Med Monthly SEPTEMBER 2012
STAGING YOUR PRACTICE FOR SUCCESS
ST. ELIZABETH HOSPITAL s l a t i p hos Goes “Lean” to Provide issue
Exceptional Patient Care
Then and Now
Ways to Improve the Patient Experience at Hospitals P. 34
HOW HOSPITALS AND DOCTORS CAN WORK TOGETHER FOR COST-EFFECTIVE CARE
contents features 34 10 WAYS TO IMPROVE THE PATIENT EXPERIENCE AT HOSPITALS 36 PRESSURES
How Hospitals and Doctors Can Work Together for Cost-Effective Care
40 HOSPITAL HOSPITALITY: THEN AND NOW 44 ST. ELIZABETH HOSPITAL GOES "LEAN" A hospital transformed for productivity & efficiency
insight 10 WHAT'S IN YOUR HOSPITAL LOBBY
Artist Feature: Zen Chuang, M.D Down the Wandering Road
research and technology 16 BRISTOL-MYERS SQUIBB FOUNDATION Awards $1.6M in grants to help communities in India address type 2 diabetes
practice tips 18 HEALTH IT
The Bad Witch or the Good Witch
Best Practices for PHI Data Security and Selecting the Right Cloud Computing Provider
12 TRAVELING NURSES
20 REDESIGNED PRIMARY CARE & READMISSIONS
Fly in to a Hospital Near You
14 AN ARTISTIC INTRODUCTION Laura Maaske, Medical Illustrator
How Hospitals and Doctors Can Work Together for Cost-Effective Care
22 BENEFITS AND DRAWBACKS Managing a Private-Owned Practice v. Managing a Hospital-Owned Practice
legal 26 JCI RELEASES NEW STANDARDS 28 HOSPITALS AND THE AFFORDABLE CARE ACT 31 NLRB NIXES WORKPLACE INVESTIGATIONS
the kitchen 32 WILD RICE & CARROTS
the arts 48 DOWN THE WANDERING ROAD
in every issue 4 editorâ€™s letter 8 news briefs
56 resource guide 78 top 9 list
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editor’s letter Greetings Medical Professionals! I am elated to be heading a brand new team here at Med Monthly. I join the staff having just relocated to Raleigh, North Carolina, from Miami, Florida. I bring with me a diverse background in “everything media”. Though my career began working for a local, Miami-based advertising agency, after 5 years I found myself craving to learn more about media. And so I began my journey through the land of communication. I chose radio first primarily due to its social nature then moved on to television. My focus was primarily in sales but I was involved in many aspects of my clients’ marketing campaigns. After 8 years, I felt an undeniable force pulling at me… it was my wicked creative streak. It moved me in the very new direction of computer graphics. I returned to school to explore this new horizon while working with an internet service provider. The Internet was just a baby and this position was paramount, affording me the rewarding opportunity to be well educated about the World Wide Web. Plus I was able to create a new revenue stream for the ISP, web design. And now, merging and molding all of my amassed skills, I am getting my feet wet in yet another media “arena”…an online magazine. Here and now, I accept this stimulating new task to transform and emerge – I rise up to accept the challenge of the Editor of Med Monthly Magazine. As I work towards the completion of my first issue with Tom (our new Creative Director), there are many pioneering goals for Med Monthly that I hope you will all assist me in achieving: – TO apprise you, the ever growing audience of Med Monthly, of what’s new in medical technology, – TO captivate you with interesting content related to the healthcare field and, – TO provoke you to shift, renew, revamp, rework or modify your thinking, your practice, your process and your world… "The important thing is this: to be ready at any moment to sacrifice what you are for what you could become." - Charles Dickens
Monica Menezes Irwin Managing Editor 4 |SEPTEMBER 2012
Med Monthly September 2012 Publisher Philip Driver Managing Editor Monica Menezes Irwin Creative Director Thomas Hibbard Contributors Ashley Acornley, MS, RD, LDN Stephanie Baum David C. Daisher, Construction Accounts Director, Transmotion Medical Lawrence Earl, MD, Medical Director, National Academy of DOT Medical Examiners (NADME) Saul Ewing, LLP Stella Fitzgibbons, MD, FACP Doug Hass, PA Bethany Houston Laura Masske Denise Price Thomas John B. Reiss, Ph.D., J.D. Frank J. Rosello, CEO Environmental Intelligence LL Lisa P. Shock, MHS, PA-C Mary Pat Whaley, FACMPE Med Monthly is a national monthly magazine committed to providing insights about the health care profession, current events, what’s working and what’s not in the health care industry, as well as practical advice for physicians and practices. We are currently accepting articles to be considered for publication. For more information on writing for Med Monthly, check out our writer’s guidelines at medmonthly.com/writers-guidelines P.O. Box 99488 Raleigh, NC 27624 email@example.com Online 24/7 at medmonthly.com
contributors David Daisher is the Construction Accounts Director for TransMotion Medical, a leading U.S. manufacturer of mobile, motorized Stretcher-Chairs that feature power drive and power positioning. He works exclusively with architects & equipment planners. He is a certified Six Sigma Black Belt and has extensive experience in LEAN process improvements.
Stella Fitzgibbons, MD, FACP is board-certified in internal medicine, with experience in both primary care and hospital medicine (and a one-year emergency medicine program where she learned a lot but didn't make much money). She currently spends most of her time as a hospitalist, along with volunteering for a clinic for the uninsured and reviewing cases for malpractice attorneys.
Laura Maaske is a medical illustrator with a Master's of Science degree in Biomedical Visualization from the University of Toronto. She launched Medimagery in 1997, specializing in the creation of patient education materials, interactive media, e-books, cellular and molecular illustrations, and design of medical education materials. For more information, please visit Medimagery.com, send a note to Laura@medimagery.com or call 262.308.1300.
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.denisepricethomas.com.
Mary Pat Whaley, FACMPE is board certified in health care management and a Fellow in the American College of Medical Practice Executives. She has worked in health care and health care management for 25 years. She can be contacted at firstname.lastname@example.org. MEDMONTHLY.COM |5
From the Drawing Board I am honored to be the new creative director at Med Monthly and am excited with this, my first issue. I am passionate about graphic design – have been since a youth. I have a two-year degree in commercial art and a BFA in graphic design. I worked at North Carolina State University in the College of Agriculture and Life Sciences, and for an automotive aftermarket trade association. So, I have illustrated and created graphic designs for everything from cockroaches to carburetors, and from tulip bulbs to transmissions! I’ve transitioned from designing only print publications to the digital age of Internet graphics and the Cloud. And I’ve enjoyed every minute of the journey, thus far! New graphic software is released almost daily, and I enthusiastically research what new applications may be available to include in my constantly expanding design toolbox. I search the web frequently, seeking new information that will assist my designing capabilities. It’s the life of a creative director. At Med Monthly, I'm enjoying the ability to apply my creative skills in the areas of medicine and healthcare. I am learning that these fields, much like graphic design, are constantly changing and evolving, generating new information to be shared quickly within the medical community. Med Monthly, with its digital format, strives to be that valuable tool for the healthcare professional – your resource to exchanging key information within the medical community. I look forward to the topics we will be addressing in the coming months and to hearing about your new ideas for content as well as design elements that will make Med Monthly a visually pleasing publication, (I wouldn’t be doing my job if it wasn’t), but also one that you look forward to reading every month!
Thomas Hibbard Creative Director
6 | SEPTEMBER 2012
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Health and Human Services Grants to Help Veterans get jobs as Physician Assistants Health and Human Services (HHS) Secretary Kathleen Sebelius today announced $2.3 million in grants to train primary care physician assistants (PAs) and help veterans transition from the military to civilian PA careers when they return home. Funded under the Physician Assistant Training in Primary Care Program, the 5-year grants aim to increase the number of physician assistant graduates who become primary care clinicians and teachers. Funding priority was given to grantees that have strong recruitment, retention and education programs for veteran applicants and students, including academic recognition of medical training and experience gained during military service. Administered by the Health Resources and Services Administration (HRSA) at HHS, the grants are part of the administration’s initiative to increase the supply of primary care practitioners in the United States. “If you can save a life on the battlefield in Afghanistan, you can save a life here at home,” said Secretary Sebelius. “These grants will help ensure veterans who served our country can use their military medical training and get good jobs serving patients.” The grants, awarded to 12 institutions, support educational programs that train PAs to practice in primary care settings, and help individuals who will teach primary care in PA training programs, preparing trainees to enter practice in primary care settings. Source: http://www.hhs.gov/news/ press/2012pres/08/20120802a.html 8 | SEPTEMBER 2012
Medicare Payments to Acute Care Hospitals Jump 2.3 Percent General acute care hospitals will see Medicare payment rates rise 2.3 percent in fiscal year 2013, after allowing for other payment and regulatory changes, thanks to the final rule issued yesterday (August 3, 2012) by the Centers for Medicare & Medicaid Services (CMS). That's a big jump from the 0.9 percent the agency proposed in April. Under the final rule for the 2013 Inpatient Prospective Payment System and the Long-Term Care Hospital Prospective Payment System, CMS expects total Medicare spending on inpatient hospital services will increase by about $2 billion in 2013. Meanwhile, long-term acute care hospitals will see a 1.7 percent bump in Medicare payments with the new rule. Provider groups already have praised the updated payment rates. For instance, the American Hospital Association "commends CMS" for its actions. "Although we remain concerned that CMS continues to implement unnecessary coding cuts for changes in 2008 and 2009, we are pleased that CMS changed course on the new 2010 proposal that would have challenged hospitals' mission of caring," AHA President and CEO Rich Umbdenstock said yesterday in a statement. With the final rule, CMS added a new outcome measure to the value-based purchasing program set to begin in October, now rewarding hospitals for avoiding central line-associated bloodstream infections. The rule also determined the methodology of the Hospital Readmissions Reduction Program, which will penalize hospitals for high readmissions for heart attack, heart failure and pneumonia starting in October. Hospitals should expect a 0.3 percent drop (about $280 million) in Medicare payments due to the readmissions program, according to CMS. In a string of rate increases, CMS last week gave skilled nursing facilities a 1.8 percent Medicare payment bump for fiscal 2013. Source: Fierce Healthcare, http://www.fiercehealthcare.com/story/medicarepayments-acute-care-hospitals-jump-23/2012-08-03
SOON G N I M CO NTHLY O M D E IN M g
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Provider-Payer ACO Cuts Readmissions by 26 Percent Advocate Health Care and Blue Cross Blue Shield of Illinois cite better outcomes with transition coaches The provider-payer accountable care organization between Illinois' largest hospital system, Advocate Health Care, and Blue Cross Blue Shield of Illinois is showing strong first-year results with lower readmission rates, suggesting improved patient care, the Chicago Sun-Times reported. AdvocateCare, the largest commercial ACO with 380,000 members, saw readmission rates for chronic conditions drop 26 percent, thanks to transition coaches. Meanwhile, ACO patients sent to nursing facilities had a 13.6 percent readmission rate during the first year of operation, falling below the 20 percent national average, noted the Sun-Times. Our keen focus on care coordination, prevention, early detection and education is ensuring our patients receive the right care, at the right time and at the right place," Advocate Health Care system Executive Vice President and Chief Medical Officer, Lee Sacks, told the newspaper. After only six months of data, AdvocateCare declared success. During the first half of 2011, the ACO led to a 10.6 percent drop in hospital admissions per member, compared to 2010, and a 5.4 percent decline in emergency department visits, FierceHealthcare previously reported. But not everyone is sold on the new delivery model, as critics note the difficulty to meet all four goals of high quality, affordability, accessibility and universal coverage, the Sun-Times noted. Nevertheless, Advocate continues to embrace accountable care, with one of its physician groups among the 89 new additions to the Medicare Shared Saving Program announced last month, noted the Chicago Tribune. Source: Fierce Healthcare, http://www.fiercehealthcare.com/story/provider-payeraco-cuts-readmissions-26/2012-08-08
FTC Won't Challenge Effort to Fight Drug Shortages The Federal Trade Commission will not recommend a challenge to a Generic Pharmaceuticals Association (GPhA) plan to assist the Food and Drug Administration as it tries to reduce drug shortages. Though the effort, known as the “Accelerated Recovery Initiative”, would have the GPhA collect competitively sensitive data that would raise antitrust concerns if it were shared with competitors, the proposed program's safeguards would prevent such sharing from occurring, according to a news release from the FTC. “Today's opinion is a critical step forward in addressing the shortages of needed medicines in our country,” said Ralph Neas, president and CEO of GPhA, in a news release. “We now look forward to continuing to work closely with our partners at the FDA and IMS Health to advance this important initiative,” he said. The GPhA introduced the plan in December as a response to substantial drug shortages that are leading to high prices for certain drugs and attracting the attention of Congress. IMS Health, a provider of healthcare information technology and services including data-mining, is assisting the group with the program. Source: Modern Healthcare, http://www.modernhealthcare.com/article/20120808/ NEWS/308089963/ftc-wontchallenge-effort-to-fight-drugshortages MEDMONTHLY.COM |9
What’s In YOUR Hospital Lobby… The Bad Witch or
The Good Witch?
By Denise Price Thomas 10 | SEPTEMBER 2012
“Mr. Price, front desk, Mr. Price!”, those words traveled loudly throughout the large, very cold and scary hospital lobby. There we were, in a place we had never been before. My daddy, a retired cost accountant, sitting beside his favorite “baby” daughter “ (me), a surgical practice administrator and my mother, waiting patiently and lovingly by his side. As daddy and I walked up to that desk, it felt as though we were about to face “The Wizard of Oz”, and I knew we “weren’t in Kansas anymore.” Almost shaking in my shoes, I was afraid for us to take the next step. His diagnosis, Multiple Myeloma, the reason we were sent to this unfamiliar place. We informed the person behind the desk, who appeared to be the bad witch, that he was indeed Mr. Price. “I need your wrist,” she said, while attaching a wristband, “You will not be called by your name. You see these last three digits, #325? They will call you by that instead. When they call that number, you will walk down that hallway and there will be someone there to get you. Any questions?” Oh no, we would certainly be afraid to ask questions. Daddy said, “No mam, but thank you.” I, on the other hand, wanted to climb over the desk and tell her who my daddy was. He is NOT #325 but a wonderful daddy,
a terrific husband to my mother, the finest example of a human being each and every day of his life. He is my daddy! Respecting daddy’s wishes, I sat down beside him and we waited. I couldn’t help but wonder which character we may meet next on this uncertain pathway. Could it be… • The Scarecrow, who will not allow the brain to connect with it’s heart? • The Tin Man, who will be lacking a heart? • The Lion, who will hopefully have found the courage to have a heart? “Number 325”--oh no, here we go. His “number” was finally called. Now we were able to follow the yellow brick road and go behind the curtain. The person standing there to greet us was obviously “The GOOD Witch!” With a sincere smile on her face, her heart seemed filled with compassion as she began to hear daddy’s story. She listened as we explained his symptoms and it was obvious that she cared. We could tell through her eyes that she had a heart and a brain along with the courage to connect with her patients and family members. She kept the CARE in healthcare. We were so grateful. Even when the news is bad and the outcome unfortunate as it was with
daddy, when we were surrounded by those who cared, those who held our hand, who listened and who understood our tears and even joined us through them, that was when we felt, “There’s no place like home.” No matter the location, it’s the way in which we were made to feel while we were around those caring people. We couldn’t measure the clinical expertise of each person that entered the room but what we could measure and still remember are those who held our hand; the ones that offered hugs and listened with a caring heart. With my 34 years experience in healthcare, I learned so much more about healthcare from the other side. I learned that the things that cost the least really mean the most and are remembered forever. While sitting in that lobby on that day, I promised daddy that I would do everything I could to make a positive difference so that people would better understand the feelings of the patients from the other side of healthcare. Every patient is someone’s family. When you find yourself there, it is very clear to see that compassion is the “number one” method of preferred treatment in healthcare and should always be the first ingredient.
