Med Monthly November 2017 by MedMedia9

PHYSICIAN SOLUTIONS PRESENTS

Med Monthly MAGAZINE

November 2017

Medical Practices Embrace Locum Tenens Option pg. 28

Three Strategies for Improving Staff Efficiency pg. 24

the

Your Practice S taff issue

6 Key Aspects for a Medical Practice Organizational Structure pg. 22

contents

BENEFITS AND DRAWBACKS TO OUTSOURCING

features

22 6 KEY ASPECTS FOR A MEDICAL PRACTICE ORGANIZATIONAL STRUCTURE 24 THREE STRATEGIES FOR IMPROVING STAFF EFFICIENCY 28 MEDICAL PRACTICES EMBRACE LOCUM TENENS OPTION 6 KEY ASPECTS FOR A MEDICAL PRACTICE ORGANIZATIONAL STRUCTURE

practice tips 6

BENEFITS AND DRAWBACKS TO OUTSOURCING

10 MORE NURSES ARE EARNING BACHELORS DEGREES

12 CANCERS ASSOCIATED WITH OVERWEIGHT AND OBESITY 14 MORE AWARENESS NEEDED FOR PHYSICIAN ASSOCIATES TO BE ACCEPTED INTO GENERAL PRACTICE WORKFORCE

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Med Monthly November 2017 Publisher Creative Director Contributors

Philip Driver Thomas Hibbard Naren Arulrajah Philip Driver Barbara Hales, M.D. Nick Hernandez, MBS, FACHE

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.

Philip Driver is the CEO of Physician Solutions, Inc. and oversees medical staffing and practice sales for its clients. He has spent more than 25 years serving medical practices with exceptional physician and mid-level staffing. Philip has orchestrated dozens of practice sales throughout the states acting as broker and facilitator.

Barbara Hales, M.D.

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

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.TheMedicalStrategist.com. For a free marketing assessment, call 561-325-9664.

Nick Hernandez, MBA, FACHE 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.

Online 24/7 at medmonthly.com

MED MONTHLY MAGAZINE |5

practice tips

Benefits and Drawbacks to Outsourcing With soaring expenses and decreased reimbursements, small medical practices must try to stop the financial bleeding wherever possible. Because of this, many groups have looked into shared billing to cut down on expenses or outsourcing billing to a third party professional billing company outside of the practice. Since billing can be demanding on staff time and challenging with new coding, the option to outsource office billing just seems to make sense. The thing is, choosing to relinquish billing is not simply a â&#x20AC;&#x153;no-brainerâ&#x20AC;?. There are disadvantages as well as benefits in making this decision, which we will review now.

Benefits to Outsourcing 1. Billing Compliance Assured

Billing companies keep abreast of Medicare, Medicaid and insurance company regulations. This is a difficult task for medical practices as rules are constantly changing. By outsourcing the billing, claim submissions are sent within a proper framework, making rejections less likely.

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2. Increased Cash-flow Proper and timely submission of insurance claims leads to increased reimbursements and a boost to revenues. Improved services and products then become more affordable for the practice to offer patients. You donâ&#x20AC;&#x2122;t have to worry about office billers out sick or on vacation for claims to be submitted.

3. Practice-Patient Relationships Improved There is nothing worse than patients feeling ignored. When billing issues and collecting money while simultaneously signing in patients harry the medical receptionist and answering phones, it is less likely that patients will get the attention that they want. By removing the billing and money collection, patients can be greeted in a warm, friendly manner and get their questions answered. Efficiency rises and patients are happier.

4. Avoiding Billing Mistakes Because billing companies have the sole job of charging and submitting claims, they ensure that their personnel go through a complete and comprehensive

‘‘

Since billing can be demanding on staff time and challenging with new coding, the option to outsource office billing just seems to make sense.

training program, complete with terminology and proper coding. This decreases denied claims and increases reimbursements received.

5. Decreased Expenses By outsourcing, you are saving the cost of: • Purchasing billing software • Salaries for billing managers and extra staff • Benefits for extra staff members • Purchasing additional, dedicated computers for billing • Training for updated regulation

Drawbacks 1. Security Breaches and Lack of Compliance While security breaches can certainly occur in the office, especially if patient information is on a laptop, the real concern is HIPAA violations, compromising patient privacy and breaching security when a third party is involved. Unauthorized disclosure of patient information is an HIPAA violation. Make sure that patients give consent to send information to outside billing

By Barbara Hales, M.D. www.TheMedicalStrategist.com agencies to minimize this risk and also get a signed consent from the billing agency that they will adhere to all the HIPAA guidelines. Doing so will lessen your liability. Just remember, the more people given access to personal patient information, the higher the risk that HIPAA guidelines and security can be compromised.

2. Loss of Control With billing and accounts being outsourced, practice managers often become less aware of account receivables, accurate billing and corrections or amendments to payments. Managers and staff must assume that: • Billing is performed in a timely, efficient manner • There is follow up with insurance companies • Patients are billed the amount that they are responsible for • Coding is correct • Correct procedures are listed Staff may only become aware of a problem when either receivables take a nosedive or patients start complaining about inaccurate bills (which takes us to the next drawback) continued on page 8

MED MONTHLY MAGAZINE

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continued from page 7

5. Added Expenses

3. Patient Complaints

The goal of outsourced billing is to save money and cut down on office expenses. However, you may need to hire an additional member of the office staff to liaise between the medical practice and the billing company. Further salary burdens, add to your office bottom line. Additional expenses may be incurred initially when the transition is made between in-office billing and preparing records for outsourced access. There are a myriad of responsibilities placed on office staff these days like involvement with patient portals and electronic health records, social media and phone calls, in addition to patient engagement. Eliminating medical billing from the list of daily burdens saves time and money. Drawbacks include the loss of financial involvement in services rendered. Whichever way you decide to go, consider all the benefits and drawbacks before you decide which is best for you. Have some thoughts on this topic? Share your experiences with us all by submitting your comments. 

