Med Monthly March 2013

Med Monthly MARCH 2013

THREE NIH-SPONSORED CLINICAL TRIALS TEST INFLUENZA TREATMENTS pg. 52

THE CLINICAL TRIALS OF

IMMUNOTECH LABORATORIES’

IPF IMMUNOTHERAPY TREATMENT Pg. 48

Clinical Trials of Medical Treatments: WHY VOLUNTEER? pg. 44

OUTSOURCING OF CLINICAL DRUG TRIALS TO INDIA: A Promise of Growth If Regulated Properly Pg. 24

the

Clinical Trials issue

contents

features

44 CLINICAL TRIALS OF MEDICAL TREATMENTS: Why Volunteer?

48 THE CLINICAL TRIALS OF IMMUNOTECH LABORATORIES’ IPF IMMUNOTHERAPY TREATMENT 52 THREE NIH-SPONSORED CLINICAL TRIALS TEST INFLUENZA TREATMENTS

insight 10 STAYING THE COURSE: Employers Show Commitment to Wellness Despite Economic Hard Times 12 MAYO CLINIC STUDY FINDS EASY, AT-HOME EXERCISE PROGRAM CAN HELP CANCER PATIENTS 14 AMERICAN COLLEGE OF PHYSICIANS LAUNCHES STUDY OF CLOUD-BASED QUALITY IMPROVEMENT PROGRAM

practice tips 16 PHYSICIANS AND ORGANIZATIONAL CULTURE: Addressing the Satisfaction Gaps Around Cultural Fit 20 THE MEDICAL MANAGER’S 2013 FLU SEASON UPDATE 22 WAIT PROOFING YOUR PRACTICE

44

CLINICAL TRIALS OF MEDICAL TREATMENTS: Why Volunteer?

54

CURIOUSITY KEY TO LIFE OF ARTIST, PHYSICIAN

international 24 OUTSOURCING OF CLINICAL DRUG TRIALS TO INDIA: A Promise of Growth If Regulated Properly

research and technology 26 MEDICAL PRACTICE MARKETING: Best Practices For Attracting New Patients Using Health IT Capabilities 28 GE HEALTHCARE INTRODUCES NEW CARDIAC MRI ANALYSIS SOFTWARE 30 YOU IMAGINE - Dental Apps That Kick

legal 38 AMA URGES CONGRESS: Retain Funding For Residency Programs, Increase Training Positions to Address Doctor Shortage 40 FDA OFFERS NEW GUIDANCE ON DEVELOPING DRUGS FOR ALZHEIMER’S 42 CMS ANNOUNCES SUNSHINE ACT FINAL RULE

the art 54 CURIOUSITY KEY TO LIFE OF ARTIST, PHYSICIAN - THOMAS HOPE

healthy living 56 SESAME SUGAR SNAP PEAS WITH CARROTS & PEPPERS

in every issue 4 editor’s letter 8 news briefs

62 resource guide 78 top 9 list

editor’s letter

What if you were sick and no treatment you tried was successful? What would you do? Doctors organize clinical trials for just this reason – running tests determines whether a new drug is safe and effectual. The government requires stringent rules to ensure that the volunteers are as protected as possible.

In the article “Clinical Trials of Medical Treatments: Why Volunteer?” the FDA delineates what these studies entail, inherent risks to the people involved and questions you should ask your doctor before you participate. Also, complete disclosure of these trials as well as research institutions’ review boards monitor risk.

An example of a trial focused on the flu comes courtesy of the National Institutes of Health News in the article “Three NIHSponsored Clinical Trials Test Influenza Treatments”. This was organized due to the earlier onset of the flu this year. One of the studies focuses on trying to reduce the amount of time people suffer from influenza using with the drug oseltamivir; another uses a combination of drugs for people that have chronic health problems. The third trial has to do with plasma enriched antibodies to combat influenza.

Thomas Hibbard discusses a laboratory in “The Clinical Trials of Immunotech Laboratories’ IFP Immunotherapy Treatment” that focuses solely on drug development. The study regarding this biologic therapy is trying to kindle a patient’s immune system to work stronger and better at combating cancer cells.

It has also worked in treating HIV with few side effects.

These clinical trials are an important way for health care professionals to try to improve the health of people around the world. If you are interested in participating in a clinical trial, ask your doctor or visit the sites in the article by the FDA.

Ashley Austin Managing Editor

4 | MARCH 2013

Med Monthly March 2013

Publisher Philip Driver Managing Editor Ashley Austin Creative Director Thomas Hibbard Contributors Ashley Acornley, MS, RD, LDN Dr Anuradha Katyal Kanupriya Katyal Laura Masske Christian Nordqvist Karen M. Rogers Frank J. Rosello Robert Sayre Robert Stark, MD Mary Pat Whaley, FACMPE Daniel J. Whitlock, MD, MBA Robin Clifford Wood

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

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

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

contributors Dr. Anuradha Katyal is a Program Associate with ACCESS Health Int, ISB, Hyderabad, India. She is a dentist and an MSc in Healthcare Management from University of Surrey. UK. She has practiced for two years and now works in the social sector with an inclination towards health financing.

Ms. Kanupriya Katyal is an Assistant Professor (Marketing) at Goa Inst. of Management, India. She is an Electronics Engineer with a Post Graduation in Management. Her research interests are fairness in joint decision making and fairness of price.

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

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

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

MEDMONTHLY.COM |5

designer's thoughts From the Drawing Board Vivek Kundra, the Obama administration’s Chief Information Officer, said about cloud computing, “Just like water from the tap in your kitchen, cloud computing services can be turned on or off quickly as needed. Like at the water company, there is a team of dedicated professionals making sure the service provided is safe, secure and available on a 24/7 basis. When the tap isn’t on, not only are you saving water, but you aren’t paying for resources you don’t currently need.”

The article “American College of Physicians Launches Study of Cloud-based Quality Improvement Program on Diabetes and Cardiovascular Disease Care” in our “Insight” section reinforces this quote. It details how the American College of Physicians (ACP) will pilot and test the impact of a technology-based quality improvement programs, focusing on physician participation, value to practices, rapid-cycle learning, and patient outcomes in diabetes and cardiovascular disease care.

The article states, “The data also will enable us to assess the ease of adopting this type of technology into the workflows of physician practices and whether it correlates with improved care processes, patient satisfaction, and patient outcomes.”

In the “Research and Technology” section of this month’s magazine, Frank J. Rosello’s “Medical Practice Marketing – Best Practices For Attracting New Patients Using Health IT Capabilities” describes how to effectively market your medical practice using current IT designed for health including electronic health records (EHR), patient reports and eNotification, eClaims, and ePrescriptions.

“YOU IMAGINE: Dental Apps That Kick” by Laura Maaske is a two-part article explaining mobile apps for dentistry for both patients and dentists. In this issue she focuses her attention to apps for children to encourage better care of their teeth and apps for dentists to show adult patients possible improvements in technique. In our April issue she’ll conclude her study of dental apps, with apps for dentists for easier record keeping and apps for patients who want to do some self exploring on their dental questions.

If there are topics or insights on advances in medical technology you would like to share with us for future issues, please contact us at medmedia9@gmail.com.

Thomas Hibbard Creative Director

6 | MARCH 2013

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news briefs MULTINATIONAL COOPERATION NECESSARY TO SPEED CLINICAL TRIAL RESULTS A new study published in The Oncologist emphasizes the critical need for regulatory authorities, pharmaceutical clinical trial sponsors, collaborative research groups and other interests to work together to expedite study approval for clinical trials in cancer research on a global scale.

Dr. Otto Metzger Filho of the Dana-Farber Cancer Institute and a team of international colleagues reviewed the time taken to set up the Adjuvant Lapatinib and/or Trastuzumab Treatment Optimization (ALTTO) trial, a phase III clinical breast cancer trial covering more than 8,300 patients in 44 participating countries.

The research team evaluated different aspects of ALTTO activation across different geographic and economic regions, measuring time intervals for regulatory approval, ethics approval, protocol amendments, and times for patient enrollment. Although some of these time periods did vary in different regions, the study’s primary finding was that significant delays and bottlenecks occurred across all regions.

“Improving the efficiency of the activation process would speed up the ability to gather scientific knowledge and evaluate its applicability,” said corresponding author Dr. Metzger Filho. “Most importantly, it would ultimately benefit the many patients who volunteer to participate in clinical trials. This is the only way to improve treatments for patients with cancer.”

“While the study’s focus on ALTTO means its findings cannot be generalized to make definitive statements about a region’s clinical trial proficiency, its main finding of consistently lengthy timetables should spark a global discussion about the need to improve the efficiency of all cancer trials,” Dr. Metzger Filho said.

“We hope that this study will help investigators in different regions to identify the bottlenecks in activating multinational trials and to address the problem of clinical trial participation,” he said.

The European Society of Medical Oncology (ESMO) heralded the study. Prof Roberto Labianca, Director, Department of Oncology and Haematology, Ospedali Riuniti di Bergamo, Italy, an ESMO spokesman, described the importance of these findings: “Unnecessary delays in the approval of clinical trials mean patients can miss the advantages of a new active drug, a new combination of drugs or a novel therapeutic strategy, because oncologists will be compelled to use traditional and potentially sub-optimal treatments.”

“These findings emphasize the obvious need to expedite, and harmonize, the process for review and approval of new trials across continents. Large studies are increasingly being conducted on an international basis. The delays in implementation of these trials not only deprive patients of access to drugs, but delay their completion and ultimately, regulatory approval. No one wins, least of all the patient,” said Dr. Bruce A. Chabner, Editor-in-Chief of The Oncologist and Director of Clinical Research, MGH Cancer Center, Massachusetts General Hospital.

Source: http://www.prweb.com/releases/2013/1/prweb10366998.htm 8 | MARCH 2013

New CPT Codes Support Medicare Payment for Care Coordination Medicare is now accepting newly created Current Procedural Terminology (CPT) codes for care coordination to pay physicians for the management of patients who have recently been discharged from a hospital or skilled nursing facility.

The American Medical Association CPT Editorial Panel created new codes (99495 and 99496) with broad input from the health care community to capture transitional care management services.

The codes allow for efficient reporting of time spent discussing a care plan, connecting patients to community services, transitioning them from inpatient settings and preventing readmissions.

Last year the AMA called on the Centers for Medicare & Medicaid Services (CMS) to adopt the new codes and cover the related services to support physicians participating in emerging models of care, such as patient-centered medical homes, accountable care organizations (ACOs) and other novel integrated delivery systems.

“Medicare’s acceptance of the new codes signals that CMS recognizes the important role these services have in improving the overall quality of health care,” said AMA President-elect Ardis Dee Hoven, M.D. “The decision supports the work involved in transitioning patients from one care setting to the next and physicians working in emerging models of care.”

The AMA/Specialty Society RVS Update Committee (RUC) also played an essential role in providing Medicare with insight and recommendations on the value of the work and resources associated with services reported by the new transitional care codes. Recently, RUC members commented on the importance of these new codes.

Source: http://www.ama-assn.org/ama/pub/ news/news/2013-01-22-cpt-codes-medicare-payment-care-coordination.page

U-M study shows BPA exposure in fetal livers New research from the University of Michigan School of Public Health found BPA, or bisphenol A, in fetal liver tissue, demonstrating that there is considerable exposure to the chemical during pregnancy.

Researchers also found a proportionately higher concentration of free BPA—as opposed to the conjugated forms modified by the body for elimination—further showing that in fetuses the ability to eliminate the chemical from the body is not the same as in adults.

“The general message from our research is that people have to be cognizant of the fact that the adult body may be able to deal with a particular exposure but a developing fetus may not,” said Muna Nahar, doctoral student in the School of Public Health’s Department of Environmental Health Sciences and first author on the paper.

Previous animal studies have associated BPA with breast and prostate cancer, and reproductive and behavioral abnormalities. Some research on effects to human health has tied BPA to cardiovascular disease, miscarriage, decreased semen quality and childhood behavioral issues. The chemical also may impact metabolism, diabetes and obesity, although more studies are required to determine its effects.

Prior research on BPA—a chemical used in many consumer products, including plastic bottles and metal food and beverage cans—has measured concentrations of the chemical in urine. About 95 percent of those who have been tested in a nationally representative health survey study show some level of BPA, but the research to date had yet to firmly establish the presence of the chemical in tissues.

Understanding the internal dose is essential to determine adverse effects on health, the researchers say. BPA can reach the body through ingestion, inhalation and by contact with the skin.

Nahar and colleagues Dana Dolinoy of the U-M School of Public Health and Chunyang Liao and Kurunthachalam Kannan of the Wadsworth Center at the New York State Department of Health studied the livers of 50 first- and second-trimester fetuses, using high-performance liquid chromatography and mass spectrometry. They found wide variances in how much BPA was present in livers, with some fetuses showing high levels of exposure.

“The finding of free BPA in fetuses is significant,” said Dana Dolinoy, the John G. Searle Assistant Professor of Environmental Health Sciences and senior/corresponding author of the study.

After measuring a three-times-higher concentration of free BPA than the conjugated forms in the fetal livers, the researchers then examined the enzymes responsible for metabolizing the chemical and compared them with those at work in adult male and female livers.

“Our research shows that the argument that it’s so rapidly metabolized is not true in fetuses,” Dolinoy said.

Source: http://www.eurekalert.org/pub_releases/2012-12/uom-uss120312.php

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MEDMONTHLY.COM |9

insight

Staying the Course: Employers Show Commitment to Wellness Despite Economic Hard Times

87 percent of global employers believe it’s their role to manage worker health

10 | MARCH 2013

W

ellness programs are no longer a “soft” issue for organizations around the globe as employers increasingly recognize the value of employees’ health and overall well-being to their organizations’ bottom line.

