Physician Solutions June 2016

PHYSICIAN SOLUTIONS magazine

June 2016

Optimizing Patient Check-in and Check-out for Your Healthcare Practice pg. 22

Physician Prep:

Interacting With Deaf People pg. 26

ENT Undercover pg. 30

the Your Checking In Patient & Out issue

contents

PHYSICIAN PREP: Interacting With Deaf People

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features

22 OPTIMIZING PATIENT CHECK-IN AND CHECK-OUT FOR YOUR HEALTHCARE PRACTICE 26 PHYSICIAN PREP: Interacting With Deaf People 30 ENT UNDERCOVER TELEMEDICINE: Reshaping Healthcare

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practice tips 6

HOW TO ADVISE PATIENTS PREPARING TO TRAVEL ABROAD

8

TELEMEDICINE: Reshaping Healthcare

10 BITTEN TO DEATH? The Zika Virus: What it is and Preventative Steps to be Taken 14 REDEFINING HEALTH AND WELL-BEING IN AMERICAS AGING POPULATION

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Physician Solutions June 2016 Publisher Creative Director Contributors

Philip Driver Thomas Hibbard Naren Arulrajah Barbara Hales, M.D. Nick Hernandez, MBA, FACHE Denise Price Thomas Vikas Vij Marilyn L. Weber Danielle S. Wilson

contributors Barbara Hales, M.D. is a skilled expert in promoting your health services. As seen on NBC, CBS,ABC and FOX network affiliates as well as Newsweek, Dr. Hales writes all the content you need to promote your medical services.

Her latest book is on the best seller list and she can do the same for you. Check out her site at www.

TheWriteTreatment.com

Nick Hernandez, MBA, FACHE is the CEO and founder of ABISA, a consultancy specializing in solo and small group practice management. He has consulted with clients in multiple countries and has over 20 years of leadership and operations experience. Visit www.abisallc.com for more information.

Denise Price Thomas

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

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

Marilyn L. Weber is president and CEO of DIS and is a certified sign language interpreter.

She has been working for more than 25 years promoting accessible communication, and advocating for the rights of the deaf community. Marilyn has over 2,900 hours of related professional training and has received several awards from various local and national organizations recognizing her work and dedication to the deaf community.

Danielle S. Wilson is president and CEO of Aero Jet Medical, an all-inclusive provider of worldwide air ambulance transport services and is an accomplished health care executive with over two decades of air medical experience. She is also the president and CEO of parent company United Medevac Solutions.

PHYSICIAN SOLUTIONS MAGAZINE | 5

practice tips

HOW TO ADVISE PATIENTS PREPARING TO TRAVEL ABROAD

By Danielle Wilson President and CEO Aero Jet Medical and United Medevac Solutions

If you have patients who are planning a trip abroad, it’s helpful to advise them about their health and provide them with a short checklist to protect against some of the most common travel disasters. After all, if you end up feeling lousy when overseas, it makes it hard to get business done or enjoy your vacation. Here are a few tips that can help save travelers from grief: 22|| JUNE DECEMBER 6 2016 2013

l Be sure you’re up-to-date on your shots. A

disease that’s not prevalent or has even been wiped out entirely in the U.S. might still be a threat abroad. Go to the Centers for Disease Control and Prevention (CDC) website to check out health information and vaccination requirements for your destination. The CDC site is also a good source of

information about whether the food and water in certain countries is safe. l Fill and bring a copy of your prescriptions. It

might be difficult to fill your prescriptions abroad so, if possible, pack enough supplies for your whole trip. It’s smart to keep prescriptions in your carry-on baggage. Bring photocopies of your prescriptions and note the generic brand name.

Always pack your medicine in prescription bottles in your carry-on bag. If you need to use syringes, make sure that you have a letter from your doctor.

Always declare the syringes before you go through security. Be sure to check the “Confiscation of Prescription Drugs and Other Medicine” on the State Department’s Country Specific Information site to learn which prescription drugs are legal at your destination. l Check your proximity to local medical facilities. This is particularly important if you have a preexisting health condition or are in fragile health. If you’re in fragile health, you shouldn’t be more than minutes away from quality treatment if something goes wrong and you need acute care.

If you’re going on a cruise, ask these questions: What kind of medical staff are on board? In which country are they licensed? What kind of diagnostic capabilities (lab equipment, x-rays, etc.) are on board? What specialty consultations are available should the on-board staff need one? l Learn about likely health hazards.

One of the most common conditions that affects people vacationing in tropical areas is heat exhaustion. The CDC and National Institutes of Health (NIH) list symptoms of heat exhaustion to keep an eye out for, such as a high temperature, red skin, shallow breathing or a rapid pulse. Heat stroke has some of the same symptoms as heat exhaustion, but it’s worse and should be treated as a medical emergency. The CDC lists warning signs of heat stroke and offers some tips on the best ways of handling the condition.

l Check for travel warnings and advisories. The

State Department lists specific travel alerts and warnings country by country here. Warnings are for situations you’re probably already aware of – an unstable government, a civil war – but travel alerts change regularly and are for short-term events that the State Department thinks you should know

about if you’re planning travel. Examples of alerts might include a health alert like an outbreak of H1N1; an election season that is bound to have many strikes, demonstrations or disturbances; or evidence of an elevated risk of terrorist attacks.

