Med Monthly June 2015

Med Monthly June 2015

Content Marketer:

Why You Need One And How to Hire the Right One pg. 36

HOW TO RUN A PROFITABLE HEALTHCARE PRACTICE pg. 32

the

Are You Reaping the Benefits From New Incentives for Your Medicare Population? pg. 30

Practice & Profit issue

contents

CLIMB THE LADDER OF SUCCESS WITH FEEDBACKS

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features 30 ARE YOU REAPING THE BENEFITS FROM NEW INCENTIVES FOR YOUR MEDICARE POPULATION? 32 HOW TO RUN A PROFITABLE HEALTHCARE PRACTICE 36 CONTENT MARKETER: Why You Need One and How to Hire the Right One

insight 6

CLIMB THE LADDER OF SUCCESS WITH FEEDBACKS

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EHRs RANK AS NO.1 AREA OF INVESTMENT FOR EUROPEAN HEALTHCARE PROVIDERS IN 2015

10 PRACTICE HABITS THAT EQUATE SUCCESS

practice tips 12 MORALE MATTERS

research and technology 18 NEW INSIGHTS INTO HOW DNA DIFFERENCES INFLUENCE GENE ACTIVITY, DISEASE SUSCEPTIBILITY 20 MANY PEOPLE ARE NOT GETTING THE RECOMMENDED CANCER SCREENING TESTS

14 HOW TO MANAGE OVERPAYMENTS: Paying Back Patients & Payers

22 EARLY DETECTION AND TREATMENT OF TYPE 2 DIABETES MAY REDUCE HEART DISEASE AND MORTALITY

16 THE FOUR CORE ELEMENTS TO MODERNIZING YOUR PRACTICE

legal

THE FOUR CORE ELEMENTS TO MODERNIZING YOUR PRACTICE

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24 PROPOSED GRADUATE MEDICAL EDUCATION LEGISLATION LOOKS TO INCREASE RESIDENCY SLOTS 26 FDA ISSUES GUIDANCE FOR MOBILE MEDICAL APPS 28 WHY THE HEALTH CARE INDUSTRY NEEDS TO FOCUS ON DATA-FLOW RESTRICTIONS IN CHINA

healthy living 38 CHICKPEA SALAD

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

Call us today at 919-833-3836 x141

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

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Med Monthly June 2015 Publisher Creative Director Contributors

Philip Driver Thomas Hibbard Ashley Acornley, MS, RD, LDN. Naren Arulrajah Nidhi Behl Vats Richard J. Ferris, Jr. Robert Fuchs Barbara Hales, M.D. Vishal Gandhi, BSEE, MBA Christopher J. Shaughnessy Lisa Shock Denise Price Thomas Vikas Vij Tianran Yan Nili Yolin

contributors Ashley Acornley, RD, LDN holds a BS in Nutritional Sciences with a minor in Kinesiology from Penn State University. She completed her Dietetic Internship at Meredith College and recently completed her Master’s Degree in Nutrition. She is also an AFAA certified personal trainer. Her blog can be found at: ashleyfreshfromthefarm.wordpress.com

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

Barbara Hales, M.D.

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

We are currently accepting articles to be considered for publication. For more information on writing for Med Monthly, check out our writer’s guidelines at medmonthly.com/writers-guidelines

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

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

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

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 WWW.MEDMONTHLY.COM |5

insight

Climb the Ladder of Success With Feedbacks

Feedbacks are your best advisors if handled correctly

By Nidhi Behl Vats Freelance Medical Writer

For any organization, whether big or small, it is always the small decisions that affect the efficiency.

There are times when people are speaking from the heart about your services. These could be positive, as well as negative, feedbacks. So how much importance should be given to such feedbacks? Many times when people are sharing something they have actually experienced, we can actually improve our services by listening to them.

We are aiming to become “better than the best” and 6 | JUNE 2015

many a times “better than the rest”. By not paying attention to the customers needs and demands, we may have to bear the consequences. If we fall short in this one service point, it could result in the loosing many patients to our competitors. But many medical professionals will agree that it is a lot easier to say than to actually do.

People who have thought to improve their services many times have lost their battle despite putting in their best efforts. The very basic reason is adopting the

wrong strategy. This will cause more harm than good.

So, before actually moving on the solution, we need to identify the problem.

The crucial factor is whether or not to give importance to the patient’s feedback. Sometimes, when everything is going great and we are just being over cautious, we only modify the process. Often these minor modifications are not acceptable to the masses.

Therefore, it is vital to understand the severity of the patients’ concern in their feedback.

The best way is to devise a procedure by which you keep on receiving and recording regular feedbacks.

On a monthly basis, you can keep on adding to these feedbacks. You can check back on these regular feedbacks and highlight those that are recurrent issues.

Are the problems coming in from one service point or individual that is actually creating a problem.

Let’s discuss the steps to adopt to bring a change towards our aim of “Better than the best”.

Stop being cynical towards criticism: While you are working to the best of your efficiency, it is very possible to still get critical feedback. Before you actually get aggressive about the feedback, it is always good to observe and check the authenticity of the feedback given.

1. How many are giving negative feedback? Is it one person who is actually spreading bad word of mouth, or are several patients sharing the same observation?

2. Who is giving the negative feedback? Is it your regular patients who have been visiting your practice for a long time having concerns, or is it new patients having issues?

3. Is everyone speaking about one concern only?

Where is the problem? Is it one point of service which is faulty or is everything seeming to be falling apart?

Constructive measures required: When you have answered these questions, then it becomes easy for you to understand where the problem areas are. You have defined your areas of concern. It is always good to record these results.

Develop the strategy: It could be possible that for every problem you need to adopt a different strategy.

Sometimes the root cause of all the problems is one concern. One example might be the lack of motivation in the staff that needs to be sorted out.

Devising the solution: One solution might be you have an in-house implementable strategy. Another solution could be that you can hire a consultant to work out the possible ways to improve under their guidance.

There are several other methods of receiving feedbacks. One is to bring in a experienced person from a successful practice to observe your office activities for a complete day and jot down some observations.

Another is your staff can become your eyes and ears to patient feedback. You can train them to listen carefully to what the patient is expressing, possibly rectifying the problem at the moment it occurs. Then, at a later time, bringing the matter to your notice so that the desired alterations can be made throughout the practice.

It is an art to understand when to act and when to hold back. When you master this art, you will be able to provide the best of the services in your practice.

For increasing the efficiency, it is always advisable to address feedback received from reliable sources. It is solely the management’s decision whether to address the feedback or to just ignore them. 

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

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

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

WWW.MEDMONTHLY.COM | 7

insight

EHRs Rank as No.1 Area of Investment for European Healthcare Providers in 2015

A

new survey from IDC Health Insights shows that electronic health records (EHRs) are the first area where European healthcare providers are planning to invest during 2015 and beyond, with 66% of survey respondents planning to do so. EHRs are also where respondents are planning to invest more in new solutions (especially non-hospital providers), either replacing the current solution or implementing it for the first time. The survey results are analyzed in a new IDC study, What Will European Healthcare Providers’ IT Investments Look Like? An IDC Health Insights Survey (IDC Health Insights #HIOH02X, April 2015).

The slow but necessary transition toward integrated care delivery models and the higher care quality and safety

8 | JUNE 2015

requirements driven by the numerous healthcare reforms and innovation initiatives are changing the IT investment priorities of European healthcare providers. Healthcare providers are increasingly aware of the general changes brought by integrated care, but, as survey results show, they are less ready to focus on specific, practical initiatives that will accelerate the alignment of IT projects with business use cases.

The study describes European healthcare providers’ investment trends on enterprise solutions and healthcarespecific solutions. It also elaborates on decision-making structures and processes, and European healthcare providers’ IT budget management and alignment with business priorities.

Key findings of the survey include: • European healthcare executives are prioritizing the provision of consistent and reliable collaboration platforms for their organization.

• Top IT investment areas include general collaboration solutions such as unified communications and industry-specific solutions such as EHRs. • Investments supporting information management and analysis, such as document life-cycle management and business intelligence and analytics, are still relatively low — potentially jeopardizing the return of other investments, as in the case of clinical decision support, for example.

• Healthcare providers need to focus more on how both enterprise business solutions and healthcare industryspecific solutions will integrate with agile analyticsdriven, mobile-first, and in the longer term cloud-first environments that are the basic condition to enable healthcare digital transformation.

“On the path to becoming a digital enterprise, healthcare IT executives still need to fully realize that collaboration and information-sharing platforms need to be supported by an information management strategy to deliver significant improvements,” said Silvia Piai, senior research manager, IDC Health Insights, EMEA. “Healthcare provider CIOs need to architect wider patient information

sharing and use, supporting a patient-centric care delivery model based on patient data integration, collaboration, broader and different uses, and analysis.”