According to the latest report from Buck Consultants, A Xerox Company (NYSE: XRX), employers cite their commitment to promoting health and wellness as a business strategy and show continued desire to expand health promotion initiatives.

“Working Well: A Global Survey of Health Promotion and Workplace Wellness Strategies” found that employers, regardless of location, identified improving worker productivity and reducing presenteeism as one of their top wellness program objectives.

“With productivity having a direct tie to bottom-line revenue, organizations now consider health promotion as a core business value that positively impacts their ability to compete,” said Dave Ratcliffe, principal, Buck Consultants. “With signs of job market improvement emerging in the U.S., employers will be challenged to maintain productivity gains earned during the recession as employees have increased job mobility.”

As health promotion takes its place as a top consideration among drivers of profitability and performance, an increasing number of organizations recognize their role in managing employee health - 87 percent in 2012 vs.

75 percent in 2010.

Overall, still only 36 percent of respondents currently measure specific outcomes of their health promotion programs, citing lack of resources (68 percent) and not knowing how to measure (34 percent) as the top reasons for not measuring. The likelihood of measurement increases with employer size, although even among the largest employers (20,000+ employees), only 47 percent report having measured specific outcomes.

Buck’s fifth annual global wellness survey analyzed responses from more than 1,300 organizations in 45

countries representing more than 17 million employees.

Another key finding to emerge in this year’s survey is employers’ reaction to the recent economic downturn between employers who measure program results and those who do not. Thirty percent of employers who measured health promotion program outcomes indicated that they increased their emphasis on wellness programs during tough economic outlook vs.

21 percent of employers who do not measure outcomes.

“Employers who measure program outcomes do so with a greater focus on driving business results,” said Ratcliffe. “A healthier workforce is a more productive workforce, which produces greater revenue that is sustainable over the long term. So these employers understand the value of continuing their wellness initiatives even during hard economic times.”

Further emphasizing the impact on the bottom line, the survey found that 23 percent of U.S. employers indicated their wellness program helped reduce the cost of providing health care benefits to their employees. Of those: • 62 percent reported health care cost trend rate reductions of 2 percentage points or more.

• 13 percent reported trend rate reductions of 6 percentage points or more.

Other key findings of Buck’s global wellness study include: • Increase in globalization Among participating multinational organizations, 49 percent have a global health promotion strategy, up from 34 percent in 2008.

• Program focus: move more, relax and eat better - Though different by specific geographic region, the majority of employers cite physical activity, stress, and workplace safety as the top three issues driving wellness program design.

• Incentives impact on program participation depends on type of activity - The survey shows that incentives have a direct cor-

‘‘

“With productivity having a direct tie to bottom-line revenue, organizations now consider health promotion as a core business value that positively impacts their ability to compete. With signs of job market improvement emerging in the U.S., employers will be challenged to maintain productivity gains earned during the recession as employees have increased job mobility.”

relation to program participation levels, but initiatives that require long-term lifestyle changes (such as physical exercise and nutrition) are not as greatly influenced by incentives as are more immediate programs (such as health assessment and biometric screenings).

• Wellness initiatives continue to add value over time - While significant results from a wellness program can take years to realize, the survey shows how the impact of wellness programs differs by short-term and long-term payoff.

Additional issues covered by Buck’s global survey include program design, incentives, organizational ownership of wellness programs and communication strategies.  Source: http://www.pressreleasepoint. com/staying-course-employers-showcommitment-wellness-despite-economic-hard-times MEDMONTHLY.COM |11

insight

Mayo Clinic Study Finds Easy, At-Home Exercise Program Can Help Cancer Patients

Courtesy of the Mayo Clinic

12 | MARCH 2013

It has been known for some time that exercise is important for cancer patients, but few studies have looked at the practicality of exercise programs and whether even a minimal workout can help. Exercise can reduce cancer-related fatigue, improve sleep, boost a sense of wellness, and reduce the recurrence of certain types of tumors. A Mayo Clinic study published in the Journal of Pain and Symptom Management found that a brief, at-home exercise program — dubbed the Rapid, Easy, Strength Training program, or REST, — was sufficient to increase cancer patients’ mobility and reduce fatigue.

“We talk a lot about how important it is for cancer patients to exercise, but until now, nobody has questioned whether less may be more for patients negotiating the demands of cancer treatment,” says lead author Andrea Cheville, M.D., of the Mayo Clinic Department of Physical Medicine and Rehabilitation. “This was the first trial to investigate what’s feasible and helpful for patients with limited time and energy.”

An interdisciplinary team of Mayo Clinic researchers developed an at-home exercise regimen, involving a pedometerbased walking program and a series of gentle resistance movements — lifts and curls using a resistance band — that can be done standing or seated. The workout takes only a few minutes a day, with minimal cost to patients.

In a randomized, controlled study of 66 adults with stage IV lung or colorectal cancer, researchers found that patients who exercised at least four times a week for two months showed improved mobility, had less fatigue and slept better when compared with those who didn’t

exercise. Though other measures such as pain were unaffected, the study suggests that the exercises can address several important disabling effects of disease and that even patients with late-stage cancer are able to perform the brief regimens.

The exercise program and study have significant implications for cancer care, Dr. Cheville says.

Other studies have suggested that cancer-related exercise programs may impose financial burdens; patients can learn the REST regimen in a single physical therapy session. A muscle-building exercise regimen may help patients at all stages of cancer treatment.

“Muscles may atrophy during cancer care,” Dr. Cheville adds.

“Our regimen preserves muscle mass so that if patients develop complications from cancer or treatment, or require hospitalization, they have the reserves necessary to ensure that their bodies heal.”  The study was funded by the National Institutes of Health; grant number KL2 RR024151-01. Other authors include Jenny Kollasch, Justin Vandenberg, Tiffany Shen, Axel Grothey, M.D. , and Jeffrey Basford, M.D., Ph.D., all of Mayo Clinic, and Gail Gamble, M.D., of the Rehabilitation Institute of Chicago.

About Mayo Clinic Mayo Clinic is a nonprofit worldwide leader in medical care, research and education for people from all walks of life. For more information, visit MayoClinic.com or MayoClinic.org/news.

Source: http://expresspress-release.net/104/ Easy-At-Home-Exercise-Program-Can-Help-Cancer-PatientsMayo-Clinic-Finds-00358972.php MEDMONTHLY.COM |13

insight

AMERICAN COLLEGE OF PHYSICIANS

Launches Study Of Cloud-based Quality Improvement Program on Diabetes And Cardiovascular Disease Care

14 | MARCH 2013

The American College of Physicians (ACP) in collaboration with CECity, developer of MedConcert®, a social cloud-based performance improvement platform, will pilot and test the impact of a technology-based quality improvement program on physician participation, value to practices, rapidcycle learning, and patient outcomes.

The one-year pilot program, “Improving the Quality of Diabetes Care,” will tailor MedConcert with diabetes and cardiovascular disease prevention content. More than 11 percent of adults in the United States – an estimated 26 million people – have diabetes, which is associated with multiple complications and co-morbid conditions, including cardiovascular disease.

“This initiative will provide important data to help us determine the feasibility of recruiting physician offices to participate in an integrated, technology-based quality improvement program and assess facilitators and barriers,” said Michael S. Barr, MD, MBA, FACP, who leads ACP’s Medical Practice, Professionalism & Quality division. “The data also will enable us to assess the ease of adopting this type of technology into the workflows of physician practices and whether it correlates with improved care processes, patient satisfaction, and patient outcomes.”

Up to 50 internal medicine practices in three states in the pilot will have access to the following web-based tools: • The ACP diabetes registry based on the 2013 Physician Quality Reporting System (PQRS) Diabetes Measure Group and related data elements.

• Patient surveys to provide important feedback on system and provider performance, including information about coordination of care and communication.

• ACP’s Medical Home Builder 2.0, an online community providing practice teams with a selfassessment tool to improve patient

care, streamline fundamental business operations, and identify and implement key features of the patient-centered medical home.

• Providers eligible for CMS PQRS incentives will have the option to submit their report through PQRIwizard®, an easy-to-use online tool for physician quality reporting.

Physicians may access MedConcert’s secure social networks to engage in peer-to-peer clinical communities that enable patient coordination of care and real-time communications for sharing best practices. MedConcert also houses a library of diabetes and CVD resources and educational materials, including patient education tools, linked to specific gaps in performance identified in the registry data, which are also available to participants.

A report on the results of the pilot quality improvement program is expected by the end of the year. The Center for Health Services and Outcomes Research at Johns Hopkins University’s Bloomberg School of Public Health will conduct the program evaluation.  About the American College of Physicians The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 133,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter and Facebook.

About CECity Founded in 1997, Pittsburgh, Pennsylvania-based CECity is the health care industry’s leading software as a service (SaaS) provider of cloud-based applications and distribution networks for Performance Improvement and

‘‘

“The data also will enable us to assess the ease of adopting this type of technology into the workflows of physician practices and whether it correlates with improved care processes, patient satisfaction, and patient outcomes.”

Lifelong Learning. Health care professionals and organizations, including quality organizations, health plans, hospitals, pharmacy chains, certifying boards, licensing boards, publishers, professional societies, academic medical centers and educational providers, count on CECity to power their solutions for continuous performance improvement, registries, professional development, patient safety and adherence, population health informatics and quality reporting in support of health care and payment reform.

MedConcert, powered by CECity, represents the health care industry’s first multi-tenant cloud-based platform that is designed to connect stakeholders in a meaningful way to bridge the “House of Medicine” and the “Practice of Medicine” to drive continuous performance improvement, coordination of care, and lifelong learning. MedConcert is a real world implementation of the Learning Health System, which has been proposed by CMS, IOM and others as a critical component of driving quality and improving patient care.

Source: http://www.acponline.org/ pressroom/diabetes_quality_improvement.htm MEDMONTHLY.COM |15

practice tips

PHYSICIANS AND ORGANIZATIONAL CULTURE:

Addressing the Satisfaction Gaps Around Cultural Fit

16 | MARCH 2013

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

A

t a time when physician engagement is critical in effectively addressing the changes impacting healthcare, organizational culture is an important factor that physicians tell us is central to their sense of engagement and overall satisfaction.

As physicians move increasingly to an employed model, organizational culture becomes a more significant issue, especially for those who previously worked in smaller medical groups and in solo practice.

Differences in areas as varied as accountability, autonomy, work environment and communication methods can create gaps between expectations and reality.

Physician Wellness Services and Cejka Search recently completed a nationwide, multi-specialty survey on organizational culture with over 2200 physicians, and a companion survey of administrators. It identified cultural attributes that were important to physicians’ overall satisfaction, and gaps between attributes that were important to them and their satisfaction with their organizations’ focus on the attributes. The survey also explored the importance of cultural fit to physicians as they evaluated and made decisions around new practice opportunities versus remaining in their existing practices.

The Importance of Culture

A literature review of organizational cultural survey instruments specific to healthcare led to 14 cultural attributes which, based upon our experience, were most relevant to physicians.

Falling into four major area— work environment, organization, leadership and management, and communication—the cultural attribute questions formed the basis of the survey.

The first notable initial finding—all the cultural attributes were important to physicians. All but one fell into the upper quartile for importance to physician satisfaction as measured on a 10-point Likert scale—well above the 3.0 to 7.0 mid-range. The top cultural attributes were: l

Respectful communication (8.6 average score) l Patient-centered care focus and supportive management approach to errors and mistakes (tied at 8.5) l Transparent communication (8.4) Asked to rank their top 3 attributes, results closely tracked with the absolute scores, although patientcentered care focus came first.

Physicians gave lower marks for how well they felt their organizations demonstrated competence around the cultural attributes, with average scores ranging from 5.8 to 7.6 and falling more in the mid-range. The highest scores—patient-centered care focus and clear mission and values (tied at 7.6), and respectful communication (7.2). The lowest score was for transparent communication (5.8).

Physicians scored even lower for satisfaction with their organizations’ focus on these cultural attributes, with average scores ranging from 5.7 to 7.0.

Gaps between perceived organization competence and satisfaction ranged from .1 to .8 points—led by clear mission and values, followed by patient-centered care focus and teamfocused environment.

Ultimately, the biggest concern was the gap of 3.0 to 4.3 points between the ideal—a 10 score—and their satisfaction scores with their organization, indicating considerable room for improvement.

The companion asked administrators how important they

felt the cultural attributes were to their physicians, and how well they felt their organizations demonstrated competence. With few exceptions, administrators were on track with what was important to physicians.

However, administrators were more positive in assessing their organizations’ competence on cultural attributes, with scores ranging from 6.9 to 9.1, compared to physicians’ average scores ranging from 5.8 to 7.6. This finding points to more gaps that could lead to issues.

Cultural Fit—and Its Implications

The final set of questions assessed how well physicians felt they fit within their current organizations, how this impacted their satisfaction, and whether issues around cultural fit had prompted them to leave a practice or job, or accept other opportunities.

Regarding their own cultural fit, physicians scored 7.0 on average—at the high end of the mid-range. When asked how much cultural fit influenced their job satisfaction, the average score was a more robust 8.4, indicating they clearly felt cultural fit was important.

Administrators gave an average score of 7.2 regarding the cultural fit between their current physician population and the organization.

While tracking very closely with physicians’ self-identified cultural fit, it is far from the ideal score of 10, showing much room to improve cultural fit.

