Physician Solutions October 2015 by MedMedia9

PHYSICIAN SOLUTIONS magazine

OCTOBER 2015

Mid-Level Providers:

Are You Using Them for Your Health Care Practice? pg. 20

the

els Mid-Lev r and You Practice issue

Quality Care in a Changing Delivery System pg. 26

THE NEW ROLE OF NURSE PRACTITIONERS IN HEALTH CARE REFORM pg. 24

contents

PHYSICIAN ASSISTANTS & NURSE PRACTITIONERS WORKFORCE

features 20 MID-LEVEL PROVIDERS: Are you Using them for your Health Care Practice? 24 THE NEW ROLE OF NURSE PRACTITIONERS IN HEALTH CARE REFORM 26 PHYSICIAN ASSISTANTS & NURSE PRACTITIONERS WORKFORCE: Quality Care in a Changing Delivery System

DECLARE YOUR MEDICAL PRACTICE A DRAMA FREE ZONE

practice tips 6

DECLARE YOUR MEDICAL PRACTICE A DRAMA FREE ZONE

ARE WE DYING TO CONNECT?

10 ALTERNATIVE THERAPY: The Good, The Bad and the Downright Ugly! 12 CALORIE RESTRICTION LOWERS SOME RISK FACTORS FOR AGE-RELATED DISEASES

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Physician Solutions October 2015 Publisher Creative Director Contributors

Philip Driver Thomas Hibbard Naren Arulrajah Starla Fitch, M.D. Barbara Hales, M.D. Audrey McLaughlin, RN Lisa Shock, MHS, PA-C Nidhi Vats Behl Vikas Vij

contributors Starla Fitch, M.D. is a board certified practicing oculoplastic surgeon in Atlanta and is the creator of lovemedicineagain. com, an online community and other health care professionals who want to reconnect with their passion for the practice. Dr. Fitch’s new book, Remedy for Burnout: 7 Prescriptions Doctors Use to Find Meaning in Medicine, has been named #1 Amazon International Bestseller, #1 Hottest Release, and Amazon Editors’ Best Books for 2014.

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

Audrey McLaughlin, RN

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 physicians practice expert, medical practice business strategist & marketing specialist. She uses her more than 12 years of diverse medical industry experience to help physicians, practice owners and managers to breathe new life into their practices.

Lisa P. Shock, MHS, PA-C 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

Nidhi Vats Behl is an experienced professional with more than 6 years, in Healthcare industry with renowned organizations like: Fortis & Aditya Birla. Currently she is working as a freelance copy writer.

PHYSICIAN SOLUTIONS MAGAZINE | 5

practice tips

Declare Your Medical Practice a

DRAMA FREE ZONE by Audrey McLaughlin, RN www.physicianspracticeexpert.com

One of my favorite topics in medicine is patient service, and this service goes beyond diagnosing and treating their clinical issues. Customer service is the new marketing, and poor customer/patient service reduces your ability to retain patients and have them refer their family and friends.

22|| OCTOBER DECEMBER 2013 6 2015

ne important aspect of customer service is what I call the “family drama effect.” Imagine you are a guest in a friend’s home for a Sunday afternoon barbeque. Everything seems to be going smoothly; you and several others are milling about the backyard, the host and their family relaxing with you. Out of the corner of your eye, you notice that the host’s oldest daughter is gesturing angrily and quietly mouthing words to the host. A quick glance at the host, his face is red with anger and embarrassment. Within seconds the host, hostess, and their family members are in an angry screaming match in front of everyone. Pretty tough to watch, are you uncomfortable yet? What if a similar scenario played out in a more professional environment, say your clinic? Imagine being the patient, and having the office manager, nurse, and physician angrily argue over the upcoming schedule while you are all sitting in a small exam room. Pretty unbelievable? Has something similar happened in your clinic? Recently this scenario played out right in front of me, while my history was being taken at a new physician’s office. I see and discuss less than desirable and even uncomfortable situations on a daily basis, but this one brought “uncomfortable” to a whole new level. I always see a look of intrigue and often field the question “how do we stack up?” on personal medical appointments when I answer the question “Ms. McLaughlin, what do you do for a living?” The look on this doctor’s face was priceless. When these types of scenarios play out in a medical practice, I call it the “family drama effect.” For many of us, our job is where we spend eight or more hours per day most days. Your coworkers are effectively a second family, and over time this family can become a big dysfunctional and loving unit. Just as parents keep kids inline, it is important for the leaders in a work family to handle disagreements in a professional manner. Disagreements must remain private and staff must be reminded that there is a professional code of conduct in front of patients. Airing your grievances is a demonstration of poor customer service (among many other issues), and in this social media age could lead to reputation damaging if a patient in my situation takes to Facebook or Twitter to complain. It is entirely possible that the patients or families in the exam rooms on either side of me did take to social media or begin texting and relaying the story as it unfolded. What if someone caught a quick video snippet when the argument continued all the way to the reception desk? There could be huge repercussions on a number of levels. It is the reality we face today. Here are five simple strategies for reducing or removing the “family drama effect” in your clinic:

1. Start with leadership.

As a leader in your medical practice, you must start with yourself. Periodically do a self-check up and be honest with yourself about your culpability in the culture of your practice. Take action to stop if you find you may be contributing to workplace drama.

2. Diagnose the issues.

Diagnosis can be difficult, sometimes it can be challenging to separate fact from opinion. It often comes down to he-said/she-said, do your best to strip the judgment and get down to the real issue. Once that issue is uncovered, shift focus on the next action that needs to be taken. For example: This afternoon’s clinic is overbooked. Rather than focusing on who is to blame, encourage staff to seek out the solution for the issue.

3. Begin treatment immediately.

Drama breeds more drama, make resolution to any problem a priority (i.e. seek solutions). Once the issue is handled, ask any involved employees to write down 10 good qualities about each other and discuss them.

4. Implement a No Gossip Policy.

Many times before and after a dramatic event between coworkers you know the rumor mill is churning up gossip. If you have an office gossip policy you should be reminding your staff about the policy. If you don’t have an official “no gossip policy,” get one.

5. Have regular staff check-ups (staff meetings).

Prevention is often the best medicine and that is true for the “family drama effect” also. Hold regular staff meetings and include reminders of personal behavior policy and the policy for handling disagreements. Also include the opportunity for staff to bring up any pending issues. (Don’t forget to add a bit of teambuilding fun to your meetings, people that have fun together have less tension.)

Disagreements will happen in a work environment, drama should not. If disagreements do get dramatic, it is imperative to keep all drama away from patients and guests. Airing your dramatic office issues in front of your patients and guests is a fast way to scare away your patients and earn a poor reputation in your community.  Audrey is a mentor to business owners, medical providers, managers, and leaders. She transforms clinics, offices, small businesses, hospitals and healthcare organizations into places employees want to be and customers/clients/patients want to return to and recommend to their friends. Her newsletter, Physicians Practice Expert goes out weekly. If you are ready for big transformations, signup for your complimentary subscription at www.physicianspracticeexpert.com. PHYSICIAN SOLUTIONS MAGAZINE

practice tips

Are We Dying to Connect? By Starla Fitch, M.D.

We’re not imagining it: We really are losing our connections to each other. It’s a huge problem. In fact, it’s life-threatening. A recent Wall Street Journal article discussed the Brigham Young University study that found that social isolation increases our risk of death by 32 percent. Duke University and the University of Arizona have been watching 8

| OCTOBER 2015

our connections go down the tubes. Each of us used to have at least three close friends. Today, we’re lucky to have one. And 25 percent of Americans say they have no one to connect to or depend on. What does that mean in real life? Eighty million Americans have no one. If you’re like me, that number – 80 million – is hard to wrap your head around. So picture this:

Eighty million people equals the current populations of California, New York, and Texas. Yep. All those people. That’s what we’re talking about. Just in America. A few weeks ago, I shared this “idea worth spreading” with almost 2,000 folks at TEDxFargo in my talk “Connect or Die: The Surprising Power of Human Relationships.” As an ophthalmologist, I see

people with vision issues every day. Sadly, I also know that my patients aren’t the only ones with vision problems. We’re all becoming blind to each other. You may not have cataracts, glaucoma, or macular degeneration but your vision may be distorted in similar ways. And without clear vision -- and I’m not talking 20/20 -- we can’t connect with each other. In my operating room, my office, and my daily life, I see people with warped perspectives every day. And don’t get me wrong: Some days I have the same visual distortions. What’s the answer? Recognition of the problem is the start of the cure. Finding steps for the remedy comes next. Easy things can truly make a