For more information about the study or to arrange a one-on-one briefing with IDC Health Insights analysts, please contact Kanupriya at kanupriya@idc.com.  About IDC Health Insights IDC Health Insights assists health businesses and IT leaders, as well as the suppliers that serve them, in making more effective technology decisions by providing accurate, timely, and insightful fact-based research and consulting services. Staffed by senior analysts with decades of industry experience, our global research analyzes and advises on business and technology issues facing the payer, provider, and life sciences industries. International Data Corporation (IDC) is the premier global provider of market intelligence, advisory services, and events for the information technology market. IDC is a subsidiary of IDG, the world’s leading technology, media, research, and events company. For more information, please visit www.idc-hi.com, email info@idc-hi. com, or call 508-935-4445. Visit the IDC Health Insights Community at http://idc-community.com/health.

Source: http://www.pressreleasepoint.com/ehrs-rank-no1area-investment-european-healthcare-providers-2015according-new-idc-health-insights-s

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

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insight

Practice Habits That Equate Success

After you have read some of the very informative feature articles in the April edition of Med Monthly, you should have your practice looking like success. Not only is your facility looking its best, your staff is dripping with knowledge, personality and compassion for your patients and you are more determined than ever to break out of average and be exceptional.

These are the MUST DO steps you need to take to assure you will not only succeed, but your practice will prosper.

 Provide your patients with a unique experience

when they visit your practice. Strive to have the most attractive staff, the best looking lobby, the most efficient office, and ease of check-in and check-out.

Be polite to every patient and inform them you are expanding and would appreciate their referral.

 Contract with a experienced and reputable Billing

Company. The small to medium practice can no longer afford the salary and unpredictability of a single biller employee in the practice. Physicians should have

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the greatest self-interest in optimizing coding practices and they must recognize that they are ultimately responsible for any coding inadequacies. Research and outsource your billing and stop putting this off. Also make sure your office manager and assistant manager talk with your billing company on regular basis. Your billing can be outsourced to a local or regional billing company for 3 to 5 percent of the collectables. We suggest you stay with a billing company within your own country. This may save you time and money.

 Get a practice website, NOW.

If your website is tired, upgrade your image and if you don’t have a practice website, you probably will struggle to be even average.

Your website is the most powerful tool to quickly and consistently present your image and will earn you money in a very short time. A professional website will attract new patients, keep your current patients informed and make it easier for your colleagues to refer patients to you.

 Measure yourself to know how you’re doing

clinically, financially, and in delivering service.

Track indicators of operational efficiency such as deliveries, diagnostic tests, surgeries by type, outpatient visits, etc. Also track relative value units and revenue per doctor. The practice should take great care with how this information is presented and discussed within the group in order to avoid conflict between physicians or damage existing working relationships. Look at budgeted versus actual expenses and evaluate your service mix each month.

Develop appropriate patient accounting indicators such as accounts receivable; 30-, 60-, and 90-day outstanding invoices; cash trend reports; and denial tracking. The resulting reports will show what your practice is doing and where improvement is needed.

These need to be examined each month.

 Make Med Monthly part of your reading habit.

The writers of Med Monthly are experts in their field and have worked with dozens, if not hundreds, of practices like yours and have developed successful outcomes. If you are one of our followers, we would like to hear from you. What type themes or articles would you like to read in Med Monthly? Your feedback if very important to us. Send us your recommendation today and thank you for reading Med Monthly. 

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

Home Grown/Nationally Known www.denisepricethomas.com denisepricethomas@gmail.com 704-747-8699 WWW.MEDMONTHLY.COM | 11

practice tips

MORALE MATTERS

By Denise Price Thomas

“I’m not running a day care, they are adults and it is NOT my job to motivate employees!” said the office manager. Well, the manager is right....to a point. It may not be written in the office manager’s job description to ‘Motivate Employees’ however, it sure makes for a happier environment when people are enjoying their work. Having fun at work can be done and in fact, it definitely improves productivity. It is much smarter to create a positive environment where everyone wins.

As Administrator of a surgical practice, where I was employed for 32 years, there was never a dull moment.

I think about the day when the patient walked into the office for a copy of his autopsy report. It appeared as though he was going to have to wait a while on that report. We quickly discovered that he needed his biopsy report. BIG difference! We never made FUN OF anyone, however we had FUN WITH them. We knew when and when not to “cut up” and we kept most of them in “stitches” (pun intended). Patients actually said they enjoyed coming to our office. I remember the little elderly gentleman who rode the bus to our office. He always arrived early so he could show us the most recent pictures of his grandchildren. You see, we listened to him and cared about him as an individual.

His family lived out of state, he lived alone and he called us his “friends.”

Creating a “HAPPY” atmosphere is easy, but it requires commitment and creativity. It starts at the top.

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If leaders are negative, their negativity will metastasize throughout the group. This attitude acts as an anchor.

No one wins. In reality, we do not all awake with a smile on our face each day and without problems in our pockets. Most everyone carries their own backpack of “issues.” We do, however, have a choice. We can choose to be a positive influence, turn our attention away from our problems and focus on the needs of others.

As for me, many days I would arrive at my office with a very heavy heart. No one knew. You see, when I pushed that door open, I closed the door to my problems. I turned my attention toward helping someone else to a good day and my bad day went away....every time. My actions along with my theme song, “Just Put on a Happy FAKE”, helped toward turning my happy fake into a happy reality each day.

I understood that it was up to ME to MOTIVATE ME. That was MY choice. To assist in helping others to motivate themselves, I created the following guide since MORALE MATTERS:

M = Motivation begins with ME from within.

It is MY choice. I choose to look for the positive in any situation and in doing so, I’ve discovered that POSITIVE is PLENTIFUL! (You won’t hear that in the news). A little fun game to engage others is to catch someone “in the act” of kindness, slip a little paper heart on their desk without getting caught. It

is then up to them to catch someone else “in the act” of kindness and pass it on, sharing the heart. This is a fun and very simple way of bringing everyone together, focusing on the positive actions of others. Soon everyone begins to look for the good and is on board toward creating kind and caring acts throughout each day. It’s sort of like a round-up in reverse. By focusing on the beauty within the flowers, we are weeding our garden.

O = Open the lines of communication.

Make sure that everyone is kept informed of changes, new physicians, new procedures, new employees, etc. While performing practice assessments, employees have shared with me that they were not told that a new physician was joining their practice and patients were calling for appointments after seeing it in the newspaper. Another group had sent thousands of beautiful flyers out about new procedures, however, they failed to inform their employees. Patients called to inquire and schedule appointments, the staff knew nothing about the procedure. They couldn’t answer any questions or schedule appointments. When employees are kept informed from the top, it becomes a TEAM. It’s easy to build an email network to announce new additions and any changes so that everyone hears the same message at the same time. Most likely, they will then jump on board.

R = Respect every person.

Treat everyone fairly. I am of the opinion that adults teach children the art of bullying. The same goes for the workplace. Leaders sometimes contribute to bullying. Step up to speak up...whether it is a physician in the hallway or someone from the cleaning crew, each person is important. I wouldn’t want to spend a day without each one. Actions of leaders never go unnoticed, therefore we need more leaders who will step up to speak up for what is right. When people feel they are respected as individuals, their self esteem is improved, which in turn promotes a team atmosphere. It cost nothing to exchange “hello” with a smile and a kind word....and the dividends are great.

BEWARE: this positive behavior is contagious and you may find yourselves celebrating often!

A = Approachable behavior.

Employees need to know they can approach you with problems. Now, the right time to share and the length of time spent there is up to you. After hear-

ing their issues, you may need to say, “I hear what you are saying, let me think about this a bit...and let’s reconnect around 4 today, will that work?” They now know that you are interested in what they had to say.

You cared. It is as important that others feel they can share new ideas and suggestions and to feel that their input is important. An “I” box is a fun way to encourage them to share. Ideas can be placed in the box, reviewed before staff meetings, igniting brainstorming and opinions and if the idea is put into action, an incentive (gift certificate) may be given. After all, who knows best than those who perform the duties.

L = Listen In.

We do not learn while we are talking (note to self here). When we are talking, we are sharing what we’ve already learned. When we listen, we learn. By the way, did you realize that the letters in LISTEN also spell SILENT? To listen, we must be silent (again, note to self). Many times I would overhear conversations, perhaps not meant for me to hear, however it would enlighten me of issues I was otherwise unaware of. I could then do something about those issues.

Take time to LISTEN. Do you know something special about each person you work with? Make it a point to find about their hobby, their family, etc. These are the threads that bind us together as a team. When leaders take time to listen and truly care about others, we are weaving a tapestry of loyalty.

E = Encourage.

When each and every person on the team feels the support of others around them, including their leaders, they will be more confident in making decisions on their own. Encourage each person to step up to speak up, leading by example. By creating an environment where the lines of communication are open, where they know that their opinion matters, where they feel respected, where they are missed when they aren’t there, that each task they perform matters, their suggestions count, their own contribution toward creating a happy work environment matters. Then it’s easy to see just how much MORALE MATTERS. When we tap into our creativity and make a commitment to focus on the positive, employees are happier, patients are happier and we are happier. A happy environment promotes productivity. Go ahead, step up to speak up, make the difference.

