Med Monthly September 2014

Med Monthly September 2014

Medical Billing:

Partnering for Success pg. 42

THE TOP

9

Humorous, But Valid, ICD-10 Codes pg. 78

Hospital Services Provided

by Physician Assistants (PAs)

WHAT ARE THE RULES? pg. 46

A Plan of Action For Successful Medical Billing pg. 48

the

Medical Billing Options issue

contents

features

42 MEDICAL BILLING: Partnering for Success 46 HOSPITAL SERVICES PROVIDED BY PHYSICIAN ASSISTANTS (PAS) – What are the Rules?

48 A PLAN OF ACTION FOR SUCCESSFUL MEDICAL BILLING

RETIRED CLINICAL PHARMACIST FINDS HIS MONTANA MUSE

51

insight

research and technology

10 DEPRESSION: An Inflammatory Disease?

28 PRIMARY CARE TELEPHONE TRIAGE DOES NOT SAVE MONEY OR REDUCE PRACTICE WORKLOAD

12 ICD-10 AND YOUR PRACTICE 14 ASSURING CALL CENTER PERFORMANCE EFFECTIVENESS

practice tips

30 FDA ISSUES SAFETY COMMUNICATION ON LAPAROSCOPIC UTERINE POWER MORCELLATION IN HYSTERECTOMY AND MYOMECTOMY

16 HOW TO SURVIVE GO-LIVE: Practical Tips for a Successful EHR Implementation

32 EARLY TREATMENT BENEFITS INFANTS WITH SEVERE COMBINED IMMUNODEFICIENCY

20 A ‘DESIRE TO ASSIST’ CAN SOOTHE POTENTIALLY VOLATILE SITUATIONS

legal

22 NUMBER ONE SOLUTION TO STOP THE LOSS OF PATIENT REFERRALS

international 26 MORE THAN 50 CDC EXPERTS BATTLING EBOLA IN AFRICA MEDICAL BILLING: PARTNERING FOR SUCCESS

42

34 ACA PROHIBITS DISCRIMINATION AGAINST LICENSED PROVIDERS 36 IRS INCREASES 9.5% AFFORDABILITY THRESHOLD - OR DID IT? 38 CMS PROPOSES REGULATIONS: Changes to Physician Fee Schedule, Hospital Outpatient, and Ambulatory Surgical Center Policy and Payment

the arts 51 DREW BODNER: Retired Clinical Pharmacist Finds His Montana Muse

healthy living 54 CORN AND BLACK BEAN SALAD

in every issue 4 publisher’s letter 8 news briefs

60 resource guide 78 top 9 list

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

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publisher’s letter Med Monthly is excited to dedicate the September issue to ‘Medical Billing Options’. We have several contributing writers discussing practice billing options, techniques and collateral services. When it comes to your practice billings, you have two distinct choices. You can have an in-house billing person or department or you can outsource your billing. We discuss the pros and cons of each to assist in implementing billing methods that will make your practice more efficient.

Michelle Durner, President of Applied Medical Systems, discusses the financial impact outsourcing can offer your practice. Many times a practice will experience a reduction in total expense while adding dependability and expertise.

Your practice should discuss the benefits a billing service can provide and ask questions like: What does the price include?

(Ie: AR follow-up, denials, appeals, postage, coding review, etc.). Does the billing service carry Errors & Omissions (E&O) Insurance? A qualified third party billing company typically embodies the efficiency, productivity, technical and operation skills through technology and staff to master the “rules” that carriers utilize when adjudicating claims. Michelle stresses that your relationship with a third party billing company should be a partnership.

Lisa Shock, President & CEO of Utilizations Solutions in Healthcare, has an in-depth article about hospital services provided by physician assistants (PAs). Lisa discusses the rules governing a physician assistant’s services and ‘How Do You Bill’? Key points are made regarding shared billing. While a physician must provide a face-to-face service to a patient in addition to the PA’s service for a shared visit to be billed, it is appropriate for the PA to have performed the majority of care (as much as 90 percent, for example) for that patient. As long as the physician has some participation in the care of the patient, the combined services of both the physician and the PA may be attributed to the physician on the claim form.

Nidhi Behl Vats, a professional international medical writer, discusses A Plan of Action for Successful Medical Billing with conclusions that mustn’t be overlooked.

In the upcoming October issue, the editorial theme is “Urgent Cares”. Walk-in medical services can be found in most cities in the United States and medical insurance companies consider urgent cares to be a major gate-keeper in the primary care system.

Thank you for reading Med Monthly and telling your colleagues about us.

Philip Driver Publisher

4 | SEPTEMBER 2014

Med Monthly September 2014 Publisher Philip Driver Creative Director Thomas Hibbard Contributors Ashley Acornley, MS, RD, LDN. Stacy H Barrow Nidhi Behl Vats Amanda Chay Brian Clark, MBA Michelle Durner, CHBME Alexis Gopal M.D. Paul M. Hamburger Corey Kestenberg Laura E. Marusinec, M.D. Peter J Marathas, Jr. Amy N. Moore Carrie A. Noriega, M.D. Denise Price Thomas Julie Rusczek Julie Scott Allen Lisa P. Shock, MHS, PA-C Jeffrey Stewart, MBA Julie Stewart, PhD Fatema Zanzi

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

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

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

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

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

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.

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

Lisa P. Shock, MHS, PA-C is a PA who has practiced in primary care and geriatrics. She enjoys parttime clinical practice and is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering services to help implement and improve the utilization of PAs and NPs in the health care system. Contact her with questions at lisa@pushpa.biz WWW.MEDMONTHLY.COM |5

designer's thoughts From the Drawing Board Topics in the “Research and Technology” section of the September Med Monthly include an article about how phone triage in medical practices might not be as money-saving and work load reducing as first thought. The second piece explains a safety communication issued by the FDA regarding the laparoscopic uterine power morcellator that gynecologists use during hysterectomy and myomectomy. The final article reports that early transplantation of blood-forming stem cells is a highly effective treatment for infants with severe combined immunodeficiency (SCID).

Primary Care Telephone Triage Does Not Save Money or Reduce Practice Workload explains how research concluded that ‘telephone triage’ systems did not reduce overall medical practice workloads. Prof. Chris Salisbury, Professor of Primary Care at the University of Bristol, said: “Providing telephone triage has been promoted as a solution, on the assumption this would be more convenient for patients and save time for doctors. But our study showed that telephone triage didn’t save practices time, nor were patients more satisfied. Practices need to think carefully before introducing major changes to their appointment systems.”

In the article FDA Issues Safety Communication on Laparoscopic Uterine Power Morcellation in Hysterectomy and Myomectomy Carrie A. Noriega, MD reports on the FDA’s concerns that 1 in 350 women undergoing hysterectomy or myomectomy for the treatment of uterine fibroids will have an unsuspected uterine sarcoma. She offers that laparoscopic use of the uterine power morcellator is not the only treatment option for surgical removal of the uterus or fibroid, but rather one of many surgical choices that may be considered.

An NIH study has found that early transplantation of bloodforming stem cells is a highly effective treatment for infants with severe combined immunodeficiency (SCID). Early Treatment Benefits Infants With Severe Combined Immunodeficiency reports the study showed almost all 68 babies transplanted within the first 3.5 months of life survived, with 64 still alive five years after transplant. NIH also state future research will focus on developing transplant procedures that improve survival and immune recovery while avoiding harmful side effects.

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 | SEPTEMBER 2014

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news briefs

European Drug Pricing to Affect CMO Profitability and Future Performance Reports PharmSource As economic austerity forces Europe’s statefunded health-care systems to limit patient access to just those pharmaceuticals with clearly proven health and cost benefits, contract manufacturing organizations (CMOs) should prepare themselves for similar de-facto drug rationing in the United States.

That’s the warning found in the latest trend report presented by PharmSource. The report, Not So NICE: How Market Access Schemes Impact the CMO Sector, presents detailed research and analysis of how European drug-rationing policies could affect pharmaceutical manufacturing profitability and future operations in Europe, the United States and elsewhere.

PharmSource’s expert researchers examined indepth how European health systems in the United Kingdom and Germany have impacted drug approvals in the past several years as well as the consequences of those drug-approval regimens and pricing policy decisions for CMOs. “As efforts to control soaring health-care costs continue to intensify, the battle for formulary access is expanding from Europe to the United States,” said Saul Richmond, Ph.D., director of market intelligence for PharmSource. “CMOs must become aware that these pharmaco-economic issues are increasingly important to their future prospects.”

The 15-page trend report is provided as a complimentary benefit to subscribers of PharmSource Strategic Advantage service, the bio/pharmaceutical industry’s most respected outsourcing information web portal for contract drug development and manufacturing audiences.

This trend report is considered required reading for CMO executives, bio/pharmaceutical sourcing and procurement executives, and private equity investors.

To learn more about the report, contact PharmSource at +1 703-383-4903.  Source: http://www.newswiretoday.com/ news/144723/ 8 | SEPTEMBER 2014

Clues to Curbing Obesity Found in Neuronal ‘Sweet Spot’ Preventing weight gain, obesity, and ultimately diabetes could be as simple as keeping a nuclear receptor from being activated in a small part of the brain, according to a new study by Yale School of Medicine researchers.

Published in the Aug. 1 issue of The Journal of Clinical Investigation (JCI), the study showed that when the researchers blocked the effects of the nuclear receptor PPARgamma in a small number of brain cells in mice, the animals ate less and became resistant to a high-fat diet.

“These animals ate fat and sugar, and did not gain weight, while their control littermates did,” said lead author Sabrina Diano, professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale School of Medicine. “We showed that the PPARgamma receptor in neurons that produce POMC could control responses to a high-fat diet without resulting in obesity.”

POMC neurons are found in the hypothalamus and regulate food intake. They are the neurons that when activated make you feel full and curb appetite. PPARgamma regulates the activation of these neurons.

Diano and her team studied transgenic mice that were genetically engineered to delete the PPARgamma receptor from POMC neurons. They wanted to see if they could prevent the obesity associated with a high-fat, high-sugar diet.

“When we blocked PPARgamma in these hypothalamic cells, we found an increased level of free radical formation in POMC neurons, and they were more active,” said Diano, who is also professor of comparative medicine and neurobiology at Yale and director of the Reproductive Neurosciences Group.

The findings also have key implications in diabetes.

PPARgamma is a target of thiazolidinedione (TZD), a class of drugs used to treat type 2 diabetes. They lower blood-glucose levels, however, patients gain weight on these medications.

“Our study suggests that the increased weight gain in diabetic patients treated with TZD could be due to the effect of this drug in the brain, therefore, targeting peripheral PPARgamma to treat type 2 diabetes should be done by developing TZD compounds that can’t penetrate the brain,” said Diano. “We could keep the benefits of TZD without the side-effects of weight gain. Our next steps in this research are to test this theory in diabetes mouse models.”

Other Yale authors on the study included Lihong Long, Chitoku Toda, Jin Kwon Jeong, and Tamas Horvath.  Source: http://www.pressreleasepoint.com/clues-curbing-obesity-found-neuronal-sweet-spot

Researchers Develop Food Safety Social Media Guide To help protect public health, researchers from North Carolina State University have developed guidelines on how to use social media to communicate effectively about food safety..

“In a crisis context, the framework can be used by health officials, businesses or trade organizations affected by foodborne illness to help them reach key audiences with information that could be used to reduce the risk of foodborne illness,” says Dr. Ben Chapman, an

SOON COMING NTHLY O IN MED M

coming In the up e, Med 2014 issu r e b to c O l theme wil Monthly’s t Care be Urgen

associate professor at NC State whose research focuses on food safety and lead author of the paper outlining the guidance. Key audiences may include consumers, the food service industry, and corporate or government decision makers, among others.

The guidance can also help health officials and the private sector actively participate in online communities to discuss and explain issues related to food safety and ways to reduce health risks.

“The literature shows us that simply pushing out information isn’t an effective way to change people’s behavior,” Chapman says. “You need to engage in dialogue, and Twitter and Facebook are excellent places to have those conversations.”

For example, Chapman says, food safety experts can use Twitter to search for – and participate in – conversations people are already having about foodborne illness.

The researchers reviewed papers on food safety risk communication and papers on social media communication, drawing on both fields to establish a set of best practices that form the foundation of the guidance.