Ultimately, the influence of cultural fit on behavior is key. When asked if their expectations around cultural fit had been a determining factor in accepting a practice or job opportunity, the average score was 7.7, showing cultural fit was a significant factor in evaluating prospective opportunities. continued on page 18 MEDMONTHLY.COM |17

continued from page 17

Asked if lack of cultural fit had prompted them to leave a practice or job, physicians scored 6.5, with 27.1% who scored 10. Over 50% of respondents felt lack of cultural fit had a greater influence on their decision to leave than not. This significant finding may be understated, given several comments in the open-ended questions by physicians saying they wanted to leave, but stayed in their present job due to concerns around family and location preference, career stage, or economic concerns.

Administrator responses, when asked what percentage of otherwise qualified candidates were not offered a position because lack of cultural fit was a determining factor, averaged 36%. Asked how often cultural fit had been cited by voluntarily departing physicians as a primary reason for leaving a practice or job, the average response was 32%. This points to another noteworthy gap: administrators may be underestimating the degree to which cultural fit affects retention and recruitment.

How to Close the Gaps

Each organization is unique, and thus, priorities and cultural attributes that are valued may vary. However, certain steps—involving a collaborative process between physicians and administrators—can be taken that are common to any organization, with tools and resources that can be helpful: l Determine what your organiz ational culture is—and where you want it to be. Some organ izations work for a long time defining their mission and values—and then stop there.

To take this to the next level: u Define your current culture.

Determine what cultural attributes are important.

Use a survey to ask for input, letting physicians rate where the organization is strong and weak—and how they feel about it.

18 | MARCH 2013

u Prioritize

where to begin the process of change, based upon the biggest potential impact, or the biggest gaps between expectation and reality. u Make sure physicians are involved—and, potentially, leading—subsequent efforts.

resilience around change. u Provide adequate time to work on change initiatives. u When significant progress has been made around the first one or two cultural attributes, start on the next priorities.

l Be deliberate in your approach.

attributes. Organizational culture must be reinforced and nurtured. u Recruit for cultural fit.

Develop assessment tools and processes to ensure that physician candidates understand the organizational culture and demonstrate their ability to fit in and support it. u Use behavioral interviewing techniques ensure candidates support the desired cultural attributes. u Create onboarding programs that tangibly educate new hires and reinforce cultural norms. u Choose physician leaders who personify and can model the desired cultural attributes. u Develop a mentoring program with specific roles and account abilities for mentors and mentees. u Incentivize the behaviors and attitudes that support the desired culture. u Continue to measure progress against the desired cultural attributes. Work at exceeding expectations. u Celebrate your culture as desired changes are achieved.

Start by pursuing one or two attributes that will have the most impact, following a defined path toward achieving mean ingful and positive change.

Set tangible benchmarks and accountabilities, and develop formal action plans. u Ensure agreement around the definition of each cultural attribute, identifying the daily and actions supporting it at the individual, workgroup and organizational levels. u Develop a roadmap around what needs to change, com municate it and act on it. n Ensure that physicians are involved in decision-making at every step. n Discuss the initiative openly, at the individual and group level, including physicians and admini stration. Outside facilitators can be helpful in encourag ing openness and creating a safe environment to share ideas and concerns. n Provide individual coaching and mentoring for those who need more help or are struggling. n Measure progress period ically and communicate results, honestly and constructively. n Provide training and education in areas sup porting the change, e.g., communication skills, civility and behavior coach ing, conflict management, coping skills around stress and burnout, developing

l Institutionalize the cultural

Ultimately, this is about changing behaviors and attitudes—not just those of physicians, but all stakeholders who work alongside them and support them. This will benefit the organization by creating a stronger sense of engagement with its physicians while improving satisfaction with their jobs and careers.  Source: http://www. physicianwellnessservices.com

practice tips

The Medical Manager’s 2013 Flu Season Update

tle lu, you’re a lit Oh, hello #F fm r: sick.io/ksx early this yea er) (@sickweath r e th a e w k ic S 2012 October 19,

By Mary Pat Whaley, FACMPE 20 | MARCH 2013

This tweet was sent out by a very interesting start up named Sickweather on October 19th of last year. Sickweather analyzes data from Twitter and Facebook to determine potential public health concerns by listening to the things people post on social media. If a lot of people are posting about coughing, sneezing or other symptomatic behavior, you could make the assumption that increased disease activity is more likely in the area. The tweet welcoming flu season early was not an ironclad prediction, announcement, or warning but six weeks later the Centers for Disease Control issued a press release titled “U.S. Flu Season Off to Early Start.”

The 2012-2013 flu season is shaping up to be “moderate to severe” with 47 states reporting “widespread geographic influenza activity” to the CDC. Outside of the Pandemic 20092010 “Swine Flu” season, the reporting of Influenza Like Illness (or ILI) to care providers this year is at levels we have not seen since 2003-2004. Although reports point to this year’s season being at or near it’s peak, we thought it would be a great time to remind or readers and clients about some of the tools and resources you have at your disposal.

Protecting Your Staff • If your staff are rusty on basic flu information you can find a wealth of information for providers

‘‘

“The tweet welcoming flu season early was not an ironclad prediction, announcement, or warning but six weeks later the Centers for Disease Control issued a press release titled ‘U.S. Flu Season Off to Early Start’.”

at the CDC and the Flu.gov websites to catch up on basics and preparation measures.

• Rule Number One: IF THEY ARE SICK THEY HAVE TO GO HOME. Sick providers and employees are powerless to help patients.

• A stronger flu season is a good time to review your staffing and preparedness plans both for pandemics specifically and disaster prep in general.

Protecting Your Patients • If you provide primary care, you are already probably dispensing the most common and effective advice against the flu: vaccination, and prevention, but patients can also be directed to more resources on their own. Tell them to check out of the information available on flu shots and staying healthy at Flu.gov for further research.

• Remember who is most susceptible to flu-based fatalities and hospitalizations: the young, the elderly, and the already sick. Make sure your vulnerable patients get the information they need up front. If you don’t offer flu shots at your facility, make sure they can find somewhere that does close by.

Protecting Your Revenue Cycle • Make sure your billing and coding departments are up on this years Flu Shot billing codes.

• With the 1st of the year having already rolled over, many of your patients will have new calendaryear deductibles, co-pays and other patient responsibilities. If you haven’t already, maybe now is the time to start a “Credit Card on File“ Program.  Source: http://www.managemypractice. com/2013-flu-season-medicalmanagers-update/

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practice tips

WAIT PROOFING

By Robert Sayre

Marketing Adviser/Business Coach High Performance Network

There are few issues more infuriating to patients than to arrive on time for an appointment and have to wait for extended period of time without any explanation. In a 2009 study by Press Graney Associates, the average wait time is 22 minutes. It also noted that patient dissatisfaction increased dramatically by every five minutes.

Recommendations and suggestions from this report are:

Open Access Scheduling

Open access involves redesigning scheduling systems to allow practices to offer same day appointments to all patients, regardless of the nature of their problems, whether routine or urgent. While this meets the flexibility that many patients need while juggling work and family issues, one 22 | MARCH 2013

YOUR PRACTICE

problem is that it does not address the complexity different kinds of patients inject into a daily schedule.

Follow-up Office Visits

This often is thought of as the heart of how doctors are compensated, by visits and procedures, but even more importantly follow-up visits are essential in establishing patient-physician relationships in co-managing disease processes. With the advent of the Healthcare Reform Act, primary care physicians will be compensated on measurable data from achieved outcomes of managing patient care involving chronic disease processes.

Accountable Care Organizations note that frequent follow-up visits are necessary factor in establishing the relationship between the physician and the patient as well

as ensuring patient compliance in treatment. A simple way to manage these appointments is to have patients schedule for their next follow-up when they finish with the office visit. Previously scheduled appointments decreased the need to over book appointments and allow for a more consistent schedule. New business practices such as concierge medicine, where the patient pays a subscription fee for physician access, shows promise in alleviating this problem as well.

Filling Out Forms Prior to Visit

Filling out forms and other paperwork prior to the visit can better facilitate the schedule in the office where interruptions in patient flow occurs due to the inevitable wait for patients to fill out forms. Using a link to have patients download forms on a practice website has decreased this issue significantly in many practices.

Another tool would be to mail forms along with a practice brochure to patients who are not able to access the forms easily via the practice website. More and more practices are looking for ways to use social media to do this.

Improving processes can increase efficiency and efficacy in patient check-in.

Patient Communications

Patient communications, if not reducing the actual time kept waiting, do impact patient satisfaction. Keeping patients informed while waiting and asking “how are you doing” goes a long way in keeping blood pressures and tempers from rising. Asking patients if they would like to reschedule as well as giving them a potential wait time empowers them to have control over their wait time as well. This simple tactic allows them to make an informed decision and increases the patient’s faith in the appointment process of the practice.

Team Huddles

Dike Drummond shared a simple tool; hold a ‘team huddle’ twice a day that improves scheduling. This is just like a football team huddle except it includes the doctor and all the staff involved with the patient flow for that half day. Hold these 3 minute meetings once at the beginning of the day and another prior to the afternoon appointments. Make sure, at the very least, your receptionist and the person who rooms your patients are there along with a copy of the schedule for that half of the day.”

Feedback and Communication

“Feedback and Communication are the keys,” Cynthia Leckman, a practice manager with 25 years of experience, noted, “Effective scheduling will decrease doctor idle time and patient wait time. The doctor and his or her staff need to apply critical analysis to the

‘‘

“Patient communications, if not reducing the actual time kept waiting, do impact patient satisfaction. Keeping patients informed while waiting and asking “how are you doing” goes a long way in keeping blood pressures and tempers from rising.”

routine daily schedule. This analysis will ensure that the appropriate types of appointments are blocked, the time necessary for each appointment is correct, as well as any potential facts about certain patients (if Mrs. Smith always needs 30 minutes to understand instruction, she should always be scheduled for 30 minutes) that could affect the visit and schedule. Perhaps the most crucial analysis is acknowledging the feasibility of the physician achieving the available start time. If the start time is 8 am and the physician never arrives until 8:15 am, consider changing the schedule. This will greatly decrease frustration levels of the patients, staff, and the physician. Starting the day late begins the schedule on a negative note because the tendency to play catch-up is necessary. In addition, delays in the schedule tend to cause idle time for the doctor.”

Cycle Time and Process Maps

Reducing cycle time and creating process maps helps the team identify bottlenecks and more crucially, how to navigate the schedule around these bottlenecks. Use large ‘sticky notes’ to create a visual map with the team of each and every process to be seen. There are few offices and processes that cannot be improved and often these improvements come from the staff of the doctor. This also improves teamwork. Cynthia Leckman noted also, that sequencing of appointments could make a big difference.

“I recommend that the first appointment of the day and after lunch be ones that are predictable in the length of time, i.e. only physicals or regularly performed procedures for established patients. This starts the morning and afternoon off on a positive note”.

Idle Time

Idle time leads to interruptions, killing schedules.

Leckman also noted, “if a doctor has idle time, the tendency is to chat with staff during that time, attend to phone messages, see pharmaceutical reps, or complete charting. All of these variables factor into increasing patient wait time. Although some think the physician has many interruptions, typically this is not the case of the delayed doctor.”  MEDMONTHLY.COM |23

international

Outsourcing of Clinical Drug Trials to India: A Promise of Growth If Regulated Properly

By Dr Anuradha Katyal, Research Associate, Administrative Staff College of India Hyderabad, India and Ms Kanupriya Katyal, Assistant Professor, Marketing at Goa Institute of Management, India 24| MARCH 2013

T

he morning headlines in India include news of cricket (the nation’s most loved sport), new economic reforms, rising prices, noble and corrupt politicians, and deaths. Interestingly these deaths are not due to the cyclones or droughts, but due to the promise of improving life. In 2011, the Indian Express reported that about 1600 lost their lives during clinical trials conducted in India between 2008 and 2010. While thousands lost their lives, only 22 of the surviving families were compensated for their loss. The Hindustan Times reported that over a 100 doctors in the state of Madhya Pradesh have been suspected of having received financial benefits from multi-national companies to conduct drug trials

fraudulently on poor patients, with the state government admitting to a number of deaths due to such practices. The Hindu has reported that Mahrashtra (the state which has the highest GDP in India and home to Bollywood) has had the highest number of deaths due to clinical trials and that India has had over 2000 deaths due to the trials between 2008 and 2010, though only 1600 have been reported. The Times of India has reported one death per day is due to clinical trials and the Indian state government is only imposing a fine of just INR 500 (less than ten dollars) on the doctors involved in malpractice.

Various research papers indicate that the cost for developing a new drug may be as high as $ 1.5 billion. In order meet these unsustainable costs the pharmaceutical industry has gone global. The unregulated and unscrutinized Indian market has become one of the major hubs of clinical trials for pharmaceutical companies of western countries which are the actual markets for these drugs. Since 2002, the number of outsourced Food and Drug Administration (FDA) regulated investigators has grown by 15% annually, and the number of those based in the U.S. has declined by 5.5%. Extensive bureaucracy and an environment of complex regulations in the wealthy nations is yet another driving factor for outsourcing. The large populations of countries like India also offer potential research subjects at a lower cost (Glickman et al, 2009). In addition, the severe unrest among the medical and dental graduates due to limited specialization options may be deemed as a cause of their easy shift to the field of clinical research. This may also be synergized by the low income of nurses and paramedics and lower educational levels in the general public.

