med monthly december 2012
DESCRIPTION
The Health Insurance issue of Med Monthly magazine.TRANSCRIPT
DECEMBER 2012
Med Monthly
HEALTH CAREPROVIDERS ANDTHE AFFORDABLECARE ACTpg. 50
TIPS FOR DOCTORS WHO NEGOTIATE REIMBURSEMENT RATES WITH INSURANCE COMPANIESpg. 48
12 Waysto Supercharge
Your PracticePart 1 of 2
pg. 18
to Navigate New‘Summary of Benefits
and Coverage’ Formspg. 44
5 CONSUMER TIPS
the health
insuranceissue
contents
44 5 CONSUMER TIPS TO NAVIGATE NEW ‘SUMMARY OF BENEFITS AND COVERAGE’ FORMS
48 TIPS FOR DOCTORS WHO NEGOTIATE REIMBURSEMENT RATES WITH INSURANCE COMPANIES
50 HEALTH CARE PROVIDERS AND THE AFFORDABLE CARE ACT
legal34 WHAT YOU NEED TO KNOW ABOUT HEALTH SAVINGS ACCOUNTS
38 COMMUNITY HEALTH CENTERS AND THE AFFORDABLE CARE ACT
42 PREPARING FOR HEALTH CARE REFORM - An Agent’s Perspective
the arts52 WHEN PAINT IS DANGEROUS
healthy living52 FESTIVE HONEY ROASTED BAKED PEARS
features
in every issue4 editor’s letter8 news briefs
60 resource guide78 top 9 list
78
52
Top 9 Holiday Health Tips
insight
10 IS YOUR MEMORY PLAYING TRICKS ON YOU? Check your medicine cabinet!
12 ELDER CARE: How to Help Your Parents Manage
14 HIGH-DOSE FLU VACCINE COVERED BY MEDICARE
Featured Artist: Emily Weinstein
practice tips18 12 WAYS TO SUPERCHARGE YOUR PRACTICE
22 CHANCE TO AVOID A 1.5% REDUCTION OF ALL MEDICARE PAYMENTS IN 2013
24 PA WORKFORCE VOLUME STRIVES TO MEET PATIENT DEMAND
research and technology26 YOU IMAGINE - PART 2Doctors connect to patients in an mHealth world
30 HEALTH IT - Best Practices to Minimize Cash Flow Disruptions Resulting from ICD-10 Implemen-tation
32 EVERYTHING ELSE IS SMART NOW...WHY NOT YOUR PILLS?international
16 UNIVERSAL HEALTH COVERAGE: Health without boundaries - An example from India
4 | DECEMBER 2012
editor’s letter
It is well known that health care in America is going through a radical change. Med Monthly’s December issue tackles this complex subject, from insurance companies’ responsibility to make the information digestible to the changing legal require-ments for practices. We also delve into how doctors and practice managers can be more pro-active to increase physi-cian reimbursement from health plans. The modifications to the health care systems are broken down for our readers so practices, physicians and patients alike can understand the new system.
Health insurance companies are obligated to answer basic questions regarding the new policies for the consumer. The article “5 consumer Tips to Navigate the New ‘Summary of Benefits and Coverage’ Forms Benefits” has selected the most pressing of concerns. These include: the out of pocket upper limit per year that a patient has to spend, their deductible, and the co-pay for in-network and out-of-network providers.
Joe Gupton from Jones Insurance writes about “Preparing for Health Care Reform – An Agent’s Perspective”. With the understanding that the Affordable Care Act’s goal is to as-sist financially disadvantaged people and reduce costs from unpaid emergency room costs, companies must adjust to the new requirements. Finding a trustworthy agent is key for a company to adapt to be governmentally compliant.
Another article explores how a practice can increase their bottom line as these changes take place. The “Tips for Doc-tors who Negotiate Reimbursement Rates with Insurance Companies” encourages practice owners to negotiate physi-cian reimbursement. That is, by being proactive, doctors can discuss with health insurance companies ways to make their compensation higher. One solution is a ‘pay-for-performance arrangement’. This new managed care and cooperation can be a win-win situation.
While the changes in the health care system seem daunting, Med Monthly hopes that its implications and ramifications can be more easily understood by both the consumer and practice owner.
Hold onto your seats – next month’s theme is “Sex in the Practice”.
Managing Editor
Ashley Austin
Med Monthly
Publisher
Managing Editor
Creative Director
Contributors
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
December 2012
P.O. Box 99488Raleigh, NC 27624
Online 24/7 at medmonthly.com
MEDMONTHLY.COM |5
contributors
Philip Driver
Ashley Austin
Thomas Hibbard
Ashley Acornley, MS, RD, LDNSimi BoticJennifer B. Daknis, AIF®
Joe GuptonAnuradha KatyalLaura MasskeEd RabinowitzFrank J. RoselloLisa P. Shock, MHS, PA-CCara Tannenbaum, MD, MScMerle Turner, D.O.Emily WeinsteinMary Pat Whaley, FACMPE
Simi Botic is an associate in Dinsmore’s Co-lumbus office focusing her practice on healthcare law. Learn more about Simi at www.dinsmore.com.
Lisa P. Shock, MHS, PA-Cis a PA who has practiced in prima-ry care and geriatrics. She enjoys part-time clinical practice and is the President and CEO of Utiliza-tion Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering services to help imple-ment and improve the utilization
of PAs and NPs in the health care system. Contact her with questions at [email protected]
Frank J. Rosellois CEO & Co-Founder of Envi-ronmental Intelligence LLC, a Complete Outsourced Health IT Company providing End-to-End meaningful physician workflows consulting, integration, and implementation in EHR, Image Management Systems, and
Practice Management to private and public practices and facilities and dedicated Health IT professionals. Visit Frank's website: http://www.goeillc.com
Ashley Acornley, RD, LDNholds a BS in Nutritional Sciences with a minor in Kinesiology from Penn State University. She com-pleted her Dietetic Internship at Meredith College and recently completed her Master’s Degree in Nutrition. She is also an AFAA certi-
fied personal trainer. Her blog can be found at: ashley-freshfromthefarm.wordpress.com
Merle Turner, D.O. is a family practice physician and founder and medical director of Warner Family Practice in Chan-dler, AZ. He previously served as the chairman of the department of family medicine and chief of staff at Tempe St. Luke’s Hospital, as well as the president of Vista Del Sol Healthcare Medical Group.
Creative Director
Thomas Hibbard
6 | DECEMBER 2012
designer's thoughts
Technology is a reality and is always moving quickly forward. And it’s no different in health care, technology is in constant change in the medical arena.
In the “Research and Technology” section of this month’s magazine, the article “Everything Else is Smart Now…Why Not Your Pills?” we shed light on ICT (Ingestible Capsule Technology), a smart pill that contains a miniaturized micro-electronic system allowing doctors to collect diagnostic and bio-medical information on patients simply by having them swallow the pill.
The second part of Laura Maaske’s article “Doctors Connect to Patients in an mHealth World” discusses how the iPad and other mobile devices have improved the relationship between patient and doctor. With the new mobile device apps available, physicians can give their patients immediate information at their office or bedside, saving the doctor time and bringing the patient the answers they seek. “Doctors say they enjoy being able to show patients the visual evidence of their medical con-ditions easily. It’s a situation where the human interaction is key and where the technology is making the experience better without dominating the human interaction.”
And in “News Briefs” we report on a new 3D Optical Micro-scope from Bruker that is easy to operate and very affordable. The new features and capabilities enable greater convenience and productivity in a host of markets, ranging from ophthal-mics and medical device implants to precision machining and semiconductor manufacturing.
Our goal each month is to provide the most current informa-tion on new technology and practices, assisting the health care community to stay fluent with new tools as they become avail-able, while remaining cost effective.
From the Drawing Board
We understand that most physicians cannot take valuable time away from seeing patients and managing their day-to-day operations of their practice to think about real estate. For over 100 years we have been helping clients find the best real estate solutions in the Triangle. Our combination of energetic young leaders, wisdom of established team members, and full range of real estate services have provided our healthcare clients with peace of mind, ideas and solutions.
RALEIGHHeadquarters & Property Management (919) 821-1350
Commercial Sales & Leasing (919) 821-7177
MOREHEAD CITY(252) 247-5772
www.yorkproperties.com
York Properties Broker Team
BROKERAGE LEASING PROPERTY MANAGEMENT INVESTMENT SECURITY MAINTENANCE LANDSCAPING
HELPING YOU WITH REAL ESTATE, SO YOU CAN FOCUS ON HELPING OTHERS.
1 Available only in AL, AR, DE, FL, GA, MD, MS, NC, SC, TN, VA, WV, DC and select counties in NJ and PA to Residents, Interns, Fellows, Doctors of Osteopathy (DO) or licensed medical physicians that have completed their residency within the last 10 years.2 Borrowers should note that 100% mortgage financing will result in no property equity until such time as the loan principal is paid down through regular mortgage payments and/or the property value appreciates. Additionally, if property values decline you could owe more than your property’s value.3 A down payment may be required if the property is located in a declining market.4 Adjustable Rate Mortgage (ARM) products have interest rates that may increase after consummation.5 Monthly payments of interest only will not reduce the principal owed. Equal Housing Lender. SunTrust Mortgage, Inc., 901 Semmes Avenue, Richmond, VA 23224 is licensed by the Department of Corporations under the California Residential Mortgage Lending Act; is an Illinois Residential Mortgage Licensee; is a Lender in Massachusetts having Mortgage Lender license #s ML1216, ML0133, ML1432, ML1914, ML1913, ML1815, ML2411, ML1214, ML2442, ML2491, and ML2538; is licensed by the New Hampshire Banking Department; is licensed by the New Jersey Department of Banking and Insurance, toll free 1-800-330-4684; is a licensed lender in Rhode Island; and is doing business in Arizona as Crestar Mortgage, 7250 N. 16th Street, Ste. 100, Phoenix, AZ 85020. ©2011 SunTrust Banks, Inc. SunTrust, SunTrust Mortgage and Live Solid. Bank Solid. are federally registered service marks of SunTrust Banks, Inc. REV 072211JC-R STMR1067
Your work is meaningful. You help people every day. At SunTrust Mortgage, Inc., we applaud your dedication and hard work. To show our appreciation, we’ve created the Doctor Loan Program1 with special mortgage financing for purchases and refinances.
• For licensed medical physicians who have completed their residency within the last 10 years: - Up to 100% financing2,3 for loan amounts up to $650,000 - Maximum loan amount of $1.5 million • For Residents, Interns and Fellows: - Up to 100% financing2,3 - Maximum loan amount of $417,000 • No mortgage insurance • Fixed rate and adjustable rate
4 loans with interest-only options
5
• Competitive pricing and special relationship discounts
A mortgage created exclusively for licensed medical physicians. It’s just what the doctor ordered.
!yadot llac ,noitamrofni erom roF
salohciN yaL , recfifO naoL roineS .cnI ,egagtroM tsurTnuS
0808.863.019 lleC [email protected]
#RSLMN 990956
Nicholas Lay, Senior Loan OfficerSunTrust Mortgage, Inc.
NMLSR# 659099
Your work is meaningful. You help people every day. At SunTrust Mortgage, Inc., we applaud your dedication and hard work. To show our appreciateion, we’ve created the Doctor Loan Program with special mortgage financing for purchases and refinances. For more information, call today!
We understand that most physicians cannot take valuable time away from seeing patients and managing their day-to-day operations of their practice to think about real estate. For over 100 years we have been helping clients find the best real estate solutions in the Triangle. Our combination of energetic young leaders, wisdom of established team members, and full range of real estate services have provided our healthcare clients with peace of mind, ideas and solutions.
RALEIGHHeadquarters & Property Management (919) 821-1350
Commercial Sales & Leasing (919) 821-7177
MOREHEAD CITY(252) 247-5772
www.yorkproperties.com
York Properties Broker Team
BROKERAGE LEASING PROPERTY MANAGEMENT INVESTMENT SECURITY MAINTENANCE LANDSCAPING
HELPING YOU WITH REAL ESTATE, SO YOU CAN FOCUS ON HELPING OTHERS.
1 Available only in AL, AR, DE, FL, GA, MD, MS, NC, SC, TN, VA, WV, DC and select counties in NJ and PA to Residents, Interns, Fellows, Doctors of Osteopathy (DO) or licensed medical physicians that have completed their residency within the last 10 years.2 Borrowers should note that 100% mortgage financing will result in no property equity until such time as the loan principal is paid down through regular mortgage payments and/or the property value appreciates. Additionally, if property values decline you could owe more than your property’s value.3 A down payment may be required if the property is located in a declining market.4 Adjustable Rate Mortgage (ARM) products have interest rates that may increase after consummation.5 Monthly payments of interest only will not reduce the principal owed. Equal Housing Lender. SunTrust Mortgage, Inc., 901 Semmes Avenue, Richmond, VA 23224 is licensed by the Department of Corporations under the California Residential Mortgage Lending Act; is an Illinois Residential Mortgage Licensee; is a Lender in Massachusetts having Mortgage Lender license #s ML1216, ML0133, ML1432, ML1914, ML1913, ML1815, ML2411, ML1214, ML2442, ML2491, and ML2538; is licensed by the New Hampshire Banking Department; is licensed by the New Jersey Department of Banking and Insurance, toll free 1-800-330-4684; is a licensed lender in Rhode Island; and is doing business in Arizona as Crestar Mortgage, 7250 N. 16th Street, Ste. 100, Phoenix, AZ 85020. ©2011 SunTrust Banks, Inc. SunTrust, SunTrust Mortgage and Live Solid. Bank Solid. are federally registered service marks of SunTrust Banks, Inc. REV 072211JC-R STMR1067
Your work is meaningful. You help people every day. At SunTrust Mortgage, Inc., we applaud your dedication and hard work. To show our appreciation, we’ve created the Doctor Loan Program1 with special mortgage financing for purchases and refinances.
• For licensed medical physicians who have completed their residency within the last 10 years: - Up to 100% financing2,3 for loan amounts up to $650,000 - Maximum loan amount of $1.5 million • For Residents, Interns and Fellows: - Up to 100% financing2,3 - Maximum loan amount of $417,000 • No mortgage insurance • Fixed rate and adjustable rate
4 loans with interest-only options
5
• Competitive pricing and special relationship discounts
A mortgage created exclusively for licensed medical physicians. It’s just what the doctor ordered.
!yadot llac ,noitamrofni erom roF
salohciN yaL , recfifO naoL roineS .cnI ,egagtroM tsurTnuS
0808.863.019 lleC [email protected]
#RSLMN 990956
Nicholas Lay, Senior Loan OfficerSunTrust Mortgage, Inc.
NMLSR# 659099
Your work is meaningful. You help people every day. At SunTrust Mortgage, Inc., we applaud your dedication and hard work. To show our appreciateion, we’ve created the Doctor Loan Program with special mortgage financing for purchases and refinances. For more information, call today!
8 | DECEMBER 2012
news briefs
University Researchers Confirm Link Between Insomnia and Hot Flashes
A team of researchers at the Stanford University School of Medicine in Cali-fornia recently embarked upon a study to help determine the causes of insomnia among premenopausal and postmenopausal women. The team conducted phone interviews with 982 women and gathered information about their sleep history, frequency of hot flashes, and overall health. They found that 51% of postmeno-pausal women suffer with hot flashes and that 79% of premenopausal women have them. Among the women with the most intense hot flashes (based on their severity and frequency), 81% of them experienced sleeplessness and insomnia.
The lead researcher said: “In this paper, we have observed without any doubt and in a significant way that hot flashes are associated with insomnia. This is the first observational study showing the link between insomnia and hot flashes while controlling for other factors that could account for insomnia in women.”
Night sweats and hot flashes have become a form of insomnia in which a woman can wake up drenched in sweat and unable to sleep. Regarding mineral deficiency at the time of menopause, the pioneering nutritionist Adelle Davis says in her book ‘Let’s Get Well’ that: “The amount of calcium in a woman’s blood parallels the activity of the ovaries. During the menopause, the lack of ovar-ian hormones (estrogen and progesterone) can cause severe calcium deficiency symptoms to occur, including irritability, hot flashes, night sweats, leg cramps, and insomnia. These problems can be easily overcome if the intakes of calcium, magnesium, and vitamin D are all generously increased and are well absorbed.”
Calcium is directly related to our cycles of sleep. In one study published in the European Neurology Journal, researchers found that calcium levels in the body are higher during some of the deepest levels of sleep, such as the rapid eye move-ment (REM) phase. The study concluded that disturbances in sleep, especially the absence of REM deep sleep or disturbed REM sleep, are related to a calcium deficiency. Restoration to the normal course of sleep was achieved following the normalization of the blood calcium level.
The research study above shows a definite link between hot flashes and insom-nia. The lead researcher suggests that if a woman can address and remedy her hot flashes, she will also likely improve her insomnia.
Source: http://www.pressreleasepoint.com/university-researchers-confirm-link-between-insomnia-and-hot-flashes
Bruker Releases New Benchmark 3D Optical Microscope System
Bruker announced the launch of the ContourGT-I 3D Optical Micro-scope to enhance R&D productiv-ity and maximize manufacturing throughput for industrial applications. The ContourGT-I has been optimized to accelerate and simplify measure-ment setup and feature-tracking and is the world’s first bench top profiling system to incorporate Bruker’s pro-prietary tip/tilt head design, along with fully automated functionality, including turret, lenses, and illumina-tion. In addition, the system has been designed from top to bottom for maximum vibration stability and ro-bustness, including a space efficient yet stable footprint with fully inte-grated air isolation. This combination of features and capabilities enables greater convenience and productiv-ity in a host of markets, ranging from ophthalmics and medical device implants to precision machining and semiconductor manufacturing.
