Physician Solutions December 2015

PHYSICIAN SOLUTIONS magazine

DECEMBER 2015

TODAY’S HEALTHCARE PRACTICE MODELS: The Changing Landscape

pg. 20

pg. 18

TEAM BASED CARE IS THE NEW NORMAL IN MEDICAL PRACTICE MODELS pg. 28

Would E-Prescriptions Be Beneficial to Your Practice Model? pg. 24

How to Know if You Are Missing Out on Referrals in Your Current Practice Model pg. 22

the

Your Practice Model issue

contents features

18 TODAY’S HEALTHCARE PRACTICE MODELS: The Changing Landscape

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22 HOW TO KNOW IF YOU’RE MISSING OUT ON VITAL REFERRALS IN YOUR CURRENT PRACTICE MODEL

TODAY’S HEALTHCARE PRACTICE MODELS

24 WOULD E-PRESCRIPTIONS BE BENEFICIAL TO YOUR PRACTICE MODEL? 28 TEAM BASED CARE IS THE NEW NORMAL IN MEDICAL PRACTICE MODELS

28

TEAM BASED CARE IS THE NEW NORMAL IN MEDICAL PRACTICE MODELS

practice tips 6

CDC RESUMES WEEKLY FLU ACTIVITY REPORTS

8

BRIEF TRAINING INCREASES PEDIATRICIANS’ USE OF SUBSTANCE ABUSE AND MENTAL HEALTH INTERVENTIONS

10 PRACTICE TIPS INFOGRAPHICS

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Physician Solutions December 2015 Publisher Creative Director Contributors

Philip Driver Thomas Hibbard Naren Arulrajah Amanda Chay Vishal Gandhi, BSEE, MBA Lisa Shock, MHS, PA-C Julia Solooki, MBA Vikas Vij

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

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

Vishal Gandhi, BSEE, MBA is the founder and CEO ClinicSpectrum Inc. He is a well-known and widely respected authority on the “nitty-gritty” of medical practice workflow and technology. His Hybrid Workflow Model is quickly becoming a new healthcare industry standard model for combining human and computer workflow, to maximize revenue and minimize cost and he has appeared in prominent health IT publications.

Lisa P. Shock, MHS, PA-C

Physician Solutions is a national monthly magazine committed to providing insights about the health care profession focusing on practical advice for physicians and practices.

We are currently accepting articles to be considered for publication.

For more information on writing for Physician Solutions, please email us at physiciansolutions@gmail.com.

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

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

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

PHYSICIAN SOLUTIONS MAGAZINE | 5

practice tips

CDC Resumes Weekly Flu Activity Reports Subscribe to receive updates on U.S. 2015-2016 flu season Information about influenza activity in the United States is collected, compiled and analyzed by the Centers for Disease Control and Prevention (CDC) and published in a report called FluView. CDC has resumed full FluView reporting for the 2015-2016 U.S. flu season and has made a number of refinements to the report this season.

FluView includes information on: • when and where influenza activity is occurring in the United States, • what influenza viruses are circulating, and • the impact of influenza disease in the United States, including flu-related illness, hospitalizations and deaths.

FluView is available in a downloadable PDF report, but the information also is available in interactive applications (FluView Interactive), which allow users to create and customize dynamic visuals.

6

| DECEMBER 2015

This season, a number of refinements have been made to FluView including: • Differentiating data provided by public health and clinical laboratories, • Providing lineage for influenza B virus data, • Displaying graphically the age distribution of influenza-positive specimens, • Transitioning to the National Center for Health Statistics electronic mortality surveillance system, which provides a more complete and accurate assessment of deaths from flu.

Subscribe to the FluView RSS feed for updates and news. The reports are posted weekly on Fridays.

Additional Information • Influenza activity is low at this time, but there are early signs that activity is increasing.

• CDC recommends that everyone six months of age and older get vaccinated against influenza every year.

• Influenza viruses are constantly changing so the composition of the seasonal influenza vaccine is reviewed annually and updated periodically to better match circulating viruses.

• The composition of the 20152016 season’s influenza vaccine has been updated to better match circulating influenza viruses.

• Laboratory data indicate that most circulating influenza viruses remain similar to the influenza viruses used to make this season’s vaccines; this suggests that vaccination should protect against most circulating influenza viruses.

• As of October 30, 2015, more than 118 million doses of 20152016 flu vaccine have been distributed.

• Learn more about flu at www.cdc.gov/flu and vaccines at Vaccines.gov.  Source: http://www.cdc.gov/media/ releases/2015/s1030-flu-activity.html

What’s your practice worth?

