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Med Monthly MAGAZINE

January 2018

New Tax Law’s Implications for the Health Care Industry pg. 24

the are Health C act Imp Reform’s r on You Practice issue

Will New Healthcare Reform Put the Patient First? Ring in the New Year With a New Practice Management Plan

pg. 26

pg. 20






practice tips








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LINDSAY DRIVER INSURANCE AGENCY Serving all of North Carolina Email: Web Address: Phone: 919.810.7438

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Physician Solutions, Inc. P.O. Box 98313 Raleigh, NC 27624 phone: 919-845-0054 fax: 919-845-1947

Scan this QR code with your smartphone to learn more.

Med Monthly January 2018 Publisher Creative Director Contributors

Philip Driver Thomas Hibbard Naren Arulrajah Bob Atlas Vishal Gandhi, BSEE, MBA Nick Hernandez, MBA, FACHE

contributors Naren Arulrajah is President and CEO of Ekwa Marketing, a complete Internet marketing company which focuses on SEO, social media, marketing education and the online reputations of Dentists and Physicians. If you have questions about marketing your practice online, call Naren direct at 877-249-9666.

Bob Atlas is President of EBG Advisors, Inc., responsible for growing the portfolio and directing the business affairs of EBG Advisors. He has decades’ worth of professional experience as advisor to senior leaders in the health care industry and governing authorities in both the private and public sectors. He is widely regarded for his strategic insight, objectivity, facilitation skills, and mastery of the complex business of health care

Vishal Gandhi, BSEE, MBA

Med Monthly is a national monthly magazine committed to providing insights about the health care profession focusing on practical advice for physicians and practices. We are currently accepting articles to be considered for publication. For more information on writing for Med Monthly, please email us at

P.O. Box 99488 Raleigh, NC 27624

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

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

Online 24/7 at


practice tips

2017 Med Monthly Cover Review


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It has been another fantastic year at Med Monthly and the cover art has been exceptional. Please feel free to click on the cover art to view that month’s issue online.

Topics Featured in 2017 January – Politics & Your Practice February – Preventive Medicine March – Locum Tenens April – Spring Cleaning Your Practice May – Checking In & Checking Out June – Making Your Practice More Valuable July – Selling Your Practice August – Clinical Trials & Your Practice September – The New “Medical Billing” October – Practices Going Paperless November – Your Practice Staff December – Modern Medical Lobby

Feature Topics for 2018 January – Health Care Reform’s Impact on Your Practice February – Your Dental Practice March – Travel Nurses and Doctors April – The Business of Medicine May – Women’s Health June – Alternative Sources of Revenue July – Considering Your Practice Options August – Telemedicine, eHealth and Your Patients September – Primary Care: Tips for Success October – Attracting New Patients November – Social Media and Your Practice December – Today’s Practice Model


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practice tips

The Difference Between Integrative and Alternative Medicine


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Recently, Roswell Park Cancer Institute started an integrative medicine pilot program for pediatric and young adult patients with the hope of easing the side effects of their cancer treatments. The program includes therapies such as acupuncture, acupressure, aromatherapy, reflexology and Reiki. Many of these therapies focus a patient’s “Qi,” an energy that can be moved through pathways along the body to help reduce the side effects of treatment. This may not sound like something that belongs in a hospital, and in the past, you may have heard these therapies labeled as “alternative medicine.” But in recent years, cancer centers have started embracing and integrating these healing practices into their cancer care. The important difference between alternative and integrative medicine is that cancer centers like Roswell Park do not claim that these therapies will cure a patient’s cancer. “Chemotherapy, radiation and surgery are going to cure your cancer,” says Doug McDaniel, L.Ac., and Integrative Medicine Program Manager at Roswell Park. Integrative therapies can help with symptom management and general supportive care, such as easing nausea, joint pain, and improving sleep and appetite. “I like to say, I’m the one that keeps you strong and healthy while you’re going through your treatment.” “If we really look at what “alternative medicine” means, it’s treating a disease with therapies like acupuncture or acupressure instead of conventional treatments like chemotherapy or surgery. What I do, is an integrative approach,” says McDaniel. Through the integrative medicine program, McDaniel is able to work in unison with the patient’s primary oncologist to come up with a supportive care plan that best suits each patient. “The therapies that I practice here are modalities that have evidence to support that they are safe for the patient and help treat certain side effects, reduce unwanted symptoms and support the efficacy of their treatments,” says McDaniel. Of course, with the Internet, it’s easy to find stories about people whose cancer went into remission without the help of conventional cancer treatment. To that McDaniel says: “Miracles happen.” “Everyone’s heard a miracle story, and there might be someone out there who changed their diet, exercised, meditated all day long, received acupuncture and maybe their cancer went into remission. That’s great, but that’s not the norm. The data does not support that and if that were true, everyone would be doing it,” says McDaniel. When approached by patients looking for alternatives to avoid conventional cancer treatments, McDaniel explains how an integrative approach can help their symptoms while still getting the cancer treatments they need. “It comes up frequently, and I tell patients that you can’t avoid the conventional treatments. I think what people fear is not only having a disease that is making them not feel well, but the side effects of the treatment making them feel worse,” says McDaniel. “I explain to the patient that the conventional treatment is necessary because it’s what’s been proven to cure cancer, but we can add integrative modalities into the mix that will help reduce those negative side effects and keep them strong, healthy and able to stay on course with their cancer treatment.”  Source:


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practice tips



iving awesome customer service to your patients is the best way to ensure their future loyalty and potential referrals. A satisfied patient will be more than ready to pay you for the time and energy you have spent on their care. And possibly refer you to a friend or colleague.

back to you today,” make sure to do just that. Even if you don’t have the appropriate response by the end of the day, a quick call to tell patients you are still pursuing an accurate answer is always best. Keep your promises, they might seem small to you, but may be very important to your patients.

Here are 10 ways to give your patients great customer service:

3. Show thankfulness and appreciation to your patients. Thanking clients is important and is a great way to show your patients you appreciate their business. Saying thank you and smiling go a long way.