First impressions set the stage.
I.M.A.G.E. – a Imagine a Mastering a All a Great a Experiences
Hospitals and healthcare facilities are filled with compassionate people. It’s important they be the first impression. In addition to an aesthetically pleasing lobby, offer your staff a facelift, a contagious smile. Smiles are free and no one is immune. MEDMONTHLY.COM |11
Traveling Nurses Fly in to a Hospital Near You
By Monica Menezes Irwin, Managing Editor
ursing shortages, underpaid nurses or labor unrest, whatever the reason, the traveling nurse (TN) grew to become one of the fastest growing segments of the nursing industry. From one hospital to another, these “temporary” nurses really got around. Its win-win scenario for both hospitals, who were experiencing difficulty in recruiting and hiring permanent staff, and for nurses, who signed with agencies that assist with housing,
12| SEPTEMBER 2012
licensing and a long list of benefits certainly helped to boost those numbers. Then you add the above market wages and possibly even a guaranteed payment plan that provided for the occasional assignment that lost shifts or got cancelled, it’s no wonder that TNs were on the rise – they were paid well and pampered. However, with hospitals experiencing a decline in revenue, experts say the emphasis is now on cutting costs. Many hospitals have been forced to tighten budgets
and freeze positions, including reducing the use of traveling nurses. The number of traveling nurses nationwide peaked in 2008 at 25,000, and then dropped dramatically to 4,500 in 2009, according to Becky Kahn, senior vice president of client sales and services at AMN Healthcare, one the companies that place the traveling nurses. Companies say the number of positions open to traveling nurses has dropped by about half since the start of the recession at the end
"Companies say the number of positions open to traveling nurses has dropped by about half since the start of the recession at the end of 2007."
22| MAY 2012
of 2007. Some nurses are leaving the traveling nurse industry for permanent positions after spouses lose jobs, and as hospitals cut back on nurses, Kahn and others said. But those numbers are moving back up to between 9,000 and 10,000 traveling nurses as the economy slowly recovers, Kahn said. With most expecting these numbers to continue their climb, the competition rages on between the TN staffing agencies, each of them hoping to contract and place these ever-more elusive trained RNs. Most of the staffing companies negotiating their contracts also offer medical, 401(k) benefits and pay travel, housing and food costs. Some of the more aggressive agencies float bonus payments, add vacation and sick days, stock investment options and continuing education reimbursements all to attract new personnel and instill company loyalty. As these benefits
continue to stack up and are passed on to the hospitals with their dwindling budgets, the perception has become that the employed RN is less cost prohibitive. The truth lies behind each hospital doing their own calculations based on their own current salary/ benefit structures. Though the traveling nurse may constitute only about one percent of the nurses employed today, the traveling nurse is in many ways holding one of the most enviable jobs in the healthcare industry. Lopez, Conrad. “Can Someone Please Explain Travel Nursing?” TheNursetown.com, January 8, 2006. < http://www.nursetown.com/travel_ nursing_articles/Travel_Nursing/15/> Sims, Scarlet. “Travelers fill the nursing gap.” The City Wire, March 20, 2012. August 20, 2012. <http://www. thecitywire.com/node/21005>
An Artistic Introduction
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In our constant search for new and innovative writers from all walks of life but with a medical twist, of course, Med Monthly is proud to introduce, Laura Maaske, Medical Illustrator. 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,
Laura specializes in the creation of patient and medical education materials, interactive media, e-books, cellular and molecular illustrations, and design. patient care and education, public relations and marketing objectives. Laura will be contributing a monthly segment and we look forward to her articles addressing the potential of educational media for medical professionals in all specialties. She will also be our featured artist for the upcoming October issue of Med Monthly so that we may learn and understand her artistic passion. So, we welcome Laura and her creative touch to our evolving group of talented professionals here at Med Monthly magazine.
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research & technology
Bristol-Myers Squibb Foundation Awards $1.6M in Grants to Help Communities In India Address Type 2 Diabetes
he Bristol-Myers Squibb Foundation announced $1.6 million in grants to four health care institutions in India that will help improve diabetes education, prevention and care and increase health care worker capacity in rural and tribal areas and among the urban poor. The prevalence of diabetes in India has grown roughly four-fold since the early 1970s – from about 2 percent of the population in 1972 to 8.3 percent today – due to factors ranging from genetic predisposition to lifestyle and dietary changes. The International Diabetes Foundation (IDF) reports that 61.26 million people in India are diagnosed with type 2 diabetes, ranking India second only to China in total cases and third behind the United States (10.9 percent) and China (9.3 percent) in terms of prevalence. By 2030, India will have 101.2 million people with type 2 diabetes, IDF projects. “Stemming the rising tide of type 2 diabetes in India will require a concerted and sustained effort at the community level to ensure adults have access to the education, preventive measures and care they need to effectively self-manage their disease,” said John Damonti, president, Bristol-Myers Squibb Foundation. “The grants we are making today through our Together on Diabetes™
initiative will test new ideas about how diabetes control efforts can be best designed and implemented to help adults in a variety of settings.” The Foundation has employed a similar capacity-building approach with its 10-year-old Delivering Hope™ initiative to address hepatitis B and C in Asia, and its ongoing work to address unmet medical needs, reduce health disparities, and build community health care capacity was recognized in late July by CMO Asia with an Asia’s Best CSR Practices Award in the Concern for Health category. The following organizations will receive Together on Diabetes™ grants: • Mamta Health Institute for Mother and Child, a national organization based in New Delhi and operating in 14 Indian states, will receive US $706,995 over three years to pilot a study to determine the feasibility of involving India’s lay community health workers (Accredited Social Health Activists) and integrating various systems of medicine including modern and AYUSH, to prevent and control non-communicable diseases, especially type 2 diabetes.
Source: Bristol-Myers Squibb Foundation 16 | SEPTEMBER 2012
• All India Institute of Diabetes and Research in Naranpura and Swasthya Diabetes Hospital in Ahmedabad will receive US $465,685 over two years to develop and test a three-setting model to improve access to diabetes education, prevention and care for the poor in rural, tribal and urban settings. • Sanjivani Health and Relief Committee in Ahmedabad will receive US $426,374 over four years to conduct a household by-household study in 348 villages to identify type 2 diabetes and ensure early diagnosis of undetected diabetes among those with pre-diabetes or at high risk of developing diabetes. The study also will determine the prevalence of type 2 diabetes and related com plications among the rural poor. About “Together on Diabetes™” “Together on Diabetes™” brings together some of the world’s most respected and influential health care organizations and academic institutions to develop effective, comprehensive solutions that integrate public health, health care services and supportive community supportive services to improve health outcomes and reduce disease burden. Since its launch in November 2010, “Together on Diabetes™” has awarded $32.57 million in grants to 17 organizations working in 23 states and the District of Columbia in the United States, $1.23 million to two organizations in China and $1.6 million to four organizations in India. The total commitment is $115 million through 2014. Learn more about “Together on Diabetes™” at TogetherOnDiabetes.com.
“Stemming the rising tide of type 2 diabetes in India will require a concerted and sustained effort at the community level to ensure adults have access to the education, preventive measures and care they need to effectively selfmanage their disease.”
About the Bristol-Myers Squibb Foundation The Bristol-Myers Squibb Foundation is an independent 501(c) (3) charitable organization whose mission is to reduce health disparities and improve health outcomes around the world for patients disproportionately affected by serious diseases. For more information about the Bristol-Myers Squibb Foundation, visit www.bms.com/foundation. MEDMONTHLY.COM |17
Health IT â€“ Best Practices for PHI Data Security and Selecting the Right Cloud Computing Provider By Frank Rosello, CEO Environmental Intelligence LL
In recent months, cloud computing is a topic that is getting a lot of attention especially when applying the technology in healthcare. Cloud computing is becoming more attractive to medical organizations predominately due to the benefits that the technology offers including reduced enterprise IT infrastructure and power consumption costs, scalability, flexibility, and accessibility. At the same time, cloud computing pose significant potential risks for medical organizations that must safeguard their patients protected health information or PHI while complying with HIPAA Privacy and Security rules. The increased number of reported PHI breaches occurring over the past two years along with ongoing HIPAA compliance and PHI data privacy concerns, has slowed down the adoption of cloud technology in healthcare. To help medical organizations and 18| SEPTEMBER 2012
providers mitigate PHI data security risks associated with cloud technology, consider the following five best practices when selecting the right cloud computing provider:
session in a cloud environment that protects data privacy and integrity.
1. Understand the importance of SSL.
The trust established between a medical organization and their cloud computing provider should also extend to the cloud security provider. The cloud provider's security is only as good as the reliability of the security technology they use. Furthermore, healthcare organizations need to make sure their cloud provider uses an SSL certificate that can't be compromised. In addition to ensuring the SSL comes from an authorized third party, the organization should demand security requirements from the cloud provider such as a certificate authority that safeguards its global roots, a certificate authority that maintains a disaster recovery backup, a chained hierarchy supporting their SSL certifi-
Secure socket layer (SSL) is a security protocol used by web browsers and servers to help users protect data during transfer. SSL is the standard for establishing trusted exchanges of information over the internet. SSL delivers two services that help solve some cloud security issues which includes SSL encryption and establishing a trusted server and domain. Understanding how the SSL and cloud technology relationship works means knowing the importance of public and private key pairs as well as verified identification information. SSL is a critical component to achieving a secure
2. Not all SSL is created equal.
cated, global roots using new encryption standards, and secure hashing using the SHA-1 standard. These measures will ensure that the content of the certificated can't be tampered with.
3. Recognize the additional security challenges with cloud technology. There are five specific areas of security risk associated with enterprise cloud computing and medical organizations should consider several of them when selecting the right cloud computing provider. The five cloud computing security risks include HIPAA Privacy and Security compliance, user access privileges, data location, user and data monitoring, and user/session reporting. In order for medical organizations and providers to reap the benefits of cloud computing without increasing PHI data security and HIPAA compliance risks, they
"SSL is a proven technology and a cornerstone of cloud computing security. "
must select a trusted service provider that can address these and other cloud security challenges.
4. Ensure data segregation and secure access. Data segregation risks are a constant in cloud storage. In a traditional client hosted IT environment, the internal IT administrators of the organization controls where the data is located and the access granted to clinicians and support staff. In a cloud computing environment, the cloud computing provider controls where the servers and the data are located. Even though certain controls are lost in a cloud environment, proper implementation of SSL can secure sensitive data and access. A medical organization will know that they are on the right path to selecting the right cloud provider if they provide the organization with three key elements as part of their cloud hosting solution: encryption, authentication, and certificate validity. It is highly recommended for organizations to require their cloud provider to use a combination of SSL and servers that support 128-bit session encryption and should also demand that server ownership be authenticated before one bit of data transfers between servers.
5. Make sure the cloud provider understands HIPAA compliance. When a medical organization outsources their IT infrastructure to a cloud computing provider, the organization is still responsible for
maintaining HIPAA compliance with all privacy and security rules. Since healthcare organizations cannot rely solely on their cloud provider to meet HIPAA requirements, it is highly recommended to select a cloud provider that has experience with HIPAA compliance and has compliance oversight processes and routines in place. Cloud computing providers that refuse to participate in external audits and security certifications are signaling a significant red flag and should be dismissed from further consideration. SSL is a proven technology and a cornerstone of cloud computing security. When a medical organization is evaluating a cloud computing provider, the organization should consider the security options selected by that cloud provider. Knowing that a cloud provider uses SSL can go a long way toward establishing confidence. The right cloud computing provider should be using SSL from an established, reliable and secure independent certificate authority. Furthermore, when selecting a cloud computing provider, healthcare organizations should be very clear with their cloud provider regarding the handling and mitigation of risk factors beyond SSL. Medical organizations that effectively perform PHI security and HIPAA compliance due diligence as part of their cloud computing provider selection process, will be best positioned to consolidate IT infrastructure, reduce IT costs, mitigate the risk of PHI data breaches, and increase business sustainability resulting from the adoption of cloud technology. This outcome will allow healthcare providers to focus more of their energy and resources to patients thus improving care and outcomes. ď‚˘ MEDMONTHLY.COM |19
Is Redesigned Primary Care the Solution to Readmissions? By Lisa P. Shock, MHS, PA-C
he Centers for Medicare & Medicaid Services (CMS) will penalize hospitals for readmissions beginning in the Fall of 2012. With increased financial pressures to address chronic diseases in hospitalized patients, changes to care delivery are critical to financial viability for practices. Primary care providers are already besieged with inefficiency and inability to provide truly valuebased care within a fee for service model. Significant care delivery changes must be implemented and resource networks must be created to redesign models of care that offer comprehensive care management to patients with chronic diseases. Ideally, offering ancillary services such as nutrition and diet counseling, remote monitoring of glucose, and
20 | SEPTEMBER 2012
daily weights for diabetes and heart failure patients will improve quality care metrics and improve patient outcomes. Improvement in outcomes is also inherently an improvement in disease control and utilization of the ER as well as inpatient services. Unfortunately, many community primary care practices do not have access to such resources. Improvements in communication, technology and team redesign may be the solution.
Communication in Care Transitions Ideally, a primary care provider would know: â€“ When their patient is admitted to the hospital.
â€“ What the inpatient treatments and interventions were. â€“ What the discharge disposition was and what changes were made so follow up could be done within the critical 72-hour window famous for bounce-back readmissions. This does not happen universally or efficiently in virtually all communities. As a primary care provider, often I am relying on patients and families to "fill me in" on what was done in the larger medical center hospital that does not communicate efficiently with our individual community office. Sadly, we are often chasing a paper trail and if that discharge summary is not dictated in a timely fashion, then we are "out" of information within that 72-hour window for bounce backs. Redesigning care transition teams that work efficiently with the hospitalists
"Redesigning care transition teams that work efficiently with the hospitalists and pharmacy will ensure timely outpatient follow up as well as critical medication reconciliation."
and pharmacy will ensure timely outpatient follow up as well as critical medication reconciliation.
Developing Smart Technology Health Information Exchanges are supposed to be building networks to facilitate such communication, but as hospitals opt out, access to this data on the community level is scarce. Electronic health records come in many shapes, sizes and capabilities, and the sad reality is that they do not communicate across systems without extensive networks and programming, a cost unable to be borne by smaller and independently owned practice groups. The creation of data feeds and information exchanges that communicate ER utilization and admissions data to primary care providers will assist those practices joining accountable care organizations (ACOs) and participating in Medicare Shared Savings Plans (MSSP).
Team Approach A significant amount of funds in the Affordable Care Act (ACA) went towards programs that train primary care providers, not just doctors
but nurse practitioners (NPs), and physician assistants (PAs). Health policy advocates believe that the wellknown shortage in primary care will be alleviated, not just by having more doctors but also by having doctors work in teams with other less highlytrained specialists who can deliver quality primary care. Many studies show that good, quality primary care can be delivered by PAs and NPs on a physician-led team. Ann Davis, senior director of state advocacy and outreach at the American Academy of Physician Assistants states in a recent National Public Radio (NPR) interview, that when you “…think about a scarce resource, there's sort of three ways to think about that. You can increase supply of physicians. You can use the scarce resource more wisely, or you can actually reduce demand. And I think the second two are where physician assistants (PAs) are particularly critical.” PAs and NPs extend the reach of physicians by that team. And, then, if the PAs are available to do some health promotion, some exquisite coordination of care so that you decrease readmissions, that helps address the physician shortage also. MEDMONTHLY.COM |21
The Benefits and Drawbacks of Managing a Privately-Owned Prac Versus Managing a Hospital-Owne Practice By Mary Pat Whaley, FACMPE, www.managemypractice.com
22 | SEPTEMBER 2012
Private practices are organized in a corporate model where the physicians are shareholders, or where one or more physicians own the practice and employ other physicians or providers. Private practices are almost exclusively for-profit. Physician practices are organized into corporations for the tax benefits as well as protecting the owners from liability judgments. Hospitals can be for-profit, not-for-profit or government-owned. For-profit hospitals make up less than 20% of the total hospitals in the United States.
