Med Monthly November 2013

NOVEMBER 2013

Health Centers to Help Uninsured Americans Gain Affordable Health Coverage pg. 40

Community Health Center, Inc. Launches Coaching Program Aimed at Improving the Quality of Healthcare pg. 42

the alth

e County H nts & e Departm h ity Healt Commun Centers

issue

Affordable Care Act Making New Roads:

Drawing Doctors to Rural America pg. 44

contents

features

42

COMMUNITY HEALTH CENTER, INC. LAUNCHES COACHING PROGRAM

40 HEALTH CENTERS TO HELP UNINSURED AMERICANS GAIN AFFORDABLE HEALTH COVERAGE 42 COMMUNITY HEALTH CENTER, INC. LAUNCHES COACHING PROGRAM 44 ACA MAKING NEW ROADS: Drawing Doctors to Rural America

insight 10 HEALTH MARKET TIP: HOW TO OPTIMIZE YOUR SITE 12 ESTROGEN BREAST CANCER LINK 14 REPORT BY CDC DETAILS TODAY’S DRUG-RESISTANT HEALTH THREATS

practice tips 16 SURVEY ASSESSES VIEWS OF PHYSICIANS REGARDING CONTROLLING HEALTH CARE COSTS 20 HOW TO GROW YOUR PRACTICE 22 5 REASONS WHY ONLINE MARKETING SHOULD BE PART OF YOUR MARKETING PLAN

international 24 CLOUD FEVER GRIPS ASIA-PACIFIC HEALTH CARE MARKET LEARNING THE ART OF OBSERVATION

46

research and technology 26 GENES VARIANTS FOUND ASSOCIATED WITH HUMAN IMMUNE SYSTEM, AUTOIMMUNE DISEASE 28 BETTER, FASTER LAB REPORTS HELP STATES’ OUTBREAK RESPONSE 30 MINI-GASTRIC BYPASS PERFORMED WITH SPIDER® SURGICAL SYSTEM

legal 32 BIPARTISAN AGREEMENT REACHED ON LEGISLATION GRANTING FDA GREATER AUTHORITY TO REGULATE DRUG COMPOUNDERS 34 ACTION STEPS NOW TO COMPLY WITH THE AFFORDABLE CARE ACT 36 THERE’S AN APP FOR THAT: FDA ISSUES FINAL GUIDANCE ON MOBILE MEDICAL APPS

the arts 46 CLASS HELPING FUTURE DOCTORS LEARN THE ART OF OBSERVATION

healthy living 48

PUMPKIN SOUPS

in every issue 4 editor’s letter 8 news briefs

56 resource guide 76 top 9 list

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editor’s letter The Affordable Care Act is the most comprehensive change in health care since Social Security was enacted in 1935. The effect of this sweeping legislation will cause shock waves throughout the medical community. Med Monthly’s November issue focuses on how county health departments and community health centers will deal with the new legislation.

Our president recognizes the fact that in enrolling more individuals in nationwide health care coverage will be an arduous task. Therefore, Health and Human Services has awarded $150 million to county and community health centers to educate people regarding their insurance options and inform them of their eligibility assistance. Our feature “Health Centers to Help Uninsured Americans Gain Affordable Health Coverage” underlines the willingness of the government to support the health centers that provide a good deal of the services to those who are in most need of health coverage.

“Community Health Center, Inc., Launches Coaching Program Aimed at Improving the Quality of Healthcare” is a feature that describes the collaboration of community health centers in the US and England. Their program, called Project ECHO Coaching International, is designed to “improve the way health care is delivered; from scheduling and coordinating care, to patient flow, to managing test results and helping patients with their care.” These coaches are instrumental in helping centers become accustomed to the new regulations in the ACA, and their numbers are growing.

The greatest need for doctors is in the rural areas. As more Americans become insured, the burden on these centers will exponentially grow. In the article “Affordable Care Act Making New Roads” a list of ACA initiatives to recruit physicians to rural areas is delineated. A few of the ideas include allocating a greater amount of money for scholarships for rural based physicians and redistribution of residency training.

The road to health care reform will be rocky but beneficial in both the long and short term. Therefore, it is important for all of us to be as knowledgeable about how it applies to individuals and families to make healthier and happier communities.

Our next issue focuses on selling your practice.

Ashley Austin Managing Editor

4 | NOVEMBER 2013

Med Monthly November 2013 Publisher Philip Driver Managing Editor Ashley Austin Creative Director Thomas Hibbard Staff Illustrator, Writer and Journalist Laura Maaske Contributors Ashley Acornley, MS, RD, LDN Roy Albert Patrick M. Allen Eliza Cole Lori Gertz Barbara Hales, M.D. Amanda Kanaan Seth Mailhot Helen McNeal Karen Peart William Rawls, MD

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

Lori Gertz is the chief genius at her 15 year old strategic marketing company, Freakin’ Genius Marketing. Her intense focus on brand building is further strengthened by her uncanny ability to weave pointsof-difference through all of the tactical solutions, most specifically 1:1 marketing solutions. Her Amazon Bestselling book, Be the News: A Guide to Going Viral With Your Human Interest Story contains even more ideas and resources to grassroots marketing techniques, most specifically media relations.

Barbara Hales, M.D.

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

We are currently accepting articles to be considered for publication. For more information on writing for Med Monthly, check out our writer’s guidelines at medmonthly.com/writers-guidelines P.O. Box 99488 Raleigh, NC 27624 medmedia9@gmail.com Online 24/7 at medmonthly.com

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

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

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illustrator's thoughts

Affordable Care Act Making New Roads

As the medical illustrator and editorial artist for Med Monthly, our publisher asked me to illustrate Med Monthly’s November 2013 cover. The Affordable Healthcare Act, with its shift in perspective towards rural America, brought me to wonder what are we looking to? What do we want from this initiative? Health insurance itself is not much more than 100 years old, in the U.S. But if we can accomplish this great aim to offer healthcare more equally to all Americans, urban or rural, we’ll be a fairer place to live, and a little bit closer to our ideals.

October 21, 2013 6 | NOVEMBER 2013

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

Call us today at 919-833-3836 x141

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

news briefs

BD SUPPORTS THE FDA’S PROPOSAL TO RECLASSIFY RAPID INFLUENZA TESTS BD (Becton, Dickinson and Company), a leading global medical technology company, supports the U.S. Food and Drug Administration’s (FDA’s) proposed reclassification of rapid influenza detection tests. A hearing, held on June 13th by FDA’s CDRH Microbiology Devices Advisory Committee Meeting, examined the FDA’s proposal to reclassify rapid influenza detection tests (RIDTs) currently regulated as Class I devices, into Class II devices.

The recent 2009 flu pandemic has emphasized the poor performance of point-of-care flu tests available at the time. The new performance standards will provide healthcare providers with criteria for evaluating the tests that they use. The proposal would increase performance requirements for RIDTs to attain at least a sensitivity of 90 percent for influenza A and 80 percent for influenza B versus viral culture and/ or 80 percent versus polymerase chain reaction (PCR) methods. If these minimum clinical performance criteria are not met, marketed devices will need to be withdrawn from the market one year after the rule is finalized. This proposal culminates years of publications showing that many of the visual read RIDTs had poor sensitivity when compared to viral culture and to reverse transcription PCR methods.

“This proposal is a step in the right direction as physicians and hospitals routinely rely on rapid diagnostic influenza tests to help manage patients that are suspected of having influenza,” said Tom Polen, President, BD Diagnostics Diagnostic Systems. “Raising the standards of rapid influenza tests will provide healthcare providers the right information to guide patient diagnosis and treatment without requiring repeat testing.”

BD pioneered the development of a higher performing test platform two years ago with the launch of the BD Veritor™ System Flu A+B test. BD recognized the need for an improved test early and developed and launched the first CLIAwaived flu test referenced to PCR that provides objective results on an easy-to-read digital display. Negative test results do not preclude influenza viral infection and should not be used as the sole basis for treatment or other management decisions.

Source: http://www.newswiretoday.com/ news/132966/ 8 | NOVEMBER 2013

Healthcare Delivery Is Changing; Consumer-Centric Focus Drives Future of Care Netsmart, the leading provider of clinical solutions for health and human services organizations nationwide, today announced availability of a white paper, “Five Clinical Trends Impacting Healthcare Today.”

Co-authored by Dennis Morrison, Ph.D., chief clinical officer, Netsmart, and Ian Chuang, M.D., chief medical officer, Netsmart, the white paper delves into five emerging themes in the always-evolving world of healthcare and their impact on the way healthcare is delivered now and in the future. The white paper is available at www.ntst.com/whitepapers.

The five emerging trends include: consumer-directed healthcare, increased accountability, changing demographics and attitudes, new clinical delivery models and personalized medicine. Two common threads within these trends are that consumers are taking more control of their own healthcare and the role of clinicians is expanding beyond just care provider to coordinator of care.

“The trends outlined in this white paper impact healthcare as a whole, are interrelated and influence each other in a variety of ways,” said Michael Valentine, chief executive officer, Netsmart. “The clinical care world is evolving rapidly toward a higher degree of engagement and involvement by consumers. As they move further along in the journey toward integrated care, it’s imperative that health and human services providers be aware of these trends and address them in their strategic business and clinical planning processes.”

Netsmart recently hosted a series of no-cost, clinically-focused Web seminars for health and human services providers. The programs were based around the theme of technology within integrated care and presented by Netsmart subject matter experts and industry partners. Viewers can learn about the various opportunities for healthcare integration and hear strategies from real-world providers who are already achieving successes with these models. The Web seminars are available for viewing on demand at http://www.ntst.com/summerseries/.

The Five Clinical Trends white paper and other Netsmart white papers on topics of interest to health and human services providers are available for download on the Netsmart website.  Source: http://www.pressreleasepoint.com/netsmartreleases-white-paper-five-clinical-trends-impactinghealthcare-today

Hospitals and Laboratories Look for Cost-effective Test Panels Enabling Simultaneous Autoimmune Diseases Testing Successful autoimmune disease awareness campaigns are encouraging patients to seek clinical diagnostics even for general symptoms such as fatigue and gastrointestinal distress, spurring the global autoimmune disease diagnostics market. The rising incidence of gastrointestinal autoimmune conditions, primarily celiac disease, also promotes testing.

As a result, market revenue is estimated to reach $1.0 billion in 2018 from $712.5 million in 2012, according to the new Global Autoimmune Disease Diagnostics Market analysis from Frost & Sullivan (lifesciences.frost.com).

For more information on this research, please email Jennifer Carson, Corporate Communications, at jennifer.carson[.]frost.com, with your full name, company name, job title, telephone number, company email address, company website, city, state and country.

The U.S. market will be the highest contributor to the growth of the global autoimmune disease diagnostics market, especially as the Patient Protection and Affordable Care Act expands health coverage to at least 19.5 million people in the country. The increase in the number of beneficiaries will lead to higher diagnostic testing of patients with autoimmune disease symptoms.

“Large advertising campaigns for relatively new autoimmune disease medications treating a wide variety of autoimmune diseases, including rheumatoid N O O S arthritis, chronic plaque COMING NTHLY psoriasis, Crohn’s disease, O IN MED M ankylosing spondylitis, ing m o c p u psoriatic arthritis, and In the ed

ue, M r 2013 iss e b m e c e D l be theme wil Monthly’s e ur Practic Selling Yo

polyarticular juvenile idiopathic arthritis improved patient awareness,” said a Frost & Sullivan Healthcare research analyst. “The subsequent growth in testing volumes will prompt clinical laboratories to employ advanced autoimmune disease diagnostic tests.”

However, due to the broad range of symptoms associated with autoimmune diseases, clinicians regularly struggle to derive the correct diagnosis, compelling some physicians to question the value of autoimmune disease diagnostics.

In fact, as much as 30 percent of healthy patients test positive incorrectly and undergo unnecessary therapies and procedures.

Moreover, several autoimmune disease diagnostic tests are designed for manual operation, and the shortage of skilled technicians limits uptake. Handling certain therapies such as enzyme-linked immunosorbent assay kits and indirect immunofluorescent assays (IFA) that are often designated as highly complex becomes all the more difficult.

This created immense demand for automated diagnostic platforms that facilitate rapid and efficient testing.

“Test panels that enable the simultaneous use of multiple autoimmune disease diagnostics will provide the greatest value,” said the analyst. “Although the price per test may decline, escalating sale volumes will fuel market growth.”

As hospital and reference laboratories globally look to enhance productivity and cost-efficiency, consolidation is an inevitable trend. As a result, vendors must address their customers’ increasing demand for automated diagnostic platforms that enable rapid and efficient laboratory testing.  Source: http://www.newswiretoday.com/news/134300/

WWW.MEDMONTHLY.COM |9

insight

Health Market Tip:

How to Optimize Your Site

(Or How to Choose the Right Keywords)

Is Website SEO Driving You Crazy?

10 | NOVEMBER 2013

By Barbara Hales, M.D.

