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Med Monthly SEPTEMBER 2013



Magic of s Referral


Growing Your Practice through a Physician Liaison Program pg. 44

Managing Referrals in an Accountable Care System pg. 50

Physician to Physician Referrals:

The Correct Communication Can Make It Super pg. 46




insight 10 DEATH & DYING: Unlearning What You Learned in Medical School 14 TIME IS RUNNING OUT! 16 WHY PHYSICIANS PREFER YOUTUBE FOR NETWORKING





practice tips










in every issue 4 editor’s letter 8 news briefs

62 resource guide 82 top 9 list


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editor’s letter

Med Monthly’s September edition focuses on one of the top ways a practice can increase its revenues: referrals. Networking can be an excellent way to grow your business. What it takes is communication and follow-through, as well as the right choice of physicians to build relationships with. A solid referral system can only be effective if you choose the right specialist. The physicians you select will be a reflection of you and your practice. Not only will they need to have the same medical goals in mind, the staff must take on the responsibility of sharing charts and making sure future appointments are scheduled. Philip Driver, CEO of Physician Solutions, outlines the key factors in his article “Setting up a Referral Network for your Practice”. Lisa Shock, in her feature “Managing Referrals in an Accountable Care System” takes on the same idea as Mr. Driver, but applies it to community health centers – those practices that need to coordinate care for patients who are at high risk. Due to the shortage of primary care doctors, the specialists rely more on the proper screening of the patient and the timeliness of sending over their information to manage both the quality of the care as well as cost efficiency. Finally in Amanda Kanaan takes the idea of referral management one step further in “Growing Your Practice through a Physician Liaison Program”. She suggests hiring a marketer to focus solely on advancing your presence in the medical community. A liaison should work to secure new business and improve relationships with the practices that are already within your referral system. If hiring a full time person seems unrealistic, a marketing consultant might make more sense. Next month goes behind the scenes to take a closer look at medical research. What are the latest breakthroughs in medicine and what lies ahead? Med Monthly’s October issue will be one you’ll want to investigate.

Ashley Austin Managing Editor

4 | SEPTEMBER 2013

Med Monthly September 2013 Publisher Philip Driver Managing Editor Ashley Austin Creative Director Thomas Hibbard Staff Writer and Journalist Ashley Warburton Staff Illustrator, Writer and Journalist Laura Maaske Contributors Ashley Acornley, MS, RD, LDN Karen Albright John Ash Jim Bisco Patrick J. Cannon, Esq Theresa C. Carnegie Philip Driver Liz Ferron, MSW, LICSW Joe Gupton, CWCS Amanda Kanaan Karen S. Lovitch Timothy C. McDonald, Esq. Paul W. Radensky, M.D. Lisa Shock Christine Park Song Denise Price Thomas Beverly Thurmond, D.D.S. John Warren Darren Witmer 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 Karen Albright owns and operates BodyLase Skin Spa, an award-winning medical spa that has been serving the Research Triangle area of North Carolina for over 11 years, with her husband, Daniel Albright, MD a board-certified surgeon. She is also the CEO of Medspa Consulting Group, a consulting business dedicated to ensuring the success of physicians starting or expanding new medical spas.

Liz Ferron, MSW, LICSW is a Senior Consultant and Manager of Clinical Services with Workplace Behavioral Solutions, Inc. and its Midwest EAP Solutions and Physician Wellness Services divisions. She has been with the company for over 10 years, and has been in the employee assistance field for over 20 years. She has served three terms as President of the Minnesota Employee Assistance Program Administrators and Counselors (MEAPAC), and is a former adjunct faculty member at the College of St. Benedict. Liz has her MSW degree from the University of Minnesota and is a Licensed Independent Clinical Social Worker.

Denise Price Thomas retired in 2009 as a surgical practice administrator where she was employed for 32 years. She is certified in healthcare management through Pfeiffer College. Speaking invitations have taken her from NC to SC, Georgia, Florida, Chicago, Alaska and more. Website: www.

Beverly Thurmond, D.S.S. graduated with honors from The University of Texas Health Science Center at Houston Dental Branch, earning her D.D.S. degree and completed her residency program in hospital dentistry at the University of Washington in Seattle. She practiced dentistry in New Mexico for thirteen years and has now relocated to North Carolina. She is an active member in the Wake County Dental society, North Carolina Dental Society, American Dental Society and the Academy of General Dentistry.


designer's thoughts From the Drawing Board Author, Douglas B. Reeves, states “Sustainable change, after all, depends not upon compliance with external mandates or blind adherence to regulation, but rather upon the pursuit of the greater good.” The medical profession is facing many new regulations in the near future and recent advances in technology and health care studies are being developed to assure these changes are for the ‘greater good’. In the “Research and Technology” section of this month’s magazine, the article “FrontRange Announces Breakthrough Electronic Medical Record Change Management Solution”, the hybrid IT software company FrontRange announced its HEAT Electronic Medical Record (EMR) Change Management software, enabling health care organizations to fully automate and meet demanding regulatory compliance requirements set by the HITECH Act of 2009. It’s available as cloud-based, on-premise, or hybrid platforms reducing the complexity of deployment. In “News Briefs”, the National Institute of Health (NIH) reports on a study it conducted indicating treatment for alcohol dependence works better in individuals who possess specific combinations of genes that regulate the function and binding of serotonin, a brain chemical affected by the treatment. The genetic makeup of a person will help determine the optimum treatment to the ‘right’ patient. “Netsmart Launches Innovative Solution to Facilitate Integrated Behavioral and Physical Healthcare” describes the launch of the Netsmart Primary Care Module, which unites behavioral health with primary care services in a team-based, integrated model of care that enables providers to effectively treat the “whole person.” Providers in behavioral health, addiction services, social services and public health can share authorized clinical data with a person’s primary care provider, and vice versa, in a single, integrated care record. Technology is a reality and is always moving quickly forward, especially in the medical arena. Med Monthly will continue in its endeavors to report on the latest medical research and technology. If there are topics or insights on advances in medical technology you would like to share with us for future issues, please contact us at

Thomas Hibbard Creative Director

6 | SEPTEMBER 2013

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Gene Combinations Help Predict Treatment Success for Alcoholism Medication

On the 48th anniversary of the signing of Medicare and Medicaid into law, the Department of Health and Human Services (HHS) released data showing that the average premium for a basic prescription drug plan in 2014 is projected to remain stable, at an estimated $31 per month. This news comes as seniors and people with disabilities continue to save money on out of pocket drug costs. Yesterday, HHS announced that more than 6.6 million people with Medicare have saved over $7 billion on prescription drugs as a result of the Affordable Care Act, an average of $1,061 per beneficiary. The Affordable Care Act closes the donut hole over time. “Seniors are benefiting from improved benefits and low premiums, thanks to a competitive and transparent marketplace for Medicare drug plans,” said HHS Secretary Kathleen Sebelius. For the fourth straight year, the average Medicare Part D monthly premium will remain steady, and is projected to be $31. For the last three years – for plan years 2011, 2012, and 2013 – the average premium was projected to be $30. Today’s projection for the average premium for 2014 is based on bids submitted by drug and health plans for basic drug coverage during the 2014 benefit year, and calculated by the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary. CMS has already announced that key parameters for Part D will actually be lower in 2014 than in 2013. For example, the Part D deductible will fall from $325 to $310, producing additional savings for enrollees. The upcoming annual open enrollment period - which begins October 15 and ends December 7 - allows people with Medicare, working with their families and their caregivers, to choose their plans for next year by comparing their current coverage and quality ratings to other plan offerings. New benefit choices are effective Jan. 1, 2014. To learn more about the Affordable Care Act, go to 

An experimental treatment for alcohol dependence works better in individuals who possess specific combinations of genes that regulate the function and binding of serotonin, a brain chemical affected by the treatment, according to a study supported by the National Institutes of Health. A report of the finding appears online in the American Journal of Psychiatry. “This study is another important step toward personalized treatments for alcohol dependence,” says Kenneth R. Warren, Ph.D., acting director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), which funded the study. “A personalized approach based on a person’s genetic makeup is increasingly being investigated for delivering optimum treatment to the ‘right’ patient.” Ondansetron is a medication currently used to treat nausea and vomiting, often following chemotherapy. It works by blocking serotonin-3 receptors, and has shown potential as a treatment for defined subpopulations with alcohol dependence. In previous studies, Professor Bankole Johnson, D.Sc., M.D., and his team at the University of Virginia, Charlottesville, have shown that variations in genes that encode the serotonin transporter, a protein that regulates the concentration of serotonin between nerve cells, can significantly influence drinking intensity. They have also shown that the effectiveness of ondansetron therapy among people with alcohol dependence is influenced by variations of the serotonin transporter gene. In the current study, Professor Johnson and his colleagues extended their prior work by analyzing variants of serotonin receptor genes, collectively designated as HTR3, among nearly 300 alcohol-dependent individuals who were participating in a clinical trial of ondansetron. They found that three HTR3 variants were significantly associated with the effectiveness of ondansetron treatment for alcohol dependence. “Taken together, these studies implicate a collective effect of serotonin receptor and transporter gene combinations, defined by a five-marker genotype panel, on the response to treatment with ondansetron for a genetically defined subpopulation of individuals with alcohol dependence,” says Professor Johnson. “Multi-site, larger studies are about to begin to progress this work.” Additional alcohol research information and publications are available at 

Source: medicare-drug-premiums-remain-stablefour-years-row

Source: niaaa-02.htm

8 | SEPTEMBER 2013

Obama Administration Launches One-Stop-Shop Website to Educate Business Owners About the Affordable Care Act The Obama Administration today launched Business., a one-stop-shop Website which will provide employers of all sizes educational materials on how the Affordable Care Act may affect businesses and help them compete. The site includes a wizard tool that is tailored based on size and location, so businesses can learn how the law helps them provide affordable coverage options to their employees while still meeting their bottom line. The site will act as a user-friendly hub that connects employers to informational content on tax credits and other provisions of the law from the Small Business Administration, the Department of Health and Human Services (HHS), and the Treasury Department. As part of the Administration’s ongoing dialogue with leaders of our nation’s top businesses, this latest tool will help ensure that employers of all sizes know what the Affordable Care Act means for them, and have the information they need to take advantage of the new benefits and opportunities under the law. The Administration will work with the employer community to ensure the site continues to be a helpful resource for businesses and their employees, including updating the site with additional, timely information. “As the Affordable Care Act is implemented, it is so important for us to work with the business community and provide employers with the information they need,” said U.S. Commerce Secretary Penny Pritzker. “The health care website on will be a tremendous resource for self-employed Americans and businesses of all sizes to learn what the Affordable Care Act means for them.” “The Affordable Care Act helps level the playing field for small businesses, expanding their bargaining power and their ability to offer the kind of valuable benefit packages that attract and retain top-quality workers. Small businesses are a cornerstone of our economy and we are committed to working with them to raise awareness and access to the historic tax credits that can help small businesses and employees cover the cost of health care,” said Treasury Secretary Jacob J. Lew. “It’s important for small business owners to know the facts about the Affordable Care Act and healthcare delivers resources and need-to-know information through one streamlined tool,” said SBA Administrator Karen Mills. “This Website will prove to be an invaluable resource for small employers to learn how the law is ushering in better options for them and their employees.” “The Affordable Care Act is providing better care and better choices for millions of Americans, and this is an-

other great tool for employers to learn how they can offer health coverage that makes sense for their business and employees, and works for their bottom line,” said HHS Secretary Kathleen Sebelius. Many parts of the Affordable Care Act, which was signed into law in March, 2010, are already in effect, including new consumer protections, and improvements to health care coverage that ensure consumers get more value for their premium dollars. Additional benefits will take effect in late 2013 and beyond. Starting October 1, 2013, individuals, including those who are self-employed, and small businesses looking for a better plan, will have a new way to shop for private health insurance through the Health Insurance Marketplace and the Small Business Health Options Program (SHOP) found at Individuals may be eligible for lower costs on their monthly premiums and self-employed individuals and small businesses may be eligible for tax credits to help with the costs of coverage. President Obama issued a challenge to government agencies to think beyond their organizational boundaries in the best interest of serving America’s business community, and start thinking and acting more like the businesses they serve. He directed the creation of, a centralized platform to make it easier than ever for businesses to access services to help them grow and hire. leverages the resources of our partners across the federal government to ensure that business owners get comprehensive information and easy-to-use tools related to range of topics, including health care. To learn more, please visit  Source:


coming In the up e, Med 2013 issu October l be theme wil ’s ly th n o M Research Medical



DEATH & DYING: Unlearning What You Learned In Medical School

By Liz Ferron, MSW, LICSW Physician Wellness Services

10 | SEPTEMBER 2013


ealing with death and dying—it’s among the most stressful experiences most humans encounter, but one would never know it from the demeanor of some of the physicians treating them. One of the first lessons taught in medical school is not to care too much. Emotionalism is viewed as unprofessional and thought to interfere with patient care. While that may be changing in some schools, for most physicians currently in practice, this is still the norm. To master this unstated curriculum, medical students have historically developed an emotional armor that both shielded them from feeling too much and disguised any depth of any emotion they experienced. Dark humor is an antidote many medical students use to overcome their revulsion at dissecting cadavers—ghoulish anecdotes surrounding pranks with corpses are common grist of the medical school humor mill. Referring to patients by their condition—the “gallbladder in room 4”—rather than by their names is another way physicians maintain emotional distance. By the time they graduate from medical school, physicians have gained experience with death and dying patients. Studies show that they are far less apprehensive about communicating with dying patients and their families than first year students, but their degree of empathy has dropped. Given the extent to which physicians are trained to repress emotion, it’s not surprising that they’re reluctant to admit they’re having strong feelings about a dire prognosis or patient death. Indeed, a recent qualitative study on the impact of grief and loss on oncologists found that by far, the most common impact—and coping strategy—was “compartmentalization” with over half also reporting feelings of burnout and emotional exhaustion as an impact. Many also noted a spillover of grief into their personal lives.


