Med Monthly October 2014

Med Monthly October 2014

CAN URGENT CARE PLAY A ROLE IN THE MEDICAL HOME MODEL?

pg. 42

DETERMINING YOUR URGENT CARE’S PHYSICIAN STAFFING MODEL pg. 48

Should Urgent Care Centers Employ a Marketer? pg. 40

The Future of

Urgent Care pg. 46

Important Metrics for Urgent Care Staffing Models pg. 20

the

Urgent Care issue

contents

IN THE SCHOOL OF HEALTH SCIENCES, ART BRINGS THE BODY TO LIFE

features

40 SHOULD URGENT CARE CENTERS EMPLOY A MARKETER? 42 CAN URGENT CARE PLAY A ROLE IN THE MEDICAL HOME MODEL? 46 THE FUTURE OF URGENT CARE 48 DETERMINING YOUR URGENT CARE’S PHYSICIAN STAFFING MODEL

52 international

insight 10 NIH AWARDS AIM TO IMPROVE UNDERSTANDING OF CELL PATHWAYS, DEVELOPMENT OF NEW THERAPIES 14 10 THINGS BURNED OUT DOCTORS DON’T HAVE TIME FOR 16 GENETIC DISCOVERY YIELDS PROSTATE CANCER TEST, PROMISE OF FUTURE THERAPY

practice tips 18 5 ACTION STEPS TO AVOID ON FACEBOOK AS A HEALTH PROVIDER 20 IMPORTANT METRICS FOR URGENT CARE STAFFING MODELS 22 OUTSOURCING SELECTED BACK-OFFICE TASKS AT PHYSICIAN PRACTICES IMPORTANT METRICS FOR URGENT CARE STAFFING MODELS

20

24 HEALTHCARE INVESTOR FOCUS ON MALAYSIA GROWS

research and technology 26 NOVEL CANCER DRUG GAINS APPROVAL 28 NEW GRANTS FUND CROSS-LIFESPAN SERVICES RESEARCH FOR AUTISM SPECTRUM DISORDER 30 RESEARCH HINTS AT WHY STRESS IS MORE DEVASTATING FOR SOME

legal 32 JUDGE REQUIRES PHRMA TO INITIATE NEW 340B ORPHAN DRUG LAWSUIT 34 FINAL MEANINGFUL USE RULE: CMS Loosens its Grip 36 RECENT HIPAA BREACHES HIGHLIGHT NEED FOR PROVIDERS TO REMAIN VIGILANT

the arts 52 IN THE SCHOOL OF HEALTH SCIENCES, ART BRINGS THE BODY TO LIFE

healthy living 54 CREAMY PUMPKIN SOUP

in every issue 4 publisher’s letter 8 news briefs

60 resource guide 78 top 9 list

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publisher’s letter The Med Monthly October issue’s featured topic is Urgent Care and addresses several important topics that influence the 9,000 plus Urgent Care centers across the United States. Many primary care practices have borrowed parts of the Urgent Care model and have found success implementing some attributes like walk-in patients being welcomed and marketing tips first implemented by Urgent Cares.

Tina Bell, Co-founder of ‘UrgentCareSuccess’ discusses the importance of having a full time staff member charged with marketing. Tina points out how marketing is more than putting together a brochure or a web page. She stresses the impact of reaching out to your colleagues for referrals and breaking out of the ‘marketing with blinders on mentality’.

Laura Marusinec, MD discusses treating patients in an Urgent Care setting, who in the past could only be seen in traditional medical clinics or the emergency department (ED). At first glance these two entities seem to be at odds, but with the right models and motivation, urgent care clinics can indeed play a role in the medical home model. The Health Resources and Services Administration define’s the medical home as “a cultivated partnership between the patient, family, and primary care provider in cooperation with specialists and support from the community”.

Also featured is a comprehensive article from the American Academy of Urgent Care Medicine that discusses the development and growth of Urgent Care Medicine fueled by the frustration over long waits in the emergency room (for non-emergency care) and a reduction in available primary care appointments. Physicians, Physician Assistants, and Nurse Practitioners who specialize in Urgent Care Medicine will continue to elevate the quality and capability of the “walk-in clinic” to include treatment of a full range of non-emergency illnesses and injuries.

Tim Reynolds, MD, the author of two books: The Green Beret Doctor’s Health Plan for Life and Living Every Minute, details the importance of “Determining Your Urgent Care’s Physician Staffing Model”. He stresses accurately accounting for the number of patients each provider can treat in a shift and the cost of treatment. Dr. Reynolds’ article is not only helpful in structuring your practice, but necessary when engaging in contracts with government and private payer insurance plans.

The staff of Med Monthly appreciates our loyal readers. Dozens of writers each month contribute to Med Monthly and we trust doctors and medical insiders alike find helpful information in our content. The November issue highlights Health Care Reform with several enlightening articles.

Philip Driver Publisher

4 | OCTOBER 2014

Med Monthly October 2014 Publisher Philip Driver Creative Director Thomas Hibbard Contributors Ashley Acornley, MS, RD, LDN. Tina Bell Starla Fitch, M.D. Barbara Hales M.D. Laura E. Marusinec, M.D. Douglas M. Poland Pam Reynolds, R.N. Tim Reynolds, M.D. Christopher J. Shaughnessy Thomas N. Shorter Julia Solooki, MBA Scott J. Thill

contributors Tina Bell

is the co-founder of UrgentCareSuccess (www.UrgentCareSuccess.com), an urgent care consulting firm and online educational resource provider for urgent care owners. She has served as the chief brand officer for HealthCARE Express since 2008, where she oversees marketing strategy and development for the company’s growing urgent care and occupational medicine business.

Starla Fitch, M.D.

is an oculoplastic surgeon in Atlanta and is the creator of lovemedicineagain.com, an online community for doctors and other health care professionals who want to reconnect with their passion for the practice. Dr. Fitch is a featured blogger for Huffington Post and KevinMD.com. Her book, Remedy for Burnout: 7 Prescriptions Doctors Use to Find Meaning in Medicine, is being released in the fall.

Barbara Hales, M.D.

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

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

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

Laura E. Marusinec, M.D. is a board-certified pediatrician with experience in general pediatrics, pediatric dermatology, and pediatric urgent care. She has supported an electronic health record implementation and optimization and is pursuing further medical writing education and opportunities.

Julia Solooki, MBA is a 10 year veteran to the Healthcare IT/Services sector and is the Director of Business Development and Marketing for ClinicSpectrum, Inc., www.clinicspectrum.com a healthcare services company providing outsourcing and back office solutions for medical billing companies, medical offices, hospital billing departments, and hospital medical records departments. Contact Julia at julia@clinicspectrum.com.

WWW.MEDMONTHLY.COM |5

designer's thoughts From the Drawing Board The “Research and Technology� section of the October Med Monthly includes a report on a new drug, Keytruda, approved by the FDA that belongs to a class of drugs that is widely thought to be a game changer in cancer therapy. Also addressed are 12 research grants awarded by the NIH to provide early diagnosis, treatment, and supportive services for people with autism spectrum disorder (ASD). The final article explains new research identifying the molecular mechanisms of socalled stress gap in mice with similar genetic backgrounds that could lead researchers to better understand the development of psychiatric disorders such as anxiety and depression in humans.

Carrie A. Noriega, MD, in her article Novel Cancer Drug Gains Approval, reports on a new cancer drug, Keytruda, approved by the FDA that is not only effective, but is very well tolerated by patients, with 90 percent of patients reporting very few side effects. Although very pricey at the present time, this new treatment is good news for the 76,000 Americans who will be diagnosed with stage 4 melanoma this year.

New Grants Fund Cross-lifespan Services Research for Autism Spectrum Disorder explains that despite the significant number of people of all ages identified with ASD, access to effective services remains inconsistent at best. This new research, funded by NIH grants, is aimed at testing care strategies, adaptable across communities, in which identification of need and engagement in optimal interventions and services will be standard for all ages.

In the article Research Hints at Why Stress is More Devastating for Some, researchers at Rockefeller University examined how stress can produce anxiety- and depression-like behaviors in mice, and they identified a key step in the loss of acetyl groups attached to DNA-supporting proteins known as histones. The results of the study point toward potential new markers to aid the diagnosis of stress-related disorders and a promising route to the development of new treatments for these devastating ailments.

MedMonthly will continue to report on the latest medical research and technology. If there are topics or insights on advances in medical technology you would like to share with us for future issues, please contact us at medmedia9@gmail.com.

Thomas Hibbard Creative Director

6 | OCTOBER 2014

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news briefs

Media Holds the Key to Tackling HIV Stigma Stigma continues to prevent people living with HIV from seeking treatment and, while the media has a crucial role to challenge such prejudice, there is a residual fatigue in their response to the global HIV epidemic, a new report has found.

The report “HIV and Stigma: The Media Challenge”, by the International Broadcasting Trust (IBT) and the International Planned Parenthood Federation (IPPF) was launched today at the House of Commons by the All Party Parliamentary Group (APPG) on HIV and AIDS. Despite progress made in the global response to HIV, stigma continues to be a major factor hindering HIV prevention, treatment, care and support, and affecting the overall health and well-being of people living with HIV. The media plays an important role in influencing people’s attitudes towards HIV, yet it is far from reaching its full potential. “HIV and Stigma: The Media Challenge”, provides an overview of media initiatives seeking the reduction of HIV-related stigma with a case study from Swaziland, a country with the highest prevalence of people living with HIV in the world.

Pamela Nash MP, Chair of the All Party Parliamentary Group on HIV and AIDS, said: “For too long stigma has stood in the way of people accessing life-saving treatment, not just in the developing world but here in the UK too. The media has an important role to play in challenging antiquated and discriminatory ideas which do

nothing to stem the continued spread of HIV. If we can overcome stigma, there is nothing to stop us from ending the epidemic once and for all.”

IPPF Director General, Tewodros Melesse spoke of the findings on HIV-related stigma, “Stigma begins and ends with each one of us. The combination of ignorance, prejudice and fear creates fertile ground for the continued spread of HIV. Openness, acceptance and accessible information to challenge stigma and support people to access sexual and reproductive health and HIV services is the key to its reduction.”

Sophie Chalk, author of the report and IBT’s Director of Campaigns spoke of the impact of media fatigue, ”It was clear from interviewing people – journalists, production companies and NGOs – around the world that it is very difficult to get stories in the press or on air about HIV nowadays. It’s only the most sensational stories which make it into the news and these are mostly negative against people living with HIV. It seems there is a lack of interest among editors and those who control media output because they believe the public aren’t interested in HIV any more – it is no longer a story. Some interviewees suggested this could lead to higher incidence rates in due course which is a real concern.”  Source: http://www.pressreleasepoint.com/media-holdskey-tackling-hiv-stigma

SOON COMING NTHLY O IN MED M ing

com In the up ue, Med r 2014 iss e b m e v o N l theme wil Monthly’s Care be Health Reform

8 | OCTOBER 2014

Integration of Services is Crucial for Patient-Centric Healthcare Systems The healthcare industry is rapidly moving from a provider-centric, individual physician expertise-based service sector to a patient-centric, consultative and analytics-driven industry. This collaborative approach will be quickened by innovations that lend momentum to the integration of healthcare systems. Integrated care services can be achieved along four lines: patient engagement, workflow management, new healthcare models, and home care.

New analysis from Frost & Sullivan, Innovations in Home Medical Devices and Integrated Care Systems, finds that the integration of healthcare systems has several connotations. Integration can either be vertical, which results in consolidation of similar services, or horizontal, which aims at expansion of organization infrastructure and patient base. Integration can also be more microscopic, involving functions, organisational policies and clinical locations.

“The holy grail of integrated care systems is achieving end-to-end integration, which would require both vertical and horizontal consolidation that results in the streamlining of treatment services, products, ancillary and support systems as well as geographical expansion,” said Technical Insights Research Analyst Bhargav Rajan.

The biggest challenge to integration, especially in emerging economies, is the highly fragmented healthcare market. Enforcing common management policies and patient services among different practices to achieve functional clinical integration will be an uphill task.

In such regions, integration can be achieved by targeting readily available avenues for growth, such as implementing technological resources to ensure care of patients at home and in the community. In turn, remote patient monitoring and telemedicine will not only serve as tools for clinical services and patient integration, but also as a means of frugal innovation.

Healthcare providers and administrators need to realise that the consolidation of practices will not necessarily lead to integration of services. Effective integration requires alignment of practices and policies as well as culture and ideologies.

“For every successful case of healthcare integration, there are several instances of failed mergers, most notably among healthcare organisations with divergent mission statements,” cautioned Rajan. “Meeting of organisation goals and resource compatibility are important criteria during mergers and horizontal expansion.”  Source: http://www.newswiretoday.com/news/145204/

Health Care Industry Familiar with HIPAA Breaches, Not So Much Hackers

By Christopher J. Shaughnessy McBrayer, McGinnis, Leslie & Kirklank, PLLC Community Health Systems (“Community”), which operates 206 hospitals in 29 states, recently notified 4.5 million of its patients that online hackers had stolen personal data information from its systems in a period between April and June 2014.

The data included names, addresses, birthdates, telephone numbers and Social Security numbers—all of which are protected under HIPAA. According to Community, the data did not include financial or medical information.

It has been reported that the hackers responsible for the attack are a group of cybercriminals from China that traditionally go after intellectual property, including medical device and equipment development data. They used malicious software to obtain the data, which has since been removed by Community from the network.

Further remedial efforts are already underway, including notifying affected patients and offering them identity theft protection services.

Hospitals should be accustomed to protecting data against privacy breaches as part of their HIPAA obligations, but outright cybertheft is a threat that many providers have not likely considered. The FBI, which is now investigating the Community incident, said in April that health care providers typically do not use the same high levels of security technology as companies in other industries (such as banking or retail). This makes providers an easy target for hackers. If a leading hospital system like Community can be breached, then hospitals of every size are at risk.

It is crucial that HIPAA-covered entities (and their business associates) understand and identify potential threats to their secured information.

The importance of HIPAA risk analysis cannot be stressed enough; in fact, a risk analysis is required as the first step in HIPAA Security Rule compliance.

While it may be impossible to build an impenetrable fortress of secured online information, it is evident that health care providers must continue to make it a top priority to protect patient records – both from HIPAA breaches and hackers.  Source: http://www.natlawreview.com/article/ health-care-industry-familiar-hipaa-breaches-notso-much-hackers WWW.MEDMONTHLY.COM |9

insight

NIH Awards Aim to Improve Understanding of Cell Pathways, Development of New Therapies

10 | OCTOBER 2014

Building on a successful three-year pilot project, the National Institutes of Health has awarded more than $64 million to six research institutions to create a database of human cellular responses, the Library of Integrated Network-based Cellular Signatures (LINCS). Discovering such cell responses will improve scientists’ understanding of cell pathways and aid in the development of new therapies for many diseases.

The funding establishes six centers, collectively called the Data and Signature Generating Centers. The National Human Genome Research Institute (NHGRI) and the National Heart, Lung, and Blood Institute (NHLBI), both part of NIH, administer the program on behalf of the NIH Common Fund.