M

any doctor’s offices, medical practices, health facilities and small businesses simply don’t understand the importance of optimizing a site, don’t have the money to hire someone who can deal with Search Engine Optimization (SEO) or know how to go about it themselves.

Here are some tips for optimizing Your Site:

1) Make the site content-rich Whether it is article publishing, ezines or blogs, content is a key part of SEO nowadays.

Published content and keywords is what search engines detect while crawling online and then they index the site and the content.

Incorporating an active blog to your website is a great SEO tactic, but many doctors complain that there just isn’t enough time to write content.

While it’s ideal to add a new blog post every day, it’s understandable that that’s just not possible for many businesses. Instead, consider having a weekly blog and get each employee to write one. Have an editorial calendar to organize the type of blog, what keyword the blog will be focusing on and what the topic will be in addition to when it will be published.

2) Incorporate social media into your content publishing Like content marketing, social media is also now an important component of an SEO campaign. There are plugins that you can use on your blog site that will automatically post your blogs to each social media site (twitter, linkedIn, Facebook) Use social media to promote content and engage with others.

Using keywords and sticking to them allows the search engine sites to know what your website purpose is, what your niche is and what types of solutions you provide as well as getting an understanding for who your target market is. Selection of the right keywords is crucial to good SEO implementation.

7 Tips to choosing the best keywords 1) Think like your client -The first step in selecting the keywords that will work most effectively is to put yourself in the shoes of your ideal client. What words would this person key in when doing a search (that also describes what you or your business does)

2) Use long-tail keywords - Combine 2-3 words together as a descriptive phrase for your products or services.

Make them specific but not so technical that a person who is not in the trade can still understand and still be apt to search these words. Don’t make them too vague or generic because you will then be competing with everyone in that genre. The trick is in the balance so that they search for a topic and you stand out, leading the pack.

3) Look at Your Website - Ask yourself, “What are all the topics that I provide solutions for?” “What words could be used that describe each product, service or feature”?

4) Look at Your Location - if you are a brick and mortar business, having your geographical location of your business works very well. When people are searching for a type of non-virtual business, most will search for the company that is closest to them. E.G. Instead of plumber, one would look for “Hartford, Connecticut Plumber”.

5) Look at Your Competition - See what other businesses are using for keywords in your niche, for ideas. Find them in the keyword tags (which you can find under source in the View tab of your browser) 6) Be Keyword Savvy - Using a keyword tool to run your selections through is vital to success. While you may have chosen the words, which seem perfect, your clients may not have the same mind frame. Entering your keywords in these programs will confirm how effective they are. Not only will keyword tool programs show how effective the keywords you entered are, these programs will also suggest word combinations that most people search for so that you can add these to your list for consideration.

7) Use an analytical program - the keywords that you have chosen are not etched in stone. Search engine optimization for your site is an ongoing process. By using an analytical program, you can see which words received the most attention and which words got no visits. You can then adjust your list accordingly until the results are satisfactory.

While in the investigative stage, you may want to enroll in a pay-per-click program for a nominal investment per month, which will tell you how many impressions are received for each keyword you are working with. When the results become blatant, you can continue with a free analytical program (e.g. Google Analytics Tool) Is optimizing your site giving you anxiety? It doesn’t have to. Outsource it for others to do.  WWW.MEDMONTHLY.COM |11

insight Proving that breast cancer is linked to estrogen is not difficult. If a woman has had her ovaries removed at a very young age, and does not receive estrogen replacement, her risk of breast cancer decreases profoundly.

Of course, the side effects of this procedure are increased risks of all other diseases, especially heart disease, and the body begins aging rapidly. Even so, by necessity, this scenario has occurred many times over the years, enough to establish a firm baseline. Having functional ovaries that produce estrogen defines a certain risk of breast cancer.

But the baseline has not been stable; the past seventy-five years has seen a dramatic rise in breast cancer. The increase has to be estrogen related, and the extra estrogen has to come from somewhere, but where? Initially experts speculated that birth control pills might be the source. This is an obvious choice - oral contraceptives contain estrogen, and if breast cancer is estrogen related, adding estrogen would certainly increase risk.

Actually it doesn’t work that way. Low dose birth control pills suppress estrogen produced by the ovaries, so the little bit of estrogen added by the pill does not raise total estrogen levels. In other words, it’s a wash. Even though the type of estrogen in oral contraceptives is synthetic, it is metabolized similarly to natural estrogen, and therefore extra stimulation of breast tissue does not occur. Thirty years of studying the use of low dose pills has not defined any significant increased risk of breast cancer. So take a deep breath and relax. (However, taking oral contraceptives for ten years or greater does decrease the risk of ovarian cancer by 50%!)

Postmenopausal estrogen replacement has also been targeted as an explanation for the rise in breast cancer and here we might have some traction. For the past fifty years the standard for postmenopausal hormone 12| NOVEMBER 2013

replacement has been conjugated equine estrogens (Premarin). Not a single estrogen, but a combination of different estrogens derived from horses. This product is very stimulating to breast tissue. Twentyfive percent of the product’s estrogens have no look-alike in the human body and are slowly metabolized.

The process of conjugation slows metabolism and increases potency even further. When the Women’s Health Initiative, (a large study done in 2001 to evaluate postmenopausal hormone replacement) showed that conjugated equine estrogens increase risk of breast cancer, it should not have been a surprise, but use of Premarin does not explain the dramatic rise in breast cancer that has occurred in premenopausal women.

It has to be related to estrogen; and if women are not producing more estrogen and birth control pills have been proven safe, then it must be coming from the environment. Bingo... the rise in breast cancer has directly paralleled the rise in environmental toxins; many (if not most) of which have estrogenic activity. Virtually all pesticides have estrogenic activity and many byproducts from the plastic industry are estrogenic. Insidiously, these chemical compounds make their way into the food supply and water supply. Even meat from the grocery store is suspect. Hormones are readily used in the livestock industry to encourage growth. Add to that the pesticides from the corn and soybeans the animal consumes every day and finding an association between red meat consumption and increased breast cancer risk is not surprising!

How do you enjoy a lifetime of having normal ovaries, live in the modern world, and NOT get breast cancer? The answer has two parts.

The first is awareness. Toxins with estrogen-like activity (sometimes called xenoestrogens) can enter the body by only three different routes.

They can be ingested in drinks and

food, breathed in a through the lungs or absorbed through skin. The solutions are obvious. Eat organic whenever possible. Lean toward fresh vegetables and fruit and cut back on meat and dairy (with the exception of fresh fish and farm eggs). Avoid processed food. Filter your water.

Never microwave food in a plastic container. Keep your drinking liquids in glass containers. Live in a place with clean air. Be careful about things that you rub on your skin.

The second is detoxification.

Elaborate detoxification protocols are really not required; the body is designed for detoxification; it just needs a little help. Cruciferous vegetables (cabbage, cauliflower, kale and especially broccoli) help the liver detoxify estrogen and estrogen-like compounds through a pathway that actually decreases risk of breast cancer.

Fiber from fresh vegetables and fruit helps pull toxins out of the body.

Hydration is also important, and the best hydration is from a source that most people don’t think about. Living cells inside fresh vegetables and fruit hold a lot of water. As the food is digested during the day, clean water is slowly and continually released; perfect for the detoxification process (compare this to the dehydrated stuff in processed food that actually requires water for digestion).

Certain supplements can enhance the detoxification process. Milk thistle is top on the list. This well-studied and well-tolerated herb is known to protect liver cells, increase bile flow (important for flushing the liver and getting toxins out of the body) and encourages regeneration of liver cells.

About 400-600 mg per day is enough for the average person. Beyond milk thistle, there are scores of natural and herbal supplements that can protect liver function, improve detoxification and decrease cancer risk. Anyone and everyone should take advantage of this extraordinary resource. 

Estrogen Breast Cancer Link

By William Rawls, MD

Awareness is essential!

Cultivate good health into your life!

WWW.MEDMONTHLY.COM |13

insight

UNTREATABLE: Report By CDC Details Today’s Drug-resistant Health Threats

LANDMARK REPORT RANKS THREATS, OUTLINES FOUR CORE ACTIONS TO HALT RESISTANCE Every year, more than two million people in the United States get infections that are resistant to antibiotics and at least 23,000 people die as a result, according to a new report issued by the Centers for Disease Control and Prevention. The report, Antibiotic Resistance Threats in the United States, 2013, presents the first snapshot of the burden and threats posed by antibiotic-resistant germs having the most impact on human health. The threats are ranked in categories: urgent, serious, and concerning.

Threats were assessed according to seven factors 14 | NOVEMBER 2013

associated with resistant infections: health impact, economic impact, how common the infection is, a 10-year projection of how common it could become, how easily it spreads, availability of effective antibiotics, and barriers to prevention. Infections classified as urgent threats include carbapenem-resistant Enterobacteriaceae (CRE), drugresistant gonorrhea, and Clostridium difficile, a serious diarrheal infection usually associated with antibiotic use.

C. difficile causes about 250,000 hospitalizations and at least 14,000 deaths every year in the United States.

“Antibiotic resistance is rising for many different pathogens that are threats to health,” said CDC Director Tom Frieden, M.D., M.P.H. “If we don’t act now, our medicine cabinet will be empty and we won’t have the antibiotics we need to save lives.”

In addition to the toll on human life, antibiotic-resistant infections add considerable and avoidable costs to the already overburdened U.S. health care system. Studies have estimated that, in the United States, antibiotic resistance adds $20 billion in excess direct health care costs, with additional costs to society for lost productivity as high as $35 billion a year. The use of antibiotics is the single most important factor leading to antibiotic resistance. Up to 50 percent of all the antibiotics prescribed for people are not needed or are not prescribed appropriately.

Antibiotics are also commonly used in food-producing animals to prevent, control, and treat disease, and to promote growth. As in humans, it is important to use antibiotics in animals responsibly. To help ensure that medically important antibiotics are used judiciously in food-producing animals, the U.S. Food and Drug Administration recently proposed guidance describing a pathway for using these drugs only when medically necessary and targeting their use to only address diseases and health problems.

“Every time antibiotics are used in any setting, bacteria evolve by developing resistance. This process can happen with alarming speed,” said Steve Solomon, M.D., director of CDC’s Office of Antimicrobial Resistance. “These drugs are a precious, limited resource—the more we use antibiotics today, the less likely we are to have effective antibiotics tomorrow.”

The loss of effective antibiotic treatments will also undermine treatment of infectious complications in patients with other diseases. Many medical advances— joint replacements, organ transplants, cancer therapy, rheumatoid arthritis therapy – are dependent on the ability to fight infections with antibiotics. If the ability to effectively treat those infections is lost, the ability to safely offer people many of the life-saving and life-improving modern medical advances will be lost with it.

To combat this serious health threat, CDC has identified four core actions critical to halting resistance: 1. Preventing Infections, Preventing the Spread of Resistance: Avoiding infections reduces the amount of antibiotics that have to be used and reduces the likelihood that resistance will develop. Drug-resistant infections can be prevented by immunization, infection prevention actions in healthcare settings, safe food preparation and handling, and general hand washing.

2. Tracking: CDC gathers data on antibiotic-resistant infections, causes of infections, and whether there are particular reasons (risk factors) that cause some people to get a resistant infection. With that information,

experts can develop strategies to prevent those infections and prevent the resistant bacteria from spreading.

3. Improving Antibiotic Use/Stewardship: Perhaps the most important action needed to greatly slow the development and spread of antibiotic-resistant infections is to change the way antibiotics are used.

Up to half of antibiotic use in humans and much of antibiotic use in animals is unnecessary. The commitment to always use antibiotics appropriately and safely —only when they are needed to treat disease – and to choose the right antibiotics and to administer them in the right way in every case is known as antibiotic stewardship.

4. Developing Drugs and Diagnostic Tests: Because antibiotic resistance occurs as part of a natural process in which bacteria evolve, it can be slowed but not completely stopped. Therefore, new antibiotics always will be needed to keep up with resistant bacteria, as will new tests to track the development of resistance.

To see the full report, please visit www.cdc.gov/ drugresistance/threat-report-2013/. For more information about drug resistance and the serious impacts it has on human health, visit www.cdc.gov/drugresistance.

Source: http://www.cdc.gov/media/releases/2013/p0916untreatable.html

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practice tips

SURVEY ASSESSES VIEWS OF PHYSICIANS REGARDING CONTROLLING HEALTH CARE COSTS In a survey of about 2,500 U.S. physicians on their perceived role in addressing health care costs, they reported having some responsibility to address health care costs in their practice and expressed general agreement with quality initiatives that may also reduce cost, but expressed less enthusiasm for cost containment involving changes in payment models, according to a study in the July 24/31 issue of JAMA. “The increasing cost of U.S. health care strains the economy.

Because physicians’ decisions play a key role in overall health care spending and quality, several recent initiatives have called on physicians to reduce waste and exercise wise stewardship of resources. Given their roles, physicians’ perspectives on policies and strategies related to cost containment and their perceived responsibilities as stewards of health care resources in general 16 | NOVEMBER 2013

are increasingly germane to recent pending and proposed policy reforms,” according to background information in the article.