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

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practice tips

Brief Training Increases Pediatricians’ Use of Substance Abuse and Mental Health Interventions

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| DECEMBER 2015

T

wo to three brief training sessions can significantly increase pediatricians’ use of techniques for identifying and treating young people with potential alcohol, substance use, and mental health problems, according to a new study in a large pediatric primary care clinic. Collectively known as screening, brief intervention, and referral to treatment (SBIRT), such techniques could be important tools for preventing and treating these common problems among young people. The study also found that pediatric practices can improve support for patients who need these services by adding behavioral health clinicians to their teams. A report of the study, which was funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health, is now online in JAMA Pediatrics.

“This research provides valuable new information about strategies that might improve implementation of SBIRT in everyday pediatric practice settings,” says NIAAA Director George F. Koob, Ph.D. Underage drinking and drug use, which often coexist with mental health problems, are common and dangerous. Risks of heavy drinking in adolescence, for example, range from injuries and school troubles to long-lasting brain changes and dependence.

Research has shown that primary care physicians who conduct SBIRT with adult patients can reduce heavy drinking, its harmful consequences, and related health care costs. In recent years, mounting evidence has supported the use of SBIRT by primary care pediatricians to prevent substance use problems from starting or escalating in their young patients.

However, physicians often face barriers to providing these services, including time constraints and a lack of training in SBIRT. The new study, led by Stacy Sterling, Dr.P.H.(c.), M.S.W. at Kaiser Permanente Northern California in Oakland, compared practical ways to overcome both barriers in a general pediatric care clinic.

In a two-year trial that involved nearly 50 pediatricians and about 1,900 adolescents, researchers measured SBIRT use among three groups of clinicians.

“A ‘pediatrician-only’ group was offered three 60-minute SBIRT training sessions,” explains Ms. Sterling. “In the clinic, this group was then expected to conduct full SBIRT assessments and brief interventions by themselves as needed.”

A second group of pediatricians had one 60-minute

‘‘

“This research provides valuable new information about strategies that might improve implementation of SBIRT (screening, brief intervention, and referral to treatment) in everyday pediatric practice settings”

training session. In the clinic, this group was expected to assess patients and refer them as needed to clinical psychologists who had been “embedded” into the practices to conduct interventions.

A “usual care” group of pediatricians served as controls. They had access to the same clinical guidelines and tools, but did not take part in SBIRT training or have embedded clinical psychologists in their practices.

The researchers found that, following SBIRT training, the pediatrician-only group was about 10 times more likely (16 percent vs. 1.5 percent) to conduct brief interventions with patients deemed at risk, compared with “usual care” pediatricians. In the group of SBIRT-trained pediatricians that worked in-tandem with “embedded” clinical psychologists the brief intervention rate was 24.5 percent, compared with 16 percent in the pediatrician-only group, and 1.5 percent in the usual care group.

“Both intervention arms administered more assessments and brief interventions than those in usual care,” notes Constance Weisner, Dr.P.H., M.S.W., at Kaiser Permanente Northern California in Oakland, and the University of California, San Francisco, the principal investigator of the study. “However, overall pediatrician attention to behavioral health concerns was still low. Embedding non-physician clinicians in primary care could be a cost-effective alternative to pediatricians providing these services, and future analyses of the study data will examine patient outcomes and cost-effectiveness of the two SBIRT modalities.”  Source: http://www.nih.gov/news-events/news-releases/ brief-training-increases-pediatricians-use-substanceabuse-mental-health-interventions PHYSICIAN SOLUTIONS MAGAZINE

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practice tips

PRACTICE TIPS INFOGRAPHICS Provided by Vishal Gandhi, BSEE, MBA and Julia Solooki, MBA Clinicspectrum

22 || DECEMBER 10 DECEMBER2013 2015

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U.S. OPTICAL BOARDS Alaska P.O. Box 110806 Juneau, AK 99811 (907)465-5470 http://www.commerce.state.ak.us/dnn/ cbpl/ProfessionalLicensing/DispensingOpticians.aspx Arizona 1400 W. Washington, Rm. 230 Phoenix, AZ 85007 (602)542-3095 http://www.do.az.gov Arkansas P.O. Box 627 Helena, AR 72342 (870)572-2847 California 2005 Evergreen St., Ste. 1200 Sacramento, CA 95815 (916)263-2382 http://www.optometry.ca.gov/ Colorado 1560 Broadway St. #1310 Denver, CO 80202 (303)894-7750 http://www.dora.state.co.us/optometry/ Connecticut 410 Capitol Ave., MS #12APP P.O. Box 340308 Hartford, CT 06134 (860)509-7603 ext. 4 http://www.ct.gov/dph/cwp/view. asp?a=3121&q=427586 Florida 4052 Bald Cypress Way, Bin C08 Tallahassee, FL 32399 (850)245-4474 http://www.pof.org/opticianry-board/ Georgia 237 Coliseum Dr. Macon, GA 31217 (478)207-1671 http://sos.ga.gov/index.php/licensing/ plb/20 Hawaii P.O. Box 3469 Honolulu, HI 96801 (808)586-2704 http://hawaii.gov/dcca/pvl/programs/ dispensingoptician/