difference. Set down your phone. Express gratitude. Share the best part of your day with someone you love. It turns out, connection is good for us! It strengthens our immune systems, and lessens anxiety and depression, which may well lead to longer lives. Perhaps we can take our cue from the Natal tribes of South Africa. Members greet each other with “Sawa bona,” which means “I see you.” They respond with “Sikhona,” which means “I am here.” As an ophthalmologist and as your Connection Doctor, I want to teach you how to save lives. My prescription for you is this: Open your eyes. Look at each other. And make the connection. I see you. 

Starla Fitch, MD, is an oculoplastic surgeon in practice in Atlanta. She has made it her life’s mission to help people see more clearly, literally and figuratively. What started as a movement to help medical professionals love medicine again has expanded into a global community, guiding people in all walks of life as they improve their connections — with their colleagues, their families, and themselves. Known as “The Connection Doctor,” Dr. Fitch is a #1 international best-selling author, professional speaker, and certified life coach. She speaks around the world on “4 Steps from Burnout to Balance” and “Connection 101.” Dr. Fitch writes at StarlaFitchMD.com, where you can get a free copy of “Encourage Connection” here from her book Remedy for Burnout. You can see her latest TEDx talk here.

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

PHYSICIAN SOLUTIONS MAGAZINE

practice tips

Alternative Therapy: The Good, The Bad and the Downright Ugly! By Barbara Hales, M.D.

www.thewritetreatment.com

As patients are becoming more involved in their healthcare options, many are turning to alternative therapies for their wellness choice. Distrust of Big Pharma and safety of traditional medicine abounds, with a genuine fear of the adverse reactions associated with them. Unfortunately, the perception that organic, naturally growing herbs and supplements are non-toxic and gentle to the system can lead to a person’s undoing, as physicians we all know. Just as prescription medication can have affiliated adverse reactions, so too can many alternative therapies. So, the big question is, are you asking your patients specifically if they are taking any herbs and supplements? Are you educating them at their office visits? Studies show that when you ask patients what medications they are taking, they rarely mention herbs and supplements since they don’t think of them as drugs. However, it is crucial that you know what’s on board because they can render medications that you have prescribed as ineffective, or worse yet, enhance it’s ef10

| OCTOBER 2015

fect, tipping it over into the toxic range. Brewer’s Yeast, taken for appetite loss or indigestion can initiate a sudden increase in blood pressure when taken with MAO inhibitors. Castor Oil, taken for constipation can lead to potassium depletion when taken habitually, increases sensitivity to digitalis and Lanoxin. The effects of Aloe, taken for constipation, can combine with diuretics like Lasix and steroids to deplete potassium with perilous results. These are just some illustrations and why it is crucial that you know if patients are either taking supplements or are contemplating usage of them. You may remember from your pharmacology class that some of our most toxic medications come from plants. A natural tendency is for people to think that if some nutrients are advantageous, more of it will work even better. Yet, even or most of our beneficial minerals and vitamins can cause harm if taken in higher quantities. Many medicinal herbs can be lethal in excess. Alternative therapies can be associated with adverse reactions the same as prescribed medications. A good

example of this is aromatherapy usage in an asthmatic patient, which could initiate an attack and constrict the bronchioles.

Don’t Write Alternative Care Off First of all, your patients don’t want to be chastised for showing an interest or natural curiosity about natural alternatives. They certainly don’t want to be criticized like a child. Though fraught with a certain amount of peril, the usage of alternative medicines shows a great deal of promise. We must be cautious however since many alternative therapies have never been formally tested. The problem also exists that since it is not under FDA scrutiny (being considered food supplements rather than drugs), there are companies who label bottles with dosages that are incorrect. A good illustration of this was the testing of St. John’s Wort, which showed promise in those suffering from depression. The dosage varied tremendously in bottles on the shelf from the same company and other companies labeling their bottles with St. John’s Wort did not even contain any!

Use in Pregnancy Unlike prescription medications, few herbs have been tested for safety in the gravid patient. Therefore, avoidance of herb usage would be the wisest action. Some are quite dangerous as those that have induced abortions.