Private practice owners take a salary draw, split any receipts after all expenses are paid, and generally distribute receipts monthly or quarterly. This leaves very little at year end to be taxed through the corporation. Hospitals that employ physicians typically guarantee a salary and offer an incentive plan where the physicians earn more for seeing more patients and/or being more productive based on work Relative Value Units (wRVUs). Hospitals may or may not use a practice expense and revenue model to measure the margin.
Benefits of Managing a Private Practice
1. You get to do everything, so if you like or want to learn
about HR, marketing, finance, IT, contract negotiation, revenue cycle management, facility management and lots of other stuff, youâ€™ll get to do it in a private practice.
2. You are the top position in the practice, so you get to put your imprint on the practice. You can often be more creative.
can be very laid-back and practices can maintain a more relaxed, family-like atmosphere.
4. Decision-making can be straightforward and swift, so you can help your practice to be nimble in response to news events, trends and new ideas. If your practice decides to become a concierge practice or stop or start taking a particular payer, so be it!
5. You may find it easier to get a foot in the door and start your management career in a private practice as physicians donâ€™t always hire managers using traditional means. A recommendation from another manager, a consultant or a physician may be enough to get you started.
continued on page 24 MEDMONTHLY.COM |23
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Drawbacks of Managing a Private Practice
1. You report to the physicians who may not have business expertise and may fight you on your well-founded recommendations.
2. There is no internal career path – you’re at the top in the practice. 3. Physicians will make less money every time a new non-revenue generating position is
added or any time equipment needs to be replaced – expect them to be generally slow to respond to capital expenditure needs, especially if they cannot see that any new revenue will come from the expense.
4. When physicians “eat what they kill”, taking home the dollars they personally earn less their expenses, they can be pitted against each other and have conflicting priorities.
5. Your practice could be purchased by a hospital and you could find yourself out of a job or your job radically changed.
24| SEPTEMBER 2012
Benefits of Managing a Hospital-Owned Practice
1. You report to a management professional who should understand the business and be supportive of your well-founded recommendations.
will receive support from other hospital departments: The human resources department will screen, orient and provide benefit support to your staff; the information systems department will provide and maintain your practice management system, EMR system and other hardware and software; and the accounting department will pay the bills and write the payroll.
3. You may be able to climb the career ladder and manage multiple practices, or become the vice president of physician practices or the COO, CFO or CEO of the hospital.
4. You will get to interact with managers of other departments and broaden your hospital knowledge and understanding of the care continuum.
5. You can learn a lot from the process of preparing for and living through a JCAHO (a.k.a. “The Joint Commission”) visit.
Drawbacks of Managing a Hospital-Owned Practice
1. Hospitals use different terminology for charges, adjustments and receipts and work on
the accrual system instead of the cash system, which most private practices use. It takes time to understand and distinguishes the terminology and process differences.
2. The entire system will be in a tizzy on a regular basis getting ready for a JCAHO (a.k.a. “The Joint Commission”) visit.
3. You can expect to have much less autonomy in a hospital system and there may be more red tape involved in getting even simple requests filled.
4. Hospital administration may find it difficult to relate to the perspective of the hourly staff and it could be frustrating to balance the needs of the staff and the needs of the organization.
5. Because the hospital is the big-dollar earner, the needs of the clinics may be second, third or fourth down the line in importance.
JCI Releases New Standards for Academic Medical Center Hospitals
oint Commission International (JCI) announced that academic medical centers accredited by JCI will be accredited under a new set of standards beginning January 1, 2013. To recognize that an academic medical center hospital has been surveyed under these standards, the Certificate of Accreditation will note that the hospital is accredited under the Joint Commission International Standards for Academic Medical Center Hospitals. These hospitals will also be recognized separately on the JCI website listing of all accredited organizations. JCI published new standards for academic medical center hospitals on July 1, 2012 that will be effective for all eligible organizations on January 1, 2013. “These new standards were developed to recognize the unique resource such centers represent for health professional education and human subject research in their communities and countries,” said Paul vanOstenberg, vice president, International Accreditation, Standards and Measurement, Joint Commission International. “These standards were also developed to present a framework for including medical education and human subject research into the quality and patient safety activities of academic medical center hospitals. Unless deliberately included in the quality
26 | SEPTEMBER 2012
framework, education and research activities often are the unnoticed partners in patient care quality monitoring and improvement.” The new standards applicable to academic medical centers are divided into two chapters – Medical Professional Education (MPE) and Human Subject Research Programs (HRP) – as medical education and clinical research are most frequently organized and administered separately within academic medical centers. For all hospitals meeting the eligibility criteria, these two chapters will be a required addition to the Joint Commission International Accreditation Standards for Hospitals, 4th Edition. These new standards will be integrated into the evaluation process for the accreditation of hospitals. For example, when the on-site evaluators are reviewing patient care in a clinical unit, they will also evaluate the contribution of medical trainees to care processes in that unit, and the integration of clinical research protocols into the care provided on the unit and the quality monitoring processes. Not every hospital with students or conducting research is considered an academic medical center hospital under these new standards, according to vanOstenberg. JCI will evaluate hospitals under the academic medical center hospitals requirements when the hospital:
• Is organizationally or administratively integrated with a medical school; • Is the principal site for the education of both medical students and medical specialty residents from the medical school noted in the previous criterion; and • Conducts academic and/or commercial human subject research involving patients of the hospital. If you have questions or need or more information about Academic Medical Center Hospital Accreditation, email JCI at email@example.com. Read more about or purchase the Academic Medical Center Hospital accreditation manual at http:// www.jointcommissioninternational.org/Accreditation-Manuals/ IAS401/2506/. Joint Commission International (JCI) was established in 1997 as a division of Joint Commission Resources, Inc. (JCR), a wholly controlled, not-for-profit affiliate of The Joint Commission. Through international accreditation, consultation, publications and education programs, JCI extends The Joint Commission’s mission worldwide by helping to improve the quality of patient care. JCI assists international health care organizations, public health agencies, health ministries and others in more than 90 countries.
"These new standards were developed to recognize the unique resource such centers represent for health professional education and human subject research in their communities and countries." MEDMONTHLY.COM |27
legal From a state's decision on whether to expand Medicaid coverage to value-based purchasing and implementing a pilot "bundling" payment plan, hospitals nationwide face much uncertainty in the coming months as implementation of the Patient Protection and Affordable Care Act begins.
What Hospitals Need To Assess Immediately Now That the Affordable Care Act Has Been Declared Constitutional By John B. Reiss, Ph.D., J.D., Saul Ewing, LLP
28 | SEPTEMBER 2012
ow that the United States Supreme Court has found the Patient Protection and Affordable Care Act ("ACA") constitutional, what are the pressing issues that face hospitals? One aspect of the Supreme Court's decision adds to the uncertainty surrounding the implementation of the ACA. The Court determined that the Federal government could not penalize those states that chose not to expand their Medicaid program coverage and benefits in accordance with the requirements of the Act. Several state governors already have said they do not intend that their states will participate in the Medicaid expansion. While the Federal government picks up the cost of the Medicaid expansion initially, it is likely that many states, their budgets already stressed by Medicaid expenditures, will give careful consideration about expanding those programs. Moreover, given the Federal budget deficit, there is little likelihood of continuing Federal financial support at a high level. Consequently, until these decisions are made, the number of people in any particular state added to the health insurance rolls through Medicaid will be highly uncertain. If a state does not
While the Federal government picks up the cost of the Medicaid expansion initially, it is likely that many states, their budgets already stressed by Medicaid expenditures, will give careful consideration about expanding those programs.
expand its Medicaid program, there will be fewer people covered by some form of health insurance program, a result not helpful to hospitals. A second issue of great concern to hospitals is whether the states will implement the health insurance exchanges, which always have been voluntary under the Act. Again, some governors have gone on record saying their states will not implement health insurance exchanges. The Federal government will be doing so if the states do not, but the terms of such Federal insurance exchanges still are not known, and will not be known for some time. This only adds to hospitals' uncertainty about size of the future insured population and the financial consequences. The Act requires various activities to be implemented in 2012. One is value-based purchasing, to be implemented in October 2012, for FY 2013, which is designed to reward hospitals for increasing the quality of patient care. Starting in 2013, the value-based purchasing methodology, an extension of existing programs for reporting quality indicators, will cover acute myocardial infarction, heart failure, pneumonia, surgeries and health care associated infections. CMS will set performance standards for each of these categories. Hospitals that exceed the performance standards will be paid additional sums per DRG for the next year and those that do not meet the performance standards will receive a decreased DRG payment for that year. Until the standards are announced, it is impossible for hospitals to assess the likelihood of their successful performance against these criteria. Moreover, implementing these quality goals may increase hospital administrative costs, which could offset any savings for those hospitals that receive additional payments, and will add to the costs for those that receive reduced payments. Hospitals need to quickly integrate these performance standards into their operational/clinical activities. continued on page 30
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continued from page 29
Another change to be implemented in 2013 is a national pilot program to bundle payments for the three days prior to hospital admission, the hospital admission and 30 days thereafter, to encourage better patient care and fewer readmissions. This means that hospitals, physicians, and post-hospital care providers will have to enter into arrangements for dividing up the payments if they choose to participate in the pilot program. These arrangements will require considerable time and effort to develop, document and implement. We recommend that hospitals participate in this pilot program, as it is likely that this will be a future model for payments. A major change are new provisions governing nonprofit hospitals' maintenance of their 501(c)(3) status, including a requirement that they develop a community health needs assessment
28| AUGUST 2012
every three years. These requirements are discussed in more detail in this previous Health Practice alert. The IRS has not provided guidance at this point on how the community health needs assessment should be developed. The ACA includes a requirement that
hospitals must have written financial assistance plans under which non-insured patients cannot be charged more than amounts paid by insurers, but then again, the details have not been defined.
The changes discussed above all await clarification resulting from the publication of regulations in final form. Consequently, the hospital industry is faced with considerable uncertainty for at least the next few months until these issues are decided. Of equal importance are the changes private insurers are making – some in the context of changed government payments – but some because of the imperative from their customers to have covered populations provided better care at a lower cost. Hospitals should consider developing new strategies for working with insurers and other participants in the health care marketplace, as many of these actors already are developing new initiatives. If you have questions or thoughts about whether and how to participate in any of these initiatives, Saul Ewing’s Health Practice has many years of experience helping clients develop new and innovative programs.
In Another Attack on General Employment Policies, NLRB Nixes Confidential Workplace Investigations By Doug Hass, PA
s we have warned recently, the National Labor Relations Board has aggressively expanded its efforts to find violations of employees’ Section 7 rights, even in areas well beyond labor disputes. We have highlighted opaque and contradictory guidance on social media policies, the assault on at-will employment policies, and a rejection of a common off-duty access policy. This week, the NLRB again showed its desire to invalidate common policies even in the absence of any union activity, employer coercion, or Section 7 activity whatsoever. In Banner Health Systems, the Board found a violation of the National Labor Relations Act because, in order to protect the integrity of her investigation, one of the Arizona hospital’s HR officers asked an employee not to discuss the matter under investigation with co-workers. Like most HR professionals, the hospital’s HR staff made this request as a matter of course in all of its workplace investigations. The Board ordered Banner to cease enforcing this “rule.” It concluded broadly that employers could only request that employees not discuss a matter under ongoing investigation if the employer had one of several “legitimate and substantial” justifications. Unfortunately, the justification of protecting the investigation’s integrity was not one of the Board’s justifications. The case arose when a hospital technician refused to follow his supervisor’s orders to clean surgical instruments with hot water from a coffee machine while a steam pipe was broken at the hospital. The hospital
investigated the technician’s failure to sterilize equipment that day and disciplined him for insubordination. In apparent retaliation, the technician then filed an unfair labor practice charge against the hospital, alleging that the hospital’s HR representative had asked him during the investigation interview not to discuss the investigation with his co-workers while it remained ongoing. The technician alleged that this informal request— which did not contain a threat of discipline or lead to any discipline— violated his and other employees’ right to engage in protected concerted activity under Section 7 of the Act. The Board majority seized on Banner’s use of a preprinted interview form with “instructions for all interviews” that contained a
request that employees not discuss the investigation with others. It found that this form created a “rule” that improperly prohibited employees from discussing HR investigations. The majority rejected this “blanket approach” and held that an employer could only make such a request on a case-by-case basis after first determining that “witnesses need[ed] protection, evidence [was] in danger of being destroyed, testimony [was] in danger of being fabricated, or there [was] a need to prevent a cover up.” Member Hayes dissented, noting that even the Board’s Administrative Law Judge had declined to find any such “rule” existed and had found instead that the HR officer only made a “suggestion” that the employee keep the investigation confidential. Notably, this unfair labor practice charge was filed by an unrepresented, individual employee, not a union or a lawyer, and contained no allegations of any union activity. While the Board’s remedy only requires the hospital to post a notice, the decision nonetheless upends another sensible and near-universal policy followed by employers and HR professionals alike. We encourage employers and HR professionals to review their internal investigation procedures to determine if any adjustments in those procedures are necessary in light of this troubling decision. To learn more about Doug Hass, view his bio http://www.franczek.com/ attorneys-88.html. See also Franczek Radelet P.C., Attorney Advertising, www.franczek.com MEDMONTHLY.COM |31
s t o r r a C d n a e c i Wild R
By Ashley Acornley MS, RD, LDN
It’s back to school season, and I’m sure most families are looking for a quick, easy, and healthy side dish to put on the table. This wild rice and carrots dish is a great way to incorporate both whole grains and vegetables on your plate, requires less than 5 ingredients, and takes less than 10 minutes to cook! There are also three different variations of this recipe to make, all equally delicious for your family to enjoy!
Ingredients: 1 (8.5-ounce) package precooked wild rice (such as Archer Farms or Uncle Ben’s) 1 tablespoons unsalted butter 1 cup thinly sliced carrots
1 tablespoon chopped fresh parsley 1/2 teaspoon freshly ground black pepper 1/4 teaspoon salt
Preparation: 1. Prepare rice according to the package directions. 2. Melt butter in a large nonstick skillet over medium heat. Add carrots; cook 8 minutes or until tender, stirring frequently. Stir in rice, parsley, pepper, and salt; cook 1 minute.
