Med Monthly April 2012

Med Monthly April 2012

ICD-10 DELAY

the

practiceent manasguem e is

HHS pushes back the deadline

PRIMARY CARE MANAGEMENT

Tips on efficient customer service

BIOHAZARDOUS WASTE What it is and what to do with it

WHAT IF HENRY FORD HAD BEEN A DOCTOR? PAGE 38

COLLECT MORE! Re-engineer your billing strategy, we'll show you how!

contents features

38

16 HANDLING A CATASTROPHE

What would you do in an emergency

34 PRIMARY CARE MANAGEMENT

If Henry Ford was a doctor

research and technology

Tips from a physician

10 IMPROVING EFFICIENCY WITH APPS

38 WHAT IF FORD WAS A DOCTOR?

practice tips

Improving health care by systemizing practices

42 SPENDING LESS TO COLLECT MORE Profit increasing techniques

12 MAKE YOUR WEBSITE A MARKETING MACHINE 18 DEVELOP A NEW FINANCIAL POLICY 20 OUTSOURCING YOUR CALL CENTER

46 ICD-10 DELAYED

24 MITIGATING THE RISKS OF ICD-10

HHS pushes back the deadline

26 MEDICAL MARKETING CALENDAR

48 BIOHAZARDOUS WASTE

What it is and what to do with it

52

legal Artist Barry Hanshaw

28 TIPS FOR REDUCING MALPRACTICE RISK 29 AFFORDABLE INSURANCE EXCHANGES 30 REASSIGNMENT OF MEDICARE INCENTIVES

finance 32 CHANGES COMING TO 401(K)

the arts 52 A MODERN RENAISSANCE MAN

the kitchen 55 ANGEL HAIR PASTA AND ASPARAGUS

in every issue 4 editor’s letter 8 news briefs

62 resource guide 76 top 9 list

COVER PHOTO COURTESY ISTOCKPHOTO

editor’s letter Hello Health Care Professionals, The success of any business is contingent on its ability to run efficient day-to-day operations and the effectiveness of its leadership. No other industry is held at the same level of accountability that is expected of health care professionals, making medical practice management a very challenging field to work in. Over the past few years the health care industry has gone through many changes that have made it even more difficult for administrators to stay on top of all the areas of their responsibility.

Personally however, I am impressed with the way that health care professionals are embracing these changes and collaborating on how to adapt in order to continue to provide top-quality medical care and remain profitable. Every issue of Med Monthly is dedicated to keeping those of you who work so diligently in the know about issues that could impact your practice. Therefore, our April issue on practice management is not only one of our most important editions, but one of our greatest achievements.

As your editor, I have prepared a healthy dose of knowledge and strategies that will position your practice for full-proof success. Suzanne Leder, our coding go-to girl, elaborates on the recent decision to delay the ICD10 conversion and explains the importance of not procrastinating in light of this extended grace period. I completely agree with her on this issue and have taken the initiative (despite the delay) to provide material that will lead you through a smooth transition, when the moment of conversion finally arrives. Robert Tennant, a national expert on health care IT, parallels the systemization methods used by Henry Ford in his efficient production of the Model T to today’s medical practices. In his article “What if Henry Ford had Been a Doctor?” he proves that finding the most efficient way of performing a task, systemizing that task and following through with consistency will always yield the best, most profitable result in any operation. The second half of Amanda Kanaan’s two-part series “How to Turn Your Website into a Medical Marketing Machine” spells out the potential detriment that a poorly designed website will have on your practice’s ability to attract and retain patients. In our cover story, Mary Pat Whaley shares her administrative genius in a how-to guide on restructuring your billing and collection areas so that you are spending less to create more revenue. These articles are only the tip of the iceberg as there is a plethora of equally as valuable information waiting for you in these pages.

We take pride in giving you career enhancing resources by staying abreast of health care administration issues and successes. I strive with every edition to provide health care professionals with information and tools that will enhance the quality of care and their practice revenue.

Thank you, as always, for your continued loyalty to Med Monthly, the best resource magazine in health care today.

Sincerely,

Leigh Ann Simpson Managing Editor 4 | APRIL 2012

Med Monthly April 2012 Publisher Philip Driver Managing Editor Leigh Ann Simpson Creative Director Courtney Flaherty Marketing & Advertising Jenna Cameron Contributors Mary Pat Whaley, FACMPE Judith Rawl, MD Gere Jordan Robert Tennant Amy Duatov Peter Polack Jennifer Daknis Ed Logan, DDS Amanda Kanaan Ashley Acornley, MS, RD, LDN Suzanne Leder, BA, M. Phil., CPC, COBGC 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 Edward Logan, DDS is a general and cosmetic dentist practicing in O’Fallon, Mo. Dr. Logan graduated from the University of Washington School of Dentistry. After years of learning the business side of dentistry, Dr. Logan decided to write a book, “Dentistry’s Business Secrets”.

You can read more articles by Dr. Logan at his website DentistrysBusinessSecrets.com

Ashley Acornley, RD, LDN holds a BS in Nutritional Sciences with a minor in Kinesiology from Penn State University. She completed her Dietetic Internship at Meredith College and recently completed her Master’s Degree in Nutrition. She is also an AFAA certified personal trainer. Her blog can be found at: ashleyfreshfromthefarm.wordpress.com

Amanda Kanaan is the owner/founder of WhiteCoat Designs – an online marketing agency committed to growing doctors’ practices through cost-effective and powerful online marketing solutions. Amanda regularly speaks at medical association meetings and conventions and is a published expert in the field of medical marketing. To learn more or for a free website evaluation, contact her at Amanda@whitecoatdesigns.com or www.whitecoat-designs.com

Mary Pat Whaley, FACMPE is board certified in health care management and a Fellow in the American College of Medical Practice Executives. She has worked in health care and health care management for 25 years. She can be contacted at marypatwhaley@gmail.com

Elizabeth “Libby” Knollmeyer, B.S., MT (ASCP) has over 40 years experience in the laboratory industry. She specializes in financial, operational management and compliance issues for hospital and physician office laboratories. Libby has a wide variety of experience with her areas of special expertise including financial review and management, compliance and regulatory assistance and lab design. She can be reached at eknollmeyer@triad.rr.com MEDMONTHLY.COM |5

publisher’s letter Dear Medical Professionals, As the publisher of Med Monthly magazine and the president of a regional physician staffing company, I am responsible for hiring a lot of people at all career levels, from interns to board certified physicians. Over the past couple of years I have noticed a huge mistake that many interviewees looking for jobs in health care are making. This simple but effective gesture is all too often forgotten, however, I think it is something that is very important when trying to get a job; the thank you note. Regardless if you spent an hour and fifteen minutes in a formal interview or had a five minute phone interview, sending a thank you note or email to your potential employer is not only appropriate but it exponentially increases your chances of being hired.

Following up with a quick thank you note after an interview takes very little time and effort, however I very rarely receive one. If I don’t get a thank you note or email from a person that I’ve recently interviewed, I assume that they don’t really want the job or they’re disorganized and discourteous.

Your thank you message doesn’t have to be long or involved, truthfully, the shorter the better. It should be direct, respectful and most importantly explain why you are the best candidate for the job. For instance, you could say: • • •

Thank you for meeting (or talking) with me.

I really want this job.

I am perfect for this position.

Here’s an example of a good thank you note: Hi Elizabeth, I wanted to thank you for meeting with me yesterday. Learning more about your primary care practice and seeing your staff in action solidified my interest in this position with your organization. The caliber of professionalism in your practice is exactly the type of environment that I am looking for to enhance my career. I am certain that I would be a perfect fit for the position and could hit the ground running and become a team player that you can depend on.

If you have any questions about me or would like to schedule a subsequent interview, please don’t hesitate to reach out.

Thank you again and I am hopeful that I will soon be joining your practice team.

Regards, Your Potential Employee Don’t be one of the many job seekers that provide minimal effort to impress potential employers. Blow them away with your professionalism, courtesy and obviously genuine interest in the position. Stepping up and letting an employer know how serious you are about working for them will always work in your favor, trust me.

Sincerely,

Philip Driver Publisher

6 | APRIL 2012

Counterfeit medicines filled with empty promises.

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Don’t be a victim!

Buy medicines only from state-licensed pharmacies that are located in the United States. Find your state’s contact information from the National Association of Boards of Pharmacy (NABP) at www.nabp.info or

Look for this seal on Internet pharmacy Web sites. Pharmacies that carry this seal are listed at www.vipps.info.

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Learn more at www.fda.gov/counterfeit V I CES • U SER

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U.S. Department of Health and Human Services Food and Drug Administration www.fda.gov 1-888-INFO-FDA

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news briefs

CMS Delays Enforcement of 5010 Standards Until July 1 The Centers for Medicare & Medicaid Services’ (CMS) Office of E-Health Standards and Services (OESS) has announced another delay of the enforcement of action against covered entities that are required to comply with the updated transactions standards adopted under the Health Insurance Portability and Accountability Act of 1996 (HIPPA) through June 30, 2012.

The delay is in response to the numerous technical problems with claim processing that have been reported by health systems and physicians practices. OESS is aware that there are still a number of outstanding issues and challenges impeding full implementation. OESS believes that these remaining issues warrant an extension of enforcement discretion to ensure that all entities can complete the transition.

OESS expects that transition statistics will reach 98 percent industry wide by the end of the enforcement discretion period. reach to include more technical assistance for covered entities.

OESS strongly encourages industry collaboration to identify and resolve all outstanding issues that are impacting full compliance, and looks forward to seeing extensive engagement in the technical assistance initiative.

8 | APRIL 2012

Affordable Care Act Will Ensure Health Coverage for Millions of Americans

Health and Human Services Secretary Kathleen Sebelius recently announced final policies that will ensure that millions of uninsured Americans will have a simple, seamless path to affordable health insurance coverage. “The Medicaid improvements in the Affordable Care Act will help simplify the system and ensure all Americans have the affordable highquality coverage they need,” said Secretary Sebelius.

The Affordable Care Act makes Medicaid available to individuals between ages 19 and 64 with incomes up to 133 percent of the federal poverty level – currently $14,856 for an individual and $30,656 for a family of four.

These changes will become effective in 2014 when Affordable Insurance Exchanges begin operation. The federal government will pay 100 percent of the cost of the Medicaid expansion for the first three years and at least 90 percent after that.

“Today, too many uninsured Americans turn to the emergency room for care and can’t pay their bills,” said Marilyn Tavenner, acting administrator of the Center for Medicare & Medicaid Services (CMS). “Insuring more Americans will decrease the hidden tax states and consumers with insurance pay to cover the cost of caring for the uninsured.”

The final rule also makes it easier for eligible individuals and families to enroll in Medicaid and the Children’s Health Insurance Program (CHIP) by cutting back on red tape and coordinating enrollment with the new Affordable Insurance Exchanges. Families will be able to enroll in the appropriate coverage proN O O gram through a single, COMING S streamlined, online THLY N O M D E application and IN M e u states will have the ntin thly will co e Med Mon th n benefit of reduced o ou reports S M C to bring y administrative de by ments ma w e n costs. r announce fo d Stay tune .

S H H d n a ents! devleopm

DocBookMD Spreads Physician Communication Region by Region

Hospital in Haiti Launches Search for CEO The board of directors of Hôpital Albert Schweitzer Haiti (HAS) has announced the launch of a search for a Chief Executive Officer for the hospital, which has been operating in Haiti since 1956. Hôpital Albert Schweitzer Haiti operates a regional referral hospital and diverse community programs that provide the only source of medical and development services for more than 350,000 people in Haiti’s Artibonite Valley.

“While much work remains to be done in Haiti today, there is great progress and great hope,” said John Walton, chairman of the board.

“For more than 50 years, Hôpital Albert Schweitzer Haiti has provided care for people in Haiti who have few or no other options. Today, we are launching a search for an individual with unique leadership skills to fill a compelling role as CEO of a hospital during a critical time in Haiti."

Officials are searching for a unique individual who can provide leadership for a multinational management team, sustain collaborative relationships with partners in the public and private sectors and advance the institution through fundraising efforts. For more information, go to www.tylerandco.com and www.hashaiti.org

Not sure if your patient needs to see a specialist? It’s no longer a guessing game as physicians in rural central Texas and the California wine country can now send text messages, X-rays, EKGs, lab results and other images to medical specialists miles away via DocBookMD, a Health Information Portability and Accountability Act (HIPPA)-complaint smartphone application.

Rural physicians handle a myriad of medical issues that often require contact with specialists whose offices may be miles away. Utilizing DocBookMD physicians can now collaborate beyond their county quickly and easily to improve patient care and determine with certainty that a trip to the specialist is necessary. “Getting patients to the right place faster is especially critical in rural areas,” said Tracey Haas, MD, a family physician and co-founder of DocBookMD. “By using DocBookMD, physicians can get nearly instant access to colleagues for consultations and to collaborate on a variety of patient concerns.”

Central Texas and the California wine country are the first areas to be regionalized by DocBookMD. Additional counties will be regionalized during the coming weeks and months.

More than 84 medical societies in 23 states now offer DocBookMD as a free member benefit to physicians. DocBookMD is available for iPhone, iPad, iPod touch and Android phones. To download the application, visit the App store on your smartphone.

For more information, visit docbookmd.com

research & technology

Improving Practice Efficiency With New Apps Utilizing inexpensive app systems to properly document processes and manage projects By Peter Polack

C

omputerized practice management systems began to appear about thirty years ago. What is their major selling point? To automate humans out of as many processes as possible to reduce error and improve efficiency.

Medical practices are attempting to achieve those same goals through the use of electronic medical records (EMR) systems. But trying to eliminate humans entirely from the practice of medicine is a fool’s errand. Relying increasingly on technology without acknowledging the human element is a recipe for failure.

10 | APRIL 2012

People will always be an integral part of the practice of medicine but there are ways that technology can leverage their effort for the better. Known as “convenience applications,” these software programs are priced anywhere from free to under a couple of thousand dollars – compared to tens of thousands of dollars for your typical EMR or practice management system. In contrast to the latter, convenience apps are specifically designed to assist humans to be more productive and profitable doing those tasks which can’t be completely automated.

They help your staff do the right things (effectiveness) and do the things right (efficiency).

Due in large part to the ubiquity of mobile devices, these apps can be found in a multitude of areas from time and task management to collaboration and communication.

If you own an iPhone or other smart phone, you’re probably using several of these already.

So how can these help you in your practice, you may ask? Let’s review two areas of interest as an example: process documentation and project management.

Process documentation The operations in your medical practice are nothing more than a bunch of processes. However, as W. Edward Deming, a pioneer in quality management, once said, “If you

can’t describe your process you don’t know what you’re doing.” Simply having well-trained, knowledgeable employees doesn’t help if they leave and take their knowledge with them. By documenting all of your processes, you can standardize them, squeeze the variability out of their execution and “clone” your A-teams by ensuring the transfer of that knowledge.

If you are a solo practitioner with a handful of employees, you may think this is overkill. You are constantly teaching your staff how to do various tasks, so what’s the use of writing things down? But what happens when employees leave and you find yourself repeating this process ad nauseum?

A bigger practice is more likely to document things (once) in a written employee training manual, but this is of little use in the middle of a busy clinic day. This is what is known as “just in case” learning, and it relies on filling workers’ minds with tons of information that they may or may not ever need to use. It also requires constant retraining and reinforcement so that, should that knowledge ever be needed, the employee will hopefully remember it.

On the other hand, documenting your processes, ideally in a digital format, employs “just in time” learning. All that a new or temporary worker would need to know is how to access your process flow maps and follow the specific steps as illustrated. An existing worker could fill in for an absent one without having to formally crosstrain for that position – he or she can merely consult the documented processes to get the job done. Another great feature of digital process documentation is the ability to use

employee feedback to constantly tweak processes for improvement. In contrast, an employee manual merely tells workers what to do but not necessarily how to do it better, and is only updated infrequently. The following are a few examples of process apps:  SmartDraw  Google Docs  Microsoft Vision  Gliffy

Project management Anything that takes two or more steps and has a beginning and an end is called a project. This can be anything from a simple remodeling of an exam room to something as complex as implementing electronic medical records in your practice. Keeping true to the concept of knowledge sharing, project management should not take place in someone’s head but in a tool specifically designed to promote collaboration.