When these short-term events are over, State cancels the alerts. l Buy travel insurance. Most

people don’t realize that the medical insurance they rely on stateside will not provide coverage when traveling internationally. If that fact isn’t concerning enough to your budget, know that $100,000 won’t even cover getting you home if you are sick or injured and require special medical transportation back to the states from distant regions. So if you purchase travel insurance, be sure to look into the “medical evacuation” option. Travel insurance can protect you from other unplanned occurrences, such as if you need to cancel your trip, if you miss your connection, if your flight is cancelled, if a hurricane damages your destination, if your baggage is delayed or lost and if your passport is lost.

If an unexpected emergency happens, a traveler can rack up tremendous expenses abroad – especially if they haven’t planned for and protected against health tribulations. Taking a bit of time to ensure you’ve taken all the steps you can to maintain your health and that you’ve effectively guarded yourself against the worst possible outcomes is the best route to take while traveling.  About the author Aero Jet Medical president and CEO, Danielle S. Wilson, is an accomplished health care executive with over two decades of air medical experience. Aero Jet Medical is an all-inclusive provider of worldwide air ambulance transport services. The company provides patients with clinical excellence and operational expertise.

In addition to Aero Jet Medical, Danielle is also the president and CEO of parent company United Medevac Solutions. United Medevac Solutions provides a full range of aviation specialty programs, health care supplementation and emergency response for the federal government, the Department of Defense and private sector organizations.

Self-termed a “global nomad,” Danielle has a passion for exploring new cultures during her extensive world travels.

PHYSICIAN SOLUTIONS MAGAZINE

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practice tips

Telemedicine:

Reshaping Healthcare

O

ne of the tenants of the Affordable Care Act was to provide access to care for all Americans. To that end, telemedicine is a piece of the healthcare transformation and the government is slowly helping with telehealth initiatives.

Currently, states fall into one of twelve regional resource centers.

Each resource center is funded by a federal grant to promote the use and expansion of telemedicine.

It is important to note that telemedicine is not a separate medical specialty but rather a different means of healthcare delivery.

Telemedicine is defined as the use of medical information exchanged

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from one site to another via electronic communications to improve a patient’s clinical health status. It is an effective delivery system for providing quality care and produces better utilization of limited healthcare resources. Under healthcare reform, we are expecting patients to be consumers and as telemedicine promotes competition, we should see prices drop. Additionally, the use of telemedicine has already revealed high patient satisfaction and demonstrated that patients prefer telemedicine over travel or wait times. Moreover, by implementing telemonitoring (the use of devices to remotely monitor patients vital signs), patients are empowered to

be active participants in their own health care.

There is a growing shortage of healthcare providers and telemedicine seeks to solve that issue as a disruptive innovation for the healthcare industry. We will begin to see part time and retired physicians engaged in telemedicine. It has been stated that there are two types of physicians: those that are doing telemedicine and those that will be doing telemedicine. That being said, there are many considerations physicians must consider before jumping into telemedicine with both feet.

While telemedicine is already available to patients nationwide,

By Nick Hernandez CEO & Founder ABISA

programs vary significantly in their objectives, scope, and complexity. Not all telemedicine programs are designed the same or offer the same level of service. Additionally, telemedicine needs are different for solo and small group practices than for hospitals and healthcare systems.

Assessing service needs and the organization of the practice, defining a program model, and developing a business case are some of the initial steps that a practice must undergo. These are critically important detailed steps to take prior to developing a plan and selecting technology. There are diligent legal concerns that must be considered

throughout the process as well.

Patient confidentiality needs to be a paramount consideration. Deciding to implement a telemedicine solution with ad hoc processes, procedures, and technology is illadvised indeed.

Indeed there are a multitude of tasks to cover before adding a telemedicine service to your practice.

Some other considerations include licensure, malpractice insurance, patient consent forms, job duties, EMR integration, charge capture, metrics capture, and marketing.

You may also be in need of financing for this new service as a startup business. Furthermore, when working on the technology phase,

selection of cool toys and software applications is not enough. Practices must also deliberate over connectivity development and contingency plans.

For all these reasons, it is highly advisable to seek out a practice consultant with experience in telemedicine solutions. An experienced consultant can help you consider critical aspects of development as well as support decision making. A structured development process allows you to consider decisions and impact before making buying and other costly decisions. 

PHYSICIAN SOLUTIONS MAGAZINE

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practice tips

Bitten to Death?

The Zika Virus: What it is and Preventative Steps to be Taken

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

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There was a time when the threat of grave medical conditions due to mosquito bites was from traveling abroad.

That’s no longer the case. Zika is headed your way!

As you have undoubtedly heard from news and the CDC, Zika has been spreading rapidly north from South America and Central America to Puerto Rico, the latest outbreak area. It will hit the U.S. mainland soon. People are starting to panic.

While the greatest threat is to the fetus of a pregnant woman with associated microcephaly, non-pregnant women and men are still in jeopardy. The Zika virus has been linked to Guillain-Barre’ syndrome and neuritis in general.

