Med Monthly November 2016

PHYSICIAN SOLUTIONS PRESENTS

Med Monthly MAGAZINE

November 2016

Doctor Patient Relationship:

TECHNOLOGY HAS CHANGED THE FACET OF THE DOCTOR-PATIENT RELATIONSHIP

Boundary Crossing pg. 22

pg. 28

How to Improve Medical Care of the Non-compliant Patient

Breaking Down Communication Barriers with Patients:

A Cup of Kindness & Compassion

pg. 30

the atient Doctor-P ship: Relation y Boundar s Crossing issue

Avoid Painting Yourself Into a Corner

pg. 26

contents

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features

THREE WAYS MEDICAL PRACTICES CAN BUDGET SMART

22 DOCTOR PATIENT RELATIONSHIP: Boundary Crossing 26 BREAKING DOWN COMMUNICATION BARRIERS WITH PATIENTS: A Cup of Kindness & Compassion 28 TECHNOLOGY HAS CHANGED THE FACET OF THE DOCTOR-PATIENT RELATIONSHIP 30 HOW TO IMPROVE MEDICAL CARE OF THE NON-COMPLIANT PATIENT DOCTOR PATIENT RELATIONSHIP: Boundary Crossing

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practice tips 6

DO YOU OFFER PRE-TRAVEL HEALTH PLANS? Easy Way to Attract More Patients, Benefiting Everyone

8

INSURERS AND PHYSICIANS CAN PARTNER TO DELIVER CARE MORE EFFICIENTLY, SAVE COSTS

10 THREE WAYS MEDICAL PRACTICES CAN BUDGET SMART 12 WHY HACKERS ATTACK HEALTHCARE DATA, AND HOW TO PROTECT IT

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Med Monthly November 2016 Publisher Creative Director Contributors

Philip Driver Thomas Hibbard Naren Arulrajah Nidhi Behl Vats Barbara Hales, M.D. Nick Hernandez, MBA, FACHE Carrie Noriega, MD Denise Price Thomas

contributors Naren Arulrajah is President and CEO of Ekwa Marketing, a complete Internet marketing company which focuses on SEO, social media, marketing education and the online reputations of Dentists and Physicians. If you have questions about marketing your practice online, call Naren direct at 877-249-9666.

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

Nick Hernandez, MBA, FACHE

Med Monthly is a national monthly magazine committed to providing insights about the health care profession focusing on practical advice for physicians and practices. We are currently accepting articles to be considered for publication. For more information on writing for Med Monthly, please email us at medmedia9@gmail.com.

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

is the CEO and founder of ABISA, a consultancy specializing in solo and small group practice management. He has consulted with clients in multiple countries and has over 20 years of leadership and operations experience. Visit www.abisallc.com for more information.

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

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

Denise Price Thomas retired in 2009 as a surgical practice administrator where she was employed for 32 years. She is certified in healthcare management through Pfeiffer College. Speaking invitations have taken her from NC to SC, Georgia, Florida, Chicago, Alaska and more. Website: www.denisepricethomas.com MED MONTHLY MAGAZINE |5

practice tips

Do You Offer Pre-Travel Health Plans?

Easy Way to Attract More Patients, Benefiting Everyone

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

As the holidays and winter months loom ahead, many families are deciding where they want to go for vacation. Many employees are likewise planning their trips before the end of the business year. Everyone is thinking of the fun they will have but not of the health challenges that may face them.

This is where you come in, playing a key role.

Why not be known as the travel health expert in your community? While your colleagues also do examinations, you can be the one to claim that positionthat is assuming you want to grow your business.

Here’s why it makes sense You already: l Perform

complete physical examinations routine vaccinations l Have an EHR that can allow medical access remotely l Give

22|| NOVEMBER DECEMBER 2016 2013 6

Your digital records are already stored securely and are HIPAA compliant. They can be accessible all over the globe through the cloud including vaccination histories.

Think about it. Everyone knows that getting sick while traveling can not only bring an end to fun but can lead to dire consequences. Quality healthcare may not be readily available at their destination so preventative care is the best treatment for safer travel. It would be prudent to plan ahead and get that pre-travel exam.

As a health professional, it’s up to you to point this out and educate the patient on how to reduce the possibility of illness. Explain how a thorough medical evaluation assures health overseas by diagnosing and thereby treating unrecognized medical conditions.

Advise a travel physical examination for not only the business travelers but also their family in their community. Post it in your office and your neighborhood circulars.

You are also positioning yourself to perform pre-travel for: l Families going abroad or to risky areas l Business travelers l Employees of large corporations where employers want multiple exams to be performed on site l Students l Volunteers l Prospective adoptive parents l Missionaries l Disaster relief workers Point out to employers that by referring their employees to you, they decrease the workload of their human resources department, ridding the need to coordinate paper medical records from providers across the community or across the globe.

These people may not be current patients to your practice but with your winning bedside manner, may have them coming to you on a regular basis. This includes family and friends- an exponential growth.

What to add to your repertoire: l Provide

disease and illness preventive plans l How and when to evacuate if healthcare is unavailable l Provide travel-specific vaccines e.g. Hepatitis A&B, Yellow Fever, Encephalitis, Typhoid l Formulate a pre-travel questionnaire and planning guide including travel advice l Make first aid kit suggestions

 Thermometer Sanitizer l Medications m Antacids m Drugs for Diarrhea (lomotil, diphenoxylate atropine oral, loperamide, paregoric oral, kaopectate) m Treatment for constipation (Dulcolax, Colace, Miralax, Metamucil, Milk of Magnesia oral) m NSAIDs for muscle aches, headaches and general analgesia m Antibiotics such as Tetracycline or Doxycycline m Motion Sickness prevention m Altitude sickness prevention m Epi Pen if allergies are an issue l Hand

Once you have devised a strategy, questionnaires, handouts and list of vaccinations or access to needed vaccinations and boosters for various locations, it will become second nature for you.

As a physician you can feel happy that you have assured your patient health in travel. As the patient, you can go with a merry heart, knowing that a healthy and fun-filled vacation awaits you. 

