Med Monthly November 2014

Med Monthly November 2014

Proposed Rule Issued

by OIG Realigns Its Enforcement Views with Health Care Reform Goals

The New Role of Nurse Practitioners in Health Care Reform

pg. 40

pg. 38

STATES EXPANDING MEDICAID UNDER THE AFFORDABLE CARE ACT pg. 36

the

are Health C Reform issue

10 TIPS TO GET MORE PATIENTS INTO YOUR PRACTICE pg. 22

contents

features

36 STATES EXPANDING MEDICAID UNDER THE AFFORDABLE CARE ACT 38 THE NEW ROLE OF NURSE PRACTITIONERS IN HEALTH CARE REFORM 40 PROPOSED RULE ISSUED BY HHS OFFICE OF THE INSPECTOR GENERAL (OIG) REMOTE EMPLOYEE WORKFORCE

insight

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6 HELPING “THE SANDWICH GENERATION” FIND WORK/LIFE BALANCE 10 HEALTH REFORM – WORKFORCE ISSUES 12 REMOTE EMPLOYEE WORKFORCE: Risks & Rewards - Could it work for you?

practice tips 16 ARE YOU “THE ONE”?

research and technology 26 HYPERTENSIVE PATIENTS LOWER SYSTOLIC BLOOD PRESSURE WITH SELF-REGULATION OF MEDICATIONS

20 4 QUESTIONS TO IMPROVE HEALTH OUTCOMES

28 2014 REPORT ON U.S. PHYSICIANS’ FINANCIAL PREPAREDNESS

22 10 TIPS TO GET MORE PATIENTS INTO YOUR PRACTICE

30 SUBSIDIES HELP BREAST CANCER PATIENTS ADHERE TO HORMONE THERAPY

38

legal

THE NEW ROLE OF NURSE PRACTITIONERS IN HEALTH CARE REFORM

32 FDA FINALIZES GUIDANCE FOR MANAGEMENT OF CYBERSECURITY IN MEDICAL DEVICES 34 HIPAA VIOLATION RESULTS IN $4.8 MILLION SETTLEMENT: An IT Perspective

healthy living 44 SWEET POTATO QUINOA SALAD

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

Call us today at 919-833-3836 x141

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

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Med Monthly November 2014 Publisher Philip Driver Creative Director Thomas Hibbard Contributors Ashley Acornley, MS, RD, LDN. Saurabh Anand Nidhi Behl Vats Theresa Carnegie Susan Cassidy Amanda Chay Thomas Crane Michelle Durner, CHBME Tyler Evans Alexis Gopal, M.D. Barbara Hales M.D. Jennifer Plitsch Carrie Roll Angela Savitri, OTR/L, RYT Lisa P. Shock, MHS, PA-C Jared A. Smith Stephanie Willis Deb Wood, PhD

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

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

contributors Amanda Chay serves as the Director of Physician Liaison & Affiliate Programs at WhiteCoat Designs, a company that specializes in marketing solutions for the healthcare industry.

With a healthcare marketing background spanning 13 years, Amanda has a strong understanding of the challenges faced by doctors and their practices in this competitive market.

Alexis Gopal M.D. has years of clinical experience in Internal Medicine in NYC and CT, and has recently transitioned into a career of freelance medical communications. She has a special interest in regulatory affairs, and patient education. Currently residing in CT, she can be reached at aliserg@msn.com.

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

Angela Savitri, OTR/L, RYT helps high-achieving women be free of burnout and chronic stress.

She is an Integrative Health Coach and combines principles of behavioral science, mindfulness, and embodiment in her 90-Day Freedom from Chronic Stress Program. www.freedomfromchronicstress. com.

Deb Wood, PhD is a senior consultant for Workplace Behavioral Solutions, Inc. and its Midwest EAP Solutions and Physician Wellness Services divisions, where she does counseling, speaking, and training and development. She specializes in the areas of team building, stress management and change in organizations, and also does critical incident stress debriefings.

She is a certified couple’s communication facilitator, a Certified Employee Assistance Professional and has her PhD in counseling from Capella University.

WWW.MEDMONTHLY.COM |5

insight

Helping “The Sandwich Generation” Find Work/Life Balance

By Deb Wood, PhD Senior Consultant Physician Wellness Services (a division of Workplace Behavioral Solutions, Inc.) The Sandwich Generation—if you have at least one parent age 65 or over, and are raising children and/or financially supporting a grown (18+) child, you’re part of it. The term, coined in 1981 by Dorothy Miller, a social worker, originally referred to women, generally in their 30s and 40s, who were “sandwiched” between young kids, spouses, employers and aging parents. Over time, while the underlying concept has stayed the same, the demographics have expanded to include both men and women, and a larger age range as childbearing is sometimes delayed, grown children move back home more frequently (or never leave) and parents are living longer.

As a societal phenomenon, being a member of the Sandwich Generation is increasingly recognized—and also linked to higher levels of stress, financial uncertainty, and downstream effects such as depression and greater health impacts that caregivers are known to suffer. If you’re 6

| NOVEMBER 2014

already providing caregiving to make a living, this may feel like a club you really don’t want to belong to. It’s important to understand that the impact of caregiving is real and tangible—and to take it seriously and approach it in a manner that protects your physical, mental and financial wellbeing.

Physical and Mental Health Impacts The American Psychological Association1 found in their 2007 Stress in America study that mothers in the sandwich generation, ages 35-54, felt more stress than any other age group. The study found that nearly 40% of those aged 35-54 reported extreme levels of stress (versus 29% of 18-34 years old and 25% of those older than 55).

Women reported higher levels of extreme stress than men, and also that they were less effectively managing their stress. This impacted personal relationships—83%

reported that relationships with their spouse, children and family were the top source of their stress—and also their own wellbeing as they struggled to take better care of themselves. An APA spokesperson noted, “It’s not surprising that so many people in that age group are experiencing stress. The worry of your parents’ health, and your children’s wellbeing as well as the financial concern of putting kids through college and saving for your own retirement is a lot to handle.”

Another study2 examined the impact of caregiving on wellbeing. Employed caregivers had an average age of 43.3 and 51.8% were female. Using various indices to evaluate different aspects of wellbeing, the study found, in comparing employed caregivers vs. non-caregivers: • 40% higher levels of stress and worry • 44% higher levels of diagnosed depression • 7% lower overall physical health A third study3 focused exclusively on health-related issues and found significantly higher rates of prevalence for caregiving employees of: • Diabetes, high cholesterol, hypertension, COPD and heart disease across all ages and both genders • Depression, which was one-third more prevalent for caregivers vs. non-caregivers • Stress in general and at home across all age and gender cohorts

Financial Impacts—and Less Tangible Support A recent Pew Research report4 talks about a “perfect storm” of issues which can appear overwhelming for those who are caught in it.

The report, based upon a survey that was conducted in late 2012, not only addresses the pressures that adults aged 40-59 are facing due to providing financial support to both their grown children and aging parents, but also touches on the emotional support they are often also providing, especially to the older generation.

Consider these statistics from the study: • 48% of adults aged 40-59 have provided some financial support to at least one grown child (aged 18 and over) in the past year and 27% have provided primary support; that number jumps to 73% providing some support when just considering those who have children 18 and over.

• 21% have provided some financial support to a parent aged 65 and older in the past year; that number jumps to 32% for those with a parent aged 65 and older • 38% said both their grown children and parents rely on them for support • For those who are providing financial support for both a parent and children of any age, 28% said they are living comfortable compared to 41% who are not financially supporting an aging parent. (Other

respondents range from those who don’t have enough money to meet basic needs to those who have enough to meet basic needs with a little left over) Beyond the financial support they are providing, the Sandwich Generation is often also involved in caregiving and providing emotional support. The study finds that a third of adults in the 40-59 age group are providing assistance with daily living to their aging parents, and that number increases as parents age, not surprisingly.

Similarly, over two-thirds of this cohort with 65+ parents report that their parents rely on them moderately or extensively for emotional support. Added to this, those with grown children report overwhelmingly that, even without financial support, their children rely on them moderately to extensively for emotional support. This number increases if they are also providing financial support.

Helping the Sandwich Generation We talk a lot about the importance of work/life balance, and this is central to being able to cope effectively with the many demands healthcare providers face, especially those who are members of the Sandwich Generation.

What does this mean? As providers come to us when they’re feeling overwhelmed, there are often multiple presenting issues, and as we work with them, we learn that they are sometimes linked. Financial stress can lead to family or relationship strains, for example. Stress, anxiety and depression can be caused by jugging too much between home and work. Responsibilities for dependent children or supporting a spouse or partner who are out of work can be daunting, in and of themselves, for many, but the added levels of support for grown children and/or aging parents can push even the most resilient past their tipping point.

For some, employers may have resources and programs that can help. Providing more flexible scheduling to allow employees to better handle family responsibilities can be very helpful. Some employers also offer eldercare benefits which can help with planning and identification of resources.

It’s also helpful to learn from others. Speak to your HR department about help forming and promoting a lunchtime or after-work support group for “sandwiched” employees to share experiences and resources—and providing the space for it to meet.

Most larger healthcare organizations also offer an EAP, which can provide valuable counseling and support around such things as: • Coping skills and resilience-building • Prioritizing and time management • Setting and maintaining appropriate boundaries continued on page 8 WWW.MEDMONTHLY.COM | 7

continued from page 7

• Finding resources to assist with caregiving • Eldercare-related education and resources around financial and life planning for your parents • Financial and budget planning to better manage your money wisely, and still plan for your own retirement, as well as your children’s college expenses and other needs Regardless of programs that your employer may have, things that you should do to help yourself include: • Watch for depression. As numerous studies have shown, this is something for which caregivers are at higher risk, and may be something that creeps up on you. If you or a spouse or partner have access to an EAP, those counselors can help with this. Otherwise, if you’re experiencing some signs of depression, speak to your primary care physician for a more complete screening and assistance—or a referral to a therapist or psychologist.

• Put yourself in the “balance” equation. You need to be intentional about setting aside time for yourself.

