Med Monthly March 2015

Med Monthly March 2015

the

Front Desk issue

The Hidden Profit Center:

Your Front Desk pg. 30

Utilizing the Front Desk to Gauge Marketing Results pg. 38

PROVIDING A POSITIVE PATIENT EXPERIENCE IN A HIGH STRESS ENVIRONMENT pg. 34

contents features

SEVEN FEATURES TO LOOK FOR WHEN SELECTING A MEDICAL GRADE COMPUTER

12

30 THE HIDDEN PROFIT CENTER: Your Front Desk 34 PROVIDING A POSITIVE PATIENT EXPERIENCE IN A HIGH STRESS ENVIRONMENT

practice tips

38 UTILIZING THE FRONT DESK TO GAUGE MARKETING RESULTS

12 SEVEN FEATURES TO LOOK FOR WHEN SELECTING A MEDICAL GRADE COMPUTER

6

NEW BOOKLET SHOWS WHAT CAN IMPROVE THE WELLBEING OF OLDER PEOPLE

14 BRINGING CORPORATE CULTURE IN MEDICAL PRACTICE MANAGEMENT COULD LEAD TO 3R’S: “Recognition, Recommendation and Revenue”

8

ALCOHOL POISONING KILLS SIX PEOPLE IN THE US EACH DAY

16 HOW TO MAKE A SUCCESSFUL EZINE AND GENERATE PUBLICITY

insight

10 FDA APPROVES NEW DRUG TO TREAT ESTROGEN-RECEPTOR–POSITIVE BREAST CANCER

34

PROVIDING A POSITIVE PATIENT EXPERIENCE IN A HIGH STRESS ENVIRONMENT

research and technology 18 SCIENTISTS IDENTIFY GENETIC CUES FOR A BIG HEART 20 IS IT POSSIBLE TO HAVE THREE GENETIC PARENTS? 22 NIH GRANTS AIM TO DECIPHER THE LANGUAGE OF GENE REGULATION

legal 24 HHS PAYMENT AND DELIVERY REFORM ANNOUNCEMENT SETS PRIORITIES FOR REMAINDER OF OBAMA ADMINISTRATION 26 IRS FINALIZES REGULATIONS PERTAINING TO TAX-EXEMPT HOSPITALS 28 LEGISLATION INTRODUCED TO CHANGE FULL-TIME EMPLOYEE DEFINITION UNDER THE AFFORDABLE CARE ACT

healthy living 40 STUFFED ARTICHOKES

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

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Med Monthly March 2015 Publisher Creative Director Contributors

Philip Driver Thomas Hibbard Ashley Acornley, MS, RD, LDN. Naren Arulrajah Maureen Dorgan Clemens, MS, LCPC, CADC, CPDC Michelle L. Durner, CHBME Vishal Gandhi, BSEE, MBA Barbara Hales, M.D. August Emil Huelle Kaitlyn N. Jakubowski Carrie A Noriega, M.D. Shira Sagal Andrew J. Shin Vikas Vij

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

Michelle L. Durner, CHBME is the President of Applied Medical Systems, Inc. – a Durham, NCbased company which provides medical billing, coding, practice management, and consulting services to start-up practices, hospitals, private practices, and emergency physician groups across the nation. To contact Michelle or to learn more about Applied Medical Systems, visit www.appliedmedicalsystems.com

Vishal Gandhi, BSEE, MBA

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

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

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

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

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

Carrie Noriega, M.D. is a board certified obstetrician/ gynecologist who has worked in both private practice in the US and a socialized medical system.

As an adventure racer and endurance mountain bike racer, she has developed a special interest in promoting health and wellness through science and medicine.

WWW.MEDMONTHLY.COM |5

insight

New Booklet Shows What Can Improve the Wellbeing of Older People

6 | MARCH 2015

beyondblue has identified and rated the best activities for improving and protecting the mental health of older Australians, in a new booklet specifically for aged care workers, but also helpful for other careers.

Based on La Trobe University research, the booklet rates activities on a scale of zero to three for how effective they are at improving older people’s mental health.

Activities identified in the booklet include playing computer games, interacting with clowns, spending time with animals and singing in a choir, among others.

Most activities featured are accompanied by case studies from across Australia, providing real examples of how activities have been implemented and the impact they have had. beyondblue CEO Georgie Harman said the booklet, What works to promote emotional wellbeing in older people, is an invaluable resource for people who work with older adults in community or residential care.

“Around one in ten older adults experiences depression and a similar number experiences anxiety. Mental health conditions are even more common among older people in the community who are frail and need support to remain at home, and among those in residential care.

Research shows nearly 35 per cent of people living in residential care facilities have depression,” she said.

“This resource makes it simple for aged care workers to determine the most effective strategies for improving the mental health of older people.

“Importantly, there are activities in the booklet to suit older people of all physical and cognitive capabilities, including those with memory problems or dementia. These range from physical activities like gardening and tai chi, to relaxation activities like meditation.

“Any aged care worker or concerned family members looking to improve

the mental health of older people needs to read this book.”

The rating of each activity shows how effective it is at improving older people’s emotional wellbeing or helping alleviate depression or anxiety, in both community and residential care.

The ‘zero-to-three’ rating is based on how many studies within the past 15 years have found that the activity is effective, meaning anyone using the booklet can have confidence in the ratings.

The top five most effective activities for improving the emotional wellbeing of older people in community care are exercise, tai chi and qigong, self-help through books (bibliotherapy), computer-based therapies or computer games, and reminiscing on the older person’s life and the challenges they have overcome.

“Every Australian, regardless of their age, deserves good mental health. It keeps people satisfied, optimistic and gives them a sense of purpose and belonging,” said Ms Harman.

“This booklet makes it much easier for those caring for older people to make informed, evidence-based decisions on how to improve their mental health.”

What works to promote emotional wellbeing in older people is available online. Aged care providers, health providers and other relevant organisations can also request a printed version from the beyondblue website here.  Source: http://www.pressreleasepoint. com/new-booklet-shows-what-canimprove-wellbeing-older-people

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insight

Alcohol Poisoning Kills Six People in the US Each Day

More than 2,200 people die from alcohol poisoning each year in the United States – an average of six deaths each day – according to a new Vital Signs report from the Centers for Disease Control and Prevention.

Three in four alcohol poisoning deaths involve adults ages 35-64 years, and most deaths occur among men and non-Hispanic whites. American Indians/Alaska Natives have the most alcohol poisoning deaths per million people.

Alcohol poisoning deaths are caused by drinking a large amount of alcohol in a short period of time. This can result in very high levels of alcohol in the body, which can shutdown critical areas of the brain that control breathing, heart rate, and body temperature - resulting in death.

More than 38 million U.S. adults report binge drinking an average of four times per month and consume an average of eight drinks per binge. Binge drinking is defined as consuming four or more drinks for women and five or more drinks for men on an occasion. The more you drink, the greater your risk of death.

“Alcohol poisoning deaths are a heartbreaking reminder of the dangers of excessive alcohol use, which is a leading cause of preventable deaths in the U.S.” said CDC Principal Deputy Director Ileana Arias, Ph.D. “We need to implement effective programs and policies to prevent binge drinking and the many health and social harms that are related to it, including deaths from alcohol poisoning.”

Alcohol poisoning death rates varied widely across states, from 46.5 deaths per million residents in Alaska to 5.3 per million residents in Alabama. The states with the highest death rates were in the Great Plains, western United States, and New England.

8

| MARCH 2015

CDC scientists analyzed deaths from alcohol poisoning among people aged 15 years and older, using multiple cause-of-death data from the National Vital Statistics System for 2010-2012. Alcohol dependence (alcoholism) was identified as a contributing factor in 30 percent of these deaths, and other drugs were noted to have been a factor in about 3 percent of the deaths. While this study reveals that alcohol poisoning deaths are a bigger problem than previously thought, it is still likely to be an underestimate.

“This study shows that alcohol poisoning deaths are not just a problem among young people,” said CDC Alcohol Program Lead and report coauthor Robert Brewer, M.D., M.S.P.H. “It also emphasizes the importance of taking a comprehensive approach to reducing binge drinking that includes evidence-based community strategies, screening and counseling in healthcare settings, and high-quality substance abuse treatment for those who need it.”

Vital Signs is a CDC report that appears on the first Tuesday of the month as part of the CDC journal Morbidity and Mortality Weekly Report, or MMWR. The report provides the latest data and information on key health indicators. These are cancer prevention, obesity, tobacco use, motor vehicle passenger safety, prescription drug overdose, HIV/AIDS, alcohol use, healthcareassociated infections, cardiovascular health, teen pregnancy, and food safety.  Source: http://www.cdc.gov/media/releases/2015/p0106alcohol-poisoning.html

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insight

FDA Approves New Drug to Treat Estrogen-Receptor– Positive Breast Cancer

10 | MARCH 2015

T

he U.S. Food and Drug Administration approved a new drug to treat patients with advanced breast cancer, signaling a new strategy for arresting tumor growth and extending the time before cancer worsens in women with metastatic disease.