“I get questions about social media and food safety all the time, so there’s a clear demand for this sort of guidance,” Chapman says. “But this is a basic framework. The guidance will continue to evolve over time, just as the field of social media itself is constantly evolving.”

“Social media may be the catchphrase today, maybe it’s big data tomorrow, but the underlying goal is fewer sick people,” said Dr. Douglas Powell of powellfoodsafety.com, a co-author of the paper. “Twitter wasn’t around 10 years ago but people still got sick. We need to adapt new tools as they arrive to the food safety sphere.”

The research team currently has three related research projects under way. Two projects are looking at food safety communication on YouTube and among parenting bloggers, respectively, while the third focuses on using social media to identify and respond to norovirus outbreaks.

The paper on the guidance, “Potential of social media as a tool to combat foodborne illness,” is published in Perspectives in Public Health. The paper was co-authored

by Benjamin Raymond, who is a graduate student at NC State. The research was funded by Agriculture and Food Research Initiative Competitive Grants, nos. 2012-6800330155 and 2011-68003-30395 from the USDA National Institute of Food and Agriculture.  Source: http://www.pressreleasepoint.com/researchersdevelop-food-safety-social-media-guide WWW.MEDMONTHLY.COM |9

insight

Depression: An Inflammatory Disease?

By Alexis Gopal M.D.

The tragic and untimely death of actor/comedian Robin Williams has catapulted the subject of depression once again into media, and into the forefront of American consciousness. The development of SSRI’s and SNRI’s was an enormous breakthrough in the treatment of depression, yet still, there is little known about the mechanism of the illness, and more effective treatments.

There is increasing evidence that inflammation may be a key factor in the development of depression. Cytokines, in particular, have been implicated in the evolution of 10 | SEPTEMBER 2014

depression. According to an article published in the August 6, 2014 issue of the Journal of the American Medical Association, studies have shown that depressed patients, irrespective of their physical health, had increased levels of inflammatory markers in their blood and cerebrospinal fluid. These markers include interleukin-6, tumor necrosis factor, and c-reactive protein. The article also states that there is a correlation between inflammation and treatment resistant depression, which accounts for one-third of all depressed patients. Research data shows that inflammatory

agents impair the action of traditional anti-depressant medications.

The results of The Avon Longitudinal Study of Parents and Children, conducted in Avon County, England, were recently published in the August 13, 2014 edition of JAMA Psychiatry. The study concluded that higher levels of interleukin-6 in children are associated with a higher risk of depression and psychosis as adults. One of the authors of this study, Dr. Golam Khandaker, was recently noted in Time Magazine as comparing our immune systems to thermostats. “Most of the time, thermostats are turned low and turned up high when we have an infection, but for some people, the thermostat is always turned up high.

For these people, they may be more likely to have chronic syndromes, and be more likely to suffer depression.”

New research on treatment for depression has focused on anti-inflammatory agents. A study conducted by Dr. Andrew Miller and colleagues at the Emory University School of Medicine was published in JAMA Psychiatry in 2013 in which the biologic infliximab, a tumor necrosis factor antagonist, was used to treat 60 adult patients with moderately treatment resistant depression. Although infliximab did not prove to be more effective than placebo in treating the depression, the authors found, after categorizing patients on the basis of inflammatory markers,

those patients with high baseline C reactive protein had the best response to infliximab. Miller concluded that a biomarker of inflammation like CRP may predict which patients will respond to immunotherapy in depression.

The implications of Miller’s study may also have bearing in finding treatments for other inflammatory diseases often found in patients with depression, such as heart disease, diabetes and cancer. Further studies need to be done, but this is an exciting trend in research of psychiatric disorders.

Until an effective anti-inflammatory treatment is found, health guru Dr. Andrew Weil is a very strong proponent of an anti-inflammatory diet in patients with depression, that is, a diet low in processed foods, with an abundance of organic fruits and vegetables, whole grains, fish high in omega-3 fatty acids like salmon, and antioxidant supplementation.  Sources: http://www.drweil.com/drw/u/ART02012/antiinflammatory-diet http://time.com/3108739/depression-cause-inflammation/ Neuroscience, 2013 Aug 29; 246: 199-229 Dialogues Clin Neurosci 2011; 13(1): 41-53 JAMA 2014 Aug 6; 312: 474-476

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0 1 D

insight

IC

and Your

Practice

By Centers for Medicare & Medicaid Services (CMS) An Introduction The ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD10 code sets. Let’s provide some background on the ICD-10 transition, general guidance on how to prepare for it, and resources for more information.

About ICD-10

ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification / Procedure Coding System) consists of two parts: 1. ICD-10-CM for diagnosis coding 2. ICD-10-PCS for inpatient procedure coding ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code 12 | SEPTEMBER 2014

sets is similar.

ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD10PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.

The transition to ICD-10 is occurring because ICD-9 produces limited data about patients’ medical conditions and hospital inpatient procedures. ICD-9 is 30 years old, has outdated terms, and is inconsistent with current medical practice. Also, the structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full.

Who Needs to Transition

ICD-10 will affect diagnosis and

inpatient procedure coding for everyone covered by Health Insurance Portability Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims. The change to ICD-10 does not affect CPT coding for outpatient procedures.

Health care providers, payers, clearinghouses, and billing services must be prepared to comply with the transition to ICD-10, which means: l

All electronic transactions must use Version 5010 standards, which have been required since January 1, 2012. Unlike the older Version 4010/4010A standards, Version 5010 accommodates ICD-10 codes. l ICD-10 diagnosis codes must be used for all health care services provided in the U.S., and ICD-10 procedure codes must be used for all hospital inpatient procedures.

Claims with ICD-9 codes for services provided on or after the compliance deadline cannot be paid.

Transitioning to ICD-10

It is important to prepare now for the ICD-10 transition. The following are steps you can take to get started: Providers – Develop an implementation strategy that includes an assessment of the impact on your organization, a detailed timeline, and budget.

Check with your billing service, clearinghouse, or practice management software vendor about their compliance plans.

Providers who handle billing and software development internally should plan for medical records/ coding, clinical, IT, and finance staff to coordinate on ICD-10 transition efforts. l Payers – Review payment policies since the transition to ICD-10 will involve new coding rules.

Ask your software vendors about their readiness plans and timelines for product development, testing, availability, and training for ICD-10. You should have an implementation plan and transition budget in place. l Software vendors, clearinghouses, and third-party billing services – Work with customers to install and test ICD-10 ready products. Take a proactive role in assisting with the transition so your customers can get their claims paid. Products and services will be obsolete if steps are not taken to prepare. l

ICD-10 Basics for Medical Practices The ICD-10 transition takes planning, preparation, and time, so medical practices should continue working toward compliance. The following quick checklist will assist you with preliminary planning steps.

Identify your current systems and work processes that use ICD-9 codes. This could include your clinical documentation, encounter forms/ superbills, practice management system, electronic health record system, contracts, and public health and quality reporting protocols. It is likely that wherever ICD-9 codes now appear, ICD-10 codes will take their place.

Talk with your practice management system vendor about accommodations for ICD-10 codes. l Confirm with your vendor that your system has been upgraded to Version 5010 standards, which have been required since January 1, 2012. Unlike the older Version 4010/4010A standards, Version 5010 accommodates ICD-10 codes. l Contact your vendor and ask what updates they are planning to make to your practice management system for ICD-10, and when they expect to have it ready to install. l Check your contract to see if upgrades are included as part of your agreement. l If you are in the process of making a practice management or related system purchase, ask if it is ICD-10 ready.

Discuss implementation plans with all your clearinghouses, billing services, and payers to ensure a smooth transition. Be proactive, don’t wait. Contact organizations you conduct business with such as your payers, clearinghouse, or billing service. Ask about their plans for ICD10 compliance and when they will be ready to test their systems for the transition.

Talk with your payers about how ICD-10 implementation might affect your contracts. Because ICD-10 codes are much more specific than ICD9 codes, payers may modify terms of contracts, payment schedules, or reimbursement.

Identify potential changes to work flow and business processes. Consider

changes to existing processes including clinical documentation, encounter forms, and quality and public health reporting.

Assess staff training needs. Identify the staff in your office who code, or have a need to know the new codes.

There are a wide variety of training opportunities and materials available through professional associations, online courses, webinars, and onsite training. If you have a small practice, think about teaming up with other local providers. For example, you might be able to provide training for a staff person from one practice, who can in turn train staff members in other practices. Coding professionals recommend that training take place approximately six months prior to the ICD-10 compliance deadline.

Budget for time and costs related to ICD-10 implementation, including expenses for system changes, resource materials, and training. Assess the costs of any necessary software updates, reprinting of superbills, trainings, and related expenses.

Conduct test transactions using ICD-10 codes with your payers and clearinghouses. Testing is critical.

You will need to test claims containing ICD-10 codes to make sure they are being successfully transmitted and received by your payers and billing service or clearinghouse. Check to see when they will begin testing, and the test days they have scheduled.  This was prepared as a service to the health care industry and is not intended to grant rights or impose obligations.

The information provided is only intended to be a general summary.

It is not intended to take the place of either the written law or regulations.

We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents.

Source: http://www.cms.gov/Medicare/ Coding/ICD10/ProviderResources.html WWW.MEDMONTHLY.COM |13

insight

Assuring Call Center Performance Effectiveness

By Brian Clark, MBA, TriHealth, Jeffrey Stewart, MBA, MS, Vitas Hospice Care, and Julie Stewart, PhD, Xavier University

Call center professionals have become critical to the success of many hospitals and physician practices serving as customer relationship experts who can assist callers in navigating a complex health care system and who provide physicians with accurate, relevant, and timely information to help them treat patients effectively.

As they create crucial first and subsequent impressions, the way they execute their roles may be critical in a patient’s judgment of a medical organization’s competency 14

| SEPTEMBER 2014

while also being instrumental in scheduling appointments for which medical practices receive income.

This article identifies performance goals for call centers, success measures by which to evaluate their performance, criteria for hiring call center agents, and a program to motivate call center workers to perform their roles effectively. It is based on research done on call centers, at the request of an urban health care organization.

Performance goals: In our analysis we identified five critical performance goals for call centers: • Complete and accurate patient information capture • Appropriate record keeping for risk mitigation • Effective interpersonal communication with all stakeholders • Patient utilization of related fee-paying services • Call center employee satisfaction and retention

Success measures:

To achieve these goals, hospital and health system call centers should have managers evaluate the agents monthly for achieving the goals of the health system and ensuring patient satisfaction.

Managers and supervisors need to be evaluating at least 10 calls per agent per month for: • Accurate data entry, including verifying caller’s information, such as name, return telephone number, purpose of call, outcome of call, and appropriate routing and scheduling decisions, all critical measures of effectiveness • The number and length of calls as well as calls abandoned because of wait time • Using correct terminology, grammar, spelling, punctuation and diction in recording information, especially as messages are permanently stored • The percentage of calls ending in fee-generating appointments for services To ensure patient satisfaction, contact a sample of callers to gain feedback on call center performance. Either through automated survey tools or manual sampling, patient satisfaction surveys should evaluate the agent’s ability to: • Create positive initial and final impressions • Practice good listening and questioning skills • Demonstrate empathy and courtesy • Gather accurate data Updating agents with critical feedback on their ability to deliver on patient satisfaction and hospital system performance goals needs to be communicated in a timely manner to agents through the use of dashboards and reporting. Providing agents with accurate, relevant and timely performance and satisfaction data through a ‘traffic light’ dashboard encourages agents to continuously improve and meet explicit success criteria and performance goals. Additionally, managers have a consistent platform to use for agent evaluation.

Training:

To improve performance, call centers need to train with both performance and interpersonal goals. At the performance level, use examples from your call center data analysis to illustrate best practices in recording and routing

information. Agent training needs to both reinforce desired processes for the routine calls with exercises that emphasize standard procedures and review a few specific outlier complex cases that demonstrate non-routine thinking and encourage patient satisfaction without sacrificing performance goals.

To improve interpersonal skills, agents should routinely complete exercises around answering calls with a positive attitude, ending calls with a scheduled appointment, when appropriate, and dealing with emotional and abusive callers; doctor, nurses, and other medical professionals; and one another in a positive, collaborative environment.