The LINCS program aims to catalog and analyze cellular function and molecular activity in response to perturbing agents — such as drugs and genetic factors — that are potentially disruptive to cells. LINCS researchers then will measure the cells’ tiniest molecular and biochemical responses, and use computer analyses to uncover common patterns in these responses — called “signatures.” LINCS data will be freely available to any scientist.

“The simplest way to think about signatures is essentially as broad common patterns, as well as uncommon behavior, in how cells respond to being exposed to various small molecules, genetic perturbations or genetic changes,” said Ajay Pillai, Ph.D., program director in NHGRI’s Division of Genome Sciences. Dr. Pillai is co-coordinator of the LINCS program, along with Albert Lee, Ph.D., a program director in NHLBI’s Division of Cardiovascular Sciences. “For example, you could figure out patterns of toxicity of potential new drug compounds by looking at cellular responses and finding common responses to other known toxic molecules.”

A major challenge that will be addressed in the second phase of LINCS is to optimize the combinations of cell types, perturbations and measurements of cellular responses to address a wider range of basic biological and disease-related problems than was possible in the program’s initial pilot stage, said Alan Michelson, M.D., Ph.D., senior investigator, Laboratory of Developmental Systems Biology, NHLBI, and co-chair of the NIH LINCS Project Implementation Team.

Even in its prototype phase, LINCS has produced meaningful results that will aid in improving human health.

For example, a research team last year used LINCS data to identify the role of a critical transcription regulator, heat shock factor 1 (HSF1), in cancer. Another team reported that the LINCS approach of measuring a wide range of cells’ responses to drugs was more accurate than conventional drug-potency tests. This recognition may point the way toward more effective therapeutics with fewer unexpected side effects.

Recipients of the new LINCS grants (pending available funds) are: • Harvard Medical School, Boston, $12.87 million over six years Principal Investigator: Peter Sorger, Ph.D. This center will develop new measurement methods and computer algorithms to detect and analyze perturbations induced by therapeutic drugs in healthy and diseased human cells.

Dr. Sorger hopes that future drug developers will be able to perform computations on LINCS data in much the same way that Google Maps makes use of GIS (geographic information system) data. The team hopes its efforts will shed light on the interrelationships of proteins in complex diseases, which is an important step in developing a rational approach to drug discovery and personalizing therapy.

• Oregon Health and Science University (OHSU), Portland, $10.29 million over six years Principal Investigator: Joe Gray, Ph.D. The environment may influence the way cells move and proliferate, and may alter their state of differentiation. But identical cells behave differently in different microenvironments — the collection of surrounding cells and the soluble signals and insoluble proteins produced by these cells. Cancer cells, for example, respond to treatment differently in different microenvironments. This is one of the mechanisms by which cancer evades many treatments.

The OHSU team will study how both malignant and non-malignant cells are controlled by the microenvironments in which they live. The researchers will provide measurements of the impacts of thousands of different microenvironments on cellular phenotypes, protein make-up and gene expression readouts in cell lines.

• Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, $12.56 million over six years Principal Investigator: Todd Golub, M.D.

continued on page 12

WWW.MEDMONTHLY.COM | 11

continued from page 11

The Golub team will study up to 50 cell types perturbed by a large number of chemical compounds and genetic reagents that activate or deactivate genes.

Each perturbation will produce about 1,000 geneexpression readouts. By the project’s end, Dr. Golub expects to have generated more than 1 million profiles of how genes are expressed in different cells.

The ultimate aim is to create a genome-scale catalog of the consequences of cellular perturbation.

This would enable researchers to simply query the database in order to learn the effect of blocking or overexpressing a particular gene.

• Icahn School of Medicine at Mount Sinai, New York City, $11.39 million over six years Principal Investigator: Srinivas (Ravi) Iyengar, Ph.D. Dr. Iyengar’s Drug Toxicity Signature Center aims to develop cell signatures that will predict adverse events that might be caused by drugs and will identify other drugs that might lessen these side effects. The researchers will leverage the U.S. Food and Drug Administration’s (FDA) Adverse Event Reporting System database to identify drugs that produce adverse events in heart, liver and neuronal function, and to search for drugs that may mitigate these events.

The researchers will use these drugs and drug combinations to develop gene-plus-protein signatures, using human heart, liver and nerve cells from stem cells that have been derived from human skin cells.

Such signatures may help repurpose FDA-approved drugs to lessen adverse events and help in preclinical drug discovery.

• Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, $8.9 million over six years Principal Investigator: Jacob D. Jaffe, Ph.D. Dr. Jaffe’s LINCS Center for Proteomic Characterization of Signaling and Epigenetics will study cell disruption at the most basic levels: phosphorylation-mediated signaling — that is, how cells communicate internally; and epigenetics, or how cells perpetuate non-genetic information as they grow. These latter signals are transmitted in part by modifications to histone proteins, around which the DNA in cells is wrapped.

As in other LINCS projects, the researchers will seek patterns from known causes of cell disruption, such as drugs, that can help identify the cause of other instances of cell damage. Dr. Jaffe’s center will test more than 11,000 perturbational conditions in several cellular model systems. Cellular phosphor-signaling and epigenetic systems are involved in a growing number of environmental and developmental diseases, and Dr. Jaffe’s project may help develop new treatments 12 | OCTOBER 2014

for these conditions as well as other diseases such as cancer.

• University of California, Irvine, $8 million over six years Principal Investigator: Leslie M. Thompson, Ph.D. The Thompson team will concentrate on human brain cells, which are far less understood than other cells in the body. The researchers believe it will be necessary to study these cell types directly to understand the causes of neurological disease and to develop new therapies.

By applying LINCS-type perturbations to studying an array of human brain cells, the researchers hope to identify targets for developing drugs against neurodegenerative diseases such as Parkinson’s disease, amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease), spinal muscular atrophy and Huntington’s disease.

Total funding for the LINCS program is set at $64 million over six years. The NIH Common Fund is funding five of the new LINCS grants as part of its Big Data to Knowledge initiative. The National Institute of Neurological Disorders and Stroke (NINDS) is funding Dr. Thompson’s grant.  Source: http://www.nih.gov/news/health/sep2014/nhgri-11. htm

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insight

10 Things Burned Out Doctors Don’t Have Time For

By Starla Fitch, M.D.

When you feel yourself sinking deeper into a bad case of physician burnout, finding a way out can feel daunting, if not impossible.

But it doesn’t have to.

I believe recovering from burnout begins when you start taking small, purposeful steps in a new direction. I recommend you start by getting a handle on your work-life balance.

Do you balance the time and energy you spend at work with the time and energy you spend living the rest of your life? Or are the scales tipped unevenly?

All of us are strapped for time. It’s a condition of modern life. And we are all guilty of using our lack of time as an excuse for so many things.

How many times have you uttered these worn out phrases? I don’t have time for : • Exercise • Cooking • Playing with my children • Vacuuming • Meditating • Balancing the checkbook • A date with my honey • Talking to my boss • Taking vacations • Flossing This list could go on forever.

But, guess what? We all make time for what matters most in our lives.

And here’s a number that just might change your mind about time: Did you know that two hours a week equals 100 hours a year?

Yikes!

Think of how many two-hour batches of time we waste every day, let alone every week.

In 100 hours during the past year, you could have: 14

| OCTOBER 2014

• Planned and enjoyed a fantastic four-day vacation • Cleaned out the garage, the attic, and the basement • Lost 10 pounds from exercising two hours a week, every week • Outlined and perhaps written that book you keep talking about • Volunteered at the shelter twice a month for a year • Enjoyed a two-hour date night every week So, be honest. What’s stopping you?

In a word, Intention.

Or rather, a failure to set an intention around living a balanced life.

If you’re one of those busy doctors who doesn’t even take time for lunch, then it’s high time for you to mend your ways.

Tweetable: “If you keep doing what you’ve always done, you’ll continue to be where you’ve always been.” @StarlaFitchMD Try this small shift in behavior, and watch the ripple it makes in your life: Take five minutes out of your day--you know now that you have it--and write down just one thing you can do this week that will equalize the scales of your work-life balance.

The first step is recognizing the change you can make; the next step is setting an intention and incorporating the change into your life.

Accountability combined with intention works wonders.

So, please share below what YOU are going to do for balance this week.

Supporting each other to promote work-life balance is a good thing.

To follow Dr. Fitch and find out more, sign up for your updates HERE. You can also follow her on Facebook at Starla Fitch MD: Love Medicine Again, Twitter at @ StarlaFitchMD and LinkIn at Starla Fitch MD  Previously published on Lovemedicineagain.com

insight

Genetic Discovery Yields Prostate Cancer Test, Promise of Future Therapy

A genetic discovery out of the University of Pittsburgh School of Medicine is leading to a highly accurate test for aggressive prostate cancer and identifies new avenues for treatment.

The analysis, published today in the American Journal of Pathology, found that prostate cancer patients who carry certain genetic mutations have a 91 percent chance of their cancer recurring. This research was funded by the National Institutes of Health (NIH), American Cancer Society and University of Pittsburgh Cancer Institute (UPCI).

“Being able to say, with such certainty, that a patient is nearly guaranteed to see a recurrence of his prostate cancer means that doctors and patients can elect to be more aggressive in treating the cancer, knowing that the benefits likely outweigh the risks,” said Jian-Hua Luo, M.D., Ph.D., professor of pathology, Pitt School of Medicine and member of UPCI. “Eventually, this could lead to a cure for prostate cancer through genetic therapy. With this discovery, we’re at the tip of the iceberg in terms of possibilities for improving patient outcomes.”

Prostate cancer is the second most common cancer among men (behind skin cancer), with one in seven men diagnosed with prostate cancer in their lifetime. The American Cancer Society estimates that this year in the U.S., 16 | OCTOBER 2014

about 233,000 new cases of prostate cancer will be diagnosed, and 29,480 men will die of prostate cancer.

Despite the high incidence rate, only a fraction of men diagnosed with prostate cancer develop metastases, and even fewer die from the disease.

“In some cases, this can make the treatment more dangerous than the disease, so doctors need more accurate tests to tell them which patients would most benefit from aggressive therapies, such as surgery, radiation and chemotherapy,” said Dr. Luo. Dr. Luo and his team sequenced the entire genome of prostate tissue samples from five prostate cancer patients who experienced aggressive recurrence of their cancer and compared them to normal tissue samples from men without cancer.

In the patients with prostate cancer recurrence, they identified 76 genetic fusion transcripts, which are hybrid genes formed from two previously separate genes and often are associated with cancer. After further testing, eight of the genetic fusion transcripts were found to be strongly associated with prostate cancer.

The researchers then screened for the eight fusion transcripts in 127 samples from patients with aggressive prostate cancer recurrence, 106 samples from prostate cancer patients with no recurrence at least five years after surgery, and 46 samples from

prostate cancer patients with no recurrence less than five years after surgery. The samples came from UPMC, Stanford University Medical Center and University of Wisconsin Madison Medical Center.

In those samples, 91 percent with aggressive recurrence of their prostate cancer were positive for at least one of the fusion transcripts. Two of the fusion transcripts in particular were strongly associated with poor outcomes — none of the patients whose samples contained them survived to five years.

In contrast, 68 percent of patients whose samples did not contain at least one of the transcripts remained cancer-free.

Dr. Luo said if continued clinical trials of the test do well, it could be available to all prostate cancer patients in a few years.

In addition, studies are being developed to further investigate the genetic fusion transcripts most strongly associated with aggressive prostate cancer. Drugs and therapies could be developed to correct or stop the mutations, thereby halting the cancer progression, Dr. Luo explained.  Source: http://www.pressreleasepoint. com/genetic-discovery-yields-prostatecancer-test-promise-future-therapy

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practice tips

5 ACTION STEPS TO AVOID ON FACEBOOK AS A HEALTH PROVIDER

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

O

f course you want to increase visibility and have tons of likes to spread your important messages. But there are both effective ways and bad ways to go about it.

Creating fresh and fascinating content is always a good strategy. Discuss new medical breakthroughs or ways to improve treatments.

18

| OCTOBER 2014

While it takes time and a focused plan, your Facebook page will grow consistently with good results. Adding photo images and videos spark people’s interests and help them understand the message that you are conveying as well. Especially if you are discussing a technique or pre and postoperative care, a video does wonders to allow patients a view towards comprehension.

There are no real shortcuts to get engaged viewers…but people do try.

them, not talk at them. In no time, you will have faithful followers who return again and again.

What Not to Do on Facebook

5) Remember HIPAA

1) Purchasing Likes There are many sellers out there trying to take advantage of you by offering to increase the number of followers and likes on your page.

While watching the numbers exponentially jump higher may be a great boost to your ego, reflect on the purpose of the likes. These are people that have proverbially “raised their hand” to designate that they are interested in your message or your brand.

These followers are hungry for your message, your products and your services. Having numbers, who lack interest in you, will lower your conversion rate and confuse your analytics in percentages of this conversion. (Going from views to actually using your services or buying into your message). Facebook might even penalize you by eliminating your RSS feed.

2) Trading Links (Backlinks) In the misguided notion that having an outpouring of links to your page spells success, people often offer to exchange links from their site to yours or offer to specific amount of increased links.

Unfortunately for those practicing these trades, the newer algorithms that Google, Facebook and other sites use, assesses your interaction and engagement with these sites and how relevant they are to you. If there is no relevancy, these links can actually harm you.

3) Go Out of Sync Posting narratives and missives that have no relevance to your brand will confuse your followers and confuse your message. Viewers will drop off and go to competitive sites that can maintain the focus on topics that your followers are interested in.

4) Inappropriate Use of Hashtags While hashtags work well in Twitter to aggregate comments to the same topic allowing fans to follow them, Facebook has a different view of its usage. It might actually be harmful unless there is a specific reason to incorporate the hashtag into your post.

Edgerank Checker discovered that posts with hashtags are actually less likely to spread virally.

Consider your followers your friends. Converse with

Doctors and nurses are a nurturing bunch. In your zeal to answer health questions, it is important that topics are approached in a general sense that can apply to everyone.

If a “patient” wants an answer that is specific to him or herself, that individual should be advised to seek medical care from you or another doctor as an office visit.

While you may be discussing your procedures, techniques or treatments, it is crucial that you don’t use anyone’s name or describes a situation that can be linked back (or ascribed) to a specific individual. A person recognizing him or her, even if a name was omitted, is a breach of confidentiality.

Keeping this in mind will enable you to build a successful following online as well as offline.  As a way of saying thank you, get my Exclusive Report “15 Easy Ways to Leverage Your Content for Successful Marketing”. It is free for only a limited time by asking for your copy at Support@CompleteContentPackage.com.

The Write Treatment

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

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

Barbara@TheWriteTreatment.com 516-647-3002

WWW.MEDMONTHLY.COM | 19

practice tips

Important Metrics for Urgent Care Staffing Models

By Pam Reynolds, R.N. Do you know how many patients your urgent care clinic sees from 10 a.m. to 11 a.m. on Tuesdays? Do you know which hour of which day of the week you see the most patients? Do you know what percentage of your revenue is spent on nursing staff each day? If your answer to these questions is yes, have you trended them over time, analyzed the numbers, and used the information to make your clinic more profitable?