“We have the ability within us to create a positive environment around us”  WWW.MEDMONTHLY.COM | 13

practice tips

How to Manage Overpayments: Paying Back Patients & Payers

By Vishal Gandhi, BSEE, MBA Founder and CEO

It does happen at times that a medical practice gets reimbursed for more money than the services provided cost. This is overpayment. Most of the time, it’s the insurance carrier that makes the overpayment. However, there are times when the patients pay too much for a service too. In both cases, the overpayment should be returned to the patient or the payer.

In case it is a patient that has made the overpayment, they should be notified as soon as it is discovered.

Overpayment can be handled in multiple ways, but the provider cannot legally keep the money indefinitely.

Patient Overpayments: Let us take an example to simplify this. Suppose a patient visits a dermatologist to remove a mole. During the visit, the patient paid the co-pay. But on the removal of mole, the procedure is considered as a surgery and does not require a co-pay. This means that the co-pay that was paid before, is now an overpayment.

When the practice finds out about this, there are two things that can be done: 1. Notify the patient. On notifying, if the patient plans on returning, you can suggest to credit the overpayment for the next visit. However, if the patient does not want the credit, the overpayment should be returned.

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2. Immediately send a check for the overpaid amount to the patient with a note that explains the overpayment.

Whatever may be the case, keeping the overpayment is against the law.

Payer Overpayments: If the overpayment is made by an insurance company, the first step would be to check if the payment is actually an overpayment. This can be done by calling the company and asking them to explain their policies that determine the payment amount. You could also ask them if the claim was processed correctly.

If the payment is indeed an overpayment, the claim should be reprocessed showing the correct payment and request should be sent for the provider to return the overpayment.

It may be possible that the payer asks the provider to return the overpayment over the telephone. When this is the case, request a written explanation. On receipt of the written request, attach the check for the overpayment and mail it to them. If a specific address is not provided, make sure you send the mail to the claims department.

Sometimes, the entire payment could be wrong. For example, the provider did not see the patient and still

received the payment for it. When this is the case, write “void” on the check and return it to the payer with a note attached explaining how the provider has not seen the patient.

When It’s Not an Overpayment: During the call, if the payer states that the claim was processed correctly and there isn’t any overpayment, then further investigation is warranted.

This can happen if the patient has two insurance plans.

The primary plan makes the payment of a certain amount and then the secondary insurance processes the claim. This results in a credit balance when the secondary payer allows and pays a higher amount than the primary carrier.

This is not actually an overpayment. The adjusted amount from the primary carrier was more, based on the secondary insurance carrier’s payment. Hence, this isn’t an overpayment. The patient’s balance needs to be adjusted to offset the credit. In such cases, no money has to be returned.

Some patient’s secondary insurance carrier is privately purchased insurance. These companies do not always follow the same guidelines as other carriers. More often than not, these carriers ignore the amount paid by the primary carrier and make payment as if they are the

‘‘

“In case it is a patient that has made the overpayment, they should be notified as soon as it is discovered. Overpayment can be handled in multiple ways, but the provider cannot legally keep the money indefinitely.”

sole insurance carrier for the patient. This results in overpayment.

Here, the overpayment belongs to the patient as the patient as purchased the plan. The provider can, in no way, keep the money. Also, they cannot collect more than what was billed for services rendered.

Overpayments shouldn’t be ignored. Always try to determine if the overpayment is actually an overpayment, if so, whom should the payment be returned to, and, what should be done to return it. 

WWW.MEDMONTHLY.COM | 15

practice tips

The Four Core Elements to Modernizing Your Practice

By Robert Fuchs Marketing Manager, Plustek USA

The healthcare industry is constantly evolving and, in order to keep up, and provide patients with the care and environment patients are becoming accustomed to, healthcare practices need to take stock in how they approach these changes to stay competitive. With technology, comes change, but there are several ways health providers can move along with the changes, and even better yet, stay ahead of the game. Knowing this, here are four core elements health practitioners should keep in mind when it comes to modernizing their practice.

Embrace mobile: Interconnected services, mobility and interoperability, are changing the way all service providers must communicate to their patients. To make sure a 16

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practice is up-to-date, make sure the practice has a mobile friendly website that connects to the appointment desk.

It is important that patients can easily access the office to book or cancel appointments and to view other patient reviews. More and more the healthcare industry is being driven by the consumer and now the consumer is used to doing the majority of their tasks via their mobile device. If a practice is going to thrive in today’s mobile environment, a practice must adapt to meet their patients’ expectations.

Embrace offering digital files as a way to offer better care: Electronic Health Records (EHR) allows for patients to have access to their own records and for other healthcare practitioners to have access to these records. This very

secure practice increases efficiencies. A modern scanner can be an added feature to an EHR system to upload records and additional tests to patient files to help patients have ownership of their care. Patients are expecting this.

Embrace the right equipment: Healthcare patients care about how long they wait in a doctor’s office waiting room. Gone are the days of keeping patients waiting at the doctor’s discretion. Now patients want to be in and out as quickly as possible. According to healthcare consultant Press Ganey, the nationwide average wait time for patients was 23 minutes.

Punctuality is fundamental in reducing time, but so is making sure an office is fully equipped to admit patients quickly and input the necessary information to move them from the waiting room to actually seeing the doctor. Professional scanners that can quickly scan documents wirelessly provide a great alternative to slower, older scanner models that don’t create an electronic file from one simple step. For instance, the eScan Series offers a range of scanners that allows users to push one button to digitize a document, upload it to a patient’s file, and move to the next patient. Make sure your other office equipment is up to date and works for today’s heavily digitized medical office. It is one of the most inexpensive ways to look and feel more modern.

Embrace social: Create a social platform to connect with patients. It is important to use social as a way to highlight a medical practice, but also to respond to customers if they have a question, or even a complaint. A social media tool such as Facebook or LinkedIn allows customers to view what others are saying, learn about the practice and its healthcare approach, and the physicians within that practice.

Consumers have adapted to social media, and so must a healthcare practice!

The future of healthcare is here and exciting changes are happening everywhere.

Understand and know that by creating a modern environment, a patient will feel more comfortable knowing that their healthcare practitioner is up to date and up with the times. Robert Fuchs Marketing Manager for Plustek, an imaging and surveillance solutions provider, dedicated to manufacturing high-quality, professional scanners, as well as security devices for businesses and professionals around the world.

WWW.MEDMONTHLY.COM | 17

research & technology

GTEx Findings Reveal New Insights Into How DNA Differences Influence Gene Activity, Disease Susceptibility

Researchers funded by the National Institutes of Health Genotype-Tissue Expression (GTEx) project have created a new and much-anticipated data resource to help establish how differences in an individual’s genomic make-up can affect gene activity and contribute to disease. The new resource will enable scientists to examine the underlying genomics of many different human tissues and cells at the same time, and promises to open new avenues to the study and understanding of human biology.

GTEx investigators reported initial findings from a two-year pilot study in several papers appearing online May 7, 2015, in Science and other journals.

These efforts provide new insights into how genomic variants — inherited spelling differences in the DNA code — control how, when and how much 18

| JUNE 2015

genes are turned on and off in different tissues, and can predispose people to diseases such as cancer, heart disease and diabetes.

“GTEx was designed to sample as many tissues as possible from a large number of individuals in order to understand the causal effects of genes and variants, and which tissues contribute to predisposition to disease,” said Emmanouil Dermitzakis, Ph.D., professor of genetics at the University of Geneva Faculty of Medicine, Switzerland, and a corresponding author on the main Science paper. “The number of tissues examined in GTEx provides an unprecedented depth of genomic variation. It gives us unique insights into how people differ in gene expression in tissues and organs.”

NIH launched the GTEx Project

in 2010 to create a data resource and tissue bank for scientists to study how genomic variants may affect gene activity and disease susceptibility.

Investigators are collecting more than 30 tissue types from autopsy and organ donations in addition to tissue transplant programs. The DNA and RNA from those samples are then analyzed using cutting-edge genomic methods. The project will eventually include tissue samples from about 900 deceased donors. GTEx is supported by the NIH Common Fund and administered by the National Human Genome Research Institute (NHGRI), the National Institute of Mental Health (NIMH) and the National Cancer Institute (NCI), all part of NIH. “GTEx will be a great resource for understanding human biological function, and will have many practical

applications in areas such as drug development,” said NHGRI Program Director Simona Volpi, Pharm.D., Ph.D. “Scientists studying asthma or kidney cancer, for example, will be interested in understanding how specific variants influence the biological function of the lung, kidney and other organs.”

