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Med Monthly May 2015

Attracting New Patients: Brand Marketing is the Key pg. 34

CAN 140-CHARACTERS OR LESS PROMOTE YOUR PRACTICE? pg. 32

the

g Attractin New Patients issue

Three Reasons Why Investing in Internet Marketing Will Attract New Patients to Your Practice pg. 30


contents features 30 THREE REASONS WHY INVESTING IN INTERNET MARKETING WILL ATTRACT NEW PATIENTS TO YOUR PRACTICE 32 CAN 140-CHARACTERS OR LESS PROMOTE YOUR PRACTICE? 34 ATTRACTING NEW PATIENTS: Brand Marketing is the Key

PHYSICIAN STRESS AND BURNOUT, RESULTS ALARMING

insight 6

RESOURCE DIRECTORY TO HELP WOMEN SUFFERING FROM POSTPARTUM DEPRESSION

8

LIVING IN FEAR - THE STORY: Britain Facing “Hidden” Allergy Epidemic

10 TRANSLATION CLOUD ENTERS HEALTH CARE INDUSTRY WITH VIDEO REMOTE INTERPRETATION SERVICES

practice tips 12 FIVE TRAITS THAT HAPPY DOCTORS SHARE

16

research and technology 18 EXPERIMENTAL EBOLA VACCINE SAFE, PROMPTS IMMUNE RESPONSE 20 STUDY REVEALS MOLECULAR GENETIC MECHANISMS DRIVING BREAST CANCER PROGRESSION

14 FORM A DEDICATED CREDENTIALING TEAM TO ENSURE SMOOTH CASH FLOW

22 NATIONAL STUDY ON USE OF BEHAVIORAL THERAPY, MEDICATION AND DIETARY SUPPLEMENTS FOR ADHD IN CHILDREN

16 PHYSICIAN STRESS AND BURNOUT, RESULTS ALARMING

legal

CAN 140-CHARACTERS OR LESS PROMOTE YOUR PRACTICE?

34

24 HOSPITAL CANNOT SHOW NURSES’ OVERTIME REFUSAL WOULD CAUSE IRREPARABLE HARM 26 MOVING TO THE CLOUD: Some Key Considerations for Healthcare Entities 28 CMS RELEASES STAGE 3 MEANINGFUL USE PROPOSED RULE

healthy living 38 FRUIT KABOBS WITH FLUFFY FRUIT DIP


January 1, 2014 begins the attestation period for Stage 2 Meaningful Use. If you are a member of the North Carolina Medical Society, you have access to the resources provided for our members to help your practice achieve Meaningful Use in 2014.

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Providing Jobs, Services, Vendors, and CME www.ncmedsoc.org

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Med Monthly May 2015 Publisher Creative Director Contributors

Philip Driver Thomas Hibbard Ashley Acornley, MS, RD, LDN. Naren Arulrajah Michael R. Bertoncini Mitchell Best Starla Fitch, M.D. Vishal Gandhi, BSEE, MBA M. Leeann Habte Paige M. Jennings Amanda Kanaan Anna Kraus Carrie Noriega, M.D. Ramy Ramadan Richard K. Rifenbark Elizabeth J. Rosen Lee J. Tiedrich Vikas Vij

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 medmonthly.com/writers-guidelines

P.O. Box 99488 Raleigh, NC 27624 medmedia9@gmail.com

contributors 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: ashleyfreshfromthefarm.wordpress.com

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

Amanda Kanaan is the owner/founder of WhiteCoat Designs – an online marketing agency committed to growing doctors’ practices through costeffective and powerful online marketing solutions. Amanda regularly speaks at medical association meetings and conventions and is a published expert in the field of medical marketing. To learn more or for a free website evaluation, contact her at Amanda@whitecoat-designs. com or http://www.whitecoat-designs.com.

Carrie Noriega, MD is a board certified obstetrician/ gynecologist who has worked in both private practice in the US and a socialized medical system. As an adventure racer and endurance mountain bike racer, she has developed a special interest in promoting health and wellness through science and medicine.

Online 24/7 at medmonthly.com

WWW.MEDMONTHLY.COM |5


insight

Innovative Resource Directory Now Available to Help Women Suffering from Postpartum Depression

The Los Angeles County Perinatal Mental Health Task Force announced the launch of the Maternal Mental Health Resource Directory a first-of-its-kind online resource for new and expectant mothers struggling with maternal depression and anxiety. The Directory lists over 185 resources more than 125 of which offer no or low-cost 6 | MAY 2015

services in Los Angeles County that provide specialized treatment and support to this vulnerable population. Maternal depression and anxiety, often referred to as perinatal mood and anxiety disorders, are the most common complication of childbirth, affecting at least one in six new mothers in Los Angeles. According to the 2012


appointments. According to the 2012 LAMB study, less than half of women discussed depression with their provider at a postpartum visit and only one-third discussed anxiety at a postpartum visit. Many health care providers cite lack of referral resources that address postpartum depression and anxiety as the primary reason for failing to screen patients. The Maternal Mental Health Resource Directory (directory.maternalmentalhealthla.org) addresses this barrier head-on by listing more than 185 agencies and private practioners who provide services and support to pregnant and new mothers. Women and heath care providers are able to search for resources based on location, services offered, ages served, languages spoken, insurances accepted, and whether no or low-cost options are available. Evidence-based services provided include support groups, individual and family therapy, specialized clinical services, and medication management for pregnant and postpartum women. As the Los Angeles County Perinatal Mental Health Task Force continues its initiatives to train hundreds of more providers in the county to recognize and respond to maternal depression, the directory will continue to grow. Dr. Caron Post, executive director of the Lost Angeles County Perinatal Mental Health Task Force says,“We are proud to launch this innovative and easy-to-use resource to pregnant and new mothers in Los Angeles. We know that depression and anxiety experienced during and after pregnancy often lead to poor birth outcomes, including prematurity, low birth weight, and elevated stress hormones in the infant. Left untreated, perinatal depression and anxiety can result in lifelong health and social problems in both the mother and child. The Maternal Mental Health Resource Directory is an effort to increase access to care for all women so that they and their infants can thrive.â€? The Maternal Mental Health Resource Directory was generously funded by the Ahmanson Foundation. The Maternal Mental Health Resource Directory is available at directory.MaternalMentalHealthLA.org. 

Los Angeles Mommy & Baby (LAMB) Survey of the Los Angeles Public Health Maternal, Child, and Adolescent Health Programs the rates are much higher among lowincome and ethnic minority women, approaching 50%. Despite these high rates, few new and expectant mothers are asked about depression or anxiety at their obstetric

The mission of the Los Angeles County Perinatal Mental Health Task Force is to remove barriers to the prevention, screening and treatment of prenatal and postpartum depression in Los Angeles County. In addition to hosting the Maternal Mental Health Resource Directory, the Task Force offers training and technical assistance to health care, mental health and community-based providers serving prenatal and postpartum women. A printed toolkit entitled Bringing Light to Motherhood: Community Provider Perinatal Mental Health Toolkit is also available for purchase. Source: http://www.newswiretoday.com/news/151482/ WWW.MEDMONTHLY.COM | 7


insight

Living In Fear - The Story

BRITAIN FACING “HIDDEN” ALLERGY EPIDEMIC Britain is in the grip of a major allergy crisis, with millions of sufferers at risk of dying because of a terrifying lack of life-saving awareness among the public. Allergy UK has found that nearly half of the nation’s severe allergy sufferers live in daily fear of suffering what could be a deadly allergic reaction, also known as anaphylaxis. Yet new research carried out by the national charity has found that the majority of the UK population (68%) would not know how to help if they saw someone suffering from a reaction. 8 | MAY 2015

The research comes as the latest NHS statistics reveal hospital admissions in England for allergic reactions are soaring to more than 20,000 each year, over 60% (12,560) of these are emergencies. But the charity is warning that this could be just the tip of the iceberg and the true dangerous toll of allergic reactions may be far greater. Lindsey McManus, Deputy CEO, Allergy UK said: “Anaphylaxis is a sudden and severe allergic reaction which can be terrifying at best and fatal at worst. There is a concerning lack of awareness of this fatal condition.


Thousands of people are being admitted to hospital every year and the number of sufferers is soaring. Yet allergy is still a relatively ‘hidden’ epidemic. More must be done to raise awareness of the deadly condition if lives are to be saved.” New research carried out by the charity to mark Allergy Awareness Week, which runs from 20th April, has also revealed that FEAR is a huge factor both for allergy sufferers and the general public. A survey of 2006 people found that 66% of UK adults admit they don’t know how to use life-saving adrenaline pens (adrenaline auto-injectors), the one thing which can quickly save a life. It also reveals that 68% of people admit they are scared, hesitant or anxious at the thought of having to give someone the easy to use ‘jab’. This hesitation is unwarranted. If the situation is misjudged and the AAI is used unnecessarily but in the correct way, the adrenaline would not cause any lasting harm, but the consequences of not using one could be fatal. The biggest lack of knowledge is among 18-24 year olds. The survey shows that 74% would not know what to do if they saw someone having a reaction, making them the least ‘allergy aware’ group. Ms McManus said: “People need to understand the signs and symptoms of an allergic reaction and have the knowledge and confidence to act swiftly if faced with an emergency by administering a life-saving injection. We are urging people to educate themselves on the signs and symptoms of anaphylaxis, which could potentially save lives.” Despite the fact that allergy is a common chronic condition, the research reveals that almost half (44%) of people in the UK have no idea what anaphylaxis is. Allergy Awareness Weeks runs from April 20th-26th and aims to bridge this gap of knowledge. Spotting symptoms early is vital. Currently, around 1 in 4 people (23%) are mistaking facial weakness as a symptom of an allergic reaction and 15% wrongly cited pain down the arm as a sign of anaphylaxis. Allergy UK is calling on people to ‘recognize the symptoms, recognize the FEAR’: • Face - is their face/are their lips swollen? Have they gone pale? Are they lightheaded? • Eyes - is there a look of fear in their eyes? Are they red, watery and puffy? • Airways - are they wheezing/uncontrollably coughing? Do they have a shortness of breath? Are they unable to talk? Are they making a strange sound? • Rash - is there a red, raised, itchy rash anywhere on their body especially their face or neck? If a combination of these symptoms is visible, the advice is to administer adrenaline into the upper, outer leg (thigh)

and call 999. If the symptoms do not improve after five minutes, administer a second dose of adrenaline into the other thigh. A massive 69% of people have no idea where to inject an adrenaline pen. This lack of public knowledge is a major contributing factor to why allergy sufferers are so fearful of a reaction. Nearly all of those living with a severe allergy say their daily life is affected by the condition with 92% concerned about eating out, while 82% worry about going on holiday. Over one in four sufferers (26%) have been teased or bullied about their condition which could be why one in three (32%) lack self-confidence. Allergy UK has issued a report entitled ‘Living in Fear’ which contains further insight into the daily impact that allergy has on the lives of its sufferers. Members of the public can show their support by taking part in Allergy UK’s #LivingInFear social media campaign. The charity is asking everyone to write down their individual fear on a piece of paper, along with #LivingInFear, and post a selfie on social media, nominating a friend to share their own fear in support of allergy sufferers.  Source: http://www.pressreleasepoint.com/allergyawareness-week-living-fear-story