The Write Treatment

Travel Supplies The travel supplies that you may suggest: l Sunscreen l Travel compression socks l Mosquito Protection  Insect repellent  External analgesic  Permethrin  Cream for itches and rashes  Mosquito netting l First Aid Kit  Band-Aids  Bandages  Hydrocortisone Cream  Antibiotic Ointment  Alcohol wipes  Gauze  Steristrips

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

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Barbara@TheWriteTreatment.com 516-647-3002

MED MONTHLY MAGAZINE

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practice tips

Insurers and Physicians Can Partner to Deliver Care More Efficiently, Save Costs

‘‘

“Our study may have been able to demonstrate a significant savings, because the financial agreement was forged directly with physicians, rather than mixed-provider organizations”

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Insurers and physicians can partner to help physicians to deliver care more efficiently and save costs, according to a study by researchers at Rice University and Cigna, a global health service company.

The study’s findings are based on an examination of an arrangement Cigna made with a multiclinic physician practice in north Texas to improve quality of service and lower health care costs for patients covered through Cigna. The arrangement was part of Cigna’s Collaborative Accountable Care (CAC) initiative, which is a shared savings program that offers practices that are in their first year of participation an up-front care coordination fee to pay for investments in infrastructure that furthers progress toward quality and cost targets.

“There have been a growing number of studies trying to test whether coordinated care — think the Affordable Care Act’s Accountable Care Organizations — can restrain cost growth,” said Vivian Ho, the chair in health economics at Rice’s Baker Institute for Public Policy and director of the institute’s Center for Health and Biosciences, who co-authored the study. “The results of other studies have been mixed. Our study may have been able to demonstrate a significant savings, because the financial agreement was forged directly with physicians, rather than mixed-provider organizations.

“Hospitals may have less incentive to restrain cost growth because so much of their revenue comes from providing inpatient care. In contrast, the share of physicians’ revenues associated with hospital care is much lower. With improved patient data provided

by Cigna plus additional nursing support within the practice for follow-up, physicians can readily focus on delivering care quickly and efficiently,” He said.

The research findings are published in the American Journal of Managed Care.

In the study, Cigna provided a physician practice, Medical Clinic of North Texas (MCNT), with funds to invest in infrastructure, including informatics and care coordination. For example, Cigna funding helped MCNT to hire a nurse who could help with hospital discharge coordination for patients at increased risk of readmission, targeted outreach to high-risk patients, patient education and patients’ compliance with prescriptions. In addition, Cigna agreed to share with MCNT any realized cost savings from moving to a more coordinated care model.

This paper compares costs in 2009 before the intervention began to 2010 and 2011 when the intervention took effect. The sample size varied by year, but included 7,100+ MCNT patients and 180,000+ other patients in north Texas covered by Cigna in each year. The researchers found that costs for MCNT’s Cigna patients were lower by almost 6 percent relative to other patients covered by Cigna in the north Texas area. The savings occurred in multiple categories, including in procedures and testing. About half the savings was due to lower use of services, while the rest was due to reductions in price.

The researchers did not quantify the improvement in quality of care associated with this contract. “However, MCNT did meet the quality requirements specified in the contract, so we know that service quality did not decline,” Ho said.

“Measuring the Cost Implications of the Collaborative Accountable Care Initiative in Texas” was also co-authored by Meei-Hsiang Ku-Goto, research programmer at the Baker Institute; current Cigna employees Tim Allen, William Keenan and Urie Kim; and former Cigna employee Mark Sanderson. Ho is also a professor of economics at Rice and a professor of medicine at Baylor College of Medicine.

Drs. Ho, Ms. Ku-Goto, and the Baker Institute did not receive funding from Cigna.  Source: http://www.pressreleasepoint.com/rice-u-study-insurers-and-physicians-can-partner-deliver-care-more-efficiently-save-costs

MED MONTHLY MAGAZINE

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practice tips

Three Ways Medical Practices Can Budget Smart

By Nick Hernandez, MBA, FACHE CEO and Founder of ABISA

It is once again the time of year when medical practices should be working to finalize their operating budget for the next calendar year.

Unfortunately, too few practices actually take the time to create a meaningful budget, instead seeing the endeavor as a complex, timeconsuming process that likely will 10

| NOVEMBER 2016

not be used. Creating and following a budget involves self-discipline and sacrifice, but will help you develop wise spending habits to better manage your practice’s finances now and into the future.

If you’re continually seeing failure at budgeting, the best place to look is usually at the fundamentals.

It only takes a fundamental misstep or two to transform a well-planned and well-formed budget into a complete disaster. Budgets should be realistic, flexible, and consistent with practice goals and objectives.

Here are three keys to consider that will point you on the right track toward success as you build

this is a great way to move towards financial success, budgeting won’t help much at all. The reason for budgeting is to help you spend less than you earn. It shows you where your spending weaknesses are and provides the structure for you to get stronger in those areas. If you’re in the dark about how much your practice spends and where you spend it, changing habits will be difficult. And even if you’re financially comfortable, a budget can help you identify unnecessary expenditures and deduce ways to redirect funds towards your priorities.

your budget: 1. Know Why You Are Budgeting.

If you’re developing a budget just because someone says it’s a good idea, it probably won’t help very much. Similarly, if you’re just following the steps in a practice finance workbook because it suggests

2. Be Realistic.

It’s not going to work if you make huge, unrealistic assumptions right off the bat. Small steps work; big steps result in failure. Operating a medical practice can be unpredictable at times, and things happen that are out of your control. Consequently, look at where money can be moved around within a budget.

For example, practices often use budgets to plan for future business growth and expansion. Capital saved on regular business expenditures may be placed into a special reserve account designated for selecting new business opportunities.

Budgeting for future growth opportunities ensures that practices have capital on hand when needing to make quick decisions for expanding business operations. This capital may also be used during slow economic times as a safety net for paying regular business expenses.

3. Be Flexible.

There will usually be moments when you’re learning to budget when you discover that some element of your budget is just not right. Take time to readjust fig-

ures. It’s not realistic because you forgot about some key piece of information while making your plans, and that means the budget you developed doesn’t really work.