Hiring practices:

Performance-based hiring practices are critical to creating a successful call center. Explicit and escalating goals for new hires encourages decreased time until they have the performance and productivity achievements of seasoned employees. Hiring needs to be based on an assessment of skills required on the job, including typing & data entry, computer navigation, listening, empathy, and persuasion skills as well as grammar, spelling, and punctuation, and phone voice delivery.

Motivational practices:

Maintaining morale and call center spirit is a key to motivating employees to continuously improve and meet performance goals and improve patient satisfaction. Several ideas for motivating agents include: • Posting a large calendar where employees can self-identify celebratory events: such as birthdays, births, perfect attendance, service anniversaries, and retirements; • Using a bulletin board, changed weekly, to highlight recognitions, post pictures, and publicize message center successes; • Planning events where physicians, nurses, and other medical professionals meet with message center personnel; and • Providing incentives for excellent performance, such as for each scheduled appointment that results in payment to a medical center; perfect attendance; top of class capture rate of information and other clear measures of quality as identified by call center managers and agents.

It is a modern mantra that “if you can’t measure it, you can’t manage it.” Given the central role that call centers can serve in promoting hospital and physician practices goals, establishing measures for call center success, both in terms of performance and interpersonal skills, and using that information to create appropriate training, hiring, and motivational practices to improve call center performance are keys to making medical call centers’ investments pay strong dividends.  WWW.MEDMONTHLY.COM | 15

practice tips

How to Survive Go-Live: Practical Tips For a Successful Electronic Health Record (EHR) Implementation

By Laura E. Marusinec, MD, Urgent Care Pediatrician

16

| SEPTEMBER 2014

Introduction Is it a coincidence that “go-live” rhymes with “survive”?

Those of you who have completed an EHR implementation understand. As a pediatrician who has been involved with two go-lives, both as the provider and as the supporter, I have learned a lot. My own go-live was about 18 months ago, and although I have become considerably knowledgeable and efficient over that time, I continue to improve. Looking back, there were many things done very well for our implementation, but there were also quite a few things that could have been done better. Approximately 6 months after my implementation, I was able to support another group in theirs. Because of my experience, I was able to give them valuable education, support, and tools to make theirs go a little smoother than ours. I am pleased to share with you some tips that may be helpful to those of you who are anticipating an EHR implementation or have recently begun your journey with optimizing the use of your new EHR.

Part One - Preparation Start early. Get the team familiar with the EHR far ahead of time, at least a few months. Provide structured education, tailored to their role as much as possible.

But, more importantly, give them plenty of time to practice, to “play’”. In medicine, most of our learning is accomplished by doing. It is the same with using an EHR. Of course, providers often learn best when working with real encounters, but practice time before the stress of the “real-world” can be very helpful. Don’t focus too much on the details, but rather get used to navigating the tools available. Some of the education can be on one’s own, but some should also be in small groups with peer mentors, allowing providers to share their experiences and tips with each other.

Use providers and other staff “superusers” as educators and support as much as possible, especially those with real-life experience with using the EHR in similar workflows. As I was fortunate to have used the same EHR in a past practice and had an interest in educating and supporting others, I was the perfect person to support my own group as well as another. After brief initial training, I joined in the formal classes, providing real-world insight and examples. I was at their side during go-live. I was available to answer questions on a daily basis, either working directly with a provider, or by a quick phone consult when needed. If you aren’t fortunate to have a provider in your group with experience in your specific EHR, you may have providers with experience with other EHRs who are able to work with information technology (IT) to become proficient, or you may look at hiring a provider consultant to fill the role.

‘‘

“In medicine, most of our learning is accomplished by doing. It is the same with using an EHR. Of course, providers often learn best when working with real encounters, but practice time before the stress of the “realworld” can be very helpful.”

Try to anticipate problems that may come up. One of our providers has a sight impairment. We were able to provide him with a program to increase screen text size and readability. Other providers had little prior keyboarding skills. Tutorials were used to increase their efficiency. Of course, there are many technical issues that need to be considered, such as use of laptops versus desktops and placement of these devices, and how they may affect workflow and interaction with patients. Internet service must be optimal-no one wants to deal with downtime!

Cut back schedules if able. In urgent care, we did not have much ability to reduce our schedules, though we were able to increase staffing somewhat. The primary care group reduced their schedules by about 50% for the first two weeks, which significantly reduced stress and gave them more opportunities to learn while the full support team was present. Most groups gradually worked back to full schedules within a few weeks. By starting a little slower, you are usually able to get back to close to full productivity faster and gain valuable tools for efficiency for the future.

And, your patients will appreciate it. The first few days, each visit often took over an hour. Imagine if you had 20 or 30 patients scheduled!

Part Two - Go-live This is it! Go-live is most likely going to be stressful, chaotic, scary, challenging, and exciting. When you look back, it will likely be much better AND much worse than you thought it would be.

Know it is temporary: The learning curve for a new EHR is actually quite steep. We had full-time support for the first two weeks. The first day was indeed stressful, chaotic, and exhausting, but after the first chart was closed, then all of them for the day, there was much celebration! From day two to week two, miles were gained. Even though it often continued on page 18 WWW.MEDMONTHLY.COM | 17

continued from page 17

takes months to really feel knowledgeable and efficient, with the right preparation and tools, it doesn’t have to be painful for long.

Share and communicate with each other. As a provider supporter, I worked directly with the consulting support team. Each day, many “tips and tricks” were sent back and forth with valuable information. We learned from each other’s mistakes and successes and worked as a team for the benefit of the group. When faced with a problem we couldn’t solve, we reached out to the team for answers. In addition, each site had team “huddles” daily to discuss the successes and challenges of the day and plan for the next.

Again, use providers and other staff superusers when able. I cannot express enough how invaluable it is to have experienced and knowledgeable providers and staff working directly with their peers. While the support team had excellent technical information, providers know about the daily workflow and issues that providers face and were able to answer questions with “This is how I do it.” versus “This is how I was told to do it.”

Part Three - Post Go-live Re-evaluate workflow. Workflows and methods that worked on paper may not work with an EHR, at least not as efficiently. An EHR affects every process involved in a patient visit, from registration, nursing, orders and medications, charges and billing, patient discharge, to provider documentation. All of these need to be reevaluated frequently over a period of many months.

Establish an EHR provider/workflow group with regular meetings and goals. Our group invited those providers and staff who had expertise and interest in improving workflow and efficiency. Initially, we were putting out fires - building workflows, documentation tools and templates, and problem solving. We met frequently, often weekly, for the first few months and then reduced to monthly. About one year later, we began meeting every few months to continue to work on efficiency issues, and after 18 months, we are still meeting infrequently.

Provide one-on-one support as well as group support.

A combination of group meetings to share important workflow and efficiency strategies and direct one-on-one support is optimal. Some providers need much more support than others, and direct support from their peers, often at their side during office hours, can be invaluable.

Some providers will have less computer skills or will even be quite resistant to the significant changes required and would most benefit from direct peer support. Eighteen months later, one provider continues to ask for my help 18 | SEPTEMBER 2014

when we are working together, and others contact me with specific concerns as they come up.

Develop templates, preference lists, and tools to personalize. Even if the training and initial support is somewhat tailored to your specialty, personalization is a huge factor in improving efficiency and satisfaction with using an EHR. Everyone has a slightly different approach to the practice of medicine, and this is also true of how they utilize an EHR. Some providers like to document with more free text, while others prefer more pre-built templates or lists to choose from. The use of dictation may be an option for some. I have developed preference lists for medications and common diagnoses, along with many ‘smart phrases’ which enter frequently used text with just a few characters entered. I share these tools with my peers and with new staff, who also find them invaluable for efficiency and thoroughness.

Final Thoughts The right EHR can be a valuable tool for your medical practice. And, for most, it is no longer optional. It can be a big factor in your financial security, both positively and negatively. There are considerable costs involved in implementing and using an EHR, and soon documentation, coding, and billing through the EHR will be tied to reimbursement and incentives as well as possible fines if not done correctly. Provider productivity, which is enhanced by EHR efficiency, is directly related to compensation for many. For these reasons as well as many others, it is of utmost importance that EHR implementation and optimization be done well. Hopefully, the tips provided will help you on your path to success.

And if you haven’t already, practice your keyboarding skills!  Laura Marusinec 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.

WWW.MEDMONTHLY.COM | 19

practice tips

A ‘Desire to Assist’ Can Soothe Potentially Volatile Situations By Denise Price Thomas

A

man and his wife entered the practice, he was loud and obviously upset, that message was very clear. He was carrying a large stack of bills that he eagerly threw down on the front desk. The receptionist attempted to assist, but had no luck. He was getting louder by the minute and the receptionist knew he was not going to listen to her any longer. Thus, Super Woman at extension 10 was paged (that would be me, the surgical practice administrator).

I invited the couple to join me in my office. (I wanted him off the stage, away from the audience. We certainly didn’t need him signing autographs in the lobby.) As we were walking I said, “I understand that you have some questions about your statements, may I look over these please?” He growled, “You are wrong! I do not have questions, I am mad that I keep getting all these bills!” I said, “I understand exactly how you feel. I’d much rather receive a check in the mail than a bill any day. Would you allow me a few minutes to review these so that we can figure them out together? We need to make sure your insurance has been filed correctly and has paid correctly.

Meanwhile, may I get you some water or a soft drink while you wait?” (I was hoping for a cool down period.)

I began looking over the stack and said, “I sure hope you are feeling better since your surgery” and he said he was. He went on to say that he had emergency surgery and therefore had only “seen” the emergency department physician and then the surgeon. He was confused as to why he would be getting bills from people he hadn’t even seen. I reviewed each one and began explaining, starting with the bill from the emergency department, the surgeon’s

20 | SEPTEMBER 2014

fee, then the pathologist fee and why this was necessary, the radiologist whose expertise helped to determine the problem, then on to the anesthesiologist bill and he hit the ceiling! He said, “you mean to tell me this doctor charged this much JUST TO PUT ME TO SLEEP?!? That is RIDICULOUS!” I looked over at his seemingly sweet, very quiet wife then back at the patient and I said, “Actually no sir, he didn’t charge you anything to put you to sleep, he only charged you to wake you up. Now, THAT was worth it, don’t you think?”

After a second, he said, “Well, when you put it like that young lady, I guess it is!” He even smiled! His wife, on the other hand, leaned over and whispered to me, “Before his next surgery, can we talk about that?”

No one wishes to pay for something they do not understand. Sometimes it only takes a few moments to review and explain, which also builds trust and rapport.

We were “buddies” after that. Of course anytime they had a question, they were asking for me, which I considered a compliment.

While presenting a seminar on “Dealing with the Difficult” I told this story and had one person say to me, “I think that is condescending.” (Merriam-Webster: showing that you believe you are more intelligent or better than other people). I personally feel that when I sincerely offer my time, engage in eye contact, offer ears to listen and a heart that is open…..most people sincerely appreciate that. I have learned that there are few people that will TAKE the time to understand where the other person is coming from with a desire to assist. I am one of those. I am proud to make a difference. 

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practice tips

Number One Solution to Stop the Loss of Patient Referrals

By Amanda Chay WhiteCoat Designs 22 | SEPTEMBER 2014

With more than half of U.S. physicians employed by hospital systems and managed care networks, independent practices are experiencing a significant loss in referrals due to the pressure to keep these patients in the network. According to the Medical Group Management Association, the percentage of medical practices owned by hospitals has soared from 25.6% to 49.5% between 2005 and 2008. The result is that patient referrals to private practices have been dwindling significantly. This trend continues to increase as hospitals are racing to buy additional primary care practices in this competitive healthcare market. Private practices are feeling the pressure in the form of decreased patient referrals and a lack of meaningful referring relationships. The solution to this concerning dilemma is the establishment of a physician liaison program.

A physician liaison program is designed to grow patient referrals, enhance referring relationships, and increase community exposure. This is achieved with the strategic use of a physician liaison. The physician liaison’s role is to represent your medical practice in the community while strengthening relationships, providing valuable customer service, and addressing concerns as they arise. While not all liaisons are created equal, a good liaison has the professional training and experience to tackle the challenges presented in the field. Hospitals have used physician liaison programs for years to increase referring relationships, but most physicians haven’t considered implementing this marketing strategy on the practice level.