Project management apps can display timelines with dependencies, task staff members with automated reminders and allow managers to display the progress of the project at a glance. They keep everyone on the same page at all times and are more flexible than calendars. Just try scheduling a multi-step project in a calendar and see what happens if one of those steps has to be postponed: chaos. Here are a few examples of project management apps:  MindManager  BasecampHQ  Microsoft Project  ProjectPlace Smart and profitable practices are efficient ones. By using “convenience” apps, your practice can match the productivity and profitability gains an EMR system gives you at a fraction of the cost.  MEDMONTHLY.COM |11

practice tips

S

even seconds: that is how long your website has to make a good impression on a potential patient. And if it doesn’t “click” the patient will move on to your competitor’s website. Regardless of how high your website ranks in the search engines, your efforts are futile without a website that ultimately persuades patients to make an appointment.

Part one of the series “How to

12 | APRIL 2012

Turn Your Website into a Medical Marketing Machine” revealed how to increase your website traffic through the use of search engine optimization (SEO). In part two of the series you will learn the five elements of highly effective medical website design to help convert visitors into actual patients. Search engine optimization and website design each play vital roles in ensuring the greatest return on your investment when it comes to

your online presence.

FIVE ELEMENTS OF HIGHLY EFFECTIVE MEDICAL WEBSITE DESIGN

1

Polish your image

Patients will make assumptions about your practice, and base their decision to seek your care on the

quality of your website. If your website is outdated, patients will assume your care is as well. Regardless of how accurate their sentiments are, perception is reality in this case.

While it’s important to present patients with a professional image, be careful not to go overboard with the use of unnecessary flash, graphics and music. Causing sensory overload is just as harmful as a poorly designed website to your practice’s image.

In fact, most mobile devices such as iphones and ipads cannot even register flash on a website and instead display a blank box on the screen.

According to a 2011 study by comScore, every month almost 17 million Americans access health information on their mobile devices. Therefore, it is best to keep the design clean, simple and mobile friendly.

Online videos and virtual tours are a great way to make patients feel welcome at your practice before they ever step foot in your office. Thirty second videos of your providers delivering a welcome message or talking about education related topics will help patients make an instant connection with your practice and also help to relieve a patient’s anxiety about what to expect when they visit your office.

Another small piece of advice that will make a big difference is to use professional photography for the providers’ headshots. One of the main reasons patients visit your website is to get an impression of your doctors.

An unflattering headshot taken with a staff member’s digital camera in the office may not portray your doctors in the best light. A professional headshot with proper lighting can make all the difference in properly branding your provider’s image.

2

Send the right message

The message you send is just as important as the image you portray.

Regardless of if you want to be known as the solo doc with friendly, personal care or a large practice that offers the convenience of multiple specialties under one roof, you can send strategic messaging through the writing style of your website’s content. Consider hiring a medical marketing professional to help you craft a message that differentiates your practice in the community. Your messaging should ultimately answer the question, “Why should I choose you?”

Evaluate what truly makes your practice unique before answering this question. Touting that you offer experienced care is not a differentiator. That is a generic statement that I bet most of your competitors boast as well. Examples of true differentiators would be “delivered the most babies in Atlanta” or “first robotic surgery performed in the state” or “Seattle’s only ‘green’ dental practice.” These are tangible statements that will set your practice apart and establish a brand that is unique.

3

Focus on functionality

Sometimes practices build beautiful websites with flashing images and elaborate intros that are pretty to look at but aren’t very functional for the user. Patients often visit your website for a very specific reason – to get directions or read about your doctors for instance. If you don’t make it easy for patients to instantly locate what they need, then it’s either one more phone call your staff has to answer or

one more potential patient you just lost.

Ask your staff about reoccurring questions they receive from patients to better understand how to organize your website’s layout. One of the most popular pages on any medical website is the “meet the doctors” page. More than ever patients are researching and comparing their providers to determine who is best to manage their treatment. Instead of burying this page in the submenu of the “about us” section, feature a button right on the homepage so patients are just one click away from reading about your providers.

When it comes to the navigation menu itself, website visitors are now used to a particular format with the menu either on the left side of the page or across the top. Do not attempt to be “cutting edge” by featuring your menu on the right side of the page, it will only confuse visitors. Just like the design itself, keep the functionality simple and clean.

4

Provide meaningful content

According to a 2010 study by the Pew Research Center, 80 percent of all internet users, or 61 percent of all adults, search online for health information. When it comes to the source of this information, ideally patients should look to their health care provider, not websites like WebMD. By providing meaningful content on your website beyond a list of services and directions to your office, you’ll not only drive more traffic to your site but you will also fulfill a growing demand of patients seeking information online.

Blogs are the best way to provide MEDMONTHLY.COM |13

ongoing medical education to your patients. Although physicians are sometimes overwhelmed by the idea of keeping up with a blog, a preset plan of blog topics will help relieve some of this anxiety. Plan your blogs 30 days, 60 days or even 90 days in advance with a schedule of topics to cover once a week. Blogs that are 350 – 400 words in length are ideal and take very little time to write.

These days you can hire marketing agencies to write your blogs for you or can use a content management system (CMS) to do it yourself. A CMS is a software program that allows you to easily manage the content on your website and blog without knowing html (computer language).

Using a free CMS, such as Wordpress, to manage your blog can save both time and money for your practice. As easy as editing a word document, staff can make simple updates to the website without incurring additional costs from a web designer or waiting several days for the change to be completed. This includes adding a bio and picture for a new doctor to your website or writing a weekly blog.

The CMS will also allow you to tag your blog entries with corresponding keywords so the article can be found by the search engines.

5

Call patients to action

Websites should be more than just an online brochure. Yes, they provide valuable information about your practice but their first priority should be to convert visitors into new patients. Just like making a sale in the business world, sometimes it’s as simple as asking the visitor to take action. Whether you prompt

14 | APRIL 2012

the patient to request an appointment, fill out a contact form, sign up for your newsletter, or simply follow you on Facebook, asking them to take some form of action will yield a much higher new patient conversion rate.

Your website should feature a call to action on every page. For instance, include your phone number at the top of the website header that says “call us to schedule an appointment” or a link at the bottom of each page that directs them to the “contact us” page.

Practices that already have a website can use these tips to tweak the design of their website and help them take it to the next level. For the practices in need of a brand new website, be cautious of do-it-yourself web design companies that claim to give you complete control of your website. Often these templated websites end up being poorly designed, may contrast with your practice’s current branding and don’t deliver the new patient volume you were hoping for.

Shop around to find a professional medical website design agency that can provide a custom website that is both within your budget and delivers the results you seek.

In part one of the series “How to Turn Your Website into a Medical Marketing Machine” we explored the importance of SEO and how to ensure your website is found by patients in the search engines. In part two you learned how to convert website visitors into patients through the five essential elements of highly effective medical website design. Together this two-part series gives your practice a comprehensive overview of how to maximize your digital presence and reap the greatest return on your online investment. 

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practice tips

Could Your Practice Handle a

Considering the effects that a devastating natural disaster could have on your bottom line

By Peter Polack

16 | APRIL 2012

H

ave you stopped to consider what would happen if a natural disaster such as a massive tornado or flood wiped out your office? What would you do first? How would you get your practice back in business? Phillip Bobo, MD, of Emergi-Care, in Tuscaloosa, Ala., learned this the hard way. In practice for 28 years, he recently suffered the demolition of his office by a killer tornado – the only medical practice in town that was completely lost. Because he heeded the warnings of meteorologists, he closed shop early as severe weather approached.

As a result, there were fortunately no casualties among his staff, but he was out of business for five weeks.

Many of us have had to deal with a power outage or some temporarily severe weather, and we may have a plan on how to handle that situation: send the patients who are there home, notify the rest that their appointments are canceled, etc.

These are events within the scope of disaster recovery and business continuity, considered to be above the “Black Swan Line,” according to Hank Christen, MD, an expert in emergency management and terrorism response. A “Black Swan Event” refers to disasters that are so unexpected and catastrophic that they are often not prepared for because they are outside of our realm of reality even though they are not impossible.

They usually result in extremely negative societal impacts that they are nearly impossible to fathom, much less prepare for. But what if

you experience an event below the Black Swan Line? There are no existing case studies for these events, they are, in essence, a “sucker punch,” says Christen. Some examples of these include the Hurricane Katrina flooding in New Orleans, the Fukushima nuclear reactor disaster in Japan, and the massive twisters in Joplin and Tuscaloosa Ala. In the case of Hurricane Katrina, medical staff at New Orleans General Hospital saw the health care in their facility degenerate from state-of-the-art to primitive – from hand-ventilating patients with untrained personnel to helping patients die comfortably as the hospital flooded – when backup rescuers would not arrive.

What if:  your town had no power or water for a week?  your employees lost their homes and had to move out of town to stay with relatives?  a fire threatened your town and you were given one hour to evacuate?  all of your patient records were paper charts?  your electronic medical records (EMR) system didn’t have backups stored off-site?

This is the area of business resiliency, where planning isn’t enough.

Christen says that the goal is trying to bounce back above the line, where the core capabilities of your business are, and your planning can once again kick in. This depends on the resourcefulness, redundancy, robustness and rapidity of your business

and its people, and often involves thinking outside of the box.

In Bobo’s case, a combination of quick thinking and some good fortune helped get his business back on its feet. He was able to lease the office building of a local physician who had been deployed overseas. Since it only had half the number of exam rooms that he needed, he also had to lease a modular building as well as an adjacent parking lot. Within three weeks he was back to his normal pretornado schedule.

Since these Black Swan scenarios are fortunately rare, it is important to have a good disaster recovery plan for the more likely events above “the Line.” For practices with an EMR system, this means:  ensuring that your EMR system has a good backup system.  off-site storage of the backup media, preferably in alternating locations.  periodic testing of the backup media to ensure its integrity.  backup power supply with sufficient reserve to gently power down servers or key computers.  considering a stand-by generator to keep the cooling systems going and prevent hardware meltdowns until they can be safely turned off.  keep a laminated disaster plan available for any personnel that have access in an emergency.  consider the use of a “hot site,” a secondary location that can quickly take over for your primary data center, thus minimizing business down time.  MEDMONTHLY.COM |17

practice tips

Develop a New Financial Policy for Your Practice A quick tutorial on improving your practice’s methods of collecting revenue

By Mary Pat Whaley, FACMPE

W

hen it comes to financial policies, I recommend staying away from financial policies that are long and wordy. Try using a simple format that your patients and staff can understand and use.

The format I recommend is one with three columns:  The patient’s plan  What the patient does  What your practice does Here’s an example of how the three columns would read:  The patient’s plan: Medicare

18| APRIL 2012

 What the patient does: Pay your deductible ($155 for 2010) and coinsurance (20 percent of the allowable).  What your practice does: We will file Medicare for you.

You can use the front of the financial policy to list all the variations of plans that the practice accepts. For instance, your list of variations for Medicare might include:  Medicare  Medicare/Medicaid  Medicare/supplemental policy  Medicare Advantage Plan (HMO/

PPO)  Medicare Advantage Plan (PFFS)  Medicare secondary (MSP)  Railroad Medicare Combine any like plans that you will treat the same. Then decide what you will expect from the patient at time of service or after, and what the practice commits to doing. Don’t forget to address patients being seen out-ofnetwork and self-pay patients.

I use the back of the policy to cover everything that you would like the patient to sign off on. This could include:  Receipt of notice of privacy policies  Receipt of advance directives/living will info  Agreement to financial policy  Assignment of benefits to practice  Guarantee of payment When you put a new policy in place, you have a number of options to inform your patients. Here are some suggestions:  Put the policy on your website.  Send a copy of the policy to all new patients.  Discuss the policy when you call patients to remind them of their appointment.  Discuss the new policy at check-in and/or check-out and let patients know it will be in effect at their next visit.  Circle the patient’s plan on the front, have the patient sign the financial policy on the back and give them a copy to take with them.

How you decide to educate the patients will depend on how much time you have between making the appointment and seeing the patient and the type of practice you have – primary care versus sub-specialty. Also, don’t forget to educate your staff. If they have not had to discuss the practice’s finances before, they will need some coaching and some practice.

If you’d like a free copy of my sample financial policy, shoot me an email at marypatwhaley@gmail.com 

practice tips

Outsourcing to Medical Call Centers Five tips to make your relationship successful and maximize their services

By Gere Jordan

W

hen managed properly, outsourcing a portion of your calls to a medical call center can be an extremely effective and worthwhile business decision. Your practice can provide patients with a better level of care filter messages for on-call personnel and avoid the high costs associated with hiring dedicated staff or implementing complicated automated systems. Done improperly, relationships with patients can be harmed and hard-earned dollars wasted. This brief guide is designed to help you make sure you do everything you can on your end to make the outsourcing relationship a success.

1

Make sure your account instructions fit your practice

It’s important that you spend some extra time making sure your call-taking script and account instructions are appropriate for the type of calls being handled on your account. Before an answering service can start taking calls

20| APRIL 2012

for you, they have to be aware of what type of calls to expect on your account and how they should be handled. This process includes developing your script and instructions for delivering your messages.

If your service provider is experienced and has worked with a lot of medical practices in the past, chances are they have a standard script and account instructions that they will present to you. Although these default scripts are a great starting point, they most likely aren’t a perfect fit right out of the box. One of the biggest mistakes you can make is to use a default script without scrutinizing it and making sure it works for your patients. For example, some medical practices do not handle prescription calls after hours and do not want their on-call personnel paged for anything regarding a prescription.

Another practice, however, such as one that performs a lot of surgeries, may routinely take such calls and may have patients with urgent prescription needs after hours. As you can imagine, hav-

ing an account that does not allow the proper calls to reach on-call personnel is a major problem, one that can not only harm your reputation but also result in lawsuits and financial losses. Take some extra time and explore the script from every angle, ensuring the questions and corresponding instructions match up with your procedures.

2

Inform the right people of your call center procedures It’s important that everyone involved — including on-call doctors, patients and office staff — be informed of your call center’s procedures and how they are personally affected by them. Doctors should be aware of how the call center will be contacting them after hours and how to make changes to that procedure. Patients should be aware of what an acceptable after-hours emergency is and how to reach the call center. Office staff should be aware of how non-urgent messages will reach them in the morning and whether or not they are listed as a backup for account clarifications.

All too often, various people are unaware of how they fit into the process and end up getting angry or frustrated when they are called upon. For example, maybe an office assistant is listed as the person your call center should reach if there is no on-call doctor listed. If that assistant isn’t aware he or she may be called after hours, they may not be prepared to assist the call center when

MEDMONTHLY.COM |21

asked and may feel that the agents aren’t performing their jobs properly. In reality, however, a lack of communication caused the mix-up and could have been easily avoided.

3

Treat your call center as part of your practice and update them regularly Just as it’s important to keep parties on your end informed, it’s also important to regularly update your call center. By considering them a part of your business, you’ll be more likely to include them when instituting changes that may affect how they operate. So if your schedule changes, you add or lose doctors, your on-call procedures change, or build a website for downloading new patient forms, it’s important your call center is made aware. If your office staff has this information but fails to provide it to the call center, callers who reach them looking for it will be upset and won’t find the service beneficial.

4

Look for new ways to integrate your call center into your practice When you first start working with your call center, it’s likely that they will only provide you with a basic service, such as after-hours answering. However, due to advances in technology, there are more services they can provide, such as appointment scheduling. As you move forward, it’s a good idea to speak

with your sales or customer service representative in order to understand all of their capabilities and to ask about the specific needs you may have. It’s possible that they could do a lot more for your callers and thus become a more valuable part of your operation. So instead of instructing a patient who calls after hours to ask about their appointment time to call back when the office opens, or taking a message so someone can return their call, perhaps it’s possible for your call center to integrate with your software system and look up their appointment information.