If you wait until you have free time, you may well be waiting until retirement—leaving you susceptible to burnout. Set regular time aside for self-care, such as a taking a yoga or exercise class, or scheduling time to jog with a friend.

• Set boundaries. This is not only reasonable, but critical so that you have time for the important things, plus take care of yourself. Be honest about what is absolutely necessary—and where there is room for compromise or to say no. Being at your child’s school play? Non-negotiable. Baking cookies for the party afterward? Not likely anyone will remember 15 minutes after the party ends if you don’t.

• Ask for help. People ask you for help all the time. Ask them to return the favor. They can always say no, but most won’t—and may be delighted to lend a hand.

• Hold family meetings. This is important—to set expectations and boundaries, get help, and enlist others share some of the responsibilities. There are ways even young children and frail elders can be part of the solution, but you have to let them understand the needs and give them a chance to meet them.

• Find and use a financial planner. You can alleviate a lot of stress by helping yourself and your parents protect your future and manage the present, and set reasonable boundaries and conditions around financial support for grown children and elders.

Eldercare can be especially challenging—but there are many sources of help. A good place to start is through the Eldercare Locator, a federally funded service that connects caregivers with local resources. Every county or multi8 | NOVEMBER 2014

county area in the country has an Area Agency on Aging which receives federal funding to provide information and referral to family caregivers on aging and caregiving services, such as adult day care, respite care, home repair and modification, personal care and more. The area agency can be reached through the Eldercare Locator toll-free number (1-800-677-1116) or website at http://www. eldercare.gov/Eldercare.NET/Public/Index.aspx  APA Psychology Help Center, “Sandwich Generation Moms Feeling the Squeeze.” Accessed 03/01/2014: http://www.apa. org/helpcenter/sandwich-generation.aspx 2 Coughlin, J, “Estimating the Impact of Caregiving and Employment on Well-being,” Outcomes & Insights In Health Management, 2:1, May 2010.

3 Albert, SM et al, “The MetLife Study of Working Caregivers and Employer Health Care Costs,” National Alliance for Caregiving, University of Pittsburgh Institute on Aging and MetLife Mature Market Institute, February, 2010.

4 Taylor, P et al, “The Sandwich Generation: Rising Financial Burdens for Middle-Aged Americans,” Pew Research Center, January 30, 2013. Accessed 3/01/2014: http://www. pewsocialtrends.org/files/2013/01/Sandwich_Generation_ Report_FINAL_1-29.pdf 1

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insight

Health Reform –

Workforce Issues

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

P

hysician Assistants (PAs) and Nurse Practitioners (NPs) are skilled medical professionals who play an integral part in health care delivery. Especially in primary care, PAs and NPs attract and manage a significant following of patients. Often, the addition of a PA/NP to a medical practice offers enhanced patient satisfaction, improved physician work-life balance, improved

10 | NOVEMBER 2014

revenues and greater access to care for patients.

Redesigning teams to include increased numbers of primary care providers, not just physicians but also Physician Assistants (PAs) and Nurse Practitioners (NPs), is a significant part of the solution to alleviate the wellknown shortage in primary care under new health care reform. Improving utilization of Physician Assistants (PAs)

and Nurse Practitioners (NPs) will be an integral part of the primary care delivery solution.

A recent USA Today article highlights the PA profession to grow at least 5% by 2017. As more baby boomers age, both PAs and NPs will be in demand with projected median wages of about $44 per hour, and expected increases in those wages due to demand of at least 14% by 2017.

PAs and NPs are estimated to do about 85% of the work a physician would otherwise provide in the primary care setting. Nationwide, hospitals and health systems are moving toward using more PAs and NPs and there is a much greater emphasis on team based care.

Growing concerns about physician shortages are increasing reliance on PAs and NPs to fill the gap.

Increasing capacity of the health system to meet the growing numbers of patients seeking care is critical and necessary. Expansions in scope of practice for both professions are recently evident in several states including NY and KY. It is estimated that teams of PAs and NPs working with physicians in the primary care setting may extend capacity enough such that there is not a shortage at all.  References: http://www.usatoday.com/longform/money/2014/10/14/ jobs-for-college-grads-by-metro/16046989/

http://www.fiercehealthcare.com/story/more-patients-openprimary-care-offered-physician-assistants/2014-10-20 http://www.witf.org/news/2014/10/how-pas-are-re-shapinghealth-care.php http://www.fiercehealthcare.com/story/4-waysimprove-primary-care-delivery/2014-10-02?utm_ campaign=SocialMedia

Lisa P. Shock, MHS, PA-C is a seasoned PA who has worked with clients to expand care teams in both large and small settings. She enjoys part time clinical practice and is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering a wide range of services to help implement and improve upon the utilization of PAs and NPs in the health care system. Contact her at lisa@pushpa.biz

WWW.MEDMONTHLY.COM | 11

insight

Remote Employee Workforce Risks & Rewards: Could it work for you?

By Michelle Durner, CHBME Applied Medical Systems, Inc.

12 | NOVEMBER 2014

Do you currently have a remote employee workforce or are you considering one? A remote workforce is not for the faint of heart. However, if you are already using a third party vendor for services such as coding or revenue cycle management then a remote workforce isn’t as foreign a concept as you might think. Outsourcing business services is essentially a remote workforce, the difference might only be whether or not they are contractors, employees or a vendor relationship. While some principles remain the same in any remote workforce situation, having an employee work remotely creates the possibility of more risks but also more rewards.

Trust and mutual respect are the foundation for allowing employees to work autonomously. If you don’t trust your employees when they are working in the office next door, you certainly aren’t going to trust them to work remotely.

According to GlobalWorkplaceAnalytics.com, 79% of U.S. workers say they would like to work from home at least part of the time (WorldatWork Telework Trendlines 2009).

GlobalWorkplaceAnalytics also offers fascinating statistics as follows: If employees worked from home just half the time, the following would happen: l

Typical business would save $11,000 per person, per year. l Telecommuters would save between $2,000 and $7,000 a year in transportation and work related costs. l Telecommuters would gain back the equivalent of 2-3 weeks of free time per year. l 36% of employees say that they would choose telecommuting over a pay raise. l Studies and empirical evidence shows productivity increases of between 15% and 55%.

Some benefits of telecommuting are: l Employee satisfaction l Reduce attrition l Reduce unscheduled absences l Increase productivity l Saves money l Increase employee empowerment l Increase collaboration l Expand talent pool l Environmental factors l Continuity of operations

The benefit to continuity of operations and disaster planning cannot be emphasized enough. In the case of natural disasters or inclement weather, having a remote workforce allows your staff to keeping working. However, in realizing those benefits, there are obstacles that must be overcome: continued on page 14 WWW.MEDMONTHLY.COM | 13

continued from page 13 l Mistrust l It’s not for everyone l Co-worker jealousy l HIPAA Security Issues l Infrastructure changes l Collaboration l Employment laws/OSHA

How can you overcome these obstacles in a way that makes the implementation of a remote workforce successful?

Business Impact Analysis

A business impact analysis is the first critical step in realizing a remote workforce. You must analyze every piece of your business and workflow to determine how your workflow will change. Can every employee do the same job remotely that they do in the office? If not, how do operations change to make that happen? Do you want all employees to work from home 100% of the time? Do you want staggered time in the office? Does your current phone system allow for remote workers and routing of calls? There are many considerations in planning and implementing a remote workforce.

Policies & Procedures

Once workflow and operations are redesigned to allow for remote work, your next step is to revisit your policies and procedures to see what changes are now necessary.

From both an operational and human resources standpoint, many policies and procedures will need to be revised to accommodate the changes that a remote workforce brings.

Training

Managers and staff should have separate training during a roll out of a remote workforce. Managers will now need to supervise employees in an entirely different way and they need to learn how to communicate with employees in ways that don’t necessarily come natural to them.

Your staff needs to know how their jobs will change.

Ideally, they have been included in the business impact analysis and have a good idea already of what’s in store for them. However, what they don’t know is what are your expectations of them as a remote worker. What measurements will you have in place to ensure that work is happening in an appropriate manner? Employees will be submerged into a world of distractions, ie. dishes, laundry, family members and the refrigerator. Communication methods will need to be identified and shared with staff.

Will you only use phone and email or will you also utilize instant messaging and group collaboration tools?

Additionally, you have to consider how you will onboard and train new hires. Will it be done remotely, will 14 | NOVEMBER 2014

there be an “in office” training period before an employee is allowed to work remotely?

Employee Qualifications

Before deciding if an employee has the qualities to work from home, keep in mind that you need to first determine if their current position is one that can be done at home.

When deciding whether or not to allow someone to work from home, some of the preferred traits are independence, organization, self-motivation and trustworthiness. Does the employee have the home space and will to work remotely? Not everyone does. Some employees relish the idea of working from home and then they find out that it can be rather lonely.

An application process for the employee can be helpful to get them thinking differently about remote work from the get go. Have the employee rate themselves on areas of communication, decision making, goal and objectives, initiative, judgment, oral expression, problem solving, professionalism, quality, responsibility and time management. If the manager and the employee differ on the degree to which an employee rated themselves, that opens the door to a candid conversation about what needs to happen before an employee is approved to work from home. As part of the application process, you can also include questions about the workspace, environment, family support, personality traits, ergonomics, safety and security.

Workspace Requirements

First things first, you will want to check with your Workers Compensation carrier to determine if they have specific requirements around covering a remote workforce.

If you plan to have employees in more than one state, how does each state’s Worker’s Compensation laws differ? Do you want to place requirements on the employees around acceptable workspace to minimize your liability? Do you want to ensure that ergonomics are appropriate? Some requirements could include: l

Work area must be enclosed and have a door which can be shut l Lighting must be adequate without glare l Desk Height l Monitor Height You will want to consider if you want to do any type of home audit on the workspace to ensure compliance with the standards set forth. This could be an employee self audit with a checklist and pictures, or you could have a company representative perform the site audit.

