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Med Monthly the

February 2012

denistiaoln& v e issu


Tips and tricks for the new revision


How to get them & keep them



• Genetic testing for eye tumors • Technology revolutionizing dentistry • Nasal spray anesthetic for dental patients • Foundation Fighting Blindness invests in research



contents features 14 TECHNOLOGY REVOLUTIONIZING DENTISTRY Advancements are changing the industry forever

26 HOW TO ATTRACT & RETAIN PHYSICIANS Successful strategies to get and keep them



Using QR codes

9 tips for maximizing marketing

research and technology



The first in a two part series


Tips and tricks for the specialty codes






in every issue


4 editor’s letter 8 news briefs

Artist feature

48 resource guide 60 top 9


editor’s letter

Greetings medical professionals! Healthy oral care and preservation of vision are two of the most valued health concerns to maintain an independent, quality lifestyle. February’s editorial theme focuses on two vital medical specialties— dentistry and vision care. In these pages you will find pertinent news and advice for the professionals who are working in these specialties today. This edition provides accurate reports of breakthroughs in research and technology that will soon affect (if not already) the way that patients receive dental and vision care. In addition, you will find out how these breakthroughs are also influencing practice management methods for these specialties. Ed Logan offers insight on how to ensure that your dental practice is maximizing its reimbursements, and Cathy Warschaw briefs us on the technology that is streamlining the front office of dental practices. We also feature an article on the recent $8.25 million investment made by the Foundation for Fighting Blindness towards gene therapy projects that will combat vision disabilities at the source of a genetic defect. Med Monthly delivers content that relates to multiple facets of health care, so that no matter what your interests are, each edition will have something that appeals to you! Our February issue covers everything from how to effectively market your practice to business strategies that apply to several medical practice models. Mary Pat Whaley and Abraham Whaley will fill you in on how QR codes can be used to channel your target audience directly to your desired online message. Robert Tennant shares a set of criteria for health care IT solutions—The Triple Aim—that indicate their effectiveness throughout the implementation process. Jim Moniz explains how important it is to provide attractive financial incentives to recruit and retain quality physicians to a practice. Kimberly Licata addresses the legal ramifications of giving patients the right to publish their criticisms about a physician on the Internet. And Suzanne Leder demonstrates the high-level of specificity that will be required after the conversion to ICD-10 coding through examples that pertain to individual medical specialties. I am excited to bring you the first piece of a two-part series by Cameron Cox on hospital acquisition strategies, be sure to check out our March issue to read the conclusion. As always, it has been a pleasure to work with such an esteemed group of professionals to deliver the most current topics of interest in health care and serve as your editor here at Med Monthly. To all of our loyal readers, may this issue enhance your successes! Sincerely,

Leigh Ann Simpson Managing Editor

4 | FEBRUARY 2012


Med Monthly February 2012

Publisher Managing Editor Contributing Editor Creative Director Contributors

Marketing Manager

Philip Driver Leigh Ann Simpson Mollie Doll

Shauna Smith Duty has written and edited numerous websites, articles, advertisements, and blogs. She is president and COO at Modern Dental Practice Marketing, an internet marketing company that caters to the dental and medical communities. Learn more about Duty at

Courtney Flaherty Mary Pat Whaley, FACMPE Abraham Whaley Kimberly Licata Nancy Walsh Robert C. Tennant Edward Logan, DDS Ashley Acornley, MS, RD, LDN Suzanne Leder, BA, M. Phil., CPC, COBGC Jim Moniz, MSFS Shauna Smith Duty Cameron Cox, III, MHA, FACMPE Cathy Warschaw Will O’Neil

Med Monthly is a national monthly magazine committed to providing insights about the health care profession, current events, what’s working and what’s not in the health care industry, as well as practical advice for physicians and practices. We are currently accepting articles to be considered for publication. For more information on writing for Med Monthly, check out our writer’s guidelines at

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

Edward Logan, DDS is a general and cosmetic dentist practicing in O’Fallon, Mo. Dr. Logan graduated from the University of Washington School of Dentistry. After years of learning the business side of dentistry, Dr. Logan decided to write a book, “Dentistry’s Business Secrets”. You can read more articles by Dr. Logan at his website

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

Kimberly Licata P.O. Box 99488 Raleigh, NC 27624 Online 24/7 at

is an attorney at Poyner Spruill, who practices health law and participates on the Firm’s Emerging Technologies and Privacy and Information Security teams. She may be reached at or 919783-2949.


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news briefs

New System Streamlines St. Joe's Communications

Life Science Conference Attracts Industry Leaders to North Carolina CED, the southeast’s largest entrepreneurial support organization is hosting its 21st annual Life Science Conference, set to be held Feb. 1516, 2012, at the Raleigh Convention Center in Raleigh, N.C.. The conference gathers industry leaders and aspiring entrepreneurs to facilitate collaborations and opportunities to commercialize important new technologies. The conference chairs are Victor J. Dzau, MD, chancellor for health affairs at Duke University and president and CEO of Duke University Health System, and Robert A. Ingram, general partner, Hatteras Venture Partners. Speakers confirmed for the conference include Christopher Viehbacker, CEO of Sanofi; Alex Gorsky, vice chairman, Johnson & Johnson; 8 | FEBRUARY 2012

Bill Hawkins, retired chairman and CEO, Medtronic, Inc.; Kris H. Jenner, vice president, T. Rowe Price Group; and Jeremy Levin, senior vice president, strategy, alliances and transactions, Bristol-Myers Squib. “This conference represents the largest gathering in the southeast of the region’s life science community,” said John Siefert Rose, CED president. “We are excited to present a top-tier line-up of speakers for this event, which showcases a robust industry for North Carolina.” The CEO Life Science Conference is presented in partnership with the North Carolina Biotechnology Center and North Carolina Biosciences. Registration information and a full conference agenda are available online at http://www.

PerfectServe, a medical facility communication systems company, recently deployed within St. Joseph’s Medical Center in Stockton, Calif., a member of the 40-hospital Catholic Healthcare West system—the nation’s eighth largest health system. PerfectServe reduces medical errors by communication breakdown, eliminates handoffs and speeds the delivery of critical lab values. Since the adoption, St. Joseph’s Medical Center reports that all the communication and delivery workflows, call schedules and contact preferences for every member of the St. Joseph Medical Center’s is maintained with the PerfectServe Platform. “Today our clinicians experience less hassle and fewer communication errors, breakdowns and delays,” said Don Wiley, chief executive officer at St. Joseph’s Medical Center. “Clinical calls and messages route with much greater accuracy and reliability.” Every physician at St. Joseph’s Medical Center—inside and outside the hospital—is connected to PerfectServe’s network. Access is provided via a single number, or via a Web portal and mobile Android and iPhone applications.


next Be sure to check us out CED month for coverage of the . ce Life Science Conferen on hospital Also, if you liked our article 32) make aquisition strategy (page part of d sure you read the secon the story in March!

Stem Cell Study Finds Success in Improving Vision Loss An early-stage study, first published on Jan. 23 in a news release from The Lancet, has suggested that human embryonic stem cells (hESC) are safe and can lead to vision improvement. The study included two participants who were both legally blind; one patient in her 70s with dry age-related macular degeneration (AMD), a leading cause of blindness in the elderly, the other in her 50s with Stargardt’s macular dystrophy, a type of macular degeneration that affects younger patients. Retinal pigment epithelium (RPE) derived from hESC were transplanted into the subretinal space in one eye. The procedure was followed by a low-dose immunosuppression therapy, which was reduced gradually over six weeks. “Our study is designed to test the safety and tolerability of hESC-RPE in patients with advanced-stage Stargardt’s macular dystrophy and dry age-related macular degeneration,” wrote Robert Lanza, MD, chief scientific officer at Advanced Cell Technology in Marlborough, Mass. “So far, the cells seem to have transplanted into both patients without abnormal proliferation, teratoma formation, graft rejection, or other untoward pathological reactions or safety signals.” The ultimate therapeutic goal of the research is earlier treatment of patients to potentially increase the likelihood of photoreceptor and central visual rescue. Researchers caution that the research is preliminary and far more study is needed before the practice might become widespread.

Licorice Root Fights Tooth Decay and Gum Disease A study conducted by the American Chemical Society (ACS) found that substances in licorice root can kill the oral bacteria that often lead to tooth loss in adults and children. Scientists have indentified two compounds in the sweet plant – licoricidin and licorisoflavan A – that are effective against two of the bacteria that cause dental cavities and two of the bacteria that promote gum disease. Licorice candy is no longer made with the sweet root here in the U.S. but instead is made with anise oil, which has a similar taste. MEDMONTHLY.COM |9

research & technology

Genetic Testing for Eye Tumor Cuts Surveillance Costs By Nancy Walsh


enetic testing of children with retinoblastoma and their families greatly reduced unnecessary and expensive clinical surveillance among potentially at-risk

10 | FEBRUARY 2012

family members, a study suggested. Analysis of the RB1 gene among 48 family members of affected children identified six individuals who carried a mutation predisposing them to retinoblastoma, although they were

clinically unaffected. This meant that 42 were negative for the mutation and did not require repeated evaluations, according to Sharon E. Plon, MD, PhD, of Texas Children's Cancer Center in Houston and colleagues. "If genetic testing had not been performed, these 42 individuals would have had to undergo expensive [examinations under anesthesia] as part of surveillance recommendations," the researchers wrote in the November Archives of Ophthalmology. Retinoblastoma is an unusual malignant ocular tumor of early childhood that can affect one or both eyes. In the 40 percent of cases that are bilateral, a germline mutation in RB1 i����������� s responsi-

ble; the remaining 60 percent of cases, which present as unilateral, have either a somatic mutation in the gene–one that occurs during development–or, in about 15 percent of unilateral patients, a hereditary mutation. Retinoblastoma can occur if there are two mutations in RB1 or a single mutation plus inactivation of a second allele.������ Testing for the genetic mutation has been available and growing increasingly sensitive during the past 15 years, with the goal of determining risk for additional cancers among affected children and for the ocular tumor itself in family members. The importance of being able to determine these risks as early as possible lies in the fact that prognosis in retinoblastoma is "highly dependent on prompt diagnosis and evaluation," the researchers observed. Guidelines on surveillance for those at risk have been developed, but little is known about the implementation of recommendations in clinical practice, so Plon and colleagues reviewed the charts of 90 children evaluated at Texas Children's Hospital between 2001 and 2008. The management process used by Plon's team involved molecular analysis of blood and/or tumor tissue, and a multidisciplinary program of monthly meetings with geneticists, genetic counselors, pediatric neuro-oncologists and pediatric ophthalmologists

in which each case was discussed and updated. These meetings also ensured that all cases were referred for genetic testing and the results disseminated to parents and other family members. In 42 percent of the children in this series, tumors were present in both eyes. Genetic testing was completed in 65 percent of children with bilateral tumors and in 62 percent of those with unilateral disease. For bilateral disease or in cases where there is a family history of retinoblastoma, the testing can be done on samples of blood, but in unilateral cases, analysis of the tumor DNA is needed following removal of the eye. During the early years of the study, the laboratory analysis included only DNA sequencing, which provided a mutation yield of 79 percent. After 2004, however, the researchers also were able to obtain copy number analysis and determination of whether promoter methylation was present leading to inactivation of the gene, which improved the yield to 88 percent. Among the 29 unilateral cases, a mutation was identified in blood in five, indicating that it was a germline mutation. In seven of the unilateral cases, no mutations could be detected in blood but they were present in the tumor tissue, signifying sporadic mutations. The six individuals who had RB1 mutations but no clinical

disease were likely to have mutations with limited penetrance or expression, the researchers explained. Genetic testing was not done in 37 percent of cases, most often because patients did not return for the appointment. Other reasons cited for failure to complete testing were cost of the program and the deaths of four patients, which highlighted the importance of the genetic analysis being done as soon as possible after the diagnosis, according to Plon and colleagues. As to the costs of their program, they noted that the price tag for DNA sequencing was $1,800 for the affected individual and $340 for family members. But the cost of each evaluation under anesthesia and related fees reached about $3,000, and a child at risk generally needs eight such evaluations in the first year of life, and up to 26 by age 6. "Thus, the relatively inexpensive, simplified familial mutation testing allows a substantial decrease in the expensive and potentially morbid [evaluation under anesthesia] procedures," the researchers noted. The multidisciplinary approach ensured that evaluations of all at-risk individuals were done promptly, when survival and preservation of vision were most likely to be achieved. Reprinted from Med Page Today 

