Med Monthly July 2013

Med Monthly JULY 2013

Want to Increase Your Practice Revenue? pg. 46

MARKETING A NEW PROCEDURE AT YOUR PRACTICE pg. 48

the

res to Procedu Your Enhance Practice

issue

EHR Technology:

Best Practices to Avoid the Appeals Process And Achieve Meaningful Use pg. 52

contents

features

46 WANT TO INCREASE YOUR PRACTICE REVENUE? Consider these tips.

48 MARKETING A NEW PROCEDURE AT YOUR PRACTICE 52 EHR TECHNOLOGY: Best Practices to Avoid the Appeals Process and Achieve Meaningful Use

16

PATIENT COMMUNICATIONS: An Integral Part of Your Marketing Strategy

international

insight

24 RISING AFFLUENCE AND AWARENESS CONTRIBUTE STRONGLY TO A BRIGHT OUTLOOK FOR THE ASIA-PACIFIC HOSPITAL MARKET

10 BT AND ACCELRYS HELP SCIENTISTS GAIN VALUABLE MEDICAL INSIGHTS FROM BIG DATA

research and technology

12 ACA WILL SOON DRIVE UP DEMAND FOR HEALTH CARE SERVICES

26 TWO GENE VARIANTS MAY PREDICT WHO WILL BENEFIT FROM BREAST CANCER PREVENTION DRUGS 28 FLIPPING THE MEDICAL CLASSROOM?

14 DEMYSTIFYING SCOLIOSIS: From Diagnosis to Treatment

34 TARGETED MUSCLE REINNERVATION: Moving Muscles With the Mind

practice tips 16 PATIENT COMMUNICATIONS: An Integral Part of Your Marketing Strategy 18 UNDERCOVER PATIENT: Checking Your Practice’s Vital Signs 22 RECRUITMENT AND RETENTION OF PAS AND NPS IN PRIMARY CARE IS CRITICAL

34

legal 38 ELECTRONIC HEALTH RECORDS SYSTEMS: Contracting for Change 40 IMPACT OF SEQUESTRATION ON THE NATIONAL INSTITUTES OF HEALTH 44 HEALTH CARE OBLIGATIONS OF EMPLOYERS UNDER THE AFFORDABLE CARE ACT

the arts 54 WHAT IS EVIDENCE-BASED ART?

healthy living 62 TROPICAL SMOOTHIE TARGETED MUSCLE REINNERVATION: Moving Muscles With the Mind

in every issue 4 editor’s letter 8 news briefs

62 resource guide 80 top 9 list

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editor’s letter

Successful medical practices view their office as a business.

Though altruistic motives hopefully prevail, profits are necessary for a practice to survive and prosper. Med Monthly’s July issue focuses on ways to enhance your practice – from new technology to marketing to adding new procedures. Not only can these help increase income, they can make your patients’ experience more satisfying.

In the feature “Want to Increase Your Practice Revenue?”

Philip Driver bullet points eight excellent ideas to increase your bottom line. For instance, you can lengthen your hours to increase your patient load. If it is high enough, a mid-level could be added to free up the physician from seeing the extra patients. You can also think about ePrescribing or spend time enhancing your referral base.

In “EHR Technology: Best Practices to Avoid the Appeals Process and Achieve Meaningful Use”, Frank Rosello describes the way to avoid appeals from Medicare and Medicaid when using electronic records, commonly known as EHR best practices.

Rosello recommends creating a thorough EHR program, including monitoring of each step of the process. It is best to go to www.cms.gov and find their Attestation page to ensure your practice is effectively compiling the patients’ data and your employees’ follow best practice.

Another way to increase revenue is to add another procedure to list of services your practice provides. But what is the most effective way of informing your current patients and finding new ones who may need this procedure? The first thing to do is to thoroughly inform your staff. You can also create a practice newsletter or send out an e-newsletter. The feature “Marketing a New Procedure at Your Practice” explains how to accomplish these marketing ideas, including creating a video for your patients to see while waiting to see the doctor.

July’s issue is jam packed with great ways to increase your practice. Even if you only implement one of the many suggestions throughout the magazine, you should see your profits grow. Our August issue is about first responders, those brave men and women who respond to medical emergencies and save countless lives.

Ashley Austin Managing Editor

4 | JULY 2013

Med Monthly July 2013

Publisher Philip Driver Managing Editor Ashley Austin Creative Director Thomas Hibbard Contributors Ashley Acornley, MS, RD, LDN Ari G. Burd, Esq. Lisa Catania Kathy Hathorn Amanda Kanaan Laura Maaske Keith Mankin, MD, FAAP Upali Nanda PhD Frank J. Rosello Lisa Shock Denise Price Thomas Clay B. Wortham

contributors Lisa Catania is a National Business Development Manager with the Dallas office of All Medical Personnel, Inc., which provides a full range of staffing services to medical and healthcare organizations throughout the nation. Lisa can be reached at Lisa.

Catania@AllMedStaffing.com.

Amanda Kanaan is the owner/founder of WhiteCoat Designs – an online marketing agency committed to growing doctors’ practices through costeffective and powerful online marketing solutions. Amanda regularly speaks at medical association meetings and conventions and is a published expert in the field of medical marketing. To learn more or for a free website evaluation, contact her at Amanda@whitecoat-designs. com or http://www.whitecoat-designs.com.

Laura Maaske

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 medical illustrator with a Master's of Science degree in Biomedical Visualization from the University of Toronto. She launched Medimagery in 1997, specializing in the creation of patient education materials, interactive media, e-books, cellular and molecular illustrations, and design of medical education materials. For more information, please visit Medimagery.com, send a note to Laura@medimagery.com or call 262.308.1300.

Keith Mankin, MD, FAAP is a board-certified, fellowship trained pediatric orthopaedic surgeon in Raleigh, NC where he a staff member with the Department of Orthopaedics at WakeMed Healthcare Center and with the Department of Orthopaedics at Rex Hospital. He has been recognized on several occasions for his research and teaching accomplishments.

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 MEDMONTHLY.COM |5

designer's thoughts

From the Drawing Board George Bernard Shaw quoted, “You see things; and you say Why? But I dream things that never were; and I say Why not?”

Our Research and Technology section features a story that echoes this thought. It’s about targeted muscle reinnervation (TMR) and was featured in a segment on 60 Minutes.

In “Targeted Muscle Reinnervation: Moving Muscles With the Mind” by our managing editor, Ashley Austin, she reports on an interview she had with Dr. Albert Chi about his team at John Hopkins Hospital and the major strides they are taking in helping amputees with their research in robotics. By reassigning existing nerves, they make it possible for people who have had upper-arm amputations to control their prosthetic devices by merely thinking about the action they want to perform. With surgery and an extended period of physical therapy, their team and their patients have seen very encouraging results.

Laura Maaske’s article, “Flipping the Medical Classroom” discusses the new standards in educating medical students and how technology is assisting in making this possible. She shares current and future “adaptive learning technology” including software that collects data on individual student’s comprehension (knowledge, skill, and confidence) and customizes, through algorithms, a personalized study plan. Also discussed are books that ‘talk back’ to students, offering instructions and suggestions for more effective ways to study.

The National Institutes of Health (NIH) informs our readers that in women at high risk for breast cancer, a long-term drug treatment can cut the risk of developing the disease in half.

Their researchers have now identified two gene variants that may predict which women are most likely to benefit from this therapy — and which should avoid it.

If there are medical technologies or research you would like to share with us for future issues, please contact us at medmedia9@gmail.com.

Thomas Hibbard Creative Director

6 | JULY 2013

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news briefs

Velocity Medical Releases New VelocityGRID Oncology Imaging Platform Version 3.0 Velocity Medical Solutions, innovators in multi-modality imaging and therapy tools for radiation oncology centers, has released v3.0 of the VelocityGRID software platform for oncology including the much anticipated VelocityConnect a cloud-based, HIPAA compliant image collaboration and exchange tool.

Prior to the 3.0 release, more than 300 cancer centers worldwide, including almost half of the Top 50 Cancer Centers in the U.S., have already selected the VelocityGRID Platform for enhanced image-guided tumor targeting and continuous monitoring of patient response to treatment and will upgrade to v3.0 in 2013. The VelocityGRID platform has been evaluated by many academic medical centers to validate the need for deformable image registration, oncology PACS, and cloud-based image and data sharing within the radiation oncology environment. The new version of the Velocity platform continues to leverage this research and includes other enhancements including a simple user interface, a unique graphical patient “map” and landing page, improved plan review, workflow, contouring, registration and our HIPAA compliant, cloud-based collaboration tool VelocityConnect.

VelocityConnect allows radiation oncology departments to exchange and collaborate on data with different users in different clinics and gives radiation oncologists access to their data anytime, anywhere. VelocityConnect allows patients to share their data with referring physicians for seamless collaborative care. “Connecting oncologists and cancer centers in the cloud is a major step towards bringing imaging and treatment information to a shared network of designated users, regardless of their location,” said Chris Hanna, CEO of Velocity Medical Solutions. “Secure, ondemand access to oncology imaging and treatment data, combined with our advanced imaging platform, is helping clinicians on our network improve outcomes and patient care.” The 3.0 release also features key enhancements to VelocityGRID, our vendor neutral oncology image management and storage system. VelocityGRID enables clinicians to make treatment decisions with greater confidence based on multiple imaging modes, total dose mapping, and a complete record of patient images and plans. VelocityGRID provides comprehensive image integration and easy dose summation, offering new levels of accuracy and safety.  Source: http://www.newswiretoday.com/news/128882/ 8 | JULY 2013

SCIENTIFIC ANIMATIONS, LLC ANNOUNCES NEW TEAM ANNOUNCEMENT FOR INDIAN MARKET Scientific Animations have announced a new team to service the needs of the Indian market. Currently, the Indian pharmaceutical market is over $20 billion and growing at more than 15% per year. “US pharmaceutical companies spend over 25% of revenue on marketing. However, in India, they estimate this is less than 10%, and with only 1% of this on graphics and animation, the market was never attractive for them,” says Girish Khera, MD,“but now we see that for drugs that are globally oriented, and non-generic, such as biosimilars, the level of spend on marketing as well as on high quality 3D animation is rising.”

Indian pharmaceutical companies are increasingly looking to produce drugs for the global market. Historically, large Indian pharmaceutical companies have produced generics (drugs that are off-patent) where margins are lower and the requirement for cutting edge marketing is less also. “Every doctor knows what a Lipitor or Neksium is, so there’s no need for an MOA (mechanism of action) video” says Dr Manissha Sharma, Director, Doctors Hub polyclinic, Gurgaon,“but for new procedures and drugs, they really help.”

Increasingly, the focus is on Drugs that are for global consumption and are lessgeneric. One such area is biosimilars, also known as biologics. Biosimilarsare drugs which are produced or recombined from living organisms. It’s anexciting new area with the global biosimilar market projected at $10billion dollars in 2015, of which the Indian market would be about $300m (source: business standard).

With over 9 years of experience in the international market Scientific Animations is able to provide truly world class 3D medical animation. “And with a local production unit, they are able to service Indian companies at half the price of the US market.” Girish expects that as Indian companies look to win in the international biosimilar market, high quality graphics and animation will become a “must-have” in their marketing arsenal.  Source: http://www.newswiretoday.com/ news/129459/

Sneak Peek Into Future United States Biosimilar Market The pharmaceutical industry is experiencing change in ways it hasn’t ever before. On the demand side, we are seeing an aging population, increased prevalence of “Western” diseases, and a dramatic growth in global access to pharmaceuticals. On the supply side, we are seeing increased competition from emerging market players, and a shift in the way drugs are being developed, manufactured, and delivered. Meanwhile, policy makers are struggling with an inherent conflict between desire to provide improved access to better medicines and the need to curb the growth of health care expenditures.

One topic at the center of all of these changes is the U.S. biosimilars market. Biosimilar products will offer competition to some of the most expensive drugs on the market, but also require high investment. The promise of biosimilars in the U.S. is to provide cost savings, increase patient access, and promote innovation. And despite being a market still void of any entrants, the U.S. biosimilars market continues to attract attention.

The release of An Outlook on U.S. Biosimilar Competition report from Thomson Reuters IP & Science provides a comprehensive view of the challenges facing companies entering the United States biosimilar market, and the key players predicted to break into this developing pharmaceutical space. The report examines the scientific and quality considerations within the U.S. FDA’s guidance document, as well as exclusivity policies, clinical trial experience, and global regulations to identify the challenges pharmaceutical companies face in establishing a U.S. market for biosimilar drugs.

An Outlook on U.S. Biosimilar Competition also identifies the potential early leaders of the emerging U.S. biosimilar market. It has named Amgen, Sandoz and Hospira as the top three pharmaceutical companies with the most potential to dominate the early stages of the entrance of biosimilar medications into the U.S. drug market.

The report features: • Update on federal regulations • Overview of current biosimilar clinical trials and FDA applications • In-depth look into how some companies are overcoming barriers • Future biosimilar industry leaders While the U.S. continues to take steps toward entering the global biosimilar market, the nation dramatically lags behind other nations with strong, existing biosimilar markets. The report compares U.S. federal regulations with the EU’s regulations to demonstrate the reasons for significant differences between these markets and to explore ways the U.S. can compete more effectively, while also reviewing the emerging regulatory developments in India and China.

An Outlook on U.S. Biosimilar Competition was created by our experts in generic and API intelligence. The team utilized Newport Premium™, the industry’s leading tool for identifying and evaluating generic drug development and licensing opportunities to compile the report.  Source: http://www.pressreleasepoint.com/sneak-peek-future-united-states-biosimilar-market

SOON COMING ONTHLY IN MED M

ugust coming A p u e th In onthly’s e, Med M 2013 issu l be theme wil onders First Resp

MEDMONTHLY.COM |9

insight

BT and Accelrys Help Scientists Gain Valuable Medical Insights From Big Data

Innovations in cloud solutions help utilize public health data to gain meaningful insight from massive datasets – so far shown nearly impossible with other technologies 10 | JULY 2013

BT and Accelrys, Inc. today announced that the two companies are working closely together to help garner valuable medical insights from vast public health datasets, using BT for Life Sciences cloud compute solutions combined with Accelrys Enterprise Platform and Accelrys Pipeline Pilot.

The UK state-funded National Health Service (NHS) has been in existence for more than 60 years. During that period, the UK population has generated a wealth of health data and much of this information is computerized. In addition, a vast amount of information on the operational delivery of health care has been made available under the UK open data policy. Similar datasets are available in other countries, most notably from the Food and Drug Administration (FDA) in the USA. BT has collated publically available health system and social care information into a research repository intended for use by the life sciences and health care industries as well as academia, initially hosted in the USA and UK, but available for global access. Such data can provide valuable insight into a number of healthcare topics, such as disease prevalence, impact of ethnic mix and adverse drug reactions. However, the information is often contained in very large datasets and may be unstructured in nature.