No one wants to get a bad reputation, especially when the fault lies elsewhere. The worst is when patients contact insurance companies, claiming that the bills are fraudulent. This opens a can of worms with insurance companies or government officials going through months of records. Almost as bad is when patients complain to the office that a mistake has been made and despite repeated, failed attempts at reaching the billers, the problem is not corrected, which compounds the problem. Patients get frustrated and angry when problems can only be rectified by phone. Such a situation happened to me when by mistake (I’m assuming that it was a computer entry mistake), the EOB showed that the insurance company was billed by my primary for an initial comprehensive examination and a repeat examination. (Only one exam was done on only one visit and one body!) I was then sent a bill for the remaining balance. Contacting the outsourced billing office was futile and many phone messages went unanswered. Each month I called the primary office and was told by staff that a corrected bill would be sent. Lo and behold, the following month, the same bill was sent. This went on for 6 months. Complaining in person, the physician and office staff informed me that no further bills would be sent, that they could not correct the problem and that the office would just take a write-off on the inaccurate bill. Not only is this frustrating and unsatisfactory for all concerned, it is a loss of revenue if it is compounded throughout the day over multiple patients. Having the ability to discuss bills with office staff directly, removes frustration and strengthens patientstaff relationships.

4. Restrictions Outsourced billing companies may face restricted access to patient encounters, which causes incorrect or insufficient bills to be sent to the appropriate parties. This is further worsened by loss of communication between the company and the medical practice. Formulating a process for communication from the beginning thwarts such problems.

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practice tips

More Nurses Are Earning Bachelors Degrees, But Likely Will Not Reach 2020 Goal

Source: http://www.pressreleasepoint. com/more-nurses-are-earningbachelors-degrees-likely-will-notreach-2020-goal

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he proportion of front-line nurses with bachelor’s degrees in U.S. hospitals increased from 44 percent in 2004 to 57 percent in 2013, but will fall short of a national goal to reach 80 percent by 2020, finds a new study by NYU Rory Meyers College of Nursing. The study, published in the Journal of Nursing Scholarship, examines the educational trends of the country’s largest health care workforce using data at the nursing-unit level from a national database. To meet the United States’ increasing and complex health care needs, such as the aging of the baby boomers and the expansion of health insurance coverage, nurses are playing a growing role in improving quality of care and patient outcomes. “A competent nursing workforce is critical,” said Chenjuan Ma, PhD, an assistant professor at NYU Meyers and the study’s author. “One strategy for preparing this workforce is to advance nurse education, particularly by increasing the number of nurses with at least a bachelor’s degree.” Growing evidence has demonstrated that more education for nurses is associated with better quality of care and patient outcomes. In fact, several studies have shown a link between a higher proportion of hospital nurses with a bachelor’s degree in nursing (BSN) and lower patient mortality rates. Based on this evidence, the Institute of Medicine recommended in its 2010 milestone report, “The Future of Nursing: Leading Change, Advancing Health,” that 80 percent of nurses should have at least a BSN by 2020. This report drew nationwide attention and resulted in many initiatives to improve nursing education. The current study examined the educational trends for front-line registered nurses to determine the growth in the number of nurses with BSN degrees. The researchers looked at data from 2004-2013 from the Registered Nurse Education Indicators, part of the National Database of Nursing Quality Indicators (NDNQI). More than 2,000 hospitals nationwide submit nursing and patient outcomes to the National Database of Nursing Quality Indicators. Looking at 2,126 nursing units from 377 acute care hospitals in the United States, Ma and her colleagues found a 30-percent increase in the proportion of nurses holding at least a BSN, from 44 percent in 2004 to 57 percent in 2013. While the growth began several years before

the 2010 Institute of Medicine report, the increase accelerated from 2010 on. On average, the proportion of nurses with a bachelor’s degree in a unit increased by 1.3 percent annually before 2010 and by 1.9 percent each year from 2010 on. The percentage of units having at least 80 percent of nurses with a bachelor’s degree increased from 3 percent in 2009 to 7 percent in 2013. Based on the current trends, the researchers projected the future growth in BSN nurses and concluded that it is unlikely that the goal of 80 percent of nurses having a bachelor’s degree will be achieved by 2020. They expect that 64 percent of hospitalbased nurses will have a bachelor’s degree by 2020; the 80-percent goal will likely be reached in 2029. However, nurses on critical care units are projected to reach this 80 percent goal first, by 2025. “The U.S. nursing workforce is undergoing an educational transformation in order to meet our increasing health care needs,” said Ma. “To help accelerate this transformation, further advocacy, commitment, and investment are needed from all health care stakeholders in order to advance nursing education and in turn improve quality of care and patient outcomes.” Policy changes present one pathway for accelerating nursing education. For instance, policymakers could consider requiring all nurses to obtain bachelor’s degrees for professional nursing practice regardless of their initial nursing degree. An example of this can be seen in New York, where NY State Senate Bill S6768 – also known as BS in 10 – would require nurses in the state to attain a bachelor’s degree in nursing within 10 years of initial licensure. Ma and her colleagues also suggest that hospital administrators invest in hiring nurses with bachelor’s degrees and support those without bachelor’s degrees in attaining them, including providing tuition benefits and flexibility in scheduling. In addition to Ma, study authors include Lili Garrard, PhD, a former data analyst at NDNQI and Jianghua He, PhD, of the University of Kansas Medical Center.  About the NYU Rory Meyers College of Nursing NYU Rory Meyers College of Nursing is a global leader in nursing education, research, and practice. It offers a bachelor of science with a major in nursing, a master of science, post-master’s certificate programs, a doctor of nursing practice degree, and a doctor of philosophy in research theory and development. MED MONTHLY MAGAZINE