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insight

Translation Cloud Enters Health Care Industry with Video Remote Interpretation Services

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| MAY 2015


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anguage barriers have long been an issue in many industries, and with the increase of various language speaking citizens in the US, this problem is felt even more strongly within the Healthcare field. More than 46 million people in the United States do not speak English as their primary language, yet everyone needs medical care at one point or another. This language-gap can cause serious issues with miscommunication between the doctor and the patient, causing a lack of proper treatment and can even lead to potentially fatal medical-related errors. This being the case, currently most health care organizations can only provide limited interpreting services, or even no services at all, relying solely on the patient’s family members, friends or non-fluent bilingual staff members to help communicate with the patient. Even when there are people available to help as much as they can, there are no guarantees they are fluent enough to translate the medical jargon accurately. So why aren’t interpreting services more prevalent? Many healthcare facilities do not want to shoulder the financial burden of keeping language interpreters on hand. Since there is no way of knowing what native-language patient will be arriving and when, there would have to be multiple language interpreters standing by at all times. This, of course, would result in a massive expenditure that may or may not even be utilized. For these reasons, many healthcare facilities are looking toward more costeffective and efficient solutions. Translation Cloud has met this need head on (figuratively and literally), by offering face to face interpreting solutions via live-streaming video remote interpretation (VRI). Through Translation Cloud’s services, healthcare facilities will be set up with custom iPads that come installed with an easy to use app which connects the user directly to Translation Cloud’s interpreting service at the tap of their finger. “We wanted to offer healthcare providers interpreting services that were all inclusive and easy to use right off the bat. That’s why we decided on VRI utilizing the iPad platform as a base. This way, doctors can easily carry the device around from room to room, and have immediate interpreting services available should they need it,” says Alex Buran, CEO of Translation Cloud. “Doctors have hard enough jobs as it is, they shouldn’t have to worry about language barriers and miscommunications.” Unlike other industries where a mistranslation might lead to a relatively small misunderstanding, or at the worst, a small financial cost to re-print the documents, healthcare mistranslations could lead to more serious medical issues. Having language gaps are not just problematic. They are a major cause for concern to both patients and the healthcare facilities. That is why translation companies with proven track-records like Translation Cloud are stepping up to the plate. “We take what we do very seriously, and that is why all of our interpreters not only sign strict confidentiality agreements, but we also only utilize interpreters with pre-screened medical backgrounds to ensure the highest quality translations for this field,” Alex went on to state. “We know what’s at stake and we put our reputations on the line, so rest assured we only use the best qualified translators in the field.” With over ten years of experience in the translation industry, Alex and Translation Cloud are eager to take on the important and much needed task of healthcare interpretation. As more and more facilities adopt this practice, Translation Cloud aims to be at the forefront of the industry.  Source: http://www.newswiretoday.com/news/151760/

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practice tips

By Starla Fitch, M.D.

12

| MAY 2015

Five Traits That Happy Doctors Share


You’ve heard the phrase “like attracts like.” It’s my experience that happy doctors attract happy patients. So if you’re looking to attract more of your ideal patients, maybe you need to look inward a bit. What is it that makes some of us happier than others? Why do some doctors live in the land of burnout and others live in happy land? As I work with doctors, nurses, and health care providers around the world, I’ve noticed there are certain traits that stand out in those who choose happiness. And if there’s a way for us to choose happiness rather than physician burnout, wouldn’t we all go there? So here’s the traits I’ve discovered that happy doctors share:

1. They learn from past mistakes.

They don’t dwell on the bad. They don’t ruminate on the negative as they drive home. But they analyze. Just a little. They say to themselves, “What can I learn from how that went down?” “How can I make a better outcome of that situation next time?” Whether it’s a surgical outcome that wasn’t their best, an encounter with a patient or staff member that was the opposite of smooth, they review it like a video game and figure out how things could be altered for the better going forward. They learn that sometimes it’s not about them.

2. They break down goals into bite-sized pieces.

Of the doctors who get it right, the majority have mastered the technique of “chunking.” They break each goal into smaller pieces which gives them the immediate reward of completion. Instead of a goal being “study for board exams this weekend,” they will say: “I’m going to spend two hours on Saturday and three hours on Sunday reviewing the next four chapters in my board review book.” Instead of saying “I’m going to revamp my schedule to make more time for myself,” they say, “What’s the one thing I can do this week that will give me a bit of extra time?”

3. They set specific goals that are measurable.

The doctors I work with learn to not only break down goals but make their smaller projects measurable. Just like when people are on a weight loss diet and the goal is to exercise for twenty minutes, three times a week, doctors who are aiming for happier lives make those milestones specific. For example, instead of “clean up my office and get organized,” they will say, “I’m going to sort thirty files on my desk and get them into the file cabinet or computer by Thursday.”

4. They know what fills them up.

The doctors who get it right give themselves reward woven into their busy weeks. But the rewards are ones they specifically choose, not ones I assign to them. Maybe it’s a dinner out with their spouse or partner. Maybe it’s going to a sporting event with a friend. Maybe it’s doing a whole bunch of nothing, with popcorn, in their PJs. When it’s time to hit “refresh,” these doctors know what works best for them.

5. They give themselves permission to act imperfectly.

We all have the best of intentions. Me, too. The beauty of the doctors who are getting it right is that they give themselves permission to fail. They may do something that is not the exact right thing but is better than doing nothing. They let themselves off the hook when it comes to Perfection Paralysis. We all need to learn how to just go forward in our own unique way. And that’s the beauty of life. Don’t you think?  Starla Fitch, MD, author of the #1 Amazon international best-seller Remedy for Burnout, is the creator of the hugely popular international online community lovemedicineagain.com for doctors, nurses, other healthcare providers, and patients who want to restore humanity to health care. Dr. Fitch speaks to audiences around the world on The 4 Steps from Burnout to Balance. She is an oculoplastic surgeon and senior partner in practice in Atlanta. To follow Dr. Fitch and get free weekly stress-busting tips and inspiration, sign up for updates here. You can also connect with her on Facebook, Twitter, and LinkedIn. WWW.MEDMONTHLY.COM | 13


practice tips

Form a Dedicated Credentialing Team to Ensure Smooth Cash Flow By Vishal Gandhi, BSEE, MBA Founder and CEO

Healthcare credentialing—the process by which providers are enrolled to participate with a particular insurer or healthcare organization—has always been a complicated one. This documentation-driven endeavor includes applications, screenings, primary source verification, and more. It’s something that must be done each time a new provider joins a practice or when providers change practices, merge their practices, join an Accountable Care Organization (ACO), or become acquired by a hospital system. It’s a tedious task that requires an impeccable attention to detail and deadlines. Over time, the process of credentialing has become even more difficult to manage simply because of the oftentimes volatile nature of the healthcare marketplace. The Affordable Care Act and other quality-driven initiatives force providers to practice smart medicine and make business decisions with the best financial outcomes in mind. New providers enter the profession daily. Others switch practices frequently. Many physicians work with a nurse practitioner, physician assistant, or other nonphysician practitioner, each of whom must be credentialed with various insurers.

What does all of this mean in terms of credentialing? Credentialing is critical to overall financial viability because it ultimately enables reimbursement. If a provider 14

| MAY 2015

is not credentialed correctly—or there has been a lapse in the credentialing process—he or she will not be paid. It’s important to think of credentialing as having no clear beginning and end—it is an ongoing task. As such, a dedicated credentialing team within the revenue cycle management department is required. Even after providers are approved, they must re-credential two years after the initial credentialing decision. The larger the organization, the more physicians and other providers there are to track, credential, and re-credential.

How a dedicated credentialing team can help A dedicated credentialing team can address the following: • Adoption of credentialing standards to ensure compliance. This includes establishing policies and procedures that address standards for payers published by the National Committee for Quality Assurance as well as standards for providers published by the Joint Commission. The team can also monitor for any updates or revisions to these standards and update processes accordingly. • Credentialing management. This includes managing the entire credentialing process for credentials such as Controlled Dangerous Substance (CDS), Drug Enforcement Agency (DEA), Medical License, Council


for Affordable Quality Healthcare (CAQH), Board Certification, Malpractice, and Hospital Privileges. In the event that a provider is not credentialed upon application, the team can appeal this decision, when appropriate. • Ongoing monitoring. This includes ensuring that all requirements are met, particularly as new providers join the practice or organization. • Re-credentialing. This includes developing processes to re-credential providers before their current credentialing expires. • Payer agreements. These agreements should outline responsibilities, develop metrics to assess performance, and identify ongoing oversight processes. Most importantly, a dedicated credentialing team ensures communication among primary stakeholders, including providers, practice administrators, coders, billers, and others. This team can—and should—provide regular status updates regarding the credentialing that is in process vs. what has been completed and approved.

Why it’s important to act now By constantly monitoring the credentialing process and identifying new opportunities for credentialing, a dedicated credentialing team reduces the overall risk for

the practice and ensures that there are no payment gaps. As the credentialing process becomes more complex to manage, it’s important for practices to ensure that a team of individuals oversees relevant deadlines and requirements. The ongoing process of credentialing requires strict oversight to ensure success. Practices that dedicate resources to this effort will reap the financial rewards and prevent revenue loss. 