“Projects supported by the Common Fund aim to advance multiple areas of biomedical research,” said James M. Anderson, M.D., Ph.D., director of the NIH Division of Program Coordination, Planning, and Strategic Initiatives, which houses the Common Fund. “The unprecedented breadth of GTEx donors and tissue types establishes a resource that scientists studying areas ranging from blood pressure to neurodegenerative disease would find invaluable.”

In the main Science paper, researchers analyzed the gene activity readouts of more than 1,600 tissue samples collected from 175 individuals and 43 different tissues types. One way that researchers evaluate gene activity is to measure RNA, which is the readout from the genome’s DNA instructions. Investigators focused much of their analyses on samples from the nine most available tissue types: fat, heart, lung, skeletal muscle, skin, thyroid, blood, and tibial artery and nerve.

The genomic blueprint of every cell is the same, but what makes a kidney cell different from a liver cell is the set of genes that are turned on (expressed) and off over time and the level at which those genes are expressed. GTEx investigators used a methodology — expression quantitative trait locus (eQTL) analysis — to gauge how variants affect gene expression activity.

An eQTL is an association between a variant at a specific genomic location and the level of activity of a gene in a particular tissue. One of the goals of GTEx is to identify eQTLs for all genes and assess whether or not their effects are shared among multiple tissues.

Investigators discovered a set of

variants with common activity among the different tissue types. In fact, about half of the eQTLs for protein-coding genes were active in all nine tissues.

They identified approximately 900 to 2,200 eQTL genes – genes linked to nearby genomic variants — for each of the nine tissues studied, and 6,486 eQTL genes across all the tissues. “We didn’t know how specific this regulation would be in different tissues,” said co-corresponding author Kristin Ardlie, Ph.D., who directs the GTEx Laboratory Data Analysis and Coordination Center at the Broad Institute of MIT and Harvard in Cambridge, Massachusetts. “The analysis showed a large number of variants whose effects are common across tissues, and at the same time, there are subsets of variants whose effects are tissue-specific.”

Comparing tissue-specific eQTLs with genetic disease associations might help provide insights into which tissues are the most relevant to a disease. The researchers also found a great deal of eQTL sharing among tissues, which can help explain how genomic variants affect the different tissues in which they are active.

Even when active in multiple tissues, the same variant can sometimes have a different effect in different tissues. GTEx researchers found, for example, that a variant that affects the activity of two genes associated with blood pressure had a stronger effect on gene expression relevant to blood pressure in the tibial artery – even though there was greater overall gene activity in other tissues.

They also noted that the same gene activity profiles characterizing tissues from living donors were seen in the GTEx samples from deceased donors.

Two companion studies in Science used GTEx data to examine other aspects of gene activity in different tissues. One study characterized the effects of protein-truncating variants (PTVs) on gene activity. PTVs shorten the protein-coding sequence of genes, and affect their function. Some rare

PTVs can lead to diseases, such as Duchenne muscular dystrophy. Each person’s genome carries about 100 PTVs, though most have little or no effect (and in some cases can even protect against disease).

Manuel Rivas, a Ph.D. candidate at the University of Oxford, and his colleagues used GTEx data and information from a large European project to examine the gene readouts from more than 600 individuals.

The team found PTVs that affect protein production either through the degradation of gene transcripts or by disrupting a process called splicing. In both cases, the researchers were able to use the GTEx data to measure these effects across individuals and tissue types. The group is now developing better methods for predicting the impact of PTVs identified in patients with diseases.

In another companion study in Science, Roderic Guigo, Ph.D., coordinator for the Bioinformatics and Genomics Program at the Centre for Genomic Regulation in Barcelona, Spain, and his colleagues examined patterns in gene readouts across nearly 1,500 GTEx tissue samples. The researchers found that gene activity differed substantially more across tissues than across individuals.

Investigators discovered just under 2,000 genes that vary with age, including genes related to neurodegenerative diseases such as Parkinson’s disease and Alzheimer’s disease. They also found more than 750 genes with differences in activity between men and women. Some genes are related to diseases with differences in prevalence between men and women, including five related to heart disease.

Three other studies analyzing GTEx data also appear May 8 in the journals Bioinformatics, PLoS Computational Biology and Genome Research.  Source: http://www.nih.gov/news/ health/may2015/nhgri-07.htm

WWW.MEDMONTHLY.COM | 19

research & technology

Many People Are Not Getting the Recommended Cancer Screening Tests

Many adults in the U.S. are not getting the recommended screening tests for colorectal, breast and cervical cancers, according to data published in the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report. For 2013, screening for these types of cancers either fell behind previous rates or showed no improvement.

20 | JUNE 2015

Among adults in the age groups recommended for screening, about 1 in 5 women reported not being up-to-date with cervical cancer screening, about 1 in 4 women reported not being up-to-date with breast cancer screening, and about 2 in 5 adults reported not being up-to-date with colorectal cancer screening.

The report found that colorectal cancer testing was

essentially unchanged in 2013 compared with 2010.

Pap test use in women age 21-65 years was lower than 2000, and the number of mammography screenings was stagnant, showing very little change from previous years.

“It is concerning to see a stall in colorectal cancer screening rates,” said Lisa C. Richardson, M.D., M.P.H., director of CDC’s Division of Cancer Prevention and Control. “We must find new ways to make people and providers aware that getting tested for colorectal cancer could prevent cancer and save their lives.”

Researchers reviewed data from the National Health Interview Survey 2013, which is used to monitor progress toward Healthy People 2020 goals for cancer screening based on the most recent U.S. Preventive Services Task Force guidelines.

The screening data for 2013 show that 58.2 percent of adults age 50-75 years reported being screened for colorectal cancer; 72.6 percent of women age 50-74 had a mammogram; and 80.7 percent of women age 21-65 had a Pap test. All of these percentages are below the Healthy People 2020 targets.

The report found that adults without insurance or a usual source of healthcare generally had the lowest screening test use. For example, fewer than one quarter of adults in these groups reported recent colorectal cancer screening, compared with more than 60 percent of adults with private insurance or a usual source of healthcare. More efforts are needed to achieve cancer screening goals and reduce screening disparities.

The authors did report some good news: the proportion of women in the highest education and income groups who were screened for breast cancer exceeded the Healthy People 2020 target, and the proportion of people age 65-75 who were screened for colorectal cancer was also near the target.

Through the Affordable Care Act, more Americans will qualify to get health care coverage that fits their needs and budget, including important preventive services such as screening for some cancers that may be covered with no additional costs. Visit Healthcare.gov or call 1-800-318-2596 (TTY/TDD 1-855-889-4325) to learn more.

CDC’s Efforts to Increase Cancer Screening The Colorectal Cancer Control Program provides funding to 25 states and 4 tribes across the U.S. The program supports population-based screening efforts

and provides colorectal cancer screening services to low-income men and women age 50–64 years who are underinsured or uninsured for screening, when no other insurance is available The Screen for Life: National Colorectal Cancer Action Campaign informs men and women aged 50 years and older about the importance of having regular colorectal cancer screening tests.

CDC has a new free continuing medical education program for clinicians about colorectal cancer screening at http://www.cdc.gov/cancer/colorectal/quality/.

The National Breast and Cervical Cancer Early Detection Program provides access to breast and cervical cancer screening services to underserved women in all 50 states, the District of Columbia, 5 U.S. territories, and 11 tribes.

The full report, “Cancer Screening Test Use – United States, 2013,” can be found at www.cdc.gov/mmwr.

For more information about CDC’s efforts in cancer prevention and control, visit www.cdc.gov/cancer.  Source: http://www.cdc.gov/media/releases/2015/ p0507-cancer-screening.html

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research & technology

Early Detection and Treatment of Type 2 Diabetes May Reduce Heart Disease and Mortality Screening to identify type 2 diabetes followed by early treatment could result in substantial health benefits, according to new research published today in Diabetes Care that combined large scale clinical observations and innovative computer modelling.

The study, led by researchers at the University of Michigan and the MRC Epidemiology Unit, University of Cambridge, used data from the ADDITION-Europe study of diabetes screening and treatment, which it combined with a computer simulation model of diabetes 22 | JUNE 2015

progression. This revealed that screening followed by treatment led to a reduced risk of cardiovascular disease or death within a 5-year follow-up period when compared to patients having no screening.

The ADDITION-Europe study enrolled people 40 to 69 years of age without known diabetes from 343 general practices in the United Kingdom, Denmark, and the Netherlands. The study had two objectives: firstly, to determine if routine screening for type 2 diabetes was feasible; secondly, to determine if early, intensive, treatment of high

blood sugar and cardiovascular risk factors such as blood pressure, cholesterol status and smoking in those diagnosed with type 2 diabetes reduced the risk of events such as stroke, heart attack, angioplasty, heart bypass surgery, amputation and death.

The researchers found that screening was feasible, but that intensive treatment did not yield statistically significant benefits over routine care, most likely because of the overall high quality of routine diabetes care delivered in general practice.