The combination of BT’s Cloud Compute platform, the Accelrys Enterprise Platform and Pipeline Pilot has proved capable of finding buried value in massive amounts of data. BT and Accelrys are focused on supporting the Big Data challenges of their customers. This initiative demonstrates the capabilities of their combined technology approaches as they focus through their collaboration on developing solutions to address the significant market need to unlock the value of large datasets. The mutual goal is to let the scientist focus on science and not worry about the complexities of information management, particularly in a cloud environment.

Accelrys, a Foundational Member of the BT for Life Sciences ecosystem, helps provide research solutions to scientists on a global basis and recently made its HEOS collaboration suite available on BT Cloud Compute platform. Accelrys solutions are being further integrated into the BT for Life Science R&D Workbench, which itself is built on the BT Cloud Compute IAAS platform. BT for Life Sciences was one of the first cloud services designed to enable collaboration within the life sciences industry for increased research and development productivity.

“The generation of ever-increasing amounts of health data is both a blessing and a curse, as they

are data-rich, but often information-poor,” said Leif Pedersen, senior vice president of marketing, product management and corporate development, Accelrys. “Working with BT, we’ve shown that we can deliver meaningful and valuable insights from these huge datasets.”

Bas Burger, President of Global Pharmaceutical & Chemical for BT Global Services, said “Building on the launch of BT for Life Sciences last year, we are excited that our continued collaboration with Accelrys is bringing new innovations to the life sciences industry. By making it easier for scientists to gain valuable medical insights from anonymous data buried in large datasets, we can help provide the interpretation of health outcomes. Working together, BT and Accelrys are making such patient outcomes analysis available to those companies developing drugs, enabling real-world outcomes that can be linked to the drug development pipeline.”  About Accelrys, Inc. Accelrys, Inc. (NASDAQ: ACCL), a leading provider of scientific innovation lifecycle management software, supports industries and organizations that rely on scientific innovation to differentiate themselves. The industry-leading Accelrys Enterprise Platform provides a broad and flexible scientific solution optimized to integrate the diversity of science, experimental processes and information requirements across the research, development, process scale-up and early manufacturing phases of product development.

By incorporating capabilities in applications for modeling and simulation, enterprise lab management, workflow and automation, and data management and informatics, Accelrys enables scientific innovators to access, organize, analyze and share data in unprecedented ways, ultimately enhancing innovation, improving productivity and compliance, reducing costs and speeding time from lab to market.

Accelrys solutions are used by more than 1,300 companies in the pharmaceutical, biotechnology, energy, chemicals, aerospace, consumer packaged goods and industrial products industries.

Headquartered in San Diego, California, USA, Accelrys employs more than 200 full-time PhD scientists. For more information about Accelrys, visit www.accelrys.com.

Source: http://www.pressreleasepoint.com/bt-andaccelrys-help-scientists-gain-valuable-medicalinsights-big-data MEDMONTHLY.COM |11

insight

ACA Will Soon Drive Up Demand For Health Care Services

By Lisa Catania All Medical Personnel, Inc. With implementation of the federal Affordable Care Act (ACA) just around the corner, health care organizations throughout the United States are making plans for an influx of new patients and increased demand for their services.

The American Public Health Association estimates 30 million Americans will be eligible for insurance under the ACA, and another 11 million may be covered under Medicaid.

While implementation of the ACA varies from state to state, the impact of the new coverage rules on providers and insurers is only a few months away. On October 1, current non-covered Americans will be able to enroll in new state-run health insurance marketplaces, with the full rollout of ACA’s health insurance mandate scheduled for January 1, 2014.

The goals of the ACA are clear: give more Americans access to quality health care, providing incentives for staying healthy, and reduce usage of emergency rooms and other high-cost inpatient services. That means sweeping changes for health care providers throughout the nation.

For instance, the health care reform act encourages the formation of integrated service delivery systems, such as Affordable Care Organizations (ACOs). These typically involve affiliations among physician groups, hospitals and ancillary services to deliver coordinated care – hopefully at a lower total cost – to patients. An ACO provides care to a group of patients based on a certain payment model, such as capitation, and is held accountable for the quality and cost of care provided to those patients.

However, creating a new ACO – other another form of integrated service delivery system – is not a simple task.

12 | JULY 2013

The various providers need to share a common clinical and business perspective in order to build a sustainable partnership. In addition, technology investments may be needed to create a common platform for patients’ electronic medical or health records (EMH/EMRs) as well as scheduling, billing and collections applications.

Also, additional staffing may be necessary on a short-term project basis or over the longer term to meet greater patient demand.

Other important aspects of the ACA focus on encouraging disease prevention and wellness through more frequent patient visits and ongoing patient and family education. The ACA also emphasizes the importance of chronic disease management programs, through follow-up and outreach services provided by case managers.

Under the ACA, independent review firms will play a growing role in analyzing provider’s billing and claims, as well as utilization of facilities and chronic disease management programs. Finally, the ACA places a great emphasis on quality improvement (QI) initiatives, a greater use of technology to reach patients in and out of providers’ offices, and the use of data such as HEDIS (Healthcare Effectiveness Data and Information Set) to improve patient outcomes over time.

From patient enrollment and scheduling to billing and claims, the ACA will place greater demands on health care providers and insurers than ever before. Therefore, it’s essential to understand the law, keep current on its implementation and continuing to plan for these sweeping changes in the health care landscape. 

insight

DEMYSTIFYING

SCOLIOSIS: FROM DIAGNOSIS

TO TREATMENT

By Keith Mankin, MD, FAAP

S

coliosis, or more specifically, Adolescent Idiopathic Scoliosis (AIS) is the most common disorder of the spine in childhood. It occurs in as many as one percent of the population, with girls affected more than twice as often as boys. With such a high prevalence, it is probable that almost everybody in the country knows someone with scoliosis.

Simply put, scoliosis is one of those things that folks know exists but just don’t talk about. The affected population is among the most secretive and insecure of demographics – teenagers.

The typical age at presentation is between nine and twelve years old, right in the midst of puberty. Teenagers are far less likely to open up about their concerns and ask the vital questions about any medical condition, let alone one that they fear will make them stand out as ‘different.’ As such there are a number of myths and misconceptions about curvature of the spine which without proper communication may cause undo fears and concerns.

The biggest myth about scoliosis is that it is a disease – that somehow the spine is not healthy in children who have curvature. This is emphatically not true! A small number of curves may be caused by abnormal growth of the spine bones, but the majority of them occur in otherwise normal

14| JULY 2013

spines. A child with scoliosis may have more back pain in adulthood than those without curves because of mechanical issues in the surrounding muscles, but the ligaments, nerves, discs and other structures in the spine are completely normal in their function and development.

Arising from this fear is the misconception that children with spinal curvature will not be able to do everything they are accustomed to once they have the diagnosis. Because their spines are normal, children with scoliosis have no limitations on their activities at all. I have patients who are active dancers, cheerleaders, and athletes of all kinds. I encourage them all to be as fit and active as possible.

The muscle imbalance may require more stretching, but this seldom interferes with their activity level.

Another concern and misconception among children and families is that all scoliosis patients will ultimately go on to require surgery. In fact, only about ten percent of children with curvature of the spine need any sort of treatment. In most cases where the curve is progressing the treatment consists of a brace – a plastic shell which holds the spine in a corrected position while the child is growing. Although the braces can be uncomfortable and inconvenient, there are now regimens that require brace wear only part of

the day, leaving the child free during daytime hours while at school and sports. The braces can be very effective at stopping progression of a curve and decreasing the need for surgery.

In those cases where the curve is severe or causing pain, surgery may be required. The procedures which correct and stabilize the spine with bony fusion are safe, reliable and generally well-tolerated by most children. Most of these surgeries are done in the mid to late teens. Children are out of school for about a month after the surgery and, depending on the length of the fusion, most children can be back to full activities by about three months after the surgery. Even after surgery, children can return to most activities, limited only from extreme contact afterwards.

The importance as physicians is to have a good sense of the prognosis of a given curvature so that the patient and family can understand what the treatment course may entail. When a child is first diagnosed with scoliosis, usually after a screening examination by her pediatrician, we try to assess how much growth is remaining and how likely the curve is to progress. The evaluation by a pediatric orthopaedic specialist includes a complete nerve and musculoskeletal evaluation and often an x-ray to determine the magnitude of the curve. The curve is

defined by the angle that the bones form with one another, termed the Cobb angle. A mild curve may be between 10 and 25 degrees, whereas a severe curve is generally over 40 degrees. Curves in the mid-range may need bracing, whereas surgery is reserved for those with severe curves.

However, sometimes it is difficult to know how the condition will progress with any given patient.

And most of the alarm that families experience can be attributed to the uncertainty regarding exactly how a child’s spinal curve will progress as they grow. But that uncertainty can be dramatically reduced through an FDA approved genetic test as part of the standard of care. The ScoliScore Test is the first and only genetic test proven to give physicians and parents ‘insight into the possible progression of AIS, reducing the uncertainty of progression and allowing for a more personalized treatment plan. For patients between the ages of 9 years to skeletal maturity, the ScoliScore test is clinically validated and analyzes 53 genetic markers associated with spinal curve progression in AIS patients. To take the test a patient provides a saliva sample, which is then sent to a lab to be analyzed. Research shows that the test is 99 percent accurate in predicting the risk of curve progression in the low risk group and 95 percent accurate in

the high-risk group.

Based on clinical evaluation and test results, as well as other factors such as family history or history of pain, the specialist will work with the child and family to develop a plan to observe or to treat the curve. Regardless of the treatment plan, it is most important to encourage the child with scoliosis to reach out to other people with curves and to find out as much information as possible. There are a number of resources available for children and families with the diagnosis. In my community, we have developed a patient-run support group with a website and monthly meetings for informative and recreational activities.

Similar groups around the country include the Curvy Girls Network and local chapters of the National Scoliosis Foundation. In addition, there are very good resources on the internet as well as commercially available books that review all aspects of the condition.

Activities that are emphasized during Scoliosis Awareness Month are often available year round in many communities as well.

Spinal curvatures should be accepted by society in the same way we accept red hair or left handedness.

Most of all, it is important to provide as much information about scoliosis as possible to patients, as well as their friends and families, so that we can ef-

fectively demystify the process and let the children get on with other far more important aspects of their developing lives.  About the Author Keith Mankin, MD, FAAP, is a boardcertified, fellowship trained pediatric orthopaedic surgeon in Raleigh, NC where he a staff member with the Department of Orthopaedics at WakeMed Healthcare Center and with the Department of Orthopaedics at Rex Hospital Previously, he was on clinical staff at the Massachusetts General Hospital in Boston, where he had a teaching appointment at Harvard Medical School.

He also has been an Adjunct Clinical Assistant Professor in the Department of Orthopaedics at the University of North Carolina School of Medicine.

After graduating cum laude from Harvard University, Dr. Mankin earned his medical degree from the University of Pittsburgh School of Medicine in Pittsburgh, PA. He completed a surgical internship at Massachusetts General Hospital then his orthopaedic surgery residency at the Combined Harvard Orthopaedics Residency in Boston.

He also received advanced fellowship training in pediatric orthopaedics at the Massachusetts General Hospital.

He has been recognized on several occasions for his research and teaching accomplishments.

MEDMONTHLY.COM |15

practice tips

Patient Communications: An Integral Part of Your Marketing Strategy You may not traditionally think of patient communication tools such as blogs and e-newsletters as a marketing tactic, but staying top of mind with current patients is an integral part of attracting new business – not to mention it can also result in increased patient satisfaction. Doctors often tell me that one of their most fruitful sources of new patients is referrals from current patients. That means it’s important not to neglect your current patients when deciding where to spend your marketing dollars.

16 | JULY 2013

The good news is that marketing to current patients is often the most cost-effective form of marketing, because it can be achieved through strategies as simple as improved communications. Some examples of ways you can utilize these communications include; enhancing patient satisfaction by sending timely updates about early closings due to inclement weather, increasing repeat business by informing patients of other services your practice offers, or positioning yourself as the medical expert by sharing or commenting on recent health news and articles.

and easy way to get a message to your patients, add fresh content to your site, feature services, and even share educational articles.

It’s also really good for your Search Engine Optimization (SEO) efforts to enhance your Google rankings. The average blog should be about 400 words in order to get the full benefit from SEO. Read articles online to learn how to optimize your blog with proper keywords. Or you can always hire an SEO agency to do it for you.

Step 2 - Social Media

Once you’ve written your blog news/article, you can then post a link to the blog on your social media pages to act as a megaphone for announcing the message. Use social media to engage patients in the content and most importantly, get them talking about it. According to a Pew Internet Survey, 50% of all adults use social media; the fastest growing age segment of which is 50-64 years of age.

This is one of your most affordable and effective tools to spread the word to your target audience. You can even ask your peers to post it as well; for instance, if you are an infertility clinic ask the OB clinics you’ve befriended on Facebook to post your blog link. Just be sure you’re willing to return the favor.

Step 3 - E-Newsletter

By Amanda Kanaan President, WhiteCoat Designs Here’s a three step process of how you can use one message or article across three different communication mediums to save time and costs when marketing to current patients:

Step 1 – Write a Blog Post

I recommend that every practice incorporate a blog into their website. Most practices title their blog something along the lines of “News and Updates” and will have their most recent posts listed on the homepage. It’s a quick

So once you’ve written your blog and posted it on your social media channels, then the third step is to include it in an e-newsletter to your patients. If you currently aren’t collecting email addresses for patients, you should start.

Email addresses are invaluable when it comes to using digital communications to stay top of mind with your patients. Not to mention, it’s something patients want; 65% of patients who use the internet say they are willing to switch to a doctor using digital communications to engage them (Pew Internet Research Group, 2011).

Using this three step process, you can take just one piece of content and deliver it across various mediums to get the most impact for your efforts. While each of these methods is extremely inexpensive, I always caution practices against thinking they are free. There is definitely time involved to carry out this strategy, and we all know time is not free.

However, as compared to relying on traditional snail mail, a digital approach is much more budget-friendly, timesensitive and preferred by most patients.  About Amanda Kanaan: Amanda Kanaan is the President of WhiteCoat Designs – a Raleigh-based medical marketing agency providing doctors with online marketing services as medical website design, search engine optimization (SEO), social media management, blog writing, graphic design, referring physician outreach and more. To contact Amanda or to learn more about WhiteCoat Designs, visit www.whitecoatdesigns.com.

