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Med Monthly NOVEMBER 2012



health care reform issue

pg. 10


Talking to Patients and Staff pg. 40



Why Doctors Should Consider Social Media pg. 18


contents features 40 HEALTH CARE REFORM: Talking to Patients and Staff


Bartering The Art of Medicine


Get Your Head Out of the Sand




Low-Cost, Time-Efficient Techniques for Growing Your Practice

22 POINT OF CARE DISPENSING How it Can Benefit Your Practice

Implications For PAs and Primary Care Delivery

research and technology





Talking to Patients and Staff

Doctors connect to patients in an mHealth world




in every issue 4 editor’s letter 8 news briefs

58 resource guide 78 top 9 list

editor’s letter

Health Care Reform – how much do you know about it? Med Monthly’s November issue revolves around making the health care reform law make sense. It is important to a practice and its staff to be well informed. Can your staff explain to a worried patient about how their insurance may change? Mary Pat and Abraham Whaley answer that question and more in their feature, “Health Care Reform: Talking to Patients and Staff.” Make sure your employees have a basic overview of the new Health Care Reform law. A new contributor, Joe Gupton, writes in his article “Health Care Reform: Get Your Head Out of the Sand!” how businesses need to prepare for the pending regulations. He points out the 3 major factors that all companies will need to focus on: compliance, efficient health management and creative funding. Michael Friedman, a professor at Columbia University, discusses how the Affordable Care Act may help people with mental health and substance abuse issues. His article “Health Care Reform Benefits Americans with Behavioral Health Conditions,” explains that many more Americans with these conditions will be covered and more behavioral health conditions will be included. Med Monthly strives to make issues like health care reform both understandable and relevant to your business. Our December issue revolves around health insurance, and how patient’s policies affect your bottom line.

Ashley Austin Managing Editor

4 | NOVEMBER 2012

Med Monthly November 2012 Publisher Philip Driver Managing Editor Ashley Austin Creative Director Thomas Hibbard Contributors Ashley Acornley, MS, RD, LDN Jeff Bugonian, CPhT James M. Burns Theresa C. Carnegie D. Michael Crites Michael B. Friedman, MSW Joe Gupton, CWCS Thomas Hess Amanda Kanaan Laura Masske Soledad Prete Frank J. Rosello Lloyd I. Sederer, MD Lisa P. Shock, MHS, PA-C David C. Smith Abraham Whaley, COO Mary Pat Whaley, FACMPE Kimberly A. Williams, MSW Tyler Williams Stephanie D. Willis 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

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

contributors 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 or http://www.whitecoat-designs. com.

James M. Burns has focused his practice on antitrust law for over 25 years, with a particular focus on the representation of healthcare and insurance industry clients in antitrust matters. He is a member in Dickinson Wright’s Washington D.C. office and can be reached at 202-659-6945 or JMBurns@

Laura Maaske is a medical illustrator with a Master's of Science degree in Biomedical Visualization from the University of Toronto. She launched Medimagery in 1997, specializing in the creation of patient education materials, interactive media, e-books, cellular and molecular illustrations, and design of medical education materials. For more information, please visit, send a note to or call 262.308.1300.

Lisa P. Shock, MHS, PA-C is a PA who has practiced in primary care and geriatrics. She enjoys part-time clinical practice and is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering services to help implement and improve the utilization of PAs and NPs in the health care system. Contact her with questions at


designer's thoughts From the Drawing Board The graphic designer I have admired my entire life is Saul Bass. His large body of work includes corporate logos, movie posters and opening title sequences for major motion pictures. Some of the logos he designed were for AT&T, the United Way, Continental Airlines, the Girl Scouts, Quaker Oats and Warner Communications. An analysis of a sample of Bass’s corporate logos in 2011 found them to have an unusual longevity. The most common cause of the demise of a Bass corporate logo was the demise or merger of the company, rather than a corporate logo redesign. The average lifespan of a Bass logo is more than 34 years, and still counting. Otto Preminger, Alfred Hitchcock, and Martin Scorsese are a few of the directors that hired his services for title sequences and movie posters. Saul once described his main goal for his title sequences and movie posters as being “to try to reach for a simple, visual phrase that tells you what the picture is all about and evokes the essence of the story”. The opening to AMC’s Mad Men is a salute to Bass’s visual technique. The most admirable thing about Saul Bass was his ability to embrace new technology in his graphic design. In his seventies, when asked by Martin Scorsese to come out of retirement to do the opening title sequence for Goodfellas, he moved away from the optical techniques he had pioneered and moved into the use of computerized effects. At seventy, still open to try new ideas! In the medical profession, it is also essential to keep up with and embrace new technology as it becomes available. Three articles in this month’s issue very effectively address new forms of technology available to the medical community. Amanda Kanaan’s article “Three Reasons Why Doctors Should Consider Social Media” informs us on the value of using social media. Laura Maaske’s “Doctors Connect to Patients in an mHealth World” enlightens readers of new mobile apps for iPads to assist physicians and lists the most popular and effective apps (including prices). And Frank J. Rosello’s “MBAN Final Rule Positions Telemedicine To Become The Next Universal Best Practice in Healthcare” reports on new wireless monitoring technology and it’s future uses in health care. I hope you find this issue informative and insightful. Drop me a line and let me know.

Thomas Hibbard Creative Director

6 | NOVEMBER 2012

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news briefs

Advanced Performance Characteristics of Polymers Expands Market for Plastics in Medical Devices The increasing average age of the U.S. population is Reduced hospital stay to lower healthcare costs will creating a vast market for medical treatment, especially increase the focus on homecare medical devices and minimally invasive procedures. In a fragile economy, enhance the demand for dialysis kits and diabetes control patients prefer minimally invasive methods, boosting the devices. This will therefore augment the need for medical consumption of plastic polymers, which are ideal for use in plastics. Plastics are preferred in homecare devices due to catheters and medical tubing. their flexibility, durability and light weight. A new comprehensive Frost & Sullivan (chemicals.frost. On the flip side, there are some concerns about the com) study Analysis of the Plastic Polymers in Medical use of polymers in medical devices, especially in terms Devices Market, finds that the total North American of degradability and recyclability. Nevertheless, this market volume of plastics in medical devices totalled environmental issue has not reached a critical state. The 1,370.0 million pounds, corresponding to revenues in low price of commodity resins like PE, PP, PVC and their excess of $1 billion. By 2018, revenues are expected to high performance characteristics makes them irreplaceable equal $1.45 billion, fuelled by a compound annual growth in the near future. rate of 5.2 percent. Commodity plastics such as polyvinyl "There has also been heightened focus on engineered chloride (PVC), polyethylene (PE) and polypropylene (PP) polymers such as co-polyether-ester elastomers (COPE), accounted for most of the total volume. polyether block amides (PEBA), and acetal chemistries that "While the baby boomer population has have more advanced performance properties for surpassed 76 million, the number of young niche, technologically advanced healthcare people requiring medical care is also on applications, such tissue engineering and SOON the rise," said Shomik Majumdar, Vice implants," said Research Analyst Tridisha COMING Y L H President, Chemicals and Materials. "The T N Goswami. "These new materials will O IN MED M higher incidence of lifestyle diseases, expand the scope of plastic polymers' coming along with governments' keener focus on application and propel the market." In the up , 012 issue 2 improving healthcare, drives the demand r e b m e Dec ides for medical devices and consequently, thly prov n Source: o M d e M lth a e h plastic polymers." n o news/118815/ insights . e c n ra u s in

More Hospitalists Working as Locum Tenens A new national survey of Hospitalists shows more are working as locum tenens and an even larger percentage are pursuing locum tenens as a full-time career. The findings come from a new survey of Hospitalists regarding their locum tenens work patterns. For the second consecutive year, the survey was conducted for Locum Leaders, a national locum tenens company specializing in Hospital Medicine, in conjunction with Today's Hospitalist magazine. 11.6% of this year’s respondents said they had worked as 8 | NOVEMBER 2012

locum tenens (a Latin term describing temporary, contracted health care providers) within the past 12 months. Of the locum tenens respondents, 14.5% said they were working full-time as a locum tenens provider. These are increases from 2011 when 10% of all hospitalists reported working as locum tenens, and 10.8% of locum tenens Hospitalists said they were full-time locums. Growing client demand for temporary hospitalists means there are more opportunities to work as a locum tenens. And those opportunities are also

more lucrative, according to Robert Harrington, MD, SFHM, a practicing Hospitalist and the Chief Medical Officer of Locum Leaders. “Industry data show that hourly pay rates for locum tenens Hospitalists have steadily increased over the past two years. I think that’s a big reason why there are more locum tenens in the specialty and more doctors who are willing to self-employ and work full-time in locum roles,” said Harrington. Source: http://www.prweb. com/releases/2012/10/ prweb9945998.htm

ANA LAUDS SUPREME COURT DECISION UPHOLDING HEALTH CARE REFORM LAW The American Nurses Association (ANA) lauds the U.S. Supreme Court’s decision today to uphold the Affordable Care Act (ACA), including the “minimum coverage provision,” hailing it as a victory for all patients and their families. This is particularly true for those 50 million adults and children who currently lack adequate health coverage. ANA praises the law’s consumer protections and the opportunity it opens for registered nurses (RNs) to assume an even greater role in providing high-quality, costeffective care. “This decision means that millions of people will have access to the basic health care and preventive services that they’ve lacked,” said ANA President Karen A. Daley, PhD, MPH, RN, FAAN. “Instead of getting sicker and developing serious and costly complications because they can’t afford to manage their health conditions, people will get the care they need to recognize problems earlier or avoid them altogether. There will be savings throughout the system. “Registered nurses are well-positioned to lead in providing essential prevention and wellness services and care coordination for individuals and families,” Daley added. “The law enhances opportunities for nurse practitioners and nurse midwives to provide primary care. This will increase accessibility for the growing number of people needing basic health services.” ANA has been a steadfast supporter of the 2010 health care reform law and its provisions to expand access to health care; protect consumers; improve the quality of care; emphasize primary care, care coordination, disease management, and prevention; increase community-based care; and utilize nurses to their fullest capabilities, as leaders and essential members of multi-disciplinary health care teams. Alarmed by the growing numbers of uninsured individuals and families, rising costs, and quality of care concerns, ANA has advocated for health care reform since 1991’s Nursing’s Agenda for Health Care Reform, most recently updated in 2008. As guiding principles, ANA contends that health care is a basic human right, and that all deserve access to essential health care services. ANA also views the decision as a win for all consumers due to the law’s protections against certain insurance industry practices, such as denying coverage because of pre-existing health conditions and imposing annual or lifetime coverage caps. For RNs, the ACA creates more opportunities to lead or participate in innovative, team-based care delivery models, such as accountable care organizations and medical homes, with incentives for nurses’ expertise in care coordination. The law also provides funding to expand nurse-managed health centers and for nursing education and workforce development. Source:

NIH study reveals Risk gene for Alzheimer's disease associated with lower brain amyloid Researchers investigating a known gene risk factor for Alzheimer’s disease discovered it is associated with lower levels of beta amyloid — a brain protein involved in Alzheimer's — in cognitively healthy older people. The findings suggest that a mechanism other than one related to beta amyloid increase may influence disease risk associated with the gene. The scientists studied a variation in the complement receptor-1 (CR1) gene, a newly identified gene associated with risk for late-onset Alzheimer's disease, in cognitively normal older volunteers. Participants with this gene variant were found to have less brain amyloid than those without the risk variant. In addition, the CR1 gene variant was found to interact with APOE, the most robust genetic risk factor for Alzheimer’s disease, to influence the amount of brain amyloid. "The prevailing hypothesis has implicated factors increasing beta amyloid in the brain as an integral element of Alzheimer's disease pathology," said NIA Director Richard J. Hodes, M.D. " This study indicates the importance of exploring and understanding other mechanisms that may be at work in this disease." "The findings suggest that the increased risk of Alzheimer's associated with CR1 is not driven by an increase in amyloid in the brain and that we may also need to consider multiple genetic risk factors in combination," lead author Madhav Thambisetty, M.D., Ph.D. said. "It may be possible that CR1 acts through other mechanisms, distinct from those that increase amyloid deposition in the brain.” Source: news/health/oct2012/nia-01.htm MEDMONTHLY.COM | MEDMONTHLY.COM |99


Health Care Reform And Health Benefits for Your Employees

By David C. Smith, Vice President, Health & Welfare Benefits, Ebenconcepts Company, Inc. 10| NOVEMBER 2012

Most physicians have been overwhelmed with information about how the Affordable Care Act will impact their practices, However there hasn’t been a lot written about what it will mean for health insurance benefits for your employees. This article is intended to discuss what could change in the next two years.


he Affordable Care Act (“ACA”) passed Congress and was signed by the President in March 2010, and recently survived Supreme Court scrutiny. While some implementation deadlines have already passed and others are on the horizon, most employers are just now beginning to appreciate what could change and frankly how confusing it all is. Keep in mind that this law’s primary purpose is to reduce the number of uninsured in America (which some estimate between 40-50 million Americans at any point in time, but only about half that number are uninsured for more than 12 months) and their impact on health care costs for all. It has been estimated that the medical costs incurred by the uninsured add about 12.5% to the cost of health insurance. There are four major issues to consider: 1. Do you have to comply with the employer mandate? One aspect of ACA is a requirement that employers with 50 or more employees must offer health benefits to their employees who work 30 or more hours per week. But it isn’t that simple: determining if you have 50 or more employees means looking at full-time equivalents, not simply headcount. You also have to look at whether or not there is common ownership between your practice and other businesses in which you have invested. And then if you do, the number of employees you have to provide coverage to will be limited. We have already begun to see some employers who are under the mandate, but have less than 20 employees who must be offered coverage. The penalty for not offering coverage is $2,000 per FTE, but you

get credit for 30 FTEs. One important point about the penalty is that it is an excise tax, which means that it is not deductible from your other income. So if your practice is taxed as a partnership (“S” Corporations, partnerships, limited liability companies and partnerships), then the tax will be paid by the owners of the practice personally. This nuance is one that has escaped the notice of many business owners and may be a big reason why many continue to offer coverage. 2. How much do your employees pay for their health insurance benefits? If you have more than 50 employees, there is an additional concern beyond whether or not you offer your employees health benefits. Specifically, ACA establishes that if the employee contributes more than 9.5% of their gross household income toward their cost of coverage, there is an annual penalty of $3,000 per affected employee. This language raised a couple major concerns. First, most employers don’t know their employees’ gross household income. Second, many employers have their employees pay for all or a significant portion of the cost of covering their dependents. But there has been some recent guidance that now appears to solve these problems. The new standard is whether or not the employee is paying more than 9.5% of their W-2 income for their employee only coverage. We have begun working with our client practices to look at W-2 income by employee for 2011, and determining what would have been the 9.5% line for each one. For example, an employee who earned $25,000 annually could not pay more than $197.91 per month for their employee only coverage.

3. What are the exchanges and how will they play a part in benefits for my employees? Beginning in 2014, the Exchange will play the role of organizing the market by creating standard benefit packages and offering comparative data, as well as determining eligibility for a premium voucher for each individual who purchases coverage through the Exchange. Individuals who earn between 150% and 400% of the federal poverty level will be eligible for the tax credit is advanced through the voucher program. States are taking the lead on Exchange formation but in those states that choose to not create an Exchange, there will be a federal Exchange providing those services. The Exchanges will primarily be responsible for getting folks covered, and for small employers with less than 50 employees, they could play a positive role of allowing greater choice and more options. However, it is a little early to know exactly how they will impact how these smaller businesses offer benefits in the future, and it is an area we are closely monitoring. 4. Do I have to worry about how the individual mandate will impact my employees? No, not currently. But if you are mandated to offer coverage and don’t, we suspect that the Exchanges will be one way that noncompliant employers are caught. We believe that both the election results in November and the regulatory actions taken in the next few months could dramatically change some or all parts of this law, but we’ll continue to follow it all and provide guidance to our clients. It’s what we do. 