5

Use your call center data to make improvements All of the calls handled by your call center should be logged and recorded, and there are a variety of ways this data can be used to improve your operation and ensure that your call center is effective. By staying on top of this data and being aware of what occurs on your line, you can be certain that your patients are receiving accurate information, that your account is configured properly and that you’re getting the most out of your service.

As an example, you may notice that a certain amount of minutes are being used but that you aren’t getting any messages. After listening to some calls, you may determine this is due to only accepting emergencies after hours and asking other callers to call

back. Armed with the knowledge that a lot of patients are calling after hours for things they can’t be assisted with, you may decide to make changes that either reduce these calls or improve what can be done for them. Maybe have your call center record an automated pre-screen message asking non-urgent callers to call back during office hours and send out an email to patients about what your call center is capable of, if you want to reduce the calls. Perhaps you take a closer look at the reasons people are calling and work with your call center to allow agents to take more messages and perform more tasks, thus eliminating the need for people to call back the next day. Either way, you’ve taken advantage of the information your call center data reveals and taken action to improve, something that your patients will certainly appreciate.

By following these steps and working closely with a professional and reputable call center, you can be certain that you’re providing the highest level of care to your patients.

As a reminder, these tips are for medical practitioners and the personnel they have managing their call center service, not the call center themselves.

There are obviously a lot of responsibilities on the call center’s end that play a part in the success of the relationship. *Article previously published for medicalpracticemanagementtrends.com 

DR. E D WA R D

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practice tips

Mitigating The Risks of ICD-10 What can your practice do to be prepared for implementing ICD-10?

By Amy Dunatov, MPH, FACMPE, CCS-P, Director, Coding Services Management Services On-Call, Inc.

24| APRIL 2012

ICD-10 IMPLEMENTATION ASSESSMENT QUESTIONS

T

he implementation of International Classification of Diseases, 10th Edition (ICD-10) will bring several challenges to hospitals, physician practices, health plans, vendors and many others. To meet these challenges, you must analyze how the transition is going to impact your business, assess the necessary changes and plan for the financial impact.

To fairly assess how the transition will impact your business, key members of the organization must be brought together for a detailed look at operations.

It is important to develop a strategy for implementation which includes a readiness assessment, an impact assessment, training plan and budget. Centers for Medicare & Medicaid Services (CMS) provides a very helpful guide for physician practices.

Business process changes to assign new codes at the most efficient point, staff training, communication among physicians, other providers, hospitals, and insurance carriers, and forms and systems updates are only a few of the ICD-10 transition challenges. The organization should develop a detailed assessment with thoughtful planning for the sequencing of events. Key critical components should be assigned to appropriate people within your organization. Assemble an implementation team and have regular meetings to foster effective communication and develop strategies to minimize problems and maximize opportunities.

Training of providers and staff can potentially be the most costly and time consuming component of the transition. Who should be trained? When should key people be trained? How do we assess and improve providers’ coding and documentation? These ques-

tions are only a starting point for the assessment.

The financial impact of the ICD-10 implementation to the organization could be significant. Medical Group Management Association estimates ICD-10 conversion costs for a threephysician practice to be $83,000 with as many as four fewer patients a day being seen. A Health Leaders Media survey reports: 46 percent of health care leaders anticipate revenue loss from ICD-10 implementation. Careful planning will aid in keeping the cost at the lowest level possible. To financially plan for the transition, you should ask:  What is the cost to train the staff and physicians?  What is the cost to modify processes and forms?  What is the cost of the necessary software changes?  What if a significant number of claims are denied post 10/1/2013?

The answers will help the organization plan for potential expense increases without corresponding revenue.

Creative solutions to reducing the financial impact may include teaming up with other local providers for cost savings. You might be able to train a staff person from one practice, who can in turn train staff members in other practices or hire one onsite trainer for multiple practices.

The risks can be reduced if the organization plans for the changes in a methodical manner, communicates effectively with internal and external team members, and prepares for the financial impact through a careful risk assessment. Asking questions and staying informed are keys to implementation success. Visit the CMS website often for updates: www.cms.gov/ICD10 

 How will the new ICD-10 codes be available in the hospital or practice management system – manual entry or download from vendor?  Are hardware upgrades necessary?  Will there be an additional fee for providing an ICD-10 download? When will it be available and how long will it take to download?  What is the process for handling ICD-9 claims after the conversion?  What are the top ICD-9 codes and the corresponding ICD-10 codes for the practice/specialty?

DEVELOP AN IMPLEMENTATION TIMELINE  Appoint an ICD-10 transition team leader to monitor readiness.  What is the most efficient and productive way to educate the staff and physicians?  Who is responsible for updating forms with new diagnosis codes?  Who will communicate updates to the organization?  How will the communication be structured to gain maximum distribution?  Does the organization participate in a research study or registry? If so, how will reporting change?  Does the organization have worker’s compensation claims? If so, will the state’s claims administrator be ICD-10 ready?  Who will monitor claim denials after the deadline?  Will more staff resources be necessary to process denials?  How will diagnosis comparison reports across 2012 and 2013 be integrated?

practice tips

Month by Month Marketing Calendar This three month sample marketing calendar details how to plan marketing efforts based on seasonal opportunities throughout the year

By Edward M. Logan, DDS

M

any dental practices have found great value in the design and utilization of a marketing calendar delineating various campaigns we anticipate employing throughout the year. Some advantages of scripting such a well conceived plan are: accountability in adhering to marketing goals, ability to track progress and accumulation of valuable return on investment data. Practices implementing such a plan are more likely to achieve maximum return

26| APRIL 2012

on investment and a steady stream of new patients. Without a clear plan and outline of marketing tasks to accomplish it is easy to overlook the need for ongoing marketing efforts.

An illustrative marketing calendar is demonstrated below.

JANUARY New mover mailings: The first month of the year is often a good time for direct mail. The holiday rush of mail has dissipated and many homeowners are stuck indoors as a

result of inclement weather.

New year insurance benefits: Use your direct mail marketing pieces, patient e-newsletter, social media outlets and website/blog to remind patients that they may have new insurance benefits with the start of the new calendar year.

Martin Luther King, Jr. Busy Day: Government, bank and school holidays provide the opportunity to easily fill the schedule with appointments for kids. This federal holiday is a very busy day in my practice. Parents and government workers look to take advantage of this day off to schedule their appointments. Train your front office staff to encourage parents to schedule their children on during these school closures.

Fourth quarter and end of year ROI: Perform a fourth quarter and year-end assessment of the return on investment (ROI) for each of your individual marketing efforts.

Discontinue marketing programs that did not benefit your practice.

New year marketing goals: Take time to brainstorm and outline your production and marketing goals for this year. Research new methods of marketing that might be beneficial and talk with colleagues in other cities to learn what is working to promote their practices.

FEBRUARY Successful new mover mailings: February is still a good time of year for direct mail. In fact, studies on the effectiveness of marketing efforts recognize this month as the most valuable month to utilize direct mail.

National Dental Hygiene Month: February is Dental Hygiene Month, so schedule your dental assistant and hygienist to visit area pre-schools and elementary schools. Kids enjoy presentations on dental hygiene that encourage their participation and always love diving into goodie bags containing personalized products that staff members leave for them. The expectation, of course, is that they will share these items with their parents, providing them the contact information necessary to appoint their family in your practice. Use your blog and social media outlets to pass along informative articles on dental

hygiene this month.

Caution! Be aware of the February fizzle: The second month of the year is commonly accompanied by a reduction in appointment scheduling, making marketing efforts even more important. Patients delaying year-end recommendations routinely complete treatment in January, thereby curtailing the rush to use new insurance benefits. Patient finances are traditionally squeezed at this time of year, resulting from credit card enhanced holiday bills.

Overdue recall reminders highlighting spring break: This is a good time to run your overdue recall report and send out reminder postcards or emails at the beginning of the month. Use these postcards to entice families whose children are overdue for recall appointments to come in during Spring Break.

Presidents’ Pediatric Dentistry Day: President’s Day is another busy federal holiday that requires us to open another patient column and gives my office the impression of a pediatric dentist.

MARCH Spring Break season is here: Hopefully, you took the opportunity in February to remind parents to

schedule children who are overdue for hygiene appointments during Spring break. Continue these efforts and look to see if you may need to hire an additional hygienist during this busy time. Remember parents are typically very amenable to exploiting school closures to efficiently care for the needs of their children.

Extended FSA deadline: Some Flexible Spending Account (FSA) plans allow benefits for the previous year to be used through March 15. Make your patients with FSA benefits and treatment plans aware of these possible provisions in their plans. Again, people tend to respond favorably to encouragement to spend benefits they may even have forgotten they possess. Remind your patients that this money, if not put to use, is essentially wasted as it will be absorbed by their company.

Baseball season is near: If your city has a Major League Baseball team, consider sending out magnets inscribed with the season schedule and your contact information. *This is a sampling of our “Month by Month Marketing Calendar” that is available on the Dentistry’s Business Secrets’ Practice Marketing Tools CD. The actual file contains 12 full months of marketing ideas. 

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legal

malpractice complaints filed, can result from a doctor’s poor handwriting on prescription scripts and records. Clear and constant verbal communication during procedures, surgeries, and in regard to patient care, details and instructions are crucial to limiting mistakes.

Bed side manner

Three Imperative Tips for Reducing the Risk of a Malpractice Lawsuit Simple precautionary procedures to prevent difficult legal ramifications

By Sara Witt

I

n 2011 the New England Journal of Medicine published data indicating that most U.S. physicians will be named in a medical malpractice lawsuit during their careers; the data also indicated that most U.S. surgeons will be sued before they reach 65. It’s a dangerous game that those in the medical community play. Their job is to save people’s lives, and the vast majority of the time they do; however, as everyone knows, one small human error can mean the loss of a life. As if the threat of losing a patient isn’t pressure enough, the threat of lawsuits constantly loom over doctors, medical practices and hospitals. Given the rate of malprac-

28 | APRIL 2012

tice lawsuits, what are ways those in the medical field can limit their risk of being sued for medical malpractice?

Below you’ll find three tips that every physician should take seriously.

Medical personnel and communication Engaging in adequate communication (verbal and written) between doctors and other medical professionals is an imperative step doctors should take to limit their risk of being sued. Medical professionals must keep adequate and legible written records so that mistakes in care do not occur. For instance, medication error, one of the most common medical

Communicating clearly and effectively with patients is not only expected of doctors, it is required by law. One of the most common complaints filed in medical malpractice cases is failure to obtain informed consent. As doctors know, there is a procedure for this and other forms of doctor-patient communication. Additionally, reducing the risk of lawsuit is not just about what doctors legally owe to patients; it’s also about the way patients feel about their doctors.

A patient who feels disrespected by his or her doctor is more likely to file a malpractice complaint than one who has been treated respectfully. Take the time to explain to patients everything they need and want to know about their care, listen to their concerns and treat them courteously.

Hiring practices Everyone from medical practice administrators to doctors in small practices should do adequate background checks on all incoming staff members.

All new hires should have their licenses checked to ensure they are valid and clean. Additionally, new hires should be checked for any past or current claims or complaints brought against them, and have a good reputation in their field. The reality is that hospitals or practices that employ physicians who have been sued for medical malpractice are often named in lawsuits, even if sued physicians have their own medical malpractice insurance. This demonstrates just how important it is to be sure that staff members are ethical and well-trained. 

The Cost of HIPPA Non-compliance – $17 Million

By Kevin McGintyand & Cynthia Larose If it wasn’t clear before, a recent settlement of Health Information Portability and Accountability Act of 1996 (HIPAA) claims brought by the Department of Health and Human Services (HHS) against BlueCross BlueShield of Tennessee (BCBST) underscores the high regulatory cost of non-compliance with privacy requirements. HHS announced on March 13, 2012 that BCBST has agreed to pay $1.5 million to settle claims that BCBST violated HIPAA in connection with the theft in 2009 of 57 unencrypted hard drives containing protected health information of over 1 million individuals. The payment to HHS, however, is the tip of the iceberg. According to the Nashville Business Journal, BCBST reported that it has spent nearly $17 million in investigation, notification and protection efforts. Thus, even though privacy class actions typically falter for inability to prove recoverable damages, the BCBST case demonstrates that data breaches can still result in substantial administrative fines and remediation costs.

The clear takeaway: businesses should be mindful of the potential cost of non-compliance when evaluating the sufficiency of their privacy-related policies, procedures and infrastructure.

Reprint from Mintz Levin – Health Law

States Given More Flexibility to Establish Affordable Insurance Exchanges

H

ealth and Human Services (HHS) Secretary Kathleen Sebelius today announced policies to assist states in building Affordable Insurance Exchanges. Starting in 2014, these one-stop marketplaces will allow consumers and small businesses to choose a private health insurance plan and offer the public the same kinds of insurance choices as members of Congress. The policies released will help states in designing their Exchanges to best meet the needs of their consumers. They offer states substantial flexibility as they design a marketplace that works for their residents. “These policies give states the flexibility they need to design an Exchange that works for them,” said HHS Secretary Kathleen Sebelius. “These new marketplaces will offer Americans one-stop shopping for health insurance, where insurers will compete for your business. More competition will drive down costs and Exchanges will give individuals and small businesses the same purchasing power big businesses have today.”

Today’s policies provide states with the guidance and certainty they need as they continue to work to build these marketplaces for their residents for operation in 2014. The policies offer guidance about the options on how to structure Exchanges in two key areas:  Setting standards for establishing Exchanges, setting up a Small Business Health Options Program (SHOP), performing the basic functions of an Exchange, and certifying health plans for partici-

pation in the Exchange;  Establishing a streamlined, webbased system for consumers to apply for and enroll in qualified health plans and insurance affordability programs.

The final rule builds on the flexibility and resources provided by HHS already to build state-based Exchanges. A majority of states have taken significant steps in building Exchanges. Previously, HHS awarded 49 states and the District of Columbia $50 million to begin planning their Exchanges, and as announced, 33 states and the District of Columbia have received over $667 million in Establishment Grants to begin building their Exchanges.

The announcement builds on over two years worth of work with states, small businesses, consumers and health insurance plans. The administration examined models of Exchanges; convened numerous meetings and regional listening sessions across the country with stakeholders; and consulted closely with state leaders, consumer advocates, employers and insurers. To finalize the rules announced today, HHS accepted public comment over 75 days to learn from states, consumers and other stakeholders on how the rules could be improved, and HHS modified the proposals based on feedback from the American people.

For more information on this announcement, visit: www.healthcare.gov/news/factsheets/2011/07/ exchanges07112011a.html and for more information on Exchanges, including fact sheets, visit www. healthcare.gov/exchanges  MEDMONTHLY.COM |29

legal

Changes in EHR Incentive Payments Medicare/Medicaid EHR Incentive Program payments have been reassigned. Is your practice covered?

By Judy Know & Jill Girardeau

T

he Health Information Technology for Economic and Clinical Health (HITECH) Act provides incentive payments through the Medicare and Medicaid programs to hospitals and certain individual health care providers – referred to as eligible professionals – that adopt and “meaningfully use” certified electronic health records (EHR) technology. Please note that hospitals may receive the payments directly from the Medicare and Medicaid programs. A reassignment from an eligible professional is not necessary to receive such payments. However, a hospital affiliated medical practice that employees eligible professionals will not be able to receive EHR incentive payments unless its eligible professional has

30 | APRIL 2012

reassigned their rights to such payments to the medical practice. As more individual health care providers receive these payments, an increasing number of medical practices have inquired about receiving these payments via reassignment from the individual providers.