When we opened our first urgent care eight years ago, we didn’t know these numbers would be important. We didn’t realize there would be big fluctuations in patient volumes at various times of the day. And it wasn’t until recently that we realized you can hire staff to work split shifts, so we didn’t have extra staff at the clinic during our slowest hours. As our business has grown, we’ve learned the importance of vacuuming up the nickels and dimes, especially when it comes to our biggest expense – staffing.

Creating the Staffing Metric for Our Urgent Care As COO at our urgent care one of my biggest jobs is 20 | OCTOBER 2014

analyzing various metrics I receive daily from department supervisors. Some of the reports I look at answer questions including: 1. How many patients were seen the previous day at each location?

2. How much cash was brought at each location?

3. How much payroll we spent in each department?

4. What percentage of that day’s revenue was spent on payroll?

When I first began to receive those reports, the numbers were not nearly as helpful as they are today. The first month my daily report showed me we were spending 4.36% of our daily revenue on the nursing staff. The information was about as useful as asking me, “Is spending $3000 to buy a camel too expensive?” Why? I had no way to compare it to anything.

I began to trend the number daily, and over time, I discovered how to use the numbers to run a tighter ship.

I had a guideline that showed when staff was just sitting around doing nothing. I also knew quickly if we’d failed to staff enough people to support the patient volume on a

the nursing staff being out of sync for what is actually required is one thing, but if you trend the numbers and start realizing you have too many providers sitting around between patients, it is a problem that could cause serious financial woes for your business.

Other Metrics to Watch Another thing to trend is the average number of patients per hour per day of week. These numbers help you determine not only where to focus your staffing, but also where you may need to have team members work on call or hire for split shifts.

I know in our largest clinic, on Mondays from 2:00 to 3:00 p.m. we check in 16.25 patients/hour. On Fridays from 2:00 to 3:00 p.m. we check in 8.25 patients/hour. Knowing this allows us to staff more people to work on Mondays and less people to work on Fridays.

At one of our other clinics, on Mondays between 2:00 to 3:00 p.m. we check in 4.75 patients/hour and on Fridays at the same time we check in 4.25 patients/hour. At that clinic, we need to staff the same number of people on both days.

We have realized if we do not watch these numbers daily, we are tossing money out the window. Worse yet, we may drop the ball on customer service because we don’t have enough people scheduled to work.

These are just a few examples of how trending metrics can make a huge difference in the way you run your urgent care business. There are an endless amount of reports you can watch every day to ensure you’re staffing levels are on par to keep you financially successful.  particular day. Now, if our staffing metric number for the nursing staff ever climbs over 5%, our nursing director is getting a phone call to explain what happened.

Creating the Right Staffing Metric for Your Urgent Care What numbers to trend will vary by your business model. Our urgent care is focused on providing a great patient experience. We know if we are going to thin expenses, payroll is not our best option. We also know anything more than 5% for our nursing staff means something is wrong with staffing.

You, however, may run a model where your payroll percentage may run lower than ours. Maybe you don’t have nurses. Or perhaps you pay higher salaries, so your percentage may be higher than ours. What I’m trying to say is 5% isn’t the magic number for all clinics, and it’s not the magic number for all departments. You have to trend and find the number that is right for you.

We trend these same numbers and percentages for the front desk staff and for our providers. The payroll of

Pam Reynolds, R.N. is the Chief WOWZA! Officer at HealthCARE Express, where her primary focus is growing the company by developing learners and leaders within the business.

During her tenure she has recruited a highly talented team dedicated to providing amazing customer service and leading the crusade to make a positive difference in each community where the company has a clinic. Pam also serves as a consultant through UrgentCareSuccess.com, where she writes a regular column on urgent care staffing and hiring tips. She also teaches at the Urgent Care Success Summit.

WWW.MEDMONTHLY.COM | 21

practice tips

Outsourcing Selected Back-Office Tasks at Physician Practices

By Julia Solooki, MBA Director of Business Development/Marketing

22 | OCTOBER 2014

Each step within the revenue cycle management (RCM) process at physician practices builds on previous tasks, so mistakes made early in the process can end up snowballing into larger problems.

The task of verifying patient eligibility is a perfect example. If done improperly – or not done at all – claims can later get denied and the practice is forced to forego the revenue generated by that encounter.

Although vital to any physician practice, back-office functions are often tedious, time consuming and costly. To reduce the burden of these tasks, practices can choose to outsource specific RCM components to help streamline operations. Two specific functions that are ideal for outsourcing include patient eligibility verification and payment posting to help with the following: 1) Applying correct payment to patient responsibility as deductibles have become a big issue.

2) Applying correct payment to secondary responsibilities.

3) Creating a follow up work queue for denied or partial paid claims when compared with Insurance Fee schedule.

Eligibility checking is the single most effective way to prevent insurance claim denials. Outsourcing this service is simple. The service provider retrieves a list of scheduled patient appointments and verifies coverage using one of three methods: 1. Online, using insurance company websites and payer portals 2. Calling the interactive voice response (IVR) systems at insurance companies and working through menus to determine eligibility status 3. Calling insurance company representatives directly when online or IVR options are not available, or to resolve more complicated situations

‘‘

To reduce the burden of these tasks, practices can choose to outsource specific RCM components to help streamline operations.

Outsourcing payment posting and reconciling is also a simple process, and enables providers to determine if full reimbursement was received.

Outsourced service providers accomplish this via two ways: 1. Manual posting – Paper explanation of benefit (EOB) statements received by physicians are collected and sent to the billing service by one of two methods. They can scan documents and send them to the service electronically, or they can simply send the paper documents to the service. Payment posting is performed in batches to ensure proper accounting and to reconcile bank deposits with EOB statements 2. Auto posting – When EOB payments come in the form of electronic remittance advice (ERA), these files can be downloaded directly into the physician’s practice management system. All posting is done directly in the system, so providers can audit at any time.

Outsourcing selected components of the RCM process is an easy way for practices to streamline operations, decrease denials and ensure payment accuracy. More importantly, it’s a great way to get tasks completed correctly the first time, rather than having to endure the headaches of correcting them later in the RCM process. 

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international

M

Healthcare Investor Focus on Malaysia Grows, Bolstered by Government Support and Medical Tourism

alaysia is turning out to be the new healthcare investor destination as a proactive government and burgeoning aging population fuel the demand for healthcare services.

In 2013, Forbes ranked it as the third best country to retire in, and the aged care industry is expected to be worth $1.2 billion by 2020. Medical tourists and foreign retirees too are choosing Malaysia due to the lower cost of healthcare and other incentives. Overall, there will be no shortage of customers for domestic and foreign healthcare providers in the country.

New analysis from Frost & Sullivan, Malaysia Healthcare Outlook, covers the scope of the healthcare services, connected health, medical devices, pharmaceutical, biotechnology, and aged care segments. In 2013, the hospital market was the top segment in terms of revenues,

24 | OCTOBER 2014

followed by the pharmaceutical and medical devices segments. Targeting the hospital, pharmaceutical and medical devices segments will be wise as they are expected to register a compound annual growth rate of 17.3 percent, 11.4 percent and 14 percent, respectively, for the 2012-2018 period.

“With the Malaysian Government’s launch of Entry Point Project (EPP) to expedite the approval process for foreign investment and reduce regulatory hassles, the country has become an attractive destination for foreign healthcare investors,” said Frost & Sullivan Healthcare Research Analyst Dr Siddharth Dutta. “The healthcare industry also remains a lucrative space for domestic companies, which are being supported in their expansion plans by venture capital and funding agencies like Khazanah Nasional.”

However, the bureaucratic process to set up businesses is still relatively tedious and can deter investment in the healthcare industry to some extent.

Moreover, widespread bribery and corruption, shortage of qualified healthcare professionals and skilled workers, and lower awareness of advanced healthcare technologies is reducing the quality of healthcare services.

In addition, competition from private aged care homes and the imposition of the six percent goods and service tax (GST) in 2015 will drive healthcare costs up and further weaken the value proposition of market participants.

“To effectively penetrate the Malaysian market, multinational healthcare companies must enter joint ventures with local manufacturers and contract manufacturing organizations,” stated Dutta. “This will create a symbiotic ecosystem, in which local companies will have access to capital, technology and intellectual property while their counterparts will benefit in terms of capturing a bigger market.”

Both multinational healthcare companies and local participants could consider adopting a segment-specific focus to stand apart from the competition. Some healthcare industry players are already using this approach by concentrating on the halal medicine segment.

For more information on this study, please email Donna Jeremiah, Corporate Communications, at djeremiah[.]frost.com.

Malaysia Healthcare Outlook is part of the Life Sciences (lifesciences.frost.com) Growth Partnership Service program.

Frost & Sullivan’s related studies include: Indonesian Infectious Disease IVD Market, APAC Healthcare Outlook, Product and Pipeline Analysis of the Global Therapeutic Lipid Modulators Market, Global Nextgeneration Sequencing Market, Global Type 2 Diabetes Therapeutics Market, Global Regenerative Medicine Market, among others. All studies included in subscriptions provide detailed market opportunities and industry trends evaluated following extensive interviews with market participants.  Source: http://www.newswiretoday.com/ news/145930/

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research & technology

Novel Cancer Drug Gains Approval

By Carrie A Noriega, MD

This new advancement in treatment for stage 4 melanoma is good news for the 76,000 Americans who will be diagnosed with melanoma this year.

26 | OCTOBER 2014

O

n September 4, 2014, the FDA approved the new drug Keytruda for use in patients with advanced or unresectable melanoma who are no longer responding to treatment with other drugs. This new drug belongs to a class of drugs that is widely thought to be a game changer in cancer therapy.

Keytruda, developed by Merck, is a human programmed death receptor-1 (PD-1) blocking antibody that works on T-cells. Specific ligands can bind to the PD-1 receptor on T-cells and limit the T-cell’s ability to produce an effective immune response. Certain types of tumors can mimic these ligands and bind to the PD-1 receptor on T-cells, thus preventing the immune system’s ability to detect the presence of tumors. Keytruda, a monoclonal antibody, is able to bind to the PD-1 receptor on T-cells and prevent the tumor’s ability to block the immune systems anti-tumor immune response. When the PD-1 receptor is blocked, a decrease in tumor growth is seen in mouse tumor models.

Keytruda was granted accelerated approval after Merck showed that it offered significant improvement in response rates and durability of the response for the treatment of melanoma over currently available drugs. So far an improvement in long-term survival rates or disease related symptoms of melanoma have not been established, although controlled clinical trials are currently underway to assess this.

The drug’s efficacy was proven in a non-controlled clinical trial involving 173 participants with melanoma refractory to other treatments. Half of the participants received the recommend dose of Keytruda, 2mg/kg every 3 weeks, and the other half received a high dose protocol of 10 mg/kg every 2-3 weeks. Approximately 24 percent of participants in both dose protocols showed shrinkage in tumor size with the effect lasting 1.4 to 8.5 months and often longer.

Preliminary data from a trial of 411 participants with advanced stage melanoma was presented at the American Society of Clinical Oncology in June, which showed 69 percent of patients treated with Keytruda were alive after one year. An average progression-free survival time of 5.6 months was also shown but not enough time had passed in the trial to evaluate median overall survival rates.

The average 5-year survival rate for patients with stage 4 melanoma is currently 10-15 percent.

Keytruda is proving to be very well tolerated by patients, with 90 percent of patients reporting very few side effects, especially compared with cytotoxic chemotherapy. The most common side effects reported were fatigue, cough, pruritus, rash, decreased appetite, constipation, arthralgia, and diarrhea. Immune mediated side effects were more rare but far more serious and included hepatitis, pneumonitis, colitis, hypophysitis, nephritis, hyperthyroidism, and hypothyroidism.

Currently, Keytruda is approved for use in patients with advanced melanoma who have failed treatment with ipilimumab, a type of immunotherapy. In patients with melanoma tumors that express a gene mutation called BRAF V600, they must have tried and failed both ipilimumab and a BRAF inhibitor before being a candidate for Keytruda treatment. As more clinical trials are completed, the indication for Keytruda’s use may eventually be broadened.

While this new drug is offering breakthrough treatment for advanced melanoma, it comes at a significant price. It is estimated to cost $12,500 a month, or $150,000 a year.

Merck does indicate that this price is inline with the cost of other cancer drugs and does offer a cost assistance program for patients who qualify.

Merck is only the first of several drug companies to gain approval for their anti-PD-1 drug in the United States.

Roche, Bristol-Myers Squibb, and AstraZeneca also have developed anti-PD-1 drugs that are currently in clinical trials. Bristol-Myers Squibb recently received approval for their drug to be used in Japan for the treatment of advanced stage melanoma. Reports indicate that companies are teaming up to test combinations of these new drugs to help improve long-term cancer survival.

This new advancement in treatment for stage 4 melanoma is good news for the 76,000 Americans who will be diagnosed with melanoma this year. Ideally, this new class of treatment will have an impact on the long-term survivability of this often deadly cancer.  Sources: www.fda.gov www.merck.com http://www.forbes.com/sites/davidkroll/2014/09/04/merckskeytruda-surprise-winner-in-u-s-pd-1-inhibitor-race/

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.

WWW.MEDMONTHLY.COM | 27

research & technology

New Grants Fund Cross-lifespan Services Research for Autism Spectrum Disorder

NIH-funded projects aim at improving access, timeliness of interventions

Developing effective, real-worldready approaches to providing early diagnosis, treatment, and supportive services for people with autism spectrum disorder (ASD) is the goal of 12 research grants awarded by the National Institute of Mental Health (NIMH). These grants are part of a broad research effort to provide models for the delivery of needed services to children, youth, and adults with ASD, across different 28 | OCTOBER 2014

communities and care settings, appropriate to each age and individual.

NIMH is part of the National Institutes of Health (NIH).

While research has yielded much on understanding the biology of autism, access to effective treatment and services tailored to life stages remains a challenge for people with ASD and their families. In 2013, the Interagency Autism Coordinating Committee, a U.S. Department of

Health and Human Services federal advisory group, developed an updated Strategic Plan for Autism Spectrum Disorder Research which identified access to services as a central concern of individuals and families affected

by ASD. To foster research on these issues, NIMH solicited applications to study models for ASD service delivery in early childhood, during the transition out of high school, and in adulthood.

‘‘

While research has yielded much on understanding the biology of autism, access to effective treatment and services tailored to life stages remains a challenge for people with ASD and their families.

ASD symptoms emerge in early childhood. The Centers for Disease Control and Prevention’s most recent data regarding autism prevalence, released in March 2014, estimated about 1 in 68 children were identified with ASD. The central features of ASD are difficulties in social communication, and restricted, repetitive patterns of behavior and interests. The diagnosis is shared by people who vary widely in abilities and symptoms, from those with intellectual and language difficulties, to people without intellectual disabilities but who have some degree of social impairment.

“Despite the significant number of people of all ages identified with ASD, access to effective services remains inconsistent at best. Parents are often left to navigate what is available as best they can, and worry for the future as their affected children grow into adulthood,” said NIMH Director Thomas Insel, M.D. “This research is aimed at testing care strategies, adaptable across communities, in which identification of need and engagement in optimal interventions and services will be standard for all ages.”