In a 2013 survey from Clinical Advisory Board Physician Survey, 66% of physicians said they were “very unlikely” to change their current referrals without a physician liaison actively communicating and building relationships with them. Establishing new relationships and strengthening current relationships with referring practices are key components of a physician liaison program. The physician liaison focuses on growing new relationships by identifying the needs of the new practice and responding to the areas of concern. Enhancing established referral relationships is achieved through listening to feedback from referral providers and physicians. If problems arise, the physician liaison is available to quickly address the issues and make immediate changes.

A physician liaison program is the most important marketing strategy to develop these crucial connections in the community and to create a robust presence in your targeted market. Time-strapped physicians simply don’t have the availability to network and establish referring relationships with other specialists and primary care providers. Whether you create your own in-house physician liaison program as hospitals do (internal program) or hire a third party company to execute it for you (external program), a physician liaison program can be a highly successful marketing strategy that often pay for themselves in new patient referrals.

Internal Physician Liaison Programs Drawing inspiration from the original hospital model, an internal physician liaison program is implemented and managed by the practice itself. After a period of setup involving liaison training, support and education, the program will begin to strategize on increasing referrals with the internal physician liaison.

There are many benefits to running an internal physician liaison program, including the establishment of a permanent program that is maintained within the practice. If changes need to be made to the program or the liaison, they can be immediately implemented. In addition, the program will continued on page 24 WWW.MEDMONTHLY.COM | 23

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maintain control over the referral data, a vital source of information.

Referral data lists practice and provider information along with the referral trends that the liaison program produces. This data alone provides practices with vital statistics that can be utilized to show practice trends.

An internally run program will have a liaison that is dedicated solely to the practice and doesn’t split his/her time representing other practices. Also, the liaison can work on a flexible basis as either a part-time or full-time employee thus potentially assigning other responsibilities to the liaison, such as marketing and social media.

Practices may feel that the task of establishing internal programs is a daunting task, but there are medical marketing companies that will assist with the implementation of these programs. While there is an investment cost associated with this type of program, the ROI usually far outweighs the initial start-up costs of implementing an internal program.

One example of a practice that chose to implement an internal physician liaison program is at an infertility practice in Florida. To combat the decline of patient referrals from hospital-owned obstetric and gynecology practices, this practice felt that it was necessary to establish a physician liaison program with setup assistance of an outside medical marketing company. While the industry standard for new patient growth is a 5% to 10% yearly increase, this infertility practice experienced a 76% average yearly growth in new patients across a span of four years. The infertility practice’s short-term investment in the creation of this program quickly paid for itself in the form of substantial long-term growth results.

External Physician Liaison Programs External physician liaison programs differ from programs run internally in their delivery method. External programs utilize an outside company to secure a physician liaison on a contractual basis.

The liaison is an employee of the outside agency and not the practice.

The liaison goes out into the community and represents the practice in the same manner without the overhead cost of an internal employee.

While hiring an outside contractor may seem simpler, there are a few downsides to this approach. The external liaison will likely represent several other practices in the community at the same time. In addition, your practice may or may not have ownership of the important referral data once the program ends. By relying on an external source for referral building, your practice won’t be involved in the day-to-day operations of the liaison. In the end, it is more challenging to control the quality of the liaison’s interactions (i.e. making sure the liaison interacts with providers a minimum of 30% of the time vs. just handing out business cards to the front desk).

In terms of costs, an internal program carries more up-front expenses while an external program may be more costly long term.

Therefore, the decision really comes down to which is the best format for your practice. Whether your chose to implement a physician liaison within your practice or with outside assistance, building a strong referral base through a physician liaison program is a vital marketing strategy that can stop the loss of referrals to the hospital systems.  24 | SEPTEMBER 2014

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international

More Than 50 CDC Experts Battling Ebola in Africa

Hundreds of public health professionals working 24/7 in support 26 | SEPTEMBER 2014

The Centers for Disease Control and Prevention now has more than 50 disease detectives and other highly trained experts battling Ebola on the ground in West Africa – successfully deploying in less than two weeks the surge of help it promised within 30 days.

CDC’s Emergency Operations Center is also at its highest level of alert. This means more than 350 CDC U.S. staff are working on logistics, communications, analytics, management, and other support functions to support the response 24/7.

“We are fulfilling our promise to the people of West Africa, Americans, and the world, that CDC would quickly ramp up its efforts to help bring the worst Ebola outbreak in history under control,” said CDC Director Tom Frieden, M.D., M.P.H. “We know how to stop Ebola. It won’t be easy or fast, but working together with our U.S. and international partners and country leadership, together we are doing it.”

CDC currently has 55 people deployed to West Africa to fight Ebola’s spread: 14 in Guinea, 18 in Liberia, 16 in Sierra Leone, and seven in Nigeria. While the number of CDC experts may change slightly from day to day, given staff rotations, more than 60 CDC personnel are expected to remain in these four countries continuously.

“CDC’s public health experts in West Africa are working closely with our U.S. Government and international partners as part of this worldwide emergency response to the Ebola outbreak,” said Inger Damon, M.D., Ph.D., incident manager for the CDC Ebola response. “Our primary goal is to bring to an end the suffering of so many as well as develop the public health infrastructure there to help prevent future outbreaks.”

The focus of the CDC effort is on stopping the outbreak. This means finding every person who is sick with Ebola and tracing their contacts. This “contact tracing” involves finding

everyone who may have been exposed to a person with Ebola and checking for signs of illness every day for 21 days. Ebola virus can remain in the body for weeks before making a person sick. If any of the people who were in contact with a person sick with Ebola develops a fever or other Ebola symptoms, that person is isolated and treated and the cycle starts again -- and all of that person’s contacts must be traced and followed for 21 days.

This response in Africa involves many healthcare personnel and community health workers. While in West Africa, CDC experts train and coordinate these workers, collect the outbreak information they gather, and analyze these data to make the best use of available resources to break the chain of Ebola transmission. CDC laboratory technicians are helping to set up labs and train lab workers to conduct Ebola testing. Other CDC staff work to educate people living in these countries on how to avoid Ebola infection and on the value of seeking help early if they develop symptoms of disease that could be Ebola. Still other CDC public health professionals work with airport and border personnel in the West African countries to keep sick people in Ebola-affected areas from traveling.

CDC’s Ebola efforts include preparing the U.S. CDC’s Ebola effort is not all overseas. A disease threat anywhere in the world is a threat everywhere in the world, and CDC is preparing for any possibility, including that a traveler might become ill with Ebola while in the United States. Although Ebola poses very little or no risk to the U.S. community at large, CDC and healthcare providers in the United States need to be prepared. Therefore, CDC has been: • enhancing surveillance and laboratory testing capacity in states to detect cases • developing guidance and tools for health departments to conduct public health investigations

• providing recommendations for healthcare infection control and other measures to prevent disease spread • providing guidance for flight crews, emergency medical units at airports, and Customs and Border Patrol officers about reporting ill travelers to CDC • disseminating up-to-date information to the general public, international travelers, and public health partners Currently, CDC and the Department of Defense have the only U.S. laboratories capable of conducting diagnostic testing to confirm that a patient has Ebola and not some other illness. That is about to change. Additional labs across the United States – part of the Laboratory Response Network (LRN) established by CDC – will soon have the technology to conduct Ebola diagnostic testing on acute-phase specimens. These labs have received detailed guidance on the inactivation and safe handling of samples potentially carrying Ebola virus. Once they demonstrate that they can accurately detect or rule out Ebola in a sample, these labs will be capable of rapidly providing presumptive diagnosis for ill people suspected of having Ebola. These rapid presumptive results will then be definitively confirmed by laboratories at CDC. CDC is confident that U.S. hospitals are capable of safely managing a patient with Ebola when carefully following CDC’s infection control recommendations and isolating that patient in his or her own room.

“Our health care professionals can safely manage an Ebola patient,” says CDC infection control expert David Kuhar, M.D. “What we recommend to prevent transmission of Ebola in hospital settings is similar to what we recommend for other infectious diseases spread by direct contact and possibly droplets.”  Source: http://www.cdc.gov/media/ releases/2014/p0813-ebola.html WWW.MEDMONTHLY.COM | 27

research & technology

Primary Care Telephone Triage Does Not Save Money or Reduce Practice Workload

Demand for general practice appointments is rising rapidly, and in an attempt to deal with this, many practices have introduced systems of telephone triage. Patients are phoned by a doctor or nurse who either manages the problem on the phone, or agrees with the patient whether and how urgently they need to be seen.

28 | SEPTEMBER 2014

A new large study, published in The Lancet on August 4, 2014 and funded by the UK National Institute for Health Research (NIHR), has investigated the potential value of telephone triage for patients and for the NHS. It concluded that patients who receive a telephone callback from a doctor or a nurse following their request for a

same-day consultation with a GP are more likely to require further support or advice when compared to patients who see a doctor in person. The research concluded that ‘telephone triage’ systems did not reduce overall practice workload.

These findings, from a team led by the University of Exeter Medical School, are important as telephone triage is becoming increasingly popular in general practice as a response to managing patient care.

The research was carried out in collaboration with the Centre for Academic Primary Care at the University of Bristol, the University of Oxford, the University of East Anglia and the University of Warwick. It was funded by the National Institute for Health Research Health Technology Assessment Programme.

Overall, the ESTEEM study – one of the first robust investigations in this field – concluded that telephone triage by a doctor or a nurse only results in a redistribution of practice workload, not a reduction. It also discovered that telephone triage is no more expensive or cheaper than care provided via traditional face-to-face appointments.

The ESTEEM trial involved more than 20,000 patients across 42 doctor surgeries in England. Practices were randomly assigned to continue delivering care in their usual way, or to change to a system using a doctor or nurse to call the patient back to offer help or advice following the patient’s request for a consultation with a GP ‘that same day’ in the practice.

The research lasted for around two to three months in each practice. The researchers examined patient’s consulting patterns in the 28 days following their initial same-day consultation request.

Practices offering triage by a GP saw an increase of 33 per cent in the total number of patient contacts amongst patients who had requested a same-day appointment compared to patients seen under usual care. For practices offering nurse triage the increase in the total number of contacts was 48 per cent.

The researchers identified that there was a redistribution of GP workload associated with introducing triage. In practices providing GP triage, GPs had 39 per cent fewer face-to-face consultations, whilst in practices providing nurse triage, GPs had 16 per cent fewer face-to-face consultations. Thus introducing GP triage was associated with a redistribution of GP workload from face-to face consultations to telephone consultations, and introducing nurse triage was associated with a redistribution of workload from doctors to nurses.

Around half of the patients seen in ‘usual care’ had no further contact with the health care system in the 28 days following their initial consultation. However, 75 per cent of patients seen in practices operating a GP telephone triage systems did make further contact, and where nurse telephone triage was in operation, 88 per cent of patients

made further contact.

Overall, patients reported a good experience of care provided by the study practices, although patients from practices providing nurse triage were slightly less satisfied than those from the other practices.

Prof Chris Salisbury, Professor of Primary Care at the University of Bristol, said: “Patients find it difficult to get an appointment with their GP, and many general practices are struggling to meet the demand to be seen on the same day.

“Providing telephone triage has been promoted as a solution, on the assumption this would be more convenient for patients and save time for doctors. But our study showed that telephone triage didn’t save practices time, nor were patients more satisfied.

“Practices need to think carefully before introducing major changes to their appointment systems. This study highlights the importance of evaluating proposed changes to general practice before they are introduced, as meeting the increasing demand for appointments is a complex problem which may not have a simple solution.”  Source: http://www.pressreleasepoint.com/primary-caretelephone-triage-does-not-save-money-or-reduce-practiceworkload

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

Home Grown/Nationally Known www.denisepricethomas.com denisepricethomas@gmail.com 704-747-8699 WWW.MEDMONTHLY.COM | 29

research & technology

FDA Issues Safety Communication on Laparoscopic Uterine Power Morcellation in Hysterectomy and Myomectomy

By Carrie A Noriega, MD

30 | SEPTEMBER 2014

Recently, the FDA issued a safety communication regarding the laparoscopic uterine power morcellator that gynecologists use during hysterectomy and myomectomy. This device has been used since 1993 to fragment a uterus or fibroid into smaller pieces so that they may be removed through incisions only a few centimeters in length. The concern is that during the fragmentation there is a small risk that unsuspected cancerous tissue, most specifically uterine sarcoma, may be spread throughout the peritoneal cavity. This spread of cancer could potentially worsen the patient’s long-term survival rate, which is why the FDA is discouraging the use of power morcellators. The American College of Obstetricians and Gynecologists (ACOG) is currently conducting a review to evaluate power morcellators and gynecologic malignancies.