Implications for PAs and Primary Care Delivery By Lisa P. Shock, MHS, PA-C On June 28, 2012, the U.S. Supreme Court issued its decision on the Patient Protection and Affordable Care Act (PPACA), ruling that Congress acted within its constitutional authority when enacting the individual mandate and the law was upheld. A major component of the health care reform law, or Affordable Care Act, (ACA) is the individual mandate—a provision that will require most individuals to purchase health care coverage or pay a penalty, beginning in 2014. The legal challenge to the ACA focused on the individual mandate and the Supreme Court ruled that Congress had the power to enact the individual mandate.

What This Means

Since the Court upheld the individual mandate, it did not need to decide whether other provisions of the law were constitutional. Therefore, the 12 | NOVEMBER 2012

Supreme Court upheld the health care reform law in its entirety. Given that the health care reform law was upheld, all aspects of the law that have already been implemented will remain in effect. For Practicing Physician Assistants (PAs) this means that you are: • Recognized as one of three primary healthcare professionals in the U.S. • Valued as a vital and growing component of the nation’s healthcare workforce as medical practices and healthcare systems seek increased cost efficiency, while maintaining high quality health care delivery of services. • Eligible for a 10% bonus for primary care codes through Medicare. • Allowed to order skilled nursing facility care for Medicare patients.

• Embraced as a favored healthcare professional in patient-centered, primary care medical homes, Independence at Home models of care, chronic care management, and other new models of care designed to better coordinate care through team-based practice designed to promote value within the healthcare delivery system. PA educators and faculty will be eligible for increased funding support through the Public Health Service Act’ Title VII Health Professions Program and additionally eligible for faculty loan repayment programs through the Title VII program.

Access to Care

As millions more become insured through the efforts of health care reform, the question of who will treat

these patients is a real concern. The United States has a deficit of nearly 40,000 primary care physicians, and this situation is expected to worsen as the population continues to age and as more patients enroll in health care exchanges. Nurse practitioners and physician assistants should be allowed to practice to the full level of their capacity and training in an effort to address this influx of patients. The ACA supports increased training opportunities in primary care, with $32 million targeted for 600 new physician assistants and $30 million for an additional 600 nurse practitioners. Upcoming PA students will be viewed as valued professionals in the nation’s future healthcare workforce and therefore eligible for increased financial support though the National Health Service Corp’s scholarship and loan repayment programs. Tapping these health professionals’ expertise and ability in a primary care capacity will undoubtedly improve access to care as well as promote workforce diversity.

The Patient Centered Medical Home - A New Model of Primary Care

As health care delivery continues to transform, the implementation of the Patient Centered Medical Home (PCMH) as a vehicle for patient care is rapidly expanding. Physician Assistants (PAs) are becoming increasingly recognized as important players on the patient care team. Recent studies from the American College of Physicians and the American College of Family Physicians state that PAs should be recognized as primary care providers in the PCMH model. Accrediting bodies such as (NCQA) and the Utilization Review Accreditation Commission (URAC) support the PCMH as a proven model for delivering high quality, costeffective patient care and encourage the inclusion of Physician Assistants. Nationally, the American Academy of Physician Assistants (AAPA) supports the fundamental premise that standards used to define PCHM and

care delivery models are not limited to physicians. Approximately 30,000 PAs practice in primary care of the nearly 80,000 PAs nationwide. Many PAs will practice in health care PCMHs; lead patient care teams and will participate in and be an integral component of quality performance reporting.

Medicaid Patient Expansion Issues

The health reform law’s expansion of Medicaid coverage to millions of Americans is challenging state budgets. The ACA includes a provision that requires states to comply with new Medicaid eligibility requirements or risk losing their federal funding. The Court upheld this section, but decided that Congress cannot penalize states that decide not to participate in the law’s Medicaid expansion by taking away their existing Medicaid funding. Some budget challenged states have capitalized on a section of the Supreme Court’s health-law decision to pare continued on page 14

continued from page 13

their existing Medicaid programs, saying the ruling lifts the March 2010 law’s ban on such cuts. The court struck down penalties for states choosing not to expand Medicaid. A few states are also trying to go farther, arguing that this ruling supports


As millions more become insured through the efforts of health care reform, the question of who will treat these patients is a real concern.

and justifies cuts to their existing programs. Several states initiated changes rapidly to their Medicaid programs. Maine started its plan to cut 20,000 participants and some $10 million in costs shortly after the ruling. Alabama and Wisconsin are expected to follow similar practices. Texas joins states such as Florida, Louisiana, Mississippi and South Carolina in disregarding the US government on the Medicaid provision in the national health care law. In Texas, only 31 percent of Texas doctors said they were accepting new patients who rely on Medicaid. These actions may result in more court battles over the law between states and the Federal government. With the advent of health reform, there is a shift toward generating payment and reimbursement for value and outcomes and away from fee for service. Additional repercussions of the PPACA focus on prevention and coordination of care, as well as the increased use of information technology and electronic health records. However, patient access to care and workforce delivery issues must be addressed in order for these care efforts to succeed. 

References: publications/pa_pro_now/item. aspx?id=4606 42405270230368400457751110384336 8654.html research-publications/find-rwjfresearch/2012/01/how-can-weexpand-the-primary-care-workforce-. html texas/fewer-texas-doctors-willing-toaccept-medicare-medicaid-2413482. html Lisa P. Shock, MHS, PA-C, is a seasoned PA who has worked with clients to expand care teams in both large and small hospital settings. She enjoys part time clinical practice in both primary and inpatient hospital care settings. Lisa is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals. USH offers a wide range of services to help implement and improve upon the utilization of PAs and NPs in the health care system. Contact her at

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Financial Impact of Health Reform on Employer Benefits Not as Significant as Anticipated

Effects of ACA varied depending on employer size; benefit strategies delayed or changed

16| NOVEMBER 2012

In spite of employer fears, the financial impact of the provisions in the Affordable Care Act (ACA) have not been as significant as anticipated for most businesses, fewer U.S. employers responded that they plan to drop coverage due to the law’s mandate than was reported in 2010. These are some of the key findings from a new 2012 employer survey conducted by the Midwest Business Group on Health (MBGH) and co-sponsored by the National Business Coalition on Health (NBCH), Business Insurance and Workforce Management. Many survey respondents indicated support for the ACA provisions that enable changes in provider payment, medical care coordination and providing medical cost and quality information for consumers. The survey also revealed divergent views among employers on whether the Supreme Court will or should strike down the individual mandate or the entire Act. This is the third national survey in a series conducted by MBGH since 2010 to gain an understanding of areas of most concern to employers related to health reform, and to help educate and inform purchasers and policymakers. “While employers uniformly expressed concern with the administrative costs and reporting burdens in the law, there was surprising support for many of the coverage and system reform provisions,” said Larry Boress , MBGH president and CEO. “It's clear that what some call ‘Obamacare’ is actually a compilation of insurance, health system and coverage reforms that are perceived by many employers as having some good, as well as having some costly, impacts. In addition, as employers have evaluated their options, the vast majority have determined there is value in continuing to offer health coverage in order to retain and recruit talent, as well as to ensure a productive workforce. Small employers fear the potential financial impact of future ACA changes, while larger organizations see the potential

of improved cost and quality improvements as enabled through many of the requirements of the ACA.”

Key survey findings • In contrast to what employers indicated in the 2010 survey, many of this year’s respondents found complying with the ACA provisions cost them less than anticipated. • While large employers found the cost impact of the ACA in 2011, including extending coverage to adult children up to age 26, was less than 2%, most small- and mid-sized employers responded that their increases were up to 5%. • Only 6% of all employers said they were likely to pay the penalty fee and drop health benefits coverage for employees in order to save money. This is down by more than half from the 2010 survey results. • Less than 30% of employers that are likely to drop coverage will raise salaries to enable individuals to buy health coverage on their own. • Many small employers anticipate increases in their health benefit costs over 10% in the future due to the ACA. • Of employers offering retiree benefits, 57% said they are likely to continue to offer these benefits.


"While employers uniformly expressed concern with the administrative costs and reporting burdens in the law, there was surprising support for many of the coverage and system reform provisions."

• Employers, particularly larger ones, expect the Supreme Court to uphold the ACA but strike down the individual mandate. Of all employers, 42% hope the ACA is struck down in its entirety. • Employers favor repeal of the following ACA provisions: the excise tax on high cost plans; capping flexible savings account (FSA) contributions; prohibiting using FSA amounts for over the counter drugs with prescriptions; and reporting cash value of benefits on W-2 forms. • Employers favor retaining the following ACA provisions: removal of co-pays for preventive care; mandating coverage of preventive services; creation of Health Insurance Exchanges; elimination of annual and lifetime limits on essential benefits; and extending coverage to adult children. • Employers are split on the value of some provisions, including requiring employers who drop coverage to offer vouchers to help people buy insurance; imposing penalties on employers who do not provide health benefits; mandating individuals obtain health insurance; and defining minimum essential benefits. “Employers appear to be warming up to the potential value of ACA provisions on prevention and wellness incentives, provider payment reform, medical homes, ACOs, and cost and quality transparency even while expressing continued frustration with the law’s slow pace towards cost containment,” said Andrew Webber, NBCH president and CEO. “And while employers seem to have less of an appetite for dropping coverage than noted in previous surveys, alternatives like defined contribution strategies are beginning to be considered and bear close monitoring in the years ahead.”  Reprinted: March 26, 2012 / PRNewswire/ MEDMONTHLY.COM |17

practice tips

Three Reasons Why Doctors Should Consider Social Media By Amanda Kanaan, WhiteCoat Designs Physicians are eager to embrace new advancements in medical technologies, but as a whole they tend to be late adopters when it comes to progressive communication tools such as social media. Although healthcare is innately social, policies like HIPAA have caused what I believe to be an unhealthy fear for physicians to interact with patients outside the confines of the office. Whether you cite HIPAA, a lack of time, or a lack of computer skills as reasons for not pursuing social media, there’s a strong possibility you could be missing out on three major opportunities to use social media to your advantage.

Are Patients Really Using Social Media? First, let’s take a look at some revealing numbers related to patient interaction online. According to a 2012 study by PricewaterhouseCoopers, a survey of more than 1,000 U.S. adults revealed: • One third of consumers now use social media sites for health related activities; • 40% of consumers have sought out reviews of treatments, physicians, and other 18 | NOVEMBER 2012

patient experiences; • 45% of consumers say information from social media sources would affect their decisions; • 73% would welcome social media-based tools like make an appointment, or ask a question. A separate survey by the National Research Corporation reported that over 40% of respondents rely on social networking for health information and nearly all of those people (94%) turn to Facebook. Additionally, they found that Americans using social media for healthcare are affluent, and on average, 41 years of age. It’s clear that social media is not a fleeting trend and patients find it to be a valuable resource for healthcare information and interaction. So now the real question is “what’s the advantage for doctors?”

Three Advantages of Social Media for Doctors 1. Cost-Effective Marketing

While there are many advantages to social media, one of the major benefits is the ability to attract new patients. Social media acts like a megaphone, amplifying your message across various channels and potentially reaching those who may have no idea who you are. This is especially effective when it comes to patient testimonials and connecting with other referring doctors online. It’s a powerful branding tool in enhancing the reach of your reputation. Facebook now even offers analytics for your page so you can monitor the impact you’re having online and analyze what type of content resonates best with patients. This makes the ROI much more trackable.

2. Patient Centered Relationships

The reason patients are eager to connect with their doctors

online isn’t so they can see where you went to dinner on Saturday night. They want to use social media as a tool to better manage their health. This is prompting health care organizations to rethink their social media strategy to not just focus on marketing but on an overall business strategy to improve outcomes and lower the cost of providing care. The physician-patient relationship is a two way street and social media provides the opportunity for both to speak, listen, understand and learn from one another. Embrace the opportunity to educate and interact with your patients to help better manage their conditions and coordinate care. Just be careful to never give personal medical advice or reveal patients’ private health information online. Think of your online interactions as communicating with your patient population as a whole in order to avoid HIPAA concerns.

3. Competitive Edge

Social media is an extremely powerful platform that allows physicians to position themselves as an expert in their specialty (for example, maybe a doctor wants to position himself/ herself as an expert in robotic surgery within the OB/GYN specialty). While their peers sit on the sidelines, doctors have an opportunity to take a leadership role and put themselves ahead of the competition. Now is the time to build up your social media network online and show your patients that you are not only a leader in your specialty but also in terms of the progressive way you interact with patients. Although social media may not be an option for all practices, the


It’s clear that social media is not a fleeting trend and patients find it to be a valuable resource for healthcare information and interaction.

advantages of participating are at least worth considering. Negative reviews will happen whether you like them or not. The good news is that social media at least gives you the opportunity to be part of the conversation and show off your customer service skills. If you decide to pursue social media, you need to ensure you have the time to interact consistently and if not, who you are going to trust to manage your page for you. Also consider putting social media policies in place so patients understand what type of behavior is acceptable on your page. 

About Amanda Kanaan:

Amanda Kanaan is the president and founder of WhiteCoat Designs, a national marketing agency catering specifically to physicians. WhiteCoat Designs offers doctors affordable marketing solutions to help them grow their practices. Services include website design, search engine optimization (SEO), social media management, online reputation monitoring, brochure and collateral design, branding makeovers and physician liaison services to build patient referrals. Amanda can be reached at amanda@whitecoat-designs. com or (919) 714-9885. To learn more visit MEDMONTHLY.COM |19

practice tips

ENTREPRENEURIAL MARKETING: Low-Cost, Time-Efficient Techniques For Growing Your Practice

By Soledad Prete, Health Directions Building a medical practice is harder than ever. Many specialists face a crowded market, and primary care physicians are getting direct competition from retail clinics. A phone book listing and a hospital affiliation are no longer enough to establish a strong patient base. Physicians today must take an entrepreneurial approach to marketing—actively seeking out new patients and referral sources. Entrepreneurial marketing does not need to be expensive. Practices can achieve good results with a few effective techniques.

Differentiate Your Practice

Health care consumers today have many choices. To compete, physicians must focus on something unique about their practice that captures the attention of patients and referring physicians. For example, a Chicago-area otolaryngologist has built a strong practice by emphasizing his unique approach to managing allergies. His 20 | NOVEMBER 2012

distinctive care philosophy and good patient outcomes help him stand out from “generic” ENTs. Primary care physicians can also differentiate their practice. Focus on diabetic care, excellent management of hypertension, teen health—wherever your special interest lies.

Reach Out for Referrals

Physicians are much more likely to make a referral when they know a specialist personally and understand his or her care approach. Specialists can clear both hurdles through lowcost networking. Lunch presentations are a great opportunity. Contact local family practices and offer to bring a sandwich platter to a lunchtime meeting. During the gathering, spend 20 minutes explaining your services and your care approach to physicians and staff. Other options include going to CME talks, attending hospital fundraisers or simply visiting the physician lounge. Any opportunity to meet physicians or office managers is a chance to develop referrals.

Get in Front of Potential Patients

Health fairs, charity runs and fitness events can draw large crowds, but medical doctors are usually underrepresented. Entrepreneurial practices can create strong market awareness by volunteering at these events. Draw people to your booth by offering health screenings that align with your care approach. For example, if your practice’s focus is caring for hypertensive patients, provide a simple stroke risk evaluation. What if a physician is uncomfortable meeting the public in this way? Identify a capable “people person” within the office to handle health fairs and other marketing efforts.