Jon C. Tilburt, M.D., M.P.H., of the Mayo Clinic, Rochester, Minn., and colleagues conducted a survey of physicians about their views on several potential proposed policies and strategies to contain health care spending, assessed physicians’ perceived roles and responsibilities in addressing health care costs, and ascertained physician characteristics associated with those views. The survey was mailed in 2012 to 3,897 U.S. physicians randomly selected from the American Medical Association Masterfile. A total of 2,556 physicians responded (response rate = 65 percent). The survey included respondents rating their level of enthusiasm (not, somewhat, or very enthusiastic) toward 17 specific means of reducing health care costs,

including but not limited to strategies proposed in the Patient Protection and Affordable Care Act; and agreement with an 11-measure costconsciousness scale.

The researchers found that most respondents believed that trial lawyers (60 percent), health insurance companies (59 percent), hospitals and health systems (56 percent), pharmaceutical and device manufacturers (56 percent), and patients (52 percent) have a “major responsibility” for reducing health care costs, whereas only 36 percent reported that practicing physicians have “major responsibility.” Most physicians were “very enthusiastic” for “promoting continuity of care” (75 percent), “expanding access to quality and safety data” (51 percent), and “limiting access to expensive treatments with little net benefit” (51 percent) as a means of reducing health care costs.

Few respondents expressed enthusiasm for “eliminating fee-forservice payment models” (7 percent).

“Most physicians reported being ‘aware of the costs of the tests/treatments [they] recommend’ (76 percent), agreed they should adhere to clinical guidelines that discourage the use of marginally beneficial care (79 percent), and agreed that they ‘should be solely devoted to individual patients’ best interests, even if that is expensive’ (78 percent) and that ‘doctors need to take a more prominent role in limiting use of unnecessary tests’ (89 percent),” the authors write.

Most physicians (85 percent) disagreed that they “should sometimes deny beneficial but costly services to certain patients because resources should go to other patients that need them more.” In models testing associations with enthusiasm for key cost-containment strategies, having a salary plus bonus or salary-only compensation type was independently

associated with enthusiasm for “eliminating fee for service.” Also, group or government practice setting and having a salary plus bonus compensation type were positively associated with cost-consciousness.

“U.S. physicians’ opinions about their role in containing health care costs are complex. In this survey, we found that they express considerable enthusiasm for several proposed cost-containment strategies that aim to enhance or promote high-quality care such as improved continuity of care. However, there is considerably less enthusiasm for more substantial financing reforms, including bundled payments, penalties for readmissions, and eliminating fee-for-service reimbursement; Medicare pay cuts are unpopular across the board. They were also more likely to identify other groups, rather than physicians, such as insurers, lawyers, hospitals, and health systems, as having a major responsibility to reduce cost. These

data document professional sentiments about addressing health care costs and speak directly to the acceptability of several key policy strategies for curbing those costs,” the authors write.

“Moving toward cost-conscious care in the current environment in which physicians practice starts with strategies for which there is widespread physician support might create momentum for such efforts, including improving quality and efficiency of care and bringing transparent cost information and evidence from comparative effectiveness research into electronic health records with decision support technology. More aggressive (and potentially necessary) financing changes may need to be phased in, with careful monitoring to ensure that they do not infringe on the integrity of individual clinical relationships.”  Source: http://www.medicalnewstoday. com/releases/263754.php

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.

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practice tips

How to Grow Your Practice

By Lori Gertz Freakin’ Genius Marketing Not too long ago, my family and I moved across the country. We settled in a wonderful little beach community where every day is paradise and first world problems are tempered by the scenic views and fresh salty air. That said, the flu still rolls in annually and the kids get sick and need preventative care, a mole removed here and a referral for something there. So, what’s a marketing strategist mom to do in an entirely new community?

Oddly enough, it wasn’t a rush to the internet. I create websites for professionals. I know that the content is direct and on point, albeit a bit contrived. However, I also know that what they sell is not what I am shopping for. I’ll write about that when I cover creating a website that works to grow your practice.

As a parent or a potential patient, I’m shopping for 18 | NOVEMBER 2013

expertise, kindness, responsiveness, intuitiveness, and someone I can like as well as trust. Oh, did I mention that they have to be on my insurance plan? The Affordable Care Act should give that one a run for its money very soon!

Actually, the first place I turned to were the parents of the kids my kids attended school with. Chances were anything my kids caught would come from that source anyhow, so I might as well have them cared for by the same professionals.

“Oh sure,” I could imagine hearing our new providers say, “I saw Jimmy with this virus yesterday, aren’t they in the same class?”

So I rang a parent or four.

“Jill, I hope you don’t mind me asking, but I’m looking for a pediatrician for Olivia. Preferably someone that takes

Or Why I Care Enough to Tell Others About My Amazing Doctor

my insurance, but more importantly, I want someone who has walk-in acute care services, convenient hours outside school and one who returns phone calls promptly. Do you love your doctor?”

Approaches like those inevitably opened the floodgates to some of the most valuable Word-of-Mouth references and recommendations as well as, a finely detailed list of who-to-avoid’s I have ever culled.

As a marketer, I couldn’t help but want to template Word-of-Mouth, akin to catching lightning in a bottle.

How can a medical professional initiate Word-of-Mouth when it seems so counterintuitive to manipulate something which should arise out of a natural satisfaction for their service?

Now I want to preface all of this by sharing that I believe

that Word-of-Mouth is neither a panacea nor a magical alternative to a well-considered marketing plan, but it’s definitely an important part of the 1:1 relationship building that can help you grow your medical practice beyond your wildest dreams.

The terminology alone can stir up false impressions because there are really two, entirely different, meanings attached to the concept of Word-of-Mouth.

Inbound referrals that are the result of Word-of-Mouth are often pre-conditioned to already need and want to hire you. I was shopping for a pediatrician. Jill led me to one she loved. Scenarios like mine are a major appeal to the whole concept. All you have to do is show up to the consult after continued on page 20 WWW.MEDMONTHLY.COM |19

continued from page 19

one of your patients like Jill sells you to me and you’ve got me in your pocket. I’m already inclined to try your services so it’s almost like you’ll have to un-sell me to make me go away.

Now, this technique of Word-of-Mouth mustn’t be confused with the need for a deliberate program to generate referrals and fill your pipeline with prospects. You don’t want to rely solely on your current client base because if you do, you will be disempowered to grow your own practice. You want to promote referrals to your existing clients so they will refer spontaneously but you also want to pursue other mechanisms of getting people to talk about you.

The reason that Word-of-Mouth advertising is increasingly important in healthcare marketing is because patients are increasingly proactive about their healthcare.

Patients have a strong voice in making health and medical choices for themselves and their families and even more to that point, 1:1 Word-of-Mouth references of a patient are being amplified in social media comments via Facebook, Twitter and others. Don’t even try to guess how many clients I get who are trying to recover their reputations from one unfortunate YELP campaign by a disgruntled client.

The question remains, how do you inspire positive Word-of-Mouth advertising in your patient roster?

What can you do to ignite commentary? As wonderful as it would be if it did, it generally doesn’t happen spontaneously. People need a reason to talk about you, your staff, the service they received and/or the overall patient care experience they received in your office.

Here are a few techniques that can inspire some deeply valuable Word-of-Mouth juju: Understand your patient’s motivation for making a referral People will tell others about you because: • You did or said something that was amazing.

• They look well informed by sharing information about you.

• They feel compelled to share your wisdom because they trust and value what you have done for them.

• They want to be associated with you.

• Something you just wrote or said will be of great value to someone they care about, who needs that help right now.

Some of the impetus for Word-of-Mouth is similar in Entrepreneur’s list of WOM “trigger” activities. A few are here: • Word-of-Mouth is triggered when a customer experiences something far beyond what was 20 | NOVEMBER 2013

expected. Slightly exceeding their expectations just won’t do it. You’ve got to go above and beyond the call of duty if you want your customers to talk about you.

• Don’t depend on your staff to trigger Wordof-Mouth by delivering “exceptional customer experience.” Deep down, customers know service comes from an individual, not from an establishment.

And even the best people have bad days.

• Physical, nonverbal statements are the most dependable in triggering Word-of-Mouth. These statements can be architectural, kinetic or generous, but they must go far beyond the boundaries of what’s ordinary.

At some point you might need to budget to deliver the experience that will trigger Word-of-Mouth. Heck, it might be by adding a play area for the children of adults who come to see you, or it might be to develop a targeted newsletter or e-book as a free giveaway. Although Word-ofMouth is (mostly) free, some activities that inspire WOM may need a budget in time and/or dollars.

The take-away? In my case, Jill’s expectations were regularly exceeded by her doctor who is now happily our doctor. I tell others about professionals I love to use even when not asked specifically because I am ever impressed by the deepening relationships I have with them. Now mind you, if I am disappointed, I will also share that.

Positive Word-of-Mouth advertising and patient referral is inspired when expectations are surpassed. The ordinary and every day patient experience will never be anything to talk about and is quickly forgotten, so don’t count on it filling your prospective patient pipeline. When your current patient is motivated to share their experience and put their own reputation on the line in making a referral it’s never ordinary and neither are you. Go the extra mile to strategize it and reap the benefits of a healthy, growing practice.  Lori Gertz is a writer since she was six, her love for proverbial ink on paper led her to a 14 year magazine publishing career followed by 15 more years running her own strategic marketing company, Freakin’ Genius Marketing, www.freakingeniusmarketing.com. Her intense focus on brand building is further strengthened by her uncanny ability to weave points-of-difference through all of the tactical solutions, most specifically 1:1 marketing solutions. Her Amazon Bestselling book, Be the News: A Guide to Going Viral With Your Human Interest Story at http://amzn.to/Z9Cdzc contains even more ideas and resources to grassroots marketing techniques, most specifically media relations. She has served as keynote speaker, a columnist and editor on multiple publications, as author of a multitude of published articles and is a national advocate for the awareness of Fetal Alcohol Spectrum Disorder.

WWW.MEDMONTHLY.COM |21

practice tips

5

Reasons Why Online Marketing Should Be Part of Your Marketing Plan

By Amanda Kanaan President, WhiteCoat Designs

22| NOVEMBER 2013

F

or most practices, as with any small business, planning objectives in marketing include increasing the amount business from previous years.

When discussing marketing strategy every medical practice, regardless of size or specialty, should consider investing in online marketing. Here are five reasons why…

1. Cost-Effective: The cost is lower than traditional media such as TV or radio and can often have a greater ROI due to the long lasting effects.

2. Increasing Demand: We are in the midst of an “e-patient” revolution (patients whose number one source of health information is the internet). As more and more health care organizations realize this, the market space will become increasingly competitive.

3. Highly Trackable: Unlike some marketing strategies, the results of online marketing are highly trackable. Most internet marketing agencies provide monthly reports showing how your search engine rankings are increasing and the direct correlation to your number of visitors, as well as the number of visitors you are converting (i.e. number of online appointment requests, etc.).

4. Wide Appeal: Online marketing is a highly effective marketing tool that caters to a wide range of demographics. The fact that you cater to a geriatric population is

‘‘

Therefore, online marketing won’t be nearly as successful without a great website and a great website won’t be nearly as successful without online marketing.

no longer an excuse. The 70-75 year-old age group is the fastest growing demographic of internet users (2009 study by Pew Internet & American Life Project).

5. Targeted Approach: If you are a plastic surgeon who wants to do more mommy makeovers for example, you can easily use online marketing to target specific keywords and demographics related to this service. It’s a great way to establish a niche or at least bill more of a particular service.

Whether you invest in search engine optimization (SEO), pay-per-click (PPC) advertising, or social media, the first step in an effective online marketing strategy is a good website.

The goal of online marketing is to bring people to your website; the goal of your website is to bring people to your practice. On average, your website has seven seconds to make an impression on a patient. Otherwise, it’s back to the search engine and on to your competitor’s site. Therefore, online marketing won’t be nearly as successful without a great website and a great website won’t be nearly as successful without online marketing.

One of the great qualities of online marketing is that it’s an even playing field. Whether you are a solo family practitioner or a 10 physician cardiology practice, you each have the opportunity to compete online. So as you enter into budget discussions to consider your medical practice’s goals, consider online marketing as a costeffective approach to growing your practice.  About Amanda Kanaan: Amanda Kanaan is the President of WhiteCoat Designs – a Raleigh-based medical marketing agency providing doctors with online marketing services as medical website design, search engine optimization (SEO), social media management, referring physician outreach and more. To contact Amanda or to learn more about WhiteCoat Designs, visit www.whitecoat-designs. com.

international

Cloud Fever Grips Asia-Pacific Health Care Market

By Frost & Sullivan

Health care is opening doors to cloud technologies all over the world and Asia-Pacific (APAC) is in a hurry to explore innovative solutions that support patient centric care through efficient capture and dissemination of medical and health information. Frost & Sullivan’s research, “Analysis of Healthcare Cloud in APAC” finds the market for cloud technologies, which included Softwareas-a-Service (SaaS) and Infrastructure-as-a-Service (IaaS) offerings, was worth USD 194.4 million in 2012.