Technology & Equipment

One big consideration in a remote workforce is who is responsible for purchasing the equipment that the employee will have at their remote office. If the employer does not provide the equipment, will you instead provide

‘‘

“The single biggest problem in communication is the illusion that it has taken place.”

a subsidy? Will you cover the cost of the internet for the employee? There are other questions that might need to be answered first around where will data reside and how the employee will access your systems.

Additionally, from a technological standpoint, there are HIPAA and security implications that need to be taken into account when determining the best way to set up access and communication protocols for your employees.

Monitoring

As the old saying goes, “You can’t manage what you don’t measure”. Ideally, you already have measures in place that would be appropriate to also measure remote workforce productivity and efficiency. Telephone system, practice management system, monthly key performance indicators as well as your timekeeping system will probably be your main resources for measuring employee work. If not already in place, you could also consider using a time tracking software such as Toggl to monitor how employees are spending their time. No one resource will measure everything and you may need to spend time manipulating the data to tell you what you need to know.

Communication

Ultimately, effective communication is the most important part of having a successful workforce. Daily communication in myriad formats will help to ensure that your staff clearly knows your expectations and feels included as a member of the team. It also makes them feel comfortable reaching out to management in times of need and makes them accessible to clients with no interruption in service.

In addition to phone and email, some other options for staying in touch are Skype, Google Hangout, and GoToMeeting. Additionally, you might need to consider online collaboration tools so that your team can work together when completing projects. Some examples of those tools are Basecamp and Trello. There is also the consideration of networking and creating a virtual water cooler. Yammer is one such enterprise social networking service that can be

George Bernard Shaw used for both personal and work related topics. Think of it as Facebook on steroids for work. Finally, will you have any opportunities for staff to gather in person from time to time to collaborate as a team as well as to socialize?

Now that you have the backbone for instituting a remote workforce, you only need to roll it out. Take your time. Use this as an opportunity to make all of your processes more efficient and your communication methods more effective.

Question everything that you do now and include as many people as possible in the discussion. This is not an IT project or an HR project, this is an “everyone” project, and it will influence everything from your culture to your bottom line. A slow and methodical roll-out allows for a pilot program to ease you into the remote workforce world.

It gives you time to identify things that you might have missed in the Business Impact Analysis and allows you to take advantage of what you learn along the way. However, if you have done your due diligence and worked through the process in painstaking detail, then the rollout should be the easiest part of the process. That, and the commute. 

Michelle L. Durner, CHBME is the President of Applied Medical Systems, Inc. – a Durham, NC-based company which provides medical billing, coding, practice management, and consulting services to start-up practices, hospitals, private practices, and emergency physician groups across the nation. To contact Michelle or to learn more about Applied Medical Systems, please visit www.appliedmedicalsystems.com WWW.MEDMONTHLY.COM | 15

practice tips

Are You “The ONE”?

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

16

| NOVEMBER 2014

Y

ou’re known as the internist, the GP, the surgeon, the________(fill in the blank) specialty doctor in town. Maybe that is how you are thought of.

But what differentiates you from the other doctors in town who practice in the same specialty? There may be a myriad of skills, techniques or office procedures that set you apart. Does the neighborhood know about it? Does anybody outside your staff know?

Consider branding yourself and your practice.

Branding Be the One! Branding is not only a way to entice people to select you over your competitors (and there are many unless you live in a small town). It is all about perception- getting prospective patients to feel that you are the only sensible choice for them- the one that provides answers to the problems they have.

Howard Schultz, the CEO of Starbucks stresses: “If people believe they share values with a company, they will stay loyal to the brand”.

Effective branding will: • Emphasize your USP (unique selling proposition- what makes you one-of-a-kind) • Motivate prospective patients to become your patients • Encourage patient loyalty • Get your message across • Supply answers to the needs and wants of people in the community • Connect with the emotions of your patients and future patients • Help to develop a relationship with patients even before they meet you

Do people know what your brand is?

Do you? Sit down and think of yourself. Why would someone come to you instead of the one down the block?

Is your office hours more convenient? Do you have better hospital coverage? Do you perform cutting edge procedures that others don’t? Do you have equipment that others don’t have?

Whatever makes you different, you can add to your list.

Jeff Bezos, Founder of Amazon.com states: “Your brand is what other people say about you when you’re not in the room”.

Differentiate yourself Donald Trump warns, “ If your business is not a brand, it is a commodity”.

There is real value in being perceived as the authority in

your field. Imagine yourself as the Dr. Oz of your practice.

Picture yourself as Sanjay Gupta. Wouldn’t patients prefer to go to big names like these?

How much would it be worth to your practice? To: • Get guaranteed placement in media such as ABC, NBC, CBS and Fox • Have the opportunity to place these logos on your website and other social media sites

The Beauty of Media Authority • It’s easier to get more patients by getting more out of the exposure than the marketing you may be currently engaged in.

• It’s easier to earn money by getting more out of the exposure you already get, than trying to go and get more exposure the traditional way • It’s easier to get a high-paying speaking engagement when you have Media Authority.

Once you are a cited authority • You become a quoted expert…apply that quote and authority in all of your marketing • You can apply the media logos stating “AS seen on…”

Something that your competition is lacking • You’re perceived as a trusted authority Places to apply your Media Authority • Business cards • Your newsletter • Your advertisement • Brochures • Website • LinkedIn, Facebook, Instagram and Pinterest profiles I’m a professional. Why do I need Media Authority? Are you asking yourself this?

Did Dr. Oz ask this? Did Sanjay Gupta? They are physicians. They are medical professionals who saw the benefit of media authority. Both of these doctors still see patients but media coverage enables them to spread their messages of health to a wider audience.

Benefits of Media Authority Media is a conversion strategy. With it you are more likely to entice prospective patients to choose you. As a cascade, you are more likely to get more media once you’ve been cited, which translates to even more exposure.

As the Internet Marketing Legend Frank Kern said at the Traffic and Conversion Summit of 2014: “Positioning yourself as an authority is the single most important thing you can do to increase your perceived value to your market place”.

Once you become a quoted expert for your field in the major media, you are now seen as the expert in your field continued on page 18 WWW.MEDMONTHLY.COM | 17

practice tips continued from page 17

and the person to go to. It brings positive exposure for you.

The thing is, once sited, you can use the All Powerful “As seen on” logo. This is a conversion tactic. It makes prospective patients want to see you, to speak with you, to be part of your practice.

Add it to your social media bio. It’s the perfect time to look back at your major professional achievements and add them to your bio.

Maybe you’re thinking, I don’t have to do this. I’m a doctor and patients need to go to doctors already so there is a built-in need. Yes, patients need to see doctors but they don’t need to see YOU! In this day and age, marketing IS necessary!

Remember, first impressions do matter.

You have seven seconds to grab their attention. THIS grabs that attention!

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practice tips

4 QUESTIONS TO IMPROVE HEALTH OUTCOMES

By Angela Savitri, OTR/L, RYT Certified Integrative Health Coach www.freedomfromchronicstress.com

20 | NOVEMBER 2014

When a patient arrives at the office to see the doctor, one would think the patient actively desires professional guidance for their concern.

On the surface this may appear to be reality, but multiple dynamics are at play to determine if your patient will follow-through with the prescribed course of treatment.

If the help the patient receives is not in the form they desire, is not aligned with their values, or if the patient does not understand the reason for the course of prescribed treatment or the consequences of non-compliance, your patient is less likely to adhere to medical guidance. This leaves the patient’s complaint insufficiently addressed - which may exacerbate a medical problem - and the healthcare provider’s time wasted.

The days of assuming patient adherence because ‘I said so’ is over. Prescriptions go unfilled and lifestyle recommendations go unimplemented. Patients are the authority of their own body.

Advice giving and prescribed treatment do not solely resolve health concerns. A health coaching approach using Motivational Interviewing can increase your patient’s adherence to prescribed treatment, help you retain patients to your practice, and influence the health outcomes of your bottom line.

Below are 4 areas to assess to influence patient behavior along with sample questions to engage the dialog.

Note the quality of your voice tone and body language while engaging the patient is just as significant as the questions themselves. In order to share openly and honestly, patients must feel safe and not judged. Make solid eye contact with a soft gaze, have your knees face the patient, with your arms and hands uncrossed to signal receptivity and collaboration. l

Assess Understanding of the Condition: Patients may not understand their diagnosis or how their condition may worsen if left improperly treated. To assess understanding, ask: t What is your understanding of how your condition affects the body? t What is your understanding of how your condition may progress if left untreated? t It can be common to not fully grasp your diagnosis. We provided educational materials during your last visit. What, if anything, is unclear to you about your condition? l Assess Importance of the Treatment: If the prescribed treatment is not important to the patient, the likelihood of adherence is minimal at best. To assess importance, ask: t How important is it to you to make the recommended lifestyle changes? t On a scale of 1-10, with 1 being not at all important and 10 being extremely important, how important is it to you to take your medication as prescribed? l Assess Barriers to Change: Good intentions do not improve health outcomes. Patients may have external barriers like finances, transportation, or lack of social support that prevent change.

Internal barriers may include denial, guilt, or lack of confidence to implement change. To assess barriers to change, ask: t What barriers, if any, may prevent you from filling your prescription? t What barriers exist that would prevent you from making the suggested lifestyle changes? l Assess Confidence to Move Forward: When making lifestyle and behavioral changes, the patient’s confidence in their ability to implement change is critical to success. To assess confidence, ask: t On a scale of 1-10, with 1 being not at all confident and 10 being extremely confident, how confident are you that you can make the recommended changes? t How confident are you that you can make the recommended changes over the next month?

When barriers are discovered that the medical practice cannot sufficiently address because of time or lack of coaching expertise, consider referring the client to an experienced health coach. The health coach can partner with your practice and the patient to increase confidence and overcome barriers to change.