“Based on over three decades of surface metrology and imaging ex-cellence, customers know they can count on our 3D optical microscopes to provide the best Z-axis resolu-tion, independent of magnification, as well as the fastest measurements with the largest fields of view on the most difficult surface geometries,” said Mark R. Munch, Ph.D., President of the Bruker Nano Surfaces Division. “By adopting automation and tip/tilt head designs from our high-volume floor-mounted systems, the bench top ContourGT-I now offers these ca-pabilities to industries that previously may not have considered 3D optical microscopes as affordable or easy to operate.”
Source: http://www.pressrelease-point.com/bruker-releases-new-benchmark-3d-optical-microscope-system
MEDMONTHLY.COM |9
Olea Medical received the FDA 510(k) clearance to market the Olea package in the US earlier this year.
Olea Sphere™ is an image processing software package intended for picture ar-chive, post-processing and communication. It helps standardize both viewing and analysis capabilities of functional and dynamic imaging datasets acquired with MRI and CT across vendors. It features innovative image viewing and analysis, process-ing of perfusion weighted image post-processing, permeability computation, as well as diffusion weighted image/tensor image post-processing, fiber tracking post-pro-cessing, and longitudinal analysis of multiple time points.
It is compliant with the DICOM standard and Windows, Macintosh or Linux op-erating systems. It runs on any standard off-the-shelf workstation or it can be used through a thin deployment with a server. The DWI Module is used to visualize local water diffusion properties from the analysis of diffusion-weighted MRI data. The Fiber Tracking feature utilizes the directional dependency of the diffusion to display different structures within anatomic areas of interest. The perfusion analysis module is used for visualization and analysis of dynamic imaging data, showing properties of changes in contrast over time. Both DSC and DCE MRI perfusion sequences are supported to cover full body analysis.
“In neuro-oncology, the role of imaging is to assess the nature and extent of dis-ease, however the information provided with structural imaging is limited, particu-larly when acquired during the course of patient therapy. Advanced information from perfusion, permeability and diffusion tensor tractography imaging assists in determining lesion grade and extent, differentiation of treatment related changes from viable tumor and serves as a guide to the appropriate lesion resection trajec-tory. To be valid in practice, an advanced rendering engine must be reliable, accu-rate and be science-based. To be integral to the clinical process it must be fast, easy to use and accessible enterprise-wide” said Lawrence Tanenbaum, MD, Associate Professor of Radiology at The Mount Sinai Hospital, New York. “Olea Sphere™ meets these lofty requirements and more than satisfies our everyday advanced neuroimag-ing needs”, he added.
“The launching of Olea Sphere is a major milestone in the development of the company. During the past years, Olea Medical has gained recognition from neu-roradiologists for our expertise in neuro-imaging. With Olea Sphere™ we are now covering the full body, regardless of the modality employed for image acquisition. This is a tremendously important development, especially for oncology but also for hepatic disorders or kidney dysfunction,” says Fayçal Djeridane, president and CEO of Olea Medical. “Also, Olea Sphere™ has been specifically designed to incorporate future innovative modules, to cover various modalities, such as spectroscopy or ASL. Olea Sphere™ shows Olea Medical’s commitment to providing a widely accessible, complete package of simple, safe, fast and accurate tools for full-body image post-processing in order to help doctors improve the diagnosis and follow-up process for pa-tients’ benefit”, he added.
Source: http://www.newswiretoday.com/news/120050/
Bacterial protein in house dust spurs asthma according to NIH study
A bacterial protein in common house dust may worsen allergic responses to indoor allergens, according to research con-ducted by the National Institutes of Health and Duke University. The finding is the first to docu-ment the presence of the protein flagellin in house dust, bolstering the link between allergic asthma and the environment.
“Most people with asthma have allergic asthma, resulting largely from allergic responses to inhaled substances,” said the paper’s corresponding author Donald Cook, Ph.D., an NIEHS scientist. “Although fla-gellin is not an allergen, it can boost allergic responses to true allergens.”
After inhaling house dust, test mice that were able to respond to flagellin displayed all of the common symptoms of allergic asthma, including more mucous production, airway obstruc-tion, and airway inflammation. However, mice lacking a gene that detects the presence of flagellin had reduced levels of these symptoms.
In addition to the mouse study, the research team also deter-mined that people with asthma have higher levels of antibodies against flagellin in their blood than do non-asthmatic subjects, which provides more evidence of a link between environmen-tal factors and allergic asthma in humans.
Source: http://www.nih.gov/news/health/oct2012/niehs-15.htm
Olea Medical Launches Olea Sphere™ Medical Imaging Enterprise Software
Package in the U.S
COMING SOON
IN MED MONTHLY
In the upcoming
January 2013 issue, Med
Monthly reports on sex
and the practice
10 | DECEMBER 2012
insight
Common medication to treat insomnia, anxiety, itching or allergies can have a negative impact on memory or concentration in the elderly, according to Dr. Cara Tannenbaum, Research Chair at the Institut universitaire de gériatrie de Montréal (IUGM, Montreal Geriatric University Institute) and Associate Professor of Medicine and Pharmacy at the University of Montreal (UdeM). Up to ninety percent of people over the age of 65 take at least one prescription medication. Eighteen percent of people in this age group complain of memory problems and are found to have mild cognitive deficits. Research suggests there may be a link between the two. Dr. Tannenbaum recently led a team of international researchers to investigate which medications are most likely to affect amnestic (memory) or non-amnestic (attention, concentration, performance) brain functions. After analyzing the results from 162 experiments on medications with potential to bind to cholinergic, histamine, GABAergic or opioid receptors in the brain, Dr. Tannenbaum concluded that the episodic use of several medications can cause amnestic or non-amnestic
deficits. This potential cause is often overlooked in persons who are otherwise in good health. The 68 trials on benzodiazepines (which are often used to treat anxiety and insomnia) that were analyzed showed that these drugs consistently lead to impairments in memory and concentration, with a clear dose-response relationship. The 12 tests on antihistamines and the 15 tests on tricyclic antidepressants showed deficits in attention and information processing. The findings support the recommendation issued in the Revised Beers Criteria published in the spring of 2012 by the American Geriatrics Society that all sleeping pills, first generation antihistamines and tricyclic antidepressants should be avoided at all costs in seniors. Dr. Tannenbaum believes in the importance of communicating this knowledge to patients: “Seniors can play an important role in reducing the risks associated with these medications. Patients need this information so that they are more comfortable talking to their doctors and pharmacists about safer pharmacological or non-pharmacological treatment options,” she explained. She also points out that
each case must be addressed on an individual basis: “Despite the known risks, it may be better for some patients to continue their medication instead of having to live with intolerable symptoms. Each individual has a right to make an informed choice based on preference and a thorough understanding of the effects the medications may have on their memory and function.”
Research summary MEDLINE and EMBASE were searched for randomized, double-blind, placebo-controlled trials of adults without underlying central nervous system disorders who underwent detailed neuropsychological testing prior to and after oral administration of drugs affecting cholinergic, histaminergic, GABAergic or opioid receptor pathways. Seventy-eight studies were identified, reporting 162 trials testing medication from the four targeted drug classes. Two investigators independently appraised study quality and extracted relevant data on the occurrence of amnestic, non-amnestic or combined cognitive deficits induced by each drug class. Only trials using
Is your memoryplaying trickson you?
By Cara Tannenbaum, MD, MScInstitut universitaire de gériatrie de Montréal (IUGM)
Check yourMEDICINECABINET!
validated neuropsychological tests were included. Quality of the evidence for each drug class was assessed based on consistency of results across trials and the presence of a dose-response gradient. This research was conducted in collaboration with researchers at the University of Sydney, the University of Calgary and the University of Iowa College of Public Health.
About the author Cara Tannenbaum, MD, MSc, is a geriatrician and researcher in the health promotion, health care services and intervention unit at the Institut universitaire de gériatrie de Montréal (IUGM). She is also the inaugural Michel-Saucier Endowed Chair in Geriatric Pharmacology, Health and Aging from the Faculty of Pharmacy at the Université de Montréal and an Associate Professor of Medicine at the Université de Montréal. She leads a program of research in epidemiologic and clinical geriatric health. Her clinical practice aims to improve medical care for older people.
Source: Institut universitaire de gériatrie de Montréal-Université de Montréal
Lindsay Driver EmployeeSync Specialist
Consolidate Payroll, Benefits Administration, Time & Attendance and Personnel Management in one single database Available in IN, KY, NC, OH, PA, TN, VA Designed for employers with 25+ employees
www.Jones‐Insurance.com/EmployeeSync
“Patients need this information so that they are more comfortable talking to their doctors and pharmacists about safer pharmaco-logical or non-pharmacological treatment options.”
‘‘
12 | DECEMBER 2012
insight
Elder Care:How to Help YourParents Manage
By Jennifer B. Daknis, AIF®
Sigmon Daknis Wealth Management
It’s a decision most adults dread: having to take over the financial and day-to-day living decisions for parents who can no longer manage on their own. When caring for your parents, you may need to plan on three levels: managing finances, making health care decisions, and making sure their daily household needs are met. Finding qualified experts who can advise you in these areas may make it easier to manage the situation.
Managing Finances If your parents currently are able to communicate, try to initiate a conversation about how they would like their money to be managed. Rather than telling them what to do, be clear that you would like to help and to make sure that their wishes are met. Access to bank and brokerage statements, insurance policies, and other financial documents may help you to safeguard your parents’ assets. If your parents work with a financial advisor, try to arrange a joint meeting where all parties can review
the situation. If you pay your parents’ bills and manage their checkbook, arranging for direct deposit of Social Security or pension benefits, as well as electronic delivery of recurring bills, could expedite the process.
Arranging for Health Care If your parents are mentally competent, ask them about consulting a lawyer who can draft a health care proxy, a legal document designating you (or another person) to make decisions about medical care when they are no longer able to do so. If your parents have opinions about end-of-life care, their wishes can be incorporated into a living will, another legal document. Even without these documents, the medical establishment is likely to look to you or other siblings to make decisions about health care, which could include arranging for long-term care or making end-of-life decisions. As part of this process, determine the type of medical insurance that your parents have and what it covers.
Overseeing Daily Living If your parents are able to remain in their home, you may need to consider helping them to manage medication, to conduct daily tasks such as bathing or meal preparation, and to make arrangements for assistance with household chores. A visiting nurse and home care agency may provide assistance in these areas. You may want to consider consulting a Professional Geriatric Care Manager, a professional who may help arrange for home care, provide crisis intervention, and help you identify solutions to potential problems. You can learn more at www.caremanager.org. Managing a parent’s affairs can be complicated, but arranging for support from qualified people may help you care for parents in a way that meets their needs and does not create too much stress on you.
Jennifer B. Daknis is a Registered Representative with and, securities are offered through LPL Financial, Member FINRA/SIPC.
14 | DECEMBER 2012
insight
T his is a tricky time of year for physicians as we continue to encourage our patients to get vac-cinated against influenza and also begin to think about ordering our vaccine supply for the next
influenza season. Importantly, it is not too late to vaccinate. Once administered, the influenza vaccine takes about two weeks to build full immunity AND typically influenza does not peak until February – so there is still plenty of time to protect our patients against influenza this flu season – especially our most vulnerable elderly patients. Two years ago, the FDA approved the higher dose influenza vaccine for adults age 65 and older. It was designed to address age-related decline in immune response among those 65 and older by increasing the amount of antigen (x4) as the standard vaccine. This high dose influenza vaccine is important because according to the Centers for Medicare and Medicaid Services (CMS), pneumonia and influenza are the fifth leading cause of deaths in older adults. Medicare Part B pays for one influenza vaccine each year with no copayment or deductible applied. Medicare generally pays for one pneumonia vaccination for all Medicare beneficiaries per lifetime. Despite full coverage for both the pneumonia and the high-dose influenza vaccine, rates of immunization in the senior population remain suboptimal, particularly in minority populations. This could be due in part to lack of
education about Medicare benefits, so we must let patients know: first, these vaccines are important and, second, they are covered by Medicare. It is also important to remind elderly patients to get their flu vaccine as part of a scheduled visit. Providers are unable to bill Medicare for an office visit when the only reason for the visit is a vaccine. If the office visit is for a medical reason covered under Medicare, the vaccine given in conjunction with that visit will be covered. Additionally, some Medicare Advantage plans limit the number of contracted providers for their Medicare members, which may eliminate some of the more convenient vaccine locations for seniors to receive their flu vaccine – such as supermarket pharmacies. Knowing all this, we can take the necessary steps to help elderly patients receive their annual flu vaccine, while still complying with Medicare policies. To find out more about this issue, visit: http://www.cms.gov/AdultImmunizations/02_Providerresources.asp.
Merle Turner, D.O. serves as a member of the American Osteopathic Association, the Arizona Osteopathic Association, the Arizona Academy of Family Practice, the Arizona State Society of the American College of Osteopathic Family Physicians and the American Osteopathic Board of General Practitioners. Dr. Turner graduated from Anderson University in 1969 and the Kansas City College of Osteopathic Medicine in 1975.
By Merle Turner, D.O.Warner Family Practice
High-Dose Flu Vaccine Covered by Medicare
international
16| DECEMBER 2012
Health Without Boundaries-An Example From India
Universal Health Coverage:
By Anuradha KatyalResearch Associate
Administrative Staff College of India Hyderabad, India
MEDMONTHLY.COM |17
The inception of the concept of Universal Health coverage occurred with the ideas of Otto von Bismarck in 1883. Since then many countries from both the developing and developed have embraced the idea. So what is it that developing countries should do to ensure that each citizen achieves their right to health? When I think about the country I grew in I have very mixed memories about the health care system. I, on one hand, think of the dispensary where my grandmother took me for a tooth extraction when I was five in a small town in India. It was an unhygienic dispensary with almost negligible sterilization, swarming with patients and no fees for treatment. In contrast, I also think of a state of art hospital with cutting edge technology and well furnished wards, with well groomed staff and very high fees for service. Access of equity has hence been questioned from time to time in not just India, but many developing nations. In 2010 WHO published its World Health Report highlighting this major problem. It said that millions of people cannot use health services because they have to pay at the time they receive them. Many of those who use services suffer financial hardship, or are even impoverished, making payment difficult. Those who cannot pay are left with two options. One, live with the disease, become morbid or even die. Or two, access medical attention at a public health care facility in the absence of quality and universal precautions for health care. Andhra Pradesh is one of the 28 states of India. Known as the country ‘rice bowl’, this state has a high literacy rate (nearly 70%), a high GDP (3rd richest in India) and has emerged as a new IT hub. In 2004, the government of Andhra Pradesh launched many health care reforms. Many new initiatives were taken and funds were allocated to support their activities and ensure sustainability. The government lay emphasis on ‘accountability, transparency and decentralization’
in planning these initiatives. The government also wanted to ensure a revolutionary scheme that would bring back to power and popularity. Hence, the Rajiv Aarogyasri Health Insurance scheme was launched in 2007. The objective of this scheme is to provide quality tertiary care by improving the infrastructure in the network hospitals and providing financial support to those facing catastrophic health needs, i.e. the ones recognized as below the poverty line by the government. This scheme provides an insurance coverage for 200,000 Indian rupees (~US$ 4000) per year to insured families, for 942 costly medical procedures. It is a good example of a public–private partnership, because it has brought together a health insurance company, private and public hospitals, and the state’s department of health. The scheme is not just about providing financial coverage. The families are also provided free transport, free food, free follow-up appointments and a one year supply of medication. The government describes this as a ‘cashless’ scheme, since the families at no point have to pay out of pocket. In order to get empanelled into the scheme the private hospitals need to fulfil very strict criteria. In India, every BPL family holds a ration card (white card), which is complemented by a Rajiv Aarogyasri Health Card. The card contains complete family data and is similar to a swipe card used for debit transactions. There have been quite a few efforts
to launch comparable schemes in other states but the Aarogyasri Scheme has proven to be different in many ways, including the proper usage of technology, hence maintaining and managing a huge database of beneficiaries; taking photographic evidence at each point, proper training of staff to make database entries and making this data open to public viewing. Nevertheless, the scheme has been accused of bad governance and malpractices. Leaving the fraud aside even if we believe that the government is not corrupt and there are no fraudulent practices, there are many other issues that need to be addressed. While the government may have a noble intention to evade of the burden of expenditure, what still lacks is an attempt to strengthen primary care. A study has shown a reduction in out-patient expenditures. This actually poses a different series of questions. Are people accessing in-patient care even for diseases which could be treated conservatively or are physicians inducing the demand? Has the government attempted to reduce the burden of disease? Shouldn’t the weak primary care system be strengthened as opposed to secondary or tertiary care? And above all, despite pregnancy being a major expense for out of pocket expenditure, why has it not been covered under the scheme? Despite the need for evaluating these few questions, Rajiv Aarogyasri has paved the future for many such schemes in India. It makes one think, even in a corrupt world, noble intentions exist and can be made to work.
Anuradha Katyal is a Research Associate at the Administrative Staff College of India, Hyderabad, India. She has a Bachelors in Dental Surgery and a Masters in Healthcare Management. She is currently working on a project evaluating the Rajiv Aarogyasri Health Insurance scheme, together with the Indian School of Business and ACCESS Health International.
‘‘“While the government may have a noble intention to evade of the burden of expenditure, what still lacks is an attempt to strengthen primary care.”