The market is expected to expand at a compound annual growth rate (CAGR) of a whopping 22.3% between 2012 and 2018.

“Health care providers are cognizant of the long term cost benefits of cloud solutions. What they are looking 24| NOVEMBER 2013

for now, are reliable technology partners who can address their concerns over data privacy and security,” said Natasha Gulati, Connected Health Industry Analyst, Frost & Sullivan Asia-Pacific. While many health care IT vendors emphasize the enhanced security and back-up support provided by cloud technologies, the message has not successfully reached hospital CIOs yet. This is why health care continues to invest in private clouds while other industries are rapidly moving to public or hybrid cloud models. Moreover, given the current pressures of rising costs and diminishing margins, health care CIOs are unable to justify the significant investment required for transitioning to a cloud environment.

Given the versatility of a cloud environment, Frost

& Sullivan predicts that cloud will be the single most important enabler of health care MegaTrends in the future.

Gulati pointed out three major industry transformations that will be catalyzed by Cloud solutions: Health Care Industry Vertical Clouds Health care expenditure across Asia-Pacific is expected to almost double over the next six years owing to the expanding elderly population. On the other hand, R&D expenditure on pharmaceuticals and biotechnology is not reaping the returns that were expected. Stakeholders across the industry, including government bodies and research organizations, are seeking tools to carry out cost effective outcomes based research.

Enter Industry Vertical Clouds secure cloud environments that allow healthy information sharing amongst all health care stakeholders, thus delivering efficiencies at all stages of the value chain. Adoption of electronic medical records (EMRs) and electronic health records (EHRs) has spurred a wave of interest in industry vertical clouds as these can help extract maximum value from digitization of health care.

Telehealth and Remote Patient Monitoring Aging populations and rising incidence of chronic diseases is driving the APAC consumers to seek tools for continuous health monitoring and assurance. Not only do

cloud technologies provide the software and infrastructure required to share vital information over a distance, they also enable real-time analysis of information gathered from remotely located systems. This has enabled telemedicine and patient monitoring devices to capture critical physiological data and action it on the fly so that the time taken to respond to an adverse situation can be minimized.

The implications of this advancement are phenomenal when one considers the volumes spent on critical care even in developed countries as well as the emotional stress a care-giver must go through when help does not arrive when needed most.

Consumerisation of Healthcare Consumers are still waiting for the day when a single, convenient biometric identifier or a mobile phone will be sufficient to secure health care services. APAC consumers are still stuck in the rut of carrying large sums of cash while visiting a hospital and insurance portability remains a distant dream. Data collaboration, not just amongst health care organizations but also across industries, is a critical component which is missing from the whole health care delivery value chain and this alone can enhance patient experience. Cloud technologies will play a pivotal role in establishing the health care industry of the future.

Source: http://www.newswiretoday.com/news/134471/

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research & technology

Gene Variants Found Associated With Human Immune System, Autoimmune Disease

NIH researchers work with international colleagues to identify genes

Numerous studies have reported that certain diseases are inherited. But genetics also plays a role in immune response, affecting our ability to stave off disease, according to a team of international researchers. The new findings, from the SardiNIA Study of Aging, supported in part by the National Institute on Aging (NIA) at the National Institutes of Health, are published in the Sept. 26, 2013 issue of Cell.

The SardiNIA researchers found 89 independent gene variants on the genome associated with regulating production of immune system cells. Five of these sites for the gene variants coincide with known genetic contributors to autoimmune diseases, and extend previous knowledge to identify the particular cell types that are affected by these genes.

26 | NOVEMBER 2013

“We know that certain diseases run in families. From this study, we wanted to know the extent to which relative immune resistance or susceptibility to disease is inherited in families,” said David Schlessinger, Ph.D., chief of NIA’s Laboratory of Genetics. “If your mother is rarely sick, for example, does that mean you don’t have to worry about the bug that’s going around? Is immunity in the genes? According to our findings, the answer is yes, at least in part.”

The study team, led by Francesco Cucca, M.D., director of the National Research Council’s Institute of Genetic and Biomedical Research in Italy, discovered that variants in particular genes had very significant effects on the levels of one or more particular types of immune system cells. A number of these genes are

also implicated in risk for various autoimmune diseases, including ulcerative colitis, multiple sclerosis, rheumatoid arthritis, and celiac disease.

Understanding the genes affecting immune system cells and risk for autoimmune disease is the first step in developing therapies that are personalized according to an individual’s needs, although more research is needed to further characterize the role genetics plays in the complex dynamics of the immune system, the researchers pointed out.

The human immune system is a complex network of cells, tissues, and organs working together to fight disease and keep us at optimal health and function. Our first line of defense, the innate immune system, includes barriers, like skin and mucus as well as

specific cells and molecules providing a prompt but nonspecific response to harmful germs — pathogens — preventing them from entering the body or eliminating them rapidly after infection. The second line of defense, the adaptive immune system, engages the body to produce, store, and transport cells and molecules providing more specific responses to combat pathogens. The immune system has evolved to reject pathogens and even some cancers, but high levels of immune function can also make the body prone to autoimmune disease.

Autoimmune diseases occur when the body uses the immune system against itself, attacking normal, healthy cells.

The number of adaptive immune system cells available to attack a pathogen or, in the case of autoimmune disease, attack healthy cells, is what appears to be regulated by genetics. The SardiNIA research team tested the heritability of this immune response using a genomewide association study, looking at approximately 8.2 million variants in blood samples taken from 1,629 Sardinians.

Small, single-letter variations in genes naturally occur throughout the DNA code and are generally without effect on any specific trait. However, in some instances, scientists find that a particular variant is more common among people with a trait or disease.

In the analyses, researchers identified 89 independent variants and 53 sites associated with immune cell characteristics. Most of these associations were previously undiscovered. Some had been identified before in other studies, but without firm statistical significance.

The researchers compared their findings with data in public repositories, and in some cases, found that these genes had already been associated with autoimmune disease.

This finding is the most recent of several discoveries made by the SardiNIA study itself and in conjunction with other groups in

international consortia. Previous findings identified gene associations with height, fasting blood sugar, cholesterol and other fats in the blood, beta-thalassemia (a blood disorder), and uric acid levels, which can contribute to gout and risk of heart and kidney disease.

One of the unique features of the investigation is its study population — the Sardinians. “The lineage of most Sardinians goes back approximately 20,000 years, to the Mediterranean island’s original settler population — and an ideal group for this type of research,” said Cucca. “We have learned that in case after case, findings in Sardinia have been applicable world-wide.”

Researchers note that understanding the genetics behind immune system response and autoimmune disease may have future implications on therapeutic targets, especially in the treatment of autoimmune disease.

The NIA leads the federal government effort conducting and supporting research on aging and the health and well-being of older people.

The Institute’s broad scientific program seeks to understand the nature of aging and to extend the healthy, active years of life. For more information on research, aging, and health, go to http://www.nia.nih.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/sep2013/nia-26.htm

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research & technology

Better, Faster Lab Reports Help States’ Outbreak Response

28 | NOVEMBER 2013

CDC Push for Electronic Lab Reports Showing Gains Once labs detect dangerous infections, it’s crucial for the correct information to get to health departments quickly and in a format that allows them to recognize disease outbreaks. The Centers for Disease Control and Prevention’s (CDC) efforts to speed this process and ensure that the best and most complete information about disease cases is reported is paying off, according to new data released in today’s issue of Morbidity and Mortality Weekly Report (MMWR).

A key to speeding lab reports is widespread adoption of electronic laboratory reporting (ELR) by the approximately 10,400 labs that send reportable data to health agencies. ELR is an important tool that gives health officials vital information on infectious disease cases. Since 2010, CDC has provided funds to help 57 states, local and territorial health departments increase the use of electronic laboratory reporting (ELR).

The MMWR report shows that the number of state and local health departments receiving electronic reports from laboratories has more than doubled since 2005, when CDC last evaluated ELR reporting. In the past year, the number of individual reports received electronically increased by 15 percent. States and local health departments now estimate that nearly two-thirds (62 percent) of total lab reports were received electronically. The number of reports received through ELR varied by jurisdiction, the types of labs reporting and by disease reported.

“Infectious disease outbreaks will always be with us—and rapid

recognition of an outbreak saves lives,” said CDC Director Tom Frieden, M.D., M.P.H. “Thanks to electronic laboratory reporting (ELR), we’re detecting outbreaks faster than ever.

Unfortunately, only a quarter of the 10,000 labs across the country use ELR. We must keep expanding use of ELR to help CDC and our partners save lives and reduce healthcare costs.”

“Electronic laboratory reporting can give health officials better, more timely and complete information on emerging infections and outbreaks than they have ever received before,” said Robert Pinner, M.D., associate director for surveillance, programs and informatics in CDC’s National Center for Emerging and Zoonotic Diseases.

“Implementing these systems is a complex task that requires substantial

‘‘

Thanks to electronic laboratory reporting (ELR), we’re detecting outbreaks faster than ever.

investment, but ELR will provide health departments the tools they need to quickly identify and respond to disease threats and monitor disease trends now and in the future.”

More work remains to be done to get more labs reporting electronically and to increase the percentage of reports that are made electronically.

The MMWR report shows that only about a quarter of the nation’s labs are reporting electronically. And ELR for some diseases lags behind others.

For example, 76 percent of reportable lab results for general communicable diseases were sent via ELR, compared to 53 percent of HIV results and 63 percent of results for sexually transmitted diseases.

Significant federal funding through

the Office of the National Coordinator for Health IT is dedicated specifically to assisting providers and hospitals in adopting and effectively using Health IT, including ELR. ELR reporting by hospitals is likely to further accelerate starting in October 2013 when it will be required in order for hospitals to receive incentive payments.

The advances in ELR implementation have been accomplished through funding from the Prevention and Public Health Fund of the Affordable Care Act, distributed through CDC’s Epidemiology and Laboratory Capacity (ELC) cooperative agreement. Through the ELC platform, CDC provides funding to all 50 state health departments, 6 local health departments (Los Angeles County, Philadelphia, New York City, Chicago, Houston, and the District of Columbia), Puerto Rico, and the Republic of Palau. Grants provided through ELC help pay for epidemiologists, lab technicians, and health information systems staff.

Speeding the nation’s response to infectious disease outbreaks is part of the CDC’s ongoing 24/7 work to connect state and local health departments across the U.S., recognizing disease patterns and making state responses to health problems more effective. Increasing ELR is only part of CDC’s effort. The President’s 2014 budget would provide $40 million for the CDC’s advanced molecular detection (AMD) initiative.

AMD allows laboratories to identify infectious agents in a fraction of the time it takes using the decades-old technology still in use at most labs.

Through the AMD initiative, CDC will be able to build critical molecular sequencing and bioinformatics capacities at national and state levels.

For more information on CDC’s ELC cooperative agreement, please visit http://www.cdc.gov/ncezid/dpei/ epidemiology-laboratory-capacity. html.  Source: http://www.cdc.gov/media/ releases/2013/p0926-better-labs.html

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research & technology

Mini-Gastric Bypass Performed with SPIDER® Surgical System

TransEnterix’s novel minimally invasive surgical platform, the SPIDER® Surgical System, has been used to successfully perform a mini-gastric bypass.

Dr. Michel Gagner, an internationally renowned laparoscopic and endoscopic surgeon, used the platform to successfully complete a mini-gastric bypass at Hôpital Européen Georges-Pompidou in Paris. Gagner serves as president of the 2014 World Congress of the International Federation for the Surgery of Obesity & Metabolic Disorders.

He was assisted by Professor Jean-Marc Chevallier, who heads the hospital’s digestive, endoscopy and obesity department. He also serves as president of the Société Française et Francophone de Chirurgie de l’Obésité et des Maladies Métaboliques (the French Society for Obesity and Metabolic Surgery).

30 | NOVEMBER 2013

The mini-gastric bypass works by restricting the amount of food a patient consumes and inhibiting the body’s appetite processes both of which support a patient’s weightloss efforts.

Using the SPIDER Surgical System, Gagner used a section of the patient’s stomach to create a narrow sleeve and attach it to the small intestine, bypassing the main section of stomach. The procedure restricts the amount of food the patient can consume helping the patient feel full sooner, having eaten less.

“The patient is doing quite well and this procedure is well suited for SPIDER,” Gagner said. “The need to create a single anasatomosis is easily achieved with the help of SPIDER and its flexible instruments. It is probable that the addition of mini-gastric bypass will increase the utility of SPIDER in more complex minimally invasive bariatric

surgery worldwide.”

The SPIDER Surgical System by TransEnterix offers a surgeon a less-invasive alternative to traditional laparoscopic surgery. Using it, the surgeon makes a small incision, inserts the device and opens it inside the patient’s abdomen like an umbrella. SPIDER’s expansion allows the surgeon to comfortably and precisely manipulate 360-degree-rotating, flexible instruments at angles that enhance access and dexterity at the operating site. When the procedure is completed, the surgeon closes the system and removes it through the same incision.