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research & technology

improving care, reducing costs and enhancing the worker experience, the Health Care IT Triple Aim. By adopting the Triple Aim, we can ensure that IT solutions have a positive impact and advance health care’s stature with regard to leveraging IT. The following are five keys to hitting the technology Triple Aim objectives.

Technology is the Enabler, not the Driver

The Health Care IT Triple Aim Utilizing technology for savings and benefit to both patients and the medical work force. By Robert C. Tennant


n terms of information technology (IT) advancement, when compared to the airline and banking industries, health care most often comes up short (although I, a traveler, might contend that the airline industry is a formidable challenger). While health

12 | FEBRUARY 2012

care's complexities and challenges are unmatched by other industries, no one would disagree that our industry needs to continue to make better use of IT. The success of health care IT projects depends on their ability to deliver on three main objectives:

Improving care, reducing costs and enhancing the worker experience produce the demand to implement IT solutions. The Triple Aim is the driver and technology is the enabler, not the other way around. Remembering this is critical to success, but is often easier said than done as technology implementations are complex and sometimes develop a life form of their own, and before we know it, assume the role of driver. Another challenge is that IT departments often end up driving the implementation of IT solutions, which is not the best approach. Solutions should be supervised by stakeholders and users who will benefit from the solution. IT departments are not to blame for assuming control; they are filling a void due to the lack of leadership. Hitting the Triple Aim requires viewing technology as the enabler along with active involvement from key stakeholders.

Trust the Technology Remember when eCommerce came into being? One of the key issues was consumer trust in these new, Internetbased technologies that a user could not touch, talk to or see. Fear of stolen identity, financial loss and general mistrust of this new, technologically advanced way of doing things slowed adoption. We are in a similar place today with health care technology.

Physicians, hospitals and patients are being asked to be more transparent and share information. We are entering a world where electronic visits and remote health monitoring is moving toward the norm. Providers are being asked to look at and respond to clinical and financial performance data, and are being told that their income will depend on that data. Like it or not, health care is fueled by data, and there is likely no escape for health care providers. The best option is to learn to trust and embrace the changes. Validate it, challenging its accuracy when necessary and get comfortable with the technology: use it to affect change. New technology will perform tasks for us that we used to do for ourselves, and we will be asked to trust the technology to guide and do support work for us. If the technology successfully performs tasks it will improve care, reduce costs, enhance work experience and hopefully allow health care workers to realize rewarding roles requiring new levels of human interaction, observation and judgment.

Pay Attention to the Often Overlooked Driver Of the Triple Aim objectives, improving the health care worker experience is the one most often overlooked. Technology projects are created to save money and decrease risk exposure to improve the quality of care. Some electronic health record (EHR) projects were started with the notion that they would make a physician’s job easier. However, many EHR implementations have not delivered; in fact, most have had the opposite effect. If technology doesn’t simplify a job, the job may not get done; or if the job does get done, it will be done at the high cost of lost productivity and worker dissatisfaction – negatively impacting the quality and cost

of care. A first step toward improved worker satisfaction is embracing it as a core objective. If we don’t believe in it ourselves, we won’t make it a priority to achieve it. Studies have shown that patients who have a good experience are more compliant to treatment plans. Does it naturally follow that health care workers whose experience is enhanced will be better performers? I believe it, do you? Once convinced, key stakeholders and users will need to stay attentive to the often overlooked driver of health care worker satisfaction.

Measure It Is our technology improving care? Reducing costs? Enhancing worker satisfaction? If so, how and to what degree? These are questions that should be asked and measured specifically and quantifiably. Create a key performance indicator (KPI) detailing the goals that support the overarching Triple Aim objectives. Items to be measured will vary by worker group. For example, physicians, nurses, schedulers, billers and administrators should all have unique KPI dashboard measures related to their specific objectives, capacity to impact care and cost. In addition, they should have their worker satisfaction evaluated on a regular basis. KPI’s may also vary depending on what issues the technology solution is intended to address but could include:  patient waiting time  gaps in care  patient satisfaction surveys  number of visits per day  number of same day visits  worker satisfaction surveys  hours required to wrap up the day after the last patient visit  traditional billing and financial measures. As the axiom goes, if it’s not measured (with results in front of you

daily or weekly), it won’t improve.

Improve It Improvement naturally follows measurement. With regard to IT improvements, there are two important things to keep in mind: 1) Today’s solution may not suffice tomorrow, and if we think it will, we’ll get left in the dust. 2) The complexity of health care’s issues stand in the way of us rapidly progressing. If we wait to deliver a solution until we can completely predict the results, the project will never get started. Complex implementations such as ambulatory EHR solutions leave users feeling overwhelmed. Likewise, data intensive accountable care models are complicated and not fully defined, requiring a lot of discovery and invention along the way. There is no linear path, missteps and rabbit trails will be the norm, not the exception if we are to keep moving forward. Many consulting firms and health system IT departments have assembled EHR optimization teams that follow implementation for 90 or more days, and work to the improve processes of adoption after everything has settled a bit. This optimization should be widely used and followed by a systematic plan that includes reviewing and responding to performance metrics. Seasoned veterans know that the devil is in the details when it comes to applying IT solutions to the complex issues of health care. Sometimes the biggest challenge is getting the proper stakeholders to spell out objectives and supervise the execution of the project to ensure that objectives are met. If you are considering a new technology implementation or find yourself in the throws of adversity from a previous implementation, it’s not too late to revisit the process and adhere to the Triple Aim objectives.  MEDMONTHLY.COM |13

research & technology

Technology Revolutionizing Dentistry From improving effeciency to better diagnosis, advancments changing the industry forever By Cathy Warschaw


entists are finding that advancements in technology are quickly working their way into every aspect of their office. In the past, the primary focus has been on how technology can improve treatment, but these days we are seeing that the front office can benefit from tech solutions as well. Some dentists have discovered that implementing these technological advances can significantly reduce the work load of their front office staff, making them more productive. The Internet has become a tremendous asset when it comes to new patient protocol. Online registration, health history and Health Insurance Portability and Accountability Act (HIPAA) forms can now be built

14 | FEBRUARY 2012

right into an office’s website for patients to easily access. This prevents the staff from having to wait for that patient who has the 8 a.m. appointment and takes 20 minutes to fill out paperwork, putting a kink in the entire schedule of the day. Patients can submit their information online or print the forms and bring them to their scheduled appointment already filled out. They can also utilize a kiosk, iPad or other tablet device to fill out forms in the office when they arrive. Electronic alerts allow dental front offices to communicate with their

patients more effectively. Many offices use text messages to send patients appointment reminders in intervals – one week, one day or 30 minutes prior to an appointment. Patients seem to prefer text message alerts, since many are now wired into our mobile devices and can confirm appointments right from their phone. Automated call systems allow patients to verify appointments without a staff member ever picking up the phone. Emails and electronic billing also reduce the work time of staff members for patient communication. The results are increased front office

efficiency! We’re also aware of the technology that has improved treatment and patient flow in the back office. Computer Aided-Designed (CAD)/ Computer Aided Manufactured (CAM) machines reduce the number of additional patient appointments by allowing dentists to create a crown and deliver it the same day. This also cuts back on missed appointments and even some collections as the patient knows that their treatment and payment will be expected on the same day. Digital radiography is eliminating

dark rooms and the harmful chemical fumes that are associated with traditional x-rays. Digital film usage provides more office space and reduces the amount of time spent processing images. Imagine if every patient’s appointment could be shortened by five minutes! Digital x-rays generate images onto a computer screen instantly for viewing, or can be scanned directly into the office management software. The image resolution is of such a higher quality, the images can be used for electronic referrals or insurance claim submissions. Advancements in oral cancer screenings are helping dentists identify possible pathologies earlier than ever. Systems like VELscope and Vizilite help mark and identify tissue lesions and anomalies that are precancerous and not always visible to the naked eye. These advanced screening methods give dentists the ability to catch oral cancer at an earlier diagnosis. These systems have become so common that patients are beginning to expect them from their dental caregivers, and even some insurance plans are beginning to cover these procedures. Lasers are taking on a broader role when it comes to dental treatment.