Provide “Free Samples”

Free introductory offers are effective in almost every industry. Medical practices can also use this approach with good results. Consider offering a monthly flu clinic with free vaccines to the first ten patients. The cost is minimal and it can attract patients who might

otherwise visit a pharmacy clinic. Another possibility: free blood pressure screenings every Wednesday. This could be especially effective for practices near retail traffic. Each strategy provides potential patients with a “taste” of your care approach.

Rethink Patient Service

Many traditional medical practices today are losing patients to retail clinics that offer greater convenience. The good news is that small medical practices can compete with the big chains. The key is to make simple changes that improve the patient experience: l


Use e-mail to send forms to patients before their appointment. Filling out forms at home allows them to spend less time in your office. Leave schedule slots open to accommodate same-day appointments. Depending on your specialty, use an open access (50 percent unscheduled) or advanced access (65 percent unscheduled) model.


Develop a patient-friendly process for individuals who need to fast before blood tests. Have staff perform blood draws as soon as possible after the patient arrives, and offer snacks afterwards.


Telephone patients when a physician is running behind. Offer them the chance to come in later or reschedule their appointment.


Follow up on sick appointments. Have a staff member call patients the next day to see how they are feeling and suggest additional steps as needed.

Practices that do a good job on patient service are in a strong position to ask for referrals. Most physicians find that existing patients are the best source for new patients.

Create Electronic Connections

Consumers increasingly expect to be able to manage their lives using digital tools. Medical practices that fulfill this expectation will succeed in forging powerful links with a strong patient base. Most electronic health record (EHR) systems can support an electronic patient portal. A portal allows your patients to check test results, view clinical visit summaries, receive health reminders, request physician appointments and download records to services like Google Health Vault and Microsoft Health. You can also build electronic connections with patients by upgrading your website. The secret is to provide strong content. In addition to providing downloadable forms, update your site often with seasonal health reminders, healthy lifestyle tips, preventive care information and other resources. You can also distribute content via Facebook, LinkedIn and Twitter or a simple e-newsletter.

Work From a Plan

The key to entrepreneurial marketing is steady progress. To turn a modest time investment into practice growth, create a solid marketing plan and work it consistently. An effective plan will identify your unique selling point, target geography, competition and potential referral sources. List specific marketing initiatives, assign responsibilities and set monthly new-patient goals. Whatever techniques you use, make sure to track referral sources. Continue marketing efforts that are working and drop those that are not.  Soledad Prete is a senior associate at Health Directions, LLC, a national consulting firm that provides business solutions for healthcare organizations. For more information, visit

Providing customized, simple



OPTIMIZE SPORTS PERFORMANCE Tracy Owens, MPH, RD, CSSD, LDN Ashley Acornley, MS, RD, LDN 6200 Falls of Neuse Road, Suite 200 Raleigh, NC 27609 919-876-9779

Blue Cross Blue Shield of North Carolina and Cigna insurance provider.

practice tips

Point Of Care Dispensing –

How It Can Benefit Your Practice

By Jeff Bugonian, CPht and Dispensing Consultant for MedX Sales


here is a misconception in the United States that every physician is making too much money or that all physicians are rich. “M.D.” does not stand for “Many Dollars” unless you are speaking of the dollars it takes to operate a practice. Just think of where the income from your practice is spent: employee salaries, employee benefits, office supplies, medical supplies, office equipment, maintenance, malpractice insurance, EMR, etc…And then there are the repayment of tuition loans. In order for most physicians to take home $100,000 per year, the practice likely needs to gross around 1 million dollars. Additionally, as expenses increase and reimbursements continue to decrease, the financial outlook does not look good. With that in mind, many physicians are looking for ways to decrease business expenses and increase revenue. Physicians are outsourcing collections, joining a physician’s buying group or hiring a practice management consultant to combat this ever growing problem. Physicians are also looking at ancillary services to improve profits. One very simple ancillary service that physicians

22 |NOVEMBER 2012

can take advantage of today is Point of Care (POC) Pharmaceutical Dispensing. “But I am not a pharmacist”, you may think. That may be true, but you do not need to be a pharmacist. Forty-three states allow physicians to dispense pharmaceuticals to their patients with few, if any, restrictions. The only states that restrict dispensing to such an extent that it becomes problematic are New York, New Jersey, Massachusetts, Texas, Montana, Wyoming and Utah. Most other states specifically mention physician dispensing as an allowable practice in their regulations and laws. Since it is legally allowable, it is highly probable that it will not result in an increase to your malpractice insurance. So how can POC Dispensing help your practice? Let’s look at 2 ways – time and money – and they are closely linked. First of all think about your time. How much time per day do you or your staff spend on the phone with pharmacies? You probably get several calls per day to clarify prescriptions or get them changed. If you spend 1 hour per day on the phone instead of seeing patients you may be conservatively losing $100. That is over $25,000 per year. How can POC Dispensing increase your revenue? Simply by filling the prescription utilizing pre-packaged medications instead of having your patient go to a pharmacy. The average physician sees 100 patients per week. Most of those visits will result in writing at least 1 prescription. Presently, you do not make any money on that prescription. POC Dispensing may allow you to fill that prescription and make an average profit of $10 for each bottle dispensed. This could increase your income by over $50,000 per year. And it only takes a minute or two to dispense since the bottles are prepackaged and sealed, there is no pill counting. It works best with generic, acute-care meds such as

antibiotics and pain control. If you treat Worker’s Comp (WC) patients and your state recognizes physician dispensing, you can earn substantially more income from dispensing. If you practice Occupational Health or another modality such as Orthopedics, Pain Management or Neurology and you treat Worker’s Comp patients, you could be losing $100,000 or more per year. Which practice types does this work especially well with? In addition to the Occupational Health and Orthopedic practices mentioned you can add Family Practice, Oral Surgery, Urgent Care and Podiatry. There is also a medical practice model that is gaining popularity which is based on membership. This Concierge model typically limits the number of patients and has them pay a monthly fee for physician services. Since these patients are normally uninsured, POC dispensing is a great fit. As you see, Point of Care Dispensing can significantly improve your practice’s financial health. How can it help the patient? It will be beneficial to your patients because it will assure compliance. Many paper prescriptions go unfilled simply because the patient does not feel that they have the time to wait for an hour or more at the pharmacy. Those patients that do wait may spend the entire time impulse shopping at a large retailer that has a pharmacy. Many of your patients would rather get the medication from you even if it means bypassing a $4 bottle cost. In the end, your patients will walk away happier and more compliant.  If you would like to contact the author for more specific information or to add this service to your practice please contact him through his website: www., or email at

research & technology

Doctors Connect to Patients In an mHealth World Part 1 of 2

YOU IMAGINE by Laura Maaske 24 | NOVEMBER 2012

It's a time to imagine. As a medical illustrator beginning to develop medical apps and e-books, that's what I am doing. It's what I am doing with my clients as I begin to create mobile health “mHealth” ideas for smartphone and iPad apps and e-book tools. I want to know what my clients need most and what they envision would be useful in their clinical settings. The mobile device has great potential as a highly interactive, sophisticated, visual, portable, and social communication tool. Apps are not yet fully embracing that potential, but they are constantly improving. Can mobile devices like the iPad truly change medicine? Are they making health and health care any better for people? In speaking with my clients, there are certain questions I encounter. I will explore those questions in this two-part series on doctors and the mHealth era. Perhaps these are your questions, too.

How are mobile devices changing the medical scene? According to a recent Manhattan Research study, 38 percent of people regularly use smartphones for health. Of those who use smartphones, 38 percent use health apps and 32 percent use their smartphone with their doctor, medical institution, or pharmacy. As for tablets, 15 percent of people use one for health related issues. And of those who own tablets, 41 percent regularly use health apps. 51 percent of people use their smartphones or tablets to handle health-related issues.1 In another study, 95 percent of patients thought the iPad was helpful for coming to understanding of their condition.2 As for doctors specifically, the rate is much higher. Nine out of ten doctors carry a smartphone.3 According to Manhattan Research, 62 percent of U.S. doctors reporting using one for professional purposes, and are adapting more rapidly to iPads than anticipated in past years. Half of iPadowning doctors also reported using their tablet with patients. Manhattan Reseach expects this to increase so that two third’s of U.S. doctors will be using iPad’s professionally in 2013.4 Brian Dolan, editor of MobiHealthNews, notes that the demand for good medical apps from physicians is even higher.5 According to Surround Health, while 15 percent of health care workers in their study used tablets during patient interactions, 59 percent of respondents said they would have preferred to use tablets.6

How can it change the doctor-patient relationship? Not every doctor uses a smartphone or iPad on the job, and not everyone is adapting at the same rate. But several medical schools have now dropped their use of textbooks in favor of

iPads for learning medicine. Stanford and Yale Medical Schools both have paperless, iPad-based curriculums. They’ve specifically designed the student and resident labcoats to hold iPads, so the devices are accessible at all times. Among the many hospitals embracing iPads is Duke University. A study of the Duke Oncology Medical division found that iPads decrease physicians’ documentation time by 17 percent.7 University of Chicago’s internal-medicine program runs a very successful iPad program, launched in part by Dr. Bhakti Patel. This program offered so many improvements to the daily routines of doctors and patients that it was considered a success early on. Now all internalmedicine residents at the university receive iPads when they begin the program. A study in the Archives of Internal Medicine, evaluating this Chicago initiative, found that patients got tests and treatments faster if they were cared for by iPad-equipped residents.8 Patients said that as a result of exposure to the iPads, they gained a better understanding of the ailments that landed them in the hospital in the first place. Johns Hopkins internal-medicine program created a similar initiative, implementing iPads for medical students and residents. In the Johns Hopkins program, residents using iPads placed 8 percent more orders before end of afternoon shift. Almost 90 percent of residents said they routinely used the iPad for clinical interactions. 78 percent said the iPad made them more efficient. And 68 percent said the iPad resulted in fewer delays in patient care. An analysis of the order submission rates for these residents confirmed that orders were submitted more readily and at the time of patient’s admission, than for patients admitted without iPads. According to the Advisory Board Company, iPads can save doctors one hour a day.9 continued on page 26 MEDMONTHLY.COM |25

continued from page 25

Every resident has their own device for test results, rather than sharing with other health professionals, there is greater efficiency. Patient records and test results are available now on the iPad, residents check test results at the patient’s bedside during conversation. Residents speak and interact more readily with patients, sharing relevant details as decisions are made. In the Texas Health iPad initiative, Ferdinand Velasco, M.D., chief medical information officer, noticed that physicians without iPads spend a great deal more time in the nursing stations sitting at computer terminals. But physicians with iPads are freer to be at the point-of-care. He said it’s striking how iPads have changed the hospital scene.10 The continued adaption rate seems inevitable, and generally for the best.

Apps that doctors use for teaching (medical apps) But smartphones and iPads offer more potential than simply as a conduit for medical records and for test results. The research is not yet out on the effectiveness of these tools on the iPad, because the field is so new. Developers work with physicians to fulfill and enhance their vision for education and health communication on the iPad. There is potential to use illustrations, and dynamic video content to teach complex medical concepts about anatomy, pathology, embryology and pediatric growth, and progressive health changes. This information can be personalized, specific, and quickly accessible as a tool for physicians to speak with patient. It can offer comparisons of conditions, before and after sequences, projections, 3D capabilities, and scaling to and from any magnitude. Such tools put physicians in a situation where they are better able to direct and narrate for the patient: making simple drawings of their own which can then be offered to patients. 26 | NOVEMBER 2012

And while apps are being developed for this, and there are more than 10,000 apps in the iTunes Medical section of iTunes, it is not impossible for physicians to work with developers to tailor and design their own apps for mobile devices. And with app development more affordable on the iPad, from just a few thousand to about $15,000, depending on the app, some clinics are developing apps specifically suited to their own needs.

What's already available in my specialty? Back in September of 2011, iTunes began offering a new category, Medical, specifically to separate from consumer apps the apps a professional might use in the clinical setting. Asking physicians and searching reviews, I have compiled a list of some of the most popular medical apps available. A particular series that stands out is a series of free apps developed by DrawMD.11 It is a vision made, “by doctors for doctors”. And these apps allow physicians to quickly pull up background anatomy illustrations relevant to their own specialty, upon which they can draw and make diagrams for a patient’s unique needs. DrawMD apps include a stamp library, the ability to draw freehand in many colors, undo and erase, email or save any sketch, print sketch by AirPrint

(accessible on AirPrint printers). The apps also allow physicians to import their own backgrounds or to draw on a blank slate. As of September 2012, DrawMD offers apps in General Surgery, Female Pelvic Surgery, Otolaryngology, Cardiology, Anesthesia & Critical Care, Pediatrics, Vascular, Urology, as well as a Sampler app. Orca Health12 is another developer offering a suite of apps for various specialties. Their apps are not all free, but they cost less than $4.99 for the initial purchase. And they offer very in-depth 3D illustrations with a 360-degree accessible view. The apps offer some common conditions and treatment recommendations. But beware that these conditions are an added in-app purchase on top of the purchase price of the app. The Orca Health Decide series offers AirPlay support, which will let you display the app on an Apple TV. The series includes these apps: AgingSpine, HeartDecide, BreastDecide, ENTDecide, EyeDecide, FaceDecide, FootDecide, KneeDecide, HandDecide, ShoulderDecide, and KidsDental. These apps do not offer sketching and diagramming capabilities, for physician users, but the graphics are more dynamic, and even the anatomical labels are offered in 3D. For more complex anatomy, the Netter's Anatomy Atlas has become a standard iTunes medical purchase. It is useful for both professional education and patient education. It offers quizzes and the ability to make notes as well. It costs $89.99. CardioTeach is an app developed by Boston Scientific. It offers a beautiful interface to explore cardiovascular and peripheral diseases, including specifically atrial and ventricular arrhythmias, coronary artery disease, heart failure, and heart rhythm disorders. The illustrations are dynamic, but do not allow sketching as the DrawMD series does. This app is free at the iTunes store. A South Florida physician, Dr. Ariel Soffer, developed MedXCom.

These figures are outlined in the Manhattan Research, Cybercitizen U.S. Health Study 2012, in which 8,639 U.S. adults were surveyed. 2 “Patient Perception of a Point-ofCare Tablet Computer (iPad) Being Used for Patient Education”. A. Nickels, V. Dimov, V. Press, R. Wolf. American College of Allergy, Asthma & Immunology (ACAAI) 2011 Annual Meeting. 3 4 Manhattan Research Physician Specialist Survey. "2012 Taking the Pulse" polling 3,015 U.S. practicing physicians in over 25 specialties. http:// 5 is a technology tracking Website. http:// 6 Surround Health. http://blog. 7 Study reported here: http://www. 8 Impact of Mobile Tablet Computers on Internal Medicine Resident Efficiency Bhakti K. Patel, MD; Christopher G. Chapman, MD; Nancy Luo, MD; James N. Woodruff, MD; Vineet M. Arora, MD, MAPP Arch Intern Med. 2012;172(5):436-438. doi:10.1001/archinternmed.2012.45. 9 10 PCWorld. article/229374/Can_the_iPad_Cure_ What_Ails_Us_.html 11 Draw MD. 12 Orca Health App Developer. 1

The app is not visual, but so useful to patient communication that is worth mentioning. It protects both doctors and patients from misinformation arising from cell phone conversations. The app records every call between doctor and patient. The recording also allows patients to replay the call and review instructions. When a patient makes or receives a call, a recording first announces, "This call may be recorded for quality purposes." And the patient is offered immediate access to the recorded call and can auto-request a transcript. The app also allows physicians to prescribe medications. This app is available in the iTunes Medical category for physicians, and in the iTunes Health & Fitness category for patients.