Nutritional Information Amount per ½ cup serving: Calories: 113 Fat: 4.6g Saturated fat: 2.8g Monounsaturated fat: 1.2g Polyunsaturated fat: 0.3g Protein: 2.8g Carbohydrate: 16.2g Fiber: 2.1g Cholesterol: 11mg Iron: 0.5mg Sodium: 173mg Calcium: 16mg 32| AUGUST 2012
1 # n atio
Bell Pepper and Fennel: Prepare rice
according to package directions. Heat 1 1/2 tablespoons olive oil in a large nonstick skillet over medium heat. Add 1/2 cup diced yellow bell pepper and 1/2 cup diced fennel bulb to pan; cook 8 minutes or until tender, stirring frequently. Stir in rice, 1 1/2 teaspoons chopped fresh oregano, 1/2 teaspoon freshly ground black pepper, and 1/4 teaspoon salt; cook 1 minute. Serves 4 (3/4 cup serving, provides 116 calories)
2 # n o riati
Cucumber and Feta: Prepare rice
according to package directions. Combine cooked rice, 1 cup diced English cucumber, 1 1/2 tablespoons olive oil, 1 tablespoon fresh lemon juice, and 2 ounces crumbled feta cheese in a medium bowl; toss to coat. Stir in 1/2 teaspoon pepper and 1/4 teaspoon salt. Serves 4 (3/4 cup serving, provides 149 calories)
i r a V
3 # n atio
Tomatoes and Pine Nuts: Prepare rice according to package directions. Melt 1 1/2 tablespoons unsalted butter in a large nonstick skillet over medium heat. Add 1/4 cup pine nuts and 8 quartered cherry tomatoes to pan; cook 8 minutes or until tomatoes are tender, stirring frequently. Stir in rice, 1 tablespoon chopped fresh basil, 1/2 teaspoon freshly ground black pepper, and 1/4 teaspoon salt; cook 1 minute. Serves 4 (1/2 cup serving, provides 163 calories) MEDMONTHLY.COM |33
10 Ways to Improve the Patient Experience At Hospitals
by Stephanie Baum, Philadelphia Bureau Chief for MedCityNews
Hospitals looking for innovative ways to improve patient care might want to encourage staff who are working with patients to offer ideas on how it could be done. Penn Medicine in Philadelphia recently launched an innovation tournament across its health system to devise ways to improve patient care. Participants worked with professors at University of Pennsylvania’s Wharton Business School to hone their proposals for its “Your Big Ideas Challenge,” spanning hospital navigation to smoothing the transition in and out of the hospital. Among the more than 1,750 ideas submitted from 1,400 participants, 10 were selected 34| SEPTEMBER 2012
to be presented before a town hall meeting next month when the winning pitches will be chosen. Kevin Mahoney, Penn Medicine chief administrative officer who developed the innovation challenge along with Judy Schueler, the chief human resources officer and vice president of organization development, said the health system was keen to get ideas from staff working on “the front lines” of care. It was pleased to have gotten participation from each of the entities that make up its health system, though the majority came from the Hospital of the University of Pennsylvania. Based on the response, Mahoney said
it would hold another innovation tournament focusing on more targeted issues such as reducing costs by 10 percent or reducing hospital stays by one day. In addition to some of the finalists, here’s a selection of some of the proposed ideas that reflect some of the innovative approaches to healthcare.
DIGITAL MAP/SIGNAGE OF HOSPITAL Inevitably, some of the most common problems are the most fundamental. Finding one’s way around a hospital, be it a patient or a staff member, seems to be among the biggest challenges.
It can cause people to be late for appointments; it can lead to mix-ups and can worsen what may already be a stressful experience. Among the ideas proffered to surmount this problem were providing a digital map, digital signs and color coordinated divisions.
MANAGING PATIENT CHECK OUT The process of checking out of a hospital can be tied up by waiting for x ray and lab results that can cause a delay in patients leaving much needed hospital beds. The “almost home” room, with reclining chairs with TV and Internet connection would help patients remain comfortably at the hospital while reducing the traffic around hallways and reception areas.
A DEDICATED ROOM FOR FAMILIES TO MOURN LOVED ONES Family who may be traveling a great distance deserve a dignified place to spend with loved ones who have died, but the demand on patient rooms is high and a shared room may not be the best setting. A bereavement room where family members can spend time with recently deceased family members in a welcoming environment could address this issue.
SPEEDING UP REFERRAL APPOINTMENTS Patients referred between Penn providers frequently wait months for their appointments and can lead to urgent care clinics getting clogged. One solution could be to provide clinical practices in the health system with times reserved for new referrals within the health system.
ONLINE PATIENT ORGANIZER In an effort to reduce the time it takes for patients to schedule appointments and fill-in questionnaires while
"Providing patients with a more informed understanding of the process through a video on YouTube or a dedicated website could facilitate that experience and help patients raise informed questions prior to the procedure."
they wait, patients could do many of these things before they set foot in the physician’s office. A webbased application could provide these services, help patients navigate the hospital campus, find out what documents or medications they need to bring to their appointment, etc. They could also read about the physician they are scheduled to see.
PATIENT EDUCATION VIDEOS For people undergoing invasive surgery, elective or not, can be stressful. Providing patients with a more informed understanding of the process through a video on YouTube or a dedicated website could facilitate that experience and help patients raise informed questions prior to the procedure. Jefferson University Hospitals has been undergoing a pilot program that addresses this issue.
MOBILE APP MAPPING OUT PATIENT’S CARE To ease patients’ anxiety, one proposal would develop an app for patients to keep track of what to expect when they are going into the hospital for elective surgery, for example. It would provide a checklist with reminders, informed consent, and decision making aids. It could also provide a post operative check list for their recovery with reminders to ensure their recovery stays on course.
HELPING PATIENTS STAY CONNECTED WITH FRIENDS AND FAMILY One downside of being in the hospital is the potential to feel isolated from family and friends. One group proposed making Skype available 24/7 to help patients keep in touch with family and friends.
SCANNABLE BRACELETS TO AVOID MEDICATION MIXUPS One group proposed developing a way to scan medication with a patient’s wrist band as an extra precaution to ensure the right medication is being given to the correct patient. The practice comes from another hospital where it “drastically reduced” medication errors at the facility.
HELPING NON-ENGLISH SPEAKERS For patients who don’t speak English, an iconography card could help them express themselves to hospital staff, particularly in urgent situations if they had pain or need to make a call when a family member or translator is not available. Reprinted from MedCityNews: http://medcitynews.com/2012/04/10ways-to-improve-the-patientexperience-at-hospitals/ MEDMONTHLY.COM |35
Pressures: How Hospitals and Doctors Can
Together for Cost-Effective Care
By Stella Fitzgibbons, MD, FACP
ith third-party payers tightening their standards and scrutinizing inpatient records, both physicians and hospitals are finding that practicing cost-effective care is more important than ever—both for getting paid for our work and for keeping the hospital financially healthy. The process needs to start on the day of admission, and it requires cooperation between office caregivers, hospitals and hospital-based doctors. “It’s just a diabetic with a kidney infection. Why does she have to sit around the ER instead of going directly to the floor?” While the primary care provider wants to keep well-insured patients happy, there are both clinical and financial reasons to make sure we have all the facts of a patient’s condition before assigning her a room. The sooner lab tests, imaging and treatment are started, the faster the patient will get
better. And the ER staff will collect information and write orders that help hospital administrative personnel decide what level of care—observation, med-surg bed, telemetry, or ICU—is both appropriate and likely to meet standards for payment. Many ERs now have case managers, usually RNs, review all admissions, and they can often help with suggestions, like higher IV fluid rates that are recognized as appropriate for acute admissions. A doctor who rejects their input is likely to spend more time than he likes arguing about unpaid bills.
Coding Made Easier Office-based doctors already deal with ICD-9 and CPT codes and study how to get paid for the work they do. A similar system is followed for hospital visits, and documenting the work done will decrease the odds of
“Why are non-physicians trying to tell me how to write a progress note?” “The hospital’s length of stay initiative…” “In other news, the readmission rates for local hospitals are under review.”
36| SEPTEMBER 2012
“downcoding”, in which third party payers decide that a doctor must not have done much work if he only wrote a two-line note. Hospital care adds another level of complexity: the diagnosis, and how doctors word their notes, can make a huge difference in what the hospital is paid. Since the 1980’s Medicare has paid by diagnosis codes and severity of illness, with big-ticket illnesses like heart failure subdivided into left and right ventricular, systolic and diastolic, etc. And more payment is received if there are complicating conditions like pulmonary edema. Hospital coding specialists, usually registered nurses, keep up with changes in the diagnosis codes and ask doctors, usually with notes on patients’ charts, to clarify the situation. “Ventilator-dependent” may sound selfexplanatory to a physician, but adding “respiratory failure” to the problem list helps assure payment for the $5000 a day that it costs the hospital to keep the patient alive. The coding specialist can use a form with alternative diagnoses (“acute blood loss anemia” vs. “anemia of chronic disease”), lets doctors check a box, scrawl a signature and move on to other matters—and a hospital’s bill listing expensive problems improves the odds that the doctor will get paid for his work.
It Starts on the Day of Admission The incentive to reduce hospital days began with diagnosis-related
Work e billing, meaning that any days spent getting inpatient treatment that could be given less expensively elsewhere will not be paid for. Unnecessary days are not just a financial problem, but can cause new problems like hospitalacquired infections and blood clots. Starting discharge planning early, particularly when a patient needs to change living situations, is both financially sound and helps patients and families adjust to change and avoid surprises. Hospital case managers are doctors’ and hospitals’ biggest asset for planning where a patient goes after discharge and in making the arrangements for home IV antibiotics, skilled nursing facilities (SNF) or acute rehabilitation. They are especially helpful with elderly patients: a doctor who works with case managers instead of dodging their phone calls can not only improve average length of stay but spend less time on the phone explaining why SNF is a good idea and which one is best for the patient. Hospitals also are under increasing pressure to reduce readmission rates— something everybody involved wants to avoid. Doctors can take advantage of hospitals’ nurse educators and medication reconciliation programs to be sure that patients and families understand how to monitor their conditions and can afford the needed medications; nurses can even check to be sure that all followup appointments have been made and written out before the patient leaves the building. Uninsured patients admitted via the
ER may be eligible for county or state outpatient programs, and they can begin the application process from their hospital beds; my hospital’s case managers regularly fax paperwork and help patients arrange interviews from the nursing station. Doctors, for their part, need to be sure that they have either notified their office that a patient is being discharged
or made contact with the primary care provider to update him or her on what happened at the hospital. A smooth handoff between hospital and outpatient care is one of the most effective ways to ensure that the patient does not return to the ER with the same problem that caused the present admission. continued on page 38 MEDMONTHLY.COM |37
continued from page 37
Don’t Shoot the Messenger It’s common to hear complaints from doctors about “hospital meddling”. But keeping length-of-stay records and letting staff physicians know how they rate compared to colleagues with similar practices makes it clear that cost-effective care is possible without impairing quality of care. The case manager who suggests a palliative care consult is not trying to take over medical decisions but rather to point out an option the doctor may not have considered. And reviewing patients’ test results to fill out those coding requests may improve both documentation and quality of care. Hospitals can ease doctors’ adjustments to the changing rules in a number of ways: continuing education
38 | AUGUST 2012
classes taught by physicians, mentoring by hospitalists or others more familiar with the current regulatory situation, and tactful reminders posted next to dictation phones.
In the end, underpayment is everybody’s problem. Good communication and communication are survival traits not only for hospitals but for the doctors whose patients depend on them.
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By Paula C. Rapp
ospitality has become an omnipotent theme in modern America. Predating the 14th century, the term was defined as the cordial and generous treatment of guests and the supplying of a pleasant environment to visitors. The word “hospital” itself was a direct derivative and enthusiastically described the envisioned physical existence of hospitals as a location of such hospitality. Today, the concept may be visibly displayed in hotels, airports, shopping malls and theme parks. Hospitality in fact has become a valuable corporate marketing concept and many universities of higher education have taken note by offering advanced degrees in hospitality.
40 | SEPTEMBER2012
Yet, historical examination of American hospitals in the 1700 and 1800s often describes them as localities of dreaded impurity, rather than a pleasant environment, filled with shards of exiled humans; a far cry from the French pseudonym for hospitals in the Middle Ages of Hotel d’Dieu or Hotel of God. Charity hospitals as they were known in the 1700s existed in the community and were maintained by volunteers and trustees. As locations to be avoided, hospitals served as the last resort for the infirm, the mentally and physically disabled and the homeless population. Furthermore, due to a lack of true curative means, the hospital staff predominately
Medical bag courtesy of RareSkins.com
Then and Now
focused on promoting morals and religious beliefs rather than health. Such hospitals, which were usually akin to almshouses, were solely for the “worthy” poor and destitute and were often unhygienic spaces where the insane and rats ran free. Patients that were of more advanced fiduciary means received care in their residence from private physicians. These patients were afforded the most experienced doctors of the time and treated in the most hospitable fashion. Of course, this came with a substantial fee. Thus having means afforded patients the comfort of not resorting to a hospital stay. Hospitals were once exclusively charitable enterprises and financed by
means of donations and government appropriations to fund their operations. Although the “charity case” or patient needed to be initially approved both on a moral and worthiness spectrum, most people in need were able to obtain shelter and care in the community hospitals. Yet since medical science and doctors were unequipped at the time to offer definitive diagnostic or curative therapies, the “treatments” focused on stringent moral reform and religious endeavors. Hospitals were not viewed by the public as comfortable, rather were perceived as loathsome and a place to die rather than live. In the 1800s, the charitable institutions began to focus on “wage wards” and initiating the charging of patients to buy care for a fee or wage. Ironically, charging patients occurred when medicine finally was at a point to offer more effective treatments
"Concierge, or boutique medicine as it has become known, has surged...For a substantial fee, the patient is afforded the luxury of truly personalized, private care in their own setting."
Courtesy of Perkins + Will
and expanded resources. During this period, the middle and upper class slowly began to realize the utility of the hospitals and physicians vied for entry as an opportunity to enhance their education and increase the size of their private practice. As such, previous to the Civil War, a practicing, welleducated physician may have not set foot in a hospital throughout his entire career in medicine. Suddenly with the discovery and advancement of anesthesia and complicated medical devices, modern hospitals were glamorized. Although the physical hospital is comprised of brick and mortar, it has become an incredible metaphorical icon highlighting the advancement of modern medicine and the healthcare profession in the 20th and 21st century. The sweeping modifications in hospitals are due predominately to the age of scientific discovery coupled with the relationship between therapeutics and the patient. The historical relationship between a doctor and patient has been altered in many ways as well. In the past, doctors were not able to offer many tangible diagnostic or curative treatments to their patients. The holding of a hand and an ounce of verbal reassurance were their most valuable asset. Together they shared an intimate bond and hospitality was extended in the form of intimate human touch and a generosity of time.
Over the years, the time and touch element of the relationship has significantly diminished and patient’s perception of hospitality is now reflected by their physician’s bedside manner. However, as of late, the traditional concept of hospitality appears to be making a reemergence in medicine and the hospital setting. Concierge, or boutique medicine as it has become known, has surged. Under this title, concierge physicians care for far fewer patients than in a typical practice, perhaps as little as 100. For a substantial fee, the patient is afforded the luxury of truly personalized, private care in their own setting. Additionally, patients are entitled to the physician’s cell phone, email and specially-deemed services. As noted, hospitality has reemerged as a vital theme in today’s culture. Hospitals are now being designed with a “healing hospitality” in mind. Longago banished wards and double rooms are increasingly being replaced with private rooms and a view. The cold tile floors are out and warm wood floors with cabinetry are in. Internet access is a given and small uncomfortable bedside seating for visitors have been replaced with comfortable, oversized, upholstered chairs. The concept of medical hospitality, whether as described in the 18th or 21st century, evokes a sense of generosity with time, care and concern. MEDMONTHLY.COM |41
The Job of
Commercial Driving By Lawrence Earl, MD, Medical Director, National Academy of DOT Medical Examiners (NADME)
A follow up to the article "NRCME: The National Registry of Certified Medical Examiners", from our August issue
ealthcare professionals must comply with new regulations to continue to provide mandatory state examinations for truck and bus drivers. Is the certification limited to current employment or job duties? When a Medical Examiner grants medical certification, he/she certifies the driver to perform any job duty required of a commercial driver, not just the driver's current job duties. There are many factors you need to consider as a medical examiner to assess driver fitness for duty: Types of routes-- The driver may be away from home up to several weeks at a time. Consider the effects this may have on any underlying medical condition or treatments and follow ups needed by their medical providers.