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

Oregon 3218 Pringle Rd. SE Ste. 270 Salem, OR 97302 (503)373-7721 http://www.oregonobo.org/optque.htm

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Delaware Cannon Building, Suite 203 861 Solver Lake Blvd.

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

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

Florida 4052 Bald Cypress Way Bin C-08 Tallahassee, FL 32399 (850)245-4474 http://floridasdentistry.gov/ 14

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

| DECEMBER 2015

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

Maine 143 State House Station 161 Capitol St. Augusta, ME 04333 (207)287-3333 http://www.mainedental.org/ Maryland 55 Wade Ave. Catonsville, Maryland 21228 (410)402-8500 http://dhmh.state.md.us/dental/ Massachusetts 1000 Washington St., Suite 710 Boston, MA 02118 (617)727-1944 http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/dhpl/ dentist/about/ Michigan P.O. Box 30664 Lansing, MI 48909 (517)241-2650 http://www.michigan.gov/lara/0,4601,7154-72600_72603_27529_27533---,00. html Minnesota 2829 University Ave., SE. Suite 450 Minneapolis, MN 55414 (612)617-2250 http://www.dentalboard.state.mn.us/ Mississippi 600 E. Amite St., Suite 100 Jackson, MS 39201 (601)944-9622 http://bit.ly/uuXKxl Missouri 3605 Missouri Blvd.

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

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

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

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

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

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

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

New Jersey P.O Box 45005 Newark, NJ 07101 (973)504-6405 http://njpublicsafety.com/ca/dentistry/

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

New Mexico Toney Anaya Building 2550 Cerrillos Rd. Santa Fe, NM 87505 (505)476-4680 http://www.rld.state.nm.us/boards/Dental_Health_Care.aspx New York 89 Washington Ave. Albany, NY 12234 (518)474-3817 http://www.op.nysed.gov/prof/dent/ North Carolina 507 Airport Blvd., Suite 105 Morrisville, NC 27560 (919)678-8223 http://www.ncdentalboard.org/ North Dakota P.O. Box 7246 Bismark, ND 58507 (701)258-8600 http://www.nddentalboard.org/

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

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

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U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (334)242-4116 http://www.albme.org/ Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 http://www.medlicense.com/alaskamedical-license.html Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 (480)551-2700 http://www.azmd.gov Arkansas 1401 West Capitol Ave., Suite 340 Little Rock, AR 72201 (501)296-1802 http://www.armedicalboard.org/ California 2005 Evergreen St., Suite 1200 Sacramento, CA 95815 (916)263-2382 http://www.mbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7690 http://www.dora.state.co.us/medical/ Connecticut 401 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/cwp/view. asp?a=3143&q=388902 Delaware Division of Professional Regulation Cannon Building 861 Silver Lake Blvd., Suite 203 Dover, DE 19904 (302)744-4500 http://dpr.delaware.gov/ District of Columbia 899 North Capitol St., NE Washington, DC 20002 (202)442-5955 http://doh.dc.gov/bomed 16 | DECEMBER 2015

Florida 2585 Merchants Row Blvd.

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

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

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

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

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

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

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

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

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

Michigan Bureau of Health Professions P.O. Box 30670 Lansing, MI 48909 (517)335-0918 http://michigan.gov/lara/0,4601,7-15472600_72603_27529_27541-58914--,00. html

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

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

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

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

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

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

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

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

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

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

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features

Today’s Healthcare Practice Models:

The Changing Landscape Introduction The healthcare environment is rapidly changing. A number of decisive trends are becoming increasingly visible. One of these trends is the shift in healthcare practice models.

The number of physician practice owners is decreasing as more

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physicians are opting to join bigger and more powerful healthcare group practices or multispecialty groups. This isn’t necessarily a negative outcome if you consider the fact that in the present market space, bigger is considered to be better. Furthermore, a substantial number of women physicians prefer balancing their family life

By Naren Arulrajah with Vikas Vij Ekwa Marketing with their work life and so are not keen on becoming practice owners.

Purchasing a new practice is a huge challenge as graduating physicians are strapped under medical school debt and very few physicians are willing to risk additional financial burdens early on in their careers.