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practice tips

Cancers Associated with Overweight and Obesity Make Up 40 percent of Cancers Diagnosed in the United States Overweight and obesity are associated with increased risk of 13 types of cancer. These cancers account for about 40 percent of all cancers diagnosed in the United States in 2014, according to the latest Vital Signs report by the Centers for Disease Control and Prevention (CDC). Overall, the rate of new cancer cases has decreased since the 1990s, but increases in overweight- and obesity-related cancers are likely slowing this progress. About 630,000 people in the U.S. were diagnosed with a cancer associated with overweight and obesity in 2014. About 2 in 3 occurred in adults 50- to 74-years-old. The rates of obesity-related cancers, not including colorectal cancer, increased by 7 percent between 2005 and 2014. The rates of non-obesity related cancers declined during that time. “A majority of American adults weigh more than recommended – and being overweight or obese puts people at higher risk for a number of cancers – so these findings are a cause for concern,” said CDC Director Brenda Fitzgerald, M.D. “By getting to and keeping a healthy weight, we all can play a role in cancer prevention.”

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In 2013-2014, about 2 out of 3 adults in the U.S. were overweight (defined as having a body mass index of 25-29.9 kg/m2) or had obesity (having a body mass index of 30 kg/m2 and higher). The body mass index (BMI) is a person’s weight (in kilograms) divided by the square of the person’s height (in meters). Many people are not aware that being overweight and having obesity are associated with some cancers. The International Agency for Research on Cancer (IARC) has identified 13 cancers associated with overweight and obesity: meningioma, multiple myeloma, adenocarcinoma of the esophagus, and cancers of the thyroid, postmenopausal breast, gallbladder, stomach, liver, pancreas, kidney, ovaries, uterus, colon and rectum (colorectal). Screening for colorectal cancer prevents new cases by finding abnormal growths in the colon and rectum before they turn into cancer. The Vital Signs report, by CDC and National Cancer Institute (NCI) researchers, analyzed 2014 cancer incidence data from the United States Cancer Statistics report and reviewed data from 2005 to 2014 to determine trends for cancers associated with overweight and obesity.

Key findings regarding cancer types associated with overweight and obesity: • 55 percent of all cancers diagnosed in women and 24 percent of those diagnosed in men are associated with overweight and obesity. • Non-Hispanic blacks and non-Hispanic whites had higher incidence rates compared with other racial and ethnic groups. Black males and American Indian/Alaska Native males had higher incidence rates than white males. • Cancers associated with overweight and obesity, excluding colorectal cancer, increased 7 percent between 2005-2014. Colorectal cancer decreased 23 percent, due in large part to screening. Cancers

not associated with overweight and obesity decreased 13 percent. • Cancers associated with overweight and obesity, excluding colorectal cancer, increased among adults younger than age 75. “As an oncologist, when people ask me if there’s a cure for cancer, I say, ‘Yes, good health is the best prescription for preventing chronic diseases, including cancer,’” said Lisa C. Richardson, M.D., M.P.H., director of CDC’s Division of Cancer Prevention and Control. “What that means to healthcare providers like me is helping people to have the information they need to make healthy choices where they live, work, learn, and play.”

HOW CAN HEALTHCARE PROVIDERS HELP?

• Measure patients’ weight, height, and body mass index, and counsel

them on keeping a healthy weight and its role in cancer prevention. • Refer patients with obesity to intensive programs that include a variety of activities to help people manage their weight. • Connect patients and families with community services to help them have easier access to healthy food and ways to be active. CDC’s efforts to prevent overweight and obesity-related cancers The National Comprehensive Cancer Control Program funds all 50 states, the District of Columbia, eight tribes, and seven territories to support cancer coalitions in each jurisdiction and coordinate cancer control activities, including comprehensive strategies to prevent and control overweight and obesity. The State Public Health Action Program addresses nutrition, physical activity, and obesity in workplaces, schools, early childhood education facilities, and in communities. CDC’s National Program of Cancer Registries and NCI’s Surveillance, Epidemiology, and End Results Program produce the United States Cancer Statistics report, which contains statistics on all new cancer cases, and the data necessary to identify trends in cancers associated with risk factors such as overweight and obesity.