Indeed globalization does lead to a cross-country and cross-ethnicity assurance of the safety and efficacy of the drugs. Just as many other global markets with a local presence, drug trials generate revenue in the overseas market and also create job opportunities for locals. They also help to fill the void in the Indian research scenario.

India benefits from having a large resource of English speaking investigators, speciality and super speciality hospitals working at lesser costs with faster patient recruitment. Furthermore, India offers a highly developed IT and data collection capability and no language barrier.

However, drug trials are looked at not just from cost point to view but also in terms of their quality, reliability and confidentiality. A number of ethical issues have been raised by many Indian non-governmental organizations. The developing nations are mainly a base for the 2nd and 3rd phase of clinical trials (Glickman et al 2009). The drugs are given to a relatively large number of people and their safety is still under scrutiny. The developing nations still do not have distinct laws to regulate any lapse which occurs during the trial.

The purpose of this article is to generate interdisciplinary thought propulsion. From the policy point

of view the government must strengthen the Clinical Trials Registry-India and lay down clear cut norms for accountability and transparency just like any other profitdriven market. This can be ensured by the government being one of the stakeholders. Encouragement of publicprivate partnerships may enhance the regulatory climate of this market. The strengthening of the human resource factor in clinical trials is needed to ensure quality, so that it does not remain just a backup profession for clinical practitioners. At the clinical and educational level, a strong imbuement of ethics into research and training is necessary in the Indian educational system. Investigator training needs to be focused on increasing the level of awareness and understanding of regulations, ethics and, most importantly, patient protection. Currently the focus of clinical trials outsourced in India is on phase 2 and 3. Over time with growth and maturity of this industry, the pharmaceutical companies may also think of drug development in phase 4. Clinical trials may be encouraged at medical training organizations, with the acumen for research. It would also mean immediate care of patients in case an emergency were to happen. In addition, these institutions have the necessary competence for ethical committees to review the drug trials to be undertaken.

The Indian Clinical Research industry is valued at roughly $ 1.4 Billion (2011) and growing at roughly 20%.

CAGR is however still to show its mettle and was barely 5.38% of the global CRO industry. Recent data suggests that 2171 trials are taking place in India currently.

According to FICCI (Federation of Indian Chambers of Commerce and Industry), “The government has a vision to catapult India into one of the top-five Pharma innovation hubs by 2020, with one out of every 5 to 10 drugs discovered worldwide coming from India by 2020”.

This might be a little over optimistic, but with the necessary regulations and dedication on the policy side this is achievable. In early January of this year a more hopeful and progressive headline appeared. The honourable Supreme Court of India instructed the Health Ministry to formulate specific laws putting the specific responsibility of a trial gone wrong on investigators and sponsors of drug trials, waking the government up from its deep slumber.  References: Bhatt A. (2004) Clinical trials in India: Pangs of globalization. Indian Journal of Pharmacology. 36, 207-8 Glickman, S., McHutchison, J., & Peterson, E. (2009).

Ethical and Scientific Implications of the Globalization. The New England Journal of Medicine , 816-824.

Jayaraman K S. (2004) Outsourcing clinical trials to India rash and risky, critics warn. Nature Medicine 10, 440 Saxena N. Gazing through the Crystal Ball – The Future of Clinical Trials in India. http://breakfastnews.tv/gazingthrough-the-crystal-ball-india-cro-industry-2020/ MEDMONTHLY.COM |25

research & technology

Medical Practice Marketing – Best Practices For Attracting New Patients Using Health IT Capabilities

By Frank J. Rosello, CEO, Environmental Intelligence LLC 26 | MARCH 2013

E

ffective marketing is a key play for any business, regardless of industry. Attracting new patients to a medical practice is no different. Most often, physicians market their credentials, emphasizing their education, board certifications, experience, and hospital affiliations. Also, many physicians establish relationships with other providers to create a referral network and many practices encourage existing patients to refer friends and family to the practice.

While this marketing approach is considered a proven best practice within the medical community, current technology offers another marketing lever that few physicians are using. Health IT and technology investments and capabilities can be a powerful competitive advantage.

Health IT systems like electronic health records (EHR) technology are designed to achieve two basic fundamental objectives: First, they enable physicians to deliver more efficient, higher quality care to patients. Second, these systems simultaneously provide patients with greater control and more convenient access to their health care.

So why aren’t more physicians and medical practices educating and marketing their capabilities to new and existing patients?

While the final answer to this question will require further study, I do know that in the not so distant future, patients will become more familiar with medical technology and the impact it has on their health. As this awareness builds, it will play a more significant role in how patients decide which physician to choose for their care.

With the last thought in mind, here are a few best practices that physicians and medical practices could adopt to better educate their existing patients while effectively marketing to future patients: First, create a tab on the physician or medical practice website called

‘‘

“While this marketing approach is considered a proven best practice within the medical community, current technology offers another marketing lever that few physicians are using. Health IT and technology investments and capabilities can be a powerful competitive advantage.”

Technology. This section should be dedicated to list all of the technology the physician or medical practice utilizes for patients care along with the benefits to the patient. This tab can also be used to announce new technologies, capabilities and system upgrades.

Second, educate existing patients.

Physicians or medical practices may produce and distribute a handout comprised of the same information listed on the Technology tab of their website. The physician or medical practice may update their patient handout as updates to the Technology tab are made. This best practice could be a powerful approach to leverage in order to educate and retain existing patients. Knowledge is power!

Also, the following examples illustrate how physicians and medical practices can showcase their technology capabilities and announce upcoming enhancements on the Technology tab of their website: Develop a tag line to serve as the header of the Technology page of your

website that speaks to the identity of your practice. An example of what this header may look like:

Excellence in Medicine…..

Patient Driven Physicians….

Superior Technology Upon developing the identity tag line for your practice, list all of your technology capabilities and upcoming enhancements followed by a brief description highlighting the value or benefit your technology investments will bring to your new and existing patients. An example of this list may look like: Electronic Health Record (EHR) – Our physicians deliver exceptional, efficient and accurate care that can be easily transferred to your Personal Health record (PHR) or to other providers allowing immediate access to your medical history.

Paperless office – No more forms!

Patients will be provided a computer tablet to provide new and updated information upon arrival.

Patient Reports & eNotifications – EHR allows for automated examination and lab results for your review at the conclusion of your office visit and via our online patient portal.

New!... eClaims – Insurance claims are processed immediately upon conclusion of your office visit. In most cases, you will no longer have to stop by the business office resulting in saving you time and money.

Coming Soon…ePrescriptions – We will soon be providing electronic transmission of your prescriptions to the pharmacy of your choice. We will save you time by not having to wait at the pharmacy. Launch Date: November 1, 2011.

Put these proven best practices to use and see your practice thrive and grow.

Good luck!  MEDMONTHLY.COM |27

research & technology

GE Healthcare Introduces New Cardiac MRI Analysis Software GE Healthcare announced two new software packages for advanced analysis of cardiovascular magnetic resonance (MR) images: CardiacVX and MR VesselIQ Xpress. Both CardiacVX and MR VesselIQ Xpress were featured in the GE Healthcare booth at the annual meeting of the Society for Cardiac Magnetic Resonance (SCMR) on February 1-2, 2013, in San Francisco, California.

Cardiac MR can provide a wealth of information about the patient’s cardiac condition such as functional parameters, flow, and infarction. However, extracting this information and presenting it in an integrated fashion to the referring physician can be a time-consuming task for the technologist or clinician performing the study. GE Healthcare’s new CardiacVX software delivers fast, intuitive, semiautomatic analysis of key cardiac parameters, allowing 28 | MARCH 2013

the user to create a comprehensive cardiac patient report within a streamlined clinical workflow.

Recently FDA 510(k) cleared, CardiacVX runs on GE Healthcare’s Advantage Workstation (AW), and provides a range of reproducible tools for rapid reviewing and reporting. For example, CardiacVX performs fast left ventricle segmentation and volumetric functional analysis in just two clicks. Additional tools include myocardial infarct evaluation, flow analysis (with Qp/Qs ratio), time-course analysis, iron-overload assessment, patent foramen ovale (PFO) assessment, and one-click customizable reporting macros, all within an intuitive, guided user interface.

“CardiacVX was designed to address the clinical demand for a more automated and user-friendly cardiac postprocessing tool to allow clinicians to quickly and easily

arrive at needed diagnostic information,” said Anja Brau, PhD, Manager of Global Cardiac MR Applications for GE Healthcare.

CT Angiography has been widely used for assessing vascular stenosis or abnormalities, but increasingly, MR Angiography is utilized due to the lack of radiation and calcium blooming artifacts. Being able to use similar analysis workflow between CT and MR can greatly improve the clinician’s diagnostic efficiency.

MR VesselIQ Xpress, built based on GE Cardiac VX Healthcare’s CT VesselIQ Xpress platform, is an optimized image analysis package for MR angiographic data to efficiently analyze selected vessels for stenosis, directional tortuosity, and other vascular anomalies. MR VesselIQ Xpress provides advanced tools such as automatic vessel tracking with centerline display of any vessel, quick 3D visualization, and fast access to vessel cross section and profile images.

In addition, MR VesselIQ Xpress automatically provides size, stenosis, and length measurements of abnormal anatomical structures with two deposited points. Measurement tables and associated images are captured and ready to be included in reports. This software was designed to assist radiologists and other clinicians in the efficient evaluation and assessment of MR VesselIQ vascular anatomy Xpress and disease.

CardiacVX and MR VesselIQ Xpress software packages run on GE’s AW and are compatible with AW releases 4.4, 4.5, and 4.6.

GE Healthcare is committed to Humanizing MR by focusing on the needs of the patient, technologist, and clinician. These are the latest offerings in a series of products designed to improve cardiovascular exam processing for the technologist and clinician while maximizing patient care -- in the true spirit of Humanizing MR.  Source: http://www.newswiretoday.com/news/124300/

research & technology

YOU IMAGINE

Dental Apps That Kick Part 1 of 2

By

30| MARCH 2013

FINDING AN APP FOR THAT Dental apps offer a promise for both dentists and patients. They can inform and educate, hold medical records, and they can change dental habits for the young and the old alike. They serve as a bridge between the dentist and the patient. What is being done to enhance this bridge? I have reviewed dozens of dental apps, spoken with dentists and developers about their plans, and I offer the insights of that exploration here. I want to be clear that I am in no way paid or compensated by any of the app developers I will be reviewing.

While iTunes doesn’t offer subcategories in Medical, dental apps came in four varieties. There are (1) apps that motivate kids to brush or visit the dentist. There are (2) apps dentists can use to to communicate with and educate patients about dental health and procedures. There are (3) apps that dentists use to hold medical records or reference data. And there are (4) apps patients can use to learn more on their own. I’ll cover 1 and 2 in this issue, with 3 and 4 following next month.

1. A HEALTHY TOOTH BEGINS AT HOME As my daughter was having her braces adjusted, one day recently, I asked her orthodontist what the biggest obstacle to good outcomes with braces would be, and she said the issue is kids brushing their teeth, that they don’t often do it long enough or thoroughly enough. Before making my suggestions to her for possible app development, I made a list for her of what’s already available.

Time2Brush I noticed that one of the toothpaste companies have been working on this idea. Aquafresh offers Time2Brush with a two minute timer. When kids brush they earn points. What makes the app fun is kids they earn accessories to dress their virtual pet “Nerdle”.

My 8 and 10 year oldes were both addicted to this app because they wanted to fill Nerdle’s closet.

continued on page 32 MEDMONTHLY.COM |31

continued from page 31

Kids Dental Health Getting kids excited about teeth is more than just a good story.. Kids Dental Health is a story for toddlers and young children. Children choose one from among four characters to lead the story. Children learn what happens when they don’t brush their teeth, what foods are health, and how often they should brush. The Lite version offers only the simple story, which would be fun except that there are an annoying number of prompts to purchase the full version ($3.99). The full version offers games to enhance the story.

StarTeeth StarTeeth is a free app and my kids loved it. It is simple with an appealing interface. It allows children to choose one of 12 characters which will then display a timer and brush their own teeth to music, as the child brushes, too. The characters are cute. There are even holiday characters like Santa Claus, and a place to vote for future characters to be added.

32 | MARCH 2013

A Little Mouse: Brush Teeth Lite One little app called A Little Mouse: Brush Teeth Lite,

by Wang Hongting, will make your kids laugh with its funny drawings, large teeth, and high-pitched child’s voice. The story begins, “Dear, we are gong to brush teeth.”, “No, I hate to brush teeth. Help. Please help me.

I want to brush my teeth.” But it draws kids in, and my kids enjoyed it.

Of all the kids apps, my kids preferred StarTeeth because they loved the character selection. And they also liked Time2Brush, for the chance to earn points and collect clothes for their character.

These motivation apps surprised me. I didn’t realize that such a simple device, one step up from an hour-glass, could give my kids the patience and pleasure to brush for the whole recommended 2 minutes, twice every day. I only hope this becomes a habit.

Before I move from the topic of motivation, there is a brushing app that appeals to teens and adults. It is called Brush DJ, by y Benjamin Underwood (http://www.brushdj.com). It is a free app and what makes it great is that it takes songs from your iTunes music collection and plays them for 2 minutes while you brush. It also offers healthy teeth reminders targeted for your particular age group.

Brush DJ

continued on page 34 MEDMONTHLY.COM |33

continued from page 33

1. IN-OFFICE INSTRUCTION Even with faithful brushing, a dentist might need to speak with the patient about improvements in technique.

And procedures will be necessary at times to keep teeth healthy. There are two types of these in-office patient instruction apps. There are free or inexpensive apps. And then there are professional grade apps that cost a great deal more.