NIMH has awarded $7.9 million in initial year funding for these 12 research grants. Each project addresses issues particular to one of three age groups (also see a separate list of the

12 projects with a brief description of each): • Early childhood (five projects): Research suggests that early and intensive interventions for ASD can reduce language and behavioral challenges, but early screening and referral to treatment is not routinely provided in pediatric settings. These newly funded projects target infants from birth to 2 years of age and are intended to test strategies for universal screening coupled with referral to and engagement in services when indicated in order to determine how to achieve earlier intervention for children with ASD in this age group. These studies will address the issues of coordination among different settings, such as primary care, social services, the education system, disability programs, ASD specialty care, and public and private health care funding.

• Transition-age (four projects): The transition period between secondary school and adulthood can be especially difficult for young people with ASD. Once they graduate from high school, these young people may not qualify for or get immediately connected to adult services. Research suggests they are less likely to continue their education or be employed, even in comparison with young adults with other types of disabilities. The new research will develop school-based service coordination to engage youth and their families in planning for the transition to adulthood in order to reduce or eliminate disconnection from needed supports, services, or age-relevant activities.

• Adults (three projects): In addition to the challenges faced by young people with ASD aging into adulthood, an increasing number of previously undiagnosed adults are being identified. Many adults diagnosed with ASD have

difficulties with employment, social relationships, housing, and functioning independently.

Studies will develop and test strategies to maintain engagement in community support, vocational and employment programs, and other services aimed at supporting independent living.

The five early childhood studies form a research network that will pool data to expand the ability to conduct further research on this valuable dataset. These data, from which personally identifiable information is removed to protect privacy, will be housed In the NIH-funded National Database for Autism Research and will be made available to others in the ASD research community.

An emphasis of this initiative is that the service strategies being developed must be effective in the real world of diverse communities and health systems. An explicit goal is to help reduce the disparities between different ethnic and socioeconomic groups in access to services. These studies have the potential to transform the current ASD service system by designing a set of strategies for young children, transition age youth, and adults that are effective and engineered for rapid adoption and implementation on a broad scale.

“The studies will provide a critical evidence base on how community services can improve the treatment, functioning, and community integration of people with ASD at important life stages,” said Denise Juliano-Bult, M.S.W., chief of NIMH’s Systems Research Program and the Disparities in Mental Health Services Research Program.

For a full list of grantees and projects, visit: http://www.nimh.nih. gov/news/science-news/2014/newgrants-fund-cross-lifespan-servicesresearch-for-autism-spectrumdisorder.shtml  Source: http://www.nih.gov/news/ health/sep2014/nimh-10.htm WWW.MEDMONTHLY.COM | 29

research & technology

Research Hints at Why Stress is More Devastating for Some

30 | OCTOBER 2014

S

ome people take stress in stride; others are done in by it. New research at Rockefeller University has identified the molecular mechanisms of this so-called stress gap in mice with very similar genetic backgrounds — a finding that could lead researchers to better understand the development of psychiatric disorders such as anxiety and depression.

“Like people, each animal has unique experiences as it goes through its life. And we suspect that these life experiences can alter the expression of genes, and as a result, affect an animal’s susceptibility to stress,” says senior author Bruce McEwen, Alfred E. Mirsky Professor and head of the Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology. “We have taken an important step toward explaining the molecular origins of this stress gap by showing that inbred mice react differently to stress, with some developing behaviors that resemble anxiety and depression, and others remaining resilient.”

A changed brain: Researchers examined how stress can produce anxiety- and depressionlike behaviors in mice, and they identified a key step in the loss of acetyl groups attached to DNA-supporting proteins known as histones. The spots above represent acetylated histones in the brain region known as the hippocampus.

The results, published September 2 in Molecular Psychiatry, point toward potential new markers to aid the diagnosis of stress-related disorders, such as anxiety and depression, and a promising route to the development of new treatments for these devastating disorders.

In experiments, researchers stressed the mice by exposing them to daily, unpredictable bouts of cage tilting, altered dark-light cycles, confinement in tight spaces and other conditions mice dislike with the goal of reproducing the sort of stressful experiences thought to be a primary cause of depression in humans. Afterward, in tests to see if the mice displayed the rodent equivalent of anxiety and depression symptoms, they found about 40 percent showed high levels of behaviors that included a preference for a dark compartment over a brightly lit one, or a loss of interest in sugar water. The remaining 60 percent recovered well from the stress.

This distinction between the susceptible mice and the resilient ones was so fundamental that it emerged even before the mice were subjected to stress; some unstressed mice showed an anxiety-like preference for a dark compartment over a lighted one.

The researchers found that the highly stress-susceptible mice had less of an important molecule known as mGlu2 in a stress-involved region of the brain known as the hippocampus.

The mGlu2 decrease, they determined, resulted from an epigenetic change, which affects the expression of genes, in this case the gene that codes for mGlu2.

“If you think of the genetic code as words in a book, the book must be opened in order for you to read it. These epigenetic changes, which affect histone proteins associated with DNA, effectively close the book, so the code for mGlu2 cannot be read,” says first author Carla Nasca, a postdoc in the lab and a fellow of the American Foundation for Suicide Prevention.

Previously, she and colleagues implicated mGlu2 in depression when they showed that a promising potential treatment known as acetyl carnitine rapidly alleviated depression-like symptoms in rats and mice by reversing these epigenetic changes to mGlu2 and causing its levels to increase.

“Currently, depression is diagnosed only by its symptoms,” Nasca says. “But these results put us on track to discover molecular signatures in humans that may have the potential to serve as markers for certain types of depression. Our work could also lead to a new generation of rapidly acting antidepressants, such as the candidate acetyl carnitine, which would be particularly important to reduce the risk of suicide.”

A reduction in mGlu2 matters because this molecule regulates the neurotransmitter glutamate. While glutamate plays a crucial role relaying messages between neurons as part of many important processes, too much can lead to harmful structural changes in the brain.

“The brain is constantly changing. When stressful experiences lead to anxiety and depressive disorders the brain becomes locked in a state it cannot spontaneously escape,” McEwen says.

“Studies like this one are increasingly focusing on the regulation of glutamate as an underlying mechanism in depression and, we hope, opening promising new avenues for the diagnosis and treatment of this devastating disorder.”  Source: http://www.pressreleasepoint.com/research-hints-why-stress-more-devastating-some WWW.MEDMONTHLY.COM | 31

legal

Judge Requires PhRMA To Initiate New 340B Orphan Drug Lawsuit to Challenge Interpretive Rule

By Jennifer L. Plitsch and Stephanie H. Barclay Covington & Burling LLP

A Washington, D.C., federal judge has declined requests from Pharmaceutical Research and Manufacturers of America(“PhRMA”) to invalidate a new interpretive rule applicable to orphan drugs in the 340B drug discount program, saying the trade group must file a new complaint in order to proceed.

Last week, the D.C. District Court ruled that PhRMA must bring a new lawsuit to challenge the recent interpretive rule regarding orphan drugs set forth by Health Resources and Services Administration (“HRSA”).

Earlier this year, PhRMA successfully invalidated the regulation promulgated by HRSA, and the court ruled that HRSA lacked the substantive rulemaking authority to implement the rule in the first instance.

HRSA responded by deciding to implement the same policy presented in a new document as an interpretive rule rather than a regulation. In turn, PhRMA argued before the court that this interpretive rule is “materially identical to the vacated and unauthorized Final Rule,” because it “adopts the same interpretation of ‘covered outpatient drug’ and imposes the same compliance obligations as the vacated Final Rule.”

32 | OCTOBER 2014

The district court rejected PhRMA’s argument and held that PhRMA’s complaint originally only challenged the final rule promulgated by HRSA. Accordingly, PhRMA’s challenge to the new interpretive rule was found to be beyond the scope of the present law suit.

The court’s ruling means that for the time being, HRSA’s current interpretive rule will stand. As we have previously reported, under this rule only some sales of orphan drugs will be excluded from the 340B program — sales of orphan drugs for orphan indications are to be excluded from the program (and thus not subject to the required discount), and sales of orphan drugs for nonorphan indications may be included and purchased at the statutory discounted price. It is the responsibility of covered entities (and contract pharmacies) to ensure that orphan drugs purchased through the 340B program are not to be transferred, prescribed, sold, or otherwise used for the orphan indication, and to maintain auditable records to demonstrate compliance.  Source: http://www.insidegovernmentcontracts. com/2014/09/judge-requires-phrma-to-initiate-new-340borphan-drug-lawsuit-to-challenge-interpretive-rule/

legal

Final Meaningful Use Rule:

CMS Loosens its Grip

By Aytan Dahukey and Vinay Bhupathy Sheppard Mullin Richter & Hampton LLP

The Centers for Medicare & Medicaid Services (“CMS”) finalized a rule on August 29th which should give providers some breathing room in complying with meaningful use requirements for the Electronic Health Record (“EHR”) Incentive Program (the “Final Rule”). The EHR Incentive Program was developed by CMS to motivate health care providers to use and implement EHR systems.

Under the EHR Incentive Program, hospitals and healthcare professionals can qualify for incentive payments from CMS for “meaningful use” of 34 | OCTOBER 2014

certified EHR technology (“CEHRT”).

However, both the definition of “meaningful use” and the technologies which qualify as CEHRT are moving targets under the EHR Incentive Program and vary by “Stage.” The EHR Incentive Program consists of Stages 1, 2 and 3 which represent set time periods during which providers must implement CEHRT to receive payments. Each Stage has progressively more robust meaningful use objectives and clinical quality measures. As a result, providers must continually update their EHR

technology and quality assurance programs to receive payments under each Stage.

With the Final Rule, CMS has modified its requirements for CEHRT in order to enable “more providers to participate and meet meaningful use objectives like drug interaction and drug allergy checks, providing clinical summaries to patients, electronic prescribing, reporting on key public health data and reporting on quality measures.”1 CMS cited public comments and feedback from stakeholders as its

• CMS has modified reporting requirements for clinical quality measures based on which CEHRT a provider chooses.

motivation for the Final Rule.

Key changes include: • Providers may be able to use previous editions of CEHRT to meet 2014 reporting requirements under the EHR Incentive Program.

• Stage 2 of the EHR Incentive Program has been extended for a full year through October 1, 2016 (institutional providers) or January 1, 2017 (non-institutional providers). As a result, Stage 3 of the program has been delayed until such dates.

The relief provided by the changes above is significant, but the Final Rule did not provide details on 2014 reporting when combinations of CEHRT are used nor did the Final Rule change the reporting requirements for 2015.

The Final Rule is likely to have a positive impact for a great number of providers who have struggled with meeting the stringent EHR deadlines set by CMS. Providers who find themselves unable to comply with CMS’s original schedule should carefully explore the flexibility measures the Final Rule provides.

Despite the benefits to numerous providers, the Final Rule has also caused consternation among a few stakeholders. Early adopters of EHR technology may feel that the Final Rule penalizes providers who were on track per the original implementation schedule set by CMS.2 Furthermore, such providers could face difficulty fulfilling interoperability measures for the EHR Incentive Program since some late adopters have not necessarily adopted Stage 2 technology. Those providers who were on track to comply should conduct an assessment of how the Final Rule may impact their business and prepare to adapt their approach to the new requirements.  __________ 1 Centers for Medicare and Medicaid Services, “New CMS rule allows flexibility in certified EHR technology for 2014.” CMS Press Release, August 29, 2014.

2 Darius Tahir, “CMS finalizes EHR meaningful-use rule, adds some flexibility.” Modern Healthcare – Healthcare Business News, August 29, 2014.

Source: http://www.sheppardhealthlaw. com/2014/09/articles/centers-formedicare-and-medicaid-services-cms/ final-meaningful-use-rule-cms-loosensits-grip/

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legal

Recent HIPAA Breaches Highlight Need for Providers to Remain Vigilant

By Thomas N. Shorter, Douglas M. Poland, and Scott J. Thill Godfrey & Kahn S.C. 36 | OCTOBER 2014

A recent disclosure by Community Health Systems, Inc. (CHS) of a data breach compromising information pertaining to 4.5 million of its patients highlights the need for providers to remain vigilant in securing patient information. The breach at CHS is just one example among others that have occurred recently involving many individuals. Health care providers may want to take this time to review and update their policies as necessary to address emerging threats and vulnerabilities to their systems.

Recent breaches of data held by health care providers CHS is a health system whose affiliates own, operate or lease 206 hospitals in 29 states. As reported by CHS in a filing with the Securities and Exchange Commission (SEC), the breach resulted from a targeted, external cyber-attack of CHS’s computer network in April and June, 2014. CHS believes the attacks originated from China and involved “highly sophisticated malware and technology” that enabled the attacker to bypass CHS’s security measures.

The breaches were the result of an advanced persistent threat, or “APT,” in which an attacker uses multiple phases, typically over a long period of time, to conduct reconnaissance of a target; break into a network, often by using social engineering; map an organization’s assets and defenses; access, capture, and exfiltrate information; and potentially install malware. According to the SEC filing, the attackers were able to copy and transfer data, including patient names, addresses, birth dates, and Social Security numbers, to networks outside of CHS. The attackers did not acquire credit card numbers or any medical or clinical information. CHS indicated it will offer credit monitoring to affected individuals and that it has liability insurance to protect against losses of this nature.

The type of breach that occurred

at CHS could happen to any health care provider. As the Federal Bureau of Investigation’s (FBI) Cyber Division noted in a Private Industry Notification earlier this year, the health care industry generally “is not technically prepared to combat against cyber criminals’ basic cyber intrusion tactics, techniques and procedures (TTPs), much less against more advanced persistent threats (APTs).”1 Given the sophisticated nature of the attack on CHS, similar attacks may be occurring at other health systems.

The breach at CHS is just one of a number of breaches in the last year involving information held by health care providers. Based on information on the Office for Civil Rights’ (OCR) website, other recent and notable breaches of data held by health care providers include: • A breach reported by St. Joseph Health System in Texas affecting 405,000 individuals. The breach may have included names, Social Security numbers, medical information, etc.

• A breach reported by UW Medicine in Washington affecting over 76,000 individuals.

• A breach reported by Centura Health in Colorado affecting over 12,000 individuals.

• A breach reported by Nrad Medical Associates in New York affecting 97,000 individuals.

• A breach reported by the Montana Department of Public Health and Human Services affecting over 1,060,000 individuals.

Incidents reported to OCR in the last 12 months include breaches involving information on desktop computers, network servers, and portable electronic devices, as well as in emails.

Cybersecurity threats facing health care providers A review of OCR’s website reveals that a wide range of health care providers have had to report breaches

‘‘

Health care providers may want to take this time to review and update their policies as necessary to address emerging threats and vulnerabilities to their systems.

involving more than 500 individuals, including health systems, mediumsized medical groups and sole practitioners. Health care providers are especially prone to data theft due to the high value cyber criminals place on medical information, which is often more valuable than credit card data. The street cost for a single patient’s medical record is reportedly $50 and has a longer useful lifespan than a credit card, while a stolen Social Security card is only worth $1.2 According to the Identify Theft Resource Center, 43.4% (204 of 470) of all breaches identified by the Center as of August 12, 2014 fell within the “medical/healthcare” category.3 Access to a patient’s protected health information (PHI) at a health care provider may reveal health insurance information, Social Security numbers, patient medical information and diagnoses, bank account information, etc.