The FDA has estimated that 1 in 350 women undergoing hysterectomy or myomectomy for the treatment of uterine fibroids will have an unsuspected uterine sarcoma. Previous estimates based on limited retrospective studies have been an estimated 2:1000 women will have an unsuspected uterine sarcoma, although no study has been done determining how many of these sarcomas were morcellated.

Overall, the annual incidence of uterine sarcoma is quite low, approximately 0.64 per 100,000 women.

Unfortunately, uterine sarcomas are extremely difficult to diagnosis prior to surgery. Unlike cervical cancer, which can be diagnosed quite accurately with a pap smear and biopsy, or endometrial cancer, which can be diagnosed by symptoms and a biopsy, there is no reliable test to diagnose uterine sarcomas. The best a physician can do is utilize known risk factors for uterine sarcomas to develop a high suspicion of a sarcomas presence. These risk factors are older age, menopausal status, documented rapid growth of uterine fibroids, certain hereditary conditions, history of pelvic radiation, and tamoxifen use greater than 5 years.

Laparoscopic use of the uterine power morcellator is not the only treatment option for surgical removal of the uterus or fibroid, but rather one of many surgical choices that may be considered.

Another option is to dissect the uterus or fibroid laparoscopically and then remove the tissue through a mini-laparotomy, colpotomy, or laparotomy incision. Alternatively, the surgical approach can be changed to a vaginal hysterectomy, abdominal hysterectomy, or a laparoscopic assisted vaginal hysterectomy.

It has been reported that some physicians and institutions are recommending the use of a peritoneal bag during morcellation to help mitigate the risk of tissue spreading throughout the abdomen.

Unfortunately, these bags are not specifically designed for use with the uterine morcellator. If the bag is used during power morcellation it can potentially limit the ability to simultaneously view the tissue being morcellated and the surrounding tissue, which may increase unintentional damage to other tissue. Also, the bags are not designed to withstand tearing from the morcellator. Future development of bags designed for use in conjunction with the morcellator may be an option to help reduce the risk of tissue spread during morcellation.

ACOG is currently recommending that the power morcellator not be used in any patient undergoing surgical treatment for a gynecological cancer. In patients who are undergoing surgery for benign disease they are recommending a thorough preoperative evaluation. All patients should have current cervical cytology and if clinically indicated, a pelvic ultrasound and an endometrial biopsy. ACOG is also endorsing the FDA’s recommendation for appropriate patient counseling on the risks associated with uterine power morcellation and informed consent.

At the moment, neither the FDA nor ACOG are asking for the removal of the device from the market, but rather both want time to gather more information. Up to this point, there have been no studies done that include enough patients to give an accurate rate of preoperatively undiagnosed uterine sarcomas in patients undergoing hysterectomy. Since uterine sarcomas are relatively rare, it is estimated that a patient cohort of approximately 100,000 would be required to give a more accurate risk assessment. ACOG is therefore encouraging the FDA to establish a national prospective morcellation surgery registry to help assess this risk. The FDA is planning to hold public meetings of the Obstetrics and Gynecology Medical Device Advisory Committee prior to any further action being taken.  References: www.fda.gov and www.acog.org 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 | 31

research & technology

Early Treatment Benefits Infants With Severe Combined Immunodeficiency NIH-funded study identifies factors contributing to successful stem cell transplants

Early transplantation of bloodforming stem cells is a highly effective treatment for infants with severe combined immunodeficiency (SCID), a group of rare, life-threatening 32 | SEPTEMBER 2014

inherited immune system disorders, a study funded by the National Institutes of Health suggests.

Approximately three-quarters of SCID infants who received transplants

survived for at least five years. Infants who received transplants within the first 3.5 months of life had the best outcomes. Researchers from the Primary Immune Deficiency

Treatment Consortium (PIDTC), funded by NIH’s National Institute of Allergy and Infectious Diseases (NIAID), report their findings in the July 31 issue of the New England Journal of Medicine.

SCID is caused by defects in genes involved in the development and function of infection-fighting T and B cells. Infants with SCID appear healthy at birth but are highly susceptible to infections. If untreated, SCID is fatal, usually within the first year of life.

Development of a newborn screening test has made it possible to detect SCID before symptoms appear. The test was added to the U.S. Department of Health and Human Services’ Recommended Uniform Screening Panel for newborns in 2010, but to date, only 21 states have implemented newborn screening for SCID. “The findings from this study highlight the positive impact of treating SCID early in life,” said NIAID Director Anthony S. Fauci, M.D. “They also suggest that widespread use of newborn screening tests for SCID is warranted to ensure that infants with this rare syndrome receive life-saving transplants.”

Stem cell transplantation can fully correct the T-cell and, less consistently, the B-cell deficiencies of SCID infants.

To identify factors that contribute to successful transplant outcomes, PIDTC investigators analyzed data from 240 SCID infants who received transplants at 25 clinical centers across the United States and Canada between 2000 and 2009.

The researchers found that younger infants and those without infections had excellent survival rates. Almost all 68 babies transplanted within the first 3.5 months of life survived, with 64 still alive five years after transplant.

Many of these babies had a family history of SCID and were diagnosed before the onset of infections. Survival rates for older infants who never had infection or whose infections cleared before transplant also were high — 90 percent and 82 percent, respectively.

Only 50 percent of babies who had infections at the time of transplant survived for five years.

“These findings indicate that early transplantation and absence of infection are critical to achieving the best transplant outcomes for infants with this serious disorder,” said Daniel Rotrosen, M.D., director of NIAID’s Division of Allergy, Immunology and Transplantation. “The results of this study pave the way for further work to identify optimal stem cell transplant procedures for infants with SCID.” Donor type also affected transplant success, with the best outcomes resulting from sibling donors whose human leukocyte antigens (HLA) — proteins that help regulate immune responses — matched those of the recipient. HLA matching reduces the risk of graft-versus-host disease, in which transplanted cells attack the recipient’s cells. Because HLA markers are inherited from both parents, siblings have a one-in-four chance of being a perfect match. In the PIDTC study, 97 percent of infants who received transplants from HLAmatched siblings survived at least five years.

Regardless of donor type, survival rates were high for infants transplanted within the first 3.5 months of life and those of any age without infection at time of transplant. SCID infants with active infection and lacking a matched sibling donor did not fare as well. These infants were most likely to survive if they received specially treated bone marrow from a parent, but did not receive any pre-transplant chemotherapy, which often is administered to help the transplanted cells survive. This finding indicates that treatment and prevention of infection and avoidance of chemotherapy if an infection cannot be cleared are important considerations before transplantation.

Transplants from matched siblings led to the best restoration of immune function. Among survivors of transplants from non-sibling

donors, use of certain pre-transplant chemotherapy regimens was associated with higher T-cell numbers and more consistent B-cell function. However, chemotherapy carries the risk of severe early side effects, which can reduce chances of survival. Survivors may experience long-term chemotherapy side effects, such as poor growth.

Future research will focus on developing transplant procedures that improve survival and immune recovery while avoiding harmful side effects.

This work was supported by NIAID, NIH, under grant numbers 1U54AI082973 and R13AI094943, and by the NIH Office of Rare Diseases Research, National Center for Advancing Translational Sciences.

The National Heart, Lung and Blood Institute, part of NIH; the St. Baldrick’s Foundation; and the David Center of Texas Children’s Hospital also provided funding.

NIAID conducts and supports research — at NIH, throughout the United States, and worldwide — to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses.

News releases, fact sheets and other NIAID-related materials are available on the NIAID website at http://www. niaid.nih.gov.  About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Source: http://www.nih.gov/news/ health/jul2014/niaid-31.htm WWW.MEDMONTHLY.COM | 33

legal

ACA Prohibits Discrimination Against Licensed Providers

By Amy N. Moore, Partner Covington & Burling LLP One of the more obscure provisions of the Affordable Care Act says that a group health plan may not discriminate against “any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.” What on earth does this provision mean? Apparently not even the federal government is sure.

ACA Federalizes State MandatedProvider Laws Before 2014, many self-insured group health plans and health insurers excluded coverage for services provided by certain categories of health care providers. The excluded services often were rendered by providers who did not have advanced medical degrees (an M.D. or equivalent), but who had professional training and were licensed by the state to perform certain services. For example, a health plan might cover the cost of a baby’s delivery by an obstetrician, but not by a nurse-midwife; it might cover the cost of treatment for back pain by an orthopedist, but not by a chiropractor or acupuncturist; it might cover the cost of treatment for glaucoma by an ophthalmologist, but not by an optometrist; and so on.

Nearly every state enacted “mandated provider” laws, 34 | SEPTEMBER 2014

which required group health plans to cover the services of particular groups of licensed providers who were not physicians. The providers covered by these laws varied from state to state, but often included chiropractors, optometrists, physical therapists, psychologists, registered nurses, and social workers. More recent laws extended this protection to practitioners of alternative medicine, such as acupuncturists, massage therapists, and naturopaths.

From the point of view of the providers, however, the state mandated-provider laws had two significant shortcomings. First, the laws could not reach self-insured group health plans, which remained free to exclude the providers’ services from coverage. Second, even in the case of insured plans, it was not clear that the mandatedprovider laws were saved from ERISA preemption as laws regulating insurance. When courts were asked to resolve this question, they reached conflicting conclusions.

ACA addressed this issue by creating a sweeping federal law that requires all non-grandfathered group health plans and insurers that provide coverage for a particular service to extend the coverage to any category of provider licensed to provide the service. ACA’s mandated-provider provision became effective on January 1, 2014; but employers are still struggling to understand its effect on their group health plans.

The ACA Provision Is Not an “AnyWilling-Provider” Law One thing, at least, is clear: the ACA provision does not require self-insured group health plans to admit any willing provider to their networks. In the 1980s, when group health plans began to establish networks of preferred providers in an effort to control costs, many states responded by enacting “any-willing-provider” laws. Under these laws, an insurance company was required to admit to its network any provider in the region that was willing to meet the conditions for participating in the network.

These laws diluted the effectiveness of the networks: providers were less willing to agree to favorable pricing and performance guarantees when the sponsors could not guarantee that their networks would direct plan participants to a limited number of providers. The question whether these laws were preempted by ERISA was litigated all the way to the Supreme Court, which decided in Kentucky Association of Health Plans, Inc. v.

Miller that state any-willing-provider laws were saved from preemption as they applied to insured plans and HMOs. The Supreme Court decision did not apply to selfinsured health plans, however, which continued to establish preferred-provider networks. The ACA provision makes clear that it does not alter the status of any-willing-provider laws for insured or self-insured plans.

Senate Committee Disagrees With Federal Agencies’ Interpretation If the ACA provision does not require self-insured plans to cover the services of any willing provider, what does it require? If a group health plan covers a particular condition, must it cover treatment offered by any provider a state chooses to license, regardless of whether the treatment is evidence-based or generally considered to be safe and effective? The federal regulatory agencies dodged this question. In April 2013, the agencies declared in an answer to a frequently-asked question that the ACA provision was self-implementing and that the agencies did not intend to issue regulations interpreting the provider non-discrimination requirement in the near future.

The FAQ does offer a few helpful observations, however.

It says that the ACA provision “does not require plans or issuers to accept all types of providers into a network.”

The FAQ also elaborates on a statement in the statute concerning reimbursement rates. The statute says that the ACA provision does not prevent a group health plan from establishing different reimbursement rates “based on quality or performance measures.” The FAQ arguably expands this flexibility: it states that the provision “does not govern provider reimbursement rates, which may be subject to quality, performance, or market standards and considerations.”

The Senate Committee on Appropriations issued a report several months later repudiating the agencies’ interpretation of the provider non-discrimination provision. The report observes that the FAQ allows health plans and issuers “to exclude from participation whole categories of providers operating under a State license or certification.” The report also notes that the FAQ “allows discrimination in reimbursement rates based on broad ‘market considerations’ rather than the more limited exception cited in the law for performance and quality measures.” The report asserts that the ACA nondiscrimination provision “was intended to prohibit exactly these types of discrimination.”

The Senate committee report directed the agencies “to correct the FAQ to reflect the law and congressional intent within 30 days of enactment” of the appropriations bill.