Vishal Gandhi, BSEE, MBA

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

WWW.MEDMONTHLY.COM | 15


practice tips

Physician Stress and Burnout, Results Alarming

By Mitchell Best CEO, VITAL WorkLife

Physician stress and burnout is prevalent and increasing Some would say it has grown to the point of epidemic, even a threat to public health. Based on continued concern for physicians and witnessing the most significant changes in healthcare’s history, we embarked again to measure physician stress and burnout with our research partner, Cejka Search. There is an urgent need for healthcare organizations to recognize and address this crisis; initiatives are needed for physicians to feel understood and supported by their leadership and to develop greater wellbeing. We see the organizations we support struggling to combat this problem, so we asked the national physician 16 | MAY 2015

population the same questions as our 2011 study to compare progress on this critical issue. The results revealed the progress, prevalence and effects of physician stress and burnout. Our goal was to not only understand the nature of the problem, but also to learn whether or not organizations have been successful in providing solutions to correct the problem.

The results are alarming The 2015 study of 2,005 physicians clearly showed not only is it prevalent, but stress and burnout is increasing. Almost 66% of the over 2000 respondents indicated more stress and burnout than in the 2011 study. 88% of all respondents identified themselves as moderately to severely stressed and 46% specified severe stress and burnout.


limited experience in building sustainable, healthy work environments.

More needs to be done – and soon Physicians are a precious resource and they are suffering. To make matters worse, when physicians suffer, the downstream effects on patient safety and satisfaction, risk management, staff retention and recruiting are immense.

The situation has gotten significantly worse. You can watch me discuss the results of the survey in a brief 5 minute overview at http://bit.ly/1GnorPe. Or see the complete presentation, Managing Disruptive Behaviors to Improve Patient Care at MMIC Group’s OnDemand webinars. The complete survey results with more details is also available for download at 2015 Physician Stress and Burnout Survey Report.

Are organizations helping? When asked if their organizations did anything to help them deal more effectively with stress and burnout only 18.5% said yes. 52.2% said there were wellness initiatives, but it was difficult to find time to use them. The top preferences for assistance were: • More time off or self-directed time 62% • More ancillary support, such as aides to deal with paperwork and charting 61% • Better understanding of the challenges and support by administration 47%

At the same time of this escalating stress and burnout, the baby-boomer generation is retiring, physicians are leaving the practice at increasing rates and millennials are questioning the benefits of entering the profession – all at a time when highly educated technical labor is predicted to be shrinking. This can seem nearly insurmountable to healthcare organizations also facing operational and technical pressures, increasing expenses and with

Healthier and happier physicians are critical in helping healthcare organizations to meet the challenges ahead. These survey results can help your organization better understand and address stress and burnout in your physician population. Individual physicians, but also teams, departments and entire organizations need to address the effects and solutions for stress and burnout. At VITAL WorkLife, we work every day with physicians presenting behavioral and performance issues, suffering from depression, lacking engagement or dealing with problems in their personal lives. We stand ready to help organizations develop the right solutions to both prevent and ameliorate stress and burnout, so your organization can, in turn, stay healthy and achieve your goals.  VITAL WorkLife, Inc.™ is a national behavioral health consulting organization headquartered in Minneapolis providing support to people facing life’s challenges, while also assisting organizations in improving workplace productivity. We have deep experience in healthcare, especially assisting physicians and providers in dealing with the challenges facing their profession. This approach of helping employees and their families, while also guiding organizations, builds healthy, sustainable behaviors. For over 30 years, we have offered industry leading Employee Assistance Programs, specialized support, training and consulting for a wide variety of industries. www.VITALWorkLife.com WWW.MEDMONTHLY.COM | 17


research & technology

Experimental Ebola Vaccine Safe, Prompts Immune Response

‘‘

“Until a safe and effective vaccine is available, the world will continue to be under-prepared for the next Ebola outbreak.” Anthony S. Fauci, M.D Director, National Institute of Allergy and Infectious Diseases (NIAID)

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| MAY 2015


A

n early-stage clinical trial of an experimental Ebola vaccine conducted at the National Institutes of Health and the Walter Reed Army Institute of Research (WRAIR) found that the vaccine, called VSV-ZEBOV, was safe and elicited robust antibody responses in all 40 of the healthy adults who received it. The most common side effects were injection site pain and transient fever that appeared and resolved within 12 to 36 hours after vaccination. A report describing preliminary results of the NIH-WRAIR study appears online today in The New England Journal of Medicine. The VSV-ZEBOV candidate is one of two experimental Ebola vaccines now being tested in the phase 2/3 PREVAIL clinical trial that is enrolling volunteers in Liberia. “The ongoing Ebola ongoing outbreak in West Africa is unprecedented in scope and duration,” said Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), part of NIH. “The outbreak is slowly coming under control, thanks to extraordinary and multi-faceted efforts in the affected nations. However, there still are no licensed specific therapies or vaccines for Ebola. Until a safe and effective vaccine is available, the world will continue to be under-prepared for the next Ebola outbreak.” Scientists at the Public Health Agency of Canada developed the candidate vaccine. It was licensed to NewLink Genetics Corp. of Ames, Iowa, a company collaborating with Merck & Co. Inc., of Kenilworth, New Jersey, which is responsible for advancing this vaccine towards regulatory approval. The investigational vaccine is based on a genetically modified and attenuated vesicular stomatitis virus (VSV), a virus that mainly affects cattle. In the investigational vaccine, a gene for a VSV protein is replaced with a gene segment from a key protein in the Zaire species of Ebola virus. The

vaccine does not contain the whole Ebola virus and therefore cannot infect vaccinated persons with Ebola. The new report summarizes results of the first 52 volunteers enrolled in the study: 26 at the NIH Clinical Center in Bethesda, Maryland, and 26 at the WRAIR clinic in Silver Spring, Maryland. Six volunteers at each site received a placebo injection of saline solution, and the remaining 40 received the experimental vaccine at either one of two different dosages (2 x107 or 3 x106 in 20 volunteers at each site.) The NIH trial was led by NIAID investigators Richard T. Davey, Jr., M.D., and John H. Beigel, M.D., while Jason A. Regules, M.D., and Stephen J. Thomas, M.D., headed the trial at WRAIR. The candidate vaccine’s ability to stimulate immune responses was assessed by sampling the volunteers’ blood at multiple time points following injection. (The blood sampling schedule differed between the two trial sites.) Of those volunteers tested at 14 days after injection, 93 percent (26 out of 28) of whose who had received vaccine developed antibodies against Zaire species of Ebola virus. Antibodies were detected in the remaining 14 volunteers who had received vaccine by 28 days after injection. Antibody responses were approximately three-fold greater in those who received the higher vaccine dose. This information was available to the designers of the PREVAIL trial and was used to guide the decision to use VSV-ZEBOV at the higher dosage level in that trial. “The prompt, dose-dependent production of high levels of antibodies following a single injection and the overall favorable safety profile of this vaccine make VSV-ZEBOV a promising candidate that might be particularly useful in outbreak interventions,” said Dr. Davey. The volunteers tolerated the vaccine well. Thirty percent (12 out of 40) of those who received the vaccine

experienced mild or moderate fever; in all but one case, fever appeared and resolved within 24 hours of vaccination. The VSV-ZEBOV vaccine is made from live, weakened VSV and self-limiting fever following immunization with a live virus vaccine is not unexpected. Some volunteers in a separate, Swiss study of this candidate vaccine reported experiencing arthritis that started in the second week after vaccination. Therefore, volunteers in the NIH-WRAIR study were specifically queried about new arthritis symptoms. No episodes of frank arthritis were reported by any volunteer. More details about the NIH portion of this study are available at ClinicalTrials.gov using the identifier NCT02280408. Further details on the WRAIR portion are at ClinicalTrials. gov using the identifier NCT02269423. NIAID conducts and supports research — at NIH, throughout the United States, and worldwide — to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available at http://www.niaid.nih.gov.  About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih. gov. Source: http://www.nih.gov/news/ health/apr2015/niaid-01.htm

WWW.MEDMONTHLY.COM | 19


research & technology

Study Reveals Molecular Genetic Mechanisms Driving Breast Cancer Progression

Researchers at UT Southwestern Medical Center have uncovered how the body’s inflammatory response can alter how estrogen promotes the growth of breast cancer cells. Dr. W. Lee Kraus, Director of the Cecil H. and Ida Green Center for Reproductive Biology Sciences. UT Southwestern researchers identified how a combination of signaling molecules inhibits the growth of breast cancer cells, improving clinical outcomes for some subtypes of breast cancers. The combination − the steroid hormone estradiol and the proinflammatory cytokine tumor necrosis factor alpha (TNFα) − act to expand the number of sites where estrogen receptor alpha (ERα) can bind to the genome in breast cancer cells. The new sites of ERα binding turn new genes on and off, which alters the growth response of the breast cancer cells, inhibiting their growth and improving clinical outcomes in certain cases. The newly identified gene set can be used as a biomarker 20 | MAY 2015

that can help physicians determine who is at risk and how they might react to certain therapies. “Our study uncovered the molecular mechanisms that alter the expression of the new set of genes in response to estradiol and TNFα, and identified potential target genes for future therapy,” said senior author Dr. W. Lee Kraus, Director of the Cecil H. and Ida Green Center for Reproductive Biology Sciences, Professor of Obstetrics and Gynecology, and a member of the Harold C. Simmons Comprehensive Cancer Center. “Since the altered pattern of gene expression can predict outcomes in breast cancer, there are important diagnostic and prognostic implications.” The findings are published online and in the journal Molecular Cell. Approximately 12.3 percent of women will be diagnosed with breast cancer at some point during their lifetime, and nearly 2.9 million women are living with breast cancer in