On the other side of the spectrum, a different catalyst is impact-

ing the healthcare sector – an acute shortage of physicians. The U.S. Bureau of Health Professions has estimated that there will be a shortage of 109,600 physicians across all specialties by the year 2020. Also worrisome is the fact that as an increasing number of Americans come under the blanket of health insurance coverage, it is going to be next to impossible for US Medical Schools and Residency Programs to supply new physicians to serve this patient base in the coming years.

So yes, there is no denying the fact that the complexities of regulatory compliance definitely make it difficult for physicians to run small or solo practices.

So what are these trends indicative of? Or the more subject question is - are the days of solo practices over?

Patient Access and Increasing Costs – Twin Healthcare Challenges Physicians with private practices are starting to feel increasingly pressurized by the substantial rise in regulatory and practice administration costs as well as a dip in reimbursements.

Consider this – in a traditional practice a physician might end up seeing 2,000 and more patients.

This definitely leaves the physician with less time to spend with each patient. Not to forget the time it takes to manage paperwork and administrative responsibilities. Solo practices also need to consider increasing overheads associated with the cost of buying and maintaining rapidly advancing technologies. The only way to break even is by increasing revenue by expanding the

practice patient base which simply means less time with current and, in some instances, really deserving patients.

New Healthcare Practice Models Given the changing healthcare environment, it is important for physicians to consider alternative practice models that can help address the twin challenges of rapidly increasing overheads and patient access. Here are 4 practice models physicians can consider.

Inclusion of Mid-level Providers While managing a solo practice has its own acute challenges, there are a number of physicians who prefer running their own practice.

It can be because they run a family practice or simply because they have spent a major portion of their lives setting up and building the practice - they are far more emotionally and financially invested in their practices. However, they are not immune to cost appreciations and lowering reimbursements and so need to give serious thought to improve practice efficiency and revenue. A good option for these physicians is to include mid-level providers into their primary care facility. The advantages mid-level providers offer include; • Managing and delivering routine care to patients which can free up a lot of time for the physician.

• Physicians have more time to focus on more complex cases.

• Mid-level providers can help address scheduling conflicts and the physician does not have

to worry about a dip in the quality of care provided by his/ her practice.

• Physicians who are past their retirement age or women physicians with families don’t have to discontinue practicing as they can cut back on their work schedules.

• Educating mid-level providers takes less time compared to the time that goes into educating physicians.

Concierge Perhaps the biggest advantage of the concierge practice model is that a physician sees less number of patients without having to worry about profits because he is on a retainer and hence has a reliable revenue source. And because the physician sees fewer patients he has the liberty of spending more time with his patients compared to a physician with thousands of patients who is time strapped and cannot form the same kind of relationship. Furthermore, he only gets paid when a patient comes in.

• The traditional concierge model is one where a patient is required to pay a monthly fee or annual fee which allows him or her direct access to the physician.

• The practice adds the fee to its profit while also billing insurance companies for visits.

• This practice model allows physicians to get to spend more time delivering personalized care, the practice earns revenue from two sources and does not have to worry about having to fight insurance companies. continued on page 20

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continued from page 19

Direct Primary Care Under the direct-primary-care model, a lot of physicians do not take insurance. Instead, they rely completely on the monthly/annual fee from their patients. Again as with the concierge practice model, under the direct-primary-care model physicians have the advantage of managing a small practice customized to take in a smaller number of patients depending on their schedules and the number of physicians available.

• A major benefit with directprimary-care model is that because the practice does not take insurance, it is not bound to adhere to Medicare regulations.

• The practice also does not have to worry about collaborating and working with insurance companies; they are also free of having to deal with pre-certification and collecting co-pays among other issues.

• However, since the practice has a single source of revenue (patient fees), there is pressure to carefully plan the practice’s financial structure to ensure that the single source of revenue can sustain practice operations.

Hybrid Practice Model The hybrid practice model is a blend of a traditional practice and the concierge model. For a number of reasons this model is popular with physicians simply because they have the liberty to retain many of their regular patients. A lot of physicians build lifelong associations with their regular patients and having to let them go can be 20

| DECEMBER 2015

a tough decision; this is one of the reasons why a number of physicians still prefer running a solo practice. Under the hybrid practice model, they get to keep their loyal patients.

• The hybrid practice model however, requires a rock solid operational and optimized scheduling structure.

• Obviously, patients that pay the practice a fee for concierge medicine will expect a certain level of exclusivity.

• Planning and staff training have to be spot on for this model to succeed.

• Also, the practice will have to adhere to some of the insurance rules and regulations because of

its insured patient base; so billing and collection issues cannot be swept aside.