In response, the agencies issued a request for information earlier this year regarding the interpretation of the provider non-discrimination provision. The RFI notes the Senate committee’s concerns, but it does not modify the FAQ or provide additional guidance concerning the meaning of the non-discrimination provision.

So Where Does That Leave Employer Group Health Plans?

Until the agencies issue more guidance, employers are expected to adopt a reasonable, good-faith interpretation of the statutory language. The statements in the Senate report do not have the force of law, and a subsequent Congress’s views on what a prior Congress intended generally receive little deference. Accordingly, the interpretive statements in the FAQ are still in effect, notwithstanding the criticism directed at them in the Senate report. It seems unlikely that the regulatory agencies will bring an enforcement action or seek to impose a penalty based on exclusions or reimbursement limitations that are permitted under the FAQ (assuming that a plan sponsor can divine which exclusions or limitations are permitted under the FAQ).

Employers should be cautious about relying on the FAQ, however. If a group health plan participant makes a claim for coverage of a service by a licensed provider, an independent review organization or a court will not necessarily adopt the interpretation suggested by the agencies in informal sub-regulatory guidance. Courts generally follow an agency’s informal interpretation only to the extent that they find it persuasive and consistent with the statute. Accordingly, non-grandfathered group health plans will run some risk if they establish networks that consist exclusively or predominantly of physicians, or if they cover treatments and services performed by some providers but not by others.  Source: http://www.insidecompensation.com/2014/07/31/ aca-prohibits-discrimination-against-licensedproviders/#more-2091 WWW.MEDMONTHLY.COM | 35

legal

IRS Increases 9.5% Affordability Threshold -

OR DID IT?

By Paul M Hamburger Peter J Marathas, Jr. Stacy H Barrow Proskauer Rose LLP

36 | SEPTEMBER 2014

On July 24, 2014, the Internal Revenue Service (IRS) released three Revenue Procedures (201446, 2014-37, and 2014-41), which provide guidance to individuals on their obligation to maintain minimum essential coverage (MEC) under the Affordable Care Act’s (ACA) socalled “individual mandate.”

Most notably for employers is that, in Revenue Procedure 2014-37, the IRS increased the threshold for determining whether an employer has offered affordable coverage to an employee. For these purposes, the IRS increased the percentage of an employee’s household income that can be charged for group health insurance and still be considered affordable for purposes of the ACA’s “pay-or-play” requirements. The IRS guidance increases the percentage from 9.5% to 9.56%. In other words, an employer assessing the affordability for employee-only coverage for its least expensive plan in 2015 can require an employee to pay up to 9.56% of his or her household income and the insurance will still be considered affordable.

It has been widely reported that the IRS has increased the affordability percentage in all cases from 9.5% to 9.56%. This is not necessarily true.

By way of background, the IRS had previously acknowledged that when it comes to having employers measure “affordability” of health coverage, tracking an employee’s household income would be difficult, if not impossible. Responding to this concern, the IRS released regulations that permitted employers to use one of three safe harbors to determine affordability. The three safe harbors permit an employer to measure affordability based on whether the applicable premium exceeds 9.5% of W-2 income, an employee’s Rate of Pay or a measure of the Federal Poverty Level. That is, an employer using one of the safe harbors would not need to ask about an employee’s household income to determine whether the

‘‘

Some type of announcement from the IRS increasing the regulatory 9.5% threshold to the statutory 9.56% threshold for the applicable safe harbors would be welcome.

insurance is affordable for purposes of the ACA; it would simply take the applicable safe harbor, multiply by 9.5% and measure the result against the premium for self-only coverage.

Some vendors, consultants and others have announced that employers can now use the increased 9.56% to determine whether coverage is affordable for purposes of the safe harbor. Based on the literal regulatory rules, this is not correct.

The reason this is not true is that the IRS regulations on affordability have “hard-wired” the 9.5% standard into those regulations; the regulations do not cross-reference to the statutory reference for affordability. As the IRS continues to index the affordability measure for household income over time, as is required by the ACA, a concomitant change to the percentage established in the regulations will be required or else these two percentages will very quickly become dramatically out-of-sync.

Some type of announcement from the IRS increasing the regulatory 9.5% threshold to the statutory 9.56% threshold for the applicable safe harbors would be welcome. In the meantime, employers planning on complying with the regulatory safe harbor rules should cap premiums based on the literal terms of those regulations.  Source: http://www.natlawreview.com/ article/irs-increases-95-affordabilitythreshold-or-did-it

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legal

CMS Proposes Regulations:

Changes to Physician Fee Schedule, Hospital Outpatient, and Ambulatory Surgical Center Policy and Payment

By Fatema Zanzi, Associate in the Health Care Practice Group, Julie Scott Allen, Governmental Relations Director, Julie Rusczek, Senior Attorney in the Health Care Practice Group, and Corey Kestenberg, Summer Law Clerk Drinker Biddle & Reath, LLP

38 | SEPTEMBER 2014

O

n July 3, 2014, Centers for Medicare and Medicaid Services (CMS) proposed two regulations, CMS1612-P and CMS-1613-P. The former revises payment policies under the Medicare Physician Fee Schedule, while the latter makes changes to hospital outpatient and ambulatory surgical center policy, payment, and quality reporting programs. CMS intends to issue final regulations, effective calendar year 2015.

Proposed changes to the Medicare Physician Fee Schedule (PFS) include: l Payment for Chronic Care Management (CCM): Providers would receive $41.92 for billing the CCM code; they would be permitted to bill it one time per month per each qualified patient.

CMS also proposed additional standards for electronic health records as they relate to CCM.[1] l Additions to the Misvalued Codes List: CMS would add roughly 80 codes to its list of potentially misvalued codes. Also, radiation therapy services would experience a pay reduction, and CMS would redistribute this funding to other PFS services.[2] l Transformation of Global Surgery Codes: Starting in 2017, all 10and 90-day global codes would be converted into 0-day global codes.

For certain surgical procedures, CMS would pay one value for services performed on the surgery day and would pay separately for visits and services rendered after the day of surgery.[3] l Enhanced Transparency Rate Setting: Before revisions to payment inputs are applied to payment rates, CMS would subject such revisions to public comment.[4] l Addition of New Telehealth Services: Annual wellness visits, psychoanalysis, psychotherapy, and prolonged evaluation and management services would be

added to the telehealth services that are available to beneficiaries.[5] l Data Collection on Off-Campus Provider-Based Departments: In an effort to collect data on services provided in off-campus providerbased departments, hospitals and physicians would need to report a modifier for services performed in these venues.[6] l Elimination of Employment Requirement for Rural Health Clinics (RHCs): CMS would abolish the current requirement that an employee of the RHC provide RHC services incident to a visit. This would allow non-employee nurses, medical assistants, and other personnel to provide services incident to an RHC visit under contract.[7] l Modifications to the Sunshine Act Requirements: This provision would delete the Sunshine Act reporting exclusion for payments or other transfers of value provided as compensation for speaking at certain accredited or certified continuing education programs. Manufacturers of covered drugs, devices, biologicals, and medical supplies would be required to report to CMS payments or other transfers of value they distribute to all continuing medical education event speakers (subject to other applicable reporting criteria).

The proposed rule would also require manufacturers to report to CMS the marketed name of covered and non-covered devices and medical supplies related to a payment or other transfer of value, aligning the requirements for devices and medical supplies with those for drugs and biologicals, for which the marketed name must be reported under current requirements. Additionally, the proposed changes would require manufacturers to report stocks,

stock options, or other ownership interests as separate reporting categories.[8] Proposed changes to the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Policy, Payment Rates, and Quality Reporting Programs include: l Updating the OPPS Market Basket: The OPPS market basket would be updated by 2.1% for calendar year 2015.[9] l Increasing the Number of Comprehensive Ambulatory Payment Classifications (APCs): CMS would add several Comprehensive-APCs, including lower cost device-dependent APCs, an APC for procedures that are largely device-dependent, and an APC for procedures that are delivered in one session but involve various components.

Some current APCs would be consolidated or restructured.[10] l Packaging Payments for Ancillary Services: This provision would enable CMS to conditionally package the payments for ancillary (those related to primary care) services that are assigned to APCs. Initially, ancillary services would be packaged this way only in APC’s with a geometric mean cost of less than or equal to $100.

Preventive, psychiatric, and drug administration services would be exempted from this packaging.[11] l Adjusting the Hospital Outpatient Outlier Payment: Hospitals would receive OPPS outlier payments only if the service’s cost exceeds 1.75 times the APC payment rate and exceeds the 2015 APC dollar amount plus $3100.[12] Currently, OPPS outlier payments to hospitals are triggered when the cost of service exceeds 1.75 times the APC amount, and exceeds the continued on page 40 WWW.MEDMONTHLY.COM | 39

continued from page 39

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APC dollar amount plus $2900.[13] l Updating Partial Hospitalization Program Per Diem Rates: The regulation would update the community mental health center per diem rates to $97.43 for Level I services and $114.93 for Level II services. These rates would remain relatively constant compared to 2014 rates. However, the regulations would also update per diem rates for hospital-based partial hospitalization programs to $177.32 for Level I services and $190.21 for Level II services. This represents a decrease of approximately $14 for Level I services and a decrease of approximately $24 for Level II services from their 2014 amounts.[14] l Changing the Measures Included in the Hospital Outpatient Quality Reporting (HOQR) Program and Aligning HOQR Measures with Measures in the ASC Quality Reporting Program: Three measures would be removed from the HOQR program—one cardiac care and two prophylactic antibiotic surgery. One claims-based measure concerning the risk of having a hospital visit after outpatient colonoscopies would be added to the HOQR Program for 2017 and a similar measure would be added to the ASC Quality Reporting Program as an outcome measure. Further reporting in both quality reporting programs on visual function 90 days after cataract surgery would change from mandatory to voluntary.[15] CMS is accepting comments on these proposed rules until September 2, 2014.  ___________ [1] See Revisions to Payment Policies Under the Physicians Fee Schedule, 79 Fed. Reg. 40318, 40365 (July 11, 2014), available here; Press Release, Centers for

Medicare and Medicaid Services (CMS), Proposed Policy and Payment Changes to the Medicare Physician Fee Schedule for Calendar Year 2015 (July 3, 2014), available here. All citations in this summary are to the versions included at the links provided.

[2] 79 Fed. Reg. 40318, 40337- 40339; Press Release, Physician Fee Schedule.

[3] 79 Fed. Reg. 40318, 40345-40346; Press Release, Physician Fee Schedule.

[4] 79 Fed. Reg. 40318, 40361-40364; Press Release, Physician Fee Schedule.

[5] 79 Fed. Reg. 40318, 40358-40359; Press Release, Physician Fee Schedule.

[6] 79 Fed. Reg. 40318, 40334; Press Release, Physician Fee Schedule.

[7] 79 Fed. Reg. 40318, 40376.

[8] 79 Fed. Reg. 40318, 40383-40385; Press Release, Physician Fee Schedule.

[9] Hospital Outpatient Policy and Payment Changes and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs, 79 Fed. Reg. 40916, 40921 (July 14, 2014), available here; Press Release, Centers for Medicare and Medicaid Services (CMS), CMS Proposes Hospital Outpatient and Ambulatory Surgical Centers Policy and Payment Changes for 2015 (July 3, 2014), available here. All citations in this summary are to the versions included at the links provided.

[10] 79 Fed. Reg. 40916, 40922; Press Release, CMS Proposes Hospital Outpatient Policy and Payment Changes.

[11] 79 Fed. Reg. 40916, 40922; Press Release, CMS Proposes Hospital Outpatient Policy and Payment Changes.

[12] 79 Fed. Reg. 40916, 40970; Press Release, CMS Proposes Hospital Outpatient Policy and Payment Changes.

[13] 79 Fed. Reg. 40916, 40970.

[14] 79 Fed. Reg. 40916, 41011-41012; Press Release, CMS Proposes Hospital Outpatient Policy and Payment Changes.

[15] 79 Fed. Reg. 40916, 41066-41067; Press Release, Centers for Medicare and Medicaid Services (CMS), CMS Proposes Hospital Outpatient and Ambulatory Surgical Centers Quality Changes for 2015 (July 3, 2014), available here.