18 | DECEMBER 2012
practice tips
There are 12 very actionable ways to make positive improvements in your practice. In this issue we’ll present the first 6 and will continue and complete the final 6 ways in our January 2013 issue. After reading through all twelve ways next month, rank them in order of importance and priority for your group. Bring them to your strategic planning meetings and discuss ways to implement them, or use them as a springboard for other ideas to improve your practice and gain a competitive edge.
12 Ways toSuperchargeYour PracticePart 1 of 2
ByMary Pat Whaley,FACMPE
MEDMONTHLY.COM |19
#1 Create a Practice Dashboard
You’ve probably heard the adage “You can’t manage what you can’t measure!” The Dashboard is a way to capture key pieces of data in your practice and demonstrate your management skills to your stakeholders. A Practice Dashboard is a one-page look at the key indicators being monitored that are necessary for the practice to thrive financially. As an administrator, I have typically presented the Dashboard Report (sometimes called a Snapshot Report) to the physicians at the monthly meeting. The Dashboard keeps the physicians operating at a high level and usually keeps them from descending into the deep detail that can derail a monthly meeting like nobody’s business!
What should be included in my Practice Dashboard?• Grosscharges,collectionsand
adjustments for the month and year-to-date (YTD) and the same month last year and YTD last year.
• AgedAccountsReceivable(typically written A/R)
• Collection%-howmuchofwhatyou can collect, do you collect?
• Newpatientreferralbreakdownbytype (referred by doctor, patient, employee, website, direct mail, TV, radio, yellow pages, etc.)
• Cumulativemoneyturnedovertothird-party collectors and money collected by the outside firm
• Statusofanyloans(remainingprincipal) or line of credit outstanding
• Salesandreturnsifyouareselling anything in the practice – medication, vitamins, supplements, books, beauty products, etc.
• Appointments–%ofappointments filled, % of no-shows, % of appointments booked the same day or the day before.
• Moneycollectedatcheck-inandcheck-out versus what should have been collected
#2 Stop Sending Patient Statements
Today the process of sending statements to patients is largely outsourced along with electronic claims, but it’s not very electronic. If we can get paid by insurance companies electronically, why not get paid by patients electronically? I suggest that the practice of sending patient statements is not only resource-intensive, but it is also a 20th century business practice unsuited for a 21st century business. Why do practices insist on clinging to an outdated method of billing?
Setting up a statement-free practice is relatively easy Use an online payment system that allows electronic payment plans. An electronic payment plan enables a practice to enter a payment plan once, and have the system draft the credit/debit card appropriately without staff management. It should also be able to send a receipt to the patient’s email, or to send a message to the patient to pick up the receipt through a secure portal. Load your contract allowables into your practice management system. If your system doesn’t have that capability, create a cheat sheet of your top codes for each contracted payer, so your check-out staff can calculate what the patient owes. There are also systems that can put together your contract information and the patient information into an estimate of what the patient owes for you. Get online eligibility access that includes information about the patients’ benefits, deductibles, co-pays and co-insurance. This is available through your practice management system, your clearinghouse, or from a separate system that reads from your appointment schedule.
Practices that offer procedures or surgery should employ a financial counselor to sit down with patients and talk through financial responsibility and set up payment plans. Coach staff on talking to patients about money. Teach them to become comfortable with collections. People pay their bills via their credit/debit card routinely – this is not new or unusual for the majority of people. The ability to “set it and forget it” via electronic payment plans simplifies the payment system and speeds up cash flow. The ability to adjust a patient plan once insurance pays means no waiting to refund the patient or collect the remaining dollars. Your staff will still have to post the payments into the practice management system (although a few have integrated posting), but eliminating statements will save your practice money and time.
#3 When Do You Think About Customer Service in Your Practice?
The problem with not thinking about customer service every day is that customer service is a day-to-day relationship. If you wait until you recognize the signs of things heading in the wrong direction, it could be too late. Just like other relationships, customer service in your practice needs consistent attention and creativity to keep things fresh and in the forefront of everyone’s mind. Just like other relationships, customer service is a living thing that needs care and feeding.
Customer Service is: - Seeing people as individuals
and remembering something about each one of them (yes, you probably will have to note it in the computer)
continued on page 20
20 | DECEMBER 2012
feelings about the person. It is taking “you” out of the equation.
#4 Consider Running an Urgent Care Within Your Practice Many stakeholders are questioning what the advent of insurance for all Americans in 2014 will mean for patients whom have not had access to a medical home and coordinated care. The primary care physician is the de facto center of the ACO model, and the hub of care coordination. The influx of patients being encouraged (and hopefully wanting) to abandon the ED for a practice with expanded hours may overwhelm primary caregivers who do not have the potential to provide care seven days per week.
Challenges of Urgent Care For many patients, going to the ED is a community norm, and one that may be difficult to redirect. The marketing budget for the Urgent Care may need to be significant to overcome long-standing community routines and to educate patients about the new Urgent Care. For the practice operating Urgent Care hours at the same location as non-urgent care services, patients may find it frustrating to understand when the practice is a practice and when it is an urgent care. Patients may also resent that an appointment at 4:30 p.m. has a co-pay of $25 and walking in for service at 5:00 may require a $50 co-pay. Other models of care that practices should contemplate, as adjuncts to face-to-face care, are a robust nurse triage program, telemedicine, and virtual visits.
Statistics on Urgent Care in America*•NumberofUrgentCareCentersin
the U.S. 8,700
• Numberofvisitspercenterperweek 342
• Ownership50percentphysicians/physician group, 13.5 percent corporation, 7.7 percent hospital
• ComparativeVisitFeesUrgentCare Center $156, Primary Care Physician Clinic $166, Emergency Room $414
#5 Create a Patient Advisory Board Call it an Advisory Board, a Focus Group, a Patient Board or Patient Council. Whatever you choose to call the group of patients you meet with regularly, you need to have a group of patients you meet with regularly.
How do you start an Advisory Board?• Budget. Have name tags made
for Board members. Have lunch (nothing fancy) at every meeting. When they leave the Advisory Board, present them with a plaque and a gift. Have a special thank you lunch (fancy) once a year for the Advisory Board.
• Havethestaffkeepacontinuouslist of patients they think would be good for the Advisory Board. Naysayers, Question Askers and Perpetual Devil’s Advocates are all good choices. That one patient (or two) you couldn’t do anything right for. Don’t forget parents or children of patients, caregivers and spouses.
• Setastandingmeeting date and time for the Advisory Board. The third Thursday of every month at noon. The first Tuesday of every month. Send invitations and/or emails for each meeting.
• Take minutes and keep an issues log. Get answers for questions. Provide Board members with written records of the meetings.
- Setting the practice thermostats to a comfortable level for the patients, not the staff. If you can’t get the thermostat to cooperate, tell every patient that the office is chilly and to bring a sweater or jacket. Buy a new or refurbished blanket warmer. Everyone loves a warm blanket, especially when they are partially undressed!
- Inviting patients to roundtables to tell you what they like and don’t like about your practice. Don’t forget to invite patients who are really upset with the practice – they will give you the best information and can become your greatest advocates – if you are willing to listen.
- Telling patients when they call for their first appointment what the routine wait time is (be honest). If the doctor always runs late, tell them how to plan for that. Some patients are willing to wait and some patients either won’t wait, or can’t wait – try to align expectations early on.
Excellent customer service means patients will feel good about coming back, they may tell 3 or more people about their experience and they might even give your practice a very good review on Twitter, Facebook, Yelp, Angie’s List, and 1 or 2 other rating sites.
Customer Service is WHATEVER MAKES PEOPLE FEEL BETTER. It is anything from saying “I’m sorry we didn’t do the best that we could have for you,” to providing a drink or a place to have a private conversation. We don’t have to be perfect, we just have to have the desire to provide the perfect experience for each patient. Compassion is having no preconceptions about the other person and being willing to serve the other person’s needs regardless of your own
continued from page 19
*Courtesy of Urgent Care Association of Americas Urgent Care Industry Information Kit, 2011 (www.ucaoa.org)
• Invite staff members to attend on a rotating basis. Make sure staff have the opportunity the introduce themselves (everyone should introduce themselves at every meeting) and tell what they do in the practice.
• Experimentwithphysician attendance and gauge if the physicians’ presence is detrimental to open communication. You may be able to introduce a physician into the group after the Board has meet several times and everyone feels comfortable.
• Youmaygettoapointwhenallthepithy issues have been addressed and the conversation doesn’t fill the Board meeting agenda. This is the time to start introducing short programs on new practice services, new physicians, or special topics you want the Board’s input on.
What is the right size for an Advisory Board? Start with 12 people. Not everyone will come to every meeting, and some will probably drop off due to other commitments. If you target 12 people, have 10 stick with it and 8 people attend most meetings, it will be about right. If it isn’t, you can expand or shrink the number by inviting more people, or not filling vacant spots. Don’t forget to set a service term that you can exercise if you need to.
#6 Use Remote Employees If you can’t find the right part-time or full-time employees, maybe you’re not looking in the right places. One of the great things about business today is that a portion of your workforce can be anywhere. Your best employees may not live in your town, your state or your time zone. Many employers can’t handle offsite employees, but study after study shows that both employers and employees win when employees work from home. Slaughter Development notes: “The real reason why telecommuting makes people more productive and more satisfied is this: outside of the office, employees are automatically in control their environment and workflow. There is no better way to build satisfaction than to give people authority and responsibility, and no better way to destroy productivity than to require people to work in environments and structures which do not leverage their expertise.”
What are other positives about remote employees?• Employeesspendlessmoneyand
have less non-productive time (e.g. commuting), get more sleep and have a better life-work balance working from home, so they feel they win as employees.
• Nothavingtoprovideofficespacefor employees means freeing up space to become revenue-producing. “Given that it costs more than $15,000 per year to provide an employee with 200 square feet of cubicle, the savings would be so great, in fact, that companies would still come out thousands of dollars ahead after springing for workers’ broadband and VoIP expenses.” (Wired Magazine)
• Havingemployeesworkfromhome means staff can be scheduled to cover early or late shifts without the safety concerns of working in
an empty building.• Remoteemployeescanbepart-
time or prn and have floating hours to help cover busy times of the year, medical leaves and unexpected shortages.
• Notbeingexposedtoofficegerms, office politics and negative behavior reduces stress and absenteeism and increases loyalty and retention.
• Telecommutingisgreen.
What are the negatives about remote employees?• Somemanagershavenoexperience
managing a remote workforce and may find it uncomfortable managing staff they cannot see.
• Iftheemployeehasn’tworkedfromhome before, s/he may experience feelings of being isolated and out of the loop.
• Mostemployerswillchoosetosupply remote workers with computers, and therefore must to take responsibility for maintaining and repairing offsite computers.
• Communicationwithremoteemployees must be very strong and very consistent. Managers must pick up the phone, have Skype talks and video conferences.
• Remoteemployeeswillneedperformance standards just as onsite employees do, but their standards may be more production-oriented than time-oriented.
What are the medical practice positions that lend themselves to remote employees?• transcription• codingandbilling• nursetriage• scheduling• anytaskthatdoesnotrequireface-
to-face time with patients
The final 6 of the 12 ways to supercharge your practice will be presented in next month’s issue of Med Monthly.
“We don’t have to be perfect, we just have to have the desire to provide the perfect experience for each patient”
‘‘
MEDMONTHLY.COM |21
Physicians, Don’t Have Money To Burn?Another ChanceTo Avoid a 1.5%Reduction ofAll MedicarePaymentsIn 2013
The Centers for Medicare and Medicaid Services (CMS) just announced that
the Quality Reporting Communication Support Page (where you go to apply
for one of the four hardship exemptions from the 2013 1.5% Medicare payment
reduction) is re-open November 1, 2012 through January 31, 2013 for Medicare
2013 Electronic Prescribing (eRx) Payment Adjustment Hardship
Exemption Requests.
practice tips
22 | DECEMBER 2012
B eginning November 1, 2012, CMS has reopened the Quality Reporting Communication Support Page to allow individual eligible professionals and CMS-selected group practices the oppor-
tunity to request a significant hardship exemption for the 2013 eRx payment adjustment. Significant hardship request should be submitted via the Quality Reporting Communi-cation Support Page (Communication Support Page) on or between November 1, 2012 and January 31, 2012. CMS will review these requests on a case-by-case basis. All decisions on significant hardship exemption requests will be final. Important — Please note that this is for the 2013 eRx payment adjustment only. Hardship exemption requests for the 2014 payment adjustment will be accepted during a separate time frame later in calendar year 2013.
Are You Already Exempt From the 2013 1.5% Payment Cut?
The 2013 eRx payment adjustment only applies to certain individual eligible professionals. CMS will automatically exclude those individual eligible professionals who meet the following criteria:
lThe eligible professional was a successful electronic prescriber during the 2011 (yes, 2011!) eRx 12- month reporting period (January 1, 2011 through December 31, 2011).
lThe eligible professional is not an MD, DO, podiatrist, Nurse Practitioner, or Physician Assistant by June 30, 2012, based on primary taxonomy code in the National Plan and Provider Enumeration System (NPPES).
lThe eligible professional does not have at least 100 Medicare Physician Fee Schedule (MPFS) cases containing an encounter code in the measures denominator for dates of service from January 1, 2012 through June 30, 2012.
lThe eligible professional does not have 10% or more of their MPFS allowable charges (per TIN) for encounter codes in the measures denominator for dates of service from January 1, 2012 through June 30, 2012.
lThe eligible professional does not have prescribing privileges and reported G8644 on a billable Medicare Part B service at least once on a claim between January 1, 2012 and June 30, 2012.
Avoiding the 2013 eRx Payment Adjustment Through Hardship Exemptions
CMS may exempt individual eligible professionals and group practices participating in eRx GPRO from
the 2013 eRx payment adjustment if it is determined that compliance with the requirements for becoming a successful electronic prescriber would result in a significant hardship.
Significant HardshipsThe significant hardship categories are as follows:
lThe eligible professional is unable to electronically prescribe due to local, state, or federal law, or regulation
lThe eligible professional has or will prescribe fewer than 100 prescriptions during a 6-month reporting period (January 1 through June 30, 2012)
lThe eligible professional practices in a rural area without sufficient high-speed Internet access
lThe eligible professional practices in an area without sufficient available pharmacies for electronic prescribing
Submitting a Significant Hardship Request To request a significant hardship, individual eligible professionals and group practices participating in eRx GPRO must submit their significant hardship exemption requests through the Quality Reporting Communication Support Page (Communication Support Page) on or between November 1, 2012 and December 31, 2012. Significant hardships associated with one of the four above reasons may be submitted ONLY via the Communication Support Page. For more information on how to navigate the Communication Support Page, please reference the following documents:
lQuality Reporting Communication Support Page User Guide
lTips for Using the Quality Reporting Communication Support Page
For additional information and resources, please visit the E-Prescribing Incentive Program web page. If you have questions regarding the eRx Incentive Program, eRx payment adjustments, or need assistance submitting a hardship exemption request, please contact the QualityNet Help Desk at 866-288-8912 (TTY 877-715-6222) or via [email protected]. They are available Monday through Friday from 7am to 7pm CST.
http://www.managemypractice.com/physicians-get-another-chance-for-2013-erx-hardship-exemption-starting-november-1/
MEDMONTHLY.COM |23
practice tips
24 |DECEMBER 2012
Physician Assistant Workforce Volume
Strives to Meet Patient Demand
By Lisa P. Shock, MHS, PA-CPresident/CEO Utilization Solutions in Healthcare, Inc.
In this time of health care reform, medical practices and health systems must find ways to provide high quality health care services while remaining cost effective. The health care system is facing a shortage of primary care clinicians. This is critical when looking at health reform and examining the concept of increasing numbers of patients seeking access to medical care under a reformed system. Currently, there is a shortage of primary care physicians and the Association of American Medical Colleges estimates that by 2020, the country will face a shortage of 90,000 physicians. Increasingly informed patients and a cost-conscious marketplace are demanding new models of care that utilize all providers to their fullest potential in order to increase access to care and demonstrate improved health outcomes. Utilization of physician assistants (PAs) may be part of the delivery solution. Studies suggest that the addition of a PA to a medical practice may offer enhanced patient satisfaction, improved physician work-life balance, improved revenues and greater access to care for patients. According to the American Academy of Physician Assistants (AAPA) there are 86,500 certified physician assistants practicing medicine nationwide. This is an increase of more than 100 percent over the last 10 years. Many successful Accountable Care Organization (ACO) models are embracing a shift from volume-based reimbursement to value based reimbursement and the formation of population health management hubs. With the development of these new structured organizations, PAs and NPs will also act as extenders to support the primary care physician within the medical home model. Accrediting bodies such as (NCQA) and the Utilization Review Accreditation Commission (URAC) support the concept of the patient centered medical home (PCMH) as a proven model for delivering high
quality, cost-effective patient care and encourage the inclusion of Physician Assistants. Nationally AAPA supports the fundamental premise that standards used to define the PCHM and newer care delivery models are not limited to physicians. Approximately 35,000 PAs practice in primary care of all PAs nationwide. Many PAs will practice in health care PCMHs, lead patient care teams and participate in and be an integral component of quality performance reporting. By integrating the care delivery system and restructuring the delivery of primary care services across settings from outpatient to hospital, populations and conditions may be managed more efficiently. A team approach to care delivery will help to improve patient satisfaction and improve quality care for chronic diseases. Utilization of PAs in the PCMH model may exist in several ways. In some settings, PAs may be focused on acute care or on management of chronic conditions, while in other communities, PAs may maintain their own panels of patients alongside physicians, and in rural communities, PAs may practice alone with a physician located off site. Optimal utilization supports the patient to choose a PA as a primary care
provider, ensuring and increasing access to care while the physician maintains oversight of the PA scope of practice. This utilization model allows for continuity of care, fosters patient/provider relationships, and underscores chronic disease management efforts for challenging care conditions including diabetes and asthma. Ultimately, the role of the PA within the PCMH will depend on the clinical setting, patient population, clinical competency and experience, and the professional relationship between the PA and the physician(s). Using broad legislative language to describe the primary providers of health care encourages flexibility and innovation as practices shift toward developing systems of care that focus on value and quality rather than volumes of patients. Population management of chronic diseases will meet the needs of patients and community through models like PCMH and utilization of PAs will be an essential part of the successful workforce solution.