1. Make sure your staff creates a great first impression with your patients. It is imperative for the front desk staff in charge of welcoming the patients via telephone or on their entry at the front desk to be friendly, caring and professional. (Tip: Hire individuals with strong backgrounds in customer service.) 2. Stay faithful to your promises. On the off chance that you or your staff says, “I will get that information 10

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4. Be prepared for each visit. Keep all EHR (electronic health records) as up to date as possible. This allows all patient information to be available immediately to you and your office staff. Office visits will move smoother and quicker with accurate records at your fingertips. This will be appreciated by both you and your patients.

5. Tune in and act upon your patient’s concerns. Each properly managed concern can be a chance to obtain a lifetime of dependability from a patient. Ensure that you tune in to the grievance, check the legitimacy, make a move to eliminate the problem, and, after that, let the patient know how it was handled. This transparency in removing these obstacles will help ensure customer satisfaction. 6. Go well beyond what your patients anticipate. It is always better to anticipate your patients’ future medical requirements, making sure you address all their needs. Be sure to inform your staff of each patient’s new needs, to guarantee complete and accurate patient records. 7. Make it simple for your patients. Make the navigation of your office as simple as possible. Achieve this through negligible holdup times, a peaceful, nonstressing environment, and civilities when conceivable (for example; espresso, tea, and water). Additionally, consider patients’ movements through your office to guarantee it is anything but difficult to navigate.

8. Be involved solving office mishaps. Neglected to get back to a patient? Overbooked the scheduled office visits? Running somewhat late? Be straightforward, apologize directly and earnestly to your patient, and offer choices to repair the issue. 9. Know your patients. Would you have a facility without them? You should know who your patients are, the reason they come to see you, and make certain they get the best treatment and follow up available. Have your front office staff attempt to recall all the names of your regular patients, making them feel immediately welcomed. 10. Treat your staff (and each other) like clients. If you treat your medical staff correctly and professionally, they, in turn, will treat your patients and each other in the same manner, paying it forward. By transforming your medical office visit into a peaceful, fulfilling experience, the entire healthcare process becomes less stressful for patients and more profitable for you. Your patients will realize by these simple changes, they are important and appreciated by you and your staff. 


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practice tips

Future Supply of Nurses in the UK ‘Remains in Peril’

Latest figures released by the Universities and Colleges Admissions Service (UCAS) reveal a worrying decline in the number of people applying to start a nursing degree. Statistics for 2017 show an 18 per cent drop in applications. While this has not translated to a drastic decline in the number of students actually starting nursing courses, it continues a worrying trend. There has been a 0.9 per cent fall in the number of students accepted onto nursing courses across the UK overall, and a 2.6 per cent decline in England. Lara Carmona, Associate Director of Policy and Public Affairs at the RCN, said, “These figures show the future supply of nurses remains in peril – we have not seen the increase we need across the UK, despite government promises. “In practice this will mean services already struggling to recruit staff will find it even harder. With a record number of people accessing services, it is patients who will pay the price for the Government’s 12

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failure.” The number of mature students being accepted onto nursing courses has also decreased, with 13 per cent less nursing students between the ages of 21 and 25 and a six per cent decline in those aged 26 or above. “Ministers said the removal of the student bursary would mean 10,000 more nurses, and promised a 25 per cent increase in training places this year. This has not happened,” added Lara. “The prospect of graduating thousands of pounds in debt appears to have deterred more mature students from applying, denying the profession their valuable life experience. “Ministers are risking the health of the nation by failing to train enough nurses. The Government must invest in nurse education to grow the domestic workforce, and provide safe and effective care.”  Source:

What’s your practice worth? When most doctors are asked what their practice is worth, the answer is usually, “I don’t know.” Doctors can tell you what their practices made or lost last year, but few actually know what it’s worth. In today’s world, expenses are rising and profits are being squeezed. A BizScore Performance Review will provide details regarding liquidity, profits & profit margins, sales, borrowing and assets. Our three signature sections include:  Performance review  Valuation  Projections

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phone: 919.845.0054 fax: 919.845.1947 e-mail:

U.S. OPTICAL BOARDS Alaska P.O. Box 110806 Juneau, AK 99811 (907)465-5470 cbpl/ProfessionalLicensing/DispensingOpticians.aspx

Idaho 450 W. State St., 10th Floor Boise , ID 83720 (208)334-5500 aspx?Bureau=OPT

Arizona 1400 W. Washington, Rm. 230 Phoenix, AZ 85007 (602)542-3095

Kentucky P.O. Box 1360 Frankfurt, KY 40602 (502)564-3296

Arkansas P.O. Box 627 Helena, AR 72342 (870)572-2847 California 2005 Evergreen St., Ste. 1200 Sacramento, CA 95815 (916)263-2382 Colorado 1560 Broadway St. #1310 Denver, CO 80202 (303)894-7750 Connecticut 410 Capitol Ave., MS #12APP P.O. Box 340308 Hartford, CT 06134 (860)509-7603 ext. 4 asp?a=3121&q=427586 Florida 4052 Bald Cypress Way, Bin C08 Tallahassee, FL 32399 (850)245-4474 Georgia 237 Coliseum Dr. Macon, GA 31217 (478)207-1671 plb/20 Hawaii P.O. Box 3469 Honolulu, HI 96801 (808)586-2704

Massachusetts 239 Causeway St. Boston, MA 02114 (617)727-5339 dpl-boards/op/ Nevada P.O. Box 70503 Reno, NV 89570 (775)853-1421 New Hampshire 129 Pleasant St. Concord, NH 03301 (603)271-5590 New Jersey P.O. Box 45011 Newark, NJ 07101 (973)504-6435 home_page New York 89 Washington Ave., 2nd Floor W. Albany, NY 12234 (518)402-5944 North Carolina P.O. Box 25336 Raleigh, NC 27611 (919)733-9321 Ohio 77 S. High St. Columbus, OH 43266 (614)466-9707