42 | SEPTEMBER 2012
Schedules - Abrupt schedule changes and rotating work schedules may result in irregular sleep patterns and a driver beginning a trip already fatigued. Long hours and extended time away from family and friends may result in a lack of social support. Types of cargo - The driver of a bus is responsible for passenger safety. Transporting passengers also demands effective social skills. Loss of cargo or shifting cargo while driving can result in serious accidents. Transporting hazardous materials, including explosives, flammables, and toxics, increases the driverâ€™s risk of injury and property damage extending beyond the accident site. Staying alert when driving - This demands sustained mental alertness and physical endurance that is not
compromised by fatigue or sudden, incapacitating symptoms. And many other considerations such as: The control of an oversized steering wheel, manipulating dashboard switches and controls, shifting gears, entering and exiting the vehicle, coupling and uncoupling trailers, loading, securing and unloading cargo, and performing vehicle inspections and safety checks. During your NADME-NRCME course, you'll learn all about the job of commercial driving and competently qualify or disqualify drivers based on their objective ability to perform not just driving functions, but all of the tasks and functions of commercial driving. ď‚˘
What’s your practice worth? When most doctors are asked what their practice is worth, the answer is usually, “I don’t know.” Doctors can tell you what their practices made or lost last year, but few actually know what it’s worth. In today’s world, expenses are rising and profits are being squeezed. A BizScore Performance Review will provide details regarding liquidity, profits & profit margins, sales, borrowing and assets. Out three signature sections include: Performance review Valuation Projections
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St. Elizabeth Hospital Goes “Lean” to Provide Exceptional Patient Care By David C. Daisher, Construction Accounts Manager, Lean Six Sigma Black Belt, TransMotion Medical, Inc.
he Gathering Storm
Today’s hospital administrators and caregivers are facing extremely challenging times. Simply put, patient care challenges are daunting. Treatment protocols are complex. Reimbursement restrictions and government-mandated reforms are impacting the bottom line. Patient satisfaction is declining. Staffing is at a crisis, with nurses suffering from back injuries that cause them to transfer out of patient care or leave the profession entirely. At St. Elizabeth Hospital in Appleton, Wisconsin, a committed team implemented Lean Six Sigma principles to develop a revolutionary new approach to the process of patient care in the Emergency Department and Outpatient Surgery area. Lean Six Sigma is an approach that combines the concepts of Lean and Six Sigma resulting in the elimination of the seven kinds of wastes: defects, overproduction, transportation, waiting, inventory, motion and over-processing, and the provision of goods and service at a very high standard of quality. The hospital’s innovative solution focuses on delivering personalized treatment that’s safer, more efficient, less stressful and more cost effective.
44 | SEPTEMBER 2012
St. Elizabeth Hospital, Appleton, WI Photo courtesy of St. Elizabeth Hospital
Established Situation Until 2009, St. Elizabeth’s Emergency Department (ED) and Outpatient Surgery (OPS) department consisted of a triage area, 13 bays and 5 private rooms that served over 26,000 patients
per year. It occupied a cramped space whose entrance was not conveniently located to any major street. In the OPS department, there was one bathroom for the 65 patients treated on average, per day. Patient areas were separated from
each other by use of only curtains, resulting in very little privacy and high noise levels. Each narrow patient bay could only accommodate either a stretcher or a recliner. When a patient had to be transferred from the stretcher to the recliner, the established process was to move the family out of the room, push the recliner in, move the patient from the stretcher to the recliner (a fall hazard), remove the stretcher, and then move the family back in. Caregivers constantly walked the halls to locate the proper device whenever a patient transfer was required. Despite these physical drawbacks, staff productivity was high. But managers observed that virtually every aspect of the ED and OPS departments could be improved.
Business Issues To solve the many issues, the hospital formed a Lean team who knew from the beginning that their solution had to accommodate not just medical requirements, but business realities. Any redesign had to use only existing resources, existing space and existing staff. The redesigned area had to be used as close to 100% capacity as possible each day, avoiding the common pitfall of overbuilt, underutilized space. Finally, any solution had to result in efficiencies that helped the hospital manage and minimize the impact of new reimbursement restrictions.
Methodology and Learning Beginning in 2009 the hospital began to develop a strategic plan for the ED and OPS departments, based on continuous improvement principles.
The plan featured a comprehensive analysis of virtually every aspect of the areas, from the patient experience, to space optimization, to the patient handling process. Patient Experience: The hospital’s methodology embraced Lean Six Sigma’s principle that all improvements should begin with “the voice of the customer.” A team of employees interviewed over 700 patients, iden-
"Simulation software confirmed that both departments could cohabit a single 'ex space,' optimizing both space and staff time."
tifying 73 key areas of improvement from initial entry to outbound transition. One result of this learning was the decision to create private rooms rather than open patient bays; private rooms are the only way to ensure that patient privacy and HIPAA regulations are met. These and other findings were then communicated to planners and architects, so that they could design a
less stressful environment for patients, family and staff. Space Optimization: Team members also recognized that a better patient flow would not only enhance the overall patient experience, but make the ED and OPS departments more cost effective. To determine the most efficient configuration, a year’s worth of data was assembled to show how many patients were treated, what time of day they arrived, and how long they stayed in the ED and OPS. The result was a critical piece of learning: the ED and OPS departments (renamed Surgical Procedure Area or SPA) have peak patient loads at different times of day. Simulation software confirmed that both departments could cohabit a single “ex space” optimizing both space and staff time. Practitioners would be able to focus on patient care as a process rather than a place. Space optimization analysis was also conducted at the room level. This included creating a “living laboratory room mock-up” to test patient comfort and process efficiency. Patient Handling: Staff members recognized that patient handling was inefficient and potentially unsafe. They reviewed the typical patient transfer process from start to finish observing where they could strip away waste and add value. They evaluated the time spent moving family members, locating a transport device, making the transfer itself, storing the unused recliner or stretcher, and then inviting the family members back in the patient area.“We knew that the patient chair or bed had to be the centerpiece of Lean patient handling,” states Michael continued on page 46 MEDMONTHLY.COM |45
Example of SPA and ED patients "flexing" into shared areas Photo courtesy of St. Elizabeth Hospital
continued from page 45 Hofmann, RN, BSN, Director of PreOperative Services at St. Elizabeth. The team then tested multiple patient transfer devices, looking for a solution that made the process simpler, faster and safer. Other testing criteria included ease of use, convenience, and maneuverability in bathrooms and other tight spaces. Several devices were
“As far as we know, this [type of space usage] hasn’t been done before in the country or the world,” says Hofmann.
46 | SEPTEMBER 2012
evaluated and rejected before ending the optimal solution.
Innovative Solutions St. Elizabeth’s redesigned ED/SPA area opened in 2011. By implementing the Lean process it is now equipped to meet the demands of healthcare today. It also meets the hospital’s key objectives of increased patient comfort and high operational efficiency. Optimizing Space & Staff Time: The design of the space itself, based on the concept of flexibility, is revolutionary. It combines the ED/SPA functions into 48 private patient rooms for major trauma, emergency and outpatient surgery/ procedures. For optimal use of space, eight of these are centrallylocated “flex rooms” that can be used either for emergency care or outpatient procedures, as the patient load dictates during any 24-hour period. The SPA utilizes
the flex space in the mornings at its typical peak times, while ER uses the same rooms in the afternoon when outpatient surgery patients have been discharged and ER patients begin arriving at a higher rate. “As far as we know, this hasn’t been TransMotion Medical's TMM4 Multi-purpose Stretcher-Chair Photo courtesy of St. Elizabeth Hospital
done before in the country or the The team addressed patient handling world,” says Hofmann. The nursing issues by selecting a stretcher-chair staff resides at centrally-located stawith exceptional motorized positiontions with convenient access to the pa- ing, purchased from TransMotion tient rooms. The rooms themselves are Medical (TMM)3. TMM’s Univeralso designed down to the last detail sal Care Platform™ replaced a bulky to enhance efficiency and maximize combination of stretchers, recliners the overall patient experience. Each is and wheelchairs with one unit that can identical in its layout and supplies. Inperform all three functions, signifiroom information technology streamcantly streamlining the patient hanlines record keeping and keeps the dling process. family informed of their loved-ones Patients stay on this surface during progress throughout the care cycle. the entire hospital visit, reducing the Minimal at surfaces and easy-to-clean number of transfers by 50%, from four glass doors reduce the risk of infection as well as cleaning time. Reinventing the Patient Experience: The new ED/ SPA puts the patient first. Incoming patients no longer wait in a reception area. They are immediately taken for triage and/or prep into a private One of the new SPA rooms at St. Elizabeth Hospital room that’s Photo courtesy of St. Elizabeth Hospital designed for their comfort. Radiant heat panels and noise reducing to two per procedure. The stretcherwall coverings create a calm treatment chair also significantly lowers the risk environment. Each room has a semiof patient falls and minimizes the private bathroom, as well as a monitor/ likelihood of back injuries to staff. The entertainment center that minimizes TransMotion stretcher-chair, which perceived wait time and displays the was assessed during a three-day trial, patient’s location and health status. has received high ratings in all evaluaPatients return to the same room after tion criteria, including patient comfort, testing and treatment. safety, ease of use, workplace hazard Revolutionizing Patient Handling reduction and pre- and post-op patient with the Universal Care Platform™ : benefit. “There are such key things
around the chair solution. It saved us on furniture, fixtures and equipment, saved us on space, on productivity and on staffing,” states Michael Perry – Project Leader, for St. Elizabeth.
Staff Acceptance Caregivers are enthusiastic about the redesigned space. “It wasn’t a big leap to get them to agree with it,” states Hofmann. “They were already doing their best to follow high productivity principles. The redesign just gave them tools so that they can do a better job at it.”
Summary With the Lean Process and Universal Care Platform™ equipment, St. Elizabeth Hospital has resolved an inherent contradiction in today’s healthcare environment; they have used the process efficiencies that economic realities demand to deliver care that is more personalized than ever. Through extensive research and analysis, detailed planning, and comprehensive testing, they have created an innovative, flexible ED/SPA area that significantly improves the overall patient experience, maintains quality of care, and increases staff efficiency. The team’s principles and methodologies might just serve as a road map for other healthcare institutions seeking to stay ahead of the curve in patient satisfaction and cost management. Designed by Bethany Houston MEDMONTHLY.COM |47
Zen Chuang, M.D., Brings Life and Healing To the Massachusetts Area By Bethany Houston 48 | SEPTEMBER 2012
hen Zen Chuang, M.D., Raynham, MA, speaks about his passions in art and medicine, he cannot help but weave colors and concepts through his words. Stemming from his dynamic upbringing in Taiwan, Argentina and the United States, Zen is a prime example of living a vibrant, well-traveled life. Zen reflects, “The traditional Chinese culture in Taiwan encouraged me to be a renaissance person - well versed in different areas of life. Therefore, my pursuit of art making and my interest in the practice of medicine feel completely natural to me. Eastern culture also fostered a sense of the individual as a small part of a larger unit - family, the community or the greater society. This instilled in me the sense of service to a larger "self," as an artist who may bring beauty to others’ lives, or as a physician who may bring health, happiness or healing to my patients.” When first deciding to pursue a career in family medicine, Zen was touched by the family philosophy of treating each person as a unique whole, greater than the sum of its' parts. He envisioned his future collaborating with the forces within and without a person’s body. So that he could come to intimately know his adopted country, the United States, he became a traveling physician for many years after his residency at Brown University. Not only did this allow Zen to see the beautiful, varied terrain America has to offer but also gave him the flexibility to transpose his time between practicing and painting. “At one point I suddenly realized that one main reason that I enjoyed each place so much was because I was a traveler, always with fresh eyes. Then I made a point to remind myself time and time again that I am ultimately a traveler in life and that I can always enjoy life as long as I keep my fresh eyes,” muses Zen. “Every place I visited was my favorite. Being a doctor at each city gave me opportunities to learn more about the culture through very unique, intimate perspectives in addition to the usual off-time sight-seeing. Each place I was had its special draws that I enjoyed in different ways.” After his stint as a traveling physician, Zen opened a solo family practice in Raynham, MA, where he gains much of his inspiration from his naturalistic environment. His
paintings reflect the energy and vivacity of nature, through sea and mountain sunrises and sunsets, animated fauna and vibrant flora. Using fluid and graceful watercolors, he vicariously depicts all landscapes and terrains. Constantly deriving inspiration from all of his surroundings, Zen find his true solace in his family practice. “My office is a renovated colonial house surrounded by an acreplus garden. Inside this house, where I try to make my patients feel warm and comfortable, my patients have taught me so much about life. The impermanence of life is the
"Then I made a point to remind myself time and time again that I am ultimately a traveler in life, and that I can always enjoy life as long as I keep my fresh eyes."