Cybersecurity threats facing health care organizations include: • A growing presence of sophisticated and coordinated cybercriminal networks.

• Malware such as that involved in CHS’s breach.

• Phishing attacks.

• Networked devices, video conferencing systems, and printers, etc. that are hacked.4 continued on page 38 WWW.MEDMONTHLY.COM | 37

continued from page 37

According to the U.S. government, the cyber threats to health care providers will only increase in the coming year. The FBI warned in April that “[c]yber actors will likely increase cyber intrusions against health care systems—to include medical devices— due to mandatory transition from paper to electronic health records (EHR), lax cybersecurity standards, and a higher financial payout for medical records in the black market.

The deadline to transition to EHR is January 2015, which will create an influx of new EHR coupled with more medical devices being connected to the Internet, generating a rich new environment for cyber criminals to exploit.”5

Steps health care providers should take In light of the recent breaches and the FBI’s warning, covered entities and business associates may want to take some time to review their Health Insurance Portability and Accountability Act (HIPAA) security measures and verify whether they are up-to-date. HIPAA requires covered entities and business associates to review their policies and procedures periodically and update them as necessary in response to environmental or operational changes affecting the security of electronic protected health information in their organization.

Here are some questions covered entities and business associates may want to ask themselves: • When did we last review and update our HIPAA security measures? When did we last perform a risk analysis? If the covered entity or business associate has not performed a recent risk analysis and recent review of its policies, now may be the time to do so. As cyber criminals continue to develop new 38 | OCTOBER 2014

methods, covered entities and business associates should take the time to address new threats and vulnerabilities in their systems.

Does your organization maintain sufficient security logs and malware detection software and employ other resources to identify external attacks and intrusions on your system?

Encrypting PHI could protect it and reduce the likelihood of a breach.

• Do we have sufficient cyber or other liability insurance to cover breaches of PHI? Breaches can be expensive and often involve the provision of credit monitoring and identity protection services for individuals. Although covered entities and business associates should take steps to prevent a breach, they should verify whether their existing insurance covers them in the event of a breach and, if not, consider whether to procure such insurance. Although the market for cyber insurance is still nascent, there are carriers that offer first-party cybersecurity insurance policies, which typically cover a company’s losses arising from events such as business interruption, destruction of data and property, and reputational harm, as well as third-party policies, which cover losses that a company causes to its customers and others, such as harms arising from the exposure of PII through a data breach.

• Have we identified all areas in our organization where we may receive or maintain PHI? Identifying all ways in which PHI enters an organization’s systems is critical. As an organization employs new technology or its IT environment changes, the organization needs to make sure that it updates and adapts its security measures appropriately.

Organizations should map the location of all PHI and the ways it enters the organization’s systems.

Several notable items which may be inadvertently overlooked include portable devices and media. Has your organization implemented a mobile device policy? Has your organization addressed the use of USB drives, CDs and other portable media?

• Have we identified all access points to our systems containing PHI? Identifying all access points is critical, including an access points that involve devices that do not contain any PHI, but which may be exploited to circumvent the organization’s security. An area that is often overlooked includes networked devices, printers, faxes, and surveillance cameras, etc.6 Has your organization reviewed its networked devices for potential vulnerabilities that may allow an intruder to bypass your security?

• Are there additional opportunities to encrypt PHI within our organization? Under HIPAA, covered entities and organizations only need to report breaches of unsecured PHI.

• Even though we have addressed HIPAA’s requirements, should we do more? HIPAA sets a minimum floor for addressing the security of PHI. Often, there may be good reasons to provide additional protection beyond the minimum required by HIPAA. Does the organization have opportunities for additional protection that are feasible?  FBI Cyber Division Private Industry Notification, Health Care Systems and Medical Devices at Risk for Increased Cyber Intrusions for Financial Gain, PIN#: 140408-009, April 8, 2014, available at: http://www.aha. org/content/14/140408--fbipinhealthsyscyberintrud.pdf (accessed August 19, 2014).

1

See EMC, Cybercrime and the Healthcare Industry, available at: http://www.emc.com/collateral/white-papers/h12105cybercrime-healthcare-industry-rsa-wp.pdf (accessed August 19, 2014).

2

PEDIATRICIAN

or family medicine doctor needed in

FAYETTEVILLE, NC

Identify Theft Resource Center, 2014 Data Breach Category Summary, August 12, 2004, available at: http://www. idtheftcenter.org/images/breach/ TRCBreachStatsReportSummary2014.pdf (accessed August 19, 2014).

3

Barbara Filkins, SANS Health Care Cyberthreat Report, February 2014, available at: http://pages.norse-corp.com/ rs/norse/images/Norse-SANS-Healthcare-CyberthreatReport2014.pdf (accessed August 19, 2014).

4

FBI Cyber Division Private Industry Notification, Health Care Systems and Medical Devices at Risk for Increased Cyber Intrusions for Financial Gain, PIN#: 140408-009, April 8, 2014, available at: http://www.aha.org/content/14/140408-fbipin-healthsyscyberintrud.pdf (accessed August 19, 2014).

5

Barbara Filkins, SANS Health Care Cyberthreat Report, February 2014, available at: http://pages.norse-corp.com/ rs/norse/images/Norse-SANS-Healthcare-CyberthreatReport2014.pdf (accessed August 19, 2014).

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6

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features

Should Urgent Care Centers Employ a Marketer?

by Tina Bell Co-founder of UrgentCareSuccess I remember it like it was yesterday. After giving a presentation at a conference in Chicago on branding your urgent care, one of the audience members and I ended up in the same van back to the airport. For almost 30 minutes I had to defend my presentation to him. Usually I like debates, but this one just went on-and-on. The thing he was arguing over was my statement of something similar to the effect of, “If you want your urgent care center to grow, I would encourage you to hire a full-time marketer whose 40 | OCTOBER 2014

sole purpose is to focus his or her time on growing your business.”

His argument, “Of course you’d say those things. If you didn’t, you wouldn’t have a job.”

Snapshot: Marketers in Urgent Care Over the course of the last six years, I’ve realized my position as a full-time urgent care marketer puts me in an elite minority. Most practices do not employ someone to

handle all of the things I do for our urgent care centers.

For the most part, depending on the size of the urgent care centers, my position is split among several staff members, or it is done, when time allows, by the clinic manager or the physician’s spouse. In the larger urgent care centers, one person handles all of the marketing for multiple locations.

Then there is me. When I started as the marketing director for HealthCARE Express in 2008, I was hired to replace the physician’s wife’s role as marketer. We had two urgent cares at that time in two different states. My job was to market them. There wasn’t a true marketing plan in place. There was no training. There was just me, the skills I’d developed in my two prior roles (a managing editor at a newspaper and a marketing coordinator for an industrial pipe supply company), and my phenomenal co-worker Kim, who had built our occupational medicine program at what is now our headquarters in Texarkana, Texas.

Together, it was our job to grow the occupational medicine business at our clinic in Arkansas that had been open only three months, and my job solely to increase awareness of that clinic in the community. Where to start?

I Don’t Need a Full Time Marketer Lucky for you, today there are sites like UrgentCareSuccess.com, where marketers in our industry can go and get ideas on what to do. Even better, there are conferences like the Medical Marketing Conferece where marketers and urgent care owners can go to get the latest and greatest industry specific ideas on how to grow your business. Those weren’t around when I started. But trust me, I kept busy.

Since I first started, we have opened eight additional clinics, and with vast expansion plans to open plenty more over the next five years, I know I’ll be busy. Many urgent care owners think marketing is a one time deal. Shoot a commercial, design an ad, put up a website, dabble in social media, send out a post card, create a brochure, and attend a few health fairs. For the most part, do it once and the people will come. In some locations, that model may work great. For us, our clinics are not the only urgent care center in town. But many people will tell you otherwise. Why? Because we’re everywhere.

What Does a Full Time Marketer Do? You can outsource a lot of things. In fact, everything I listed above except the health fair can be outsourced to someone. And if that is your only plan, your clinic manager can probably coordinate all of that. There are pros and cons of outsourcing your marketing, but I’ll tackle that in another article at a later date.

What if you want your urgent care center to really grow? Our busiest urgent care center sees between 125150 patients a day during the spring and summer. In the fall and winter, that number can grow to over 200 per day.

Our newer clinics see between 40-60 a day depending on the time of year, and that number continues to grow each month. Why? Because the management team recognized the need to have someone who worked fulltime developing and implementing strategies to grow our business.

When I first started my position six years ago, our website averaged between 8-15 visits a day. We now have between 800-1200 visits a day. That is in large part due to a lot of internal legwork developing our website and managing our PPC campaigns in-house. Let’s face it, in 2014, if you’re not being found on-line, your competitor is getting your business.

Another thing your full-time marketer should be responsible for is growing your occupational medicine business. If this is a service you offer, this role has a potential to be a full-time job. Our marketers, however, are only required to spend at least two days a week working solely on this. The remainder of their time is spent on grassroots marketing. From daycare presentations, school athletic events, and community volunteerism, to civic club presentations, Chamber of Commerce events, and B2C marketing, our community educators easily put in 40+ hours a week.

Can I Really Justify Another Salary?

I think the question you need to ask yourself isn’t, “Should I hire a full-time marketer?” The question you really need to ask is, “Can my business grow the way I want it to if I don’t?” For $30,000 to $60,000 per year (depending on cost of living in your market), you can hire someone to fill this role. Do the math. If your average reimbursement per urgent care patient is $100-$150, and your marketer helps bring in an additional 40 new patients per month, that means you’re making an extra $4,000-$6,000 per month or $48,000 to $72,000 per year. Now multiply that by the lifetime value of that patient. And you haven’t even added in yet the money you can make by growing your occupational medicine program. After six years of being open, our oldest clinic still sees over 494 new patients every single month. Is my salary as a full-time marketer worth it?

You decide.  About the Author: Tina Bell is the co-founder of UrgentCareSuccess (www.

UrgentCareSuccess.com), an urgent care consulting firm and online educational resource provider for urgent care owners.

She has served as the chief brand officer for HealthCARE Express since 2008, where she oversees marketing strategy and development for the company’s growing urgent care and occupational medicine business. She regularly presents at industry conferences like the Urgent Care Success Summit, the Medical Marketing Conference, and the Urgent Care Association of America’s conference. She can be reached at info@urgentcaresuccess.com.

WWW.MEDMONTHLY.COM | 41

features

Can Urgent Care Play a Role in the Medical Home Model?

by Laura Marusinec, M.D. 42 | OCTOBER 2014

Introduction:

Recently featured in medical news are the growth of urgent care (UC) clinics and the concept of the medical home. Both are becoming a part of mainstream medicine.

Urgent care clinics can now be found in almost every mid- or large-sized community, and they are likely here to stay. They are treating many patients who in the past could only be seen in traditional medical clinics or the emergency department (ED). Many of these traditional medical clinics are adapting to the new ideal of the medical home, whose goal is to provide comprehensive and centered care to the patient and family. At first glance these two entities seem to be at odds, but with the right models and motivation, urgent care clinics can indeed play a role in the medical home model.

The Medical Home:

The American Academy of Pediatrics (AAP) introduced the concept of the medical home in 1967 to create a center for a child’s medical records, initially focusing on children with special needs.

More recently, the medical home has expanded to become a home base for the care-both medical and nonmedical-for all children and adults.

The Health Resources and Services Administration defines the medical home as “a cultivated partnership between the patient, family, and primary care provider in cooperation with specialists and support from the community”. According to the AAP, some of the key characteristics of the medical home are that the care provided is “accessible, familycentered, continuous, comprehensive, coordinated, compassionate, and culturally effective”. Several organizations, including the AAP, have collaborated to form the Joint Principles of the Patient Centered Medical Home. This organization has defined seven key principles for a medical home. These include: • Personal Physician-to be the first,

ongoing, and coordinating care provider • Physician directed-the physician leads the team • Whole person orientation-includes acute, chronic, preventative, and end-of- life care as well as mental and behavioral health, dental health, and other needs • Care is coordinated and/or integrated-this includes the primary physician as well as subspecialty care, hospitals, home health agencies, nursing homes, as well as community-based services.

Information must be able to be accessed and shared among these groups.

• Quality and safety are vital-this incorporates evidence-based medicine, clinical decision-support tools, quality improvement activities, information technology, accountability, and patientcentered care • Enhanced access to care-through expanded hours, open scheduling, and patient portals which also may allow online scheduling • Payment-which recognizes and reflects the value of additional services provided In addition, an effective medical home should incorporate several other objectives such as: ease of referrals, a high level of communication of the primary provider with other physicians and programs, adequate time spent with the family, cultural sensitivity, and interpreter service availability.

In short, the medical home provides comprehensive care in partnership with a patient and family to meet all of the medical and non-medical needs of the patient.

Urgent Care:

Urgent Care clinics are big business, and they are growing. Several recent articles demonstrate the recent rapid growth in urgent care clinics and estimate that there are currently from 5000 to 9,000 clinics that may be classified as urgent care in the United States, with approximately 50-100 new

clinics opening per year.

Essentially, urgent care clinics fall somewhere between primary care and an emergency department. They focus on acute care, though they do not aim to treat the severity of conditions seen in an ED. Most urgent care clinics share the following characteristics: • Accept walk-in patients • Are open extended hours, usually including evenings, weekends, and holidays • Are staffed and led by at least one physician • Have on-site diagnostics such as radiology and laboratory services • Treat a variety of acute illnesses and injuries, including musculoskeletal injuries and lacerations, and have the ability to perform minor procedures • Contain multiple exam rooms Urgent care clinics provide several advantages to the traditional ED – namely cost, convenience, and time/ efficiency. With higher copays and deductibles, this cost difference matters to patients as well as to insurers, employers, and taxpayers.

There are several different business models of urgent care clinics. These include clinics owned by physicians, hospitals, or health-plans, as well as non-physician individual or corporation-owned centers, and franchises. Initially heavily physicianowned, there is a shift towards more franchise and other non-physician ownership.

Can urgent care clinics play a role in the medical home model, and if so, what are the key characteristics of those that do?

The most important concept is that urgent care is not, and should not attempt to replace, the medical home; rather, it should complement it.

Urgent care clinics are growing; people are now treating health care similar to the rest of their lives, where convenience is key. Studies show the primary motivations for going to an UC clinic are convenience, timely continued on page 44 WWW.MEDMONTHLY.COM | 43

continued from page 43

care, and affordability. In addition, a nationwide shortage of primary care physicians and overcrowded emergency departments contribute to this growth.

There are many benefits of urgent care and many appropriate uses. When an injury occurs or an illness flares after office hours, urgent care is a great option for care. However, an increase in the inappropriate use of urgent care for non-urgent concerns is a problem that has significant economic and healthcare consequences. Using urgent care in place of primary care opposes the concept of the medical home. The medical home stresses continuity and the role of the primary care physician; when patients bypass the primary care physician and choose urgent care instead, the many benefits of the medical home are lost. Patients who primarily utilize resources such as urgent care may not receive preventive care services or adequate care for their chronic medical conditions.