The SPIDER Surgical System’s expansion ability and flexible instruments are proprietary technologies created

by TransEnterix; they cannot be found in any other system.

Surgeons worldwide are using the system to successfully treat obesity and a variety of general surgery conditions.  About TransEnterix: TransEnterix (transenterix.com) is a publicly traded (OTCBB: SFES) development-stage medical-device company that is pioneering the use of flexible instruments and robotics to improve how minimally invasive surgery is performed. TransEnterix is focused on the development and commercialization of SurgiBot™, a novel patient-side minimally invasive surgical robotic system.

Source: http://www.newswiretoday.com/news/134734/

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legal

Bipartisan Agreement Reached on Legislation Granting FDA Greater Authority to Regulate Drug Compounders

By Roy M. Albert Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.

32 | NOVEMBER 2013

Last week, Democrat and Republican leaders of both houses of Congress agreed to the terms of a bill that would give the U.S. Food and Drug Administration (FDA) greater authority to regulate drug compounding and would revamp the way drugs are tracked from the manufacturer to the pharmacy. The House of Representatives voted in favor of the bill shortly after the agreement was announced. The bipartisan agreement comes at a time when compromise between the two major political parties has been rare and fights over the federal budget and raising the “debt ceiling” have become commonplace. Congress’s failure to agree on a spending bill has resulted in the first government shutdown since 1995-1996.

The Drug Quality and Security Act (Act) would give the FDA oversight authority over large-volume compounders who elect to register as outsourcing facilities. The FDA’s oversight of such compounders would be similar to the manner in which the FDA regulates traditional drug manufacturers. Those compounders that elect to remain as traditional pharmacies would continue to be regulated by state boards of pharmacy.

The Act would also create a uniform framework to track drugs from the manufacturer to the pharmacy and would supersede the current “patchwork of state prescription-drug tracing laws.” Federal officials believe the uniform tracking framework will limit the number of counterfeit or stolen drugs that reach consumers.

This legislation follows a July 2013 Government Accountability Office (GAO) report which concluded that the FDA needed more explicit authority and reliable data to improve its oversight of drug compounding.

Last year, at least 64 people were killed and 750 people were injured following a meningitis outbreak tied to the New England Compounding Center.

Federal officials contend that the legislation will help prevent a future public health crisis similar to last year’s meningitis outbreak.

Although the Act would not require drug compounders to register with the FDA, it does create an incentive to register, and will give hospitals and physicians confidence that they are getting drugs from an FDA-approved source if the compounder is registered.

Organizations in the pharmaceutical supply chain should both monitor the bill’s progress in Congress and understand FDA’s expanded oversight role if the bill is enacted.  Source: http://www.natlawreview.com/article/ bipartisan-agreement-reached-legislation-granting-fdagreater-authority-to-regulateWWW.MEDMONTHLY.COM |33

legal

Action Steps NOW To Comply With The Affordable Care Act

By Patrick M. Allen Womble Carlyle Sandridge & Rice, PLLC Although the one-year delay in the effective date of the pay-or-play provisions of the Affordable Care Act (“ACA”) (until January 1, 2015) gives employer-sponsored health plans more time to prepare for those requirements, many ACA provisions will take effect on January 1, 2014.

Employees are asking for information regarding these changes and the Department of Labor is already including ACA requirements in its benefit plan audits. The target keeps moving. Here is what you need to do NOW to ensure that your health plan is in compliance on January 1, 2014 and that you are prepared for what’s coming: • Distribute the required Notice informing your employees about their coverage options by October 1, 2013 and to all new hires after October 1, 2013.

• Determine if your plan will have “grandfathered” status in 2014.

• Confirm that required plan design changes are in effect for 2014, including: t Elimination of annual limit on essential health benefits. t Elimination of pre-existing condition exclusions for new enrollees. t Limiting waiting period for enrollment to 90 days. t Elimination of restrictions related to participation in clinical trials (non-grandfathered plans only).

34 | NOVEMBER 2013

t Conform cost-sharing provisions to ACA requirements (non-grandfathered plans only). t Provide coverage for ACA “essential benefit” categories (insured plans in individual and small group markets only).

• Timely provide updated Summaries of Benefits & Coverage.

• Develop strategies on how to use the rest of 2013 and 2014 to plan for ACA provisions that will go into effect in 2015, including (1) pay-or-play provisions, such as determination or confirmation of applicable larger-employer status and how to determine full-time employee status; and (2) reporting requirements.

• Consider alternative options to continuing to provide health care coverage for your various categories of employees.

• Implement cafeteria plan changes related to ACA and repeal of DOMA. • Bring wellness programs into compliance with ACA. • Prepare to pay ACA reinsurance fees (self-insured plans only).

• Make sure you are complying with the final HIPAA rules concerning “protected health information” that went into effect on September 23, 2013.  Source: http://www.wcsr.com/

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legal

There’s an App for That: Food and Drug Administration (FDA) Issues Final Guidance on Mobile Medical Apps

By Seth A. Mailhot Michael Best & Friedrich LLP

36 | NOVEMBER 2013

‘‘

“According to the guidance, mobile platforms are defined as commercial offthe-shelf (COTS) computing platforms, with or without wireless connectivity, that are handheld in nature.”

T

he U.S. Food and Drug Administration (FDA) issued a final guidance September 25, 2013 titled, “Mobile Medical Applications.” The guidance sets out the scope of FDA’s enforcement discretion on medical software applications designed for mobile devices. The final guidance follows up on a draft guidance issued on July 21, 2011, and is intended to provide even more predictability and clarity for manufacturers of mobile medical apps. The final guidance provides further examples of the types of mobile medical apps to be regulated (and not regulated) by FDA. FDA has planned a Twitter chat to discuss the new guidance on September 26 at 3:30 p.m.

Much of the guidance reiterates or restates the longstanding policy set out by FDA on the regulation of software as a medical device. For example, as noted in the guidance, “when stand-alone software is used to analyze medical device data, it has traditionally been regulated as an accessory to a medical device or as medical device software.” The regulatory policy set out in the guidance applies a risk based approach to mobile medical apps.

As stated in the guidance, “certain mobile medical apps can pose potential risks to public health. Moreover, certain mobile medical apps may pose risks that are unique to the characteristics of the platform on which the mobile medical app is run. . . .FDA intends to take these risks into account in assessing the appropriate regulatory oversight for these products.”

One important point to note is that with the expansion in portable computing power, almost any medical software application that operates on a current off-the-shelf operating system may be viewed as a mobile medical app subject to the guidance. According to the guidance, “’mobile platforms are defined as commercial off-the-shelf (COTS) computing platforms, with or without wireless connectivity, that are handheld in nature. Examples of these mobile platforms include mobile computers such as smart phones, tablet computers, or other portable computers.”

While the guidance refers to “desktops” as being distinct from “mobile platforms,” the guidance does not distinguish software that may operate on both a desktop and a mobile platform due to a shared operating system.

The definition of a mobile platform is actually a departure from the draft guidance, which adhered more closely to what would typically be considered a “mobile platform.” In the draft guidance, the definition included as examples, “the iPhone®, BlackBerry® phones, Android® phones, tablet computers, or other computers that are typically used as smart phones or personal digital assistants (PDAs).” While computing technology has advanced, expanding the definition to contemplate notebooks and other slim-profile computers adds a certain layer of confusion to the guidance.

The final guidance restates and expands the policy from the draft guidance on the entities that qualify, and do not qualify, as mobile medical app manufacturers. For example, developers that create a mobile medical app based on specifications from an “author” do not qualify as a manufacturer subject to FDA regulation. Content distributors, such as the owners and operators of “Google play,” “iTunes App store,” and “BlackBerry App World,” also are not held to be mobile medical app manufacturers. The final guidance, however, fails to address what responsibility such content distributors might have in terms of complaint handling and recalls, given the control such content distributors exert over the distribution system for mobile devices1. continued on page 38 WWW.MEDMONTHLY.COM | 37

legal continued from page 37

FDA did note that entities that distribute their mobile medical app software as a service, such as through a web-based subscription, do qualify as manufacturers.

Note that this does not mean that FDA is extending into the regulation of services distributed through web-based software applications, only that the software distributed under this model would be subject to FDA regulation.

The core policy articulated in the guidance is the categories of medical software that are considered mobile medical apps, and those that are subject to enforcement discretion by FDA. FDA identifies three categories that the agency considers to be mobile medical apps: 1. Mobile apps that are an extension of one or more medical devices by connecting to such device(s) for purposes of controlling the device(s) or displaying, storing, analyzing, or transmitting patient-specific medical device data.

2. Mobile apps that transform the mobile platform into a regulated medical device by using attachments, display screens, or sensors or by including functionalities similar to those of currently regulated medical devices.

Mobile apps that use attachments, display screens, sensors or other such similar components to transform a mobile platform into a regulated medical device are required to comply with the device classification associated with the transformed platform.

3. Mobile apps that become a regulated medical device (software) by performing patient-specific analysis and providing patient-specific diagnosis, or treatment recommendations. These types of mobile medical apps are similar to or perform the same function as those types of software devices that have been previously cleared or approved.

FDA also outlines six general categories of medical software that are subject to enforcement discretion: 1. Mobile apps that provide or facilitate supplemental clinical care, by coaching or prompting, to help patients manage their health in their daily environment.

2. Mobile apps that provide patients with simple tools to organize and track their health information.

3. Mobile apps that provide easy access to information related to patients’ health conditions or treatments (beyond providing an electronic “copy” of a medical reference).

4. Mobile apps that are specifically marketed to help patients document, show, or communicate to providers potential medical conditions.

5. Mobile apps that perform simple calculations routinely used in clinical practice.

6. Mobile apps that enable individuals to interact with PHR systems or EHR systems.

38 | NOVEMBER 2013

In particular, FDA expanded the types of medical imaging software that would be exempt from FDA regulation. The previous draft guidance suggested that using a magnifying function for a specific medical purpose would make the software a regulated medical device. This left the impression that using any camera or light source native to a mobile platform for a specific medical purpose might be regulated by FDA. FDA clarified that “utiliz[ing] the mobile device’s built-in camera or a connected camera for purposes of documenting or transmitting pictures (e.g., photos of a patient’s skin lesions or wounds) to supplement or augment what would otherwise be a verbal description in a consultation between healthcare providers or between healthcare providers and patients/caregivers” would not be regulated by FDA as a mobile medical app.

FDA also provided specific clinical calculations that would be exempt from FDA regulation as a medical device: • Body Mass Index (BMI) • Total Body Water / Urea Volume of Distribution or Mean Arterial Pressure • Glascow Coma Scale Score • APGAR Score • NIH Stroke Scale • Delivery Date Estimator Although the guidance ostensibly deals with mobile medical apps, the policy statements on what medical software qualifies for FDA regulation may also be applied to medical software designed for desktop platforms, as the underlying basis for many of the positions articulated

by FDA are founded upon long standing polices on medical software. The issuance of this guidance provides companies with an opportunity to review product offerings to confirm whether their medical software products meet the threshold for FDA regulation. Michael Best can assist medical software companies with this review, and can advise on how to meet FDA’s regulatory requirements for mobile medical apps. Michael Best has experience with medical software submissions to FDA, and the role that the software design control process plays in FDA’s regulation of medical software.  _______________ 1 This was an issue carried over from the draft guidance.

FDA suggests that these content distributors “do not engage in any manufacturing functions as defined in 21 CFR Parts 803, 806, 807, and 820,” but overlooks the pervasive control some content distributors have over software updates and complaint reporting.

Reprinted with permission from Michael Best & Friedrich LLP. © 2013 Michael Best & Friedrich LLP Source: http://www.michaelbest.com/pubs/pubDetailMB. aspx?xpST=PubDetail&pub=3425

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features

Health Centers to Help Uninsured Americans Gain Affordable Health Coverage Obama administration awards $150 million to provide enrollment assistance

Health and Human Services (HHS) Secretary Kathleen Sebelius announced $150 million in grant awards to 1,159 health centers across the nation to enroll uninsured Americans in new health coverage options made available by the Affordable Care Act. Speaking at the Mountain Park Health Center in Phoenix, Ariz., the Secretary noted that, with these funds, health centers are expected to hire an additional 2,900 outreach and eligibility assistance workers 40 | NOVEMBER 2013

to assist millions of people nationwide with enrollment into affordable health coverage.

HHS Secretary Sebelius said, “Investing in health centers means that people in neighborhoods and towns across the country have one more resource to help them understand their insurance options and enroll in affordable coverage.�

Health centers have a long history of providing eligibility assistance to patients along with delivering

high-quality, primary health care services in communities across the nation. Today, health centers serve more than 21 million patients annually.

With these awards, which health centers in all 50 states have received, consumers will get help understanding their coverage options through the new Health Insurance Marketplace, Medicaid and the Children’s Health Insurance Program; determine their eligibility and what financial help they can get; and enroll in new affordable health coverage options.

These awards, issued by the Health Resources and Services Administration (HRSA), complement and align with other federal efforts, such as the Centers for Medicare & Medicaid Services-funded Navigator program.