Under the Medicare program, eligible professionals include physicians, dentists, chiropractors, podiatrists and optometrist. Hospital-based professionals who provide substantially all (i.e. 90 percent) of their services in an inpatient or emergency room setting, such as emergency physicians, anesthesiologists, hospitalists and pathologists, are not eligible to receive payments from the Medicare program. Under the Medicaid program, eligible professionals include physicians,

dentists, certified nurse-midwives, nurse practitioners and physician assistants who lead rural health clinics or federally qualified health centers who meet certain Medicaid volume criteria. Please note that the Medicare EHR Incentive Program will provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals that demonstrate meaningful use of certified EHR technology. The Medicaid Incentive Program will provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology.

The HITECH Act and the related rules do not provide for automatic payment of the ERH incentive payments to an eligible professional’s medical practice (including a medical practice affiliated with a hospital) or other entity which bills for the eligible professional’s services. However, the HITECH Act and the related rules do permit (but do not require) eligible professionals to reassign their right to receive the EHR incentive payments to an employer or other entity with which they have a contractual arrangement allowing the entity to bill for the services of the eligible professionals. It is important to note that each eligible professional may reassign the entire amount of the incentive program to only one employer or entity. An eligible professional may also reassign his or her incentive payments to a state-designed entity promoting the adoption of certified EHR technology.

This reassignment must be consistent with the general rules governing reassignment of Medicare and Medicaid payments. As a result, medical practices, medical practice foundations, community clinics and hospital outpatient clinics that bill for their eligible professional’s services may receive the EHR incentive payments, provided that these organizations have taken appropriate steps to ensure receipt of such payments. 

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legal

New 401(k) Rules Could Affect Your Practice Upcoming regulation changes for 401(k) plans

By Jennifer B. Daknis

32 | APRIL 2012

2

012 brings a magnitude of regulatory changes that affect all qualified retirement plans such as 401(k)s, 403(b)s, defined benefit plans and profit sharing plans. Many business owners, ex-

ecutives and human resources managers are unaware of these upcoming regulatory changes and how this will affect both them and their plan participants. These regulations, imposed by the Department of Labor (DOL), are designed to enhance the communication of the fees and expenses of the plan as well as conflicts of interest between the plan sponsor (the business owner or organization that establishes the retirement plan for their employees), the covered service provider (to be defined later in this article) and the plan participants (employees or beneficiaries who have an account balance in these types of plans). New fee disclosure rules require plan sponsors to have access to a complete description of the services being provided to the plan as well as information about how much their retirement plan actually costs.

To understand these regulations, we must first define who is a fiduciary and what it means to be a fiduciary.

A fiduciary can be defined as a plan trustee (normally the business owner or high-level executive), an individual who exercises discretionary authority or control over plan assets, an individual who provides investment advice for compensation or an

individual who is responsible for plan administration. Simply put, a fiduciary is anyone having legal or ethical responsibility for looking after someone else’s money. The DOL handbook states, “Fiduciaries have important responsibilities and are subject to standards of conduct because they act on behalf of participants in a retirement plan and their beneficiaries.”

Fiduciaries are required to operate solely in the best interest of the plan participants (versus non-fiduciaries who have divided duties of loyalty).

These DOL regulations affect both plan fiduciaries and plan participants.

Let’s take a look at two of these regulations: ERISA Section 408(b)(2): this regulation requires that all covered service providers must provide certain disclosures to plan fiduciaries.

Services as a registered investment advisor, certain recordkeeping and brokerage services, accountants and attorneys that receive indirect compensation from the plan are all considered covered service providers.

These covered service providers must disclose in writing to the plan fiduciary, by July 1, 2012, the description of service that they are

providing, compensation (direct or indirect) they expect to receive and how that compensation will be paid to them in connection to those services.

Up until ERISA Section 408(b)(2) was introduced it was difficult for plan fiduciaries to get information from service providers in order to make well informed decisions on plan contracts. Now this regulation will help plan fiduciaries make better decisions about who they will hire to help them manage and administer their plan, and to determine whether the arrangement with the service provider is reasonable.

ERISA Section 404(a)(5): this regulation requires that plan fiduciaries who offer participantdirected accounts (where the participant can choose their investment options from a predetermined line up) provide all participants certain plan and investment-related information. This includes:  A listing and description of all available investment options  Instructions on how to select and/ or change their investment options and how often those changes can be made

 An explanation of all administrative fees and expenses that are charged and/or deducted from their individual accounts/balances  Any individual fees incurred by the participant such as loan fees or transaction fees.

In addition the plan sponsor must provide the participant performance data, benchmark data and a glossary of terms.

These requirements are designed to help the plan participant better understand their investment options in order to make an informed decision when it comes to their retirement plan assets. Plan fiduciaries must provide this information to the participant by August 31, 2012.

The most important decision a plan fiduciary can make is to enlist the assistance of an investment representative who can help them navigate their own duties as a fiduciary, including the selection of other service providers, investment managers and custodians. These plan fiduciaries must apply prudent process to make a proper decision about many areas of their qualified plan and involves a careful review of ERISA Section 408(b)(2) and ERISA Section 404(a)(5). 

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features

Customer Service is Key Experiences from a Primary Care Physician

By Judith Rayl MD, PhD

T

oday a 24 year old man named Ted made an appointment at my clinic. He is an earnest young man who struggles with depression. Ted travels forty-five minutes to be seen at my clinic because he has not been able to find a doctor in his area to help him with his medication. Despite

34| APRIL 2012

seeking care at multiple offices, Ted said that all the doctors seemed too rushed. During Ted’s visit I spent half an hour with him (which is normal in my practice) reviewing his symptoms and medications. I genuinely listened to his concerns, answered his questions and helped him improve his medica-

tion regimen. At the end of his visit, Ted expressed his gratitude for being able to be seen on short notice. He was pleased that I remembered him that members were so kind and helpful. Ted was disappointed that the other doctors he had visited only were able to spend a few minutes with him. He was upset that they could not provide him with the care that he needed and asked, “Why aren’t other doctors’ offices more like yours?”

I do things very differently in my practice. I have implemented changes in my practice management techniques that connect me with my patients, allowing me to spend more time with them and to maintain personalized care. These enhancements are simple and lend excellent patient satisfaction. In fact, I have been voted my community’s “Best Doctor” since 2007. These innovations involve two very basic concepts; I have developed an extremely efficient workplace and have eliminated all of my unnecessary expenses.

I believe that efficiency does not mean working faster to push more patients through the office, nor does it involve spending any less time with patients. Instead efficiency functions

behind the scenes to improve my work processes.

Here are some specific steps to improve practice management:

Efficiency should only benefit my patients directly I no longer chart on paper, I use a computerized medical record system that puts patients’ health information literally at my fingertips. Test results are electronically delivered directly from our lab into each patient’s file and I am immediately notified by an automated email. My staff scans specialists’ notes into the patient’s electronic chart so they are easily accessible. With computerized medical records time isn’t wasted scavenging for old chart volumes, paper notes or lab printouts. Electronic charting provides easy access a patient’s current contact information allowing me to leave them a message with detailed information, instead of expending time making multiple phone calls. During appointments I complete the electronic chart notes in front of the patients and then print a copy of the plan from the patient’s visit note. The feedback received from patients regarding this change has been uniformly positive. Some patients file these notes at home so they can easily recall our long-term plans which have reduced follow-up phone calls from patients needing reminders about clinical information.

Check-in has also been simplified; two medical assistants keep their desks at a station in the front lobby. When patients arrive, the medical assistants collect their co-pay, confirm their address and insurance information and then room the patients immediately.

Patients seldom have to sit in the waiting room because there is no delay

between check-in and moving to an exam room.

All non-controlled medication prescriptions are faxed to a patient’s pharmacy and automatically recorded in their chart. Electronic prescribing eliminates handwriting errors and is also much quicker than writing a paper prescription. In addition, it cuts my patients’ wait times at the pharmacy as they no longer need to wait in the prescription drop-off line at their pharmacy, and their medication is often ready to pick when they arrive.

Every computer has internet connectivity and is loaded with medical databases that are continually updated.

This provides instant access to current medical data during patient visits and eliminates having to leave an exam room to find a textbook, which may already be outdated. I can also print updated information handouts for patients as well.

My exam rooms are fully stocked at all times. I never have to interrupt appointments to find missing equipment or supplies. Each exam room contains a cabinet for ancillary supplies such as printer paper, ink, drinking cups and bandages. Workspaces are designed so that frequently used equipment is easily within reach. For example, in my office, when sitting in my chair I can reach my computer, phone, copy machine, printer, paper supply, stapler, date stamp, inbox/outbox trays, envelopes, paperclips and address stamp.

These advances in efficiency allow me to spend more time with my patients. I’m no longer tied up with phone calls, chart issues, or running around the clinic looking for lost items. I also no longer have to wait ten minutes just for a patient to move from the front desk to an exam room.

We generally run on time and I seldom have to stay late at work.

Commitment to a healthy reduction of overhead High overhead forces doctors to either pass costs on to their patients and/ or to limit staff salaries and benefits.

With my low overhead, I am able to avoid overcharging my patients and do not need to add any concierge fees.

My staff has the highest wages of all medical assistants at similar clinics in our region I give raises twice a year, an annual bonus, and a 401k with profit sharing and matching funds. I am also able to compensate myself fairly.

To achieve a low-cost clinic, I started by renting a small space in a beautiful mixed-use complex that is a 1000-square foot jewel. Because I don’t use paper charts I have no excessive storage needs and can comfortably rent such a small space. Also, I built my clinic with multiple tall cabinets so we have extra room for supplies. All expansion occurs either electronically or vertically rather than in squarefootage, so rent stays low.

Electronic records have also eliminated filing and chart maintenance and the cost of medical records personnel.

In my opinion, a small, healthy clinic does not necessarily require an office manager. At our clinic, work conflicts are solved directly, without any triangulation through an administrator. I work closely with my accounting and billing staff as well, so no manager is required to control finances. This administrator-free process has been seamless.

My practice has an automated phone system that obviates the need for a receptionist. When patients call in, they are greeted by a message recorded by MEDMONTHLY.COM |35

me. If they press one, they get a message with our location and business hours. Pressing two allows them to leave us a message and pressing five gets them through to us directly on our back line. Many of my patients make use of the message line, at all times of the day and night, for nonurgent communication. This frees my staff for other tasks, instead of keeping them tied to the phones.

My staff are highly experienced, cross-trained medical assistants.

Since both of my assistants are talented phlebotomist, I haven’t had to hire a dedicated lab tech, an injection nurse, anti-coagulation nurse, nor triage assistant at my clinic. The practice management changes that I have implemented are extremely popular and sustainable. I also have little turnover in my patient panel and staff roster.

Catherine is a 66 year old woman who transferred her health care to my clinic in 2007. Five years prior she had endured a severe accident that resulted in a hip injury. Three subsequent surgeries were only partially successful leaving her in chronic pain. When I met her she was unhappy with her prior primary care provider’s office because her medical visits were too short. The physicians worked too rapidly and were out of the office frequently, so her care lacked continuity. This caused conflicts among the various primary care doctors participating in her care. According to Catherine, one doctor asked her to start taking narcotics for her pain, while another suggested that Catherine was engaging in drug seeking behavior.

When we started working together it became clear to me that Catherine’s care at her prior office was terribly fragmented. Through a series of frequent, intense visits over the 36 | APRIL 2012

course of about three years we were able to piece together a productive regimen of physical therapy, acupuncture, specialist visits and new medication.

Last week Catherine came to see me for a complete physical exam. For the first time ever, we had the luxury of discussing preventive care because her acute and chronic pain was resolved. She stopped narcotic medications fourteen months ago and her quality of life is nearly normal. She is swimming, traveling and even dating again. Her recovery from the injury is finally complete and I am happy to have been able to assist her.

I would not have been able to help Catherine improve her situation without my new practice model.

With my low overhead commitment, I have time for good, comprehensive patient care. Also, with my efficient practice and electronic records, I was easily able to track Catherine’s progress as we monitored her specialists and medications.

I hope that other physicians will be inspired to make positive practice management changes. Without such change, I fear that we will only alienate more patients and make more mistakes in their care. Simple practice management alterations have allowed me to be the physician I aspired to be early in my career.

My work is now once again sustainable and satisfying because I am able to make more of an impact on my patients’ lives.

Practice management isn’t just about balancing the checkbook. It’s about giving patients the time and respect they deserve. My practice management innovations connect me with my patients and improve the care they receive at my clinic: compassion and healing are paramount. 

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By the numbers...

NPI and DEA numbers

What you need to know about the National Provider Identifier and the Drug Enforcement Administration numbers

National Provider Identifier A National Provider Identifier (NPI) is a 10-digit identification number issued to health care providers in the United States. The number is issued by Centers for Medicare and Medicaid Services (CMS).

The NPI began replacing the unique provider identification number (UPIN) in 2006 as the required identifier for Medicare services and other payers, including commercial health care insurers. The change to the NPI was mandated as part of the Administrative Simplifications portion of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and the first numbers were issued in October of 2006.

The NPI was proposed as an eight-position alphanumeric identifier. However, many stakeholders preferred a 10-position numeric identifier with a check digit in the last position to help detect keying errors.

The NPI contains no embedded intelligence; that is it contains no information about the health care provider, such as the type or location.

All individual HIPAA covered health care providers (physicians, physician assistants, nurse practitioners, dentists, chiropractors, physical therapist, athletic trainers, etc.) or organizations (hospitals, home health care agencies, nursing homes, residential treatment centers, group practices, laboratories, pharmacies, medical equipment companies, etc.) must obtain an NPI for use in all HIPAA standard transactions, even if a billing agency prepares the transaction. Once assigned, a provider’s NPI is permanent and remains with the provider regardless of job or location changes.

More information regarding NPI numbers can be found at http://nppes.cms.hhs.gov

DEA Number The Drug Enforcement Administration (DEA) is a U.S. Department of Justice law enforcement agency tasked with enforcing the Controlled Substances Act of 1970. It shares concurrent jurisdiction with the Federal Bureau of Investigation (FBI) in narcotics enforcement matters.

A DEA number is a series of numbers assigned to a health care provider allowing them to write prescriptions for controlled substances. Legally the DEA number is supposed to only be used for tracking controlled substances, however, the DEA number is often used by the industry as a general “prescriber” number that is a unique identifier for anyone who can prescribe medication.

A valid DEA number consists of two letters, six numbers and a one check digit.

More information regarding DEA numbers can be found at www.deanumber.com MEDMONTHLY.COM |37

features

38| APRIL 2012

A look at improving health care by systemizing and automating common practices

By Robert C. Tennant

H

enry Ford left his mark on America by creating the first massproduced, affordable automobile. Henry Ford’s efficient, systematic method of production made an impact well beyond the automobile industry, revolutionizing manufacturing around the world. Considering the success of his approach, I wonder, “What if Henry Ford had been a doctor and applied his same techniques and vision to a service industry such as health care? Would this influence health care in a similar way, making it more accessible and affordable to today’s average American?”

Of course today’s health care system is not as it was in the days of Henry Ford. Prior to 1920, medical technology provided very little to MEDMONTHLY.COM |37

Focus on the common Henry Ford didn’t invent the car, but he made and sold a lot of them. During its first 16 years, Ford Motor Company produced and sold 10 million Model Ts. The success of the company stemmed from its clear focus on high volume production and affordability to the common consumer. Health care, for the most part, is also a high volume industry that focuses on the common consumer. Research demonstrates that a large percentage of healthcare costs are related to common, often preventable or manageable conditions such as diabetes, asthma and heart disease. In addition to common clinical conditions, there are a multitude of common administrative and social-interactive issues such as billing processes, communication between health care settings, handling of patient complaints and patient non-compliance. Considering the complexity of health care and the small amount of time and money we have to deal with making changes, our only choice is to address these common, everyday concerns first.

We simply can’t afford to put as much focus on the once a month non-emergent occurrence, as we must put on the day to day, week to week occurrences.

If we do not identify and find ways to be more efficient with the common, repetitive occurrences, they will 40 | APRIL 2012

continue to drain our time and energy.