The drug, Ibrance (palbociclib), was studied in 165 post-menopausal women with advanced estrogen– receptor positive (ER+) and HER2– negative (HER2-) breast cancer who had received no prior systemic therapy for their metastatic disease. In 2013, after patients in a clinical study led by UCLA researchers showed a dramatic improvement, the FDA granted the drug “breakthrough therapy” status, allowing it to be fast-tracked for approval.

ER+/HER2- is the most common type of breast cancer; it is traditionally treated with therapies like tamoxifen or letrozole that target the hormone receptor pathway.

“Ibrance is the first drug in its class to be approved by the FDA,” said Dr. Richard Finn, the study’s principal investigator and a researcher at UCLA’s Jonsson Comprehensive Cancer Center. “All of us at UCLA are very proud of the important role we played in bringing this new agent to patients.”

Developed by Pfizer, Ibrance targets proteins in cancer cells — cyclin D kinase 4 (CDK 4) and cyclin D kinase 6 (CDK 6) — preventing the cells from dividing. A multiyear phase 2 study found a significantly higher progression-free survival rate for patients with advanced ER+/ HER2- breast cancer who were given palbociclib in addition to letrozole, a standard anti-estrogen treatment, compared with women who received letrozole alone.

“With the FDA approval, this study represents a potential practicechanging result,” said Dr. Dennis Slamon, director of the Revlon/ UCLA Women’s Cancer Research Program and director of clinical and

translational research at the Jonsson Cancer Center. “I believe palbociclib will now become a standard treatment approach for postmenopausal women with ER+/HER2- metastatic breast cancer.”

Developing Ibrance The research originated in 2007, when Finn and Slamon met with Pfizer to discuss palbociclib and other experimental drugs in the company’s pipeline.

In preclinical trials, the drug showed encouraging results against human breast cancer cells in culture dishes — and specifically against ER+ cancer cells. This led to a clinical study collaboration with Pfizer led by Finn and Slamon built on work at the Jonsson Cancer Center’s Translational Oncology Research Laboratory.

A phase 2 study evaluated the drug in 165 post-menopausal women with advanced ER+/HER2- breast cancer who had not received prior systemic therapy for their metastatic disease. It showed progression-free survival was 20.2 months for patients who received palbociclib plus letrozole, compared with 10.2 months for those who received the letrozole alone. The results also indicated a 51 percent reduction in the risk of disease progression when palbociclib was used with letrozole.

“What is really remarkable is that we doubled the median progressionfree survival,” Finn said. “That type of result is not often seen in cancer medicine.”

Over 80 percent of the women in the study with metastatic ER+ breast cancer received some benefit from the treatment. The drug’s safety profile is distinct from traditional chemotherapy, but it does result in a lowered white blood cell count, which is manageable.

A phase 3 international clinical trial of the drug conducted by Finn and Slamon with Pfizer in approximately 660 people with advanced ER+/HER2breast cancer has been completely enrolled.

Survivor Stories Janet Klein was first diagnosed with stage 1 ER+ breast cancer in 2004, and she decided to undergo a double mastectomy. A few years later, doctors discovered that the breast cancer had returned as metastatic disease in her bones.

Dr. Sara Hurvitz, a UCLA oncologist and member of the Jonsson Cancer Center, told Klein about the clinical trial at UCLA. Klein enrolled and was prescribed Ibrance in combination with an anti-estrogen treatment. Nine months later, her scans showed no evidence of the cancer.

“I had a large party with a lot of champagne,” she said. “It was lifechanging but in a good way.” said Klein.

Klein, now 59, said the FDA approval was cause for more celebration. “Sixty percent of all women diagnosed with this disease have my variety, and this drug having this sort of an impact, so fast and so effectively, is earth shattering.”

Gloria Zollar, 78, joined the phase 2 clinical trial in 2010 after her UCLA oncologist discovered that her advanced breast cancer had spread to her bones. She has been on treatment since then.

But after only a year of treatment, doctors noticed that Zollar’s tumors had stopped progressing — allowing her to remain active and continue playing golf.

“I am now in remission, and every day I’m thankful to God that I’m alive and able to see my great-grandchildren and spend time with them,” Zollar said.

She also is excited that the drug is now available to other women. “I am very pleased that other women could have a second chance at life like many of us who participated in the trial,” Zollar said.  Source: http://www.pressreleasepoint. com/fda-approves-new-drug-treatestrogen-receptor-positive-breast-cancer WWW.MEDMONTHLY.COM | 11

practice tips

Seven Features to Look For When Selecting a Medical Grade Computer

By Shira Sagal Content Manager Teguar Computers 12

| MARCH 2015

Medical Grade Computers are becoming a necessity whether you are practicing in a small clinic or managing major healthcare facilities. With many available choices, it is important to narrow down which features are the most important for your facility so you can ensure the best computer hardware fit.

When choosing a medical grade computer, consider these seven factors:

1. Medical Certification

Electronic Medical Certification has been a requirement in much of Europe for some time and is quickly migrating over to the Americas. If this is a requirement for your facility within the next five years, you will need to find medical grade computers that are EN/UL 60601-1 certified as well as possible general electronic equipment certifications such as LVD, VCCI, CE, FCC Class B and ISO 14971. Medical Electronic certification is put in place to protect the integrity of the system functions, the user, and the patient from receiving electronic surges.

2. Anti-bacterial Coating

Some medical computers have an anti-bacterial coating. This cuts down on the spread of MRSA and other bacteria that can grow on high traffic surfaces. Having an anti-bacterial coating on touch screen medical computers can bring down your HAI (Healthcare Associated Infections) which are tracked by the CDC (Center for Disease Control). Any way to contribute to decreasing overall length of hospital stays as well as the number of post operational infections will improve patient care as well as contribute to better CDC ratings on your facility.

3. EMR/EHR and Other Medical Software Compatible

Medical Grade computers are most commonly used to run EMR/EHR interactive programs or used in conjunction with diagnostics and patient monitoring.

These types of programs require demanding processors which can integrate large amounts of data quickly. Finding the hardware that runs your operating system platform combined with a robust processor will help you to easily run current and future software.

4. Good Device Connectivity with Needed Input / Outputs

As medicine and technology increasingly integrate, it is important to choose a medical grade computer that will connect with medical devices, networks, and sometimes be used as a communication device to connect people. The hardware necessary for this could

include COM ports, USB ports, mics, cameras, RFID readers, barcode scanners, wireless options and more.

5. Great Placement Options and Aesthetics

Many things contribute to creating a healing environment. Some of the most impactful environmental factors often go unnoticed such as color and smooth lines. A medical computer is a core piece of equipment and should be able to be placed anywhere in a healthcare facility while contributing to an overall peaceful aesthetic. Choosing an all-in-one medical pc will greatly reduce wires, clutter and surfaces to collect bacteria. Medical grade computers are typically available in white in order to not visually disrupt a healing environment. A well designed computer will also convey that your facility cares about every detail thus giving patients higher overall satisfaction.

6. Ability to Run 24/7 365

Medical care never stops and there is always an important task at hand. Consumer grade computers are not made to run 24/7 365. The hardware in medical grade computers should be made with industrial grade components so that the internal functions do not burn out. Reliable healthcare computers offer a great ROI (return on investment) as they do not need to be constantly replaced as they are designed to function non-stop for years on end.

7. Great Customer Service

When buying a product, you are putting your trust in the company that sells it. Select a medical grade computer from a company with an excellent reputation among your colleagues and one with industry experience. Get to know your medical grade computer provider to ensure that they will support you through any technical challenge that may come up. Sales reps can guide you in finding a computer with the features you want while explaining the amount of support you can expect to receive over the computer’s lifetime.

A medical grade computer is a major investment, so think strategically and choose one that will support the best possible medical care for your patients while keeping physicians and purchasing officers happy.

Choosing a computer using these seven factors to determine your needs can help you reach an efficient decision.  Shira Sagal is a graduate of Asbury University and now works as the Content Manager for Teguar Computers.

Teguar provides medical grade computers to healthcare professionals in order to help increase their standard of care.

WWW.MEDMONTHLY.COM | 13

practice tips

Bringing Corporate Culture in Medical Practice Management Could Lead to 3R’s:

“Recognition, Recommendation and Revenue”

By Vishal Gandhi, BSEE, MBA Founder and CEO

14

| MARCH 2015

“Management” is a process of dealing with or controlling things, processes, technology or people. Just like any other business, we find success and failure stories in Medical Practice Management as well.