An important question is what impact screening followed by treatment has on the later health outcomes of people with undiagnosed type 2 diabetes, as previous research indicates that in Europe onset of the disease typically occurs six years before its clinical diagnosis. Because all participants in ADDITION-Europe were screened for type 2 diabetes at the start of the study, the researchers could not determine what difference would have been observed had screening and treatment for T2DM been compared with no screening, and therefore no treatment, until the time of eventual clinical diabetes diagnosis.

To answer this question the authors used the Michigan Model for Type 2 Diabetes, which simulates the progression of diabetes and its complications, co-morbidities, quality-of-life, and costs, and provides estimates of cardiovascular events and mortality.

In order to assess the impact of a delay in diagnosis and treatment for type 2 diabetes, the researchers simulated scenarios where screening did not take place and there was either a three-year or six-year delay before diagnosis, after which routine care was initiated.

At 10 years after baseline, the simulations predicted that with a delay of 3 years in diagnosis and treatment 22.4 % of those with type 2 diabetes would experience a cardiovascular disease event, such as stroke or heart bypass surgery, which rose to 25.9% with a delay of six years. However, if screening and routine care had been implemented, the simulation predicted only 18.4% would experience a cardiovascular disease event at 10 years after baseline. The simulated incidence of all-cause mortality was

16.4% with a delay of three years and 18.2% with a delay of six years, compared to 14.6% for screening and treatment.

This means that over 10 years, the model predicts that for people with undiagnosed type 2 diabetes, screening would be associated with a 29% reduction in relative risk of a cardiovascular disease event compared with a delay of six years in diagnosis and treatment. This amounts to a 7.5% reduction in the absolute risk of adverse cardiovascular outcome in this population.

The comparable change in all-cause mortality was 20% relative risk and 3.6% absolute risk reduction.

Before they used the Michigan model to assess the impact of a delay in diagnosis and treatment for type 2 diabetes, the authors first evaluated its ability to predict the previous outcomes of ADDITIONEurope by simulating the impact of the intensive treatment and routine care on the composite cardiovascular outcome and all-cause mortality, and comparing these two scenarios.

The results were similar to those of ADDITION-Europe, with little difference between the intensive treatment and routine care scenarios.

Professor William Herman of the University of Michigan, first author on the paper, said: “Comparing the results of our simulations with the real-world data gave us confidence that our model successfully predicts the impact of delaying diagnosis of type 2 diabetes on future cardiovascular health outcomes.

“Diabetes can be debilitating for patients and costly for healthcare.

This research shows that the early identification of diabetes has major health benefits, and supports the introduction of measures such as screening to reduce the time between development of type 2 diabe-

tes and its treatment.”

Professor Nick Wareham, senior author on the paper and Director of the MRC Epidemiology Unit, University of Cambridge, added: “This work shows the value of public health modelling to assess impacts and interventions for diseases such as type 2 diabetes that pose an increasing public health challenge.

“ADDITION-Europe is a large, high quality study, but even so there are limitations in how much direct clinical observation can tell us about the costs and benefits of screening. Computer simulations add an extra dimension which we hope will guide future research as well as the development of public health policy.”

The authors caution that, even without a diabetes diagnosis, individuals might in the interim receive treatment for conditions such as blood pressure or cease smoking, so that the outcomes might be somewhat less pronounced than their model predicts. However, they note that the model assumes that, as in ADDITION-Europe, all participants were recruited from primary care, and were thus already receiving medical care, so this distortion is not expected to be large.  Reference Herman, WH et al. Early detection and treatment of type 2 diabetes reduces cardiovascular morbidity and mortality: A simulation of the results of the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION-Europe). Diabetes Care (2015) Source: http://www.pressreleasepoint.com/early-detection-and-treatment-type-2-diabetes-may-reduceheart-disease-and-mortality WWW.MEDMONTHLY.COM | 23

legal

Proposed Graduate Medical Education Legislation Looks to Increase Residency Slots

By Nili S. Yolin Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.

24 | JUNE 2015

L

ast week, new bi-partisan legislation was introduced to increase the number of graduate medical education (GME) slots over the next five years at teaching hospitals and academic medical centers. If passed, the Resident Physician Shortage Reduction Act of 2015 (S. 1148/H.R. 2124) will create 3,000 additional full time equivalent (FTE) residency slots each year from 2017 through 2021, for a total of 15,000 new residency slots. Half of the 3,000 slots must be used for a “shortage specialty residency program,” as defined by the Health Resources and Services Administration (HRSA), until the National Health Care Workforce issues a new report on specialty shortages in 2018.

The purpose of the legislation is to guard against the precipitous shortfall of primary care physicians that at least one study is predicting will occur by 2025 – another says 2035 – if there is no increase in residency training slots. The shortfall is said to be due primarily to changing demographics and the expansion of health care insurance as a result of federal health care reform.

In determining whether a hospital should receive additional slots, the Secretary of the Department of Health and Human Services will consider the likelihood of the hospital filling the positions. Priority will be given to hospitals as follows: • First to hospitals in states with new medical schools or that have established additional branches or locations for existing medical schools; • Second to hospitals that have exceeded their resident cap; • Third to hospitals affiliated with Veteran’s Health Administration medical centers; • Fourth to hospitals that emphasize training in community-based settings or in hospital outpatient departments; • Fifth to hospitals that are eligible for incentive payments pursuant to meaningful electronic health record (EHR) use legislation; and • Last, to all other hospitals.

A hospital that receives an increase in its residency slots must at all times ensure that (i) at least 50% of the slots are for a shortage specialty residency program, (ii) the total number of FTE residents (excluding additional positions attributable to the increase) is not less than the average number of FTE residents the hospital has trained during the three most recent cost reporting period, and (iii) the ratio of FTE residents in a shortage specialty residency program is not less than the average ratio of FTE residents in such program during the three most recent cost reporting periods If a hospital fails to meet the foregoing criteria for maintaining its additional slots, the Secretary can reduce and redistribute the slots. A hospital may not receive more than 75 slots in the aggregate from 2017 through 2021, unless the Secretary determines there are extra slots available for distribution. Finally, if the number of FTE slots distributed in a particular year is less than the aggregate number of positions available for that year, those slots will be available for distribution the following year.

While the increase in residency slots is a step forward in addressing the needs of the nation’s changing demographics, it will be interesting to see if additional changes are implemented to improve GME, such as removing the resident cap altogether, raising the actual amount of indirect and direct Medicare GME funding, and establishing a greater role for states and private payers to play in GME reimbursement.  Source: http://www.natlawreview.com/article/proposed-graduate-medicaleducation-legislation-looks-to-increase-residency-slots

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legal

FDA Issues Guidance for Mobile Medical Apps

By Christopher J. Shaughnessy McBrayer, McGinnis, Leslie and Kirkland, PLLC Just so you know, that iPhone or iPad you have with you may be an FDA-regulated medical device.

More precisely, the apps on the device may meet the definition of a medical device under the Federal Food, Drug, and Cosmetic Act (“FD&C Act”). In February of this year, the FDA released a revised set of guidance concerning how it will apply regulatory oversight to mobile apps, addressing the growing number and potential uses of these apps as they proliferate alongside rapidly changing mobile technology.

In this new guidance, the FDA set forth three classifications of mobile apps: those that do not meet the definition of a medical device under the FD&C Act, those that may meet the definition but pose a low risk to the public, and those that do meet the definition of a medical device, the functionality of which could risk patient safety in a malfunction. The determining factor in whether an app meets the definition of a medical device for purposes of the FD&C Act is the intended use of the app, which the FDA will determine through labeling, advertising, and statements by the manufacturer. If a mobile app is intended to perform a medical device function, such as diagnosing or curing disease, it is considered a medical device.

While the FDA could regulate all devices it deems meet the definition for “medical device,” it will draw the regulatory line only when there is potential risk to a patient if an app doesn’t perform as specified. These apps include those that connect to other devices to control them or actively monitor patient data, apps 26 | JUNE 2015

that transform a mobile platform into a medical device by using sensors, attachments or display screens, and apps that perform patient-specific analysis, diagnosis, or treatment recommendations.

Apps that function as medical devices but that pose a low risk of harm will escape FDA scrutiny, although the FDA urged manufacturers of all mobile medical apps to abide by Quality System regulations. The list of low-risk app types that the FDA is currently choosing to provide little, if any, oversight over has grown significantly since the last guidance just two years ago.

The guidance is intended to help mobile medical app creators determine if their app falls under FDA regulations, triggering certain controls according to device class (I, II or III). If a mobile app is seen as a medical device, it must conform to applicable regulations concerning device classification and follow regulatory controls, which may include registration, labeling, and premarket notification or approval, among others.