One health care provider’s common conditions and situations seen in their practice may differ from another’s due to demographics, health conditions being treated and other factors. The key is to look at your individual setting, identify the common and then move on to the next step – finding the most efficient way to systematize your best practices to deal with the situations that you encounter the most.

Systematize the best practices Henry Ford’s systematic approach was paramount to his success. Once he determined the best way to assemble each piece of the Model T, he made sure that it was done the same way every time. By doing so, he controlled costs, worker productivity and the quality of his product resulting in happy customers and lots of profit. Likewise, health care professionals should determine the best way to address each of their practices' common situations and then follow that procedure the same way every time. Evidence based care guidelines or your own adaptation of such guidelines are a great place to start from a clinical perspective. From a non-clinical perspective, consult with administrators to identify problems with the current protocol and then establish best practices with regard to billing and collections, scheduling, customer service and other aspects of practice management and patient

care. Once you’ve established the best practices for your most common situations, document them and put systems and reporting mechanisms in place to assure these best practices are followed every time by your staff.  What is the best way to handle prevention and treatment of common conditions in your area of specialty?  What is the best way to handle non-compliant patients, late appointments and no shows?  What is the best way to handle referrals moving in and out of your office?  What is the best way to handle chart completion, billing and collections?  Where are you inefficient and wasting time, energy and money with regard to the situations that your practice deals with day after day?

Systematizing common, best practices also makes the cross-training of staff easier as it is not as difficult to learn one “best” way to efficiently perform a task than five variations depending which physician you are working with.

Not to mention, consistency reassures your patients they are in an environment where quality is important which can help reinforce positive behavior.

For example, if patients know they will be asked to reschedule or wait for the next open slot when they are 15 minutes late for an appointment, the likelihood of them being late will drop.

THE

patients, and most were treated in their homes by a family physician who knew each patient on a first name basis.

Medical technology is clearly much more advanced now, enabling doctors to treat extremely complex conditions; however, the way we deliver health care is often inefficient and ineffective, leaving the benefits of modern medical technology to waste and health care consumers to suffer. This is where Henry Ford’s innovative approach comes into play.

We must stop burning human capital and energy on information processing and transmission that can be done consistently and accurately by a computer like automating appointment reminders and test result delivery.

Automate it While Henry Ford was putting systems in place to perform tasks the same, “best” way every time, he was also automating as many processes as possible, further driving down costs, improving consistency and making work easier for his employees. Rather than taking the worker to the car, Henry Ford, brought the car to the worker, perfecting the production line such that a car could be produced in 90 minutes. We might not like to admit it, but much of our health care system is a high production, low profit business.

And if your particular specialty or area is not there yet, it is likely headed in that direction. The only good way to deal with a high production, low profit business (and the only way our health care system will thrive) is to automate as many operations as possible. In health care, much of our “manufacturing line” relates to analyzing and communicating information. Health care decisions, processes and workflows are data driven and information rich. We must stop burning human capital and energy on information processing and transmission that can be done consistently and accurately by a computer such as:  Automating care gap alerts to address scheduling of physicals and chronic care visits.  Automated point of care reminders for routine labs, tests and vaccinations.  Automating appointment reminders to address no shows.  Automating the delivery of test results.

In general, things that can be automated by a computer should be.

Personal service is important but our health care system is beyond the point of using “personal service” as an excuse against leveraging technology to automate daily operations. Frankly,

given the state of health care, we cannot afford to deliver personal service for some things and most patients, if they knew the potential ramifications, would not want it. I have seen examples where failure to automate created dangerous, potentially life-threatening situations because information got lost in the tangle and plethora of the common, mundane tasks – like a needle in a haystack. We are burning human capital on things that can be done faster and more consistently by a computer. We must automate the common tasks, and fully leverage our human capital for things that require reasoning, personality and person to person interaction. Not only is this automated approach efficient, it is more rewarding for the health care worker.

Innovation There is a caveat regarding the idea of performing common tasks more efficiently by doing them the same, “best” way every time – we must leave room for innovation and change. One of the most important benefits of the human element is the ability to reason and see beyond the limited capacity of a machine. Be sure to give your staff the right to override the system when appropriate. However, deviation should only be allowed under the condition that those who do not follow protocol (including physicians), for any reason, must document the event and bring it to the attention of the appropriate person to explain their decision. Allowing this autonomy will open the door for continuous improvement and innovation to your systems.

Finding the common, systematizing, automating around best practices and leaving room for innovation; in Henry Ford’s case, it was about the birth of an industry; in the case of healthcare, it might just be about survival. 

features

s s e l g n i d spen e r o m t c colle in order to

A list of billing techniques to increase profits in your practice

By Mary Pat Whaley, FACMPE

H

ow does a medical practice consistently provide top quality health care to its patients while operating a highly-regulated business on less income? Start by examining one of the most expensive processes in the practice – billing.

Billing requires skilled employees, sophisticated technology and constant vigilance from everyone in the office. Let’s explore processes that can reduce your billing expense as well as increase your collection percentage.

Clear financial policy If you don’t have a written financial policy, how do patients know when and how to pay?

Your practice should have a very understand42 | APRIL 2012

able (eighth grade level or less) financial policy that explains what your practice will do and what the financial responsibilities of the patient are. Use the same financial policy to train your entire staff on your policies. If any employee does not support your practice's protocal, that employee should not work for you.

How you save money: If a clear financial policy is established everyone is on the same page, so there is no way a patient can game the system by claiming a staff member or physician told them no payment was needed at the time of service. By the time the patient receives a service; they should have heard verbally about the policy three times (appointment,

learn how restructuring billing can help you keep

more of your hard-earned cash

appointment reminder, check-in) and should have received at least one written copy of the policy, which they’ve signed.

Formal financial assistance program You should have a clearly defined financial assistance program if your practice discounts patients who require financial aid. You can discount your fees to any patient without insurance who is paying cash at the time of service. You have the money in hand and you will not be spending anything to bill the insurance company or the patient. Most patients without insurance are very pleased to pay cash at time of service at a discounted rate. Patients without insurance who are unable to pay cash at time of service should be offered an application

for financial assistance. Practices can set up discounting based on multiples of the federal poverty level – many use two or three times the published level. It can be as simple as a percentage off the retail rate, or it can be a sliding scale. Whatever you choose, underprivileged patients are typically quite happy to produce information that qualifies them for medical care at a discount. My experience has been that patients who defer completing financial assistance applications usually aren’t as destitute as they claim to be.

How you save money: If you take the time to put a financial assistance program in place, you will writeoff the discounted amounts on the front end and do away with sending numerous statements and sending the patient to collections. Write it off

to charity care, and if need be, place a limit on how much charity care the practice can support.

Check eligibility Check every patient at every appointment to make sure (as sure as you can be) that they have the insurance policy you think they do. Most practice management (PM) systems have eligibility built in or available as an add-on service. If your system can’t check eligibility, there are standalone systems that can extract appointment information from your software, or you can check the patient’s eligibility individually.

How you save money: The time it takes to file the wrong insurance for a patient, have the claim denied, obtain the correct

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ingle day. s ry e v e t n e rc be 100 pe ld u o h s s n o ti see llec ld o u c o y h a s u -p o o y c r y u h Yo reasons w w fe ry e v f o k I can thin co-pay. ir e th id a p t o has n a patient who information and refile will eat a hole in any profit attached to the service.

Require payment at time of service Your co-pay collections should be 100 percent every single day. I can think of very few reasons why you should see a patient who has not paid their co-pay. At every step of the way, patients should be told their co-pay will be collected before they receive the service. If the patient checks in without a co-pay, staff should offer the patient the choice of leaving to get their co-pay (where is the closest ATM?) or reschedule the appointment. Yes, there are a few times when the patient should be seen despite not having their co-pay, but they are much rarer than you might think.

How you save money: As soon as a patient walks out the door without paying, the value of that money has decreased, and the possibility that you will collect 100 percent of what is due starts to drain away.

Don’t accept checks Very few people do not have credit or debit cards. Your practice should accept all kinds of credit cards, but don’t take checks. They are timeconsuming to handle, they have to be scanned or deposited and they bounce! A bounced check charge usually only covers the bank charge and so the time your staff spends collecting on a bad check is eating away at any profit. If a patient truly does not have a credit/debit card, ask them to bring cash or a money order.

How you save money: This removes billing for co-pays and collection efforts for small amounts of money.

How you save money: Reduces staff time, decreases the risk of bounced checks and bank transaction charges, and you will not be charged for check vetting services.

Collect deductibles

Don’t send statements

Many practices are afraid to collect deductibles or they don’t want to over-collect them and have to refund the patient. Or they don’t know how to find out what the patients deductible is. But as deductibles get larger, practices are leaving more money on the table. The best solution is to ascertain the deductible information during the eligibility process and collect the appropriate amount at check-out. You can refund (with most web-based credit card systems) the patient via their credit card – no written refund check required.

You knew I was leading up to this, didn’t you? I don’t think statements, unless they are email statements for reference, are cost-effective tools.

Take credit/debit cards, and then adjust the amount due up or down when the insurance company pays.

If the patient requires a payment plan for a larger, unexpected service, make it an electronic payment plan that drafts automatically without staff intervention.

How you save money: Without statements you have no postage,

no mail to process, no overdue payments or self-assigned payments plans and reduces staff management.

Outsource billing Most practice administrators have very strong opinions on whether billing should be outsourced or not – about 50 percent believe it should and 50 percent believe it should not.

I think every practice is unique and the answer to this question will be different for each practice. If you have the technology, the staff and are hitting your benchmarks month after month, then you have the resources to handle billing in-house. If you have trouble finding or keeping quality staff, your physicians don’t want to invest in the technology, or you need the square footage for revenueproducing activities, you might want to consider hiring remote staff to work out of their homes, or you might consider outsourcing.

The good news is that outsourcing billing has never been easier or more feasible. There is a buffet of choices for every practice’s size and specialty, from small local companies to large national, even international organizations. Some software companies offer free electronic medical records (EMR) software when you use their billing services, which could be a boon for smaller practices shooting for the Medicare or Medicaid incentive program dollars.

How you save money: Your billing will be done within guaranteed time frames regardless of staffing issues, weather conditions or internet outages. You ultimately reduce payroll, benefits and office space, and you pay only on what is collected.  MEDMONTHLY.COM |45

features

ICD-10 Deadline Postponed, HHS Confirms Delay beyond original October 1, 2013 deadline could offer practices additional time to prepare for the coding changes

By Suzanne Leder, BA, M.Phil., CPC, COBGC, certified ICD-10 trainer and Torrey Kim, MA, CPC, CGSC, editor-in-chief of Part B Insider

J

ust three months ago, Centers for Medicare & Medicaid Services (CMS) representatives firmly told medical practices that the International Classification of Diseases, 10th Edition (ICD-10) implementation date would not be pushed back beyond Oct. 1, 2013 — what a difference a few months can make.

The Department of Health and Human Services (HHS) announced on Feb. 16 that the ICD-10 implementation date will indeed be postponed. The agency stated that it “will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes.”

“ICD-10 codes are important to many positive improvements in our health care system,” said HHS Secretary Kathleen Sebelius in a statement. “We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead,” Sebelius said. “We are committing to work with the provider community to re-examine the pace at which HHS and

46 | APRIL 2012

the nation implement these important improvements.”

The announcement followed hints that CMS was planning a pushback.

On Feb. 14, acting CMS administrator Marilynn Tavenner said she intended to “re-examine the pace at which we implement ICD-10” which would require the agency to go through the standard federal rulemaking process.

Tavenner made her comments to great applause at the American Medical Association’s (AMA) National Advocacy Conference, attendees said.

Physicians are cautiously optimistic Neither the HHS nor CMS has announced just how much of a delay will take place, but physicians are pleased that they’ll benefit from some additional time to implement the new diagnosis coding system. “The American Medical Association appreciates Secretary Sebelius’ swift response to address the AMA’s serious concerns with ICD-10 implementation,” said AMA President Peter W. Carmel, MD, in a Feb. 16 statement. “The timing of the ICD-10 transition could not be worse

for physicians as they are spending significant financial and administrative resources implementing electronic health records in their practices and trying to comply with multiple quality and health information technology programs that include penalties for non-compliance. We look forward to having a productive dialogue with the administration regarding the impact of ICD-10 and decreasing unnecessary hassles for physicians so they can take care of their patients.”

Practices: continue to work toward transition Sebelius’s announcement appears to fall short of the AMA House of Delegates’ original recommendation last fall for a full repeal of ICD-10.

However, a slower pace could at least buy time for practices that have not yet considered the impact of ICD-10 on their systems. Despite the announcement of a slower timeline, practices should continue to work toward compliance with the new diagnosis coding system, which appears to still be in place for future implementation.

There is no indication of any reduction in the number of ICD-10 codes. In fact, additional new codes have already been added since the announcement. So, even with this delay, the complexity of the coding system remains.

To read Sebelius’s statment, visit www.hhs.gov/ newspress/2012pres/02/20120216a.html.

For all the latest CMS news, subscribe to the Part B Insider at www.codinginstitute.com/part-b-insider-20.html 

WHAT’S YOUR REACTION TO THE ICD-10 DELAY? Chime in by emailing the author The coding industry’s reaction to the ICD-10 delay has run the gamut, but many experts caution not to fall back into a holding pattern. If you recently visited the Coding News (http://codingnews.inhealthcare. com/), you would have seen the current poll that asks, “How did you react to CMS delaying the implementation deadline?”

Here’s the voting statistics (as of publication date):

57 26% 17 %

%

said “Back to procrastination phase.” of voters said, “Hip, hip, hooray!” of voters said, “I’ll keep on rolling but now I can be on time.”

Warning: Going back to the procrastination phase could set you up for disaster.

Instead, you should take this as an opportunity to surge ahead of schedule, rather than finding yourself scrambling to keep up. “When we heard the news, we didn’t stop anything. We’ve kept on course,” says Suzan Berman, CPC, CEMC, CEDC, Senior Director of Physician Services at Healthcare Revenue Assurance Associates of Plantation, Fla. “We are still moving forward educating the coders (anatomy and physiology), providing regular updates in publications and pursuing a clinical documentation improvement plan to align with ICD-10 — when the time comes,” Berman explains.

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Biggest lesson: You must stay with your education action plan, as the delay could only be for a few months. “Even if the delay goes to a few years, you’ll have to start preparing for ICD-11, so why stop preparing at all?” Berman says.

Want to be heard? Email your reaction to the author at suzannel@codinginstitute.com For all the latest ICD-10 news, subscribe to the ICD-10 Coding Alert: www.codinginstitute.com/icd-10-coding-alert.html

Lindsay Driver EmployeeSync Specialist

features

What is it and what do I do with it?

By Elizabeth Knollmeyer, BS, MT (ASCP)

T

he terms “biohazardous material,” “biohazardous waste,” “medical waste,” “regulated waste,” and “regulated medical waste” are used somewhat interchangeably, but they all have different definitions, and the definitions can change depending on the state in which you are located.

Biohazardous material: refers to materials that present a risk or potential risk to the health of humans, animals, or the environment. They can be infectious agents or chemicals or other products that can damage the environment. Certain chemotherapy drugs and most laboratory reagents fall into the biohazardous material

48 | APRIL 2012

category.

Biohazardous waste: refers to waste (e.g. body fluids or tissues) which has the risk of carrying human pathogens. Biohazardous waste is usually generated at health care facilities or research facilities, and the term is used interchangeably with medical waste.

Regulated waste: is the term used by the Occupational Safety and Health Associations (OSHA) to describe blood, body fluids and other potentially infectious material (OPIM) as defined in the Bloodborne Pathogens Regulation (BBP).

Regulated medical waste: refers to biohazardous waste whose

handling is regulated by state or federal laws.

In a medical practice or laboratory we are most often concerned with the BBP-defined regulated waste and the state-defined regulated medical waste which we must discard per state and federal regulations. The failure to understand the difference in the definitions can lead to unnecessary expenses for disposing of regulated medical waste.