The announcement is part of the administration’s broader effort to make applying for health coverage as easy as possible. The new, consumer-focused HealthCare.gov website and the 24-houra-day consumer call center help Americans prepare for open enrollment and ultimately sign up for health coverage. These new tools will help Americans understand their coverage options and select the plan that best suits their needs for the open enrollment in the new Health Insurance Marketplace, which began on Oct. 1, 2013.

“Health centers are excited to help individuals in their communities take advantage of the benefits of new health insurance coverage options that start January 2014,” said HRSA Administrator Mary Wakefield, Ph.D, R.N. “Having trained, face-to-face assistance in enrollment from trusted resources at local health centers means that more people will get the help they need.”

For a list of health centers receiving this funding, visit: http://www.hrsa.gov/about/ news/2013tables/outreachandenrollment/.

To learn more about the Affordable Care Act, visit www.HealthCare.gov. To learn more about HRSA’s Health Center Program, visit http://bphc.hrsa.gov/about/ index.html.  Source: http://www.hhs.gov/news/ press/2013pres/07/20130710a.html

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features

Community Health Center, Inc. Launches Coaching Program Aimed at Improving the Quality Of Health Care

By Eliza Cole Community Health Center, Inc. Community Health Center, Inc. (CHC), based in Middletown, Connecticut, announces the launch of a new telehealth program to assist health centers in improving the quality of health care. This unique program, called Project ECHO Coaching International, is the first of its kind, joining experts in quality improvement from the United States and Sheffield, England.

Quality improvement coaches are health care professionals who have received specialized training in tools and techniques to improve the way health care is delivered; from scheduling and coordinating care, to 42 | NOVEMBER 2013

patient flow, to managing test results and helping patients with their care. Coaches are increasingly being used by health systems to help them adapt to the many important changes that are happening in health care. They can be found in many different health care settings. Project ECHO Coaching International allows these coaches to join via videoconferencing with a team of expert faculty from CHC and England. Coaches will present challenging problems they are facing in their own practices to the expert team who will offer advice and recommendations. Working together, participants and faculty will help each other learn

and gain new skills that can be used to make the health care system more patient centered, more effective, and more efficient.

The CHC faculty will be led by Deb Ward RN, Senior Quality Improvement Manager. She will be joined by Dr. Daren Anderson, VP, Chief Quality Officer, as well as Agi Erickson, and Patti Feeney, Quality Improvement Specialists. Additional faculty will include Ann Marie Hess APRN, Quality Improvement Specialist from Maine, and Steve Harrison, Service Improvement Manager from the Sheffield Teaching Hospitals in Sheffield, England.

CHC will host the monthly videoconferences using a new teleconferencing system that will allow participants to join from almost anywhere using laptop computers, iPads, or even smartphones. “This format will bring together experts in quality improvement and measurement to provide solutions to complex issues faced by coaches as they work with front line teams,” says Ms. Ward. “Coaches will prepare case presentations describing their team’s work and difficult challenges they are facing. The faculty will review the cases in advance of the session and will assist the coach by offering expert advice.”

Sheffield and CHC share a common goal of using state of the art quality improvement methods to improve health care for their patients. CHC hosted the staff from Sheffield last fall for a symposium on health care quality. “We realized immediately that there was great opportunity for collaboration and set out to make these sessions a reality,” said Dr. Anderson. Going forward, CHC will be offering these sessions to centers across the US and internationally, building a unique learning community dedicated to improving healthcare for all.  Source: www.chc1.com/News/PressReleases/20130628Pr ojectEchoCoachesInternational.pdf About Community Health Center, Inc. Since 1972, Community Health Center, Inc. has been one of the leading health care providers in the state of Connecticut, building a world-class primary health care system committed to caring for uninsured and underserved populations. CHC is focused on improving health outcomes for its more than 130,000 patients as well as building healthy communities. Recognized as both a Level 3 Patient-Centered Medical Home by the National Committee for Quality Assurance and a Primary Care Medical Home by The Joint Commission, CHC delivers service in more than 200 locations statewide, offering primary care in medical, dental and behavioral health services. For more information, visit www.chc1.com.

Project ECHO® Overview Project ECHO® is an evidence-based intervention that aims to transform the interface between primary care and specialty medicine to improve quality, safety, and efficiency of care through the use of video conferencing, case management, and electronic health record technology. In the existing model of care, patients are referred by their primary care physician to a specialist for help when initial efforts to treat a subacute problem fail or when help is needed with complex, chronic illness care. This system has a number of drawbacks that adversely affect cost, quality, and safety of care, and limit the success of the Patient Centered Medical Home Model.

Problems include: • Limited access to specialists due to insurance issues, travel distance, or affordability • Poor communication infrastructure between primary care and specialty leading to fragmented, uncoordinated care • Limited or no financial incentive to support collaborative care between specialty and primary care • Fewer opportunities for primary care providers to improve their own knowledge and skills regarding management of complex and chronic conditions • Duplication of diagnostic testing due to poor coordination and communication leading to increased costs to the patient and health care system Project ECHO® is a new model designed to address these issues through the use of innovative technology and communications to link primary care and specialty care providers virtually. Realizing that much of the actual care for complex patients can be delivered through the primary care provider office, the Project ECHO® program provides a “virtual consultation” with a panel of experts to support the primary care team. These video conferences join primary care providers with specialists to improve outcomes particularly for underserved patients who may have difficulty gaining access to specialty care. Unlike traditional educational interventions, Project ECHO® provides case-based learning and case management for complex cases by using technology to link primary care providers to a multidisciplinary team of specialists. Project ECHO® creates “communities of practice” that build expertise in primary care providers, improve access to specialty care for those requiring it, and improve retention of primary care providers in underserved communities through reducing isolation. CHC operates ECHO® clinics in several areas including Hepatitis C, HIV, and addiction management.

Additional features of CHC’s ECHO® clinics that promote shared learning include the use of Twitter, Google, and other online tools to enhance knowledge sharing and collaboration amongst participants.

Source: http://174.129.214.216/quality/echo/overview/ WWW.MEDMONTHLY.COM |43

features

Affordable Care Act Making New Roads: Drawing Doctors to

Rural America By

This October 1st opened enrollment of the Affordable Health Care Act (ACA), which is the most sweeping social change for Americans since the Social Security Act Roosevelt signed in in 1935. The AMA has praised this event as historic. And with the government taking a stronger control in healthcare, there will be a guiding hand.

One only need look at the news headlines and the Health Provider Shortage Areas (HPSAs) to understand that rural Americans face greater health risks than urban Americans. Only 10% of American physicians practice in rural areas, 44 | NOVEMBER 2013

whereas rural regions compose 25% of the American population.

The ACA offers coverage to millions of otherwise uninsured Americans.

Particularly, the change affects 60 million who live in rural areas of the United States. Presently, one out of every five uninsured Americans lives in a rural area, compared to one in six for the population at large. And because of lower income among rural residents compared to urban residents, there will be an even greater need for doctors to an area that has historically suffered a doctor shortage.

With 32 million Americans harnessing new access to healthcare,

between 4,307 and 6,940 additional primary care physicians would be needed to accommodate this increase by 2019.

But despite the need for physicians in rural areas, the incentives have remained low. Physicians in rural areas perform tasks that would be performed by specialists in more urban areas. Call schedules remain a burden in rural areas, with a one in two or one in three call ratio. Educational resources are not available in rural areas to the degree they are in urban areas. Typically, even local physicians who want to practice in rural areas where they grew up must go out-of

state to urban centers for residency, which has resulted in less interest among physicians to practice in rural hometowns.

How will the ACA bring physicians to rural areas?

Initiatives of the ACA to increase physician distribution to rural areas: 1. Increases competition among insurance providers, allowing the Health Insurance Marketplace to lower costs.

2. Authorizes funding for additional medical residency training programs through the Health Resources and Services Administration (HRSA) and the ACA’s own Prevention and Public Health Fund. Training would preferentially encourage primary care and general surgery.

In general, the ACA will offer incentives to physicians for more necessary specializations.

Presently, the ratio of primary care physicians is one-third, to two-thirds specialists. In a report completed this by the Congressional Research Service (CRS), this ratio is not in proportion to the health needs of patients.

3. Allocates money to increase the primary care workforce by training more doctors.

4. Requires that Medicare-funded residency training slots be redistributed from hospitals that are not using them or that have closed, to hospitals seeking to train additional residents.

5. Allocates a greater amount of money for scholarships and loans for all health professionals.

It relieves the basic need for physicians by training an increased number of physician assistants and nurses.

6. Expands the number of general staff who work in rural health centers.

7. Increases the number of nursemanaged clinics at nursing schools where nurses in training treat rural patients.

8. Offers a 10 percent bonus, through 2015 for primary care doctors who offer services to Medicare patients.

9. Subsidizes loan repayment or offers education grants to professionals trained in undersupplied specialties such as pediatrics, mental health, geriatrics, behavior health, and general surgery, in exchange for serving in under-serviced areas.

10. Plans to increase physician productivity.

11. Encourages increased efficiency and coordination among all personnel in medical homes, clinics, and hospitals, as well as other care organizations.

12. Reduces isolation among physicians by offering access between rural centers and colleagues, and by increasing further continuing educational opportunities to rural physicians.

13. Establishes a National Health Care Workforce Commission to develop economic incentives and grants and contracts for physicians, encouraging greater support of primary care training and greater distribution to rural areas. This includes distributing Residency slots to rural areas. It also encourages physician training in community-based settings to offset the greater orientation toward specialty care in hospital-based residency training. This may be the most important aspect of the new law, as it creates a regulatory commission which will continue to promulgate rules and regulations to improve delivery of healthcare services.

For more information, read the Federal Office of Rural Health Policy report, “Office of Rural Health Policy Rural Guide to Health Professions Funding“.

And for an in-depth definition of “rural”, visit the USDA Website page defining this term.  WWW.MEDMONTHLY.COM |45

the arts

Class Helping Future Doctors Learn the Art of Observation

Kevin Koo and other medical students filed into the Yale Center for British Art recently to spend the afternoon looking at paintings.

While future physicians with heavy course loads at the Yale School of Medicine usually don’t have the time to ponder art, these students were visiting the museum for a required class — one that could someday save a patient’s life.

All first-year students at the School of Medicine are required to take the innovative class, which was developed

by Yale medical school faculty member Dr. Irwin Braverman and Linda Friedlaender, curator of education at the Yale Center for British Art, which houses the world’s largest collection of British art outside the United Kingdom.

The visual tutorial, now marking its 10th anniversary, draws together disciplines that are usually worlds apart — art and medicine — in order to hone the observational skills of future physicians.

Braverman and other experts believe that, in an age when physicians rely heavily on high-tech imaging and tests, the art of detailed, careful observation is getting short shrift. But detecting small details can make all the difference in coming up with accurate diagnoses, believes the Yale faculty member.

Braverman began trying to find a way to increase observational skills of medical school students at around 46 | NOVEMBER 2013

the same time that Friedlaender became frustrated with the continued misdiagnosis of a close friend. They happened to meet at a gathering and began laying the groundwork for the class, which makes the most of the museum’s collection by asking medical students to “diagnose” individuals portrayed in its artworks.

The course has proven so successful that more than 20 other medical schools have imitated the program.

“We know that this works,” said Braverman, professor of dermatology. In fact, Braverman and colleagues published a study in the Journal of the American Medical Association based on the experiences of the first groups of students who received the training. The results showed a nearly 10% improvement in students’ ability to detect important details.

Koo, a student from New Hampshire, says he found the class eye-opening — literally. He says it trained him to look at things he was seeing more carefully, without initially making assumptions and interpreting what he saw.

On a recent afternoon at Yale, the students noted what they saw in detailed Victorian paintings in the museum and then applied their enhanced observational skills to photographs of patients with skin and other ailments they could encounter as doctors.

For the class, sheets of paper had been placed over the titles of the paintings and the accompanying texts so the students had to start their observations from scratch —

By Karen Peart Yale University the way Braverman wants his students eventually to look at their patients. The students discovered that the images often were not what they appeared to be.

“This painting is of a young man reclining on a bed in a dark room in the morning,” Koo said as he began to tell professor Braverman what he saw. The student managed to pick out several clues — smoke rising from a justextinguished candle, for example, morning light streaming into the attic room, and writings torn to shreds.

As fellow students chimed in with their observations, and Braverman drew out detail upon detail, Koo began to see things more precisely, until the young man’s contorted position on the bed, his pallid face and an empty vial on the floor made it clear to him that the painting depicted a suicide. “I believe that he’s dead,” Koo finally said of the subject of the painting.

He was right. “The Death of Chatterton,” an 1856 work by Henry Wallis, depicts Thomas Chatterton, who poisoned himself in despair in 1770 after his forgeries of 15th-century poems were unmasked.

“It made me notice things that my eyes had just not seen,” Koo said of the class. “In going through it in my own mind and with my peers I was able to develop a fuller story, and that enabled me to put the pieces together in a way that was closer to the reality.”