Oregon 3218 Pringle Rd. SE Ste. 270 Salem, OR 97302 (503)373-7721 Rhode Island 3 Capitol Hill, Rm 104 Providence, RI 02908 (401)222-7883 php? page=DetailDeptAgency&eid=260 South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4665 Tennessee Heritage Place Metro Center 227 French Landing, Ste. 300 Nashville, TN 37243 (615)253-6061 Texas P.O. Box 149347 Austin, TX 78714 (512)834-6661 Vermont National Life Bldg N FL. 2 Montpelier, VT 05620 (802)828-2191 aspx Virginia 3600 W. Broad St. Richmond, VA 23230 (804)367-8500 HAS-Opticians/ Washington 300 SE Quince P.O. Box 47870 Olympia, WA 98504 (360)236-4947 aspx MED MONTHLY MAGAZINE

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U.S. DENTAL BOARDS Alabama Alabama Board of Dental Examiners 5346 Stadium Trace Pkwy., Ste. 112 Hoover, AL 35244 (205) 985-7267 Alaska P.O. Box 110806 Juneau, AK 99811-0806 (907)465-2542 cbpl/ProfessionalLicensing/BoardofDentalExaminers.aspx Arizona 4205 N. 7th Ave. Suite 300 Phoenix, AZ 85103 (602)242-1492 Arkansas 101 E. Capitol Ave., Suite 111 Little Rock, AR 72201 (501)682-2085 California 2005 Evergreen Street, Suite 1550Â Sacramento, CA 95815 877-729-7789

Hawaii DCCA-PVL Att: Dental P.O. Box 3469 Honolulu, HI 96801 (808)586-3000 Idaho P.O. Box 83720 Boise, ID 83720 (208)334-2369 Illinois 320 W. Washington St. Springfield, IL 62786 (217)785-0820 Indiana 402 W. Washington St., Room W072 Indianapolis, IN 46204 (317)232-2980

Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7800 Dental_Board

Iowa 400 SW 8th St. Suite D Des Moines, IA 50309 (515)281-5157

Connecticut 410 Capitol Ave. Hartford, CT 06134 (860)509-8000 asp?a=3143&q=388884

Kansas 900 SW Jackson Room 564-S Topeka, KS 66612 (785)296-6400

Delaware Cannon Building, Suite 203 861 Solver Lake Blvd. Dover, DE 19904 (302)744-4500

Kentucky 312 Whittington Parkway, Suite 101 Louisville, KY 40222 (502)429-7280

Florida 4052 Bald Cypress Way Bin C-08 Tallahassee, FL 32399 (850)245-4474 16

Georgia 237 Coliseum Drive Macon, GA 31217 (478)207-2440

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Louisiana 365 Canal St., Suite 2680 New Orleans, LA 70130 (504)568-8574

Maine 143 State House Station 161 Capitol St. Augusta, ME 04333 (207)287-3333 forms.html Maryland 55 Wade Ave. Catonsville, Maryland 21228 (410)402-8500 Massachusetts 1000 Washington St., Suite 710 Boston, MA 02118 (617)727-1944 dentist/about/ Michigan P.O. Box 30664 Lansing, MI 48909 (517)241-2650,4601,7154-72600_72603_27529_27533---,00. html Minnesota 2829 University Ave., SE. Suite 450 Minneapolis, MN 55414 (612)617-2250 Mississippi 600 E. Amite St., Suite 100 Jackson, MS 39201 (601)944-9622 Missouri 3605 Missouri Blvd. P.O. Box 1367 Jefferson City, MO 65102 (573)751-0040 Montana P.O. Box 200113 Helena, MT 59620 (406)444-2511 boards/den_board/board_page.asp

Nebraska 301 Centennial Mall South Lincoln, NE 68509 (402)471-3121

Ohio Riffe Center 77 S. High St.,17th Floor Columbus, OH 43215 (614)466-2580

Nevada 6010 S. Rainbow Blvd. Suite A-1 Las Vegas, NV 89118 (702)486-7044

Oklahoma 201 N.E. 38th Terr., #2 Oklahoma City, OK 73105 (405)524-9037

New Hampshire 2 Industrial Park Dr. Concord, NH 03301 (603)271-4561

Oregon 1600 SW 4th Ave. Suite 770 Portland, OR 97201 (971)673-3200

New Jersey P.O Box 45005 Newark, NJ 07101 (973)504-6405

Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)783-7162 Pages/default.aspx#.VbkfjPlPVYU

New Mexico Toney Anaya Building 2550 Cerrillos Rd. Santa Fe, NM 87505 (505)476-4680 New York 89 Washington Ave. Albany, NY 12234 (518)474-3817 North Carolina 507 Airport Blvd., Suite 105 Morrisville, NC 27560 (919)678-8223 North Dakota P.O. Box 7246 Bismark, ND 58507 (701)258-8600

Rhode Island Dept. of Health Three Capitol Hill, Room 104 Providence, RI 02908 (401)222-2828 South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4599 South Dakota P.O. Box 1079 105. S. Euclid Ave. Suite C Pierre, SC 57501 (605)224-1282 Tennessee 227 French Landing, Suite 300 Nashville, TN 37243 (615)532-3202

Texas 333 Guadeloupe St. Suite 3-800 Austin, TX 78701 (512)463-6400 Utah 160 E. 300 South Salt Lake City, UT 84111 (801)530-6628 Vermont National Life Building North FL2 Montpelier, VT 05620 (802)828-1505 and_commissions/dental_examiners 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 aspx?Page=90c5523f-bab0-4a45-ab943d9f699d4eb5 Wyoming 1800 Carey Ave., 4th Floor Cheyenne, WY 82002 (307)777-6529