Assessing these four areas surface challenges that need to be addressed so the patient can experience the best possible outcome. If left unacknowledged or unexplored, the patient is more likely to be non-adherent or apathetic to medical care. When addressed with compassion and courage, the patient experiences greater quality of life while the healthcare provider rests assured the most effective level of care was provided.  WWW.MEDMONTHLY.COM | 21

practice tips

10 Tips to Get More Patients Into Your Practice

by Amanda Chay WhiteCoat Designs With more patients taking their business to other providers and health plans dictating exactly which physicians they’ll work with, many physicians are looking at marketing techniques to keep their appointment books full. To follow are ten tips to get more patients referred into your practice:

1. It’s all about who you know Strong referring relationships are essential in today’s competitive market. No longer can physicians rely on their past reputations; they need to get out and secure new relationships and revive the old ones. A strong referring relationship means that more patients will come your way as a result, since trust and knowledge are necessary for this dynamic to develop. Referring practices want to know that their patients will be in good hands when they refer them to you, certainly as this reflects upon their reputation as well. Focusing on building personal connections at referring practices is the key to strong relationships.

2. Practices that are easy to work with get the most referrals

Practices that are simple to work with will get more patients referred to them. It’s as simple as that. How can this be achieved at your practice? Make it easy to send 22 | NOVEMBER 2014

patients with referral forms that are clear and concise; combine this with prompt scheduling of referred patients and don’t make their patients wait too long for an appointment. Provide a direct phone number for contacts in your office as this will alleviate the frustration of a lengthy phone tree system. After patients have received medical care at your office, send over the progress notes within one to three weeks. Clear communication along with prompt feedback will enhance your reputation and bring more patients into your door.

3.

Hire a skilled physician liaison

The responsibilities of building relationships and communicating consistently are timely tasks that are best tackled with a dedicated physician liaison. A physician liaison represents your practice in the referring community to promote your services, treatments, and providers. This responsibility shouldn’t go to your front desk employee who goes out once a quarter to drop off cookies. Keep in mind that a physician liaison can be a full-time or part-time employee, or even an independent contractor. Strategic promotion of your practice is achieved with a skilled physician liaison that has experience in pharmaceutical sales, medical sales, or other similar sales avenues. While clinical knowledge can be taught, personal drive and ambition cannot. Choose wisely.

‘‘

Your professional branding should be uniform across all platforms, including both print and online.

Standardizing your brand will help develop and increase trust in the medical community.

4. Train your liaison appropriately Now that you have carefully hired an experienced physician liaison, it is equally important that this individual is trained appropriately. There are two important components of training that need to be stressed: clinical knowledge and strategic direction. Clinical knowledge includes speaking intelligently about your specific medical specialty and practice. Strategic promotion of your practice involves knowing where your practices strengths and weaknesses lie as well as the same components for your competition. It’s also important to establish a list of practices to call on and to devise specific attainable goals for the liaison.

5. Make sure to implement tracking for best ROI

If you are going to market your practice, it is essential that you track the ROI (Return on Investment). All new marketing efforts need a period of time to determine if the ROI is hitting its intended target. Here are some questions to consider that will help determine if you are getting the most from your marketing efforts: what is your percentage growth last year?; did the marketing tactic accomplish its goal?; did your practice gain or lose income across a period of time? In order to track the ROI, the following

considerations should be kept in mind: set a specific goal and track the steps towards achieving this goal with either a CRM (Customer Relationship Management) software or similar product.

6. Keep your friend close and your enemies closer

Times have changed in healthcare and your competition is getting smarter and more resourceful each day.

Competition can both keep you on your toes and it can cripple your referral sources. The challenge is to use it appropriately. It is vital that you know how your competition is performing since underestimating their strengths can be one way to lose referrals. Be aware of what they are offering in regards to charges for similar services, insurance plans being accepted, and availability to schedule patients. It is equally important to learn if they have a physician liaison promoting their services in the medical community as well.

7. If you don’t have a strong presence online, you might as well not exist

Patients often shop online for doctors in the same way they shop online for a new pair of shoes. Therefore, it’s continued on page 24 WWW.MEDMONTHLY.COM | 23

continued from page 23

essential you have not just a good, but a great website that can be easily found in the search engines. Investing in internet marketing solutions, such as Search Engine Optimization (SEO), Pay-Per-Click (PPC) advertising, social media marketing and blogging, is one of the most important investments you can make in your practice.

8. Find your voice through social media Social media is an ideal way to engage patients online. It essentially acts as a megaphone for your practice since it exposes you to new networks of patients you might have otherwise not reached.

Keeping your social media accounts up to date is also a smart online marketing strategy to help your practice rank better in the search engines since Google has placed more emphasis on social media in their ranking algorithm.

9. Don’t neglect your online reputation: patient reviews are a powerful thing

Unfortunately it’s usually the disgruntled patients that are most vocal on online review sites like Healthgrades and RateMds. This can lead to a gross misrepresentation of the great care you provide on a daily basis. That’s why it’s important to monitor your online reviews, respond quickly to negative remarks and dispute comments that are slanderous, etc. You can’t control what patients say about you online, but you can control how you respond. It’s also important to consistently ask your happy patients to share reviews online in order to outweigh the few negative patients.

10. Keep consistent branding to create instant recognition

With so many different avenues to showcase your medical practice, it can be easy for your messaging to become inconsistent across the mediums. Your professional branding should be uniform across all platforms, including both print and online. Standardizing your brand will help develop and increase trust in the medical community. If referring practices and patients can distinguish your name and logo from others, they are more likely to connect with you for their needs.

Know that you don’t have to tackle any of these medical marketing tasks alone. From implementing a physician liaison program to creating an effective website: these tasks are best left to the medical marketing professionals. There are medical marketing companies who have the expertise to assist you on the guidance and execution of your marketing needs while keeping the goals of increasing patient referrals at heart.  About WhiteCoat Designs WhiteCoat Designs specializes in marketing solutions for the healthcare industry, including physician liaison programs, website design, internet marketing, social media, and branding. Visit www. whitecoat-designs.com to learn more.

24 | NOVEMBER 2014

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research & technology

Hypertensive Patients Lower Systolic Blood Pressure with Self-regulation of Medications

By Alexis Gopal M.D.

A randomized clinical trial shows that self-surveillance and self-adjustment of anti-hypertensive therapy in hypertensive patients resulted in lower systolic blood pressure after one year compared to traditional treatment.

Hypertensive subjects at high risk of cardiovascular disease were able to reduce their systolic blood pressure after 12 months with self-monitoring and self-adjustment of medications, vs. usual care given by primary care physicians, according to the findings of a randomized clinical trial.

Richard J. McManus, FRCGP and colleagues at the University of Oxford in Oxfordshire, UK published the results of their Targets and Self-Management for the Control of Blood Pressure in Stroke and at Risk Groups (TASMIN-SR) trial in the August 27, 2014 issue of the Journal of the American Medical Association.

A previous study found that self-management of hypertension resulted in significantly lower systolic blood pressure after 1-year vs ordinary care. However, this study had few patients with high-risk illnesses, like cardiovascular disease, and their blood pressure reduction was less. The current study was designed to address these high-risk patients, specifically.

A total of 555 hypertensive patients above age 35 with 26 | NOVEMBER 2014

at least 1 of the high-risk conditions (cardiovascular disease, diabetes, or stage 3 chronic kidney disease) were randomized to receive usual care (278) or the intervention (220).

Primary outcome data were obtained from 450 patients (81%). After 1 year, the intervention group had a reduction in their systolic blood pressure of 9.2 mm Hg more than the control group (95% CI, 5.7-12.7). In addition, for the same period of time, the intervention group had a reduction of 3.4 mm Hg in their diastolic blood pressure more than the control group (95% CI, 1.8-5.0). There were no significant adverse effects.

“This study has shown that self-monitoring with selftitration of antihypertensives is feasible and achievable in a high-risk population without special equipment and by following a modest amount of training and additional family physician input”, the authors concluded.  This study was conducted independently and funded by the National Institute for Health Research.

WWW.MEDMONTHLY.COM | 27

research & technology

AMA Insurance finds employed physicians have own set of personal financial issues in latest report,

2014 Report on U.S. Physicians’ Financial Preparedness

About AMA Insurance: Established in 1988 as a wholly owned subsidiary of the American Medical Association, AMA Insurance Agency, Inc. specializes in meeting the insurance and financial services needs of America’s 1,000,000 physicians, both AMA members and non-members. Authorized to conduct business in all 50 states, AMA Insurance offers a portfolio of physician-exclusive disability, life, and health insurance for individuals, medical group practices and other institutions. AMA Insurance’s national reach enables the agency to provide physicians with unique physicianfocused coverage at competitive rates from top carriers.

For more information, visit www.amainsure.com.

28 | NOVEMBER 2014

A new, in-depth report from AMA Insurance shows that employed physicians – now comprising 59 percent of all American physicians – have their own set of personal financial challenges, in part due to their employment status. The 2014 Report on U.S. Physicians’ Financial Preparedness: Segment Focus on Employed Physicians (http://bit.ly/1tWKlOV) not only tracks their concerns about retirement savings and other key personal financial areas, but also checks the status of their employee insurance protection and points up their new key concern: funding long term care expenses.

The report’s findings were taken from a national survey, conducted by AMA Insurance, of employed physicians primarily working in group practices, hospitals and medical schools. Topics included: retirement planning and savings, financial concerns, personal financial acumen, use of professional financial advisors, family finances, and disability and other types of insurance protection.

Different dimensions to employed physicians’ financial picture “Employed physicians have different dimensions to their personal financial picture due to their employment status,” said Alfred C. Drowne, Vice President and General Manager, AMA Insurance, a wholly owned subsidiary of the American Medical Association (AMA). “Through the survey, we were able to capture some specifics of that picture. For example, nearly half of employed physicians reported that their employer pays their disability insurance premiums. It’s important for physicians in this situation to understand that the benefit paid to them may be taxable income and could result in a shortfall. We see clearly from report findings that spending more time and/or working with a professional advisor to understand options and manage the full extent of their finances can be vital to their personal financial health.”

