR SALE IN NORTH CAROLINA

Urology Practice minutes from Lake Norman, 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

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

Please direct all correspondence to driverphilip@gmail.com.

Only serious, qualified inquirers.

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

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

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

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

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

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

MedicalPracticeListings.com | medlisting@gmail.com | 919-848-4202 34 | JANUARY 2017

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

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

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

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

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

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

Pediatrics Practice Wanted

Internal Medicine Practice in the Heart of Raleigh

Pediatrics Practice Wanted in NC Considering your options regarding your pediatric practice? We can help. Medical Practice Listings has a well qualified buyer for a pediatric practice anywhere in central North Carolina.

Contact us today to discuss your options confidentially.

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

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

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

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

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PEDIATRICIAN

or family medicine doctor needed in

FAYETTEVILLE, NC

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

Comfortable seeing children. Needed immediately.

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

Contact Medical Practice Listings today to discuss the practice details.

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

www.medicalpracticelistings.com

CALLING ALL WRITERS

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

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

Contact us:

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

Editorial Calendar:

January - Politics & Your Practice February - Preventive Medicine 36 | JANUARY 2017

Modern Med Spa Available

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

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

Practice for Sale in Raleigh, NC 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.

Primary Care Practice For Sale in Wilmington, NC Established primary care on the coast of North Carolina’s beautiful beaches. Fully staffed with MD’s and PA’s to treat both appointment and walk-in patients. Excellent exam room layout, equipment and visibility.

Contact Medical Practice Listings for more information.

List price: $435,000

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

Medical Practice Listings

919.848.4202 | medlistings@gmail.com www.medicalpracticelistings.com MED MONTHLY MAGAZINE

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State of Cha-Ching.

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

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

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

GET TO A BETTER STATE .

CALL ME TODAY. ™

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

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

Listing Price: $430,000

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

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

1101216.1 State Farm, Home Office, Bloomington, IL

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

Eastern North Carolina Family Practice Available Well-appointed Eastern North Carolina Family Practice established in 2000 is for sale in Williamston, NC. This organized practice boasts a wide array of diagnostic equipment including a GE DEXA scanner with a new tube, GE case 8000 stress testing treadmill and controller and back up treadmill, Autoclave and full set of operating equipment, EKG-Ez EKG and much more. The average number of patients seen daily is between 12 to 22. The building is owned

by MD and can be purchased or leased.

The owning physician is relocating and will assist as needed during the transition period. The gross receipts for the past three years average $650,000 and the list price was just reduced to $185,000. If you are looking to purchase a well equipped primary care practice, please contact us today.

919-848-4202 medlisting@gmail.com medicalpracticelistings.com 38 | JANUARY 2017

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

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

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

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

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

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

Pediatric Practice Available Near Raleigh, NC

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

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

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

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

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

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

MED MONTHLY MAGAZINE

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THINKING ABOUT SELLING YOUR PRACTICE?

Medical Practice Listings can help you sell your practice online!

Now offering two types of listings to better serve all practice specialties and budgets.

For Sale by Owner Listing The For Sale by Owner Listing offers you the opportunity to gain national exposure by posting your listing on our website which is viewed daily by a network of qualified professionals. This option includes a brief practice consultation to explain the benefits of marketing through the Medical Practice Listings website. Our special rate for the For Sale by Owner listing through the end of 2015 is only $29.95 per month.

Professional Listing In addition 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.

919.848.4202 | medicalpracticelistings.com