most humbling. It, along with the suffering I see in many of my patients, makes me want to paint more ‘beautiful’ paintings to help brighten up the world. At the same time, philosophically I see my medical practice as a large piece of performance art. My office surrounded by the garden is the performance stage. I, myself, am the principal performance artist, and my patients, the participating audience. Every day the show is on in an effort to make each participating patient's life fuller, happier and healthier.” Zen has had solo exhibitions of his work in New York, Connecticut, Rhode Island and Massachusetts. Currently, Zen’s work is represented at ThreeWheel Studios in Providence, RI and his next work will be a fantasy picture book painting project featuring his rescue dog Cosmos traveling through the varied American terrain. You can view his entire gallery at his website: www.fromearthtosky.com
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Short-term or long-term, Physician Solutions has you covered P.O. Box 98313, Raleigh, NC 27624 phone: 919.845.0054 fax: 919.845.1947 e-mail: firstname.lastname@example.org www.physiciansolutions.com
U.S. OPTICAL BOARDS Alaska P.O. Box 110806 Juneau, AK 99811 (907)465-5470 http://www.dced.state.ak.us/occ/pdop.htm
Idaho 450 W. State St., 10th Floor Boise , ID 83720 (208)334-5500 www2.state.id.us/dhw
Oregon 3218 Pringle Rd. SE Ste. 270 Salem, OR 97302 (503)373-7721 www.obo.state.or.us
Arizona 1400 W. Washington, Rm. 230 Phoenix, AZ 85007 (602)542-3095 http://www.do.az.gov
Kentucky P.O. Box 1360 Frankfurt, KY 40602 (502)564-3296 http://bod.ky.gov
Rhode Island 3 Capitol Hill, Rm 104 Providence, RI 02908 (401)222-7883 www.health.state.ri.us
Arkansas P.O. Box 627 Helena, AR 72342 (870)572-2847
Massachusetts 239 Causeway St. Boston, MA 02114 (617)727-5339 http://1.usa.gov/zbJVt7
South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4665 www.llr.state.sc.us
Nevada P.O. Box 70503 Reno, NV 89570 (775)853-1421 http://nvbdo.state.nv.us/
Tennessee Heritage Place Metro Center 227 French Landing, Ste. 300 Nashville, TN 37243 (615)253-6061 www2.state.tn.us/health
California 2005 Evergreen St., Ste. 1200 Sacramento, CA 95815 (916)263-2382 www.medbd.ca.gov Colorado 1560 Broadway St. #1310 Denver, CO 80202 (303)894-7750 www.dph.state.ct.us Connecticut 410 Capitol Ave., MS #12APP P.O. Box 340308 Hartford, CT 06134 (860)509-7603 ext. 4 http://www.dph.state.ct.us/
New Hampshire 129 Pleasant St. Concord, NH 03301 (603)271-5590 www.state.nh.us New Jersey P.O. Box 45011 Newark, NJ 07101 (973)504-6435 http://bit.ly/wLM20Y
Florida 4052 Bald Cypress Way, Bin C08 Tallahassee, FL 32399 (850)245-4474 doh.state.fl.us
New York 89 Washington Ave., 2nd Floor W. Albany, NY 12234 (518)402-5944 email@example.com
Georgia 237 Coliseum Dr. Macon, GA 31217 (478)207-1671 www.sos.state.ga.us
North Carolina P.O. Box 25336 Raleigh, NC 27611 (919)733-9321 http://www.ncoptometry.org/
Hawaii P.O. Box 3469 Honolulu, HI 96801 (808)586-2704 firstname.lastname@example.org
Ohio 77 S. High St. Columbus, OH 43266 (614)466-9707 http://optical.ohio.gov/
Texas P.O. Box 149347 Austin, TX 78714 (512)834-6661 www.roatx.org Vermont National Life Bldg N FL. 2 Montpelier, VT 05620 (802)828-2191 www.vtprofessionals.org Virginia 3600 W. Broad St. Richmond, VA 23230 (804)367-8500 www.state.va.us/licenses Washington 300 SE Quince P.O. Box 47870 Olympia, WA 98504 (360)236-4947 www.doh.wa.gov
U.S. DENTAL BOARDS Alabama Alabama Board of Dental Examiners 5346 Stadium Trace Pkwy., Ste. 112 Hoover, AL 35244 (205) 985-7267 http://www.dentalboard.org/ Alaska P.O. Box 110806 Juneau, AK 99811-0806 (907)465-2542 http://bit.ly/uaqEO8 Arizona 4205 N. 7th Ave. Suite 300 Phoenix, AZ 85103 (602)242-1492 http://azdentalboard.us/ Arkansas 101 E. Capitol Ave., Suite 111 Little Rock, AR 72201 (501)682-2085 http://www.asbde.org/ California 2005 Evergreen Street, Suite 1550Â Sacramento, CA 95815 877-729-7789 http://www.dbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7800 http://www.dora.state.co.us/dental/ Connecticut 410 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/site/default.asp Delaware Cannon Building, Suite 203 861 Solver Lake Blvd. Dover, DE 19904 (302)744-4500 http://1.usa.gov/t0mbWZ Florida 4052 Bald Cypress Way Bin C-08 Tallahassee, FL 32399 (850)245-4474 http://bit.ly/w1m4MI 52 | SEPTEMBER2012
Georgia 237 Coliseum Drive Macon, GA 31217 (478)207-2440 http://sos.georgia.gov/plb/dentistry/ Hawaii DCCA-PVL Att: Dental P.O. Box 3469 Honolulu, HI 96801 (808)586-3000 http://1.usa.gov/s5Ry9i Idaho P.O. Box 83720 Boise, ID 83720 (208)334-2369 http://isbd.idaho.gov/ Illinois 320 W. Washington St. Springfield, IL 62786 (217)785-0820 http://bit.ly/svi6Od Indiana 402 W. Washington St., Room W072 Indianapolis, IN 46204 (317)232-2980 http://www.in.gov/pla/dental.htm Iowa 400 SW 8th St. Suite D Des Moines, IA 50309 (515)281-5157 http://www.state.ia.us/dentalboard/ Kansas 900 SW Jackson Room 564-S Topeka, KS 66612 (785)296-6400 http://www.accesskansas.org/kdb/ Kentucky 312 Whittington Parkway, Suite 101 Louisville, KY 40222 (502)429-7280 http://dentistry.ky.gov/ Louisiana 365 Canal St., Suite 2680 New Orleans, LA 70130 (504)568-8574 http://www.lsbd.org/
Maine 143 State House Station 161 Capitol St. Augusta, ME 04333 (207)287-3333 http://www.mainedental.org/ Maryland 55 Wade Ave. Catonsville, Maryland 21228 (410)402-8500 http://dhmh.state.md.us/dental/ Massachusetts 1000 Washington St., Suite 710 Boston, MA 02118 (617)727-1944 www.mass.gov Michigan P.O. Box 30664 Lansing, MI 48909 (517)241-2650 www.michigan.gov Minnesota 2829 University Ave., SE. Suite 450 Minneapolis, MN 55414 (612)617-2250 http://www.dentalboard.state.mn.us/ Mississippi 600 E. Amite St., Suite 100 Jackson, MS 39201 (601)944-9622 http://bit.ly/uuXKxl Missouri 3605 Missouri Blvd. P.O. Box 1367 Jefferson City, MO 65102 (573)751-0040 http://pr.mo.gov/dental.asp Montana P.O. Box 200113 Helena, MT 59620 (406)444-2511 http://mt.gov/ Nebraska 301 Centennial Mall South Lincoln, NE 68509 (402)471-3121 http://bit.ly/uBEqwK
Nevada 6010 S. Rainbow Blvd. Suite A-1 Las Vegas, NV 89118 (702)486-7044 http://www.nvdentalboard.nv.gov/
Oklahoma 201 N.E. 38th Terr., #2 Oklahoma City, OK 73105 (405)524-9037 http://www.dentist.state.ok.us/
Utah 160 E. 300 South Salt Lake City, UT 84111 (801)530-6628 http://1.usa.gov/xMVXWm
New Hampshire 2 Industrial Park Dr. Concord, NH 03301 (603)271-4561 http://www.nh.gov/dental/
Oregon 1600 SW 4th Ave. Suite 770 Portland, OR 97201 (971)673-3200 http://www.oregon.gov/Dentistry/
New Jersey P.O Box 45005 Newark, NJ 07101 (973)504-6405 http://bit.ly/uO2tLg
Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)783-7162 http://bit.ly/s5oYiS
Vermont National Life Building North FL2 Montpelier, VT 05620 (802)828-1505 http://bit.ly/zSHgpa
New Mexico Toney Anaya Building 2550 Cerrillos Rd. Santa Fe, NM 87505 (505)476-4680 http://www.rld.state.nm.us/boards/ Dental_Health_Care.aspx
Rhode Island Dept. of Health Three Capitol Hill, Room 104 Providence, RI 02908 (401)222-2828 http://1.usa.gov/u66MaB
New York 89 Washington Ave. Albany, NY 12234 (518)474-3817 http://www.op.nysed.gov/prof/dent/
South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4599 http://www.llr.state.sc.us/POL/Dentistry/
North Carolina 507 Airport Blvd., Suite 105 Morrisville, NC 27560 (919)678-8223 http://www.ncdentalboard.org/
South Dakota P.O. Box 1079 105. S. Euclid Ave. Suite C Pierre, SC 57501 (605)224-1282 https://www.sdboardofdentistry.com/
North Dakota P.O. Box 7246 Bismark, ND 58507 (701)258-8600 http://www.nddentalboard.org/
Tennessee 227 French Landing, Suite 300 Nashville, TN 37243 (615)532-3202 http://health.state.tn.us/boards/dentistry/
Ohio Riffe Center 77 S. High St.,17th Floor Columbus, OH 43215 (614)466-2580 http://www.dental.ohio.gov/
Texas 333 Guadeloupe St. Suite 3-800 Austin, TX 78701 (512)463-6400 http://www.tsbde.state.tx.us/
Virginia Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4538 http://www.dhp.virginia.gov/dentistry Washington 310 Israel Rd. SE P.O. Box 47865 Olympia, WA 98504 (360)236-4700 http://1.usa.gov/tKBFHT West Virginia 1319 Robert C. Byrd Dr. P.O. Box 1447 Crab Orchard, WV 25827 1-877-914-8266 http://www.wvdentalboard.org/ Wisconsin P.O. Box 8935 Madison, WI 53708 1(877)617-1565 http://bit.ly/sEhr0Q Wyoming 1800 Carey Ave., 4th Floor Cheyenne, WY 82002 (307)777-6529 http://plboards.state.wy.us/dental/index.asp
U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (334)242-4116 http://www.albme.org/
Florida 2585 Merchants Row Blvd. Tallahassee, FL 32399 (850)245-4444 http://www.doh.state.fl.us/
Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 http://bit.ly/zZ455T
Georgia 2 Peachtree Street NW, 36th Floor Atlanta, GA 30303 (404)656-3913 http://bit.ly/vPJQyG
Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 (480)551-2700 http://www.azmd.gov
Hawaii DCCA-PVL P.O. Box 3469 Honolulu, HI 96801 (808)587-3295 http://hawaii.gov/dcca/pvl/boards/medical/
Arkansas 1401 West Capitol Ave., Suite 340 Little Rock, AR 72201 (501)296-1802 http://www.armedicalboard.org/ California 2005 Evergreen St., Suite 1200 Sacramento, CA 95815 (916)263-2382 http://www.mbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7690 http://www.dora.state.co.us/medical/ Connecticut 401 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/site/default.asp Delaware Division of Professional Regulation Cannon Building 861 Silver Lake Blvd., Suite 203 Dover, DE 19904 (302)744-4500 http://dpr.delaware.gov/ District of Columbia 899 North Capitol St., NE Washington, DC 20002 (202)442-5955 http://www.dchealth.dc.gov/doh
54 | SEPTEMBER2012
Idaho Idaho Board of Medicine P.O. Box 83720 Boise, Idaho 83720 (208)327-7000 http://bit.ly/orPmFU Illinois 320 West Washington St. Springfield, IL 62786 (217)785 -0820 http://www.idfpr.com/ Indiana 402 W. Washington St. #W072 Indianapolis, IN 46204 (317)233-0800 http://www.in.gov/pla/ Iowa 400 SW 8th St., Suite C Des Moines, IA 50309 (515)281-6641 http://medicalboard.iowa.gov/ Kansas 800 SW Jackson, Lower Level, Suite A Topeka, KS 66612 (785)296-7413 http://www.ksbha.org/ Kentucky 310 Whittington Pkwy., Suite 1B Louisville, KY 40222 (502)429-7150 http://kbml.ky.gov/default.htm
Louisiana LSBME P.O. Box 30250 New Orleans, LA 70190 (504)568-6820 http://www.lsbme.la.gov/ Maine 161 Capitol Street 137 State House Station Augusta, ME 04333 (207)287-3601 http://bit.ly/hnrzp Maryland 4201 Patterson Ave. Baltimore, MD 21215 (410)764-4777 http://www.mbp.state.md.us/ Massachusetts 200 Harvard Mill Sq., Suite 330 Wakefield, MA 01880 (781)876-8200 http://www.mass.gov Michigan Bureau of Health Professions P.O. Box 30670 Lansing, MI 48909 (517)335-0918 http://www.michigan.gov/lara Minnesota University Park Plaza 2829 University Ave. SE, Suite 500 Minneapolis, MN 55414 (612)617-2130 http://bit.ly/pAFXGq Mississippi 1867 Crane Ridge Drive, Suite 200-B Jackson, MS 39216 (601)987-3079 http://www.msbml.state.ms.us/ Missouri Missouri Division of Professional Registration 3605 Missouri Blvd. P.O. Box 1335 Jefferson City, MO 65102 (573)751-0293 http://pr.mo.gov/
Montana 301 S. Park Ave. #430 Helena, MT 59601 (406)841-2300 http://bit.ly/obJm7J p
North Dakota 418 E. Broadway Ave., Suite 12 Bismarck, ND 58501 (701)328-6500 http://www.ndbomex.com/
Nebraska Nebraska Department of Health and Human Services P.O. Box 95026 Lincoln, NE 68509 (402)471-3121 http://www.hhs.state.ne.us/
Ohio 30 E. Broad St., 3rd Floor Columbus, OH 43215 (614)466-3934 http://med.ohio.gov/
Nevada Board of Medical Examiners P.O. Box 7238 Reno, NV 89510 (775)688-2559 http://www.medboard.nv.gov/ New Hampshire New Hampshire State Board of Medicine 2 Industrial Park Dr. #8 Concord, NH 03301 (603)271-1203 http://www.nh.gov/medicine/ New Jersey P. O. Box 360 Trenton, NJ 08625 (609)292-7837 http://bit.ly/w5rc8J New Mexico 2055 S. Pacheco St. Building 400 Santa Fe, NM 87505 (505)476-7220 http://www.nmmb.state.nm.us/ New York Office of the Professions State Education Building, 2nd Floor Albany, NY 12234 (518)474-3817 http://www.op.nysed.gov/ North Carolina P.O. Box 20007 Raleigh, NC 27619 (919)326-1100 http://www.ncmedboard.org/
Oklahoma P.O. Box 18256 Oklahoma City, OK 73154 (405)962-1400 http://www.okmedicalboard.org/ Oregon 1500 SW 1st Ave., Suite 620 Portland, OR 97201 (971)673-2700 http://www.oregon.gov/OMB/ Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)787-8503 http://bit.ly/havKVj Rhode Island 3 Capitol Hill Providence, RI 02908 (401)222-5960 http://1.usa.gov/xgocXV South Carolina P.O. Box 11289 Columbia, SC 29211 (803)896-4500 http://www.llr.state.sc.us/pol/medical/ South Dakota 101 N. Main Ave. Suite 301 Sioux Falls, SD 57104 (605)367-7781 http://www.sdbmoe.gov/ Tennessee 425 5th Ave. North Cordell Hull Bldg. 3rd Floor Nashville, TN 37243 (615)741-3111 http://health.state.tn.us/
Texas P.O. Box 2018 Austin, TX 78768 (512)305-7010 http://bit.ly/rFyCEW Utah P.O. Box 146741 Salt Lake City, UT 84114 (801)530-6628 http://www.dopl.utah.gov/ Vermont P.O. Box 70 Burlington, VT 05402 (802)657-4220 http://1.usa.gov/wMdnxh Virginia Virginia Dept. of Health Professions Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4400 http://1.usa.gov/xjfJXK Washington Public Health Systems Development Washington State Department of Health 101 Israel Rd. SE, MS 47890 Tumwater, WA 98501 (360)236-4085 http://www.doh.wa.gov/PHIP/default.htm West Virginia 101 Dee Dr., Suite 103 Charleston, WV 25311 (304)558-2921 http://www.wvbom.wv.gov/ Wisconsin P.O. Box 8935 Madison, WI 53708 (877)617-1565 http://drl.wi.gov/section. asp?linkid=6&locid=0 Wyoming 320 W. 25th St., Suite 200 Cheyenne, WY 82002 (307)778-7053 http://wyomedboard.state.wy.us/
medical resource guide
Ajishra Technology Support
Boyle CPA, PLLC 3716 National Drive, Suite 206 Raleigh, NC 27612 (919) 720-4970 www.boyle-cpa.com
3562 Habersham at Northlake, Bldg J Tucker, GA 30084 (866)473-0011 www.ajishra.com
Applied Medical Services 4220 NC Hwy 55, Suite 130B Durham, NC 27713 (919)477-5152 www.ams-nc.com
Axiom Business Solutions Find Urgent Care
PO Box 15130 Scottsdale, AZ 85267 (602)370-0303 www.findurgentcare.com
Frost Arnett 480 James Robertson Parkway Nashville, TN 37219 (800)264-7156 www.frostarnett.com
PO Box 98313 Raleigh, NC 27624 (919)747-9031
4704 E. Trindle Rd. Mechanicsburg, PA 17050 (866)517-0466 www.axiom-biz.com
Ring Ring LLC
6881 Maple Creek Blvd, Suite 100 West Bloomfield, MI 48322-4559 (248)819-6838 www.ringringllc.com
Gold Key Credit, Inc. PO Box 15670 Brooksville, FL 34604 888-717-9615 www.goldkeycreditinc.com
Horizon Billing Specialists
ANSWERING SERVICES Corridor Medical Answering Service
4635 44th St., Suite C150 Kentwood, MI 49512 (800)378-9991 www.horizonbilling.com
Management Services On-Call
3088 Route 27, Suite 7 Kendall Park, NJ 08824 (866)447-5154 www.corridoranswering.net
200 Timber Hill Place, Suite 221 Chapel Hill, NC 27514 (866)347-0001 www.msocgroup.com
Docs on Hold
Marina Medical Billing Service
14849 West 95th St. Lenexa, KS 66285 (913)559-3666 www.soundproductsinc.com
BILLING & COLLECTION Advanced Physician Billing, LLC
PO Box 730 Fishers, IN 46038 (866)459-4579 www.advancedphysicianbillingllc.com
56| SEPTEMBER 2012
Sweans Technologies 501 Silverside Rd. Wilmington, DE 19809 (302)351-3690 www.medisweans.com
PO Box 1350 Forney, TX 75126 (214)499-3440 www.vipbilling.com
CAREER CONSULTING SEAK Non-Clinical Careers Conference Oct. 21-22, 2012 in Chicago, IL (508)457-1111 www.nonclinicalcareers.com
Doctorâ€™s Crossing 4107 Medical Parkway, Suite 104 Austin, Texas 78756 (512)517-8545 http://doctorscrossing.com/
CODING SPECIALISTS The Coding Institute LLC 2222 Sedwick Drive Durham, NC 27713 (800)508-2582 http://www.codinginstitute.com/
18000 Studebaker Road 4th Floor Cerritos, CA 90703 (800)287-8166 www.marinabilling.com
American Medical Software
6451 Brentwood Stair Rd. Ft. Worth, TX 76112 (800)378-4134 www.mediservltd.com
Practice Velocity 1673 Belvidere Road Belvidere, IL 61008 (888)357-4209 www.practicevelocity.com
1180 Illinois 157 Edwardsville, IL 62025 (618) 692-1300 www.americanmedical.com 300 N. Milwaukee Ave Vernon Hills, IL 60061 (866)782-4239 www.cdwg.com/
Instant Medical History
4840 Forest Drive #349 Columbia, SC 29206 (803)796-7980 www.medicalhistory.com
medical resource guide
CONSULTING SERVICES, PRACTICE MANAGEMENT
The Dental Box Company, Inc.