Guillain-Barré syndrome is a disorder in which the body’s immune system attacks part of the peripheral nervous system, destroying the myelin sheath around the axons (i.e. autoimmune disease). Thus signal transmission is compromised.

Symptoms include: • Initial weakness and tingling in the legs • Parasthesia spreads to arms and upper torso.

• Progression is paralysis with inability to breath • Heart rate and respiratory restriction • Respirator may be needed for breathing assistance • Risk of arrhythmias, blood clots and hyper or hypotension • Emotional turmoil, depression, anxiety This syndrome occurs within a few days or weeks after a viral infection and may occasionally be triggered by vaccinations. The theory is that the virus modifies neural cells, making the immune system view these new cells as foreign and open for attack.

Guillain-Barre syndrome requires immediate hospitalization because the downhill course can be quite rapid.

Since there is an elevation of protein in cerebrospinal fluid with Guillain-Barre’, a spinal tap is performed as part of the differential workup.

Because there is no known cure for the devastation done by the Zika virus with Guillain-Barre and microcephaly, it is paramount that preventative steps be taken.

9 Protective Steps The public should be advised to: 1. Wear repellent 2. Repair all window and door screens to seal sites of insect entry

3.

4.

5.

6.

Spray Pesticide inside Remove standing water sources around your home (Clean/drain eaves and objects around the yard.)

Introduce genetically altered, sterile mosquitos into the environment 7. Wear long pants and long-sleeved shirts if gardening to decrease exposed skin 8. Use netting over baby strollers and playpens 9. Plant marigolds around the home. They work as a natural bug repellent due to the emitted fragrance that offend insects

Pesticide Risks DEET (N, N-diethyl-meta-toluamide) is the active ingredient in effective pesticides sprayed in the home.

It has been linked to chronic kidney disease. There is also an increased risk of childhood lymphoma and leukemia according to Dr. Dale Sadler of the National Institute of Environmental Health and Sciences, Research Triangle Park, North Carolina. Toxic encephalopathy is also linked to DEET insect repellents.

Mild reactions to products with DEET range from itching to rash, swelling and eye-irritation. Mood disturbances, impaired cognitive ability and seizures have been reported.

The American Academy of Pediatrics advises parents to limit DEET to 10% for use on children and to thoroughly wash skin areas that have had repellent exposure. Take care to avoid repellents on young children’s hands as accidental eye contact or ingestion may occur.

Natural Remedies Bite Blocker

Components consist of soybean, coconut and oils of geranium, available as lotion or spray. According to the U.S.D.A., Bite Blocker is more effective than a synthetic 7% DEET mosquito repellent.

Lemon Eucalyptus Oil Repellents

Lemon eucalyptus oil repellents, in addition to DEET and picaridin, have been registered with the U.S. Environmental Protection Agency and recommended by the CDC (Centers for Disease Control and Prevention).

Research by the US Department of Agriculture found that Repel Lemon Eucalyptus was the most continued on page 12

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effective repellent, more so than a 7% DEET repellent.

A Consumer Reports article stated that after conducting tests, Repel Lemon Eucalyptus was the best nonDEET mosquito repellent.

A comparison of various chemical and herbal repellants by the New England Journal of Medicine found: A 2002 study in the New England Journal of Medicine compared different synthetic chemical and herbal repellents: “Repel Lemon Eucalyptus Repellent provided 120.1 minutes of mosquito protection, more than a repellent with a low concentration of the chemical DEET (Off Skintastic for Kids with 4.75% DEET provided 88.4 minutes of protection) and less than Off Deep Woods with 23.8% DEET, which provided 301.5 minutes of protection.”

Citronella

These plant oils are proven effective as natural mosquito repellents and are produced in lotion, candle and spray forms.

Results from a University of Guelph study which assessed the effectiveness of 3% citronella candles and 5% citronella incense in protecting subjects from bites, found participants near the candles had 42.3% less bites and those near the citronella incense had 24.2% fewer bites. Based on this, citronella candles shouldn’t be used as a stand-alone repellent, although they may help in combination with topical repellents.

According to the EPA, citronella oil, which has been applied for the last 60 years as a topical insect repellent, shows little or no toxicity. There is a risk of dermatitis in sensitive people.

Natural Ingredients Currently Undergoing Research • Celery extract - A Thai study found this to be active against a wide range of mosquito species comparable to a 25% DEET formula.

• Clove oil - Two studies have found that undiluted topical clove oil is active against mosquitoes, but should not be applied undiluted to skin as it can be absorbed through the skin and result in adverse effects.

• Fennel - A small study by Seoul National University in Korea found that a spray mosquito repellent containing 5% fennel oil was 84% effective after 90 minutes and a repellent cream with 8% fennel 12

| JUNE 2016

oil was 70% effective after 90 minutes.

• Neem oil - An extract from the tropical neem tree, contains azadirachtin, an insecticidal compound.

• Thyme - Carvacrol and alpha-terpinene, derived from the essential oil of thyme, were found to have significantly greater repellency than a commercial DEET repellent. Spray made with 2% alpha terpinene is a promising natural mosquito repellent.

Ten commercial products were tested for efficacy in 2015 by researchers at New Mexico State University.