The Guide to Community Preventive Services recommends several evidence-based programs that communities can use to prevent and control obesity. For more information about CDC’s efforts to prevent cancer and reduce overweight and obesity visit www.cdc.gov/cancer and www.cdc.gov/obesity. To read the entire Vital Signs report, visit: www.cdc.gov/vitalsigns/obesity-cancer  About Vital Signs Vital Signs is a report that appears as part of the CDC’s Morbidity and Mortality Weekly Report. Vital Signs provides the latest data and information on key health indicators: cancer prevention, obesity, tobacco use, motor vehicle passenger safety, prescription drug overdose, HIV/AIDS, alcohol use, health care-associated infections, cardiovascular health, teen pregnancy, food safety, viral hepatitis, and others. Source: https://www.cdc.gov/media/releases/2017/ p1003-vs-cancer-obesity.html MED MONTHLY MAGAZINE

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practice tips

More Awareness Needed for Physician Associates to Be Accepted Into General Practice Workforce

â&#x20AC;&#x2DC;â&#x20AC;&#x2DC;

It is really important to understand what barriers might be in place preventing PAs from effectively integrating into the general practice workforce in order to address them.

A University of Sheffield Study

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Physician Associates may be prevented from providing support to general practice at a time of staffing crisis due to a lack of awareness and understanding, a new study has found. Research from the University of Sheffield has shown physician associates (PAs) – whose role is to support doctors in the diagnosis and management of patients, and who have been described as one possible solution to the workforce problems facing primary care – may meet resistance from GPs, despite being welcomed by patients. The study, published in the British Journal of General Practice, found more needs to be done to remove the barriers and prejudices facing PAs in order to establish how effective they may be in helping to relieve the unprecedented pressure on frontline staff. Dr Ben Jackson, lead author of the study and Head of Teaching in Primary Medical Care at the University of Sheffield, said: “General Practice is the cornerstone of the NHS (National Health Service) and the workforce issues are critical. “Although PAs will not offer a complete solution to the NHS crisis they may help to reduce waiting times in surgeries for patients and allow GPs to focus on patients with more complex needs. “It is really important to understand what barriers might be in place preventing PAs from effectively integrating into the general practice workforce in order to address them.” Researchers from the University of Sheffield found that although GPs expressed concerns regarding PAs non-prescriber status and the supervision burden, they

recognised that support for general practice was needed to improve access for patients. Advanced nurse practitioners (ANP) who took part in the study highlighted their own negative experiences entering advanced clinical practice, and the need for support for new PAs to counteract stereotypical and prejudicial attitudes. The findings showed patients were more accepting of a PAs role and were less concerned about specific competencies as long as there was effective supervision. “Although we desperately need more doctors and nurses, the physician associate profession allows an additional route for people with science backgrounds to be involved in health care who would not have otherwise done so,” said Dr Jackson. “Patients broadly welcome the new role and the potential support this would provide. Their training in the medical model was identified as a factor that may make them especially suitable to work under the supervision of GPs as part of their teams. “This research does not assess how effective PAs are - but highlights that more understanding about the role is necessary.” In response to the findings, researchers from the University of Sheffield have proposed a conceptual model to help regulators and educationalists support the integration of PAs. This could have relevance to other advanced clinical roles emerging in primary care such as practice nurses, paramedics, pharmacists and even physiotherapists. The University of Sheffield is one of a number of UK universities who

offer a Post Graduate Diploma in Physician Associate Studies aimed at talented graduates who have achieved a high grade at degree level in Biochemistry, Physiology or Biomedical Science. The new study has already informed curriculum changes to the Physician Associate Studies course at the University of Sheffield in order to help PAs overcome the barriers highlighted and improve the chances of successful integration, in collaboration with NHS stakeholders. Additional teaching and learning on clinical decision-making and managing complex health care, increasing the minimum amount of time spent in general practice and A&E settings and enhancing learning on drugs management have now been implemented on the course in response to the new study. The role of the PA was originally developed in the US in the 1960s, primarily as a method of increasing access to healthcare for underserved communities. In 2003, a number of PAs were recruited from the US to both accident and emergency (A&E) and general practice in the West Midlands in response to an acute workforce shortage at the time. The first UKtrained PAs graduated in 2009 and as the ongoing workforce crisis in A&E and primary care continue, there is a renewed interest in the role with Health Education England now starting to invest in its development.  Source: http://www. pressreleasepoint.com/moreawareness-needed-physicianassociates-be-accepted-gp-workforce

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U.S. OPTICAL BOARDS Alaska P.O. Box 110806 Juneau, AK 99811 (907)465-5470 https://www.commerce.alaska.gov/web/ cbpl/ProfessionalLicensing/DispensingOpticians.aspx

Idaho 450 W. State St., 10th Floor Boise , ID 83720 (208)334-5500 https://ibol.idaho.gov/IBOL/BoardPage. aspx?Bureau=OPT

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/

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://floridasoptometry.gov/ 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://cca.hawaii.gov/pvl/boards/optometry/

Massachusetts 239 Causeway St. Boston, MA 02114 (617)727-5339 http://www.mass.gov/ocabr/licensee/ dpl-boards/op/ Nevada P.O. Box 70503 Reno, NV 89570 (775)853-1421 http://nvbdo.state.nv.us/ New Hampshire 129 Pleasant St. Concord, NH 03301 (603)271-5590 www.state.nh.us New Jersey P.O. Box 45011 Newark, NJ 07101 (973)504-6435 http://www.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/