Although they may have access to patient records, urgent care providers don’t usually know the patient’s full medical history. Urgent care may treat patients with an acute exacerbation of a chronic condition, but it is not the appropriate place to manage the conditions themselves or to make significant long-term medication or treatment changes. Urgent care usually has limited imaging and laboratory services and does not have close relationships with specialists. Finally, although urgent care providers may address prevention, behavioral, safety, mental health, dental, and other “whole person” issues, they are not equipped to provide the level of service needed for quality care.

When used appropriately; however, urgent care can indeed play a role in the medical home model, and when an urgent care clinic is developed with the medical home in mind, it can be an effective one. There are several key concepts that must be included to make this possible. These 44 | OCTOBER 2014

include several key characteristics and principles of a medical home as noted above, as well as several others:

Accessible:

This is one of the key advantages of urgent care. With clinics in the community away from the hassles of navigating a large medical center; evening, weekend, and holiday hours; and immediate walk-in services; urgent care provides many convenient features. Lower copays and fees than emergency departments also provide accessibility to patients with economic limitations. Along with this, patients in certain geographic areas have limited access to primary care providers due to a shortage, and the increased number of people seeking care as insurance coverage is expanded under the Affordable Care Act will only increase this problem.

Collaboration/Cooperation/ Coordination:

Probably the most important concept to align urgent care with the medical home is collaboration of the clinic with the primary care provider (PCP) and community organizations.

Two-way communication between the urgent care clinic and primary care provider is optimal. This includes phone calls, letters, faxes, and electronic records from the urgent care clinic to inform the PCP of the details of the patient’s visit and followup recommendations. Occasionally, a PCP may refer a patient to urgent care and even provide information to facilitate care for a more ill or complicated patient. In addition, the UC provider contacts the ED or hospital before transferring a patient and may even contact a specialist to discuss the care of a patient. A shared electronic health record (EHR) can help provide accurate, thorough, and timely information.

In addition to sharing information, the UC provider should attempt to be consistent with the treatment plans in place by the PCP when available and appropriate and refer the patient

back to the PCP for further care. If the provider has alternative ideas for care, then contacting the PCP with these or including them in discharge instructions can be helpful. Finally, to be even more successful, an urgent care clinic could work with the local hospital or other community health resources to align their scope of care, treatment guidelines, quality and safety controls and improvement strategies, and triage and transfer protocols with that of the hospital or other organizations.

Of course, this collaboration only works if the patient actually has a primary care provider. In pediatrics, most patients are seen by a pediatrician or family physician regularly due to routine check-ups and immunizations, so this should be more easily attainable. Unfortunately, many adults don’t have a regular care provider, especially younger adults who often don’t see the need or those without insurance coverage. It is especially important for older adults or those with chronic medical problems to have a medical home to manage their health in a more efficient and thorough manner.

Quality and safety of care and quality and safety improvements:

Urgent care clinics should have in place the same level of quality and safety measures and accountability as other medical practices. UC providers should practice evidencebased medicine. To facilitate quality and safety, electronic health records should be utilized, ideally those that allow sharing of information between centers, contain clinical decision-support tools, and allow capture of data to measure outcomes.

Finally, protocols for triage, transfers, and managing emergent situations should be in place and evaluated and practiced at regular intervals.

Culturally effective/ Community:

Urgent care clinics are often located

in the community neighborhoods and employ staff that lives in the same neighborhoods. This can aid in the cultural sensitivity and effectiveness of the clinic along with decreased language barriers. Interpreter services are essential when staff is not fluent.

Physician led:

As noted above, an urgent care clinic should be led and staffed by at least one physician. Many clinics may have nurse practitioners or physician assistants working with physicians, but this is similar to most medical practices and even emergency departments. While a good nurse practitioner or physician assistant can be invaluable, a physician is able to independently recognize and manage more ill or complicated patients.

Cost:

This is not the same concept as payment, but deserves mention. A medical home is valuable in many ways, and one of them is reduction of the cost of care. A coordinated medical home attempts to keep costs low by reducing hospital admissions, inappropriate emergency department use, and duplication of services. Most urgent care fees are slightly higher, but similar, to those of a primary care provider, and they are usually much less those of an ED for similar conditions. A concern, however, would be unnecessary visits to urgent care when a phone call to the primary care provider for advice, refills, etc., could suffice. Another concern is the possibility of duplication of services from an urgent care if they do not have access to results of diagnostic testing completed or the plan of care in place by the primary provider or other sources. In addition, inherent in their nature, ED and UC clinics tend to rely more heavily on diagnostic tests than primary care providers, which can add to higher costs.

Scope of care:

Urgent care clinics should define the scope of illnesses and injuries they manage. They should not exhaustively

diagnose or treat chronic illnesses more than the acute flare, unless the patient is in need of care that is not being provided by a primary physician.

In general, preventive medicine is not a focus of urgent care. When treating patients who are lacking in preventive care or management of chronic conditions, UC providers should encourage the establishment and consistent use of a primary care provider.

Type/model of urgent care matters:

Considering the different models of urgent care and the above issues, some are better able to fit into the medical home model. Because of their integration and alignment with health systems and insurance companies, hospital-owned and health plan-owned clinics should be able to fulfill many of the criteria. They may share similar goals, including patientcentered care and incentives for costcontainment, and they should readily be able to share information with the primary care clinic, ideally through the same EHR. A solid physicianowned urgent care clinic may not have the relationships already in place but would likely have motivation to do so. Non-physician owned and franchise UC clinics may have less of the relationships and systems in place and may have less incentive to do so, focusing more often on the business aspects than the medical community as a whole. In time, as the medical home becomes a larger factor in healthcare, these clinics may need to adapt to succeed.

Conclusion

As discussed, both urgent care and the medical home are becoming part of the new norm for healthcare.

While quite distinct, they can both contribute to the goal of a healthier community. The medical home aims to be the foundation for a patient and family’s overall health and well-being, while urgent care fits the needs of busy working families and fills the

gaps of accessibility and convenience, especially for the many things that can happen after 5 pm. In addition, urgent care possesses some attractive features of the medical home that primary care often lacks and may look to adopt, such as convenient access and timely care. A pediatric clinic recently posted a blog discouraging their patients from seeking care from urgent care, especially retail clinics, and reminded them of the availability of same day appointments and a 24 hour nurse line. They specifically mentioned the importance of the medical home, but were also likely concerned about competition for patients that urgent care clinics create. In turn, this competition likely encouraged the primary care clinic to increase attractive features offered to their patients to make the medical home more convenient and accessible. In this case, urgent care can not only play a role in the medical home, but can actually improve it.  References: http://www.hrsa.gov/healthit/ toolbox/Childrenstoolbox/ BuildingMedicalHome/whyimportant. html Scott DR, Batal HA, Majere S, et al. Access and care issues in urban urgent care clinic patients. BMC Health Serv Res. 2009; 9: 222. http://www. biomedcentral.com/1472-6963/9/222.

Weinick RM, Burns RM, Mehrotra A. How Many Emergency Department Visits Could be Managed at Urgent Care Centers and Retail Clinics? Health Aff (Millwood). Sep 2010; 29(9): 1630–1636. http://www.ncbi.nlm.nih. gov/pubmed/20820018.

Bell, T. The Growing Business of Urgent Care. Med Monthly. Aug 2014. http://medmonthly.com/insight/thegrowing-business-of-urgent-care/ Creswell J. Race Is On to Profit From Rise of Urgent Care. The New York Times. July 9, 2014. http://www. nytimes.com/2014/07/10/business/raceis-on-to-profit-from-rise-of-urgent-care. html?_r=0 WWW.MEDMONTHLY.COM | 45

features

The Future of Urgent Care By the American Academy of Urgent Care Medicine

The growth and development of Urgent Care Medicine should be of no surprise to anyone. Fueled by frustration over long waits in the emergency room (for nonemergency care), and a reduction in available primary care appointments (often resulting in patients waiting for weeks to see their primary care physician), a new growth spurt for the Urgent Care industry began in the mid-1990s and continues today. Since 2008, the number of facilities has increased from 8,000 to 9,300. The public’s desire for immediate access to medical care has been the driving force behind this monumental growth.

46 | OCTOBER 2014

Many Urgent Care centers are now seeking Urgent Care Center Accreditation. Accreditation is a voluntary process through which an Urgent Care center is able to measure the quality of its services and performance against nationally recognized standards. The Accreditation certificate is a symbol to others that an organization is committed to providing high-quality care. Urgent care organizations value Accreditation as a measure of professional achievement and quality of care. Urgent Care Center Accreditation is a benchmark of quality, not only to those involved in the health care industry but to the general public as well. Accreditation enhances the appeal of an Urgent Care center to payors and employers, and attracts the best providers who are eager to practice at a superior Urgent Care center. Click here to learn more about Urgent Care Center Accreditation.

For many patients, Urgent Care centers are the main place to go for care — especially on weekends or evenings when their primary-care physicians don’t have office hours. Only 29% of primary care doctors have after-hours coverage. Urgent Care centers are a boon for patients in other ways. The wait time to see a provider is typically half an hour or less, compared to a multi-hour wait time in many Emergency Departments. And patients can often see a doctor, as opposed to a nurse practitioner if they go to a retail clinic. Moreover, Urgent Care centers offer imaging and other services not found in retail outlets. Employers, insurers and other payers also benefit from urgent-care centers, which charge only a fraction of what an ED visit would cost. And employees can get back to work sooner instead of spending half the day in the ED. The extended hours and immediate availability of care at Urgent Care centers provides convenience for patients. As the specialty of Urgent Care Medicine grows, the public is learning that Urgent Care is a better choice over the emergency room for their immediate, non-life-threatening healthcare needs.

There are currently 20,000 physicians who practice Urgent Care Medicine today, and the number is growing.

Urgent Care professionals have developed Urgent Care Medicine into an important, recognized specialty that represents this fast-growing medical field.

So, what does the future hold for the specialty of Urgent Care Medicine?

Physicians training in primary care specialties such as Family Medicine, Internal Medicine, Emergency Medicine and Pediatrics are pursuing additional education in Urgent Care Medicine, and seasoned physicians are becoming Board Certification in Urgent Care Medicine. As the specialty grows, the development of training programs geared specifically towards Urgent Care Medicine will take place.

Increased recognition of Urgent Care Medicine as a distinct specialty. Many organizations and facilities accept and recognize Board Certification in Urgent Care Medicine and have requested verification of the Board Certification of our Diplomates.

Because of the excellence of AAUCM Accreditation standards, many third-party payers, commercial insurance carriers, and local and state agencies recognize Urgent Care Center Accreditation with the AAUCM as a valuable accomplishment. The Academy’s UCCA program is accepted by Aetna and Cigna, and United Healthcare recommends Accreditation with the AAUCM to facilities which are contracting with them.

Physicians, Physician Assistants, and Nurse Practitioners who specialize in Urgent Care Medicine will continue to elevate the quality and capability of the “walk-in clinic” to include treatment of a full range of nonemergency illnesses and injuries.

Quick Stats • There are approximately 9,300 walk-in, stand-alone urgent care centers in the United States, and 50-100 new clinics open every year (numbers fluctuate with corporate buy overs, expansions and consolidations).

• Emergency room visits now number approximately 110 million annually.

• In a ten-year span, from 1994 to 2004, the number of hospitals and emergency rooms decreased by 9%, while emergency room visits increased by more than one million visits a year.

• Family Practice residencies face a continued downward spiral of applicants to their training programs; of 2,555 open positions, 2,329 positions were filled. (AAFP 2009 Match Summary and Analysis) • In 2009, fewer medical school seniors selected Family Medicine as their specialty than in 2008 (1,083 vs.1,172).

• A 2009 RAND Corp. study reported 14 to 27%of ED visits could be handled by Urgent Care centers or retail clinics, saving up to $4.4 billion a year in health costs.

• The U.S. likely will need almost 52,000 additional primary care physicians by 2025 to meet the country’s health care utilization needs. That’s the conclusion reached by a team of researchers whose work is highlighted in an article titled “Projecting U.S. PrimaryCare Physician Workforce Needs: 2010-2025”.  Source: http://www.aaucm.org/about/future/default.aspx WWW.MEDMONTHLY.COM | 47

features

Determining Your Urgent Care’s Physician Staffing Model

By Tim Reynolds M.D.

Trying to determine the perfect physician staffing model is an ongoing saga for any urgent care center. For the first 10 years of my career I was responsible for staffing a busy emergency room, and for the last eight years I have been staffing busy urgent care clinics with physicians. Creating the perfect physician schedule is a constantly moving target. The target is finding the balance between adequately staffing to allow time to provide great patient care and not overstaffing and killing the budget.

Why You Should Analyze Your Staffing When swine flu hit in the fall of 2009, our urgent care clinics were the busiest they had ever been. Both our physician and our physician extender staffing was maxed out. In fact, we couldn’t find enough people to work all the shifts it took to adequately take care of the influx of 48 | OCTOBER 2014

flu patients. By the fall of 2010, the swine flu numbers had tapered off, and we were back to our normal patient flow volumes.

In August of 2010 I noticed our profit margins had really decreased. We had not switched our staffing number to reflect our normal patient volumes. Someone had fallen asleep at the wheel, and that someone was me. After fixing the problem, our profit margins went back up. In a service based industry, staffing is your number one expense. You have to be diligent at not over spending on staff, especially in the highly compensated roles filled by physicians and physician extenders. Decreasing staffing costs by as little as 10 percent can increase your profits by 50 percent.

Physician Staffing Formulas I wish I could tell you there was a simple formula for you

Tip 2: Physicians and Physician Extenders The decision to utilize physician extenders at your urgent care center really comes down to two things: 1. The laws in your state; and 2. Your philosophy on patient care.

At HealthCARE Express, we use physician extenders to compliment our physician staff. I think they work great and patients love them. The key is physicians must be able to provide adequate supervision in compliance with your state laws. Your supervision policies should be clearly written in your policies and procedures manual.

Tip 3: The Right Mixture Finding the right mixture of physicians and/or physician extenders depends on two equally important parts. First, it is your responsibility to make sure your clinic culture is what it should be and that your clinical standards are high. Therefore, you must be able to determine the clinical abilities of your medical providers.

Second, you must insist your providers become part of your company culture. Creating the right culture, and allowing people to become part of it, is more important in the long run than finding the “right” people. Providing a challenging, positive, and great work environment will help ensure your providers are always performing at their best, even when you are super busy. Remember, physician staffing numbers change as the patient volume at your urgent care clinic changes. What works this month may not work next month. If you keep an eye on your volumes and are quick to adjust your coverage accordingly, your profits should stay positive. If you hire quality people and allow them to become part of your culture, staffing will be a pleasurable experience, too.

Tips on Physician Employment Contracts

to use to determine the exact number of physicians and physician extenders you need at your urgent care clinic.

There is not. However, there are a few numbers and tips you can use to create your own staffing formula.

Tip 1: Number of Patients by Hour The average provider at an urgent care clinic should be able to see between 2.5 and 4 patients per hour. Physicians who are responsible for overseeing physician extenders may see less patients per hour. Additionally, depending on the acuity of what you see at your urgent care center, your numbers may be higher or lower.