the United States, according to statistics from the National Cancer Institute (NCI). About 232,670 new cases were reported in 2014, constituting about 14 percent of all new cancer cases. About 40,000 deaths were attributed to breast cancer in 2014. Cancer cells release signals that can prompt the body to respond with an inflammatory response. As part of this response, TNFα is released and can impact the growth of the cancer cells. Previous studies suggested that inflammation might exacerbate the cancer, while the present study suggests that, in some cases, it might actually promote a better outcome. The study revealed that, when present together, TNFα and estradiol cause ERα, a nuclear transcription factor that is present in about two-thirds of breast cancers (so-called ER+ cancers), to bind to new sites in the genome where the protein does not bind with either TNFα or estradiol alone. These new ERα binding sites allow altered gene expression and, for some subtypes of breast cancers, inhibit the growth of cancer cells. Since the effect only happens when the two are combined, researchers can use the altered gene expression patterns as an indicator that both agents are at work in the cancer and as a biomarker that may help determine who might be more at risk and how they might react to therapy, said Dr. Kraus, Professor and Vice Chair for Basic Sciences in Obstetrics and Gynecology, Professor of Pharmacology, and holder of the Cecil H. and Ida Green Distinguished Chair in Reproductive Biology Sciences. The mission of the Cecil H. and Ida Green Center for Reproductive Biology Sciences, endowed by Cecil and Ida Green in 1974, is to promote and support cutting-edge, integrative, and collaborative basic research in female reproductive biology, with a focus on signaling, gene regulation, and genome function. Other UT Southwestern researchers involved in the work were postdoctoral researcher Dr. Hector Franco and computational biologist Anusha Nagari. The work was supported by a postdoctoral fellowship from the American Cancer Society - Lee National Denim Day Fellowship and a grant from the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health. UT Southwestern’s Harold C. Simmons Comprehensive Cancer Center is the only National Cancer Institutedesignated cancer center in North Texas and one of just 68 NCI-designated cancer centers in the nation. The Simmons Cancer Center includes 13 major cancer care programs with a focus on treating the whole individual with innovative treatments, while fostering groundbreaking research that has the potential to improve patient care and prevention of cancer worldwide. In addition, the Center’s education and training programs support and develop the next generation of cancer researchers and clinicians. The Simmons Cancer Center is among only 30 U.S.

cancer research centers to be named a National Clinical Trials Network Lead Academic Participating Site, a prestigious new designation by the NCI, and the only Cancer Center in North Texas to be so designated. The designation and associated funding is designed to bolster the cancer center’s clinical cancer research for adults and to provide patients access to cancer research trials sponsored by the NCI, where promising new drugs often are tested. About UT Southwestern Medical Center UT Southwestern, one of the premier academic medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty includes many distinguished members, including six who have been awarded Nobel Prizes since 1985. Numbering approximately 2,800, the faculty is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide medical care in 40 specialties to about 92,000 hospitalized patients and oversee approximately 2.1 million outpatient visits a year.  Source: http://www.pressreleasepoint.com/study-revealsmolecular-genetic-mechanisms-driving-breast-cancerprogression

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research & technology

CDC Publishes First National Study on Use of Behavioral Therapy, Medication and Dietary Supplements for ADHD in Children

By Centers for Disease Control and Prevention

The first national study to look at behavioral therapy, medication, and dietary supplements to treat attentiondeficit/hyperactivity disorder (ADHD) among children ages 4-17 shows that less than one half of children with ADHD were receiving behavioral 22 | MAY 2015

therapy in 2009-2010. The Centers for Disease Control and Prevention (CDC) study, “Treatment of AttentionDeficit/Hyperactivity Disorder among Children with Special Health Care Needs,� published today in The Journal of Pediatrics provides a snapshot into

how ADHD was treated just before the release of the 2011 clinical guidelines for treatment of ADHD from the American Academy of Pediatrics (AAP). According to the study, among children 4-17 years of age, about 4 in


10 children with ADHD were treated with medication alone, 1 in 10 received behavioral therapy alone, 3 in 10 were treated with both medication and behavioral therapy, and 1 in 10 received neither medication nor behavioral therapy. Overall, about 1 in 10 children took dietary supplements for ADHD. The data show that 1 in 2 preschoolers ages 4-5 with ADHD received behavioral therapy and about 1 in 2 were taking medication for ADHD. Almost 1 in 4 preschoolers were treated with medication alone. Among children ages 6-17 with ADHD, fewer than 1 in 3 received both medication and behavioral therapy. “We do not know what the long-term effects of psychotropic medication are on the developing brains and bodies of little kids. What we do know is that behavioral therapy is safe and can have long-term positive impacts on how a child with ADHD functions at home, in school, and with

friends,” said CDC Principal Deputy Director Ileana Arias, Ph.D. “Because behavioral therapy is the safest ADHD treatment for children under the age of 6, it should be used first, before ADHD medication for those children.” In 2011, AAP released ADHD treatment guidelines recommending behavioral therapy alone for treatment of preschoolers and combination therapy of medication and behavioral therapy for children with ADHD between the ages of 6-17. “Treatment decisions for ADHD in children can be complex. Parents, health professionals, psychologists, and educators can work together to ensure that children receive the best treatment available,” said Susanna Visser, DrPH, M.S., epidemiologist with CDC’s National Center on Birth Defects and Developmental Disabilities. She added, “The good news is that we now have strong clinical guidelines to support the more than 5 million children living with ADHD.”

The study shows significant state-to-state variability in the type of treatment used to treat ADHD in children 4-17 years of age. On average, states with higher behavioral therapy rates had lower medication treatment rates and vice versa. Rates of medication treatment among children with ADHD ranged from a low of 57 percent in California to a high of 88 percent in Michigan. Rates of behavioral therapy among children with ADHD ranged from a low of 33 percent in Tennessee to 61 percent in Hawaii. This analysis was from parent reported data from the 2009-2010 National Survey of Children with Special Health Care Needs. For a copy of the full article visit: http://www.jpeds.com/pb/assets/raw/ Health%20Advance/journals/ympd/ Visser.pdf.  Source: http://www.cdc.gov/media/ releases/2015/p0401-adhd.html

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legal

Hospital Cannot Show Nurses’ Overtime Refusal Would Cause Irreparable Harm, Court Rules No TRO

By Michael R. Bertoncini Jackson Lewis P.C.

D

enying a hospital’s request to restrain its unionized nurses from refusing overtime assignments after the hospital had announced it would make layoffs, a federal court in Rhode Island concluded the hospital failed to demonstrate that it or its patients would suffer irreparable harm as a result of the nurses’ refusal to work overtime. New England Healthcare Employees Union, District 1199, SEIU v. Women & Infants Hospital, C.A. No. 15-55 S (D. R.I. Mar. 27, 2015). After Women & Infants Hospital announced layoffs, the union representing its nurses and other employees notified the hospital that it would conduct informational picketing and that nurses would refuse to accept overtime assignments (the parties’ collective bargaining agreement and Rhode Island law prohibit the hospital from mandating overtime except in emergencies). The hospital asked the federal district court for a temporary restraining order requiring the nurses to accept overtime assignments pending arbitration of the parties’ dispute over the layoffs. To establish the requested “Boys Market” injunction (named after a 1970 Supreme Court decision) in aid of arbitration would be appropriate, the hospital had to demonstrate that (1) the parties’ collective bargaining agreement contains mandatory arbitration procedures; (2) the work stoppage to be enjoined is over an arbitrable grievance; and (3) ordinary principles of equity warrant the injunctive relief, such as a showing of irreparable harm in the absence of injunctive relief. The court found the hospital established the first two conditions, but failed to show that the nurses’ refusal to accept overtime assignments would cause the hospital irreparable harm. The hospital argued it would have to divert patients to other hospitals. It identified three ways in which it said diverting patients would cause irreparable harm: (1) reputational harm; (2) harm to patients; and (3) lost

24 | MAY 2015

revenues. The court found the hospital’s evidence as to each type of alleged harm insufficient to warrant injunctive relief. The court noted that the hospital had diverted patients in the past, including as a result of labor disputes, and that there was no evidence these past diversions caused any reputational harm. The court found the hospital’s evidence of potential harm to diverted patients was speculative and contradictory, in part because the hospital provided no evidence that past diversions had posed a health risk to the diverted patients. Further, the court could not gauge the amount of lost revenue the hospital might suffer because the hospital failed to provide monetary figures for the average reimbursements it received in the units that may be affected by patient diversion. Moreover, the court noted it was not clear the hospital would suffer any financial loss when patients were diverted to other hospitals within the same healthcare network as the hospital. Significantly, the court also found the hospital’s claim that patient diversion would occur at all was speculative and prevented a finding of irreparable harm at this stage of the litigation because the hospital had alternatives to assigning overtime shifts, such as using per diem and temporary nurses. The court’s analysis in this case illustrates the importance of contingency planning when healthcare employers face potential work stoppages.  © 2015 Jackson Lewis P.C. Reprinted with permission. Originally published at www.jacksonlewis.com. Jackson Lewis P.C. is a national workplace law firm with offices nationwide. Source: http://www.healthcareworkplaceupdate.com/labor/ hospital-cannot-show-nurses-overtime-refusal-would-causeirreparable-harm-court-rules-no-tro/


legal

Moving to the Cloud: Some Key Considerations for Healthcare Entities

By Paige M. Jennings, Anna Kraus, Ramy Ramadan, and Lee J. Tiedrich Covington & Burling LLP

Healthcare providers, health plans, and other entities are increasingly utilizing cloud services to collect, aggregate, store and process data. A recent report by IDC Health Insights suggests that 80 percent of healthcare data is expected to pass through the cloud by 2020. As a substantial amount of healthcare data comprises “personal information” or “protected health information” (PHI), federal and state privacy and security laws, including the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act, raise significant questions for healthcare providers and health plans utilizing the cloud in connection with such data. Such questions include whether HIPAA requirements extend to cloud providers, how and if entities storing health data on the cloud will be notified in case of a breach, and whether storage of data overseas by cloud providers triggers any additional obligations or concerns. Given the complex legal issues at play, any contract between a healthcare provider or health plan and a cloud service provider that involves using the cloud in connection with PHI should therefore address the regulatory restrictions and requirements applicable to PHI. By way of example, recent guidance from the HHS Office for Civil Rights suggests that health care providers must likely have a business associate agreement in place with their cloud service provider. Moreover, although cloud providers might not regularly access the data they store and may never “use” or “disclose” that data as those terms are 26 | MAY 2015

defined under HIPAA, cloud providers probably need to adhere to HIPAA breach notification requirements. There have also been indications of late that HHS may consider it advisable, if not required, that entities subject to the HIPAA Security Rule encrypt PHI data even when that data is at rest and not being transmitted electronically. The recent data breaches involving health plans Anthem and Premera highlight the vulnerability of health care data and may lead to additional pressure for providers to implement additional encryption measures. Even if HIPAA rules do not apply to cloud service provider contracts, healthcare providers and health plans storing data on the cloud should be aware that many states now have privacy and breach notification laws which could come into play. Finally, in addition to addressing the regulatory requirements and data privacy and security, a healthcare provider or health plan should negotiate appropriate service level terms with the cloud provider that address such issues as the performance requirements for the cloud network and the process and procedures for addressing problems with the cloud network. The healthcare provider or health plan should also include appropriate back-up and disaster recovery provisions in the contract with the cloud provider, as well as appropriate remedies in the event it suffers losses as a result of the contract.  Source: http://www.covingtonehealth.com/2015/04/movingto-the-cloud-some-key-considerations-for-healthcare-entities/