They can make treatment less painful and decrease recovery time after dental procedures. Lasers were traditionally used for tissue modification like crown lengthening or tumor removal; now they can also be used to treat cold sores, remove decay, dental fillings and in some cases even provide therapy for sleep apnea or temporomaudibular joint disorders (TMJ). Dental implants are evolving and extending eligibility to patients who may not have been implant candidates in the past. The mini-implant is a thin, titanium implant placed immediately after an extraction. They are useful in the replacement of one tooth or in groups of four to seat immediate dentures for added stability. Because of the lack of healing time (compared to six months for a traditional implant), it reduces the necessity of follow-up appointments and can improve office profits. Hygienists and assistants can save time for dentists with the use of caries detection devices like the diagnodent. Diagnodent devices use a laser to penetrate the tooth density and detect decay at earlier stages and more accurately than traditional methods (checking for a “stick” with an explorer). The hygienist or assistant can record these readings prior to the exam so dentists will know ahead of time what areas may require treatment. As technology becomes more prominent in the dental field, embracing these changes will increase office efficiency throughout the entire practice. Patients will be able to benefit from the increased amount of oneon-one time spent with practitioners and reduced wait time for treatment. This makes patients and the office happy, making quality of care that is promoted by the use of technology well worth the investment!  MEDMONTHLY.COM |15

research & technology

Foundation Invests $8.25 Million in Gene Therapy Research Six projects slated to battle retinal degerative diseases


he Foundation Fighting Blindness, a national non-profit dedicated to advancing sightsaving research, announced an $8.25 million investment in six new

16 | FEBRUARY 2012

gene therapy research projects in late October of last year. The projects are targeted to have treatments ready for clinical trials within three years. The grants focus on treating a broad range

of retinal degenerative diseases and will be allocated through the Foundation’s Translational Research Acceleration Program, which funds research efforts with strong, near-term clinical potential. “The Foundation Fighting Blindness recognizes the great potential of gene therapy for saving and restoring vision, and we’re eager to build on the clinical development of retinal gene therapies that has been accelerating at an incredible rate over the past few years,” said Stephen Rose, PhD, chief research officer, Foundation Fighting Blindness. “It was just three years ago that we reported groundbreaking results from our first gene therapy

clinical trials that restored vision in children and young adults who were virtually blind from Leber congenital amaurosis (LCA). The success of those studies set the stage for this rapid expansion in gene therapy development.” As part of the new investment, one innovative project involves the use of gene therapy to resurrect and reactivate cone cells that are compromised by disease. In many inherited retinal conditions, including retinitis pigmentosa, cones stop working before they completely degenerate. The Institut de la Vision in Paris and the Friedrich Miescher Institute in Basel, Switzerland, are developing a gene therapy that revives degenerating cones, enabling them to regain their ability to respond to light and provide vision. The treatment also improves the health of cones and extends their lifespan significantly. This therapeutic approach holds the potential to benefit people affected by a range of conditions, because it works independently of the underlying disease-causing genetic defect. Resurrecting cones can improve an affected individual’s well being, because these cells provide central, daytime and detailed vision that is critical for independent living. The Foundation is also funding the Oklahoma University Health Sciences

Center, which in collaboration with Copernicus Therapeutics, is developing a nanoparticle gene therapy delivery system. Nanoparticles are tiny manmade particles, 1/12,000th the diameter of a human hair, which can readily penetrate retinal cells making them effective for delivery of therapeutic genes. They may provide advantages in certain cases over viral gene delivery technologies currently


"The success of (prior) studies set the stage for this rapid expansion in gene therapy development."

used in retinal disease therapies. Perhaps most beneficial is their ability to deliver large genes — genes that exceed the capacity of viral delivery systems — for treating some diseases. Through a Foundation grant to Applied Genetic Technologies Corporation (AGTC), a clinical stage biotechnology company, funds will support researchers at Oregon Health & Science University’s Casey Eye Institute and the University of Florida in their pre-clinical work to evaluate

a gene therapy treatment for X-linked retinoschisis, a blinding disease that affects over 35,000 patients in the United States and Europe. Portions of the Foundation’s $8.25 million investment will also go toward research happening at the Massachusetts Eye and Ear Infirmary and the University of Florida for projects investigating gene therapy for two different LCA-causing genes. The final grant supports work at the University of Pennsylvania for choroideremia gene therapy led by Jean Bennett, MD, who is also one of the lead investigators on the landmark LCA gene therapy clinical trial that has restored vision in more than 40 patients. There are now human studies of gene therapy underway for LCA, wet agerelated macular degeneration and Stargardt disease, with clinical trials for Usher syndrome (the leading cause of deaf-blindness) type 1B and autosomal recessive retinitis pigmentosa (RP) scheduled to begin in late 2011 or early 2012. Currently supporting 30 other gene therapy efforts, including RDH12 and other genetic forms of LCA and RP, which are at various stages of development, the Foundation allocates funding toward basic research and investigation into a gene’s role in disease, as well as projects poised for clinical trials. 

Career Coaching for Physicians *Career renewal *Non-clinical careers certified coach and physician Heather E. Fork, MD, CPCC (512)517-8545 MEDMONTHLY.COM |17

research & technology

The Benefits and Demand of PRK Procedure grows in popularity as viable option to LASIK for many


he American Academy of Ophthalmology (AAO) reports that eye doctors performed 800,000 refractive surgical procedures in 2010. The AAO also indicates that more than 3.6 million people age 40 and older are visually impaired, or have 20/40 or worse vision in the better eye even with eyeglasses. At his Baltimore LASIK surgery and eye

18| FEBRUARY 2012

care practice, Jay C. Grochmal, MD, says many of his patients are choosing photorefractive keratectomy (PRK) surgery as an alternative to LASIK to correct their poor vision. He also says the procedure is rapidly growing in popularity as patients are beginning to see the benefits it can offer for those who are not candidates for LASIK. While LASIK surgery accrues more

attention because of its well-known success and prevalence, Dr. Grochmal says PRK is extremely successful and is often the best option for patients who meet certain criteria. Unlike LASIK, where a flap is created to perform the surgery, the surgeon removes the epithelial layer of the cornea and then reshapes it using an excimer laser. Because the procedure does not involve flap creation on the eye, patients with thin corneas can often achieve the most effective results through a PRK procedure. Dr. Grochmal says the procedure can also work for patients seeking enhancement of a previous LASIK procedure. PRK can also be used for treatment of epithelial distrophy or issues with the epithelium of the cornea. Additional benefits of PKR include the removal of scars on the cornea, strengthening the cornea through cross-linking and reduced formation of scar tissue. “PRK uses the same laser as LASIK and is adaptable for ‘advanced’ procedures, such as CustomVue, in order to obtain the best visual results,” says Dr. Grochmal. “For those with thin or borderline thickness corneas, as well as higher myopic refractive errors, PRK can be performed with the confidence of assuring the patient’s long-term corneal stability.” While some patients may only qualify for either LASIK or PRK based on an assessment of their individual eye, Dr. Grochmal says both procedures have proven effective and successful. He also recommends consulting with a highly trained and experienced eye surgeon before undergoing any procedure. “Every patient is unique and requires individualized care. A surgeon experienced in PRK and LASIK can help guide the patient in the better treatment for him or her with the goal of preserving corneal health,” he says. 

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research & technology

Anesthetic... Now in a Nasal Spray New numbing agent may eliminate needles and patients' fears at the dentist


or the millions of people who fear going to the dentist because they hate the pain caused by needles used to numb teeth for many procedures, help is finally in sight. St. Renatus, LLC, based out of Fort Collins, Colo., heard the plea from the masses and is in the process of clinically testing a drug that the company believes will enhance pain control in dentistry. St. Renatus has patented the world’s first, needle-free nasal mist dental anesthetic. It is administered through the nasal cavity and is suitable for use in operative procedures involving most of the upper teeth such as fillings, crowns, bridges and root canals. The benefits of this new technology include:  Reducing the anxiety and fear asscoiated with dental injections.  Decreasing the risk of diseases associated with contaminated needles.  Lowering the number of patient complaints of lip swelling or the

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“fat lip” feeling after leaving the and 23 percent are very likely to dentist. switch to a dentist offering the nasal The Industrial Research Center re- spray option. This same study also cently conducted a study to find iniconcluded that 96 percent of dentists tial consumer data for the nasal mist surveyed expect to offer the new product. Results indicated that nasal mist anesthetic to their when patients were patients when it begiven the choice becomes available. FAST FACT tween a nasal mist St. Renatus’ St. Renatus, LLC, based anesthetic and a nasal mist has out of Fort Collins, Colo., needle-injected successfully unis currently in the process of anesthetic, 90 dergone Phase clinically testing a drug that the company believes will enhance percent are very I and Phase II pain control in dentistry with or somewhat clinical trials the world’s first, needle-free likely to choose of the U.S. Food nasal mist dental anesthe new product, and Drug Adminthetic.

istration (FDA) process. The Phase II trials’ initial results indicated 90 percent efficacy which is equal to needle injection results. With a completed favorable End of Phase II review with the FDA in March 2011, St. Renatus established readiness to proceed with conducting Phase III efficacy studies. “We are very pleased with how the nasal mist has performed in trials thus far, and with the outcome of our meetings with the FDA,” says Steve Merrick, chief executive officer for St. Renatus, LLC. “We believe it represents a significant step forward for both St. Renatus and the field of dentistry.” In December 2011, St. Renatus announced it secured an additional investment of up to $3.5 million for completing FDA clinical trials for its innovative needle-free dental anesthetic product. “This is a major step toward bringing this new technology to dentists and their patients,” says Merrick. “With this additional funding, we can proceed with all remaining clinical trials.” The FDA has granted permission for the company to proceed with Phase III clinical studies that will conclude by late spring of 2012. St. Renatus is planning to submit the New Drug Application to the FDA by the summer of 2012 for review. Additional funding, when secured in 2012, will be used to prepare for U.S. commercialization in 2013 and for submitting additional registration in other countries. For more information and continuous updates, please visit or contact Jill Shoemaker, Vice President of Investor Relations, at (970) 282-0156 ext. 16 or by email at 

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practice tips

Using QR Codes in Health Care Providing an electronic shortcut into your practice's message

By Abraham Whaley and Mary Pat Whaley, FACMPE


s health care embraces technology to improve patient outcomes, streamline operations and lower costs, the technologies that have the most impact are those that make things simpler. One of the most basic ways to do this is to remove friction. The electronic medical record (EHR) elevates the hassles of paper records — finding, handling, storing and securing them — all the things that can get between the critical information on the page and the physician who needs it. A smartphone eliminates the necessity of being near a desktop to read and send email, get contact information and securely access practice documents and patient data. This technology provides value by simplifying a process to its core so that time, effort and resources aren’t wasted on mishaps, transportation and basic human inertia. Now, think about your practice’s website: the basic information and

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elevator pitch that you want to communicate to existing and prospective patients. Your content is the reason you have a website in the first place, and you should always be looking for ways to get more eyes in front of it. Email lists, Facebook, Twitter, direct mail and practice brochures are all designed to connect people with your information and drive business to your practice. If someone sees a link to your website while they’re at their computer, the only friction you’ll en-

counter is getting them to click to go to your page. But what about all the mobile time your potential customers spend? If they see an advertisement - TV, billboard, print – that has the URL (web address) you want to send them to, they will have to bypass a lot of friction before they see your content. They have to:  Commit to going to the website later.  Remember the URL, and why they wanted to go there.

 Follow through with this commitment  Type the URL into their browser. With social media and email campaigns that are usually accessed through Internet enabled PCs or mobile devices, a simple link enables you to bypass this friction because there’s a chance that your customer will either click the link immediately or bookmark it to check it out later (enabling a much easier recall). With print, public and televised advertising campaigns, the odds are the customer doesn’t have either:  An Internet enabled device on them at the moment.  The time or inclination to check out the website immediately. So how can you overcome this and get the benefits of a simple link in a “real world” marketing situation? One method that is growing in popularity is the use of quick response (QR) codes. A QR code is a two-dimensional barcode that can be read by a smartphone to communicate a piece of information: text, a phone number or a web address. Most of the QR codes themselves are a small jumble of black and white pixilated dots that resemble a “digital bacteria” or some sort of computer life form. But in many ways, QR codes are like hyperlinks that exist in our physical lives. By installing a small software program on your mobile device, and then taking a picture of the code with your smartphone, you can immediately access the information embedded within.  See a newspaper ad about a sale at one of your favorite stores, and scan the QR code to get a link to a cou pon for an additional discount or register to be informed about up coming sales.  See a TV commercial about a new restaurant, scanning the QR code on TV leads your smartphone to a

website to make reservations for dinner or receive a dinner special.  See a poster at a health fair booth and scan the QR code to get an instant calculator app that gives you exercise options that are suitable for someone your age and level of physical fitness. QR codes smooth the entire education process by removing the friction caused by simply telling someone about web content without giving them the ability to access it automatically. A QR code on a brochure can facilitate initial contact with a patient by sending them to a website to get more information or book an appointment. When a patient is given a phone number to call for more info, or even just the practice’s web address, the patient has to “go the rest of the way” on their own. A QR code is an effective way to improve your organization’s image on both the technical and user friendly fronts, and flexible enough to handle several applications in your practice:

 Flyers about annual checkup ser vices — blood pressure, weight management, mammograms — that your patients see as they leave your practice (often when most motivated to seek additional services) can include QR codes that link them to general information sites, government warnings, approved resource sites, treatment communities or direct them to your website or blog.  Advertisements for surgical pro cedures that contain QR codes can provide access to patient testimo nials or a landing page to submit requests for more information. By simplifying the process of fulfilling a patient’s request to “tell me more,” QR codes give practices an easy (and did I mention free?) way to build relationships, influence patient health choices and outcomes, direct patients to the content you intended for them to see and send the message that your practice is on the leading edge of technology. 