Source: http://www. drinkerbiddlehealthcare.com/insight/ cms-proposes-regulations-changesphysician-fee-schedule-hospitaloutpatient-ambulatory-surgicalcenter-policy-payment/

features

Medical Billing:

Partnering for Success

By Michelle Durner, CHBME Applied Medical Systems, Inc.

If you have a private practice chances are high that you’ve at least considered outsourcing your revenue cycle management functions at some point in time. You’ve likely asked yourself questions like; Would it make my practice more profitable? Would it make life easier? Would it free up my time to do the things that I really want to do? Yes. Yes. Yes. In the end, the question becomes do you want to treat patients or deal with insurance companies? Is there really a choice to be made?

In the past 10 years the “administrative simplification” 42 | SEPTEMBER 2014

of HIPAA has made the medical billing process extremely difficult and more so for the majority of small medical practices. Yet even as cumbersome as medical coding and billing has become, we aren’t at the end of the tunnel yet. The average time and resources to process a claim throughout the full revenue cycle can be surprising. The 2013 American Health Association (AMA) National Health Insurer Report Card (NHIRC) reported that, for Medicare alone, 46.8% of claim lines were the source of a disclosed claim edit (or processing “rule”) applied due

payer-specific edits, estimated around 780,000 if you’re keeping count.

A qualified third party billing company typically embodies the efficiency, productivity, technical and operating skills through technology and staff to master the “rules” that carriers utilize when adjudicating claims. Certified and expert staff, continuous education, compliance and active involvement in the billing industry will set apart a qualified third party billing company.

If these aren’t reasons enough to outsource your billing, there are many others that a practice might consider worthy in deciding to work with a third party billing company to enhance their revenue cycle management:

Why? l Increase Collections l Reduce Labor Costs l Reduce Overhead & Technology Costs l Complexity of Coding & Billing l Increased Patient Confusion & Financial Responsibility l Control Billing Costs l Compliance/HIPAA l Optimize Coding l Access Technology l Billing Expertise l Patient Satisfaction

While this list might seem exhaustive, I promise you it is not, and each of these bullet points could be expanded.

Ultimately, there are many personal and business reasons why a practice might choose to outsource and you have to determine what those reasons are for you.

Ask Questions If you do choose to investigate third party billing companies, there are more questions to consider than just “How much does it cost?” l What does the price include? ie. A/R Follow Up,

Denials, Appeals, Postage, Coding Review, etc.

l What certifications does the company/employees hold? l What trade associations are they active with? ie.

HBMA, AAPC, EDPMA, etc.

l Do they support your medical society or specialty

to CPT, NCCI, CMS Publication 100-04, ASA Relative Value Guide or payer-specific edits. Medicare’s payerspecific edits alone numbered 3,009,536. That’s a lot of edits to keep up with. Additionally, the 2013 NHIRC says that 2.0% of Medicare claim lines had an undisclosed claim edit applied which resulted in zero payment for the lines. Essentially physicians are now required to be technologically knowledgeable, meticulous, AND psychic.

And this is ONLY Medicare. There are 7 other commercial carriers which make up the NHIRC that have their own

association? ie. AAFP, AAP, ACEP, etc. l Is the company experienced in your specialty/state? l Do they have a compliance plan? l Will you have a dedicated team? l Will they bill off of your practice management system or theirs? l Do they carry Errors & Omissions (E&O) Insurance?

Cyber Insurance? continued on page 44 WWW.MEDMONTHLY.COM | 43

continued from page 43 l How do they keep their/your employees up to date on

industry changes?

l What’s their philosophy on patient balances and

helping patients who call? Does that philosophy mesh with yours? l Do they have references?

Sure, this article is about billing, but most billing companies also offer consulting, bookkeeping, payroll, coding and auditing, provider enrollment, training, human resource management, ICD10 implementation. How hard is it to find one or two employees that encompass that wealth of knowledge? And how much would it cost you to pay them a salary and benefits vs. using the services only as you needed them?

I realize that everyone hates the dreaded sales pitch and I encourage you to speak with a representative, not necessarily the salesman, of the billing company. The manner in which that conversation flows, as well as resulting follow up and follow through, could be a major indicator of what you can expect if they are your chosen billing company.

‘‘

A qualified third party billing company typically embodies the efficiency, productivity, technical and operating skills through technology and staff to master the “rules” that carriers utilize when adjudicating claims.

Pricing In order to price appropriately, expect that a reputable third party billing company is going to have questions for you. There are some companies that charge a flat percentage of collections regardless of EMR, location, form of documentation, specialty, volume, financial mix, historical charge and collection data, etc. There is no way to know the true cost of processing a claim without having some knowledge of these variables. Depending upon speciality and volume, some companies may require a feasibility study in the form of a chart audit. If a company is offering you a very low, flat fee without asking questions, some things could be at play. One option is that some practices are subsidizing the true claim processing cost of their peers. For example, the average collected amount on 44 | SEPTEMBER 2014

a Plastic Surgery claim is going to be much higher than that of a Family Practice claim, yet in a flat-fee scenario they are both paying 4%. Who is paying the brunt of the cost? Is there that much work involved with a Plastic Surgery case that it necessitates that they pay a substantially higher fee? The other option is that perhaps FULL revenue cycle management is not included as part of the price. ie. working denials, appeals, etc. or maybe there are other fees that are added on such as postage or clearinghouse fees.

To further illustrate. please review the table below showing example collection amounts.

Company 1

Company 2

Billing Fee

7.0%

6.0%

Monthly Collections

$50,000

$45,000

Billing Fee

$3,500

$2,700

Net Cash Flow

$46,500

$42,300

At first glance it might seem like the best choice is the lowest percentage. However, consider that you might not be comparing apples to apples. The difference between a full-service and a a bargain-bin billing company can be astonishing. Disparities in technology, employee knowledge, process efficiencies, etc. could lead to huge differences in the total amount collected. Choosing the cheaper option could result in lower collections and a resulting decreased net cash flow. Sometimes paying more for more is better than paying less for less!

Regardless of the direction you decide to take, do your due diligence. Make it a point to ask the right questions and to take the time to analyze the answers that you receive. Hard work and patience in the selection process can pay huge dividends in long run, both in the profit of your practice and the relationship with the billing company that you select.

Partnership It cannot be stressed enough that your relationship with a third party billing company should be PARTNERSHIP. A partnership that must be built on trust, transparency, ongoing communication and follow through.

It isn’t a matter of simply handing over the reins. The revenue cycle starts inside of the practice, and unless you are outsourcing the front desk and/or coding processes, the practice bears the responsibility of: l Accurate Demographics l Eligibility Checking l Collecting copays, coinsurance and deductibles at the

time of service

l l

Documenting appropriately Coding according to documentation

To reference the 2013 NHIRC again, consider that 14.0% of Medicare’s allowed amount for a service is patient financially responsible. Aetna comes in at 22.0%. The chances of collecting that money increase exponentially when your front desk is proactive and effective in asking for and collecting patient due amounts.

Both the practice and the billing company must be timely and thorough in all communication. As with any collaboration, you work in tandem to reach common goals.

A practice cannot take a hands off approach once they decide to utilize a billing service, otherwise, the partnership is doomed to fail.

In the end the decision to outsource your billing, or any part of your practice for that matter, can be difficult. You have put a lot of time and energy into your business and it is understandably hard to hand over responsibility to someone else. Ultimately it comes down to what it costs and what you can afford. Specifically, how much does it cost, in both time and money, to handle the administration side of your business? And how much can you afford to spend on the areas of your practice that don’t directly benefit your patients? Essentially, do you want your time to be consumed by words like manage, appeal, and adjudicate, or by words like practice, treat, and restore? 

Michelle L. Durner, CHBME is the President of Applied Medical Systems, Inc. – a Durham, NC-based company which provides medical billing, coding, practice management, and consulting services to start-up practices, hospitals, private practices, and hospital based physician groups across the nation. Michelle is actively involved in the Healthcare Billing and Management Association (HBMA), serving as Vice Chair of the Education Committee. In 2014, Michelle was awarded the J. Dennis Mock Award which is one of the highest honors that HBMA can bestow on a member. This award recognizes outstanding dedication to the purposes and goals of HBMA to one who consistently influences members with a definition of purpose. To contact Michelle or to learn more about Applied Medical Systems, visit www.appliedmedicalsystems.com

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features

Hospital Services Provided by Physician Assistants (PAs) –

WHAT ARE THE RULES?

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

In my consulting career, the number of hospital employers who do not bill properly for PA services consistently fascinates me. I have also encountered some smaller hospitals that, until recently, never billed for PA inpatient services.

While the landscape for inpatient delivery of services is changing, it is important to realize that PAs are an integral part of the healthcare delivery team and these services rendered are indeed billable and reimbursable.

In September 2013, the Centers for Medicare & Medicaid Services (CMS) issued revised guidance and clarification that affirms the ability of PAs, nurse practitioners (NPs) and medical residents to write admission orders and perform the history and physical (H&P) for hospital inpatient admissions. The Hospital Inpatient Perspective Payment System (IPPS) rule for 2014 originally questioned and appeared to restrict the authority of PAs nurse practitioners (NPs) and 46 | SEPTEMBER 2014

medical residents to provide these important and critical admission services.

The primary purpose of the IPPS rule was to assist hospitals in defining the appropriate use of hospital admission versus observation status, thereby helping more Medicare beneficiaries become eligible for nursing home care after a minimum three-day hospital inpatient stay.

Physician certification of the admission must occur after the order is written and the H&P has been performed. Currently, only a physician is authorized to authenticate the certification and the certification must occur prior to the patient’s discharge.

BILLING AND REIMBURSEMENT How can billing be maximized in the hospital setting? The concept of “incident-to” billing is an outpatientonly application. While physician assistants (PAs) may not bill incident-

to in a hospital, they may bill under the physician they are working with and collect 100 percent reimbursement if the shared billing criteria are met.

What is Shared Billing?

Shared billing is a provision that allows a medical service predominately provided by a PA to be billed under the name and Medicare number of the supervising physician at 100 percent, as opposed to 85 percent if the service had been billed under the PA’s name and NPI. While a physician must provide a face-to-face service to a patient in addition to the PA’s service for a shared visit to be billed, it is appropriate for the PA to have performed the majority of care (as much as 90 percent, for example) for that patient. As long as the physician has some participation in the care of the patient, the combined services of both the physician and the PA may be attributed to the physician on the claim form.

How Do You Bill?

The Centers for Medicare & Medicaid Services (CMS) rules give PAs and their supervising physicians some flexibility in hospital billing for evaluation and management services.

The requirements, found in Medicare Transmittal 1776, allow PAs and physicians who work for the same employer to “share” visits made to patients on the same calendar day by billing their combined work under the physician’s NPI number. The reimbursement will then be at 100 percent of the fee schedule, even if the PA performed the majority of the work.

Criteria for Shared Visits (These must all be met and clearly documented in the patient record): • Both the PA and the physician must have a common employer (e.g., same group practice, same hospital, or PA employed by a solo physician).

• The service provided is not a consultation evaluation and management (E/M) service, procedure or a critical care service.

• The physician must provide some face-to-face portion of the E/M visit; simply reviewing and/or signing the patient’s chart isn’t sufficient to qualify for a shared service.

• Both the PA and the physician’s professional services for the patient must be clearly documented on the patient’s chart.

• Both the PA and the physician must see the patient on the same calendar day.

The physician must provide some face-to-face portion of the E/M encounter. If this is not the case, then the service should then be billed at the full fee schedule amount under the PA’s NPI number, and that visit will be reimbursed at the 85 percent rate.

Shared billing allows maximum reimbursement to be achieved in the

hospital setting when the team of the physician and the PA delivers the care for the patient.  References: http://www.cms.gov/Medicare/ Medicare-Fee-for-Service-Payment/ AcuteInpatientPPS/Downloads/IPCertification-and-Order-09-05-13.pdf http://www.cms.gov/Regulations-andGuidance/Guidance/Transmittals/ downloads/R1776B3.pdf About the Author: Lisa P. Shock, MHS, PA-C, is a seasoned PA who has worked with clients to expand care teams in both large and small settings. She enjoys part time clinical practice and is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering a wide range of services to help implement and improve upon the utilization of PAs and NPs in the health care system. Contact her at lisa@pushpa.biz

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features

A PLAN OF ACTION FOR SUCCESSFUL MEDICAL BILLING

By Nidhi Behl Vats Freelance Medical Writer

48 | SEPTEMBER 2014

H

ow effective is your practice’s medical billing? The time has come to put a full stop to any negativity about the billing department!