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legal

CMS Releases Stage 3 Meaningful Use Proposed Rule

By M. Leeann Habte, Richard K. Rifenbark, and Elizabeth J. Rosen Foley & Lardner LLP

The Centers for Medicare & Medicaid Services (“CMS”) released the Stage 3 proposed rule to the Medicare and Medicaid Electronic Health Records Incentive Programs (“Proposed Rule”) on March 20, 2015. To provide context, eligible professionals (“EPs”) and hospitals must attest to demonstrating meaningful use of certified electronic health record (“EHR”) technology to qualify for incentive payments through the Medicare and Medicaid EHR Incentive Programs. Failure to demonstrate meaningful use 28 | MAY 2015

generally results in negative payment adjustments under the Medicare program for EPs and hospitals, unless an EP or hospital qualifies for a hardship exception. The criteria used by CMS to determine meaningful use by providers has evolved over three stages of rulemaking. Now in Stage 3, the Proposed Rule aims to broaden CMS’s efforts to increase simplicity and flexibility in the Medicare and Medicaid EHR Incentive Programs, while driving interoperability and increasing the focus on


improved patient outcomes. It also seeks to further align the Medicare and Medicaid Incentive Programs with other CMS quality reporting programs that use certified health information technology, such as the hospital inpatient quality reporting and the physician quality reporting systems. The Proposed Rule specifies the meaningful use criteria that EPs and hospitals must meet in order to qualify for Medicare and Medicaid EHR incentive payments and to avoid negative payment adjustments under Medicare. These meaningful use criteria are optional in 2017, but are mandatory beginning in 2018. Among other proposals, CMS seeks the following in the Stage 3 Proposed Rule:

current law, there are several potential hardship exceptions to the imposition of Medicare payment adjustments. These generally include hardship waivers due to insufficient internet access, problems with EHR vendors, lack of face-to-face patient interactions or patient follow up (applicable to EPs), certain types of specialties (applicable to EPs), lack of control over certified EHR technology for more than 50 percent of patient encounters (applicable to EPs), EPs who are new to the practice of medicine and newly formed hospitals, and inability to satisfy meaningful use due to natural disasters or other unforeseen barriers. CMS proposes no changes to the current types of hardship exceptions.

• EHR Reporting Period: In the Stage 1 and Stage 2 final rules, CMS established that the EHR reporting period for eligible hospitals is based on the federal fiscal year (October 1st through September 30th). In Stage 3, CMS seeks to change the EHR reporting period so that all providers would report under a full calendar year timeline and eliminate the 90-day EHR reporting period for new meaningful users, with a limited exception under the Medicaid EHR Incentive Program for providers demonstrating meaningful use for the first time. CMS proposes that these changes would apply beginning in calendar year 2017. • Meaningful Use Objectives and Measures: CMS proposes a single set of objectives and measures to meet meaningful use, covering eight areas: (1) protection of patient health information, (2) electronic prescribing, (3) clinical decision support, (4) computerized provider order entry (“CPOE”), (5) patient electronic access to health information, (6) coordination of care through patient engagement, (7) health information exchange, and (8) public health and clinical data registry reporting. Each of these objectives has between one and six proposed measures. • EPs Practicing in Multiple Practices/Locations: Under current law, to be a meaningful user, an EP must have 50 percent or more of his or her outpatient encounters during the EHR reporting period at one or more practice(s)/location(s) equipped with certified EHR technology. CMS proposes to maintain this requirement. • 2015 Edition Certified EHR Technology Required for 2018: CMS proposes that starting with calendar year 2018, all EPs and hospitals will be required to use technology certified to the 2015 edition of EHR technology to demonstrate meaningful use in 2018 and subsequent years. The Office of the National Coordinator for Health Information Technology released the proposed 2015 edition health information technology certification criteria on March 20, 2015. • No New Categories of Hardship Exceptions: Under

CMS intends for Stage 3 to be the final stage of the meaningful use framework and to incorporate portions of Stage 1 and Stage 2 into its requirements. As a result, Stage 3 will be the single final set of objectives and measures for meaningful use and will eliminate Stages 1 and 2. CMS believes this will reduce provider burden and allow for greater focus on improving outcomes, enhancing interoperability, and increasing patient engagement. The comment period for Stage 3 ends May 29, 2015.  Source: http://www.foley.com/cms-releases-stage-3meaningful-use-proposed-rule-04-02-2015/

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features

Three Reasons Why Investing in Internet Marketing Will Attract New Patients to Your Practice

By Amanda Kanaan WhiteCoat Designs For most patients, the search for a doctor now begins online. In the same way consumers shop the internet for a new pair of shoes or to find a new restaurant, patients engage in similar behavior when it comes to their medical care. If your practice isn’t investing in internet marketing then it’s likely that one of your competitors is (especially if you are going “head to head” with a hospital system). The less doctors that engage in internet marketing, the easier it is to compete for search engine rankings. Therefore, by not investing online, you’re not only losing out on potential patients but you are also making it easier for your competitors to attract those patients in your absence. If that’s not reason enough, here are three additional reasons why you should invest in internet marketing.

1. It’s Where Patients Search for Doctors

Eighty percent of U.S. adults search for health information online. More importantly, 44 percent of those searches are from potential patients seeking treatment from a healthcare provider. Since most clicks occur within the first three search engine listings, if your website isn’t ranked in the top three or at least on the first page then you might as well not exist. Google’s search algorithm is constantly changing and while no one knows the exact measurements in

30 | MAY 2015

their “secret sauce”, we at least know the ingredients. This is where a Search Engine Optimization (SEO) agency can be of assistance. They are the experts in knowing just what strategies to utilize in order to improve your organic rankings online. However, SEO is only one part of the battle. Google now takes into account other factors, such as social media, when ranking your website in the search results. So if you haven’t joined the Facebook band wagon just yet then here’s yet another reason to consider hopping aboard. Due to these recent search algorithm changes, most digital marketing agencies are now shifting away from stand-alone SEO services in favor of more comprehensive strategies. That may mean a larger investment up front to pursue several services at once, such as SEO, pay-per-click (PPC) ads, social media posting, etc., but the thought is that you’ll get a better return on the back end – in the same way that you encourage your patients to not just take their medicine but also eat well and exercise.

2. It’s Influential

The beauty of internet marketing is that it applies to every specialty and almost every target demographic. That even includes older populations – the 55+ age


group is the fastest growing demographic on Facebook. With statistics like one in five internet users have consulted online reviews of health care providers and treatments, and forty-one percent say social media would affect their choice of a provider, it’s clear that internet marketing can be highly influential when utilized properly. You have a unique opportunity to shape perceptions of your providers and practice online by having a well-designed website that makes an impactful first impression, an engaging social media presence that allows you to control the conversation, and positive online reviews that support your reputation. Internet marketing is also an effective strategy, because it’s a “pull” versus a “push” approach. With advertising outlets, such as TV, you are pushing your service on a viewer who may or may not want to receive it or even be a potential candidate. With marketing tactics, such as SEO, patients are actually seeking your service when they search for something like “Cardiologist, Dallas, TX”. That makes your online efforts more influential than traditional advertising because you are targeting your ideal demographic.

3. It’s Cost-Effective

Practices often have limited marketing budgets and traditional, outbound marketing tactics (such as TV, print and radio) are not only expensive but also difficult to track. Inbound marketing (such as SEO) is not only less expensive but the ROI is also much more measurable. On average, inbound leads cost about sixty-one percent less than outbound leads: $135 versus $346 per lead. For those with a substantial marketing budget, pursuing both an outbound and inbound marketing strategy is a possibility. For those with a limited market budget, it’s important to spend those precious marketing dollars on a strategy where you’ll get the most for your money – i.e. inbound marketing. A good internet marketing strategy will pay for itself in new patients. For example, if you know a new patient is worth $200 to your practice then you can easily calculate the minimum number of new patients you need to at least cover your costs. With that in mind, you also need to be willing to invest enough in the campaign to show an ROI. It’s unrealistic to think that you’re going to invest $200 a month in internet marketing and expect a decent return. The cost ultimately depends on your goals and how competitive the market is that you are in.