When you first open, you only need one provider at your clinic until you begin to see more than three patients per hour. After your patient volume increases, consider adding an additional provider during peak hours.

Once you have your staffing metrics in place, you may find you need additional physicians. Once you have found a physician for your team, the “fun” of negotiation an employment contract begins. In the urgent care business, physicians you hire are your customers. Unfortunately, many of them have been taken advantage of by previous groups or employers, so they may come to you very wary, especially when you start discussing their contract. The best way to approach a physician contract is with a mutual understanding of what is expected of the physician and what they can expect from you.

Because it is a contract, legalese will be used. But at the end of the day, the contract is about a cooperative effort to make you and the physician happy. Don’t let all the legal stuff get in the way of the primary goal you both share: Finding a way to employ the physician with your urgent continued on page 50 WWW.MEDMONTHLY.COM | 49

continued from page 49

care. Compensation, benefits, and the like should be worked out long before the physician is given the contract to sign. Additionally, any other “sticky points” should be discussed face-to-face before the contract is given out. The contract is not a place to hide things.

It is important to include certain things in the contract like: 1. Essential job functions 2. Length of the agreement and performance benchmarks 3. Compensation

When you discuss compensation, make sure to include: a. Benefits u Will

the benefits be the same as all your employees? the company pay for all of the health and/or life insurance or will the physician pay a portion? u Will vacation accrue from day one? Will it be scheduled according to staffing needs? u Will

b. How pay is structured u Base

salary only rate u Base salary plus commission (i.e. % of net profits) u What if the physician leaves prior to the end of the month? Will you prorate? u Hourly

c. Required hours u 40

hour work week hour work week including weekends and/or rotation thru facilities

u 40

d. Sign on-bonus u What

if the physician leaves after he has received the bonus?

e. Will you allot funds for licenses? f. Will you pay for the professional liability insurance coverage?

Who will pay for the “tail” policy covering the physician after termination of employment?

Non-Compete Clause I do not believe in making doctors sign a noncompete that says they will not go to work for one of my competitors. However, I do have them sign a non-compete saying they will not take my ideas and then open a business that competes directly with mine.

Example language: On the termination of the physician’s employment with the company for any reason, the physician will not solicit any patient of the company that was a patient of the company during the course of the physician’s employment with the company, whether or not knowledge of the patient is considered confidential information, or in any way aid and assist any other person to solicit any 50 | OCTOBER 2014

such patient for a period of three (3) years from the date of termination of the physician’s employment in urgent care within a 30 mile radius of any company location where physician has provided services.

It’s important for you to note that different states have different laws on non-compete language in an employment agreement.

In Summary, the best way to overcome fear of physician contracts is to be straight forward and work together to problem solve rather than “negotiate”. Instead of putting both sides on the defensive, work together towards a win-win solution. 

Tim Reynolds M.D. is the Urgent Care Industry’s leading expert on Leadership, business strategies, and work-life balance. He is committed to helping doctors, owners and practice managers put the FUN back in their business.

He has written nearly 100 articles for industry publications and online resources, regularly presents at industry conferences, and is a sought after consultant for some of the top urgent care clinics across the nation. He is the managing partner for a rapidly growing network of urgent care, occupational, and wellness centers known for providing the WOWZA! Customer Experience. He is the co-creator of the industry’s leading online resource for growing and improving your business, UrgentCareSuccess.com, and his annual Urgent Care Success Summit, is often described by attendees as “the best conference in the industry.”

Prior to starting his urgent care business in 2006, Dr. Reynolds held numerous positions across the medical field including: medical director of a busy level II trauma center; president of a medical billing company and an associate clinical professor for a local university. In addition to his medical experience, Dr. Reynolds owns several businesses including a real estate investment, development and management company.

He is the author of two books, The Green Beret Doctor’s Health Plan for Life, and Living Every Minute.

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the arts

In the School of Health Sciences, Art Brings the Body to Life Article and photos courtesy of

Elon University

Graduate students in Elon’s Doctor of Physical Therapy and Physician Assistant Studies programs worked July 11 with a nationally recognized artist to paint muscles, tissue and bone onto classmates in a hands-on approach to anatomy.

A Massachusetts artist whose reputation for body painting has made him highly sought after among medical educators visited Elon University to share his talents with School of Health Sciences graduate students.

Artist Danny Quirk’s appearance offered an opportunity

DPT candidate Lizzie Guilford and PA candidate Stephanie Meiners paint leg muscles and tissue onto DPT candidate Alie Thomas.

52 | OCTOBER 2014

Artist Danny Quirk talks with (from left) Justin Ollis, Carys Roberts and Becky Ramey in Elon University’s Physician Assistant Studies program.

for students to learn about human anatomy through an exercise that many of them described as more useful than books or lab demonstrations. By mid afternoon on July 11, 2014, much of the second floor of the Francis Center teemed with future physical therapists and physician assistants using paint to depict bone, muscle and tissue on the limbs and backs of their classmates.

Assistant Professor Cindy Bennett in the Department of Physician Assistant Studies described the activity as a creative approach to helping students observe anatomy “in spontaneous motion” that has found great success in international health care. While body painting isn’t new in the School of Health Sciences, this week was the first time an acclaimed artist has been invited to campus for the lesson.

“Some people learn best by doing things like dissecting, and some people learn best by creating something themselves,” she said. “Body art has never been a big educational tool in the United States, but it’s done in other countries. It’s inexpensive and easy, it doesn’t take a lot of time, and it’s incredibly engaging.”

Three students in the Physician Assistant Studies program - Justin Ollis, Becky Ramey and Elon alum Carys Roberts ‘13 - had earlier volunteered as human canvases.

Quirk used latex, acrylic paint and markers to create

Physican Assistant candidate Isaac Stappas works on the leg of DPT candidate Candace Riccio on July 11, 2014, as part of an afternoon lesson on human anatomy using body paint.

stunning images of muscle and ligaments in Roberts’ right leg, the tendons and fibers in Ramey’s left forearm and the bone, muscle and tendons on the back of Ollis’ head.

Quirk shot to fame less than two years ago when his

work was discovered by a prominent science blog that lauded his craft. A graduate of the Pratt Institute in Brooklyn, he has since developed a large social media following with nearly 49,000 “likes” on his Facebook page. For a man who initially wanted to be a medical illustrator, the newfound attention has provided an avenue to share a love of the human body in ways that illustrate its complexity and beauty.

“A lot of work that I do tries to get people excited about the body, and I continue to learn through the whole process,” Quirk said, calling his evolving skills “artistic Darwinism.”

Students said they enjoyed the body-painting activity.

“It’s a lot more fun, and anything that’s more fun is more engaging,” said Stephanie Meiners, a candidate in the Physician Assistant Studies program. “It’s also made me spend more time looking at pictures in books that I would have otherwise.”

Quirk’s visit was funded through a grant Bennett secured from the university’s Center for the Advancement of Teaching and Learning.  Source: http://www.elon.edu/e-net/Article/96938

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WWW.MEDMONTHLY.COM | 53

healthy living

Creamy Pumpkin Soup

By Ashley Acornley, MS, RD, LDN

Fall is finally here! With the cooler weather approaching, it is time to savor something warm and creamy. What could be better than the taste of pumpkin during this time of year? Pumpkin is rich in antioxidants, fiber, and Vitamin A- it is so nutritious that it is considered a superfood! This velvety smooth pumpkin soup is a delicious appetizer to prepare around Halloween.

Ingredients: • 1/8 cup (1/4 stick) butter • 1 small onion, chopped • 1 clove garlic, finely chopped • 2 teaspoons packed brown sugar • 1 can (14 1/2 fluid ounces) low sodium chicken broth • 1/2 cup water • 1/2 teaspoon salt (optional) • 1/4 teaspoon ground black pepper • 1 can (15 ounces) LIBBY’S® 100% Pure Pumpkin • 1 can (12 fluid ounces) NESTLÉ® CARNATION® Evaporated Milk • 1/8 teaspoon ground cinnamon

Prep Time: 10 minutes Cooking: 25 minutes Yields: 5 servings

Preparation: 1. Melt butter in large saucepan over medium heat. Add onion, garlic and sugar; cook for 1 to 2 minutes or until soft.

2. Add broth, water, salt and pepper; bring to a boil, stirring occasionally. Reduce heat to low; cook, stirring occasionally, for 15 minutes.

3. Stir in pumpkin, evaporated milk and cinnamon. Cook, stirring occasionally, for 5 minutes. Remove from heat.

4. Transfer mixture to food processor or blender (in batches, if necessary); process until smooth. Return to saucepan. Serve warm and enjoy!

54

| OCTOBER 2014

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Delaware Cannon Building, Suite 203 861 Solver Lake Blvd.

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

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

Florida 4052 Bald Cypress Way Bin C-08 Tallahassee, FL 32399 (850)245-4474 http://floridasdentistry.gov/ 56

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

| OCTOBER 2014

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (334)242-4116 http://www.albme.org/ Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 http://commerce.alaska.gov/dnn/cbpl/ ProfessionalLicensing/StateMedicalBoard.aspx Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 (480)551-2700 http://www.azmd.gov Arkansas 1401 West Capitol Ave., Suite 340 Little Rock, AR 72201 (501)296-1802 http://www.armedicalboard.org/ California 2005 Evergreen St., Suite 1200 Sacramento, CA 95815 (916)263-2382 http://www.mbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7690 http://www.dora.state.co.us/medical/ Connecticut 401 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/cwp/view. asp?a=3143&q=388902 Delaware Division of Professional Regulation Cannon Building 861 Silver Lake Blvd., Suite 203 Dover, DE 19904 (302)744-4500 http://dpr.delaware.gov/ District of Columbia 899 North Capitol St., NE Washington, DC 20002 (202)442-5955 http://doh.dc.gov/bomed 58 | OCTOBER 2014

Florida 2585 Merchants Row Blvd.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

WWW.MEDMONTHLY.COM | 59

medical resource guide Urgent Care & Occupational Medicine Consultant

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

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

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

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

ADVERTISING

www.pushpa.biz

MedMedia9

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

DENTAL www.medmedia9.com

BILLING & COLLECTION

Biomet 3i

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

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

CODING SPECIALISTS Place Your Ad Here

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

Urgent Care America

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

60 | OCTOBER 2014

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

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

www.AccountingProfessionalsAgency.com

The Dental Box Company, Inc.

FINANCIAL CONSULTANTS

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

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

ELECTRONIC MED. RECORDS

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

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

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

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

LOCUM TENENS Physician Solutions

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

medical resource guide MEDICAL ARCHITECTS MMA Medical Architects

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

MEDICAL MARKETING

Bank of America

MedMedia9

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

WhiteCoat Designs

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

MEDICAL ART Deborah Brenner

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

MedImagery

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

PRACTICE FINANCING

MEDICAL PRACTICE SALES Medical Practice Listings

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

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

PROFESSIONAL SPEAKER Capri Health

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

REAL ESTATE York Properties, Inc.

MEDICAL EQUIPMENT Assured Pharmaceuticals Matthew Hall (704)419-3005 mhall@assuredpharma.com

MEDICAL PRACTICE VALUATIONS

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

BizScore

PO Box 99488 Raleigh, NC 27624 (919)846-4747

www.assurepharma.com

STAFFING COMPANIES

www.bizscorevaluation.com

Additional Staffing Group, Inc.

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

MEDICAL PUBLISHING www.thetps.com

MEDICAL EQUIPMENT FINANCING Bank of America

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

Headquarters & Property Management 1900 Cameron Street Raleigh, NC 27605 (919) 821-1350

MedMedia9

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

8319 Six Forks Rd, Suite 103 Raleigh, NC 27615 (919) 844-6601 Astaffinggroup.com

SUPPLIES, GENERAL www.medmedia9.com

MEDICAL RESEARCH

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

WEBSITE DESIGN

Scynexis, Inc.

3501 C Tricenter Blvd.

Durham, NC 27713 (919) 933-4990

MedMedia9 www.scynexis.com

PO Box 98313 Raleigh, NC 27624 (919)747-9031 www.medmedia9.com WWW.MEDMONTHLY.COM | 61

classified listings

Classified To place a classified ad, call 919.747.9031

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

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

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

62 | OCTOBER 2014

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

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

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

Classified To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Family Practice 1 h SE of Raleigh seeks coverage.

Goldsboro FP seeks MD for July 6-7 and intermittent shifts. 8-5p. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com. continued on page 65 WWW.MEDMONTHLY.COM | 63

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

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

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

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

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

Contact: Cara or Philip at 919-848-4202

medlisting@gmail.com medicalpracticelistings.com

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.

64 | OCTOBER 2014

NC OPPORTUNITIES LOCUMS OR PERMANENT

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

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

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

classified listings

Classified

continued from page 63

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

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

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

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

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

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

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

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

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

IM/FP/Peds opportunity in Fayetteville clinic immediately. Fayetteville clinic needs immediate coverage for the following clinics: adult health, women’s health and STD. No call 8a-5p. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

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

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

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

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

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

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

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

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

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

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

Family MD opportunity at an Urgent Care facility that sees all ages in the Jacksonville, NC area. This will be an ongoing schedule from 8:00am until 6:00pm 1-2 days a week, including weekend dates. You will treating generally 30-35 patients a day. There is potential for permanent placement. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com. continued on page 66 WWW.MEDMONTHLY.COM | 65

classified listings

Classified

continued from page 65

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

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

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

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

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

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

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

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

Pediatrics Opportunity - Roanoke Rapids Area Northeastern North Carolina Pediatric Practice seeks on-going physician for full time coverage beginning 66 | OCTOBER 2014

mid-October through the end of the year. Practice sees about 16-25 patients a day, hours are 8:00-5:00 with negotiable call. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

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

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

Family Physician –Williamston area Immediate opportunity at a developing family practice in the Williamston area. You will be treating 8-16 patients per day from 8:00-5:00 pm. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com. continued on page 68

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

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

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

Medical Practice Listings Buying and selling made easy

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

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

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

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

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

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

Medical Practice Listings Selling and buying made easy

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

Women’s Health Practice in Morehead City, NC

PEDIATRICIAN

OR FAMILY MEDICINE DOCTOR NEEDED IN

ROANOKE RAPIDS, NC

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

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

Credentialing at the hospital is necessary.

Medical Practice Listings Buying and selling made easy

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

Call 919- 845-0054 or email: physiciansolutions@gmail.com www.physiciansolutions.com WWW.MEDMONTHLY.COM | 67

classified listings

Classified

continued from page 66

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

MD Suboxone Duties Suboxone is a prescription medicine used for the maintence treatment of oproid dependence. Duties include opioid dependence recovery, rehabilitation, substance abuse and general Internal medicine. We have 4 practices to support with 3 to 5 day coverage. This means you have choices in the city you wish to practice. Slow to moderate patient pace with an exceptional staff and facility. Please contact Physician Solutions at; (919) 8450054 or Email; physiciansolutions@gmail.com Family Practice Opportunity, treating patients of all ages, looking for a FP or well informed Pediatric MD to work a full schedule Monday through Friday in Raleigh NC. This job is available immediately and is on-going contracted assignment. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@ gmail.com Methadone Treatment facility in the Western part of North Carolina has an immediate opening for a dependable MD. This is a highly regulated facility and the nursing staff performs most of the routine duties. The physicians that currently work in this environment really enjoy the work environment. We are accepting applications for this position and we will consider 3 to 5 shifts per weekly. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Physician Assistant to work primary care settings in North Carolina. We have 5 or 6 primary care practices that are looking for permanent or locum to perm PA’s.

Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Fayetteville area practice on-going physician for full time coverage. Practice sees about 16-25 patients a day, hours are 8:00-5:00 with negotiable call. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Pediatrician needed for permanent placement at Fayetteville area practice. Board Certified or Board Eligible. Practice sees about 16-25 patients a day, hours are 8:00-5:00 with negotiable call. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com

68 | OCTOBER 2014

Winston Salem clinic seeks PA for FT ongoing locums position immediately. Average daily patient load is 25.

Primary care services as well as some pain management. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Chiropractic Clinic seeks mid-level provider in Greenville, NC for Monday and Tuesdays shifts beginning in April. No call required, 8-5. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Cardiology practice has immediate opportunity for full time mid-level or physician in Fayetteville area to provide primary care assistance for the practice. The position has the potential for permanent placement. No call required, 8-5 M-F. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Clinic seeks PA immediately 3 days per week ongoing in Rocky Mount. Small clinic in Rocky Mount seeks 2-3 days coverage a week immediately. Few peds, 8-5pm M-F days flexible. Temp to perm. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Occupational Therapist (OT) - 3 positions available in Eastern, NC. We have opportunities for 3 on-going Occupational Therapists. These positions are 40 hour per week temp status to permanent positions. Contact Cara at; physiciansolutions@gmail.com or PH: (919) 845-0054 for more details.

Immediate opportunity for a Family or Internal Medicine MD to practice 3 to 5 days per week in Charlotte.

Light patient volume along with top wage make this a very attractive position. If you have 3 to 5 hour shifts you can work from Monday through Friday, we would like to discuss this upscale practice opportunity.

Contact Cara; (919) 845-0054 or Email us at physiciansolutions@gmail.com Primary care practice in North Raleigh has an immediate opening for a well rounded Medical Doctor in Raleigh, NC. 3 to 5 days per week seeing 16 to 22 patients between the hours of 8-5. This is an on-going opportunity with some flexibility as there are two other providers as co-workers. Outpatient with no hospital duties makes this a very desirable locum’s job. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com

Classified To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

Family practice in Wake Forest, NC seeks 2 to 3 shifts per week from a Board Certified FP. There is one doctor and 2 PA’s already practicing here and the growth requires another provider. No call, no hospital and great colleagues and facility. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Addictive medicine practice would like FP or IM physician to see 8 to 15 patients per day in Charlotte, NC. This position requires a solid level of Administrative writing skills for outlining patient protocol. The ideal doctor will have 2 to 4 shifts per week. Providers with Suboxone credentials can start within days. If you would like to obtain Suboxone certification, the process time is one to two weeks (on-line course). Call (919) 845-0054 or Email us at physiciansolutions@gmail.com Wilson, NC Urgent care treating 25 to 35 patients per day has an opportunity for a well qualified MD. The shifts are 10 hour days during the week and 6 to 8 hour shifts on the weekend. This allows you to work 3 to 4 days per week comfortably. You must be comfortable seeing children to geriatrics and basic suturing skills are required. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Walk-in primary care practice in Wilmington, NC would like to add 1 to 3 shifts per week for a primary care doctor. Heavy population of female patients and young adults are seen between 8 and 5 M-F. This is an on-going locum opportunity. Contact Cara; (919) 845-0054 or Email us at physiciansolutions@gmail.com

management. This job starts May and is on-going. Call (919) 845-0054 or Email us at physiciansolutions@gmail.com Asheville, NC needs long term PA opportunity in this beautiful mountain city. This is a 40 hours per week on-going positions that can develop into permanent.

No call or hospital. This is a locum assignment for the serious PA to work with 3 MD’s and several other PA’s.

Primary care medicine at its best in this modern facility.

Contact Cara; (919) 845-0054 or Email us at physiciansolutions@gmail.com Charlotte area pediatric practice seeks on-going mid-level for immediate coverage, 1-2 shifts per week.

Hours are 8:00-5:00 with no call. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com Vascular Surgeon needed for multi-practice specialty group located in Greensboro area to cover weekend shifts. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Family practice with Sports Medicine focus in Greensboro, NC seeks physician assistant, practice sees all ages. Must be familiar with electronic records. Practice sees 20-25 patients a day, hours are 8:00-5:00. Contact Cara; (919) 845-0054 or Email us at physiciansolutions@gmail.com Family practice with busy allergy clinic in Rocky Mount, NC seeks full time physician assistant to join their practice. Clinic hours 8-5 with no call. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com

On-going contract with an Assistive Living and Nursing Home organization in Raleigh, Durham, Greensboro, Charlotte, Wilmington, High Point, Greenville, Wilson, Asheboro, Rocky Mount, Asheville and Hillsboro. The mentioned cities are the major cities we need Geriatric MD’s to see patients. 6 to 8 doctors are required as this a long term locum opportunity. You will be paid hourly (no commissions or fee splits) plus mileage and lodging when necessary. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com

Immediate opportunity for Physician Assistant with Fayetteville area family practice and Heart clinic. Practice is conveniently located with excellent support staff. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

PA opportunity in Raleigh, NC for long term locum opportunity. This large primary care practice would like to add one, possible two physician assistants. If you can provide 3 to 5 shifts per week, we would like to introduce you to this up-scale practice. No call, no hospital and no pain

Urgent Care with busy Occupational Medicine practice in Greensboro, NC seeks Internal Medicine Physician with North Carolina DOT Certification for intermittent shifts. All shifts are 8-5, with no call. Contact Cara; (919) 845-0054 or Email us at physiciansolutions@gmail.com

Immediate opportunity for Geriatrics or Family Physician with statewide practice. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

continued on page 70 WWW.MEDMONTHLY.COM | 69

classified listings

Classified

continued from page 69

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

Family Medicine Physicians needed for Fayetteville primary care clinic, physician will see all ages. Hours are 8-5 with no call. Contact Cara; (919) 845-0054 or Email us at physiciansolutions@gmail.com

Urgent Care in Fayetteville, NC with busy Occupational Medicine practice seeks Internal Medicine Physician with North Carolina DOT Certification for intermittent shifts. All shifts are 8-5, with no call. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

Urgent Care with busy Occupational Medicine practice seeks Internal Medicine Physician with North Carolina DOT Certification for intermittent shifts. All shifts are 8-5, with no call. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

Pediatrician needed for practice one hour north of Raleigh, NC Mondays and Wednesdays on going. All shifts are 8-5 with no call. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com Family Physician needed to see all ages in Eastern North Carolina clinic. Flexible dates, and on-going opportunities available. Contact Cara; (919) 845-0054 or Email us at physiciansolutions@gmail.com

Addictive medicine practice would like FP or IM physician to see 8 to 15 patients per day. This position requires a solid level of Administrative writing skills for outlining patient protocol. The ideal doctor will have 2 to 4 shifts per week. Providers with Suboxone credentials can start within days. If you would like to obtain Suboxone certification, the process time is one to two weeks (on-line course). Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com

Urgent Care in Greensboro, NC with busy Occupational Medicine practice seeks Physician Assistant with North Carolina DOT Certification for intermittent shifts. All shifts are 8-5, with no call. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com

Asheboro urgent care seeks FP/GP for ongoing shifts starting in July 2014. Week days are 8-8pm and weekends 9-6pm. There are two providers and usually 3 NPs. Average 60 patients per day. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com

Urgent Care with busy Occupational Medicine practice in Fayetteville, NC seeks Physician Assistant with North Carolina DOT Certification for intermittent shifts. All shifts are 8-5, with no call. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

Elizabeth City pediatrics clinic seeks physician Oct 1-31, M-F or 4 days a week ongoing. Hours are 8-5pm and average patient load is 25 per day. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 8450054, email: physiciansolutions@gmail.com

Multi-speciality practice seeks family physician to cover shifts from July 11-Sept 5 (3-5 days/week) in Carolina Beach. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com

Permanent Nurse Practitioner sought for Franklin, NC family practice (1 hour 10 min west of Asheville) 8-5 M-F. Immediate placement available. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 8450054, email: physiciansolutions@gmail.com

Family practice in Holly Springs seeks physician to cover intermittent shifts throughout the summer. Hours are 8-4p, practice sees 10-15 patients per day. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

Permanent placement available for Nurse Practitioner or physician assistant in Winston Salem family practice, M-F 8-5. Contact Cara; (919) 845-0054 or Email us at physiciansolutions@gmail.com

Primary care practice in North Raleigh has an immediate opening for a well rounded Medical Doctor. 3 to 5 days per week seeing 16 to 22 patients between the hours of 8-5. This is an on-going opportunity with some flexibility as there are two other providers. Outpatient with no hospital duties makes this a very desirable locum’s job. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com 70 | OCTOBER 2014

Fayetteville urgent care seeks Physician Assistant Sept 2-5, 8-12, any or all days, 8-5p. Must be able to see all ages. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

Classified To place a classified ad, call 919.747.9031

Physicians needed

Nurse Practitioners needed

South Carolina

North Carolina

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

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

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

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

Physicians needed Virginia Pediatric Locums Physician needed in Harrisonburg, Danville and Lynchburg, VA. These locum positions require 30 to 40 hours per week, on-going. If you are seeking a beautiful climate and flexibility with your schedule, please consider one of these opportunities. Send copies of your CV, VA. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Urgent Care opportunities throughout Virginia. We have contracts with numerous facilities and eight to 14-hour shifts are available. If you have experience treating patients from pediatrics to geriatrics, we welcome your inquires. Send copies of your CV, VA medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, E-mail: physiciansolutions@gmail.com Virginia practice outside of Washington DC seeks IM doctor FT/PT now – June 1. IM physician needed immediately FT/PT for Virginia clinic near Washington DC. 8-5p Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

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

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

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

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

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

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

Medical Marketing & Sales needed North Carolina Accounts Manager; Physician Solutions has an immediate opportunity for a professional to work from our North Raleigh corporate offices. Duties include; calling on developed practice accounts while developing new accounts. Recruiting physicians and overseeing all marketing and sales duties. Contact Cara; (919) 845-0054 or Email us at physiciansolutions@gmail.com WebSite Development and Hosting Sales; MedMedia9 is accepting applications for Sales Associates in all parts of North Carolina. We are looking for Independent Medical Sales Reps that are looking for a really solid product that is needed by 6 out of 10 practices, cost effective and will enhance their practice income while attracting new patients. Easy sales delivery by a confident professional. Please send your resume and contact information to; medmedia9@gmail.com or go to www.medmedia9.com the About Us tab and view the Reseller Application.  WWW.MEDMONTHLY.COM | 71

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

Family Primary Care Practice

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

Family Practice/Primary Care

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

Med Spa

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

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

Practice Type: Internal Medicine

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

Dental Practices Place Your Ad Here

Optical Practices Place Your Ad Here

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

Considering your practice options? Call us today.

72 | OCTOBER 2014

NC Opportunities DENTISTS AND HYGIENISTS

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

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

• • • • • •

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

There is a Compounding Pharmacy located in the same suites with a consulting pharmacist working with this Integrative practice. Average Patients per Day: 12-20 Physician Solutions has immediate opportunities for dentists and hygienists throughout NC. Top wages, professional liability insurance and accommodations provided.

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

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

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

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

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

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

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

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

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

Listing Price: $430,000

Contact us today to discuss your options confidentially.

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

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

ADVERTISE YOUR PRACTICE BUILDING IN MED MONTHLY

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

List price: $435,000

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

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

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

medmonthly.com | 919.747.9031

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

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

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

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

Medical Practice Listings Selling and buying made easy

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

Primary Care Practice For Sale

NC MedSpa For Sale MedSpa Located in North Carolina

Wilmington, NC

We have recently listed a MedSpa in NC

Established primary care on the coast of North Carolina’s beautiful beaches.

Fully staffed with MD’s and PA’s to treat both appointment and walk-in patients.

Excellent exam room layout, equipment and visibility.

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

Contact Medical Practice Listings for more information.

Contact Medical Practice Listings today to discuss the practice details.

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

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

www.medicalpracticelistings.com

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

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

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

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

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

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

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

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

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

Modern Med Spa Available

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

The Gross revenue is over $1,500.000 during 2012 with consistent high revenue numbers for the past several years. The average number of patients seen daily is between 26 and 32 with room for improvement. You will find this Med Spa to be in a highly visible location with upscale amenities. The building is leased and the lease can be assigned or restructured. Highly profitable and organized, this spa POISED FOR SUCCESS. 919.848.4202 medlisting@gmail.com medicalpracticelistings.com WWW.MEDMONTHLY.COM | 77

the top Urgent care centers have seen significant growth in recent years. Their lower costs compared with emergency departments and easy access have attracted both patients and investors as the industry looks for lower-cost options and resources to care for the nearly 30 million patients who gained health insurance under the Patient Protection and Affordable Care Act. Here are the top 9 facts and statistics about the urgent care market.

1

NUMBER OF URGENT CARES

There are approximately 9,300 urgent care centers in the U.S., up from 8,000 in 2008.

2

PHYSICIAN STATS

The majority of centers, 94.1 percent, have at least one full-time employed physician on staff. The most common physician specialty is family medicine at 47.8 percent, followed by emergency medicine at 30.1 percent.

78 | OCTOBER 2014

Things to Know About Urgent Care

3

FACILITY AND LOCATION

About half of urgent care centers are freestanding buildings, and the other half are in retail shopping centers. Seventy-five percent of urgent care centers are located in suburban areas, 15 percent in urban areas and 10 percent in rural areas.

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MOST COMMON DIAGNOSIS AND TREATMENT

The most common diagnosis in an urgent care center was upper respiratory condition, and the most common procedure was wound treatment.

Fewer than 4 percent of patients needed a transfer to an emergency room.

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HOURS OF OPERATION

Eighty-five percent of urgent care centers are open seven days a week, with 95 percent closing after 7 p.m.

SERVICES PROVIDED

92.6 percent of urgent cares provide some kind of occupational medicine services, 93.3 percent process some lab tests onsite, 80.7 percent offer fracture care, including splinting and casting, and 79.3 percent provide sports and school physicals.

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SAVINGS OVER EMERGENCY ROOM VISIT

An estimated 13.7 to 27.1 percent of all emergency room visits could take place at an urgent care center or a retail clinic, generating a potential cost savings of approximately $4.4 billion annually.

LENGTH OF WAIT

Sixty-nine percent of urgent care centers have wait times of less than 20 minutes, 28 percent have wait times between 21 and 40 minutes and 3 percent have more than a 40 minute wait.

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COST SAVINGS PER VISIT

One factor driving the growth of urgent care centers in the health reform era is their lower costs than emergency department visits. The overall cost of care for an urgent care visit was $156, compared with $166 at physician offices and $570 at emergency rooms.

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