References:http://www.smartmoney.com/plan/health-care/your-surgeon-may-not-be-a-doctor-1346970593986/
https://www.aapa.org/news_and_publications/news/item.aspx?id=5187
http://www.ahrq.gov/research/pcwork2.htm
Lisa P. Shock, MHS, PA-C, is a seasoned PA who has worked with clients to expand care teams in both large and small settings. She enjoys part time clinical primary care practice and is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering a wide range of services to help implement and improve upon the utilization of PAs and NPs in the health care system. Contact her at [email protected]
“Currently, there is a shortage of primary care physicians and the Association of American Medical Colleges estimates that by 2020, the country will face a shortage of 90,000 physicians.”
‘‘
MEDMONTHLY.COM |25
26 | DECEMBER 2012
Doctors Connect to Patients In an
mHealth World
YOUIMAGINE
Part 2 of 2
research & technology
By
MEDMONTHLY.COM |27
Patients prefer the iPad when communicating with their doctors
The use of iPads in clinical situations sets a good trend for patients. Ferdinand Velasco, M.D., chief medical information officer at Texas Health, sees a change in the doctor-patient interaction from doctors who are often leaving patient rooms to access information at computer terminals, to doctors who are using iPads as an accessory and offering more engaged patient conversations.1 Los Angeles, CA: Cedars-Sinai Medical Center has adopted widespread use of mobile devices in their hospitals.2 Lahey Clinic in Burlington, Massachusetts, has, too.3 Those involved in these initiatives have been widely in favor of the changes: both patients and doctors. Since it is the one-on-one relationship with a doctor that patients find most satisfying, patients in these settings experience what feels like less indifference.4 Patients feel as if they are spending a lot more time with their doctors because of mobile devices. Dr. Finkel, co-chair of Lahey’s medical device committee, said that much of the time a physician typically spends away from the patient but attending to their medical needs, such as consulting with other physicians, reviewing, and ordering tests, can now be spent with the patient attending to those same tasks. He says patients see their own x-rays and test results, they are a part of the decisions made on the team, and they feel more in control and more connected than with the traditional setup. And doctors say they enjoy being able to show patients the visual evidence of their medical conditions easily. It’s a situation where the human interaction is key and where the technology is making the experience better without dominating the human interaction. Elderly patients, specifically, benefit from this situation
because physicians are sitting closer to them within good earshot, and pointing to data and visual details on their mobile devices so that understanding the medical details is easier. Even family members of the patients prefer this kind of interaction, as the mobile device is easily shared between people and passed around. The readily available content and medical records makes viewing x-rays and ekgs more accessible for family members and everyone involved in the patient’s care.5
“I can do anything at the patient bedside that I can do at a physician station, which saves time in my day,” Henry J. Feldman, MD, chief information architect for Harvard Medical Faculty Physicians and a hospitalist at Boston’s Beth Israel Deaconess Medical Center.6
An effective tool
This trend is extending beyond the hospital setting. More and more frequently, iPads are being offered to patients as they walk into their
continued on page 28
In my last article I wrote about the increasing trend for doctors and medical staff to be using mobile devices in the clinical setting, and how this has changed the clinical setting: allowing for easier information and access to records right at patient bedside. In this article, I’d like to explore this question from the point of view of the patient. Has this clinical change impacted the patient’s experience? Are patients happy with the changes? How are patients using iPads and mobile devices? What is available for them to use? How is this changing the relationship to their health? And how can it change their relationship to their health?
“And doctors say they enjoy being able to show patients the visual evidence of their medical conditions easily. It’s a situation where the human interaction is key and where the technology is making the experience better without dominating the human interaction.”
‘‘
continued from page 27
28 | DECEMBER 2012
doctor’s office, where a dynamic eForm captures all information and signatures, and then transmits the data to an EMR or EHR system, places a copy to SharePoint or other collaboration platform, and e-mails a PDF copy to whomever requires a copy. At the Duke Oncology clinic, patients access secure online Web portals to answer questions between visits. Three-quarters of breast-cancer patients reported that they were able to remember their symptoms more accurately, and one-third of them said the online questionnaire prompted them to bring up issues with their doctors. And the staff feels there is a sense of anonymity, which has led to greater honesty and accuracy among patients in answering questionnaires about alcohol, sex, anxiety, and depression.7
One particular example I found was a medical student, Ales Chamessian, who made it clear to me how personal and helpful the mobile device can be:
“Our team cared for a newborn who was showing signs of what appeared to be benign neonatal sleep myoclonus. The baby’s mother was very disturbed by the sight of her new (and first) daughter contracting during her sleep. When I was presenting this case on rounds, I pulled up a Youtube video of benign neonatal sleep myoclonus and showed it to the parents and the rest of my team. When the mom saw the video of someone else’s baby twitching like her own, she was reassured that her daughter’s condition was fairly common and of little concern. Likewise, the rest of my team, which included residents, medical students, nurses and attendings, got a better view of what benign sleep myoclonus looks like.”8
How convenient it is, for those who have watched the changes in medicine
from the old paradigm to the new, simply to have medical and visual information so close at hand.
Is the iPad or smartphone secure?
With so many physicians enthusiastic about the use of iPads in the clinical setting, if there is reluctance among physicians about the mobile device, it has to do with security. Unless doctors are using encrypted apps that securely protect patient information, they can’t use the devices to communicate to or about patients’ personal medical information without violating the Health Insurance Portability & Accountability Act, or HIPAA. But on September 28, new legislation was announced to make the approval process simpler and more streamlined for the FDA. The Healthcare Innovation and Marketplace Technologies Act (HIMTA) will allow the formation of a special Office of Mobile Health at the FDA.9 This office will provide approval and recommendations for apps and offer a developer support program at the Department of Health and Human Services. Such support will give app developers understanding
about the privacy regulations, and acknowledgment as to whether they are following the privacy regulations required by HIPAA. While this effort to make apps secure is a hot topic in iPad technology, in the meantime, apps have are avoiding the issue by “dumbing down”. Apps do not include personal information or store data that might be associated with a particular patient. This may be unfortunate for the patient, according to Chris Wasden, Global Healthcare Innovation Leader for PricewaterhouseCoopers.10 But it is an issue which may, in the long run, find a good solution. For those app developers who have made special effort to comply with secure protocols and have been cleared by the FDA, it is easy enough to find them on iTunes by doing a search for “AirStrip”. Meanwhile, AT&T is developing the mHealth Platform to help bridge the gap between health and mobility. The platform will allow users to aggregate date from their insurance company, various devices and applications, and doctor’s offices, and hold it in a secure form, allowing applications to track health information with a secure infrastructure while sharing date with friends, family, and their health care professionals. This will all
MEDMONTHLY.COM |29
be integrated into one app platform, creating a powerfully useful tool for the consumer to authorize and offer to health care providers when needed. It also promises to make the use of this secure system easy for app developers. Many of the apps available offer something interesting without the need to reference medical records. But there is freedom for developers, in designing apps with this purpose in mind. Recently I was speaking with an orthodontist to design a tooth-brushing app for children, and the question came up of being able to keep a tooth-brushing record that the child could share with the orthodontist. Presently this is not something the orthodontist can offer, with the security concerns on iPad. And for those settings where EHR transfer is secure, according to the Manhattan Research Study, 63% of doctors are using them.11
It’s a future more patient-focused vision for medicine
Technology changes rapidly. We have as our vision an ideal: a future where both doctors’ and patients’ needs are met. This technology, mobile devices, offers a step in a better direction. Mobile devices satisfy doctors because they are an immediate and rich source of information. They also satisfy patients because they offer a closer and more interactive experience with the health professional. The future looks promising to offer secure apps so that medical records can be transferred confidentially. And developers are eager to create new application models with new possibilities. In my last article I offered a review of medical apps. Next month I will explore health apps and offer a review for some of the apps available in this expanding field of mobile health.
1 Can the iPad Cure What Ails Us? By Tom Kaneshige. http://www.pcworld.com/article/229374/Can_the_iPad_Cure_What_Ails_Us_.html2 HC industry needs to put the iPad in contextBy Brian Dolan. http://mobihealthnews.com/special-issue-ipad-in-healthcare/3 Have iPad—can travel. How tablets at the bedside save doctors an hour a dayBy Bonnie Darves http://www.todayshospitalist.com/index.php?b=articles_read&cnt=14384 Trouble with the Caregiver – Patient Connection http://www.nurture.com/category/report/.5 See 4.6 Today’s Hospitalist. Taking your tablet to work? The benefits and challenges of mobile computing in the hospitalhttp://www.todayshospitalist.com/index.php?b=articles_read&cnt=15117 The Economist Group. Saving Lives One iPad at a Time. http://www.economistgroup.com/leanback/new-business-models/saving-lives-one-ipad-at-a-time/8 How a medical student uses an iPad for patient care and education. By Alex Chamessian. October 23, 2011 in TECH. http://www.kevinmd.com/blog/2011/10/medical-student-ipad-patient-care-education.html.9 Who Should Regulate Medical Mobile Apps? FDA or Some Other HHS Agency? By Carmelina G. Allis. Oct 4, 2012 in FADALAWBLOG. http://www.fdalawblog.net/fda_law_blog_hyman_phelps/2012/10/who-should-regulate-medical-mobile-apps-fda-or-some-other-hhs-agency.html10 Mobile health is taking off but what’s still in its way? By Ki Mae Heussner. Jul 10, 2012 in GigaOm. http://gigaom.com/2012/07/10/mobile-health-is-taking-off-but-whats-still-in-its-way/11 Manhattan Research Physician Specialist Survey. “2012 Taking the Pulse” polling 3,015 U.S. practicing physicians in over 25 specialties. http://manhattanresearch.com/News-and-Events/Press-Releases/physician-digital-media-adoption.
30 | DECEMBER 2012
research & technology
Health IT -Best Practices to
Minimize Cash FlowDisruptions Resulting
from ICD-10Implementation
In order for medical organizations to effectively mitigate the risks involved
with ICD-10 implementation,it is imperative for them to
include a thoroughreview of potential
cash flow risks as partof their overall
ICD-10 planning. by Frank J. Rosello,CEO, EnvironmentalIntelligence LL
MEDMONTHLY.COM |29
W hen any business is involved with a major system conversion, at risk is the potential
disruption to cash flow, resulting in a negative impact to the bottom line. With the current 10th revision of the International Statistical Classifica-tion of Diseases and Related Health Problems (ICD-10) implementation deadline of October 1, 2013 quickly approaching, medical organizations need to be well prepared to handle the financial risks associated with this initiative. In order for medical organi-zations to effectively mitigate the risks involved with ICD-10 implementation, it is imperative for them to include a thorough review of potential cash flow risks as part of their overall ICD-10 planning. A component of a sound holistic risk mitigation strategy includes providers understanding their current revenue stream and be able to forecast possible changes to cash flow before, during, and post ICD-10 implementation. Medical organizations who proactively engage in advanced planning to protect revenue loss will also experience the unique opportunity to evaluate and improve their overall business operations, maximize operational efficiency, enhance their revenue stream, and control costs on a global scale. While it is expected that reimbursements will initially decline with ICD-10 conversion, providers should now be engaged in aggressively taking advantage of the time remaining to diagnose and put in place a risk mitigation plan that will address any cash flow fluctuations from moving to ICD-10. To help medical organizations and providers prepare to make the transition to ICD-10, consider the following nine best practice action items when preparing a risk mitigation plan:
1. Explore and determine budgeting avenues for additional cash reserves if material delays in
payment occur resulting from the transition to ICD-10.
2. Perform a comprehensive review of all managed care contracts to potentially negotiate protective language relevant to reimbursement in the event payment shifts occur that could have a negative impact to cash flow and subsequently the bottom line.
3. Conduct a series of financial modeling to better understand the financial implications of moving from ICD-9 to ICD-10 and forecast the revenue impact by provider or facility, line of business, and geography.
4. Proactively engage with high-volume payers to assess their readiness level to process claims in the ICD-10 compliant format.
5. Develop a strategic plan for the coding, billing and claim backlogs processes to minimize disruptions and maximize cash flow.
6. Conduct clinical documentation improvement reviews with all stakeholders using the ICD-10 code set.
7. Develop a strategy and process for managing claim denials pre and post ICD-10 implementation.
8. Review audits currently occurring that may be impacted in the future by compliant use of the ICD-10 code set.
9. Perform ICD-10 readiness level assessments of all external vendors who support the coding, billing, follow up, and denials functions
As the United States moves closer towards the deadline for this important classification conversion, top priority for both payers and providers should be on what IT systems will require retooling, what workflows will require reengineering, and budgeting for any infrastructure investments. Medical organizations and providers who proactively develop strategic and risk mitigation plans will be best positioned to experience a smooth transition to ICD-10.
Providing customized,
simple
NUTRITION SOLUTIONS
to ENHANCE
HEALTH and
OPTIMIZE SPORTS
PERFORMANCE
Blue Cross Blue Shield of North Carolina and
Cigna insurance provider.
Tracy Owens, MPH, RD, CSSD, LDN Ashley Acornley, MS, RD, LDN
6200 Falls of Neuse Road, Suite 200 Raleigh, NC 27609
919-876-9779
32| DECEMBER 2012
research & technology
Everything Else is Smart Now...
Why NotYourPills?
You’ve heard of smart cars, smartphones and smart grids. What about smart pills? They are not, unfortunately, pills that boost people’s smarts. They comprise a small diagnostic tool for health care professionals. Also called Ingestible Capsule Technology (ICT), a smart pill is a miniaturized micro-electronic systems in a single chip enclosed in a small capsule that a patient can swallow. The tiny device then uses its diagnostic and bio-medical applications to collect information and transmit it to physicians and other specialists. And it will soon be worth big money, according to new research. According to a new market research report, “Smart Pill Technology Market (2012-2017)” published by MarketsandMarkets, the smart pill technology market is expected to grow at a compound annual growth rate (CAGR) of 17 percent, reaching $965 million by the year 2017. The rapid growth the market is attributed in part to the rising number of screening treatments
for gastrointestinal (GI) disorders as well as improved reimbursement coverage across both developing and developed nations. Research has broken the smart pill market into sub-categories, including capsule endoscopy (observing and collecting data from the patient’s digestive system), smart pills for drug delivery and patient monitoring smart pills, which deliver data about a patient’s condition to physicians or researchers. The report identifies the potential market drivers and restraints to anticipate future technology trends, opportunities and overcoming the challenges. The market is segmented and revenue is forecasted on the basis of major regions such as North America, Europe, Asia-Pacific and Middle-east and Africa.
http://www.healthtechzone.com/topics/healthcare/articles/2012/10/16/312097-everything-else-smart-nowwhy-not-pills.htm
What’s your practice worth?When most doctors are asked what their practice is worth, the answer is usually, “I don’t know.” Doctors can tell you what their practices made or lost last year, but few actually know what it’s worth.
In today’s world, expenses are rising and profits are being squeezed. A BizScore Performance Review will provide details regarding liquidity, profits & profit margins, sales, borrowing and assets.