If your practice wants to grow new patient volume, influence the conversation online and do it in a cost-effective way then internet marketing should be your primary strategy. Never before has marketing to patients online, especially for the medical industry, been more effective as it is today. It’s undeniable that patients are searching online for healthcare information, your practice just needs to invest in a strong online presence in order to attract these patients to your practice.  Sources: Pew Research Center’s Internet & American Life Project Surveys Hubspot’s 2012 State of Inbound Marketing Report


features

Can 140-characters or Less Promote Your Practice? By Carrie A Noriega, MD

32 | MAY 2015


W

e have all heard of social media. Outlets like Facebook and Twitter are commonplace in many of our daily lives. But can these be used to promote our professional lives as well, and if so how? The answer is yes, it absolutely can be used to promote a medical practice. Of more than 1,000 people surveyed in 2012, 90% of people ages 18-24 trust health information from social media sources and 56% of people ages 45-64 are willing to engage in health activities on social media1. By engaging in social media, you can become the trusted medical source people look to when they have questions. And one of the best parts is that this a free way to get your message out to the masses. How to create a productive social media presence is important to understand before immediately going out and opening an account for your practice. First you need to find out which social media sites your patients are using to get their health information. If you aren’t using a site your patients are following, you may just be wasting a lot of your valuable time. One of the easiest ways to find out which social media sites are popular with your patients is to just ask them. You can develop a short questionnaire that you hand out to patients when they come for their appointment, asking them if they use social media to get answers to their health questions and, if so, which sites. Once you have figured out which sites your patients are using, you should pick just one social media form to start your new endeavor. To get the most out of your social media campaign, you should take the time to get to know how to use it and get comfortable sending out your messages. Once you feel that you have a good understanding of your new account, then you may want to branch out to other social media outlets. When creating you social media accounts it is important not to mix your personal accounts with your business accounts. You want to portray a professional image that will help promote your practice and attract new patients. Posting pictures of your latest family vacation won’t help do this. Always have two separate accounts, even if you are already using a private account and think that you will just transition it to your professional account. It isn’t worth the possibility of losing patients over something you may have written long ago, especially since it is so easy to open additional accounts. Physicians who successfully use social media to build their practice have a constant presence on social media. Patients are turning to social media to build online relationships with doctors and their staff on a regular basis, so having a constant presence is important. It is recommended that you post daily on Facebook and several times per day on Twitter. If this seems too daunting, don’t worry, there are applications like Hoot Suite that allow you to write a week’s worth of posts all at once and then schedule when and where they are posted. If you don’t think you can come up with enough material to post, you can easily search social media to find out which health care concerns are trending and write about these subjects. Most likely your patients will be interested in these topics too. One concern that physicians have about social media is dealing with a patient’s dissatisfaction with their practice so publically. Fortunately, it doesn’t happen all that often but it is a good idea to have a plan in place for handling these situations smoothly from the beginning. To do this, it is best to stay connected with your accounts often, so that when this happens you can respond quickly. You should keep any private information out of public view, but it is important to let the public know that you are taking this complaint seriously and addressing the problem. By doing this, you are letting your patients know you take their concerns seriously. In private, you should contact the patient to find out the details of the problem and do your best to address the concern. Whichever social media outlets you employ to promote your practice, remember to have fun doing it and allow it to be an expression of the personality of your clinic. Patients really want to get to know the practice and by allowing them to do this, you will attract patients that are a good fit for your clinic. This will hopefully lead to long-term, successful relationships with your patients.  References: 1 Social media “likes” healthcare: From marketing to social business. PWC Health Research Institute. http://www.pwc.com/us/en/health-industries/publications/health-care-social-media.jhtml. 2012. Accessed April 14, 2015. WWW.MEDMONTHLY.COM | 33


features

Attracting New Patients -

Brand Marketing is the Key

By Naren Arulrajah with Vikas Vij Ekwa Marketing

Attracting new patients is one of the biggest challenges for healthcare practices. Let’s face it, the business of marketing a brand has undergone tremendous changes in the past few years. Factor in reforms to the healthcare system, the emergence of a highly competitive digital marketplace, and the changing face of consumerism and it becomes easy to understand why finding and attracting new patients has become a bigger challenge than ever.

Three big challenges in healthcare marketing: • Increased competition faced by both hospital-owned and privately run medical practices. • Changes in patient expectations and brand perceptions. • Emergence of tech-savvy patients who are better informed and in control of the decision making process.

Only the Best Will Do Today’s marketplace is digital. And it is the consumers who dominate this space and are at the epicenter of marketing reforms and trends. They know what they want and where they can find it. From a serious health concern to a routine checkup, your patients only want the best. The digital market space has placed the power of extensive 34 | MAY 2015

choice at their disposal and this is why an increasing number of healthcare practices are finding it harder to sustain and build their patient base. If potential patients are not convinced you are their best choice, they will not come to you.

Market your Brand Message – Showcase Your Practice Value Until a few years back, most doctors displayed a certain reluctance towards advertising and brand promotion. However, in today’s competitive digital marketplace, prominent and compelling marketing messages are the key to attracting a potential patient base. Brand marketing is one of the most effective ways of building trust. Strategic use of marketing messages can help define your practice brand, allow patients to understand what you can do for them, while also demonstrating clear and tangible practice value. In short, it can set you apart from your competitors and provide potential patients with compelling reasons to choose your practice.

Build Brand Value for your Practice The digital landscape is vibrant, expansive, and is dominated by a multitude of media channels. In addition to a website, healthcare practices can reach out and connect with a potential target base via social media, blogs and visual media, as well as over popular review sites. An


continued on page 36 WWW.MEDMONTHLY.COM | 35


continued from page 35

all-encompassing and comprehensive digital marketing strategy can help you pull in your desired patient base.

Top 5 ways in which you can build brand value for your practice and attract new patients: Content marketing – is one of the most effective ways of attracting leads and winning new patients. Create wellresearched, in-depth content targeting popular health issues and concerns in your area of specialization. This is the kind of information that potential patients look for. Social media platforms – such as Facebook, Twitter, and Google+ are powerful social domains. In addition to delivering fantastic brand exposure, leading social sites are conducive to building relationships with your target patient base. Patient testimonials and doctor credentials – on your website can easily help boost patient flow to your practice. Patients want tangible value and testimonials as well as doctor credentials speak volumes about the kind of patient treatment and care your practice offers. Collect positive reviews – as they are crucial to building and managing your online reputation. Leading review sites are one of the first places that potential patients will

visit when looking for a doctor of their choice. While it is important that you encourage your patients to leave reviews, it is equally important that you regularly monitor your reviews. Take care of any negative feedback immediately and don’t forget to thank patients who leave good reviews. Optimize for the mobile – as an increasing number of potential patients today use their mobile devices to access information about healthcare issues, and to look up a doctor. Given the role that mobile plays in digital marketing, there is every chance that a substantial percentage of your traffic will come from a mobile device and this is why you need to optimize for different mobile devices.  About the Author: Naren Arulrajah is President and CEO of Ekwa Marketing, a complete Internet marketing company which focuses on SEO, social media, marketing education and the online reputations of Dentists and Physicians. With a team of 130+ full time marketers, www.ekwa.com helps doctors who know where they want to go, get there by dominating their market and growing their business significantly year after year. If you have questions about marketing your practice online, call Naren direct at 877-2499666.


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healthy living

Fruit Kabobs with Fluffy Fruit Dip (Adapted From: Eat Right Press, from Healthy Eating, Healthy Weight for Kids and Teens by Jodie Shield, MEd, RD)

By Ashley Acornley, MS, RD, LDN Looking for a light refreshing spring dessert that is sure to satisfy your sweet tooth? Look no further because this recipe will do the trick. You can use any fruits for your kabob but I recommend including strawberries because May is when they are at their peak ripeness. It’s hard to resist those mouth-watering lush red strawberries at your local farmer’s market. When combined with other fruits and a light fluffy dip, this will surely satisfy your sweet tooth.

Ingredients for Dip: l 1

cup fruit-flavored, low-fat yogurt l 1 cup fat-free whipped topping, thawed l 1 teaspoon honey

Ingredients for Kabobs: l 6

to 8 pineapple chunks l 6 to 8 whole strawberries l 1 banana, cut into 1⁄2 chunks l 6 to 8 red or green grapes l 6 wooden skewers

Preparation: 1. In a small bowl, make dip by mixing together yogurt, whipped topping and honey. 2. Cover and refrigerate until needed. 3. Thread one piece of each fruit onto a skewer. 4. Repeat until the fruit is gone or skewers are full. 5. Serve with dip. Variation: Use any of your kids’ favorite fruits.

38

| MAY 2015

Nutrition Facts Per Serving (1/6 of recipe): Calories: 64 Fat: 0.4 g Saturated fat: 0.2 g Cholesterol: 1.9 mg Sodium: 26 mg Carbohydrates: 16.5 g Fiber: 1.1 g Protein: 2.5 g


U.S. OPTICAL BOARDS Alaska P.O. Box 110806 Juneau, AK 99811 (907)465-5470 http://www.dced.state.ak.us/occ/pdop.htm

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

Oregon 3218 Pringle Rd. SE Ste. 270 Salem, OR 97302 (503)373-7721 www.obo.state.or.us

Arizona 1400 W. Washington, Rm. 230 Phoenix, AZ 85007 (602)542-3095 http://www.do.az.gov

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

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

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

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

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

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

Arkansas P.O. Box 627 Helena, AR 72342 (870)572-2847 California 2005 Evergreen St., Ste. 1200 Sacramento, CA 95815 (916)263-2382 http://www.optometry.ca.gov/ Colorado 1560 Broadway St. #1310 Denver, CO 80202 (303)894-7750 http://www.dora.state.co.us/optometry/ Connecticut 410 Capitol Ave., MS #12APP P.O. Box 340308 Hartford, CT 06134 (860)509-7603 ext. 4 http://www.ct.gov/dph/cwp/view. asp?a=3121&q=427586 Florida 4052 Bald Cypress Way, Bin C08 Tallahassee, FL 32399 (850)245-4474 http://www.pof.org/opticianry-board/ Georgia 237 Coliseum Dr. Macon, GA 31217 (478)207-1671 http://sos.ga.gov/index.php/licensing/ plb/20 Hawaii P.O. Box 3469 Honolulu, HI 96801 (808)586-2704 http://hawaii.gov/dcca/pvl/programs/ dispensingoptician/

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

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

WWW.MEDMONTHLY.COM | 39


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

Hawaii DCCA-PVL Att: Dental P.O. Box 3469 Honolulu, HI 96801 (808)586-3000 http://1.usa.gov/s5Ry9i Idaho P.O. Box 83720 Boise, ID 83720 (208)334-2369 http://isbd.idaho.gov/

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

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

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

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

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

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

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

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

Delaware Cannon Building, Suite 203 861 Solver Lake Blvd. Dover, DE 19904 (302)744-4500 http://1.usa.gov/t0mbWZ

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

Florida 4052 Bald Cypress Way Bin C-08 Tallahassee, FL 32399 (850)245-4474 http://floridasdentistry.gov/ 40