MEDMONTHLY.COM |17

practice tips

Undercover Patient: Checking Your Practice’s Vital Signs

By Denise Price Thomas 18 | JULY 2013

T

he patient experience should always be top priority. Seeds are planted prior to the patient ever seeing the physician face to face. You may be the most qualified, experienced and reputable physician however if your support staff does not reflect the same, the patient experience suffers.

As an EMT, I learned quickly just how important patient’s vital signs are. As a practice administrator I learned the importance of vital signs within a hospital and practice. As an “Undercover Patient” and “Patient Shadow” I’ve learned exactly what it takes to make a positive difference for each patient.

It can be as simple as a phone call to schedule an exam or a procedure that will make or break a first impression.

Recently I sat among a group of health care professionals and listened as they explained to me the pros and cons of the Pediatric Practice their children attend. They shared that the physicians within the group are absolutely wonderful however they have to overlook their negative, resistant and unhelpful support staff. They have considered changing practices all because of those employees but truly love the physicians.

Do you know how your patients are treated? Well now, in the age of digital and social media, everyone can know almost immediately.

Patients can record their health care experience by going to www.CMS. gov and taking the HCAHPS: Patients’ Perspectives of Care Survey.

The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care.

HCAHPS (pronounced “H-caps”), also known as the CAHPS Hospital Survey, is a survey instrument and data collection methodology for measuring patients’ perceptions of their hospital experience. While many

hospitals have collected information on patient satisfaction for their own internal use, until HCAHPS there was no national standard for collecting and publicly reporting information about patient experience of care that allowed valid comparisons to be made across hospitals locally, regionally and nationally.

Checking Your Practice’s Vital Signs Heart Beat - compassion driven care Breathing Rate - just as our heart and lungs must work together, the care team must work together to do what is best for each patient Temperature - maintaining a consistently pleasant environment Blood Pressure - keeping a positive attitude circulating throughout the facility even under pressure.

To obtain vital signs, a health care provider observes the patient, notates results and continues to monitor the patient. The same technique is applied during an Undercover Patient Assessment.

When there are signs of distress, we need to take note, take the necessary measures to correct any issues before a negative patient experience occurs.

We should continue to monitor, making certain the same mistakes are not repeated.

We take the straight A approach: • Assess • Accept • Act upon As an Undercover Patient, I will sometimes appear to be lost within a facility. It is always interesting to see if and when someone asks if I need help. Will they point me in the right direction or personally LEAD me to

the next location? That is what makes the difference.

I can sometimes be a difficult patient. I doubt anyone has ever had to deal with one of those in real life.

Patients are nervous, afraid of the unknown as well as having financial concerns and other uncertainties.

I’ve witnessed patients arriving for their procedures, being NPO since midnight and yet are greeted at the registration by the smell of coffee being enjoyed by the patient representative.

When nurses start taking their lunch orders and the patient overhears, “the special today is chicken and dumplings” and they have not had anything to eat preparing for a procedure, one really begins to understand just how important the “little things” are.

I am happy to say that I have experienced many positive situations as an “UP,” unfortunately there have been numerous negative encounters as well as some very humorous occurrences as well. In fact, prior to an exam before a colonoscopy, while the physician was washing his hands, I decided it was time to reveal myself as the Undercover Patient. I also couldn’t believe my eyes as I watched a receptionist greet a new patient with a “crumby clip board” - the receptionist was enjoying her breakfast when a new patient interrupted, walking up to check in. The receptionist handed over the clipboard, dusting the crumbs off while explaining, “those are crumbs from my breakfast, I’m sorry.” There are plenty more stories that are teaching moments. I do not share the names of facilities or employees but use these situations when teaching with a bit of humor. In fact, I have been told that my alter ego “Gladys Friday” kicks off many staff meetings with her YouTube videos. She paves the way with humor to open the eyes of employees and get them thinking about the way they may look from the other side and ways to improve. continued on page 20 MEDMONTHLY.COM |19

continued from page 19

Most times the physicians and management team are fully aware of the Undercover Patient however most do not wish to know my name, when I will arrive and which physician I will be seeing. Most facilities want to obtain a true picture from the patient side.

Through experiences with my Daddy on the “Other Side of Health Care” - we could not measure the clinical skills of health care professionals but we could measure the way we felt when we were around those who truly cared. We learned very quickly that the things that cost the least really mean the most.  To schedule an Undercover Patient Assessment & DPT Booster, you may contact: Denise Price Thomas www.denisepricethomas.com denisepricethomas@gmail.com

20 | JULY 2013

Denise Price Thomas brings with her 34+ years

experience in health care. She is Certified in Healthcare Management and was a surgical practice administrator, retiring after being employed there for 32 years.

Undercover Patient assessments address your specific needs and will provide detailed documentation including: • Phone call experiences • Curb appeal • Aesthetics of lobby • Cleanliness of exam rooms • First impression: scheduling, check-in, insurance, clinical, physician, check-out and more • Recommendations • Plan of Action Patient Shadowing - is also a service she provides as a family member or friend along side the patient.

Med Monthly’s Summer Practice Tip of the Month As a physician, mid-level or med- specialist, it is imperative to make yourself ‘Relevant’. The successful doctor must have or develop a professional network. If you are a primary care doctor, I encourage you to contact specialist in your geographical service area and even consider specialist in your most frequented destination city. With a solid network of professional colleagues in place, you WILL receive more new patients every month.

Now that you are ‘Relevant’ in your medical community, it is also essential that you put your practice’s best foot forward. The most effective and economical way to showcase your practice is with a Practice or Professional Personal Web Site. Make it easy for your network of specialist to find and communicate with you.

The following is a short list of requirements for your Referral Network:  Identify your practice profile. It only takes one or two sentences. i.e. The name of your practice and your specialty will do.  Develop a referral agreement. This should be a short however descriptive page of your services, hours of operation and contact information. Listing contact names will become most useful.  Identify how you will communicate. Either by text, phone, Email, letter, etc  Make clear your expectations. The referral procedures, any charges, the return of patient-charts and your medical care path for the patient.

Does your practice have a Web Site? To discuss your practice image and web page, contact MedMedia9 at 919-747-9031 or Email; medmedia9@gmail.com www.medmedia9.com

practice tips

RECRUITMENT AND RETENTION OF PAs AND NPs IN PRIMARY CARE IS CRITICAL

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

Fewer than 25 percent of new doctors in the United States go into primary care, and only about 5 percent open offices in rural areas.

While estimates on exact numbers vary, changes in health care reform guarantee to put more patients into an already complicated system. Bridging the gap with Physician Assistants (PAs) and Nurse Practitioners (NPs) will be inevitable.

PAs and NPs are skilled medical professionals who play an integral part in health care delivery. Especially 22 | JULY 2013

in primary care, PAs and NPs attract and manage a significant following of patients, especially in rural communities. Recruitment is challenging in more underserved areas, however, retention is often more important as practices and patients invest in an individual with the hope that they will stay and practice for a considerable amount of time.

In the United States, about 66 million people live in rural areas or urban neighborhoods with too few primary care doctors or a shortage

of primary care in clinics. Estimates indicate that 1 in 5 Americans lacks access to essential primary care and could develop more serious health problems as a result.

So how do you attract a great PA or NP to your practice?

Suburban, rural and smaller practices all have the same complaint that they cannot recruit to their area because they cannot pay as much in

salary as their competition. However, often these groups are missing the mark as they often qualify for loan repayment within the state, or they might offer flexibility within a clinical work schedule that is appreciated by the provider. For example, if a PA/NP lives in town where they work, it might be agreeable that they can leave at 3 to pick up a child from school and then come back to wrap up the clinical day.

Such flexibility is not easily achievable in a larger hospital or health system.

Highlighting those “extras” will be important as you list all the reasons why your office is a great place to work.

Highlighting the type of duties you need performed as well as the type of patient population is critical to the messaging. For example, don’t just say family practice PA/NP wanted in Xyz town, NC. Instead, say: Dynamic PA/NP wanted for charming rural underserved area in Xyz, NC. Interested providers will be responsible for health care delivery to an appreciative population that has limited resources. Medicare and Medicaid credentialing are a must.

You’ve hired a great PA or NP. Now how do you keep them?

Once the practice team is expanded with a great PA or NP, retention becomes the new norm. Often practice administrators are frustrated because they say PAs and NPs change jobs too often. My response to them is that if you create a great work environment, any employee, from front office to physician will want to stay and contribute. Often, PAs and NPs will leave a position if they feel their contributions are not valued. This is referencing not only patient care decisions, but also decisions related to work environment or technology. For example, if the physician does not support the PA/NP care rendered to a patient publicly or if they do not advocate for the PA/NP

within the medical community, these are flags of incomplete acceptance and lack of full incorporation into the team.

Recognition is individual and personal to every PA/NP. Some may prefer a public acknowledgement at a staff meeting while others may greater appreciate a personal note or face meeting. Supervisors and practice managers should have processes in place to assess communication styles and play to team strengths.

It’s not always about the money….

Often, individuals leave a position for reasons that are not financial.

Fostering improved communication will result in improved retention of your medical staff. Genuine acknowledgement of value and contribution goes a long way to foster loyalty to the practice and the group, and ultimately to the patients we serve.  References:

http://consumer.healthday.com/ general-health-information-16/doctornews-206/primary-care-doctors-still-inshort-supply-in-u-s-study-677317.html http://www.healthcarefinancenews. com/news/managing-doctornurse-practitioner-turnover-rateskey-delivery-collaborative-caremodel?topic=24 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 primary care 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

international

Rising Affluence and Awareness Contribute Strongly to a Bright Outlook for the Asia-Pacific Hospital Market

By Frost & Sullivan

24| JULY 2013

T

he prevalence of chronic and infectious diseases, changing demographics, and increasing disposable incomes have created tremendous opportunities for the hospital sector in Asia-Pacific. Rising patient awareness spurs demand for quality healthcare services, forcing hospitals to adopt innovative technology, thereby aiding market development.

New analysis from Frost & Sullivan (medtech.frost. com), Asia-Pacific Hospital Outlook 2013, finds that the market earned revenues of more than US$377.90 billion in 2012 and estimates this to reach US$1085.98 billion in 2017. The countries covered in the research are China, India, Indonesia, Thailand, Vietnam, Malaysia and Hong Kong.

Governments in Asia-Pacific remain the main financiers of healthcare, with more than 55 percent of the total healthcare expenditure in the region incurred by the public sector. However, inadequate budgets have led to resource constraints in terms of doctors, nurses, hospitals and hospital beds in public hospitals. The lack of resources to handle the growing number of patients decreases the quality of care in these choked facilities.

“Private hospitals, on the other hand, are growing by virtue of favourable government policies, which encourage investments in state hospitals and public-private partnerships,” said Frost & Sullivan Healthcare Senior Industry Analyst Nitin Dixit. “Nevertheless, high costs in the sector may deter potential consumers even if the quality of care is good.”

Another market challenge is the uneven distribution of healthcare facilities and resources in Asia-Pacific. Rural areas in most countries have poor access to healthcare. In addition, more than 90 percent of large, quality private hospitals in the region are located in Indonesia and Thailand alone.

Despite this, the private hospital segment is expected to see robust growth primarily due to an ageing, yet affluent population, as well as growing medical tourism, particularly in Thailand, Singapore, India and Malaysia.

The acquisition of smaller hospitals by large hospital groups provides added economic impetus to the healthcare system in the region.

New hospital designs, fresh business models, integration of holistic healthcare, and strong focus on healthcare IT will be crucial for private and public hospitals in the region to increase their competitiveness. Market players need to invest extensively in installing, maintaining, and upgrading hospital information systems to enhance operational efficiency, clinical outcomes, and profitability. Sustainable and innovative business models such as green buildings and day care centers will ensure market expansion.

“Electronic medical and electronic health records systems will be top priority in hospital budgets in the next

five years,” observed Dixit. “Smart hospitals are anticipated to evolve over the next decade in Asia-Pacific.”

If you are interested in more information on this research, please send an email to Donna Jeremiah, Corporate Communications, at djeremiah[.]frost.com, with your full name, company name, job title, telephone number, company e-mail address, company website, city, state and country.

Asia-Pacific Hospital Outlook 2013 is part of the Advanced Medical Technologies Growth Partnership Service program. Frost & Sullivan’s related research services include (non-exhaustive): Key Hospital Indicators in GCC, ICT Deployment in European Public Hospitals and U.S. Hospital Revenue Cycle Management. All research services included in subscriptions provide detailed market opportunities and industry trends evaluated following extensive interviews with market participants.  About Frost & Sullivan Frost & Sullivan (frost.com), the Growth Partnership Company, works in collaboration with clients to leverage visionary innovation that addresses the global challenges and related growth opportunities that will make or break today’s market participants.

Source: http://www.newswiretoday.com/news/129630/

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research & technology

Two Gene Variants May Predict Who Will Benefit From Breast Cancer Prevention Drugs NIH-supported discovery could advance individualized care of high-risk women In women at high risk for breast cancer, a long-term drug treatment can cut the risk of developing the disease in half. Researchers supported by the National Institutes of Health have now identified two gene variants that may predict which women are most likely to benefit from this therapy — and which should avoid it.

The work represents a major step toward truly individualized breast cancer prevention in women at high risk for the disease based on their age, family history of breast cancer, and personal medical history.

“Our study reveals the first known genetic factors that can help predict which high-risk women should be offered breast cancer prevention treatment and which women should be spared any unnecessary expense and risk from taking these medications,” said the study’s lead scientist, James N. Ingle, M.D., professor of oncology at the Mayo Clinic in Rochester, Minn. “We also discovered new information about how the drugs tamoxifen and raloxifene work to prevent breast cancer.”

Ingle and Mayo-based colleagues in the NIH Pharmacogenomics Research Network (PGRN) conducted the study in collaboration with PGRN-affiliated researchers at the RIKEN Center for Genomic Medicine in Tokyo. Data and patient DNA came from the long-running National 26 | JULY 2013

Surgical Adjuvant Breast and Bowel Project (NSABP), supported by the National Cancer Institute.

“This innovative, PGRN-enabled international research partnership has produced the first gene-based method to identify which women are likely to benefit from a readily available preventive therapy,” said PGRN director Rochelle Long, Ph.D., of the NIH’s National Institute of General Medical Sciences. “Because the disease affects so many women worldwide, this work will have a significant impact.”