Don’t panic. Don’t abandon your plans. Just go back to your plans, make the needed adjustments, and start over again. This is normal, it happens to everyone. It does not mean your budget was a failure at all, it just means it needed to evolve a little bit. Regularly revisiting your practice’s budget will help you better control financial decisions because you will know exactly what you can afford to spend versus how much the practice is projecting to make.

An accurate, useful budget can be a valuable decision-making tool to analyze potential business threats and opportunities and help physician owners and practice administrators make sound, strategic, and disciplined choices. Having a business budget in place enables you to plan ahead, prioritize your allocation of funds and gauge whether your financial predictions are being met. It will also enable you to make educated decisions to enhance your business operations with added clarity and efficiency.

When properly executed, a practice budget will quickly become one of the most valuable resources in a practice’s decision-making toolbox. A proactive, comprehensive budget gives a practice the ability to properly track results, identify areas of concern, and quickly intervene when issues arise. And don’t be afraid to seek out the professional advice of a healthcare consultant or CPA. They have worked with many practices and can help identify budgetary items which you may be inclined to overlook.  MED MONTHLY MAGAZINE

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practice tips

Why H

acke r s Atta Healt c k hcare Data, and H ow to Prote ct It

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R

emote patient monitoring technologies are forecasted to dominate the future of healthcare systems. Consisting of devices such as connected heart monitors, implanted sensors, and wearables, these technologies are designed to simplify and transform the way patients currently approach, access, and receive care. These technological advances are set to lead to the prevention of disease and early diagnoses.

However, with great advances come great challenges. The increase in data liquidity has brought one particular challenge to the tipping point: security.

This liquidity means patients’ data is flowing over the cloud, from provider to clinician and back to the patient.

One challenge of protecting patient data is that journey the data must take. Recorded on wearable devices and implanted sensors, highly personalized and comprehensive data of a patient’s basic health indicators first will go through secure home networks, from devices to apps over the internet, and then begin a more precarious journey through cloud or central repositories to reach physicians and payers.

Another challenge is the nature of the data itself.

The personal nature of this information, along with its long shelf life, makes health records highly valuable to hackers. Health records contain policy numbers, medical history, billing information, and Social Security numbers. Bank accounts and credit cards can be shut down at the first sign of fraudulent activity, but changing your Social Security number or address is a bigger challenge. Patients’ health records and prescription records are permanent and can be sold on the sold on the black market for a premium. In addition to allowing a hacker to use the information for identity theft and fraud, this data is valuable because of the social stigma that patients may feel if their health information were to be leaked. For these reasons, medical data are more sought after than financial data.

Risk Points

In theory, breaches have the potential to occur at any point along the journey. However, the breaches that will pose the greatest threat are those that occur when data is being relayed over the internet to cloud or centralized “safe keeping” database systems. Hackers looking for patient data on the cloud need only exploit one vulnerability on a network to bring that network down and compromise millions of patient

records. The Office of Civil Rights under Health and Human Services reported last year that more than 113 million medical records were compromised.

This is where payers and physicians will be hardest hit. According to McKinsey, nearly 45 percent of U.S. Hospitals are participating in local or regional Health Information Exchanges. Standards to protect data security have been established as part of the Health Insurance Portability and Accountability Act (HIPAA), but that can change and businesses are hard pressed to keep up. In fact, a recent study done by Infinite Convergence found that 92 percent of healthcare institutions are not HIPAA compliant. Standards are rapidly changing based on needs and new threats, and companies unable to operate by those standards are left all the more vulnerable to attacks.

An emerging danger facing physicians and payers is malicious hacking through programs like ransomware, software that blocks an organization’s access to its own computer system until a sum of money is paid.

Ransomware already has demonstrated the ability to install on wearable devices as well as laptops, systematically eating away stored data. According to a study conducted by the Institute for Critical Infrastructure Technology, “Ransomware attacks on healthcare organizations will wreak havoc on America’s critical infrastructure community.”

Hollywood Presbyterian Medical Center paid nearly $17,000 in ransom to re-obtain access to its computer systems after a ransomware attack. There is a direct correlation between the growth of healthcare technology and ransomware attacks, and the pressure to keep information secure and private will continue to increase. In May, the Medical Colleagues of Texas, an 11-physician practice in Texas experienced a breach, exposing 50,000 patient records.

While patients risk personal data hacks, payers and providers risk potential lawsuits and backlash from the public and the government if data is compromised. The cost of securing data on your networks is far outweighed by the costs of multiple lawsuits that arise from breaches and non-compliance – as evidenced by the Hollywood Presbyterian attack.

Technological Countermeasures

One of the more sophisticated technologies we have seen to protect data is encrypted enterprise platforms continued on page 14

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continued from page 13

that provide 256-bit AES encryption to ensure that all data are exchanged safely and according to standards.

These platforms also help to expose existing threats on the network. Backing up your data occasionally might be simple, but there are companies dedicated to securing and backing up medical records in real time. With patient records backed up, organizations have less exposure to ransom demands, and hackers have less motivation to pursue them. Beyond backing up data, hospitals would be wise to back up their systems and configurations as well. That additional backup, known as a “gold image,” resembles a bare-bones model of the system before patient information was added. Both the backed-up data and the “gold image” should be kept in a fully secure environment with physical and IT safeguards for ensuring privacy.

Biometric authentication technologies are another safeguard against data breaches. Software that can identify physical features of an individual, such as fingerprints, retinal patterns of the eyes, and voice, can help organizations control access to labs and records.

Payers and providers should be ensuring end-toend encryption and security of their patients’ data on all devices 24/7. Device-management systems protect phones in the event of theft. Security features monitor existing data for traces of suspicious activity, and wipe-and-lock systems keep unauthorized users out.

There are also platforms that prevent untrusted, noncompliant file-sharing apps from accessing patient data, further protecting application data.