While working with several practices nationwide, I come across practices that are well recognized, well recommended and doing very well financially. In a nutshell, we come across practices that have mastered processes, technology and people management. I call these practices “3R” or well recognized, well recommended, and financially stable institutions.

Let’s analyze the reasons behind the success of “3R” practices. Uniformly, these practices adopted what I call, a “Corporate Culture”.

“Corporate culture refers to the shared values, attitudes, standards, and beliefs that characterize members of an organization and define its nature. Corporate culture is rooted in organization’s goals, strategies, structure, and approaches to labor, customers, investors, and the greater community”.

I would like to describe some of these attributes and their relationship to “3R” (Recognition, Recommendation and Revenue).

Practice has a Mission Statement.

What’s a mission statement anyway? A practice’s mission statement should represent core values and ideals of the founder’s vision for their practice. It should be a constant reminder to the practice’s employees and clients (your patients) of why the practice exists. Furthermore, a good mission statement is the tool by which the practice navigates, and by which patient-centric decisions should be made and measured. This results into recognition, recommendation and financial stability as the practice is driven by a common goal or objective.

Here is an example of a mission statement “It is our Mission and Our Pride to provide excellent quality primary healthcare to every individual, regardless of differences in cultural background or language”.

It is necessary to keep in mind a practice’s ultimate objective while defining the mission statement. These objectives could govern internal and external factors and can clearly define an actionable plan.

A well-defined mission statement leads to establishing core values. The core values are basic elements of how we go about our work. Let’s look at some of these elements.

A practice has a defined language and customs for interaction with their patients.

Standardization in language, customers and interactions lead towards replicable patient experiences. It creates such a positive and motivational environment for patients.

They feel well respected and enjoy coming back to his/her

doctor. This can be a possible referral business as a happy customer will bring good referrals.

A practice systematically records, analyzes and shares patient feedback internally.

Patient survey or feedback results into an indirect evaluation whether our processes/people are working as per the core values. It is an invaluable tool for self-learning and improvement. It makes patients’ feel connected with the practice. It truly brings out a feeling of “My Doctor” with pride.

A practice places greater emphasis on patients’ retention and recall for clinical management.

We have been seeing increased new patient volume in most medical practices due to Obamacare. It is necessary to emphasize on established patients’ clinical care coordination along with taking care of new patients.

A practice should utilize Disease Management and/or Clinical Alerts to make sure that patients’ follow a required care plan for better risk management. A well-defined Risk Management or adherence to a Care Plan can benefit patients and earn additional incentives from payers.

A practice empowers employees to make on-the-spot decisions that enable valueadded and personalized experiences to occur.

It is necessary to define role of each and every individuals in a practice. It is necessary to decentralize power and responsibilities within a practice so that patient concerns are resolved promptly.

A practice believes in Tasks, Milestones and Reminder management.

Most of the complaints in practice management are “Poor Response Time” from staff. A patient may have called in to find out details of blood work or test results, he/she may have to call a few times before someone gets back. It is necessary to have well-defined tasks, milestones and reminder management in place. Most patients’ require reminders for various things including appointments, outside diagnostic tests or medication adherence. A practice utilizing technology/system for above functions would come out ahead compared to others.

I encourage participation from all of you, please add to this article. What is your story, your process, your corporate culture, your success, or challenge? This will certainly help many practices tackle their day-to-day management problems.  WWW.MEDMONTHLY.COM | 15

practice tips

How to Make a Successful Ezine and Generate Publicity

By Barbara Hales, M.D. www.thewritetreatment.com Saying you have been published is impressive to your patients and gives you additional clout.

The thing is, submitting a manuscript for publication in journals is time-consuming and requires a fair amount of research. Even then, a journal may decide not to publish you if you have no academic standing in an Ivy League institution.

There is a much simpler way! (And still affords you the opportunity to tout your publications to patients) I’m talking about an inexpensive and effective tool that carries maximum impact…the Ezine or digital newsletter.

Ezines are much more than a smart tactical business strategy. Your viewers receive solutions to problems they are struggling with and come to rely on you and your information. This is an opportunity that I cherish as it puts me in touch with patients who are appreciative and are empowered to make better health choices.

Benefits to Having Your Own E-zine Exposure in e-zines is one of the surest and most costeffective ways to gain credibility. Its many benefits include: 16 | MARCH 2015

• Building relationships based on trust with your patients. It goes a long way toward relationship building, which is crucial to the acquisition and retention of patients and prospective patients • A means to which your referrals will keep your name in mind over others in the same field.

• Increases the fresh content on your website by links.

This indirectly boosts your ranking with search engines.

• Increases traffic to your website, giving more visibility • Adds links- search engines and spiderbots will find an impressive amount of links to your website. When people do searches about a specific topic that is covered in the newsletter, your name pops up.

• Archives-Placing your ezines in cloud storage, current and new subscribers can access the issues • Keywords- With continued publication of content within the same niche or category; specific keywords become attached to you, giving you more visibility.

• Keeps your name in the mind of your patients and your referrals

By opting in to receive your digital newsletters, subscribers have given you: • Their information for your database • Permission to send them announcements and correspondence • An opportunity to promote your services • A vehicle for your books and product launches Do not send your newsletter to anyone that has not opted in first. To do so, would be considered sending spam.

Do not use subject lines that are sensational but unrelated to the articles within the newsletter. Though you may be tempted to do this for a higher opening rate from your readers, it is a sure way for readers to opt out if they feel that they have been duped. Once you have lost your fans, it is difficult and almost impossible to get them back.

Subject Lines This is the most important device and will determine whether the newsletter is opened or deleted, untouched.

The subject line has to be compelling, grabbing attention and capturing viewers while being true to the content within the issue. Make it less than 60 characters long.

Content to Include You will be creating helpful articles for your newsletter but certain segments are standard. They include: • Welcome • Thank you to your subscribers • Information to unsubscribe as well as sharing with friends and colleagues • Disclaimer • Privacy policy • Contact information • Helpful resources • Relevant and information-filled articles • Premiums or bonuses • Surveys to discover what your viewers are interested in reading • Comment box • Contests • FAQs Feel free to add photos and 1-2 minute videos to your newsletter that your viewers can click on. Videos and photos provide an additional and memorable dimension.

Consider even having a recipe of the week which utilizes all natural organic foods that are rich in vitamins and low in fats, complying with heart health or whichever specialty you are in.

as fans from forums, chat rooms and social media.

However, publishing your ezine from RSS feeds, public directories and referral programs greatly boosts the number of subscribers. Let’s face it, you need subscribers to make newsletter creation worthwhile and maximum exposure means more business for you.

Add your ezine to directories associated with your niche or types of individuals who are likely to seek out your services. Establish referrals from other websites. Advertise your ezines on other websites that have a large audience and are well respected.

Optimizing an RSS feed enables rapid access through other sites, directories and search engines.

Golden Nugget An ezine is a way to get publicity and attention without paying directly for it as you would with advertising spaces, Focus on your clients and patients.  Send for your free copy of “8 Things You Can Do NOW to generate free publicity” at Support@ CompleteContentPackage.com. See how much you currently do and what you can put on your goal list for 2015.

The Write Treatment

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

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

Barbara@TheWriteTreatment.com 516-647-3002

How to Publish your Ezine Of course you will be circulating your newsletter to patients that have expressed a desire to receive them as well WWW.MEDMONTHLY.COM | 17

research & technology

Scientists Identify Genetic Cues for a

BIG HEART

18 | MARCH 2015

Bigger isn’t always better, even when it comes to the body’s most vital organs. An enlarged or thickened cardiac muscle can actually force the heart to work harder to pump blood throughout the body, weakening the organ until it eventually wears out.

Despite the disastrous consequences of oversized organs, researchers have just begun to uncover the circuitry of signals that govern growth.

What they do know comes in large part from genes of the tiny fruit fly, Drosophila melanogaster. Over the years, biologists have deleted or suppressed tens of thousands of genes in the fly genome, aptly naming each one after the unusual characteristics displayed by the resulting mutants.

Deletions in a gene known as Hippo generate flies with unusually large organs. Likewise, defects in a gene called Yorkie create flies with strikingly small organs.

Now, Duke researchers have shown that a different gene, which goes by the decidedly more staid moniker Raf, can act as a type of switch that turns on Yorkie to make fly hearts grow bigger.

They discovered that these hearts bulked up by expanding the size of already existing heart cells, rather than adding new cells.

Our genes are similar enough that the fly study gives insight into a dangerous enlargement of the heart in humans called cardiac hypertrophy, which can result from high blood pressure or certain inherited conditions like Noonan syndrome. The work appeared Feb. 3 in the journal Science Signaling.