The group of students that curator Friedlaender tutored in the museum carefully noted the details in a 1770s

painting called “The Gore Family,” by Johann Joseph Zoffany.

Sounok Sen, a student originally from Maryland, deftly described the details he picked out in the painting. “That was fantastic,” Friedlaender told him.

The painting depicts an engagement party. But the nature of the event — and which of the several individuals in the work were the man and woman about to be married — didn’t become apparent to the students until Friedlaender drew out their detailed observations.

A student from Nigeria, Oluwatosin Onibokun, wasn’t sure at the outset of the class that her observational skills could improve by looking at the paintings. By the end, after she had painstakingly considered details in the photographs of patients that Braverman passed around a table for examination, she had no doubt of the museum tutorial’s benefit.

“I paid more attention to colors, shapes and sizes of skin blotches, lesions and other conditions,” she said. Her observational skills had already improved. “It was great,” she said of the class.

Lane English, a museum docent, spoke to the medical students, offering her own very personal support for what Braverman and Friedlaender are doing to train doctors.

Several years ago English suffered what appeared to be a blockage — the result of a stroke — behind her left eye that caused temporary blindness. Her sight partially returned, but she was directed to Yale-New Haven Hospital for examination, and doctors initially could not figure out what was wrong. Braverman invited English to tell her story to his students at the end of the museum class.

“All of a sudden,” she told the students, “one of them said, ‘Oh my God, look at her lip.’” That physician noticed a spot that was a telltale sign of a hereditary condition known as HHT, which causes blood vessel malformations in the lungs that rob the body of oxygen. HHT can be fatal if not detected and treated. Tests confirmed the suspected diagnosis, and Dr. Robert I. White, an expert in the detection and treatment of HHT, was able to correct the condition without surgery by an image-guided procedure to close off abnormal blood vessels, noted English.

The students were transfixed as English described her ordeal. As Braverman and Friedlaender had hoped, English became the embodiment of how keen observational skills can impact the lives of patients, their families and the doctors who diagnose them.

Because of English’s eye problem, the doctors initially were thinking of stroke, Braverman told the students. The correct diagnosis of HHT came about because someone was looking at English with much more attention to small detail.

“That probably saved my life,” English said.  Source: http://news.yale.edu/2009/04/10/class-helpingfuture-doctors-learn-art-observation WWW.MEDMONTHLY.COM |48

healthy living

Pumpkin Soups

By Ashley Acornley, MS, RD, LDN

Sweet & Smoky Roasted Pumpkin Soup

Serves 4 - 6

Ingredients: 5 cups pumpkin, cut into 1-inch cubes 1 onion, diced 4 cloves garlic, chopped 2 tablespoons brown sugar 1.5 teaspoons smoked paprika 1.5 teaspoons hot paprika 2 teaspoons chili powder 2 teaspoons sea salt 2.5 cups chicken broth

48 | NOVEMBER 2013

Preparation: 1. Roast pumpkin at 375 degrees in a baking pan for approximately 15 minutes. Meanwhile, mix together sugar, spices and salt in a small bowl.

2. Heat olive oil in a large soup pot over medium heat. Add onion, garlic and 1/2 of the spice mixture. Sauté until fragrant.

3. Add cooked pumpkin and chicken broth to pot.

Mix well and bring to a boil, then reduce to a simmer. Let simmer ten minutes then blend.

Taste for spice and add more mixture to taste.

Top with roasted pumpkin seeds (seen above) or a dollop of crème fraiche.

(Roast extra pumpkin for morning pancakes!)

Curried Coconut Pumpkin Soup Serves 2 as a meal, 4 as a starter

Ingredients: 1 teaspoon black mustard seeds olive oil 1 small onion, chopped finely 1 teaspoon garlic, chopped finely 1 tablespoon ginger, chopped finely 1/2 tablespoon turmeric powder 1/2 teaspoon cayenne 1 1/2 cup pumpkin, mashed (fresh or canned, organic) 1 can low-fat coconut milk salt and pepper to taste cilantro for garnishing

Preparation: 1. Heat up about a tablespoon of oil. Put in the mustard seeds and wait until the seeds to crackle.

2. Then add the onion, garlic and ginger. Sauté until the onions caramelize slightly. Then add the turmeric and cayenne pepper powders and continue to cook for another minute or two.

3. Add the pumpkin and cook on a gentle heat for about five minutes. Add the coconut milk and stir gently until the pumpkin is well combined. Simmer gently for about ten minutes.

Add seasonings and taste. Adjust accordingly. Serve garnished with fresh cilantro.

Serve with a crisp green salad topped with pomegranate seeds for even more autumn beauty

For more seasonal, local, and healthy cuisine recipes using produce commonly found in CSA (Community Supported Agriculture) boxes and at farmer’s markets, purchase Ashley Acornley’s book Fresh from the Farm Cookbook.

The cookbook is available in both electronic and printed form. For the electronic version, contact Ashley Acornley at ashleyk1010@gmail.com for more information. The printed version is available through LuLu at http:// www.lulu.com/shop/ashley-acornley/fresh-from-the-farm-cookbook/ hardcover/product-16266372.html WWW.MEDMONTHLY.COM | 49

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

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

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

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

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

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

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

South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4665 www.llr.state.sc.us Tennessee Heritage Place Metro Center 227 French Landing, Ste. 300 Nashville, TN 37243 (615)253-6061 http://health.state.tn.us/boards/do/ Texas P.O. Box 149347 Austin, TX 78714 (512)834-6661 www.roatx.org Vermont National Life Bldg N FL. 2 Montpelier, VT 05620 (802)828-2191 http://vtprofessionals.org/opr1/ opticians/ Virginia 3600 W. Broad St. Richmond, VA 23230 (804)367-8500 www.state.va.us/licenses Washington 300 SE Quince P.O. Box 47870 Olympia, WA 98504 (360)236-4947 http://www.doh.wa.gov/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://bit.ly/uaqEO8 Arizona 4205 N. 7th Ave. Suite 300 Phoenix, AZ 85103 (602)242-1492 http://azdentalboard.us/ Arkansas 101 E. Capitol Ave., Suite 111 Little Rock, AR 72201 (501)682-2085 http://www.asbde.org/ California 2005 Evergreen Street, Suite 1550Â Sacramento, CA 95815 877-729-7789 http://www.dbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7800 http://www.dora.state.co.us/dental/ Connecticut 410 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/site/default.asp Delaware Cannon Building, Suite 203 861 Solver Lake Blvd.

Dover, DE 19904 (302)744-4500 http://1.usa.gov/t0mbWZ Florida 4052 Bald Cypress Way Bin C-08 Tallahassee, FL 32399 (850)245-4474 http://bit.ly/w1m4MI 52 | NOVEMBER 2013

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

Maine 143 State House Station 161 Capitol St. Augusta, ME 04333 (207)287-3333 http://www.mainedental.org/ Maryland 55 Wade Ave. Catonsville, Maryland 21228 (410)402-8500 http://dhmh.state.md.us/dental/ Massachusetts 1000 Washington St., Suite 710 Boston, MA 02118 (617)727-1944 http://www.mass.gov/eohhs/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.dentist.state.ok.us/

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

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

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

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

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

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

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

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

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

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

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

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

Texas 333 Guadeloupe St. Suite 3-800 Austin, TX 78701 (512)463-6400 http://www.tsbde.state.tx.us/ Utah 160 E. 300 South Salt Lake City, UT 84111 (801)530-6628 http://1.usa.gov/xMVXWm Vermont National Life Building North FL2 Montpelier, VT 05620 (802)828-1505 http://bit.ly/zSHgpa Virginia Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4538 http://www.dhp.virginia.gov/dentistry Washington 310 Israel Rd. SE P.O. Box 47865 Olympia, WA 98504 (360)236-4700 http://www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/Dentist.aspx West Virginia 1319 Robert C. Byrd Dr. P.O. Box 1447 Crab Orchard, WV 25827 1-877-914-8266 http://www.wvdentalboard.org/ Wisconsin P.O. Box 8935 Madison, WI 53708 1(877)617-1565 http://dsps.wi.gov/Default. aspx?Page=90c5523f-bab0-4a45-ab943d9f699d4eb5 Wyoming 1800 Carey Ave., 4th Floor Cheyenne, WY 82002 (307)777-6529 http://plboards.state.wy.us/dental/index.asp WWW.MEDMONTHLY.COM |53

U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (334)242-4116 http://www.albme.org/ Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 http://bit.ly/zZ455T Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 (480)551-2700 http://www.azmd.gov Arkansas 1401 West Capitol Ave., Suite 340 Little Rock, AR 72201 (501)296-1802 http://www.armedicalboard.org/ California 2005 Evergreen St., Suite 1200 Sacramento, CA 95815 (916)263-2382 http://www.mbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7690 http://www.dora.state.co.us/medical/ Connecticut 401 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/site/default.asp Delaware Division of Professional Regulation Cannon Building 861 Silver Lake Blvd., Suite 203 Dover, DE 19904 (302)744-4500 http://dpr.delaware.gov/ District of Columbia 899 North Capitol St., NE Washington, DC 20002 (202)442-5955 http://www.dchealth.dc.gov/doh 54 | NOVEMBER 2013

Florida 2585 Merchants Row Blvd.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

WWW.MEDMONTHLY.COM | 55

medical resource guide ACCOUNTING

Applied Medical Services

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

ADVERTISING

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

MedMedia9

www.medmedia9.com

Ring Ring LLC

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

ANSWERING SERVICES Docs on Hold

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

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

PO Box 15670 Brooksville, FL 34604 888-717-9615 www.goldkeycreditinc.com

Advanced Physician Billing, LLC

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

56 | NOVEMBER 2013

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

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

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

CODING SPECIALISTS

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

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

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

COMPUTER, SOFTWARE

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

Practice Velocity

BILLING & COLLECTION

VIP Billing

Frost Arnett

Gold Key Credit, Inc.

Find Urgent Care

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

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

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

Sweans Technologies

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

American Medical Software

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

CDWG

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

Instant Medical History

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

medical resource guide CONSULTING SERVICES, PRACTICE MANAGEMENT

Dental Management Club

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

The Dental Box Company, Inc.

Medical Credentialing

(800) 4-THRIVE www.medicalcredentialing.org

PO Box 101430 Pittsburgh, PA 15237 (412)364-8712

www.thedentalbox.com

Medical Practice Listings

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

DIETICIAN

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

FINANCIAL CONSULTANTS

Triangle Nutrition Therapy

myEMRchoice.com

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

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

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

Synapse Medical Management

18436 Hawthorne Blvd. #201 Torrance, CA 90504 (310)895-7143 http://www.synhs.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/ UrgentCareMentor.com

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

www.pushpa.biz

DENTAL Biomet 3i

EQUIPMENT APPRAISER

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

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

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

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

INSURANCE, MED. LIABILITY

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

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

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

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

Aquesta Insurance Services, Inc.

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

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

Medical Protective

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

MGIS, Inc.

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

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

www.mgis.com www.integritas.com WWW.MEDMONTHLY.COM | 57

medical resource guide INSURANCE, MED. LIABILITY

Nicholas Down http://bit.ly/yHwxb0

Martin Fried

www.martindfried.com

Professional Medical Insurance Services

16800 Greenspoint Park Drive Houston, TX 77060 (877)583-5510 http://www.pmis.com/

Wood Insurance Group

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

LOCUM TENENS Physician Solutions

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

Bank of America

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

MMA Medical Architects

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

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

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

MEDICAL EQUIPMENT

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

Biosite, Inc

9975 Summers Ridge Road San Diego, CA 92121 (858)805-8378 http://www.alere.com/us/en.html

Cryopen

MEDICAL ART

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

www.artisanprinter.com

Deborah Brenner

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

Pia De Girolamo

www.piadegirolamo.com

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

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

www.dicomsolutions.com

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

58 | NOVEMBER 2013

MEDICAL MARKETING High Performance Network Robert Sayre Marketing Adviser/Business Coach http://www.linkedin.com/pub/robsayre/2/977/355/

MedMedia9

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

WhiteCoat Designs

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

MEDICAL PRACTICE SALES Medical Practice Listings

www.cryopen.com

Carolina Liquid Chemistries, Inc. Brian Allen

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

MedImagery

ALLPRO Imaging

MEDICAL ARCHITECTS

MEDICAL EQUIPMENT FINANCING

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

MEDICAL PRACTICE VALUATIONS BizScore

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

www.thetps.com

medical resource guide

MEDICAL PUBLISHING

PRACTICE FINANCING Bank of America

Greenbranch Publishing

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

MEDICAL RESEARCH

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

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

Dermabond

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

DJO

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

REAL ESTATE

www.djoglobal.com

Arup Laboratories

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

www.aruplab.com

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

www.crlcorp.com

Sanofi US

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

Scynexis, Inc.