Beyond Technology

Technology is not the only way to keep healthcare data protected. Hospitals, payers, and providers should be developing not only preventative steps toward keeping hackers out, but also an action plan for all employees should their systems suffer any kind of hack. An action plan should have explicit, step-by-step procedures for both pre-breach and post-breach, and work against past data breaches. Such plans should include setting up notifications when an employee has sent data outside the network and regular risk assessment. Companies then need to regularly test these plans to eliminate weak spots and ensure employees are following protocol. Trained employees are the first step toward protecting patients’ data, and action plans act as prevention and as remediation for past breaches. It is the organization’s obligation to make sure their 14

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employees understand training protocols and to understand where weak spots exist, so they may correct immediately. Limited employee access, disallowing USBs, deleting phishing emails, and avoiding virusridden websites may seem like obvious steps, but they must be stated policy, and policies must be enforced.

It is easy for hospitals to feel exposed in this era of breaches and ransomware attacks. However, with the right combination of technologies and training, they are already on a safer path.  Harish Pai is CTO at Infinite Computer Solutions and has over 25 years of experience in the technology and analytics landscape. He started his career at Microsoft and moved to NIIT, Tech Mahindra and, most recently, Infinite Computer Solutions. At Infinite, he is responsible for creating and defining Infinite’s healthcare service offerings, mainly focusing on big data, analytics, security, and compliance. He is responsible for ensuring big data is safely and securely shared across platforms throughout all relevant geographies.

Source: http://www.pressreleasepoint.com/why-hackers-attack-healthcare-data-and-how-protect-it

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U.S. OPTICAL BOARDS Alaska P.O. Box 110806 Juneau, AK 99811 (907)465-5470 http://www.commerce.state.ak.us/dnn/ cbpl/ProfessionalLicensing/DispensingOpticians.aspx Arizona 1400 W. Washington, Rm. 230 Phoenix, AZ 85007 (602)542-3095 http://www.do.az.gov 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/

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 http://www.oregonobo.org/optque.htm

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://tn.gov/health

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.njsop.org/aws/NJSOP/pt/sp/ home_page 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

MED MONTHLY MAGAZINE

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U.S. DENTAL BOARDS Alabama Alabama Board of Dental Examiners 5346 Stadium Trace Pkwy., Ste. 112 Hoover, AL 35244 (205) 985-7267 http://www.dentalboard.org/ Alaska P.O. Box 110806 Juneau, AK 99811-0806 (907)465-2542 https://www.commerce.alaska.gov/web/ cbpl/ProfessionalLicensing/BoardofDentalExaminers.aspx Arizona 4205 N. 7th Ave. Suite 300 Phoenix, AZ 85103 (602)242-1492 http://azdentalboard.us/ Arkansas 101 E. Capitol Ave., Suite 111 Little Rock, AR 72201 (501)682-2085 http://www.asbde.org/ California 2005 Evergreen Street, Suite 1550Â Sacramento, CA 95815 877-729-7789 http://www.dbc.ca.gov/

Hawaii DCCA-PVL Att: Dental P.O. Box 3469 Honolulu, HI 96801 (808)586-3000 http://cca.hawaii.gov/pvl/boards/dentist/ Idaho P.O. Box 83720 Boise, ID 83720 (208)334-2369 http://isbd.idaho.gov/ Illinois 320 W. Washington St. Springfield, IL 62786 (217)785-0820 http://www.isds.org/LawsLegislation/ boardOfDentistry.asp 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 https://www.colorado.gov/pacific/dora/ Dental_Board

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/ 18

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

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Louisiana 365 Canal St., Suite 2680 New Orleans, LA 70130 (504)568-8574 http://dentistry.ky.gov/

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/about/ Michigan P.O. Box 30664 Lansing, MI 48909 (517)241-2650 http://www.michigan.gov/lara/0,4601,7154-72600_72603_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://njpublicsafety.com/ca/dentistry/

Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)783-7162 http://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Dentistry/ Pages/default.aspx#.VbkfjPlPVYU

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 New York 89 Washington Ave. Albany, NY 12234 (518)474-3817 http://www.op.nysed.gov/prof/dent/ North Carolina 507 Airport Blvd., Suite 105 Morrisville, NC 27560 (919)678-8223 http://www.ncdentalboard.org/ North Dakota P.O. Box 7246 Bismark, ND 58507 (701)258-8600 http://www.nddentalboard.org/

Rhode Island Dept. of Health Three Capitol Hill, Room 104 Providence, RI 02908 (401)222-2828 http://1.usa.gov/u66MaB South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4599 http://www.llr.state.sc.us/POL/Dentistry/ South Dakota P.O. Box 1079 105. S. Euclid Ave. Suite C Pierre, SC 57501 (605)224-1282 https://www.sdboardofdentistry.com/ Tennessee 227 French Landing, Suite 300 Nashville, TN 37243 (615)532-3202 http://tn.gov/health

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

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U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (334)242-4116 http://www.albme.org/ Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 http://www.medlicense.com/alaskamedical-license.html 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 20

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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://www.maine.gov/md/

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/

Michigan Bureau of Health Professions P.O. Box 30670 Lansing, MI 48909 (517)335-0918 http://michigan.gov/lara/0,4601,7-15472600_72603_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 https://www.nebraska.gov/LISSearch/ search.cgi 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://www.medlicense.com/new-jerseymedical-license.html 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.pa.gov/ProfessionalLicensing/BoardsCommissions/Medicine/ Pages/default.aspx#.Vbkgf_lPVYU 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://tn.gov/health

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/

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features

Doctor Patient Relationship: Boundary Crossing

By Naren Arulrajah Ekwa Marketing

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Professional boundaries are integral to the doctor-patient relationship.

Boundaries help in establishing trust and confidence in a healthcare professional. For a patient, being able to confide in their physician and entrusting their health and wellbeing in the capable hands of the physician is crucial to establishing a healthy and productive relationship with the physician.

Anytime boundaries are crossed by either party (doctor or patient) it can compromise the dynamics of the doctor-patient relationship which in turn can impact the quality of care.

For this reason, professional and ethical boundaries need to be established and adhered to closely.