Conclusion A lot of thinking and planning goes into building a successful practice. And for a physician balancing the quality side of healthcare in addition to the financial side of running his or her practice can be like walking the tight rope.

Each of these healthcare models can work for a practice and deliver desired results provided that careful thought is given to which model fits your present situation while also helping you meet your future goals the best. 

About the Author: Naren Arulrajah is President and CEO of Ekwa Marketing, a complete Internet marketing company which focuses on SEO, social media, marketing education and the online reputations of Dentists and Physicians.

With a team of 130+ full time marketers, www.ekwa.com helps doctors who know where they want to go, get there by dominating their market and growing their business significantly year after year. If you have questions about marketing your practice online, call Naren direct at 877-249-9666.

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features

How to Know if You’re Missing Out on Vital Referrals in Your Current Practice Model

By Amanda Chay Director of Physician Liaison & Affiliate Programs, WhiteCoat Designs In the past, it was easy for physicians to market their practice by simply placing an “open” sign on their door. Times have greatly changed and now we have ‘in–your-face’ marketing with billboards, television ads, social media, and websites all demanding the patient’s attention. Despite these marketing methods used to attract more patients, physicians still ponder if referrals are quietly slipping through their fingers. The question of “how do practices know if they are missing out on referrals?” remains unanswered for many practices.

The following are three ways to identify if this situation is occurring at your practice:

Assess Your Competition

Understanding how you are similar and different from the competition is important for any practice looking for additional advancement. In order to discover this potential, you will need to gather 22

| DECEMBER 2015

information about the associated services and abilities from the competition as well as assessing the barriers and abilities that your practice offers the medical community.

A competitive analysis is the best and quickest way to calculate your potential threats, uncover your influence in the community, and help your practice stay ahead of trends that could impact your business. This is achieved by calculating the strengths and weaknesses of current and potential competitors as well as your practice. Through this analysis, your opportunities and threats will be uncovered and it will provide vital information for a formulation of a strategic plan for gaining future patient referral growth. A competitive analysis is not a one-time task though. It should be reviewed for any edits and additions once a quarter, or whenever you feel a shift occurring in the community (e.g. new practice opening near you).

Dedicated Individual to Grow Referrals

Practices can greatly benefit from a dedicated person who goes out into the medical community and creates a presence in the targeted market in order to garnish additional patients.

This dedicated person is a physician liaison. A liaison represents your practice with the goal of increasing both patient referrals and practice revenue. The liaison achieves this with consistent visits at referring offices to grow new relationships through identifying the needs of the practice and educating physicians on services offered. For relationships that are already established, they are further enhanced through active listening from the liaison and responding to the areas of noted concern. If problems arise, the physician liaison is available to quickly address the issues and make immediate changes.

It should be noted that most practices would suffice with a physician liaison that works part-time, thus saving the practice on associated benefits and salary requirements.

If you don’t have a physician liaison and your competition does, you can safely assume that you are missing out on referral sources.

Referral Tracking

Referral tracking involves analyzing patient data across a variety of factors, such as number of patient referred, referring practices and physicians/providers, patient services, insurance mix, etc. It is recommended that the frequency for reviewing the referral data is on a monthly basis, although the trends should also be assessed quarterly and annually for large trends.

Remember to compare these numbers to the same timeframe for the previous year for a perspective on growth.

When reviewing the data, look for patterns of referral behavior from both practices and physicians, such as one top referring office gradually increasing their referrals across a span of six months or a physician who has begun to only send patients with a specific insurance plan. Keep an eye out for data outliers, including significant decreases of patients sent from a specific area, medical specialty, or during a particular month. These will merit additional consideration. It is a good practice to analyze the services and procedures that referring practices are sending as well. By doing this, you can identify certain services and procedures for promotion in upcoming months.

If these tasks become overwhelming, there are outside medical marketing agencies that can provide assistance. Another option is to set up an online CRM (customer relationship management) system to track the referrals internally. The CRM will review the data entered into the system in order to provide specific referral trends.

With these three concepts, your practice will know if you are missing out on important patient referrals. 

features

Would E-Prescriptions Be Beneficial to Your Practice Model?

By Thomas Hibbard Creative Director, Med Monthly

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It is estimated that approximately 7,000 deaths occur each year in the United States due to medication errors.