Our three signature sections include: Performance review Valuation Projections
919.846.4747bizscorevaluation.com
Scan this QR code with your smart phone to learn more.
legal
I. What is an HSA? A HSA “is a tax exempt trust or custodial account,” which is set up through a qualified HSA trustee or insurance company.1 HSAs first became available in 2004 through the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (“MMA”). 2 An HSA can be contributed to, by or on behalf of, “eligible individuals,” as defined below, and is used to pay for certain medical expenses for the
eligible individuals, their spouses and their tax dependents. For eligible individuals, HSAs offer the following numerous benefits: •ThefundscontributedtoanHSA
are set aside tax-free to be used for qualified medical expenses;
• employercontributionstoanemployee’s HSA are excluded from income and employment taxes 3;
• anindividualcanclaiman“abovethe line” tax deduction for any contribution made to the HSA4;
• anindividualcandecideexactlyhow much to set aside for medical expenses;
• anindividualcanusethemoneyin his or her HSA for a variety of health care expenses which health insurance plans may not cover, including dental expenses like cleanings and braces, vision care, and alternative treatments like acupuncture;
• anindividual’scontributionsremain in his or her HSA from
What You Need to Know About Health Savings Accounts
Is a health saving account (“HSA”) right for you? Find out in this article which summarizes what a HSA is, who is eligible to establish one, types of expenses that can be paid with HSA funds, increases to HSA limits in 2013 and how health care reform changed the way HSAs are used. By Simi Botic
Associate at DinsmoreMedical Office Today
34 |DECEMBER 2012
year to year until they are used; • interestandotherearningsinan
HSA are tax free; distributions from an HSA may be tax free if used for a qualified medical expense;
• anHSAisportable,soittravelswith an individual as he or she changes employers or leaves the work force.5
II. Who is Eligible to Establish an HSA? You must be an eligible individual to qualify for an HSA. To be HSA-eligible, an individual must meet the following four requirements:• AnHSAisonlyavailabletoan
individual who is enrolled in a high-deductible health plan (“HDHP”)6 for the months in which contributions are made to the HSA.7
• Anindividualcannothaveotherhealth coverage, except for a few permitted “other health coverage”8 exceptions.9
• Anindividualcannotbeenrolledin Medicare.10
• Anindividualcannotbeclaimedas a dependent on someone else’s tax return.11
III. Types of Expenses that can be Paid with HSA Funds HSA distributions are entirely voluntary, and HSA distributions are generally available without restriction. This means, an individual can pay any expense with his or her HSA funds. Specifically, IRS Notice 2004-2 states “an individual is permitted to receive distributions from an HSA at any time.”12 While an individual can always access the funds in his or her HSA, the tax treatment of a distribution will depend on the timing of the distribution and whether any unreimbursed medical expenses can be used to offset the distribution. An HSA distribution is excluded
from an individual’s gross income and tax-free if used for the qualified medical expenses of an account holder, his or her spouse, and tax dependents. A “qualified medical expense” is an “expenditure for medical care, as defined by §213(d), for the account holder and his or her spouse or tax dependents, to the extent that such accounts are not reimbursed by insurance or otherwise.”13 Typically, a distribution to pay for insurance premiums is not tax-free. If a distribution is made from an HSA for nonmedical expenses, those distributions will be included in an individual’s gross income and will be subject to an additional 20% tax (this 20% additional tax took effect beginning with the 2011 tax year. This is an increase from 10% that applied for tax years prior to 2011).14
IV. IRS Increases to HSA Limits in 2013 HSA contributions may be made by an HSA account holder, or other individuals including the account holder’s spouse, tax dependents and employer.15 The amount that can be contributed to an individual’s HSA depends on factors, including the type of HDHP coverage the person has, the individual’s age16 and date of eligibility.17, 18 Limits on HSA contributions apply to an individual account holder based on his or her taxable year. The same annual limits apply regardless of who makes an HSA contribution.19 Changes to these limits are around the corner as the IRS has announced increases to HSA account limits, effective in 2013. HSA limits will adjust each year for cost of living. The current 2012 maximum contributions for HSAs are $3,100 for individuals and $6,250 for families.20 However, the maximum contributions for both individuals and families will be increasing slightly in 2013, according to the IRS.21 Under IRS Revenue Procedure 2012-36, the maximum contributions that can be
made to HSAs in 2013 will increase to $3,250 for employees with individual coverage and to $6,450 for employees with family coverage.22 It is important to note that HSA account fees are not treated as an HSA contribution, and therefore are not calculated in the maximum contribution.23
In addition to the rise in maximum contribution, the IRS has also announced a simultaneous rise in the minimum deductable for all HDHPs, which HSAs must be linked to.24 In 2013, the minimum deductible will rise from $1,200 to $1,250 for employees with individual coverage and from $2,400 to $2,500 for employees with family coverage.25
Finally, the maximum out-of-pocket expense, which includes but is not limited to an employee’s deductibles, will also rise in 2013.26 For employees with individual plans, the maximum out-of-pocket expense will rise from $6,050 to $6,250, and for employees with family plans it will increase from $12,100 to $12,500.27 No changes will be made to the HSA catch-up contributions.28 Therefore, the 2012 $1,000 HSA catch-up contribution limit will carry-over to 2013.29
If HSA contributions exceed the limits imposed by law, an individual will be subject to an excise tax of 6% for each taxable year in which excess contributions are made.
V. How Health Care Reform Changes the Way HSAs are Used Health care reform, specifically the Patient Protection and Affordable Care Act (“ACA”)30 has changed the way HSA accounts are used in two ways. Significantly, ACA has: (1) added a prescription requirement for the reimbursement of over-the-counter (“OTC”)31 medicines and drugs, other than insulin32; and (2) increased the amount of penalty for nonmedical
continued on page 36
MEDMONTHLY.COM |35
expense distributions from an HSA as more fully explained below.33 ACA establishes new restrictions on reimbursement for OTC34 drugs and medicines if purchased in tax years after December 31, 2010. According to these new restrictions, HSAs can only provide tax-free distributions for medicines and drugs if they are prescribed35, with the exception of insulin.36 This is true even if a prescription is not necessary to acquire the medicines or drugs. The new health care reform restrictions do not apply to OTC items that are not drugs or medicines (i.e. medical devices, equipment, crutches, blood sugar test kits and eyeglasses). Under ACA, if distributions are made from an HSA for nonmedical expenses, the distribution will be subject to a 20% tax.37 This increase applies to all distributions made for tax years after December 31, 2010. As previously discussed, this is an increase from 10% that applied for tax years prior to 2011.
1 See IRS Publication 969 (2011), Health Savings Accounts and Other Tax-Favored Health Plans.2 Id.3 See Code §§106(d), 3231(e)(11), 3306(b)(18), and 3401(a)(22). 4 See Code §62(a)(19). 5 See IRS Publication 969 (2011), Health Savings Accounts and Other Tax-Favored Health Plans.6 An HDHP is a health insurance plan with high deductibles but lower premiums than traditional health insurance plans. 7 See IRS Publication 969 (2011), Health Savings Accounts and Other Tax-Favored Health Plans.8 Generally, an HSA eligible individual cannot have other health coverage. But, an individual can have additional insurance that provides benefits only for the following items: liabilities incurred under workers’ compensation laws, tort liabilities or liabilities related to ownership or use of property; a
specific disease or illness; and a fixed amount per specified period for hospitalization. An individual may also have coverage for: accidents; disability; dental care; vision care; and long-term care. 9 Id.10 Id.11 Id.12 Only reasonable restrictions on frequency or amount of distributions from an HSA are permissible by the IRS. 13 See Code §223(d)(2); IRS Notice 2004-2, 2004-2 I.R.B. 269, Q/A-26, See also IRS Notice 2004-50, 2004-33 I.R.B. 196, Q/As-26 and 028.14 See Code §223(f)(2) and (4) as amended by PPACA, Pub. L. No. 111-148, §9004(a)(2010)(applicable to distributions made after December 31, 2010).15 See IRS Notice 2004-50, 2004-33 I.R.B. 196, Q/A-28. 16 Known as “Catch-up Contribution.” 17 Known as “The Last-month Rule.”18 See IRS Publication 969 (2011), Health Savings Accounts and Other Tax-Favored Health Plans.19 See IRS Notice 2004-2, 2004-2 I.R.B. 269, Q/A-12 and IRS Notice 2004-50, 2004-33 I.R.B. 196, Q/A-28.20 See Geiser, Jerry Workforce, Health Savings Account Contribution Caps to Rise Slightly in 2013, available at http://www.workforce.com/article/20120427/NEWS01/120429965/health-savings-account-contribution-caps-to-rise-slightly-in-2013 (April 27, 20 12).21 Id.22 Id.23 See IRS Notice 2004-50, 2004-33 I.R.B. 196, Q/A-71. 24 See Geiser, Jerry Workforce, Health Savings Account Contribution Caps to Rise Slightly in 2013, available at http://www.workforce.com/article/20120427/NEWS01/120429965/health-savings-account-contribution-caps-to-rise-slightly-in-2013 (April 27, 2012).25 Id.
26 Id.27 Id.28 See Paton, Jenn, FosterThomas, Health Savings Account (HSA) Changes for 2013, available at http://www.fosterthomas.com/blog/bid/53573/Health-Savings-Account-HSA-Changes-for-2013 (May 24, 2012).29 Id.30 See Patient Protection and Affordable Care Act, Pub. L. No. 111-148 (2010), as amended by Health Care and Educational Reconciliation Act of 2010, Pub. L. No. 111-152 (2010).31 A “prescription drug” is defined as a “drug that can be obtained only by means of a physician’s prescription,” while “OTC” is a term used to describe “a drug that is sold lawfully without a prescription.” See U.S. National Library of Medicine, MEDLINEplus: Medical Dictionary (as visited Oct. 12, 2012).32 Under the ACA, non-prescription insulin will still be considered qualified medical expenses, and therefore disbursements for insulin will be tax-free. 33 See Patient Protection and Affordable Care Act, Pub. L. No. 111-148 (2010), as amended by Health Care and Educational Reconciliation Act of 2010, Pub. L. No. 111-152 (2010).34 OTC drugs are not taken into account when determining an individual’s medical expense deduction under Code §213. See §213(b). 35 “Prescription” is defined as “a written or electronic order that satisfies the legal requirements for a prescription in the state in which the expense is incurred, including t hat it be issues by someone who is legally authorized to issue a prescription in that state.” See IRS Notice 2010-59, 2010-39 I.R.B. 396. 36 See Code §106(f), as added by ACA, Pub. L. No. 111-148 (2010).37 Code §§ 223(f)(4)(A) and 220(f)(4)(A) as amended by ACA, Pub. L. No. 111-148(2010).
continued from page 35
36 |DECEMBER 2012
MEDMONTHLY.COM |37
38| DECEMBER 2012
legal
For more than 40 years, community health centers have delivered comprehensive, high-quality preventive and primary health care to patients regardless of their ability to pay. During that time, community health centers have become the essential primary care medical home for millions of Americans including some of the nation’s most vulnerable populations. With a proven track record of success, community health centers have played an essential role in national recovery and reinvestment efforts and will play a key role in implementation of the Affordable Care Act.
The Affordable Care Act: The Essential Role of Community Health Centers
The Affordable Care Act provides $11 billion to bolster and expand community health centers over 5 years.l $1.5 billion will support major
construction and renovation projects at community health centers nationwide.
l $9.5 billion will: u Create new community health center sites in medically under served areas; and
u Expand preventive and primary health care services, including oral health, behavioral health, pharmacy, and/or enabling services, at existing community health center sites.
$250 million was made available to support the establishment of approximately 350 new community health center sites in fiscal year 2011. The expansion of community health center sites and services will make affordable, cost-effective, high quality preventive and primary care services available to nearly twice as many
Increasing Access to Affordable, Cost Effective, High Quality Care
Community Health Centers and the Affordable Care Act:
MEDMONTHLY.COM |39
people regardless of their insurance status or ability to pay; and will create thousands of direct employment opportunities in many of the country’s most economically distressed, low income communities. Community health centers are poised to play an essential role in the implementation of the Affordable Care Act. In particular, community health centers emphasize coordinated primary and preventive services or a “medical home” that promotes reductions in health disparities for low-income individuals, racial and ethnic minorities, rural communities and other underserved populations. Community health centers place emphasis on the coordination and comprehensiveness of care, the ability to manage patients with multiple health care needs, and the use of key quality improvement practices, including health information technology. The community health center model also overcomes geographic, cultural, linguistic and other barriers through a team-based approach to care that includes physicians, nurse practitioners, physician assistants, nurses, dentists, dental hygienists, behavioral health care providers, case managers and health educators.
Delivery of Care: Increased Access to Health Services
Rooted in a commitment to community-based, patient-centered care, community health centers continue to focus on comprehensive services that meet the varying needs of their patient populations including: chronic disease management, prevention and patient education activities, and outreach. Today, a network of more than 1,100 community health centers operate 8,100 service delivery sites that provide care to nearly 19.5 million patients in every State, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and the Pacific Basin. About half of
all community health center grantees serve a critical need in rural America; the remainder are found in urban areas. This network of community health centers has created one of the largest safety net systems of primary and preventive care in the country with a true national impact.l Community health centers,
supported by the Health Resources and Services Administration (HRSA), treated 19.5 million people in 2010, more than half of whom were members of racial and ethnic minority groups. Nearly forty percent had no health insurance; a third were children.
l In 2009, one out of every 17 people living in the U.S. now relies on a HRSA-funded clinic for primary care.
l Community health centers are an integral source of local employment and economic growth in many underserved and low-income communities. Since the beginning of 2009, health centers have added more than 18,600
new full time positions in many of the nation’s most economically distressed communities.
l In 2010, they employed more than 131,000 staff including 9,600 physicians, 6,400 nurse practitioners, physicians’ assistants, and certified nurse midwives, 11,400 nurses, 9,500 dental staff, 4,200 behavioral health staff, and more than 12,000 case managers, health education, outreach, and transportation staff.
Community health center quality of care equals and often surpasses that provided by other primary care providers. A programmatic emphasis on quality improvement as well as community-responsive and culturally appropriate care has also translated into impressive reductions in health disparities for community health center patients. Calendar Year 2009 Health Center Program data demonstrate that centers continue to provide high quality care and improve patient outcomes, while
Community Health CentersServe All Ages
Source: U.S. Department of Health and Human Services, Health Resources and Services Administration, Uniform Data System, 2009.
continued on page 40
reducing disparities, despite serving a population that is often sicker and more at risk than seen nationally:l Between 2008 and 2009, the
percent of low birth weight babies decreased yet again, from 7.6 percent to 7.3 percent, which is lower than the most recent estimated national rate of 8.2 percent. In addition, the rate of entry into prenatal care in the first trimester increased from 65 percent to 67 percent.
l 71 percent of community health center patients demonstrated control over their diabetes with a hemoglobin A1c (HbA1c) level less than or equal to 9.
l 63 percent of hypertensive community health center patients have their blood pressure under control; an increase from 2008.
Community health centers also reduce costs to health systems; the community health center model of care has been shown to reduce the use of costlier providers of care, such as emergency departments (EDs) and hospitals. Community health centers continue to deliver high quality care efficiently and effectively at a total annual cost of $600 per patient in 2009.
Recovery and Reinvestment: Demonstrated Community Health Center Impact Enacted in 2009, the American Recovery and Reinvestment Act (ARRA) provided $2 billion for community-based grants to community health centers over a 2-year period; an unprecedented opportunity to serve more patients, retain existing and support new jobs, meet the significant increase in demand for primary health care services among the nation’s uninsured and underserved populations and address essential construction, renovation, equipment and health information technology systems
needs in community health centers. To date, this $2 billion investment in community health centers has resulted in major increases in access to care while supporting the long term capacity of community health centers to serve even more patients through facility and technology expansions and upgrades, including:l The establishment of 127 new
community health center sites.l Preventive and primary health care
services for more than 4.3 million additional patients, about 50% who are uninsured;
l In 2009, community health centers hired 10,000 additional staff, and overall provided employment opportunities for more than 123,000 people in many of the nation’s most economically distressed communities; and
The construction, repair and renovation of more than 1,600 community health center sites nationwide, including the addition of electronic health records systems in more than 350 community health centers.
http://www.healthcare.gov/news/factsheets/2010/08/increasing-access.html
With a proven track record of success, community health centers have played an essential role in national recovery and reinvestment efforts and will play a key role in implementation of the Affordable Care Act.
‘‘continued from page 39
legal
MEDMONTHLY.COM |41
42| DECEMBER 2012
Preparing for Health Care Reform -An Agent’s Perspective
By Joe Gupton, CWCS,EmployeeSync Specialist,Jones Insurance
legal
MEDMONTHLY.COM |43
W ith the elections over, we now have a very clear image of the future of health insurance in the
U.S.. The intent of PPACA is clearly a good idea because there is a need for an initiative to help truly disadvan-taged families and individuals strug-gling with chronic disease. Further-more, the idea that by helping these Americans, the $49 billion in unpaid and unrecoverable costs that hospitals incur annually could be lowered by this same act. Unfortunately, along with the good intentions of this legisla-tion come some major challenges. Some businesses for example will now be held responsible for providing and administering medical insurance plans for their employees. Additionally, these plans will be subject to increasingly intense governmental scrutiny. Con-sidering these circumstances, the roles of health insurance brokers and agents will now be more important than ever. With the pending changes, agents will need to reevaluate their business model and decide if they will fight harder to prosper in an increasingly difficult market or gradually lose their books of business to more qualified and pro-active agencies. We have already seen the commissions paid by health insurance carriers fall and are very aware that the same insurance companies will soon create on-line “pick-your-own” health plans for individuals which require very little help from a professional. Small employers will also have access to S.H.O.P. exchanges (Small-business Health Option Programs) and may decide that the additional fees to hire a licensed agent seem unnecessary or unaffordable. The most significant challenge that agents face will be maintaining large employers (over 50 full time equivalent employees) as clients because those organizations will be evaluating the cost per service provider ever more closely. Owners and executives of 50-plus employee groups need to embrace the idea of a 3 year plan regarding the
‘‘“The most significant challenge that agents face will be maintaining large employers (over 50 full time equivalent employees) as clients because those organizations will be evaluating the cost per service provider ever more closely.”
management of their benefits package and must now take a very subjective look at what their current agent is suggesting. As any trusted advisor should, a benefits broker will need to present a complete understanding of how reform will impact each client’s unique business, as well as a specific strategy for achieving long term goals. The January 1st, 2014 deadline for implementation of health care reform is approaching quickly and the concept of picking major medical plans from a spreadsheet once a year is now an invalid solution. So what does all this mean to insurance agencies and the broker community? First of all, we must make our clients aware of the reality of the new legislation. The reality for some businesses is that they are not even subject to the mandate, or that they already provide adequate and affordable coverage by the new governmental standards. These groups will only need guidance on how to gradually adapt to the requirements in the coming years and advise on how to “future-proof ” their compliant status. Other groups who are not offering any health coverage or have non-compliant plans will need to hear the honest truth and prepare to make a significant change to the way they operate. As agents, we must also be ready to offer businesses help in establishing wellness plans that result in lower utilization of, and dependence on, health insurance as a means of health care. After all, health care and medical insurance are two separate and different components of “reform”. Health care is effectively maintaining one’s physical wellbeing which includes doctor’s visits, prescriptions and major medical care for chronic disease, terminal illness and accidents. Health insurance on the other hand, is a viable way to cover the financial costs associated with that care. Employees and employers must be aware of the difference in the two and, at the same time, the direct correlation of both components. That means that
significant investments must be made to educate employees, measure and track improvements in employees’ health, and help those with chronic diseases, weight management and unhealthy lifestyle issues. Ultimately, agents must be poised to handle these tasks for their clients and in turn use the results to actively fine tune their insurance purchases to be as cost effective as possible. Agents who intend to remain in the health insurance and group benefits business will have to work harder, learn more, and re-invest a larger portion of their earnings in value added services in order to remain useful advisors for their clients. The complex role of compliance auditor, human resources support, wellness coordinator, and contract negotiator that agents play, has now become more complicated and is more crucial than ever. Business owners will have to rely more and more on their broker’s advice in the coming years and the consequences of poor recommendations could be financially catastrophic.