Retirement comfort the top financial goal; half behind in retirement savings In the report, physician respondents of all ages cited funding ‘a comfortable retirement’ for themselves and their spouses as their top financial goal – and having enough money to retire as their top financial concern. However, only 8 percent of employed physicians consider themselves ‘ahead of schedule’ in retirement savings. In fact, 42 percent consider themselves ‘behind where they’d like to be.” In terms of actual savings, report results show that 44 percent report they have less than $500,000 saved for retirement.

Funding long-term care a new top financial concern Also, funding long-term care expenses has emerged as a top concern for employed physicians, second only to

having enough savings to retire. Sixty-five percent of the survey respondents are ‘very concerned’ or ‘somewhat concerned’ about being able to fund long-term care expenses for themselves and their spouse/partner in case of chronic illness or disability. While 67 percent plan to use long-term care insurance or self-fund it, 33 percent are not sure how they will pay these expenses.

Most employers offer malpractice, disability, life insurance From an employee benefits perspective, the AMA Insurance report found that the majority of employers offer malpractice, disability income protection and life insurance. Nearly all employed physicians have malpractice insurance through their employer. Seventysix percent also have life insurance and 73 percent have disability insurance through their employer. Nearly half of employed physicians reported that their employer pays their disability premiums; 12 percent were not sure.

Physicians using professional financial advisors fare better The report also indicated that more than half (57 percent) of employed physicians use the services of a professional financial advisor; 43 percent do not. Those who do are more confident and on-track with their personal finances and retirement savings, have more in emergency savings, have more diverse financial investments, and feel more confident about personal financial decision-making. Forty-five percent of those who do not use an advisor say they have not found someone they can trust.

More results on AMA Insurance Report available Above are several key findings of the 2014 Report on U.S. Physicians’ Financial Preparedness: Segment Focus on Employed Physicians. More highlights are available at: http://bit.ly/1tWKlOV  About the Survey: The national survey was sent to approximately 125,000 practicing U.S. physicians, ages 3069 in June 2014. The respondent profile (N=2,073) showed representation across ages 30-69 and across specialties.

Full report confidence interval 95% with a +/- 4% margin of error. The total employed physician sample (N=1,025) confidence interval is 95% with a +/- 4% margin of error.

The employed physician sample included 62% male/38% female ratio; about half working in a large group practice or hospital; 20% in a small or mid-sized practice and 16% employed by a medical school. Another 10% are employed in foundation, industry, government, etc. 26% of employed physicians graduated from medical school outside the United States or Canada. All survey data collected through Qualtrics®.

WWW.MEDMONTHLY.COM | 29

research & technology

Subsidies Help Breast Cancer Patients Adhere to Hormone Therapy A federal prescription-subsidy program for low-income women on Medicare significantly improved their adherence to hormone therapy to prevent the recurrence of breast cancer after surgery.

“Our findings suggest that outof-pocket costs are a significant barrier” to women complying with hormone therapy, said Dr. Alana Biggers, assistant professor of clinical medicine at the University of Illinois at Chicago College of Medicine, and lead investigator on the study. Programs that lower these costs can “improve adherence — and, hopefully, breast cancer outcomes — for low-income women,” she said.

Biggers presented the results of the study at an Oct. 14 press conference in advance of the American Society for Clinical Oncology Quality Care Symposium in Boston.

Breast cancer is a leading cause of cancer-related deaths for women of all races, but survival rates differ by race and socioeconomic status, with African American women and women of low income having higher rates of death.

Hormone therapy, such as tamoxifen or drugs called aromatase inhibitors, is usually taken for five years following mastectomy or surgery to remove breast tumors and can significantly reduce the risk that that cancer will return. Poor adherence to post-surgical hormone therapy regimens is associated with diminished chance of survival.

Biggers and her colleagues looked 30 | NOVEMBER 2014

at data from the U.S. Centers for Medicare and Medicaid Services on adherence to hormone therapy for three years after breast cancer surgery.

The 23,299 women, all 65 or older and enrolled in Medicare, were 86 percent white, 7 percent African American, 4 percent Hispanic, and 2 percent other racial backgrounds. All had had either a mastectomy or lumpectomy in 2006 or 2007.

Twenty-seven percent were enrolled in the Medicare Part D low-income subsidy, also known as the Extra Help program, which helps qualifying individuals pay for prescriptions. For the purposes of the study, medication adherence was defined as refilling a prescription as instructed 80 percent of the time or better.

“When we looked at women not enrolled in the subsidy plan, we saw that African American and Hispanic women had lower rates of adherence than white women,” Biggers said. “But when we added in data from women enrolled in the subsidy plan, these disparities disappeared, and we saw that adherence rates improved and evened out across races.”

The average rate of adherence over three years for women enrolled in the Extra Help program was 68 percent, compared to 52 percent for women not in the program. Sixty-one percent of women overall remained adherent to their hormone therapy over three years, with African American and Hispanic women having higher adherence rates — 62 percent and 64 percent, respectively — than

white women at 58 percent. Biggers attributes this to the higher enrollment in subsidy programs among African American women (70 percent) and Hispanics (57 percent) compared to white women (21 percent) or women from other racial backgrounds (60 percent).

The data also showed that women enrolled in the Extra Help program have similar rates of adherence year after year, while adherence dropped over three years among women not in the program.

“Although we didn’t study the effects of the Extra Help program on survival rates, any time you can improve adherence to a proven drug therapy, health outcomes are likely to improve,” Biggers said.

Co-investigators on the research, all from the Medical College of Wisconsin in Madison, are Dr. John Charlson, assistant professor of medicine; Liliana Pezzin, professor of medicine in the Center for Patient Care and Outcomes Research; Purushottam Laud, professor of biostatistics; Elizabeth Smith, biostatistician; Alicia Smallwood, clinical research coordinator; and Dr. Joan Neuner, associate professor of medicine.

The study was funded by grant RSG-11-098-01-CPHPS from the American Cancer Society and grant R01-CA 127648 from the National Institutes of Health.  Source: http://www.pressreleasepoint. com/subsidies-help-breast-cancerpatients-adhere-hormone-therapy

What’s your practice worth?

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legal

FDA Finalizes Guidance for Management of Cybersecurity in Medical Devices

By Susan Cassidy, Jennifer Plitsch, Saurabh Anand, & Tyler Evans Covington & Burling LLP 32 | NOVEMBER 2014

T

he U.S. Food and Drug Administration (“FDA”) has increasingly focused on promoting cybersecurity because compromised medical devices can pose a risk to patient health as well as the confidentiality of personal medical information. On October 2, 2014, FDA issued final guidance on the content of premarket submissions for the management of cybersecurity in medical devices. The final guidance sets forth recommendations for the design and development of medical devices, as well as the preparation of premarket submissions, that are intended to reduce the likelihood that medical devices will be compromised as a result of inadequate cybersecurity.

Although the final guidance is not binding, it is broadly applicable—the recommendations apply to all premarket submissions except investigational device exemption applications, as well as to requirements under the Quality System Regulation. The guidance supplements other standards generally applicable to software included in medical devices, as well as specific standards addressing cybersecurity risks in medical devices containing off-the-shelf software. The final guidance also adopts the National Institute of Standards and Technology’s core cybersecurity framework, which FDA recently agreed to promote in a Memorandum of Understanding with the National Health Information Sharing and Analysis Center.

The final guidance sets forth concrete recommendations specifically applicable to medical devices. For example, device manufacturers should put systems in place to detect compromises and implement safeguards to preserve critical functionality and recover previous configurations. In addition, the final guidance recommends that device manufacturers track all cybersecurity risks considered in the design of a device and justify in premarket submissions the safeguards put in place to addresses identified risks. Specifically, the final guidance recommends that manufacturers justify a decision to use a particular security function, such as the use of one among many authentication processes or methods of securing the transfer of data.

The final guidance encourages device manufacturers to implement plans to provide and validate software updates throughout the life of a medical device.

FDA’s guidance on off-the-shelf software states that device manufacturers have an obligation under the Quality System Regulation to provide systematic software updates to respond to identified risks. However, the final guidance indicates that software updates will not typically need FDA review when their sole purpose is to strengthen the cybersecurity of a medical device.

The final guidance recommends that manufacturers balance the benefit of increased safeguards with the usability of a medical device in its intended use environment. For example, device manufacturers should consider the need to access a device promptly in emergency situations when designing authentication procedures. A previous report by the U.S. Government Accountability Office on information security risks to medical devices had suggested that device manufacturers consider the risk that additional safeguards could lead to decreased battery life, potentially creating a need for more frequent surgical procedures to replace batteries in implantable devices, as well as the risk of unforeseen consequences as a result of new software updates.

Although the final guidance only establishes FDA’s recommendations for best practices, device manufacturers should become familiar with the final guidance as it is likely to inform FDA’s review of premarket submissions as well as Quality System Regulation compliance.  Source: http://www.insidemedicaldevices.com/2014/10/10/fda-finalizesguidance-for-management-of-cybersecurity-in-medical-devices/

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legal

HIPAA Violation Results in $4.8 Million Settlement: An IT Perspective

By Jared A. Smith Associate Dickinson Wright

In today’s healthcare industry, information technology (“IT”) systems play an ever-expanding role in the success of a medical practice.

Medical practitioners consistently juggle e-billing and electronic medical records software risk, HIPAA compliance issues, data security and data privacy requirements and meaningful use thresholds, all of which 34 | NOVEMBER 2014

are typically addressed in IT vendor agreements. Further, IT vendors are often willing to accept significant revisions to their standards contracts, and well-negotiated and properly structured relationships with IT vendors can protect medical practices from disaster in the event of an IT system failure like the one outlined below.

In our previous issue of Healthcare Legal News, Rose Willis described a record-setting fine imposed on New York-Presbyterian Hospital (“Hospital”) and Columbia University Medical Center (“Columbia”) for HIPAA violations associated with their IT infrastructure. Specifically, a Columbia doctor inadvertently disclosed the electronic protected

health information (“ePHI”) of about 7,000 patients to Google and other easily-accessible search engines when he deactivated his personally owned server from the Columbia network.