These errors are predominately due to hand-writing illegibility, wrong dosing, missed drug-drug or drug-allergy reactions. With approximately 3 billion prescriptions written annually, which constitutes one of the largest paper-based processes in the United States, the writing of prescriptions can be streamlined and efficient by using an e-prescribing system.1 Electronic prescribing or e-prescribing (e-Rx) is the computerbased electronic transmission and filling of a medical prescription, taking the place of paper and faxed prescriptions. E-prescribing allows a physician, nurse practitioner, or physician assistant to electronically transmit a new prescription or renewal authorization to a local or mail-order pharmacy. It has the ability to send error-free, accurate, and understandable prescriptions electronically from the healthcare provider to the pharmacy.

E-prescribing is meant to reduce the risks associated with traditional prescription script writing. It is also one of the major reasons for the push for electronic health records (EHR).

Small and mid-size practices are leading the way, making up a sizeable chunk of the 58% of physicians using e-prescribing tools outside of the hospital.2

Do E-prescriptions Actually Improve Patient Health?

According to a study by Surescripts, e-prescribing is linked to an increase in first-fill medication adherence and health care savings that could lead to $140 to $240 billion in health care savings and improved health outcomes over the next ten years.

Physicians adopting e-prescribing wrote out nearly 40% of their prescriptions electronically. This resulted in a 10% increase in patient first-fill medication adherence, which

translates to fewer doctor visits and reduced risk of hospitalization.

When taking into account the 60/40 ratio of paper-to-electronic prescriptions, the study demonstrated prescription delivery rates rising to 81.8%, and 76.5% getting picked up.

This is encouraging, considering how many prescriptions never make it to a pharmacy counter.3

Benefits The benefits of e-prescribing to both patients and clinicians include: l Improving patient safety and quality of care - Illegibility from handwritten prescriptions is eliminated, decreasing the risk of medication errors while simultaneously decreasing risks related to liability. Oral miscommunications regarding prescriptions can be reduced, as e-prescribing should decrease the need for phone calls between prescribers and dispensers.

Electronic prescribing has the potential to eliminate most of these types of errors. Warning and alert systems are provided at the point of care. E-prescribing systems can enhance an overall medication management process through clinical decision support systems that can perform checks against the patient’s current medications for drug-drug interactions, drug-allergy interactions, diagnoses, body weight, age, drug appropriateness, and correct dosing. Based on these algorithms, the system can alert prescribers to contradictions, adverse reactions, duplicate therapies and flag lethal dosages and lethal combinations of drugs. l Reducing time spent on phone calls and call-backs to pharmacies - According to estimates, almost 30 percent of prescriptions require pharmacy callbacks. E-prescribing can significantly reduce the volume of pharmacy call-backs related to

‘‘

“E-prescriptions not only fulfill Meaningful Use requirements, but it’s clear that they help reduce or prevent errors.

They can aid in making your practice more organized and save your practice money.”

illegibility, mistaken prescription choices, formulary and pharmacy benefits, decreasing the amount of time wasted on the phone. This ultimately impacts office workflow efficiency and overall productivity in a positive manner. l Reducing time spent faxing prescriptions to pharmacies Both prescribers and pharmacists can save time and resources spent on faxing prescriptions through a reduction in labor costs, handling costs, and paper expenses waste due to unreliability. l Automating the prescription renewal request and authorization process With e-prescribing, renewal authorization can be an automated process that provides efficiencies for both the prescriber and pharmacist. With limited resource utilization and just a few clicks on behalf of the prescriber, they can complete a medication renewal task while enhancing continuous patient documentation. l Increasing patient convenience and medication compliance - It is estimated that 20% of paperbased prescription orders go unfilled by the patient, partly due to the hassle of dropping off a paper prescription and waiting for it to be filled. By eliminating or reducing this waiting period, e-prescribing may help reduce the continued on page 26 PHYSICIAN SOLUTIONS MAGAZINE

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number of unfilled prescriptions and hence, increasing medication compliance. l Improving formulary adherence permits lower cost drug substitutions - By checking with the patient’s health plan or insurance coverage at the point of care, generic substitutions or lower cost therapeutic alternatives can be encouraged to help reduce patient costs. Lower costs may also help improve patient compliance. l Allowing greater prescriber mobility - Improved prescriber convenience can be achieved when using mobile devices that work on a wireless network, to write and renew prescriptions. Such mobile devices may include laptops, PDA’s, tablet computers, or mobile phones. This freedom of mobility allows prescribers to write/renew prescriptions anywhere, even when not in the office.

l

l

l

Challenges and Limitations Challenges and limitations that may hinder the widespread adoption of e-prescribing practices are: l Financial Cost and Return on Investment (ROI) - The costs associated with purchasing, implementing, training staff and maintaining such a system may be beyond the means of small clinical practices, and is noted to be one of the greatest implementation barriers. As a result, large urban areas (large practices) may see the greatest ROI when compared to those in rural or inner city locations (small practices). l Change Management - Many underestimate the challenges pertaining to change management when transitioning from paper-based prescriptions to e-prescribing. This is especially true in busy practices where health care providers and associated staff are accustomed to their 26

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l

current management system.