The Bloodborne Pathogens Standard uses the term “regulated waste” to refer to the following categories of waste:  Liquid or semi-liquid blood or OPIM

MEDMONTHLY.COM MEDMONTHLY.COM | |49 49

Items contaminated with blood or OPIM and which would release these substances in a liquid or semi-liquid state if compressed  Items that are caked with dried blood or OPIM and are capable of releasing these materials during handling  Contaminated sharps  Pathological and microbiological waste containing blood or OPIM In order to avoid some confusion, I’m going to refer to the BBP-defined regulated waste as “medical waste” or “biohazardous waste” to more easily differentiate it from “regulated medical waste” as administered by the state.

Biohazardous medical waste: Must be discarded in containers that are clearly marked with a biohazard symbol or in a red bag, which is universally accepted as a symbol of biohazardous waste.

Sharps: must be disposed of in hard-sided containers which cannot be penetrated by the sharp material and marked as biohazardous if the container has potentially infectious material within. Almost all sharps generated in a medical practice contain potentially infectious materials.

Regulated medical waste: generally refers to waste whose disposal is regulated by state and/ or federal laws. In North Carolina, regulated medical waste is defined in general as “blood and body fluids in individual containers in volumes greater than 20 mL, microbiological waste, and pathological waste that have not been treated pursuant to specific standards.” Therefore, a 10 mL tube of blood is medical (biohazardous) waste, but is not regulated medical waste it doesn’t meet the 20 mL individual container specification. Table paper 50| APRIL 2012

contaminated with blood or vaginal secretions is medical (biohazardous) waste but not regulated medical waste; it doesn’t meet the expressible blood specification. Regulated medical waste is generally handled by contracting with a waste management company to take the waste offsite and bury it, decontaminate it or otherwise destroy the potential for harm. The big square boxes with the red liners and biohazard signs on all sides that you have picked up by waste disposal companies contain regulated medical waste. You pay (per box) to have these removed. and get a receipt when a box is picked up, and eventually a certificate with proof of destruction or decontamination.

Technically, most medical practices do not generate any state-defined regulated medical waste. Individual tubes of blood or body fluids are almost always smaller than 20 mL. Urine, which is not considered medical waste unless it is visibly contaminated with blood or pus, may be disposed of by pouring it down the sink. Contaminated table paper doesn’t fit the expressible blood definition required for regulated medical waste. Gloves which do not have visible blood on them are not considered medical waste.

OK, so why are we paying so much?

The big square boxes with the red liners have to be picked up and taken offsite because most landfills won’t accept the red biohazardous bags in which we discard the biohazardous waste that is not regulated. Therefore the practice is left with little choice but to pack it up and send it with the waste management people as regulated medical waste. I would recommend checking with the municipal authorities to see if it is allowable to

discard red biohazard bags (that don’t contain regulated medical waste) in the landfill. If your municipality does allow this, there is no need to put these red bags in the large boxes dedicated to regulated medical waste.

Whether or not you are allowed to dispose of biohazardous waste that isn’t regulated in the community landfill, you can limit the amount of regulated medical waste you have picked up by educating your staff as to what qualifies for the big square boxes or a biohazard bag disposal, and what can be put in ordinary trash.

Table paper that isn’t visibly contaminated does not qualify as medical waste – put it in the regular trash.

Gloves that are not contaminated with blood can go in the regular trash.

And make sure the staff isn’t putting paper waste into a big square box just because it is conveniently located!

Pearls of Wisdom from OSHA It is the employer’s responsibility to determine the existence of medical waste. This determination, according to OSHA, should not be made based on the volume of blood, but rather on the potential to release blood (e.g. when compacted in a waste container). OSHA states that bandages which are not saturated to the point of releasing blood or OPIM if compressed and not considered biohazardous waste. Likewise, discarded feminine hygiene products do not normally meet the criteria for medical waste as defined by the BBP standard. Beyond these guidelines, it is the employer’s responsibility to determine the existence of medical waste.

Here is a link to a website where you can get to the state regulated medical waste regulations by state. http://www.envcap.org/statetools/ rmw/rmwlocator.html 

Our secret weapon against smoking?

Each other.

I first lit up a cigarette when I was 9. I started smoking at 16 and smoked for 15 years. When I wanted to quit, I found out the average person takes 3-4 efforts to quit because nicotine is so powerful. I learned that if you pick it up again, it’s part of a process. It’s not that you failed, that’s just how it works. When I finally quit, I had more weapons to help me — my pills, my support and my nurse practitioner to talk to. Now we have Tobacco Free Nurses to help, too.

Photo: Todd Pickering

— Maria, RN Tobacco Free Nurses is a one-stop shop for all nurses, especially nurses who want to help their patients quit smoking and nurses who want to quit themselves. We are nurses who want to benefit nurses and patients, and promote a tobacco free society. Please visit our website or call for further information.

Toll Free: 877-203-4144 | www.tobaccofreenurses.org Support for the Initiative was provided by a grant from the Robert Wood Johnson Foundation in Princeton, New Jersey, to the School of Nursing, University of California, Los Angeles in partnership with American Association of Colleges of Nursing, American Nurses Foundation / American Nurses Association, and National Coalition of Ethnic Minority Nurse Associations.

MEDMONTHLY.COM |51

the arts

MODERN RENAISSANCE MAN AN INSPIRING STORY OF ART AND MEDICINE

By Leigh Ann Simpson

52| APRIL 2012

T

he life of Barry Hanshaw, MD, has been a remarkable adventure filled with accomplishment, sacrifice, love, international quests for knowledge, beauty and imagination. A true renaissance man, Hanshaw has excelled in many facets of both art and science. In addition to Hanshaw’s prestigious, 60-year career as a physician and researcher of pediatric infectious disease, he is also an extremely talented artist who possesses the ability to transport viewers to the majestic natural scenes that are portrayed in his works with oil paints and pastels.

Growing up in New York during the 1930s and 40s, Hanshaw displayed an obvious artistic talent at a very young age. As a teen, Hanshaw quickly developed a fan base among the locals who admired his drawings of political figures of the day such as Winston Churchill and Dwight Eisenhower. It was during this time that he also developed an interest in the human body. “I developed an interest in the human form and started doing figurative drawings of scantily clad young women,” Hanshaw recalls.

Hanshaw’s passion for art was strong; however he considered the discipline to be too risky to pursue a career in. He had always been fascinated by science, but his decision to pursue medicine as a career was solidified in his freshman biology course at Syracuse University. Hanshaw went on to medical school at Upstate Medical University where he met his wife, Chris. They were married and started their family while Hanshaw was in his residency at the University of Rochester. Being faced with the financial responsibility of having a wife and small children at home, Hanshaw put his art on the back burner and became focused on finding success as a physician in order to provide for his family.

Even though he had to place one of his pas-

sions on hold, he was equally as enthusiastic about his medical career. As a teaching physician and researcher at Harvard University he worked with some of pediatrics’ most notorious physicians such as Thomas H. Weller, MD, who won the Noble Prize for isolating poliovirus, which led to the creation of the polio vaccine. His career opportunities at Harvard were outstanding but the demands of the job kept him away from his family. After spending two years at Harvard he became a professor and scientist of microbiology and pediatrics at the University of Rochester, where he worked for 15 years. He eventually became the chair of the department of pediatrics and ultimately dean of the School of Medicine.

Hanshaw’s research in pediatrics took him and his family around the world. Accompanied by his wife and five children, Hanshaw frequently traveled through Europe to speak at countless medical schools and meetings. He acquired an impressive collection of art in Europe and the beautiful landscapes that he encountered while on these trips served as a tremendous source of artistic inspiration. In addition to his European travels, he and his wife spent time in Japan after World War II and fell in love with the Japanese culture. “We bought a little Japanese house with a wonderful view of Mount Fuji, visited the famous Japanese shrines and temples in the nearby mountains, shopped in Tokyo and had an extended honeymoon for two years,” Hanshaw recalls. “We admired the simplicity and beauty of Japanese art, gardens and architecture.”

While serving as dean at the University of Massachusetts Medical School, Hanshaw’s wife began to encourage his interests in art again. He began taking formal art classes at the Worchester Art Museum and expanded his technique to incorporate oil painting in addition to pastels. In 2010 he retired and began his career as a professional artist. Hanshaw and his wife are settled in a cottage on Lake Morey in Fairlee, Vermont where he spends most of his time painting or with this family. Now that he is able to focus all of his energy on his art, Hanshaw’s remarkable journey has become full circle.

MEDMONTHLY.COM |53

What’s your practice worth?

When most doctors are asked what their practice is worth, the answer is usually, “I don’t know.”

Doctors can tell you what their practices made or lost last year, but few actually know what it’s worth.

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the kitchen

! h t r a e e t a r Celeb ly d n e ri f lly ta n e m n o ir v n e t Ea

By Ashley Acornley, MS, RD, LDN

A

great Earth Day recipe features seasonal fruits and vegetables that are less likely to contain harmful pesticides. Peaches, apples, sweet bell peppers, celery, nectarines, strawberries, cherries, pears, imported grapes, spinach, lettuce and potatoes typically have the highest pesticide levels, according to the Environmental Working Group. While onions, avocados, frozen sweet corn, pineapples, mangoes, asparagus, frozen peas, kiwi, bananas, cabbage, broccoli and papayas have the lowest. Choosing fruits and vegetables from the latter list and avoiding those in the former, unless they’re organic, could slash your pesticide exposure by almost 90 percent! This month look for spring produce such as asparagus, blueberries, cabbage, cauliflower, mushrooms and peas at ANGEL HAIR PASTA WITH ASPARAGUS your local farmer’s market.

Try this earth-friendly Servings: 4 sauté of tender, fresh Active Time: 10 minutes | Total Time: 1 1/2 hours asparagus tossed with Ingredients: angel hair pasta, mushrooms and n broth 8 ounces angel hair pasta (whole 1/4 cup low-sodium chicke oms, parmesan. This dish 1/2 pound fresh mushro wheat preferred) sliced makes a wonderful oil 1 tablespoon olive 1/2 teaspoon crushed red pepper gourmet lunch or light 1-1/2 pounds fresh asparagus, 1/2 cup grated Parmesan cheese trimmed and cut into 1 inch supper. pieces

Preparation:

Nutrition facts per serving: 299 calories 9g total fat 10mg cholesterol 413mg sodium 40g carbohydrates 5.2g fiber 17.1g protein

1. Cook pasta according to package instructions. pan 2. Heat the olive oil in a non-stick skillet. Sauté asparagus in the over medium heat for three minutes. more.

3. Add chicken broth and mushroom slices; cook 3 minutes with pasta toss Gently dish.

4.Drain pasta, and transfer to a serving r. peppe red d asparagus mixture; sprinkle with Parmesan and crushe

MEDMONTHLY.COM |55

SOMETIMES, THE GAME THEY LOVE DOESN’T LOVE THEM BACK. More and more, young athletes are focusing on a single sport and training for that sport year-round — a practice that’s led to an increase in Overuse Injuries. Left untreated, overuse trauma to young shoulders, elbows, knees and wrists may require surgery and have lifelong consequences. For information on preventing and treating Overuse Injuries, visit these sites: orthoinfo.org

stopsportsinjuries.org

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 www2.state.id.us/dhw

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://1.usa.gov/xMFQAK

Rhode Island 3 Capitol Hill, Rm 104 Providence, RI 02908 (401)222-7883 www.health.state.ri.us

Arkansas P.O. Box 627 Helena, AR 72342 (870)572-2847

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 www2.state.tn.us/health

California 2005 Evergreen St., Ste. 1200 Sacramento, CA 95815 (916)263-2382 www.medbd.ca.gov Colorado 1560 Broadway St. #1310 Denver, CO 80202 (303)894-7750 www.dph.state.ct.us Connecticut 410 Capitol Ave., MS #12APP P.O. Box 340308 Hartford, CT 06134 (860)509-7603 ext. 4 http://www.dph.state.ct.us/

New Hampshire 129 Pleasant St. Concord, NH 03301 (603)271-5590 www.state.nh.us New Jersey P.O. Box 45011 Newark, NJ 07101 (973)504-6435 http://bit.ly/wLM20Y

Florida 4052 Bald Cypress Way, Bin C08 Tallahassee, FL 32399 (850)245-4474 doh.state.fl.us

New York 89 Washington Ave., 2nd Floor W. Albany, NY 12234 (518)402-5944 opunit3@mail.nysed.gov

Georgia 237 Coliseum Dr. Macon, GA 31217 (478)207-1671 www.sos.state.ga.us

North Carolina P.O. Box 25336 Raleigh, NC 27611 (919)733-9321 http://www.ncoptometry.org/

Hawaii P.O. Box 3469 Honolulu, HI 96801 (808)586-2704 optician@dcca.hawaii.gov

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 www.roatx.org Vermont National Life Bldg N FL. 2 Montpelier, VT 05620 (802)828-2191 www.vtprofessionals.org Virginia 3600 W. Broad St. Richmond, VA 23230 (804)367-8500 www.state.va.us/licenses Washington 300 SE Quince P.O. Box 47870 Olympia, WA 98504 (360)236-4947 www.doh.wa.gov

MEDMONTHLY.COM |57

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://bit.ly/uaqEO8 Arizona 4205 N. 7th Ave. Suite 300 Phoenix, AZ 85103 (602)242-1492 http://azdentalboard.us/ Arkansas 101 E. Capitol Ave., Suite 111 Little Rock, AR 72201 (501)682-2085 http://www.asbde.org/ California 2005 Evergreen Street, Suite 1550Â Sacramento, CA 95815 877-729-7789 http://www.dbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7800 http://www.dora.state.co.us/dental/ Connecticut 410 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/site/default.asp Delaware Cannon Building, Suite 203 861 Solver Lake Blvd.

Dover, DE 19904 (302)744-4500 http://1.usa.gov/t0mbWZ Florida 4052 Bald Cypress Way Bin C-08 Tallahassee, FL 32399 (850)245-4474 http://bit.ly/w1m4MI

58 | APRIL 2012

Georgia 237 Coliseum Drive Macon, GA 31217 (478)207-2440 http://sos.georgia.gov/plb/dentistry/ 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/ Illinois 320 W. Washington St. Springfield, IL 62786 (217)785-0820 http://bit.ly/svi6Od Indiana 402 W. Washington St., Room W072 Indianapolis, IN 46204 (317)232-2980 http://www.in.gov/pla/dental.htm Iowa 400 SW 8th St. Suite D Des Moines, IA 50309 (515)281-5157 http://www.state.ia.us/dentalboard/ Kansas 900 SW Jackson Room 564-S Topeka, KS 66612 (785)296-6400 http://www.accesskansas.org/kdb/ Kentucky 312 Whittington Parkway, Suite 101 Louisville, KY 40222 (502)429-7280 http://dentistry.ky.gov/ 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 www.mass.gov Michigan P.O. Box 30664 Lansing, MI 48909 (517)241-2650 www.michigan.gov 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://mt.gov/ Nebraska 301 Centennial Mall South Lincoln, NE 68509 (402)471-3121 http://bit.ly/uBEqwK

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.dentist.state.ok.us/

Utah 160 E. 300 South Salt Lake City, UT 84111 (801)530-6628 http://1.usa.gov/xMVXWm

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

Vermont National Life Building North FL2 Montpelier, VT 05620 (802)828-1505 http://bit.ly/zSHgpa

New Mexico Toney Anaya Building 2550 Cerrillos Rd. Santa Fe, NM 87505 (505)476-4680 http://bit.ly/vCnCP4

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

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/

Virginia Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4538 http://bit.ly/zDkIU2 Washington 310 Israel Rd. SE P.O. Box 47865 Olympia, WA 98504 (360)236-4700 http://1.usa.gov/tKBFHT 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://bit.ly/sEhr0Q Wyoming 1800 Carey Ave., 4th Floor Cheyenne, WY 82002 (307)777-6529 http://plboards.state.wy.us/dental/index.asp

MEDMONTHLY.COM |59

U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (334)242-4116 http://www.albme.org/

Florida 2585 Merchants Row Blvd.