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

| MAY 2015

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

Maine 143 State House Station 161 Capitol St. Augusta, ME 04333 (207)287-3333 http://www.mainedental.org/ Maryland 55 Wade Ave. Catonsville, Maryland 21228 (410)402-8500 http://dhmh.state.md.us/dental/ Massachusetts 1000 Washington St., Suite 710 Boston, MA 02118 (617)727-1944 http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/dhpl/ dentist/ Michigan P.O. Box 30664 Lansing, MI 48909 (517)241-2650 http://www.michigan.gov/lara/0,4601,7154-35299_28150_27529_27533---,00. html Minnesota 2829 University Ave., SE. Suite 450 Minneapolis, MN 55414 (612)617-2250 http://www.dentalboard.state.mn.us/ Mississippi 600 E. Amite St., Suite 100 Jackson, MS 39201 (601)944-9622 http://bit.ly/uuXKxl Missouri 3605 Missouri Blvd. P.O. Box 1367 Jefferson City, MO 65102 (573)751-0040 http://pr.mo.gov/dental.asp Montana P.O. Box 200113 Helena, MT 59620 (406)444-2511 http://bsd.dli.mt.gov/license/bsd_ boards/den_board/board_page.asp


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

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

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

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

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

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

New Jersey P.O Box 45005 Newark, NJ 07101 (973)504-6405 http://bit.ly/uO2tLg

Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)783-7162 http://bit.ly/s5oYiS

New Mexico Toney Anaya Building 2550 Cerrillos Rd. Santa Fe, NM 87505 (505)476-4680 http://www.rld.state.nm.us/boards/Dental_Health_Care.aspx

Rhode Island Dept. of Health Three Capitol Hill, Room 104 Providence, RI 02908 (401)222-2828 http://1.usa.gov/u66MaB

New York 89 Washington Ave. Albany, NY 12234 (518)474-3817 http://www.op.nysed.gov/prof/dent/

South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4599 http://www.llr.state.sc.us/POL/Dentistry/

North Carolina 507 Airport Blvd., Suite 105 Morrisville, NC 27560 (919)678-8223 http://www.ncdentalboard.org/

South Dakota P.O. Box 1079 105. S. Euclid Ave. Suite C Pierre, SC 57501 (605)224-1282 https://www.sdboardofdentistry.com/

North Dakota P.O. Box 7246 Bismark, ND 58507 (701)258-8600 http://www.nddentalboard.org/

Tennessee 227 French Landing, Suite 300 Nashville, TN 37243 (615)532-3202 http://health.state.tn.us/boards/dentistry/

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

WWW.MEDMONTHLY.COM | 41


U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (334)242-4116 http://www.albme.org/ Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 http://commerce.alaska.gov/dnn/cbpl/ ProfessionalLicensing/StateMedicalBoard.aspx Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 (480)551-2700 http://www.azmd.gov Arkansas 1401 West Capitol Ave., Suite 340 Little Rock, AR 72201 (501)296-1802 http://www.armedicalboard.org/ California 2005 Evergreen St., Suite 1200 Sacramento, CA 95815 (916)263-2382 http://www.mbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7690 http://www.dora.state.co.us/medical/ Connecticut 401 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/cwp/view. asp?a=3143&q=388902 Delaware Division of Professional Regulation Cannon Building 861 Silver Lake Blvd., Suite 203 Dover, DE 19904 (302)744-4500 http://dpr.delaware.gov/ District of Columbia 899 North Capitol St., NE Washington, DC 20002 (202)442-5955 http://doh.dc.gov/bomed 42 | MAY 2015

Florida 2585 Merchants Row Blvd. Tallahassee, FL 32399 (850)245-4444 http://www.stateofflorida.com/Portal/ DesktopDefault.aspx?tabid=115

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

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

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

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

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

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

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

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

Michigan Bureau of Health Professions P.O. Box 30670 Lansing, MI 48909 (517)335-0918 http://www.michigan.gov/lara/0,4601,7154-35299_28150_27529_27541-58914-,00.html

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

Minnesota University Park Plaza 2829 University Ave. SE, Suite 500  Minneapolis, MN 55414 (612)617-2130 http://bit.ly/pAFXGq Mississippi 1867 Crane Ridge Drive, Suite 200-B Jackson, MS 39216 (601)987-3079 http://www.msbml.state.ms.us/ Missouri Missouri Division of Professional Registration 3605 Missouri Blvd. P.O. Box 1335 Jefferson City, MO  65102 (573)751-0293  http://pr.mo.gov/healingarts.asp


Montana 301 S. Park Ave. #430 Helena, MT 59601 (406)841-2300 http://bsd.dli.mt.gov/license/bsd_ boards/med_board/board_page.asp Nebraska Nebraska Department of Health and Human Services P.O. Box 95026 Lincoln, NE 68509 (402)471-3121 http://www.mdpreferredservices.com/ state-licensing-boards/nebraska-boardof-medicine-and-surgery Nevada Board of Medical Examiners P.O. Box 7238 Reno, NV 89510 (775)688-2559 http://www.medboard.nv.gov/ New Hampshire New Hampshire State Board of Medicine 2 Industrial Park Dr. #8 Concord, NH 03301 (603)271-1203 http://www.nh.gov/medicine/ New Jersey P. O. Box 360 Trenton, NJ 08625 (609)292-7837 http://bit.ly/w5rc8J New Mexico 2055 S. Pacheco St. Building 400 Santa Fe, NM 87505 (505)476-7220 http://www.nmmb.state.nm.us/ New York Office of the Professions State Education Building, 2nd Floor Albany, NY 12234 (518)474-3817 http://www.op.nysed.gov/ North Carolina P.O. Box 20007 Raleigh, NC 27619 (919)326-1100 http://www.ncmedboard.org/

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

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

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

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

Oklahoma P.O. Box 18256 Oklahoma City, OK 73154 (405)962-1400 http://www.okmedicalboard.org/ Oregon 1500 SW 1st Ave., Suite 620 Portland, OR 97201 (971)673-2700 http://www.oregon.gov/OMB/ Pennsylvania P.O. Box 2649 Harrisburg, PA 17105  (717)787-8503  http://www.dos.state.pa.us/portal/server. pt/community/state_board_of_medicine/12512 Rhode Island 3 Capitol Hill Providence, RI 02908 (401)222-5960 http://1.usa.gov/xgocXV South Carolina P.O. Box 11289 Columbia, SC 29211 (803)896-4500 http://www.llr.state.sc.us/pol/medical/ South Dakota 101 N. Main Ave. Suite 301 Sioux Falls, SD 57104 (605)367-7781 http://www.sdbmoe.gov/ Tennessee 425 5th Ave. North Cordell Hull Bldg. 3rd Floor Nashville, TN 37243 (615)741-3111 http://health.state.tn.us/boards/me/

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

WWW.MEDMONTHLY.COM | 43


medical resource guide ACCOUNTING

Utilization Solutions service@pushpa.biz (919) 289-9126

www.pushpa.biz

Boyle CPA, PLLC 3716 National Drive, Suite 206 Raleigh, NC 27612 (919) 720-4970 www.boyle-cpa.com

BILLING & COLLECTION

DENTAL Biomet 3i

4555 Riverside Dr. Palm Beach Gardens, FL 33410 (800)342-5454 www.biomet3i.com

Dental Management Club Applied Medical Systems, Inc. Billing - Coding - Practice Solutions 4220 NC Hwy 55, Suite 130B Durham, NC 27713 (800) 334-6606 www.ams-nc.com

CODING SPECIALISTS Place Your Ad Here

CONSULTING SERVICES, PRACTICE MANAGEMENT Physician Wellness Services 5000 West 36th Street, Suite 240 Minneapolis, MN 55416 888.892.3861 www.physicianwellnessservices.com

Urgent Care America

17595 S. Tamiami Trail Fort Meyers, FL 33908 (239)415-3222 www.urgentcareamerica.net

Urgent Care & Occupational Medicine Consultant Lawrence Earl, MD COO/CMO ASAP Urgentcare Medical Director, NADME.org 908-635-4775 (m) 866-405-4770 (f ) http://www.asap-urgentcare.com/ http://www.UrgentCareMentor.com

44 | MAY 2015

4924 Balboa Blvd #460 Encino, CA 91316 www.dentalmanagementclub.com

The Dental Box Company, Inc.

PO Box 101430 Pittsburgh, PA 15237 (412)364-8712 www.thedentalbox.com

DIETICIAN Triangle Nutrition Therapy 4030 Wake Forest Road, Suite 300 Raleigh, NC 27609 (919)876-9779 http://trianglediet.com/

ELECTRONIC MED. RECORDS

EXECUTIVE ACCOUNTING & FINANCE RECRUITER Accounting Professionals Agency, LLC Adrienne Aldridge, CPA, CGMA, FLMI President 1204 Benoit Place Apex, NC 27502 (919) 924-4476 aaldridge@AccountingProfessioinals Agency.com www.AccountingProfessionalsAgency.com

FINANCIAL CONSULTANTS Sigmon Daknis Wealth Management 701 Town Center Dr. , Ste. #104 Newport News, VA 23606 (757)223-5902 www.sigmondaknis.com

INSURANCE, MED. LIABILITY Jones Insurance 820 Benson Rd. Garner, North Carolina 27529 (919) 772-0233 www.Jones-insurance.com

AdvancedMD 10011 S. Centennial Pkwy Sandy, UT 84070 (800) 825-0224 www.advancedmd.com

CollaborateMD 201 E. Pine St. #1310 Orlando, FL 32801 (888)348-8457 www.collaboratemd.com

EQUIPMENT APPRAISER Brumbaugh Appraisals 8601 Six Forks Road, Suite 400, Raleigh, NC 27615 (919) 870-8258 www.brumbaughappraisals.com

LOCUM TENENS Physician Solutions

PO Box 98313 Raleigh, NC 27624 (919)845-0054 www.physiciansolutions.com

MEDICAL ARCHITECTS MMA Medical Architects

520 Sutter Street San Francisco, CA 94115 (415) 346-9990 http://www.mmamedarc.com


medical resource guide WhiteCoat Designs

MEDICAL ART Deborah Brenner

877 Island Ave #315 San Diego, CA 92101 (619)818-4714 www.deborahbrenner.com

Web, Print & Marketing Solutions for Doctors (919)714-9885 www.whitecoat-designs.com

MEDICAL PRACTICE SALES

PROFESSIONAL SPEAKER Capri Health

Angela Savitri, OTR/L, RYT, IHC, RCST速 919-673-2813 angela@caprihealth.com www.freedomfromchronicstress.com

MedImagery

Laura Maaske 262-308-1300 Laura@medimagery.com http://www.medimagery.com

Medical Practice Listings

8317 Six Forks Rd. Ste #205 Raleigh, NC 27624 (919)848-4202 www.medicalpracticelistings.com

MEDICAL EQUIPMENT MEDICAL PRACTICE VALUATIONS

Assured Pharmaceuticals Matthew Hall (704)419-3005 mhall@assuredpharma.com

BizScore

www.assurepharma.com

Tarheel Physicians Supply 1934 Colwell Ave. Wilmington, NC 28403 (800)672-0441

www.thetps.com

MEDICAL RESEARCH

Bank of America

Mark MacKinnon, Regional Sales Manager 3801 Columbine Circle Charlotte, NC 28211 (704)995-9193 mark.mackinnon@bankofamerica.com

York Properties, Inc. Headquarters & Property Management 1900 Cameron Street Raleigh, NC 27605 (919) 821-1350 Commercial Sales & Leasing (919) 821-7177 www.yorkproperties.com

STAFFING COMPANIES

PO Box 99488 Raleigh, NC 27624 (919)846-4747 www.bizscorevaluation.com

MEDICAL EQUIPMENT FINANCING

REAL ESTATE

Additional Staffing Group, Inc. 8319 Six Forks Rd, Suite 103 Raleigh, NC 27615 (919) 844-6601 Astaffinggroup.com

SUPPLIES, GENERAL

Scynexis, Inc.