44 | DECEMBER 2012
Consumer Tips to Navigate New ‘Summary of Benefits
and Coverage’ Forms
features
5
MEDMONTHLY.COM |45
Consumer Tips to Navigate New ‘Summary of Benefits
and Coverage’ Forms
H ealth insurance companies are required to make copies of the new Summary of Benefits and Coverage forms available to consumers for each health insurance plan they sell beginning September 23, 2012. The intent of the new forms is to provide consumers with a standardized,
easy-to-understand description of how benefits and costs are balanced by each health insurance plan, and to help consumers make informed purchasing and enrollment decisions. “Translating health insurance terminology into language the average person can understand helps consumers make the right coverage decisions for their personal needs.” said Gary Matalucci, eHealthInsurance, Vice President of Customer Care. The new Summary of Benefits and Coverage forms answer basic consumer questions (like “What is the overall deductible?” or “Does this plan use a network of providers?”) and explain why answers to these questions matter. They describe “common medical events” (such as visiting a doctor’s office, needing prescription drugs, or staying overnight in the hospital) and explain how much a patient may be required to pay for these services. The forms also provide a list of medical services excluded from coverage, and an estimate of the total patient responsibility for medical bills incurred in case of pregnancy and delivery, or for the management of Type 2 diabetes. The final template for the Summary of Benefits and Coverage forms produced by the U.S. Department of Health and Human Services is six pages long and it’s recommended that health insurance consumers review the whole form before making a final plan selection. The highlights and tips provided below were selected to provide a summary guide to items of special consumer concern.
Top Five Things to Look for on the New Summary of Benefits and Coverage Forms:
1. The Maximum Out-of-pocket Limit. What would happen if you became seriously ill or suffered an accident and suddenly found yourself facing serious hospital bills? The maximum out-of-pocket limit (MOOP) describes the upper limit of your personal financial exposure per year under a particular plan. Once you reach your maximum out-of-pocket limit, the health insurance company picks up all bills for most covered, medically necessary expenses. A typical MOOP ranges between $5,000 and $7,500. Be sure that, if the worst happened, you could afford your MOOP. Note that the maximum out-of-pocket limit does not include your monthly premiums. To find a plan’s MOOP on the new Summary of Benefits and Coverage form, look under “Important Questions” and find the question: “Is there an out-of-pocket limit on my expenses?”
2. The Deductible. The deductible is an amount you must pay out-of-pocket each year for specified medical services before the health insurance company steps in to provide coverage. Monthly premiums and copayments do not apply toward the deductible. Not all medical care is subject to the deductible, however. Many preventive care services, for example, are covered by most plans even before you meet your deductible. Some health insurance plans may also have more than one deductible. For example, some may have separate deductibles for in-network and out-of-network physicians. Others may have a separate deductible for prescription drugs. The new Summary of Benefits and Coverage form addresses deductibles in the “Important Questions” section.
eHealthInsurance, America’s first and largest private health insurance exchange, released its top five tips to help consumers navigate the new “Summary of Benefits and Coverage” (SBC) forms in accordance with provisions of the 2010 Affordable Care Act (ACA). Many consumers will come into contact with these new forms for the first time as they review and compare health insurance plans during this year’s open enrollment season.
continued on page 46
46| DECEMBER 2012
3. The Cost of a Doctor’s Office Visit When Ill. Since many people only see the doctor when sick, it’s important to understand your level of coverage for these visits. When reviewing the new Summary of Benefits and Coverage form, you will find this addressed in the section describing coverage for common medical events. Make sure you understand what your copayment is when visiting an in-network or out-of-network physician, and whether your doctor’s office visit is subject to your annual deductible.
4. The Network of Providers. Many health insurance plans – especially HMOs and PPOs – contract with medical provider networks to negotiate discounted charges for patient care. It’s important to know if the plan you’re considering restricts your access to doctors, and whether or not your preferred doctor is covered by the plan. Under the “Important Questions” section of the new Summary of Benefits and Coverage form, you’ll find information about provider networks and covered doctors. If there are differences in coverage between in-network and out-of-network providers, these differences should be described in the “Common Medical Events” section of the form.
5. Coverage for Prescription Drugs. In order to pick up a prescription drug from the pharmacy, most health insurance plan members are required to make a copayment or pay a percentage of the drug’s total cost. Some health insurance plans may have a separate deductible for prescription drugs. Many, however, have different coverage tiers for different kinds of drugs. Make sure you understand how much you’ll be required to pay for generic drugs, preferred brand-name drugs, and other drugs, before you enroll in a plan. Information about prescription drug coverage is found in the new Summary of Benefits and Coverage forms in the section describing common medical events.
There is a great deal of complexity to health insurance coverage and many consumers will not readily understand how to judge between two different plans. It’s recommended that consumers considering their health insurance alternatives work with their employer’s Human Resources department or contact a licensed health insurance agent, like eHealthInsurance.com, for personal assistance and advice. Reprinted courtesy of eHealthInsurance http://news.ehealthinsurance.com/pr/ehi/health-insurance-open-enrollment-238927.aspx
continued from page 45
Scan this QR code with your smartphone to learn more.
It’s Time to Get Online!Showcase your practice and
develop the right image.
Our website package is custom designed and affordable.
Increase your patient volume and profitability with a website from MedMedia9.Visit us today at medmedia9.com to find out how we can make your practice grow. Click on the “Web Design” tab for more details and view the sample website. Call MedMedia9 today at 919-747-9031.
MedMedia9medmedia9.com
48 |DECEMBER 2012
TIPS FOR DOCTORS WHO
NEGOTIATE REIMBURSEMENT
RATES WITH INSURANCE
COMPANIES
by Ed Rabinowitz
features
When it comes to negotiating fees with health plans, practices and physicians have more leverage than they realize. The problem, says John Schmitt, a managed care expert with EthosPartners Healthcare Management Group, is that practices often don’t even try. “Groups negotiate an agreement with a payer and then, for whatever reason, just file it away. Most medical groups do not have a good, proactive methodology for negotiating for physician reimbursement,” Schmitt says. Schmitt says the adversarial fee negotiating environment that has existed between physicians and health plans is changing to a more cooperative partnership between payers and providers. As an example, Schmitt points to a Michigan-based orthopedic group whose contracts he helped renegotiate. He contacted the medical director of the group’s largest payer and indicated the group wanted to renegotiate its contract and fee schedule, and suggested talking about
a pay-for-performance arrangement. Not only was the medical director receptive, he arranged to meet with members of the orthopedic group to further discuss the arrangement. “What used to be a poker game is now transparent,” Schmitt says. “The realization is, we all have an economic problem with respect to medical costs. But the doctors have the clinical solutions to those economic problems. Health plans are saying, ‘Let’s see if we can’t be better business partners not only for our sake, but for the sake of the patients and the community as well.’ It’s a new era of managed care, which is really what it should have been when it kicked off twenty years ago.”
Using leverage Taylor Moorehead, a partner with Zotec Partners, a leading medical billing company, suggests there are several ways physicians can begin renegotiating fees with health plans. If a physician is hospital-based, he or she has a little more leverage. For example, the physician is performing services at a hospital and being paid the health plans’ usual, customary rates for that location. The physician asks for an increase, and the health plan says no, so the physician cancels his or her contract and begins working non-contracted with the plan, knowing that the plan’s patients are going to come to the hospital regardless of whether he’s contracted with the payor or not. But now, the physician begins billing the patient for 100 percent of their fee schedule. The health plan will pay what it believes is appropriate, and the balance is owed by the patient. “Now, the patient becomes the physician’s advocate,” Moorehead says. “The patient is subject to paying a lot more money out of pocket, which is upsetting. They complain to the hospital, the hospital complains to the doctor, and the doctor complains to the carrier. Ultimately, it ends up in the lap of the carrier. So, if you can go non-contracted for a period of time,
applying the pressure to the payer, the payer will bend and give you a better rate.”
Building the business case Negotiating is a bit more difficult for office-based physicians, who rely on the carrier to direct its members to the physician’s practice. In those circumstances, where there isn’t as much leverage, building a business case is critical. That means shifting your strategy from reactive to proactive. “If you sit around and wait, you’re never going to get increases,” says John Haresch, MD, who runs One Family Doctor, a micropractice based in Kill Devil Hills, NC. “I’ve had some success at it, but not enough to make it easy.” Haresch begins by sending a letter to the carrier outlining his case. He points out that costs are going up while the carrier’s reimbursement level is not. More importantly, he supplies data in support of the way he runs his practice— one physician who spends more time with his patients. He tells the carrier, “If you want full, patient-centered, medical home stuff that’s being proven out in studies, here’s the level of payment I need. Now, tell me what level of service you’re prepared to pay for.” It’s challenging, says Haresch, and sometimes frustrating. What keeps him going? “There’s the underlying, altruistic part that if we can keep the reimbursement going, keep the practice going, and keep finding ways to improve the quality of care, it’s good for people—and that’s why I originally got into all of this. It’s just the right thing to do.”
Ed Rabinowitz is a healthcare writer and reporter.
Source: http://www.kevinmd.com/blog/2010/01/tips-doctors-negotiate-reimbursement-rates-insurance-companies.html
kevinmd.com
“Health plans are saying, ‘Let’s see if we can’t be better business partners not only for our sake, but for the sake of the patients and the community as well.’ It’s a new era of managed care, which is really what it should have been when it kicked off twenty years ago.”
‘‘
MEDMONTHLY.COM | 49
T he Affordable Care Act makes investments to help raise the quality of care, while giving Americans – and their health
care providers – more control over their health care. It puts patients’ relationships with their doctors and nurses ahead of insurance company profits and paperwork, and gives health care providers incentives to better coordinate care. The Affordable Care Act also ensures that millions of Americans will have access to afford-able insurance – giving them access to the quality care you deliver.
What Does the Affordable Care Act Mean for Doctors, Nurses, and Other Health Care Providers? For health care providers, health reform is designed to make our health care system stronger and make it work better for you and your patients:
• Expanded coverage and consumer protections will offer security. As health care
providers, you experience the impact of uninsured patients and uncompensated care first-hand. Under the Affordable Care Act, more than 32 million uninsured Americans will have increased access to affordable, quality health coverage options, such as those through the new Health Insurance Exchanges, which will provide essential benefits and impose limits on cost sharing. With better access to health coverage, fewer Americans will need to delay or avoid seeking the care they need because they can’t afford it. This will lower the burden of uncompensated care on physicians, hospitals, and the rest of the system.
• Reduced paperwork and administrative simplification will bring down the cost of care. New rules will simplify paperwork and lessen administrative hassle to allow you to focus on caring for your patients instead of dealing with insurance company bureaucracy. This comes alongside investments in electronic health record adoption that will bring
doctors’ offices and hospitals into the 21st century.
• Tough new consumer protections will hold health insurers more accountable for treating patients and providers fairly. By eliminating many of the worst insurance industry practices, the Act will free you and your patients to focus on what really counts – taking care of the illnesses and injuries that affect them. Insurers won’t be able to cancel coverage because a patient made an unintentional mistake on his or her application for coverage. They won’t be able to set annual or lifetime limits on benefits that leave patients without coverage when they need it most. And they won’t be able to exclude millions of Americans from coverage because of a pre-existing medical condition. Patients will have new rights to choose their primary care professionals – including pediatricians – and to file appeals when insurers deny claims. Finally, insurers will be required to spend a minimum amount of premium dollars on
features
50 |DECEMBER 2012
Reprinted from HealthCare.gov
patient care, reducing their ability to make excessive profits and pay unreasonably high salaries.
• Medicare will be stronger and offer new benefits. The Act preserves the guaranteed benefits under Medicare, makes recommended preventive services available with no cost-sharing, and provides an annual wellness visit. It closes the Medicare Part D prescription drug program “donut hole” over time, beginning with a $250 rebate to seniors who reach that limit in 2010. By lowering cost-sharing, the Act empowers providers, who will have to worry less about patients being unable to afford needed treatments.
• New investments in prevention and public health will support your efforts to help patients live healthier lives. In addition to expanded access to preventive services, the Affordable Care Act will give states and local communities new resources to address the nation’s mounting health problems, such as the increase in chronic diseases, or in conditions linked to obesity. This will strengthen provider efforts to help patients make healthy choices like losing weight or quitting smoking.
• Health care providers will help drive improvements to health care delivery. New models of patient-centered, coordinated care will give you and your patients more control over how care is delivered. Investments in medical homes and other advanced care coordination and disease management models will help you ensure that your patients receive seamless, efficient care. Providers who provide high-quality services will be rewarded based on standards that they help develop, based on solid medical evidence. And Medicare will pay bonuses to qualified primary care doctors and general surgeons, particularly
those who practice in underserved areas.
Of course, none of these changes can happen without highly trained and dedicated health care professionals – and independent experts are already projecting that, unless we take action, we will see a shortfall in primary care providers. For that reason, the Affordable Care Act will make an unprecedented investment in workforce development:
• Strengthening and growing our health care workforce. Combined with the earlier investments made by the American Recovery and Reinvestment Act of 2009, the provisions of the Affordable Care Act will support the training and development of more than 16,000 new primary care providers over the next five years.
• Investing in community health centers and new clinical settings. In addition to new resources to build new and expand existing community health centers, the Affordable Care Act will establish new nurse-managed health clinics to train nurse practitioners and operate in underserved communities.
• Loan forgiveness and scholarships. The National Health Service Corps will be expanded in order to repay student loans and provide scholarships for even more primary care physicians, physician assistants and nurse practitioners willing to work in underserved areas.
Talking to Your Patients About Health Reform
When patients have questions about their care or coverage, they often turn to one of their most trusted sources: the men and women who care for them when they are sick or injured. Your patients are likely to have a lot of
questions about how health reform will affect them. Here are a few key things about the new law to remind patients about:
• Greater insurance security for families. The Affordable Care Act will help to ensure that patients will have choices among quality, affordable health coverage options, even when they lose their job, switch jobs, move or get sick. In fact, through the creation of Health Insurance Exchanges, millions of Americans will have the same choice of health plans as their member of Congress.
• Protecting patients when they get sick. For policies issued or renewed on or after September 23, 2010, insurance companies are now prohibited from dropping patients from coverage when they get sick just because of an unintentional mistake on a form, and can no longer be able to deny coverage to children based on pre-existing conditions. The new law also eliminates lifetime coverage limits and, by 2014, will phase out annual limits that adversely affect the sickest patients with the highest costs.
• Preventive care leads to better health. For plan years beginning on or after September 23, 2010, the law now requires health plans and health insurance policies to cover certain recommended preventive services at no charge to patients. And Medicare patients are now eligible for an annual wellness exam and certain preventive services with no cost-sharing.
You can download consumer-friendly brochures and posters to share important benefits of the law with your patients.
http://www.healthcare.gov/news/factsheets/2010/07/health-care-providers.html
MEDMONTHLY.COM | 51
the arts
52| DECEMBER 2012
A few years ago I became incoherent, unable to string a sentence together. The villain in this drama turned
out to be paint. Oil paints are my preferred medium, but after a winter of painting inside and using oil paints exclusively, I encountered a terrifying condition. A fellow artist noticed my inability to communicate fluently and suspected what was probably causing my aphasia, as she had had the same experience. She suggested a naturo-pathic practitioner who ultimately prescribed mega-doses of vitamin C, Lipotropic Complex, and a suspen-sion of painting with oils for a while. Within months I was back to myself. Nowadays when the weather turns cold, I paint primarily with acrylics or mineral coating. In creating a mural in public, particularly when children are involved, I have always used less toxic paints. It was a great relief that my friend recognized my need for help. In my state of mind I had no idea where to turn or the strength to figure anything out. I was in my mid-forties when this occurred and it was frightening to think I perhaps had an early onset of
Alzheimer’s, or perhaps a stroke? One might wonder why hadn’t anyone else noticed something was wrong with me? Well, I had kept this fearful state to myself as it had been progressing into a vague depression that didn’t lend itself to being with people. Also, remarkably, my clients were still getting their commissioned artwork in a timely manner. Since age three I’ve been drawing, so even when not in top form, as a creature of long-realized habit, I’m either in the studio working on a series or out in the field on a mural site. Certainly there are days when what I produce astounds and other days that are less inspired. What likely added to my condition prior to diagnosis and cure is that the new home I’d design-built was being freshly painted that winter. Standard latex paint emits gasses for weeks after being applied; with windows closed the curing paint could certainly have contributed to making the air toxic. Presently on the market, water-based paints are made with considerably less VOC’s (volatile organic compounds), and many of the higher end brands report zero VOC’s. Having used the new “healthy” paint, I strongly
recommend it over the old standard as well as to have all windows open, for maximum ventilation when applying paint and during the drying and curing process. For the past 35 years of painting public murals, I’ve used acrylics exclusively. No oils as the fumes become an issue when working inside and too dangerous when working with children. Most recently I completed a 10 x 64 foot mural using mineral coating imported from Europe, known for never fading, peeling or outgassing, but, oh my, is it hard to paint with! Mineral coating has the consistency of ground-up chalk mixed with water. Using it won’t kill you, but it will surely try one’s patience because the colors change as they dry. However, the end results are beautiful, and happily, after many months of painting the 50th Anniversary Mural for Durham Tech, pictured above, I experienced no fallout. To view a video about this mural, please follow this link: http://www.youtube.com/watch?v=2emnjs3cdx4 The safest way to use oils is of course, painting outside, en plein aire, communing with nature, landscape
By Emily WeinsteinFeatured Artist
Above: Durham Tech 50th Anniversary Mural 10’ x 64’ Mineral coating on cement panels
When Paint is Dangerous
MEDMONTHLY.COM |53
painting. In tribute to the pursuit of healthy practices, I teach my students to use vegetable oil to clean brushes, then wipe on old phone books, dip in Murphy Oil soap, rinse off before reshaping. I can’t imagine a time when I won’t be painting, but after marrying at the young age of 54, wondering where my life had gone, I began my limited-edition 25-year Handmade Book Series. Each year I design a 6 x 6 inch structure encapsulating my year in art along with its most notable events, and then make no more than 75 signed and numbered copies. The first year focuses on all my art leading up to the wedding while the 2nd volume describes my actual creation of a mural from A to Z. My most recent project, the 3rd year, is a triptych with images of 60 works of art ranging from 3 x 3 inches to 3 x 3 feet. I will be 80 years old when this series is complete, and so far, since I’m determined that making my book series won’t poison me, I just might make my goal.