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U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (334)242-4116 Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 (480)551-2700 Arkansas 1401 West Capitol Ave., Suite 340 Little Rock, AR 72201 (501)296-1802 California 2005 Evergreen St., Suite 1200 Sacramento, CA 95815 (916)263-2382 Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7690 Connecticut 401 Capitol Ave. Hartford, CT 06134 (860)509-8000 asp?a=3143&q=388902 Delaware Division of Professional Regulation Cannon Building 861 Silver Lake Blvd., Suite 203 Dover, DE 19904 (302)744-4500 District of Columbia 899 North Capitol St., NE Washington, DC 20002 (202)442-5955 18

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Florida 2585 Merchants Row Blvd. Tallahassee, FL 32399 (850)245-4444 DesktopDefault.aspx?tabid=115

Louisiana LSBME P.O. Box 30250 New Orleans, LA 70190 (504)568-6820

Georgia 2 Peachtree Street NW, 36th Floor Atlanta, GA 30303 (404)656-3913

Maine 161 Capitol Street 137 State House Station Augusta, ME 04333 (207)287-3601

Hawaii DCCA-PVL P.O. Box 3469 Honolulu, HI 96801 (808)587-3295

Maryland 4201 Patterson Ave. Baltimore, MD 21215 (410)764-4777

Idaho Idaho Board of Medicine P.O. Box 83720 Boise, Idaho 83720 (208)327-7000

Massachusetts 200 Harvard Mill Sq., Suite 330 Wakefield, MA 01880 (781)876-8200

Illinois 320 West Washington St. Springfield, IL 62786 (217)785 -0820

Michigan Bureau of Health Professions P.O. Box 30670 Lansing, MI 48909 (517)335-0918,4601,7-15472600_72603_27529_27541-58914--,00. html

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

Minnesota University Park Plaza 2829 University Ave. SE, Suite 500  Minneapolis, MN 55414 (612)617-2130 Mississippi 1867 Crane Ridge Drive, Suite 200-B Jackson, MS 39216 (601)987-3079 Missouri Missouri Division of Professional Registration 3605 Missouri Blvd. P.O. Box 1335 Jefferson City, MO  65102 (573)751-0293

Montana 301 S. Park Ave. #430 Helena, MT 59601 (406)841-2300 boards/med_board/board_page.asp Nebraska Nebraska Department of Health and Human Services P.O. Box 95026 Lincoln, NE 68509 (402)471-3121 search.cgi Nevada Board of Medical Examiners P.O. Box 7238 Reno, NV 89510 (775)688-2559 New Hampshire New Hampshire State Board of Medicine 2 Industrial Park Dr. #8 Concord, NH 03301 (603)271-1203 New Jersey P. O. Box 360 Trenton, NJ 08625 (609)292-7837 New Mexico 2055 S. Pacheco St. Building 400 Santa Fe, NM 87505 (505)476-7220 New York Office of the Professions State Education Building, 2nd Floor Albany, NY 12234 (518)474-3817 North Carolina P.O. Box 20007 Raleigh, NC 27619 (919)326-1100

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

Texas P.O. Box 2018 Austin, TX 78768 (512)305-7010

Ohio 30 E. Broad St., 3rd Floor Columbus, OH 43215 (614)466-3934

Utah P.O. Box 146741 Salt Lake City, UT 84114 (801)530-6628

Oklahoma P.O. Box 18256 Oklahoma City, OK 73154 (405)962-1400 Oregon 1500 SW 1st Ave., Suite 620 Portland, OR 97201 (971)673-2700 Pennsylvania P.O. Box 2649 Harrisburg, PA 17105  (717)787-8503 Pages/default.aspx#.Vbkgf_lPVYU Rhode Island 3 Capitol Hill Providence, RI 02908 (401)222-5960 South Carolina P.O. Box 11289 Columbia, SC 29211 (803)896-4500 South Dakota 101 N. Main Ave. Suite 301 Sioux Falls, SD 57104 (605)367-7781 Tennessee 425 5th Ave. North Cordell Hull Bldg. 3rd Floor Nashville, TN 37243 (615)741-3111

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


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Ring in the New Year With a New Practice Management Plan

By Naren Arulrajah Ekwa Marketing


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For most doctors, the challenge is how to prepare in a sea of uncertainty. What legislation will be repealed, introduced, or revised? With the Affordable Care Act hanging in the balance and perpetual upheaval in Washington, D.C., no one can answer that question with certainty. What is true today may change next month, or even next week. Instead of fretting about the unknowns, focus on what you do know. The legislation and details may (almost certainly will) change, but it is apparent that some trends are here to stay. Most notably, the focus on improving value and upgrading technology.

Modern Medicine – High Tech, High Stress

What legislation will be repealed, introduced, or revised? With the Affordable Care Act hanging in the balance and perpetual upheaval in Washington, D.C., no one can answer that question with certainty.

Promoted as a dream come true for healthcare reform, EHR (electronic health records) have turned out to be a nightmare for doctors and patients alike. The concept is wonderful, but the implementation is not. Since the transition was incentivized in 2009, nine out of ten office-based doctors have taken the leap. If we were to believe the hype and promises, medical treatment would be more efficient, and better coordinated than ever. Instead, we have a plethora of incompatible systems, endless confusion, and doctors spending nearly half of their time on data entry and other clerical work. Although you might long for the days of simple paper files, there is no going back. The move to digitize everything is much bigger than partisan politics, or even the healthcare system. It is the way of the modern world, and even more so the way of the future. Some industry experts are pushing to make usability and compatibility a priority. However, that hasn’t happened yet, as any physician can attest. Until it does, the only practical option is moving forward, and making the best of available options. If you aren’t happy with your software, watch for better alternatives. The process of implementing your current system is probably something you don’t want to repeat. However, technology is constantly evolving, and better options are likely to appear. You will be richly rewarded for the time and effort of changing systems, if the new one better meets your needs. Most importantly, make an effort to educate yourself and your team. Learn what your current system will do, and how to use all of its features. Invest in staff training to ensure that your employees are proficient in the portions of the program that they need. You might find out that some of the software problems are actually user-error. Identify your specific needs by making note of which features are beneficial, and where the program is lacking. If the software is not satisfactory, keep continued on page 22


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shopping until you find a system that meets your needs.