Oregon 3218 Pringle Rd. SE Ste. 270 Salem, OR 97302 (503)373-7721 http://www.oregonobo.org/optque.htm Rhode Island 3 Capitol Hill, Rm 104 Providence, RI 02908 (401)222-7883 http://sos.ri.gov/govdirectory/index. php? page=DetailDeptAgency&eid=260 South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4665 www.llr.state.sc.us Tennessee Heritage Place Metro Center 227 French Landing, Ste. 300 Nashville, TN 37243 (615)253-6061 http://tn.gov/health Texas P.O. Box 149347 Austin, TX 78714 (512)834-6661 http://www.tob.state.tx.us/ Vermont National Life Bldg N FL. 2 Montpelier, VT 05620 (802)828-2191 http://vtprofessionals.org/opr1/ opticians/ Virginia 3600 W. Broad St. Richmond, VA 23230 (804)367-8500 http://www.dpor.virginia.gov/Boards/ HAS-Opticians/ Washington 300 SE Quince P.O. Box 47870 Olympia, WA 98504 (360)236-4947 http://www.doh.wa.gov/LicensesPermitsandCertificates/MedicalCommission. aspx

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U.S. DENTAL BOARDS Alabama Alabama Board of Dental Examiners 5346 Stadium Trace Pkwy., Ste. 112 Hoover, AL 35244 (205) 985-7267 http://www.dentalboard.org/ Alaska P.O. Box 110806 Juneau, AK 99811-0806 (907)465-2542 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.boardofdentistry.net/illinoisboard-of-dentistry-db13 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://dpr.delaware.gov/boards/dental/

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://www.lsbd.org/

Maine 143 State House Station 161 Capitol St. Augusta, ME 04333 (207)287-3333 http://www.maine.gov/dental/licensure/ forms.html 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://www.boardofdentistry.net/nebraska-board-of-dentistry-db27

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://dental.wyo.gov/

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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.docjungle.com/medicalboards/colorado-physician-licensing/ 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/index.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 https://www.ndbom.org/

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

6 Key Aspects for a Medical Practice Organizational Structure

By Nick Hernandez, MBA, FACHE CEO and Founder of ABISA The purpose of an organization chart is to depict the skeletal structure of the practice, including the functional relationships between, among, and within the specific components. An organization chart provides a point of reference and improves the flow and direction of communications. It allows people to see how they fit in the big picture, increases efficiency, and maintains a balance in the practice. The development of good structure for organizations has been a concern for managers throughout history. Medical practices have both structure and process. The structure refers to the formal organization and the plans, schedules, and procedures that hold it together. Structure is the instrument by which people formally organize themselves to carry out a task. Process represents what actually goes on: what is done, how it is done, and the way individuals or groups behave and carry out their 22

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perceptions of the assigned tasks. The structure can be seen as the anatomy of a practice, and the process as the practice’s physiology. There are six key aspects of an organization chart. 1. Division of Work The principle of “division of work” means to divide a given activity or work into small pieces or parts so that each part is handled with great ease and efficiency. When too many people share responsibilities, it wastes time and resources. When staff is stretched thin, tasks are not completed on time. By referring to an organization chart, each person in the practice can determine what his or her responsibilities are. Because of this, the medical practice functions more efficiently. 2. Line of Authority Line of authority can also be phrased “chain of

can effectively be directed and coordinated by one supervisor. As the number of subordinates in each echelon increases, the shape of the organization chart changes from a tall pyramid to a flatter one. The size of the span of control will impact a practice’s time to make decisions and cost structure. 5. Delegation and Decentralization These are structural concepts that are closely related to the span of control. Delegation is the assignment of responsibility and the transfer of authority for directing and coordinating task performance to one or more subordinates by a supervisor. It is about entrusting someone else to do parts of your job. When this is done, authority is in effect decentralized, or removed from the single central position it once occupied. Continued decentralization has the effect of transferring authority and responsibility relationships to successively lower levels of the organization, widening the span of control at the higher levels. To be clear though, you cannot delegate absolute responsibility, but rather authority.

command”; it essentially establishes who is in charge of giving orders. An organization chart is characterized by a rigid, formal structure of authority relationships in which the authority and the responsibility for performing each specialized task in the practice are legitimized. Authority is impersonal, since it is vested in the position rather than in the individual holding that position, and this is reflected in an organization chart. 3. Flow of Authority Authority flows from top to bottom on an organization chart and defines the hierarchical structure of the medical practice. This accounts for the pyramidal shape of most organization charts. 4. Span of Control The span of control concept of organization structure refers to the number of subordinates who

6. Departmentalization This is a natural consequence of specialization and division of labor. As specialization increases, division of labor naturally results in the formation of organizational segments, usually referred to as departments. The larger a medical practice becomes, the more departmentalization it requires to facilitate the specialization of activities. In very large practices, the basis for departmentalization may vary at different levels. Although departmentalization is necessary in every practice to provide specialization, it usually poses problems in coordinating activities. I know many physicians who take pride in having a “flat” organization. Every one of those groups whom I’ve worked with found the benefits of developing an organizational structure and would never go back to being “flat”. Organizational structure improves operational efficiency by providing clarity to employees at all levels of a company. Physicians with flat structures ultimately spend too much time managing the practice, a function that is not reimbursed. By creating an effective structure, with the right people in each role, physicians can spend more time taking care of patients and earning revenue for the practice. 

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features

Three Strategies for Improving Staff Efficiency By Naren Arulrajah Ekwa Marketing

| NOVEMBER 2017

Staffing can be one of the greatest challenges in practice management, and one of the greatest sources of stress for doctors and dentists. Try these winning strategies to improve productivity and efficiency in your office.