“We have found that physicians often underestimate the toll that the death and dying of their patients takes on their emotional health and wellbeing.” continued on page 12 MEDMONTHLY.COM |11

continued from page 11


How Physician Empathy Affects Patient Care While a certain amount of emotional detachment is necessary, how much is too much? Studies conducted over the past 20 years suggest that the emotional detachment that physicians work so hard to develop isn’t necessarily helping patient care and outcomes: • Numerous studies suggest that patients who perceive their doctors as emotionally distant when giving a cancer diagnosis are less apt to adhere to their treatment plans and seek subsequent care. • In a 3‐year study of 891 diabetic patients, patients whose physicians had high scores on the empathy scale were significantly more likely to have good control of hemoglobin A1c (56%) than were patients of physicians with low empathy scores (40%). • In a 2010 study, when patients perceived their clinicians as empathetic, the severity, duration and objective measures of the common cold significantly changed. • In the 2012 study on oncologists referenced earlier, physicians reported distraction, distancing or withdrawing as patients are closer to death, as well as impacts on treatment decisions What about the health and wellbeing of the physician? Are caring and empathetic doctors at a higher risk for burnout and “compassion overload?” The research suggests not: • In a recent study of palliative and hospice‐care clinicians, frequent exposure to death and dying was largely a positive experience that added meaning to their lives. • In a 2009 study, participation in a mindful communication program was associated with short term and sustained improvements in well being and attitudes associated with patient‐centered care. • A 1995 study found that oncologists who expressed an inability to communicate with patients had greater stress and more symptoms of burnout. • In the oncologist study, positive impacts included a motivation to improve patient care, and gaining a greater perspective on life and what is important. We have found that physicians often underestimate the toll that the death and dying of their patients takes on their emotional health and wellbeing. Just because they often say they “don’t have time” to think about their emotions doesn’t mean they aren’t experiencing them. 12| SEPTEMBER 2013


In many instances, it’s not only the intensity of the emotions that he or she is experiencing that upsets a physician, it’s also the nature of the emotions that disturbs them. In addition to sadness over the loss of a patient, most doctors feel a wide mix of emotions, including anger and guilt. It’s not unusual for them to lose confidence, blame the patient, worry that they did something wrong, or worry about getting blamed for something they couldn’t have prevented. Even though those reactions are quite commonplace, it’s also quite normal for physicians to think they’re “the only ones” that ever experienced them. Physicians are typically somewhat competitive with their colleagues and concerned about appearing less than competent. It’s not unusual for them to isolate and suffer in silence.


Improving Communication and Empathy Skills Few physicians are entirely comfortable with delivering bad news to patients or dealing with the emotional aftermath. Given how hard they’ve worked to repress their own emotions, it’s often very difficult for them to communicate with patients and family members who are in emotional distress. The most important step physicians can take is to allow themselves to experience the emotions of grief. This can be accomplished in several ways, including: • Approaching the subject of patient loss with a trusted colleague or physician peer coach • Participating in a spiritual retreat • Putting thoughts and feelings into writing, such as through journaling Some studies suggest that physicians who have undergone communication training are perceived as more empathetic by their patients. One interpretation of those findings is that, in order to improve their communications skills, physicians often become more aware their own feelings as they learn to watch for and understand emotional cues given by their patients. Unfortunately, given the demands of their jobs, attending communication workshops isn’t a top priority for most physicians. The good news is that communication and empathy are skills that can be built—on the job—with coaching and commitment. It can be helpful to “rehearse” how they’ll approach delivering a bad diagnosis with an objective listener. In

other instances, physicians may find a debriefing after the death of some patients with other members of the care team, or with a peer coach, to be helpful to access and work through emotions. This may be especially helpful after the loss of some patients, such as children or young people, or those who have had especially valiant struggles, and to whom the physician and other members of the team become especially attached to or affected by during their course of treatment.. Another good way to prepare for difficult conversations is for physicians to take better care of themselves. In a 2005 study from Mayo Clinic, residents who had a greater sense of wellbeing received higher empathy ratings from patients. Over time, most physicians find that a relatively small investment of time spent improving the way they communicate with their patients and co‐workers can make their work significantly more rewarding. If it also helps them confront and deal with feelings of grief and loss more effectively, the benefits to themselves and their patients can make it an even more worthwhile investment.  References: Granek, L, Tozer, R, Mazzotta, P, Ramjaun, A, Krzyzanowska, M. “Nature and Impact of Grief Over Patient Loss on Oncologists’ Personal and Professional Lives,” Archives of Internal Medicine (2012). Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C, Gonella JS. “Physicians’ empathy and clinical outcomes for diabetic patients,” Journal of Academic Medicine (2011). Kasket, E. “Death and the doctor,” Journal of the Society for Existential Analysis (2006).

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Krasner, MS, Epstein, RM, Beckman, H, et al. “Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians,” JAMA (2009). Ramirez AJ, Graham J, Richard MA, et al. “Burnout and psychiatric disorder among cancer clinicians,” British Journal of Cancer (1995). Rakel, D, Barrett, B, Zhang, Z, Hoeth, T, Chewning, B, Marchand, L, Scheder, J. “Perception of empathy in the therapeutic encounter: Effects on the common cold,” Journal of Patient Education and Counseling (2011). Shanafelt TD, West C, Zhao X, Novotony P, Kolars J, Habermann TM, Sloan JA. “Relationship between increased personal well‐being and enhanced empathy among internal medicine residents.” Journal of General Internal Medicine (2005). Sinclair, S. “Impact of death and dying on the personal lives and practices of palliative and hospice care professionals,” CMAJ, (2011).

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Major Insurance Companies Committed to Participate in State and Federal Marketplaces/Exchanges in Accordance With ACA Deadline By Joe Gupton, CWCS, EmployeeSync Specialist, Jones Insurance

Beginning October 1st of this year individuals will be able to apply for health insurance through the exchanges.

14| SEPTEMBER 2013


any employers are breathing a sigh of relief after the July 5th announcement of a delay in enforcing parts of the Affordable Care Act. They feel that a bullet has been dodged. However, there has not been any significant change in what individuals and businesses must do to comply with the rules of “Obamacare”. The individual mandate that continues to drive the ACA legislation was upheld by the Supreme Court in 2012; that means it’s here to stay. January 1st, 2014, is still a very important deadline for everyone. That is when the requirement for every individual to purchase health insurance goes into effect. The state and federal marketplaces/ exchanges have already been established and most major insurance companies have committed to participate. Beginning October 1st of this year individuals will be able to apply for health insurance through the exchanges. Tax subsidies based on income may allow some individuals and families to find more affordable health insurance, but others will see significant rate increases in their personal policies. Employers of all sizes will be required to distribute a notice to their employees explaining the obligation of each individual to purchase health insurance. This must go to employees by October 1, 2013. The notice will certainly generate questions and concerns as it states “you may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn’t meet certain standards”. Employers who offer health plans will be required to complete an “Employer Coverage Tool” in which the employer must disclose whether his group health insurance plan is “adequate” and “affordable”. The challenge for businesses to comply with the new law is only just beginning. Preparation and planning is still crucial because we know that there are other bullets coming in 2015. The coming year will be a chance for many employers to catch up on what they should have done in the past six months. Business owners should consult their benefit advisors to develop their individualized plan for compliance. 

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Why Physicians Prefer YouTube for Networking

By Ashley Warburton, Staff Writer and Journalist, Med Monthly

The saying “It is not what you know but who you know” may best describe the present day networking scene with any profession. Nowadays, when we need information on a certain topic, especially medical expertise, we head straight to the internet and start our search. This is where millions of patients and medical professionals seek out medical expertise every day. Physicians in particular have taken a new approach in networking with social media. While the plain old asking doctors directly may work for some, there are other ways to generate a physician’s interest in your expertise. With social media reaching the entire medical community across the globe, it has never been easier for 16 | SEPTEMBER 2013

physicians to network with existing or potential patients and colleagues. Facebook is still rated the most popular approach among networking research, followed by YouTube and then LinkedIn. A survey of 2,790 health care professionals by AMN Healthcare, a health care work force management and staffing agency, found that 29% use YouTube for professional networking, second to Facebook, which 41% said they used. Twenty-three percent said they use LinkedIn. Respondents could provide more than one response. YouTube is one of the most popular search engines out there making it simple to search millions of healthcare industry videos. In today’s society

physicians see YouTube as a way to reach out to patients as well as educate themselves. When browsing the Internet people are more likely to first click on an informative video posted by a respected colleague. Research shows this is where patients and medical professionals from various fields go to for expertise on new prescription drugs, demos on new technology, and procedures of the future. Busy schedules can hinder physician’s ability to attend industry events and conferences where networking takes place. Most likely their curiosity will lead them to the Internet to see what they have missed. YouTube videos are a direct link to

Social Media For Professional Networking

Graph: AMN Healthcare

get a quick look at what they missed. Another trend some hospitals have embraced is the idea of promoting their impressive staff and modern facility technology on their careers page of their website with a YouTube video. This is also an excellent way for doctors, nurses, or healthcare administrators to learn about the facility in their job search. YouTube videos allow people to feel more of a connection to the topic they are researching and the videos are easy to repost onto other networking sites, such as, Twitter, Facebook or LinkedIn. They connect people more than other outlets, suggested AMN’s President of Health Care Staffing Ralph Henderson in an article, so it’s a good place for healthcare professionals to look for advice, success stories or personal experiences from others like themselves. It is also a good place to share their own experiences and expertise, both for the benefit of patients and for other professionals like themselves. 


practice tips

Recent Increases in Aesthetic Medical Procedures Make Now a Profitable Time to Enter the “Cosmetic Boom”

By Karen Albright, Owner/Operater, BodyLase Skin Spa As a physician, practice manager or physician extender, you may have often wondered... is it possible to escape the yoke of managed care? Dwindling reimbursements, increased paperwork and mounting overhead have made physicians everywhere discouraged and disappointed. The recent boom in aesthetic medical procedures, however, provides an excellent opportunity for physicians and other medical professionals to offer quality fee-for-service procedures into their practices and enjoy a revenue stream that is unencumbered by third-party payers. If you have ever thought of profiting from the “cosmetic boom,” now is the time to jump on board. 18 | SEPTEMBER 2013

All of the forces are in place to create a “perfect storm” for the demand for aesthetic cosmetic procedures. The baby boomer population is a “Silver Tsunami” that is gradually gaining strength in the United States. In fact, baby-boomers are turning 50 years old at a rate of one per every 8 seconds. These boomers want to look as young as they feel and thumb their noses at the inevitability of aging. In addition, our world of instant communication quickly spreads the word about the latest aesthetic medical breakthroughs (think “Dr. Oz!”). Recent advances in cosmetic medicine, moreover, that firm, rejuvenate and shape the aging face and body have been scientifically

proven to deliver consistent, measurable results. All of these factors suggest an opportunity for you to profit by leveraging your medical acumen with the latest trends in demographics and advances in aesthetic medicine. With all of this going for you, it may seem that all you have to do is take out a few ads and wait for the onslaught of baby boomers to head to your office. As with most things successful, however, hard work and a little industry knowledge are required. Now, physicians are no strangers to hard work. The challenge for physicians is to understand that an aesthetic medical practice is very much a hybrid between a business and a medical practice. While you certainly have acquired a plethora of medical knowledge, most medical schools are woefully inadequate at preparing physicians for understanding the “business of medicine”. It is imperative, therefore, that you understand some of the challenges, as well as the opportunities, of running a cashbased medical business. First, you must believe that it is entirely possible for any physician to get involved in aesthetic medicine. You have spent years learning the practice of medicine and, while you may need to learn about the specifics of certain aesthetic procedures, medical school has taught you first and foremost how to think like a physician. Thus, you are uniquely trained to understand how to learn about these new procedures. Courses, trainers, consultants and the like are available at your fingertips to help you learn how to administer aesthetic procedures. Take advantage of the internet and start shopping around. If you are a physician with an ongoing practice in a complimentary field such as OB/GYN, dermatology, or ophthalmology, you are in the enviable position of already having much of the infrastructure in place for a medical spa. You likely have an established office, support staff, and patient base of many thousands of patients. During the initial stages of your medical spa practice, use this infrastructure to your benefit. A good way to dip your toe into the waters of aesthetic medicine is to start with injectables, such as Botox and dermal fillers. These procedures involve minimal investment on the part of the physician and can take years off your patients’ appearance. Once you get the basics down through good training, start treating your staff (they will love you!) and get them excited about the procedures. Your staff is your “sales team” and will sell your patients on these procedures. Finally, roll out the new procedure to your internal database of clients via mailings, signage in the practice, brochures in your waiting room, and targeted emails to your existing patient base. This will be the cheapest form of advertising you will ever use. Furthermore, I would recommend a dedicated “aesthetic procedure room,” which may evolve into a dedicated “aesthetic procedure day,” as this element of your practice grows. After all, people coming to you for these expensive

elective procedures really don’t want to be sitting next to your influenza patients who are coughing and feverish. Aesthetic “medicine” is a completely different type of medicine and the patients, because they are paying their own hard-earned cash and not just showing an insurance card, are quite a bit more discriminating. For physicians new to practice, emergency room physicians, anesthesiologists, and other surgical specialties with a limited internal base of existing patients, your plan will be different. This “different” plan will also apply to those physicians who are serious about getting into the medical spa business and are ready to embrace aesthetic medicine quickly, rather than nurturing a slower, homegrown practice. For all of you, the best opportunity lies in purchasing an existing medical spa with a proven track record of repeat patients and consistent revenues. Trust me when I say there are ALOT of moving parts to these businesses. If you can find one that has successfully navigated these very choppy waters and is available for you to acquire, this will catapult you to the top of aesthetic medicine in a way that only years of advertising, branding and stand-out customer service can match. It will cost you more up front, but will likely get you to your end result much more quickly. The ultimate question then becomes - how much money can you expect to make from your medical spa? Assuming you have spent adequate time, money and education in learning the business of medical spas (or purchasing a successful one), you are poised to do quite well. Let’s say that you have 500 clients in you market that you are able to service with your medical spa. If the average patient spends $250 per visit (a conservative number) and returns 4 times per year (the typical number of visits for a medical spa patients), you would generate gross revenues of $500,000 per year. If you offered more expensive laser services, your average patient could easily spend $400 per visit, which would then generate gross revenues of $800,000 per year. And this revenue is 100% paid in cash - no collections, no accounts receivable and no bad debt. Now this is starting to sound interesting! In conclusion, for those laboring under the yoke of managed care, alternative options do exist. The cosmetic medical industry offers an opportunity for those medical professionals who wish to enjoy an additional or even completely different revenue stream. Moreover, your gains come not only in the financial arena but in many other forms. For example, you can spend quality time with your patients; you can learn about new treatments in an emerging, dynamic field of medicine; and you enjoy the benefits of helping people feel more beautiful, confident and self-assured. In sum, aesthetic medicine is “happy medicine.” Your office will be filled with positive energy and you will, once again, be in charge of your own destiny.  MEDMONTHLY.COM |19

practice tips

EFFECTIVE REFERRALS: Help More People and Increase Profitability

By Darren Witmer CEO / Co-Founder of Reset My Business

I’ve been called a “connector”, a “power networker”, a “good person to know”, a “great referral partner” and someone who “gives more than he gets”. In this article I will share what I’ve learned about creating simple educational statements to increase referrals. I will also explain how to simplify your patient treatment education so that you can help more people and generate more profits for your practice. We all currently live in a very complicated world. Most of us are craving simple solutions to our biggest challenges, but finding eludes the simple solution eludes a majority of us. While all professionals usually try to educate everyone on every way that they can help the reality is that people today are bombarded with information overload. Therefore the best way to help the most people is to simplify your message to maximize those that you actually do help. First, as a medical practitioner of any kind, it is important to remember that your patients generally have no 20| SEPTEMBER 2013

idea what you are talking about. Medical terminology is like a foreign language to most of us. While you may have a great treatment which helps many patients, you are missing out on helping many more potential people than you currently do if you do not explain it in plain English. Second, most of your patients know many people that they would like to introduce to your practice if you can help them with their ailments. However, if they don’t understand your terminology, then they can’t make those introductions.