Virtual Dentist: Free, Premium, and Professional Exploring the patient-ed apps, I found two that stood out from the others. The first is Virtual Dentist by ModiFace. The free version allows dentists to demonstrate cavities and individualized drilling, filling, and tooth reshaping approaches by drawing on pre-installed sample mouth photos, or by shooting or importing photo directly into the app. This free version also offers a tooth whitening feature to lighten and darken a set of teeth. There is a Premium version includes veneers, gum bleaching, and braces, for $2.99, and a professional version that includes personalization to the clinic among other additional features costs $99.99. I suggest experimenting with the free app to see if it suits your needs. If it is typical for you to draw examples of the procedures to be performed, he results here are more sophisticated than a line drawing, but if patients expect the images to look exactly the way their teeth will look when the procedures are completed, the app may be misleading.

34 | MARCH 2013

DCStory DCStory by Happy Space (http://www.dcsipad.com) is a $699 robust app full of films revealing various procedures for iPad. There is a lite version which shows a few seconds of each video, but perhaps the only value in this lite version would be to decide if the design is right for your needs.

continued on page 36 MEDMONTHLY.COM |35

continued from page 35

DCStoryM Also in the series of DCStory is the DCStoryM app, which offers movies of implants, bridge im-plants, splinting, gingival grafts, and tooth loss. And DCStoryM Special for $499.99.

DC Series: Dental RC, DCStory X-ray Plan Special, and DCStoryO Special There are other apps in the DC series. Dental RC, for example, allows users to take photos and communicate orthodontic knowledge to the dentist. And DCStory X-ray Plan Special offers x-rays for $199.99, And then DCStoryO Special offers 200 orthodontic animations with patient photo uploading to personalize the instruction. It also offers hand drawing on the photos to personalize the patient understanding. It also offers a record keeping feature so that records can be emailed or reviewed at home. Images from the DCStoryO orthodontic, follow:

The extensive collection of videos these apps offer explains the high prices. But it may be a worthwhile investment to a dentist, as the videos are well prepared and may save time in the long run.

Next month, in Part 2, I’ll report on apps for dentists and apps for patient self-exploration.  info@medimagery.com 36 | MARCH 2013

l

http://www.medimagery.com/

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http://www.linkedin.com/in/lauramaaske

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legal

AMA Urges Congress: Retain Funding for Residency Programs, Increase Training Positions to Address Doctor Shortage

Medical student advocacy day, new website part of campaign to protect graduate medical education

P

hysicians and medical students from across the country are urging Congress to retain Medicare funding for graduate medical education (GME) programs, known as residencies, and to lift the cap on the number of available residency slots. As the nation deals with a physician shortage, it is important that all medical students can complete their training and care for patients.

“Residency training gives new physicians hands-on experience and provides high-quality care to patients,” said AMA President Jeremy Lazarus, M.D. “Limiting the slots available to train physicians as they leave medical school creates a bottleneck in the system and prevents the physician workforce from growing to meet the

38 | MARCH 2013

needs of our nation’s patients.”

The demand for physicians will grow as the US population continues to age, 30 million newly-insured Americans have increased access to health care services from the Affordable Care Act and life expectancies become longer.

Medical schools are expanding enrollment and making changes to prepare students for the future practice of medicine, and the AMA has announced a $10 million initiative to further accelerate change in undergraduate medical education. But that is just part of the continuum of medical education essential to produce physicians ready to meet future demands.

The number of GME slots has been frozen by the federal government since 1997. As a result, U.S. medical school

graduates will exceed the number of available slots as soon as 2015.

“Medical students, patients and physicians who are concerned about protecting GME slots to reduce the physician shortage can contact their elected officials through a new website, www.SaveGME.org,” said Dr. Lazarus.

“Medical students also carried this important message to Congress during their advocacy day on Capitol Hill on February 11. The timing is especially critical as Medicare budget cuts from sequestration could have an impact on funding for graduate medical education.”  Source: http://www.ama-assn.org/ ama/pub/news/news/2013-02-03-urgecongress-retain-funding-for-residencyprograms.page

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legal

FDA Offers New Guidance on Developing Drugs For Alzheimer’s The FDA has issued a proposal designed to assist companies developing new treatments for patients in the early stages of Alzheimer’s disease, before the onset of noticeable dementia.

“The scientific community and the FDA believe that it is critical to identify and study patients with very early Alzheimer’s disease before there is too much irreversible injury to the brain,” said Russell Katz, M.D., director of the division of neurology products in the FDA’s Center for Drug Evaluation and Research. “It is in this population that most researchers believe that new drugs have the best chance of providing meaningful benefit to patients.”

The draft guidance titled, “Guidance for Industry, Alzheimer’s Disease: Developing Drugs for the Treatment of Early Stage Disease,” explains the FDA’s current thinking about the way researchers can identify and select patients with early Alzheimer’s disease, or those who are at risk of developing the disease, for participation in clinical trials. In recent years, the research community has tried to find ways to identify these patients using criteria that are based on biomarkers. Researchers have also tried to develop sensitive clinical measures that can detect subtle mental decline.

“This draft guidance is intended to serve as a focus for continued discussions between the FDA and pharmaceutical sponsors, the academic community, advocacy groups and the public,” said Katz. “The FDA is committed to vigorously addressing Alzheimer’s disease and will work with industry to help develop new treatments in this early population as expeditiously as possible.”

For drugs designed to treat patients with overt dementia, the FDA currently requires that treatments not only show an effect on abnormal thinking, but also how well patients 40| MARCH 2013

function. The goal for these trials is to ensure that any beneficial effect on thinking is associated with a clinically meaningful outcome for the patient (e.g., improvement or lack of decline in how patients feel or function). However, because patients with early Alzheimer’s disease have littleto-no impairment of global functioning, it is difficult to assess changes in function in these patients. This can make it difficult to determine if a given treatment’s effect is clinically important.

FDA is seeking public comment on the draft guidance for 60 days. Instructions on how to submit comments are included in a related Federal Register notice. In finalizing the guidance document, the agency will consider the information received from the public.

The FDA proposal is part of U.S. Department of Health and Human Services’ efforts under the National Plan to Address Alzheimer’s Disease, which calls for both the government and the private sector to intensify efforts to treat or prevent Alzheimer’s and related dementias and to improve care and services. It responds to recommendations from a May 2012 HHS and National Institutes of Health Alzheimer’s research summit to conduct clinical trials in at-risk individuals without symptoms and to develop and validate new measures so that Alzheimer’s can be measured at the earliest possible time in the course of the disease.  Source - FDA news release as posted on CenterWatch at http://www.centerwatch.com/news-online/article/4416/fdaoffers-new-guidance-on-developing-drugs-for-alzheimers Read FDA news release at http://www.fda.gov/NewsEvents/ Newsroom/PressAnnouncements/ucm338659.htm

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Editorial Calendar: Feb. 2013 - ENT l March 2013 - Clinical Trials

legal

CMS Announces

Sunshine Act Final Rule

By Christian Nordqvist, Editor Medical News Today The CMS (Centers for Medicare and Medicaid Services) announced the long-awaited Sunshine Act final rule which will raise public awareness of the financial relationships between medical device and pharmaceutical companies and doctors and teaching hospitals.

Peter Budetti, MD, CMS deputy administrator for program integrity said that patients have the right to know whether their doctor has a financial relationship with the makers of medical devices or medications they may need. “Disclosure of these relationships allows patients to have more informed discussions with their doctors.”

The “National Physician Payment Transparency Program: Open Payments” is one of several steps in the Affordable Care Act aimed at creating greater transparency in health care.

Peter Budetti, M.D. CMS deputy administrator for Program Integrity, said: “You should know when your doctor has a financial relationship with the companies that manufacture or supply the medicines or medical devices you may need. Disclosure of these relationships allows patients to have more informed discussions with their doctors.”

The rule, known as the Physician Payments Sunshine Act, is the final step in making sure that manufacturers of medications, medical devices, medical supplies and biologicals which are covered by CHIP (Children’s Health Insurance Program), Medicaid, or Medicare tell CMS about payments or any other transfers of value that are sent to doctors and teaching hospitals.

42 | MARCH 2013

All physician disclosure data received by CMS will be posted in a public website. Manufacturers and GPOs (group purchasing organizations) will have to disclose to CMS whether any doctors have investment or ownership interests.

The aim of this greater transparency is to help reduce the conflict-ofinterest situations that doctors or teaching hospitals might face if there is a relationship with manufacturers.

Applicable GPOs and manufacturers will be bound by this new reporting requirement. These organizations, as well as teaching hospitals and doctors, will be able to check through the information about them before it is published online.

So that applicable GPOs and manufacturers have plenty of time to prepare, the collection of data will start on August 1st, 2013. GPOs and manufacturers will report data from August to the end of December 2013 to CMS by March 31st, 2014, at the latest. These data will be released by CMS online by September 30th, 2014.

In order to facilitate the reporting process, CMS is developing an electronic system.

You can download the final rule at www.federalregister.gov/publicinspection.

American Medical Association Response to the Sunshine Act Jeremy A. Lazarus, MD, President, American Medical Association, wrote in an online communiqué: “The AMA will carefully review the new Physician

Payment Sunshine Act rule. Physicians’ relationships with the pharmaceutical industry should be transparent and focused on benefits to patients.

Our feedback during this rulemaking process was aimed at ensuring the new registry will provide a meaningful picture of physician-industry interactions and give physicians an easy way to correct any inaccuracies. As the rule is implemented, we will work to make sure physicians have up-to-date information about the new reporting process.”

Do financial disclosures impact on prescribing practices? Apparently not Laws designed at more transparency, forcing doctors to reveal their financial links with pharmaceutical companies, have “little or no effect on what medications doctors prescribe”, according to a study carried out by Genevieve PhamKanter, Ph.D., an assistant professor in the Department of Health Systems, Management and Policy at the Colorado School of Public Health and a research fellow at Harvard University and Massachusetts General Hospital.

If the policymakers who pass these measures expect a change in prescribing practices, they may be disappointed, Pham-Kanter explained.

The study was published in Archives of Internal Medicine (May 2012 issue).

Pham-Kanter and team were specifically investigating the effect of the laws on the prescribing of HMGCoA reductase inhibitors (statins)

‘‘

“Our feedback during this rulemaking process was aimed at ensuring the new registry will provide a meaningful picture of physicianindustry interactions and give physicians an easy way to correct any inaccuracies. As the rule is implemented, we will work to make sure physicians have up-to-date information about the new reporting process.”

and selective serotonin reuptake inhibitors (SSRIs). They theorized that if disclosure laws were really effective and deterred doctors from receiving money from drug manufacturers, they in turn would be less likely to prescribe branded statins and SSRIs over similar generic medications.

They compared Maine, which introduced a disclosure law in 2004 with New Hampshire and Rhode Island, two states with no such laws but similar demographics. Then they compared West Virginia, which passed a disclosure law in 2004, with Kentucky and Delaware which also had no such laws.

They found that the laws had little to no effect in Virginia, and a small but not significantly important effect in Maine.

Pham-Kanter said “Our results show that the disclosure laws in the two states we examined had a negligible to small effect on physicians switching from branded therapies to generics and no effect on reducing prescription costs.”  Source: http://www.medicalnewstoday. com/articles/255815.php

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features

Clinical Trials of Medical Treatments: Why

Volunteer?

Courtesy of the Food and Drug Administration (FDA)

44 | MARCH 2013

What Is A Clinical Trial?

“Clinical trial” is the scientific term for a test or study of a drug or medical device in people. These tests are done to see if the product is safe and effective for people to use. Doctors and other health professionals run the tests according to strict rules set by the Food and Drug Administration (FDA).

FDA sets the rules to make sure that people who agree to be in the studies are treated as safely as possible.

Why Volunteer?

By taking part in a clinical trial, you can try a new treatment that may or may not be better than those that already exist. You can also help others better understand how the treatment works in people of different races and genders.

Why Should Minorities and Women Participate In Clinical Trials?

In the past, most drug testing had been done on white men. This means that some groups, such as African Americans, Hispanics/Latinos, American Indians, Asians, Pacific Islanders and women, had not always been included in the tests done on drugs.

But sometimes drugs work differently in these people than on white men. So FDA wants people from many different groups included in these studies.

What Happens in a Clinical Trial?

Clinical trials are done to test whether new products are safe and work against disease. Study products are tested to see how they compare to standard treatments or to no treatment if there is not presently one.

Many studies require that neither the patient nor the doctor know whether the patient is receiving the study treatment, the standard treatment, or a placebo (an inactive substance that looks like the drug being tested). In other words, some people may be getting no treatment at all.

Studies are done in phases to find different kinds of information. Usually, Phase 1 studies include only a few healthy people. Here, scientists find the best way to give a new treatment and how much they can safely give.

Phase 2 studies include more people than Phase 1 studies, and the people have disease that the product is going to treat. Now scientists try to see how well the product works against the disease. If the product works, the study moves into Phase 3. Here large numbers of patients with the disease are included to see if the new treatment works as well as the standard treatment.

What Are the Risks?

Some treatments that are being tested have side effects that can be unpleasant, serious or even life-threatening. Because the treatments being studied are new, doctors don’t always know what the side effects will be.

Many side effects are temporary and go away when the treatment is stopped.

But others can be permanent. Some side effects appear during treatment, while others may not show up until after the treatment is over. The risks depend on the treatment being studied and all known risks should be fully explained to you by the researchers.

How am I Protected?