Boundaries Professional boundaries between doctors and their patients are necessary to keep both doctors and patients safe. However, at times, due to certain circumstances or for a variety of reasons, these boundaries may be crossed or violated.

A non-sexual hug when greeting a patient or after a bereavement, a home visit when the patient is bed-ridden or elderly, or even exchanging appropriate gifts and cards on special occasions can constitute boundary crossing.

But in each of these cases, the doctorpatient relationship is not altered to the extent of becoming risky or inappropriate. These kind of boundary crossings can in fact help strengthen the doctor-patient relationship.

A boundary violation, exploitative sexual or business relationships, on the other hand constitutes a far greater risk and its implications can alter/ damage the doctor-patient relationship. Not only do boundary violations have the potential to cause a trust deficit to develop on both sides, but more importantly, it can compromise the quality of patient care.

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continued from page 23

Boundary violations can be initiated either by the doctor or the patient. The best way to prevent the situation from escalating is by recognizing the warning signs and taking appropriate steps to limit or restrict such interactions at the very beginning.

Boundary Crossing in an Evolving Healthcare Space The nature of healthcare practice is evolving at a fast pace. Digitization of this space has given patient healthcare management a new form. In this new space, the patient is an equal partner in care management. To facilitate this kind of collaborative partnership, physicians are encouraged to form a more interactive relationship with their patients.

Most healthcare professionals are on a first name basis with their patients. They also are far more involved in the lives of their patients. Informal interactions during medical consultations or even social media interactions that are quickly becoming the norm, often lead to a situation where professional and personal boundaries are hard to maintain. And this can result in boundary crossing.

Boundary Crossing Risk Factors Faced

by Healthcare Professionals Poor communication is a big risk factor when it comes to boundary crossings. If a physician is unable to communicate effectively with patients, it leaves room for misinterpretation. The patient might construed what is routine questioning and examination to be inappropriate. Here the physician is only doing his job and no boundaries have been violated, but because of a lack of communication, his actions can be questioned.

Stress and lack of emotional/mental counselling for healthcare professionals is again a big risk factor. Emotional instability and working under duress can also lead to physicians developing serious mental conditions which can push them to cross or violate the sanctity of the doctor-patient relationships. This is why physicians need to have a support system in place in the form of family or colleagues, or even professional counsellors.

Boundary crossings or violations can also happen in the case of junior or inexperienced physicians. With very little experience in patient communications and 24

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interactions, the risk of boundary crossings is high.

Educating junior doctors or providing them with clear boundary crossing guidelines is a necessary step in reducing instances of boundary crossings and or violations.

Patients and Boundary Crossing Instances of patients crossing and or violating the boundaries of the doctor-patient relationship can happen in the case of those patients who face considerable difficulty in maintaining interpersonal relationships.

These patients find it difficult to maintain relationship boundaries and are inconsistent in their behavior and actions with their healthcare professionals.

Strategies to Reduce Instances of Boundary Crossing and Boundary Violation Risks It is vital that healthcare professionals uphold and maintain the trust that patients place in them. Here are 10 questions that can help raise awareness and encourage self-reflection as a way of maintaining professional and ethical boundaries in doctor-patient relationships. • Am I favoring patients who are more agreeable to my recommendations? • Am I finding it difficult to terminate my relationship with patients who are emotionally dependent on me? • Are cultural beliefs and taboos conflicting with my treatment recommendations? If yes, how am I dealing with the conflict?

• How do I feel and treat patients who complain about my treatment recommendations?

• Are my thoughts about a particular patient affecting my ability to maintain professional boundaries and provide effective treatment?

• Are my actions, words, suggestions, and/or tone preventing certain patients from participating in the decision-making process about their health care?

• Am I open to accepting inappropriate gifts and or communications from patients?

• Am I deliberately seeking more personal details about a certain patient than what is clinically required?

• Am I making exceptions for patients that I find physically attractive or important?

• Am I interested in engaging with certain patients on a social level outside of clinically scheduled visits? If yes, why?

These are just some of the important questions physicians can use for self-reflection when in doubt about their interaction with specific patients. If the answer to these questions places you in a position of risk of boundary crossing or boundary violation, then

it is best to step back and reassess your standing and seek professional help.

Conclusion The quality of the patient–physician relationship is an essential aspect of quality care. Relationships that are based on mutual respect and trust, and faith in the skills, knowledge, values of a healthcare professional allow for effective doctor-patient interactions. This not only leads to enhanced accuracy of diagnosis and better treatment, but it also helps lower instances of boundary crossing and boundary violations that are counter-productive to patient healthcare.  About the Author: Naren Arulrajah is President and CEO of Ekwa Marketing, a complete Internet marketing company which focuses on SEO, social media, marketing education and the online reputations of Dentists and Physicians. With a team of 140+ full time marketers, www.ekwa.com helps doctors who know where they want to go get there by dominating their market and growing their business significantly year after year. If you have questions about marketing your practice online, call 855 598-3320 to speak one-on-one with Naren.

features

Breaking Down Communication Barriers with Patients: A Cup of Kindness & Compassion

By Denise Price Thomas

Once upon a time a very nice elderly gentleman walked into the surgeon’s office and was greeted by our “Super Star” receptionist. “Good Morning, how may I help you today?” she asked with her genuinely caring smile. He replied, “I’m here to pick up my autopsy report.” Our first thought was that he was going to have to wait a while on that one!

If you don’t think that will get your attention… along with the attention of everyone in the lobby….. think again! Our “Super Star” receptionist heard the chuckles coming from the lobby and to save him from further embarrassment, she asked the gentleman to come around to the other side of the desk. It was there where she asked if he’d like a cup of coffee (with the purpose of obtaining a better understanding of what it was that he needed). After a cup of kindness & compassion was served, it was learned that he needed a copy of his biopsy report. Big difference!

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This true story is a reminder that healthcare is our profession. Therefore it is our responsibility to communicate, educate & advocate, not to complicate. In fact, we are here to un-complicate and to help them to feel more secure. Normally, when patients enter the hospital or a physician’s practice, they are very anxious. Matter of fact, I went to the doctor with my husband recently for his procedure and the young lady said, “Are you scared?” He said, “No ma’am, I’m not scared….I am downright SKEEEERD!” We sometimes forget that this is a typical day for us, like taking your car to the mechanic for an oil change.