The Three Steps to Providing Effective Patient Education About Treatments That Can Help Them. Here’s how to simplify your patient education to maximize the positive impact that you can have on more patients, more potential patients and your practice. As I mentioned, most people want to get connected or help others get connected to treatments that can help them but they often don’t or can’t

because they don’t understand how you can help. Here are the 3 elements when educating your patients that create an environment where they will accept your most effective treatments and refer those that they know who can also receive the help that they need from your practice. 1) You have to educate your patient base in terms of a life event (turning 40), a symptom (chronic back pain) or an illness (diabetes). Make sure to pick a life event, symptom or illness that describes the biggest patient or potential patient demographic that your practice / specialty can help which should be presented in the following manner: “As someone who is suffering from chronic back pain I would like to educate you on the most successful treatment reported by our patients” 2) You need to educate your patient base in a positive manner on the specific value that you, a treatment or your practice can have for them or someone who is experiencing one of these life events, symptoms or

illnesses in the following manner: “There is a procedure to alleviate chronic back pain which is non-invasive and 82% of our patients have reported feeling much better within days so we are trying to make more people aware of it.” Make sure that you quantify the percentage of your patients who report positive outcomes for your treatments. Also avoid any “negative” tone or reason why someone may not want to set an appointment to receive help by not using anything like the following: “When people hit 40 the risk of colon cancer dramatically increases so you should come in for a colonoscopy.” Psychology tells us that most people are more comfortable living in denial of something negative in their life so it’s important to avoid playing into this fact when educating your patients on treatments that could help them or others they know. Putting it all together, the most effective way to educate your patients so that you can help more of them to engage in the most effective treatments that are available should sound something like this. “As a diabetic I would like to educate you on the most successful treatment reported by our patients. There is a medication that we have been prescribing and 76% of our diabetic patients have reported dramatic improvements in their symptoms.” By educating your patients in this manner, you will be able to help more of them and allow more of them to convey the same message to anyone that they know who is also suffering from diabetes. Being simple is key, especially in the medical field. 3) To maximize the positive impact that your practice has on your patients or potential patients you should create only one education statement that your entire practice uses for each treatment and only for a handful of treatments. One potential risk in the medical field worth noting is the following: Never use medical terminology,

drug names or any other long / complicated word in any portion of your education statement. Again medical terminology is like a foreign language to most of your patients so they won’t be able to understand it or explain it to others if it’s not simple. While it may seem counterproductive to educate patients on fewer treatments the reality is that the current patient education methodologies employed by most medical practices are minimizing the people that the medical community actually does help. While every medical practice and patient in the US facing more complexity, you have the opportunity to help more patients, improve the financial stability of your practice and receive more new patient referrals then you thought possible if you embrace the methodology that I just described. If you would like to implement an education model like this one but are struggling with any aspect of it, please contact me for help so that you can increase the effectiveness of your education and referral practices.  Darren Witmer is a Connection Broker and CEO / Co-Founder of Reset My Business, a firm that connects small businesses to missing resources, allowing them to improve their businesses faster than their own time permits. Darren specializes in creating innovative approaches that simplify common business interactions and transactions which deliver simplified business processes and cost savings to buyers as well as new revenue to sellers. Darren founded Reset My Business while he was building his professional network and he learned “The Magic of Referrals,” which led him to create a business model that would generate meaningful introductions and referrals from small business to small business.

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

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practice tips

Bringing Technology into the Dental Office By Beverly Thurmond, D.D.S.

22 | SEPTEMBER 2013

Dr. Thurmond designs a crown using CEREC


fter relocating to Raleigh from New Mexico in 2009, I chose to purchase an existing dental practice from a retiring dentist. From the beginning I knew that upgrades and updates would be necessary to take the practice to the next level. This is where a motivated, eager and capable staff can be your best asset! We began with the basics, installing an internet connected network of computers in each operatory and the front desk, that included Eaglesoft dental management software. Investing good money into old technology does not make good financial sense. So we transitioned from conventional film to digital x-rays. The new digital x-ray systems reduce radiation exposure by up to 80%, eliminate environmental waste (no processing solutions), allow immediate viewing and increase diagnostic efficiency. Additionally, when a patient needs to be referred to a specialist sending digital x-rays via email saves time and money. We also added a Schick intraoral camera in the operatory which adds digital photos of a patient’s tooth or tissue into their permanent record. This “wow” feature can make a problem crystal clear to the patient and encourage them to take ownership and action. Intraoral photos are very helpful when submitting pre-authorizations for dental treatment. For example, a tooth fracture that runs mesial to distal cannot be seen on an x-ray but it is clearly visible in a photo. Most insurance companies appreciate the additional information and documentation to assess the medical necessity of the proposed treatment. Implementing technology requires adequate space, so we relocated to a newly renovated space that will support our growth for years to come. As part of this growth an additional monitor was added in each operatory. Patients are excited to conveniently view their x-rays on a 14” dedicated computer monitor used for patient education and not on a 1.5” piece of film held up to a light source. To prepare for HITECH Act compliance due by 2015, we have implemented electronic patient charts, claims submission and referrals when sending a patient continued on page 24 MEDMONTHLY.COM |23

continued from page 23

to a specialist. For instance, when we receive patient information from another provider, the documents are not printed, but imported into the patient’s digital file cabinet. These “e-tools” increase efficiency, reduce errors, and allow for faster reimbursement. Another important technology is the use of third-party software to handle patient communications. Using email and text messages to remind patients of their appointments has reduced overhead, no-shows and late cancellations. We use this service to track recalls; patients due for an appointment but not scheduled. These patients receive a combination of email, text and postcards as reminders. In the near future, our patients will be able to access their account, patient chart and even make payments through a secure internet portal. In 2011 we brought in CEREC CAD-CAM technology to our office. CEREC (Chairside Economical Restoration of Esthetic Ceramics) was first introduced in 1985. It is a dental restoration product that allows a dental practitioner to produce ceramic dental restorations using computer assisted technologies, including 3D photography and CAD/CAM. This replaces the use of messy impression materials and physical stone models. It is possible to design inlays, onlays, veneers, and crowns on the computer, articulate the restoration with adjacent and opposing teeth, and then mill and cement the final restoration in a single appointment. Patients appreciate the single visit appointment. It reduces their time off from work and reduces anesthetic use. If needed, the scans can be e-mailed to the lab for the fabrication of custom abutments used with implants and implant 24 | SEPTEMBER 2013

crowns. Initial training classes are required for the doctor and dental assistant(s) to introduce the techniques and tools. As new releases of the software and improvements in the technology are available, continuing education training is a must for the doctor and dental assistant(s). As with any new technology, there is a learning curve for the implementation into the actual schedule. The process must flow from doctor to assistant and back, letting each do their assigned tasks to achieve the final product. Implementing the steps understandably takes much longer initially, so extra time must be built into the schedule to allow for this to occur. Another time saving tool that we have introduced is the SonicFill™ by Kerr Dental. It is a sonic-activated bulk fill composite delivery system. Kerr’s sonic activation allows for a rapid flow of composite material into the cavity for effortless placement and excellent adaptation. This has become an incredibly efficient method for using tooth-colored restorative materials. Previously we used an incremental fill technique done by hand, effective, but much more time consuming. It is truly amazing the number of innovations that have been introduced into the dental field in the past 15-20 years and it seems that many more advancements are on the horizon. It is easy to get overwhelmed or over extend your budget when trying to keep up with the latest and greatest. Each segment of technology implemented must benefit the office, make fiscal sense and contribute to a patient’s oral health in a positive way. Over the last 4 years, we have fast tracked the adoption of new and efficient technology into our dental practice and haven’t looked back!  An assistant loads the CEREC milling unit.

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26| SEPTEMBER 2013

Intensifying competition among private hospitals in Brazil has compelled them to use advanced clinical systems as a market differentiator, thereby driving the uptake of electronic medical records (EMR). The need to reduce expenses in both public and private hospitals has further fuelled EMR installations in the country. As such, the Brazilian EMR market is expected to be one of the fastest growing segments in the country’s healthcare IT sector. New analysis from Frost & Sullivan, Electronic Medical Records (EMR) Market in Brazil, finds that the market earned revenues of $145 million in 2012 and estimates this to reach $336 million in 2018 at a compound annual growth rate of 15 percent. EMR implementation in Brazil has increased as healthcare institutions look to optimize flux, gain control over patient demands, manage information, and reduce waiting times. Educational programs by local healthcare IT associations have improved awareness on the importance of EMR across the country and promoted EMR usage. “So far, concerns among healthcare institutions regarding the security of patient data have been the primary reason for their reluctance to adopt EMR,” said Frost & Sullivan Healthcare Research Analyst Gabriel Walmory Silveira. “Standards for electronic security and the security certification established by the Brazilian Health Informatics Association (SBIS) in partnership with the Brazilian Medical Council (CFM) for EMR systems have raised consumer confidence, spurring sale volumes.” However, the CFM certification does not include an interoperability standard and the lack of integration among different healthcare IT systems limits the development of a more sophisticated EMR market in Brazil. Thus, most local companies provide their EMR solutions as a module of

an integrated hospital information system (HIS). Local HIS vendors are responsible for 80 percent of the total EMR market, and this shortage of specific EMR vendors restrains the growth of high-quality EMR solutions. Local vendors are gradually beginning to offer advanced EMR systems rather than just managementfocused HIS solutions. This is a new move for firms in the country and they must continue to adapt to changing hospital requirements to compete with multinational companies. “Overseas EMR providers can adapt quickly by partnering with local HIS vendors that have a strong focus on enterprise resource planning (ERP)” concluded Silveira. “The Brazilian market has already witnessed several mergers and acquisitions. Alert, a Portuguese company has formed a partnership with Benner, while Philips has acquired Wheb-Tasy, and Agfa has bought WPD.” If you are interested in more information on this research, please send an email to Francesca Valente, Corporate Communications, at francesca.valente[.], with your full name, company name, job title, telephone number, company email address, company website, city, state and country. Electronic Medical Records (EMR) Market in Brazil is part of the Connected Health (connectedhealth. Growth Partnership Service program. Frost & Sullivan’s related research services include: Analysis of the Cardiac Rhythm Device Market in Mexico, Biologics Market in Brazil, Healthcare Landscape, Outlook and Growth Opportunities in Brazil. All research services included in subscriptions provide detailed market opportunities and industry trends evaluated following extensive interviews with market participants.  Source: http://www.newswiretoday. com/news/132365/ MEDMONTHLY.COM |27

research & technology

FrontRange Announces Breakthrough Electronic Medical Record Change Management Solution

FrontRange, the Hybrid IT software company, announced its HEAT Electronic Medical Record (EMR) Change Management solution. Integrating healthcare industry best practices, the HEAT EMR Change Management platform enables healthcare organizations to fully automate and meet demanding regulatory compliance requirements mandated by the HITECH Act of 2009 for Healthcare organizations implementing EMR software systems. Available as a cloud-based, on-premise, or hybrid offering, the HEAT EMR Change Management platform reduces the complexity associated with the deployment, operation and maintenance of an EMR software system. The platform uniquely integrates healthcare industry best practices that automate the management and documentation of EMR costs, budgeting and workflow analysis during the pre- and post-deployment phase, EMR change requests, and ongoing IT EMR software support and operations. FrontRange’s customers, such as Essentia Healthcare, have efficiently rolled out their EMR system quickly and efficiently using the HEAT platform. Read about Essentia Healthcare’s success in this case study. “Health care organizations are under pressure to implement fully-compliant EMR systems prior to 2015 if they are to avoid reimbursement penalties,” said IT analyst Carl Lehmann with 451 Group. “Correctly implementing EMR technology requires effective EMR change management processes and the means to demonstrate ‘Meaningful Use,’ a regulatory standard that describes EMR quality and value. Offerings such as those from FrontRange look promising in their ability to meet the changing workflow requirements of EMR systems and assist with the 28 |SEPTEMBER 2013

attestation of Meaningful Use.” To accommodate the operations phase of an EMR implementation, the HEAT Change Management solution enforces compliance and security requirements by automating the management of in-process changes to systems that report through the EMR system. This secures patient records during the transition from paperbased to electronic file formats. It also helps define what information can be shared and determines external vendor access to health records. Enhancing the maintenance phase of an EMR implementation, the HEAT Change Management solution enables healthcare organizations to automate ongoing EMR changes required by new government mandates. This will assist healthcare staff working across disparate departments to better understand EMR change requirements and accelerate issue resolution times in order for caregivers to focus on providing premium care without being burdened by new and unfamiliar EMR software systems. Featuring a next-generation visual workflow editor, fully integrated voice automation and comprehensive client management capabilities, the HEAT EMR Change Management platform maximizes operational efficiencies while reducing total cost of ownership. By integrating service management and client management capabilities, the HEAT platform enables users to easily request an EMR service or change, automatically deploys those changes to end users and monitors compliance and service level agreements. A key challenge healthcare organizations face as they make the transition from manual paper-based approaches to automated EMR systems—estimated to be a $3.8 billion market—is the ability to achieve “meaningful use”—a series

Company’s HEAT Change Management Platform Streamlines Deployment, Maintenance and Regulatory Compliance for EMR software pre and post deployment

of core objectives that must be met by the fast-approaching 2016 deadline imposed by the American Recovery and Reinvestment Act. Non-compliance with these complex requirements can directly impact the profitability of healthcare organizations as a result of significant fines, loss of monetary incentives and a curtailment of government reimbursements for Medicaid and Medicare payments, which can account for up to 50% of all revenue for some healthcare providers. FrontRange’s EMR change management solution is specifically designed to help healthcare organizations address this imposing challenge as they transition to an EMR system, upgrade, or replace an existing EMR system. FrontRange’s HEAT EMR Change Management solution provides a high level of process automation, unified management and compliance enforcement which form the foundation for efficient and effective IT services and yield improved end-user productivity. Benefits include:

Maximized Operational Efficiency

• Reduced time on EMR package development by up to 85 percent • Reduced time spent on EMR application deployment by up to 95 percent

Reduced IT Costs

• Reduced purchases of unneeded EMR hardware/ software by 50 percent • Reduced number of on-site engineer visits by up to 99 percent • Reduced total cost of ownership (TCO) costs by up to 70 percent

Improved Service Quality and Compliance

• Reduced compliance risk by up to 80 percent • Reduced EMR software troubleshooting efforts by up to 85 percent • Improved overall customer satisfaction by reducing the mean time to repair (MTTR) by up to 75 percent

“With the introduction of our EMR Change Management solution, we’re dramatically reducing the complexity associated with the deployment, operations and maintenance of government-mandated EMR systems,” said Jon Temple, CEO of FrontRange. “More importantly, we’re in a unique position to help healthcare organizations preserve their profitability by enhancing their ability to comply with ARRA requirements while lowering their EMR total cost of ownership.”  About FrontRange FrontRange is a leading provider of Hybrid IT software solutions for organizations of all sizes. With our suite of HEAT applications, FrontRange is the only company in the world that provides, from a single platform, Service Management and Client Management software on-premise and in the cloud. HEAT manages millions of service interactions and millions of devices every day for more than 15,000 leading organizations around the world. Our customers deliver world-class service while maximizing operational efficiencies with reduced cost and complexity. FrontRange is headquartered in Milpitas, California and can be found at Source: MEDMONTHLY.COM |29

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research & technology


Med Monthly Welcomes Laura Maaske as a Staff Illustrator, Writer and Journalist

his month Med Monthly welcomes Laura Maaske on board as a staff illustrator, writer and journalist. She will be supplying an article or illustration each month dealing with ground breaking health care advances and state-of-the-art medical images. She has been a regular contributor, with several articles during the past year featured in our Research & Technology section. With a Master’s of Science degree in Biomedical Visualization from the University of Toronto, she is bound to amaze you with wildly colorful, graphically outrageous images and an interesting insight into her world. Simply combine anatomy, physiology, pathology, embryology, histology, with design, airbrush, carbon dust, pen and ink and there you’ll have it; the beauty and wonder found in the human body as seen and expressed by a master illustrator. Collaborating with scientists, physicians, and other specialists, medical illustrators serve as visual translators of complex technical information to support education, medical and bio-scientific research, patient care and education, public relations and marketing objectives. Laura did her masters research on interactivity in computer design and experimenting with the small world being offered by a computer interface. Laura explains, “It was like science itself, in a nutshell. I wanted to be creating small worlds where you were able to learn how things worked.” If you review Laura’s website, you’ll notice she states that all of her work is done by hand. Once again, having been trained in traditional art, she always begins with a hand-sketch. “Bringing the work (sketch) to the computer is a useful step in the process, but I do this only when I feel I have captured the essential movements and curves on paper that are to be the underlying focus in the final piece.” Every project that Laura creates is custom done. In the inception of each one she questions, “What does this individual piece have to say to its audience?” Only then can she truly begin to develop the perfect concept for her final piece. What is the most difficult question to ask such a complex artist? What project are you the most proud of and why? Laura replies, “As an artist, I am in search of a balance between the chaos and rich excess of information

being offered in the surgical scene and simple educational objectives about that particular procedure. There is a particular series of surgical illustrations which gave me insight about this balance. It had been a goal of mine to render the surgical scene in a way as if the surgeon were operating in a clean field. It was my job to clear away what a photograph could not. But it occurred to me as I was beginning to draw the series that perhaps I was avoiding something beautiful about the nature of surgery, to avoid the dissolution. During a surgical procedure, the tissues become a little swollen, and there is some bleeding, and this is all understood as a way of adapting the body for a healthier state of being when the surgical procedure is done. But it seems like a contradiction: destruction first before healing. We open the body, aware of this small loss, in favor of a greater gain. So I decided to render this dissolution in my surgical series. The results worked in a way that seemed very natural to me, compared to what my cleaner renderings had been as in previous work. This lesson made this project very special.” Laura shares a whimsical illustration on the following two pages of her creative process in the making of a medical illustration. We welcome Laura and her creative touch to our evolving group of talented professionals here at Med Monthly magazine.  Following is a list of some of Laura’s published work: Feature Article. Maaske, L. 1999. "A Study of Interactivity in Educational Patient Hypermedia". Journal of Biocommunication. V(3); 2-11. Feature Illustration. Papsin, B., Maaske, L., McGrail, S., 1996 "Repair of orbicularis oris rupture". Laryngoscope. V(6);757-60. Cover Illustration. Chan, A., Ross, J., 1996. "The management of unstable coronary syndrome in patients with previous coronary artery bypass grafts". University of Toronto Medical Journal. 73(3);132-8. Feature Illustration. Chung, H.T., Gordon, Y.K. Ng, and George, S.R.,1996. "Biochemical characteristics D2 receptor monomers and dimers expressed in Sf9 cells". University of Toronto Medical Journal. 73(2);86-93. MEDMONTHLY.COM |31

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research & technology

Netsmart Launches Innovative Solution to Facilitate Integrated Behavioral and Physical Healthcare


he link between physical and behavioral health is a pervasive reality for millions of people. According to the Robert Wood Johnson Foundation, 68 percent of adults with mental health conditions also have medical conditions, and 29 percent of adults with medical conditions also have mental health conditions. Additionally, 70 percent of all primary care visits are for psychosocial issues. Netsmart, the leading provider of clinical solutions for health and human services organizations nationwide, today announced the launch of the Netsmart Primary Care Module, which unites behavioral health with primary care services in a team-based, integrated model of care that enables providers to effectively treat the “whole person.” “We have to ‘put the head back on the body’ and address patients’ physical and mental health conditions equally,” said Michael Valentine, chief executive officer,

34 | SEPTEMBER 2013

Netsmart. The advent of accountable care and focus on patient-centered medical homes brings the opportunity to utilize integrated approaches to treating the body and mind. Our Primary Care Module equips health and human services providers to deliver a high quality, comprehensive, integrated model of care.” Netsmart’s Primary Care Module is an integrated solution that incorporates a person’s entire medical ecosystem for a holistic approach to care. Providers in behavioral health, addiction services, social services and public health can share authorized clinical data with a person’s primary care provider, and vice versa, in a single, integrated care record. Each provider involved in the care process can view the patient’s full medical record in their own chosen “point of view,” including medical history, medications and other key attributes as they diagnose and develop treatment plans.

The Primary Care Module works with Netsmart’s myAvatar™, TIER® and myEvolv™ CareRecord™ Solutions, with both primary care and behavioral health information residing in the same, integrated CareRecord. The module includes a complete, intuitive primary care office visit workflow delivered with seamless integration between the CareRecord desktop user interface and iPad-based Primary Care Office Visit workflow, including an integrated treatment model for all services. Clinicians can easily document reason for visit, patient/family histories, collect vitals, update allergies, prescribe medications and include all details of the office visit with relevant behavioral health information available as part of office visit workflow. Documentation is completed following evidence-based practice guidelines. Prior to the nationwide launch, the module was implemented and tested by Tarzana Treatment Centers, Inc., of Tarzana, Calif., and Henderson Behavioral Health of Fort Lauderdale, Fla. “This primary care integration module has had a dramatic impact on our ability to care for our consumers in a more holistic way,” said Steve Ronik, chief executive officer, Henderson Behavioral Health. “Our clinicians have embraced it because it is ‘clinician-friendly’ and it allows them to provide more comprehensive care.” “Improving care at the point of care is the number one benefit of the Netsmart Primary Care Module,” said Albert Senella, chief executive officer, Tarzana Treatment Centers, Inc. “We have also reduced the time and cost of documentation and increased the timeliness and accuracy of patient information capture and management.” “As the industry moves toward pay-for-performance models and reimbursements based on care quality and improved outcomes, having this level of information in a single integrated solution helps providers fulfill their missions to improve the of individuals and ultimately, broader populations,” said Valentine. For more information about the Netsmart Primary Care Module, visit or call Netsmart at 1-800472-5509.  About Netsmart Netsmart is committed to helping health and human services providers deliver effective, recovery-based care with Netsmart CareFabric™, a tightly woven framework of innovative clinical and business solutions and services that supports integrated, coordinated delivery of health services across the spectrum of care. More than 22,000 client organizations, including 350,000 care providers and more than 40 state systems use Netsmart products to help improve the quality of life for tens of millions of people each year. Netsmart clients include mental health and substance use treatment agencies, psychiatric hospitals, private and group mental health practices, public health departments, social services and child and family health agencies, vital records offices, and managed care organizations. Netsmart is pleased to support the EveryDay Matters Foundation, which was established for behavioral and public health organizations to learn from each other and share their causes and stories. Organizations can also request grants for their cause or to help fund technology that advances the way care is delivered. For more information, visit Source:

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By Theresa C. Carnegie and Karen S. Lovitch Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.

36 | SEPTEMBER 2013

Representative Jackie Spier (D-Calif) has introduced a bill (HR 2914) that would eliminate advanced diagnostic imaging, anatomic pathology, radiation therapy, and physical therapy services from the Stark Law’s in-office ancillary services exception (IOASE). The stated goal of the Promoting Integrity in Medicare Act of 2013 (PIMA) is to cut unnecessary Medicare spending, reduce overutilization of complex services, and narrow the IOASE to better reflect congressional intent. PIMA creates a new definition under the Stark Law for “specified non-ancillary services” and excludes such services from protection under the IOASE. A specified nonancillary service is defined as a service that is “not usually provided and completed during an office visit to a physician’s office in which the service is determined to be necessary” and includes: • Anatomic pathology services, including the technical or professional component of the following: • Surgical pathology (cytopathology, mematology, blood banking, pathology consultation and clinical laboratory interpretation services), • Radiation therapy services • Advanced diagnostic imaging studies, including diagnostic MRI, computed tomography, and nuclear medicine • Physical therapy services In addition to excluding these complex services from the IOASE, PIMA also increases the civil monetary penalties (CMPs) applicable to referrals for specified non-ancillary services and creates new compliance review procedures involving HHS and the OIG. The CMP for improper claims relating to specified nonancillary services is $25,000 ($15,000 for all other improper claims) and the CMP for specified non-ancillary service circumvention schemes is $150,000 ($100,000 for all other


circumvention schemes). The legislation requires that HHS and the OIG review compliance with PIMA’s new prohibition and specifically target types of entities that the Secretary determines represent a high risk of noncompliance. PIMA suggests that HHS and OIG review such entities through prepayment reviews, claims audits, focused medical reviews, and computer algorithms designed to identify billing and payment abnormalities. Finally, the bill clarifies that: • the legislation does not affect the Stark Law exceptions for rural providers, • physician groups participating in ACOs in the Medicare Shared Savings Program can continue to provide integrated services, and • physician practices billing for the technical component or professional component of a specified non-ancillary service are subject to the Stark Law’s restrictions even if billing in compliance with Medicare’s antimarkup rule.

Spier’s office reports that a fourth GAO report on self-referral in physical therapy services is expected later this year. The bill has broad-based support from a number of health care industry trade associations and coalitions, including the Alliance for Integrity in Medicare (AIM), which is composed of the American Clinical Laboratory Association (ACLA), the American College of Radiology, the American Physical Therapy Association, the American Society for Clinical Pathology, the American Society for Radiation Oncology, Association for Quality Imaging, the College of American Pathologists, and Radiology Business Management Association. As noted in a recent post, the ACLA, in particular, has taken a strong stance against abusive self-referral arrangements and has advocated for many years for CMS to close the loopholes that have allowed these arrangements to proliferate. Given that CMS has repeatedly failed to heed the call – even after Dr. Jean Mitchell’s April 2012 study identified a link between self-referrals by urologists and increased utilization – advocates like ACLA wisely chose to look to Congress instead for relief. CMS has disappointed many in the laboratory industry with its apparent efforts to hinder abusive self-referral arrangements by imposing reimbursement cuts applicable to all laboratories providing pathology services – even independent laboratories that do not (and cannot) order biopsies. Although HR 2914 has the support of many well-known organizations, its success remains to be seen given that Republicans in Congress typically take a hands-off approach when it comes to fixing the Stark Law. 

PIMA comes in the wake of three recent GAO reports that have found an increase in utilization ofadvanced imaging services, anatomic pathology services, and prostate cancer treatments where providers self-refer.

Source: http://www. healthlawpolicymatters. com/2013/08/07/new-bill-proposesto-eliminate-stark-law-exceptionfor-certain-in-office-ancillaryservices/#more-3573

“A specified nonancillary service is defined as a service that is “not usually provided and completed during an office visit to a physician’s office in which the service is determined to be necessary”


legal On July 8, 2013, the Centers for Medicare & Medicaid Services (CMS) released a pre-publication version of the 2014 Medicare Physician Fee Schedule and the 2014 Medicare Hospital Outpatient Prospective Payment System Notices of Proposed Rulemaking. The proposed rules will be officially published in the Federal Register on July 19, 2013, but these pre-publication versions include proposed changes to the Clinical Laboratory Fee Schedule intended to address the rapid technological changes in the clinical diagnostic lab environment.