From a provider standpoint, healthcare practitioners who use mobile medical apps on tablets, phones or other devices should consider whether those apps have been FDA-approved if they meet enough criteria to reasonably fall under the definition of a medical device. For more information on mobile medical apps and potential regulatory issues, contact the attorneys of McBrayer, McGinnis, Leslie & Kirkland, PLLC.  Source: http://mcbrayerhealthcare.com/2015/05/14/ fda-issues-guidance-for-mobile-medical-apps/

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Why the Health Care Industry Needs to Focus on Data-Flow Restrictions in China

By Richard J. Ferris, Jr. and Tianran Yan Foley & Lardner LLP U.S. health care providers, device manufacturers, lab managers, health information technology and telemedicine/telehealth project investors, and other industry members involved in projects in China, need to be aware of a long and growing list of Chinaspecific data-flow and content restrictions. These restrictions are increasingly concerning in light of the health care industry’s growing use of cloud technology and need for financial and other systems that protect medical record, insurance data and other sensitive information, but that are efficient, and that provide unimpeded online access.

The data-flow restrictions in China arise from a complex combination of government concerns, such as cybersecurity, data privacy, and patient and other consumer protection. U.S. and other industry associations have called upon China to openly discuss changes to rules that require disclosure of sensitive intellectual property and restrict cross-border flows of commercial data. The concerns have reportedly even fueled Chinese manufacturer’s efforts to market replacements for foreign technology with Chinesedeveloped systems.

With this in mind, while U.S. government and industry negotiators continue to push for resolution of industry concerns involving China data-flow restrictions, the fact remains that health care industry members must understand these restrictions in order to enjoy continued business success, minimize dataaccess and business continuity risks, and even avoid criminal liability exposure.

Health Care Information and Patient Privacy Measures issued last year potentially apply to a vast 28 | JUNE 2015

array of health information which medical, health care and family planning service agencies of all types and at all levels generate within China while providing services or managing health care operations. These Measures prohibit storage of such information “in overseas servers, [or in] hosted or rented overseas servers.” See Management Measures for Population Health Information (for Trial Implementation), (National Health and Family Planning Commission, May 5, 2014), Section 10.

Personal Data Privacy China’s personal data privacy laws and guidelines have been expanding over the last few years. Certain of these laws and guidelines touch upon the issue of data flow. For instance, China has issued standards that provide that “without express consent of the subject of personal information, the express requirement of any law or regulation, or the consent of the competent authority, a personal information administrator should not transmit personal information to any overseas personal information recipient, including an individual located abroad or an organization or institution registered abroad.” See Information Security Technology – Guidelines for Personal Information Protection within Information Systems for Public and Commercial Services (GB/Z 28828-2012), (Standardization Administration of China and the Administration of Quality Supervision, Inspection and Quarantine, November 5, 2012), Section 5.4.5. See also Decision on Strengthening Online Information Protection (Standing Committee of the National People’s Congress, December 28, 2012) (among other things, making illegal the collection and provision of personal

information without authorization); Provisions on Protecting the Personal Information of Telecommunication and Internet Users (Ministry of Industry and Information Technology, July 16, 2013) (regulating the activities of telecommunications service providers and Internet infrastructure service providers in collection and use of personal data in services conducted within China).

Criminal Liability China has proposed criminalizing unauthorized “sale or offers to sell personal information obtained… during the provision of services,” according to the 9th Amendment Draft of the Criminal Law of the People’s Republic of China published on November 3, 2014 (National People’s Congress), at proposed Section 253.1. If enacted, this would significantly expand the scope of such criminal liability, which was introduced in the 7th Amendment of the Criminal Law, effective February 28, 2009, and which currently focuses on employees in the health care, among other sectors.

National Security Internet companies operating in China would need to store customer data on Chinese servers and to provide technical interfaces and encryption keys to public security agencies to enable these authorities to monitor terrorism threats under the proposed Counter-Terrorism Law of the People’s Republic of China published on November 3, 2014 (National People’s Congress), at proposed Section 15. National security issues driving China’s restrictions on data flow and content are not limited to this proposal. The proposed National Security Law of China (Standing Committee of the National People’s Congress, May 6, 2015) introduces in proposed Section 26 the concept of “internet sovereignty,” which essentially provides that a country has the right to determine what data flows in and out of the country’s territory. Existing Chinese laws also reflect these issues for company data-flow and content restrictions. See State Secrets Law of the People’s Republic of China (Standing Committee of the National People’s Congress, as amended April 29, 2010) (prohibiting, among other things, unauthorized overseas transfer of information that the government deems a “State secret,” including classified matters concerning national economic and social development and science and technology); Foreign Trade Law of the People’s Republic of China (Standing Committee of the National People’s Congress, April 6, 2004)

(restricting export of data associated with certain technologies).

Financial Information We note that this growing trend of data-flow restrictions in China also extends to other sectors, such as the financial industry. Certain measures for restricting data-flow initiated for this sector offer a preview of what the healthcare sector in China may have to deal with in the future. For instance, China recently temporarily suspended the implementation of new banking sector Guidelines that would require companies which provide technology equipment to Chinese banks to, among other things, turn over source code.

Specifically, goals indicated in the Guidelines included substantially increasing financial institution use of “safe and controllable” information technology by the end of 2019. See Circular on the Guidelines for Secure and Controllable Information in the Banking Industry (2014-2015) (General Offices of the China Banking Regulatory Commission and the Ministry of Industry and Information Technology, December 26, 2014) (temporarily suspended), Section 2(10). See also Circular of the People’s Bank of China on Urging Banking and Financial Institutions to Undertake Protection of Personal Financial Information (People’s Bank of China, January 21, 2011), Section 6 (requiring, among other things, that personal financial information collected in China must be stored, processed, and analyzed within the territory of China); Management Regulation on Credit Information Industry (State Council, December 26, 2012), Article 24 (specifying, among other things, that information collected by credit institutions in China shall be organized, stored, and processed within the territory of China).

Much of the great promise for health care-sector internet-based and other technology innovations is dependent upon predictable and reliable data flow and globally accepted standards to address security improvements. Not surprisingly, understanding how China’s restrictions and risks may affect data flow helps U.S. health care sector members develop proper controls in the near term to minimize risks.

Also, specific examples, such as those provided above, strengthen advocacy for globally accepted security standards in the long term to best take advantage of China market opportunities.  Source: http://www.natlawreview.com/article/whyhealth-care-industry-needs-to-focus-data-flow-restrictions-china WWW.MEDMONTHLY.COM | 29

features

Are You Reaping the Benefits From New Incentives for Your Medicare Population?

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

In these times of health reform, reaping added financial benefits for managing a Medicare patient are now more commonplace. The Centers for Medicare & 30 | JUNE 2015

Medicaid Services (CMS) issued a new rule that will update payment policies and payment rates for services furnished under the Medicare Physician Fee Sched-

ule (PFS) on or after Jan. 1, 2015. Medicare will now pay physicians Physician Assistants (PAs) and Nurse Practitioners (NPs) for care management services as part of in person, face-to-face visits. Last year, CMS finalized a separate payment, outside of a face-to-face visit, for managing the care of Medicare patients with two or more chronic conditions beginning in 2015.

The payment rate for the new chronic care management (CCM) code is $41.92, billed no more frequently than once per month per qualified patient. This could amount to more than $200,000 per year per provider in added revenue assuming a 20% Medicare population with at least 700 unique Medicare patients per year who have 2 or more chronic conditions. Chronic care management (CCM) services include development and revision of a plan of care, communication with other health professionals, and medication management.

Payment for CCM is only one part of a multi-faceted CMS initiative to improve Medicare beneficiaries’ access to primary care. PAs and NPs are estimated to do about 85% of the work a physician would otherwise provide in the primary care setting. Nationwide, hospitals and health systems are moving toward using more PAs and NPs and there is a much greater emphasis on team based care.

Additional financial incentives for physicians and eligible providers, called the physician value based modifier (VBM) is another incentive which allows the federal government to boost or lower the amount it reimburses physicians and eligible providers including PAs and NPs based on how they score on quality measures and how much their patients cost Medicare.

How providers rate this year will determine payments for more than 900,000 clinicians by 2017. Medicare is easing providers into the program, applying it this year only to medical groups with at least 100 health professionals including physicians, Physician Assistants, Nurse Practitioners, speech-language pathologists and occupational therapists. Next year the program will expand to groups of 10 or more health professionals. In 2017, all remaining providers who take Medicare—along with about 360,000 other health professionals—will be included.

Increasing capacity of the health system to meet the growing numbers of patients seeking care is critical and necessary. Medicare population growth is significant and leaves many patients facing access issues.

Between 2012 and 2050, the United States will experience considerable growth in its older population. In

2050, the population aged 65 and over is projected to be 83.7 million, almost double its estimated population of 43.1 million in 2012. The baby boomers are largely responsible for this increase in the older population, as they began turning 65 in 2011.

PAs and NPs are skilled medical professionals who play an integral part in health care delivery. Especially in primary care, PAs and NPs attract and manage a significant following of patients. Redesigning teams to include increased numbers of primary care providers, not just physicians but also Physician Assistants and Nurse Practitioners, is a significant part of the solution to alleviate the well-known shortage in primary care.