Invest in Staff Training As a doctor, you have committed to continuing education throughout your career. In all likelihood, you exceed the minimum licensing requirements. You know that it is necessary to expand your skills and keep up with new developments. The same is true of other clinicians in your practice, as well as your office personnel. Inadequate or outdated training can contribute significantly to productivity problems. Some of the most important areas of training include: • Technology – A surprising number of dentists and doctors implement practice management software with little to no training. In addition to causing errors, this prevents your practice from utilizing the full benefit of a (very expensive) system. • Sales and service – Customer service skills are essential for front office staff, and they are helpful for the rest of your team. • Cross-training – Teaching employees to fill additional roles in your practice has several benefits. It can improve cooperation and efficiency between departments, because each understands the other’s needs better. It also increases your option for filling vacancies continued on page 26

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continued from page 25

when an employee misses work or requests time off.

Hire Carefully Retraining is always preferable to replacing an employee, due to high costs and legal liability. However, in some cases, termination is the only feasible solution. More likely, subpar employees may leave when they realize that they will be held to high standards. Of course, vacancies also occur because people retire, move away, or you simply need to expand your staff. Whatever the reason, you can avoid many future problems by choosing the right person. Hiring is a tedious process, and you might be tempted to go with the first candidate who seems qualified enough. However, you don’t want to settle for “good enough.” If you want to wow patients and maximize efficiency, you need to start with top quality employees. When evaluating applicants, look beyond experience and credentials. Some of the most important qualifications cannot be listed on a resume. When conducting interviews, evaluate traits such as: • Positive attitude – A good employee is a team player, eager to learn, and enthusiastic. Take into consideration the culture within your practice. Every team dynamic is unique. Would this person be a good fit? • Appropriate for the role – Someone in a customer service position should be outgoing and friendly, with excellent communication skills. A bookkeeper or HIPAA compliance manager should be detail oriented. Clinical staff 26

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should have a compassionate manner. • Dedication – Does the person want a long-term career with your practice? The lack of upward mobility in a medical practice is a common cause of employee turnover. Make sure that applicants understand your management hierarchy, what opportunities are available, and what incentives you offer. • Patient care beliefs – Your standard of care is part of your brand identity, and an important building block in patient loyalty. Is your practice known for being ultra-efficient or child-friendly? Do you believe in a heavy focus on patient education, or promise patients that they will never be lectured? Whatever your patient care beliefs and policies may be, make sure your new hire is in alignment with them.

Stop Micromanaging You may be surprised to learn that your management style can

contribute to staffing problems. Doctors and dentists tend to have a strong sense of personal responsibility, and independent work style. When there is a problem, they identify it, determine the cause, and create a detailed plan to solve it. They insist that their orders be followed precisely, because they know that any misstep will reduce the effectiveness. In patient care, this approach is simply diagnosis and treatment, which is what physicians are trained for. However, when the same approach is applied to the business aspect of a medical practice, it becomes micromanagement. The physician personally directs every task, makes managerial decisions without team input, and avoids delegating responsibility. Of course, as the practice manager, you know your office better than anyone. Why is micromanagement a problem? • Physician burnout: Answering simple questions, smoothing out minor daily glitches, and overseeing mundane tasks

should not be the direct responsibility of the medical director. It can eat up your time, cause you to fall behind, and skyrocket your stress levels. Lower level managers and trusted employees should reduce your workload, not add to it. • Reduced employee productivity: Staff members often resent working under a microscope and having minimal flexibility in their own workflow. Additionally, micromanagement reduces employee confidence and discourages people from taking initiative to solve problems. • Office inefficiency: What happens when there is an issue, but you are busy with a patient? Or when a patient is waiting to see you, but you

are busy with administrative tasks? These delays hinder the overall workflow. Additionally, employees that feel unempowered or incompetent tend to make more errors and be less productive. The antidote to micromanagement is effective delegation and teamwork. Involve your staff in decisions, especially those directly impacted. Are there too many billing errors? Ask employees in that department what is wrong, and how they suggest correcting it. Find out if they need more help, better training in software use, or changes in procedures. Most importantly, learn to trust your employees and managers. According to Karen Dillon, a Harvard Business Review author, the key to good management

is training and delegation. Acknowledge that you can’t feasibly deal with every detail, and learn to prioritize. Focus on the issues that are most important, and trust your team to handle the micro-details.  About the Author: Naren Arulrajah is President and CEO of Ekwa Marketing, a complete internet marketing company that focuses on SEO, social media, marketing education, and the online reputations of dentists and physicians. With a team of 180+ 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

Medical Practices Embrace Locum Tenens Option By Philip Driver CEO of Physician Solutions

| NOVEMBER 2017

edical facilities are finding it takes much longer to find a staff physician these days. In many cases it can take a year or longer. So what do practices and hospitals do in the interim? The answer is simple: increase the hours of your staff providers, cut services or use locum tenens. A locum tenens physician is a quick answer for many practices throughout the country when time is of the essence. Before the locum doctor arrives for the first shift, the practice should have a credentialing package in hand with copies of the appropriate medical license, curriculum vitae and other supporting documents as required by the practice. Generally professional liability insurance is provided for the locum doctor or PA by their agency. This process can be accomplished by email attachments cutting the process time by weeks. Here are a few situations in which a practice might use a locum physician. • staff physician becomes sick • maternity leave • vacation • business obligations • staff leaves with short or no notice • seasonal increase of patients It certainly is important to be able to staff a new position or facility while a permanent physician is recruited. Many practice owners choose to close their practices if they can’t work, leaving their patients without their routine care. By having a substitute or locum doctor or provider contracted for, your patients are not inconvenienced and their medical requirements are met. A locum tenens agency should be able to furnish a qualified provider in the form of a medical doctor or physician assistant, depending on the specialty, with reasonable notification. Many practices are even hiring a locum provider to work a set weekly or monthly schedule enabling the main physician to become more productive, treat more patients and create practice options. If you are a male doctor it may enhance your practice to consider having a female doctor or physician assistant work in the practice a few days per week or several days a month filling a locum’s role. This could increase the procedures you provide your patient base and certainly add a comfort level to many patients that want a same gender relationship with their doctor.