CMS Proposes Changes to Modernize and U By Paul W. Radensky, M.D., Christine Park Song, and John Warren McDermott Will & Emery Since 1984 Medicare has paid for most clinical diagnostic laboratory services based on the Clinical Laboratory Fee Schedule (CLFS). The CLFS methodology sets Medicare payment rates at the lesser of the amount charged, the fee schedule amount in the state or local geographic area in which the service was performed, or the national limitation amount. With the exception of modest inflation adjustments, payment rates set under the CLFS do not adjust. While a reconsideration process was established, this process allows only for a one-time review of newly priced codes and does not include an adjustment mechanism for existing codes. As a result, Medicare payments under the CLFS are essentially locked in place and unable to adjust based on changes to the cost of the test. 38 | SEPTEMBER 2013

The Centers for Medicare & Medicaid Services (CMS) is proposing a process under its existing authorities in 1833(h)(2)(A)(ii) that would allow for the systematic examination of payment amounts. This examination would seek to identify those codes that had undergone “technological changes� affecting the price of the test. CMS cites the increased use of point of care testing, genetic and genomic testing, and laboratory developed tests as rationale for developing this process CMS defines a technological change as any change to the tools, machines, supplies, labor, instruments, skills, techniques and devices that results in changes to the resources required to perform the test, the types of personnel required to perform the test and/or the volume, frequency and site of service of the testing. Notably absent from the proposal is

a review of the costs of the resources needed and used to develop tests. This is a significant cost associated with developing certain newer tests that is generally not accounted for in CLFS payment rates. Under its proposal CMS would review all CLFS codes over a five-year period, beginning with the oldest codes, reviewing a portion of the total codes each year and making appropriate adjustments. CMS notes that adjustments could result in increases to payment amounts, but expects most adjustments to result in decreases. After the initial review of the codes, CMS will allow the public to nominate codes for review; however, these codes must have been on the CLFS for at least five years. Public nominations must include sufficient rationale describing the technological changes and how those changes affect

Update the Clinical Laboratory Fee Schedule payment and delivery. In addition to its proposal to modernize the rate-setting process under the CLFS, CMS proposed in the CY2014 Hospital Outpatient Prospective Payment System (OPPS) Notice of Proposed Rulemaking to bundle clinical laboratory payments into the OPPS payments. CMS believes that clinical laboratory tests essentially support the underlying outpatient encounter. CMS argues that, because the OPPS is meant to be an all-inclusive payment system and not a fee schedule, bundling clinical laboratory payments into the OPPS payment is appropriate. CMS proposes two exceptions to this policy: if a lab test is unrelated to the primary service, that is, if the test was ordered for purposes unrelated to the OPPS encounter, it would continue to be paid separately. Lab tests

meeting this exception criterion would also need to be ordered by a physician other than the physician ordering the OPPS service. CMS would also exempt from this policy molecular diagnostic tests, citing the novelty and different use patterns for these tests. CMS does suggest that it reserves the right to revisit this decision in the future. While CMS does not believe its proposal would affect beneficiary cost sharing, it is welcoming comments on how such a proposal may effect beneficiary financial obligations. The full list of codes that CMS is proposing to package is available on CMS’ website (Addendum P). A third proposal would limit Medicare payments for non-facility based services paid under the Physician Fee Schedule to the amount paid when the service is performed

in the facility setting. CMS believes that anomalies in data and the way that data is used in the resource-based Practice Expense (PE) methodology leads to inaccurate payments for certain services. CMS believes that PE input data voluntarily submitted by the Relative Value Scale Update Committee (RUC) may be inaccurate, incomplete or biased. Further, the lack of a comprehensive review and evaluation of PE inputs is believed to contribute to these discrepancies. For most services, this proposed policy change will have a small impact (-2 percent to +1 percent); however, for clinical laboratories, CMS estimates that this proposal will reduce payments by 25 percent.  Source:



Employers Still Must Play Nice: “Pay or Play Rules” Delayed, but Compliance Planning Must Continue By Timothy C. McDonald, Esq. and Patrick J. Cannon, Esq. of von Briesen & Roper, s.c.

40 |SEPTEMBER 2013

On July 2, 2013, the U.S. Treasury Department announced that implementation of the Pay or Play Rules of the Affordable Care Act (“ACA”) will be delayed one year until January 1, 2015. Employers, however, should not delay their compliance planning. A. The Pay or Play Rules Delayed. The ACA imposes penalties on large employers (defined as those with 50 or more full-time equivalent employees) that do not offer affordable health plan coverage to their full-time employees. These penalty provisions of the ACA are often referred to as the “Pay or Play Rules.” In general, the Pay or Play Rules provide that, for each month that a large employer does not offer health insurance to at least 95% percent of its full-time employees and at least one full-time employee receives a premium tax credit or subsidy for coverage purchased through an ACA health insurance exchange, the employer will be subject to a penalty equal to $166.671 times its number of full-time employees (not counting the first 30 full-time employees) (the “No Offer Penalty”). For each month that a large employer offers health insurance to full-time employees but that coverage is unaffordable or not minimum value coverage (as defined under regulations), the employer will be required to pay a penalty equal to $2502 times the number of full-time employees who purchase coverage on an ACA exchange and receive a premium tax credit or subsidy (the “Unaffordable Coverage Penalty”). In no event will the amount of the Unaffordable Coverage Penalty exceed the amount of the No Offer Penalty if the No Offer Penalty had applied. In addition to the penalties referenced above, the Pay or Play Rules require large employers to report to the IRS various information needed to track compliance, such as: the number of employees enrolled in the employer’s health plan, the months the employer offered coverage, the monthly premium for the lowest cost option, and certain identifying information regarding covered employees. The implementation of both the penalties and the employer reporting obligations under the Pay or Play Rules has been delayed until January 1, 2015. However, to assist in preparing systems to implement the Pay or Play Rules, the IRS encourages employers to voluntarily comply with the reporting requirements for 2014. B. Employers Must Continue to Plan for the Pay or Play Rules. It is important for employers to remember that implementation of the Pay or Play Rules has only been delayed. These rules havenot been repealed. In addition, the likelihood that the Pay or Play Rules will be repealed is remote. The gridlock in Washington alone makes repeal highly unlikely. As the Treasury Department noted in its announcement, the implementation of the Pay or Play Rules has been delayed to allow employers time to adapt their health coverage and reporting systems to meet the requirements of the ACA. Given the complexity of the Pay or Play Rules, employers should continue to establish their compliance strategies with a sense of urgency. C. The Compliance Schedule for Other ACA Requirements Remains Unaffected. The delay in the implementation of the Pay or Play Rules does not affect any other provisions of the ACA. Therefore, employers must continue to comply with provisions of the ACA already in effect and continue to prepare for compliance with provisions of the ACA set to take effect in the near future, including, for example: • W-2 Reporting of Aggregate Health Care Costs—Currently in Effect: Employers who were required to provide a Form W-2 to at least 250 employees in the prior calendar year must report the cost of employer-provided health care coverage on each employee’s Form W-2. To learn more about the requirements, as well as exclusions, please see the IRS’ page here. • Medicare Part D Subsidy—Currently in Effect: The tax-deduction for employers who receive Medicare Part D retiree drug subsidy payments is eliminated. • PCORI Fee— Currently in Effect: Employers sponsoring self-funded health plans must pay a fee based upon the lives covered under their plans. For many plans, the first PCORI fee payment is due July 31, 2013. For more information on the PCORI fee, please see von Briesen’s Compensation & Benefits Law Update here. • Employee Notice Requirement—Currently in Effect: Employers must provide a notice to current employees by October 1, 2013 regarding the availability of the ACA insurance exchanges, potentially available premium subsidies for coverage purchased on the exchange, and the potential loss of employer contributions toward the cost of coverage under the employer’s plan if the employee continued on page 42 MEDMONTHLY.COM |41

continued from page 41

purchases coverage on an exchange. A new employee hired on or after October 1, 2013 must be provided the notice within 14 days of his or her start date. (Note: COBRA notices should also be revised to address the availability of exchange coverage). • Transitional Reinsurance Fee—Effective January 1, 2014: Employer-sponsored self-insured plans that provide major medical benefits are generally subject to a new ACA Transitional Reinsurance Fee. For more information on the Transitional Reinsurance fee and the due date for payment, please see von Briesen’s Compensation & Benefits Law Update here. • Small Business Health Options Program (SHOP)— Effective January 1, 2014: Beginning in 2014, small businesses will have access to health insurance exchanges to purchase health insurance. A small business for this purpose is generally an employer with up to 100 full-time equivalent employees. Prior to 2016, however, states have the option to limit the definition of a small business for purposes of SHOP to an employer with up to 50 full-time equivalent employees. • 90-Day Maximum Waiting Period—Effective January 1, 2014: Effective for plan years beginning on or after

January 1, 2014, an employer health plan cannot impose a waiting period of more than 90 days. The IRS has provided temporary guidance on how employers should apply the 90-day rule. • Workplace Wellness Programs—Effective January 1, 2014: Provided certain conditions are satisfied, employers may implement health contingent wellness programs with rewards of up to 30% of the cost of coverage (50% if the wellness program is designed to prevent or reduce tobacco use). Unless dependents can reasonably participate in the wellness program, the “cost of coverage” refers to the cost of employee-only coverage. While the Treasury Department’s postponement of the implementation of the Pay or Play rules and the related reporting rules is good news for employers, employers must remember that these are the only ACA requirements that have been delayed. In addition, employers should take advantage of the delay in the implementation of the Pay or Play Rules to plan their compliance strategy now. These rules are not likely to go away and 2015 will be here before you know it.  Source: articles/pay_or_play_rules_delayed_7-13.html

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Growing Your Practice Through a Physician Liaison Program By Amanda Kanaan President, WhiteCoat Designs

A piece of marketing advice I often share with physicians is “if you’re not saying it, you’re not doing it.” That means that if you aren’t effectively communicating your services to the medical community then don’t expect referring physicians to know what you do. Specialists constantly tell me that they want more referrals. It’s probably their number one marketing wish. Yet they don’t put a plan in place to make that wish come to fruition. The simple answer to this dilemma is the addition of a physician liaison program to your medical practice. A physician liaison’s role is to support and grow your practice by representing and promoting the practice’s clinical services, physicians and programs. Your physician 44 | SEPTEMBER 2013

liaison will become the voice of the practice in the medical community. The ultimate goal is to increase patient referrals from existing providers and secure new business from non-referring physicians. Their main priority is not to hand out brochures and bagels, but to build meaningful relationships between you and the referrers. That’s a necessary skill of any successful liaison, and not all liaisons are created equal. A good liaison has professional training and experience and will call on your referring offices consistently, not hand out their card once a quarter. Establishing new relationships and enhancing current relationships with referring practices are key components

of a physician liaison program. The physician liaison focuses on growing new relationships by identifying the needs of the new practice and responding to the areas of concern. Enhancing established referral relationships is achieved through listening to feedback from referral providers and physicians. If problems arise, the physician liaison is available to quickly address the issues and make any necessary changes. On a visit to a primary care practice that had previously referred patients, my physician liaison was surprised by the response that she received when speaking to a physician. As she was discussing a new service that her practice offered, the physician quickly interjected “your practice

would not see my Medicaid patient last week.” Had it not been for her diligence in digging deeper into this matter and resolving the physician’s concern, the two medical practices could have dissolved their relationship and chances of future referrals along with it. As the saying goes; out of sight, out of mind. By working closely with a physician liaison, your practice and services will be brought into the forefront of referrer’s minds on a consistent basis. This may be achieved through direct physician meetings, lunch sessions, or educational materials used to add value to the relationship and position you as the expert in your field. Liaisons not only deliver information to referrers but also bring market intelligence back to the practice. This is a great way for you to stay on top of news within the medical community. For instance, you’ll be aware if one of your top referrers is about to retire, if a practice just added another physician that you want to meet, or if your competitor is marketing a new service. This is an advantage most physicians don’t have. Physicians refer to practices they like, trust, and believe are both competent and successful. By adding a physician liaison to your practice, you are consistently strengthening the practices’ and physicians’ reputation among peers and in the community. Referrals from outside practices constitute the majority of new patients entering into the practice. In fact, nearly 70 percent of all referrals are sent to specialists from the primary care providers. Therefore, specialists and sub-specialists are the practices who have potential to make the greatest gains from a physician liaison program. The addition of a physician liaison to the medical practice will not result in overnight success. Rather this is ongoing process that involves the establishment of clear goals, timelines, and commitments from both the liaison and the medical practice. While many practices feel that they could benefit from a physician liaison program, the added cost of this new employee can cause them to take pause. However, the physician liaison can be an affordable option when hired on a contract basis rather than recruiting a full-time employee. When the benefits of growing referrals, enhancing relationships, and gaining community exposure are considered, adding a physician liaison program to your practice can be just what the doctor ordered.  Amanda Kanaan is a medical marketing specialist whose company, WhiteCoat Designs, provides physician liaison services, award-winning medical website design, online marketing and social media management to private medical practices and health care organizations. Email Amanda at, call at 919-714-9885 or visit the website at MEDMONTHLY.COM |45


Physician to Physician Referrals:

The Correct Communication Can Make It SUPER

By Denise Price Thomas


nce upon a time there was a family practice and a surgical practice side by side, even sharing the same parking lot. What a wonderful opportunity to better serve their patients. The surgical practice administrator had visited the family practice group, welcoming them to the neighborhood and had introduced the referral coordinators. They scheduled a meeting with a desire to better understand what each needed when referring

46 | SEPTEMBER 2013

patients. The surgical practice asked how the physicians would like to be kept informed. The family practice physicians said, “a phone call, chat in the parking lot or a letter works for us. Whatever works best for you.� The surgical practice administrator and employees were very understanding about work-ins and when at all possible, would offer same day appointments. Patients very much appreciated this, conveniently walking over from right next door. To the patient, the family practice

physician appeared to be “Super-Doc,” having extraordinary powers in requesting that the neighboring surgeon address their surgical needs so quickly. It was a win-win for both practices. Occasionally, a patient would have to be sent directly to the hospital for urgent surgery. They were able to bypass the emergency department. This made the family practice physician, the surgeon, the patient and patient’s family members very happy. Then one day a patient who had previously been referred by the family practice physician to the surgeon had returned to see his family physician for flu-like symptoms. While there, the family physician said, “I see in my notes that I had referred you to a surgeon about possible gallstones, did you see anyone?” the patient confirmed stating, “Yes sir, I had surgery months ago. I have the scar to prove it. I really liked that surgeon.” The patient pulled up his shirt and low and behold, he was right! There it was, one of the nicest post gallbladder scars ever seen. How embarrassing this was to the family physician. He liked to be kept informed about his patients. The family practice physician understood that mistakes happen so he called over next door to inquire. Copies of physician notes were hand delivered by the staff but one important piece was missing. There was no follow up with the physician, informing him of what the surgeon had found. This was quickly brought to the practice administrator’s attention. When she brought it to the surgeon’s attention, he said, “they should know by now that we are going to take care of their patients. There is no need for all that back and forth. If that’s a problem, then they don’t have to send me anyone else.” And they didn’t. The moral to the story is without effective, timely communication between physicians, both the quality of care and the patient experience can suffer. Physicians who reported a lack of timely communication regarding referrals had less confidence in their ability to provide high-quality care than colleagues who received timely communication. Primary care physicians know that if they don’t get information about referrals back from specialists, particularly for patients with complex conditions, it impacts the quality of the health care they provide. Gaps in communication may lead to patient harm, delays in care, continuation of incorrect treatment, prolonged length of stay, and increased costs. Lack of direct communication between physicians leads to delays in patients receiving the assessment and treatment they need. In order for the patient, family members, physicians, surgeons and staff to live “happily ever after” it takes 100% from all players. When one person drops the magic wand, the entire referral process looses all its miraculous powers. Communication is the essential key. Make it a priority to understand what each practice and each player needs to better serve your patients. 