ExpertMed

York Properties, Inc.

www.sanofi.us

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

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

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

www.expertmed.com

Gebauer Company

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

Scarguard

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

WEBSITE DESIGN

SUPPLIES, GENERAL

3501 C Tricenter Blvd.

Durham, NC 27713 (919) 933-4990

MedMedia9 www.scynexis.com

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

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

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classified listings

Classified To place a classified ad, call 919.747.9031

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

Averages 25 patients per day with no call and shift hours from 8:30 am to 5:30 pm. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com 3-5 days per week in Durham, NC . Geriatric physician needed immediately 3-5 days per week, on-going at nursing home in Durham. Nursing home focuses on therapy and nursing after patients are released from the hospital. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com GP Needed Immediately On-Going 1-3 Days Per Week at Addictive Disease Clinics located in Charlotte, Hickory, Concord & Marion North Carolina. General Practitioner with a knowledge or interest in addictive disease. Needed in October on-going 1-3 times per week. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Primary Care Physician in Northwest NC (multiple locations). Primary care physician needed immediately for ongoing coverage at one of the largest substance abuse treatment facilities in NC. Doctor will be responsible for new patient evaluations and supportive aftercare. Counseling and therapy are combined with physician’s medical assessment and care for the treatment of adults, adolescents and families. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Pediatrician or Family Medicine Doctor in Fayetteville Comfortable with seeing children. Need is immediate - Full time ongoing for maternity leave. 8 am - 5 pm.

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

60| NOVEMBER 2013

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

Pediatrician or Family Physician Needed Immediately at clinic in Roanoke Rapids, NC. Pediatric clinic in Roanoke Rapids, NC seeks Peds physician or FP comfortable with children for 2-3 months/on-going/full-time.

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

Classified To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

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

Physician Solutions, PH: (919) 845-0054, email: physiciansolutions@gmail.com

FT/PT Mid-Level Provider needed for Wilmington practice immediately. Small internal medicine private practice 45 minutes outside Wilmington seeks mid-level provider starting immediately. FT/PT. M-F 8:00-5:00.

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

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

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

Child Health Clinic in Statesville, NC seeks pediatrician or Family Physician comfortable with peds for on-going, full-time shifts. Physician will work M-F 8 am - 5 pm, ongoing. Qualified physician will know EMR or Allscripts software. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

IM/FP needed in Fayetteville clinic immediately. Fayetteville health department needs coverage March through June full or part time. Patients adult health and women’s health. Adults only. No call 8a-5p.

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

Peds Clinic near Raleigh seeks Mid-Level Provider for on-going coverage 4x/wk. Health Department pediatrics clinic 45 min from Raleigh needs coverage 4 days a week from January through June. Provider will see about 20 patients daily, hours are 8am-5pm with an hour for lunch. Please contact Physician Solutions at 919-8450054 or emailphysiciansolutions@gmail.com.

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

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

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

FT Mid-Level Provider needed for Wilmington practice immediately. Small private practice 45 minutes outside Wilmington seeks mid-level provider starting January.

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

Employee Health Clinic seeks Mid-Level Provider for FT on-going coverage near Charlotte. Practice 45 minutes from Charlotte seeks on-going coverage for employee health clinic beginning in March. Provider will see about 20-24 patients daily, hours are 8am-5pm with an hour for lunch. Please contact Physician Solutions at 919-845-0054 or email us at physiciansolutions@gmail.com.

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

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

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classified listings

Classified

continued from page 61

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

Fayetteville occupational health care clinic seeks GP for May. Primary care physicians needed for occupational medicine. Adults only. 8-5p. Large corporation, no call required. Intermittent dates in the future and second office in Greensboro with ongoing scheduling.

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

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

Family Practice 1 h SE of Raleigh seeks coverage.

Goldsboro FP seeks MD for July 6-7 and intermittent shifts. 8-5p. Please contact Physician Solutions at 919845-0054 or email physiciansolutions@gmail.com.

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

Greenville Clinic seeks GP. GP/IM needed for intermittent shifts. Must have experience or be willing to do pain management and trigger point injections. 8-5p.

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

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

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

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

Western North Carolina Clinic needs continuing physician coverage. Clinic seeks coverage for their walk in clinic which sees all ages. Ongoing, 8am-5pm, no call.

35-40 patients a day. Well established clinic located in a beautiful area. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

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

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

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

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

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

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

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

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

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

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classified listings

Classified

continued from page 63

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

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

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

Family Practitioner opportunity available one hour east of Charlotte Monday through Friday. The hours will be 8:00am until 5:00pm either full time or part time.

You will be seeing 15-20 new patients a day. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Family Physician opportunity for a leading medical practice in the Raleigh area. Must be able to start immediately and be comfortable with seeing all ages.

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

General Practitioner/ Internal Medicine/ Family Physician opportunity available at a large substance abuse treatment facilitiy in Western NC. Doctor will be responsible for new patient evaluations and supportive aftercare. Counseling and therapy are combined with physician’s medical assessment and care for the treatment of adults, adolescents and families. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com. continued on page 66

Woman’s Practice in Raleigh, North Carolina.

Immediate opportunity for a Primary Care Physician at a large practice located one hour south of Raleigh. The hours are from 8:00am until 5:00pm You will be treating generally 20-25 patients per day. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Family MD opportunity at an Urgent Care facility that sees all ages in the Jacksonville, NC area. This will be an ongoing schedule from 8:00am until 6:00pm 1-2 days a week, including weekend dates. You will treating generally 30-35 patients a day. There is potential for permanent placement. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Primary care physician opportunity for busy occupational medicine practices near Greensboro/Fayetteville, NC. There are two locations with positions available within 15 minutes of Greensboro and Fayettteville. Your schedule will be from 8:00am until 5:00 pm either full time or part time, no call necessary. Patient treatment will consist of adults only in both facilities. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

64| NOVEMBER 2013

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

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

Medical Practice Listings; 919-848-4202

Primary Care Specializing in Women’s Health

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.

919.848.4202 medlisting@gmail.com medicalpracticelistings.com

PEDIATRICIAN

or family medicine doctor needed in

FAYETTEVILLE, NC

NC OPPORTUNITIES LOCUMS OR PERMANENT

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

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

Please contact Physican Solutions at 919-845-0054 or physiciansolutions@gmail.com Comfortable seeing children. Needed immediately.

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

For more information about Physician Solutions or to see all of our locums and permanent listings, please visit physiciansolutions.com

classified listings

Classified

continued from page 64

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

Primary Care Physician opportunity for a leading women’s practice in the Lenoir, NC area. Treating Physician must be comfortable with light OB and well women’s exams. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

General Practitioner/Internal Medicine Physician opportunity for intermittent shifts at a prominent practice in the Greenville, NC area. Treament schedule will be from 8:00am until 5:00pm. The practicing physician must have experience or be willing to perform pain management and trigger point injections. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Exceptional Family Physician opportunity at a practice in the Raleigh, NC area. Schedule will be ongoing Monday through Friday from 8:00am until 5:00pm. Must be comfortable with treating all ages. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Immediate Pediatrician opportunity at a small outpatient hospital. Located between Fayetteville and Wilmington, this facility requires someone for intermittent shifts. Please contact Physician Solutions at 919845-0054 or email physiciansolutions@gmail.com.

Pediatrics Opportunity - Roanoke Rapids Area Northeastern North Carolina Pediatric Practice seeks on-going physician for full time coverage beginning mid-October through the end of the year. Practice sees about 16-25 patients a day, hours are 8:00-5:00 with negotiable call. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Family Practitioner Opportunity - Greenville area Immediate opportunity for a family practitioner for a practice about 20 miles east of Greenville. The hours will be 8:00am until 5:00pm. Must see all ages. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

66| NOVEMBER 2013

Primary Care Physician - Washington area Seeking a physician for a general primary care practice.

Treatment will include seeing 3-4 pediatric and about 10 adult patients per day. The hours are 8:00- 5:00pm M-F. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Family Physician –Williamston area Immediate opportunity at a developing family practice in the Williamston area. You will be treating 8-16 patients per day from 8:00-5:00 pm. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

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

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

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

continued on page 68

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

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

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

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

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

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

• • • • • •

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

There is a Compounding Pharmacy located in the same suites with a consulting pharmacist working with this Integrative practice. Average Patients per Day: 12-20

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

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

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

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

Call for pricing and details.

Gross Yearly Income: $335,000+ | List Price: $125,000

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

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

classified listings

Classified

continued from page 66

To place a classified ad, call 919.747.9031

Physicians needed Virginia (cont.)

Urgent Care opportunities throughout Virginia. We have contracts with numerous facilities and eight to 14-hour shifts are available. If you have experience treating patients from pediatrics to geriatrics, we welcome your inquires. Send copies of your CV, VA medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, E-mail: physiciansolutions@gmail.com Virginia practice outside of Washington DC seeks IM doctor FT/PT now – June 1. IM physician needed immediately FT/PT for Virginia clinic near Washington DC. 8-5p Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

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

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

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

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

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

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

68 | NOVEMBER 2013

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

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

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

Contact us today at (919) 848-4202.

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

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

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

Classified To place a classified ad, call 919.747.9031

Practice for sale North Carolina (cont.)

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

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

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

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

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

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

WWW.MEDMONTHLY.COM | 69

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

Practice for Sale in South Denver

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

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

Live and work in one of the most healthy cities in the U.S. List Price: $150,000 | Established: 2007 | Location: Colorado

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

For more information contact Dr. Jack McInroy at 303-929-2598 or Shrink1324@gmail.com

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

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

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

Medical Practice Listings Selling and buying made easy

MedicalPracticeListings.com | medlisting@gmail.com | 919.848.4202

Primary Care Practice For Sale Wilmington, NC

NC MedSpa For Sale MedSpa Located in North Carolina We have recently listed a MedSpa in 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.

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 for more information.

Contact Medical Practice Listings today to discuss the practice details.

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

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

www.medicalpracticelistings.com

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

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

PRACTICE FOR SALE

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

Asking price: $385,000

medmonthly.com | 919.747.9031

To view more listings visit us online at medicalpracticelistings.com

Comprehensive Ophthalmic and Neuro-Ophthalmic Neuro-Ophthalmic Practice

PEDIATRICIAN

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

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

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

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

Contact Cara or Philip 919-848-4202 for more information or visit MedicalPracticeListings.com

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

Wanted: Urgent Care Practice

Women’s Health Practice in Morehead City, NC

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

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.

Buying and selling made easy

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

Buying and selling made easy

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

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

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

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

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

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

Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624 PH: (919) 845-0054 | email: physiciansolutions@gmail.com WWW.MEDMONTHLY.COM | 73

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. l One

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

Please direct all correspondence to driverphilip@gmail.com.

Only serious, qualified inquirers.

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

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

Listing Price: $430,000

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

Pediatrics Practice Wanted

Practice for Sale in Raleigh, NC

Pediatrics practice wanted in NC

Primary care practice specializing in women’s care

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.

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

Raleigh, North Carolina

List price: $435,000

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

Unfortunately, its motor is inside playing video games.

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

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

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

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

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

American Council on Exercise

®

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

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

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E-mail is a useful tool for any medical practice, but unlike phone or face-to-face communication, it poses challenges when conveying the tone and the message you are trying to communicate. Here are 9 tips to help keep your e-mails clear and professional.

1

WATCH YOUR TONE

Your tone can be misinterpreted an e-mail, so the more to the point you can be the better.

Also using words like “please” and “thank you” can go a long way.

2

KEEP E-MAILS BRIEF AND TO THE POINT

Make your most important point first, and then provide supporting details if necessary. Paragraphs should be short and easy to read.

3

AVOID TYPING IN ALL SMALL CAPS OR ALL UPPER CAPS This can make your e-mail look lazy (small caps) or like you are shouting (all upper caps). This is one of the most basic rules.

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| NOVEMBER 2013

Med

dical Practice E-mail Tips

4

DON’T REPLY WHEN IRRITATED OR ANGRY

If you find yourself becoming irritated reading an e-mail, step away for a minute and calm down before replying. You might be getting worked up over something that is simply an error in the translation of the tone.

5

ONE E-MAIL PER SUBJECT

When you are e-mailing patients, it is best to send one e-mail per subject so that it is easily referenced again by the subject line.

6

USE PDF FILES WHEN SENDING ATTACHMENTS

You want to make sure that the person receiving the e-mail will be able to open the file. PDF is often the best format for documents, because most systems can open it.

7

LIMIT TEXT FORMATTING

Just because your e-mail service or program offers text formatting options doesn’t mean you should use them. Various fonts and colors can make the e-mail difficult to read, and can often times seem unprofessional.

8

USE “IF –THEN” OPTIONS WHENEVER POSSIBLE

Using “if-then” options cuts down on the back and forth of e-mailing, especially for appointment times. For example: “Can you come in for a follow-up appointment at 3 p.m. on Wednesday? If not, then please give me other days and times that would be more convenient for you.”

9

ALWAYS SIGN OFF WITH CARE Use words such as “Thanks,” “Sincerely,” “Best regards,” for closing e-mails. This is polite, respectful, and conveys a nice tone.

Always use care and common sense when using e-mail as a tool to communicate with your colleagues, staff, and patients.

WWW.MEDMONTHLY.COM | 77

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

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

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

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