Results found only one repellent that did not contain DEET had a strong effect for the duration of the 240 minutes test: a lemon eucalyptus oil repellent, against Aedes aegypti, the vector of Zika virus. All DEETcontaining mosquito repellents were active.

Studies have not been substantiated yet that the natural ingredients above are biocidal (effective as a repellent).

Now that you know how to protect yourself and advise others, travel plans do not have to be put on hold. Go forth with friends and family, making great memories. Bon Voyage! 

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

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practice tips

Redefining Health and Well-being in Americas Aging Population New Approach Looks at Factors in Addition to Disease

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Research at the University of Chicago provides new perspectives on how to define the health and well-being of aging Americans and presents a sharp departure from the traditional biomedical model’s reliance on a checklist of infirmities centered on heart disease, cancer, diabetes, high blood pressure, and cholesterol levels.

The work, part of the National Social Life, Health, and Aging Project (NSHAP), supported by the National Institute on Aging of the National Institutes of Health is a major longitudinal survey of a representative sample of 3,000 people aged 57 to 85 done by the independent research organization NORC at the University of Chicago.

The study yielded comprehensive new data about the experience of aging in America that formed the underpinning of the research and its conclusions.

Using what they call a “comprehensive model” of health and aging, the team has shown how other factors such psychological well-being, sensory function, mobility and health behaviors are essential parts of an overall health profile that better predicts mortality.

The research concludes that many people currently classified as healthy under the biomedical model in fact are not, and many seen as unhealthy are in much better shape when the additional factors in the comprehensive model are included. The comprehensive model reflects a definition of health long advanced, but little studied, by the World Health Organization that considers health to include psychological, social, and physical factors in addition to the diseases that are the basis for the current medical model of health.

The newly published research may well have an impact on everything from the nature of older people’s conversations with their doctors to health policy, researchers said. It is based on the results of a major longitudinal study of aging Americans, funded by the National Institute on Aging, that is the first of its kind to collect this sort of information from a scientificallyselected group of people chosen randomly to represent aging among the entire older U.S. population.

Noteworthy is the finding that chronological age itself plays almost no role in accounting for differences in older people’s health and well-being.

Instead of looking only at chronic diseases, such as heart disease and other organ decline in aging, the comprehensive model includes many other dimensions, that collectively yield six new classes of well-being for judging the health of older individuals. The results appear in “An Empirical Redefinition of Comprehensive Health and Wellbeing in the Older Adults of the US” published in the current issue of the Proceedings of the National Academy of Sciences.

The multidisciplinary UChicago team includes the lead author and biopsychologist Martha McClintock, the David Lee Shillinglaw Distinguished Service Professor in Psychology; geriatrician William Dale, Associate Professor of Medicine, Chief, Section of Geriatrics & Palliative Medicine at University of Chicago Medicine; sociologist Edward Laumann, the George Herbert Mead Distinguished Service Professor in Sociology; and demographer Linda Waite, the Lucy Flower Professor in Urban Sociology.

Highlights of the research include: • Cancer by itself is not related to other conditions that undermine health.

• Chronological age itself plays little or no role in accounting for differences among older people’s health status.

• Poor mental health, which afflicts one in eight older adults, undermines health in ways not previously recognized.

• Obesity in older adults with excellent physical and mental health, seems to pose very little risk.

• Sensory function and social participation play critical roles in sustaining or undermining health.

• Having broken a bone since age 45 is a major marker for future health issues in people’s lives.

• Older men and women have different patterns of health and well-being during aging.

• Mobility issues are one of the best markers of well-being.

“The new comprehensive model of health identifies constellations of health completely hidden by the medical model and reclassifies about half of the people seen as healthy as having significant vulnerabilities that affect the chances that they may die or become incapacitated within five years,” said McClintock.

“At the same time, some people with chronic disease are revealed as having many strengths that lead to their reclassification as quite healthy, with low risks of death and incapacity,” Waite added. continued on page 16

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continued from page 15

Six new ways of looking at aging The comprehensive model’s first category had the highest levels of measured and personally assessed physical and mental health compared to all other groups, and represented 22% of older Americans.

This group was typified by higher obesity and blood pressure, but had fewer organ system diseases, better mobility, sensory function, and psychological health. They had the lowest prevalence of dying or becoming incapacitated (six percent) five years into the study.

A second category had normal weight, low prevalence of cardiovascular disease and diabetes, but had one minor disease such as thyroid disease, peptic ulcers, or anemia. Although not causes of death, the conditions could be harbingers of danger that require more attention. People in this group were more than twice as likely to have died or become incapacitated five years after the initial survey than people in category one.

Two emerging vulnerable classes of health traits, completely overlooked by the medical model, included 28 percent of the older population. One group included people who had broken a bone after age 45. A second new class had mental health problems, in addition to poor sleep patterns, engaged in heavy drinking, had a poor sense of smell and walked slowly, all of which correlate with depression.

Both groups had moderate risks of dying or becoming incapacitated within five years of the initial survey.

The most vulnerable older people

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were in two classes, one characterized by immobility and uncontrolled diabetes and hypertension.