“Our finding helps us to better understand how the human heart responds to disease,” said Matthew J. Wolf, M.D., Ph.D., senior author of the study and associate professor of medicine at Duke University School of Medicine. “The question remains, why does it choose to add on mass rather than proliferate new cells? If we could solve that riddle, then we could find ways to manipulate the system to help hearts heal after injury.”

During cardiac hypertrophy, the walls of the heart thicken, decreasing the size of the cardiac chambers and eventually restricting the heart’s ability to pump blood. If left untreated, hypertrophy can cause heart failure, which is usually fatal.

Wolf modeled this condition by activating the Yorkie gene in fruit flies. Unlike the human heart with its complex array of four chambers, four valves, and multiple vessels, the fruit fly heart is simply a linear tube composed of a single layer of 104 heart cells. Wolf and his colleagues were able to visualize enlargement of the tiny beating heart with a method called optical coherence tomography that is something like the echocardiograms used to diagnose heart failure in humans.

Using this method, the researchers could see that the heart walls of the mutants were thicker than normal, creating a much smaller central chamber through which to pump blood. The mutant flies also had weaker heart muscles and shorter lifespans than normal flies.

The researchers then took out the fly hearts – each of them smaller than the head of a pin -- and counted the number of cells to determine whether the heart growth was the result of more cells or bigger cells. The numbers stayed the same, indicating that the cells were growing larger.

The finding reminded Wolf of a fly he had encountered many years back, one whose growth had been fueled by too much activity of a gene called Raf. In humans, mutations in this gene cause Noonan syndrome, an inherited condition that is characterized by a number of physical defects, including an enlarged heart.

Wolf decided to breed fruit flies with Yorkie and Raf mutations to see how the two were related. He took flies that had thin hearts due to a genetic deletion in Yorkie, and bred them with flies that had thick hearts caused by an activated form of Raf. By looking at the offspring of these

‘‘

“The question remains, why does it choose to add on mass rather than proliferate new cells? If we could solve that riddle, then we could find ways to manipulate the system to help hearts heal after injury.”

flies, he could determine whether the two genes were connected in the same signaling pathway or if they were acting independently to tell hearts to grow bigger or smaller. To his surprise, the genes cancelled each other out, yielding flies with hearts of perfectly normal size. In other words, Raf couldn’t activate organs to grow larger without having Yorkie there to switch on.

Next, Wolf would like to see if these same connections hold true in other models of human disease.

He has already acquired a number of transgenic mice and plans to manipulate both Raf and Yorkie to measure their effects on the mouse heart.

“Ultimately, our goal is to try to understand how this pathway influences cardiac hypertrophy, not only within the context of specific conditions like Noonan syndrome, but also in the more general context of hypertension and high blood pressure, with the hopes of finding new targets to treat this disease,” said Wolf.

The research was supported by a grant from the National Institutes of Health (NIH R01 HL116581).  Source: http://www.pressreleasepoint. com/scientists-identify-genetic-cues-bigheart WWW.MEDMONTHLY.COM | 19

research & technology

Is it Possible to Have Three Genetic Parents?

By Carrie A Noriega, MD

The British House of Commons recently voted to allow a new fertility treatment called mitochondrial DNA replacement therapy. While this won’t become a law until it is also approved by the House of Lords, they are the first country in the world that may soon offer an IVF technique that creates a baby with genetic material from three different individuals. The US FDA has begun hearings to consider granting approval for this technique as well, but has not yet reached a decision.

20

| MARCH 2015

The technique to modify maternal mitochondrial DNA (mtDNA) has been developed to help women with mutations in their mitochondrial DNA give birth to offspring who are free of mitochondrial disease. The disease is passed on to offspring either through mutations in the maternal mtDNA or in mutations of nuclear DNA that alter mitochondrial function. Currently, there is no curative treatment for patients affected by mitochondrial disease, so the focus has been on preventing the inheritance of the condition.

Mitochondrial disease is relatively rare, affecting an estimated 11.5 per 100,000 people3. Mutations in mitochondrial function do not lead to the development of one specific disease, rather they create a group of clinically heterogeneous diseases. Since mitochondria are responsible for supplying cellular energy via ATP production, mitochondrial disease tends to affect high energy requiring tissues like the brain, muscle, liver, heart, kidney, and CNS2.

Symptoms associated with the disease include blindness, muscle wasting, deafness, diabetes, seizures, neuropathy, and organ failure3.

Prenatal testing and interpretation for mitochondrial disease is difficult because each individual cell can contain a mixture of both normal and abnormal mtDNA, referred to as heteroplasmy. The percentage of abnormal mtDNA that is seen in a chorionic villus sample may not adequately reflect the percentage of abnormal mtDNA that is present in the rest of the fetal tissue. Additionally, the percentage level may change as the fetus continuous to develop and can continue to change throughout the person’s entire lifetime3. These same limitations for prenatal testing exist for preimplantation genetics as well.

A woman who is at high risk for having offspring affected by mitochondrial disease can use donor oocytes to insure against having an affected child. However, this option does not allow for her to have a genetic link to her children, which isn’t always an optimal choice. By using only the mitochondrial DNA from a donor, a woman can insure that she has an unaffected child while still maintaining a genetic link to that child.

Several techniques have been developed that would make it possible to use a donor’s mitochondrial DNA. While using different methods, all techniques involve injecting the cellular material from a healthy donor egg into an unfertilized egg from a women with mitochondrial disease before undergoing in vitro fertilization. The transferred ooplasm would thus contain the genetic material from three different individuals.

Concerns about this technique among scientists are that potential mismatches between the donor and the host could cause unanticipated problems. Many argue that not enough is known about the long term consequences of this technique to pursue its use in human patients1.

Since this technique permanently alters the genetics of the

future child, any problems could be passed on to future generations.

It is estimated that approximately 150 women per year could benefit from this new technique in the UK4.

So while its use would not be broad, it would offer a new opportunity for reproduction to a group of women who previously had few options.  References: 1 Vogel g, Stokstad E. U.K. Parliament approves controversial three-parent mitochondrial gene therapy. Science Magazine. http://news.sciencemag.org/biology/2015/02/u-k-parliamentapproves-controversial-three-parent-mitochondrial-genetherapy. Feb. 3, 2015. Accessed Feb. 13, 2015 2 Amato P, Tachibana M, Sparman M, Mitalipov S. ThreeParent IVF: Gene replacement for the prevention of inherited mitochondrial diseases. Fertil Steril. 2014 Jan;101(1):31-35.

3 Chinnery P. Mitochondrial disorders overview. In: Pagon RA, et al. GeneReviews. Seattle, WA: University of Washington, Seattle;1993-2015.

4 Gorman G, et al. Mitochondrial donation- How many women could benefit? NEJM. 2015 Jan DOI: 10.1056/ NEJMc1500960.

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research & technology

NIH Grants Aim to Decipher the Language of Gene Regulation

T

he National Institutes of Health has awarded grants of more than $28 million aimed at deciphering the language of how and when genes are turned on and off. These awards emanate from the recently launched Genomics of Gene Regulation (GGR) program of the National Human Genome Research Institute (NHGRI), part of NIH. The GGR program aims to develop new ways for understanding how the genes and switches in the genome fit together as networks.

“There is a growing realization that the ways genes are regulated to work together can be important for understanding disease,” said Mike Pazin, Ph.D., a program director in the Functional Analysis Program in NHGRI’s Division of Genome Sciences. “The GGR program aims to develop new ways for understanding how the genes and switches in the genome fit together as networks. Such knowledge is important for defining the role of genomic differences in human health and disease.”

22 | MARCH 2015

With these new grants, researchers will study gene networks and pathways in different systems in the body, such as skin, immune cells and lung. The resulting insights into the mechanisms controlling gene expression may ultimately lead to new avenues for developing treatments for diseases affected by faulty gene regulation, such as cancer, diabetes and Parkinson’s disease.

Over the past decade, numerous studies have suggested that genomic regions outside of protein-coding regions harbor variants that play a role in disease. Such regions likely contain gene-control elements that are altered by these variants, which increase the risk for a disease.

“Knowing the interconnections of these regulatory elements is critical for understanding the genomic basis of disease,” Dr. Pazin said. “We do not have a good way to predict whether particular regulatory elements are turning genes off or activating them, or whether these elements make genes responsive to a condition, such as infection.

We expect these new projects will develop better methods

to answer these types of questions using genomic data.”

Recipients of the new GGR three-year grants (pending available funds) are:

including the genes that are turned on and off, molecules that are made and receptors that are activated.