The Hospital and Columbia learned of the data security breach when they received a complaint from an individual who discovered the ePHI of the individual’s deceased partner through a simple Internet search, and the Hospital and Columbia then selfreported the breach to the Department of Health and Human Services Office for Civil Rights (“OCR”). At the conclusion of OCR’s investigation into the breach, the Hospital and Columbia agreed to enter into a settlement and a Corrective Action Plan that required the payment of $4.8 million to OCR, the largest settlement for HIPAA security violations to date.

Aside from the extent of the breach – almost 7,000 patients’ ePHI exposed to anyone with Internet access – the size of the settlement

can be attributed to two major failures on the part of the Hospital and Columbia. First, the Hospital and Columbia lacked sufficient IT safeguards, which permitted a single doctor to accidentally expose the ePHI of such a large number of patients.

Generally, a medical practice’s IT infrastructure should not be structured in a way that permits one person to accidentally compromise the entire system’s security, and a strong IT services agreement with a reputable IT vendor is an important first step in avoiding such a scenario. The best IT vendors work closely with their clients to implement IT safeguards tailored to each distinct medical practice, and a negotiated IT vendor contract should appropriately allocate data security risk between the medical practices and the IT vendors.

Second, the Hospital and Columbia failed to perform a sufficiently thorough risk analysis of their IT systems. Under the HIPAA Security

Primary Care Specializing in Women’s Health

Rule, most healthcare providers are required to conduct a risk analysis of their IT equipment to determine where data security vulnerabilities exist and how to effectively address them. Here, the Hospital and Columbia did, in fact, conduct risk analyses, but OCR determined that their risk analyses did not adequately address their particular data security issues. Again, experienced IT vendors collaborate with their clients so that data security vulnerabilities are discovered, and the risk analysis obligations of the applicable medical practice and the IT vendor should be well-defined in a negotiated IT vendor agreement.

Jared A. Smith is an attorney in Dickinson Wright’s Troy, Michigan office. He can be reached at 248.433.7597 or jsmith@ dickinsonwright.com.  Source: http://www.natlawreview. com/article/hipaa-violation-results-48million-settlement-it-perspective

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features

States Expanding Medicaid Under the Affordable Care Act Expect 18% Enrollment Growth in Fiscal Year 2015, With Federal Funds Picking Up Most of the Cost 50-State Survey Finds ACA and Delivery System Reforms are Primary Focus for State Medicaid Programs in FY 2014 and FY 2015 States expect the number of people enrolled in Medicaid will increase an average of 13.2 percent across the country in state fiscal year 2015 (which runs through June in most states), showing the early effects of the first full year of Affordable Care Act implementation, according to the 14th annual 50-State Medicaid budget survey by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU).

The 28 states (including the District of Columbia) implementing the Medicaid expansion for FY 2015 expect to see the largest enrollment and spending growth — an 18 percent increase in enrollment and an 18.3 percent increase in total Medicaid spending in FY 2015, on average.

The spending growth is mostly driven by the boost in new enrollment that is financed by 100 percent federal funds.

With the additional federal dollars, state spending in expansion states is projected to increase at a slower rate of 4.4 percent in FY 2015.

Without the coverage expansion and federal funding, the 23 states not implementing the ACA Medicaid expansion project an average 5.2 percent enrollment growth for fiscal year 2015, and project state spending to increase at a similar rate as their total Medicaid spending (6.8% and 6.5%, respectively).

Based on the survey of state Medicaid directors, the 36 | NOVEMBER 2014

Medicaid enrollment and spending report also provides estimates for Medicaid enrollment and spending growth in fiscal year 2014.

A second report drawn from the 50-state survey, jointly released with the National Association of Medicaid Directors (NAMD), examines major policy actions implemented or planned for state Medicaid programs. It shows that the implementation of the ACA and delivery system reforms are the main focus for state Medicaid directors in fiscal years 2014 and 2015.

“Whether a state elected to expand or not, Medicaid programs across the nation are being transformed with new enrollment procedures and outreach efforts combined with increased emphasis on delivery systems reforms,” said Diane Rowland, Executive Vice President of the Foundation and Executive Director of the KCMU. All states are implementing a host of ACA-related changes that require states to streamline Medicaid enrollment and renewal processes, transition to a uniform income eligibility standard and coordinate with new ACA insurance Marketplaces. State Medicaid officials reported continued growth in managed care initiatives and other delivery system reforms, including the implementation or expansion of Medicaid health homes, patient-centered medical homes, and initiatives to integrate care and

financing for the dual eligible beneficiaries. The majority of states also reported expanding services in a home or community-based setting for persons needing long term care. With improvements in the economy, more states were implementing provider rate and benefit enhancements.

Findings, reports released at a public briefing today The 50-state survey of state Medicaid directors was conducted by KCMU and Health Management Associates (HMA), with the cooperation of NAMD. These and other findings from the survey were discussed today at a public briefing held jointly by Kaiser and the NAMD. The following new reports based on the survey are available: • Implementing the ACA: Medicaid Spending & Enrollment Growth for FYs 2014-2015, which provides an analysis of national trends in state Medicaid enrollment and spending; • Medicaid in an Era of Health & Delivery System Reform: Results

from a 50-State Medicaid Budget Survey for State Fiscal Years 2014 and 2015, jointly released with NAMD, which provides a detailed look at the various policy and program changes in Medicaid programs in all 50 states; and • Putting Medicaid in the Larger Budget Context: An In-Depth Look at Four States in FY 2014 and 2015, which uses four case studies to examine Medicaid programs in Michigan, Utah, Virginia and West Virginia.

An archived webcast of the briefing, as well as copies of presentation slides and other materials, will be available online later today.  Source: http://www.pressreleasepoint.com/states-expandingmedicaid-under-affordable-care-act-expect-18-enrollmentgrowth-fiscal-year-2015-fed

features

“Change is the only thing which remains constant…”

The New Role of Nurse Practitioners in Health Care Reform

By Nidhi Behl Vats Freelance Medical Writer In past patients were treated with little, or no, technology. Now the latest equipment and technology, created almost daily, assist in treating prolonged and deadly diseases. Being adaptive has always been essential in the field of medicine.

The same goes for health care reforms, amendments are made to the existing plan and new features are added. With the launch of the Affordable Care Act (ACA), practices aim to provide health care facilities to everyone, including the previously uninsured population.

Health care is not only related to curative care. It involves preventive, primitive care and overall well being of an individual. The ever increasing gap between primary 38 | NOVEMBER 2014

care physicians and the number of patients will be the challenge to overcome. There is always a disparity between the demand and the supply of trained primary care physicians. Often physicians are unwilling to go for remote/ rural locations for primary health care. As a result, there is a visible shortage of physicians, which is expected to be approximately 44,000 by the year 2025, in treating basic ailments.

Health regulations are there to help patients, but how justified is it to rely only on doctors for the completion of the ACA’s goals? It is understood that forceful implementation will always have repercussions, in the times to come. To addition, there have been various new

ways to involve doctors under primary care, adding to their work load. Other options need to be looked at to solve this problem.

Lack of skilled primary care providers is a major problem in United States and it is expected to worsen further as the population continues to age and a major chunk of young adults (approximately 30 million) will gain access to health care coverage during 2014.

One of the possible remedies to curb this problem is promoting nurse practitioners. A nurse practitioner can be defined as trained personnel who has completed their graduate level education in nursing services and are specifically trained to deliver high quality primary care services. Nurse practitioners, combined with physician assistants, can lead to an increase in existing primary care providers.

According to the recent reports by the American Academy of Nurse Practitioners, around 89% of the nurse practitioners are trained to provide primary care independently. Approximately 75% of the nurse practitioners are actually practicing in a primary health care delivery system. The clinical role of the nurse practitioner is formulated by the state’s SOP (scope of practice) laws that mention the range of services that they can deliver, as well as the norms regarding their independent practice.

A win-win situation for all: l

Bridging up the gap between the demand and supply of the skilled primary health care providers. l The nurses would benefit from a promising career with good compensation and the market value of the nurses would increase substantially. l The physicians can devote their attention to the secondary and tertiary level of care to patients, improving the overall health care of the community at large.

This structure will prove beneficial to both the nurses as well as the physicians. Also, the spectrum of health care delivery would increase.

Additional roles for nurses:

Nurse practitioners would not only provide primary care to the ill and in need but: l They would also act as community facilitators as well as nursing faculty members. l They would spread awareness regarding basic health and hygiene, preventive measures for common ailments, immunizations, etc. l They would be active members of the nursing colleges where they can impart basic nursing knowledge as well as share their valuable experiences with the students.

Studies have shown that 90% of the services offered by a physician in a primary health care setting can be

provided by a nurse practitioner at a much lower cost.

Nurse managed health care institutions save a lot of money as patients use generic medicines and are also less hospitalized than other patients.

If the government is serious about adopting this practice as a long term solution, than attention should be paid towards l Developing such skilled manpower. l Clear guidelines should be provided as to how nurses should go about becoming independent primary health care providers. l Competency mapping is equally needed if this model is to become successful.

This isn’t the only solution for increasing health care demand, but at the moment this is the most feasible solution available. It can immediately start filling in the gap between the demand and supply, which is constantly increasing.

Health care reform in the United States will need an increased number of experienced nurse practitioners as leaders in the primary care arena. There are approximately 150,000 nurse practitioners at present and this figure is expected to rise in the coming years. In the near future, nurse practitioners will be the brand ambassadors of health care and will be the recognized face of primary medical care. 