1 2

Decide how QR Codes fit into your overall marketing and education effort. Which real-world situations do you want to link to web content?

Setting up a QR plan doesn’t have to involve a big up-front expense. Use free programs like Kaywa ( to generate codes for your campaigns, and free readers like i-nigma for iPhone ( and QRDroid for Android ( to get started right away.


Think carefully about where you place the codes themselves. You want people to have access to the info without making the code itself the center of the message. The code is the link to more, not the point of the marketing effort. And make sure people can see and frame the code easily enough that they don’t struggle to scan it. Don’t add friction now!


Don’t assume everyone knows what the code is or what to do with it. Give them a clear call to action, complete with instructions. “Scan this code with a QR reader to receive (learn more, find out, book now...)"


Make sure the payoff at the other end of the code is worth the effort. Give them some real value for their scan. It could be a discount, it could be exclusive, it could be a simple way to make an appointment with you (win-win!) Don’t just have people scan, if the effort won’t be rewarded with real value.

practice tips

Helpful Hints for Submitting Dental Insurance Claims

By Edward Logan, DDS


entists are reminded daily of the importance that accurate and efficient submission of insurance claims on behalf of their patients has on their bottom line. If you submit insurance claims as a service to your patients, every time you perform a procedure that entitles payment you are required to send documentation of the procedural codes, descriptions of the services provided

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and the reasons necessitating the performed treatment to the payer. If your practice does not accept assignment of benefits from insurance companies, you are not required to provide that information. Under this payment arrangement, insurance companies pay patients directly, making them responsible for paying you. In this case, you are required to provide the patient with a statement detailing

the procedures performed and their associated codes that they forward, along with a claim form, to their insurance company for payment. The only exception to this rule of insurance companies paying dentists directly is found with Delta Dental Insurance, who reimburses patients for services rendered even when the dentist does not accept assignment of benefits for the practice’s patients. Insurance companies are beginning to reduce the number of x-rays required for claim processing. Crowns, bridges and root canals are the main procedures that full mouth x-rays and full mouth periodontal pocket charting that routinely accompany a claim for scaling and root planning. Some insurance companies no longer request x-rays for any procedures. Your front office manager should become familiar with the requirements of each insurance company in order to expedite the processing of claims and ensure timely reimbursement. Expected payment time on a claim will range between two and four weeks. Several major insurance companies encourage direct deposit into your bank account to accelerate the

payment process. One concern about direct deposits is that a paper copy of the explanation of benefits (EOB) often does not accompany the payment. The EOB can only be accessed online, requiring the staff member posting payments to print out these EOBs to keep in patient files. Your staff should be cautious of missing an EOB online and not crediting a patient account accurately. Additionally, direct deposit does not allow the matching of posted payments with a daily deposit slip and requires checking the bank statements for each deposit. Certain banks charge a fee for so many individual direct deposits to your account. Expected payment time and actual payment time may vary tremendously. You will quickly learn which payers are notoriously delinquent and which submit payments in a timely fashion. The goal is to receive payment as promptly as possible, because as is the case with a crime scene, the longer the case goes unsolved, the less is the likelihood that it ever will be. Insurance companies are infamous not only for denying claims, but also for delaying payment indefinitely. They know that the longer an employee lingers over a claim, the greater the probability that the employee will overlook its hanging in abeyance or forget about it altogether. It is incumbent on you to instill in your employees the highest level of diligence in collecting on every claim. It should be made a matter of pride to not fall prey to the postponement ploys of insurance companies. You are entitled to that money, you earned it and therefore you should ensure that you are paid! Interestingly, after establishing your office as one that demands to be paid, insurance companies tend to fall in line and exclude you from the list of practices they bully. Insurance companies highly recommend pre-authorization, also known

as pre-treatment estimates, for larger procedures. Pre-treatment estimates provide a patient with the exact amount their insurance company will pay and the amount they will owe. They also provide reassurance that the proposed treatment will be approved. The disadvantage to these pre-authorizations is the delay in treatment and scheduling they necessitate. It can take over a month before an estimate is returned. By this time, the dental disease may have progressed, or the patient may have forgotten about the importance of the procedure. I prefer to avoid the pre-authorization step if possible. It is an insurance company stall tactic, and many times will result in no treatment being rendered and therefore no payment being required. Whatever form of claim submission you implement, the collection of insurance monies receivable should be one of the most critical staff training components of your business. As a dentist, you can be the best diagnostician, the greatest communicator and the most skilled clinician with the capability of providing the highest quality dental care faster and more efficiently than your peers. You may be the most gregarious, friendly and endearing health care provider available and possess the most astute knowledge of business. However, you are not likely in charge of collecting on what you have produced. It is crucial to thoroughly train your staff in the importance of properly gathering data, submitting accurate claims and tracking their status until the full payment is received.

Electronic Claim Submission Filing claims online saves time and money, especially if your dental software is encoded with specific electronic submission programs. Electronic

claims are processed for the insurance companies by third-party merchants. Most of these vendors charge a fee per claim submitted that covers the cost of postage, printing and processing. Some dental insurance companies absorb this fee and offer free electronic claims through a vendor. It makes sense for insurance companies to do this because the process of receiving claims electronically significantly reduces their required staff time and associated overhead. Claim Connect is an electronic submission software that provides a simple process for filing claims and the largest number of insurance companies for which they offer free processing. Claim Connect’s system notifies you if a claim contains an error or cannot be processed; it also monitors the status of each submission, allowing you to verify if and when the claim was received. Gone are the days of the customary insurance company reply, “We never received that claim, it must have gotten lost in the mail.” The introduction and increasing popularity of electronic claim submission has revolutionized the way we are remunerated for our services. Claims previously delayed or denied under the old system are now processed and paid expediently. Claim Connect is integrated to work with most major dental practice software programs including Eaglesoft and Dentrix, and has the capacity to transmit electronic attachments, such as digital x-rays, through the use of FastAttach. You may utilize its free programs or Claim Connect’s paid service that includes claim processing and eligibility information for a more extensive network of insurance companies. For more information about Claim Connect please visit www.  MEDMONTHLY.COM |25

practice tips

Healthy Value Propositions to Attract and Retain Physicians By James E. Moniz, MSFS, President of Northeast VisionLink

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hysician shortages are being experienced throughout the country as a result of various economic, geographic and demographic conditions, and are predicted to get worse. In order to attract and retain quality doctors, medical practices must employ specific recruitment and retention strategies that speak to physicians as individuals and to the organization as a whole. A framework for building and communicating a balanced approach to compensation must give proper weight to short and long-term incentives as well as fixed and variable pay. Competitive salaries with bonuses are fundamental in attracting exemplary physicians and surgeons; however, health care environments that foster loyalty and achievement often do so through long-term incentive programs that create a “value proposition.” These programs trump high salaries and bonuses by providing the ability to grow wealth and impact future compensation. For example, phantom stock is an equity incentive that can be tied exclusively to performance. Phantom stock plans are not tax-qualified and therefore not subject to the same tax rules as 401(k) plans and can act as “golden

handcuffs,” making a key member of a practice think twice about moving on to another opportunity. Deferral plans are gaining popularity since they allow for pre-tax contributions that mirror 401(k) contributions lost under limitation rules. A deferral plan is a bonus that gives throughout the year as it allows physicians to reduce their current income tax liability and watch funds grow tax-deferred. In addition, a medical practice can match contributions to cover those not allowed under a 401(k) plan, making the deferral plan an incentive for longevity. The foundation of a good incentive plan will include elements of vision, communication and motivation. A sound incentive program projects the potential that can be realized if incentive promises are fulfilled – by both the medical practice and the individual physician. The absence of welldefined indicators and framework of long-term benefits can cause even the most comprehensive program to fall short. Indicators – essentially the measures and metrics in a company’s reward strategy – are pivotal to a comprehensive incentive program. It can be difficult to determine the extent to incentivize physicians, as the

number of patients seen and revenue generated can vary widely. A general practitioner may see a high number of patients at relatively low incoming revenue per patient, compared with a surgeon who generates larger revenue with just a couple of procedures. Any incentive program must be built for the long-term so that a higher probability for retention exists. The role of indicators is to improve performance, influence behavior and create focus. These elements can only be accomplished through communication and consistent reinforcement that promotes a mindset of employee ownership. Without a base of thoroughly defined indicators, motivation can collapse, creating a domino effect that can negatively impact an organization’s structure and culture in short time. Compensation strategies must meet the requisite of the medical group and appeal to the individual goals of key physicians. If a doctor has a clear vision of how his/her performance impacts the group, a vested interest in the organization’s success is developed, creating a sense of ownership for the physician and will ultimately lead the medical group toward revenue growth.  MEDMONTHLY.COM |27

practice tips

A Vision for Success By Shauna Smith Duty

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hat will the New Year bring for your practice? For private physicians, balance should be a resolution in the coming months. Attending to patients, managing employees and running your office must flow with continuing education, human resources, patient retention and personal time. Marketing, then, seems to be one more rock in the mountain of things to do. Never forget that you are the ruler of your schedule. Careful planning and execution will save valuable time and keep you on the road to success in all areas of your professional and personal life.

What is marketing? The American Marketing Association defines marketing as “the activity, set of instructions, and processes for creating, communicating, delivering, and exchanging offers that have value for customers, clients, partners and society at large.” In short, marketing is your practice’s external communication with potential patients and the community.

Why does a physician need marketing? While the purpose of a physician’s office is to help people lead healthy, high quality lives, the profitable physician’s office consistently attracts new patients through marketing. From a solid website and blog to newspaper articles and word of mouth, marketing is essential for both short-term and long-term success in business. The most important thing to remember is to plan and execute. If you want to attract more patients, plan to market and then follow through by sticking to your marketing plan.


Brand Your Practice

Every business has an identity, but not all convey it with a well-managed brand. From logo design and tagline creation to every piece of collateral and online content associated with your practice, branding is a big undertaking. A solid branding campaign will ensure a consistent and accurate message goes out to your potential patients.