Informed Consent

To help you decide if you want to be in a study, FDA requires that you be given complete information about the study before you agree to take part.

This is known as informed consent.

FDA requires that people be told: • that the study involves research of an unproven drug or device • the purpose of the research • how long the study will take • what will happen in the study and which parts of the study are experimental • possible risks or discomforts • possible benefits • other procedures or treatments that you might want to consider

• •

• •

instead of the treatment being studied that FDA may look at study records, but the records will be kept secret whether any medical treatments are available if you are hurt, what those treatments are, where they can be found, and who will pay for the treatment the person to contact with questions about the study, your rights, or if you get hurt you can quit at any time.

Informed consents must be written so you can understand it. If you don’t, be sure to ask the doctor or other medical person to explain it. Make sure you understand all of it before you agree to be in the study.

Before you can be in the study, you must sign the informed consent form, showing that you have been given this information and understand it. The informed consent form is NOT a contract and you can leave the study at any time, for any reason.

Other Ways Volunteers Are Protected Institutional Review Boards (IRBs)

Scientists, doctors and other people from the local community serve on IRBs to review and monitor their hospital’s or research institution’s medical research involving people. They monitor studies to help make sure that there is the least possible risk to volunteers and that the risks are reasonable in relation to the expected benefits. IRBs make sure volunteer selection is fair and that informed consent is done correctly.

Data Monitoring Committees

These committees are used mainly when one treatment is being compared with another. These committees are particularly important in tests of treatments for serious or life-threatening continued on page 46 MEDMONTHLY.COM |45

continued from page 45

disease. These experts review information from studies to make sure they are being done in a way that is safest for the volunteers. During a study, if the committee finds that the treatment is harmful or of no benefit, it will stop the study. If a study shows that one treatment works better than another, the committee stops the study and all volunteers are offered the better treatment.

FDA Inspections

FDA inspects records and various scientists, clinics, and other research sites involved in a study. The agency does this to make sure volunteers are being protected and studies are being done correctly. From time to time such inspections are done in response to complaints.

What Questions Should I Ask? Here are some questions to ask your doctor to help you decide if you want to take part in a clinical trial: • What is the study trying to find out?

• What kinds of test and exams will I have to take while I’m in the study?

How much time do these take?

What is involved in each test?

• How often does the study require me to go to the doctor or clinic?

• Will I be hospitalized? If so, how often and for how long?

• What are the costs to me? Will my health insurance pay for it?

• What follow-up will there be?

• What will happen at the end of the study?

• What are my other treatment choices? How do they compare with the treatment being studied?

• What side effects can I expect from the treatment being tested? How do they compare with side effects of standard treatment?

• How long will the study last?

46| MARCH 2013

Points to Remember • Clinical trials are tests of medical treatments to see if they are safe and if they work.

• Before you agree to take part in a study, you must be given complete information about the study, including possible side effects and benefits.

• You should ask lots of questions to be sure you understand the study.

• You must sign a special agreement called “Informed Consent” before taking part in the study.

• The Informed Consent is not a contract. You can leave the study at any time.

How Can I Find Out About Clinical Trials?

One good way to find out if there are any treatments in clinical trials that might help you is to ask your doctor.

Other sources of information include: For cancer, call 1-800-4-CANCER (1-800-422-6237) or visit this World Wide Website: http://www.cancer.gov/ clinicaltrials For AIDS and HIV, call 1-800-TRIALS-A (1-800-874-2572) or visit this World Wide Website: www.actis.org For general information about clinical trials, call FDA’s Office of Special Health Issues at 301-827-4460 or visit the Information for Patients web site For other clinical trials of other diseases, visit this World Wide Website: www.clinicaltrials.gov The Food and Drug Administration, or FDA, is part of the United States government. It is FDA’s job to make sure medical treatments are safe and effective for people to use.  Source: http://www.fda.gov/ForConsumers/ByAudience/ForPatientAdvocates/ParticipatinginClinicalTrials/ ucm129557.htm

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features

The Clinical Trials of

Immunotech Laboratories’ IPF Immunotherapy Treatment

By Thomas Hibbard, Creative Director, Med Monthly

48 | MARCH 2013

Immunotech Laboratories is a drug development company committed to the commercialization of its proprietary proteins for the treatment of debilitating infectious diseases.

Harry Zhabilov, president and chief science officer at Immunotech Laboratories with a PhD. in biochemistry, disclosed that they are currently performing clinical trials in Mexico on a unique immunotherapy treatment involving an inactivated pepsin fraction (IPF), a sterile biological product that helps fight malignant cells for cancer and treats HIV infection very effectively.

The Nabors Group and Immunotech Laboratories are currently in phases of IND and clinical trials.

Immunotherapy, also referred to as biologic therapy or biotherapy, is a treatment that uses certain parts of the immune system to fight diseases. This can be achieved in a couple of ways: • Stimulating the patient’s immune system to work harder or smarter to attack cancer cells • Giving the patient immune system components, such as man-made immune system proteins (an example being IPF, in the case of this trial) The focus in this trial is with salvage patients and Immunotech has had a good success rate with immunotherapy in treating HIV and cancer (prostate, ovarian and pancreatic cancer) with little or no side effects from the treatment. Their concentration on salvage patients is an area big pharma is not interested in. Salvage therapy is a form of treatment given after an ailment does not respond to standard treatment, with the most common ailments being HIV and various tumors.

Antiretroviral drugs (ARVs) are given to slow down the HIV reproduction or tumor growth, which in turn increases quality of life and survival. If the patient’s viral load starts to increase instead of staying very low, it almost

always means the virus has developed a resistance to the ARVs. As more and more mutations develop, it becomes harder to select an ARV that will contain it. Salvage therapy is the attempt to contain it and can be used when at least one regimen containing protease inhibitors has failed in a patient.

With regard to HIV, the IPF based vaccine has been studied as a salvage therapy on stage CDC-3 AIDS patients using a mono approach. The results of four non-US experimental trials on 200 patients show the action and effectiveness of the vaccine. Immunological results are: 1. Increase in percentages and numbers of CD8 and CCR5 positive cells in the treated patients.

2. Significant Iincrease in CD8+, CD38+ cells in the treated patients.

3. Significant increase in both CD4+ iNFg, secreting cells in the treated patients.

The major goal of immune therapy with cancer patients is to harness a patient’s immune system against tumor cells. The technology developed over a decade by Dr. Zhabilov, involves treatment to increase the immunogenicity of cancer cells. This immunogenicity leads to an induction of anticancer immune response, specifically cancer T cells responses. IPF increases levels of interference (IFNs). Clear demonstrations are available of increased immunogenicity of treated melanoma cells. Immunogenicity of the vaccine is further enhanced through the inclusion of proprietary adjuvant IL2.

This adjuvant act to protect the immune cells activated in response to the vaccine. This protection increases survival and prolongs the post vaccine immune response.

Currently Immunotech Laboratories, Dr. Zhabilov shared, is conducting pilot studies in Mexico and is in negotiations with two of the largest Bulgarian hospitals for the start of clinical trials for their patented IPF-ITV

and IPF-ITV Phases on 50 advanced stage patients. Each country has different requirements for clinical trials.

For this trial Bulgaria requires not less than 150 patients, while the United States requires 1000. Bulgaria has been selected for the “country of origin” for this clinical trial through their associate company, Immunotech BG. Dr. Zhabilov stated, “The clinical trials in Bulgaria are scheduled to begin in March 2013 and will end in August 2013, which will give us the necessary results to receive approval for increased application for mass distribution for our IPF medicine.”

For more information visit http://www.immunotechlab.com/ or http://lifechoicemx.com/  This article contains forward-looking statements that involve risks and uncertainties associated with financial projections, budgets, milestone timelines, clinical development, regulatory approvals, and other risks described by Immunotech Laboratories, Inc. from time to time in its periodic reports filed with the SEC. IPF is not approved by the US Food and Drug Administration or by any comparable regulatory agencies elsewhere in the world. While Immunotech Laboratories believes that the forward-looking statements and underlying assumptions contained therein are reasonable, any of the assumptions could be inaccurate, including, but not limited to, the ability of Immunotech Laboratories to establish the efficacy of IPF in the treatment of any disease or health condition, the development of studies and strategies leading to commercialization of IPF in the United States, the obtaining of funding required to carry out the development plan, the completion of studies and tests on time or at all, and the successful outcome of such studies or tests. Therefore, there can be no assurance that the forwardlooking statements included in this release will prove to be accurate. In light of the significant uncertainties inherent in the forward-looking statements included herein, Immunotech Laboratories or any other person that the objectives and plans of Immunotech Laboratories will be achieved should not regard the forward-looking statements as a representation.

MEDMONTHLY.COM |49

features

Preclinical Testing and Clinical Trials for a N Preclinical Testing New drugs begin in the laboratory with scientists, including chemists and pharmacologists, who identify cellular and genetic factors that play a role in specific diseases. They search for chemical and biological substances that target these biological markers and are likely to have drug-like effects. Out of every 5,000 new compounds identified during the discovery process, only five are considered safe for testing in human volunteers after preclinical evaluations. After three to six years of further clinical testing in patients, only one of these compounds is ultimately approved as a marketed drug for treatment. The following sequence of research activities begins the process that results in development of new medicines: l Target Identification. Drugs usually act on either cellular or genetic chemicals in the body, known as targets, which are believed to be associated with disease.

Scientists use a variety of techniques to identify and isolate individual targets to learn more about their functions and how they influence disease. Compounds are then identified that have various interactions with the drug targets that might be helpful in treatment of a specific disease. l Target Prioritization/Validation. To select targets most likely to be useful in the development of new treatments for disease, researchers analyze and compare each drug target to others based on their association with a specific disease and their ability to regulate biological and chemical compounds in the body. Tests are conducted to confirm that interactions with the drug target are associated with a desired change in the behavior of diseased cells. Research scientists can then identify compounds that have an effect on the target selected. l Lead Identification. A lead compound or substance is one that is believed to have potential to treat disease. Laboratory scientists can compare known substances

50 | MARCH 2013

with new compounds to determine their likelihood of success. Leads are sometimes developed as collections, or libraries, of individual molecules that possess properties needed in a new drug. Testing is then done on each of these molecules to confirm its effect on the drug target. l Lead Optimization. Lead optimization compares the properties of various lead compounds and provides information to help biopharmaceutical companies select the compound or compounds with the greatest potential to be developed into safe and effective medicines. Often during this same stage of development, lead prioritization studies are conducted in living organisms (in vivo) and in cells in the test tube (in vitro) to compare various lead compounds and how they are metabolized and affect the body.

Three Phases of Clinical Trial Most clinical research that involves the testing of a new treatment progresses in phases. This allows researchers to ask and answer questions in a way that yields reliable information about the treatment and protects the patients.

Clinical trials are usually classified into one of three phases: 1. Phase I Trials are the first step in testing a new treatment in humans. In these studies, researchers may evaluate how a new drug should be given (by mouth, injected into the blood, or injected into the muscle), how often, and what dose is safe. A phase I trial usually enrolls only a small number of patients, sometimes as few as a dozen. About 70 percent of experimental drugs pass this initial phase of testing.

2. Phase II Trials focus on evaluating how well the new treatment works. They also continue to test the safety of the treatment. This second phase of testing may last from several months to two years, and involves up to several hundred patients. About one-third of experimental drugs successfully complete both phase I and phase II studies.

3. Phase III Trials compare the results of people taking the new treatment with results of people

New Drug Discovery taking standard treatment. Investigators usually assign participants to the standard treatment group or the new treatment group at random (called randomization).

Phase III trials often enroll large numbers of people and may be conducted at many doctors’ offices, clinics, and health centers nationwide.

The Length of Clinical Trials Clinical trials can take several years to complete. Some possible reasons are: l For chronic conditions such as cancer, it takes months, if not years, to see if a cancer treatment has an effect on a patient. l For drugs that are not expected to have a strong effect (meaning a large number of patients must be recruited to observe ‘any’ effect), recruiting enough patients to test the drug’s effectiveness (i.e., getting statistical power) can take several years. l Only certain people who have the target disease condition are eligible to take part in each clinical trial. Researchers who treat these particular patients must participate in the trial. Then they must identify the desirable patients and obtain consent from them or their families to take part in the trial.

The biggest barrier to completing studies is the shortage of people who take part. All drug and many device trials target a subset of the population, meaning not everyone can participate. Some drug trials require patients to have unusual combinations of disease characteristics. It is a challenge to find the appropriate patients and obtain their consent, especially when they may receive no direct benefit (because they are not paid, the study drug is not yet proven to work, or the patient may receive a placebo). In the case of cancer patients, fewer than 5% of adults with cancer will participate in drug trials.

http://www.immunotechlab.com/ipf-preclinical-testing/ http://www.dukehealth.org/health_library/health_articles/the_clinical_trial_process MEDMONTHLY.COM |51

features

Three NIHSponsored Clinical Trials Test Influenza Treatments Courtesy of National Institutes of Health News 52 | MARCH 2013

T

hree clinical trials that seek to find more effective treatments for influenza are enrolling volunteers with influenza at the National Institutes of Health’s Clinical Center in Bethesda, Md., and at several dozen other domestic and international sites.

One study examines whether treatment with a licensed influenza drug, oseltamivir, reduces the time that infected people continue to produce virus in the upper airway.

A second tests whether a combination of three licensed flu antiviral drugs works better than oseltamivir alone in people with influenza who have chronic health conditions, such as heart or lung disease, that put them at greater risk of severe illness.