PO Box 101430 Pittsburgh, PA 15237 (412)364-8712 www.thedentalbox.com
Manage My Practice
103 Carpenter Brook Dr. Cary, NC 27519 (919)370-0504 www.managemypractice.com
ELECTRONIC MED. RECORDS INSURANCE, MED. LIABILITY
Medical Practice Listings
1207 Delaware Ave. #433 Buffalo, NY 14209 (800)267-2235 www.abelmedicalsoftware.com
(800) 4-THRIVE www.medicalcredentialing.org 8317 Six Forks Rd. Suite #205 Raleigh, NC 27624 (919)848-4202 www.medicalpracticelistings.com
24 Cherry Lane Doylestown, PA 18901 (888)348-1170 www.myemrchoice.com
Synapse Medical Management
18436 Hawthorne Blvd. #201 Torrance, CA 90504 (310)895-7143 www.synapsemgmt.com
Urgent Care America
17595 S. Tamiami Trail Fort Meyers, FL 33908 (239)415-3222 www.urgentcareamerica.com
Utilization Solutions email@example.com (919) 289-9126
Sigmon & Daknis Williamsburg, VA Office 325 McLaws Circle, Suite 2 Williamsburg, VA 23185 (757)258-1063 http://www.sigmondaknis.com/
Acentec, Inc 17815 Sky Park Circle , Suite J Irvine, CA 92614 (949)474-7774 www.acentec.com
AdvancedMD 10011 S. Centennial Pkwy Sandy, UT 84070 (800) 825-0224 www.advancedmd.com
CollaborateMD 201 E. Pine St. #1310 Orlando, FL 32801 (888)348-8457 www.collaboratemd.com
Aquesta Insurance Services, Inc.
Michael W. Robertson 3807 Peachtree Avenue, #103 Wilmington, NC 28403 Work: (910) 794-6103 Cell: (910) 777-8918 www.aquestainsurance.com
Jones Insurance 820 Benson Rd. Garner, North Carolina 27529 (919) 772-0233 www.Jones-insurance.com
Medical Protective 5814 Reed Rd. Fort Wayne, In 46835 (800)463-3776
1849 W. North Temple Salt Lake City, UT 84116 (800)969-6447 www.mgis.com
DocuTAP 4701 W. Research Dr. #102 Sioux Falls, SD 57107-1312 (877)697-4696 www.docutap.com
Professional Medical Insurance Services
16800 Greenspoint Park Drive Houston, TX 77060 (877)583-5510 www.promedins.com
Wood Insurance Group
2600 Garden Rd. #112 Monterey, CA 93940 (800)458-2486 www.integritas.com
4835 East Cactus Rd., #440 Scottsdale, AZ 85254-3544 (602)230-8200 www.woodinsurancegroup.com
4555 Riverside Dr. Palm Beach Gardens, FL 33410 (800)342-5454 www.biomet3i.com
Dental Management Club
4924 Balboa Blvd #460 Encino, CA 91316 www.dentalmanagementclub.com
FINANCIAL CONSULTANTS Sigmon Daknis Wealth Management 701 Town Center Dr. , Ste. #104 Newport News, VA 23606 (757)223-5902 www.sigmondaknis.com
LOCUM TENENS Physician Solutions
PO Box 98313 Raleigh, NC 27624 (919)845-0054 www.physiciansolutions.com
medical resource guide
9975 Summers Ridge Road San Diego, CA 92121 (858)805-8378
Brian Allen www.artisanprinter.com Deborah Brenner 877 Island Ave #315 San Diego, CA 92101 (619)818-4714 www.deborahbrenner.com Zen Chuang, MD www.fromearthtosky.com Pia De Girolamo www.piadegirolamo.com Nicholas Down http://bit.ly/yHwxb0
MEDICAL PUBLISHING www.biosite.com
firstname.lastname@example.org 800-933-3711 www.greenbranch.com
800 Shoreline, #900 Corpus Christi, TX 78401 (888)246-3928
www.martindfried.com Barry Hanshaw 18 Bay Path Drive Boylston MA 01505 508 - 869 - 6038 JHans76271@aol.com www.barryhanshaw.com Ako Jacintho email@example.com www.facebook.com/akojacintho www.akojacintho.com
391 Technology Way Winston Salem, NC 27101 (336)722-8910 www.carolinachemistries.com
Dicom Solutions 548 Wald Irvine, CA 92618 (800)377-2617
1934 Colwell Ave. Wilmington, NC 28403 (800)672-0441
MEDICAL PRACTICE SALES Medical Practice Listings
Marianne Mitchell (215)704-3188 http://www.mariannemitchell.com http://www.colordrop.blogspot.com
MEDICAL EQUIPMENT ALLPRO Imaging
1295 Walt Whitman Road Melville, NY 11747 (888)862-4050 www.allproimaging.com 58| SEPTEMBER 2012
Chimerix, Inc. 2505 Meridian Parkway, Suite 340 Durham, NC 27713 (919) 806-1074 www.chimerix.com 8433 Quivira Rd. Lenexa, KS 66215 (800)445-6917
Sanofi US 55 Corporate Drive Bridgewater, NJ 08807 (800) 981-2491 www.sanofi.us
MedMedia9 PO Box 98313 Raleigh, NC 27624 (919)747-9031 www.medmedia9.com
500 Chipeta Way Salt Lake City, UT 84108 (800)242-2787
Clinical Reference Laboratory
MedImagery Laura Maask 262-308-1300
Julie Jennings (678)772-0889
firstname.lastname@example.org http://silksynergy.com/ http://www.coroflot.com/naddie09
Carolina Liquid Chemistries, Inc.
Tarheel Physicians Supply
8317 Six Forks Rd. Ste #205 Raleigh, NC 27624 (919)848-4202 www.medicalpracticelistings.com
MEDICAL PRACTICE VALUATIONS BizScore
PO Box 99488 Raleigh, NC 27624 (919)846-4747 www.bizscorevaluation.com
Scynexis, Inc. 3501 C Tricenter Blvd. Durham, NC 27713 (919) 933-4990 www.scynexis.com
MORTGAGE PROFESSIONAL SunTrust Mortgage, Inc.
Nicholas Lay, Senior Loan Officer 910.368.8080 Cell nick.lay@SunTrust.com NMLSR# 659099 www.suntrust.com
NUTRITION THERAPIST Triangle Nutrition Therapy 6200 Falls of Neuse Road, Suite 200 Raleigh, NC 27609 (919)876-9779 http://trianglediet.com/
medical resource guide
DJO 1430 Decision St. Vista, CA 92081 (760)727-1280
York Properties, Inc. Headquarters & Property Management 1900 Cameron Street Raleigh, NC 27605 (919) 821-1350 Commercial Sales & Leasing (919) 821-7177 www.yorkproperties.com
STAFFING COMPANIES Additional Staffing Group, Inc. 8319 Six Forks Rd, Suite 103 Raleigh, NC 27615 (919) 844-6601 Astaffinggroup.com
BSN Medical 5825 Carnegie Boulevard Charlotte, NC 28209 (800)552-1157 www.bsnmedical.us CNF Medical 1100 Patterson Avenue Winston Salem, NC 27101 (877)631-3077 www.cnfmedical.com Dermabond Ethicon, Route 22 West Somerville, NJ 08876 (877)984-4266 www.dermabond.com
ExpertMed 31778 Enterprise Dr. Livonia, MI 48150 (800)447-5050
4444 East 153rd St. Cleveland, OH 44128-2955 (216)581-3030 www.gebauerspainease.com
Green Pear Health
East Greenwich, RI (203)247-9912 www.greenpearhealth.com
15 Barstow Rd. Great Neck, NY 11021 (877)566-5935 www.scarguard.com
Manage My Practice is the go-to online source of technology, information and resources for
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Do you use Process Improvement (PI) to address negative trends?
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Is patient satisfaction measured and prioritized for improvement of the practice?
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Contact us: 919.747.9031 email@example.com medmonthly.com
Classified To place a classified ad, call 919.747.9031
North Carolina (cont.)
Occupational Health Care Practice in Fayetteville North Carolina has two to five days of locums work per week. 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, and PH: (919) 8450054, email: firstname.lastname@example.org Occupation Health Care Practice located in Greensboro, NC has an immediate opening for a primary care physician. This is 40 hours per week opportunity with a base salary of $135,000 plus incentives, professional liability insurance and an excellent CME, vacation and sick leave package. Send copies of your CV, 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, and PH: (919) 845-0054, email: email@example.com Family Practice physician opportunity in Raleigh, NC This is a locum’s position with three to four shifts per week requirement that will last for several months. You must be BC/BE and comfortable treating patients from one year of age to geriatrics. You will be surrounded by an exceptional, experienced staff with beautiful offices and accommodations. No call or hospital rounds. Send copies of your CV, 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, and PH: (919) 845-0054, email: firstname.lastname@example.org Methadone Treatment Center located near Charlotte, NC has an opening for an experienced physician. You must be comfortable in the evaluation and treatment within the guidelines of a highly regulated environment. Practice operating hours are 6 a.m. till 3 p.m. Monday through Friday. Send copies of your CV, 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, and PH: (919) 845-0054,email: email@example.com Immediate Full-Time Opportunity for Board Certified occupational health care MD in Greensboro, NC. Excellent working environment, wage and professional liability insurance provided. 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, and PH: (919) 845-0054, email: firstname.lastname@example.org
Cardiology Practice located in High Point, NC has an opening for a board certified cardiovascular physician. This established and beautiful facility offers the ideal setting for an enhanced lifestyle. There is no hospital call or invasive procedures. Look into joining this three physician facility and live the good life in one of North Carolina’s most beautiful cities. 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, and PH: (919) 845-0054, email: email@example.com Board Certified Internal Medicine physician position is available in the Greensboro, NC area. This is an out-patient opportunity within a large established practice. The employment package contains salary plus incentives. Please send a copy of your current CV, NC medical license, DEA certificate and NPI certificate with number along with your detailed work history and CME courses completed to: Physician Solutions, P.O. Box 98313, Raleigh, NC 27624. email: firstname.lastname@example.org or phone with any questions, PH: (919) 845-0054. Family Practice physician is needed to cover several shifts per week in Rocky Mount, NC. This high profile practice treats pediatrics, women’s health and primary care patients of all ages. If you are available for 30 plus hours per week for the remainder of the year, this could be the perfect opportunity. Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, N.C. 27624, and PH: (919) 845-0054, email: email@example.com Health department in North Carolina seeks FP/GP/IM for June 30-Aug 10 Health Dept in North Carolina seeks physician for jail. Primarily will treat minor ailments, small trauma, and sutures. The dates the physician will need to cover are: 7/31/12, 8/3/12, 8/6/12, 8/8/12, 8//12, 8/13/12. Please send a copy of your current CV, NC medical license, DEA certificate and NPI certificate with number along with your detailed work history and CME courses completed to: Physician Solutions, P.O. Box 98313, Raleigh, NC 27624. email: firstname.lastname@example.org or phone with any questions, PH: (919) 845-0054.
Classified To place a classified ad, call 919.747.9031
North Carolina (cont.)
Sports Medicine center in Charlotte seeks FP/GP/IM immediately FT/PT to perm Doctor needed immediately in Charlotte Sports Medical Clinic to help decrease the risk of sports injuries by evaluating baseline and preexisting conditions to provide treatment and rehabilitation. 8a-5p M-F no call. 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, and PH: (919) 845-0054, email: email@example.com
Fayetteville Health Dept seeks FP/GP/IM for June 30-Aug 10 County Health Dept seeks physician for jail for minor ailments, small trauma, and sutures. 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, and PH: (919) 845-0054, email: firstname.lastname@example.org
GP needed immediately for Cary center to treat knee related disorders A small practice in Cary is looking for a physician for 2 weeks in July and intermittently. The physician will need to be able to do injections for Non-Surgical knee pain and the injection is done via video Flouroscopy . 8a-5p.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, and PH: (919) 845-0054, email: email@example.com
Urgent care and occupational practice 30 minutes north of Greensboro, needs family practice doctor able to see all ages. Dates are Aug 13-17, likely further scheduling. 20-25 patients a day. Hours are 8:15 to 5:30. 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, and PH: (919) 845-0054, email: firstname.lastname@example.org
GP/FP/IM needed for urgent care near Greensboro Aug 13-17
Charlotte Health Department Seeks On-going General Practitioners: • •
• • •
County Health Department seeks physicians immediately to work 8am-5pm in the following departments: Child Health FP or pediatrician needed for intermittent dates to do physicals, immunizations, vision and hearing screenings among other basic procedures. Need coverage July 12-13 & 20. Employee Health GP/IM needed for physicals and sick visits for staff. Family Planning FP sought for first time wellness check-ups; no follow-up appointments. Approx 20 patients per day. Diabetes GP/FP needed for outpatient diabetic clinic. Approx 10 patients per day.
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, and PH: (919) 845-0054,email: email@example.com
62| SEPTEMBER 2012
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North Carolina (cont.)
North Carolina (cont.)
Internal Medicine Practice located in High Point, NC, has two full-time positions available. This wellestablished practice treats private pay as well as Medicare/Medicaid patients. There is no call or rounds associated with this opportunity. If you consider yourself a well-rounded IM physician and enjoy a team environment, this could be your job. You would be required to live in or around High Point and if relocating is required, a moving package will be extended as part of your salary and incentive package. BC/BE MD should forward your CV, and copy of your NC medical license to firstname.lastname@example.org - View this and other exceptional physician opportunities at www.physiciansolutions.com or call (919) 845-0054 to discuss your availability and options.
Internal/ Family Physician needed in Fayetteville Well-established health department seeks ongoing coverage Mondayâ€“Thursday for Aug 20 - Sept 27 . Physician will see about 20 adult patients daily, hours are 8am-5pm with an hour for lunch. No call.
Locum Tenens Primary Care Physicians Needed If you would like the flexibility and exceptional pay associated with locums, we have immediate opportunities in family, urgent care, pediatric, occupational health and county health departments in NC and VA. Call today to discuss your options and see why Physician Solutions has been the premier physician staffing company on the eastern seaboard. Call (919) 845-0054 or review our corporate capabilities at www.physiciansolutions.com Occupational Clinic in Greensboro NC seeks GP immediately PT General Practitioner needed for an occupational, urgent care and walk in clinic. The practice is located in Greensboro NC. Hours are 8a-5p. Approximately 20 patients/day. Excellent staff. Outpatient only. No call or hospital duties. Please send a current CV to email@example.com or call (919) 845-0054 for details on this and other opportunities across the state. Physicians Needed Immediately We have several immediate needs for physician coverage for various facilities in North Carolina for addiction medicine. For immediate consideration please call or email us at firstname.lastname@example.org or call (919) 8450054. We can put you to work tomorrow! We have very competitive salaries, we pay for mileage, your accommodations if necessary. We look forward to hearing back from you.