Involve Your Team

The term “corporate culture” is big these days. Zappos, Red Frog, Google, Amazon—business owners should be familiar with the culture of these successful companies. (If you aren’t, familiarize yourself right now!) Part of creating a great business requires activating your team members in everything from office decor to marketing. Let your team know about your plans for online, print and in-office marketing and give them tasks so that they can contribute. Their buy-in could lead to case acceptance and greater word of mouth referrals.


Engage in the Internet

You can hire a marketing firm to Tweet, post and chat about your office online, but you need to engage in social networking, as well. Facebook, Twitter and Google+ are a few of the most popular social networks. You must comment, respond and share to reap the benefits of online communities to engage your patients!

4 Measure ROI

Any savvy businessman or woman will tell you to track ROI (return on investment). This means, your office administrators need to document the many roads that lead potential patients to your office. Furthermore, stay on top of your website’s Google Analytics, track your YouTube views and if you use a quick response (QR) code, be sure to pay for associated reporting data. Doctors often repeat poor marketing choices because they can’t gauge effectiveness. As a rule, if

you cannot track return on your investment, don’t invest.

5 Measure your efforts

At the end of each month and each quarter, review your marketing plan with your team to make sure that you’re staying on track. Make tweaks as necessary, and always enforce deadlines.


Partner with Professionals


Prioritize Service

Like-minded local business owners, those that are interested in healthy living, may be interested in link-swapping, a search engine optimizing (SEO) tactic that is mutually beneficial. They may also go in with you on marketing projects that would expand both of your client bases. You can lead a patient to a doctor’s office, but if you don’t provide good service, they won’t return. Word of mouth marketing is the most cost effective strategy for attracting loyal patients. The service your team provides has a direct impact on word of mouth referrals. Hire a secret shopper to report back to you on all types of communication with your office: email, phone call, blog comment, Facebook comment, appointment scheduling, appointment rescheduling and an actual in-person appointment. You can learn a lot from an outsider’s review of your customer service.

8 Educate Patients

Everyone wants to be smarter. By educating your patients on their health, healthy living and new procedures, you’re empowering them with knowledge, and they’ll appreciate you for it! At every opportunity, share your expertise with your patients.

9 Ask for Referrals

Though it can be intimidating or even embarrassing (at first) to ask for referrals, studies show that business people who ask for referrals tend to get more referrals than those who neglect to ask. Just do it!  MEDMONTHLY.COM |29


Can You Prevent Your Patients from Criticizing You? With so many outlets to share opinions, patient satisfaction is paramount By Kimberly Licata


very practitioner has likely wondered about it... can you legally prevent your patients from criticizing you? Patient review and inevitable criticisms of providers have gained importance as online stories and comments have the propensity to spread like wild fire. Providers look for ways to manage their reputation and online presence, and some resort to using contracts with patients that purportedly prohibited the patients from publishing bad reviews or criticisms, among other restraints. Recently, the legality of a dentist-patient contract that required patients to give up their rights to criticize their providers online came under scrutiny by the Federal Trade Commission (FTC) and a New York-based federal court. Involved in these complaints were not only dentists, but also a company that provided such agreements to practitioners to use in their practice. The two actions were a federal court case, Lee v. Makhnevich, Southern District of New York (SDNY), No. 11-8665 (filed 11/29/11), and a FTC complaint, In re Medical Justice Corp., FTC docket number not available (filed 11/29/11). These legal battles are potentially not limited to dentists, and

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may implicate all types of professional service providers. The agreements in these matters are not novel in their approach to an age-old problem faced by marketers everywhere: protecting your “brand” or reputation. Over the years, many have questioned if such agreements are enforceable, specifically in matters that sought to stop patients from publishing comments about their provider and from disparaging a provider. The agreements went further and assigned the copyright to any text published by the patient to the provider that were mentioned in the comments. Nondisparagement and prohibition on certain communications are not new concepts or provisions. Similar provisions have found their place in other common legal documents, like, for example, settlement and severance agreements. In legal documents where such provisions have previously been included and enforced, the interests have often focused on restricting the conduct or communications of the parties to the agreement as a means of resolving a dispute. Employers have faced legal challenges, including enforcement actions by the FTC and others, when prospectively attempting to restrain their employees’

communications about the employer or their reputation. These contract provisions are an attempt to protect a brand or reputation, a valid business interest. In certain contexts, this otherwise valid interest may be considered less important than free communication or expression. Managing your reputation has become a balancing act between protecting a valid business interest, while not infringing on long-standing rights. In the context of patient communication about providers, the issue becomes more sensitive. People want to gather information about providers before, during and throughout a relationship. Because of this, the challenge to these agreements in the professional realm has focused on unconscionability, the infringement of patients’ First Amendment right to free speech and their misuse of federal copyright law to restrain patient communication about experiences with providers. While the matters identified remain active, following these assertions (although the company disclaims a link to the legal complaints), the company involved has ceased marketing the agreements and has advised providers to stop using such a prohibition.

Notwithstanding the likelihood that the agreements in the FTC and court cases above may no longer present an active legal issue with the company’s change of strategy, these activities focus our attention on an important problem for providers: how do you protect your reputation or your brand both online and otherwise? In hindsight, requesting a patient to sign an agreement not to communicate about your services may not be the best option. Instead, you should consider the following:  Communicate with your patients and address any concerns before and after any encounter.  Carefully explain all procedures and be sure that your patient under stands the risks, benefits and likely outcome of your services. Disap pointed patients are one thing; dis appointed patients who feel like they have been deceived or mis treated through lack of communi cation or otherwise are an entirely different (and significantly more volatile) problem. Your informed consent process can be a powerful tool in your practice for improving communication.  Address any complaint promptly and appropriately. Do not minimize a patient’s concerns over an issue, especially an adverse outcome (by result or cost to the patient). Don’t let a patient believe that you need to be sued to hear his or her complaint. Having good communication skills won’t necessarily prevent a negative review from or experience with a patient, but it will significantly reduce the likelihood of a patient telling others about their complaints or concerns. Working to diffuse a tense situation with an upset patient will yield far better results (on average) than contractual attempts to prevent communication. Remember good communication goes a long way. Be accessible to your patients to establish the type of environment and relationship where complaints and claims can be ad-

dressed and worked through before they cause you legal (or business) headaches. If you are considering a more formal process for handling and responding to patient complaints (online or otherwise) or want a current policy or practice reviewed, consult your attorney or a health lawyer familiar with the related case law and issues of patient communication. You should also contact your professional liability insurer about other resources they may offer regarding patient communications and handling patient complaints. Frequently, professional liability insurers have risk managers and others on their staff who are

willing and able to provide valuable insights and resources on practice topics, such as patient communications or complaints. Finally, you can contact a variety of companies who, for a fee, will manage your online reputation and brand. When you consider developing or revising an online strategy for your practice, be sure that the company or consultant you hire is familiar with your industry and your potential risks. Editor’s Note: These comments are not intended to establish an attorney-client relationship and are not intended to be legal advice. 

Connect. Find. Learn. CED Life Science Conference Feburary 15–16, 2012 Raleigh Convention Center

The conference features: partnering sessions, entrepreneur and grants workshops, financing panel, and more. CED, BIO, and NCBIO members save $200 on registration. Register at

Featured speakers: Christopher A. Viehbacher Chief Executive Officer, Sanofi

Alex Gorsky Vice Chairman of Johnson & Johnson’s Executive Committee Mehmood Khan, M.D. Chief Scientific Officer and Chief Executive Officer, Global Nutrition Group, PepsiCo Full list of speakers and agenda available online at


Perspective on Hospital Acquisition Strategy Is independence still an option in today's enviroment? By Cameron M. Cox, III, MHA, FACMP, President at Management Services On-call


ndependence has been, is and will continue to be a challenging road for physicians. However, like all business decisions, a modified structure and effective strategy will carry a practice through difficult times. This may require an investment of capital to improve technology, facilities and operations. It may also be necessary to improve marketing techniques or become more focused on providing

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outstanding customer service to ensure patient satisfaction. Your success will stem from your efforts. Understanding the genesis of acquisition strategy is simple when you consider the basic strengths, weaknesses, opportunities and threats (SWOT) analysis of a typical small physician practice and a hospital. As two of the primary components of a community’s health care delivery system, it is im-

perative that survival and progress are maintained. Physicians face numerous threats such as:  mandated technology requirements; tiered programs from insurers/employers;  increased branding by systems;  proposed bundled payments by government programs;  mounting pressure to recruit new physicians to meet the health care demands of the surging “boomer” generation. Acquisition seems inevitable when practices weigh the positive and negative aspects of maintaining independence. Likewise, hospitals need to maintain; the stream of patients to the system, leverage size for better reimbursement, enhance the current technology infrastructure and capitalize on multiple projects at the same time. The health care industry is currently under a tremendous amount of scrutiny. Employers, insurers and government agencies expect measurable quality care in return for dollars spent, and this expectation is perfectly reasonable. The ability to meet this objective, however, is almost insurmountable with the current infrastructure of most health care systems. The strategy of collaboration has been instituted in many communities as a result of this apparently unattainable goal. Is this current trend an indication of the future of health care? There are numerous similarities when you compare today’s activities with those of the 90s. The parallels encompass the economic pressures (i.e., recession, high unemployment) of the respective periods. These financial burdens force insurance carriers, employers and the government to closely monitor how their health care dollars are being spent. The differences between these periods are striking and relate primarily to technology, physician work force and the growing baby boomer population.

At present, technology dominates the landscape. Mobile health care apps, patient portals and online health care education/information are currently the norm for patients. Physician shortage is almost a certainty, and the pressure that physicians face to bring new health care providers to the practice requires a new level of diligence that is overwhelming. The volume of patients continues to increase as the aging population begins to require more medical services. Patients today are savvy consumers, which presents a tremendous opportunity as physicians already deliver one-to-one care to their respective

patients. In conjunction with the advent of the Internet and technology, this opportunity can be maximized to lay the groundwork for prosperity. The pathway to this success is not as easy as it was in the past. Simply hanging out a shingle, opening the office at 8 a.m. and putting magazines in the waiting room are no longer effective strategies. You must reinvest in the business of your practice of medicine in order to reap the rewards of remaining independent – both from a financial and personal perspective. What can we learn from the current environment? Perhaps an alternative strategy is in order. Economics

101 suggests that the high demand of health care needs combined with a low supply of physicians supported by an improved and robust technological infrastructure would imply a bright future for independent physicians. However, the road to independence is not easy to navigate. An effective strategy for developing a solid infrastructure is necessary and attainable in order to avoid the potholes and fallen trees that obstruct the road to independence. Practices must incorporate more effective business intelligence and manage the dynamics of consumerism as they move into an age of one-to-one marketing and better-informed patients. 