Visit Emily Eve Weinstein’s website at Weinsteinart.com. Her most current painting series have not been posted yet, but her four art gift books are listed along with many landscapes and moon paintings. Please feel free to phone her with any questions or suggestions at 919-402-0160.
Above: Rails to Trails 14” x 6” Oil on wood - From Weinstein’s book, Saving Magic Places, published by Beaux Soleil Publishers which features many of her landscapes.
Above: Two Moon Pond 10” x 10” Oil on wood - To date Weinstein has painted over 300 moon
paintings of which 72 are featured in Moon Book, published by Discovery Press. Sizes range from 6 inches to 8 feet.
At Left: Daffadill 32” x 16” Wood, latex, acrylic, UV protectant, primer on roofing felt - show cased in Volume III of the 25-year Handmade Book Series
By Ashley Acornley MS, RD, LDN
54 | DECEMBER 2012
healthy living
When people think of holiday desserts, they often think of a plethora of homemade cakes, traditional cookies, and delec-table pies. Although all of these desserts are truly delicious, they can pack quite a large calorie punch in our diets. The average American consumes an excess of 3,000 calories on Thanksgiv-ing and Christmas, and gains a total of 10 pounds each year throughout the holiday season. Instead of providing plenty of sugar and fat laden goodies at the dinner table, why not try a fruit-based dessert? This recipe for honey-roasted pears is a baked dish that infuses flavors of honey, balsamic vinegar, and pepper. If desired, the baked fruit can be served warm with a scoop of vanilla ice cream and sauce drizzled on top. This dessert is a perfect option for doctors to suggest to their pa-tients who struggle with obesity, diabetes, high cholesterol, or hypertension. Try this delicious recipe for under 200 calories this holiday season!
FestiveHoney Roasted
Baked Pears
Ingredients 2 tablespoons unsalted butter, melted5 firm-ripe pears, halved lengthwise (leave stems intact), and cored3 tablespoons balsamic vinegar2/3 cup honeyFreshly ground black pepper (as needed)2 1/2 cups low-fat or slow-churned ice cream
Directions1. Preheat oven to 400°. Pour butter into a large baking pan. Tilt pan to coat with the butter. Arrange pears in one layer, cut sides down. Roast 20-25 minutes or until tender when pierced with a knife.2. Combine vinegar and honey. Spoon mixture over pears, and bake 5 minutes more. Arrange pear halves on each of 10 dessert plates. Spoon pan juices over top, add pepper and 1/4 cup ice cream; serve.
Nutritional Facts:Calories: 198Fat: 3gSaturated fat: 2gMonounsaturated fat: 1gPolyunsaturated fat: 0gProtein: 2gCarbohydrates: 42gFiber: 3gCholesterol: 9mgIron: 0mgSodium: 26mgCalcium: 61mg
Prep Time: 10 minutesCook Time: 25 minutesYield: 10 servings (serving size is equivalent to 1/2 pear with 1/4 cup ice cream and 1/8 cup sauce)
MEDMONTHLY.COM |55
U.S. OPTICAL BOARDSAlaskaP.O. Box 110806Juneau, AK 99811(907)465-5470http://www.dced.state.ak.us/occ/pdop.htm
Arizona1400 W. Washington, Rm. 230Phoenix, AZ 85007(602)542-3095http://www.do.az.gov
ArkansasP.O. Box 627Helena, AR 72342(870)572-2847
California2005 Evergreen St., Ste. 1200Sacramento, CA 95815(916)263-2382www.medbd.ca.gov
Colorado1560 Broadway St. #1310Denver, CO 80202(303)894-7750http://www.dora.state.co.us/optometry/
Connecticut410 Capitol Ave., MS #12APPP.O. Box 340308Hartford, CT 06134(860)509-7603 ext. 4http://www.dph.state.ct.us/
Florida4052 Bald Cypress Way, Bin C08Tallahassee, FL 32399(850)245-4474doh.state.fl.us
Georgia237 Coliseum Dr.Macon, GA 31217(478)207-1671www.sos.state.ga.us
HawaiiP.O. Box 3469Honolulu, HI 96801(808)[email protected]
Idaho450 W. State St., 10th FloorBoise , ID 83720(208)334-5500 www2.state.id.us/dhw
KentuckyP.O. Box 1360Frankfurt, KY 40602(502)564-3296http://bod.ky.gov
Massachusetts239 Causeway St.Boston, MA 02114(617)727-5339http://1.usa.gov/zbJVt7
NevadaP.O. Box 70503Reno, NV 89570(775)853-1421http://nvbdo.state.nv.us/
New Hampshire129 Pleasant St.Concord, NH 03301(603)271-5590www.state.nh.us
New JerseyP.O. Box 45011Newark, NJ 07101(973)504-6435http://www.njconsumeraffairs.gov/ophth/
New York89 Washington Ave., 2nd Floor W.Albany, NY 12234(518)402-5944http://www.op.nysed.gov/prof/od/
North CarolinaP.O. Box 25336Raleigh, NC 27611(919)733-9321http://www.ncoptometry.org/
Ohio77 S. High St.Columbus, OH 43266(614)466-9707http://optical.ohio.gov/
Oregon3218 Pringle Rd. SE Ste. 270Salem, OR 97302(503)373-7721 www.obo.state.or.us
Rhode Island3 Capitol Hill, Rm 104Providence, RI 02908(401)222-7883http://sos.ri.gov/govdirectory/index.php? page=DetailDeptAgency&eid=260
South CarolinaP.O. Box 11329Columbia, SC 29211(803)896-4665www.llr.state.sc.us
TennesseeHeritage Place Metro Center227 French Landing, Ste. 300Nashville, TN 37243(615)253-6061http://health.state.tn.us/boards/do/
TexasP.O. Box 149347Austin, TX 78714(512)834-6661www.roatx.org
Vermont National Life Bldg N FL. 2 Montpelier, VT 05620(802)828-2191http://vtprofessionals.org/opr1/opticians/
Virginia3600 W. Broad St.Richmond, VA 23230(804)367-8500www.state.va.us/licenses
Washington300 SE Quince P.O. Box 47870Olympia, WA 98504(360)236-4947http://www.doh.wa.gov/LicensesPermit-sand Certificates/ProfessionsNewRene-worUpdate/DispensingOptician.aspx
U.S. DENTAL BOARDSAlabamaAlabama Board of Dental Examiners 5346 Stadium Trace Pkwy., Ste. 112 Hoover, AL 35244(205) 985-7267http://www.dentalboard.org/
AlaskaP.O. Box 110806Juneau, AK 99811-0806(907)465-2542http://bit.ly/uaqEO8
Arizona4205 N. 7th Ave. Suite 300Phoenix, AZ 85103(602)242-1492http://azdentalboard.us/ Arkansas101 E. Capitol Ave., Suite 111Little Rock, AR 72201(501)682-2085http://www.asbde.org/
California2005 Evergreen Street, Suite 1550 Sacramento, CA 95815877-729-7789http://www.dbc.ca.gov/
Colorado1560 Broadway, Suite 1350Denver, CO 80202(303)894-7800http://www.dora.state.co.us/dental/
Connecticut410 Capitol Ave. Hartford, CT 06134(860)509-8000http://www.ct.gov/dph/site/default.asp
DelawareCannon Building, Suite 203861 Solver Lake Blvd.Dover, DE 19904(302)744-4500http://1.usa.gov/t0mbWZ
Florida4052 Bald Cypress WayBin C-08Tallahassee, FL 32399 (850)245-4474http://bit.ly/w1m4MI
Georgia237 Coliseum DriveMacon, GA 31217(478)207-2440http://sos.georgia.gov/plb/dentistry/
HawaiiDCCA-PVLAtt: DentalP.O. Box 3469Honolulu, HI 96801(808)586-3000http://1.usa.gov/s5Ry9i
IdahoP.O. Box 83720Boise, ID 83720(208)334-2369http://isbd.idaho.gov/
Illinois320 W. Washington St.Springfield, IL 62786(217)785-0820http://bit.ly/svi6Od
Indiana402 W. Washington St., Room W072Indianapolis, IN 46204(317)232-2980http://www.in.gov/pla/dental.htm
Iowa400 SW 8th St. Suite DDes Moines, IA 50309(515)281-5157http://www.state.ia.us/dentalboard/
Kansas900 SW Jackson Room 564-STopeka, KS 66612(785)296-6400http://www.accesskansas.org/kdb/
Kentucky312 Whittington Parkway, Suite 101Louisville, KY 40222(502)429-7280http://dentistry.ky.gov/
Louisiana365 Canal St., Suite 2680New Orleans, LA 70130(504)568-8574http://www.lsbd.org/
Maine143 State House Station161 Capitol St.Augusta, ME 04333(207)287-3333http://www.mainedental.org/
Maryland55 Wade Ave.Catonsville, Maryland 21228(410)402-8500http://dhmh.state.md.us/dental/
Massachusetts1000 Washington St., Suite 710Boston, MA 02118(617)727-1944http://www.mass.gov/eohhs/provider/ licensing/occupational/dentist/
MichiganP.O. Box 30664Lansing, MI 48909(517)241-2650http://www.michigan.gov/lara/0,4601,7-154-35299_28150_27529_27533---,00.html
Minnesota2829 University Ave., SE. Suite 450Minneapolis, MN 55414(612)617-2250http://www.dentalboard.state.mn.us/
Mississippi600 E. Amite St., Suite 100Jackson, MS 39201(601)944-9622http://bit.ly/uuXKxl
Missouri3605 Missouri Blvd.P.O. Box 1367Jefferson City, MO 65102(573)751-0040http://pr.mo.gov/dental.asp
MontanaP.O. Box 200113Helena, MT 59620(406)444-2511http://bsd.dli.mt.gov/license/bsd_boards/den_board/board_page.asp
56 | DECEMBER 2012
OhioRiffe Center77 S. High St.,17th FloorColumbus, OH 43215(614)466-2580http://www.dental.ohio.gov/
Oklahoma201 N.E. 38th Terr., #2Oklahoma City, OK 73105(405)524-9037http://www.dentist.state.ok.us/
Oregon1600 SW 4th Ave. Suite 770Portland, OR 97201(971)673-3200http://www.oregon.gov/Dentistry/
PennsylvaniaP.O. Box 2649Harrisburg, PA 17105(717)783-7162http://bit.ly/s5oYiS
Rhode IslandDept. of HealthThree Capitol Hill, Room 104Providence, RI 02908(401)222-2828http://1.usa.gov/u66MaB
South CarolinaP.O. Box 11329Columbia, SC 29211(803)896-4599http://www.llr.state.sc.us/POL/Dentistry/ South DakotaP.O. Box 1079105. S. Euclid Ave. Suite CPierre, SC 57501(605)224-1282https://www.sdboardofdentistry.com/
Tennessee 227 French Landing, Suite 300Nashville, TN 37243(615)532-3202http://health.state.tn.us/boards/dentistry/
Texas333 Guadeloupe St. Suite 3-800Austin, TX 78701(512)463-6400http://www.tsbde.state.tx.us/
Utah160 E. 300 SouthSalt Lake City, UT 84111(801)530-6628http://1.usa.gov/xMVXWm
VermontNational Life BuildingNorth FL2Montpelier, VT 05620(802)828-1505http://bit.ly/zSHgpa
VirginiaPerimeter Center9960 Maryland Dr., Suite 300Henrico, VA 23233(804)367-4538http://www.dhp.virginia.gov/dentistry
Washington310 Israel Rd. SEP.O. Box 47865Olympia, WA 98504(360)236-4700http://www.doh.wa.gov/LicensesPermit-sandCertificates/ProfessionsNewRene-worUpdate/Dentist.aspx West Virginia1319 Robert C. Byrd Dr.P.O. Box 1447Crab Orchard, WV 258271-877-914-8266http://www.wvdentalboard.org/
WisconsinP.O. Box 8935Madison, WI 537081(877)617-1565http://bit.ly/sEhr0Q Wyoming1800 Carey Ave., 4th FloorCheyenne, WY 82002(307)777-6529http://plboards.state.wy.us/dental/index.asp
MEDMONTHLY.COM |57
Nebraska301 Centennial Mall SouthLincoln, NE 68509(402)471-3121http://dhhs.ne.gov/publichealth/Pages/crl_medical_dent_hygiene_board.aspx
Nevada6010 S. Rainbow Blvd. Suite A-1Las Vegas, NV 89118(702)486-7044http://www.nvdentalboard.nv.gov/
New Hampshire2 Industrial Park Dr. Concord, NH 03301(603)271-4561http://www.nh.gov/dental/
New JerseyP.O Box 45005Newark, NJ 07101(973)504-6405http://bit.ly/uO2tLg New MexicoToney Anaya Building2550 Cerrillos Rd.Santa Fe, NM 87505(505)476-4680http://www.rld.state.nm.us/boards/dental_health_care.aspx
New York89 Washington Ave.Albany, NY 12234(518)474-3817http://www.op.nysed.gov/prof/dent/
North Carolina507 Airport Blvd., Suite 105Morrisville, NC 27560(919)678-8223http://www.ncdentalboard.org/
North DakotaP.O. Box 7246Bismark, ND 58507(701)258-8600http://www.nddentalboard.org/
AlabamaP.O. Box 946 Montgomery, AL 36101 (334)242-4116http://www.albme.org/
Alaska550 West 7th Ave., Suite 1500Anchorage, AK 99501(907)269-8163http://bit.ly/zZ455T
Arizona9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258(480)551-2700http://www.azmd.gov
Arkansas1401 West Capitol Ave., Suite 340Little Rock, AR 72201(501)296-1802http://www.armedicalboard.org/
California2005 Evergreen St., Suite 1200Sacramento, CA 95815(916)263-2382 http://www.mbc.ca.gov/
Colorado1560 Broadway, Suite 1350Denver, CO 80202(303)894-7690http://www.dora.state.co.us/medical/
Connecticut401 Capitol Ave. Hartford, CT 06134(860)509-8000http://www.ct.gov/dph/site/default.asp
DelawareDivision of Professional Regulation Cannon Building 861 Silver Lake Blvd., Suite 203 Dover, DE 19904(302)744-4500http://dpr.delaware.gov/
District of Columbia899 North Capitol St., NE Washington, DC 20002 (202)442-5955http://www.dchealth.dc.gov/doh
Florida2585 Merchants Row Blvd.Tallahassee, FL 32399(850)245-4444http://www.stateofflorida.com/Portal/DesktopDefault.aspx?tabid=115
Georgia2 Peachtree Street NW, 36th Floor Atlanta, GA 30303 (404)656-3913http://bit.ly/vPJQyG
HawaiiDCCA-PVL P.O. Box 3469 Honolulu, HI 96801(808)587-3295http://hawaii.gov/dcca/pvl/boards/medical/
IdahoIdaho Board of Medicine P.O. Box 83720 Boise, Idaho 83720(208)327-7000http://bit.ly/orPmFU
Illinois 320 West Washington St. Springfield, IL 62786(217)785 -0820http://www.idfpr.com/profs/info/Physicians.asp
Indiana402 W. Washington St. #W072Indianapolis, IN 46204(317)233-0800http://www.in.gov/pla/
Iowa400 SW 8th St., Suite C Des Moines, IA 50309(515)281-6641http://medicalboard.iowa.gov/
Kansas800 SW Jackson, Lower Level, Suite ATopeka, KS 66612(785)296-7413http://www.ksbha.org/
Kentucky310 Whittington Pkwy., Suite 1B Louisville, KY 40222(502)429-7150http://kbml.ky.gov/default.htm
LouisianaLSBMEP.O. Box 30250New Orleans, LA 70190(504)568-6820http://www.lsbme.la.gov/
Maine161 Capitol Street 137 State House Station Augusta, ME 04333 (207)287-3601http://bit.ly/hnrzp
Maryland4201 Patterson Ave.Baltimore, MD 21215(410)764-4777http://www.mbp.state.md.us/
Massachusetts200 Harvard Mill Sq., Suite 330 Wakefield, MA 01880 (781)876-8200http://www.mass.gov/eohhs/gov/departments/borim/
MichiganBureau of Health Professions P.O. Box 30670 Lansing, MI 48909(517)335-0918http://www.michigan.gov/lara/0,4601,7-154-35299_28150_27529_27541-58914--,00.html
MinnesotaUniversity Park Plaza 2829 University Ave. SE, Suite 500 Minneapolis, MN 55414 (612)617-2130 http://bit.ly/pAFXGq
Mississippi1867 Crane Ridge Drive, Suite 200-B Jackson, MS 39216(601)987-3079http://www.msbml.state.ms.us/
MissouriMissouri Division of Professional Registration 3605 Missouri Blvd. P.O. Box 1335 Jefferson City, MO 65102 (573)751-0293 http://pr.mo.gov/healingarts.asp