Memorial Sloan Kettering Cancer Center, New York City, $3.2 million

Stanford University, Stanford, California, $7.1 million

Principal Investigators: Christina Leslie, Ph.D. and Alexander Rudensky, Ph.D.

Principal Investigator: Michael Snyder, Ph.D.

The body’s immune system can cause inflammation, which plays a central role in some diseases. The investigators will use a mouse model to study genomic mechanisms underlying immune system activity during inflammation.

They will determine what and when genes are turned on and off, and how they are controlled, in the development and activation of two different types of immune cells with opposite functions. One cell type promotes the immune system’s response and inflammation; the other dampens these functions.

Duke University, Durham, North Carolina, $5.9 million Principal Investigator: Timothy Reddy, Ph.D. Researchers will characterize how human lung epithelial cells respond to anti-inflammatory drugs called glucocorticoids (a type of steroid hormone). They will determine what and when genes are turned on and off, and how this process is controlled. They hope to create a model for this type of response, and detail the gene regulation patterns involved. This may allow the researchers to understand how glucocorticoids control both anti-inflammatory and metabolic responses.

University of Massachusetts Medical School, Worcester, $6.1 million Principal Investigators: Jeremy Luban, M.D. and Manuel Garber, Ph.D. Investigators will study a type of immune cell called a dendritic cell as a model with which to explore gene regulation. This cell is part of the innate immune system that, together with the acquired immune system, distinguishes self from non-self and enables the body to react to pathogenic invaders. The researchers will examine the changes that the dendritic cell undergoes when it encounters a pathogen,

Dr. Snyder and his team will study the development of one type of skin cell (keratinocyte) as it develops from an early stage skin cell into a mature cell. To do this, they will examine the network of genes and pathways that control this developmental change. The results may ultimately have implications for better understanding skin biology and hundreds of skin disorders.

University of California, Los Angeles, $6 million Principal Investigators: Alexander Hoffmann, Ph.D. and Douglas Black, Ph.D. Researchers will study the immune system’s response to pathogens. They will examine how a type of white blood cell called a macrophage reacts to a bacterial pathogen, which can result in the activation of more than 1,000 genes. This model system will allow the scientists to examine various steps in the gene expression pathway to try to better understand some of the control mechanisms involved.

The grant numbers of the awards are: 1U01HG007893-01; 1U01HG007900-01; 1U01HG007910-01; 1U01HG007919-01; and 1U01HG007912-01.

NHGRI is one of the 27 institutes and centers at the National Institutes of Health. The NHGRI Extramural Research Program supports grants for research and training and career development at sites nationwide. Additional information about NHGRI can be found at http://www.genome.gov.  About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Source: http://www.nih.gov/news/health/jan2015/nhgri-05. htm WWW.MEDMONTHLY.COM | 23

legal

HHS Payment and Delivery Reform Announcement Sets Priorities for Remainder of Obama Administration

By Andrew J. Shin Director, Health Care Policy & Life Sciences Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C. 24 | MARCH 2015

‘‘

It marked the first time the Administration had set out comprehensive and bright-line metrics to gauge progress towards delivery and payment reform goals.

One week prior to the unveiling of the President’s first budget under a completely Republican-controlled Congress, the Department of Health and Human Services (HHS) made its most formal announcement yet on the Obama Administration’s efforts to reduce total Medicare and Medicaid spending.

Citing success in expanding coverage to “many more Americans,” HHS Secretary, Silvia Burwell, penned a perspective piece in the New England Journal of Medicine, outlining the Obama Administration’s plan going forward. Burwell laid out her priorities within three categories: 1. Using incentives to motivate higher-value care by increasingly tying payment to value through alternative payment models; 2. Changing the way care is delivered through greater teamwork and integration, more effective coordination of providers across settings, and greater attention by providers to population health; and 3. Harnessing the power of information to improve care for patients.

In large part, the announcement came as a restatement of the broad portfolio of initiatives already undertaken by the Administration to improve or maintain the quality of health care while reducing total spending, in particular for the Medicare program.

Burwell pointed to the Accountable Care Organization (ACO) program as a sign of early success, saving the Medicare program roughly $417 million to-date. Additionally, preliminary estimates demonstrate that various quality improvement initiatives ranging from Quality Improvement Organizations (QIOs) to hospital readmission penalties, have helped improve quality while potentially saving $12 billion from 2010 to 2013.

When combined with efforts in partnership with state Medicaid programs through innovative waivers and grant funding, it is clear that the Obama Administration has already invested a considerable amount of time and resources into delivery and payment reform. This includes significant resource allocations in both scope and staff to carry out these various initiatives such as the Medicare-Medicaid Coordination Offices (Duals Office), CMS Innovation Center, and Office of Enterprise Data and Analytics as a few recent examples.

Beyond the summary of current programs, the Burwell announcement did mark two new issues for stakeholders to consider: 1. It marked the first time the Administration had set out comprehensive and brightline metrics to gauge progress towards delivery and payment reform goals; and 2. The creation of the “Learning Action Network” to align efforts and accelerate the transition to more value-based payment and delivery models via a public-private collaborative of stakeholders.

Many stakeholders, especially providers, have cited multi-payer approaches as the best way to achieve truly transformative efforts and system redesign. Although Medicare and Medicaid can often represent the dominant payor for many providers, without alignment of payment systems, quality measures, and data sharing among other attributes, most experts believe that providers will be limited in their ability to transform care.

Interestingly, in what many perceive as a coordinated announcement, a task force consisting of major health systems and payers announced two days later their intent to move 75% of their business into value-based models by 2020. The alliance of private sector stakeholders is led by Trinity Health CEO and former CMS official, Dr. Rick Gilfillan. Other similarly-themed announcements by industry coalitions spanning employers to health systems are expected soon as industry stakeholders jockey to shape national efforts to support (or at least not hinder) their own local and regional ones.  Source: http://www.healthlawpolicymatters.com/2015/02/02/hhs-payment-and-deliveryreform-announcement-sets-priorities-for-remainder-of-obama-administration/ WWW.MEDMONTHLY.COM | 25

legal

IRS Finalizes Regulations Pertaining to Tax-Exempt Hospitals

By Kaitlyn N. Jakubowski Associate Barnes & Thornburg LLP

The IRS recently released final regulations clarifying requirements added by Affordable Care Act to the Internal Revenue Code, which charitable hospitals must meet in order to maintain their tax-exempt status. Those statutory requirements provide that charitable hospitals must: • Establish and widely publicize a written financial assistance policy clearly describing to patients the eligibility criteria for obtaining financial assistance and the method of applying for such assistance; • Limit the amounts charged for emergency or other medically necessary care to individuals eligible for assistance under the hospital’s financial assistance policy; • Make reasonable efforts to determine whether an individual is eligible for assistance under the hospital’s financial assistance policy before engaging in extraordinary collection actions against the individual; and • Perform a community health needs assessment at least once every three years.

The final regulations expand access to translations for patients, by lowering the threshold for having translations 26 | MARCH 2015

of financial assistance policies available from 10 percent of the community served to the lesser of 5 percent of the community served or population expected to be encountered by the facility, or 1,000 persons.

Additionally, the final regulations revise the notification requirements. Charitable hospitals must still issue general notifications regarding their financial assistance policy on bills and in the hospital. Now, however, individual written and oral notifications are only required when the hospital plans to use extraordinary collections actions, such as reporting a debt to a credit bureau, selling the debt to a third party, or garnishing wages.

The first three requirements listed above took effect shortly after the ACA passed 2010; the last took effect in 2012. Charitable hospitals have been required to make a good-faith effort to comply with them since their effective dates and must continue to do so. The regulations finalize the requirements and provide time for hospitals to fully phase into them.  Source: http://www.natlawreview.com/article/irs-finalizesregulations-pertaining-to-tax-exempt-hospitals

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Legislation Introduced to Change Full-Time Employee Definition Under the Affordable Care Act

By August Emil Huelle Associate Epstein Becker Green On January 7, 2015, U.S. Senators Susan Collins (R-ME) and Joe Donnelly (D–IN) along with Lisa Murkowski (R-AK) and Joe Manchin (D-WV) introduced the Forty Hours is Full Time Act legislation that would amend the definition of a “full-time employee” under the Affordable Care Act to an employee who works an average of 40 hours per week. In the coming days, the House is expected to vote on its own version of this legislation, the Save American Workers Act. The teeth of the Affordable Care Act have the ability to sink excise taxes on employers who do not offer affordable healthcare coverage to fulltime employees, which the Affordable Care Act defines as employees who work an average of 30 hours per week.

In announcing the introduction of the legislation, Senator Collins argued that the current definition “creates a perverse incentive for businesses to cut their employees’ hours so they are no longer considered full time.”