Staff accustomed to certain work practices may have particular aversions to the technology, so it may be difficult to get everyone on board immediately when introducing such a dramatic change.

Hardware and Software Selection - Choosing the right hardware platform and software applications can be a rather daunting task for practices, especially in regards to small and busy settings. Initiatives must be put into place to allow for effective and strategic planning prior to adoption.

Integrity of data input - Accidental data entry errors such as selecting the wrong patient or clicking on the wrong choice in a menu of dosages may occur. Software vendors should continually review user feedback and follow best practices in user interface design.

Security and Privacy - As with many eHealth solutions, privacy of patient information stored in electronic format may lead to the possibility of novel errors, such as inadvertently divulging protected health information on the internet through inadequate security practices. Instances of negligence may also arise, where employees may forward prescriptions to organizations outside its intended use. Therefore, hospitals, practices and pharmacies should be protected with firewalls, use strict computer permission settings, and remain vigilant toward signs of an intrusion.

System Downtime - Periods of system downtime may arise, either due to network-related issues, hardware failure, or loss of electricity. The inability to use electronic prescribing when the system is not accessible is of great concern, and must be addressed with the discussion of fall-back procedures and mechanisms when such situations arise.4

How to Get Your Practice Started l

Purchase hardware such as desktop PC’s, laptops, pocket PC’s, tablet PC’s , PDA’s utilizing a wired or wireless network. l Install an internet connection; high speed is highly recommended. l Decide whether you wish to choose a stand-alone e-prescription software or a full EMR system which includes e-prescribing functionality. l Choose an e-prescribing software vendor. The e-prescribing vendor will need to utilize a company which supplies the electronic prescribing network (hub or gateway for transmissions).

There are several e-prescription networking companies. Among the industry leaders are SureScripts (http://surescripts.com/), RxHub (http://www.rxhub.net/index. html), and ProxyMed (http://www. proxymed.com/).

In Conclusion E-prescriptions not only fulfill Meaningful Use requirements, but it’s clear that they help reduce or prevent errors. They can aid in making your practice more organized and save your practice money. Furthermore, e-prescriptions assist your patients to adhere to their medication regimen, contributing to their improved health and satisfaction.  References: 1 http://www.emrconsultant.com/ education/e-prescribing 2 http://www.poweryourpractice.com/ do-eprescriptions-actually-improvepatient-health/ 3 http://www.poweryourpractice.com/ eprescribing-could-save-health-carebillions/ 4 http://en.wikipedia.org/wiki/ Electronic_prescribing

features

Team Based Care is the New Normal in Medical Practice Models

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

Physician Assistants (PAs) and Nurse Practitioners (NPs) are estimated to do about 85% of the work a physician would otherwise provide in the primary care setting. It has been discussed by many sources that the population of patients being managed is sicker and more complex than initially imagined. Nationwide, hospitals and health systems are moving toward using more PAs and NPs and there is a much greater emphasis on team based care. Increasing capacity of the health system to meet the growing numbers of patients seeking care is critical and necessary.

PAs are fond of the term delegated autonomy. This is simply defined as the more experience you have clinically, the more independently you will work.

There should be a consistent growth pattern to the relationship between the collaborating physician and 28

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the PA and with time, this builds more and more trust.

Expanding the scope of practice in the clinical setting should occur more and more with time and, in time, the PA or NP should be practicing to the “top of his/ her license.�

Increasing capacity of the health system to meet the growing numbers of patients seeking care is critical and necessary. Medicare population growth is significant and leaves many patients facing access issues.

Between 2012 and 2050, the United States will experience considerable growth in its older population. In 2050, the population aged 65 and over is projected to be 83.7 million, almost double its estimated population of 43.1 million in 2012. The baby boomers are largely responsible for this increase in the older population, as they began turning 65 in 2011.

‘‘

“Now with even greater added financial incentives for quality care delivery, improved utilization of Physician Assistants (PAs) and Nurse Practitioners (NPs) will be an integral part of the primary care delivery solution for current and future practice models.”

partners, allows the primary care medical home to more effectively design efficient and important outreach processes to support patient health goals. This multipronged approach allows greater clarity of roles and distribution of tasks among care team members to reflect their skills, abilities and credentials.

As hospitals and health care systems continue to address quality patient care and improved access for patients to care, team based care is becoming more the norm. It is cost effective and efficient to hire a PA or NP to perform the clinical tasks that were traditionally performed by physicians, and to leverage support staff including care managers to engage patients for improved health outcomes. Organized medicine is catching on to not only the value for patients but also the return on investment when team based care is used to improve the health of their patients. 