This group was more likely to have morbid obesity, cardiac, lung, and liver disease, but only moderate risk (19%) of dying or being incapacitated within five years. The most vulnerable class had multiple illnesses and many other problems, were quite frail, and fully 44% either died or became incapacitated by the time of the second interview.

A majority of people in each of these categories were women, who tend to outlive men.

Implications for seniors — or older adults The study points for a need for revising the nature of patient/doctor conversations during yearly medical checkups, the authors note.

“From a health system perspective, a shift of attention is needed from disease-focused management, such as medications for hypertension or high cholesterol, to overall wellbeing across many areas,” said Dale.

“Instead of policies focused on reducing obesity as a much lamented health condition, greater support for reducing loneliness among isolated older adults or restoring sensory functions would be more effective in enhancing health and well-being in the older population,” said Laumann.

Important new survey provides better look at aging Unlike studies that look at groups of people with similar medical conditions, the research is the first of its size and scope to look at a group of people scientifically se-

lected to represent the entire population of older Americans with the intent to characterize their overall health and well-being.

In conducting the study, NORC gathered data from individuals who were tested not only for medical conditions, such as high blood pressure, but also 35 different aspects of their health behaviors, psychological well-being and physical functioning not covered by the medical model. The people were first interviewed in 2005, were interviewed again in 2010, and are currently undergoing a third round of interviews.

The research team used its data to study the traditional medical model and found that it overestimates the influence of some factors, such as obesity, which is not a particularly dangerous condition among people who are healthy, active and socially connected, the team found. It also highlights diabetes and hypertension as the diseases best discriminating types of aging patterns, rather than cancer.

The new approach, which takes medical, psychological, functional abilities and lifestyle factors into account, yields a more accurate view of health among aging Americans.

The size of the research sample and the depth of the data enables this new look at an age-old question. “Taking a broad definition of health seriously, and empirically identifying specific constellations of health and comorbidities in the US population, provides a new way of assessing health and risk in older adults living in their homes, and thereby may ultimately inform health policy,” the authors write.  Source: http://www.pressreleasepoint.com/print/984310

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/ 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/cwp/view. asp?a=3143&q=388884 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://floridasdentistry.gov/ 18

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Georgia 237 Coliseum Drive Macon, GA 31217 (478)207-2440 https://gbd.georgia.gov/ Hawaii DCCA-PVL Att: Dental P.O. Box 3469 Honolulu, HI 96801 (808)586-3000 http://cca.hawaii.gov/pvl/boards/dentist/ Idaho P.O. Box 83720 Boise, ID 83720 (208)334-2369 http://isbd.idaho.gov/ Illinois 320 W. Washington St. Springfield, IL 62786 (217)785-0820 http://www.isds.org/LawsLegislation/ boardOfDentistry.asp 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.dental.ks.gov/ 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://dentistry.ky.gov/

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

PHYSICIAN SOLUTIONS MAGAZINE

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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 20 | JUNE 2016

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/

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 https://www.nebraska.gov/LISSearch/ search.cgi Nevada Board of Medical Examiners P.O. Box 7238 Reno, NV 89510 (775)688-2559 http://www.medboard.nv.gov/ New Hampshire New Hampshire State Board of Medicine 2 Industrial Park Dr. #8 Concord, NH 03301 (603)271-1203 http://www.nh.gov/medicine/ New Jersey P. O. Box 360 Trenton, NJ 08625 (609)292-7837 http://www.medlicense.com/new-jerseymedical-license.html New Mexico 2055 S. Pacheco St. Building 400 Santa Fe, NM 87505 (505)476-7220 http://www.nmmb.state.nm.us/ New York Office of the Professions State Education Building, 2nd Floor Albany, NY 12234 (518)474-3817 http://www.op.nysed.gov/ North Carolina P.O. Box 20007 Raleigh, NC 27619 (919)326-1100 http://www.ncmedboard.org/

North Dakota 418 E. Broadway Ave., Suite 12 Bismarck, ND 58501 (701)328-6500 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

Optimizing Patient Check-in and Check-out for Your Healthcare Practice

By Naren Arulrajah with Vikas Vij Ekwa Marketing

An important aspect of patient experience is monitoring and optimizing patient flow from checkin to clinical practice areas and then to check-out. This movement of patients should be seamless and efficient if you want to make positive brand impressions. Undue wait times, unclear destinations (reception, check-in and check-out counters, etc.) and uncomfortable transitions between physicians or 22

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different service areas can have a negative impact on patient experience.

Make your patients feel cared for and comfortable from the time they make an appointment to the time they leave your clinic and your patients will reward you with loyalty.

Here are a few things you can do to ensure good patient flow at your practice office.

Improving Patient Check-in Positive brand impressions ensure that patients not only come back to you but also encourage them to refer their friends to your practice.

Make it Easy for Patients to reach their Destinations The last thing you want is for patients to wander around and

re-walk a path trying to figure out which counter to visit. Put up signs providing clear directions right from parking to the building, floor, or entrance to your practice office, the check-in counter, different service areas, check-out, and restrooms so your patients know where they need to go.