MACRA and HCPLAN Are Here to Stay As the healthcare debate rages, one piece of legislation stands strong. MACRA (Medicare Access and CHIP Reauthorization Act) has enjoyed bi-partition support since its inception, and therefore is unlikely face threat of repeal. This was made apparent in the 2017 final ruling, which was issued last November. Although some reporting requirements were increased, the 2018 performance year is still part of the transitional period. Therefore, many of 2017’s flexibilities will continue this year, and a few changes were made with the intention of easing the transition for physicians. One of the most significant changes in the final ruling was an increase in minimum eligibility for the MIPS (Merit-Based Incentive Payment System) track, which is expected to exempt more than half a million physicians. If your practice is exempted by the new rule, you can also decline to have your information published in Medicare’s public database, Physician Compare. Individual doctors and small groups who do not qualify for the low-volume exemption can benefit from bonus points for reporting in one or more performance categories. Bonus points are also offered for practices that treat particularly complex patient populations. Another change in the rule is designed to help doctors impacted 22

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by the catastrophic hurricanes of 2017 and other disasters. If your practice location is in a disaster or emergency area, declared by FEMA (Federal Emergency Management Agency), you are eligible to file a hardship application. Those who are unable to report due to natural disasters will not be penalized. Some minor revisions have been made, but the structure and primary goal remain the same. This system is intended to tie payment to value and quality of care in the Medicare system. Therefore, any steps you can take to improve patient satisfaction or cut costs will better position your practice for success with MACRA. Even if your practice does not accept Medicare payments, you are not excluded from the changes in American healthcare. Like MACRA, the Health Care Payment

Learning and Action Network (HCPLAN) was introduced in 2015, with the goal of improving quality and affordability of medical care. However, HCPLAN is not restricted to Medicare. It is a collaboration of public, private, and non-profit sectors, with the specific mission of hastening the transition to alternative payment models (APM) across the healthcare system. The 2017 year-end report from HCPLAN showed 29 percent of healthcare payments were made using APMs. That number is expected to nearly double in 2018, with a projected 50 percent APMs. Currently, commercial, Medicare, and Medicaid HCPLAN participants represent over 80 percent of covered Americans. The takeaway is clear. No matter what your specialty is, or what

types of payment you accept, there is no avoiding the implications of healthcare reform. However, you can stay ahead of the game by embracing technology and patientcentric philosophies.  About the Author: Naren Arulrajah is President and CEO of Ekwa Marketing, a complete internet marketing company that focuses on SEO, social media, marketing education, and the online reputations of dentists and physicians. With a team of 180+ full time marketers, helps doctors who know where they want to go, get there by dominating their market and growing their business significantly year after year. If you have questions about marketing your practice online, call 855-598-3320 to speak one-on-one with Naren.


New Tax Law’s Implications for the Health Care Industry By Robert F. Atlas EBG Advisors


he U.S. Senate and House of Representatives have now both passed a unified tax reform bill, and President Trump signed it into law on December 22. The final bill looks more like the Senate’s original version than the House’s. The legislation will affect health care in both direct and indirect ways. Looked at in whole, the bill appears to add some new pressures for health care industry participants.


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Individual Mandate. The bill does away with the Affordable Care Act’s (ACA’s) penalty on individuals who do not purchase health insurance, effective January 2019. The Congressional Budget Office (CBO) has estimated that this change will save the federal government $338 billion over 10 years. By 2027, CBO projects that 13 million individuals, most of whom would have received federal subsidies to pay their premiums, would decline to take up coverage and thus become uninsured. Moreover, since the people most likely to elect not to purchase health insurance would be younger and healthier, this change could further destabilize the non-group market and possibly lead to higher premiums and fewer choices of plans and providers for those wanting to stay covered.

Market Stabilization Prospects. To win the vote of Senator Susan Collins (R-ME) for the tax reform bill, Senate Majority Leader Mitch McConnell promised to support separate measures to restore ACA costsharing reductions and to help states set up reinsurance pools to undergird plans selling individual policies. President Trump has backed up McConnell’s statement. However, House Speaker Paul Ryan has not committed to promote the legislation in his chamber. Even if such legislation is enacted, without the individual mandate, it is uncertain whether the intended benefits would become realized.

PAYGO Ramifications. Because the bill would grow the deficit significantly, the “pay as you go” law enacted in 2010 would force mandatory cuts to many programs, called sequestration. The CBO has projected that Medicare would immediately have to reduce spending by 4 percent yearly, taking $25 billion out of the health care system in the first year alone. However, Congress has the power to waive sequestration, and in fact it did so right before recessing for the year, as part of the stopgap funding measure passed to keep the federal government open until at least January 19.

Pass-through Tax Deduction. A companion to the bill’s centerpiece corporate tax rate reduction is a new deduction for certain pass-through businesses, among them some types of medical practices. Currently, “passthroughs” do not pay tax on their income; the income “passes through” to the owners, who pay tax at individual rates. The bill allows a tax deduction for such owners equal to 20% of the taxpayer’s “qualified business income.” But there are multiple limitations. For medical professionals, the deduction would be disallowed for those with taxable income in excess of $207,500 if single, and $415,000 for joint filers. The benefits of this change might therefore accrue mainly to primary care physicians and such others as clinical psychologists whose incomes are at the lower end of the range of health care professionals’ pay. State Taxes. The bill caps the deductibility of state and local income and property taxes at $10,000 per household per year. Consequently, states with higher taxes will feel intense pressure from their taxpayers to lower such taxes. As has been widely reported, these are mostly “blue” states. However, “red” states may not escape similar pain. Those states tend to be net positive recipients of federal tax dollars—that is, they receive more in federal outlays than their residents send to the federal government in taxes—so expected future cuts to federal spending will affect them, too. Whenever states feel budget pressure, they often curtail Medicaid payments and public health outlays. Health care providers that rely on Medicaid and other state funding, such as mental health and substance abuse providers and nursing facilities, will likely feel the brunt of such cuts.  The contents of this document should not be construed as legal, investment, tax, regulatory, or accounting advice. The recipient should consult with qualified professional advisors before acting on pertinent matters. The information contained herein does not necessarily reflect the official position of the sponsoring entity. About EBG Advisors EBG Advisors is a national strategy and management consultancy that serves leading organizations on health care and employment matters. With a far-reaching network of skilled professionals, EBG Advisors is capable of supporting client innovations from ideation to full implementation. We further aid transactions, operational improvement, compliance, and data security to promote the growth and sustainability of businesses. EBG Advisors consultants often collaborate with Epstein Becker Green attorneys on engagements that require a multidisciplinary approach spanning strategic, policy, regulatory, governance, clinical, and economic topics. For more information, visit MED MONTHLY MAGAZINE

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Will New Healthcare Reform Put the Patient First?