Tallahassee, FL 32399 (850)245-4444 http://www.doh.state.fl.us/

Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 http://bit.ly/zZ455T

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

Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 (480)551-2700 http://www.azmd.gov

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

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/site/default.asp 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://www.dchealth.dc.gov/doh

60 | APRIL 2012

Idaho Idaho Board of Medicine P.O. Box 83720 Boise, Idaho 83720 (208)327-7000 http://bit.ly/orPmFU Illinois 320 West Washington St. Springfield, IL 62786 (217)785 -0820 http://www.idfpr.com/ 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/default.htm

Louisiana LSBME P.O. Box 30250 New Orleans, LA 70190 (504)568-6820 http://www.lsbme.la.gov/ Maine 161 Capitol Street 137 State House Station Augusta, ME 04333 (207)287-3601 http://bit.ly/hnrzp Maryland 4201 Patterson Ave. Baltimore, MD 21215 (410)764-4777 http://www.mbp.state.md.us/ Massachusetts 200 Harvard Mill Sq., Suite 330 Wakefield, MA 01880 (781)876-8200 http://www.mass.gov Michigan Bureau of Health Professions P.O. Box 30670 Lansing, MI 48909 (517)335-0918 http://www.michigan.gov/lara 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/

Montana 301 S. Park Ave. #430 Helena, MT 59601 (406)841-2300 http://bit.ly/obJm7J p

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://bit.ly/rFyCEW

Nebraska Nebraska Department of Health and Human Services P.O. Box 95026 Lincoln, NE 68509 (402)471-3121 http://www.hhs.state.ne.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/

Oklahoma P.O. Box 18256 Oklahoma City, OK 73154 (405)962-1400 http://www.okmedicalboard.org/

Vermont P.O. Box 70 Burlington, VT 05402 (802)657-4220 http://1.usa.gov/wMdnxh

Oregon 1500 SW 1st Ave., Suite 620 Portland, OR 97201 (971)673-2700 http://www.oregon.gov/OMB/

Virginia Virginia Dept. of Health Professions Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4400 http://1.usa.gov/xjfJXK

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/

Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)787-8503 http://bit.ly/havKVj 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/

Washington Public Health Systems Development Washington State Department of Health 101 Israel Rd. SE, MS 47890 Tumwater, WA 98501 (360)236-4085 http://www.doh.wa.gov/PHIP/default.htm 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://drl.wi.gov/section. asp?linkid=6&locid=0 Wyoming 320 W. 25th St., Suite 200 Cheyenne, WY 82002 (307)778-7053 http://wyomedboard.state.wy.us/

MEDMONTHLY.COM |61

medical resource guide

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

ADVERTISING 1-800-Urgent-Care

6881 Maple Creek Blvd, Suite 100 West Bloomfield, MI 48322-4559 (248)819-6838 www.ringringllc.com

Find Urgent Care

PO Box 15130 Scottsdale, AZ 85267 (602)370-0303 www.findurgentcare.com

www.medmedia9.com

Ring Ring LLC

6881 Maple Creek Blvd, Suite 100 West Bloomfield, MI 48322-4559 (248)819-6838 www.ringringllc.com

ANSWERING SERVICES Corridor Medical Answering Service

3088 Route 27, Suite 7 Kendall Park, NJ 08824 (866)447-5154 www.corridoranswering.net

Docs on Hold

14849 West 95th St. Lenexa, KS 66285 (913)559-3666 www.soundproductsinc.com

BILLING & COLLECTION Advanced Physician Billing, LLC

PO Box 730 Fishers, IN 46038 (866)459-4579 www.advancedphysicianbillingllc.com 62| APRIL 2012

3562 Habersham at Northlake, Bldg J Tucker, GA 30084 (866)473-0011 www.ajishra.com

Applied Medical Services

Sweans Technologies 501 Silverside Rd. Wilmington, DE 19809 (302)351-3690 www.medisweans.com

VIP Billing

4220 NC Hwy 55, Suite 130B Durham, NC 27713 (919)477-5152 www.ams-nc.com

PO Box 1350 Forney, TX 75126 (214)499-3440

Axiom Business Solutions

CAREER CONSULTING

4704 E. Trindle Rd. Mechanicsburg, PA 17050 (866)517-0466 www.axiom-biz.com

Frost Arnett 480 James Robertson Parkway Nashville, TN 37219 (800)264-7156 www.frostarnett.com

Gold Key Credit, Inc. PO Box 15670 Brooksville, FL 34604 888-717-9615 www.goldkeycreditinc.com

MedMedia9

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

Ajishra Technology Support

Horizon Billing Specialists 4635 44th St., Suite C150 Kentwood, MI 49512 (800)378-9991 www.horizonbilling.com

Management Services On-Call 200 Timber Hill Place, Suite 221 Chapel Hill, NC 27514 (866)347-0001 www.msocgroup.com

www.vipbilling.com

SEAK Non-Clinical Careers Conference Oct. 21-22, 2012 in Chicago, IL (508)457-1111 www.nonclinicalcareers.com

Doctor’s Crossing 4107 Medical Parkway, Suite 104 Austin, Texas 78756 (512)517-8545 http://doctorscrossing.com/

CODING SPECIALISTS The Coding Institute LLC 2222 Sedwick Drive Durham, NC 27713 (800)508-2582 http://www.codinginstitute.com/

COMPUTER, SOFTWARE

Marina Medical Billing Service 18000 Studebaker Road 4th Floor Cerritos, CA 90703 (800)287-8166 www.marinabilling.com

American Medical Software

Mediserv

CDWG

6451 Brentwood Stair Rd. Ft. Worth, TX 76112 (800)378-4134 www.mediservltd.com

Practice Velocity 1673 Belvidere Road Belvidere, IL 61008 (888)357-4209 www.practicevelocity.com

1180 Illinois 157 Edwardsville, IL 62025 (618) 692-1300 www.americanmedical.com 300 N. Milwaukee Ave Vernon Hills, IL 60061 (866)782-4239 www.cdwg.com/

Instant Medical History

4840 Forest Drive #349 Columbia, SC 29206 (803)796-7980 www.medicalhistory.com

medical resource guide

CONSULTING SERVICES, PRACTICE MANAGEMENT Manage My Practice

103 Carpenter Brook Dr. Cary, NC 27519 (919)370-0504 www.managemypractice.com

myEMRchoice.com

24 Cherry Lane Doylestown, PA 18901 (888)348-1170 www.myemrchoice.com

Urgent Care America

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

Medical Practice Listings

The Dental Box Company, Inc.

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

Dentistry’s Business Secrets

9016 Phoenix Parkway O’Fallon, MO 63368 (636)561-5445 www.dentistrysbusinesssecrets.com

Modern Dental Marketing Practices

504 N. Oak St. #6 Roanoke, TX 76262 (940)395-5115 www.moderndentalmarketing.com

ELECTRONIC MED. RECORDS

ABELSoft 1207 Delaware Ave. #433 Buffalo, NY 14209 (800)267-2235 www.abelmedicalsoftware.com

Laboratory Management Resources

Acentec, Inc

3729 Greene’s Crossing Greensboro, NC 27410 (336)288-9823 www.managemypractice.com

17815 Sky Park Circle , Suite J Irvine, CA 92614 (949)474-7774 www.acentec.com

200 Welsh Rd. Horsham, PA 19044 (215)657-7010

AdvanceMD www.nextgen.com

Synapse Medical Management

18436 Hawthorne Blvd. #201 Torrance, CA 90504 (310)895-7143 www.synapsemgmt.com

DENTAL Biomet 3i

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

Dental Management Club

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

Sigmon Daknis Wealth Management 701 Town Center Dr. , Ste. #104 Newport News, VA 23606 (757)223-5902 www.sigmondaknis.com Sigmon & Daknis Williamsburg, VA Office 325 McLaws Circle, Suite 2 Williamsburg, VA 23185 (757)258-1063 http://www.sigmondaknis.com/

INSURANCE, MED. LIABILITY Jones Insurance

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

NextGen

FINANCIAL CONSULTANTS

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

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

DocuTAP 4701 W. Research Dr. #102 Sioux Falls, SD 57107-1312 (877)697-4696 www.docutap.com

Integritas, Inc.

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

Medical Protective 5814 Reed Rd. Fort Wayne, In 46835 (800)463-3776

MGIS, Inc.

1849 W. North Temple Salt Lake City, UT 84116 (800)969-6447 www.mgis.com

Professional Medical Insurance Services

16800 Greenspoint Park Drive Houston, TX 77060 (877)583-5510 www.promedins.com

Wood Insurance Group

4835 East Cactus Rd., #440 Scottsdale, AZ 85254-3544 (602)230-8200 www.woodinsurancegroup.com

LOCUM TENENS Physician Solutions

2600 Garden Rd. #112 Monterey, CA 93940 (800)458-2486 www.integritas.com

PO Box 98313 Raleigh, NC 27624 (919)845-0054 www.physiciansolutions.com MEDMONTHLY.COM |63

medical resource guide LOCUM TENENS (CONT.) Simply Locums, Inc. Your direct, simple & comprehensive source for locum tenens and permanent positions for physicians and other healthcare professionals. Simply Locums was developed to provide a source for both healthcare providers and healthcare facilities to efficiently and directly manage and negotiate their locum tenens and permanent assignments. We’ve streamlined the process, eliminated the costly middleman, and directly link highly qualified healthcare professionals to healthcare facilities. By prohibiting 3rd party recruiter access to our site, we provide cost savings to healthcare facilities and maximize your income.

3949 Hester Lane Salem, IL 62881 liz@simplylocums.net www.simplylocums.com

Marianne Mitchell (215)704-3188 http://www.mariannemitchell.com http://www.colordrop.blogspot.com Nicholas Down http://bit.ly/yHwxb0

Roche Diagnostics

9115 Hague Rd. Indianapolis, IN 46250-0457 (317)521-2000 www.roche-diagnostics.us

MEDICAL MARKETING

MEDICAL EQUIPMENT Abaxis

3240 Whipple Road Union City, CA 94587 (800)822-2947 www.piccoloxpress.com

Abott Laboratories

100 Abbott Park Road Abbot Park, Il 60064 (847) 937-6100

www.abott.com

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 PRACTICE SALES

ALLPRO Imaging

1295 Walt Whitman Road Melville, NY 11747 (888)862-4050 www.allproimaging.com

Biosite, Inc

9975 Summers Ridge Road San Diego, CA 92121 (858)805-8378 www.biosite.com

Medical Practice Listings

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

MEDICAL PRACTICE VALUATIONS

Brymill Cryogenic Systems

MEDICAL ART

105 Windermere Ave. Ellington, CT 06029 (860)875-2460

Deborah Brenner 877 Island Ave #315 San Diego, CA 92101 (619)818-4714 www.deborahbrenner.com Martha Petty 316 Burlage Circle Chapel Hill, NC 27514 (919)933-4920

BizScore www.brymill.com

Cryopen

800 Shoreline, #900 Corpus Christi, TX 78401 (888)246-3928

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

MEDICAL RESEARCH www.cryopen.com

Carolina Liquid Chemistries, Inc.

Arup Laboratories

391 Technology Way Winston Salem, NC 27101 (336)722-8910 www.carolinachemistries.com

500 Chipeta Way Salt Lake City, UT 84108 (800)242-2787

Julie Jennings (678)772-0889 juliejenn@silksynergy.com http://silksynergy.com/ http://www.coroflot.com/naddie09

Dicom Solutions

Chimerix, Inc. 2505 Meridian Parkway, Suite 340 Durham, NC 27713 (919) 806-1074 www.chimerix.com

Eduardo Lapetina 318 North Estes Drive Chapel Hill, NC 27514 (919)960-3400 eduardolapetina.com/index.shtml

Radical Radiology

www.marthapetty.com

64| APRIL 2012

548 Wald Irvine, CA 92618 (800)377-2617

www.dicomsolutions.com

524 Huffman Rd. Birmingham, AL 35215 (866)324-9700 www.radicalradiology.com

www.aruplab.com

Clinical Reference Laboratory 8433 Quivira Rd. Lenexa, KS 66215 (800)445-6917

www.crlcorp.com

medical resource guide Peters Medical Research

507 N. Lindsay St., 2nd Floor High Point, NC 27262 www.Petersmedicalresearch.com Sanofi US 55 Corporate Drive Bridgewater, NJ 08807 (800) 981-2491 www.sanofi.us

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

SUPPLIES, GENERAL

Scynexis, Inc. 3501 C Tricenter Blvd.

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

NUTRITION THERAPIST Triangle Nutrition Therapy 6200 Falls of Neuse Road, Suite 200 Raleigh, NC 27609 (919)876-9779 http://trianglediet.com/

BSN Medical 5825 Carnegie Boulevard Charlotte, NC 28209 (800)552-1157 www.bsnmedical.us CNF Medical 1100 Patterson Avenue Winston Salem, NC 27101 (877)631-3077 www.cnfmedical.com

Dermabond Ethicon, Route 22 West Somerville, NJ 08876 (877)984-4266 DJO 1430 Decision St. Vista, CA 92081 (760)727-1280 ExpertMed 31778 Enterprise Dr. Livonia, MI 48150 (800)447-5050

www.dermabond.com

www.djoglobal.com

www.expertmed.com

Gebauer Company

4444 East 153rd St. Cleveland, OH 44128-2955 (216)581-3030 www.gebauerspainease.com

Scarguard

15 Barstow Rd. Great Neck, NY 11021 (877)566-5935 www.scarguard.com

Buying or selling? We can help!

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Medical Practice Listings Scan this QR code with your smartphone to learn more

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classified listings

Classified To place a classified ad, call 919.747.9031

Physicians needed

Physicians needed

North Carolina

North Carolina (cont.)

Occupational Health Care Practice in Fayetteville North Carolina has two to five days of locums work per week.

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, and PH: (919) 8450054, email: physiciansolutions@gmail.com

Cardiology Practice located in High Point, NC has an opening for a board certified cardiovascular physician. This established and beautiful facility offers the ideal setting for an enhanced lifestyle. There is no hospital call or invasive procedures. Look into joining this three physician facility and live the good life in one of North Carolina’s most beautiful cities. 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, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

Occupation Health Care Practice located in Greensboro, NC has an immediate opening for a primary care physician. This is 40 hours per week opportunity with a base salary of $135,000 plus incentives, professional liability insurance and an excellent CME, vacation and sick leave package. 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, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Family Practice physician opportunity in Raleigh, NC This is a locum’s position with three to four shifts per week requirement that will last for several months. You must be BC/BE and comfortable treating patients from one year of age to geriatrics. You will be surrounded by an exceptional, experienced staff with beautiful offices and accommodations. No call or hospital rounds. 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, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Methadone Treatment Center located near Charlotte, NC has an opening for an experienced physician. You must be comfortable in the evaluation and treatment within the guidelines of a highly regulated environment.

Practice operating hours are 6 a.m. till 3 p.m. Monday through Friday. 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, and PH: (919) 845-0054,email: physiciansolutions@gmail.com Immediate Full-Time Opportunity for Board Certified occupational health care MD in Greensboro, NC. Excellent working environment, wage and professional liability insurance provided. 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, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

Board Certified Internal Medicine physician position is available in the Greensboro, NC area. This is an out-patient opportunity within a large established practice. The employment package contains salary plus incentives.

Please send a copy of your current CV, NC medical license, DEA certificate and NPI certificate with number along with your detailed work history and CME courses completed to: Physician Solutions, P.O. Box 98313, Raleigh, NC 27624. email: physiciansolutions@gmail.com or phone with any questions, PH: (919) 845-0054.