3501 C Tricenter Blvd. Durham, NC 27713 (919) 933-4990

CNF Medical www.scynexis.com

PRACTICE FINANCING

1100 Patterson Avenue Winston Salem, NC 27101 (877)631-3077 www.cnfmedical.com

www.bankofamerica.com/practicesolutions

Bank of America

MEDICAL MARKETING Ekwa Marketing

Mark MacKinnon, Regional Sales Manager 3801 Columbine Circle Charlotte, NC 28211 (704)995-9193 mark.mackinnon@bankofamerica.com www.bankofamerica.com/practicesolutions

303, Pinetree Way Mississauga Ontario L5G 2R4, Canada (855) 345-0593 www.ekwa.com

WWW.MEDMONTHLY.COM | 45


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

Family Primary Care Practice

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

Family Practice/Primary Care

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

Med Spa

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

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

Practice Type: Internal Medicine

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

Dental Practices Place Your Ad Here

Optical Practices Place Your Ad Here

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

Considering your practice options? Call us today. 46 | MAY 2015


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

Scan this QR code with your smart phone to learn more.

919.846.4747 bizscorevaluation.com


3 OCCUPATIONAL THERAPISTS POSITIONS IN JACKSONVILLE, NC These positions are 40 hour per week temp status to permanent positions with the following qualifications required: l Have graduated from an accredited Occupational Therapist program with a Masters Degree and 1 year experience or a Bachelors Degree with 3 years experience in Occupational Therapy. Program must be accredited by the Accreditation Council for Occupational Therapy Education (ACOTE). l Possess and maintain a valid license or certificate to practice as an Occupational Therapist in any of the 50 states, District of Columbia, the Commonwealth of Puerto Rico, Guam or the US Virgin Islands. l Possess and Occupational Therapist Registered (OTR) certification by the National Board for Certification of Occupational Therapy (NBCOT). l Possess a minimum of one year experience as an Occupational Therapist, preferably working in the neurological based practice setting and with a familiarity of TBI specific patient care practice needs. HOW TO APPLY: Send us your Resume/CV along with the following: available date to start, salary history, cover letter, eight hour shifts available per week. We will contact you by Email or phone to discuss our program. Make sure you provide your phone numbers and Email address. Contact Cara at: physiciansolutions@gmail.com or phone (919) 845-0054 for details

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

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

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

Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624 PH: (919) 845-0054 | email: physiciansolutions@gmail.com 48 | MAY 2015


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.

Family Practice/Urgent Care in Durham/Chapel Hill area This 100% physician owned practice is only 3 hours from North Carolina coast or mountains. It’s in close proximity to excellent public schools, universities and cultural activities. Total area is 3450 sq ft with 8 exam rooms and the equipment includes CellDynEmerald (CBC), CLIA certified lab (moderate complexity), radiology (standard), exam tables, and a trauma room. Average number of patients seen is 42. Established: 1985 l Annual Revenues: $2,000,000 Patient Centered Medical Home III

Medical Practice Listings Buying and selling made easy

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

Contact Info: Fwalker@ncmedsoc.org (Serious inquiries only)

Internal Medicine Practice Wilmington, North Carolina Newly listed Internal Medicine practice in the beautiful city of Wilmington, NC. With Gross revenues over $400,000, 18 to 22 patients per day, this practice is ready for the physician that enjoys beach life. The medical office is located in a brick wrapped condo and is highly visible. This well appointed practice has a solid patient base and is offered for $85,000. Medical Practice Listings l 919-848-4202 l medlisting@gmail.com l medicalpracticelistings.com WWW.MEDMONTHLY.COM | 49


PRIMARY CARE PRACTICE - Hickory, North Carolina This is an outstanding opportunity to acquire one of the most organized and profitable primary care practices in the area. Grossing a million and a half yearly, the principal physician enjoys ordinary practice income of over $300,000 annually. Hickory is located in the foot-hills of North Carolina and is surrounded by picturesque mountains, lakes, upscale shopping malls and the school systems are excellent. If you are looking for an established practice that runs like a well oiled machine, request more information. The free standing building that houses this practice is available to purchase or rent with an option. There are 4 exam rooms with a well appointed procedure room. The owning physician works 4 to 5 days per week and there is a full time physician assistant staffed as well. For the well qualified purchasing physician, the owner may consider some owner-financing. Call us today. List price: $425,000 | Year Established: 2007 | Gross Yearly Income: $1,500,000

Medical Practice Listings Selling and buying made easy

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

Primary Care Practice For Sale

PEDIATRICIAN

or family medicine doctor needed in

FAYETTEVILLE, NC

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.

Medical Practice Listings 919.848.4202 | medlistings@gmail.com www.medicalpracticelistings.com 50 | MAY 2015

Comfortable seeing children. Needed immediately.

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


Women’s Health Practice in Morehead City, NC

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

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

The average patients per day is 20-25+, and the gross yearly income is $555,000. Listing Price: $430,000

Medical Practice Listings Buying and selling made easy

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

Primary Care Specializing in Women’s Health

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

Located on NC’s Beautiful Coast, Morehead City

Practice established in 2005, averaging over $540,000 the past 3 years. Free standing practice building for sale or lease. This practice has 5 well equipped exam rooms and is offered for $20,000. 919.848.4202 medlisting@gmail.com medicalpracticelistings.com WWW.MEDMONTHLY.COM | 51


NC Opportunities

NC MedSpa For Sale

DENTISTS AND HYGIENISTS

MedSpa Located in North Carolina We have recently listed a MedSpa in NC This established practice has staff MDs, PAs and nurses to assist patients. Some of the procedures performed include: Botox, Dysport, Restylane, Perian, Juvederm, Radiesse, IPL Photoreju Venation, fractional laser resurfacing as well as customized facials. There are too many procedures to mention in this very upscale practice. The qualified buyer will be impressed with the $900,000 gross revenue. This is a new listing, and we are in the valuation process. Contact Medical Practice Listings today to discuss the practice details.

For more information call Medical Practice Listings at 919-848-4202 or e-mail medlistings@gmail.com

www.medicalpracticelistings.com

Physician Solutions has immediate opportunities for dentists and hygienists throughout NC. Top wages, professional liability insurance and accommodations provided. Call us today if you are available for a few days a month, on-going or for permanent placement. Please contact Physican Solutions at 919-845-0054 or physiciansolutions@gmail.com

PRIMARY CARE PRACTICE East of Raleigh, North Carolina We are offering a well established primary care practice only minutes east of Raleigh North Carolina. The retiring physician maintains a 5 day work week and has a solid base of patients that can easily be expanded. There are 6 fully equipped exam rooms, a large private doctor’s office, spacious business office, and patient friendly check in and out while the patient waiting room is generous overlooking manicured flowered grounds. This family practice is open Monday through Friday and treats 8 to a dozen patients per day. Currently operating on paper charts, there is no EMR in place. The Gross revenue is about $235,000 yearly. We are offering this practice for $50,000 which includes all the medical equipment and furniture. The building is free standing and can be leased or purchased. Contact Cara or Philip at 919-848-4202 to receive details and reasonable offers will be presented to the selling physician.

Medical Practice Listings Selling and buying made easy

MedicalPracticeListings.com | medlisting@gmail.com | 919-848-4202 52 | MAY 2015


Eastern North Carolina Family Practice Available Well-appointed Eastern North Carolina Family Practice established in 2000 is for sale in Williamston, NC. This organized practice boasts a wide array of diagnostic equipment including a GE DEXA scanner with a new tube, GE case 8000 stress testing treadmill and controller and back up treadmill, Autoclave and full set of operating equipment, EKG-Ez EKG and much more. The average number of patients seen daily is between 12 to 22. The building is owned by MD and can be purchased or leased. The owning physician is retiring and will assist as needed during the transition period. The gross receipts for the past three years are $650,000 and the list price was just reduced to $240,000. If you are looking to purchase a well equipped primary care practice, please contact us today. Contact: Cara or Philip at 919-848-4202

medlisting@gmail.com medicalpracticelistings.com

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

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

• • • • • •

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

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

PEDIATRICIAN

OR FAMILY MEDICINE DOCTOR NEEDED IN

ROANOKE RAPIDS, NC In mid December, a pediatrician or family medicine doctor comfortable with seeing children is needed full time in Roanoke Rapids (1 hour north of Raleigh, NC) until a permanent doctor can be found. Credentialing at the hospital is necessary.

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

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

Call 919- 845-0054 or email: physiciansolutions@gmail.com www.physiciansolutions.com WWW.MEDMONTHLY.COM | 53


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

Ongoing and intermittent shifts are available for physicians, mid-levels, DDS, dental hygienists, and registered dental assistants as well as permanent placement. Find out why providers choose Physician Solutions. P.O. Box 98313, Raleigh, NC 27624 Scan this QR code with your smartphone to learn more.

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

Med Monthly May 2015  

The Attracting New Patients issue of Med Monthly magazine.

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