Education There are hundreds of natural therapies found in supermarkets, health food stores and drugstores sold as dietary supplements. Most of them are herbs and extracts of herbs. While it is undeniable that they may produce a positive effect. they can be dangerous in certain conditions. For instance, certain herbs can produce tachycardia the way caffeine does which would be harmful in someone with hypertension or cardiac conditions. Who is going to inform your patients about alternative therapies? Some are learning about them online. This may be good or bad. Many are learning about the supplements from some pimple-faced seventeenyear old working at a health store. As people seek out ways to become healthier or

address medical issues, the need for accurate information is ever increasing. They need facts and figures to empower themselves and make their healthcare decisions. Knowing about vitamins, herbs and supplements, puts you ahead of your colleagues and your competition. But, it also helps your patients a great dealthose that need to know what options are available to them. At least steer them to the right sources- places that you respect to give them accurate information. So, I ask you again, where will your patients be learning about alternative therapies? Will it be from you?  Note Producing a newsletter helps provide patients with information that they are looking for and a place that you can refer your patients. If you would like help in creating a newsletter tailored to your practice, contact Dr. Barbara Hales at: Support@CompleteContentPackage.com

The Write Treatment

Ezines and NewslettersCost Effective Powerful Tools • Drive traffic to your business website • Build relationships between yourself and patients • Get new patients • Announce a new service or product • Give great impact Have you got a newsletter yet or want to spread a message? Contact Barbara Hales, M.D. for a free consultation. Barbara@TheWriteTreatment.com 516-647-3002

PHYSICIAN SOLUTIONS MAGAZINE

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practice tips

Calorie Restriction Lowers Some Risk Factors for Age-related Diseases

A National Institutes of Healthsupported study provides some of the first clues about the impact of sustained calorie restriction in adults. Results from a two-year clinical trial show calorie restriction in normal-weight and moderately overweight people failed to have some metabolic effects found in laboratory animal studies. However, researchers found calorie restriction modified risk factors for 12

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age-related diseases and influenced indicators associated with longer life span, such as blood pressure, cholesterol, and insulin resistance. The study was reported in the September, 2015 issue of the Journal of Gerontology: Medical Sciences. Calorie restriction is a reduction in calorie intake without deprivation of essential nutrients. It has been shown to increase longevity and delay the progression of

a number of age-related diseases in multiple animal studies. Called Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE), the randomized trial was funded by the National Institute on Aging (NIA) and the National Institute of Diabetes, Digestive and Kidney Diseases, both part of NIH. It was conducted at Washington University in St. Louis, Louisiana State Universityâ&#x20AC;&#x2122;s

Pennington Biomedical Research Center in Baton Rouge, and Tufts University in Boston. The study coordinating center was at Duke University in Durham, North Carolina. “The study found that this calorie restriction intervention did not produce significant effects on the pre-specified primary metabolic endpoints, but it did modify several risk factors for age-related diseases. It is encouraging to find positive effects when we test interventions that might affect diseases and declines associated with advancing age,” notes NIA Director Richard J. Hodes, M.D. “However, we need to learn much more about the health consequences of this type of intervention in healthy people before considering dietary recommendations. In the meantime, we do know that exercise and maintaining a healthy weight and diet can contribute to healthy aging.” In laboratory animals, calorie restriction’s favorable effects on life span have generally been found when it is begun in youth or early middle age. An equivalent trial in people would take decades. However, shorter trials can determine feasibility, safety and effects on quality of life, disease risk factors, predictors of life span and effects on mechanisms influenced by calorie restriction in laboratory animal studies. CALERIE was a two-year randomized controlled trial in 218 young and middle-aged healthy normal-weight and moderately overweight men and women to measure these outcomes in a CR group, compared with a control group who maintained their regular diets. The calorie restriction participants were given weight targets of