“Training Wheels in Heels” Denise Price Thomas Trainer for Health Care Professionals Focusing on Exceptional Customer Service, Effective Communication & Exemplary Compassion 34+ year career in health care and certified in health care management Undercover Patient Providing Insight to Your Practice Through the “Eyes of a Patient” Conference Speaker Presenting also as “Gladys Friday”, Health Care Comedienne

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eveloping a strong referral network can be an important advantage for your practice and a source of new patient volume. What are the keys to getting a solid referral structure in place and maintaining strong relationships over time? Let’s examine a few key factors. Make sure you pick the right specialist. When you are building a referral network, you should to be selective in who you choose to partner with. Spend time getting to know their providers and staff. Develop a line of communication and make sure there is a similar vision and purpose in both of your practices. It’s easy to simply select some other practices that are convenient to partner with, but it takes real work and effort to pick practices that will be long-lasting and effective. In the mind of your patients, your referral network is an extension of you and your practice. What’s done well at the practices of your referrals will reflect positively on you. What’s done poorly there, will also reflect negatively on your practice. If your practice has a great communication flow with your patients, be sure that your partners follow a similar philosophy. Communicate and build your referral relationship. Setup a communication structure so that when you refer a patient, the receiving office gets all the information they need to serve the patient well. Develop follow-up procedures where the office you referred to provides regular updates back to your office on the status of a patient and how they’re responding to the treatment approach. If you receive referrals from other practices, send emails or hand-written thank you notes to the referring physician. It is also helpful to provide the patient with treatment materials upon discharge. When the patient returns to their original physician, you want them to be able to have a conversation about the treatment approach you used and how well it worked. The expectation of the patient is that the medical system treating them is talking to each other and sharing information. By providing this kind of communication flow between practices, you’ll create an environment that generates patient satisfaction and more referrals from your ‘specialist network’. Physician referrals are a significant basis of volume for many practices. Be sure that you get the right infrastructure in place to manage those relationships and over time they will provide even more benefit. 

48 | SEPTEMBER 2013




Managing Referrals in an Accountable Care System By Lisa P. Shock, MHS, PA-C President/CEO Utilization Solutions in Healthcare, Inc.

In the United States, about 66 million people live in rural areas or urban neighborhoods with too few primary care doctors or a shortage of primary care in clinics. Estimates indicate that 1 in 5 Americans lacks access to essential primary care and could develop more serious health problems as a result. Access to specialty care is equally challenging in these communities. Value based, population focused models of care delivery rely on proactive identification and management of the “highest risk” patients. These “sickest of the sick” patients need to be accurately attributed to physicians and care teams in order for these care teams to coordinate care across the entire continuum and systematically manage multiple chronic illnesses through use of a common care plan. This is the definition of true clinical integration and is a challenge in our current system. Referral management in such a system becomes increasingly important as we work to meet the triple aim goals of delivering the highest quality care at the most efficient cost with great patient satisfaction. The concepts of accountable care and shared savings 50 | SEPTEMBER 2013

imply a coordination of information that enables this success. Coordination and delivery of timely information are the greatest challenges in making the data “actionable” for providers and patients. Some estimate that Accountable Care Organizations could be responsible for managing the 40% of all office visits that are referrals from primary care to specialty practitioners. Referral systems ideally would include clinical guidelines to ensure that all “pre-work” and screening is done in the primary care setting prior to specialty referral when the care required for the patient exceeds the availability in the primary care office. Referral management systems must include reciprocal communication from primary care to the specialist, detailing the needs and clinical data for the patient, and back from the specialist to primary care, detailing the results of consultation and treatment. Coordination and communication regarding clinical outcomes will be critical to payment in the value based world. Future shared savings models will distribute funds based on adherence to clinical guidelines and

provider payments may be based on this adherence as well as meeting or exceeding quality targets. Meeting the goals of clinical integration will involve coordination and cooperation between specialists and primary care in a new paradigm.  References: articles/201204/aco-rule-has-bigimplications-for-it.php publications/healthreform/pdfs/howusing-care-management.pdf About the Author: Lisa P. Shock, MHS, PA-C, is a seasoned PA who has worked with clients to expand care teams in both large and small settings. She enjoys part time clinical primary care practice and is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering a wide range of services to help implement and improve upon the utilization of PAs and NPs in the health care system. Contact her at

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the arts

Physician Painter, Catherine O’Neill

By Jim Bisco University at Buffalo Reporter

While many people have a family album of cherished photos, Catherine O’Neill has a family canvas on which she has depicted several generations in brilliant watercolor detail. In the process, her work has been exhibited in dozens of juried art shows from New York to California, has won more than 30 awards and has appeared on the cover of a national magazine. An amazing feat for the internist at Buffalo General Hospital and clinical associate professor in the School of Medicine and Biomedical Sciences, who first picked up a brush a mere 12 years ago on the encouragement of her friend and babysitter at the time who taught beginner watercolor classes at a local arts center. “Working as a physician and the mother of four young children, I thought it would be a good chance for a weekly night out,” O’Neill says. “It turned out to be so much more.” Her goal was simple at first. There was a family gift exchange every Christmas and she—being a craft person— always liked to give something uniquely homemade. “When my paintings were coming out good enough that I thought I might be able to give them away, that really got me excited about it and I just barreled along from there,” she says. She painted from old family photographs at first, choosing subject matter to which she had great emotional 52 | SEPTEMBER 2013

ties. Familiar scenes of the central Adirondacks, for example, where she and her family had vacationed since childhood. As she gained confidence, she began painting people— the familiar figures of her grandparents sitting in their customary chairs on a typical late summer day in the Adirondacks. “The scene was so familiar to me, so filled with warm memories and tradition,” she recalls. “I completed the painting as a gift to my mother the summer after my grandmother died. Since then, I have continued to portray our family stories in my paintings.” The paintings came pouring out. Her father attempting to read the newspaper with twin nieces who had climbed onto his lap. An impromptu card game on the lawn with her children and their cousins. Young daughter Meg longingly looking outside with hands pressed against a glass door (which peered out from newsstands across the country last year on the cover of Watercolor magazine). Each of O’Neill’s paintings is distinguished by dramatic light and shadows, with rich detail noted in surroundings and figures—from individual blades of grass to the whites of young fingers pressed against a windowpane. She considers herself a very deliberate painter, beginning with careful planning before putting brush to paper. After

using existing photographs of family members, she began taking photos herself of scenes with canvas potential. O’Neill likes to paint scenes that tell a story. The detail greatly appeals to her in conveying that story. Averaging four to five paintings a year, O’Neill works in the attic of her home in Hamburg, usually going for a couple of weeks in a row amid work duties and household chores. She credits a unique job-share arrangement for allowing her to be a physician, parent and painter. After participating in the Internal Medicine Residency Program at UB in 1991, O’Neill engaged in a job-share partnership at Buffalo General Hospital proposed by fellow internist and UB clinical associate professor Janet Sundquist. The pair has now been splitting duties for the past 19 years, each having her own set of patients while providing clinical teaching. “I think it’s a great example for students to see an alternative to working full time,” O’Neill observes. “Sometimes, it seems overwhelming how you would practice medicine, have a family and try to do all the things that you would like to do and fit it all in. This has been an ideal situation for us. The hospital and university have been fantastic as far as support. “I feel we’re providing a service to the community and I really love the personal relationship I have with my patients. I also love working with the residents and I feel that teaching them what I know, how to cope with


“Working as a physician and the mother of four young children, I thought it would be a good chance for a weekly night out. It turned out to be so much more.”

difficulties and how to reap the rewards of being an internist is a real privilege.” As for her role as award-winning artist, O’Neill l is considering ramping up her efforts to gain wider interest. “I rarely sell my pieces. One of the first paintings I sold was entered into a show that required my piece to be for sale. I set it at a price that I didn’t think would sell and it did sell. It was a landscape and I was fine to part with it,” she says. “So I thought maybe I could at least meet my expenses. In order to do that, I have to put more time into painting things that I think would be more appropriate for the market, as opposed to these personal ones that would be hard to part with.”  Source: archive/2011_08_25/profile.html

healthy living

Crostini With Ricotta and Chestnut Honey By John Ash This recipe uses ciabatta or “slipper” bread which has a moist interior and a crisp crust. You can grill it as I’ve done here or use a grill pan on top of the stove. Choice of ricotta and honey are all important in this simple recipe. Look for whole milk ricotta from an artisan producer such as Bellwether Farms www. who make both cow and sheep’s milk versions. Chestnut honey from Italy is available in good food stores and on line. Ingredients The flavor is unique, not so sweet d a re b and with a very slightly bitter nt-style nother peasa a r o a tt a b but lovely aromatic aftertaste. 1 loaf of cia live oil Extra-virgin o half loves, cut in c ic rl a g m sh Fre heese at roo c a tt o c ri ilk m 2 cups whole re temperatu thin wedges to in t u c d n h, pitted a 1 large peac Preparation y e n o h t u n st e Prepare a m Ch edium-hot c ly ground sh e fr harcoal fire d n a lt set gas grill to Sea sa in a grill or m e r d e iu p m p -h e p ig k h c h la e b at. Cut brea 1/2”-thick cro d into sswise slices a n d brush genero olive oil. Grill usly with bread slices until both sid marks and sl es have grill ightly charre d crusts, 4–5 m inutes total. While hot, ru b bread with garlic. Spoo dollop of ric n a heaping otta on top of each toa with a peac st e d slice. Top h wedge, a drizzle of che and a bit of st nut honey salt and pep Serves 8 at least per.

54 | AUGUST 2013

John Ash

Many refer to Chef John Ash as the “Father of Wine Country Cuisine”. In 1980 he opened his namesake restaurant, John Ash & Company, in Santa Rosa, CA. He co-hosted a radio show for 26 years in Northern California. He also hosted two shows on the Food Network. John is an adjunct instructor at the Culinary Institute of America in the Napa Valley. In 2008 John was voted “Cooking School Teacher of the Year” by the International Association of Culinary Professionals. John is a champion of sustainable food issues, having served on the Board of the Chef’s Collaborative, as well the Board of Seafood Watch, an educational initiative of the Monterey Bay Aquarium. John has written 3 books: John Ash Cooking Oneon-One which won a 2005 James Beard award. He has authored two other books: From the Earth to the Table and American Game Cooking. The former was awarded the IACP Julia Child Cookbook of the Year. His new book: Culinary Birds will be published by Running Press Books in fall of 2013. John has consulted for Del Monte Foods, University of Massachusetts at Amherst, Brown Forman Corporation, Alaska Seafood Marketing Institute, Viking River Cruises, and more.

healthy living

Oven Roasted Turkey Burgers with Brussels Sprouts and Baked Sweet Potatoes

By Ashley Acornley, MS, RD, LDN

Servings: 4 servings

Ingredients: Vegetables:

1 lb. Brussels sprouts, trimmed 2 medium sweet potatoes, peeled and cut into Âź -inch thick wedges 1 tsp. extra virgin olive oil Sea salt and freshly ground black pepper


1 lb. lean ground turkey 4 ounces white button mushrooms, chopped ½ small yellow onion, minced 1 celery rib, mined 1 T finely chopped fresh parsley 1 T reduced sodium tamari 1 T chopped fresh rosemary 1 garlic close, finely chipped 1 tsp. extra virgin olive oil

Nutritional Facts: Per Serving - 1 burger, 1 cup vegetables calories 494 fat 21 g saturated fat 3 g cholesterol 84 mg fiber 7 g protein 27 g carbohydrate 34 g sodium 231 mg * *Adapted from The Blood Sugar Solution Cookbook, Mark Hyman Little Brown & C0 2013

Preparation: To make the vegetables

1. Preheat over to 400 degrees 2. Drizzle the Brussels sprouts and sweet potato wedges with olive oil and season with sea salt. Place in a roasting pan

To make the burgers

1. While the vegetable is roasting, in a medium bowl combine all of the burger ingredients (except the olive oil). Mix well until the vegetables are evenly distributed throughout the meat. 2. Form the mixture into four equal patties. Grease a baking sheet with the oil and place patties on the baking sheet. Roast burgers for 15 minutes, flipping them once halfway through the cooking (you can also grill the burgers for approximately 7-8 minutes on each side.) Serves: 4, Prep time: 10 minutes, Cook time: approx. 30 minutes 56 | SEPTEMBER 2013

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Oregon 3218 Pringle Rd. SE Ste. 270 Salem, OR 97302 (503)373-7721

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

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

Arkansas P.O. Box 627 Helena, AR 72342 (870)572-2847

Massachusetts 239 Causeway St. Boston, MA 02114 (617)727-5339

Rhode Island 3 Capitol Hill, Rm 104 Providence, RI 02908 (401)222-7883 page=DetailDeptAgency&eid=260

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

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

South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4665 Tennessee Heritage Place Metro Center 227 French Landing, Ste. 300 Nashville, TN 37243 (615)253-6061 Texas P.O. Box 149347 Austin, TX 78714 (512)834-6661 Vermont National Life Bldg N FL. 2 Montpelier, VT 05620 (802)828-2191 opticians/ Virginia 3600 W. Broad St. Richmond, VA 23230 (804)367-8500 Washington 300 SE Quince P.O. Box 47870 Olympia, WA 98504 (360)236-4947 aspx


U.S. DENTAL BOARDS Alabama Alabama Board of Dental Examiners 5346 Stadium Trace Pkwy., Ste. 112 Hoover, AL 35244 (205) 985-7267 Alaska P.O. Box 110806 Juneau, AK 99811-0806 (907)465-2542 Arizona 4205 N. 7th Ave. Suite 300 Phoenix, AZ 85103 (602)242-1492 Arkansas 101 E. Capitol Ave., Suite 111 Little Rock, AR 72201 (501)682-2085 California 2005 Evergreen Street, Suite 1550Â Sacramento, CA 95815 877-729-7789 Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7800 Connecticut 410 Capitol Ave. Hartford, CT 06134 (860)509-8000 Delaware Cannon Building, Suite 203 861 Solver Lake Blvd. Dover, DE 19904 (302)744-4500 Florida 4052 Bald Cypress Way Bin C-08 Tallahassee, FL 32399 (850)245-4474 58 | SEPTEMBER 2013

Georgia 237 Coliseum Drive Macon, GA 31217 (478)207-2440 Hawaii DCCA-PVL Att: Dental P.O. Box 3469 Honolulu, HI 96801 (808)586-3000 Idaho P.O. Box 83720 Boise, ID 83720 (208)334-2369 Illinois 320 W. Washington St. Springfield, IL 62786 (217)785-0820 Indiana 402 W. Washington St., Room W072 Indianapolis, IN 46204 (317)232-2980 Iowa 400 SW 8th St. Suite D Des Moines, IA 50309 (515)281-5157 Kansas 900 SW Jackson Room 564-S Topeka, KS 66612 (785)296-6400 Kentucky 312 Whittington Parkway, Suite 101 Louisville, KY 40222 (502)429-7280 Louisiana 365 Canal St., Suite 2680 New Orleans, LA 70130 (504)568-8574