The implication being that the Forty Hours is Full Time Act will increase employee wages because the employers who reportedly reduced employee hours below 30 per week in an effort to avoid costs associated with providing 28 | MARCH 2015

healthcare coverage to employees (or the tax for not providing coverage to employees) are the same employers who will raise employee hours above 30 per week if they are not faced with such costs.

A cost estimate issued by the Congressional Budget Office states that legislation changing the definition of full-time employee would not only add $53.2 billion to the deficit between 2015 and 2025, but it would cut the number of people receiving healthcare coverage through employers by roughly 1 million and increase the number of uninsured by less than 500,000 people. The Congressional Budget Office also explains that such legislation would reduce the number of employers required to pay excise taxes for not providing coverage to employees.

In a January 7, 2015 Statement of Administrative Policy, the Executive Office of the President stated that the Administration strongly opposes the introduced legislation because it would significantly increase the deficit, shift costs to taxpayers, reduce the number of Americans with employer-based health insurance coverage, and create incentives for employers to shift their employees to part-time work – causing

the problem it intends to solve. It appears that the President would veto any bill increasing the 30 hour threshold.

If the introduced legislation is signed into law, it will be welcomed news for employers and likely alleviate the aforementioned perverse incentive to cut employee hours. If the introduced legislation is not signed into law, employers should tread carefully when considering changes in employee hours to avoid the ACA mandate, as other laws may be triggered when implementing such a change. For example, section 510 of the Employee Retirement Income Security Act prohibits employers from taking employment actions that have the purpose of interfering with an employee’s right to benefits under an employee benefit plan. Prudence suggests employers contact their legal counsel prior to restructuring employee hours or otherwise modifying their employee benefit plans in an attempt to circumvent current requirements under the ACA.  Source: http://www. employeebenefitsinsight.com/2015/01/ legislation-introduced-to-change-fulltime-employee-definition-under-theaffordable-care-act/

WWW.MEDMONTHLY.COM | 31

features

The Hidden Profit Center:

By Michelle Durner, CHBME Applied Medical Systems, Inc. Your front desk staff are the first people to greet your patients when they walk through your door and the last people they see when they leave. They have the ability to set your patients at ease before their visit begins and to tie up all loose ends when it is over. They collect a seemingly endless amount of information about the patient, from demographic details to ever-changing insurance information, and are responsible for making sure that 30 | MARCH 2015

everything is up to date. Regardless of this, the front desk staff, and the importance of their job function to both your practice and your patients, is greatly underrated in today’s healthcare environment.

Imagine a scenario where a patient receives a statement from your practice and is being charged the full cost of your services as a self pay, even though the patient presented their insurance card at the time of the visit.

YOUR FRONT DESK

their friends and co-workers about the time and effort they spent on something that should have been handled already. And let’s hope etc., etc. You get the point. It is in your best interest to get all of this right the first time.

There is no debating that the revenue cycle continues to become more cumbersome. What used to take two steps now takes four, and there is generally a pitfall somewhere in the middle.

So how can you ensure that your front desk staff aren’t just the people that answer the phones and check patients in, but are also recognized as a profit center to your practice? Easy, the best way to beat cumbersome is with knowledge and expertise.

Hiring

Long gone are the days of hiring just anybody for the front desk. Your front desk staff is the gatekeeper to your practice. They will be the liaison between provider and patient and will likely be the first impression that the patient has of you, the provider. Job responsibilities at the front desk now range from customer service to collector to scheduler to insurance guru, and sometimes these responsibilities change on a daily basis.

Expertise

While your front desk staff may not actually do your billing, they should at least have the knowledge of what elements are necessary to file a clean claim. Demographics, eligibility, preauthorizations, referring providers, co-pays, coinsurance, deductible, etc. They should understand the purpose and importance of each task that they perform and how essential each is to the revenue cycle and your bottom line.

Information

Already frustrated, the patient now has to take the time out of their own busy day to call the office and update their insurance information. Hopefully they have no issue getting through to the right person in your office and everything is updated and a new claim is sent immediately.

And let’s hope that the original statement was sent in a timely manner and the claim is not approaching the filing limit. And let’s hope that the patient doesn’t complain to

Every time a patient visits you should verify their demographic and insurance information.

Verifying does not mean asking “Has any of your information changed since the last time you were here?”. Have the patient tell you their address and phone number and ask to see their insurance card.

Once you have the insurance card in hand, check the eligibility. Just because you are looking at an insurance card does not mean that the coverage is active.

Depending on your technology, eligibility checks can be done through EMRs, your clearinghouse, phone calls or a website search. An eligibility check will provide you with information regarding a patient’s co-pay, coinsurance and/ continued on page 32 WWW.MEDMONTHLY.COM | 31

continued from page 31

or deductible levels and will set the stage for a discussion with the patient regarding the amount that you will collect from them at that time.

Make sure that you have an eligibility process in place that is efficient for your office even if it means an extra expense. In a chaotic office environment, comprehensive eligibility checks are often one of the first tasks to be skipped because people assume that “billing” will catch any issues that arise. However, by the time the claim reaches billing, it will be too late to collect the proper co-pay from the patient or to discuss coverage.

Better yet, have your registration process available through your website so that it can be done ahead of time.

At a minimum, have forms available on your website so that they can be brought in already completed. The more efficient you are on the front end, the better the experience for the patient and the more efficient your front desk staff can be.

Also, depending on your specialty, a pre-authorization could be required before you see the patient. If that’s the case, that should be done PRIOR to the patient presenting for their scheduled appointment. Pre-authorizations can be very time consuming, and similar to co-pays, you need to have an efficient system for handling them. Spend the time to figure out what works best for the flow in your office.

Additionally, the front desk staff should be able to discuss a patient’s account or have a dedicated contact that can speak to the patient while they are at the provider’s office. Chances of collecting an outstanding balance are far higher face to face than via the post office. This is key and is the point of failure in most offices. Your practice is a place of business and your front desk needs to treat it as such. There will occasionally be difficult conversations about outstanding balances, co-pay collections, etc. and it is important that your front desk staff is prepared to have these conversations. When they occur, knowledge is your most powerful defense. The better your front desk staff understands why an outstanding balance is what it is, the better chance they have of explaining it in a way that the patient can understand.

Nuances

In addition to the front desk basics already discussed, there are always nuances that are specific to the state, the MAC, the plan and/or the patient. As an example, with the Affordable Care Act, there are new plans being added to existing carriers. Just because you participate with a carrier does not mean that you are automatically enrolled in ALL the plans that are offered. Have someone on your front desk or billing staff that can stay on top of new plans that your patients have and can keep the rest of your staff 32

| MARCH 2015

updated so that they know what to look out for.

Other potential issues revolve around simple data collection so your staff needs to be diligent and not distracted when checking a patient in. Something as trivial as a date of birth being incorrect or using someone’s nickname vs. the name on their insurance card can automatically eliminate the chances of a clean claim.

Additionally, the more information that is given to the patient via the front desk, the more accepting they will be to your policies and procedures. If it’s clear that you expect payment at time of service then the patient comes prepared. If you make sure that the patient understands preventative visits versus medical visits and how that impacts their co-pay then there are no surprises and no resulting disgruntled patients. The reason for the patient’s visit, or chief complaint, drives the type of service that they are going to be billed for. Be clear and be persistent.

Everyone on your front desk staff should handle the checkin / check-out process in exactly the same way.

Training

The healthcare industry is quickly changing. Without continuous training for your staff, they cannot serve you and your patients to their best ability. Local medical societies are a great resource for staff training. Your clearinghouse or billing company should offer training opportunities. Finally, there is no shortage of free webinars available these days. If you allow your staff just an hour a month for training, the difference in your bottom line will more than make up for the time you set aside for them to train.

Another free training option is to have your billing staff communicate with your front desk regarding errors and denials that originated from the front desk. Discuss ways to avoid the errors and create processes that the front desk can follow while still maintaining their general flow of work. Most people want to do the best possible job, but if they aren’t given the proper training and feedback then they will not be successful.

Customer Service

Finally, your patients are no longer just “patients”, they are consumers. As consumers, they shop around, they compare pricing and they choose providers who provide the best overall experience. Though extremely important, time spent with the physician is just one part of their visit. Your front desk is a key function of that consumer experience and they can make it an exceptional experience or they can cause the patient to leave feeling frustrated and underappreciated. The front desk is a key factor in patient loyalty and it is up to you to build a strong front desk staff and to take the time to provide the support that they need to be successful. An ounce of prevention... 