15.5 percent weight loss in the first year, followed by weight stability over the second year. This target was the weight loss expected to be achieved by reducing calorie intake by 25 percent below one’s regular intake at the start of the study. The calorie restriction group lost an average of 10 percent of their body weight in the first year, and maintained this weight over the second year. Though weight loss fell short of the target, it is the largest sustained weight loss reported in any dietary trial in non-obese people. The participants achieved substantially less calorie restriction (12 percent) than the trial’s 25-percent goal, but maintained calorie restriction over the entire two-year period. The control group’s weight and calorie intake were stable over the period. The study was designed to test the effects of calorie restriction on resting metabolic rate (after adjusting for weight loss) and body temperature, which are diminished in many laboratory animal studies and have been proposed to contribute to its effects on longevity. The study found a temporary effect on resting metabolic rate, which was not significant at the end of the study, and no effect on body temperature. Although the expected metabolic effects were not found, calorie restriction significantly lowered several predictors of cardiovascular disease compared to the control group, decreasing average blood pressure by 4 percent and total cholesterol by 6 percent. Levels of HDL (“good”) cholesterol were increased. Calorie restriction caused a 47-percent reduction in levels of C-reactive protein, an inflammatory factor linked to cardiovascular disease. It also markedly decreased insulin re-

sistance, which is an indicator of diabetes risk. T3, a marker of thyroid hormone activity, decreased in the calorie restriction group by more than 20 percent, while remaining within the normal range. This is of interest since some studies suggest that lower thyroid activity may be associated with longer life span. The study also assessed calorie restriction’s effects on mood (particularly hunger-related symptoms) and found no adverse effects. No increased risk of serious adverse clinical events was reported. However, a few participants developed transient anemia and greater-thanexpected decreases in bone density given their degree of weight loss, reinforcing the importance of clinical monitoring during calorie restriction. “The CALERIE results are quite intriguing. They show that this degree of sustained calorie restriction can influence disease risk factors and possible predictors of longevity in healthy, non-obese people. It will be important to learn how calorie restriction at this level affects these factors despite the lack of the predicted metabolic effects,” said Evan Hadley, M.D, director of NIA’s Division of Geriatrics and Clinical Gerontology and an author of the paper. “Since this group already had low risk factor levels at the start of the study, it’s important to find out whether these further reductions would yield additional long-term benefits. It also would be useful to discover if calorie restriction over longer periods has additional effects on predictors of health in old age, and compare its effects with exercise-induced weight loss.”  Source: http://www.nih.gov/news/ health/sep2015/nia-01.htm

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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/ 16

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

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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 18 | OCTOBER 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

MID-LEVEL PROVIDERS: Are You Using Them for Your Health Care Practice?

By Naren Arulrajah with Vikas Vij Ekwa Marketing

| OCTOBER 2015

imely access to a primary

care physician (PCP) is an essential social necessity. In an ideal world, everyone would have easy and quick access to a PCP allowing them to maintain good health while also preventing any unnecessary last minute emergency room visits or avoidable health risks. However, as things stand today, there is a shortage of primary care physicians. According to the American Academy of Family Physicians by 2020 there will be a shortage of 40,000 primary care physicians. Compounding this projection is another statistic given by the U.S. Bureau of Health Professions which predicts a shortage of 109,600 physicians across all specialties by the year 2020. This presents a serious cause for concern in light of the fact that health insurance has become mandatory which means a significant increase in the number of patients. Because of this most healthcare practices today are finding it extremely difficult to deal with the increase in patient flow. In addition to increasing wait times for patient appointments, the instances of emergency rooms visits have gone up significantly.

‘‘

The biggest challenge when it comes to incorporating mid-levels into your practice pertains to determining their role and responsibilities and making the best use of their skills and experience.

The real issue is that unlike other professions, medical professionals need to invest considerable time into completing their education and in gaining substantial experience to successfully treat patients. The time frame again differs depending on the kind of specialty a potential physician selects. Under these circumstances, the best option for dealing with the present and future shortage of PCPs lies in incorporating mid-level providers.

also to improve the way they manage and deliver healthcare for patients. By incorporating mid-level providers healthcare facilities stand to effectively improve the quality of care they provide, significantly increase patient satisfaction, while also benefiting from lowered costs and increased revenue. Expanding the roles of midlevels in your practice - top 3 benefits