It’s a time for action. Making the most of the given team should be the goal of an administrator. Here is a possible plan of action to consider for increasing the efficiency and profitability of your practice’s medical billing.

A successful model is divided into three main parts.

1. Process of a successful billing plan 2. Understands the myths 3. The key areas to address in the billing process

Part 1: Process of a successful billing plan 1. Plan & strategize: Have you developed policies in regard to billing and insurance related matters? What is your plan of action for planned cases, surgeries, and unplanned admissions? Do you have pre– approval for planned admission?

2. Data Entry: It’s important to identify your data entry points and to make sure that the trained staff performs the data entry on the appropriate software.

If everyone is allowed to perform data entry, then what is your system to crosscheck the correctness of data entry?

3. Expressive Communication: How does your team communicate with your end users? Do you have scheduled times to communicate new billing needs? How effective are your financial counseling sessions? Do you to do regular updates and do you communicate the changes to your patients?

Two other parameters to consider are feedback analysis and co-ordination while completing the entire billing cycle. It’s believed that man has the solution to all his problems, provided he looks within himself. The same is true for organizations, too. If practice/hospitals are to emerge victorious from this billing pit, then they have to strengthen, empower and encourage their team.

Despite of all the new software and procurements in medical billing and record keeping, billing is human centric. All administrators will agree with this fact, there are several service delivery points in billing process and at each point it’s a human who makes an entry for the each and every service provided to the patient.

Part 2: The common myths practiced in the healthcare billing set-ups

2.

3.

4.

5.

6.

an admission and pre-admission process which is only totaled at the time of discharge. The process of billing starts when the patient is at the admission department/receptionist. They should be addressed about insurance at this time and should be guided through the registration information.

It’s the patient’s responsibility: The patient is only responsible to pay the amount. It is the medical facility’s role to let the patient know the amount to be paid, as well as to provide information to the patient regarding the insurance approval needs and the amount of co-payment.

The patient is smart and well informed: People who have insurance are not always aware of a lot of things in their health policy. So it is the responsibility of the medical staff to ask and inform them about components like co-payments, excluded items cost, and out of pocket payments. It can be a routine job for the medical staff, but not so common to the patient. It is the responsibility of the staff to communicate and assist the patient so that they understand each and every query related to billing and payments.

Brochures, websites and written material should suffice: Nothing can beat one-to-one communication between the patient and the staff. Speaking with patients over telephone or face-to-face will achieve the best feedback and allow a better chance for hassle-free payment from the patient. The mantra is “Expressive communication”.

I’m just being professional: When you talk to the patient about the financial part of their visit, add that humane touch to it. Don’t just babble all the figures that you have scribbled, but explain in simple terms what each amount is for. That’s your job!

Billing department is responsible for billing: This is a big myth which most medical staff believes.

The billing staff only does the summation and segregation of the items under correct heading/subheading. Actual billing is done by the nurses or PAs. They are the people who add the components which are prescribed by the treating physician. So rather than blaming the billing staff for all errors, it’s better to understand that it’s the team effort which includes everyone to get an accurate final figure.

Part 3: The key areas to address in the billing process

We have explained about the process for successful billing. There are few myths in billing which are dangerous and must be addressed if we want to have a successful plan of action for our medical billing.

1. Strong communication: Know who to address about the billing information pattern, who is the primary person responsible, what the best method of communication (in person, telephone, or email).

1. Billing is a discharge process: The fact is billing is

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2. Trained administrative staff: Administrative staff should have everything in writing and even the commonest information should be communicated to the patient.

3. Prepare well before communicating: It is equally important to understand the medical facts about the patient before moving into a conversation regarding billing matters. The staff needs to modify the talks and may have to alter the time of discussion, if the patient is not comfortable or not in a condition where such aspects should be discussed.

4. Team work for success: The administrative staff should be in touch with clinical departments, treating doctors, laboratory and radiology. This helps in understanding which patient requires new estimates and new insurance approvals.

5. Double-check is important: A senior person should be appointed who can check the services given from the patient file to the amount billed, or not billed, for that service in the software for final accuracy.

It becomes easier to handle most billing situations, if these steps are followed. Many times billing concerns can be avoided if administration handles the billing part smoothly. 

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

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

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

Located on NC’s Beautiful Coast, Morehead City

the arts

Drew Bodner: Retired Clinical Pharmacist Finds His Montana Muse

By Thomas Hibbard

Our Montana Home

Creative Director, Med Monthly

Tubac Gold Course and Country Club

D

rew Bodner, RPh is a retired clinical pharmacist with a passion for art. He retired in 2003 after 39 years of continual employment at Shawnee Mission Medical Center in Johnson County, Kansas.

He started the clinical program there for the Medical Surgical Unit. Bodner also worked in ICU and was the wound care pharmacist for SMMC. He still remains active, maintaining his Missouri and Kansas pharmacy licenses and continuing his APhA, MSHP, and KPha memberships, including helping to plan KPhA conferences.

His grandparents homesteaded in Montana in 1892 from what is now the Slovak Republic and he and his wife, Joanne, own a cattle ranch, the N Lazy J, there on a side hill of the Highwood Mountains where they go each summer.

With only 1200 people in the entire county and 60 miles between his home and the closest full line grocery store, life can be challenging. But after 7 years, they finally have TV and internet. From his home he can see Glacier National Park 150 miles away because there is nothing but flat prairie between them.

The beautiful Montana landscape is where he gets much of his inspiration and he has been a featured artist in Montana for the last several years. Even his company name, Montanamuses.com, reflects his love of the area. Bodner states, “My art is all about nature, even down to the wood grains I like to paint. And the Montana sunsets are great.”

His art roots go clear back to his grandparents and their homestead. They were frequently visited by C.M. Russell (Charlie Russell), a famous Montana artist of the Old American West, when he was passing through on horseback.

Bodner’s father painted many art pieces throughout his life imitating Charlie Russell’s style and subject matter and was quite an accomplished artist himself. Bodner believes that is why he became an artist and he still has over 30 of his father’s paintings.

Bodner started painting while wintering in Foley, Alabama at Paulette’s Palette and has painted in Florida, Alabama, New Mexico, Arizona, Oklahoma, and Arkansas.

When he’s in Montana he paints at the Mid-Montana State continued on page 52 WWW.MEDMONTHLY.COM | 51

continued from page 51

Art Society and at Studio 706; when he’s in Kansas he’s a member at the Seniors’ Art Council. His recent works are in acrylic and watercolor, but he would love to get back into oils in the near future.

His work is displayed at Prairie Collection in Stanford, Montana; Made in Montana in Great Falls, Montana; and a gallery in Raton, New Mexico. And his photograph entitled “Mama Owl” was juried into the Arti Gras show in Leawood, Kansas. And he also teaches watercolor classes as an enrichment activity at Learning Club of Kansas City, a non-profit program for high risk kids, where he also tutors reading and math as a volunteer.

“There’s no bad art. All art is good art. I find and encourage the good points in everyone’s art,” he shares.

Every Picture Tells a Story...

At Left: This rider leads his stray calf down a dangerous mountain road from Hughesville, an abandoned mining town, past a long vacated homestead at base of a steep drop off. The three - cowboy, horse and calf - will slowly make their way safely at the base of the mountain.

The painting below is the watercolor he did from his friend’s childhood memory entitled. “Waiting for My Coal Miner Husband.”

Returning a Stray

Waiting for My Coal Miner Husband 52 | SEPTEMBER 2014

Last Signs of Winter Each of his paintings has a story. They bring back fond memories from the artist’s personal life or from the people who have shared their stories with him. A friend, a former grade school teacher in Hughesville who became a Sister of Charity in Leavenworth, told him of a tender remembrance of standing in front of her cabin in Ashland, Montana in 1925 with her mother and siblings waiting for their father to return from the coal mine. Bodner did the painting, “Waiting for My Coal Miner Husband”, from her description of her mother with her three children all under the age of 4; daughter on one side, young boy on other, small baby in her arms. The young boy in the image is of Drew, himself, at age four.

He shares, “Can you imagine the mother’s stress with those small children, at dusk, waiting for her husband to return from the coal mine. In those days, coal was mined for their own use.

My friend is the young girl on the right side. I took a painting of myself with the sheep in Montana as a little boy for the picture of the boy on the other side. Her parents went on to have many more children.”

“I paint these pictures and envision myself there. I can transport myself to another world and actually feel I’m there in what I am painting. That’s the fun of it and that’s what relieves stress. It’s just like magic.”

Besides his original paintings for sale, Bodner currently has a line of over 150 stationery cards, each card displaying an original piece of his art. 

Hotel Meade Bannock State Park, Montana

Mystery Camp

Still Life

healthy living

Corn and Black Bean Salad from AllRecipes.com

By Ashley Acornley, MS, RD, LDN Freshly shucked corn is one of summer’s greatest gifts, and this salad really showcases the sweetness of the corn in contrast to the earthiness of the black beans. The cilantro and spice profile is ideal for lovers of Southwest cuisine, and you can kick up the heat to your liking as desired. Super simple and fresh, you don’t even need to boil the corn. This recipe is southwest summer in a bowl. I like to add fresh tomatoes if I have them on hand, too.

Nutritional Facts: Calories: 214 Fat: 8.4 g Carbohydrates: 28.6 g Protein: 7.5 g Sodium: 805 mg Fiber: 7 g Cholesterol: 0 mg

Ingredients: (Makes 4 servings) 1/4 cup balsamic vinegar 2 tablespoons vegetable oil 1/2 teaspoon salt 1/2 teaspoon white sugar 1/2 teaspoon ground black pepper 1/2 teaspoon ground cumin 1/2 teaspoon chili powder 3 tablespoons chopped fresh cilantro 1 (15 ounce) can black beans, rinsed and drained 2 cobs fresh sweet corn, sliced off cob (or 1 can sweet corn, drained)

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Preparation: In a small bowl, mix together balsamic vinegar, oil, salt, sugar, black pepper, cumin, and chili powder. In a medium bowl, stir together black beans and corn. Toss with vinegar and oil dressing, and garnish with cilantro. Cover, and refrigerate overnight.

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/

| SEPTEMBER 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 | SEPTEMBER 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 | SEPTEMBER 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 | SEPTEMBER 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

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 64 | SEPTEMBER 2014

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

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

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

Please direct all correspondence to driverphilip@gmail.com.

Only serious, qualified inquirers.

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 | SEPTEMBER 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 listings

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 | SEPTEMBER 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 | SEPTEMBER 2014

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

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

74 | SEPTEMBER 2014

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

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

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

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

medmonthly.com | 919.747.9031

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

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

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

the top

Humorous, But Valid, ICD-10 Codes

Or, Yes, There’s a Code For That

While the ICD-10 transition is no laughing matter, the federal government, with their exceptional ability to over-document everything, has created a series of diagnosis codes that will bring a smile to your face. There are several websites online that point out these humorous, yet actual ICD-10 codes. Here are listed Med Monthy’s Top 9.

1 2

4

BURN DUE TO WATER-SKIS ON FIRE, INITIAL ENCOUNTER Code - V91.07XA

SUCKED INTO JET ENGINE, SUBSEQUENT ENCOUNTER Code - V97.33XD

STRUCK BY MACAW, INITIAL ENCOUNTER Code - W61.12XA

5

ANIMAL-RIDER INJURED IN COLLISION WITH STREETCAR, INITIAL ENCOUNTER Code - V80.730A

6

7

INJURED WHILE KNITTING OR CROCHETING Code - Y93.D1

HEADACHE ASSOCIATED WITH SEXUAL ACTIVITY Code - G44.82

8

UNSPECIFIED SPACECRAFT ACCIDENT INJURING OCCUPANT, INITIAL ENCOUNTER Code - V95.40XA

3

PROBLEMS IN RELATIONSHIP WITH IN-LAWS Code - Z63.1

78 | SEPTEMBER 2014

9

PARENTAL OVERPROTECTION Code - Z62.1

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

Ongoing and intermittent shifts are available for both physicians and mid-levels as well as permanent placement.

Find out why providers choose Physician Solutions.

P.O. Box 98313, Raleigh, NC 27624 Scan this QR code with your smartphone to learn more.

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