Maine 143 State House Station 161 Capitol St. Augusta, ME 04333 (207)287-3333 Maryland 55 Wade Ave. Catonsville, Maryland 21228 (410)402-8500 Massachusetts 1000 Washington St., Suite 710 Boston, MA 02118 (617)727-1944 dentist/ Michigan P.O. Box 30664 Lansing, MI 48909 (517)241-2650,4601,7154-35299_28150_27529_27533---,00. html Minnesota 2829 University Ave., SE. Suite 450 Minneapolis, MN 55414 (612)617-2250 Mississippi 600 E. Amite St., Suite 100 Jackson, MS 39201 (601)944-9622 Missouri 3605 Missouri Blvd. P.O. Box 1367 Jefferson City, MO 65102 (573)751-0040 Montana P.O. Box 200113 Helena, MT 59620 (406)444-2511 boards/den_board/board_page.asp

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

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

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

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

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

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

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

Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)783-7162

New Mexico Toney Anaya Building 2550 Cerrillos Rd. Santa Fe, NM 87505 (505)476-4680

Rhode Island Dept. of Health Three Capitol Hill, Room 104 Providence, RI 02908 (401)222-2828

New York 89 Washington Ave. Albany, NY 12234 (518)474-3817

South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4599

North Carolina 507 Airport Blvd., Suite 105 Morrisville, NC 27560 (919)678-8223

South Dakota P.O. Box 1079 105. S. Euclid Ave. Suite C Pierre, SC 57501 (605)224-1282

North Dakota P.O. Box 7246 Bismark, ND 58507 (701)258-8600

Tennessee 227 French Landing, Suite 300 Nashville, TN 37243 (615)532-3202

Texas 333 Guadeloupe St. Suite 3-800 Austin, TX 78701 (512)463-6400 Utah 160 E. 300 South Salt Lake City, UT 84111 (801)530-6628 Vermont National Life Building North FL2 Montpelier, VT 05620 (802)828-1505 Virginia Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4538 Washington 310 Israel Rd. SE P.O. Box 47865 Olympia, WA 98504 (360)236-4700 West Virginia 1319 Robert C. Byrd Dr. P.O. Box 1447 Crab Orchard, WV 25827 1-877-914-8266 Wisconsin P.O. Box 8935 Madison, WI 53708 1(877)617-1565 aspx?Page=90c5523f-bab0-4a45-ab943d9f699d4eb5 Wyoming 1800 Carey Ave., 4th Floor Cheyenne, WY 82002 (307)777-6529 MEDMONTHLY.COM |59

U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (334)242-4116 Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 (480)551-2700 Arkansas 1401 West Capitol Ave., Suite 340 Little Rock, AR 72201 (501)296-1802 California 2005 Evergreen St., Suite 1200 Sacramento, CA 95815 (916)263-2382 Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7690 Connecticut 401 Capitol Ave. Hartford, CT 06134 (860)509-8000 Delaware Division of Professional Regulation Cannon Building 861 Silver Lake Blvd., Suite 203 Dover, DE 19904 (302)744-4500 District of Columbia 899 North Capitol St., NE Washington, DC 20002 (202)442-5955 60 | SEPTEMBER 2013

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

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

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

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

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

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

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

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

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

Michigan Bureau of Health Professions P.O. Box 30670 Lansing, MI 48909 (517)335-0918,4601,7154-35299_28150_27529_27541-58914-,00.html

Indiana 402 W. Washington St. #W072 Indianapolis, IN 46204 (317)233-0800 Iowa 400 SW 8th St., Suite C Des Moines, IA 50309 (515)281-6641 Kansas 800 SW Jackson, Lower Level, Suite A Topeka, KS 66612 (785)296-7413 Kentucky 310 Whittington Pkwy., Suite 1B Louisville, KY  40222 (502)429-7150

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

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

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

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

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

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

Oklahoma P.O. Box 18256 Oklahoma City, OK 73154 (405)962-1400

Vermont P.O. Box 70 Burlington, VT 05402 (802)657-4220

Oregon 1500 SW 1st Ave., Suite 620 Portland, OR 97201 (971)673-2700

Virginia Virginia Dept. of Health Professions Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4400

Pennsylvania P.O. Box 2649 Harrisburg, PA 17105  (717)787-8503 pt/community/state_board_of_medicine/12512 Rhode Island 3 Capitol Hill Providence, RI 02908 (401)222-5960 South Carolina P.O. Box 11289 Columbia, SC 29211 (803)896-4500 South Dakota 101 N. Main Ave. Suite 301 Sioux Falls, SD 57104 (605)367-7781 Tennessee 425 5th Ave. North Cordell Hull Bldg. 3rd Floor Nashville, TN 37243 (615)741-3111

Washington Public Health Systems Development Washington State Department of Health 101 Israel Rd. SE, MS 47890 Tumwater, WA 98501 (360)236-4085 West Virginia 101 Dee Dr., Suite 103 Charleston, WV 25311 (304)558-2921 Wisconsin P.O. Box 8935 Madison, WI 53708 (877)617-1565 asp?boardid=35&locid=0 Wyoming 320 W. 25th St., Suite 200 Cheyenne, WY 82002 (307)778-7053


medical resource guide ACCOUNTING

Ajishra Technology Support

Boyle CPA, PLLC 3716 National Drive, Suite 206 Raleigh, NC 27612 (919) 720-4970


PO Box 15130 Scottsdale, AZ 85267 (602)370-0303


Ring Ring LLC

6881 Maple Creek Blvd, Suite 100 West Bloomfield, MI 48322-4559 (248)819-6838

ANSWERING SERVICES Corridor Medical Answering Service

3088 Route 27, Suite 7 Kendall Park, NJ 08824 (866)447-5154

Docs on Hold

14849 West 95th St. Lenexa, KS 66285 (913)559-3666

BILLING & COLLECTION Advanced Physician Billing, LLC

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

62 | SEPTEMBER 2013

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

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

VIP Billing

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

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

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

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

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

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

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

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

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

COMPUTER, SOFTWARE American Medical Software

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 Management Club

4924 Balboa Blvd #460 Encino, CA 91316

The Dental Box Company, Inc.

Medical Credentialing

(800) 4-THRIVE

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

Medical Practice Listings

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


Brumbaugh Appraisals 8601 Six Forks Road, Suite 400, Raleigh, NC 27615 (919) 870-8258


Triangle Nutrition Therapy

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

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

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

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

DENTAL Biomet 3i


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

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

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


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

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

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

Integritas, Inc. 2600 Garden Rd. #112 Monterey, CA 93940 (800)458-2486 MEDMONTHLY.COM | 63

medical resource guide INSURANCE, MED. LIABILITY

Nicholas Down

Martin Fried

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

LOCUM TENENS Physician Solutions

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

Bank of America

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

MMA Medical Architects

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

Laura Maaske 262-308-1300

Marianne Mitchell (215)704-3188


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

Biosite, Inc

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

Deborah Brenner

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

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

Pia De Girolamo

64 | SEPTEMBER 2013

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

Robert Sayre Marketing Adviser/Business Coach


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

WhiteCoat Designs

Web, Print & Marketing Solutions for Doctors (919)714-9885

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

Medical Practice Listings

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


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

High Performance Network


Carolina Liquid Chemistries, Inc. Brian Allen




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


ALLPRO Imaging




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

medical resource guide



Greenbranch Publishing 800-933-3711


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

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


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

Sanofi US

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

Scynexis, Inc.


York Properties, Inc.

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

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

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

Gebauer Company

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


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



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


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

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

Subscribe to receive Med Monthly e-news Click here to join our e-news subscribers and get current medical news as it happens Visit us online anytime at MEDMONTHLY.COM | 65

classified listings

Classified To place a classified ad, call 919.747.9031

Physicians needed North Carolina 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: 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:

66| SEPTEMBER 2013

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, 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. Please contact Physician Solutions at 919-845-0054 or email us at 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. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: 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. 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. Call or email for more information. 919-845-0054 Clinic between Fayetteville and Wilmington seeks FP/ GP/IM Mar 22 FT ongoing. A small hospital’s outpatient clinic located within an hour of both Fayetteville and Wilmington seeks PA to work FT ongoing beginning March 22. Shifts can be either 8 or 12 hours. No call. email:

Classified To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.) 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. Physician Solutions, PH: (919) 845-0054, email: 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: Peds Clinic near Raleigh seeks Mid-Level Provider for on-going coverage 4x/wk. Health Department pediatrics clinic 45 min from Raleigh needs coverage 4 days a week from January through June. Provider will see about 20 patients daily, hours are 8am-5pm with an hour for lunch. Please contact Physician Solutions at 919-8450054 or Employee Health Clinic seeks Mid-Level Provider for FT on-going coverage near Charlotte. Health Department 45 minutes from Charlotte seeks on-going coverage for employee health clinic beginning in January. Provider will see about 20-24 patients daily, hours are 8am-5pm with an hour for lunch. Call or email for more information. 919-845-0054 FT Mid-Level Provider needed for Wilmington practice immediately. Small private practice 45 minutes outside Wilmington seeks mid-level provider starting January. M-F 8:00-5:00, PT or FT. This practice also is looking for a PA permanently in April. Accommodations, PLI, and mileage provided. Please contact Physician Solutions at 919-845-0054 or

Employee Health Clinic seeks Mid-Level Provider for FT on-going coverage near Charlotte. Health Department 45 minutes from Charlotte seeks on-going coverage for employee health clinic beginning in March. Provider will see about 20-24 patients daily, hours are 8am-5pm with an hour for lunch. Please contact Physician Solutions at 919-845-0054 or email us at FT/PT Mid-Level Provider needed for Wilmington practice immediately. Small internal medicine private practice 45 minutes outside Wilmington seeks mid-level provider starting immediately. FT/PT. M-F 8:00-5:00. Possible permanent placement. Please contact Physician Solutions at 919-845-0054 or email us at Western North Carolina Health Department needs continuing physician coverage. County Health Department seeks coverage for their walk in clinic which sees all ages. Ongoing, 8am-5pm, no call. 35-40 patients a day. Well established clinic located in a beautiful area. Please contact Physician Solutions at 919-845-0054 or Asheboro Family Practice and Urgent Care seeks GP for intermittent coverage. Family Practice and Urgent Care seeks general practitioner for intermittent days beginning in March from 8a-8p. Provider will see about 35 patients with no call. Please contact Physician Solutions at 919-845-0054 or email us at Greensboro occupational health care clinic seeksgeneral practitioner for intermittent shifts. Primary care physicians needed for occupational medicine. Adults only. Hours are 8am-5pm. Large corporation, no call required. Please contact Physician Solutions at 919-8450054 or IM/FP needed in Fayetteville health department immediately. Fayetteville health department needs coverage March through June full or part time. Clinics are adult health and women’s health. Adults only. No call 8a-5p. Please contact Physician Solutions at 919845-0054 or

continued on page 69 MEDMONTHLY.COM |67

PRIMARY CARE PRACTICE East of Raleigh, North Carolina We are offering a well established primary care practice only minutes east of Raleigh North Carolina. The retiring physician maintains a 5 day work week and has a solid base of patients that can easily be expanded. There are 6 fully equipped exam rooms, a large private doctor’s office, spacious business office, and patient friendly check in and out while the patient waiting room is generous overlooking manicured flowered grounds. This family practice is open Monday through Friday and treats 8 to a dozen patients per day. Currently operating on paper charts, there is no EMR in place. The Gross revenue is about $235,000 yearly. We are offering this practice for $130,000 which includes all the medical equipment and furniture. The building is free standing and can be leased or purchased. Contact Cara or Philip at 919-848-4202 to receive details and reasonable offers will be presented to the selling physician.

Medical Practice Listings Selling and buying made easy | | 919-848-4202

Woman’s Practice in 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

Physician Solutions has immediate opportunities for psychiatrists throughout NC. Top wages, professional liability insurance and accommodations provided. Call us today if you are available for a few days a month, on-going or for permanent placement. Please contact Physican Solutions at 919-845-0054 or For more information about Physician Solutions or to see all of our locums and permanent listings, please visit

classified listings


continued from page 67

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.) Geriatric physician needed immediately 2 to 5 days per week, on-going eastern NC. Nursing homes in Durham, Fayetteville and Rocky Mount seek GP/IM/ FP with geriatric experience to work full or part time. Nursing home focuses on therapy and nursing after patients are released from the hospital. 8a-5p, no call. Please contact Physician Solutions at 919-845-0054 or email Nursing home in Durham seeks PT/FT NP/PA for immediate ongoing scheduling. Durham nursing home seeks part time or full time mid-level for ongoing locums. Must have geriatric experience. 8-5p. Other facilities in Fayetteville and Rocky Mount. Please contact Physician Solutions at 919-845-0054 or email us at COLUMBUS IM FT/PT Mid-Level Provider needed for practice near Wilmington. Small internal medicine private practice 45 minutes outside Wilmington seeks mid-level provider starting immediately. FT/PT. M-F 8-5p. Possible permanent placement. Please contact Physician Solutions at 919-845-0054 or email Fayetteville occupational health care clinic seeks GP for May 5-9. Primary care physicians needed for occupational medicine. Adults only. 8-5p. Large corporation, no call required. Intermittent dates in the future and second office in Greensboro with ongoing scheduling. Please contact Physician Solutions at 919-845-0054 or email Health Dept 45 min NE of Raleigh seeks MD coverage Tues/Thurs ongoing May 14. GP/FP/IM/Peds doctor needed for the following clinics in Louisburg: Adult, Family Planning, Peds, STD for ongoing scheduling or intermittent shifts. 8-5p.Please contact Physician Solutions at 919-845-0054 or email us at Community Health Dept in Washington, NC (1 h 45 min E of Raleigh) seeks FP for coverage June 15 FT/PT ongoing. Family practitioner sought for eastern Carolina community health center in Washington, NC. Must see all ages, 8-5p. Start June 15 ongoing. Please contact Physician Solutions at 919-845-0054 or email