9th Annual

Non-Clinical Careers for Physicians

Your Action Plan for the Future October 20–21, 2012, Chicago, IL

Also featuring recruiters and employers

Nutrition and physical activity for all ages! Our mission is to provide customized, simple nutrition solutions to enhance health and optimize sports performance. We offer many individualized services in nutrition, fitness, and corporate wellness according to your specific needs and interests. We are also a Blue Cross Blue Shield of North Carolina insurance provider. BCBS participants are eligible for up to 6 free face-to-face nutrition counseling sessions per year with a Registered Dietitian. Refer to us today! Tracy Owens, MPH, RD, CSSD, LDN Ashley Acornley, MS, RD, LDN 6200 Falls of Neuse Road, Suite 200 Raleigh, NC 27609 919-876-9779


ICD-10 Specialty Round-Up Documentation tips and hints for the new coding manual By Suzanne Leder, BA, M. Phil., CPC, COBGC, certified AHIMA ICD-10 trainer, and executive editor at The Coding Institute


art of your 2012 New Year’s resolution should be preparing for International Classification od Diseases 10th Revision (ICD-10). Centers for Medicare and Medicaid Services (CMS) has not instituted any delay or elimination of ICD-10, which means you’ll need to be ready to use the new code set by Oct. 1, 2013 — less than two years away.

The codes are also specific to acute cases, as opposed to chronic. Coding for DVT will become more detailed under ICD-10, following is what you can expect.

Rule of thumb: You should search

 I82.441, Acute embolism and thrombosis of right tibial vein  I82.442, Acute embolism and thrombosis of left tibial vein  I82.443, Acute embolism and thrombosis of tibial vein, bilateral  I82.449, Acute embolism and thrombosis of unspecified tibial vein  I82.491, Acute embolism and thrombosis of other specified deep vein of right lower extremity  I82.492, Acute embolism and thrombosis of other specified deep vein of left lower extremity  I82.493, Acute embolism and thrombosis of other specified deep vein of lower extremity, bilateral  I82.499, Acute embolism and thrombosis of other specified deep vein of unspecified lower extremity

for specificity whenever possible, which means expanding your documentation in certain situations. Examine these top diagnoses for cardiology, oncology, orthopedics, general surgery, ob-gyn and radiology and how they change in ICD-10.

CARDIOLOGY: CHECK OUT YOUR NEW DVT CHOICES FOR 2013 An embolism is the obstruction of a vessel by a clot or foreign substance (such as plaque or fatty deposits). Thrombosis is obstruction by a blood clot. The codes featured here are specific to deep vessel, and are appropriate for deep vein thrombosis (DVT). 34| FEBRUARY 2012

ICD-9-CM 2011 code:

 453.42, Acute venous embolism and thrombosis of deep vessels of distal lower extremity

ICD-10-CM 2011 codes:

 I82.4Z1, Acute embolism and thrombosis of unspecified deep veins of right distal lower extremity  I82.4Z2, Acute embolism and thrombosis of unspecified deep veins of left distal lower extremity  I82.4Z3, Acute embolism and thrombosis of unspecified deep veins of distal lower extremity, bilateral  I82.4Z9, Acute embolism and thrombosis of unspecified deep veins of unspecified distal lower extremity ICD-10 expands your options dramatically, creating codes that differ based on if the diagnosis involves the right leg, the left leg, both legs or an unspecified leg. You also must choose among codes that differ based on whether the vein involved is the tibial, another specified vein or is not specified.

Takeaway: Your documentation

must be clear about the vessel(s) and limb(s) involved for you to choose the most appropriate ICD-10 code. Remember that “other” means you documented the type, but ICD-10 doesn’t offer a code specific to the documented type. “Unspecified” means you did not document the

ICD-10 coding examples to prepare your practice for the conversion.

required information.

Coder tips: The codes shown here are specific to acute, deep vein and distal lower extremity diagnoses. You’ll see similarly detailed coding options for chronic and proximal lower extremity diagnoses, as well as diagnoses specific to other anatomic features, such as thoracic or upper extremity vessels. If these are diagnoses you see in your practice, take the time to review those new code ranges.

ONCOLOGY: GET SPECIFIC WITH UNSPECIFIED NONHODGKIN LYMPHOMAS When you start using ICD-10 in 2013, the new code set won’t always offer a simple one-to-one relationship to the old codes. Often, you’ll have additional options that may require tweaking the way your physician documents a service and the way your coder reports it. Right now, your go-to code for unspecified non-Hodgkin lymphoma (NHL) is 202.8x (other lymphomas). So 202.8x serves as both a not elsewhere classifiable/other specified (NEC) and not otherwise specified/ unspecified (NOS) code.

ICD-10-CM change: ICD-10 does this differently, offering one code range for NHL NEC and another for NHL NOS.

NEC: ICD-10 2011 includes C85.8-

(other specified types of non-Hodgkin lymphoma) for reporting NHL when you document the type, but ICD-10 doesn’t offer a more specific code appropriate for that diagnosis. To start preparing to use this code range, take a close look at the ICD-10 codes available for specified types of NHL. 36| FEBRUARY 2012

That way, you’ll be able to identify more quickly when you document a type that doesn’t match available specific codes. And, just as with ICD9, be sure to start your ICD-10 code search in the index for terms that match your documentation. That will help you identify the most specific code for your case.

NOS: ICD-10 2011 includes C85.9-

(non-Hodgkin lymphoma, unspecified) for when you document NHL without stating the specific type. Keep in mind; the NHL codes require a fifth digit to be complete. The fifth digit sub-classification is based on the lymph nodes involved. The ICD-10 and ICD-9 options are similar, with one important difference. You will have separate ICD-10 options for unspecified site (0) and extranodal and solid organ sites (9). In ICD-9, the two are both reported using fifth digit (0).

ORTHOPEDICS: PAY ATTENTION TO LATERALITY WHEN REPORTING MERALGIA PARESTHETICA Meralgia paresthetica may be a diagnosis you encounter frequently in your orthopedic practice; under ICD10, you’ll need to look specifically for laterality details to accurately code this condition. Code 355.1 Meralgia paresthetica in ICD-9 expands into three options in ICD-10, as of Oct. 1, 2013:  G57.10, Meralgia paresthetica, unspecified lower limb  G57.11, Meralgia paresthetica, right lower limb  G57.12, Meralgia paresthetica, left lower limb Meralgia paresthetica means the patient is experiencing numbness

or pain in the outer thigh that is not caused by an injury to the thigh but an injury to the sensory nerve supplying that region. This nerve, called the lateral femoral cutaneous nerve, extends from the spinal column to the thigh. The cause of the numbness or pain is usually an entrapment or compression of the nerve. The pain may be acute, severe and may radiate distantly into the groin or ribs. You’ll choose these codes based on if the complaints are in the right or left lower limb. You do have an unspecified option, but payers will want the highest specificity: either right or left. Make sure you clearly specify which side was affected.

Takeaway: You probably already

documented the patient has meralgia paresthetica in the right or left lower limb, but in ICD-10-CM, you have a new way to reflect that.

GENERAL SURGERY: APPLY THESE NEW APPENDICITIS ADDITIONS When you remove an appendix, you’ll have more specific diagnosis code choices under ICD-10. Coding for acute appendicitis will change as follows, from ICD-9 to ICD-10:  540.0 (Acute appendicitis with generalized peritonitis) becomes K35.2 with an identical definition.  540.1 (Acute appendicitis with peritoneal abscess) becomes K35.3 (acute appendicitis with localized peritonitis).  540.9 (Acute appendicitis without peritonitis) leads to two possible ICD-10 codes: K35.80 (unspecified acute appendicitis) or K35.89 (other acute appendicitis). ICD-10 provides a similar distinction

between “other” and “unspecified” for the following ICD-9 to ICD-10 crosswalks:  541 (Appendicitis unqualified) becomes K37 (unspecified appendicitis).  542 (Other appendicitis) becomes K36 (other appendicitis).

Note: Although you’ll find a

one-to-one crosswalk for appendix hyperplasia (543.0, hyperplasia of appendix [lymphoid] to K38.0, hyperplasia of appendix), ICD-10 provides many more specific codes for other conditions. Instead of ICD-9’s 543.9 (other and unspecified diseases of appendix), you’ll choose one of the following codes starting Oct. 1, 2013:  K38.1, Appendicular concretions  K38.2, Diverticulum of appendix  K38.3, Fistula of appendix  K38.8, Other specified diseases of appendix  K38.9, Disease of appendix, unspecified.

Takeaway: You should be ultra specific when documenting a patient’s appendicitis.

OB-GYN: YOUR LEUKORRHEA CODE WILL BECOME A GENERAL ONE If a patient has leukorrhea, she has whitish, yellowish or greenish discharge from the vagina. The discharge can be normal or the sign of an infection. Right now, you should report this condition with 623.5 (leukorrhea not specified as infective). When you switch to ICD-10, you should report N98.8 (other specified noninflammatory disorders of

vagina) instead. These two codes have a one-to-one correlation, but you should examine how the descriptors differ.

Takeaway: You should turn

to code N89.8 when documenting leukorrhea. If you document leukorrhea NOS, you’ll still turn to N89.8 because this term appears as an explanatory term under N89.8.

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RADIOLOGY: N20.2 ADDS OPTION TO KIDNEY AND URETER CALCULUS CODING Kidney stone sufferers number in the millions each year. Because those numbers are on the rise, the diagnosis code for this ailment is sure to still rank among your commonly used codes when the transition to ICD-10 occurs in 2013.


Good news: For “calculus of

kidney and ureter” codes, you’ll find almost a one-to-one code correspondence between ICD-9 2011 and ICD-10 2011. The major difference is that ICD-10 offers a code (N20.2) that is appropriate when the patient has calculi of both the kidney and the ureter. Under ICD-9, you would report the same diagnosis using two codes (592.0 and 592.1). Learn more at ICD10/ and icd/icd10cm.htm#10update

WANT MORE SPECIALTY EXAMPLES LIKE THIS? Get more specialty-specific information and coding guidelines advice. Subscribe to the ICD10 Coding Alert at http://www. 





Personalize. Promote. Profit.


the arts



s patients become more informed about their health and are given more provider options, the value of positive patient experience has skyrocketed and become a major competitive focal point in the health care today. Patients and their families no longer expect doctors to simply treat, they are demanding to be – and respond better when – shown compassion. Although a physician’s ability to empathize with patients is more essential than ever before, some doctors still find it difficult to utilize both their knowledge and intuition at the same time during their daily routine of practicing medicine. Marianne Mitchell, a professor at the Division of Medical Humanities of Drexel University College of Medicine in Philadelphia, teaches medical students how to enhance their capability to be more considerate and in tune with their patients with a unique theory that she has developed on how to integrate logical and intuitive thought. Mitchell instructs her students on the application of this theory through the process of painting abstract art. Through her experience as both an artist and a teacher, Mitchell has developed an understanding of the relationship between the right and left sides of the brain that she applies to her paintings. “My process of creating a painting always starts in 'reckless abandonment mode' – the subconscious, intuitive realm of thought – and eventually employs my 'critic'– logical, linear thought, to determine the next course of action in the work,” Mitchell says. “Making a painting is a continuous, simultaneous process of going back and forth between spontaneity and intention – intuition and logic – ultimately leading to its completion.”