Physicians should take a measured approach to the future of their practice, keeping in mind that patients define value as appointment access and availability. Patients make inferences about how much they are valued by their provider based on the experiences they have during a clinic visit. To be clear, patient experience is not simply amenities, satisfaction, service; the practice’s patient loyalty and community reputation are at stake. With the changes and incentives (often misaligned incentives) in play as a result of healthcare reform, many hospitals and provider groups are hedging their bets that bigger is better. To that extent, some are attempting to leverage their brand outside of their catchment area in an attempt to secure more patients. The pitch to those communities receiving the new 26

| JANUARY 2018

facility is often the same: “we bring an unparalleled level of expertise”, “extending the benefits of an academic institution”, “to better serve the residents”. The problem is that the community often becomes confused and questions what sort of care they have been receiving for decades before this new entity decided to ride in on their white horse and save us all. Equally important, the entire medical community is often upset for the same reasons, with physicians stating “So, I have been providing substandard care to my patients?” Although this has not stopped hospitals and provider groups from expanding their arena in the past, it was not as widespread as it has been in the past few years. This is due to the Affordable Care Act’s push to have fewer players in the healthcare

By Nick Hernandez, MBA, FACHE CEO and Founder of ABISA sector, which can pressure solo and small group medical practices that have longstanding roots in their communities. A university physician’s group in Florida, for example, entered a market nearly two hours away to offer specialty care such as cardiology, gynecology, and orthopedics. In just 6 months, they walked away from their $4 million investment. The center was tracking to be $2 million in the red during its first year, but the university is conflicted. On one hand, they are not happy about the loss, to which they acknowledged “due diligence could have been better.” On the other hand, they are still eager to jump into that remote community due to the population health initiatives being driven by healthcare reform. In Indiana, a proton therapy center closed after

being in operation for 10 years. This Indiana center, which had a $3.5 million operating loss its last year, cited several reasons for closing including changes in new payment models like bundled payments. The point here is not this center is closing but rather the plethora of other proton centers still being built and planned for around the country. There are over a dozen such centers in operation, but a dozen more are currently being developed. Perhaps there is going to be a demand to justify doubling the number of proton therapy centers in the U.S. And perhaps, clinical studies and payment reforms will be in favor of all this growth. Time will tell. On the other hand, patients do prefer hospitality design elements (certainly much more than they like seeing “narrow networks” and lack of access to providers). To this end, medical offices and hotels share the challenge of designing facilities that are cost-effective, are functional, and promote their organizations’ missions. Research shows that facility design influences customer behaviors and brand perceptions in a variety of industries. Customers make decisions about a company’s capabilities and quality based on their perceptions of the physical setting. Convenience, atmosphere, outcomes, and personal treatment will be key decision factors patients make when seeking care. Such consumer decisions are very important in healthcare since clinical outcomes are often intangible and difficult to measure for non-clinicians. Research has shown that a patient’s perception of quality can be influenced by facilities design. Several studies found that patients surveyed in physically attractive waiting areas gave higher ratings on quality of care and patient-staff interactions. These patients also were more willing to recommend the facility to others than those surveyed in comparatively unattractive waiting rooms. A recent study of hospitals demonstrated that patients value hotel-like features twice as much as they value the clinical reputation! Examples such as these must be heeded in this era where patients are increasingly doing more choosing of their place of service. There is no crystal ball as to how U.S. healthcare reform will shake out. I believe that our entrepreneurial society which includes outstanding physicians and great business leaders will prevail and patients will be the benefactors . . . providing all continue to put the patient first. 


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ObamaCare ACA Pros and Cons List Source:


ObamaCare ACA Pros

ObamaCare ACA Cons

Tens of millions of uninsured people have access to affordable, high-quality health insurance through Medicaid expansion, their employers, and the Health Insurance Marketplace.

To get the money to help insure all these people, there are new taxes (mostly on high-earners and the healthcare industry). The taxes that may affect you directly are the individual mandate and the employer mandate.

Over half of uninsured Americans can get free or lowcost health insurance, and some can get help on outof-pocket costs using their state’s Health Insurance Marketplace.

The individual mandate says all Americans who can afford health insurance have to obtain health coverage, get an exemption, or pay a fee. That creates an extra complication with regards to filing taxes. Some folks who just barely miss the Federal Poverty Level limit of 400% are hit the hardest as they don’t qualify for assistance. Those who do get cost assistance will need to adjust tax credits on the 8962 – Premium Tax Credit form.

Over 20 million people were exempt from the fee in 2016. Those with exemptions may still get cost assistance. Exemptions also qualify you for special enrollment.

To get many of the exemptions, you’ll need to submit a form to HealthCare.Gov or file the 8965 – Exemptions form.

There are now more private coverage options, and all major medical coverage options must provide minimum essential coverage.

More options mean more complicated shopping for coverage. Keeping a private health insurance system means that shopping for health insurance can be confusing, and consumers risk over-buying or underbuying. Coverage options also, by nature, create a tiered healthcare system where more money equates to a better quality of care. However, in that respect, nothing has changed.