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features

Providing a Positive Patient Experience in a High Stress Environment

By Maureen Dorgan Clemens, MS, LCPC, CADC, CPDC

Much has been written about what makes great customer service. The definition usually includes responsiveness to the customer, the ability to resolve issues, timeliness and friendliness. Most of us have experienced great customer service at some time in our lives; an instance where we feel acknowledged, responded to and cared for. A great patient experience has those same elements. In healthcare, having the patient feel acknowledged, responded to and cared for is essential because many patients find themselves in a vulnerable position coming into a healthcare setting. Sometimes it is just routine healthcare services but other times the patient can feel anxious, uncertain and, depending on the reason for his or her appointment, afraid.

34 | MARCH 2015

To give the patient that needed attention and care right from the beginning is very important but can be challenging to the office staff who may be feeling stress of their own from high patient volumes, scheduling mishaps, demands from the physicians, and understaffing.

Work stress is significant in many occupations including healthcare. A nationwide poll by the American Psychological Association (APA) showed that approximately 75% of Americans experienced substantial work stress and half noted that their productivity had decreased because of stress(1). The cost of stress in the workplace is high and is seen in terms of absenteeism, “presenteeism” (defined as an employee being present at work but not engaged or focused), employee turnover and negative physical and psychological symptoms (2).

Chronic stress often times can lead to burnout, a syndrome commonly seen in helping professions of all types, and very evident in healthcare. In the early 1980’s, social psychologist Christina Maslach began researching the concept of burnout in high stress work environments. She saw burnout as the result of chronic stress that developed from a variety of environmental causes that included such risk factors as work overload or excessively high work volume, lack of control or the feeling of powerlessness to effect change and make decisions to improve the situation, and insufficient reward or the lack of acknowledgement of one’s individual contributions (3).

Today’s healthcare setting has many, if not all, of the environmental risk factors that Dr. Maslach identified. A case in point is medical center receptionists. Receptionists

are on the front lines of health care. One study reveals that over two-thirds of receptionists surveyed reported being verbally abused by patients. 60% reported telephone abuse and 55% reported face to face abuse (4). The same study showed that most receptionist feel that physicians fail to respect the complexity of their work. These are just a couple of the reported stressors added to issues for all office personnel such as insufficient staff, decreasing resources and increased patient volumes. A 2013 survey of healthcare employees found that 60% of healthcare workers say that, because of their working conditions, they are feeling burned out by the demands of their jobs with 21% percent saying they always or often feel burned out. Of those who say they always or often feel burned out, 67% plan to look for a new job (5).

Physician dissatisfaction and staff dissatisfaction tend to feed off one another. An overly stressed doctor can be angry and critical and abusive. Studies have shown that in the last few years there has been a notable increase in physician stress and burnout and the situation is only getting worse.

The 2015 study clearly showed not only is physician stress and burnout prevalent, but it is increasing. Almost 66% of the over 2000 respondents indicated more stress and burnout than in the 2011 study, 88% of all respondents identified themselves as moderately to severely stressed and 46% specified severe stress and burnout. Common sense and a wealth of evidence tells us that an unhappy stressed out work environment makes for a poor patient experience. continued on page 36

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continued from page 35

By the same token, a staff member who is stressed and moving toward burn out will be more prone to mistakes, be more disorganized or just stop caring about the quality of his or her work. This adds more stress on an already overextended physician. For more information on this topic and the most recent data regarding physician burnout please visit www.VITALWorkLife.com/survey/Stress.

Symptoms often seen in high stressed healthcare settings are: • Poor communication or miscommunication. In a stressful office environment information is sometimes thought to be communicated when in fact it has only been partially communicated, if at all. Often the poor communication stems from the assumption, “She/he should know” • Unclear Expectations. Staff are not sure of the office manager’s or the physician’s expectations. They may feel pulled in different directions because they are getting mixed messages. Often times you hear, “they think we can read their minds and get angry when we can’t”.

• Unclear roles and responsibilities. Tension and frustration can build when there is a lack of clarity regarding roles and responsibilities. Instead of accomplishing the task at hand, team members are likely to waste energy negotiating rules and protecting turf. In an office where there are “multiple bosses” (physicians) these issues can be magnified.

• Disrespectful Interactions. If staff and physicians have difficulty managing conflict or difference of opinion, it can result in frustration overload that can lead to angry outbursts or chilly silences. Both of these responses can increase the tension in an already stressed environment.

Taking steps to improve communication and decrease stress.

The best way to develop an accurate assessment of the stress level in a high demand environment is to regularly gather observations from the staff about their work environment and experiences. This can be accomplished by:

Office Manager Rounding

On a regular basis the office manager can check in with each staff person by asking a few key questions to see how the employees are doing and if they have any suggestions for improvement. This brief inquiry can help you stay on top of any developing problems and concerns and allows you to proactively solve issues.

36 | MARCH 2015

Anonymous Staff Surveys

This can take the form of a brief 8-10 question Survey Monkey questionnaire or a full employee engagement survey administered by the institution. Any format that allows you to query your staff and get honest feedback about what is working well, what needs improvement and what are suggestions for improvement is valuable. One caveat is that if you do a survey, review the information and report back to your staff about what you discovered and what steps will be taken to respond to the feedback. Nothing is more frustrating to employees than to be asked to take time to fill out multiple surveys with no action taken on the feedback.

Once information has been gathered it can be examined for themes and reoccurring issues. When these themes have been identified, getting input and ideas for solutions from the staff and the physicians is essential. One way this can be accomplished is by implementing Inter-professional work groups – these are small groups of identified staff and physicians committed to meet on a regular basis to review the information gathered by the surveys, identify priorities and present solutions for change. These solutions and action steps are then presented to the leadership for review and implementation.

In order to increase communication and provide clarity regarding expectations as well as de-stressing the office environment, a helpful solution is BID Huddles – 3 minute stand up meeting that takes place twice a day that brings together the physician and any staff involved with patient flow. It serves as a staff and physician check in that improves communication and also a proactive tool to trouble-shoot patient or office concerns. Find more information about this method at http://www.thehappymd. com/blog/bid/289959/Physician-Leadership-Patient-Flowand-Team-Huddle-POWER-Training In order to help members of the office staff feel their

contributions are valuable it is important to acknowledge the good work being done. A good way to do this is using Recognition tools – There are many ways to reward and recognize performance. Examples include words of appreciation when you see that person in the hallway, a hand written thank you note, or a team recognition event held regularly to acknowledge work above and beyond.

These efforts can be driven by an office manager or a Reward and Recognition Team who implement recognition events. However you do it, it is important to acknowledge and celebrate the wins.

Engaged employees are the primary drivers for delivering an exceptional patient experience. Paying attention to the sources of stress in a medical office, actively engaging in dialogue with staff and physicians on ways to improve the workplace environment and then taking action to make it better benefits the staff, the physicians and most importantly the patients.  1. American Psychological Association. Overwhelmed by Workplace Stress? You Are Not Alone.https://www2.kumc. edu/PDFATraining/Admin/documents/Long%206.11.09%20 Handouts.pdf 2. McKee, MG, Ashton K. Stresses in Daily Life. Lang R, Hensrud DD (eds). Clinical Preventative Medicine. 3rd ed.

Chicago, IL: AMA press, 2004. 81-89.

3. Maslach C. Burnout: The Cost of Caring. Cambridge, MA: Malor Books; 2003 4. Dixon CAJ, Tompkins CNE, Allgar VL, Wright NMJ. Abusive behavior experienced by primary care receptionist: a cross sectional survey. Family Practice 2004;21(2):137-139 5. Career Builder press release, April 30, 2013. More than one third of health care workers plan to look for new jobs this year. http://www.careerbuilder.com/share/aboutus/ pressreleases.aspx 6. 2015 Stress and Burnout Survey, VITAL WorkLife and Cejka Search, February 2015,

Maureen Dorgan Clemens, MS, LCPC, CADC, CPDC

Maureen has 23 years of experience in working collaboratively and effectively with health care leaders and physicians. She has consulted, trained and coached many physicians, executives, healthcare leaders and supervisors regarding the topics of leadership, effective communication, collaboration, effective team work and conflict resolution. Maureen has helped those she has coached to further develop their strengths in order to navigate the demanding healthcare environment.

Maureen is a Certified Physician Development Coach and one of her areas of practice is coaching individuals with disruptive or unprofessional behavior. Her coaching program is designed to help participants increase self-awareness, develop more productive communication skills and identify effective strategies to deal with stress. She provides services to physicians at all levels of the organization including those in leadership positions as well as residents and fellows.

Maureen has facilitated and participated in behavioral interventions with physicians and residents and also helped design a Physician Peer Mentor Program based on the Vanderbilt University Medical Center model that trains volunteer physician mentors to intervene with colleagues in the early stages of problematic behavior.

In addition to her Masters in Clinical Psychology and Licensed Clinical Professional Counselor (LCPC) credential, she holds a certificate in Human Resources Consulting, is a Certified Addictions Counselor as well as a Certified Physician Development Coach.