The third tests whether treatment with plasma enriched with anti-influenza antibodies improves the condition of hospitalized influenza patients compared to standard antiviral treatment alone.

“This year’s flu season came earlier than usual and has been particularly hard on the elderly,” said Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious diseases, part of the NIH. “Despite our best efforts to prevent influenza through vaccination, people still get sick every year with the flu. At best, influenza infection is a miserable experience. At worst, it can be a deadly one.

We need better ways to treat people with influenza, which kills thousands of people in the United States each year, and clinical research supported

by NIAID helps to address that need.”

The studies are sponsored by the NIAID Influenza Research Collaboration, a clinical research network funded by the NIAID Division of Clinical Research (DCR). Researchers at 36 sites in the United States and additional sites in Argentina, Australia, Mexico and Thailand participate. Activities of the collaboration are coordinated under the leadership of Richard Davey, M.D., deputy clinical director, NIAID DCR, and John Beigel, M.D.,

medical affairs scientist on contract with NIAID. Although oseltamivir has been approved for use in the United States since 1999, no studies have shown conclusively whether the drug significantly reduces the amount of virus produced (shed) by an infected person.

Reduced shedding would likely lessen the chances of an infected person passing the virus to others. The oseltamivir trial will enroll a total of approximately 560 people at 31 locations in the United States, Argentina and Thailand.

Enrollees must be between the ages of 18 and 65 years and have confirmed influenza virus infection but not be hospitalized or suffering from any other health conditions that would put them at risk of developing influenza complications.

The trial comparing oral oseltamivir alone to treatment with oseltamivir plus two other licensed antiviral drugs is enrolling a total of up to 720 adults at sites in the United States, Argentina, Australia, Mexico and Thailand. In addition to having laboratory-confirmed influenza, enrollees must have at least one other characteristic that places them at higher risk of developing serious complications. Asthma and other lung disorders, heart disease, obesity, weakened immune function and being over age 65 are some of the conditions that place people at higher risk for serious disease.

The third trial is enrolling children as well as adults, including pregnant women, hospitalized with severe influenza. This trial aims to enroll a total of approximately 100 people at approximately 20 sites in the United States. All participants will receive standard drug treatment for influenza, and half will also receive two infusions of plasma enriched with antibodies against the virus. Antibodies are infection-fighting proteins produced by the immune system. The antibodies used in the trial are derived from blood donated by volunteers who were recently vaccinated against flu or are recovered from a recent bout of flu.

“Anecdotal evidence suggests that the addition of plasma with high levels of antibody against the virus may confer additional benefit over drug treatment alone. This trial will be one of the first to examine that possibility in a scientifically rigorous fashion,” said Dr. Davey. “The outcome of this trial may provide valuable data on how best to treat patients hospitalized with severe influenza.”

Information about the NIAID Influenza Research Collaboration, including a listing of all participating clinical sites worldwide, is available at http://fluresearch.org/. Detailed information about each of the trials now enrolling volunteers is also available at http://www.clinicaltrials.gov and through the following direct links: l Evaluating the Use of Oselta mivir for the Treatment of Influenza in Adults (NCT01314911) http://www.clinicaltrials.gov/ ct2/show/NCT01314911?term =IRC004&rank=1 l Comparing the Efficacy, Safety, and Tolerability of Combination Antivi rals versus Oseltamivir for the Treatment of Influenza in Adults at Risk for Complications (NCT01227967) http://www.clinicaltrials.gov/ct2/ show/NCT01227967?term= NCT01227967&rank=1 l Safety and Efficacy of Investigation al Immune Plasma in Treating In fluenza A (NCT01052480) http:// www.clinicaltrials.gov/ct2/show/ NCT01052480?term= NCT01052480&rank=1 For more about NIAID research on all aspects of influenza, visit http:// www.niaid.nih.gov/topics/flu/Pages/ default.aspx. Also visit http://www.flu. gov for one-stop access to U.S. government information on seasonal and pandemic flu.  http://www.nih.gov/news/health/ feb2013/niaid-05.htm

MEDMONTHLY.COM |53

the arts

Curiosity Key to Life of Artist, Physician - Thomas Hope

By Robin Clifford Wood,

Freelance Writer and Columnist for the Bangor Daily News

T

homas Hope is a painter who has had a gallery showing in Spain. He is a sculptor; he does carpentry, brickwork and stonework; he plays piano and guitar and composes music; and he is fluent in three languages, having lived abroad for many years. He designed several houses, including the one he built for himself — a one-of-a-kind rambling structure in South Gouldsboro that incorporates old-world stone walls, an arched stone hallway and driftwood beams. And oh, by the way, he has been practicing emergency medicine in Bangor for 32 years.

One of my favorite children’s storybooks, which happens to be set in Maine, is Barbara Cooney’s “Miss Rumphius.”

54| MARCH 2013

It tells the story of a girl who had three goals: she would see faraway places, come home to live by the sea and do something to make the world more beautiful. As I think over Thom’s story, I can’t keep “Miss Rumphius” from my mind. Thom has lived in faraway places, he came home and built a house by the sea and every day he does something to make the world more beautiful.

Thom grew up in Nyack, N.Y., overlooking the Hudson River. His mother was one of the first subjects Thom brought into our conversation, and it is clear that she has been one of the most profound influences in Thom’s life.

Dorothea Stater Hope had a doctorate in biochemistry, was a concert pianist, an artist and a lifetime inspiration for her

son. Her artwork hangs alongside Thom’s throughout his home, and she comes up regularly in Thom’s recounting of his life experiences.

A second constant in Thom’s life was his dream of building his own house one day. It began when he was five years old and built sand castles and dirt forts. Throughout his life his attention was drawn toward construction sites and potential settings for his future home.

In 1961, when Thom was 13, his family spent the summer in England, his father’s home country. Influenced by a book, Thom asked his mother if he could go youth hosteling by himself for a week around Wales. To his surprise, she said yes. He scrounged up a 3-speed girl’s bike and took the train to Wales. It was a transformative experience.

“People in the villages were so friendly and generous.

They’d ask, ‘Where are your parents?’ and I’d tell them I was on my own. They’d call up the baker — the baker’s light would come on. They’d call the butcher for something to feed me.”

Thom fell in love with England, and asked if he could go to school there.

“If you make the honor roll this year,” his mother said, “I’ll see what I can do.”

So Thom made the honor roll.

“It was an eye-opener to be an unruly American in an English school,” said Thom, but he thrived in the structured environment. He stayed for four years, getting exposure to the arts and architecture as well as biology and chemistry, not to mention exposure to the world and to independence.

“On vacations when everyone else went home, I’d hitchhike all over Europe.”

Thom asked his mother once, years later, how she could have let him take that bicycle trip alone.

“You always showed a good sense of survival,” she said.

I expect she saw even more — the light of curiosity and wonder in a young man thirsty for exploration. She did well to set him loose, because the freedom opened Thom up to new worlds that nurtured both his intellect and his creative soul.

Thom attended college in New York, where he studied fine arts and art history, then he returned to Europe. In Belgium, he quickly realized that art would not earn him a living, so he enrolled in medical school in Brussels, taking classes in French and in Flemish.

“That was where I really learned how to study,” he said.

As he studied medicine, Thom also explored his world atlas, always looking for the ideal setting for his future house. He decided it would have to be on the ocean.

The medical profession was ideal for Thom in many ways.

“It is stimulating, your brain never gets stagnant, and there is always something new to learn. You can never know it all.” At the same time, he said, “medicine was never the center point of my life.”

Thom found work as a physician back in the states, but for a long time he continued visiting Europe and working

An arched stone niche Thom built into the wall of his home recalling his love of old European architecture

on his art, often for months at a time. Notwithstanding Europe’s charm, somewhere along the way the state of Maine inserted itself in Thom’s psyche. It felt like home. He took a job in Bangor in 1980 and immediately began looking for land to build on. In September of 1982 he bought a piece of coastal property in South Gouldsboro, overgrown with puckerbrush, and he set to work — practicing medicine and building a house.

“I was living two lives. I was happy.”

The house and grounds, a perpetually evolving work of art, grew to accommodate aging parents and expanding hobbies. Thom and his wife Pamela keep beautiful gardens and a meadow filled with many varieties of fruit trees.

“Fruit trees are his passion,” Pamela said.

I had to laugh. “How many passions do you have, Thom?”

His answer was a thoughtful one. The most important thing, the thread that weaves everything together, he said, is curiosity. Curiosity and patience.

Thom looks forward to retiring before too long, so he’ll have even more time for art. He wants to build a stone bridge over his pond. He is planning to create a stained glass window for a wall in his home. He wants to take a course in welding. And he described his idea, under construction in his mind, for an illustrated children’s book.

In his house by the sea, after a life in faraway places, Thom continually makes the world more beautiful.  Source: https://bangordailynews.com/2012/07/26/living/ curiosity-key-to-life-of-artist-physician/ MEDMONTHLY.COM |55

healthy living

Sesame Sugar Snap Peas with Carrots & Peppers Nothing says spring to me like fresh picked sugar snap peas from the farm. They are bright, crispy, and a light food to snack on during the springtime months, because they are in full season then. The colorful combination of sugar snap peas, red bell pepper and carrot plus an make this Asian flavored side dish a pleasure to whip up for a weeknight dinner. Plus, it is low in calories and high in vitamins and minerals to boost immunity!

By Ashley Acornley, MS, RD, LDN

Nutritional Facts: Calories: 80 Total Fat: 4 g Saturated Fat: 1 g Monounsaturated Fat 2 g Sodium 168 mg Carbohydrate 9 g Fiber 3 g Protein 2 g Potassium 220 mg

Servings: 4 servings Serving Size: 3/4 Preparation Time: 20 mins

Ingredients: Preparation: 1. Place peas, bell pepper and carrot in a steamer basket over 2 inches of boiling water in a saucepan. Cover and steam, stirring once, until a little tender, about 5-7 minutes.

2. Toss with soy sauce, oil, sesame seeds and pepper, as desired.

56 | MARCH 2013

8 ounces sugar snap peas, trimmed (about 2 cups) 1 small red bell pepper, cut into strips (about 1 cup) 1 large carrot, peeled and thinly sliced (about 1 cup) 1 tablespoon reduced-sodium soy sauce 1 tablespoon toasted sesame oil 1 teaspoon sesame seeds Ground black pepper, a pinch

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

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

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

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

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

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

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

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

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

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

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

MEDMONTHLY.COM |57

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Florida 2585 Merchants Row Blvd.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Nebraska Nebraska Department of Health and Human Services P.O. Box 95026 Lincoln, NE 68509 (402)471-3121 http://www.mdpreferredservices.com/ state-licensing-boards/nebraska-boardof-medicine-and-surgery

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

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

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

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

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

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

Nevada Board of Medical Examiners P.O. Box 7238 Reno, NV 89510 (775)688-2559 http://www.medboard.nv.gov/ New Hampshire New Hampshire State Board of Medicine 2 Industrial Park Dr. #8 Concord, NH 03301 (603)271-1203 http://www.nh.gov/medicine/ New Jersey P. O. Box 360 Trenton, NJ 08625 (609)292-7837 http://bit.ly/w5rc8J New Mexico 2055 S. Pacheco St. Building 400 Santa Fe, NM 87505 (505)476-7220 http://www.nmmb.state.nm.us/ New York Office of the Professions State Education Building, 2nd Floor Albany, NY 12234 (518)474-3817 http://www.op.nysed.gov/ North Carolina P.O. Box 20007 Raleigh, NC 27619 (919)326-1100 http://www.ncmedboard.org/

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

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

MEDMONTHLY.COM |61

medical resource guide ACCOUNTING

Ajishra Technology Support

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

ADVERTISING

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

MedMedia9

www.medmedia9.com

Ring Ring LLC

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

ANSWERING SERVICES Corridor Medical Answering Service

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

Docs on Hold

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

BILLING & COLLECTION Advanced Physician Billing, LLC

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

62| MARCH 2013

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

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

VIP Billing

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

Axiom Business Solutions

Find Urgent Care

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

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

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

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

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

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

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

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

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

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

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

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

COMPUTER, SOFTWARE American Medical Software

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

CDWG

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

Instant Medical History

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

medical resource guide CONSULTING SERVICES, PRACTICE MANAGEMENT

DENTAL Biomet 3i

Manage My Practice

103 Carpenter Brook Dr. Cary, NC 27519 (919)370-0504 www.managemypractice.com

Medical Credentialing

(800) 4-THRIVE www.medicalcredentialing.org

Medical Practice Listings

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

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

Dental Management Club

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

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

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

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

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

The Dental Box Company, Inc.

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

DIETICIAN

myEMRchoice.com

DocuTAP

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

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

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

ELECTRONIC MED. RECORDS

Synapse Medical Management

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

Urgent Care America

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

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

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

www.pushpa.biz

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

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

AdvancedMD 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

INSURANCE, MED. LIABILITY Aquesta Insurance Services, Inc.

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

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

Medical Protective

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

MEDMONTHLY.COM |63

medical resource guide INSURANCE, MED. LIABILITY

Nicholas Down http://bit.ly/yHwxb0

Martin Fried MGIS, Inc.