Nursing home in Durham seeks PT/FT Geriatrics doctor for immediate ongoing scheduling. Durham nursing home seeks part time or full time MD for ongoing locums. Must have geriatric experience. 8-5p. Other facilities in Fayetteville and Rocky Mount. Please contact Physician Solutions at 919-845-0054 or email Family Practice 1 h SE of Raleigh seeks July 6-7 coverage. Goldsboro FP seeks MD for July 6-7 and intermittent shifts. 8-5p. Please contact Physician Solutions at 919-845-0054 or email Pediatric clinic near Greensboro needs 10 weeks of 3 day a week coverage beginning June 1. Burlington pediatric clinic seeks coverage June 1 3 days a week for 10 weeks. 8-5p. Please contact Physician Solutions at 919-845-0054 or email Greenville Clinic seeks GP May 20-22. GP/IM needed for May 20-22 and intermittent shifts. Must have experience or be willing to do pain management and trigger point injections. 8-5p. Please contact Physician Solutions at 919-845-0054 or email Raleigh practice seeks BC FP for permanent placement in new facility summer 2013. Board Certified Family Practitioner sought for FT permanent placement in new clinic in Raleigh to start summer of 2013. Please contact Physician Solutions at 919-845-0054 or email Clinic between Fayetteville and Wilmington seeks FP/ GP/IM Mar 22 FT ongoing . A small hospital’s outpatient clinic located within an hour of both Fayetteville and Wilmington seeks PA to work FT ongoing beginning March 22. Shifts can be either 8 or 12 hours. No call. Please contact Physician Solutions at 919-845-0054 or email Western North Carolina Health Department needs continuing physician coverage. County Health Department seeks coverage for their walk in clinic which sees all ages. Ongoing, 8am-5pm, no call. 35-40 patients a day. Well established clinic located in a beautiful area. Please contact Physician Solutions at 919-845-0054 or email

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classified listings


continued from page 69

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.) IM/FP/Peds needed in Fayetteville health department immediately. Fayetteville health department needs immediate coverage for the following clinics: adult health, women’s health and STD. No call 8a-5p. Please contact Physician Solutions at 919-845-0054 or email Pediatrician Needed MD June-Aug, Burlington NC 3x week for 10 wks starting June 1st, 8-5 Mon-Fri Burlington, NC: located 1 hour west of Raleigh. Please contact Physician Solutions at 919-845-0054 or email Pediatrician, IM & FP needed, Fayetteville NC Urgent Need for immediate MDs - Pediatrics, Family Practice or Internal Medicine - PT/FT, 8-5 Mon-Fri. Ongoing. Please contact Physician Solutions at 919-845-0054 or email Locum & Permanent MD Needed , Kinston NC Urgent Need for immediate MD placement, 8-5 MonFri. Must be able to do family planning & light maternity, Kinston, NC: 1.5 hours outside Raleigh. Please contact Physician Solutions at 919-845-0054 or email PT MD needed for Occupational practice, Greensboro NC. Urgent need for PT MD to do disability physicals 2-3 days weekly, 8-5, on-going scheduling. Greensboro, NC. Please contact Physician Solutions at 919-845-0054 or email Permanent Family Practice doctor needed for Summer 2013, Raleigh, NC Need FP/BC MD for June-Sept MonFri , 8-5, New Facility in downtown Raleigh, NC. Please contact Physician Solutions at 919-845-0054 or email Permanent PA or MD needed in Goldsboro, NC On-going permanent position Mon- Fri 8-5, Goldsboro, NC: 1 hour 10 minutes outside Raleigh. Please contact Physician Solutions at 919-845-0054 or email Family Practice MD needed 2-3x/w in July, Goldsboro July 6 & 7 and intermittent dates, 8-5p,Goldsboro, NC 1h SE of Raleigh. Please contact Physician Solutions at 919-845-0054 or email 70| SEPTEMBER 2013

FULL TIME MD needed for Family Practice in Washington, N.C. Family Practitioner needed for FT MD June 15-Sept 1 on-going Mon- Fri 8-5, Washington, NC, 1 hour 45 minutes outside Raleigh. Please contact Physician Solutions at 919-845-0054 or email Geriatric Experienced Mid Level or MD, Durham NC Must have geriatric experience, PT/FT, Locations in Durham, Rocky Mount & Fayetteville, NC. Please contact Physician Solutions at 919-845-0054 or email MD needed for June 6 & intermittent dates, Charlotte N.C. June 6 & Intermittent weekdays, 8-5 in Charlotte, NC. Please contact Physician Solutions at 919-845-0054 or email Family Practitioner opportunity available one hour east of Charlotte Monday through Friday. The hours will be 8:00am until 5:00pm either full time or part time. The start date is October 1st and will be ongoing for at least 6 months. You will be seeing 15-20 new patients a day. Please contact Physician Solutions at 919-8450054 or email Immediate opportunity for a Primary Care Physician at a large practice located one hour south of Raleigh. The hours are from 8:00am until 5:00pm You will be treating generally 20-25 patients per day. Please contact Physician Solutions at 919-845-0054 or email Family MD opportunity at an Urgent Care facility that sees all ages in the Jacksonville, NC area. This will be an ongoing schedule from 8:00am until 6:00pm 1-2 days a week, including weekend dates. You will treating generally 30-35 patients a day. There is potential for permanent placement. Please contact Physician Solutions at 919-845-0054 or email Primary care physician opportunity for busy occupational medicine practices near Greensboro/Fayetteville, NC. There are two locations with positions available within 15 minutes of Greensboro and Fayettteville. Your schedule will be from 8:00am until 5:00 pm either full time or part time, no call necessary. Patient treatment will consist of adults only in both facilities. Please contact Physician Solutions at 919-845-0054 or email

continued on page 72

classified listings


continued from page 70

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.) Family Physician opportunity for a leading medical practice in the Raleigh area. Must be able to start immediately and be comfortable with seeing all ages. Please contact Physician Solutions at 919-845-0054 or email General Practitioner/ Internal Medicine/ Family Physician opportunity available at a large substance abuse treatment facilitiy in Western 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. Please contact Physician Solutions at 919-845-0054 or email Primary Care Physician opportunity for a leading women’s practice in the Lenoir, NC area. Treating Physician must be comfortable with light OB and well women’s exams. Please contact Physician Solutions at 919-845-0054 or email General Practitioner/Internal Medicine Physician opportunity for intermittent shifts at a prominent practice in the Greenville, NC area. Treament schedule will be from 8:00am until 5:00pm. The practicing physician must have experience or be willing to perform pain management and trigger point injections. Please contact Physician Solutions at 919-845-0054 or email Exceptional Family Physician opportunity at a practice in the Raleigh, NC area. Schedule will be ongoing Monday through Friday from 8:00am until 5:00pm. Must be comfortable with treating all ages. Please contact Physician Solutions at 919-845-0054 or email Immediate Pediatrician opportunity at a small outpatient hospital. Located between Fayetteville and Wilmington, this facility requires someone for intermittent shifts. Please contact Physician Solutions at 919845-0054 or email

72| SEPTEMBER 2013

Pediatrics Opportunity - Roanoke Rapids Area Northeastern North Carolina Pediatric Practice seeks on-going physician for full time coverage beginning mid-October through the end of the year. Practice sees about 16-25 patients a day, hours are 8:00-5:00 with negotiable call. Please contact Physician Solutions at 919-845-0054 or email Family Practitioner Opportunity - Greenville area Immediate opportunity for a family practitioner for a practice about 20 miles east of Greenville. The hours will be 8:00am until 5:00pm. Must see all ages. Please contact Physician Solutions at 919-845-0054 or email Primary Care Physician - Washington area Seeking a physician for a general primary care practice. Treatment will include seeing 3-4 pediatric and about 10 adult patients per day. The hours are 8:00- 5:00pm M-F. Please contact Physician Solutions at 919-845-0054 or email Family Physician –Williamston area Immediate opportunity at a developing family practice in the Williamston area. You will be treating 8-16 patients per day from 8:00-5:00 pm. Please contact Physician Solutions at 919-845-0054 or email County Health Department near Charlotte seeks FT Family Practitioner October 1- ongoing. FP needed Monday- Friday (or part- time) 8-5pm at a county health department one hour east of Charlotte. Start date is October 1st ongoing for at least 6 months. 15-20 new patients a day. Basic Primary Care. Please contact Physician Solutions at 919-845-0054 or email

Physicians needed South Carolina A family and urgent care in Little River, SC seeks an FP/EM physician for 1 to 2 days per week, on-going shifts. The practice is a one-physician facility and is looking for a physician to come in regularly. The practice is small and does not have a large patient load. The qualified physician will have experience in Family or Emergency medicine. If you have any availability and a SC medical license contact us today and we will do our best to work around your schedule. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: continued on page 74

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

Practice for Sale in South Denver

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.

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

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

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

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

classified listings


continued from page 72

To place a classified ad, call 919.747.9031

Physicians needed Virginia (cont.) 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: 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:

Charlotte Occupational clinic seeks NP in March for ongoing coverage. Nurse practitioner needed in employee health clinic for large corporation in Charlotte. 8a-5p ongoing full time or part time. Please contact Physician Solutions at 919-845-0054 or 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.

Virginia practice outside of Washington DC seeks IM doctor FT/PT now – June 1. IM physician needed immediately FT/PT for Virginia clinic near Washington DC. 8-5p Please contact Physician Solutions at 919-845-0054 or email

Practice for sale

Nurse Practitioners needed

Primary Care Practice Only Minutes East of Raleigh North Carolina. The retiring physician maintains a 5 day work week and has a solid base of patients that can easily be expanded. There are 6 fully equipped exam rooms, a large private doctor’s office, spacious business office, and patient friendly check in and out while the patient waiting room is generous overlooking manicured flowered grounds. This family practice is open Monday through Friday and treats 8 to a dozen patients per day. The Gross revenue is about $235,000 yearly. Contact Cara or Philip at 919 848 4202 or email: to receive details.

North Carolina Permanent NP needed in Goldsboro, NC On-going permanent position Mon- Fri 8-5 Goldsboro, NC: 1hour 10 minutes outside Raleigh. Please contact Physician Solutions at 919-845-0054 or email Charlotte Occupational clinic seeks NP in March for ongoing coverage. Nurse practitioner needed in employee health clinic for large corporation in Charlotte. 8a-5p ongoing full time or part time. Please contact Physician Solutions at 919-845-0054 or email Permanent NP needed in Goldsboro, NC On-going permanent position Mon- Fri 8-5 Goldsboro, NC: 1hour 10 minutes outside Raleigh. Please contact Physician Solutions at 919-845-0054 or email 74 | SEPTEMBER 2013

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:

Classified To place a classified ad, call 919.747.9031

Practice for sale North Carolina (cont.) 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: 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 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

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. 



or family medicine doctor needed in


Comfortable seeing children. Needed immediately.

Call 919- 845-0054 or email:

Primary Care Practice For Sale Wilmington, NC

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

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

Contact Medical Practice Listings for more information.

Contact Medical Practice Listings today to discuss the practice details.

Medical Practice Listings 919.848.4202 |

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

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

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

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

• • • • • •

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

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

Primary Care Practice for Sale 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.

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

Call 919-848-4202 or email

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

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:



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.


Are you educated in the medical and health care field and looking to showcase your exceptional writing skills?

To become a contributing writer in Med Monthly magazine, contact MedMedia9 at Call 919- 845-0054 or email: 78 | SEPTEMBER 2013

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Editorial Calendar: Oct. 2013 - Medical Research l Nov. 2013 - County Health Departments

Internal Medicine Practice for Sale

Pediatrics Practice Wanted Pediatrics practice wanted in NC

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

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.

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

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

Call 919-848-4202 or email

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

American Council on Exercise


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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ADVERTISE YOUR PRACTICE BUILDING IN MED MONTHLY By placing a professional ad in Med Monthly, you're spending smart money and directing your marketing efforts toward qualified clients. Contact one of our advertising agents and find out how inexpensive yet powerful your ad in Med Monthly can be. | 919.747.9031

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.


OCCUPATIONAL HEALTH CARE PRACTICE FOR SALE Greensboro, North Carolina Well-established practice serving the Greensboro and High Point areas for over 15 years. Five exam rooms 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.

Asking price: $385,000

To view more listings visit us online at

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.

List Price: $75,000 | Gross Yearly Income: $310,000

Medical Practice Listings Buying and selling made easy

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

Call 919-848-4202 or e-mail

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

Medical Practice Listings Selling and buying made easy | | 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

Please direct all correspondence to Only serious, qualified inquirers.

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

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

the top

Medic For Pro

There are numerous medical apps for iPhones, iPads, and android smartphones which fall into many categories of medical applications. Here are the top 9 apps for medical professionals.



The free Medscape app is one of the most downloaded medical applications from Apple’s app store. Useful for medical professionals, students and nursing, Medscape can be used to receive news from 34 fields. Articles can be saved, emailed and shared across social media. Also offering a clinical reference section, the app includes safety guidelines on drugs, videos that show various procedures, and educational activities for students. id321367289?mt=8



4 5

Designed specifically for the iPad and iPad mini, the Epocrates app features tabbed monograph views, enhanced pill identification displays, and more convenient search tools. 50% of doctors are currently using this medical application and, along with Medscape, they are the two most popular medical apps. The app is free.


This free app is the mobile version of Micromedex’s drug library. It includes the same search information, including dosage, toxicology and therapeutic class. And now Micromedex 2.0 has been revamped to make finding evidencebased drug information and clinical answers much faster and easier.

The ePSS app was developed by the U.S. Department of Health and Human services. Research conducted by the department over health care quality, costs, outcomes and patient safety has been used to assist primary care providers to recommend the best course of action based on a patient’s characteristics -- including age, sex and behavioral risk factors.


One of the big three apps, along with Epocrates and Medscape, Skyscape is used by medical professionals and students worldwide. The free app includes drug information, a medical search, medical calculators and data ranging over 800 separate topics. Also included for free is MedAlert - a speciality-focused tool with journal articles, clinical news, drug alerts and links. id293170168?mt=8



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Developed in collaboration with Stanford’s school of medicine, the app offers a 3D look inside the human body. 360 degree rotation, movement animations, name pronunciation and activities are part and parcel of this popular app. Connective tissues can be viewed through a scalpel tool, zooming and tap functions bring up additional information about different body parts. The app costs $14.99.

cal Applications ofessionals



A handy app for researching muscle trigger points -- tight places in the muscle which cause pain. Over 100 trigger points can be referenced in the application for over 70 muscles. Once you find a trigger point through a specific muscle or zone search, recommendations and notes pop up on screen. The app costs $2.99, and may be useful not only for those in the medical field but people in sports. real.bodywork.muscle.trigger.points&hl=en



Predecessor of the Inkling. com books, this website deals with eBooks of various medical subjects, including leukemia, diabetes, hematology, dermatology, etc. Download to your iPhone and read when you have time. Also can get free CME credit.



This useful app provides multiple images of different disease variations and strains. When it comes down to visual conditions, it can be useful for the mobile dermatologist to speed up the diagnosis process. Although the app is free and has received good reviews, like many professional resources it does require a subscription.

By Thomas Hibbard Creative Director, Med Monthly


Med Monthly September 2013  

The Magic of Referrals issue of Med Monthly magazine.

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