The research, which shows nearly a six-fold difference in disease risk depending on a woman’s genetic makeup, appears in the June 13, 2013, issue of Cancer Discovery.

Women undergoing breast cancer preventive treatment take tamoxifen or raloxifene for five years. In rare cases, the drugs can cause dangerous side effects, including blood clots, strokes and endometrial cancer.

Many women never try the therapy because the chance of success seems small (about 50 women in the NSABP trials needed to be treated to prevent one case of breast cancer) compared to the perceived risk of side effects.

More women might benefit from the potentially life-saving strategy if doctors could better predict whether the therapy was highly likely to work. That’s what the current study

begins to do.

The investigators leveraged data from past NSABP breast cancer prevention trials that involved a total of more than 33,000 high-risk women — the largest sets of such data in the world. Women in the trials gave scientists permission to use their genomic and other information for research purposes.

The scientists analyzed the genomic data by focusing on more than 500,000 genetic markers called single nucleotide polymorphisms (SNPs). Each SNP represents a single variation in the DNA sequence at a particular location within the genome.

To determine whether any SNPs were associated with breast cancer risk, the researchers computationally searched for SNPs that occurred more commonly in women who developed breast cancer during the trial than in women who remained free of the disease. The analysis identified two such SNPs — one in a gene called ZNF423 and the other near a gene called CTSO. Neither ZNF423 nor CTSO — nor any SNPs related to these genes — had previously been associated with breast cancer or response to the preventive drugs.

The scientists’ work revealed that women with the beneficial version of the two SNPs were 5.71 times less likely to develop breast cancer while taking preventive drugs than were women with neither advantageous SNP. Using a variety of biochemical studies, the scientists learned that ZNF423 and CTSO act by affecting the activity of BRCA1, a known breast cancer risk gene.

Healthy versions of BRCA1 reduce disease by repairing a serious form of genetic damage. Harmful versions of BRCA1 dramatically increase a woman’s chance of developing breast cancer.

“The results of our collaborative research bring us a major step toward the goal of truly individualized prevention of breast cancer,” said Ingle. “Our findings also underscore the value of studying the influence of gene variations on drug responses.”  Source: http://www.nih.gov/news/health/ jun2013/nigms-13.htm

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research & technology

Flipping the Medical Classroom?

The high-tech future of medical education

By

28 |JULY 2013

Was your medical training all you had hoped it to be?

Did you learn as much as you expected or knew you could?

Was learning effective, efficient, and fun? Technology is changing the practice of medicine. But it is also changing the way medical students learn, expectations of their potential, and the way they want to be learning.

A Changing World AMA outlines a need for change in medical education Medical education cannot remain the same, given the changing world. According to James L. Madara AMA EVP and CEO, there is gap between what students are learning, and the everyday reality of practicing as a physician1. In fact, the AMA is taking suggestions as models for this change, and has funded a number of schools to begin to reform standards in medical education.

To instigate practical change, he American Medical Association is granting $11 million in the course of five years to a list of winning medical schools that will explore teaching innovations. These schools must come up with better offerings for individual learning styles, methods to assess core competencies, improving patient outcomes and safety, and better efficiencies health care financing.

Grant recipients for this initiative, named Accelerating Change in Medical Education, include, Indiana University School of Medicine Mayo Medical School NYU School of Medicine Oregon Health & Science University School of Medicine Penn State University College of Medicine The Brody School of Medicine at East Carolina University The Warren Alpert Medical School of Brown University University of California – Davis School of Medicine University of California – San Francisco School of Medicine University of Michigan Medical School Vanderbilt University School of Medicine To read a summary of the proposal offered by each school, visit the AMA Grant Projects Webpage2.

What Endures in Education?

Plato was right We all know better than to say because a learning strategy is new, it is better. So how do we judge? Educators create exhaustive studies to answer this question. And their insights offer us a few points of focus as we look through

the filter of new technology to see how education might be improved. Reading and collecting ideas about education, through my own effort to create good ebooks for students, I have gathered a list of keys to good education: 1. Individualized learning. This seems like a new idea.

But formal education is new in human history. Before the Egyptians introduced formal education, 30005000 BCE3, people learned person-to-person. So all education was individualized. Formal education offered efficiency. But more recently, educators are making the effort to allow students options to learning, so that their individual needs and preferences might be addressed. In studies of medical students preferred learning styles, it was found that students prefer that instruction to be offered in all avaiable formats (visual, audio, reading/writing, and kinisthetic) rather than one or another4.

2. Socratic method. Perhaps the greatest innovation in education came from Socrates. The Socratic method is way of teaching so that the student systematically explores a question. Through active thinking, the student finds answers.

3. The lecture. Plato did not believe the written word was the best form of transmitting knowledge, and he suggested the oral tradition as the best way to learn5,6.

Certainly his students would have had to take notes in order to have any record of all as to what was taught. Socrates, as well, felt that the implementation of written texts would weaken the mental faculties of students, who would no longer be inclined to commit ideas to memory7. The word itself, “lecture” is a 14th Century Latin word, which means, “to read” from a text. But this is not what students need today, and the traditional 45 minute lecture has been shown to be too long for a student’s attention span. 20 minutes works best for adults8. It must be modified to be effective.

And it is typical for most people, that their minds wander during a lecture9.

4. The textbook. Although the Greeks used texts for learning. And while Gutenberg printed a few Latin books on his presses. The use of textbooks in formal education did not begin until the 19th Century10.

5. Repetition. Repetition as a key to learning dates back to the earliest forms of edcuation. However, it takes on a new possibility in the classroom. More recently, as students are using the computer and “flip the classroom” lectures as a way to review lecture materials, students find it extremely easy to review the materials that they find challenging. It has even reduced the need for students to ask professors questions outside class.

This has been shown to be one of the most exciting innovations with technology, and it has freed time for continued on page 30 MEDMONTHLY.COM |29

continued from page 29

professors to use in class to engage in less lecture-based and more Socratic forms of interaction with students.

6. Practical Immersion. Apprenticeship is the traditional and enduring environment for hands-on learning.

Many professions require internship. While many of these skills cannot be replicated in the digital environment, still many can be with simulated threedimensional “worlds�.

7. Interactive design. This really follows fromt the Socratic Method, as an ideal which enourages students to think and solve problems as a way of gaining deeper knowledge and understanding. Interactive, active rather than passive engagemnt with information, is best form of learning that can be offered to students.

8. Fun, engagement, and interest. Traditionally, these goals were considered a luxury or frivolity in education. But more recently, educators are offering these aims as objectives in learning. As we all know, when we enjoy our work, when we become absorbed and engaged, and whatever helps us to focus our efforts, will make learning possible. Global learning, offered int he digital age, offers not just interactivity, but the possibility for great and interesting educators who are fantastic at teaching to reach extremely wide

audiences and experience world recognition in a way teachers and professors rarely have before.

9. Tests or markers of knowledge. Controversial as tests may be as a tool to measure knowledge, they are nonetheless an eduring method for self- and outside-assessment. With technology, increasingly it is becoming possible to test student remorely. This brings education closer to a one-world classroom.

Keeping education goals in mind What do we want our new doctors to be capable of?

Among the suggestions for using technology to make education better, medical schools offer these goals to keep in mind: 1. Possess strong foundation of science with ability to use scientific method to seek new knowledge, and to critically evaluate medical literature 2. Know the human body: cell and organ structure and function, system function and integration 3. Understand molecular, genetic, biochemical, and cellular processes as they relate to human body 4. Know determinants of human health and disease: personal, social, or environmental impacts; apply

principles of pharmacology and therapeutics 5. Safely perform routine diagnostic and therapeutic procedures 6. Interpret routine laboratory results, clinical tests, and image scans related to common conditions and illnesses 7. Skillfully perform physical and psychiatric examinations 8. Formulate appropriate management strategies for patients, suitable to that patient’s needs and values 9. Curiosity and passion to address future needs of society from a health perspective 10. Learn in a self-directed way with lifelong commitment to learning 11. Capacity to collaborate well and communicate clearly 12. Capacity for reflective practice, to recognize one’s own limitations, to improve one’s own performance 13. Exercise sound clinical reasoning and decisionmaking skills; to perform critical evaluations of healthcare situation and systems 14. Professionalism and leadership skills 15. Capacity to interpret and apply evidence, to interpret clinical information 16. Creativity: to produce new discoveries, to assimilate new information, and to apply this information to patient care 17. High ethical standards; Recognize, anticipate and navigate ethical dilemmas in medical care.

18. Empathy towards others and understanding of others’ needs; advocate for the interests of their patients.

19. Ability to gather the necessary information from patient history, to understand socioeconomic and cultural impacts, to accurately write a patient history, and then to correctly interpret this information 20. Understand and utilize the healthcare in context as a larger system

So what changes are taking place now?

Among schools making the transition, Stanford School of Medicine is taking a lead. Its goals are to reinvigorate the classroom by offering online lectures in short segments.

These lectures are offered my many instructors and specialists in the field, as needed. This allows textbooks to pull from primary sources for knowledge. Short lectures are followed up with quizzes.

The classroom time then is freed up. It becomes a place for discussions rather than lectures. Students take more initiative in asking questions so learning can be individuized. Time traditionally spent in lecture is now spent in real-world application, problem-solving, case studies, and team-based endevors.

The new paradigm offers a growing possibility for academic superstars. Stanford Medical School relies on input from Salman Khan12, famous for his engaging style in teaching subjects from math to art history, to help faculty make their presentations more interesting and egaging. Khan says, “I have a self-paced lecture to be seen at home… and what used to be homework, I now have students doing in the classroom.”

But medical schools cannot accomplish this alone.

Textbook publishers play an enormous part in offering content. Innovative digital textbook company Kno has introduced, “Kno Me.” It’s a personalized dashboard which allows students to mark their performance, time commitment, and engagement with materials, in mastering content.

Textbook publishing giant, McGraw Hill, recently announced a plan that offers a place for textbooks in the changing medical classroom. This Spring it has begun to offer a textbook suite with “adaptive learning technology”, which means it collects data on individual student comprehension (knowledge, skill, and confidence). It uses this data to create algorithms for customized study.

The program also offers “before-the-course” materials to help students warm-up before difficult classes. It includes

New possibilities emerge as a result of technology “Born-digital” textbooks and learning materials are those which have been originally created in a digital format. They offer a full range of necessary features to make learning all the objectives of the course possible. These include interactive features to test principles and formulas being described, video clips to augment learning, and an audio track of the book text.

Schools are still in an embryonic stage, to be taking full advantage of technology that is offered today. In a survey of 940 bookstores, run by the Follett Higher Education Group, roughly 2% of textbooks sold at college bookstores are in a born-digital format11.

Kno Me’s personalized dashboard continued on page 32 MEDMONTHLY.COM |31

continued from page 31

photo-realistic virtual labs to make preparation for labs more effective. The book “talks” to students, offering instructions and suggestions on the most effective way to read, based on the student’s needs and performance. This textbook is not groundbreaking, but it is a good step forward.

The new changes put students in the powerful position to make critical suggestions, and of demanding that their educational content be effective.

New materials should be available easily to all devices, probably Web-based.

Content should be updated frequently and as soon as facts change. The books should be as interactive in teaching concepts and in testing them, encouraging critical thinking skills in the time-proven Socratic style.

Instructors should have greater impact as well, trusting that the material is peer-reviewed and authoritative. Instructors will have the freedom to choose which chapters and segments of material to be included in a course. Both students and faculty will be able to make use of the analytical capabilities of Smartbooks as a method of assessing their effectiveness in student learning.  References: 1 AMA pledges millions to jump-start innovation in medical education.

By Kevin B. O’Reilly. Jan. 28, 2013 http://www.amednews.com/ article/20130128/profession/130129956/6/ 2 Proposals offered by each school can be viewed at http://www.ama-assn. org/sub/accelerating-change/grant-projects.shtml 3 Formal education introduced by Egyptians. http://en.wikipedia.org/wiki/ Education#History 4 Heidi L. Lujan and Stephen E. DiCarlo. First-year medical students prefer multiple learning styles. 10 October 2005. http://advan.physiology.org/ content/30/1/13.full 5 Plato advising the oral tradition as the best: http://people.ucalgary. ca/~dabrent/webliteracies/platowr 6 Plato’s Seventh Letter advising the oral tradition over written for passing significant knowledge, 360 BCE. http://classics.mit.edu/Plato/seventh_ letter.html 7 Socrates discourages written text as detrimental to learning. http:// en.wikipedia.org/wiki/Textbook#History 8 Joan Middendorf and Alan Kalish. The Change-up in Lectures. 1995. http://www.iub.edu/~tchsotl/part3/Middendorf%20&%20Kalish.pdf 9 Rick Nauert. Short Lectures, Frequent Quizzes Maximize Online Learning.

April 8, 2013. http://psychcentral.com/news/2013/04/08/short-lecturesfrequent-quizzes-maximize-online-learning/53562.html 10 Textbooks become standardized in formal education. http://en.wikipedia. org/wiki/Textbook#History 11 Jeffrey R. Young. The Object Formerly Known as the Textbook. January 27, 2013. https://chronicle.com/article/Dont-Call-Them-Textbooks/136835/ 12 http://www.youtube.com/user/khanacademy Medimagery Medical Illustration & Design info@medimagery.com http://www.medimagery.com/ http://www.linkedin.com/in/lauramaaske http://twitter.com/#!/Medimagery http://www.facebook.com/Medimagery http://www.facebook.com/laura.maaske http://medillsb.com/ArtistPortfolioThumbs.aspx?AID=4115 32 | JULY 2013

research & technology

TARGETED MUSCLE REINNERVATION:

Moving Muscles With the Mind

By Ashley Austin Managing Editor, Med Monthly Dr. Albert Chi and Johnny Matheny - Courtesy of 60 Minutes

34 |JULY 2013

Targeted Muscle Reinnervation (TMR) is a new surgical procedure that reassigns nerves that once controlled the arm and hand. By reassigning existing nerves, doctors can make it possible for people who have had upperarm amputations to control their prosthetic devices by merely thinking about the action they want to perform.

Once experimental, this innovative procedure is now available at The Johns Hopkins Hospital.

F

or someone who has lost an arm it is difficult to imagine being able to shake someone’s hand – especially using just your mind. Dr. Albert Chi, along with the team at Johns Hopkins, has successfully created a prosthetic limb that can be attached to an amputated arm to do exactly that. After 60 Minutes aired their story, Dr. Chi has almost become the face of targeted muscle reinnervation (TMR), but states he’s honored to be representing a brilliant team.