Many medical apps on iTunes are simply not useful for education. There are several "plastic surgery" apps, for example, which allow users to experiment with and manipulate faces. These are apps that allow the user to drag facial features into various contortions. But the apps are more fun than educational or useful for demonstrating before and after illustrations of plastic surgery. For a complete list of the apps I've explored, please see the table on pages 28 and 29. I will be talking in Part 2 about what patients need and want from health apps. I will also explore the question of security, which looms large in the mind of many doctors I speak to. 

Laura Maaske - Medimagery LLC Website: MEDMONTHLY.COM |27

Physician's Apps now available DrawMD

Developed by surgical oncologists and Harvard Medical School classmates Todd Morgan and Alexander Kutikov and technology expert John Cox, these apps allow physicians to quickly pull up background anatomy illustrations relevant to their own specialty, upon which they can draw and make diagrams relevant to that patients unique needs. These apps include a stamp library, the ability to draw freehand in many colors, undo and erase, email or save any sketch, print sketch by Airprint (accessible on Airprint printers). The apps also allow physicians to import their own backgrounds or to draw on a blank slate.

All apps are Free

Teaches heart Anatomy, Conditions, best practices, and helps you Find a Specialist. The interface is divided into three sections: Anatomy, Condition, and Find a Specialist. Using medical images and annotations which are specific to each condition, the app describes each condition, shows what it looks like, allows 3D manipulation, lists symptoms and findings, and gives treatment recommendations based on best practices. It also provides a directory of specialists based on the user's location. The app utilizes the AirPlay Mirroring feature in iOS 5, allowing users to stream the app's content to a larger Apple TV screen.

All are $4.99, except EyeDecide and ENTDecide, which are free. Beware that there are in-app purchase for each and every condition. Conditions may be purchased in bulk, as well.

This app is an upper airway 3D simulator offering 3D manipulation. Tappable targets provide access to clinical information, photographs, and additional medical illustrations. Offers 34 different anatomical structures with a crosssection showing an overview of the entire area. A navigation head shows current location and orientation



Allows ENT professionals to explain ear, nose and throat related conditions and treatments to patients within the office. Included are videos, simulations, and closed captions, This app may easily be used in reception areas to for waiting patients to explore, and can be used throughout the practice to reveal details about complex topics.



Visual DX is an extensive image library, holding 90,000 peer-reviewed photographs and more than 800 diseases. It depicts disease variations based on severity and stage. It includes common as well as rare conditions, and the collection continues to grow. It has a simple graphical user interface that allows easy browsing, and it offers text descriptions. While typically used by physicians, it is also as useful to dentists, infectious disease specialists, and public health workers.

Free Sampler General Surgery Female Pelvic Surgery Otolaryngology Cardiology Anesthesia & Critical Care Pediatrics Vascular Urology


By ORCA MD EyeDecide ENTDecide FaceDecide HeartDecide SpineDecide AgingSpineDecide ShoulderDecide HandDecide KneeDecide FootDecide KidsDental

Upper Respiratory Virtual Lab

By Georgia Health Sciences University http://www.georgiahealth. edu/mobile/urvl.html

By Eyemaginations, Inc. http://corporate.

By Logical Images, Inc., Rochester, NY

Compiled by Laura Maaske 28 | NOVEMBER 2012

Nova Body System series

This app series offers a range of apps for different body systems, used for teaching and patient education. Anatomy is displayed manipulated in 360º 3D with diagrams. Dozens of animations as well as additional medical illustrations make the app a thoroughly useful teaching tool.

Ranging from $1.99 to $14.99, with iPad versions being more expensive

The Visible Body 2 app offers over 3,400 anatomical structures for both male and female bodies. It boasts realistic tissue textures, and the ability save your own views. There is a keyword search. All the structures in both models are rendered in 3D. The user can view any combination of anatomy, rotate freely, and adjust the zoom area. Each structure includes definitions with detailed information about location, form, function and physiology. Atlas 2 provides a visual reference tool for healthcare professionals and a lab-like study aide for students.

$9.99-$29.99, price depending on iPhone or iPad version, at the iTunes Store

Netter’s Atlas

The Netter’s Atlas app includes 531 Frank Netter Plates from the 5th edition Atlas of Human Anatomy. And it offers anatomy quizzes.

$89.99 at the iTunes Store


WebMD offers a Symptom Checker, Drugs & Treatments, First Aid Information and Local Health Listings. WebMD also offers access to first aid information without having to be connected wirelessly. It allows secure saving of information about drugs, conditions and articles relevant to.

Free at iTunes Store


The MedXCom app protects both doctors and patients from misinformation arising from cell phone conversations. The app records every call between doctor and patient. The recording also allows patients to replay the call and review instructions. When a patient makes or receives a call, a recording first announces, "This call may be recorded for quality purposes." And the patient is offered immediate access to the recorded call and can auto-request a transcript. The app also allows physicians to prescribe medications.

The patient pays nothing for the service. The physician pays $29.95 to $79.95 a month, depending on how many physicians make up the practice. (A bare-bones version with secure textmessaging is free.)

By, LLC http:// applications.3d4medical. com/hip_pro.php Muscle System Skeletal System Heart Pro III Brain & Nervous System Brain Pro iMuscle Knee Pro III Shoulder Pro III Hip Pro III Ankle & Foot Pro Hand & Wrist Pro Elbow Pro III Spine Pro III Orthopedic Patient

Visible Body 2

Argosy Publishing atlas_overview 3D Human Anatomy Atlas 2 3D Muscle Premium 2 Circulatory Premium 2 Nervous System Anatomy 3D Respiratory Anatomy 3D Reproductive & Urinary Anatomy

By Elsevier, Inc app/netters-anatomy-atlas/ id461841381?mt=8

By WebMD

developed by South Florida cardiologist Dr. Ariel Soffer

Compiled by Laura Maaske MEDMONTHLY.COM | 29

research & technology

MBAN Final Rule Positions Telemedicine To Become the Next Universal Best Practice in Health Care by Frank J. Rosello, CEO Environmental Intelligence LL

It’s official. On Tuesday, September 11, 2012 The Federal Communication Commission (FCC) released a final rule that officially allocates wireless spectrum for the development and deployment of mobile body area networks (MBANs). In its final rule, the FCC will set aside 40 MHz in the 2360-2400 MHz band for wireless medical devices. FCC officials confirmed that allocating this once protected broadband space for MBANs will not cause service disruptions nor interfere with Wi-Fi and other high-powered mobile devices. The MBAN final rule is slated to go into effect on October 1, 2012. So how does the implementation of MBANs positions telemedicine to become the next universally adopted best practice in health care? Let’s begin addressing this question by describing what MBANs and telemedicine will actually do for patients. Many inpatient and telemedicine monitors today require connecting patients to devices using cables. The elimination of wires will increase a patient’s mobility which will help contribute to improved patient outcomes, enhancing overall comfort, and improve quality of life. By eliminating the cables that restrict patients to their hospital bed or home, experts say the combination of wireless devices and sensors could transform the way a patient’s health is monitored. With MBANs, patients can stay connected to their clinicians at all times allowing for the continuous monitoring of vital signs even before they reach a hospital, while being moved from unit to unit, and even after they are discharged from the hospital. This technology is essential to reducing the costs of health care and giving patients and their providers an uninterrupted portal through which to share information. In other words, telemedicine technology will not only save patients money on their healthcare costs, but it could also save their life at the same time. These benefits represent a true win for patients. Next, here are four ways that MBANs and telemedicine can help physicians and clinicians increase the quality of patient care and improve outcomes: 30| NOVEMBER 2012

1) Real time heart monitoring – For patients that are considered to be at high-risk for suffering a heart attack, wireless monitoring devices have already proven to reduce hospitalization and even death through early detection of heart failure. These devices help physicians work more efficiently and effectively since the monitoring device only sends notifications and data when a patient’s heart rate falls outside an acceptable range. 2) Diabetes monitoring – For patients with diabetes, these wireless devices can send alerts to patients and physicians when glucose levels move outside an acceptable range. These same telemedicine wireless devices can also monitor for dietary intake that would affect a patient’s course of action as directed by a physician in real time. This type of monitoring will result in reduced visits to the emergency room by both physicians and patients while alleviating the need for patients to constantly poke themselves to check glucose levels. 3) Hypertension monitoring – The wireless sensor nodes used today to monitor blood pressure have become cost-effective and energy efficient. As a result, this allows physicians to improve the critical monitoring of high-risk patients accounting for stress, eating habits, and other triggers in greater detail. The availability of this real-time data helps physicians accurately pinpoint life-or-death situations and ultimately save more lives. 4) Sleep apnea monitoring – Telemedicine devices used for sleep apnea today are capable of handling both investigatory and direct treatment. Physicians are

now better equipped to deliver higher quality care and treatment to their patients due to the sleep patterns, body position, and breathing patterns data available to them through this wireless telemedicine technology. There is no question that implementing MBANs along with the ongoing development of telemedicine technologies will drive significant improvement in the quality of patient care and outcomes. These telemedicine capabilities are important for physicians, clinicians, and their patients. For the final point in addressing this question, let’s shift the focus away from patients and physicians and briefly turn our attention to medical organizations. Medical organizations and our overall health care system for that matter, have the significant potential to reduce health care costs resulting from investments in telemedicine. In 2011, a study released by the National Institute for Health Care Reform found that hospital readmissions within a month of discharge cost medical organizations over sixteen billion dollars each year. Medical organizations now have the opportunity to leverage telemedicine technology as a means to reduce hospital readmissions and other adverse events which will result in reducing costs over time. The fact is the investment in telemedicine technology is significantly less than the cost associated with readmissions thus resulting in a net cost savings for medical organizations. Here are four ways that MBAN’s and telemedicine can be used to reduce health care costs to medical organizations: 1) Remote analysis services – Teleradiology and telepathology are examples of remote analysis services that can help to lower operating costs while delivering higher quality care, especially with low-volume providers. Medical organizations that use

these remote services benefit by having 24/7 coverage at a much lower cost than having a full-time radiologist or pathologist on site. 2) Triage Services – There are certain medical conditions where at home triage services provided by nurses and physicians via televisits would reduce the cost associated with emergency room visits. 3) mHealth monitoring – This form of telemedicine can significantly reduce the cost associated with complications due to chronic illness. Averting patient complications proactively will improve the quality and lower the cost of care. 4) Remote monitoring – This form of telemedicine allows patients to be monitored on an outpatient basis in cases where in the past, the same patients may have required hospitalization in order to receive the necessary monitoring and care. Medical organizations that reallocate some forms of monitoring and observation to an outpatient basis will best positioned to reduce inpatient related costs without compromising the quality of care and patient outcomes. In conclusion, MBANs combined with telemedicine technology offers the entire health care system a refreshing and innovative approach to improve the quality of patient care, achieve efficiencies that can reduce overall healthcare costs, and improve patient comfort and outcomes. MBAN’s and telemedicine have the great potential to deliver a complete win for patients, physicians, clinicians, and medical organizations, and as a result, also becoming the next universally adopted best practice in health care.  MEDMONTHLY.COM |31

research & technology

Don’t Waste the Meaningful Use Crisis

By Tom S. Lee, Ph.D., MBA, CEO & Founder, SA Ignite 32| NOVEMBER 2012

“You never want a serious crisis to go to waste.” Rahm Emanuel, Mayor of Chicago


act: at no other time in human history has $30B been dedicated to drive the use of a software application! The electronic health record (EHR) Meaningful Use (MU) program is exactly this, but it also conjures up images of an organizational “crisis” of epic proportions. It’s one thing to install an EHR system, but another matter to drive on-going proper and efficient usage of it. Provider organizations can use the crisis of needing to achieve MU to transform their organizations in ways that would otherwise be very difficult in normal times. It should not only be about the MU incentive dollars. Visionary organizations see that enabling MU naturally encompasses workflow, system, and role changes that can reduce errors, increase efficiency, and increase patient engagement, not just garner incentive dollars. It’s not often that a crisis of this magnitude emerges that can move mountains within previously slow-to-move organizations of all shapes and sizes. In this respect, we have seen numerous successful examples. For instance, practices are beginning to use MU clinical quality measures to drive real behavior change among their providers, even though MU does not yet set minimum thresholds on those measures. Organizations such as Advocate Physician Partners are driving greater clinical integration with their 3,900 physicians by making EHR adoption and ultimately Meaningful Use a minimum requirement for participation in their network. To handle patient visits efficiently while achieving MU, practices are offloading certain MU documentation tasks, and thereby the associated clinical tasks, from doctors to other clinical staff who are actually better suited to perform those tasks. The list goes on and on. We have also discovered that these visionary organizations share a common attribute: the realization that driving MU is truly a journey-without-end that delivers on-going direct and collateral benefits. Such organizations have Stage 2 and Stage 3 MU achievement built into their strategic plans for the rest

of the decade. They have created on-going staff roles and infrastructure to stay MU compliant on an annual basis to avoid the up-to-5% Medicare reimbursement penalty starting in 2015. They also realize that private payers, such as Humana and Aetna, have added MU compliance as a minimum requirement for pay-forperformance programs and will drive MU compliance more broadly to measure quality, a requirement for health care reform’s shift towards pay for quality. Practices looking to become acquired are aware that acquirers are increasingly using a practice’s on-going level of MU achievement as an input into valuing the worth of the practice. Health systems are building MU compliance into their staff compensation plans and are instituting processes to enable providers new to the system to achieve MU as quickly as possible, then stay compliant as the standards are raised. MU is a catalyst to setting an organization on a never-ending journey towards quality and efficiency improvements that otherwise would be difficult to start. Furthermore, strong external forces are making MU an on-going organizational initiative that is critical to staying competitive in light of health reform, no matter which political party is in charge. Incentive dollars are a good reason to start, but not also striving to reap the broader and perpetual benefits of MU risks letting the crisis go to waste.  Tom S. Lee is CEO & Founder of SA Ignite, a health care IT provider of software tools that enhance the reporting capabilities and usage of any electronic health record (EHR) system. The company’s flagship product, MU Assistant®, automates Meaningful Use (MU) reporting and attestation, including the country’s first ability to electronically attest complete MU data sets to Medicare. Previously, Tom was an early leader at an informatics company that went public on NASDAQ and was CTO of an IT startup that was successfully acquired by Disney. For more information, visit MEDMONTHLY.COM |33



THE FTC CONTENDS THIS ISSUE COSTS CONSUMERS BILLIONS EACH YEAR IN HEALTH CARE COSTS. by James M. Burns, Member, Dickinson Wright PLLC The Third Circuit Court of Appeals issued its long-awaited decision in the K-Dur Antitrust Litigation. In its decision to reverse the district court and to decline to follow prior decisions from the Second, Eleventh, and Federal Circuit Courts on the issue, the Third Circuit ruled that “any payment from a patent holder to a generic patent challenger who agrees to delay entry into the market is prima facie evidence of an unreasonable restraint of trade”. As took place in cases in the other circuits, in the K-Dur Antitrust Litigation, the court considered whether the settlement of a patent infringement suit brought by a branded drug manufacturer against a generic drug maker, in which the branded manufacturer withdraws its claim that the generic infringes the patent and, in connection with the settlement, also pays the generic not to enter the market until the patent expires, potentially violates the antitrust laws. The settlements, pejoratively referred to as “pay for delay” and “reverse payment” settlements, have become increasingly 34 | NOVEMBER 2012

common over the last ten years, and several circuits had previously held that, as long as the “delay” did not extend beyond the patent’s original expiration date, the settlements were not anticompetitive. The FTC has strenuously disagreed, arguing that the practice is anticompetitive and that it costs consumers billions of dollars each year in increased health care costs. Until K-Dur, however, the FTC had been largely unsuccessful in persuading the courts of this view. In addition to finding that such payments are prima facie evidence of an unreasonable restraint of trade, the Third Circuit also stated that “there is no need to consider the merits of the underlying patent suit because absent proof of other offsetting considerations, it is logical to conclude that the quid pro quo for the payment was an agreement by the generic to defer entry beyond the date that represents an otherwise reasonable litigation compromise.” FTC Chairman Jon Leibowitz applauded the decision, stating that the Third Circuit had “gotten [the issue] just right” and that “these

sweetheart deals are presumptively anticompetitive.” The Third Circuit decision creates a clear split among the circuits, and the FTC is expected to seek to have this issue resolved by the Supreme Court. While that may not be possible based upon the Third Circuit’s ruling (unless the branded drug manufacturer seeks certiorari), only days after the Third Circuit ruled, the Eleventh Circuit again ruled against the FTC in a similar case presenting the same issue, providing the FTC with a clear path to seek Supreme Court review. With that, the issue immediately become “one to watch” at the Supreme Court for this fall, and a ruling on the issue by the Supreme Court could have significant repercussions throughout the health care industry.  Reprint Source: http://www. News/e2097c8d-9f13-49b8-b1e115263459135a/Presentation/ NewsAttachment/830c96231da5-4d04-b284-158239a5c22c/ Healthcare%20Newsletter%208.12.pdf