Carefully Plan Patient Schedules Scheduling of patients is a tricky situation. Too many patients will not only overburden your practice healthcare provider(s), but it also means longer wait time for your patients. Optimize patient check-in process by encouraging new patients to fill out their registration forms online or ask them to fill the hard copies before arriving for their appointment. Instruct your staff to collect insurance information prior to the actual appointment so they have enough time to verify insurance eligibility and benefits.

Optimize Patient Movement Aim for a linear patient flow.

After check-in, move the patient to financial consultation then to vitals check and consultation with the healthcare provider and then finally to the checkout counter. Ideally, this entire process should happen without patients crossing paths or going back and forth. Encourage patients to provide feedback on their experience and use this to work with your staff on a plan to optimize patient traffic.

Make it Easy for Healthcare Providers to Update EHRs Moving between examination rooms and the office to update pacontinued on page 24

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continued from page 23

tient EHRs can be taxing for physicians. It also increases patient wait time; the time spent moving back and forth can instead be spent with a patient. Instead, provide a mobile workstation or have an anchored workstation placed at strategic locations. This will not only make it easy for healthcare providers to document in the Electronic Health Record, but it will also effectively bring down patient wait times.

Improving Patient Check-out The last stop for a patient is the check-out and billing area. Here are a few considerations to keep in mind as you plan the last step of your patient’s visit.

Ensure Seamless Transition A good practice to maintain positive brand impressions is to escort your patient(s) to the checkout area. Provide instructions to patients on how they can proceed if they need lab tests or need a physician referral and/ or if they need to call and schedule or walk-in for their appointment. Patient understanding is important so make sure your patients understand the next step(s) by providing them with either written or verbal instructions. Make sure your checkout staff goes over the clinical summary with a patient, and that any special instructions or follow-up action is clearly understood by the patient.

Another best practice is for physicians to introduce the staff member who will be dealing the patient at the check-out counter.

This helps in creating an immediate connection and helps building trust in the team. Train and instruct your 24

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staff to be helpful and sincere when dealing with patients. Little things such as the tone in which your staff speaks, or eye contact, and pleasant attitude can go a long way in maintaining the positive impression a patient has of your healthcare practice brand.

Focus on Reducing Wait Time and Patient Comfort Long lines at check-out can easily switch brand impressions even for patients who are otherwise happy with your service. Identify bottleneck and work towards streamlining patient flow to the check-out and billing area. Automated services and use of advanced EHR technology can help both you and your staff improve patient experience and reduce wait times. Try and work out follow-up appointment schedules according to patient convenience as much as possible.

Single mothers and/or working mothers and senior citizens in particular will appreciate your office if you can provide them with flexible and convenient scheduling.

Improve your Internal Systems Follow-up visits with a healthcare provider and prescription refills are again opportunities for building brand impressions. Work on scheduling follow-up visits based on patient and the physician convenience. Make sure patients are not unduly inconvenienced when they call in for a prescription refill.

Optimizing patient experience is an ongoing process so make sure you conduct regular process audits for improving patient flow.

Ask for Feedback Patient service surveys can help you better understand patient

difficulties and to identify what is working and what needs to be rectified immediately. Gamify surveys to encourage participation. Offer a gift card, movie tickets, or a discount coupon(s) to survey participants and let them know they stand a chance to win the goodies even if they provide negative feedback.

Remember, negative feedbacks are opportunities to improve.

Conclusion Long wait times, shorter consultations, and haphazard patient movement at the doctor’s office can easily put off a patient. Your patients expect to be treated well right from the moment that they make an appointment till the moment they walk out of your office.

The best way to deliver on their expectation is by optimizing patient movement so patients can easily find their destinations, meet with their healthcare provider, get consulted, and leave your office without having to unnecessarily move between different counters or service areas, and without experiencing long wait times.  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 140+ full time marketers, www.ekwa.com helps doctors who know where they want to go get there by dominating their market and growing their business significantly year after year. If you have questions about marketing your practice online, call 855 598-3320 to speak one-on-one with Naren.

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features

Physician Prep: Interacting With Deaf People

By Marilyn L. Weber President & CEO Deaf Interpreter Services

26

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Communicating effectively with deaf or hard-of-hearing patients is a challenge that physicians can successfully meet with some forethought and planning. It’s important to take the time to be familiar with their specific needs and how to communicate properly to that deaf patient.

It’s not only emergency situations you need to worry about.

There are a wide variety of situations in which communication can be absolutely critical. These include obtaining a medical history, explaining diagnoses, explaining medication, treatment and prognosis of an illness, obtaining informed consent and permission for treatment, conducting psychotherapy, communicating prior to and after major medical procedures, explaining medical costs and insurance issues, and explaining patient care upon discharge from a medical facility.

Here’s a checklist of tips you can use to make sure your office is prepared: l Have

a sign language interpreter ready. The Americans with Disabilities Act (ADA) of 1990 requires that physicians provide deaf patients with an interpreter and not charge either the patient or his insurance for it. If an interpreter isn’t on staff, one can usually be contracted to ensure interpreters are available for effective communication between all medical staff and the deaf patients.

l Consider

video remote interpreting. Some hospitals and medical facilities provide communication access through the use of video conferencing technology equipment and a high-speed Internet connection to access an interpreter in a remote location (called “video remote interpreting” or VRI service). If you choose this route be sure you have reliable technology set up, and be sure to provide your staff with regular training on how to use the equipment.