Ms. Clemens is a physician consultant and member of the Advisory Team for VITAL WorkLife™, a national behavioral consulting company with providers in every major city and wide-ranging expertise in every aspect of behavioral health. VITAL WorkLife is the only company today providing healthcare organizations and practitioner’s easy access to the help they need. Dedicated teams of experienced medical and behavioral health practitioners understand the unique needs of doctors and their families, and deliver the services needed to help overcome work and life challenges.

WWW.MEDMONTHLY.COM | 37

features

Utilizing the Front Desk to Gauge Marketing Results

By Naren Arulrajah with Vikas Vij Ekwa Marketing The front desk at your healthcare practice can perform an interesting qualitative task without having to spend any extra time or effort. Your office front desk can prove to be a crucial link in your online marketing campaign and help you gauge the marketing results effectively. All you need to do is install an automated call tracking system at the front desk to determine which specific marketing strategies, tools and campaigns are generating patient inquiries, and which are not.

Identifying Your Marketing Strengths When your office receives a phone call from a new patient seeking an appointment, it can be difficult to guess whether the patient came to know about you through your website, social media, Google+ listing, or an online ad that you have placed somewhere. If you knew this, over a period of time, you will have a pattern before you to analyze which of the sources are proving to be your marketing strengths, and which are your weaknesses.

This will allow you to redirect more of your marketing time, money and effort on what is working, and review what is wrong with the others. That makes call tracking one of the simplest and most effective tools of monitoring returns on investment (ROI) pertaining to different marketing channels. With this innovative technology, the haze or mystique that often surrounds online marketing, 38 | MARCH 2015

with regard to whether it is really working or not, is finally getting cleared.

How Does it Work?

Call tracking integrations will enable you to use a unique phone number for each specific marketing campaign or a specific page on your website, social network, blog, or e-newsletter as well as traditional offline marketing channels such as a direct mailer or a billboard. Different phone numbers for each of these channels will let you compare, say, how many calls you are receiving via your website homepage and how many through a direct mailer or a billboard during a specified period of time.

You can also use call tracking to determine which of your specific website pages are producing the highest ROI by placing different phone numbers on different landing pages. This will give you an insight into whether it is the homepage, the contact page, the About Us page, the patient testimonials page, or the page for a particular healthcare procedure or technology that is generating the maximum inquiries.

Motivation for the Front Desk Call tracking technology also provides you with the ability to listen to a recording of the phone call. This lets

the front desk staff members know that their conversations with patients are subject to review and even become a source of incentive for them, if they perform their task in an outstanding manner.

At the same time, you get an opportunity to gain valuable patient insights about their prime concerns from such call recordings. You can even determine when a patient made their first, second, or twentieth phone call during the entire patient lifecycle.

For online based marketing campaigns, call tracking is particularly proving to be highly successful and popular.

You can give your practice that necessary marketing and analytical edge, and optimize the results with more targeted efforts with this simple front desk support strategy.  About the Author: Naren Arulrajah is President and CEO of Ekwa Marketing, a complete Internet marketing company which focuses on SEO, social media, marketing education and the online reputations of Dentists and Physicians.

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

WWW.MEDMONTHLY.COM | 39

healthy living

Stuffed Artichokes

(Adapted From All Recipes)

By Ashley Acornley, MS, RD, LDN

Ingredients:

• 6 whole artichokes • 3 slices Italian bread, cubed • 1 clove garlic, minced • 1/8 cup chopped fresh parsley • 1/4 cup grated Romano or Parmesan cheese • 1/2 teaspoon dried oregano • 6 tablespoons vegetable oil, divided • Salt and pepper, to taste

Preparation: 1. Snip the pointed tips of artichoke leaves, and cut off the stems. Wash and drain. Holding artichoke firmly by base, firmly rap the top of it on a hard surface; this will open it so it can be stuffed.

2. In a medium bowl combine bread cubes, garlic, parsley, Romano cheese, oregano, 2 tablespoons vegetable oil, salt and pepper; mix well.

3. Press about 1/2 cup of stuffing into each artichoke. Tightly pack stuffed artichokes together in a large heavy saucepan or Dutch oven. Add enough water to reach half way up artichokes and add 4 tablespoons oil.

4. Bring to a boil over high heat; reduce heat to low and simmer, covered, for 1 hour, or until leaves pull out easily.

40

| MARCH 2015

Nutrition Information: Calories: 175 Carbohydrates: 11.6g Fat: 13.2g Protein: 4g Cholesterol: 5mg Fiber: 4.8g Sodium: 149mg

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Delaware Cannon Building, Suite 203 861 Solver Lake Blvd.

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

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

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

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

| MARCH 2015

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Florida 2585 Merchants Row Blvd.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

WWW.MEDMONTHLY.COM | 45

medical resource guide ACCOUNTING

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

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

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

CODING SPECIALISTS Place Your Ad Here

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

Urgent Care America

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

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

46 | MARCH 2015

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

The Dental Box Company, Inc.

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

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

ELECTRONIC MED. RECORDS

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

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

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

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

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

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

LOCUM TENENS Physician Solutions

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

MEDICAL ARCHITECTS MMA Medical Architects

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

medical resource guide MEDICAL ART

MEDICAL PRACTICE SALES

Deborah Brenner

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

Medical Practice Listings

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

MedImagery

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

MEDICAL EQUIPMENT

MEDICAL PRACTICE VALUATIONS

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

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

www.assurepharma.com

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

www.thetps.com

Capri Health

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

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

BizScore

Assured Pharmaceuticals

PROFESSIONAL SPEAKER

MEDICAL RESEARCH

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

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

Scynexis, Inc.

3501 C Tricenter Blvd.

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

MEDICAL EQUIPMENT FINANCING Bank of America

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

SUPPLIES, GENERAL PRACTICE FINANCING Bank of America

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

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

www.bankofamerica.com/practicesolutions

MEDICAL MARKETING WhiteCoat Designs

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

WWW.MEDMONTHLY.COM | 47

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

Family Primary Care Practice

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

Family Practice/Primary Care

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

Med Spa

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

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

Practice Type: Internal Medicine

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

Dental Practices Place Your Ad Here

Optical Practices Place Your Ad Here

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

Considering your practice options? Call us today.

48 | MARCH 2015

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

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

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

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

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

Medical Practice Listings Selling and buying made easy

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

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

of the oldest Locums companies 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

PEDIATRICIAN

or family medicine doctor needed in

FAYETTEVILLE, NC

l One

l Large

Please direct all correspondence to driverphilip@gmail.com.

Only serious, qualified inquirers.

Comfortable seeing children. Needed immediately.

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

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

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

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

Medical Practice Listings Buying and selling made easy

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

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

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

Medical Practice Listings l 919-848-4202 l medlisting@gmail.com l medicalpracticelistings.com

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

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

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

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

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

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

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

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

Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624 PH: (919) 845-0054 | email: physiciansolutions@gmail.com WWW.MEDMONTHLY.COM | 51

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

List price: $435,000

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.

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

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

Modern Med Spa Available

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

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

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

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

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

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

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

Contact: Cara or Philip at 919-848-4202

medlisting@gmail.com medicalpracticelistings.com

Adult & pediAtric integrAtive medicine prActice for sAle This Adult and Pediatric Integrative Medicine practice, located in Cary, NC, incorporates the latest conventional and natural therapies for the treatment and prevention of health problems not requiring surgical intervention. It currently provides the following therapeutic modalities: • • • • •

Conventional Medicine Natural and Holistic Medicine Natural Hormone Replacement Therapy Functional Medicine Nutritional Therapy

• • • • • •

NC Opportunities DENTISTS AND HYGIENISTS

Mind-Body Medicine Detoxification Supplements Optimal Weigh Program Preventive Care Wellness Program Diagnostic Testing

There is a Compounding Pharmacy located in the same suites with a consulting pharmacist working with this Integrative practice. Average Patients per Day: 12-20 Gross Yearly Income: $335,000+ | List Price: $125,000

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

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

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

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

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

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

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

Medical Practice Listings Selling and buying made easy

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

PEDIATRICIAN

OR FAMILY MEDICINE DOCTOR NEEDED IN

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

Credentialing at the hospital is necessary.

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

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

Women’s Health Practice in Morehead City, NC

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

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

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

Listing Price: $430,000

Medical Practice Listings Buying and selling made easy

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

Primary Care Specializing in Women’s Health

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

Located on NC’s Beautiful Coast, Morehead City

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

919.848.4202 medlisting@gmail.com medicalpracticelistings.com WWW.MEDMONTHLY.COM | 55

Physician Solutions, Inc. Medical & Dental Staffing

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

Physician Solutions

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

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