Using advanced algorithms, a surgical procedure can be performed that dissects nerves and reroutes them to existing muscles. Dr. Chi equates this procedure to working with electrical wiring. Using pattern recognition algorithms to identify individual muscles that are contracting, how well they communicate with each other, and their amplitude and frequency, Chi is able to classify up to 12 separate motions for an amputee. So where before a prosthetic arm had only two motions, it now has 12. A patient now has the ability with natural thought to flex their wrist, point, pinch, close their hand and to deviate their wrist towards the thumb and pinky.

“The body is amazing in terms of its will to return to normal function,” Chi says. “When you have a missing

limb, all the information is there, but the body has no way to get it out. So we rerouted the pathway for that information so that it can be expressed.”

After the surgery on the nerve endings it is about six months before the initial fitting of the robotic limb takes place. Reinnervation does not take place immediately because takes time to reestablish signals from the brain down to the muscles. When the robotic arm is fitted, sensors are placed on the skin to pick up the brain’s signals from the nerves and use those signals to control the robotic arm. The strength of robotic limb is controlled by both the user and pre-set robotic limitations. Prosthetic arms are preset to curl 45-50 pounds. Settings on the robotic limb can be readjusted during physical therapy sessions with the patient’s feedback, allowing the user to feel more sensations and have more control over speed and strength.

A man named Johnny Matheny, who lost his arm to cancer, was the first to have this TMR done. After three years of having no arm, Matheny’s remaining nerves and muscles— though intact and functional—had forgotten how to communicate with and respond to motor commands. So Matheny, Chi and a team of physical therapists and technicians set out to retrain those muscles and nerves to

perform much like they had before he lost his arm. Within six months after the surgery to his nerve endings, and after many sensory and motor tests and strengthening exercises, he was fitted with a prosthetic arm and is able do highly dexterous tasks. It takes a great deal of rehabilitation to build the signal from your brain to the muscle. Your brain identifies a certain signature for movement and patients do mental imagery exercises to refine these motions. This virtual reality system mimics the prosthetic and then minor adjustments are made within your mind from session to session to reinforce the patterns that are being fired.

Johns Hopkins works with 2-3 patients a month, and Dr. Chi said that every patient that is part of their TMR program has shown significant promise to be fitted with advanced prosthetics. These patients include both amputees and people born without limbs. Dr. Chi is commissioned in the Navy and has privileges at Walter Reed Hospital and is hopeful that their reinnervation can be extended to help the Wounded Warriors. This technology has been used to create robots that will help prevent some limb injuries from happening in the first place. Robots continued on page 37 MEDMONTHLY.COM |35

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‘‘

“I realized that we have now stepped over a great threshold into what is possible... Not rehab, but restoration of function.”

continued from page 35

soon may be used to diffuse bombs and guard checkpoints.

Dr. Geoffrey Ling, a retired Army colonel and neurologist, is in charge of the Revolutionizing Prosthetics Program. After seeing the wounded on several tours in Iraq and Afghanistan, he told his team that he wanted a breakthrough for amputees within five years.

Dr. Ling states, “They thought we were crazy. But that’s quite all right because I think it’s in our insanity that things happen.

I’m old enough to have watched Neil Armstrong take that step on the moon. And, to watch [patients who have had TMR], I had the same tingles. Because I realized that we have now stepped over a great threshold into what is possible. And very importantly, what patients can now expect in terms of restoration.

Not rehab, but restoration of function.”

There is no doubt that remarkable strides have been made for TMR patients as far as their ability to do highly coordinated and complex tasks.

Dr. Chi shared, “Ultimately, though, the goal is to make the progression of surgery and biotechnology fully integrated into the human living system.”

The current use of surface EMG electrodes will be replaced with

implanted ones, both in the muscle and the bone.

Incorporating advanced algorithms, they are now assisting patients born without limbs and patients who have lost limbs six months out of their injury. Dr. Chi’s team was initially called the Targeted Muscle Reinnervation Program, but now

Providing customized, simple

NUTRITION SOLUTIONS to

ENHANCE HEALTH and refer to themselves as the Advanced Prosthetics Program, because of all the advancements they have made.

They haven’t met a patient yet they were not able to help in some way.

A commercially available system to deliver assistance to the general public is now also being considered and researched.

If you’d like to see an interview with Dr. Chi and Johnny, “Breakthrough: Robotic limbs moved by the mind” which aired on 60 minutes on June 2, 2013, view the video online at http://www.cbsnews.com/video/ watch/?id=50148119n. The segment also includes Jan Scheuermann, a quadriplegic who had sensors attached to her brain that can move robotic limbs using only her thoughts. 

OPTIMIZE SPORTS PERFORMANCE Tracy Owens, MPH, RD, CSSD, LDN Ashley Acornley, MS, RD, LDN 6200 Falls of Neuse Road, Suite 200 Raleigh, NC 27609 919-876-9779

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legal

Electronic Health Records (EHR) Systems:

Contracting for Change

By Clay B. Wortham

Recently, two EHR Technology systems previously certified under ONC (Office of the National Coordinatory for Health Information Technology) standards failed a retest conducted by an ONC-authorized certification body.

The decertification was the first following the push to adopt EHR Technology to qualify for meaningful use incentives and to avoid an eventual reduction in Medicare program reimbursement.

The ONC decertification announcement is certainly a concern for health care providers that have purchased and implemented EHR Technology at great expense. But there are ways that providers can protect their organizations and mitigate the legal risks associated with an ONC decertification.

On the front-end of a transaction to purchase EHR Technology, it is important for provider organizations to exercise due diligence when evaluating available systems and system vendors. Confirming that the EHR Technology is certified under ONC standards is an important first step, but the provider organization should also evaluate the software vendor, the vendor’s history and responsiveness, and feedback from other users of the EHR Technology.

The next step in evaluating EHR Technology should be to learn about the software vendor’s system update and 38 | JULY 2013

upgrades policy and process. If a system change is required to meet evolving ONC standards, how quickly will the vendor implement that change and at what cost to the provider?

Perhaps the most important item in the due diligence process is to ensure the EHR Technology purchase and maintenance agreement between the provider organization and the EHR Technology vendor contains protections for the provider in the event ONC standards change, or the EHR Technology no longer qualifies for ONC certification. At minimum, the purchase and maintenance agreement should require the EHR Technology vendor should provide prompt system updates to ensure continuous compliance with ONC standards, and indemnify the provider for any loss resulting from an ONC decertification. Finally, the purchase and maintenance agreement should contain an express warranty that the EHR Technology does meet and will continue to meet ONC standards or the vendor will, at minimum, refund the purchase price paid by the provider for the EHR Technology.  cwortham@mmlk.com 859-554-4414 http://mcbrayerhealthcare.com/

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legal

IMPACT OF SEQUESTRATION

ON THE NATIONAL INSTITUTES OF HEALTH (NIH) 40| JULY 2013

T

he National Institutes of Health is the nation’s medical research agency and the leading supporter of biomedical research in the world. NIH’s mission is to seek fundamental knowledge about the nature and behavior of living systems and apply that knowledge to enhance health, lengthen life, and reduce the burdens of illness and disability. Due in large measure to NIH research, a person born in the United States today can expect to live nearly 30 years longer than someone born in 1900.

More than 80 percent of the NIH’s budget goes to over 300,000 research personnel at more than 2,500 universities and research institutions throughout the United States.

In addition, about 6,000 scientists work in NIH’s own Intramural Research laboratories, most of which are on the NIH main campus in Bethesda, Md. The main campus is also home to the NIH Clinical Center, the largest hospital in the world totally dedicated to clinical research.

Sequestration:

On March 1, 2013, as required by statute, President Obama signed an order initiating sequestration. The sequestration requires NIH to cut 5 percent or $1.55 billion of its fiscal year (FY) 2013 budget. NIH must apply the cut evenly across all programs, projects, and activities (PPAs), which are primarily NIH institutes and centers. This means every area of medical research will be affected.

While much of these decreases are due to sequester, NIH funding is always a dynamic situation with multiple drivers: l Approximately 700 fewer competitive research project grants issued l Approximately 750 fewer new patients admitted to the NIH Clinical Center l No increase in stipends for National Research Service Award recipients in FY2013

“Due in large measure to NIH research, a person born in the United States today can expect to live nearly 30 years longer than someone born in 1900.”

The impact: l Delay

in medical progress: n Medical breakthroughs do not happen overnight. In almost all instances, breakthrough discoveries result from years of incremental research to understand how disease starts and progresses. n Even after the cause and potential drug target of a disease is discovered, it takes on average 13 years and $1 billion to develop a treatment for that target. n Therefore, cuts to research are delaying progress in medical breakthroughs, including: u development of better cancer drugs that zero in on a tumor with fewer side effects u research on a universal flu vaccine that could fight every strain of influenza without needing a yearly shot. continued on page 42 MEDMONTHLY.COM |41

continued from page 41

u prevention of debilitating chronic conditions that are costly to society and delay development of more effective treatments for common and rare diseases affecting millions of Americans. l Risk to scientific workforce: n NIH drives job creation and economic growth.

NIH research funding directly supports hundreds of thousands of American jobs and serves as a foundation for the medical innovation sector, which employs 1 million U.S. citizens. Cuts to NIH funding will have an economic impact in communities throughout the U.S. For every six applications submitted to the NIH, only one will be funded.

Sequestration is reducing the overall funding available for grants. See the history of NIH funding success rates.

Frequently asked questions:

How many fewer grants will be awarded?

Approximately 700 fewer research project grants compared to FY 2012.

Have the institutes and centers announced their adjusted paylines based on these cuts?

The adjusted NIH Institute and Center (IC) paylines and funding strategies can be found here: http://grants.nih.gov/ grants/financial/index.htm#strategies What percent cut will be made to existing grants?

Reductions to noncompeting research project grants (RPG) vary depending on the circumstances of the particular IC. The NIH-wide average is -4.7 percent.

Will the duration of existing grants be shortened to accommodate the cuts?

In general, no.

Will all grants receive the same percentage cut or will some grants be cut more than others?

Institutes and centers have flexibility to accommodate the new budget level in a fashion that allows them to meet their scientific and strategic goals. As noted above, there are different percentages for different ICs, and in some cases for different mechanisms within an IC (RPGs, Centers, etc.). In addition, there may be reductions to grants for reasons other than sequestration, as is the case every year.

Will certain areas of science that are at a critical juncture be affected by these cuts?

All areas of science are expected to be affected.

Will some areas of science be affected more than others?

The sequester does not stipulate the precise reduction to 42 | JULY 2013

each scientific area. However, it is likely that most scientific areas will be reduced by about 5 percent because the sequester is being applied broadly at the NIH institute and center level.

What will be the impact of these cuts to NIH’s intramural research at its Bethesda campus and offcampus facilities?

The impact on NIH’s intramural research is substantial, especially because it applies retroactively to spending since Oct. 1, 2012. That can double the effect — a full year’s cut has to be absorbed in less than half a year.

Will NIH be furloughing or cutting employees at its NIH campus and off-campus facilities?

There are no current plans to do so. At present, HHS is pursuing non-furlough administrative cost savings such as delayed/forgone hiring and reducing administrative services contracts so that furloughs and layoffs can be avoided. Additionally, employee salaries at NIH make up a very small percentage (only 7 percent) of the NIH budget.

How will current patients at the NIH Clinical Center be affected?

Services to patients will not be reduced.

Will the NIH Clinical Center see fewer patients because of the cuts?

Approximately 750 fewer new patients will be admitted to the NIH Clinical Center hospital in 2013 or a decrease from 10,695 new patients in 2012 to approximately 9,945 new patients in 2013. While much of this decrease is due to funding, clinical activity is always a dynamic situation with multiple drivers.

Will the sequester cut need to be applied to the FY 2014 budget?

The President’s FY 2014 Budget would replace sequestration and reduce the deficit in a balanced way. The President is ready to work with Congress to further reduce deficits while continuing to make critical investments.  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/jun2013/nih-03. htm

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legal

Health Care Obligations of Employers Under the Affordable Care Act

Many media outlets continue to incorrectly suggest that this provision requires employers to provide health insurance to all of their employees. This is not actually the case.

By Ari G. Burd, Esq.

Giordano, Halleran & Ciesla

44 |JULY 2013

For most employers, the most important part of the Patient Protection and Affordable Care Act (commonly referred to as the “ACA” or “Obamacare”) will be the section known as the employer shared responsibility provision.

Many media outlets continue to incorrectly suggest that this provision requires employers to provide health insurance to all of their employees. This is not actually the case. Instead, this provision subjects employers to taxes or penalties if they fail to offer “adequate” and “affordable” health insurance to their employees. Another fact commonly misunderstood is that for now, the only employers who need to be concerned about this issue are those who employ 50 or more “full time” employees (the ACA uses a very specific formula to determine who is considered full time) or those who employ under 25 employees and are looking to take advantage of the small business tax credit.

The employer shared responsibility provision goes into effect on Jan 1, 2014.

In most cases, in order to determine who is a full time employee, the employer reviews each employee’s full time status by “looking back” at a past employment period of between three (3) and twelve (12) months. As a result, it is critically important that employers start thinking about their obligations under the ACA right now so they can be prepared for January 1, 2014.

Determining who is considered a full time employee under the ACA can be complex. Under the ACA, a full time employee is someone who works 30 or more hours per week, on average. Also taken into consideration are full time equivalent employees (“FTE”). The number FTE employees are determined by adding up the total number of hours worked in a given month by part time employees and dividing than number by 120. So for example, 10 part time employees working 60 hours per month would be counted as 5 FTE employees (10×60 = 600; 600/120=5). Special rules also apply for seasonal employees, temporary employees, etc.

For those employers who have 50 or more full time employees under the ACA, the employer shared responsibility provision leaves the employer with several options: Option 1- Provide health care coverage that is both “adequate” and “affordable” under the ACA. Determining if coverage meets these requirements requires analysis of the costs of the plan to full time employees and the number of full time employees eligible under the plan. The employer must also determine if providing coverage is more costly than the fines it would be subject to if it chose not to provide coverage.

Option 2 – Do nothing and provide no coverage to the employees, potentially subjecting the employer to a $2000 fine per employee. Rather than simply rejecting this option of out of hand, the employer needs to determine the potential fine it faces and whether or not certain exemptions are applicable that could greatly reduce, if not eliminate the fine entirely.

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Option 3 – Provide coverage that is not considered “affordable” under the ACA, subjecting the employer to a $3000 fine for each employee who chooses not to partake in the employer offered health plan and who instead purchases coverage through an insurance exchange and receives a tax credit or subsidy. Before taking this route, an employer must carefully consider whether it believes its employees will seek coverage through an exchange and whether the savings it will gain from not paying its portion of the employee’s health care coverage will offset any potential penalty.  Source: http://www.natlawreview.com/article/health-care-obligations-employersunder-affordable-care-act

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features

WANT TO INCREASE YOUR PRACTICE REVENUE? Consider these tips.