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. Out three signature sections include:  Performance review  Valuation  Projections

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Health Affairs Briefing Speakers Discuss Payment Reform Research

By Theresa C. Carnegie and Stephanie D. Willis

Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C. On September 7, 2012, the health policy peer-review journal, Health Affairs, sponsored a day-long briefing at the National Press Club to showcase its September issue, “Payment Reform to Achieve Better Health Care.” Throughout the day, prominent academics, government officials, representatives of health care providers, and commercial insurer executives discussed their research and recommendations regarding alternative payment structures designed to increase quality of care, promote better health outcomes, and reduce costs. Go to http:// health-affairs-briefing-paymentreform-to-achieve-better-health-care/ for a complete list of the speakers, including authors from the September 36| NOVEMBER 2012

issue and their articles discussed at the briefing. Jonathan Blum, a Deputy Administrator and Director from the Centers for Medicare & Medicaid Services (CMS), kicked off the event by listing three types of payment reforms to transform the American health care system: (1) promoting the value of care over the volume of care (e.g., capitation or shared savings programs); (2) implementing pay-for-performance arrangements; and (3) changing fee schedule structures (e.g., paying more for primary care versus specialty care services). He outlined six principles and objectives currently guiding CMS’s approach to payment reform: 1. Equipping health care providers with multiple reform mechanisms to suit their level of experience

and readiness to adopt changes. For example, participants in the Medicare Shared Savings Program (MSSP) can elect to only share savings with the government (one-sided risk model) or to share savings and losses (two-sided risk model) related to the costs of delivering health care services to Medicare beneficiaries. 2. Partnering with health care providers to promote their ability to adopt payment reforms. For instance, MSSP participants are now granted direct access to CMS’ health claims data which previously was available only to researchers subject to strict confidentiality agreements. 3. Providing education and training opportunities for health care

providers seeking to participate in payment reform initiatives. 4. Implementing robust quality metrics to measure quality of care and ensure that beneficiaries receive higher quality of services from health care providers who adopt payment reforms. Thus far, Mr. Blum reported that quality of care metrics for Medicare services have stayed constant. 5. Involving multiple types of payors in payment and quality of care initiatives. For example, through its Innovation Center, CMS is using the Comprehensive Primary Care Initiative as one vehicle to engage multiple commercial payors in primary care coordination activities. 6. Working with other federal agencies to identify laws and regulations that can affect care coordination among health care providers. Specifically, CMS, the Office of Inspector General, and the Department of Justice have developed waivers to the fraud, waste and abuse laws in an Interim Final Rule applicable to MSSP participants.

Sam Nussbaum, Executive Vice President and Chief Medical Officer of insurer WellPoint, Inc., followed up with his perspective on how focusing on the health care delivery system is key to addressing cost and quality issues and expanding access and coverage. He noted that 1% of Wellpoint’s membership drives 28% of the company’s health care costs. Using this statistic, Mr. Nussbaum highlighted the need to better coordinate health care services to treat those with chronic conditions and accessed other educational and economic factors to help prevent the onset of chronic illness. Following the opening presentations, four panels of speakers discussed their own experiences with evaluating various payment reform alternatives and innovations

to better coordinate care for patients. Multiple panelists made the following observations in summarizing lessons learned: • No single payment reform approach provides a one-size-fitsall solution; • Actual care coordination improvements at the provider level must complement any approach to payment reform; • Achieving lasting payment reform, improvements in health care quality, and health care delivery coordination requires collaboration between public and commercial payors and health care providers; • Payment reform efforts should help beneficiaries realize that higher quality of care need not come at a higher cost; and • Data-sharing among providers and payors is integral to achieving and measuring results, but requires all parties to address significant legal and logistical implementation issues. The panelists also debated the government’s role in achieving payment reform. For example, the speakers discussed whether government must structure payment reform initiatives to force providers to quickly abandon fee-for-service payments or continue its gradual approach to reforming payment mechanisms. Overall, the briefing provided a forum for multiple health care stakeholders to discuss payment reforms currently underway and debate further changes needed to address the cost-versus-quality challenge facing the American health care system. The progress of these payment reform initiatives and their ultimate ability to promote higher quality, more cost-efficient health care will continue to generate debate for the foreseeable future.  MEDMONTHLY.COM |37


Health Care Reform Increases Compliance and Enforcement Concerns By Thomas Hess, D. Michael Crites and Tyler Williams Skilled Nursing Facilities Compliance and Ethics Programs The Patient Protection and Affordable Care Act contains multiple sections regarding compliance and ethics programs, including Section 6102. That section applies only to skilled nursing facilities that receive Medicare or Medicaid reimbursement.1 Section 6102 requires skilled nursing facilities to “have in operation a compliance and ethics program that is effective in preventing and detecting criminal, civil, and administrative 38 | NOVEMBER 2012

violations . . . and in promoting quality of care consistent with regulations.� 2 According to that section, skilled nursing facilities are to have such programs in place by March 23, 2012. The Secretary of Health and Human Services (HHS), in conjunction with the Inspector General of the Department of Health and Human Services, was to promulgate regulations regarding the programs by March 23, 2012, which could possibly have included a model compliance plan. Recent communication with HHS, however, confirmed that

the regulations have not yet been promulgated. Notwithstanding, facilities will likely be held to the requirement in the Act that they have proper programs in place by March 23, 2013. Although skilled nursing facilities are currently without regulations shaping their required compliance and ethics programs and without a model compliance plan, Section 6102 itself requires that plans include certain components: l established

standards and procedures to be followed by employees that are reasonably

capable of reducing the prospect of criminal, civil, and administrative violations; l specific individuals within highlevel personnel must be assigned overall responsibility to oversee compliance with standards and procedures and have sufficient resources and authority to assure compliance; l the organization must use due care not to delegate substantial discretionary authority to individuals whom the organization knew had a propensity to engage in violations; l the organization must take steps to communicate effectively its standards and procedures to all employees and other agents, such as by requiring training or by disseminating publications that explain in a practical manner what is required; l the organization must take reasonable steps to achieve compliance with its standards, such as by utilizing monitoring and auditing systems reasonably designed to detect violations by employees and other agents and by having in place and publicizing a reporting system for employees and other agents to report violations by others within the organization without fear of retribution; l the standards must be consistently enforced through appropriate disciplinary mechanisms, including discipline of individuals responsible for the failure to detect an offense; l after an offense has been detected, the organization must take all reasonable steps to respond appropriately to the offense and to prevent further similar offenses, including any necessary modification to its program; and l the organization must periodically undertake reassessment of its program to identify changes necessary to reflect changes within the organization and its facilities.

Clearly, the goal of these components is to reduce legal and regulatory violations. Many of the required components are phrased broadly, and the pending regulations will likely fill in the gaps and provide further, detailed guidance regarding facilities’ programs. Be on the lookout for HHS’s regulations in this area. Facilities should ensure that they have an adequate program in place by the March 23, 2013 deadline.

Holder and Sebelius Issue Stern Warning to Nation’s Providers The Department of Justice (DOJ) and HHS sternly warned health care providers that they utterly “will not tolerate health care fraud” in a September 24, 2012 letter. United States Attorney General Eric Holder and Secretary of HHS Kathleen Sebelius wrote to several national hospital associations as well as the Association of Academic Health Centers and the Association of American Medical Colleges, taking a hard line on fraud and abuse in billing the government for health care services. The letter stated that, in addition to the DOJ and HHS, the FBI and other law enforcement agencies are monitoring trends in abuse of electronic health records (EHR) and “upcoding” evaluation and management services. Holder and Sebelius cautioned that “false documentation of care is not just bad patient care; it’s illegal.” Specific concerns included “cloning” medical records, a practice where providers cut information from a patient’s records and paste it into another record of the same patient or the records of another patient, and exaggerating the intensity of care or severity of a patient’s condition to improperly increase reimbursement. Both are illegal, and the authorities have vowed to aggressively pursue fraud and abuse when it occurs. Evidence bears this

out, as prosecutions in 2011 were 75% higher than in 2008. The letter’s tone is emblematic of the current climate in which health care providers operate. A significant enforcement method that the government employs to crack down on fraud and abuse is Recovery Audit Contractors (RACs). RACs are private entities that contract with the government to identify overpayments and underpayments to providers and to recoup or repay them. RACs operate on a contingency fee arrangement with the government, so they are incentivized to find as much overpayment as possible. The Tax Relief and Health Care Act of 2006 implemented the permanent operation of RACs in the Medicare Program, and the Affordable Care Act of 2010 implemented RACs in the Medicaid Program, with an implementation deadline for Medicaid RACs of January 1, 2012. Providers must be vigil and proactive about these and other regulatory compliance and enforcement efforts, especially considering the announced stringent attitude of Holder, Sebelius, and the various regulatory bodies. The time to adopt compliance programs, conduct internal audits, and train employees and administrative personnel is before the regulators take enforcement action. Providers are better served avoiding targeted enforcement actions in the first instance rather than limiting the damage after the fact.  This section is codified at 42 U.S.C. 1320a-7j. 2 42 U.S.C. 1320a-7j(b)(1) 1

Thomas Hess, D. Michael Crites and Tyler Williams are members of Dinsmore’s Health Care Practice Group practicing out of the firm’s Columbus, Ohio office. Learn more about each attorney at www.dinsmore. com. care_reform_increases_compliance_ enforcement_concerns/ MEDMONTHLY.COM |39


Health Care Reform: Talking to Patients and Staff

The process of passing and implementing a law is a long and winding road, but President Obama’s Health Care Reforms cleared a significant hurdle when the Supreme Court upheld most of the law as constitutional against challenges from many of the states as well as business organizations. You have probably been getting a lot of questions from employees, patients, friends and relatives, and even your providers and colleagues, and they all basically boil down to this: How does the law affect me? 40 | NOVEMBER 2012

by Mary Pat Whaley, FACMPE and Abraham Whaley, Chief of Operations

As Managers and Administrators, one of the most basic ways you influence outcomes for your employees, your patients, and ultimately, your organization is to be informed, and to inform others. Can you give a basic overview of the law that was passed to a worried patient? Has your staff gotten any information about handling patient questions? Do your providers have a basic idea of how the practice will respond to the changes? Many states and organizations have been delaying plans for the changes in the PPACA because of the court challenges to the law (many were plaintiffs in the suit) or for this November’s elections, which could put a President in the White House who has promised to repeal the law. On top of that, even if President Obama wins another term, a Republican-controlled Congress could choose not to fund certain programs so that the law could not be put into place. For the moment however, the Affordable Care Act is the law of the land for the immediate future, and something all managers need to have a basic grasp on.

What’s Changing For Individuals? The goal of the legislation is to decrease the number of uninsured people in the country by tweaking existing federal programs like Medicaid and Medicare, and issuing new regulations on the health insurance industry as well as on private businesses and individual citizens. By the year 2014 everyone will have a responsibility to carry some kind of health insurance. If you don’t get health care coverage through your work or your family, or through an existing program like Medicare, Medicaid, or Tricare, you will have to purchase a minimum level of private insurance or face a penalty. Subsidies to help pay for the required insurance

will be available to individuals and families who make up to 400% of the poverty level on a sliding scale. One example from Wikipedia, of how that would work in real life: A family of four whose income is at 150% of the Federal Poverty Level (~$34,000 a year) would be subsidized so that their monthly premiums would be about 2% of income, or $50. To further help individuals comply with the mandate to have insurance coverage, by 2014 each state will set up a Health Insurance “Exchange”. This is a marketplace where individuals can compare benefits and premiums for health insurance, and find out if they qualify for federal subsidies.

Are My Taxes Going Up? In addition to the individual mandate, in 2013 people with income $200,000 a year or more ($250,000 a year for couples) will have their Medicare Tax increased from 1.45% to 2.35% on the income above the limit. The Medicare Tax on Net Investment Income over the $200,000 limit will be raised from 2.9% to 3.8%. These increased Medicare taxes on high income individuals account for roughly half of the new income to pay for the bill. Other new taxes on individuals include a 40% excise tax on “Cadillac Plans” or insurance plans that cost more than $10,200 a year for an individual ($27,500 for a family) starting in 2018, and a 10% sales tax on tanning services that began in 2010. New restrictions will also be placed on Health Care Savings Accounts and Medical Expenses taken as tax deductions.

How Will Insurance Change? Although people will be required to carry some form of policy, new regulations on insurance companies should increase the overall benefit

to the private citizen for purchasing coverage. For example, insurance companies can no longer deny (or overcharge for) coverage to people with pre-existing medical conditions, cannot drop someone’s coverage who becomes ill, and cannot impose either lifetime or annual caps on how much a policy will pay out in benefits. Insurance now also has to pay for basic preventative care like wellness visits without co-pays or deductibles, and children can stay on their parents’ insurance until their 26th birthdayeven if the child is not a financial dependent, or is married. Insurance companies also have to adhere to a “Medical Loss Ratio”, which means that they have to spend a certain amount of the money they collect from your premiums on either medical services or quality improvement. Every year the insurance companies must report how much of the premiums they collect are spent on these medical losses, and if they spend less than the ratio (80% for individual and small group plans, 85% for large group plans), the difference is refunded to the policyholder.

What About Medicare And Medicaid? Federal Health Plans Medicare and Medicaid will also be changed. Medicare enrollees who hit the “donut hole” in the prescription drug benefit receive a 50% discount on covered name-brand drugs, and the benefit will continue to increase until the “donut hole” is completely closed in 2020. Also, federal money will be made available to the states to expand Medicaid coverage to anyone who makes up to 133% of the Federal Poverty Line. At the time of this writing, the governors of two states, Florida and Louisiana, have already indicated that they will not take the additional Medicaid funding from the federal government.  MEDMONTHLY.COM |41


Health Care Reform:

Get Your Head Out of...