Especially in primary care, PAs and NPs attract and manage a significant following of patients. Redesigning teams to include increased numbers of primary care providers, not just physicians but also Physician Assistants (PAs) and Nurse Practitioners (NPs), is a significant part of the solution to alleviate the well-known shortage in primary care. Now with even greater added financial incentives for quality care delivery, improved utilization of Physician Assistants (PAs) and Nurse Practitioners (NPs) will be an integral part of the primary care delivery solution for current and future practice models.

Implementing interdisciplinary care teams is a critical element of transforming a practice into a patientcentered medical home (PCMH). Leveraging the entire care team, including families and community

References: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-07-03-1. html http://www.witf.org/news/2014/10/how-pas-are-reshaping-health-care.php http://www.fiercehealthcare.com/story/4-waysimprove-primary-care-delivery/2014-10-02?utm_ campaign=SocialMedia http://www.safetynetmedicalhome.org/change-concepts/continuous-team-based-healing-relationships Lisa P. Shock, MHS, PA-C, is a seasoned PA who is an alumna of the Duke PA Program. She enjoys part time clinical practice and is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering a wide range of services to help implement and improve upon the utilization of PAs and NPs in the health care system. Contact her at lisa@pushpa.biz PHYSICIAN SOLUTIONS MAGAZINE

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

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

30 | DECEMBER 2015 D

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

Family Primary Care Practice

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

Family Practice/Primary Care

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

Med Spa

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

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

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

Dental Practices Place Your Ad Here

Optical Practices Place Your Ad Here

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

Considering your practice options? Call us today.

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Primary Care Specializing in Women’s Health

Located on NC’s Beautiful Coast, Morehead City

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

919.848.4202 medlisting@gmail.com medicalpracticelistings.com

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

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

• • • • • •

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

There is a Compounding Pharmacy located in the same suites with a consulting pharmacist working with this Integrative practice. Average Patients per Day: 12-20

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

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

Listing Price: $430,000

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

Call 919-848-4202 or email medlistings@gmail.com www.medicalpracticelistings.com 32 | DECEMBER 2015

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

Primary Care Practice For Sale

Med Spa in the Raleigh-Durham, NC Area

Wilmington, NC

Beautiful Med Spa located in the Raleigh-Durham is among our newest listings.

This very upscale facility is established and boosts consistent gross revenues of a million plus. Some of the procedures performed are: Botox, Dermal Fillers, Minimal light based treatments, laser hair removal, cool sculpting (external cooling treatment that freezes the hair and the body metabolizes the fat). This practice is ideal for the Plastic Surgeon or Dermatologist.

Established: 2010 l Annual Revenue: $1,000,000 Average Patients per Day: 15 to 25

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.

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

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

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

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

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

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

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

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

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

List price: $435,000

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

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

Eastern North Carolina Family Practice Available Well-appointed Eastern North Carolina Family Practice established in 2000 is for sale in Williamston, NC. This organized practice boasts a wide array of diagnostic equipment including a GE DEXA scanner with a new tube, GE case 8000 stress testing treadmill and controller and back up treadmill, Autoclave and full set of operating equipment, EKG-Ez EKG and much more. The average number of patients seen daily is between 12 to 22. The building is owned by MD and can be purchased or leased.

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

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

34 | DECEMBER 2015

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

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

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

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

Medical Practice Listings Selling and buying made easy

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

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

l One

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

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 Please direct all correspondence to driverphilip@gmail.com.

Only serious, qualified inquirers.

www.medicalpracticelistings.com PHYSICIAN SOLUTIONS MAGAZINE

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

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

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

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

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

Medical Practice Listings Selling and buying made easy

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

Women’s Health Practice in Morehead City, NC

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

PEDIATRICIAN

or family medicine doctor needed in

FAYETTEVILLE, NC

Comfortable seeing children. Needed immediately.

Medical Practice Listings Buying and selling made easy

Call 919-848-4202 or email medlistings@gmail.com www.medicalpracticelistings.com 36 | DECEMBER 2015 D

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

NC Opportunities DENTISTS AND HYGIENISTS

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

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

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

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

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

Modern Med Spa Available

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

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

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Physician Solutions, Inc. Medical & Dental Staffing

The fastest way to be $200K in debt is to open your own practice The fastest way to make $100K is to choose

Physician Solutions

THE DECISION IS YOURS Physician Solutions, Inc. P.O. Box 98313 Raleigh, NC 27624 Scan this QR code with your smartphone to learn more.

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