Also, make sure you are using a company that specializes in sign language when working with the Deaf Community.

Problems can arise when hospitals use a spoken language company for their deaf patients who need sign language.

Translation companies may try to include sign language as one of their languages, but “translating” a language and “interpreting” a language is very different. Sign language is a three dimensional language where much of it is dependent upon the “non-manual” aspects, and could have different “interpretations”. The difference between being able to ‘sign’ and being able to ‘interpret’ sign language could be compared to the difference between a medical assistant and a medical doctor. It’s critical to have a certified sign language interpreter that is skilled and familiar with Deaf Culture, and understands all of the nuances and esoteric aspects of the language. continued on page 28

PHYSICIAN SOLUTIONS MAGAZINE

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continued from page 27 l Don’t

assume you can communicate effectively with writing. For most deaf people, American Sign Language (ASL) is their first language and English is a second (and sometimes a third) language. There are significant differences between the two languages. Unless the deaf person has an extremely good command of the English language, writing notes in English would have little benefit.

It could be compared to writing notes in English to a Spanish-speaking person. For proper medical diagnosis, it’s crucial to have accurate communication in the deaf individual’s primary language for complete understanding. Not providing accurate and effective communication for that deaf individual could result in tremendous liability.

l Don’t

assume all deaf or hard-of-hearing folks can read lips. Some can. Some can’t. Many, even if they can read lips, do it with only limited proficiency.

At best, only 40 percent of what’s being said can be read on the lips, and that is only if the deaf person has complete knowledge and understanding of the topic and terminology being discussed. This is due to the fact that so many words are formed in the back of the mouth, as well as numerous words looking the same on the lips. To help provide cues and information to those who do have some lip reading ability, be sure not to speak too fast or too slow, do not over exaggerate enunciation, make sure you’re facing your patient, be sure you’re speaking in a well-lit area (but NOT in front of a window), and make sure you are not chewing gum as this makes it impossible to read the lips.

Additional things that interfere with the ability to read lips are: facial hair around the mouth of the speaker, lisps, those with very thick or very thin lips and people speaking with accents. Most importantly, don’t rely on lip reading as a cure-all method or primary mode of communication.

To see first-hand what I mean, try this experiment: silently mouth to another person ‘island view’ and see what they think you said. You will get everything from ‘I love you’ to ‘elephant juice’! l Pay

attention to the way you communicate. To get a patient’s attention, tap the person on the shoulder or arm. Always face the patient while speak-

28

| JUNE 2016

ing since this helps the patient see critical facial expressions. Maintain eye contact. Pay attention to your body language since this can provide important cues about what you’re saying. All of this is true even when utilizing a sign language interpreter to communicate with a deaf patient. In addition, when using a sign language interpreter never address your questions to the interpreter (ex: “ask him if his stomach hurts” or “does she have pain…”) – always look directly at the patient. The interpreter will place themselves next to the medical professional so the deaf individual can glance between the doctor and the interpreter to get the total concept of what is being said, with accurate tone and inflection from the face of the speaker.

In summary, be proactive. Individuals who are deaf or hard-of-hearing often have different communications skills, and the best way to handle a dialogue is to consult with each individual to determine what aids or services are necessary to provide effective communication for them in that particular situation.

In a world where physicians are increasingly being judged not just on the number of fee-for-service procedures they perform, but on the quality of care, it’s important to provide tailored service that meets the needs of all your patients, including those who are deaf and hard-of-hearing. Additionally, this knowledge is key to limit your liability for failing to provide effective communication to your patient.

Your efforts will almost invariably be greeted with much gratitude, appreciation and praise for your professionalism.  About the author: Marilyn L. Weber, president and CEO of DIS, is a certified sign language interpreter and has an adult daughter who is deaf. Marilyn has been working for more than 25 years promoting accessible communication, and advocating for the rights of the deaf community. She has interpreted in thousands of professional situations, and conducts deaf awareness workshops, cultural diversity training, and ADA Compliance Consulting. Marilyn has over 2,900 hours of related professional training.

Marilyn has received several awards from various local and national organizations recognizing her work and dedication to the deaf community.

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features

ENT UNDERCOVER

By Denise Price Thomas

‘‘

“I have a friend who is aging and having some difficulty hearing.

She decided to get a hearing aid.

She was pleasantly surprised at what she could hear once she had her new hearing aid. In fact, she decided not to tell anyone in her family about it. Since then, she has changed her Last Will and Testament four times!”

Gladys Friday

Health Care Comedienne, Denise Price Thomas’ alter ego

A

s an Undercover Patient, I begin my assessment in the lobby of a practice or hospital using all my senses. I’ll narrow my observations here down to my ENT (Ear, Nose, and Throat) senses.

Ears:

I understand the reason we have two ears and only one mouth, therefore I am reminded to listen twice as much as I speak. Unfortunately, patients overhear the bad as well as the good. Imagine being a patient and hearing screams from the room across the hall followed by a conversation that a child was accidentally given ears drops in her eyes! This happened as I sat in an exam room, waiting to see a physician. Would YOU want to continue waiting for your turn? While in the exam room or lobby, I would much rather hear conversations about new in30

| JUNE 2016

house procedures, what physicians are doing for the community and why the employee of the month was nominated.