38| FEBRUARY 2012

Mitchell’s course offers insight into the complementary roles of emotional and analytical thinking in regards to developing a comprehensive approach to patient interaction. It also allows medical students to take a break from their rigid schedule to seek personal discovery through the process of creating abstract art. “There is an initial focus on intuitive thinking through a series of drawing exercises, immediately eliminating the student’s control over the outcome and judgment regarding what it ‘should’ be and what it ‘is’," Mitchell says. “When delight in the unknown and acceptance of their own expression is apparent, tools of logical composition are introduced.” The objective is for students to learn to shift from intuition and logic simultaneously, which will enhance their development as doctors, she says. The feedback that Mitchell receives from both students and medical faculty is extremely positive. The course was the highest rated humanities elective at Drexel University for the past two years, with this being its third year offering. Mitchell says that her students seem to enjoy the break from their intense medical curriculum and find that they have a better understanding of themselves and others after taking the class. Mitchell recently had her seventh solo exhibition at the Rosenfeld Gallery in Philadelphia where she has been represented for the past 15 years. Other recent acquisitions of her work include Capital Health in Hopewell, N.J., Sloan Kettering Cancer Research Center in New York and Wharton School of Business in Philadelphia. To find out more about Marianne Mitchell please visit 




the kitchen


Just for Two

alentine’s Day is a festive, flirty holiday that is filled with sweets. This year, instead of ordering a calorie-laden, expensive dessert at a restaurant, try making a healthier option in the comfort of your own home. This recipe for chocolate hazelnut fondue is delicious and romantic to share with your significant other!



Serves 2 Fondue: 2/3 cup fat-free chocolate syrup 1/4 cup chocolate hazelnut spread

For dipping: 1 pint strawberries 3 kiwis, sliced 2 oranges, sectioned 1 small banana, sliced 5 1/2 ounces cubed angel food cake

Preparation: To make the fondue, stir chocolate syrup and chocolate hazelnut spread together in a small saucepan over low heat until smooth and warm. Serve warm or at room temperature. Arrange strawberries, kiwi slices, orange sections, bananas and angel food cake cubes around the sauce. Serve with toothpicks or fondue forks.

40| FEBRUARY 2012

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919.848.4202 |

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Virginia Perimeter Center 9960 Maryland Dr. Suite 300 Henrico, VA 23233 (804)367-4538 Washington 310 Israel Rd. SE P.O. Box 47865 Olympia, WA 98504 (360)236-4700 West Virginia 1319 Robert C. Byrd Dr. P.O. Box 1447 Crab Orchard, WV 25827 1-877-914-8266 Wisconsin P.O. Box 8935 Madison, WI 53708 1-877-617-1565 Wyoming 1800 Carey Ave. 4th Floor Cheyenne, WY 82002 (307)777-6529

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46| FEBRUARY 2012

Idaho Idaho Board of Medicine P.O. Box 83720 Boise, Idaho 83720 208-327-7000 Illinois 320 West Washington St. Springfield, IL 62786 217-785 -0820 Indiana 402 W. Washington St. #W072 Indianapolis, IN 46204 317-233-0800 Iowa 400 SW 8th St., Suite C Des Moines, IA 50309  515-281-6641 Kansas 800 SW Jackson, Lower Level, Suite A Topeka, KS 66612 785-296-7413 Kentucky 310 Whittington Pkwy., Suite 1B Louisville, KY  40222 502-429-7150

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391 Technology Way Winston Salem, NC 27101 336-722-8910

Dicom Solutions

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

548 Wald Irvine, CA 92618 800-377-2617

Radical Radiology

524 Huffman Rd. Birmingham, AL 35215 866-324-9700

Roche Diagnostics

Julie Jennings 678-772-0889 Eduardo Lapetina 318 North Estes Drive Chapel Hill, NC 27514 919-960-3400


9115 Hague Rd. PO Box 50457 Indianapolis, IN 46250-0457 317-521-2000

MEDICAL PRACTICE SALES Medical Practice Listings

8317 Six Forks Rd. Ste #205 Raleigh, NC 27624 919-848-4202



3240 Whipple Road Union City, CA 94587 800-822-2947


ALLPRO Imaging


Biosite, Inc

Arup Laboratories

Brymill Cryogenic Systems 105 Windermere Ave. Ellington, CT 06029 860-875-2460

50| FEBRUARY 2012

NUTRITION THERAPIST Triangle Nutrition Therapy 6200 Falls of Neuse Road, Suite 200 Raleigh, NC 27609 919-876-9779

SUPPLIES, GENERAL BSN Medical 5825 Carnegie Boulevard Charlotte, NC 28209 800-552-1157 CNF Medical 1100 Patterson Avenue Winston Salem, NC 27101 877-631-3077 Dermabond Ethicon Route 22 West Somerville, NJ 08876 877-984-4266 DJO 1430 Decision St. Vista, CA 92081 760-727-1280

PO Box 99488 Raleigh, NC 27624 919-846-4747

1295 Walt Whitman Road Melville, NY 11747 888-862-4050 9975 Summers Ridge Road San Diego, CA 92121 858-805-8378

507 N. Lindsay St. 2nd Floor High Point, NC 27262

ExpertMed 31778 Enterprise Dr. Livonia, MI 48150 800-447-5050

Gebauer Company 500 Chipeta Way Salt Lake City, UT 84108 800-242-2787

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

4444 East 153rd St. Cleveland, OH 44128-2955 216-581-3030

Scarguard 15 Barstow Rd. Great Neck, NY 11021 877-566-5935

Buying or selling? We can help! Listing Benefits • • • • •

Buying Benefits

Maintain confidentiality Professional representation National and regional marketing Maximize your practice value BizScore Valuation assessment

• Accurate practice pricing • Detailed reports and financials • Largest selection of health care facilities • Work one-on-one with an experienced team of qualified professionals

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

A Philip Driver Company

classified listings

Classified To place a classified ad, call 919.747.9031

Physicians needed

Physicians needed

North Carolina

North Carolina (cont.)

Occupation Health Care Practice located in Greensboro, N.C. has an immediate opening for a primary care physician. This is 40 hours per week opportunity with a base salary of $135,000 plus incentives, professional liability insurance and an excellent CME, vacation and sick leave package. Send copies of your CV, N.C. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, N.C. 27624, and PH: (919) 845-0054, E-mail:

setting for an enhanced lifestyle. There is no hospital call or invasive procedures. Look into joining this three physician facility and live the good live in one of North Carolina’s most beautiful cities. Send copies of your CV, N.C. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, N.C. 27624, and PH: (919) 845-0054, E-mail:

Family Practice physician opportunity in Raleigh, N.C. This is a locum’s position with three to four shifts per week requirement that will last for several months. You must be BC/BE and comfortable treating patients from one year of age to geriatrics. You will be surrounded by an exceptional, experienced staff with beautiful offices and accommodations. No call or hospital rounds. Send copies of your CV, N.C. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, N.C. 27624, and PH: (919) 845-0054, E-mail: Methadone Treatment Center located near Charlotte, N.C. has an opening for an experienced physician. You must be comfortable in the evaluation and treatment within the guidelines of a highly regulated environment. Practice operating hours are 6 a.m. till 3 p.m. Monday through Friday. Send copies of your CV, N.C. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, N.C. 27624, and PH: (919) 845-0054, E-mail: Family Practice physician is needed to cover several shifts per week in Rocky Mount, N.C. This high profile practice treats pediatrics, women’s health and primary care patients of all ages. If you are available for 30 plus hours per week for the remainder of the year, this could be the perfect opportunity. Send copies of your CV, N.C. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, N.C. 27624, and PH: (919) 845-0054, E-mail: Cardiology practice located in High Point, N.C. has an opening for a board certified cardiovascular physician. This established and beautiful facility offers the ideal 52| FEBRUARY 2012

Board Certified Internal Medicine Physician position is available in the Greensboro, N.C. area. This is an outpatient opportunity within a large established practice. The employment package contains salary plus incentives. Please send a copy of your current CV, N.C. medical license, DEA certificate and NPI certificate with number along with your detailed work history and CME courses completed to: Physician Solutions, P.O. Box 98313, Raleigh, N.C. 27624. Email: physiciansolutions@ or phone with any questions, PH: (919) 8450054. Locum Tenens opportunity for Primary Care MD in the Triad area N.C. This is a 40 hour per week on-going assignment in a fast pace established practice. You must be comfortable treating pediatrics to geriatrics. We pay top wage, provide professional liability insurance, lodging when necessary, mileage and exceptional opportunities. Please send a copy of your current CV, N.C. medical license, DEA certificate and NPI certificate with number along with your detailed work history and CME courses completed to: Physician Solutions, P.O. Box 98313, Raleigh, N.C. 27624. E-mail: physiciansolutions@ or phone with any questions, PH: (919) 8450054. Internal Medicine practice located in High Point, N.C., has two full time positions available. This well-established practice treats private pay as well as Medicare/ Medicaid patients. There is no call or rounds associated with this opportunity. If you consider yourself a wellrounded IM physician and enjoy a team environment, this could be your job. You would be required to live in or around High Point and if relocating is required, a moving package will be extended as part of your salary and incentive package. BC/BE MD should forward your CV, and copy of your N.C. medical license to View this and other exceptional physician opportunities at or call (919) 845-0054 to discuss your availability and options.

Careers Customer Service Day-to-Day Operations Your go-to resource for health-care practice management

Electronic Medical Records Finance Human Resources Innovation Leadership Marketing Medicare & Reimbursement Social Media

About the expert Mary Pat Whaley, FACMPE, is board certified in health-care management and a fellow in the American College of Medical Practice Executives. She has worked in health care and health-care management for over 25 years. Mary Pat is also a well-respected author and highly sought-out speaker and consultant.

Manage My Practice is the go-to online source of technology, information and resources for practice management professionals, and it is visited by over 10,000 medical-practice managers and medical providers each month.

Visit Today!

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


To find out more information call 919-848-4202 or e-mail

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

For more information call (919) 848-4202. To view other practice listings visit

Gross revenues in 2010 were 1.5 million, and there is even more upside. The retiring physician is willing to continue to practice for several months while the new owner gets established. Excellent medical equipment, staff and hospital near-by, you will be hard pressed to find a family practice turning out these numbers. Listing price is $625,000.

54| FEBRUARY 2012

e in Dall ce Practic

as, TX

We have a qualified buyer that is looking for an established hospice practice in the Dallas,Texas area. To review your hospice practice options confidentially, contact Medical Practice Listings at 919-848-4202 or e-mail us at

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

Medical Practice Listings

: d e t Wan

To view our national listings visit

Wanted: Urgent Care Practice Urgent Care Practice wanted in North Carolina. Qualified physician is seeking to purchase an established urgent care within 100 miles of Raleigh, North Carolina. If you are considering retiring, relocations or closing your practice for personal reasons, contact us for a confidential discussion regarding your urgent care. You will receive cash at closing and not be required to carry a note.

Medical Practice Listings Buying and selling made easy

Call 919-848-4202 or e-mail

Classified To place a classified ad, call 919.747.9031

Physicians needed

Practice sales

North Carolina (cont.)