It’s just what they do. On the other hand, I wouldn’t attempt to replace my own radiator, I prefer to leave all of that up to the experts. We aren’t in the automobile service department and these aren’t automobiles.

These are real people, people who are loved by their parents, children, spouses, family members, co-work-

ers, etc. All arrive with a story.

Our desire as healthcare professionals should be to hear their story. We learn so much by listening.

Remember to ask questions and truly listen to the answers. I’ve witnessed physicians and professionals talking over a family member who was telling “their story”, the story of what had just happened. I’ve witnessed multiple healthcare professionals coming in and out of the exam room, restocking the room and talking among themselves, telling each other what supplies they will need and what the doctor is going to do. Meanwhile, the patient is just sitting there, grasping what little information they can. And it’s about them! We can say the same thing to the patient and our co-workers are kept informed. Patients and family members of patients want to hear it from the professional.

When I would take my elderly Mother to the doctor, the doctor would look at me and talk to me about her. She was there, she was the patient in the same room and she did not like this at all. She said to me, “He talks more to you than to me!” She was right. I was even uncomfortable. I began looking at her while he was talking to me and he finally got it. Whether the patient has dementia, is in a wheelchair, is a child, has a disability, has a caregiver with them, whatever the situation is, let us remember to talk to the patient instead of around the patient. Not only does it make that patient feel more at ease, it leaves a great impression on the hearts of all who witness this care.

While working in the emergency department in the 70’s, a physician told me that we should always talk to patients as if they were a sixth grader. Not that we are talking down to them; we talk to them in such a manner that everyone would understand from all walks of life. I remember soaking up his words of wisdom, then adding my ingredients, which are a cup of kindness & compassion. People can tell if you truly care and you will most likely be better understood.

I found that to be true from the banker and business professionals, skilled laborers, children and guess what, even other physicians. Yes, even physicians are “skeeeeered!”

As an administrator of a surgical practice, I received a call from the hospital charge nurse one day.

She said, “Denise, can you please come over here? We need your help with one of your physicians.” Well, I knew he was a patient at that time, I’d visited with him on a daily basis, but what she needed was for me to

help calm him down. She said, “He is really a horrible patient!!” and she was telling the truth. No one enjoys being a patient, even the professionals who know what is going on. After talking with him and calming him down, I learned that he felt uninformed. He said, “When the nurses come in my room, they just assume that I know what they are going to do and I don’t!

When they tell me to “stand up”, I want to know what we are doing. When they say, “it’s time for your medicine” I want to know what medicine and what it’s for”.

In healthcare, every day is a brand new day. No day repeats itself. The stage is set for unknown players to arrive at unscheduled times, no script is made available that will fit each one. Unforeseen problems will arise at any second and healthcare professionals must be there to respond promptly.

Taking the time to talk with the patient is like offering a cup of kindness and compassion with a caring smile and disposition. It goes such a long way. So let’s remember to talk to each patient instead of talking around them. Once again, may we be reminded each day that this is our profession, but it is their life. 

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

Home Grown/Nationally Known www.denisepricethomas.com denisepricethomas@gmail.com 704-747-8699 MED MONTHLY MAGAZINE

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features

TECHNOLOGY HAS CHANGED THE FACET OF THE DOCTOR-PATIENT RELATIONSHIP

Nidhi Behl Vats Freelance Medical Writer To lead a comfortable life in 21st century we are dependent on technology. The same is true for healthcare. The technology has given us multiple ways to assist in our wellness, exercising or monitoring health. We are able to lead healthier lives thanks to new breakthroughs in medical technology.

Indeed the technology has helped in making the relationship between a doctor and a patient better. Patients can interact and consult with the doctors online without having to see them in the traditional office setting. With the advancement of video and voice call services, a doctor doesn’t even have to be present in the vicinity of 28

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the patient to make a full and successful diagnosis.

This remote process of consulting with the use of technology is called telemedicine. Telemedicine has advantages of its own.

• Better treatment without adding on to the medical travel cost As one doesn’t have to travel long distances anymore to get first class treatment, the cost of consultation has gone down quite a bit. All you need is a decent internet connection and a communication device.

• Quick access Telemedicine saves a lot of time and in turn might even save

someone’s life. Telemedicine has established a system in which a doctor can be made available as soon as something goes wrong, giving immediate diagnosis and treatment.

• Remote access Remote consultations are easier because the patient doesn’t need to be physically present with the doctor for treatment. This makes medical consultations easily available in rural areas of developing countries and that, too, is at a minimal cost.

With the ever increasing demand of telemedicine for treatment, this facet of the doctor-patient relation-

ship has emerged fresh with challenges of its own. Provided the relationship is established in the right way, telemedicine can give better results in patient treatment. Bear in mind, if the physician is meeting the patient for the first time over a digital communication platform, the consultation must occur with the utmost caution. No prior relationship has been established at this point. However, when the consultation is happening with a familiar physician who has already treated the patient before and is aware of the patient’s health history, then telemedicine will just make things a lot easier.

It is not always possible to get treated by a known doctor over video or voice calls especially in case of emergencies. In such situations, doctors have to use their wisdom and must keep a couple of things in mind.

Some points to keep in mind while using telemedicine: 1. Prescribing narcotics or mental health drugs: A doctor shouldn’t prescribe narcotics virtually as this might entail unforeseen risks during the very first interaction.

2. Prescribing diabetes or antihypersensitive drugs: Doctors can advise about the diabetics or hypertensive medication in the first interaction, depending upon the patient’s diabetic and BP family history. As consultations take place outside of an established relationship, it is necessary for the doctor to be aware of the patient’s health history for him to diagnose him properly.

3. Way of interaction: It is crucial to make the patients comfort-

able with the doctor while asking preliminary questions over the internet. Patients may be wary of technology and might not be as open and forthcoming as they might have been with their regular doctor.