Many solo physicians find they become more comfortable having a second provider working with them on-going or a few shifts a week. They have time to have an out of the office meeting with their banker, insurance agent, attorney or a lunch with their spouse. Having a locum doctor may add more expertise to your practice in the form of coding or procedures that you are comfortable with but are reluctant to perform. Usually a staffing firm can provide continuity with the locum provider in a short period of time. Also, in today’s competitive healthcare industry more and more medical executives include locum tenens as an integral part of their master staffing plans. This way they can maintain moderate physician staffing and bring in a locum physician or two during traditional periods of peak volume. Often this is more cost-effective than maintaining peak staffing levels and paying for a lot of down time - in addition to employee benefits and physician perks. Used strategically, locum tenens physicians can help you attract and keep more of your staff, which helps your facility or group retain more patients and produce higher revenue. Because a locum physician generally works in more environments and facilities than the average U.S. physician, and because his or her training and experience undergo perpetual scrutiny, that physician is more likely to be up-to-date on the latest technologies and procedures than his or her staff physician counterpart. Other advantages of having a locum physician work consistently in your practice reach beyond patient care and the convenience of sharing a work load. When it becomes time to sell your practice and that time will come, you will find that your practice value is greatly increased by having a locum or second provider on staff. As a solo doctor, you are the practice. However with a second provider or locum doctor, you now have a business capable of generating income in your absence. Conventional arguments suggest that your practice will increase in value by 20% or more by having an agreement in place with locum staffing agency and are using these options routinely. I think you will find that when a locum tenens physician or physician assistant is used, the practice will want to implement this option as their main short term provider solution.  Philip Driver is the CEO of Physician Solutions, North Carolina’s oldest and leading Locum Tenens agency and the publisher of Med Monthly magazine.

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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 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 at 919-848-4202

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: Philip at 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: 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: Philip at 919-848-4202

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: Philip at 919-848-4202

Orthopedic Practice serving Eastern NC Location: Eastern NC List Price: $135,000 Equipment: Includes X-ray Total Exam Rooms: 3 Average Patients 10 to 15 Contact: Philip 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. 30

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Physician Solutions, Inc. Medical & Dental Staffing

Physician Solutions can help match you with dental opportunities that fit your professional and personal goals. We are now hiring dentists and dental hygienists in North Carolina, Florida, Georgia, Kentucky, South Carolina, Tennessee and Virginia. Ongoing and intermittent shifts are available, as well as permanent placement.

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.

VIRGINIA PEDIATRIC PRACTICE AVAILABLE -

Serving Alexandria, Annandale, Springfield, Newington, Franconia and surrounding areas Pediatric practice listed in a beautiful part of Virginia. Surrounded by medical providers and services; radiology, pharmacy, lab & dentist to name a few. Treating 14 to 16 patients on average daily and growing. The gross yearly revenue is $200,000 for this two year old practice and it is realizing steady growth and patient volume. This beautiful practice condo has 6 exam rooms, two doctor offices, a large procedure room, manager suite and lots of storage in this 3,245 sq. ft. practice. You will find this practice to be well designed, modern and tastefully appointed. The numbers: Practice Price is $125,000 and the building can be leased or purchased for $1,200,000. Contact Physician Solutions today at (919) 845-0054 to discuss this practice opportunity, confidentially of course.

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

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

l One

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

Please direct all correspondence to driverphilip@gmail.com. Only serious, qualified inquirers. 32

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Urology Practice minutes from Lake Norman, North Carolina

Discounts as big as a house. Or condo. Or apartment. Lindsay Gianni, Agent 12333 Strickland Road Suite 106 Raleigh, NC 27613 Bus: 919-329-2913 lindsay.gianni.f23o@statefarm.com

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.

See just how big your savings could be. Your savings could add up to hundreds of dollars when you put all your policies together under our State Farm roof. GET TO A BETTER STATE. CALL ME TODAY. ÂŽ

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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

1103155.1

State Farm Mutual Automobile Insurance Company, State Farm Indemnity Company, Bloomington, IL

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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Pediatric Practice Available Near Raleigh, NC

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.

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 doctorâ&#x20AC;&#x2122;s office, five exam rooms, and an in-house lab.