Now with even greater added financial incentives for quality care delivery, improved utilization of PAs and NPs will be an integral part of the primary care delivery solution.  References: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-07-03-1. html http://www.witf.org/news/2014/10/how-pas-are-reshaping-health-care.php http://www.fiercehealthcare.com/story/4-waysimprove-primary-care-delivery/2014-10-02?utm_ campaign=SocialMedia http://www.cms.gov/Medicare/Medicare-Fee-for-Service Payment/PhysicianFeedbackProgram/ValueBasedPaymentModifier.html http://www.cms.gov/Medicare/Quality-InitiativesPatient-Assessment Instruments/PQRS/Downloads/ PQRS_List-of-EligibleProfessionals_022813.pdf http://www.cms.gov/Medicare/Medicare-Fee-for-Service Payment/PhysicianFeedbackProgram/Downloads/ CY2015ValueModifierPolicies.pdf http://www.census.gov/prod/2014pubs/p25-1140.pdf About the Author: Lisa P. Shock, MHS, PA-C, is a seasoned PA who has worked with clients to expand care teams in both large and small settings. She enjoys part time clinical practice and is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering a wide range of services to help implement and improve upon the utilization of PAs and NPs in the health care system.

Contact her at lisa@pushpa.biz WWW.MEDMONTHLY.COM | 31

features

How to Run a Profitable Healthcare Practice

By Naren Arulrajah with Vikas Vij Ekwa Marketing

Running a successful and profitable healthcare practice in today’s digital environment is not without challenges. Patients are well informed about their available choices when it comes to selecting a doctor or a healthcare practice. Not only do doctors need to address economic challenges but they also need to take into account healthcare measures such as the Affordable Care Act among others and the kind of impact it can have on their practice profits. This is why healthcare practices need to be proactive 32 | JUNE 2015

about managing the business side of their practice.

How to Remain Viable in a Competitive Environment

rience, cash inflow among others, practices can achieve long-term sustainability. Consider the following strategies.

Achieving practice success in a highly competitive marketplace takes time and strategic planning.

Although healthcare practices face their own unique set of challenges, it is not completely impossible to build a profitable practice. By focusing on areas that are high-impact such as the online reputation of a practice, patient service expe-

The most important element of running a successful medical practice is the kind of value a practice brand builds and how well that value is communicated to a target audience. Relationship building is the first step in that direction. Here is what you can do;

Make Your Practice Invaluable

Create a brand culture of delivering exceptional clinical care and service. Communicate efficiency and quality of your practice brand at all stages of the patient service experience cycle.

• Make use of the collective might of various digital marketing platforms (your practice website, blog, social channels, review sites) to build brand exposure.

• Personalize communication via your monthly email newsletters.

• Include elements that are of specific interest to your patients.

• Build social groups and share information through interesting and useful content.

• Create a system of rewarding your brand advocates – introduce attractive offers, discounts, or gift-cards.

• Try to find ways in which you can add value to the relationship – easy scheduling options, discounts or first access to new services and products are just some of the ways to build relationship value.

Focus on Patient Satisfaction Your practice front desk plays a crucial role in the patient satisfaction journey. It is vitally important to create a positive first impression.

Depending upon how a first time patient was treated, your front desk can be instrumental in creating practice brand ambassadors or a one-time patient.

• Encourage your staff to be warm and friendly. Staff that is proficient in soft skills while also being efficient in managing more important issues such as insurance verification is the ideal fit.

• Streamline patient intake. Don’t keep you patients waiting; ensure your intake forms can be easily downloaded and filled or provide a secure system for submitting their information online.

• Organize your schedules for optimal delivery value. Schedule appoints based on “firsttime” patients, “regular routine” patients, and “time-consuming” patients. If you are unsure how much time you are going to spend with a “time-consuming” patient, it makes little sense to schedule a “first-time” patient immediately after. This is why it is best to organize your schedule to fit different patient types.

Find Out What Patients Are Saying About Your Practice Review sites like Healthgrades and Yelp can help you gain a better understanding of what your patients want and how best you can deliver on their expectations. Keep in mind, your relationship with a patient does not end as soon as he is out of your clinic. The real time nature of the digital space and social media makes it easy for patients to post their experiences with a medical practice almost instantly.

And it is true – an unhappy patient will readily post negative reviews online. But it can take a bit of coaxing to get your happy patients to drop positive and raving reviews.

Don’t shy away from asking your patients to share their experiences. When happy patients share their experiences online it can help tremendously in creating awareness for your brand first and then adding positive layers to your brand reputation. What you need to keep continued on page 34

continued from page 33

in mind is that it is perfectly fine if a happy review does not always come with a five-star rating. You don’t want to appear too perfect all the time!

Review Your Practice Operations A key aspect of good financial management is to maintain a reasonable level of practice overheads while also maintaining your revenue flow. It is important to ensure that your revenue flow exceeds your expenses at all times. Here are a few things to keep in mind; • Take a closer look at your recurring costs. You don’t want to spend massively on software and hardware expenses if

34 | JUNE 2015

cheaper and better options are available. Look for cost-effective alternative or service providers who can work well within your budgets.

• Try to connect with older patients, or more recent one-time patients. A good way to entice dormant patients is by offering them discounts on a checkup or on a new product or service.

• Review contracts with all your insurance companies. If you can work a reimbursement improvement even if it is a small percentage, the annual impact can leave you happy.

• See how best you can improve staff performance. Sometimes positive motivation or a more workable schedule for staff can bring in the desired results.

Look at how best you can improve present conditions before you decide you absolutely need to hire new staff.  About the Author: Naren Arulrajah is President and CEO of Ekwa Marketing, a complete Internet marketing company which focuses on SEO, social media, marketing education and the online reputations of Dentists and Physicians.

With a team of 130+ full time marketers, www.ekwa.com helps doctors who know where they want to go, get there by dominating their market and growing their business significantly year after year. If you have questions about marketing your practice online, call Naren direct at 877-249-9666.

WWW.MEDMONTHLY.COM | 35

features

Content Marketer:

Why You Need One and How to Hire the Right One

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

36 | JUNE 2015

A

ccording to Wikipedia, content marketing is “ all marketing formats that involve the creation and sharing of content in order to attract, acquire and engage clearly defined and understood current and potential consumer bases with the objective of driving profitable customer action�.

Quite simply, content marketing is the information that you want to convey about you and your medical practice across several channels and by many techniques to get your messages out in an understandable way and give you the visibility to do so.

7 Reasons Why You Need Content Marketing Content marketing serves to: 1. Strengthen your brand Providing great content that is useful to your market, links your brand to the source that people look toward and promotes you, giving publicity and referrals.

2. Establish you as a thought leader By providing solutions on your site, forums and chat rooms to problems that people are struggling with, you are considered a leader in your field- that that people will seek out for answers.

3. Improve search engine ranking Valuable content that people need helps it go viral, thereby giving you more exposure.

The greater the engagement, the higher the ranking will be. When writing with the proper keywords, you are also highly rewarded for it.

4. Promote you and get you known in the community A recent survey by Consumer’s Digest reported that consumers trust brand recommendations from both friends and those they trust online. The more your brand is seen in the community, the more they will trust you.

5. Generates leads (prospective patients/clients) to promote your practice According to MarketingSherpa, content marketing converts as much as 30% organic traffic into leads. The right clients are drawn to your practice and will be repeat visitors.

6. Engage and increase your social media fans Knowing your target market will help you decide which sites to concentrate on- to be seen on sites where your prospective patients will see you. (e.g. Tumblr is used by a 2030 year old group). Unlike paid advertising, information on social media sites will be passed around and viewed (without additional investment) for months or even years).

Getting quoted is golden! This will give thousands of dollars in free publicity!

7. Serves to provide the information that everyone seeks Your site and brand must provide the 3 Es- Engagement, Entertainment and Education.

The 3 Es helps build a great content system with information that people are searching for. Since people are searching you out before deciding on scheduling a consultation with you over your competition, having this system in place is crucial these days.

Content Marketer The content marketer is the one that formulates a strategy that decides which content should be published and the best way for it to be seen.

Before having a content marketer on your permanent staff, consider a freelance one. continued on page 38 WWW.MEDMONTHLY.COM | 37

continued from page 37

Freelance refers to a short- term employment usually confined to a specific project. This way you can determine if this marketer is compatible with your practice.

Content Marketing Strategy Regardless of whether the content marketer is here on a trial basis, permanent or freelance, have goals in mind that you would like your newest team member to accomplish.

Strategic goals include: 1. Content Marketing Plan- the role content plays will be mapped out in how it will achieve the healthcare provider’s objectives.

2. SEO- search engine optimization provides for a higher ranking in various search sites like Google, Bing, Yahoo, and Tumblr. The higher your ranking, the greater the visibility your site will have.

Your website should be professionally evaluated and issues addressed. Appropriate keywords should be identified and maximized on the site.