Mid-levels definitely provide a number of crucial advantages for growing and expanding a practice. The role of mid-level providers Consider the following; has undergone extensive change in • The time duration for educatthe last few decades. Today miding mid-level providers is much levels practice not only in primary shorter compared to the time care practices but are also recruited that goes into educating physito work in hospitals, specialty facilicians. This is one of the reasons ties inpatient and outpatient surgiwhy it is easier to increase the cal facilities, as well as in emergenpresence of mid-levels in a cy departments. healthcare practice. Mid-level providers can be • Mid-level providers are a authorized to take on a number of cost-effective alternative for a responsibilities. Important responprimary care facility. They can sibilities include the following; manage and provide routine • Patient evaluation. care to a patient which means • Taking patient history and perthe physician is free to focus on forming physical examinations. more complex cases. • Diagnosing and treating health • Mid-level providers can ease and medical issues. scheduling conflicts without • Ordering and analyzing a impacting quality of care delivnumber of important diagnostic ered by a practice. Another adtests including X-rays and CT vantage here is that physicians scans and lab results. who are past their retirement • Prescribing medications and age as well as women physicians treatments options/procedures with families can continue pracfor patients. ticing without having to com• Educating patients on impormit to full-time schedules. tant and necessary lifestyle How to make the best use of changes/choices, as well as edu- mid-level providers cating them on disease prevenThe biggest challenge when it tion practices. comes to incorporating mid-levels There is immense pressure on into your practice pertains to hospitals and primary care physicians to not only re-evaluate but continued on page 22 The Changing role of mid-level providers

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continued from page 21

determining their role and responsibilities and making the best use of their skills and experience. Keep the following tips in mind when you integrate mid-levels into your practice. • Start by evaluating your practice. Determine if your practice really needs a mid-level provider(s). • Consider the cost factor. In addition to salary and benefits, you will also need to take into account rent for exam rooms that your mid-level provider will use, and other variable expenses (medical supplies, drugs etc.) associated with each patient visit. • Be prepared to provide your mid-level provider with support staff and phone coverage among other basic necessary support. • Provide extensive training as and when required and or orientation within the practice. • Clearly specify case protocols with reference to types of cases the midlevel provider will see. • Make sure you align with state laws with respect to supervisory requirements and prescriptive authority when it comes to mid-level providers. • Take a proactive approach and introduce patients to your midlevel provider. Educate them on the role and responsibility of the mid-level provider so patients feel comfortable with your mid-level provider. Conclusion Improving patient access without diluting quality of healthcare delivered is one of the most important challenges that most primary care

| OCTOBER 2015

practices face today. Mid-level providers can easily address this issue as they not only effectively boost patient access, but they can drive practice revenue, and help lower the workloads for physicians by taking care of routine complaints which allows physicians to concentrate on more complex cases. ď&#x201A;˘ 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

“Change is the only thing which remains constant…”

The New Role of Nurse Practitioners in Health Care Reform

By Nidhi Behl Vats Freelance Medical Writer

In past patients were treated with little, or no, technology. Now the latest equipment and technology, created almost daily, assist in treating prolonged and deadly diseases. Being adaptive has always been essential in the field of medicine. The same goes for health care reforms, amendments are made to the existing plan and new features are added. With the launch of the Affordable Care Act (ACA), practices aim to provide health care facilities to everyone, including the previously uninsured population. Health care is not only related to curative care. It involves preventive, primitive care and overall well being of an individual. The ever increasing gap between primary care physicians and the number of patients will be the 24

| OCTOBER 2015

challenge to overcome. There is always a disparity between the demand and the supply of trained primary care physicians. Often physicians are unwilling to go for remote/ rural locations for primary health care. As a result, there is a visible shortage of physicians, which is expected to be approximately 44,000 by the year 2025, in treating basic ailments. Health regulations are there to help patients, but how justified is it to rely only on doctors for the completion of the ACA’s goals? It is understood that forceful implementation will always have repercussions, in the times to come. To addition, there have been various new ways to involve doctors under primary care, adding to their work load. Other options need to be looked at to solve this

problem. Lack of skilled primary care providers is a major problem in United States and it is expected to worsen further as the population continues to age and a major chunk of young adults (approximately 30 million) will gain access to health care coverage during 2014. One of the possible remedies to curb this problem is promoting nurse practitioners. A nurse practitioner can be defined as trained personnel who has completed their graduate level education in nursing services and are specifically trained to deliver high quality primary care services. Nurse practitioners, combined with physician assistants, can lead to an increase in existing primary care providers. According to the recent reports by the American Academy of Nurse Practitioners, around 89% of the nurse practitioners are trained to provide primary care independently. Approximately 75% of the nurse practitioners are actually practicing in a primary health care delivery system. The clinical role of the nurse practitioner is formulated by the stateâ&#x20AC;&#x2122;s SOP (scope of practice) laws that mention the range of services that they can deliver, as well as the norms regarding their independent practice.