ObamaCare’s many protections ensure that you can’t be dropped from coverage when you get sick or make an honest mistake on your application. You also can’t be denied coverage or treatment for being sick or get charged more for being sick. Additionally, you can’t be charged more for being a woman. Other protections ensure that you have the right to a rapid appeal, that health insurance companies can’t make unjustified rate hikes, and that these companies must spend the majority of premium dollars on care, not paying executives.

Insurance companies must cover sick people, and this increases the cost of everyone’s insurance. To ensure people don’t just buy coverage when they need it, most people must obtain coverage or pay a per-month fee. Also, you can only get coverage during annual open enrollment periods. You can owe the fee due to forgetting to pay a premium, and then not be able to get coverage until next open enrollment. Some people benefited from being in a low-risk group. Men in good health with no pre-existing conditions, who were not responsible for anyone but themselves, and who remained healthy had low insurance costs. They may have had cheap limited coverage before the premium hikes took place in 2014.

All major medical coverage must count as minimum essential coverage. This means that coverage must offer the ACA/ObamaCare’s protections, cover essential health benefits such as free preventative services, limit deductibles and out-of-pocket maximums, provide minimum actuarial value, and not have annual or lifetime dollar limits.

Minimum essential coverage can only be obtained during open enrollment unless you qualify for a special enrollment period. Those who don’t understand how to compare plans or didn’t have coverage before the ACA may be shocked by how cost sharing works on higher deductible plans. Also many may get non-minimum essential coverage like short term insurance because of their confusion.

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Here is a short list of the Pros and Cons of ObamaCare, the ACA. The ACA, ObamaCare, doesn’t create insurance; it regulates private insurance to ensure you get more rights and protections. In doing this, it helps tens of millions get access to high-quality Affordable Health Insurance. Of course, health care reform has both financial and private costs. Below are just a few of ObamaCare’s pros and cons: ObamaCare ACA Pros

ObamaCare ACA Cons

ObamaCare, the ACA, includes some cost-curbing measures, which led to health care spending growing at the slowest rate on record (since 1960) in 2014. Meanwhile, health care price inflation is at its lowest rate in 50 years. Unfortunately, even though the costs are increasing more slowly than they might have, health care costs are steadily increasing.

The law also includes spending. Upfront spending and more regulation are required to realize long-term costcurbing measures.

Medicaid has expanded to cover up to 15.9 million men, women, and children who fall below 138% of the poverty level.

Medicaid expanded using Federal and State funding. Not all States had to expand Medicaid. The states that have chosen not to expand Medicaid leave 5.7 million of our nations’ poorest people without coverage options.

CHIP has expanded to cover up to 9 million children.

CHIP also uses Federal and State funding.

The employer mandate says that starting 2015/2016, businesses with the equivalent of more than 50 full-time employees must provide health coverage.

In anticipation of the employer mandate, some businesses cut employee hours. This added extra operation costs to businesses that did not provide health insurance. Many lower wage employees find health insurance unaffordable and end up with no affordable options due to having been offered coverage through work.

Small businesses with less than 25 full-time equivalent employees can get tax credits for up to 50% of their employees’ health insurance premium costs.

Employee health benefits can be expensive. Lower wage workers may end up getting better value through the marketplace, but having employer-sponsored coverage means that they can’t get cost assistance. Also, dependents of employees with coverage are unable to use the marketplace.

Young Adults can stay on their parents’ plan until 26 and 82% of uninsured adults will qualify for free or low-cost insurance. Insurance helps everyone get healthcare and protects them in an emergency. Young adult’s uninsured rates have dropped 46% (HHS).

Young people tend to be healthy and not to need coverage as often as older Americans. However, due to low premiums and the benefits of having a plan, young people have some of the best deals of anyone under the ACA when purchasing care.

Medicare has improved for Seniors by measures that eliminate the donut hole, keep rates down, cut wasteful spending and fraud, and expand free preventive services.

Some Medicare payments to doctors and hospitals have been limited. Medicare pays doctors according to a fee schedule. Its rates have led to very complex problems that are driving the costs of health care up for everyone. Also, retaining supplemental Medicare options involves confusing options for seniors. The unfounded death panel rumor led to cutting out an important provision in the law that would have provided end-of-life counseling.

The ACA, ObamaCare, retrains a free market semi-private healthcare system and thus still allows our $3 trillion dollar healthcare industry to thrive.

Retaining a for-profit healthcare system has economic benefits, but it also means that every aspect of the system requires making a profit. Americans have higher health care costs than other countries, which have more “universal” healthcare systems.


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Medical Practice Listings can help you sell your practice online! Now offering two types of listings to better serve all practice specialties and budgets. For Sale by Owner Listing The For Sale by Owner Listing offers you the opportunity to gain national exposure by posting your listing on our website which is viewed daily by a network of qualified professionals. This option includes a brief practice consultation to explain the benefits of marketing through the Medical Practice Listings website. Our special rate for the For Sale by Owner listing through the end of 2018 is only $29.95 per month.

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

Visit us today at to learn more.

919.848.4202 |


Serving Alexandria, Annandale, Springfield, Newington, Franconia and surrounding areas Pediatric practice listed in a beautiful part of Virginia. Surrounded by medical providers and services; radiology, pharmacy, lab & dentist to name a few. Treating 14 to 16 patients on average daily and growing. The gross yearly revenue is $200,000 for this two year old practice and it is realizing steady growth and patient volume. This beautiful practice condo has 6 exam rooms, two doctor offices, a large procedure room, manager suite and lots of storage in this 3,245 sq. ft. practice. You will find this practice to be well designed, modern and tastefully appointed. The numbers: Practice Price is $125,000 and the building can be leased or purchased for $1,200,000. Contact Physician Solutions today at (919) 845-0054 to discuss this practice opportunity, confidentially of course. | | 919-848-4202

North Carolina Dentist Opportunities

PSYCHIATRIST PRACTICE LOCATED IN CHARLOTTESVILLE, VA Located in Charlottesville in a professional business community, this well established psychiatry practice offers a comfortable therapeutic setting with easy access to street level entry and parking. This shared transitional suite comprises approximately 1,129 square foot including; large clinician office, patient waiting area, two-bathrooms, storage supply room, kitchen and reception & greeting areas. There are a total of 435 active patients; sees an average of 14 patients per day.