By Philip Driver CEO, Physician Solutions, Inc.

46 | JULY 2013

O

ne of the most obvious ways to boost your bottom line is to follow this basic business philosophy: Increase Your Practice Revenue and Decrease Your Expenses.

The staff of Med Monthly polled practices from across the country and we developed this list of tips many doctors have done to enhance their revenue.

• Increase the number of hours per week you see patients. You can do this by extending the practice hours or working through lunch and staggering your staff lunches.

• For the solo provider that schedules patients, add one or two more patients daily.

• Consider adding ePrescrobing that will add revenue. Medicare is now participating in this program.

• Cross train your staff. Your front desk professionals should be able to triage patients.

• On your practice light patient days, add DDS (state disability physicals). Contact your state and sign up for the program. The physicals usually take 30 minutes to an hour, however getting comfortable with the process will speed up the time you spend with the patient. You can schedule one or several of these physicals for your state per day.

• If you are in an under-served area of your state, you may qualify for grants from the County, State or Federal Government. There are also programs that may increase the number of patients assigned by Medicare.

• Develop and continue to enhance your referral base. Have your marketing staff call your referral contacts monthly and email, as well as visit, your referring colleague’s routinely. Let them know you appreciate their referrals and reciprocate referrals back.

• Add a mid-level to your practice.

A Family Nurse Practitioner or Physician Assistant can really increase the number of patients

you see with limited overhead.

Develop a practice structure and direct certain types of patients to these providers. You may be surprised that you don’t need to increase support staff and if you do, your scope of services may be greatly enhanced.

The Following Tips May Help In the Overall Success of Your Practice Make Yourself Available

You practice has to contract with as many insurances companies as possible – especially the major players in your local market. Referring offices are looking for a one stop shop to send all of their patients, so do not be afraid to include some lower reimbursing ones as well if you receive referrals in your specialty. The second way to make you accessible is to offer extended or shifted hours for appointments. A good way to do this is to end the workday on Friday at 1 pm and incorporate an early day at 7 am with a late day until 8 pm or have a half-day on the weekend.

Answer Questions and Address Concerns

Just about every physician has a few negative comments on various medical ratings websites on-line. While you don’t want to respond to the specifics of a comment online, you can respond in a way that shows other patients you care. For example, “We are sorry to hear you had an unacceptable experience with our practice. Please feel free to call our office and we will be able to remedy this situation.

Patient satisfaction and quality care are our two highest priorities.”

Stay In Touch With Your Community and Get Involved

There are great opportunities to gain exposure to the general and medical communities through presentations.

These can range from community center presentations on a common symptom, to medical dinner CME’s,

to business lunch and learns. Because presentations take preparation, it can often be best to roll them out in a series at several locations than to attempt one oversized event.

Keep Your Patients Informed

Patients are becoming ever more perceptive about their medical care, wanting to know as much as possible.

If you provide educational pamphlets about your specialty that truly informs patients, it adds value to both your practice and the offices that refer their patients to you. Even if you’re not a specialty physician, educational checklists about what preventative care people should complete are well received by many places. Your practice web site is your first step in connecting with your patients and keeping them informed.

Image is Everything

Your image is not simply the materials you create with your logo, but also includes your building, your staff, and how everyone interacts with patients. Using a consultant or expert to create the right office atmosphere can provide vast amounts of marketing and public relations benefits. Couple this with professional staff that are dressed in matching attire and know the professional protocols set forward in answering the phone and interacting with patients and you have set yourself up for success.

Utilize Existing Patients to Generate New Ones

Medicine is a market that revolves around trust since people seek your services when they are most vulnerable. Who are the best people to explain to others why you should handle their care? Simple, the existing patients who you treat and have trust in you themselves. Most physicians see 2000 patients yearly. If half of them recommended two people to see you that are a solid equation to double your patient load. Yes, the best way to increase your patient base may be ‘Old Fashion Word of Mouth’.  MEDMONTHLY.COM |47

features

Marketing a New Procedure At Your Practice

Your practice is offering a new office procedure. How do you get this message out to your current patients, prospective patients and your medical colleagues?

You need to let all your current patients know about your new medical procedure, but do not think this is enough.

You will need to have a comprehensive marketing plan in place prior to the start of your latest procedure, to inform your existing patients and attract new ones.

Marketing In-house to Your Existing Patients

Making sure your staff knows what you’re trying to accomplish in marketing your new procedure. They will become your advocates inside the office and out when they clearly know your goals. Team meetings should be held regularly and all staff members should attend. This is your chance to praise or remind staff of marketing the added procedure when speaking to patients. Use part of this time to review the new procedure and address any relevant 48 | JULY 2013

topics that should be communicated to patients.

Create a printed practice newsletter or brochure that covers all pertinent information about the new procedure and leave copies in your waiting room/practice in several locations including examination rooms. If you have patient email information, send your patients an e-newsletter announcing the new procedure.

Even when the procedure is elective and offers obvious benefits, many patients still tend to have a fear of the unknown. The medical world can be intimidating. It’s often difficult for patients to fully comprehend how significantly a procedure can change their lives for the better.

You or your staff, in the past, have spent extended periods of time repeating the same information over and over again, explaining new procedures to patients. It can be tedious and it’s not a very efficient way to run your practice.

And patients, during the short consult, are bombarded with information and can be literally overwhelmed.

Videos about a specific procedure watched in the office privately is one option for informing your patients.

By Thomas Hibbard Creative Director, Med Monthly

Another option is mobile apps, especially animated medical videos. These can be delivered right to a handheld digital device and are the latest technology used by a large number of your patients. This has the potential to transform your new marketing plan.

Giving patients the opportunity to watch and listen to a simulated medical procedure, at their leisure, can cut through the confusion by taking away the mystery of the unknown. In effect, it is an ideal “digital consult.” And if some part of the message is not understood, the video or app can be repeated as many times as needed – while continuing to deliver the same, consistent top-quality information.

External Marketing for New Patients

Next, make sure you have a marketing plan to reach prospective clients outside your practice. Some possible tools to use to effectively achieve this are: Revamp your Website – time for your website to promote the new procedure. Launch a professional,

successful and engaging design and you’ll be on your way to reaching new patients in no time at all.

Online Marketing – there are many online options now available including Facebook Ads, Google Adwords, Local Search Tools and Email Marketing.

Referral Programs – implement a patient referral program or field marketing program to focus on patient and practice referrals.

Patient Newsletters – enhance your patient communication with a professional newsletter. Leave copies in the office or email them to patients on a quarterly basis.

You should always be networking within your community. In its simplest form, it’s connecting with people to exchange ideas, information, and resources.

There are many places to network, from the local chamber continued on page 50 MEDMONTHLY.COM |49

Conclusion

continued from page 49

of commerce, community groups, health care associations, or you can join a board or peer group. Not only will you gain great ideas to help you with your advertising your new procedure, but you can possibly connect with some new clients as well.

External Marketing Through Physician Referrals

Reach out to potential referring physicians in the community by yourself. In physician marketing, YOU are the brand, so don’t dilute it. Never send a representative or a liaison to do this job. Introduce yourself to possible referring physicians with a phone call and schedule a “Lunch and Learn” about your new procedure. 15 minutes of your time can guarantee a referral for life.

In physician marketing, the key point to understand is that you are the expert in the room, but you’re not the absolute power - you need to demonstrate that you value your referring physicians’ work before you can even demonstrate your capabilities.

After explaining your new procedure in detail, ask for 5 consultations to demonstrate the effectiveness of working together with referring physicians. You’re setting yourself up for success if you establish a team effort with them so that from the first moment of contact with a patient you can ensure the best standard of care possible.

While your website, your educational videos and apps, your staff and your referring physicians serve as important sources to marketing your new procedure, spend the time to educate your patients about why you are an expert in your field face-to-face. Answer their questions, provide additional resources, and ensure that a patient leaves your office with information to refer their friends, family, and co-workers. And your medical website will perform this function 24/7. Every new question deserves a new page of its own so that the answer can be easily found.  Resources:

http://www.ampupmypractice.com/educating-patients/ http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source= web&cd=1&ved=0CEsQFjAA&url=http%3A%2F%2Fwww. dayspaassociation.com%2Fdocs%2Fnews-items-library-articles% 2F2011%2F12%2F29%2F6%2520Tips%2520to%2520Adding%2 520Aesthetic%2520Medicine%2520Procedures%2520to%2520y our%2520Practice.pdf&ei=Dy63UeSHE4-w8QT35IDADw&usg= AFQjCNHQuHKoGqPNoAy96APt4pVPCs3adA&sig2=X9raAUu5 0qvgf8J-07xpNQ&bvm=bv.47534661,d.eWU http://www.healthcaremarketingcoe.com/medical-practicemarketing/physician_marketing.php http://medmarketers.wordpress.com/2011/01/04/5-must-dos-tosuccessfully-market-your-medical-practice-in-2011/

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features

EHR Technology Best Practices to Avoid the Appeals Process And Achieve Meaningful Use

by Frank J. Rosello, CEO, Environmental Intelligence LLC 52 | JULY 2013

T

he Centers for Medicare and Medicaid (CMS) began accepting appeals for EHR Incentive Program payments from eligible professionals and eligible hospitals on December 1, 2011.

Of the 33,595 Medicare physicians that had attested to meeting Meaningful Use requirements so far in 2011, 355 were unsuccessful. That is 355 physicians too many that may have to go through the appeals process in order to receive or keep their incentive payment.

To help current and future eligible providers and medical practices avoid the appeals process and achieve EHR Meaningful Use, consider the following three best practices that work for any size practice: l Develop an end-to-end comprehensive EHR

implementation plan. An effective EHR implementation plan needs to include every aspect of the project from initial EHR vendor selection to post adjustment activities. Within the plan itself, there must be absolute clarity as to who will be responsible for monitoring every milestone of the plan including Meaningful Use objectives and measures post go-live.

Successful EHR implementations follow a basic fundamental rule: Plan Your Work then Work Your Plan.

l Be in the know. The CMS EHR Incentive

Program appeals process allows providers to appeal based on eligibility, Meaningful Use, and incentive payment calculation. After attestation, if an eligible provider is denied incentive payment because of eligibility or incentive payment calculation, the reality is either the provider was poorly consulted or the designated person or persons in the practice responsible for the project was not well informed of the incentive program and its requirements.

There are many places to go on the web to obtain the information needed to successfully accomplish all of the CMS EHR Incentive Program requirements including how to achieve Meaningful Use. The best place to find constant up-to-date complete information on the CMS EHR Incentive Program is located on the CMS. gov Attestation page of their website.

If an eligible provider is denied incentive payment because of not meeting all Meaningful Use required objectives and associated measures (Currently Stage 1), the root cause

will most likely be an internal breakdown of not effectively executing the process of tracking and measuring results and progress. The way to avoid this situation is for the practice to build out a routine (should be part of the EHR implementation planning process) to pull and analyze Meaningful Use data in order to stay on track and provide feedback to clinicians on a consistent basis. CMS offers a Meaningful Use Attestation Calculator, http://www.cms. gov/apps/ehr/, which allows a practice to monitor their progress to successfully achieve Meaningful Use. This calculator requires the practice or provider to compile and input data from their EHR into the tool. On the other hand, many EHR’s provide Meaningful Use reporting functionality. The frequency Meaningful Use reporting is available to providers range from daily, weekly, or monthly depending on the EHR platform. It is important for providers to choose the reporting frequency and routines that will work best for them. l Providers and medical practices need to

determine whether they will manage the complete EHR implementation process internally or look to outsource the project to an outside firm. Many providers and practices hire an outside consultant to help with EHR vendor selection and the development of the implementation plan. This approach requires either a member of the staff or a provider or both will be responsible for managing and executing the EHR implementation plan. It is important to consider workflows, staffing, and capacity when taking this approach in implementing an EHR. There is health IT firms that provide complete EHR technical and implementation consulting along with EHR installation and deployment, and will work side-by-side the designated person in the practice, post go-live, to insure all goals and objectives are being met including Meaningful Use.

There many factors providers and practices have to consider when deciding which direction to take when implementing or upgrading an EHR platform. The end goal for providers and practices is to successfully implement an EHR, successfully attest to Meaningful Use, and improve patient’s overall health and outcomes.  MEDMONTHLY.COM |53

the arts

What is Evidence-based Art?

By Kathy Hathorn and Upali Nanda American Art Resources

Resting With Lonesome Charlie

by Drew Bodner

Twilight

by Zen Chuang

52| 54 | JUNE JULY 2013

A Fishing Village

by Gary Bodner

How are Evidence-based Art Programs different from regular art programs and what advantage do they offer hospitals?

Evidence-based Art is based upon the principles of Evidence-based Design, and makes a commitment to basing design decisions on the best available research evidence. There is a small but significant body of research evidence today on the impact of art on clinical and behavioral outcomes of patients in hospital settings. Viewing artwork with appropriate nature content has been seen to reduce stress and pain perception, as measured by physiological outcomes such as blood pressure, heart-rate, and skin conductance, in addition to self-report measures such as pain-rating scales and surveys. For example, in a study conducted in Sweden by Roger Ulrich, heart surgery patients in an ICU who were shown nature scenes with water, trees and high depth of field, showed lesser anxiety, suffered less intense pain, and required lower strength pain medication, than those shown abstract scenes or no image at all. Economic benefits of lower cost of pain medication, reduced length of stay, and increased patient and staff satisfaction, can be extrapolated from such studies and strengthen the case for taking an evidence-based approach.

Unfortunately, the critical importance of Evidence-based Art programs has not yet been fully appreciated within the industry....

While experienced art consultants have the ability to provide aesthetically pleasing artwork consisting of pretty, local pictures, the insight into whether this aesthetic is appropriate for healthcare populations is often missing. Given the evidence on the therapeutic effect of using appropriate art (discussed above), this could be a critical oversight.

Yet another aspect of evidence that is relevant, in addition to the therapeutic benefit of art, relates to how presence and quality of art can

effect patient/visitor perception of the quality of care at the hospital, act as a de-stressor for staff, have an impact on the branding of the hospital, serve as a point of focus and discussion for visitors, and of course, add to the overall appeal of the visual environment (these themes are emergent from a 2007 post-occupancy evaluation of the art program at MD Anderson Cancer Center, Houston).