...the Sand! PPACA, the federal legislation commonly referred to as Health Care Reform, is here to stay, at least for a while. By Joe Gupton, CWCS, EmployeeSync Specialist, Jones Insurance 42| NOVEMBER 2012


egardless of who wins the presidential race and how many seats may change in the house and senate, the new rules have been made and there are auditors in place to enforce them. The truth is that reform legislation will continue to change over the coming months and years, but it will require businesses to take a close look at their health care coverage today. At the core of the bill are the individual and employer mandates to purchase insurance. Although many people expected these pieces to be repealed, both were recently upheld by the Supreme Court and are becoming more well defined every day. Because reform is moving forward, every business needs to prepare for the pending regulations. Three key components will determine how any company will adapt to the new legislation: 1) compliance 2) effective health/wellness management, and 3) creative funding. Compliance is perhaps the simplest but most important aspect. The best advice is to play by the rules. Unfortunately, the rules are not simple. Furthermore, because breaking the rules may result in hefty excise taxes, HR departments will need to be prepared to produce valid and detailed documentation in order to prove that they are in fact abiding by the law. Moreover, to avoid the potential DOL, EEOC and NLRB audit pitfalls, the same departments should also make it abundantly clear to all employees that the rules are being followed. This is an important cue to evaluate your HR systems. If you do not have a certified HR administrator or up-to-date and compliance ready HR software, you would be well advised to invest the time, money and energy necessary to get one or both very soon. The next important consideration that reform will precipitate is health data tracking and "Wellness". The value of wellness should not be overlooked, but it is necessary to understand that

a wellness program should be paired with information gathering. Certainly, the idea that helping employees become healthier and lowering their health care costs has a positive impact on your health insurance rates is legitimate, but there are factors that determine the extent of that success. For example, a high level of employee participation and the ability to monitor improvement are both paramount. Like all businesses in a competitive market, propositions must be backed with a proven track record in order to negotiate value and pricing. When we apply that theory to medical insurance it means that organizations must now present a compelling history of decreases in high risk health conditions and effective treatment of chronic disease among their employees. While the free wellness programs that many agents and carriers offer can be worthwhile, ultimately, they lack the crucial component of specific data tracking and data ownership. A true wellness plan should be one that yields health data which is owned by the business and can be used to negotiate rates with multiple insurance carriers. Health data is a powerful tool that a growth minded business should review frequently for the sake of cost effective benefits planning. A true wellness plan and health data tracking system, will have an associated cost, but should more than pay for itself in the first year of implementation. A basic plan may have an initial cost of $2 per employee per month, but this should be affordable for any business especially considering that they may see their insurance rates drop by $4 or more per employee per month for the following year. Finally, businesses need to take a close look at how they are paying for insurance, and what they get for their premium dollar. Health care costs and insurance premiums continue to rise, but it is interesting that tax laws continue to allow, and

even incentivate, the pre-tax and tax deductible advantages of sustainable and compliant benefit plans. This is a clear message that if an administrative team understands the intent of reform and knows how to budget their benefit costs wisely, they will lower their tax liability over the next few years. Creative funding that incorporates consumer driven health plans (CDHP’s), health savings accounts (H.S.A.’s) and health reimbursement arrangements (H.R.A.’s) should be a mandatory part of any benefits planning discussion in the coming months. Businesses should also be financially prepared to self-fund part of their employee benefit packages and create a re-insurance strategy to cover the potential for large claims pay-outs. In fact, an accurate illustration of partial self-funding will usually show that the reduction in annual premium greatly outweighs the business’s potential exposure in the first year. Furthermore, lower premium costs can free up budget funds which can be used to support a valuable wellness initiative. Groups with 50 or more full time employees – or equivalents - must begin to embrace the idea of reinsurance, aggregate risk caps and corridors. Self-funding is no longer only for the large employers with 500 or so emplyees. The concept of buying less insurance and sharing the burden with employees is a sustainable model. If managed correctly a business can achieve both lower premium rates and an improved benefits package. There is no trend or study that indicates fully insured plans will do the same. Opinions on reform differ, but the facts point to a universal conclusion drastic change. This change does not have to be a detriment to profitability if you understand how to adapt. Businesses who do not evolve to meet the new standards or who continue to simply hope for the legislation to go away will have a difficult and costly few years starting in January of 2014.  MEDMONTHLY.COM |43



By Michael B. Friedman, MSW; Lloyd I. Sederer, MD; and Kimberly A. Williams, MSW 44 | NOVEMBER 2012


he Affordable Care Act (ACA), which the Supreme Court recently upheld, is of great potential benefit to people with behavioral health conditions, i.e., people with mental and/or substance abuse disorders. This is true because, under the provisions of the ACA1: 1. Many Americans with such conditions who currently do not have health care coverage will get coverage. 2. Behavioral health conditions that now are not covered or are only partially covered will be covered (“parity”). 3. Coordination of physical and behavioral health care should become more common than it is now. 4. Health maintenance activities are encouraged and supported to some extent. 5. Community-based care is encouraged and supported. 6. Some economic barriers to screening for and treating behavioral health conditions will be eliminated. Improvements in behavioral health care under the ACA have not been a prominent part of the discussions and debates about health care reform in the United States. Probably because spending on behavioral health is under 7% of all health spending2, mental and substance use disorders just don’t seem to be of the same order of importance as physical health conditions. In our view this is unfortunate for several reasons. • Behavioral health conditions are a source of suffering for the people who have them and often for their family members as well. • They are the leading cause of long-term disability as measured by disability adjusted life years. (DALYS).3 • People with co-occurring chronic physical disorders such as heart disease and mental disorders

especially depression—are at substantially elevated risk for dis ability and premature mortality.4, 5 • Care for people with co-occurring physical and behavioral disorders is considerably more expensive than care for people without co occurring disorders, driving up the overall cost of health care in the United States.6 • Disabled older adults with co occurring disorders are more likely to be placed in nursing homes than cared for in community settings, driving up the cost of long-term care.7, 8 • People with serious mental illness often do not get the physical health care that they need for obesity, high blood pressure, diabetes, and heart conditions for which they are at high risk and which contribute to low life expectancy for this population.9 • Improved overall health of Americans, such as reduced obesity, depends on changes in lifestyle and behavior, which rarely happen unless motivation and other psychological issues are addressed.10

Improved coverage People with behavioral health conditions, especially those with serious, long-term conditions are at high risk for poor health, disability, and premature death. Unfortunately, many of them do not have health coverage and therefore do not get treatment—or get poor treatment— for conditions for which they are at high risk such as obesity, high blood pressure, diabetes, heart and pulmonary conditions, hepatitis, and sexually transmitted diseases, including HIV+/AIDS. The ACA mandates that all American citizens and legal aliens have health coverage. Subsidies will be available for people too poor to afford coverage. Employers for the most part are required to cover their employees,

with exceptions for small businesses, many of which will get subsidies to pay for coverage. Medicaid will be expanded to cover people up to 133% of poverty in states that choose this option. State health insurance exchanges will provide a mass market through which individuals and small groups can purchase standardized health insurance packages at the same rates as large groups. Young adults up to the age of 26 can continue to be covered under their parents’ health insurance plans. In addition, health insurance reforms will be of benefit to everyone with health insurance, including people with behavioral health conditions. The most important of these reforms are that plans will not be permitted to exclude people with preexisting conditions or to drop coverage of people who become seriously (and expensively) ill.

Parity The ACA also provides improved coverage of mental health and substance abuse conditions. This is a major advance. A very few years ago, new federal laws required "parity" in the coverage of mental and physical health conditions in employer-based health benefit plans and Medicare, but the provisions were limited. The ACA carries these requirements forward and expands them considerably by making behavioral health services for both mental and substance use disorders part of the basic, minimal coverage package that will be mandated. The ACA also provides enhanced Medicare coverage of medication, including of psychiatric medications. This will result in (1) reduced out-ofpocket spending on pharmaceuticals by shrinking the phase of personal spending on medications not covered by Medicare, i.e. the "donut hole" and (2) enhanced access to psychiatric medications prescribed by a physician continued on page 46


continued from page 45

that were not covered in the original version of Medicare prescription drug coverage.

Coordinated Care There has been widespread agreement for several decades that it is critical to improve coordination of care between the mental health and substance abuse care and between behavioral health and physical health care. The ACA emphasizes the importance of integrating and coordinating the delivery of physical and mental health services and provides incentives to providers to integrate care, including: • Rate increases for medical practices recognized as "medical homes" that provide coordinated care and preventive services, among other features. • Increased federal funding for Medicaid payments to "health homes," which are organizations that coordinate care for people with chronic physical and/or behavioral health conditions. • Contracts with "accountable care organizations" – a new type of structure designed to improve care quality and contain costs. In these, and other health delivery structures "meaningful" use of electronic medical records is also encouraged and supported.

Home and Community Based Services The ACA emphasizes services in the home and community instead of in institutions. There are new demonstration grants as well as new opportunities for Medicaid waivers for state efforts to reduce the use of nursing homes and other institutions and instead provide care for people with disabilities in their homes and communities. In this way it carries 46| NOVEMBER 2012

forward the policy goal of helping people with psychiatric and other mental disabilities to live in the community rather than in institutions. It also will help states to fulfill the mandate of the Olmstead Decision11 of the Supreme Court, which interpreted the Americans with Disabilities Act as requiring states to provide supports to enable people with disabilities to live in the "most integrated" setting in the community rather than in institutions.

Health Maintenance The ACA also emphasizes health maintenance (lately called "wellness") and preventive interventions. For example, it provides Medicare payments for some preventive health care and health promotion for the first time. This, of course, benefits people without mental illness as well as those with mental illness, but it is particularly important for people at high risk of obesity and the diseases it drives such as hypertension, diabetes, and heart disease—conditions that are particularly common among people with serious mental illness.

Removing Economic Barriers To Screening and Treatment Protocols for high quality primary care, pediatrics, cardiology, and other medical specialties call for routine screening for mental and substance use disorders—especially for depression. But many, if not most, practitioners do not do screening, let alone provide or arrange for adequate treatment for behavioral health conditions. Economic barriers are one of the reasons so many practitioners do not follow the protocols of their fields of practice. One such barrier has been that Medicare and most private health plans have paid less for the treatment of behavioral health services (if covered at all) than for treatment of physical health conditions. As noted previously, this disparity in financing

It will take vast changes in practice and vast workforce development efforts to bring about the kind of overhaul the American health care system needs. is being totally eliminated under the ACA. Medicare has also added payments for: • Screening for alcohol abuse and for depression under some circumstances12, 13 (Provisions related to depression also require "follow up",14 which may help to support the use of care management models that improve outcomes of depression treatment by about 50%.15) • An annual "wellness visit", the purpose of which is to develop a plan to maintain or improve basic health. Another major economic barrier has been the virtual impossibility of coordinating financing of integrated treatment for people who have both Medicare and Medicaid (the "dual eligibles.") This tends to be a population with co-occurring physical and psychiatric disabilities—which is the population currently most costly to serve in part because of the severity of their conditions and in part because they often do not get care until their conditions are critical

and require long-term, very expensive interventions. Under provisions of the ACA, demonstrations are now beginning to develop systems of coordinated care, and financing, for this population. Although there undoubtedly will remain economic disincentives to addressing behavioral health conditions in primary care and specialty practices, the ACA does address some of the significant barriers. Both by providing coverage for services not previously covered and by encouraging the re-arrangement of medical care into large multi-specialty groups linked by electronic medical records, the ACA lays the groundwork for significant improvement of behavioral health services in the context of the delivery of physical health care.

Conclusion Will the ACA by itself result in widespread accessibility to high quality physical and behavioral health care for people with behavioral health conditions? Certainly not. It will take vast changes in practice and vast workforce development efforts to bring about the kind of overhaul the American health care system needs. But the ACA lays the groundwork for far better health care (behavioral and physical) for people with behavioral health conditions.  Kaiser Family Foundation. “Summary of the New Health Reform Law”. 2010. http://www. 2 Mark, et al. “Changes in U.S. Spending on Mental Health from 1986-2005 and Implications for Policy” in Health Affairs, February 2011. content/30/2/284 3 Healthy People 2020. “Mental Health and Mental Disorders” . 2012 http://www. overview.aspx?topicid=28 4 For example, Freedland K. et al. "Impact of Depression on Prognosis in Heart Failure" in PubMedCentral, January 2012. http://ukpmc. 5 Ciechanowski, P. et al. "Depression and 1

Diabetes ... " in Archives of Internal Medicine, November 2000. .http://archinte.jamanetwork. com/article.aspx?articleid=485556. 6 Druss, BG & Reisinger, W. “Mental Disorders and Medical Co-Morbidities.” Report of the RWJ Foundation, February 2011. http://www. 7 Fullerton, C.A., McGUIRE, T.G., Feng, Z., Mor, V., & Grabowski, D.C. “Trends in Mental Health Admissions to Nursing Homes, 1999-2005”. Psychiatric Services, July 2009. aspx?articleid=100604 8 Grabowski, D.C., Aschbrenner, K.A., Feng, Z., & Mor, V. (2009). “Mental Illness In Nursing Homes: Variations Across States. Health Affairs, May/June 2009. content/28/3/689.abstract 9 Colton, C. and Mandersheid, R. “Congruencies in Increased Mortality Rates, Years of Potential Life Lost, and Causes of Death Among Public Mental Health Clients in Eight States” in Preventing Chronic Disease, April 2006. articles/PMC1563985/ 10 Van Dorsten, B. “The Use of Motivational Interviewing in Weight Loss” in Current Diabetes Reports, October 2007. http://www. 11 U.S. Department of Justice. “Olmstead: Community Integration for Everyone.” http:// 12 Andrews, M. “Medicare Now Covers Annual Screening for Depression” in Kaiser Health News, April 2012. http://www. 13 Anon. “Medicare Coverage for Alcohol Misuse Screening and Counseling” in Medicare Interactive, January 2012. http:// counselor&page=script&slide_id=1730, 14 Anon. “Medicare Pays for Annual Depression Screening” in ACP Internist, March 2012 archives/2012/03/tips.htm 15 Unitzer, J. et al. “Collaborative Care Management of Late-Life Depression in the Primary Care Setting: A Randomized Controlled Trial” in Journal of the American Medical Association, December 11, 2002. aspx?articleid=195599

Michael B. Friedman, MSW is Adjunct Associate Professor at Columbia University’s School of Social Work and School of Public Health. Lloyd I. Sederer, MD is the Medical Director of the NYS Office of Mental Health. Kimberly Williams, MSW is Director of the Center for Policy, Advocacy and Education of the Mental Health Association of New York City.

the arts

Bartering the Art of Medicine for The Medicine of Art at Kingston’s

O+ Festival

It’s no secret that some of our best, most talented artists and musicians struggle to survive and don’t have health care insurance. The O+ Festival was designed to provide immediate help, by enabling artists and musicians to get free or reduced medical and dental care in exchange for their participation, as well as to shine a spotlight on the issue. It has been a hit, and this year the Festival featured over 40 bands performing at various venues around Uptown Kingston, NY. There were 41 artists, whose work was displayed on building walls, in murals and storefront windows; a consultation with performance artist Linda Montano; a free health expo; and tai chi, yoga and “gong bath” sessions. Artist Thom Grady, a member of O+ Festival’s Art Committee, helped install the 14 pasteups of work by artists, which mostly adorned the buildings along Fair Street. Some of 48| NOVEMBER 2012

the paper forms, which were attached to building walls with wheat-paste, were digital photograph prints or eerie blue cyanotypes, such as Emily Gui’s series depicting the lunar cycles. This year, in addition to the 14 wheat-paste artists, there were “living moss art, storefront windows with everything from data-embedded knitwear to steel sculpture, projections from the Cave Dogs, Polly Law’s digital Exquisite Corpse and video art, as well as more ‘traditionally hung’ paintings at BSP, Sissy’s Café and Blue 57,” according to Festival organizers.