Family Practice physician is needed to cover several shifts per week in Rocky Mount, NC. This high profile practice treats pediatrics, women’s health and primary care patients of all ages. If you are available for 30 plus hours per week for the remainder of the year, this could be the perfect opportunity. 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, N.C. 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Locum Tenens opportunity for primary care MD in the Triad Area NC. This is a 40 hour per week on-going assignment in a fast pace established practice. You must be comfortable treating pediatrics to geriatrics. We pay top wages, provide professional liability insurance, lodging when necessary, mileage and exceptional opportunities. Please send a copy of your current CV, NC medical license, DEA certificate and NPI certificate with number along with your detailed work history and CME courses completed to: Physician Solutions, P.O. Box 98313, Raleigh, NC 27624. email: physiciansolutions@gmail.com or phone with any questions, PH: (919) 845-0054.

MEDMONTHLY.COM |67

EXCELLENT FAMILY PRACTICE FOR SALE North Carolina family practice located 30 miles from Lake Norman has everything going for it.

Medical Practice Listings For more information call (919) 848-4202. To view other practice listings visit medicalpracticelistings.com

NC OPPORTUNITIES LOCUMS OR PERMANENT

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

Gross revenues in 2010 were 1.5 million, and there is even more upside. The retiring physician is willing to continue to practice for several months while the new owner gets established.

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

Excellent medical equipment, staff and hospital nearby, you will be hard-pressed to find a family practice achieving these numbers.

For more information about Physician Solutions or to see all of our locums and permanent listings, please visit physiciansolutions.com

Listing price is $625,000.

Medvertising

compound noun: 1. The action of calling attention to medical goods or services for sale. Exclusively refers to advertising in Med Monthly.

Come see why we’re not your father’s medical journal Scan this code with your smartphone or visit medmonthly.com

Med Monthly 919.747.9031 | medmedia9@gmail.com | medmonthly.com

Hospice Practice Wanted Hospice Practice wanted in Raleigh/ Durham area of North Carolina.

Medical Practice Listings has a qualified physician buyer that is ready to purchase. If you are considering your hospice practice options, contact us for a confidential discussion regarding your practice.

To find out more information call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com

Practice for Sale in Raleigh, NC Primary care practice specializing in women’s care

Med Monthly Med Monthly is the premier health care magazine for medical professionals.

By placing an ad in Med Monthly you’ll reach: family medicine, internal medicine, physician assistants and more!

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919.747.9031

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Wanted: Urgent Care Practice

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.

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.

List price: $435,000

Medical Practice Listings Buying and selling made easy

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

Call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com MEDMONTHLY.COM |69

PRACTICE FOR SALE

OCCUPATIONAL HEALTH CARE PRACTICE FOR SALE Greensboro, North Carolina Well-established practice serving the Greensboro and High Point areas for over 15 years. Five exam rooms that are fully equipped, plus digital X-Ray. Extensive corporate accounts as well as walk-in traffic. Lab equipment includes CBC. The owning MD is retiring, creating an excellent opportunity for a MD to take over an existing patient base and treat 25 plus patients per day from day one. The practice space is 2,375 sq. feet. This is an exceptionally opportunity. Leased equipment includes: X-Ray $835 per month, copier $127 per month, and CBC $200 per month. Call Medical Practice Listings at (919) 848-4202 for more information.

Asking price: $385,000

To view more listings visit us online at medicalpracticelistings.com

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

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

Contact us today to discuss your options confidentially.

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

MODERN MED SPA AVAILABLE Located in beautiful coastal North Carolina

Modern, well-appointed med spa is available in a picturesque part of the state. This practice is positioned in a highly traveled area with positive demographics adding to the business appeal and revenue stream. A sampling of the services and procedures offered are: BOTOX, facial therapy and treatments, laser hair removal, eye lash extensions and body waxing as well as a menu of anti-aging options.

If you are currently a med spa owner and looking to expand or considering this high profile med business, this is the perfect opportunity.

Highly profitable and organized, you will find this spa poised for success.

The qualified buyer can obtain detailed information by contacting Medical Practice Listings at 919-848-4202.

MedicalPracticeListings.com | medlisting@gmail.com | 919.848.4202 70| APRIL 2012

Classified To place a classified ad, call 919.747.9031

Physicians needed

Practice sales

North Carolina (cont.)

North Carolina

Internal Medicine Practice located in High Point, NC, has two full-time positions available. This well-established practice treats private pay as well as Medicare/Medicaid patients. There is no call or rounds associated with this opportunity. If you consider yourself a well-rounded IM physician and enjoy a team environment, this could be your job. You would be required to live in or around High Point and if relocating is required, a moving package will be extended as part of your salary and incentive package. BC/BE MD should forward your CV, and copy of your NC medical license to physiciansolutions@gmail.com - View this and other exceptional physician opportunities at www.physiciansolutions.com or call (919) 845-0054 to discuss your availability and options.

Locum Tenens Primary Care Physicians Needed If you would like the flexibility and exceptional pay associated with locums, we have immediate opportunities in family, urgent care, pediatric, occupational health and county health departments in NC and VA. Call today to discuss your options and see why Physician Solutions has been the premier physician staffing company on the eastern seaboard. Call (919) 8450054 or review our corporate capabilities at www. physiciansolutions.com

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

Family Practice located in Hickory, NC. Well-established and a solid 40 to 55 patients split between an MD and physician assistant. Experienced staff and outstanding medical equipment. Gross revenues average $1,500,000 with strong profits. Monthly practice rent is only $3,000 and the utilities are very reasonable. The practice with all equipment, charts and good will are priced at $625,000. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or email: medlistings@gmail.com Impressive Internal Medicine Practice in Durham, NC: The City of Medicine. Over 20 years serving the community, this practice is now listed for sale. There are four well-equipped exam rooms, new computer equipment and a solid patient following. The owner is retiring and willing to continue with the new owner for a few months to assist with a smooth transition. Contact Medical Practice Listings at (919) 8484202 for more information. View additional listings at: www. medicalpracticelistings.com Modern Vein Care Practice located in the mountains of NC. Booking seven to 10 procedures per day, you will find this impressive vein practice attractive in many ways. Housed in the same practice building with an internal medicine, you will enjoy the referrals from this as well as other primary care and specialties in the community. We have this practice listed for $295,000 which includes charts, equipment and good will. Contact Medical Practice Listings at (919) 8484202 for more information. View additional listings at www. medicalpracticelistings.com

MEDICAL PRACTICE LISTINGS Are you looking to sell or buy a practice?

View national practice listings by visiting our website or contact us for a confidential discussion regarding your practice options. We are always ready to assist you.

919.848.4202 medlistings@gmail.com | medicalpracticelistings.com We have in-house practice experts and an attorney ready to assist.

MEDMONTHLY.COM | 71

Classified To place a classified ad, call 919.747.9031

Practice for sale

Practice for sale

North Carolina (cont.)

South Carolina (cont.)

Primary Care Practice specializing in women’s care. The owning female 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 profitable practice that 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 wellappointed exam rooms throughout. New computers and medical management software add to this modern front desk environment. This practice is being offered for $435,000. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or send an email to medlistings@gmail.com

you want. Physician will to stay on for a smooth transition.

Hospital support is also an option for up to a year. The listing price is $395,000 for the practice, charts, equipment and good will. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or email: medlistings@gmail.com.

Internal Medicine Practice located just outside Fayetteville, NC is now being offered. The owning physician is retiring and is willing to continue working for the new owner for a month or two assisting with a smooth transaction. The practice treats patients four and a half days per week with no call or hospital rounds. The schedule accommodates 35 patients per day. You will be hard pressed to find a more beautiful practice that is modern, tastefully decorated and well appointed with vibrant art work. The practice, patient charts, equipment and good will is being offered for $415,000 while the free standing building is being offered for $635,000. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or email: medlistings@gmail.com

South Carolina Lucrative ENT Practice with room for growth, located three miles from the beach. Physician’s assistant, audiologist, esthetician and well-trained staff. Electronic medical records, mirror imaging system, established patient and referral base, hearing aids and balance testing, esthetic services and Candela laser. All aspects of otolaryngology, busy skin cancer practice, established referral base for reconstructive eyelid surgery, Botox and facial fillers. All new surgical equipment, image-guidance sinus surgery, balloon sinuplasty, nerve monitor for ear/parotid/ thyroid surgery. Room for establishing allergy, cosmetics, laryngology and trans-nasal esophagoscopy. All the organization is done; walk into a ready-made practice as your own boss and make the changes you want, when 72| APRIL 2012

Washington Family Practice located in Bainbridge Island, WA has recently been listed. Solid patient following and cash flow makes this 17-year-old practice very attractive.

Contact Medical Practice Listings for more details. email: medlistings@gmail.com or (919) 848-4202.

Practice wanted North Carolina Pediatric Practice Wanted in Raleigh, NC Medical Practice Listings has a qualified buyer for a pediatric practice in Raleigh, Cary or surrounding area. If you are retiring, relocating or considering your options as a pediatric practice owner, contact us and review your options. Medical Practice Listings is the leading seller of practices in the US. When you list with us, your practice receives exceptional national, regional and local exposure.

Contact us today at (919) 848-4202.

Wanted: Classified ads

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: d e t n Wa Ho

in Da e c i t c a r P spice

MD STAFFING AGENCY FOR SALE Great opportunity for anyone who wants to purchase an established business.

llas, TX

We have a qualified buyer that is looking for an established hospice practice in the Dallas,Texas area.

To review your hospice practice options confidentially, contact Medical Practice Listings at 919-848-4202 or e-mail us at medlistings@gmail.com.

To view our national listings visit www.medicalpracticelistings.com

 One of the oldest Locums companies  Large client list  Dozens of MDs under contract  Executive office setting  Modern computers and equipment  Revenue over a million per year  Owner retiring  List price is over $2 million

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

FAMILY PRACTICE FOR SALE A beautiful practice located in Seattle, Washington This upscale primary care practice has a boutique look and feel while realizing consistent revenues and patient flow. You will be impressed with the well appointed layout, functionality as well as the organization of this true gem of a practice. Currently accepting over 20 insurance carriers including Aetna, Blue Cross and Blue Shield, Cigna, City of Seattle, Great West and United Healthcare. The astute physician considering this practice will be impressed with the comprehensive collection of computers, office furniture and medical equipment such as Welch Allyn Otoscope, Ritter Autoclave, Spirometer and Moore Medical Exam table.

Physician compensation is consistently in the $200,000 range with upside as you wish. Do not procrastinate; this practice will not be available for long.

List price: $255,000 | Year Established: 2007 | Gross Yearly Income: $380,000

Medical Practice Listings Selling and buying made easy

MedicalPracticeListings.com | medlisting@gmail.com | 919.848.4202 MEDMONTHLY.COM |73

ADVERTISE YOUR PRACTICE BUILDING IN MED MONTHLY

Exceptional North Carolina Primary Care Practice for Sale Established North Carolina Primary Care practice only 15 minutes from Fayetteville, 30 minutes from Pinehurst, 1 hour from Raleigh, 15 minutes from Lumberton and about an hour from Wilmington. The population within 1 hour of this beautiful practice is over one million. The owning physician is retiring and the new owner will benefit from his exceptional health care, loyal patient following, professional decorating, beautiful and modern free standing medical building with experienced staff. The gross revenue for 2010 is $856,000, and the practice is very profitable.

We have this practice listed for $415,000. Call today for more details and information regarding the medical building.

Our Services: • Primary Health • Well Child Health Exams • Sport Physical • Adult Health Exams • Women’s Health Exams • Management of Contraception • DOT Health Exam • Treatment & Management of Medical Conditions • Counseling on Prevention of Preventable Diseases • Counseling on Mental Health • Minor surgical Procedures

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

For more information call Medical Practice Listing at (919) 848-4202.

To view our other listings, visit medicalpracticelistings.com.

Private Medical and Mental Health Care Practice for Sale Coastal North Carolina, minutes from Atlantic Beach

Established private internal medicine practice treating general as well as adolescent patients and licensed clinical psychologist’s combine for a high profile multi-disciplinary practice. The staff includes a medical doctor, physician assistant, three licensed clinical psychologists, and a complement of nurses and administrators. The internal medicine practice also uses locum physicians to treat primary care patients as needed.

Excellent gross income with solid profits are enjoyed in this evergrowing practice located in a bustling community with handsome demographics. Two all brick condominiums house these practices which are offered for lease or purchase.

This expanded services private health care facility has a solid following and all the tools necessary for enhanced services, income and expansion.

For more details which include a BizScore Practice Valuation, financial statements, patient demographics and furniture and equipment details, contact one of our professionals.

Medical Practice Listings PH: (919) 848-4202 Email: medlistings@gmail.com www.medicalpracticelistings.com 74| APRIL 2012

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

Contact Medical Practice Listings today to discuss the practice details.

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

www.medicalpracticelistings.com

Practice for Sale in South Denver Neurofeedback and Psychological Practice Located in South Denver, Colorado, this practice features high patient volume and high visibility on the internet. Established referral sources, owner (psychologist) has excellent reputation based on 30 years experience in Denver. Private pay and insurances, high-density traffic, beautifully decorated and furnished offices, 378 active and inactive clients, corporate clients, $14,000 physical assets, good parking, near bus and rapid transit housed in a well-maintained medical building.

Live and work in one of the most healthy cities in the U.S. List Price: $150,000 | Established: 2007 | Location: Colorado For more information contact Dr. Jack McInroy at 303-929-2598 or Shrink1324@gmail.com

Primary Care Practice For Sale

Practice at the beach Plastic Surgery practice for sale with lucrative ENT specialty Myrtle Beach, South Carolina Practice for sale with room for growth, located only three miles from the beach. Physician’s assistant, audiologist, esthetician and well-trained staff. Electronic medical records, Mirror imaging system, established patient and referral base, hearing aids and balance testing, esthetic services and Candela laser. All aspects of Otolaryngology, busy skin cancer practice, established referral base for reconstructive eyelid surgery, Botox and facial fillers. All new surgical equipment, image-guidance sinus surgery, balloon sinuplasty, nerve monitor for ear/parotid/thyroid surgery. Room for establishing allergy, cosmetics, laryngology & trans-nasal esophagoscopy. Walk into a ready made practice as your own boss and make the changes you want, when you want. Physician will stay on for smooth transition. Hospital support also an option for up to a year. The listing price is $395,000.

For more information call Medical Practice Listing at (919) 848-4202. To view our other listings, visit medicalpracticelistings.com

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

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

Excellent exam room layout, equipment and visibility.

Contact Medical Practice Listings for more information.

Medical Practice Listings 919.848.4202 | medlistings@gmail.com www.medicalpracticelistings.com MEDMONTHLY.COM |75

the top

Ways to tell if your practice is well managed

PATIENT SATISFACTION is prioritized and measured, and improvement is valued.

April's top nine asks what are the hallmarks of a well-managed practice?

There are many, but here are nine basics.

7

EMPLOYEE TURNOVER rate is 10 percent or less and NEW EMPLOYEES are onboarded with training, coaching and competency testing.

Compiled by Mary Pat Whaley

UNFILLED APPOINTMENT PERCENTAGE is 5 percent or less. This is in retrospect, so it includes no-shows.

8

GUIDELINES FOR OPERATIONS such as a compliance plan, disaster plan, personnel handbook, job descriptions and requirements for annual evaluations, raises, bonuses and progressive discipline.

2

FOUNDATION DOCUMENTS appropriate to the corporate structure and written agreements describing how income and expenses are shared by physicians and/or other providers and how partners enter and exit the practice.

3

NO COMMERCIAL PAYER comprises no more than 50 percent of the practice's business.

76| APRIL 2012

5

A BUDGET that addresses variances.

The budget also allocates funds for marketing and has a written marketing plan.

NET COLLECTION PERCENTAGE is 95 percent or more. This means that of the expected collectible dollars, 95 percent are collected.

9

A LINE OF CREDIT or other means to draw upon in the case of unexpected cash flow drop.

A simple question can reveal as much as a test.

“WHAT ARE OUR GOALS FOR TODAY?” Ask your patients about their health priorities at each visit. When you do, both you and your patient can make the most out of the time you have together, and they’ll feel more invested in their own care. Not only does that improve efficiencies, but it also helps improve health outcomes.

For tools and tips to share with your patients, visit www.ahrq.gov/questions