Contact Philip or Danielle at 919-848-4202 or email

Physician Solutions currently has the following positions available: l Wilson

Practice – General Dentist Full-time, Monday – Fridays – Full-time Dentists (2) Positions l Henderson – Part-time Pediatric Dentist (DDS/DMD), Thursdays and every other Monday l Washington/Williamston

Top wages, professional liability insurance and accommodations provided. Please contact Physican Solutions at 919-845-0054 or


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Pediatric Practice Available Near Raleigh, NC

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

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

Pediatric practice located minutes south of Raleigh, North Carolina is now listed for sale. Located in an excellent area convenient to Raleigh, Cary, and Durham, it is surrounded by a strong health care community. This is a well established practice with a very solid patient base. The building is equipped with a private doctor’s office, five exam rooms, and an in-house lab.

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

Established: 1980s l Gross Yearly Income: $350,000 Average Patients per Day: 16 to 22 l List Price: $145,000

Call 919-848-4202 or e-mail

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

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

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

Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624 PH: (919) 845-0054 | email: 32

| JANUARY 2018

Gastroenterology and Endoscopy Practice for Sale This large and modern practice has been serving Eastern North Carolina for over 11 years including Goldsboro, Kinston, New Bern, Greenville, New Bern and Jacksonville. The building that houses this practice is a stand-alone with spacious parking and outstanding street appeal. The full time staff consists of 15 to 18 clerical and nurse staffers. Fully equipped and furnished with G-Med EMR system in place. CON in place and transfers with the practice ownership. The owning physician is moving out of the area and is selling the practice as well as the building. Gross Yearly Income for the Gastroenterology: $625,000 Gross Yearly Income for the Endoscopy: $900,000 Combined Gross Yearly Income: $1,525,000 Building Asking Price: $1,700,000 List Price for Combined Practices: Check back as practice is being valuated | | 919-848-4202

Urgent Care serving the South Raleigh and Garner, NC area

Orthopedic Practice serving Eastern NC, minutes from the Atlantic Ocean

Established practice averaging 25 to 30 patients per day, year round. Open 7 days a week with two providers and established staff members. 4 exam rooms, 1 procedure room and 1 lab-phlebotomy room. This is a very well laid out and attractive practice in a heavily traveled area with excellent parking. Gross revenues of about one million per year and positioned for continued growth. Priced at $200,000. Orthopedic practice for sale on the coast of North Carolina, established with a solid patient base. The demographics for this practice are excellent and the location impressive. This newly listed practice is fully furnished, staffed and ready for a fresh face to see orthopedic patients in this beautiful part of North Carolina. The ingredients for success have been established and the owning doctor is willing to stay with you for a reasonable time to assure a smooth transfer of care. This is the perfect practice to add on to your existing practice as a satellite or to make it your main orthopedic practice. Includes X-Ray, 3 exam rooms and could be easily converted into an urgent care. Average Orthopedic Patients per Day: 10 to 15

Medical Practice Listings Call 919-848-4202 or e-mail


List Price: $135,000

Contact Philip or Danielle at 919-848-4202 or email MED MONTHLY MAGAZINE

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Urgent Care

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

Serving Raleigh, Cary, Apex, Holly Springs, Fuquay Varina, Brier Creek and South Point Mall areas. This is certainly one of the most consistently utilized practices serving a large demographic area. 6 exam or procedure rooms, 1 X-Ray in a well appointed and nicely designed practice. Averaging 28 to 30 patients per day, year round and open 365 days per year. The staff includes two providers and full experienced staff to include X-Ray personal. The gross revenues of this practice exceeds one million two hundred thousand yearly. Priced at $260,000.

Call 919-848-4202 or e-mail

l One

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

Please direct all correspondence to Only serious, qualified inquirers.


Areas of Consideration; Raleigh, Cary, Durham, Chapel Hill, Holy Springs, Apex, Morrisville, Pittsboro and Fuquay Varina

Physician Solutions is working with a well qualified Pediatrician to find a Pediatric Practice to purchase. If you would like to discuss your practice options, confidentially of course, contact me. The doctor we are working with is looking to purchase a practice within the next few months. If you have a friend or colleague that has mentioned selling their Pediatric practice, I would appreciate your referral.

Contact Philip Driver at 919-845-0054 or email 34

| JANUARY 2018

Pediatrics Practice Wanted Pediatrics Practice Wanted in NC Considering your options regarding your pediatric practice? We can help. Medical Practice Listings has a well qualified buyer for a pediatric practice anywhere in central North Carolina. Contact us today to discuss your options confidentially.

Medical Practice Listings Call 919-848-4202 or e-mail

Primary Care Practice For Sale in Wilmington, NC


Established primary care on the coast of North Carolina’s beautiful beaches. Fully staffed with MD’s and PA’s to treat both appointment and walk-in patients. Excellent exam room layout, equipment and visibility. Contact Medical Practice Listings for more information.

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Medical Practice Listings


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Physician Solutions, Inc. Medical & Dental Staffing

Physician Solutions can help match you with dental opportunities that fit your professional and personal goals. We are now hiring dentists and dental hygienists in North Carolina, Florida, Georgia, Kentucky, South Carolina, Tennessee and Virginia. Ongoing and intermittent shifts are available, as well as permanent placement.

Physician Solutions, Inc. P.O. Box 98313 Raleigh, NC 27624 phone: 919-845-0054 fax: 919-845-1947

Scan this QR code with your smartphone to learn more.

Med Monthly January 2018  

The "Health Care Reform’s Impact on Your Practice" issue of Med Monthly magazine.

Med Monthly January 2018  

The "Health Care Reform’s Impact on Your Practice" issue of Med Monthly magazine.