Nose:

After 34+ years in a health care career, I tend to be a bit “nosey” as an “Undercover Patient” asking questions and finding out all sorts of things the hospital or practice may or may not know about physicians, employees and more. Once I asked about a particular procedure and the appointment scheduler told me the physician was new to this procedure, only returning recently from a seminar on it. The scheduler continued, telling me they had just hired a new nurse to assist him with this procedure and had turned an exam room into the procedure room. Although I enjoy hearing about the continuing education, I became a little reluctant to be scheduled as the first

patient. (nosey, yes: guinea pig, no) Employees should be kept informed and educated on what’s new, but should be educated about what is appropriate and inappropriate to share with the patient. It’s helpful to provide your staff with a script to guide them in explaining topics to patients.

Throat:

“What does he think he is doing? He made me so mad I could SCREAM! I hate working with him!” It seems that “Voice Art” has become a lost art. We should always choose our words carefully. When patients overhear comments such as these spoken while they wait for their appointment, their imagination will conclude the remarks must be about their physician. As humans, we will continue to make mistakes, however words spoken by us are our choice.

Communication, both verbal and non-verbal in health care is very important in how the public perceives your practice.

Health care professionals should allow their heart to guide them by listening to each patient with a desire to hear their story, looking them in the eye and connecting the dots before choosing their words. Using these senses will help to build patient/physician relationships even stronger. These are windows to a heart filled with compassion. When kind, positive and encouraging words become the normal spoken throughout the facility, you become part of creating an environment in which your patients will be happy, employees will have more of a team approach and physicians will be able to take care of their patients.  www.denisepricethomas.com

We may not always know what others are hearing around us.

Perhaps we should come back to our senses: EARS We can use our EARS to hear what is being said throughout our facility. It’s much easier to prevent problems than to correct them. Listen for good news and acknowledge it when we hear it.

NOSE We should be “NOSEY” and ask our patients their opinion of our facility. KNOW what their perception is and always have a plan of action and a desire to improve.

THROAT Start each day off right. Acknowledge every person in a cheerful and professional tone.

Speaking kind and encouraging words to those around us helps to create a most positive working environment.

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

Home Grown/Nationally Known www.denisepricethomas.com denisepricethomas@gmail.com 704-747-8699

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Practices for Sale Medical Practices Urology Practice in the Charlotte North Carolina Location: Minutes from Charlotte, NC List Price: Valuation in Process Gross Yearly Income: $275,000 Year Established: 1980 Average Patients per Day: 12 to 15 Building Owned/Leased: Leased Contact: Philip or Danielle at 919-848-4202

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

Family 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

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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| JUNE 2016

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

Scan this QR code with your smartphone to learn more.

PEDIATRICIAN

NC MedSpa For Sale

or family medicine doctor needed in

FAYETTEVILLE, NC

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.

Comfortable seeing children. Needed immediately.

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

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

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 34 | JUNE 2016

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

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

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

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

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

l One

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

Please direct all correspondence to driverphilip@gmail.com.

Only serious, qualified inquirers.

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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

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

Call 919-848-4202 or email medlistings@gmail.com www.medicalpracticelistings.com 36 | JUNE 2016

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

Women’s Health Practice in Morehead City,

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

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.

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

Medical Practice Listings Buying and selling made easy

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

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

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

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

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

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

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

Medical Practice Listings Selling and buying made easy

MedicalPracticeListings.com | medlisting@gmail.com | 919-848-4202 PHYSICIAN SOLUTIONS MAGAZINE

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Primary Care Practice For Sale in Wilmington, NC

Urology Practice Near Charlotte, North Carolina

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.

This Urology practice, minutes from Charlotte, NC, is very established and well appointed. Currently treating 12 to 15 patients daily for the following; Pediatric & Adult Urology, Special Interest of Treatment and Prevention of Kidney Stones, Bladder Problems, Incontinence, Prostate Problems, Urinary Tract Infections, Wetting Problems, Prostate Problems and Erectile Dysfunction.

Established: 1980 l Gross Yearly Income: $275,000 Average Patients per Day: 12 to 15

Medical Practice Listings

919.848.4202 | medlistings@gmail.com www.medicalpracticelistings.com

Contact Philip or Danielle at 919-848-4202 or email medlistings@gmail.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 38 | JUNE 2016

Located on NC’s Beautiful Coast,

Morehead City

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

919.848.4202 medlisting@gmail.com medicalpracticelistings.com

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.

Discounts as big as a house.

Or condo.

Or apartment.

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

See just how big your savings could be.

Your savings could add up to hundreds of dollars when you put all your policies together under our State Farm roof.

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Listing Price: $430,000

Medical Practice Listings Selling and buying made easy

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

1103155.1

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

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is now hiring primary care MD’s and PA’s, DDS’s, dental hygienists, and registered dental assistants in North Carolina, Virginia and South Carolina

Ongoing and intermittent shifts are available for physicians, mid-levels, DDS, dental hygienists, and registered dental assistants as well as permanent placement. Find out why providers choose Physician Solutions.

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

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