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

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

Freelance, expert medical writer who also covers such topics as travel, wellness, parenting, food, lifestyle, fashion, living abroad, self healing and grooming, women and social issues Email Nidhi Behl Vats at nidhibehl5@gmail.com or visit her on the web at http://about.me/behlnidhi WWW.MEDMONTHLY.COM | 39

features

Proposed Rule Issued by HHS Office of the Inspector General (OIG) Realigns Its Enforcement Views with Health Care Reform Goals

By Theresa Carnegie, Thomas Crane, Carrie Roll and Stephanie Willis Mintz Levin

40 | NOVEMBER 2014

Fridays never seem to be slow in the health care regulatory world. On Friday, October 3rd, the HHS Office of the Inspector General (OIG) issued a highly anticipated proposed rule (the Proposed Rule) that provides amendments to the Anti-Kickback Statute’s regulatory safe harbors (AKS Safe Harbors) and adds protections for increasingly common payment practices and business arrangements under the Civil Monetary Penalty Law (CMP). These amendments and updates to the AKS and CMP regulations attempt to clarify the OIG’s enforcement position in light of changes due to health reforms, to streamline the OIG’s advisory opinion workload, and to implement long-existing mandates enacted in statutes.

New and Modified AKS Safe Harbors The OIG’s Proposed Rule with respect to the AKS Safe Harbors makes additions and modifications related to the following five business practices and arrangements: 1. Referral Services. As a “technical correction,” the proposed AKS Safe Harbor will revert to the language of the 1999 final rule, which prohibited payments from participants to referral services that are based on the volume or value of referrals to, or business otherwise generated by, “either party for the other party,” rather than “business generated by either party for the referral service.” Thus, the nexus for negating this AKS Safe Harbor’s protection is generating a direct benefit to another participant in the referral service, rather than the referral service itself.

2. Low-Risk Cost-Sharing Waivers. The OIG proposes additional provisions to protect certain “cost-sharing waivers that pose a low risk of harm” to allow for Part D cost-sharing waivers by pharmacies (the Part D Waiver) and for emergency ambulance services (the Ambulance Waiver). t Part D Safe Harbor – The Part D Waiver implements the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) addition of subparagraph (G) to Section 1128B(b)(3) of the Social Security Act (the Act).

In the proposed new 42 C.F.R. § 1001.952(k)(3), a pharmacy that waives Part D cost-sharing amounts for patients must meet the following three criteria to receive protection: l The waiver or reduction is not advertised or part of a solicitation; l The pharmacy does not engage in routine waiver of cost-sharing amounts; l The pharmacy determines “in good faith that the beneficiary has a financial need or fails to collect the cost-sharing amount after making a reasonable effort to do so.”

The pharmacy must only meet the first criterion if it

waives cost-sharing amounts for a Part D beneficiary eligible for subsidies under Section 1860D-14(a)(3) of the Act. t Ambulance Safe Harbor – The OIG’s proposed new Ambulance Safe Harbor is an attempt to reduce the amount of “advisory opinion requests concerning the reduction or waiver of coinsurance or deductible amounts owed for emergency ambulance services to an ambulance supplier that is owned and operated by a State or a political subdivision [thereof].” Seven out of the last 26 advisory opinions issued in 2013-2014 dealt with these arrangements. In its proposed new 42 C.F.R. § 1001.952(k)(4), the OIG sets out ownership, contracting, and Medicare Part B participation requirements, as well as criteria regarding the extent to which the state or political entity may pay for such emergency ambulance services. The state must implement the cost-sharing uniformly for all patients and may not claim these amounts as bad debt for payment purposes under Medicare or a state health care program or otherwise shift these costs to public or private payers. The OIG is also seeking comment on whether other Federal health care program cost-sharing waivers should be included in this new AKS Safe Harbor.

3. Federally Qualified Health Centers (FQHCs) and Medicare Advantage Organizations (MAOs). The Proposed Rule also implements Section 237 of the MMA, which imposes an “anti-swapping” prohibition that requires agreements between MAOs and FQHCs to mandate that the MAO pay the FQHC “no less than the level and amount of payment that the plan would make for the same services if the services were furnished by another type of entity.” The Proposed Rule also incorporates the AKS statutory exception at Section 1128(B)(b)(3)(H) of the Act that allows Medicare Advantage (MA) beneficiaries to receive services at a FQHC that has a written agreement with the beneficiary’s MA Plan into a new 42 C.F.R. § 1001.952(z).

4. Medicare Coverage Gap Discount Program. The Proposed Rule implements the new exception to the AKS from the Medicare Coverage Gap Discount Program (Discount Program) established by Section 3301 of the Affordable Care Act (ACA) in new proposed 42 C.F.R. S 1001.952(aa). The new exception defines “applicable drugs” and “applicable beneficiaries” to which the AKS Safe Harbors would apply.

5. Transportation Waivers. The OIG proposes an AKS Safe Harbor “for free or discounted local transportation continued on page 42 WWW.MEDMONTHLY.COM | 41

continued from page 41

made available to established patients . . . to obtain medically necessary items and services.” The Proposed Rule solicits comments on the proposed criteria for this AKS Safe Harbor, including those regarding the advertisement and referral of such transportation services, permissible modes of transportation, the types of patients to whom such services are offered, and the maintenance of beneficiary eligibility criteria regarding service areas and financial need.

Beneficiary Inducement Amendments The beneficiary inducement provisions of the CMP prohibit any person from offering inducements to Medicare or Medicaid beneficiaries that the offeror knows or should know are likely to influence the selection of particular providers, practitioners, or suppliers. The Proposed Rule would amend the definition of “remuneration” in the CMP regulations by codifying certain statutory exceptions: 1. Copayment Reductions for Certain Hospital Outpatient Department (OPD) Services. As part of the Balanced Budget Act of 1997 (BBA), Congress exempted from prosecution under the CMP arrangements involving a reduction in the copayment amount for hospital covered OPD services. The OIG proposes to adopt language identical to the statutory exception language.

2. Remuneration that Promotes Access to Care and Poses a Low Risk of Harm. As part of the Affordable Care Act (ACA), Congress enacted an exception that permits any remuneration that “promotes access to care and poses a low risk of harm to patients and Federal health care programs.” Although the Proposed Rule does not contain any regulatory text implementing this exception, the OIG does propose specific definitions for “promotes access to care” and “low risk of harm to Medicare and Medicaid beneficiaries and the Medicare and Medicaid programs.” The OIG proposes that the phrase “promotes access to care” be defined to mean that “the remuneration provided improves a particular beneficiary’s ability to obtain medically necessary health care items and services.” The OIG further proposes that the phrase “low risk of harm” mean that the remuneration (1) “is unlikely to interfere with, or skew, clinical decision-making,” (2) “is unlikely to increase costs to Federal health care programs or beneficiaries through overutilization or inappropriate utilization,” and (3) “does not raise patient-safety or quality-of-care concerns.” The OIG is explicitly soliciting comments on the potential expansion of both of these definitions to cover more types of remuneration that could be beneficial to patients and 42 | NOVEMBER 2014

decrease costs of providing health care services to beneficiaries. Of note, the Proposed Rule expressly reiterates the OIG’s long-standing concern that rewards offered by providers or suppliers to patients who comply with a treatment regimen pose a risk of abuse when the rewards are likely to influence the recipients to order or receive items or services from a particular source. But the OIG also recognizes that such programs can promote health and wellness as well as encourage patients to engage in arrangements that lower health care costs. To that end, the OIG is soliciting comments on whether incentives for compliance with treatment regimens should be explicitly permitted under this exception and, if so, what limitations or safeguards should be put in place.

3. Coupons, Rebates, and Other Retailer Reward Programs. The OIG also proposes to codify the ACA exception permitting retailers to offer or transfer coupons, rebates, or other rewards (including store merchandise, gasoline, or frequent flyer miles) for free or less than fair market value if the items or services are available on equal terms to the general public and are not tied to the provision of other items or services reimbursed in whole or in part by Medicare or Medicaid. The OIG notes that “this new exception should increase retailers’ willingness to include Federal health care program beneficiaries in their reward programs in appropriate circumstances,” but the OIG offers somewhat confusing guidance on what the appropriate circumstances would be. For example, the OIG states that “a drugstore program that offered a $20 coupon to customers, including Medicare beneficiaries, who transferred their prescriptions to the drugstore would not meet the [exception] because the $20 coupon would be tied to the drugstore’s getting the recipients’ Medicare Part D prescription drug business.” However, “a program that awarded a $20 coupon once a customer spent $1,000 out-of-pocket in the store — even if a portion of that $1,000 included copayments for prescription drugs — would likely meet the [exception].” Although the Proposed Rule explicitly excludes from protection reward programs in which the rewards themselves are items or services reimbursed in whole or in part by a Federal health care program, the example provided by the OIG indicates that rewards can be redeemed on customer’s out-ofpocket costs for federally reimbursable items as long as the rewards can also be redeemed for anything else purchased in the store.

4. Financial-Need-Based Exception. The third ACA exception that would be codified in the Proposed Rule permits the offer or transfer of items or services for free or less than fair market value if there is a good faith determination of the individual’s financial need,

the items or services are not advertised, the offer is not tied to the provision of other items or services reimbursed by Medicare or Medicaid, and there is a “reasonable connection” between the items or services being offered and the medical needs of the individual.

The OIG notes that a “reasonable connection exists from a medical perspective when the items or services would benefit or advance identifiable medical care or treatment that the individual patient is receiving.” The OIG is soliciting comments on the boundaries of a “reasonable connection” for purposes of this exception.

5. Waivers of Cost-Sharing for the First Fill of a Generic Drug. The final ACA exception permits Part D and MA-PD plan sponsors to waive enrollee copayments for the first fill of a generic covered Part D drug. The OIG proposes to rely on the definition of “generic drug” set forth in the Part D regulations.

Additionally, the Proposed Rule would require sponsors to disclose this incentive program in their benefit plan package submissions to CMS.