4. Role of patient: For a successful diagnosis, the patient should be honest about his symptoms and other signs. It’s the doctor who should take the lead and should make the patient comfortable, so that patient can speak up about their problem frankly.

5. Role of family physician or the treating doctor: Since one major drawback of telemedicine is that one cannot do the physical examination, it’s the family physician or the treating doctor, who on behalf of the remote doctor, have to do the physical examination because it is perception dependent.

6. Preliminary case study: If an accurate diagnosis is not possible, then an assessment of the case should be done, followed by extensive live discussions.

Also, medical records should be studied by the new consulting doctor over telemedicine conferencing. The treating doctor, sitting remotely, should review all the reports thoroughly and should have a number of discussions depending on the severity of the case. Also, the treating doctor should also be involved with the discussions from the patient’s side.

7. Advising additional tests: The treating doctor should not feel shy about advising additional tests, if he feels necessary. It is vital that the patient is informed about the reason why these ad-

ditional tests are required and how they are helpful for a better diagnosis. Also, these will assist in determining a further course of action.

8. Documentation: Medical patient history and current conditions all should be thoroughly documented, and should be maintained in the electronic health records of the patient.

Recent advances in information and biomedicine technology have significantly increased the technical feasibility, clinical viability and economic affordability of telemedicine-assisted service collaboration and delivery. The ultimate success of telemedicine in an adopting practice requires the organization’s proper addressing of both the technological and managerial challenges. Adoption of telemedicine technology in many organizations has been driven by legitimate motivations, including service improvement, patient market extension, and organizational performance and competitiveness enhancement.

However, not all program drivers are pragmatic or sustainable. In effect, healthcare organizations can and do sometimes adopt telemedicine technology without proper motives or due consideration. That is why technology adoption is an important factor in telemedicine.

Whenever a health organization decides to incorporate telemedicine into its business structure, it should be very careful about the motivations driving it and focus on what kind of technology would suit its needs. All the protocols to take care of complications, if they arise, should be set in place well in advance of opting new technology solutions in any practice. 

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features

How to Improve Medical Care of the Non-compliant Patient

By Carrie A. Noriega, MD

W

e have all had the patient that just won’t follow the medical recommendations that they are given, no matter how many times we explain to them why it is so important. My worst experience was with a pregnant diabetic who refused to follow a diabetic diet and kept trying to overcompensate for this by adjusting her insulin. At 31 weeks gestation, she was brought to the hospital unconscious with a blood sugar of only 31. In the process of evaluating her in the labor and delivery triage area, she went into cardiac arrest. While the resuscitation team was performing CPR, the operating room team was taking her back to the O.R for an emergency cesarean for severe fetal bradycardia.

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In the end, I was able to deliver a viable baby girl safely, who was immediately taken to the NICU for what was to be a rough few months. During the cesarean, the patient got a pulse again and was stabilized.

The mom spent a few days in the ICU, eventually recovered and went home. When it was all over, I was left wondering if this entire situation could have been prevented if I had only done things differently and convinced the patient to comply better with her care.

I began researching for better ways to communicate with non-compliant patients and found several good ideas. One method that I did find useful in working with patients to achieve better compliance was the following ‘SIMPLE’ mnemonic [Atreja 2005].

S- Simplify the regimen I- Impart knowledge M- Modify the patient’s beliefs P- Patient communication L- Leaving the bias E- Evaluating adherence This method recommends making the treatment course or the drug regimen as simple as possible to help patients achieve better compliance.

One thing that may help patients take their medications as prescribed is to reduce the number of pills a patient has to take every day by using a combination medication, if available. Trying to find medications with fewer dosing requirements or a more comfortable delivery system may also motivate patients to take their medications regularly. Writing everything down for patients while they are in the office is also useful in reducing any confusion about what was discussed during their office visit and may motivate the patient to follow the written instructions when they are at home.

Helping the patient understand what the illness is that they are being treated for and how the recommended treatment is going to make them feel better or improve their quality of life is key. It is important to take the time to explain the patient’s medications or treatment, how it will impact their illness, and why it is important to the patient’s health. If you can convince the patient that what you are asking them to do will have a real benefit on their health, they may be more willing to follow the recommendations. In general, the more the patient understands about their disease and treatment, the more likely they are to follow the recommendations they were given.

Managing patients with a chronic disease can be especially challenging because there is no specific end point to their care. You can’t just tell them to take something for 10 days and then they are cured. It

takes a long-term commitment from the patient, so it is important to take the time to understand what the patient believes about their disease and what their intentions are for treating it. Addressing the following has been shown to help improve compliance [Atreja 2005]: - The patient needs to understand their disease is serious - They have to perceive that they are at risk if they don’t comply with healthy behavior - They need to believe their medical regimen will improve their outcome - They must have methods to address their fears about their disease or the treatment - They need to believe that they are capable of changing so they can follow the medical recommendations All of these can only be accomplished through good patient-physician communication, plenty of time, and sometimes, a lot of patience.

One challenge in dealing with non-compliant patients that is frequently overlooked by physicians is the physician’s own bias. While treating patients, it is always important to never assume a patient is following the recommended treatment based solely on their education, sex, race, income, occupation, or ethnicity.

Studies don’t support compliance of a patient based on any of the previously mentioned factors. Every patient needs to be evaluated for compliance by simply asking them if they ever forget to take their medications or are careless about taking them and whether or not they are following the medical recommendations they were given. By directly asking the patients what they are and are not doing, it can help better direct conversations about compliance.

By following the SIMPLE method, compliance can be improved and so can outcomes. However, this clearly will not solve all patient compliance problems.

Sometimes the physician-patient relationship just won’t work and in these situations, it is frequently best for both parties to end the relationship. But, when possible, putting in a little extra time and effort with a patient may significantly enhance the results the patient is able to achieve with their health.  References: Atreja A, Bellam N, Levy S. Strategies to enhance patient adherence: Making it simple. Medscape General Medicine. 2005; 7(1): 4.