Visitors to the Festival in Uptown Kingston could do more than observe artworks; they could also participate in an interactive drawing session held by Dr. Sketchy at Boitson’s restaurant, with two models posed in theatrical dress. Students from the Advanced Painting class at Kingston High School participated in the Festival; each making a painting on a piece of vinyl donated by Timely Signs, displayed on a piece of green plywood erected at the patio end of Wall Street. The Friends of Historic Kingston were also chipping

in: The organization commissioned artists Jessica Posner and Michael Asbill to create 12 life-sized silhouettes of period shopkeepers, collaged with fragments of historic photos depicting Kingston’s shops circa 1914. Six of the silhouettes were displayed in the Uptown area. Three artists were painting murals: one at Forsyth Park and the others on two black-painted cement walls comprising the base of the former parking garage. Joseph Mastroianni, who recently earned an MFA from SUNY-New Paltz, had covered a wall-and-a-half with his “little dudes,” hieroglyphic-like doodles. Originally from the Albany area, Mastroianni described his Keith Haring-inspired forms as “glorified doodles, stream of conscious drawings done with a paintbrush,” in either blue or yellow. His spontaneous grinning faces, comical aliens and other images – a total of 156 on one wall and eight larger characters on the wall adjacent to the first – were neatly grouped into orderly grids, which tone down the anarchy of this graffiti art, as if each doodle were waiting to break out of jail. Yet the effect was scintillating: His yellow and blue squiggles seemed to be gyrating against the black ground, fooling the eye. The collective work was monumental in size and encyclopedic in content. Mastroianni, who usually works in pen on small wood panels, said that he was thrilled to blow up his imagery and interact with the public, who could view his work from a distance and then explore the details, close up. “I’m really into the public aspect, reaching people

Glorified Doodles Mural

Mini Hoffman - 3x4ft Acrylic and Ink on Canvas

Glorified Doodle 4x6ft

who are afraid to go into a gallery, who otherwise don’t see art,” he said. Mastroianni added that he “wasn’t into illegally scribbling graffiti,” although he loves painting on walls, having covered his studio with squiggles at school, à la Kenny Scharf. The mayor-approved paintable parking lot wall was hence a dream come true. So is getting the free dental care. Mastroianni, who works full-time, said that he lost his health insurance when he graduated from grad school. At the Festival, he had a dental examination and cleaning and fillings put in, as needed, for only $20 apiece. “There’s nothing like this anywhere else,” he said of the Festival. “It just gets bigger and bigger. It’s really nice to get that support and help from the O+ team.”  All images are of Joseph Mastroianni's work and supplied by the artist. To see more of Mastroianni’s art, visit Reprinted courtesy of the Hudson Valley Almanac: MEDMONTHLY.COM |49

healthy living Not only do sweet potatoes taste like dessert when prepared in any form, but they provide some surprising health benefits. Sweet potatoes are a delicious, versatile, and inexpensive staple to have in your pantry. This deep orange-fleshed nutritional “superfood” adds several important components to the diet. Their health and weight management benefits far exceed the nutritional value found in ordinary white potatoes, and they are an excellent food to incorporate into your patient’s diets. Sweet potatoes contain almost twice as much fiber as other types of potatoes. A medium sweet potato provides 7 grams of fiber per serving, which makes an excellent starchy addition to any meal. The high fiber content of a sweet potato makes this a complex carbohydrate, keeping you feeling full and stabilizing your blood sugar. Sweet potatoes are also heart healthy because they contain a large amount of vitamin B6. This vitamin is crucial in breaking down a substance called homocysteine, which contributes to hardening of the arteries and blood vessels, creating inflammation in the body. Vitamin B6 helps keep the walls of these important blood passageways flexible and healthy, allowing blood to flow more freely. In addition, sweet potatoes contain high amounts of potassium. Potassium is an electrolyte that plays an important role in lowering blood pressure by ridding the body of excess sodium, regulating fluid balance, and helps to regulate the natural rhythm of the heart. Sweet potatoes get their orange color because they are rich in the antioxidant beta-carotene, or Vitamin A. One medium sweet potato provides your body with the complete recommended daily allowance of vitamin A. Beta-carotene also helps to internally protect your skin from sun damage and has been linked to prevention of vision loss and macular degeneration. Sweet potatoes are also a great source of manganese, Vitamin C, and Vitamin E, which are all potent vitamins and minerals that are crucial for overall health and disease prevention. 50| NOVEMBER 2012

Roasted Roasted sweet potatoes, red bell peppers, and leafy greens provide a delicious fusion of flavors and pack a large nutritional punch. It is recommended to serve this as side dish or add goat cheese and grilled chicken for a satisfying lunch.

Preparation: 1. Preheat the oven to 425°F. In a large roasting pan, combine the oil, salt, and black pepper. Add the sweet potatoes and bell peppers and toss to coat well. Roast, stirring occasionally, for 40 minutes, or until the potatoes are tender. Remove from the oven and stir in the vinegar. 2. Place the spinach or arugula in a large serving bowl. Add the potato mixture and toss to coat well. Serve immediately.

Sweet Potato Salad Ashley Acornley, MS, RD, LDN

Ingredients: Serves: 4 Cook: 40 minutes

2 tablespoons olive oil 1/4 teaspoon salt 1/4 teaspoon freshly ground black pepper 2 pounds sweet potatoes, scrubbed and cut into 1" chunks 2 large red bell peppers, cut into 1" pieces 2 tablespoons white balsamic or white wine vinegar 1 pound spinach or arugula, torn into bite-size pieces

Nutritional Facts:

Calories: 303 Fat: 7.6g Saturated Fat: 1.1g Cholesterol: 0mg Sodium: 363mg Carbohydrates: 55g Sugar: 13g Fiber: 11g Protein: 8g

Note for Physician: Patients with depression who take monoamine oxidase inhibitors (MAO inhibitors) should not use alcohol or other fermented products, such as the vinegar in this recipe. In this instance, substitute apple juice for the vinegar. MEDMONTHLY.COM |51

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PO Box 730 Fishers, IN 46038 (866)459-4579

58| NOVEMBER 2012

Applied Medical Services 4220 NC Hwy 55, Suite 130B Durham, NC 27713 (919)477-5152

Axiom Business Solutions

Find Urgent Care

PO Box 98313 Raleigh, NC 27624 (919)747-9031

3562 Habersham at Northlake, Bldg J Tucker, GA 30084 (866)473-0011

4704 E. Trindle Rd. Mechanicsburg, PA 17050 (866)517-0466

Frost Arnett 480 James Robertson Parkway Nashville, TN 37219 (800)264-7156

Gold Key Credit, Inc. PO Box 15670 Brooksville, FL 34604 888-717-9615

Horizon Billing Specialists 4635 44th St., Suite C150 Kentwood, MI 49512 (800)378-9991

Management Services On-Call 200 Timber Hill Place, Suite 221 Chapel Hill, NC 27514 (866)347-0001

Sweans Technologies 501 Silverside Rd. Wilmington, DE 19809 (302)351-3690

VIP Billing

PO Box 1350 Forney, TX 75126 (214)499-3440

CAREER CONSULTING SEAK Non-Clinical Careers Conference Oct. 21-22, 2012 in Chicago, IL (508)457-1111

Doctor’s Crossing 4107 Medical Parkway, Suite 104 Austin, Texas 78756 (512)517-8545

CODING SPECIALISTS The Coding Institute LLC 2222 Sedwick Drive Durham, NC 27713 (800)508-2582


Marina Medical Billing Service 18000 Studebaker Road 4th Floor Cerritos, CA 90703 (800)287-8166

American Medical Software



6451 Brentwood Stair Rd. Ft. Worth, TX 76112 (800)378-4134

Practice Velocity 1673 Belvidere Road Belvidere, IL 61008 (888)357-4209

1180 Illinois 157 Edwardsville, IL 62025 (618) 692-1300 300 N. Milwaukee Ave Vernon Hills, IL 60061 (866)782-4239

Instant Medical History

4840 Forest Drive #349 Columbia, SC 29206 (803)796-7980


DENTAL Biomet 3i

Manage My Practice

103 Carpenter Brook Dr. Cary, NC 27519 (919)370-0504

Medical Credentialing

(800) 4-THRIVE

Medical Practice Listings

8317 Six Forks Rd. Suite #205 Raleigh, NC 27624 (919)848-4202

24 Cherry Lane Doylestown, PA 18901 (888)348-1170

Physician Wellness Services 5000 West 36th Street, Suite 240 Minneapolis, MN 55416 888.892.3861

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

Dental Management Club

4924 Balboa Blvd #460 Encino, CA 91316

The Dental Box Company, Inc.

PO Box 101430 Pittsburgh, PA 15237 (412)364-8712

DIETICIAN Triangle Nutrition Therapy 6200 Falls of Neuse Road, Suite 200 Raleigh, NC 27609 (919)876-9779


DocuTAP 4701 W. Research Dr. #102 Sioux Falls, SD 57107-1312 (877)697-4696

Integritas, Inc. 2600 Garden Rd. #112 Monterey, CA 93940 (800)458-2486

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

Sigmon & Daknis Williamsburg, VA Office 325 McLaws Circle, Suite 2 Williamsburg, VA 23185 (757)258-1063


Synapse Medical Management

18436 Hawthorne Blvd. #201 Torrance, CA 90504 (310)895-7143

Urgent Care America

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

Urgent Care & Occupational Medicine Consultant Lawrence Earl, MD COO/CMO ASAP Urgentcare Medical Director, 908-635-4775 (m) 866-405-4770 (f )

Utilization Solutions (919) 289-9126

ABELSoft 1207 Delaware Ave. #433 Buffalo, NY 14209 (800)267-2235

Acentec, Inc 17815 Sky Park Circle , Suite J Irvine, CA 92614 (949)474-7774

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

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

Aquesta Insurance Services, Inc.

Michael W. Robertson 3807 Peachtree Avenue, #103 Wilmington, NC 28403 Work: (910) 794-6103 Cell: (910) 777-8918

Jones Insurance 820 Benson Rd. Garner, North Carolina 27529 (919) 772-0233

Medical Protective

5814 Reed Rd. Fort Wayne, In 46835 (800)463-3776 medical-protective

MGIS, Inc.

1849 W. North Temple Salt Lake City, UT 84116 (800)969-6447 MEDMONTHLY.COM |59

medical resource guide INSURANCE, MED. LIABILITY Professional Medical Insurance Services

16800 Greenspoint Park Drive Houston, TX 77060 (877)583-5510

Wood Insurance Group

4835 East Cactus Rd., #440 Scottsdale, AZ 85254-3544 (602)230-8200


Tarheel Physicians Supply

Barry Hanshaw 18 Bay Path Drive Boylston MA 01505 508 - 869 - 6038

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

Ako Jacintho


Julie Jennings



Physician Solutions

PO Box 98313 Raleigh, NC 27624 (919)845-0054

Laura Maask 262-308-1300

Marianne Mitchell (215)704-3188



PO Box 98313 Raleigh, NC 27624 (919)747-9031 WhiteCoat Designs Web, Print & Marketing Solutions for Doctors (919)714-9885

MEDICAL PRACTICE SALES Medical Practice Listings

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

MMA Medical Architects

520 Sutter Street San Francisco, CA 94115 (415) 346-9990

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

Nicholas Down

Martin Fried

60| NOVEMBER 2012


9975 Summers Ridge Road San Diego, CA 92121 (858)805-8378

Deborah Brenner

Pia De Girolamo

1295 Walt Whitman Road Melville, NY 11747 (888)862-4050

Biosite, Inc


ALLPRO Imaging

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


800 Shoreline, #900 Corpus Christi, TX 78401 (888)246-3928


Carolina Liquid Chemistries, Inc.

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

Dicom Solutions 548 Wald Irvine, CA 92618 (800)377-2617

Greenbranch Publishing 800-933-3711

medical resource guide



Arup Laboratories

500 Chipeta Way Salt Lake City, UT 84108 (800)242-2787

Chimerix, Inc. 2505 Meridian Parkway, Suite 340 Durham, NC 27713 (919) 806-1074

Mark MacKinnon, Regional Sales Manager 3801 Columbine Circle Charlotte, NC 28211 (704)995-9193


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

York Properties, Inc.

Sanofi US

55 Corporate Drive Bridgewater, NJ 08807 (800) 981-2491

Scynexis, Inc.

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

Headquarters & Property Management 1900 Cameron Street Raleigh, NC 27605 (919) 821-1350 Commercial Sales & Leasing (919) 821-7177


CNF Medical 1100 Patterson Avenue Winston Salem, NC 27101 (877)631-3077


Ethicon, Route 22 West Somerville, NJ 08876 (877)984-4266


1430 Decision St. Vista, CA 92081 (760)727-1280


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

SunTrust Mortgage, Inc.

Nicholas Lay, Senior Loan Officer 910.368.8080 Cell NMLSR# 659099

8319 Six Forks Rd, Suite 103 Raleigh, NC 27615 (919) 844-6601


Gebauer Company

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


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

Additional Staffing Group, Inc.



PO Box 98313 Raleigh, NC 27624 (919)747-9031

5825 Carnegie Boulevard Charlotte, NC 28209 (800)552-1157

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classified listings

Classified To place a classified ad, call 919.747.9031

Physicians needed

Physicians needed

North Carolina

North Carolina (cont.)

GP Needed Immediately On-Going 3 Days Per Week at Occupational Clinic General Practictioner needed on-going 3 days per week at occupational clinic in Greensboro, NC. Numerous available shifts for October. Averages 25 patients per day with no call and shift hours from 8:30 am to 5:30 pm. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email:

Immediate need for full time GP/FP for urgent cares in eastern NC Urgent care centers from Raleigh to the eastern coast of NC seek immediate primary care physician. Full time opportunity with possibility for permanent placement. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email:

3-5 days per week in Durham, NC Geriatric physician needed immediately 3-5 days per week, on-going at nursing home in Durham. Nursing home focuses on therapy and nursing after patients are released from the hospital. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: GP Needed Immediately On-Going 1-3 Days Per Week at Addictive Diease Clinics located in Charlotte, Hickory, Concord & Marion North Carolina General Practitioner with a knowledge or interest in addictive disease. Needed in October on-going 1-3 times per week. This clinic requires training so respond to post before October 1st. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: Primary Care Physician in Northwest NC (multiple locations) Primary care physician needed immediately for ongoing coverage at one of the largest substance abuse treatment facilities in NC. Doctor will be responsible for new patient evaluations and supportive aftercare. Counseling and therapy are combined with physician’s medical assessment and care for the treatment of adults, adolescents and families. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: Pediatrician or Family Medicine Doctor in Fayetteville Comfortable with seeing children. Need is immediate - Full time ongoing for maternity leave. 8 am - 5 pm. Outpatient only. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email:

General Practitioner Needed in Greensboro Occupational health care clinic seeks general practitioner for disability physicals ongoing 1-3 days a week. Adults only. 8 am-5 pm. No call required. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: Pediatrician or Family Physician Needed Immediately at clinic in Roanoke Rapids, NC Pediatric clinic in Roanoke Rapids, NC seeks Peds physician or FP comfortable with children for 2-3 months/ on-going/full-time. The chosen physician will need to be credentialed through the hospital, please email your CV, medical license and DEA so we can fill this position immediately. County Health Department in Fayetteville, NC seeks GP/IM/FP Full-Time, On-Going Shifts GP/IM/FP Needed Immediately at County Health Department in Fayetteville, NC. Approximately 20 patients per day with hours from 8 am -5 pm. Call or email for more information. 919-845-0054 Occupational Clinic in Greensboro, NC seeks FP/GP for On-Going Shifts Locum tenens position (4-5 days a week) available for an occupational, urgent care and walk in clinic. The practice is located in Greensboro NC. Hours are 8 am-5 pm. Approximately 20 patients/day. Excellent staff. Outpatient only.

continued on page 64 MEDMONTHLY.COM |63

classified listings


continued from page 63

To place a classified ad, call 919.747.9031

Physicians needed

Physicians needed

North Carolina (cont.)

Virginia (cont.)

Diabetic Clinic 1 hour from Charlotte seeks FP/GP/IM for On-Going Shifts Primary care physician needed immediately for outpatient diabetic clinic one hour outside Charlotte, NC On-going. Hours are 8 am -5 pm with no call. Approximately 15-20 patients a day.