North Carolina

Locum Tenens Primary Care Physicians Needed If you would like the flexibility and exceptional pay associated with locums, we have immediate opportunities in family, urgent care, pediatric, occupational health and county health departments in N.C. and Va. Call today to discuss your options and see why Physician Solutions has been the premier physician staffing company on the Eastern seaboard. Call 919-845-0054 or review our corporate capabilities at

Impressive Internal Medicine Practice in Durham, N.C.: The City of Medicine. Over 20 years serving the community, this practice is now listed for sale. There are four well equipped exam rooms, new computer equipment and a solid patient following. The owner is retiring and willing to continue with the new owner for a few months to assist with a smooth transition. Contact Medical Practice Listings at (919) 848-4202 for more information. View additional listings at:


Modern Vein Care Practice located in the mountains of N.C. Booking seven to 10 procedures per day, you will find this impressive vein practice attractive in many ways. Housed in the same practice building with an Internal Medicine, you will enjoy the referrals from this as well as other primary care and specialties in the community. We have this practice listed for $295,000 which includes charts, equipment and good will. Contact Medical Practice Listings at (919) 848-4202 for more information. View additional listings at

Urgent Care opportunities throughout Virginia. We have contracts with numerous facilities and eight to 14-hour shifts are available. If you have experience treating patients from Pediatrics to Geriatrics, we welcome your inquires. Send copies of your CV, Va. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, N.C. 27624, and PH: (919) 8450054, E-mail: Pediatric Locums Physician needed in Harrisonburg, Danville and Lynchburg, Va. These locum positions require 30 to 40 hours per week, on-going. If you are seeking a beautiful climate and flexibility with your schedule, please consider one of these opportunities. Send copies of your CV, Va. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, N.C. 27624, and PH: (919) 845-0054, E-mail:

Family Practice located in Hickory, N.C. Well-established and a solid 40 to 55 patients split between an MD and physician assistant. Experienced staff and outstanding medical equipment. Gross revenues average $1,500,000 with strong profits. Monthly practice rent is only $3,000 and the utilities are very reasonable. The practice with all equipment, charts and good will are priced at $625,000. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, N.C. 27624. PH: (919) 848-4202 or E-mail: medlistings@

MEDICAL PRACTICE LISTINGS Are you looking to sell or buy a practice? We can help you! View national practice listings by visiting our website or contact us for a confidential discussion regarding your practice options. We are always ready to assist you.

919.848.4202 | We have in-house practice experts and an attorney ready to assist. MEDMONTHLY.COM | 55

Classified To place a classified ad, call 919.747.9031

Practice for sale

Practice for sale

North Carolina (cont.)

South Carolina (cont.)

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

you want. Physician will to stay on for smooth transition. Hospital support is also an option for up to a year. The listing price is $395,000 for the practice, charts, equipment and good will. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, N.C. 27624. PH: (919) 848-4202 or E-mail:

Primary Care practice specializing in women’s care. The owning female physician is willing to continue with the practice for a reasonable time to assist with smooth ownership transfer.  The patient load is 35 to 40 patients per day, however that could double with a second provider.  Exceptional cash flow and profitable practice that will surprise even the most optimistic practice seeker.  This is a remarkable opportunity to purchase a well-established woman’s practice.  Spacious practice with several wellappointed exam rooms throughout.  New computers and medical management software add to this modern front desk environment.   This practice is being offered for $435,000. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, N.C. 27624. PH: (919) 848-4202 or E-mail:

South Carolina Lucrative ENT practice with room for growth, located three miles from the beach. Physician’s assistant, audiologist, esthetician and well-trained staff. Electronic medical records, mirror imaging system, established patient and referral base, hearing aids and balance testing, esthetic services and Candela laser. All aspects of otolaryngology, busy skin cancer practice, established referral base for reconstructive eyelid surgery, Botox and facial fillers. All new surgical equipment, image-guidance sinus surgery, balloon sinuplasty, nerve monitor for ear/parotid/ thyroid surgery. Room for establishing allergy, cosmetics, laryngology and trans-nasal esophagoscopy. All the organization is done; walk into a ready-made practice as your own boss and make the changes you want, when 56| FEBRUARY 2012

Washington Family Practice located in Bainbridge Island, Washington has recently been listed. Solid patient following and cash flow makes this 17 year old practice very attractive. Contact Medical Practice Listings for more details. Email: or (919) 848-4202.

Practice wanted North Carolina Pediatric Practice wanted in Raleigh, N.C. Medical Practice Listings has a qualified buyer for a Pediatric Practice in Raleigh, Cary or surrounding area. If you are retiring, relocating or considering your options as a pediatric practice owner, contact us and review your options. Medical Practice Listings is the leading seller of practices in the U.S. When you list with us, your practice receives exceptional national, regional and local exposure. Contact us today at (919) 848-4202.

Wanted: Classified ads

Call today to find out about all the advertising opportunities available with Med Monthly.


Visit us online anytime at

Pediatrics Practice For Sale Minneapolis, Minn.

Pediatrics Practice Wanted Pediatrics Practice wanted in N.C.

Located in the beautiful suburbs of Minneapolis, Minn., this two year old pediatric practice is successful and growing steadily. Averaging 14 patients per day and projected numbers top 35 per day within a short few months. Contracts have been established with Blue Cross Blue Shield of Minnesota, HealthPartners, Medica, PreferredOne, UCare, Minnesota Medicaid, and America’s PTO. Providers include one MD, one LPN and two CMAs.

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.

Fully equipped with modern computer networking in this 3,370 sq. foot leased medical space. Contact Medical Practice Listings for more information.

Medical Practice Listings 919.848.4202 |

MD STAFFING AGENCY FOR SALE Great opportunity for anyone who wants to purchase an established business.  One of the oldest Locums companies  Large client list  Dozens of MDs under contract  Executive office setting  Modern computers and equipment  Revenue over a million per year  Owner retiring  List price is over $2 million

Please direct all correspondence to Only serious, qualified inquirers.

Contact us today to discuss your options confidentially. Medical Practice Listings Call 919-848-4202 or e-mail PRACTICE FOR SALE

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

Asking price: $385,000

To view more listings visit us online at


Primary Care Practice For Sale

Exceptional North Carolina Primary Care Practice for Sale

Medical Practice Listings

Established North Carolina Primary Care practice only 15 minutes from Fayetteville, 30 minutes from Pinehurst, 1 hour from Raleigh, 15 minutes from Lumberton and about an hour from Wilmington. The population within 1 hour of this beautiful practice is over one million. The owning physician is retiring and the new owner will benefit from his exceptional health care, loyal patient following, professional decorating, beautiful and modern free standing medical building with experienced staff. The gross revenue for 2010 is $856,000, and the practice is very profitable. We have this practice listed for $415,000. Call today for more details and information regarding the medical building. Our Services: • Primary Health • Well Child Health Exams • Sport Physical • Adult Health Exams • Women’s Health Exams • Management of Contraception • DOT Health Exam • Treatment & Management of Medical Conditions • Counseling on Prevention of Preventable Diseases • Counseling on Mental Health • Minor surgical Procedures

919.848.4202 |

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

Wilmington, N.C. 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.

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

Established private internal medicine practice treating general as well as adolescent patients and licensed clinical psychologist’s combine for a high profile multi-disciplinary practice. The staff includes a medical doctor, physician assistant, three licensed clinical psychologists, and a complement of nurses and administrators. The internal medicine practice also uses locum physicians to treat primary care patients as needed. Excellent gross income with solid profits are enjoyed in this evergrowing practice located in a bustling community with handsome demographics. Two all brick condominiums house these practices which are offered for lease or purchase. This expanded services private health care facility has a solid following and all the tools necessary for enhanced services, income and expansion. For more details which include a BizScore Practice Valuation, financial statements, patient demographics and furniture and equipment details, contact one of our professionals.

Medical Practice Listings PH: (919) 848-4202 Email: 58| FEBRUARY 2012

N.C. MedSpa For Sale MedSpa Located in North Carolina We have recently listed a MedSpa in N.C. 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

Practice for Sale in Raleigh, NC Primary Care practice specializing in Women’s care Raleigh, North Carolina The owning female physician is willing to continue with the practice for a reasonable time to assist with smooth ownership transfer. The patient load is 35 to 40 patients per day, however, that could double with a second provider.  Exceptional cash flow and profitable practice that will surprise even the most optimistic practice seeker.  This is a remarkable opportunity to purchase a well-established woman’s practice.  Spacious practice with several well-appointed exam rooms, tactful and well appointed 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 view our other listings at


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

Physician Solutions has immediate opportunities for psychiatrists throughout N.C. 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 Ashley at 919-845-0054 or For more information about Physician Solutions or to see all of our locums and permanent listings, please visit

For more information call Medical Practice Listing at (919) 848-4202. To view our other listings, visit MEDMONTHLY.COM |59

the top

Tech for dental & vision

VOLK PICTOR DIGITAL IMAGING DEVICE The Volk Pictor is portable and offers four interchangeable imaging modules for ophthalmic examination.

For February’s Top 9 List we looked back at the technological advancements made in 2011 within the fields of dentistry and vision correction.


Compiled by Leigh Ann Simpson

THE LENSX LASER The LenSx Laser is the first femtosecond laser cleared for use in cataract surgery and offers image-guided precision and reproducibility.

REICHERT IPAC PACHYMETER The iPac Pachymeter is accurate, easy-to-use and hand held. Its features include bluetooth wireless connectivity, one-button navigation, rechargeable lithium ion battery and a three year warranty.


AIR TECHNIQUES SPECTRA CARIES DETECTION AID Using fluorescence technology, the Spectra Caries Detection Aid identifies decay with color and numerical readings and stores the images to track effectiveness overtime.


CURVE DENTAL WEB-BASED SOFTWARE Curve Dental yields maximum convenience with digital imaging that is sent from any camera to a cloud and can be accessed anywhere.

60| FEBRUARY 2012


EYLEA (AFLIBERCEPT) INJECTION Eylea was recently approved by the Food and Drug Administration (FDA) to treat patients with wet agerelated macular degeneration (one of the leading causes of vision loss in the elderly).


CADENT ITERO IMPRESSIONS Cadent iTero is designed to aid in all dental restoration procedures and increases efficiency with the use of real time digital scans of the teeth and bite that are instantly displayed and sent to a processing lab. TOPCOM CV-5000 COMPUTERIZED VISION TESTER The CV-5000 provides a 21 refraction vision screening with high-speed lens rotation, paperless refraction, a compact design and can send data to every CV system in the office.


DENTAL R.A.T. This simple device will streamline your computerized periodontal chartings, and because the Dental R.A.T. is hands-free, it reduces the amount of attention required from dental assistants allowing them to be more productive.

Trust patient education from the leading names in heart and stroke health. Krames is your source for American Heart Association and American Stroke Association patient education. Built on an 80-year foundation of research and science, these resources help healthcare professionals reach patients, caregivers, and at-risk groups to promote disease management and prevention, create awareness, and inspire change.

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Let MedMedia9’s expert designers create a website for your practce. Need more? We can also create print collateral to help your practice grow.

Scan this QR code with your smartphone to learn more.

MEDMEDIA9.COM | 919-747-9031


Med Monthly February 2012  

The vision and dental issue of Med Monthly magazine