A win-win situation for all: l

Bridging up the gap between the demand and supply of the skilled primary health care providers. l The nurses would benefit from a promising career with good compensation and the market value of the nurses would increase substantially. l The physicians can devote their attention to the secondary and tertiary level of care to patients, improving the overall health care of the community at large.

This structure will prove beneficial to both the nurses as well as the physicians. Also, the spectrum of health care delivery would increase.

Additional roles for nurses:

Nurse practitioners would not only provide primary care to the ill and in need but: l They would also act as community facilitators as well as nursing faculty members. l They would spread awareness regarding basic health and hygiene, preventive measures for common ailments, immunizations, etc. l They would be active members of the nursing colleges where they can impart basic nursing knowledge as well as share their valuable experiences with the students. Studies have shown that 90% of the services offered by a physician in a primary health care setting can be provided by a nurse practitioner at a much lower cost.

Nurse managed health care institutions save a lot of money as patients use generic medicines and are also less hospitalized than other patients. If the government is serious about adopting this practice as a long term solution, than attention should be paid towards l Developing such skilled manpower. l Clear guidelines should be provided as to how nurses should go about becoming independent primary health care providers. l Competency mapping is equally needed if this model is to become successful. This isnâ&#x20AC;&#x2122;t the only solution for increasing health care demand, but at the moment this is the most feasible solution available. It can immediately start filling in the gap between the demand and supply, which is constantly increasing. Health care reform in the United States will need an increased number of experienced nurse practitioners as leaders in the primary care arena. There are approximately 150,000 nurse practitioners at present and this figure is expected to rise in the coming years. In the near future, nurse practitioners will be the brand ambassadors of health care and will be the recognized face of primary medical care. ď&#x201A;˘

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

Nidhi Behl Vats Strategist, Content Developer, and Social Media Marketer

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

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features

Physician Assistants & Nurse Practitioners Workforce Quality Care in a Changing Delivery System

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

| OCTOBER 2015

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.

Many of us enter medicine for the noble aspirations to help others and do good work. We also collectively believe that as a result of sound training and clinical experience that we are great at what we do. However, as in many situations, there is a truer bell curve of performance. New emphasis on quality metrics and performance have pushed providers of all types to examine clinical performance in new ways, and with new comparisons to their peers locally, regionally and nationally. Physician Assistants (PAs) are a relatively new profession. The first PA class enrolled at Duke in 1965 and accurate population data highlighting PA performance and workforce contributions are only more recently beginning to emerge. Since 2006, according to the American Academy of Physician Assistants, there has been a 34% increase in the PA workforce.

Currently, the likelihood that a patient will see a PA when seeking clinical care is substantially increased. Recently, a survey by the Harris Corporation showed PAs are trusted health care professionals and 91% of patients believe PAs provide quality care and improve outcomes. This data codifies the value that PAs are bringing to health care delivery. The Harris data showed that 93% of patients who saw a PA agreed that they added significant value to the healthcare team. In addition, 83% of patients stated that PAs increased their satisfaction with the health care services they received. As hospitals and health care systems continue to address quality patient care and improved access for patients to care, PAs are increasingly becoming more recognized as part of the solution. It is cost effective and efficient to

hire a PA or NP to perform 85% or more of the clinical tasks that were traditionally performed by physicians. Organized medicine is catching on to not only the value for patients but also the value and return on investment. With this increased emphasis on value and team based care, now incentives for care delivery are beginning to emerge. One example is the chronic condition management code (CCM) introduced by the Centers for Medicare & Medicaid Services (CMS). Beginning in 2015, CMS finalized a separate payment, outside of a face-to-face visit, for managing the care of Medicare patients with two or more chronic conditions. CMS issued a new rule that will update payment policies and payment rates for services continued on page 28

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continued from page 27

furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2015. Medicare pays physicians, PAs and NPs for care management services as part of in person, face-to-face visits. The payment rate for the new code is $41.92, billed no more frequently than once per month per qualified patient. This could amount to more than $200,000 per year per provider in added revenue assuming a 20% Medicare population with at least 700 unique Medicare patients per year who have 2 or more chronic conditions. Chronic care management (CCM) services include development and revision of a plan of care, communication with other health professionals, and medication management.