Gainsharing Updates Nearly 20 years after it abandoned its last attempt at formal rulemaking in December 1994 (1994 Proposal) and over 15 years after publishing the Special Advisory Bulletin on “Gainsharing Arrangements and CMPs for Hospital Payments to Physicians to Reduce or Limit Services to Beneficiaries” in 1999 as a stopgap, OIG attempts to address a long-standing dilemma regarding the Gainsharing CMP in the Proposed Rule. Given that the Gainsharing CMP is a self-implementing law that explicitly “prohibits hospitals and critical access hospitals from knowingly paying a physician to induce the physician to reduce or limit services to Medicare or Medicaid beneficiaries who are under the physician’s direct care,” the OIG has no authority to create an exception to the Gainsharing CMP, even to limit the prohibition to limiting services that are not “medically necessary.” However, the OIG seeks comments on its proposal to narrow its interpretation of “reduce or limit services” to better align the statute with current health care reform goals. The OIG is particularly interested in comments on the following four aspects that would inform whether it should issue definitions of this key phrase of the statute: 1. Whether the prohibition of payments to reduce or limit services requires the OIG to also prohibit the reduction or limit of items used in providing such services; 2. Whether a hospital’s decision to standardize certain items or rely on clinical protocols based on objective quality metrics amounts to reducing or limiting care for patients; 3. Whether permissible standardizing of such items or processes should require hospitals to “establish

certain thresholds based on historical experience or other clinical protocols, beyond which participating physicians could not share in cost savings;” and 4. Whether the OIG should include a requirement that the parties participating in a gainsharing arrangement disclose it to patients as a per se criteria that the arrangement is for legitimate purposes allowed by the statute.

The OIG is also proposing to add a definition of “hospital” to proposed section 42 C.F.R. § 1003.110 (which is currently § 1003.101). Otherwise, the proposed rule mostly reflects the same language as used in the 1994 Proposal, which essentially codifies the statute.

Although Congress has not amended the statute since its enactment, the OIG now acknowledges that “[h] ealth care payment and delivery systems are changing, with greater emphasis on accountability for providing high quality care at lower costs,” which is evidenced by Congress’s authorization of programs that essentially endorse gainsharing as a mechanism to lower health care costs (e.g., the Medicare Shared Savings Program and the Medicare Hospital Gainsharing Demonstration).

But given that the OIG has never pursued a Gainsharing CMP case and has, in fact, approved 16 gainsharing arrangements through its advisory opinions, the proposed reinterpretation of the Gainsharing CMP language is long in coming. Unfortunately, the OIG is continuing to rely heavily on the 1994 Proposal as a starting point for the Proposed Rule, which shows that the OIG’s position on gainsharing arrangements has not evolved significantly.

Rather than only requesting stakeholder input to inform its future enforcement approach, the OIG could have been more helpful by proposing actual regulation text. Thus, stakeholders should consider focusing their comments on whether the Proposed Rule on gainsharing provides sufficient clarity for practical implementation.

Conclusion The OIG is accepting comments on the Proposed Rule until December 2, 2014. This proposed rulemaking represents an attempt by the OIG to adapt its fraud and abuse enforcement position in light of broader health care reform initiatives and demonstrates how difficult it is to balance the broad prohibitions in the law with actual business practices and the particular needs of patients.

Health care providers and industry stakeholders involved in creating patient incentive programs, care coordination arrangements, or gainsharing arrangements with hospitals should be especially interested in providing comments to the Proposed Rule and may have an invaluable opportunity to influence the outcome of this rulemaking.  Source: http://www.mintz.com/newsletter/2014/ Advisories/4340-1014-NAT-HL/ WWW.MEDMONTHLY.COM | 43

healthy living

Sweet Potato Quinoa Salad

By Ashley Acornley, MS, RD, LDN November is the perfect time to incorporate more sweet potatoes into your diet. These nutritional powerhouses are filled with fiber, Vitamin A, and plenty of micronutrients to keep you vibrant and healthy. Sweet potatoes are especially popular to cook with around Thanksgiving. This sweet potato quinoa salad is a tasty side dish to use as a part of your Thanksgiving feast, or to make as a weeknight meal on its own. Enjoy!

Ingredients:

• 1 cup dry quinoa • 2 cups water • 2 cups roasted sweet potato “fries”,

diced (recipe below right)

• 1 can (15 ounces) organic black beans,

rinsed and drained

• 1 cup frozen corn kernels, thawed • 1 cup diced red bell pepper • 3 scallions, finely chopped • 2 tablespoons chopped fresh parsley • 3 tablespoons extra virgin olive oil, divided • Freshly squeezed lemon juice to taste • 1/2 cup crumbled low fat feta cheese • Salt and pepper to taste Yields: 5 servings for a meal or 10 servings as a side dish

Preparation:

Easy Sweet Potato Fries Preparation:

1. Preheat oven to 425°F. 2. Cut 2 medium sweet potatoes into half-inch thick fries.

3. Lay on a sheet pan and toss with 1 tablespoon extra virgin olive oil, cinnamon and pepper.

4. Bake for 30 until golden brown — turn once half way through roasting.

1. Rinse and drain quinoa.

2. In a saucepan, combine quinoa, water and a pinch of salt. Bring to a boil, reduce heat, cover and simmer for 15 to 20 minutes, until water is absorbed and quinoa is tender.

3. Once quinoa is cooked, transfer to a large bowl, stir in 1 tablespoon of olive oil and set aside to cool.

4. In a separate bowl combine sweet potato, black beans, corn, bell pepper, scallion and parsley- toss to combine.

5. Combine sweet potato mixture with quinoa; add remaining oil, lemon juice, and feta – season with salt and pepper to taste.

6. Toss and serve chilled or at room temperature.

44

| NOVEMBER 2014

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

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

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

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

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

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

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

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

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

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

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

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

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

WWW.MEDMONTHLY.COM | 45

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

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

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

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

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

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

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

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

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

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

Delaware Cannon Building, Suite 203 861 Solver Lake Blvd.

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

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

Florida 4052 Bald Cypress Way Bin C-08 Tallahassee, FL 32399 (850)245-4474 http://floridasdentistry.gov/ 46

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

| NOVEMBER 2014

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

WWW.MEDMONTHLY.COM | 47

U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (334)242-4116 http://www.albme.org/ Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 http://commerce.alaska.gov/dnn/cbpl/ ProfessionalLicensing/StateMedicalBoard.aspx Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 (480)551-2700 http://www.azmd.gov Arkansas 1401 West Capitol Ave., Suite 340 Little Rock, AR 72201 (501)296-1802 http://www.armedicalboard.org/ California 2005 Evergreen St., Suite 1200 Sacramento, CA 95815 (916)263-2382 http://www.mbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7690 http://www.dora.state.co.us/medical/ Connecticut 401 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/cwp/view. asp?a=3143&q=388902 Delaware Division of Professional Regulation Cannon Building 861 Silver Lake Blvd., Suite 203 Dover, DE 19904 (302)744-4500 http://dpr.delaware.gov/ District of Columbia 899 North Capitol St., NE Washington, DC 20002 (202)442-5955 http://doh.dc.gov/bomed 48 | NOVEMBER 2014

Florida 2585 Merchants Row Blvd.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

WWW.MEDMONTHLY.COM | 49

medical resource guide ACCOUNTING

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

www.pushpa.biz

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

BILLING & COLLECTION

DENTAL Biomet 3i

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

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

CODING SPECIALISTS Place Your Ad Here

CONSULTING SERVICES, PRACTICE MANAGEMENT

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

The Dental Box Company, Inc.

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

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

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

Urgent Care America

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

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

50 | NOVEMBER 2014

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

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

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

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

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

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

LOCUM TENENS Physician Solutions

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

MEDICAL ARCHITECTS MMA Medical Architects

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

medical resource guide MEDICAL ART

MEDICAL PRACTICE SALES

Deborah Brenner

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

Medical Practice Listings

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

MedImagery

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

MEDICAL EQUIPMENT

MEDICAL PRACTICE VALUATIONS

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

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

www.assurepharma.com

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

www.thetps.com

Capri Health

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

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

BizScore

Assured Pharmaceuticals

PROFESSIONAL SPEAKER

MEDICAL RESEARCH

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

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

Scynexis, Inc.

3501 C Tricenter Blvd.

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

MEDICAL EQUIPMENT FINANCING Bank of America

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

SUPPLIES, GENERAL PRACTICE FINANCING Bank of America

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

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

www.bankofamerica.com/practicesolutions

MEDICAL MARKETING WhiteCoat Designs

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

WWW.MEDMONTHLY.COM | 51

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

Family Primary Care Practice

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

Family Practice/Primary Care

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

Med Spa

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

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

Practice Type: Internal Medicine

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

Dental Practices Place Your Ad Here

Optical Practices Place Your Ad Here

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

Considering your practice options? Call us today.

52 | NOVEMBER 2014

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

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

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

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

l One

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

Medical Practice Listings Buying and selling made easy

Please direct all correspondence to driverphilip@gmail.com.

Only serious, qualified inquirers.

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

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

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

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

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

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

Contact: Cara or Philip at 919-848-4202

medlisting@gmail.com medicalpracticelistings.com

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

Women’s Health Practice in Morehead City, NC

PEDIATRICIAN

OR FAMILY MEDICINE DOCTOR NEEDED IN

ROANOKE RAPIDS, NC

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.

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.

Medical Practice Listings Buying and selling made easy

Call 919-848-4202 or email medlistings@gmail.com www.medicalpracticelistings.com 54 | NOVEMBER 2014

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

NC Opportunities DENTISTS AND HYGIENISTS

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

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

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

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

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

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

Modern Med Spa Available

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

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

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

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

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

Contact us today to discuss your options confidentially.

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

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

ADVERTISE YOUR PRACTICE BUILDING IN MED MONTHLY

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

List price: $435,000

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

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

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

medmonthly.com | 919.747.9031

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

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

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

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

Medical Practice Listings Selling and buying made easy

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

Primary Care Practice For Sale

NC MedSpa For Sale MedSpa Located in North Carolina

Wilmington, NC

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

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

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

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

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

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

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

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

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

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

NC OPPORTUNITIES LOCUMS OR PERMANENT

PEDIATRICIAN

or family medicine doctor needed in

FAYETTEVILLE, NC

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

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

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

Comfortable seeing children. Needed immediately.

Call 919- 845-0054 or email: physiciansolutions@gmail.com www.physiciansolutions.com WWW.MEDMONTHLY.COM | 59

Physician Solutions, Inc. Medical & Dental Staffing

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

Physician Solutions

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

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