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

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

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

PHYSICIANS NEEDED: Mental health facility in Eastern North Carolina seeks: PA/FT ongoing, start immediately Physician Assistant needed to work with physicians to provide primary care for resident patients. FT ongoing 8a-5p. Limited inpatient call is required. The position is responsible for performing history and physicals of patients on admission, annual physicals, dictate discharge summaries, sick call on unit assigned, suture minor lacerations, prescribe medications and order lab work. Works 8 hour shifts Monday through Friday with some extended work on rotating basis required. It is a 24 hour in-patient facility that serves adolescent, adult and geriatric patients. FT ongoing Medical Director, start immediately The Director of Medical Services is responsible for ensuring all patients receive quality medical care. The director supervises medical physicians and physician extenders. The Director of Medical Services also provides guidance to the following service areas: Dental Clinic, X-Ray Department, Laboratory Services, Infection Control, Speech/Language Services, Employee Health,

Pharmacy Department, Physical Therapy and Telemedicine. The Medical Director reports directly to the Clinical Director. The position will manage and participate in direct patient care as required; maintain and participate in an on-call schedule ensuring that a physician is always available to hospitalized patients; and maintain privileges of medical staff. Permanent Psychiatrist needed FT, start immediately An accredited State Psychiatric Hospital serving the eastern region of North Carolina, is recruiting for permanent full-time Psychiatrist. The 24 hour in-patient facility serves adolescent, adult and geriatric patients. The psychiatrist will serve as a team leader for multi-disciplinary team to ensure quality patient care/treatment. Responsibilities include:

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

Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624 PH: (919) 845-0054 | email: physiciansolutions@gmail.com 34

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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

Urgent Care serving the South Raleigh and Garner, NC area

Orthopedic Practice serving Eastern NC, minutes from the Atlantic Ocean

Established practice averaging 25 to 30 patients per day, year round. Open 7 days a week with two providers and established staff members. 4 exam rooms, 1 procedure room and 1 lab-phlebotomy room. This is a very well laid out and attractive practice in a heavily traveled area with excellent parking. Gross revenues of about one million per year and positioned for continued growth. Priced at $200,000. Orthopedic practice for sale on the coast of North Carolina, established with a solid patient base. The demographics for this practice are excellent and the location impressive. This newly listed practice is fully furnished, staffed and ready for a fresh face to see orthopedic patients in this beautiful part of North Carolina. The ingredients for success have been established and the owning doctor is willing to stay with you for a reasonable time to assure a smooth transfer of care. This is the perfect practice to add on to your existing practice as a satellite or to make it your main orthopedic practice. Includes X-Ray, 3 exam rooms and could be easily converted into an urgent care. Average Orthopedic Patients per Day: 10 to 15

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

List Price: $135,000

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

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PEDIATRIC PRACTICE WANTED

Areas of Consideration; Raleigh, Cary, Durham, Chapel Hill, Holy Springs, Apex, Morrisville, Pittsboro and Fuquay Varina

Physician Solutions is working with a well qualified Pediatrician to find a Pediatric Practice to purchase. If you would like to discuss your practice options, confidentially of course, contact me. The doctor we are working with is looking to purchase a practice within the next few months. If you have a friend or colleague that has mentioned selling their Pediatric practice, I would appreciate your referral.

Contact Philip Driver at 919-845-0054 or email physiciansolutions@gmail.com

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

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

www.medicalpracticelistings.com 36 | NOVEMBER 2017

PSYCHIATRIST PRACTICE LOCATED IN JACKSONVILLE, FL Established with a solid patient base, this well appointed practice also has a Psychologist in house. The psychiatrist is willing to stay and practice for a month or so assuring a nice patient transition. The city of Jacksonville is underserved by psychiatrist as most patients wait 4 to 5 months to secure an appointment. Treating over a dozen patients per day year round, you can step into this practice with the assurance knowing you will have a solid income and positioning for success. The established doctor is looking to retire but very willing to assure the buyer is comfortable moving forward. Asking $135,000 fully furnished.

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

MODERN

Practice for Sale in Raleigh, NC

Urgent Care

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

Serving Raleigh, Cary, Apex, Holly Springs, Fuquay Varina, Brier Creek and South Point Mall areas. This is certainly one of the most consistently utilized practices serving a large demographic area. 6 exam or procedure rooms, 1 X-Ray in a well appointed and nicely designed practice. Averaging 28 to 30 patients per day, year round and open 365 days per year. The staff includes two providers and full experienced staff to include X-Ray personal. The gross revenues of this practice exceeds one million two hundred thousand yearly. Priced at $260,000.

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

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 MED MONTHLY MAGAZINE

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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

Primary Care Practice For Sale in Wilmington, NC

CALLING ALL WRITERS

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.

Are you educated in the medical and health care field and looking to showcase your exceptional writing skills?

Med Monthly

To become a contributing writer in Med Monthly magazine, please contact us at medmedia9@gmail.com

Editorial Calendar: December - Modern Medical Lobby 38

| NOVEMBER 2017

Medical Practice Listings

919.848.4202 | 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 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

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

Get discounts up to 35% * Saving money is important. Thatâ&#x20AC;&#x2122;s why you can count on me to get you all the discounts you deserve. GET TO A BETTER STATE . CALL ME TODAY. â&#x201E;˘

Pediatrics Practice Wanted Pediatrics Practice Wanted in NC Considering your options regarding your pediatric practice? We can help. Medical Practice Listings has a well qualified buyer for a pediatric practice anywhere in central North Carolina. Contact us today to discuss your options confidentially.

*Discounts and their availability may vary by state and eligibility requirements. For more information, please see or call a State Farm agent. 1101216.1 State Farm, Home Office, Bloomington, IL

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

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Our large database of MDs, NPs, PAs, and DDSs means that we will be able to find the perfect provider for your practiceâ&#x20AC;&#x2122;s unique needs.

At Physician Solutions, all assignments are important, all clients are valuable, and all candidates are treated with the respect they deserve. We listen carefully to your needs and look beyond the obvious to find innovative solutions. Find out why providers choose Physician Solutions. P.O. Box 98313, Raleigh, NC 27624 Scan this QR code with your smartphone to learn more.

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