64| SEPTEMBER 2012
Sports Medical Center in Charlotte seeks FP/GP/IM immediately. Two to four days a week. 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, and PH: (919) 845-0054, email: email@example.com Occupational Health Care Clinic seeks GP/IM. One to three days a week. Adults only. 8am-5pm. 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, and PH: (919) 845-0054, email: firstname.lastname@example.org State Mental Health Facility in Goldsboro needs GP/IM/FP. Physician needed for mental health facility about an hour east of Raleigh. FT ongoing 8am-5pm. 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, and PH: (919) 845-0054, email: email@example.com
Virginia Pediatric Locums Physician needed in Harrisonburg, Danville and Lynchburg, VA. These locum positions require 30 to 40 hours per week, on-going. If you are seeking a beautiful climate and flexibility with your schedule, please consider one of these opportunities. Send copies of your CV, VA. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: firstname.lastname@example.org
To place a classified ad, call 919.747.9031
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: email@example.com
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.
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1-855-4-THRIVE Visit us at
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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 Gross Yearly Income: $335,000+ | List Price: $125,000
NC MedSpa For Sale MedSpa Located in North Carolina We have recently listed a MedSpa in NC This established practice has staff MDs, PAs and nurses to assist patients. Some of the procedures performed include: Botox, Dysport, Restylane, Perian, Juvederm, Radiesse, IPL Photoreju Venation, fractional laser resurfacing as well as customized facials. There are too many procedures to mention in this very upscale practice. The qualified buyer will be impressed with the $900,000 gross revenue. This is a new listing, and we are in the valuation process. Contact Medical Practice Listings today to discuss the practice details.
62| JULY 2012
Call 919-848-4202 or email firstname.lastname@example.org www.medicalpracticelistings.com
For more information call Medical Practice Listings at 919-848-4202 or e-mail email@example.com
Woman’s Practice in Raleigh, North Carolina.
EMPLOYING PEOPLE THAT FIT With over 30 years of experience, Additional Staffing Group can provide your practice with an exceptionally talented staff that will streamline operations in your health care facility.
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
OUR SERVICES INCLUDE: Short/Long Term Temporary Placement Direct Hire and Executive Permanent Placement Payroll Services HR Consultant Services
WE STAFF: Receptionists Medical Records Technicians Accounting and Medical Billing Specialists
WORKFORCE EXPANSION SOLUTIONS 919-844-6601 www.astaffinggroup.com
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: www.ACEfitness.org
( 8 0 0 )
8 2 5 - 3 6 3 6
X 6 5 3
A M E R I C A’ S A U T H O R I T Y O N F I T N E S S
Med Monthly Med Monthly is the premier health care magazine for medical professionals.
By placing an ad in Med Monthly you’ll reach: family medicine, internal medicine, physician assistants and more!
Call us today to place your classified!
Also available online 24/7
68| SEPTEMBER 2012
Practice for Sale in South Denver Neurofeedback and Psychological Practice Located in South Denver, Colorado, this practice features high patient volume and high visibility on the internet. Established referral sources, owner (psychologist) has excellent reputation based on 30 years experience in Denver. Private pay and insurances, high-density traffic, beautifully decorated and furnished offices, 378 active and inactive clients, corporate clients, $14,000 physical assets, good parking, near bus and rapid transit housed in a well-maintained medical building. Live and work in one of the most healthy cities in the U.S. List Price: $150,000 | Established: 2007 | Location: Colorado For more information contact Dr. Jack McInroy at 303-929-2598 or Shrink1324@gmail.com
Classified To place a classified ad, call 919.747.9031
Practice for sale
Practice for sale
North Carolina (con't)
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: firstname.lastname@example.org
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: email@example.com
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 well-equipped exam rooms, new computer equipment and a solid patient following. The owner is retiring and willing to continue with the new owner for a few months to assist with a smooth transition. Contact Medical Practice Listings at (919) 848-4202 for more information. View additional listings at: www.medicalpracticelistings.com 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 www.medicalpracticelistings.com 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 firstname.lastname@example.org
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: email@example.com
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: firstname.lastname@example.org or (919) 848-4202.
Pediatrics Practice Wanted Pediatrics practice wanted in NC Considering your options regarding your pediatric practice? We can help. Medical Practice Listings has a well qualified buyer for a pediatric practice anywhere in central North Carolina. Contact us today to discuss your options confidentially. Medical Practice Listings Call 919-848-4202 or e-mail email@example.com www.medicalpracticelistings.com
Comprehensive Ophthalmic and Neuro-Ophthalmic Neuro-Ophthalmic Practice Raleigh North Carolina
A leading destination covering the business of healthcare and life science innovation for decision makers in the healthcare industry. Visit MedCityNews.com for whatâ€™s next and what matters A mix of breaking news and analysis on startups and established industry leaders, personalities, policies and the most important deals.
This is a great opportunity to purchase an established ophthalmic practice in the heart of Raleigh. Locate on a major road with established clients and plenty of room for growth; you will appreciate the upside this practice offers. This practice performs comprehensive ophthalmic and neuro-ophthalmic exams with diagnosis and treatment of eye disease of all ages. Surgical procedures include no stitch cataract surgery, laser treatment for glaucoma and diabetic eye disease. This practice offers state-of-the-art equipment and offer you the finest quality optical products with contact lens fitting and follow-up care & frames for all ages. List Price: $75,000 | Gross Yearly Income: $310,000
Contact Cara or Philip 919-848-4202 for more information or visit MedicalPracticeListings.com MEDMONTHLY.COM | 71
Wanted: Urgent Care Practice Urgent care practice wanted in North Carolina. Qualified physician is seeking to purchase an established urgent care within 100 miles of Raleigh, North Carolina. If you are considering retiring, relocations or closing your practice for personal reasons, contact us for a confidential discussion regarding your urgent care. You will receive cash at closing and not be required to carry a note.
Medical Practice Listings
Hospice Practice Wanted Hospice Practice wanted in Raleigh/ Durham area of North Carolina. 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.
Buying and selling made easy
Call 919-848-4202 or e-mail firstname.lastname@example.org www.medicalpracticelistings.com
To find out more information call 919-848-4202 or e-mail email@example.com www.medicalpracticelistings.com
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
MedicalPracticeListings.com | firstname.lastname@example.org | 919.848.4202 72| SEPTEMBER 2012
Primary Care Practice For Sale Wilmington, NC Established primary care on the coast of North Carolina’s beautiful beaches. Fully staffed with MD’s and PA’s to treat both appointment and walk-in patients. Excellent exam room layout, equipment and visibility. Contact Medical Practice Listings for more information.
MD STAFFING AGENCY FOR SALE The perfect opportunity for anyone who wants to purchase an established business. l One
of the oldest Locums companies l Large client list l Dozens of MDs under contract l Executive office setting l Modern computers and equipment l Revenue over a million per year l Retiring owner l List price is over $2 million
Medical Practice Listings 919.848.4202 | email@example.com www.medicalpracticelistings.com
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.
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Please direct all correspondence to firstname.lastname@example.org. Only serious, qualified inquirers.
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.
Call Medical Practice Listings at (919) 848-4202 for details and to view our other listings vist www.medicalpracticelistings.com MEDMONTHLY.COM |73
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 email@example.com www.medicalpracticelistings.com
Internal Medicine Practice for Sale Located in the heart of the medical community in Cary, North Carolina, this Internal Medicine practice is accepting most private and government insurance payments.
Primary care practice specializing in women’s care Raleigh, North Carolina
The average patients per day is 20-25+, and the gross yearly income is $555,000.
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.
Listing Price: $430,000
List price: $435,000
Call 919-848-4202 or email firstname.lastname@example.org www.medicalpracticelistings.com 74| SEPTEMBER 2012
Practice for Sale in Raleigh, NC
Call Medical Practice Listings at (919) 848-4202 for details and to view our other listings visit www.medicalpracticelistings.com
MODERN MED SPA AVAILABLE Located in beautiful coastal North Carolina
Modern, well-appointed med spa is available in a picturesque part of the state. This practice is positioned in a highly traveled area with positive demographics adding to the business appeal and revenue stream. A sampling of the services and procedures offered are: BOTOX, facial therapy and treatments, laser hair removal, eye lash extensions and body waxing as well as a menu of anti-aging options. If you are currently a med spa owner and looking to expand or considering this high profile med business, this is the perfect opportunity. Highly profitable and organized, you will find this spa poised for success. The qualified buyer can obtain detailed information by contacting Medical Practice Listings at 919-848-4202.
MedicalPracticeListings.com | email@example.com | 919.848.4202
GROW YOUR PRACTICE MedMedia9 understands the medical industry and that medical marketing is important. It is time to get online! Be seen everywhere, at any time with a professionally produced website by MedMedia9 designed to increase your revenue and patient volume. Let MedMedia9 assist you with marketing your practice. We now offer Web hosting and design. Choose from a variety of packages that will fit any budget and can also include social media marketing and collateral production. Visit us today at medmedia9.com to find out how we can make your practice grow!
MedMedia9â€™s skilled designers can create an online presence for your practice.
Need more? We will help you develop the right image throughout all your marketing efforts that will encourage your practice to thrive and grow.
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MEDMEDIA9.COM | 919-747-9031
PHYSICIANS NEEDED: Mental health facility in Eastern North Carolina seeks: PA/FT ongoing, start immediately Physician Assistant needed to work with physicians to provide primary care for resident patients. FT ongoing 8a-5p. Limited inpatient call is required. The position is responsible for performing history and physicals of patients on admission, annual physicals, dictate discharge summaries, sick call on unit assigned, suture minor lacerations, prescribe medications and order lab work. Works 8 hour shifts Monday through Friday with some extended work on rotating basis required. It is a 24 hour in-patient facility that serves adolescent, adult and geriatric patients. FT ongoing Medical Director, start immediately The Director of Medical Services is responsible for ensuring all patients receive quality medical care. The director supervises medical physicians and physician extenders. The Director of Medical Services also provides guidance to the following service areas: Dental Clinic, X-Ray Department, Laboratory Services, Infection Control, Speech/Language Services, Employee Health,
Pharmacy Department, Physical Therapy and Telemedicine. The Medical Director reports directly to the Clinical Director. The position will manage and participate in direct patient care as required; maintain and participate in an on-call schedule ensuring that a physician is always available to hospitalized patients; and maintain privileges of medical staff. Permanent Psychiatrist needed FT, start immediately An accredited State Psychiatric Hospital serving the eastern region of North Carolina, is recruiting for permanent full-time Psychiatrist. The 24 hour in-patient facility serves adolescent, adult and geriatric patients. The psychiatrist will serve as a team leader for multi-disciplinary team to ensure quality patient care/treatment. Responsibilities include:
evaluation of patient on admission and development of a comprehensive treatment plan, serve on medical staff committees, complete court papers, documentation of patient progress in medical record, education of patients/families, provision of educational groups for patients.
Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624 PH: (919) 845-0054 | email: firstname.lastname@example.org
NC OPPORTUNITIES LOCUMS OR PERMANENT
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 email@example.com For more information about Physician Solutions or to see all of our locums and permanent listings, please visit physiciansolutions.com
PRACTICE FOR SALE
OCCUPATIONAL HEALTH CARE PRACTICE FOR SALE Greensboro, North Carolina Well-established practice serving the Greensboro and High Point areas for over 15 years. Five exam rooms 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 medicalpracticelistings.com
the top For September’s Top 9, we recognize the top nutritional ideas implemented by national hospital cafeterias.
Compiled by Thomas Hibbard
NAVIGATING THE CAFETERIA
UCLA Ronald Reagan Medical Center Dining Commons Erin Neistat, the chief clinical dietitian for the UCLA Health System, leads crowds on one of many tours she conducts at the Center, which feeds about 7,000 visitors, outpatients and employees daily. When two doctors recently called her in one week to ask how they could eat healthier in the cafeteria, the idea for the tour was born. The cafeteria always includes vegetarian options among the soups and hot entrees, offers a few vegan options, and recently switched all their pasta to whole wheat. "It's not just about losing weight," Neistat said. "The tour is also to showcase the healthy items we have. People don't realize what an impact nutrition can have on how you feel."
78| SEPTEMBER 2012
Healthy Hospital Cafeterias
ON-SITE GARDEN Fauquier Hospital “The Bistro” At Fauquier in Virginia, the food starts literally at ground level at the hospital's "culinary healing garden" located just outside the Bistro. Even in early May, food service staff are harvesting fast-growing lettuce that will be used in the coming hours in the cafeteria's salad bar as well as in patients' meals. There's also the essential herbs, like oregano, dill, sage and chives. The all-organic garden is also home to ripening strawberries, tomatillos, spinach and the lavender used for aromatherapy.
HEALTHY EATING PLEDGE Bridgeport Hospital A coalition is asking businesses in the region to sign a "Healthy Eating Pledge," vowing to serve healthy options at events and meetings, in addition to, or instead of, doughnuts, croissants and the like. Bridgeport Hospital in Connecticut is one of about 40 businesses that have signed the pledge. Last year, the hospital renovated its main cafeteria, renamed Fresh Inspirations, and added a number of healthy options. Items on the cafeteria's menu carry symbols marking them as healthy options – meaning they're low in calories, fat and sodium – vegetarian options or vegan options. The menus also contain nutrition information about food items, including calorie counts.
ELIMINATING TRANS FATS University of Washington Medical Center Edith CacheroWillard, Food and Nutrition Services Manager, says, “When a new vendor comes in to see me, I ask if their product is trans fat-free. If so, I’ll try it. If not, I invite them to come back when the product is trans fat-free.”
EAT FIT MENU AND A DISCOUNT Texas Health Plano Chef Manager Gary Vorstenbosch and a team of dietitians had to re-think the menu and replace dishes that required butter or cheese with spices and herbs.
“It’s a rewarding of the time we spend on it, that people are liking it,” Vorstenbosch said. “Because in the beginning we were a little bit scared because people here in Texas like their fried items.”
It sounds expensive, but it’s not. Employees who choose from the Eat Fit menu get a 30% discount. With sales up 14% it's a hit.
FOOD PLACEMENT Maine Medical Center The hospital is making eating healthier much easier. As part of a plan to improve employee well-being, the hospital has revamped the Brighton cafeteria. Roland Gosselin, the manager of nutrition services, says the menu now includes more vegetable dishes, fewer fried foods and, during the summer, fresh, local produce.
COLOR CODING AND CHEAPER PRICES Gaston Memorial Hospital At Gaston Memorial in North Carolina, diners are guided by color-coded signals - green for "eat and enjoy," yellow for "eat moderately," and red for "eat sparingly." Portions, placement and prices have changed. Prices are set to encourage better choices. Desserts are smaller and banished to far corners, with fruits and vegetables taking center stage. Bottled water and Diet Coke sell for less than sugar-filled Coke. Veggie burgers are cheaper than the traditional beef hamburgers.
But perhaps the biggest change has been food presentation. "The desserts were the first thing you saw when you came into the cafeteria, so it encouraged people to eat higher, traditionally more sugary-type foods," Gosselin says. "They have been moved all the way down to the end now. It's the last thing you see."
BETTER MENU CHOICES Elmhurst Memorial Hospital To complement cutting-edge services and technology, Elmhurst Memorial Hospital in Chicago, Illinois offers healthier food choices at its new Wildflower Cafe, the latest addition to a growing list of area hospital cafeterias that serve up tasty, nutritious meals. Among the choices for Elmhurst visitors are turkey burgers with lower sodium content, sweet potato fries, a grilled portobello sandwich, a Mediterranean vegetable bake, vegetable stir fries, and mahi mahi with mushrooms and tomatoes. Also on the menu are whole wheat breads, low-fat yogurt and braised lentil pilaf. "The plan of the hospital was to offer more selections of food and healthier and more cooked-to-order food," said James Roth, certified executive chef at the cafe.
LABELING HEALTHY ITEMS UC Davis Children's Hospital A study of the healthiness of food offered to patients, staff and visitors at California's children's hospitals has found that the cafeteria for UC Davis Children's Hospital scored highest among all of the 14 food venues at the 12 major pediatric hospitals in the state scoring a 30 out of 37. No other hospital received a higher score. UC Davis Children's Hospital scored highly for offering and clearly labeling a wide variety of healthy options, including foods that are low-fat, high-fiber and heart healthy. MEDMONTHLY.COM |79
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