Artwork is often the most visible and noticeable aspect of the visual environment and this increases its potential impact on patients/ staff/ visitors, and in the final analysis, the economic bottom-line at the hospital.

There are well-researched guidelines in place today for appropriate healthcare art based on rigorous research findings, which can be implemented, creatively, by experienced art consultants. Ulrich and Gilpin’s chapter on Healing Arts, in Frampton’s Putting Patients First, is one of the most comprehensive resources and recommends the use of 1. Waterscapes (Calm or Nonturbulent Water), 2. Landscapes (with visual depth or open foreground, trees with broad canopy, Savannah Landscapes, verdant Vegetation, or positive cultural artifacts), 3. Flowers (familiar, healthy and fresh, in natural settings with open foreground), and 4. Figurative Art (depicting emotionally positive faces, diverse and leisurely in nature).

While these guidelines are in place today, an evidence-based art consultant has the onus of creative but conscientious interpretation, in order to ensure that the most appropriate art for the facility is chosen while maintaining a standard of visual appeal that is befitting to the hospital.

‘‘

Economic benefits of lower cost of pain medication, reduced length of stay, and increased patient and staff satisfaction, can be extrapolated from such studies and strengthen the case for taking an evidence-based approach.

Furthermore, there is little known on art for special populations, or different ethnicities, and mere prescriptive adherence to guidelines cannot suffice.

In the end, commitment to an Evidence-based Art program entails going the step beyond the implementation of existing guidelines, to improving and updating guidelines towards the maximum impact art can have on improving the healthcare environment.  Kathy Hathorn is the CEO of American Art Resources.

Upali Nanda PhD is Vice President and Director of Research at American Art Resources. American Art Resources is the largest art consulting firm in the United States working exclusively with the healthcare industry. It is one of only two Art Consulting firm conducting original research on Evidence-based Design.

The other firm is Aesthetics based in San Diego.

Source: http://www.healthcarefineart. com/2007/09/what-is-evidenc.html MEDMONTHLY.COM |55

healthy living

Tropical Smoothie With fruit and yogurt

By Ashley Acornley, R.D., L.D.N.

T

his quick and easy yogurt smoothie is the perfect breakfast to drink on your way to work or to give your kids as an after-school snack. Yogurt is also a great source of calcium and Vitamin D, to help build and maintain strong bones! Blend in other fruits for a variety of flavors. Try incorporating a refreshing smoothie into your daily diet to keep your bones healthy!

Smoothie Recipe Yield: Makes 5 cups (serving size: 1 cup)

Preparation: smooth, Process all ingredients in a blender until immediately. stopping to scrape down the sides. Serve

56 | JULY 2013

Nutritional Information Amount per serving

Calories: 180 Calories from fat: 4 percent Fat: 0.8g Protein: 6.5g Carbohydrate: 37g Fiber: 2.2g Cholesterol: 4mg Iron: 1mg Sodium: 93mg Calcium: 227mg

PHOTO COURTESY KEENAN MILLIGAN

Ingredients: 2 cups fat-free milk urt (soy 1 (8-ounce) container vanilla low-fat yog ose lact yogurt can be substituted if vegan or intolerant) concentrate 1/2 cup thawed pineapple-orange juice 2 cups frozen strawberries 1 banana, coarsely chopped 1 tbsp. ground flax seed (optional)

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

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

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

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

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

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

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

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

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

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

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

MEDMONTHLY.COM |57

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

Dover, DE 19904 (302)744-4500 http://1.usa.gov/t0mbWZ Florida 4052 Bald Cypress Way Bin C-08 Tallahassee, FL 32399 (850)245-4474 http://bit.ly/w1m4MI 58 | JULY 2013

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Texas 333 Guadeloupe St. Suite 3-800 Austin, TX 78701 (512)463-6400 http://www.tsbde.state.tx.us/ Utah 160 E. 300 South Salt Lake City, UT 84111 (801)530-6628 http://1.usa.gov/xMVXWm Vermont National Life Building North FL2 Montpelier, VT 05620 (802)828-1505 http://bit.ly/zSHgpa Virginia Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4538 http://www.dhp.virginia.gov/dentistry Washington 310 Israel Rd. SE P.O. Box 47865 Olympia, WA 98504 (360)236-4700 http://www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/Dentist.aspx West Virginia 1319 Robert C. Byrd Dr. P.O. Box 1447 Crab Orchard, WV 25827 1-877-914-8266 http://www.wvdentalboard.org/ Wisconsin P.O. Box 8935 Madison, WI 53708 1(877)617-1565 http://dsps.wi.gov/Default. aspx?Page=90c5523f-bab0-4a45-ab943d9f699d4eb5 Wyoming 1800 Carey Ave., 4th Floor Cheyenne, WY 82002 (307)777-6529 http://plboards.state.wy.us/dental/index.asp MEDMONTHLY.COM |59

U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (334)242-4116 http://www.albme.org/ Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 http://bit.ly/zZ455T Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 (480)551-2700 http://www.azmd.gov Arkansas 1401 West Capitol Ave., Suite 340 Little Rock, AR 72201 (501)296-1802 http://www.armedicalboard.org/ California 2005 Evergreen St., Suite 1200 Sacramento, CA 95815 (916)263-2382 http://www.mbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7690 http://www.dora.state.co.us/medical/ Connecticut 401 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/site/default.asp Delaware Division of Professional Regulation Cannon Building 861 Silver Lake Blvd., Suite 203 Dover, DE 19904 (302)744-4500 http://dpr.delaware.gov/ District of Columbia 899 North Capitol St., NE Washington, DC 20002 (202)442-5955 http://www.dchealth.dc.gov/doh 60 | JULY 2013

Florida 2585 Merchants Row Blvd.

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

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

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

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

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

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

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

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

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

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

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

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

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

Montana 301 S. Park Ave. #430 Helena, MT 59601 (406)841-2300 http://bit.ly/obJm7J p

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

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

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

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

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

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

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

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

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

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/

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

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

MEDMONTHLY.COM | 61

medical resource guide ACCOUNTING

Ajishra Technology Support

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

ADVERTISING

PO Box 15130 Scottsdale, AZ 85267 (602)370-0303 www.findurgentcare.com

MedMedia9

www.medmedia9.com

Ring Ring LLC

6881 Maple Creek Blvd, Suite 100 West Bloomfield, MI 48322-4559 (248)819-6838 www.ringringllc.com

ANSWERING SERVICES Corridor Medical Answering Service

3088 Route 27, Suite 7 Kendall Park, NJ 08824 (866)447-5154 www.corridoranswering.net

Docs on Hold

14849 West 95th St. Lenexa, KS 66285 (913)559-3666 www.soundproductsinc.com

BILLING & COLLECTION Advanced Physician Billing, LLC

PO Box 730 Fishers, IN 46038 (866)459-4579 www.advancedphysicianbillingllc.com

62 | JULY 2013

Applied Medical Services 4220 NC Hwy 55, Suite 130B Durham, NC 27713 (919)477-5152 www.ams-nc.com

Sweans Technologies 501 Silverside Rd. Wilmington, DE 19809 (302)351-3690 www.medisweans.com

VIP Billing

PO Box 1350 Forney, TX 75126 (214)499-3440 www.vipbilling.com

Axiom Business Solutions

Find Urgent Care

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

3562 Habersham at Northlake, Bldg J Tucker, GA 30084 (866)473-0011 www.ajishra.com

4704 E. Trindle Rd. Mechanicsburg, PA 17050 (866)517-0466 www.axiom-biz.com

Frost Arnett 480 James Robertson Parkway Nashville, TN 37219 (800)264-7156 www.frostarnett.com

CAREER CONSULTING Doctor’s Crossing 4107 Medical Parkway, Suite 104 Austin, Texas 78756 (512)517-8545 http://doctorscrossing.com/

Gold Key Credit, Inc. PO Box 15670 Brooksville, FL 34604 888-717-9615 www.goldkeycreditinc.com

Horizon Billing Specialists 4635 44th St., Suite C150 Kentwood, MI 49512 (800)378-9991 www.horizonbilling.com

CODING SPECIALISTS The Coding Institute LLC 2222 Sedwick Drive Durham, NC 27713 (800)508-2582 http://www.codinginstitute.com/

Management Services On-Call 200 Timber Hill Place, Suite 221 Chapel Hill, NC 27514 (866)347-0001 www.msocgroup.com

Marina Medical Billing Service 18000 Studebaker Road 4th Floor Cerritos, CA 90703 (800)287-8166 www.marinabilling.com

Mediserv 6451 Brentwood Stair Rd. Ft. Worth, TX 76112 (800)378-4134 www.mediservltd.com

Practice Velocity 1673 Belvidere Road Belvidere, IL 61008 (888)357-4209 www.practicevelocity.com

COMPUTER, SOFTWARE American Medical Software

1180 Illinois 157 Edwardsville, IL 62025 (618) 692-1300 www.americanmedical.com

CDWG

300 N. Milwaukee Ave Vernon Hills, IL 60061 (866)782-4239 www.cdwg.com/

Instant Medical History

4840 Forest Drive #349 Columbia, SC 29206 (803)796-7980 www.medicalhistory.com

medical resource guide CONSULTING SERVICES, PRACTICE MANAGEMENT

DENTAL Biomet 3i

Medical Credentialing

(800) 4-THRIVE www.medicalcredentialing.org

Medical Practice Listings

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

myEMRchoice.com

24 Cherry Lane Doylestown, PA 18901 (888)348-1170 www.myemrchoice.com

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

Synapse Medical Management

18436 Hawthorne Blvd. #201 Torrance, CA 90504 (310)895-7143 www.synapsemgmt.com

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

Dental Management Club

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

DocuTAP 4701 W. Research Dr. #102 Sioux Falls, SD 57107-1312 (877)697-4696 www.docutap.com

Integritas, Inc. 2600 Garden Rd. #112 Monterey, CA 93940 (800)458-2486 www.integritas.com

The Dental Box Company, Inc.

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

FINANCIAL CONSULTANTS Sigmon Daknis Wealth Management

DIETICIAN Triangle Nutrition Therapy 6200 Falls of Neuse Road, Suite 200 Raleigh, NC 27609 (919)876-9779 http://trianglediet.com/

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

Sigmon & Daknis Williamsburg, VA Office 325 McLaws Circle, Suite 2 Williamsburg, VA 23185 (757)258-1063 http://www.sigmondaknis.com/

ELECTRONIC MED. RECORDS

Urgent Care America

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

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

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

www.pushpa.biz

ABELSoft 1207 Delaware Ave. #433 Buffalo, NY 14209 (800)267-2235 www.abelmedicalsoftware.com

Acentec, Inc 17815 Sky Park Circle , Suite J Irvine, CA 92614 (949)474-7774 www.acentec.com

AdvancedMD

INSURANCE, MED. LIABILITY Aquesta Insurance Services, Inc.

Michael W. Robertson 3807 Peachtree Avenue, #103 Wilmington, NC 28403 Work: (910) 794-6103 Cell: (910) 777-8918 www.aquestainsurance.com

Medical Protective

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

5814 Reed Rd. Fort Wayne, In 46835 (800)463-3776 http://www.medpro.com/ medical-protective

CollaborateMD

MGIS, Inc.

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

1849 W. North Temple Salt Lake City, UT 84116 (800)969-6447 www.mgis.com

MEDMONTHLY.COM | 63

medical resource guide INSURANCE, MED. LIABILITY

Nicholas Down http://bit.ly/yHwxb0

Martin Fried

www.martindfried.com

Professional Medical Insurance Services

16800 Greenspoint Park Drive Houston, TX 77060 (877)583-5510 www.promedins.com

Wood Insurance Group

4835 East Cactus Rd., #440 Scottsdale, AZ 85254-3544 (602)230-8200 www.woodinsurancegroup.com

LOCUM TENENS Physician Solutions

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

Bank of America

Barry Hanshaw 18 Bay Path Drive Boylston MA 01505 508 - 869 - 6038 JHans76271@aol.com www.barryhanshaw.com

MMA Medical Architects

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

Laura Maask 262-308-1300 Laura@medimagery.com

medimagery.com

Marianne Mitchell (215)704-3188 http://www.mariannemitchell.com http://www.colordrop.blogspot.com

MEDICAL EQUIPMENT

1295 Walt Whitman Road Melville, NY 11747 (888)862-4050 www.allproimaging.com

Biosite, Inc

9975 Summers Ridge Road San Diego, CA 92121 (858)805-8378

www.artisanprinter.com

Deborah Brenner

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

800 Shoreline, #900 Corpus Christi, TX 78401 (888)246-3928

www.cryopen.com

Pia De Girolamo

64 | JULY 2013

www.piadegirolamo.com

391 Technology Way Winston Salem, NC 27101 (336)722-8910 www.carolinachemistries.com

Robert Sayre Marketing Adviser/Business Coach http://www.linkedin.com/pub/robsayre/2/977/355/

MedMedia9

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

WhiteCoat Designs

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

www.dicomsolutions.com

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

Medical Practice Listings

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

MEDICAL PRACTICE VALUATIONS

Dicom Solutions 548 Wald Irvine, CA 92618 (800)377-2617

High Performance Network

MEDICAL PRACTICE SALES

Carolina Liquid Chemistries, Inc. Brian Allen

MEDICAL MARKETING

www.biosite.com

Cryopen

MEDICAL ART

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

MedImagery

ALLPRO Imaging

MEDICAL ARCHITECTS

MEDICAL EQUIPMENT FINANCING

www.thetps.com

BizScore

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

medical resource guide

MEDICAL PUBLISHING

PRACTICE FINANCING Bank of America

Greenbranch Publishing

info@greenbranch.com 800-933-3711 www.greenbranch.com

MEDICAL RESEARCH

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

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

Dermabond

Ethicon, Route 22 West Somerville, NJ 08876 (877)984-4266 www.dermabond.com

DJO

1430 Decision St. Vista, CA 92081 (760)727-1280

REAL ESTATE

www.djoglobal.com

Arup Laboratories

500 Chipeta Way Salt Lake City, UT 84108 (800)242-2787

www.aruplab.com

Chimerix, Inc. 2505 Meridian Parkway, Suite 340 Durham, NC 27713 (919) 806-1074 www.chimerix.com Clinical Reference Laboratory 8433 Quivira Rd. Lenexa, KS 66215 (800)445-6917

www.crlcorp.com

Sanofi US

55 Corporate Drive Bridgewater, NJ 08807 (800) 981-2491

Scynexis, Inc.