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

Professional Medical Insurance Services

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

Wood Insurance Group

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

LOCUM TENENS Physician Solutions

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

MEDICAL ARCHITECTS

www.martindfried.com

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

Ako Jacintho

chuchinho58@gmail.com www.facebook.com/akojacintho www.akojacintho.com

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

www.dicomsolutions.com

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

www.thetps.com

MEDICAL MARKETING High Performance Network

Julie Jennings

(678)772-0889 juliejenn@silksynergy.com http://silksynergy.com/ http://www.coroflot.com/naddie09

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

MedMedia9

MedImagery

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

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

www.medmedia9.com

medimagery.com

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

MEDICAL EQUIPMENT

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

MEDICAL PRACTICE SALES

MMA Medical Architects

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

ALLPRO Imaging

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

Biosite, Inc

MEDICAL ART Brian Allen

www.artisanprinter.com

Deborah Brenner

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

Pia De Girolamo

64| MARCH 2013

www.piadegirolamo.com

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

www.biosite.com

Cryopen

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

Medical Practice Listings

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

MEDICAL PRACTICE VALUATIONS BizScore

www.cryopen.com

Carolina Liquid Chemistries, Inc.

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

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

medical resource guide

MEDICAL PUBLISHING

PRACTICE FINANCING Bank of America

Greenbranch Publishing

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

MEDICAL RESEARCH

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

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

Dermabond

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

DJO

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

REAL ESTATE

www.djoglobal.com

Arup Laboratories

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

www.aruplab.com

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

www.crlcorp.com

Sanofi US

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

Scynexis, Inc.

ExpertMed

York Properties, Inc.

www.sanofi.us

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

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

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

www.expertmed.com

Gebauer Company

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

Scarguard

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

WEBSITE DESIGN

SUPPLIES, GENERAL

3501 C Tricenter Blvd.

Durham, NC 27713 (919) 933-4990

MedMedia9 www.scynexis.com

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

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

Subscribe to receive Med Monthly e-news Click here to join our e-news subscribers and get current medical news as it happens Visit us online anytime at medmonthly.com MEDMONTHLY.COM |65

Woman’s Practice in Raleigh, North Carolina.

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:

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

• • • • •

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

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

Medical Practice Listings; 919-848-4202

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

classified listings

Classified To place a classified ad, call 919.747.9031

Physicians needed

Physicians needed

North Carolina

North Carolina (cont.)

GP Needed Immediately On-Going 3 Days Per Week at Occupational Clinic General Practictioner needed on-going 3 days per week at occupational clinic in Greensboro, NC. Numerous available shifts for October. Averages 25 patients per day with no call and shift hours from 8:30 am to 5:30 pm. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

Immediate need for full time GP/FP for urgent cares in eastern NC Urgent care centers from Raleigh to the eastern coast of NC seek immediate primary care physician. Full time opportunity with possibility for permanent placement. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

3-5 days per week in Durham, NC Geriatric physician needed immediately 3-5 days per week, on-going at nursing home in Durham. Nursing home focuses on therapy and nursing after patients are released from the hospital. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com GP Needed Immediately On-Going 1-3 Days Per Week at Addictive Diease Clinics located in Charlotte, Hickory, Concord & Marion North Carolina General Practitioner with a knowledge or interest in addictive disease. Needed in October on-going 1-3 times per week. This clinic requires training so respond to post before October 1st. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Primary Care Physician in Northwest NC (multiple locations) Primary care physician needed immediately for ongoing coverage at one of the largest substance abuse treatment facilities in NC. Doctor will be responsible for new patient evaluations and supportive aftercare.

Counseling and therapy are combined with physician’s medical assessment and care for the treatment of adults, adolescents and families. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Pediatrician or Family Medicine Doctor in Fayetteville Comfortable with seeing children. Need is immediate - Full time ongoing for maternity leave. 8 am - 5 pm.

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

General Practitioner Needed in Greensboro Occupational health care clinic seeks general practitioner for disability physicals ongoing 1-3 days a week.

Adults only. 8 am-5 pm. No call required. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Pediatrician or Family Physician Needed Immediately at clinic in Roanoke Rapids, NC Pediatric clinic in Roanoke Rapids, NC seeks Peds physician or FP comfortable with children for 2-3 months/ on-going/full-time. The chosen physician will need to be credentialed through the hospital, please email your CV, medical license and DEA so we can fill this position immediately.

County Health Department in Fayetteville, NC seeks GP/IM/FP Full-Time, On-Going Shifts GP/IM/FP Needed Immediately at County Health Department in Fayetteville, NC. Approximately 20 patients per day with hours from 8 am -5 pm. Call or email for more information. 919-845-0054 physiciansolutions@gmail.com Occupational Clinic in Greensboro, NC seeks FP/GP for On-Going Shifts Locum tenens position (4-5 days a week) available for an occupational, urgent care and walk in clinic.

The practice is located in Greensboro NC. Hours are 8 am-5 pm. Approximately 20 patients/day. Excellent staff. Outpatient only.

continued on page 68

MEDMONTHLY.COM |67

classified listings

Classified

continued from page 67

To place a classified ad, call 919.747.9031

Physicians needed

PT or FT. This practice also is looking for a PA permanently in April.

North Carolina (cont.)

Accommodations, PLI, and mileage provided. Please contact Physician Solutions at 919-845-0054 or emailphysiciansolutions@gmail.com.

Diabetic Clinic 1 hour from Charlotte seeks FP/GP/IM for On-Going Shifts Primary care physician needed immediately for outpatient diabetic clinic one hour outside Charlotte, NC On-going. Hours are 8 am -5 pm with no call. Approximately 15-20 patients a day.

Clinic between Fayetteville and Wilmington seeks FP/ GP/IM Mar 22 FT ongoing. A small hospital’s outpatient clinic located within an hour of both Fayetteville and Wilmington seeks FP/GP/IM to work FT ongoing beginning March 22. Shifts can be either 8 or 12 hours. No call.

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

South Carolina

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

Employee Health Clinic seeks Mid-Level Provider for FT on-going coverage near Charlotte Health Department 45 minutes from Charlotte seeks ongoing coverage for employee health clinic beginning in January. Provider will see about 20-24 patients daily, hours are 8am-5pm with an hour for lunch.

FT Mid-Level Provider needed for Wilmington practice immediately Small private practice 45 minutes outside Wilmington seeks mid-level provider starting January. M-F 8:00-5:00, 68| MARCH 2013

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

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

Physicians needed Virginia Pediatric Locums Physician needed in Harrisonburg, Danville and Lynchburg, VA. These locum positions require 30 to 40 hours per week, on-going. If you are seeking a beautiful climate and flexibility with your schedule, please consider one of these opportunities. Send copies of your CV, VA. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Urgent Care opportunities throughout Virginia. We have contracts with numerous facilities and eight to 14-hour shifts are available. If you have experience treating patients from pediatrics to geriatrics, we welcome your inquires. Send copies of your CV, VA medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, E-mail: physiciansolutions@gmail.com

Classified To place a classified ad, call 919.747.9031

Practice wanted

Practice for sale

North Carolina

North Carolina

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

Contact us today at (919) 848-4202.

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

Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or email: medlistings@gmail.com continued on page 71

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

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

medmonthly.com | 919.747.9031

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

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

Excellent exam room layout, equipment and visibility.

Contact Medical Practice Listings for more information.

Medical Practice Listings 919.848.4202 | medlistings@gmail.com www.medicalpracticelistings.com MEDMONTHLY.COM |69

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

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

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

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

NC OPPORTUNITIES LOCUMS OR PERMANENT

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

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

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

classified listings

Classified

continued from page 69

To place a classified ad, call 919.747.9031

Practice for sale

Practice for sale

North Carolina

North Carolina (con't)

Impressive Internal Medicine Practice in Durham, NC: The City of Medicine. Over 20 years serving the community, this practice is now listed for sale. There are four wellequipped exam rooms, new computer equipment and a solid patient following. The owner is retiring and willing to continue with the new owner for a few months to assist with a smooth transition. Contact Medical Practice Listings at (919) 848-4202 for more information. View additional listings at: www.medicalpracticelistings.com

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

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

Primary Care Practice specializing in women’s care. The owning female physician is willing to continue with the practice for a reasonable time to assist with smooth ownership transfer. The patient load is 35 to 40 patients per day, however that could double with a second provider.

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

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

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

MEDMONTHLY.COM |71

Practice for Sale in Raleigh, NC

Comprehensive Ophthalmic and Neuro-Ophthalmic Neuro-Ophthalmic Practice

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.

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

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

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

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

List price: $435,000

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

Contact Cara or Philip 919-848-4202 for more information or visit 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 72| MARCH 2013

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

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

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

Medical Practice Listings Selling and buying made easy

MedicalPracticeListings.com | medlisting@gmail.com | 919.848.4202

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

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

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

PEDIATRICIAN

or family medicine doctor needed in

FAYETTEVILLE, NC

Comfortable seeing children. Needed immediately.

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 a picturesque part of the state. This practice is positioned in a highly traveled area with positive demographics adding to the business appeal and revenue stream. A sampling of the services and procedures offered are: BOTOX, facial therapy and treatments, laser hair removal, eye lash extensions and body waxing as well as a menu of anti-aging options.

If you are currently a med spa owner and looking to expand or considering this high profile med business, this is the perfect opportunity.

Highly profitable and organized, you will find this spa poised for success.

The qualified buyer can obtain detailed information by contacting Medical Practice Listings at 919-848-4202.

MedicalPracticeListings.com | medlisting@gmail.com | 919.848.4202

PEDIATRICIAN

OR FAMILY MEDICINE DOCTOR NEEDED IN

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

Credentialing at the hospital is necessary.

PRACTICE FOR SALE

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

Asking price: $385,000

Call 919- 845-0054 or email: physiciansolutions@gmail.com www.physiciansolutions.com 74| MARCH 2013

To view more listings visit us online at medicalpracticelistings.com

Wanted: Urgent Care Practice

Med Monthly Med Monthly is the premier health care magazine for medical professionals.

By placing an ad in Med Monthly you’ll reach: family medicine, internal medicine, physician assistants and more!

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.

Call us today to place your classified!

919.747.9031

Medical Practice Listings Buying and selling made easy

Also available online 24/7

medmonthly.com

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

Unfortunately, its motor is inside playing video games.

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

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

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

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

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

American Council on Exercise

®

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

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

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PARAMOUNT

( 8 0 0 )

DRIVE,

8 2 5 - 3 6 3 6

SAN

X 6 5 3

|

DIEGO,

CA

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USA

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compound noun: 1. The action of calling attention to medical goods or services for sale. Exclusively refers to advertising in Med Monthly.

Come see why we’re not your father’s medical journal Scan this code with your smartphone or visit medmonthly.com

Med Monthly 919.747.9031 | medmedia9@gmail.com | medmonthly.com

Internal Medicine Practice for Sale

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

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

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

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

Listing Price: $430,000

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

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

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

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

Contact us today to discuss your options confidentially.

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

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.

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

Contact Medical Practice Listings today to discuss the practice details.

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

www.medicalpracticelistings.com

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

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

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

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

Call for pricing and details.

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

MEDMONTHLY.COM |77

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By Karen M. Rogers, Glacial Multimedia, Inc. MAKE YOUR CONTENT YOURS

It is very important to make the text your own and unique to represent your practice’s standing on the subject at hand.

Duplicate content from another site comes with potential legal implications. It can also have a seriously negative impact on SEO rankings.

2

LEARN THE PROPER WAY TO TAG YOUR BLOG

For your blog articles to work even better in the search engines, it is important to know the proper tagging technique. It is important to consider your searchable keywords when writing your article and making sure those exact terms are in the content and in the tags, including your practice and doctor’s names.

3

MAKE SURE YOUR BLOG IS PART OF YOUR WEBSITE

Make sure your website/ practice benefits from each and every article you write by having your blog installed as part of your website. This makes it so that with every article you write, a page of fresh new content is added to your site.

78 | MARCH 2013

Best B Practices Medical P

ENGAGE YOUR READER TO LEARN MORE OR TAKE ACTION

Some articles may be related to an event, offer, or new service being provided. Provide the user with easy tools to learn more, request an appointment, register for an event, ask a question, etc. This can be done by linking to the appropriate pages on your site from your blog article.

5

MAKE YOUR BLOG A PART OF YOUR SOCIAL MEDIA STRATEGY

A great way to attract attention to your blog and to your website is to make sure your blog is integrated with your social media profiles. You can decide to have your blog articles post to Facebook, which can also post to Twitter. This drives readers to your website (where your blog should live) to learn more about you.

Blogging s for the Practice

6

EXCITE THEN EXPLAIN

Google likes robust and relevant pages on your website, and these pages will rank higher than short articles. So to help the user not get bored, highlight the important items and all the call outs at the beginning of your article, then go into detail about the rest once you have given them the exciting, engaging information.

7

BE CAREFUL LINKING TO EXTERNAL SITES

External links (those that direct your perspective patient away from your website) increase bounce rates and reduce the SEO value of your website and your blog.

The goal is to always work to get incoming links to lead people to your website and blog, increasing the credibility of your site.

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BLOG OFTEN

Keep to a schedule and try to blog consistently about news, events, specials, etc. Creating new blog articles often (3-4 per month) will have a long term positive effect on your SEO ranking results. Write articles that have to do with the key words you are looking to move up in.

ALLOW INTERACTION AND MONITOR

For the medical practice, it’s recommended practices allow the user to comment to articles, pose questions, etc. But make sure you have the opportunity to review posts before making them public, protecting your doctors and patients by making sure the questions and comments are appropriate.

For more information about blogging and Internet marketing for the medical practice please visit http://www.glacial.com/ Source: http://www.glacial.com/company-blog/blog/ detail/2012/07/16/10-best-blogging-practices-for-themedical-practice.html MEDMONTHLY.COM | 79

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Scan this QR code with your smartphone to learn more.

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

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