| OCTOBER 2015

Payment for CCM is only one part of a multi-faceted CMS initiative to improve Medicare beneficiaries’ access to primary care. Quality metrics and value are two ingredients in health reform and changing care delivery systems that will be measured and tracked as health reform efforts continue. It is critical that PA and NP performance and quality be measured in an objective fashion as these new models of care are developed nationwide.  References: http://www.aapa.org/ twocolumn.aspx?id=3358&utm_ content=10102014_story1_link1 http://www.cms.gov/Newsroom/ MediaReleaseDatabase/ Fact-sheets/2014-Fact-sheetsitems/2014-07-03-1.html

http://www.witf.org/news/2014/10/ how-pas-are-re-shaping-health-care. php http://www.fiercehealthcare.com/ story/4-ways-improve-primarycare-delivery/2014-10-02?utm_ campaign=SocialMedia Lisa P. Shock, MHS, PA-C, is a seasoned PA who is an alumna of the Duke PA Program, celebrating its 50th Anniversary of the PA Profession this month. 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

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

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. 30 | OCTOBER 2015

THINKING ABOUT SELLING YOUR PRACTICE?

Medical Practice Listings can help you sell your practice online! Now offering two types of listings to better serve all practice specialties and budgets. Standard Listing The Standard Listing offers you the opportunity to gain national exposure by posting your listing on our website which is viewed daily by our network of professionals. This option also includes a brief practice consultation to explain the benefits of marketing through the Medical Practice Listings website.

Professional Listing In addtion to the benefits in the standard listing our Professional Listing affords you access to services provided by our expert legal and marketing team and a Bizscore Practice Valuation. This valuation compares your practice with other practices in your area, provides projections and determines what your practice is worth.

Visit us today at www.medicalpracticelistings.com to learn more.

919.848.4202 | medicalpracticelistings.com

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 | OCTOBER 2015

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

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

l One

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

NC 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

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

PHYSICIAN SOLUTIONS MAGAZINE

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Primary Care Practice For Sale

Med Spa in the Raleigh-Durham, NC Area

Wilmington, NC Established primary care on the coast of North Carolina’s beautiful beaches. Fully staffed with MD’s and PA’s to treat both appointment and walk-in patients. Excellent exam room layout, equipment and visibility.

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.

Contact Medical Practice Listings for more information.

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

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

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

PHYSICIANS NEEDED: Mental health facility in Eastern North Carolina seeks: PA/FT ongoing, start immediately Physician Assistant needed to work with physicians to provide primary care for resident patients. FT ongoing 8a-5p. Limited inpatient call is required. The position is responsible for performing history and physicals of patients on admission, annual physicals, dictate discharge summaries, sick call on unit assigned, suture minor lacerations, prescribe medications and order lab work. Works 8 hour shifts Monday through Friday with some extended work on rotating basis required. It is a 24 hour in-patient facility that serves adolescent, adult and geriatric patients. FT ongoing Medical Director, start immediately The Director of Medical Services is responsible for ensuring all patients receive quality medical care. The director supervises medical physicians and physician extenders. The Director of Medical Services also provides guidance to the following service areas: Dental Clinic, X-Ray Department, Laboratory Services, Infection Control, Speech/Language Services, Employee Health,

Pharmacy Department, Physical Therapy and Telemedicine. The Medical Director reports directly to the Clinical Director. The position will manage and participate in direct patient care as required; maintain and participate in an on-call schedule ensuring that a physician is always available to hospitalized patients; and maintain privileges of medical staff. Permanent Psychiatrist needed FT, start immediately An accredited State Psychiatric Hospital serving the eastern region of North Carolina, is recruiting for permanent full-time Psychiatrist. The 24 hour in-patient facility serves adolescent, adult and geriatric patients. The psychiatrist will serve as a team leader for multi-disciplinary team to ensure quality patient care/treatment. Responsibilities include:

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

Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624 PH: (919) 845-0054 | email: physiciansolutions@gmail.com 34 | OCTOBER 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

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 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

Womenâ&#x20AC;&#x2122;s Health Practice in Morehead City, NC

Newly listed Primary Care specializing in Womenâ&#x20AC;&#x2122;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 | OCTOBER 2015

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