Urgent Care opportunities throughout Virginia. We have contracts with numerous facilities and eight to 14-hour shifts are available. If you have experience treating patients from pediatrics to geriatrics, we welcome your inquires. Send copies of your CV, VA medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, E-mail:

Addictive Disease Clinic in Charlotte, NC and surrounding cities seeks GP/FP/IM for on-going shifts An addictive disease clinic with locations with locations in Charlotte, NC and surrounding cities seeks a GP with an interest in addictive medicine for on-going shifts. This clinic has 15-25 open shifts every month and we are looking to bring on a new doctor for consistent coverage. The average daily patient load is between 20 and 25 with shifts from 8 am - 5 pm and 6 am - 2 pm. If you are interested in this position please send us your CV and feel free to contact us via email or phone with questions or to learn about other positions. Child Health Clinic in Statesville, NC seeks pediatrician or Family Physician comfortable with peds for on-going, full-time shifts. Physician will work M-F 8 am - 5 pm, ongoing. Qualified physician will know EMR or Allscripts software. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email:

Virginia Pediatric Locums Physician needed in Harrisonburg, Danville and Lynchburg, VA. These locum positions require 30 to 40 hours per week, on-going. If you are seeking a beautiful climate and flexibility with your schedule, please consider one of these opportunities. Send copies of your CV, VA. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email:

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

Practice for sale North Carolina Family Practice located in Hickory, NC. Well-established and a solid 40 to 55 patients split between an MD and physician assistant. Experienced staff and outstanding medical equipment. Gross revenues average $1,500,000 with strong profits. Monthly practice rent is only $3,000 and the utilities are very reasonable. The practice with all equipment, charts and good will are priced at $625,000. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or email: continued on page 68

64| NOVEMBER 2012

Woman’s Practice in Raleigh, North Carolina.

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

We have a established woman’s practice in the Raleigh North Carolina area that is available for purchase. Grossing a consistent $800,000.00 per year, the retained earnings are impressive to say the least. This is a two provider practice that see patients Monday through Friday from 8 till 6. This free standing practice is very visible and located in the heart of medical community. There are 7 well appointed exam rooms, recently upgraded computer (EMR), the carpet and paint have always been maintained. The all brick building can be leased or purchased.

Contact Cara or Philip for details regarding this very successful practice. Medical Practice Listings; 919-848-4202

The owning physician is willing to continue with the practice for a reasonable time to assist with smooth ownership transfer. The patient load is 35 to 40 patients per day, however, that could double with a second provider.  Exceptional cash flow and profit will surprise even the most optimistic practice seeker.  This is a remarkable opportunity to purchase a well-established woman’s practice.  Spacious practice with several well-appointed exam rooms and beautifully decorated throughout.  New computers and medical management software add to this modern front desk environment.    List price: $435,000

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


NC MedSpa For Sale MedSpa Located in North Carolina

Med Monthly Med Monthly is the premier health care magazine for medical professionals.

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.

By placing an ad in Med Monthly you’ll reach: family medicine, internal medicine, physician assistants and more!

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Contact Medical Practice Listings today to discuss the practice details.

For more information call Medical Practice Listings at 919-848-4202 or e-mail

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classified listings


continued from page 64

To place a classified ad, call 919.747.9031

Practice for sale

Practice for sale

North Carolina (con’t)

North Carolina (con't)

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

decorated and well appointed with vibrant art work. The practice, patient charts, equipment and good will is being offered for $415,000 while the free standing building is being offered for $635,000. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or email:

Modern Vein Care Practice located in the mountains of NC. Booking seven to 10 procedures per day, you will find this impressive vein practice attractive in many ways. Housed in the same practice building with an internal medicine, you will enjoy the referrals from this as well as other primary care and specialties in the community. We have this practice listed for $295,000 which includes charts, equipment and good will. Contact Medical Practice Listings at (919) 848-4202 for more information. View additional listings at Primary Care Practice specializing in women’s care. The owning female physician is willing to continue with the practice for a reasonable time to assist with smooth ownership transfer. The patient load is 35 to 40 patients per day, however that could double with a second provider.  Exceptional cash flow and profitable practice that will surprise even the most optimistic practice seeker. This is a remarkable opportunity to purchase a well-established woman’s practice. Spacious practice with several wellappointed exam rooms throughout. New computers and medical management software add to this modern front desk environment. This practice is being offered for $435,000. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or send an email to Internal Medicine Practice located just outside Fayetteville, NC is now being offered. The owning physician is retiring and is willing to continue working for the new owner for a month or two assisting with a smooth transaction. The practice treats patients four and a half days per week with no call or hospital rounds. The schedule accommodates 35 patients per day. You will be hard pressed to find a more beautiful practice that is modern, tastefully

68| NOVEMBER 2012

South Carolina Lucrative ENT Practice with room for growth, located three miles from the beach. Physician’s assistant, audiologist, esthetician and well-trained staff. Electronic medical records, mirror imaging system, established patient and referral base, hearing aids and balance testing, esthetic services and Candela laser. All aspects of otolaryngology, busy skin cancer practice, established referral base for reconstructive eyelid surgery, Botox and facial fillers. All new surgical equipment, image-guidance sinus surgery, balloon sinuplasty, nerve monitor for ear/parotid/thyroid surgery. Room for establishing allergy, cosmetics, laryngology and trans-nasal esophagoscopy. All the organization is done; walk into a ready-made practice as your own boss and make the changes you want, when you want. Physician will to stay on for a smooth transition. Hospital support is also an option for up to a year. The listing price is $395,000 for the practice, charts, equipment and good will. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or email:

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

Unfortunately, its motor is inside playing video games. Kids spend several hours a day playing video games and less than 15 minutes in P.E. Most can’t do two push-ups. Many are obese, and nearly half exhibit risk factors of heart disease. The American Council on Exercise and major medical organizations consider this situation a national health risk. Continuing budget cutbacks have forced many schools to drop P.E.—in fact, 49 states no longer even require it daily. You can help. Dust off that bike. Get out the skates. Swim with your kids. Play catch. Show them exercise is fun and promotes a long, healthy life. And call ACE. Find out more on how you can get these young engines fired up. Then maybe the video games will get dusty. A Public Service Message brought to you by the American Council on Exercise, a not-for-profit organization committed to the promotion of safe and effective exercise

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ACE Certified: The Mark of Quality Look for the ACE symbol of excellence in fitness training and education. For more information, visit our website:



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8 2 5 - 3 6 3 6


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A M E R I C A’ S A U T H O R I T Y O N F I T N E S S



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

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

Visit us today at to learn more.

919.848.4202 |

Comprehensive Ophthalmic and Neuro-Ophthalmic Neuro-Ophthalmic Practice Raleigh North Carolina This is a great opportunity to purchase an established ophthalmic practice in the heart of Raleigh. Locate on a major road with established clients and plenty of room for growth; you will appreciate the upside this practice offers. This practice performs comprehensive ophthalmic and neuro-ophthalmic exams with diagnosis and treatment of eye disease of all ages. Surgical procedures include no stitch cataract surgery, laser treatment for glaucoma and diabetic eye disease. This practice offers state-of-the-art equipment and offer you the finest quality optical products with contact lens fitting and follow-up care & frames for all ages. List Price: $75,000 | Gross Yearly Income: $310,000

Contact Cara or Philip 919-848-4202 for more information or visit

Hospice Practice Wanted

Adult & pediAtric integrAtive medicine prActice for sAle

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

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:

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

• •

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

• • •

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

• • • • • •

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

There is a Compounding Pharmacy located in the same suites with a consulting pharmacist working with this Integrative practice. Average Patients per Day: 12-20 Gross Yearly Income: $335,000+ | List Price: $125,000

Call 919-848-4202 or email MEDMONTHLY.COM |71



Physician Solutions has immediate opportunities for psychiatrists throughout NC. Top wages, professional liability insurance and accommodations provided.

By placing a professional ad in Med Monthly, you're spending smart money and directing your marketing efforts toward qualified clients.

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

Contact one of our advertising agents and find out how inexpensive yet powerful your ad in Med Monthly can be.

For more information about Physician Solutions or to see all of our locums and permanent listings, please visit | 919.747.9031

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: 72| NOVEMBER 2012

Woman's Practice A vailable for Sale Available for purchase is a beautiful boutique women’s Internal Medicine and Primary Care practice located in the Raleigh area of North Carolina. The physician owner has truly found a niche specializing in women’s care. Enhanced with female-related outpatient procedures, the average patient per day is 40+. The owner of the practice is an Internal Medicine MD with a Nurse Practitioner working in the practice full time. Modern exam tables, instruments and medical furniture. Gross Yearly Income: $585,000 | List Price: $365,000

Call 919-848-4202 or email

Primary Care Practice For Sale 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 |

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

Medical Practice Listings Buying and selling made easy

Call 919-848-4202 or e-mail




or family medicine doctor needed in

Greensboro, North Carolina


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

Comfortable seeing children. Needed immediately.

Asking price: $385,000

To view more listings visit us online at

Call 919- 845-0054 or email:

Internal Medicine Practice for Sale Located in the heart of the medical community in Cary, North Carolina, this Internal Medicine practice is accepting most private and government insurance payments. The average patients per day is 20-25+, and the gross yearly income is $555,000. Listing Price: $430,000

Practice for Sale in South Denver Neurofeedback and Psychological Practice Located in South Denver, Colorado, this practice features high patient volume and high visibility on the internet. Established referral sources, owner (psychologist) has excellent reputation based on 30 years experience in Denver. Private pay and insurances, high-density traffic, beautifully decorated and furnished offices, 378 active and inactive clients, corporate clients, $14,000 physical assets, good parking, near bus and rapid transit housed in a well-maintained medical building. Live and work in one of the most healthy cities in the U.S. List Price: $150,000 | Established: 2007 | Location: Colorado

Call 919-848-4202 or email

For more information contact Dr. Jack McInroy at 303-929-2598 or


Primary Care Practice for Sale


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.

Hickory, North Carolina Established primary care practice in the beautiful foothills of North Carolina The owning physician is retiring, creating an excellent opportunity for a progressive buyer. There are two full-time physician assistants that see the majority of the patients which averages between 45 to 65 per day. There is lots of room to grow this already solid practice that has a yearly gross of $1,500,00. You will be impressed with this modern and highly visible practice. Call for pricing and details.

Call 919- 845-0054 or email:

Call Medical Practice Listings at (919) 848-4202 for details and to view our other listings vist

FAMILY PRACTICE FOR SALE A beautiful practice located in Seattle, Washington This upscale primary care practice has a boutique look and feel while realizing consistent revenues and patient flow. You will be impressed with the well appointed layout, functionality as well as the organization of this true gem of a practice. Currently accepting over 20 insurance carriers including Aetna, Blue Cross and Blue Shield, Cigna, City of Seattle, Great West and United Healthcare. The astute physician considering this practice will be impressed with the comprehensive collection of computers, office furniture and medical equipment such as Welch Allyn Otoscope, Ritter Autoclave, Spirometer and Moore Medical Exam table. Physician compensation is consistently in the $200,000 range with upside as you wish. Do not procrastinate; this practice will not be available for long. List price: $255,000 | Year Established: 2007 | Gross Yearly Income: $380,000

Medical Practice Listings Selling and buying made easy | | 919.848.4202 76| NOVEMBER 2012

MODERN MED SPA AVAILABLE Located in beautiful coastal North Carolina

Modern, well-appointed med spa is available in a picturesque part of the state. This practice is positioned in a highly traveled area with positive demographics adding to the business appeal and revenue stream. A sampling of the services and procedures offered are: BOTOX, facial therapy and treatments, laser hair removal, eye lash extensions and body waxing as well as a menu of anti-aging options. If you are currently a med spa owner and looking to expand or considering this high profile med business, this is the perfect opportunity. Highly profitable and organized, you will find this spa poised for success. The qualified buyer can obtain detailed information by contacting Medical Practice Listings at 919-848-4202. | | 919.848.4202

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

of the oldest Locums companies l Large client list l Dozens of MDs under contract l Executive office setting l Modern computers and equipment l Revenue over a million per year l Retiring owner l List price is over $2 million

Please direct all correspondence to Only serious, qualified inquirers.

Pediatrics Practice Wanted Pediatrics practice wanted in NC Considering your options regarding your pediatric practice? We can help. Medical Practice Listings has a well qualified buyer for a pediatric practice anywhere in central North Carolina. Contact us today to discuss your options confidentially. Medical Practice Listings Call 919-848-4202 or e-mail MEDMONTHLY.COM |77

the top These are all misconceptions commonly heard by doctors and it puts an end to them once and for all – or at least we hope it does! We're sure you have your own favorite myths.



Most of us probably know at least one person who claims to be walking around with a contact lens stuck permanently behind their eye. The good news is that it is impossible for a contact lens to get stuck there, because there is no cavity behind the eye. So if you think you have lost your lens – the most likely places to find it are either tucked into a ball in your eyelid or on the bathroom floor where you tried to remove it!






Rumor has it that you can catch the flu from a flu shot. Well – rumor be damned – you can’t. Flu shots are made of viruses that has been deactivated or killed. Despite the virus not being alive, your body is still able to recognize it for what it is and try to do something about it.


Pulp Fiction, an entertaining film, perpetuates an untruth that you can inject a person directly into the heart in order to provide them with drugs as quickly as possible. Regrettably this is entirely false. Doctors never, ever inject a person directly into the heart – adrenaline is delivered in the case of heart attack, but it is delivered directly to a vein. Also, adrenaline is not used to treat a heroine overdose, as in the film, narcan is.



The myth goes like this: the older you are, the less sleep you need. But it is just that – a myth. In fact, the rate of sleep needed is fairly constant throughout our adult life, but once we get over the age of sixty-five we need a little extra sleep. The most likely reason for this myth is that old people can have more difficulty getting to sleep and this reduces the overall quantity taken.

78 | NOVEMBER 2012




Many are the number of kids berated everyday with the warnings against eating too much chocolate or greasy food with “you will get acne!” In fact, there have been very carefully done scientific studies that show an extremely low probability of acne being caused by either of these things. But don’t forget: too much of either will make you fat.



This is a myth that at least has some basis in real observations. The belief that the heart stops when you sneeze is false, but the reason that this myth has come about is that in some cases a sneeze can cause a slightly erratic heartbeat. This is merely due to a change in pressure inside the chest.



It's very probable that everyone reading this list has, at least once in their life, cut their finger and stuck it straight in their mouth. This is bad because the mouth is full of bacteria. Sticking one’s finger in one’s mouth after cutting it is an open invitation to infection.




Again we have the movies to blame for this one. Falling asleep after getting a concussion is not life-threatening, and you don’t need to slap your children repeatedly in the face to keep them awake if they knock their head. Concussion almost never leads to a coma. If you or someone you know does have a severe knock to the head, take them to the doctor so they can be sure that everything is okay.


If you have ever had a cold-sore you know how agonizing they can be and they are extremely contagious. But unlike cold-sores, mouth ulcers are not contagious though many people wrongly think they are. The cause of mouth ulcers is likely caused by disturbances in the immune system – but viruses and bacteria have been ruled out.

Read more at: MEDMONTHLY.COM | 79

Physician Solutions MD STAFFING Locum tenens Nurses Front Desk and Office Staff Permanent placement When someone in your practice can’t work tomorrow, make us your Plan B With an extensive network of health care providers and over 20 years of experience in physician staffing, Physician Solutions is a leader in the industry. We specialize in primary care and place doctors, nurses and office staff, including front desk and billing, in family practices, urgent cares, internal medicine, pediatrics offices and occupational health facilities.

We’ve got you covered!

Short-term or long-term, Physician Solutions has you covered 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:

Med Monthly November 2012  
Med Monthly November 2012  

The health care reform issue of Med Monthly magazine.