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Practices for Sale Medical Practices Pediatric Practice Near Raleigh, NC

Location: Minutes South of Raleigh, North Carolina List Price: $145,000 Gross Yearly Income: $350,000 Year Established: 1980(s) Average Patients per Day: 16-22 Total Exam Rooms: 5 Building Owned/Leased: Owned. Will sell or lease.

Contact: Philip or Wendy at (919) 848-4202

Urology Practice near Lake Norman, NC Location: Minutes from Charlotte, NC List Price: $165,000 Gross Yearly Income: $275,000 Year Established: 1980 Average Patients per Day: 12 to 15 Building Owned/Leased: Leased Contact: Philip or Wendy at (919) 848-4202

Primary Care specializing in Women’s Practice

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: Philip or Wendy at (919) 848-4202

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: Philip or Wendy at (919) 848-4202

Med Spa

Family Primary Care Practice

Practice Type: Mental Health, Neuropsychological and Psychological

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: Philip or Wendy at (919) 848-4202

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: Philip or Wendy at (919) 848-4202

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: Philip or Wendy at (919) 848-4202

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.

32

| NOVEMBER 2016

THINKING ABOUT SELLING YOUR PRACTICE?

Medical Practice Listings can help you sell your practice online!

Now offering two types of listings to better serve all practice specialties and budgets.

For Sale by Owner Listing The For Sale by Owner Listing offers you the opportunity to gain national exposure by posting your listing on our website which is viewed daily by a network of qualified professionals. This option includes a brief practice consultation to explain the benefits of marketing through the Medical Practice Listings website. Our special rate for the For Sale by Owner listing through the end of 2015 is only $29.95 per month.

Professional Listing In addition to the benefits in the standard listing our Professional Listing affords you access to services provided by our expert legal and marketing team and a Bizscore Practice Valuation. This valuation compares your practice with other practices in your area, provides projections and determines what your practice is worth.

Visit us today at www.medicalpracticelistings.com to learn more.

919.848.4202 | 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 relocating and will assist as needed during the transition period. The gross receipts for the past three years average $650,000 and the list price was just reduced to $185,000. If you are looking to purchase a well equipped primary care practice, please contact us today.

919-848-4202 medlisting@gmail.com medicalpracticelistings.com

Practice for Sale in Raleigh, NC

State of Cha-Ching.

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

Lindsay Gianni, Agent 12333 Strickland Road Suite 106 Raleigh, NC 27613 Bus: 919-329-2913 lindsay.gianni.f23o@statefarm.com

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Internal Medicine Practice in the Heart of Raleigh

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

This is a beautiful practice, well appointed with great street visibility, parking and a very strong patient following. There are 4 exam rooms and a procedure room. The lobby is very comfortable with hardwood floors and tastefully decorated.

The gross revenues are over $600,000 with a strong income after expenses.

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

36 | NOVEMBER 2016

l One

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

Please direct all correspondence to driverphilip@gmail.com.

Only serious, qualified inquirers.

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

Urology Practice minutes from Lake Norman, North Carolina

Primary Care Practice For Sale in Wilmington, NC Established primary care on the coast of North Carolina’s beautiful beaches. Fully staffed with MD’s and PA’s to treat both appointment and walk-in patients. Excellent exam room layout, equipment and visibility.

Contact Medical Practice Listings for more information.

Urology Practice minutes from Lake Norman is now listed for sale. This excellent located practice is convenient to Charlotte, Gastonia, Lincolnton and Hickory. With a solid patient base, procedures currently include; Adult & Pediatric Urology, Kidney Stones, Bladder Problems, Incontinence, Prostate Issues, Urinary Tract Infections, Wetting Problems, Erectile Dysfunction and related issues. Three exam rooms with two electronic tables and one flat exam table.

Established: 1980 l Gross Yearly Income: $275,000 Average Patients per Day: 12 to 15 l List Price: $165,000

Contact Philip or Danielle at 919-848-4202 or email medlistings@gmail.com

Medical Practice Listings

919.848.4202 | medlistings@gmail.com www.medicalpracticelistings.com MED MONTHLY MAGAZINE

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We have several qualified MDs seeking established Urgent Care Practices in North Carolina.

Urgent Care Practices Wanted If you have an urgent care practice and would like to explore your selling options, please contact us. Your call will be handled confidentially and we always put together win-win solutions for the seller and buyer.

Call Medical Practice Listings today and ask for Philip Driver 919-848-4202.

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

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

Listing Price: $430,000

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

Modern Med Spa Available

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

The Gross revenue is over $1,500.000 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 is POISED FOR SUCCESS. 919.848.4202 medlisting@gmail.com medicalpracticelistings.com

38 | NOVEMBER 2016

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

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

North Carolina Dentist Opportunities

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.

Physician Solutions has immediate opportunities for dentists 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

Contact us today to discuss your options confidentially.

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

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Located on NC’s Beautiful Coast,

Morehead City

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

919.848.4202 medlisting@gmail.com medicalpracticelistings.com

NC MedSpa For Sale

Pediatric Practice Available Near Raleigh, NC

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

Contact Medical Practice Listings today to discuss the practice details.

Pediatric practice located minutes south of Raleigh, North Carolina is now listed for sale. Located in an excellent area convenient to Raleigh, Cary, and Durham, it is surrounded by a strong health care community. This is a well established practice with a very solid patient base. The building is equipped with a private doctor’s office, five exam rooms, and an in-house lab.

Established: 1980s l Gross Yearly Income: $350,000 Average Patients per Day: 16 to 22 l List Price: $145,000

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

www.medicalpracticelistings.com 40 | NOVEMBER 2016

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

PEDIATRICIAN

Discounts as big as a house.

Or condo.

Or apartment.

or family medicine doctor needed in

FAYETTEVILLE, NC

Lindsay Gianni, Agent 12333 Strickland Road Suite 106 Raleigh, NC 27613 Bus: 919-329-2913 lindsay.gianni.f23o@statefarm.com

See just how big your savings could be.

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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

MedicalPracticeListings.com | medlisting@gmail.com | 919-848-4202 MED MONTHLY MAGAZINE

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

Scan this QR code with your smartphone to learn more.