3. Videos and Photos: play a key role in content strategy. In addition to attracting more eyes and explaining techniques more efficiently, search engines and social sites rank images higher than the written word alone.

• Blogging • Email Campaigns • Newsletters • Video marketing • Podcasts • Social media marketing • Copywriting • Search Engine Optimization (SEO) • Understands terminology in your specialty • Demonstrates ability to generate leads • Understands the demographics of your niche • Knowledge of analytical platforms (e.g. Google Analytics or Omniture) so that various strategies can be modified depending on the results obtained • Understands how to do the Split A/B Testing Since the practice of medicine these days is all consuming, content marketing is best left to the professionals. Outsourcing this means less that you have to do and more time to concentrate on what you do best.

However, it is a good idea to understand what content marketing is all about. For more information, read “Content Copy Made Easy” which you can find on Amazon.com. 

The Write Treatment

Videos can be used in email campaigns and sales letters in addition to website and social applications.

4. Social Media Plan- works well in establishing your practice as the “go-to” spot with all the solutions for the problems that patients are struggling with. The thing is, not every site is equal or valuable to your type of practice.

The content marketer will identify which social media sites make the most sense for you considering your target market (e.g. demographics as in age of patients, gender, academics, geographical location). Once these sites are identified, the content marketer will discuss the part that social media plays in accomplishing your objectives.

Finding the right one!

During the interview process, find out if the prospective content marketer is proficient in the following skills: 38 | JUNE 2015

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

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

Barbara@TheWriteTreatment.com 516-647-3002

Physician Solutions, Inc. Medical & Dental Staffing

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

Physician Solutions

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

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

healthy living

Chickpea Salad

(Adapted From: Eat Right Press, from Healthy Eating, Healthy Weight for Kids and Teens by Jodie Shield, MEd, RD)

By Ashley Acornley, MS, RD, LDN June is the time of the year when we see the fresh cucumbers and tomatoes rolling out into the local farmers’ markets. This light summery recipe is sure to satisfy your need for a quick nutrient dense lunch. The recipe can be served as raw chopped ingredients or as a refreshing zesty hummus spread. It is great served with whole-wheat pita bread or over top of fresh crisp romaine lettuce.

Ingredients: l 1

cup cooked or canned chickpeas,

drained and rinsed l 3 tablespoons diced green bell pepper l 2 tablespoons peeled, seeded and

diced cucumber l 1⁄2 tablespoon chopped fresh parsley l 1⁄2 cup diced tomato l 3 tablespoons snipped fresh dill or

1⁄4 teaspoon dried dill l 1⁄2 tablespoon lemon juice l 1 tablespoon olive oil l Salt and pepper to taste

Preparation: 1. In a medium-size bowl, combine all ingredients.

2. Refrigerate for several hours to allow flavors to

blend.

3. Serve the salad on romaine lettuce leaves or in whole wheat pita bread pockets.

4. You may also puree the salad in a food

processor to make a chickpea spread.

40

| JUNE 2015

Nutrition Facts Per Serving (1/6 of recipe):

Calories: 76 Fat: 3 g Saturated fat: 0.5 g Cholesterol: 0 mg Sodium: 112 mg Carbohydrates: 11 g Fiber: 2 g Protein: 2.5 g

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

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

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

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

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

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

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

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

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

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

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

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

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

WWW.MEDMONTHLY.COM | 41

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

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

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

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

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

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

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

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

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

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

Delaware Cannon Building, Suite 203 861 Solver Lake Blvd.

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

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

Florida 4052 Bald Cypress Way Bin C-08 Tallahassee, FL 32399 (850)245-4474 http://floridasdentistry.gov/ 42

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

| JUNE 2015

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

WWW.MEDMONTHLY.COM | 43

U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (334)242-4116 http://www.albme.org/ Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 http://commerce.alaska.gov/dnn/cbpl/ ProfessionalLicensing/StateMedicalBoard.aspx Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 (480)551-2700 http://www.azmd.gov Arkansas 1401 West Capitol Ave., Suite 340 Little Rock, AR 72201 (501)296-1802 http://www.armedicalboard.org/ California 2005 Evergreen St., Suite 1200 Sacramento, CA 95815 (916)263-2382 http://www.mbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7690 http://www.dora.state.co.us/medical/ Connecticut 401 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/cwp/view. asp?a=3143&q=388902 Delaware Division of Professional Regulation Cannon Building 861 Silver Lake Blvd., Suite 203 Dover, DE 19904 (302)744-4500 http://dpr.delaware.gov/ District of Columbia 899 North Capitol St., NE Washington, DC 20002 (202)442-5955 http://doh.dc.gov/bomed 44 | JUNE 2015

Florida 2585 Merchants Row Blvd.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

WWW.MEDMONTHLY.COM | 45

medical resource guide ACCOUNTING

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

www.pushpa.biz

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

BILLING & COLLECTION

DENTAL Biomet 3i

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

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

CODING SPECIALISTS Place Your Ad Here

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

Urgent Care America

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

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

46 | JUNE 2015

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

The Dental Box Company, Inc.

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

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

ELECTRONIC MED. RECORDS

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

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

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

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

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

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

LOCUM TENENS Physician Solutions

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

MEDICAL ARCHITECTS MMA Medical Architects

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

medical resource guide WhiteCoat Designs

MEDICAL ART Deborah Brenner

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

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

MEDICAL PRACTICE SALES

PROFESSIONAL SPEAKER Capri Health

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

MedImagery

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

Medical Practice Listings

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

MEDICAL EQUIPMENT MEDICAL PRACTICE VALUATIONS

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

BizScore

www.assurepharma.com

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

www.thetps.com

MEDICAL RESEARCH

Bank of America

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

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

STAFFING COMPANIES

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

MEDICAL EQUIPMENT FINANCING

REAL ESTATE

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

SUPPLIES, GENERAL

Scynexis, Inc.

3501 C Tricenter Blvd.

Durham, NC 27713 (919) 933-4990

CNF Medical www.scynexis.com

PRACTICE FINANCING

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

www.bankofamerica.com/practicesolutions

Bank of America

MEDICAL MARKETING Ekwa Marketing

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

303, Pinetree Way Mississauga Ontario L5G 2R4, Canada (855) 345-0593 www.ekwa.com

WWW.MEDMONTHLY.COM | 47

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

Family Primary Care Practice

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

Family Practice/Primary Care

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

Med Spa

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

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

Practice Type: Internal Medicine

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

Dental Practices Place Your Ad Here

Optical Practices Place Your Ad Here

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

Considering your practice options? Call us today.

48 | JUNE 2015

What’s your practice worth?

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

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

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

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

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

919.846.4747 bizscorevaluation.com

Primary Care Practice For Sale

PEDIATRICIAN

or family medicine doctor needed in

FAYETTEVILLE, NC

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.

Contact Medical Practice Listings for more information.

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

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

Modern Med Spa Available

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

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

50 | JUNE 2015

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

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

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

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

Medical Practice Listings Selling and buying made easy

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

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

List price: $435,000

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

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

l One

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

Please direct all correspondence to driverphilip@gmail.com.

Only serious, qualified inquirers.

WWW.MEDMONTHLY.COM | 51

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

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

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

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

Medical Practice Listings Buying and selling made easy

Call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com 52 | JUNE 2015

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

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

Contact us today to discuss your options confidentially.

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

Med Spa in the Raleigh-Durham, NC Area

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: • •

Beautiful Med Spa located in the Raleigh-Durham is among our newest listings.

This very upscale facility is established and boosts consistent gross revenues of a million plus. Some of the procedures performed are: Botox, Dermal Fillers, Minimal light based treatments, laser hair removal, cool sculpting (external cooling treatment that freezes the hair and the body metabolizes the fat). This practice is ideal for the Plastic Surgeon or Dermatologist.

• • •

Established: 2010 l Annual Revenue: $1,000,000 Average Patients per Day: 15 to 25

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

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

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

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

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

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

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

Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624 PH: (919) 845-0054 | email: physiciansolutions@gmail.com WWW.MEDMONTHLY.COM | 53

Women’s Health Practice in Morehead City, NC

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.

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

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

Listing Price: $430,000

Medical Practice Listings Buying and selling made easy

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

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

919.848.4202 medlisting@gmail.com medicalpracticelistings.com 54 | JUNE 2015

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

Located on NC’s Beautiful Coast, Morehead City

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

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

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

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

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

Contact: Cara or Philip at 919-848-4202

medlisting@gmail.com medicalpracticelistings.com

NC MedSpa For Sale MedSpa Located in North Carolina

NC Opportunities DENTISTS AND HYGIENISTS

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

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

Call us today if you are available for a few days a month, on-going or for permanent placement. Please contact Physican Solutions at 919-845-0054 or physiciansolutions@gmail.com WWW.MEDMONTHLY.COM | 55

Physician Solutions, Inc. Medical & Dental Staffing

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

Physician Solutions

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

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