ExpertMed

York Properties, Inc.

www.sanofi.us

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

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

31778 Enterprise Dr. Livonia, MI 48150 (800)447-5050

www.expertmed.com

Gebauer Company

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

Scarguard

15 Barstow Rd. Great Neck, NY 11021 (877)566-5935 www.scarguard.com

WEBSITE DESIGN

SUPPLIES, GENERAL

3501 C Tricenter Blvd.

Durham, NC 27713 (919) 933-4990

MedMedia9 www.scynexis.com

BSN Medical 5825 Carnegie Boulevard Charlotte, NC 28209 (800)552-1157 www.bsnmedical.us

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

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classified listings

Classified To place a classified ad, call 919.747.9031

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

Averages 25 patients per day with no call and shift hours from 8:30 am to 5:30 pm. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com 3-5 days per week in Durham, NC . Geriatric physician needed immediately 3-5 days per week, on-going at nursing home in Durham. Nursing home focuses on therapy and nursing after patients are released from the hospital. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com GP Needed Immediately On-Going 1-3 Days Per Week at Addictive Diease Clinics located in Charlotte, Hickory, Concord & Marion North Carolina. General Practitioner with a knowledge or interest in addictive disease.

Needed in October on-going 1-3 times per week. This clinic requires training so respond to post before October 1st. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Primary Care Physician in Northwest NC (multiple locations). Primary care physician needed immediately for ongoing coverage at one of the largest substance abuse treatment facilities in NC. Doctor will be responsible for new patient evaluations and supportive aftercare. Counseling and therapy are combined with physician’s medical assessment and care for the treatment of adults, adolescents and families. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Pediatrician or Family Medicine Doctor in Fayetteville Comfortable with seeing children. Need is immediate - Full time ongoing for maternity leave. 8 am - 5 pm.

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

66| JULY 2013

Immediate need for full time GP/FP for urgent cares in eastern NC. Urgent care centers from Raleigh to the eastern coast of NC seek immediate primary care physician. Full time opportunity with possibility for permanent placement. Physician Solutions, PH: (919) 845-0054, email: physiciansolutions@gmail.com General Practitioner Needed in Greensboro. Occupational health care clinic seeks general practitioner for disability physicals ongoing 1-3 days a week. Adults only. 8 am-5 pm. No call required. Physician Solutions, PH: (919) 845-0054, email: physiciansolutions@gmail. com Pediatrician or Family Physician Needed Immediately at clinic in Roanoke Rapids, NC. Pediatric clinic in Roanoke Rapids, NC seeks Peds physician or FP comfortable with children for 2-3 months/on-going/full-time.

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

Classified To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

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

Physician Solutions, PH: (919) 845-0054, email: physiciansolutions@gmail.com Child Health Clinic in Statesville, NC seeks pediatrician or Family Physician comfortable with peds for on-going, full-time shifts. Physician will work M-F 8 am - 5 pm, ongoing. Qualified physician will know EMR or Allscripts software. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Peds Clinic near Raleigh seeks Mid-Level Provider for on-going coverage 4x/wk. Health Department pediatrics clinic 45 min from Raleigh needs coverage 4 days a week from January through June. Provider will see about 20 patients daily, hours are 8am-5pm with an hour for lunch. Please contact Physician Solutions at 919-8450054 or emailphysiciansolutions@gmail.com.

Employee Health Clinic seeks Mid-Level Provider for FT on-going coverage near Charlotte. Health Department 45 minutes from Charlotte seeks on-going coverage for employee health clinic beginning in January. Provider will see about 20-24 patients daily, hours are 8am-5pm with an hour for lunch. Call or email for more information. 919-845-0054 physiciansolutions@gmail.com FT Mid-Level Provider needed for Wilmington practice immediately. Small private practice 45 minutes outside Wilmington seeks mid-level provider starting January.

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

Employee Health Clinic seeks Mid-Level Provider for FT on-going coverage near Charlotte. Health Department 45 minutes from Charlotte seeks on-going coverage for employee health clinic beginning in March.

Provider will see about 20-24 patients daily, hours are 8am-5pm with an hour for lunch. Call or email for more information, 919-845-0054 or physiciansolutions@ gmail.com FT/PT Mid-Level Provider needed for Wilmington practice immediately. Small internal medicine private practice 45 minutes outside Wilmington seeks mid-level provider starting immediately. FT/PT. M-F 8:00-5:00.

Possible permanent placement. Call or email for more information. 919-845-0054 physiciansolutions@gmail. com Western North Carolina Health Department needs continuing physician coverage. County Health Department seeks coverage for their walk in clinic which sees all ages. Ongoing, 8am-5pm, no call. 35-40 patients a day. Well established clinic located in a beautiful area. Please contact Physician Solutions at 919-845-0054 or emailphysiciansolutions@gmail.com.

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

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

IM/FP needed in Fayetteville health department immediately. Fayetteville health department needs coverage March through June full or part time. Clinics are adult health and women’s health. Adults only. No call 8a-5p. Please contact Physician Solutions at 919845-0054 or emailphysiciansolutions@gmail.com.

continued on page 69 MEDMONTHLY.COM |67

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

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

Call 919-848-4202 or email medlistings@gmail.com www.medicalpracticelistings.com 68 | JULY 2013

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

classified listings

Classified

continued from page 67

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

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

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

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

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

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

COLUMBUS IM FT/PT Mid-Level Provider needed for practice near Wilmington. Small internal medicine private practice 45 minutes outside Wilmington seeks mid-level provider starting immediately. FT/PT. M-F 8-5p. Possible permanent placement. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Fayetteville occupational health care clinic seeks GP for May 5-9. Primary care physicians needed for occupational medicine. Adults only. 8-5p. Large corporation, no call required. Intermittent dates in the future and second office in Greensboro with ongoing scheduling. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Health Dept 45 min NE of Raleigh seeks MD coverage Tues/Thurs ongoing May 14. GP/FP/IM/Peds doctor needed for the following clinics in Louisburg: Adult, Family Planning, Peds, STD for ongoing scheduling or intermittent shifts. 8-5p.Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail. com.

Community Health Dept in Washington, NC (1 h 45 min E of Raleigh) seeks FP for coverage June 15 FT/PT ongoing. Family practitioner sought for eastern Carolina community health center in Washington, NC. Must see all ages, 8-5p. Start June 15 ongoing. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

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

Family Practice 1 h SE of Raleigh seeks July 6-7 coverage. Goldsboro FP seeks MD for July 6-7 and intermittent shifts. 8-5p. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

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

Greenville Clinic seeks GP May 20-22. GP/IM needed for May 20-22 and intermittent shifts. Must have experience or be willing to do pain management and trigger point injections. 8-5p. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@ gmail.com.

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

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

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

Western North Carolina Health Department needs continuing physician coverage. County Health Department seeks coverage for their walk in clinic which sees all ages. Ongoing, 8am-5pm, no call. 35-40 patients a day. Well established clinic located in a beautiful area. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

continued on page 70 MEDMONTHLY.COM | 69

classified listings

Classified

continued from page 69

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

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

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

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

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

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

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

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

Permanent Family Practice doctor needed for Summer 2013, Raleigh, NC Need FP/BC MD for June-Sept MonFri , 8-5, New Facility in downtown Raleigh, NC. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

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

Family Practice MD needed 2-3x/w in July, Goldsboro July 6 & 7 and intermittent dates, 8-5p,Goldsboro, NC 1h SE of Raleigh. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

70| JULY 2013

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

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

MD needed for June 6 & intermittent dates, Charlotte N.C. June 6 & Intermittent weekdays, 8-5 in Charlotte, NC. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

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

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

Physicians needed Virginia Pediatric Locums Physician needed in Harrisonburg, Danville and Lynchburg, VA. These locum positions require 30 to 40 hours per week, on-going. If you are seeking a beautiful climate and flexibility with your schedule, please consider one of these opportunities. Send copies of your CV, VA. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com continued on page 72

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

Live and work in one of the most healthy cities in the U.S.

Hospice Practice wanted in Raleigh/ Durham area of North Carolina.

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

List Price: $150,000 | Established: 2007 | Location: Colorado For more information contact Dr. Jack McInroy at 303-929-2598 or Shrink1324@gmail.com

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

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

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

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

Medical Practice Listings Selling and buying made easy

MedicalPracticeListings.com | medlisting@gmail.com | 919.848.4202

classified listings

Classified

continued from page 70

To place a classified ad, call 919.747.9031

Physicians needed

Practice wanted

Virginia

North Carolina

Urgent Care opportunities throughout Virginia. We have contracts with numerous facilities and eight to 14-hour shifts are available. If you have experience treating patients from pediatrics to geriatrics, we welcome your inquires. Send copies of your CV, VA medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, E-mail: physiciansolutions@gmail.com

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

Contact us today at (919) 848-4202.

Virginia practice outside of Washington DC seeks IM doctor FT/PT now – June 1. IM physician needed immediately FT/PT for Virginia clinic near Washington DC. 8-5p Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Practice for sale

Nurse Practitioners needed

North Carolina

North Carolina

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

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

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

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

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

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

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

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

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

72 | JULY 2013

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

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

Classified To place a classified ad, call 919.747.9031

Practice for sale North Carolina (cont.)

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

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

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

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

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

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

MEDMONTHLY.COM | 73

PRACTICE FOR SALE

Comprehensive Ophthalmic and Neuro-Ophthalmic Neuro-Ophthalmic Practice

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

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

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

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

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

Asking price: $385,000

Contact Cara or Philip 919-848-4202 for more information or visit MedicalPracticeListings.com To view more listings visit us online at medicalpracticelistings.com

MD STAFFING AGENCY FOR SALE IN NORTH CAROLINA The perfect opportunity for anyone who wants to purchase an established business. of the oldest Locums companies l Large client list l Dozens of MDs under contract l Executive office setting l Modern computers and equipment l Revenue over a million per year l Retiring owner

Wanted: Urgent Care Practice

l One

Urgent care practice wanted in North Carolina.

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

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

Medical Practice Listings Buying and selling made easy

Please direct all correspondence to driverphilip@gmail.com.

Only serious, qualified inquirers.

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

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

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

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

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

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

Woman’s Practice in Raleigh, North Carolina.

NC OPPORTUNITIES LOCUMS OR PERMANENT

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

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

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

Medical Practice Listings; 919-848-4202

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

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

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

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

Medical Practice Listings Selling and buying made easy

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

CALLING ALL WRITERS

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.

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

Contact us today to discuss your options confidentially.

Med Monthly

To become a contributing writer in Med Monthly magazine, contact MedMedia9 at medmedia9@gmail.com

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

Contact us:

919.747.9031 medmedia9@gmail.com medmonthly.com

Editorial Calendar: August 2013 - First Responders

l

Sept. 2013 - The Magic of Referrals

Unfortunately, its motor is inside playing video games.

Kids spend several hours a day playing video games and less than 15 minutes in P.E. Most can’t do two push-ups.

Many are obese, and nearly half exhibit risk factors of heart disease. The American Council on Exercise and major medical organizations consider this situation a national health risk. Continuing budget cutbacks have forced many schools to drop P.E.—in fact, 49 states no longer even require it daily.

You can help. Dust off that bike. Get out the skates.

Swim with your kids. Play catch. Show them exercise is fun and promotes a long, healthy life. And call ACE. Find out more on how you can get these young engines fired up. Then maybe the video games will get dusty.

A Public Service Message brought to you by the American Council on Exercise, a not-for-profit organization committed to the promotion of safe and effective exercise

American Council on Exercise

®

ACE Certified: The Mark of Quality Look for the ACE symbol of excellence in fitness training and education.

For more information, visit our website: www.ACEfitness.org

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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

PEDIATRICIAN

or family medicine doctor needed in

FAYETTEVILLE, NC

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.

Comfortable seeing children. Needed immediately.

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

Contact Medical Practice Listings for more information.

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

ADVERTISE YOUR PRACTICE BUILDING IN MED MONTHLY

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

By placing a professional ad in Med Monthly, you're spending smart money and directing your marketing efforts toward qualified clients.

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.

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

List price: $435,000

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

medmonthly.com | 919.747.9031

Primary Care Practice for Sale Hickory, North Carolina

NC MedSpa For Sale MedSpa Located in North Carolina

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

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

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

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

Call for pricing and details.

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

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

Contact Medical Practice Listings today to discuss the practice details.

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

www.medicalpracticelistings.com

the top

Future Tech

1

STAFF TRAINING

The first stage of CMS’ meaningful use initiative is in full swing, and prep for Stage 2 is in progress. EHR adoption and implementation will keep on growing, so training for practice staff will continue to be a priority.

2

HEALTH IT OUTSOURCING

The number of health care information technologies will continue to increase and become more challenging for smaller practices to manage. Therefore, since they don’t have the adequate staff to train, they will begin to outsource their technology needs, because the daily upkeep of these systems will take them away from their primary role — treating patients.

3

CLOUD TECHNOLOGY

More physicians are seeing the benefits of cloud-based EHRs, which are easier to adopt and implement than on-premise solutions. Smaller practices will especially take advantage of cloud technology when choosing their future EHR. 80

| JULY 2013

hnology Focuses for Medical Practices

4

MOBILE TABLETS

Mobile devices will become even more indispensable with the additional ability to digitally sign documents. Doctors and other healthcare professionals will not only be able to access patient records, but they’ll be able to sign off on treatments and prescriptions without being tethered to their offices or the hospital.

5

PATIENT PORTALS

Providing patients the ability to view medical records online, downloading, and transmitting their health information securely will be a priority in keeping patients informed and satisfied with their health care.

8

6 7

HEALTH CARE MOBILE APPS

Health care apps are popular among patients and physicians, whether health reference medical apps or location services that tell consumers where to find the nearest practice or hospital.

And, with technology becoming increasingly more sophisticated, medical apps will continue to improve.

MEANINGFUL USE REQUIREMENTS

In addition to EHR training, expect practices to be more focused on meaningful-use-fueled tasks, such as partnerships. Even insurance carriers have been looking toward embracing flourishing governmentsponsored ACO models with their own incentive plans.

HEALTH INFORMATION EXCHANGES (HIE)

Practices will be seeking ways to send information to health care partners to better coordinate care. One way to do this is by using health information exchanges, which are rapidly being developed. It includes data collection to facilitate information exchange, analyzing data to yield coordinated care, and the introduction of patient driven initiatives to both engage and inform patients.

9

TELEHEALTH

There is an increase of the practice of medicine outside of the medical office setting. More corporations, because of co-pay increases, are encouraging employees to take advantage of telehealth services to connect with physicians easily and inexpensively. Technology is improving and virtual visits (via video) can provide health care consultation for patients, especially those who can’t travel.  MEDMONTHLY.COM | 81

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

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

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

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