U.S. MEDICAL BOARDS
58 | DECEMBER 2012
Montana301 S. Park Ave. #430Helena, MT 59601(406)841-2300http://bit.ly/obJm7J p
NebraskaNebraska Department of Health and Human ServicesP.O. Box 95026Lincoln, NE 68509(402)471-3121http://www.mdpreferredservices.com/state-licensing-boards/nebraska-board-of-medicine-and-surgery
NevadaBoard of Medical ExaminersP.O. Box 7238Reno, NV 89510 (775)688-2559 http://www.medboard.nv.gov/
New HampshireNew Hampshire State Board of Medicine 2 Industrial Park Dr. #8 Concord, NH 03301 (603)271-1203http://www.nh.gov/medicine/
New JerseyP. O. Box 360Trenton, NJ 08625 (609)292-7837http://bit.ly/w5rc8J
New Mexico2055 S. Pacheco St. Building 400 Santa Fe, NM 87505 (505)476-7220http://www.nmmb.state.nm.us/
New YorkOffice of the ProfessionsState Education Building, 2nd FloorAlbany, NY 12234(518)474-3817http://www.op.nysed.gov/
North CarolinaP.O. Box 20007Raleigh, NC 27619(919)326-1100http://www.ncmedboard.org/
North Dakota418 E. Broadway Ave., Suite 12Bismarck, ND 58501(701)328-6500http://www.ndbomex.com/
Ohio30 E. Broad St., 3rd FloorColumbus, OH 43215(614)466-3934http://med.ohio.gov/
OklahomaP.O. Box 18256 Oklahoma City, OK 73154(405)962-1400http://www.okmedicalboard.org/
Oregon1500 SW 1st Ave., Suite 620Portland, OR 97201(971)673-2700http://www.oregon.gov/OMB/
Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)787-8503 http://www.dos.state.pa.us/portal/server.pt/community/state_board_of_medicine/12512
Rhode Island3 Capitol HillProvidence, RI 02908(401)222-5960http://1.usa.gov/xgocXV
South CarolinaP.O. Box 11289Columbia, SC 29211(803)896-4500http://www.llr.state.sc.us/pol/medical/
South Dakota101 N. Main Ave. Suite 301Sioux Falls, SD 57104(605)367-7781http://www.sdbmoe.gov/
Tennessee425 5th Ave. NorthCordell Hull Bldg. 3rd FloorNashville, TN 37243(615)741-3111http://health.state.tn.us/boards/me/
TexasP.O. Box 2018Austin, TX 78768(512)305-7010http://bit.ly/rFyCEW
UtahP.O. Box 146741 Salt Lake City, UT 84114(801)530-6628http://www.dopl.utah.gov/
VermontP.O. Box 70Burlington, VT 05402(802)657-4220http://1.usa.gov/wMdnxh
VirginiaVirginia Dept. of Health ProfessionsPerimeter Center9960 Maryland Dr., Suite 300Henrico, VA 23233(804)367-4400http://1.usa.gov/xjfJXK
WashingtonPublic Health Systems DevelopmentWashington State Department of Health101 Israel Rd. SE, MS 47890Tumwater, WA 98501(360)236-4085http://www.medlicense.com/washington-medicallicense.html
West Virginia101 Dee Dr., Suite 103Charleston, WV 25311(304)558-2921http://www.wvbom.wv.gov/
WisconsinP.O. Box 8935Madison, WI 53708(877)617-1565http://drl.wi.gov/board_detail.asp?boardid=35&locid=0
Wyoming320 W. 25th St., Suite 200Cheyenne, WY 82002(307)778-7053http://wyomedboard.state.wy.us/
MEDMONTHLY.COM |59
medical resource guide
Find Urgent CarePO Box 15130Scottsdale, AZ 85267(602)370-0303
www.findurgentcare.com
MedMedia9PO Box 98313Raleigh, NC 27624(919)747-9031
www.medmedia9.com
Ring Ring LLC6881 Maple Creek Blvd, Suite 100West Bloomfield, MI 48322-4559(248)819-6838
www.ringringllc.com
ADVERTISING
BILLING & COLLECTION
Advanced Physician Billing, LLCPO Box 730Fishers, IN 46038(866)459-4579
www.advancedphysicianbillingllc.com
60| DECEMBER 2012
ANSWERING SERVICES
Corridor Medical Answering Service3088 Route 27, Suite 7Kendall Park, NJ 08824(866)447-5154
www.corridoranswering.net
Docs on Hold14849 West 95th St. Lenexa, KS 66285(913)559-3666
www.soundproductsinc.com
CODING SPECIALISTS
The Coding Institute LLC2222 Sedwick DriveDurham, NC 27713(800)508-2582
http://www.codinginstitute.com/
CAREER CONSULTING
Doctor’s Crossing4107 Medical Parkway, Suite 104 Austin, Texas 78756 (512)517-8545
http://doctorscrossing.com/
COMPUTER, SOFTWARE
American Medical Software1180 Illinois 157Edwardsville, IL 62025(618) 692-1300
www.americanmedical.com
CDWG300 N. Milwaukee AveVernon Hills, IL 60061(866)782-4239
www.cdwg.com/
Instant Medical History4840 Forest Drive #349Columbia, SC 29206(803)796-7980
www.medicalhistory.com
SEAK Non-Clinical Careers ConferenceOct. 21-22, 2012 in Chicago, IL(508)457-1111
www.nonclinicalcareers.com
ACCOUNTING
Boyle CPA, PLLC3716 National Drive, Suite 206Raleigh, NC 27612(919) 720-4970
www.boyle-cpa.com
Ajishra Technology Support3562 Habersham at Northlake, Bldg JTucker, GA 30084(866)473-0011
www.ajishra.com
Applied Medical Services4220 NC Hwy 55, Suite 130BDurham, NC 27713(919)477-5152
www.ams-nc.com
Axiom Business Solutions4704 E. Trindle Rd.Mechanicsburg, PA 17050(866)517-0466
www.axiom-biz.com
Frost Arnett480 James Robertson ParkwayNashville, TN 37219(800)264-7156
www.frostarnett.com
Gold Key Credit, Inc.PO Box 15670Brooksville, FL 34604888-717-9615
www.goldkeycreditinc.com
Horizon Billing Specialists4635 44th St., Suite C150Kentwood, MI 49512(800)378-9991
www.horizonbilling.com
Management Services On-Call200 Timber Hill Place, Suite 221Chapel Hill, NC 27514(866)347-0001
www.msocgroup.com
Marina Medical Billing Service18000 Studebaker Road4th FloorCerritos, CA 90703(800)287-8166
www.marinabilling.com
Mediserv6451 Brentwood Stair Rd.Ft. Worth, TX 76112(800)378-4134
www.mediservltd.com
Practice Velocity1673 Belvidere RoadBelvidere, IL 61008(888)357-4209
www.practicevelocity.com
Sweans Technologies501 Silverside Rd.Wilmington, DE 19809(302)351-3690
www.medisweans.com
VIP BillingPO Box 1350Forney, TX 75126(214)499-3440
www.vipbilling.com
ELECTRONIC MED. RECORDS INSURANCE, MED. LIABILITY
medical resource guide
FINANCIAL CONSULTANTS
Sigmon Daknis Wealth Management701 Town Center Dr. , Ste. #104Newport News, VA 23606(757)223-5902
www.sigmondaknis.com
Sigmon & DaknisWilliamsburg, VA Office325 McLaws Circle, Suite 2Williamsburg, VA 23185 (757)258-1063
http://www.sigmondaknis.com/
MEDMONTHLY.COM |61
Biomet 3i4555 Riverside Dr.Palm Beach Gardens, FL 33410(800)342-5454
www.biomet3i.com
Dental Management Club4924 Balboa Blvd #460Encino, CA 91316
www.dentalmanagementclub.com
The Dental Box Company, Inc.PO Box 101430Pittsburgh, PA 15237(412)364-8712
www.thedentalbox.com
ABELSoft1207 Delaware Ave. #433Buffalo, NY 14209(800)267-2235
www.abelmedicalsoftware.com
Acentec, Inc17815 Sky Park Circle , Suite JIrvine, CA 92614(949)474-7774
www.acentec.com
AdvancedMD 10011 S. Centennial PkwySandy, UT 84070(800) 825-0224
www.advancedmd.com
CollaborateMD201 E. Pine St. #1310Orlando, FL 32801(888)348-8457
www.collaboratemd.com
Aquesta Insurance Services, Inc.Michael W. Robertson3807 Peachtree Avenue, #103Wilmington, NC 28403Work: (910) 794-6103Cell: (910) 777-8918
www.aquestainsurance.com
Jones Insurance 820 Benson Rd. Garner, North Carolina 27529 (919) 772-0233
www.Jones-insurance.com
Medical Protective5814 Reed Rd.Fort Wayne, In 46835(800)463-3776
http://www.medpro.com/medical-protective
MGIS, Inc.1849 W. North TempleSalt Lake City, UT 84116(800)969-6447
www.mgis.com
Manage My Practice103 Carpenter Brook Dr.Cary, NC 27519(919)370-0504
www.managemypractice.com
Medical Credentialing(800) 4-THRIVE
www.medicalcredentialing.org
Medical Practice Listings8317 Six Forks Rd. Suite #205Raleigh, NC 27624(919)848-4202
www.medicalpracticelistings.com
myEMRchoice.com24 Cherry LaneDoylestown, PA 18901(888)348-1170
www.myemrchoice.com
Physician Wellness Services5000 West 36th Street, Suite 240Minneapolis, MN 55416888.892.3861
www.physicianwellnessservices.com
Synapse Medical Management18436 Hawthorne Blvd. #201Torrance, CA 90504(310)895-7143
www.synapsemgmt.com
Urgent Care America17595 S. Tamiami TrailFort Meyers, FL 33908(239)415-3222
www.urgentcareamerica.com
Urgent Care & Occupational Medicine ConsultantLawrence Earl, MDCOO/CMO ASAP UrgentcareMedical Director, NADME.org908-635-4775 (m)866-405-4770 (f )
ASAP-Urgentcare.comUrgentCareMentor.com
Utilization [email protected](919) 289-9126
www.pushpa.biz
DENTALCONSULTING SERVICES,PRACTICE MANAGEMENT
Triangle Nutrition Therapy6200 Falls of Neuse Road, Suite 200Raleigh, NC 27609(919)876-9779
http://trianglediet.com/
DIETICIAN
DocuTAP4701 W. Research Dr. #102Sioux Falls, SD 57107-1312(877)697-4696
www.docutap.com
Integritas, Inc.2600 Garden Rd. #112Monterey, CA 93940(800)458-2486
www.integritas.com
62| DECEMBER 2012
medical resource guide
MEDICAL ART
Brian Allenwww.artisanprinter.com
Deborah Brenner877 Island Ave #315San Diego, CA 92101(619)818-4714
www.deborahbrenner.com
Pia De Girolamowww.piadegirolamo.com
Nicholas Downhttp://bit.ly/yHwxb0
Martin Friedwww.martindfried.com
MEDICAL EQUIPMENT
ALLPRO Imaging1295 Walt Whitman RoadMelville, NY 11747(888)862-4050
www.allproimaging.com
Biosite, Inc9975 Summers Ridge RoadSan Diego, CA 92121(858)805-8378
www.biosite.com
Cryopen800 Shoreline, #900Corpus Christi, TX 78401(888)246-3928
www.cryopen.com
Carolina Liquid Chemistries, Inc.391 Technology WayWinston Salem, NC 27101(336)722-8910
www.carolinachemistries.com
MEDICAL PRACTICE SALES
Medical Practice Listings8317 Six Forks Rd. Ste #205Raleigh, NC 27624(919)848-4202
www.medicalpracticelistings.com
BizScorePO Box 99488Raleigh, NC 27624(919)846-4747
www.bizscorevaluation.com
MEDICAL PRACTICE VALUATIONS
MEDICAL MARKETING
MedMedia9PO Box 98313Raleigh, NC 27624(919)747-9031
www.medmedia9.com
WhiteCoat DesignsWeb, Print & Marketing Solutions for Doctors(919)714-9885
www.whitecoat-designs.com
MEDICAL PUBLISHING
Greenbranch Publishing [email protected]
www.greenbranch.com
MMA Medical Architects520 Sutter StreetSan Francisco, CA 94115(415) 346-9990
http://www.mmamedarc.com
MEDICAL ARCHITECTS
LOCUM TENENS
Physician SolutionsPO Box 98313Raleigh, NC 27624(919)845-0054
www.physiciansolutions.com
Barry Hanshaw 18 Bay Path DriveBoylston MA 01505508 - 869 - [email protected]
www.barryhanshaw.com
Ako [email protected]/akojacintho
www.akojacintho.com
Julie Jennings(678)[email protected]
http://silksynergy.com/http://www.coroflot.com/naddie09
MedImageryLaura Maask 262-308-1300 [email protected]
medimagery.com
Marianne Mitchell(215)704-3188
http://www.mariannemitchell.comhttp://www.colordrop.blogspot.com
Emily Eve [email protected]
http://www.weinsteinart.com
Professional Medical Insurance Services16800 Greenspoint Park DriveHouston, TX 77060(877)583-5510
www.promedins.com
Wood Insurance Group4835 East Cactus Rd., #440Scottsdale, AZ 85254-3544(602)230-8200
www.woodinsurancegroup.com
INSURANCE, MED. LIABILITY Dicom Solutions548 WaldIrvine, CA 92618(800)377-2617
www.dicomsolutions.com
Tarheel Physicians Supply1934 Colwell Ave. Wilmington, NC 28403 (800)672-0441
www.thetps.com
MEDICAL RESEARCH
Arup Laboratories500 Chipeta WaySalt Lake City, UT 84108(800)242-2787
www.aruplab.com
Chimerix, Inc.2505 Meridian Parkway, Suite 340Durham, NC 27713(919) 806-1074
www.chimerix.com
Clinical Reference Laboratory8433 Quivira Rd.Lenexa, KS 66215(800)445-6917
www.crlcorp.comSanofi US55 Corporate DriveBridgewater, NJ 08807(800) 981-2491
www.sanofi.usScynexis, Inc.3501 C Tricenter Blvd.Durham, NC 27713(919) 933-4990
www.scynexis.com
MORTGAGE PROFESSIONAL
SunTrust Mortgage, Inc.Nicholas Lay, Senior Loan Officer910.368.8080 [email protected]# 659099
www.suntrust.com
medical resource guide
Additional Staffing Group, Inc.8319 Six Forks Rd, Suite 103Raleigh, NC 27615(919) 844-6601
Astaffinggroup.com
SUPPLIES, GENERAL
BSN Medical5825 Carnegie BoulevardCharlotte, NC 28209(800)552-1157
www.bsnmedical.us
STAFFING COMPANIES
CNF Medical1100 Patterson AvenueWinston Salem, NC 27101(877)631-3077
www.cnfmedical.comDermabondEthicon, Route 22 WestSomerville, NJ 08876(877)984-4266
www.dermabond.com DJO1430 Decision St.Vista, CA 92081(760)727-1280
www.djoglobal.com ExpertMed31778 Enterprise Dr.Livonia, MI 48150(800)447-5050
www.expertmed.com
Gebauer Company4444 East 153rd St. Cleveland, OH 44128-2955(216)581-3030
www.gebauerspainease.com
Scarguard15 Barstow Rd.Great Neck, NY 11021(877)566-5935
www.scarguard.com
MedMedia9PO Box 98313Raleigh, NC 27624(919)747-9031
www.medmedia9.com
REAL ESTATE
York Properties, Inc.Headquarters & Property Management 1900 Cameron StreetRaleigh, NC 27605(919) 821-1350
Commercial Sales & Leasing (919) 821-7177
www.yorkproperties.com
MEDMONTHLY.COM |63
WEBSITE DESIGN
PRACTICE FINANCING
Bank of AmericaMark MacKinnon, Regional Sales Manager3801 Columbine CircleCharlotte, NC 28211(704)[email protected]
www.bankofamerica.com/practicesolutions
Wanted: Classified AdsCall today to find out about all the advertising opportunities
available with Med Monthly.
919.747.9031Visit us online anytime at medmonthly.com
Med Monthly
Medvertisingcompound noun: 1. The action of calling attention to medical goods or services for sale. Exclusively refers to advertising in Med Monthly.
Scan this code with your smartphone or visit medmonthly.com
Come see why we’re not your father’s medical journal
919.747.9031 | [email protected] | medmonthly.com
To place a classified ad, call 919.747.9031
classified listings
Classified
MEDMONTHLY.COM |65
Physicians needed
North Carolina
GP Needed Immediately On-Going 3 Days Per Week at Occupational Clinic General Practictioner needed on-going 3 days per week at occupational clinic in Greensboro, NC. Numer-ous available shifts for October. Averages 25 patients per day with no call and shift hours from 8:30 am to 5:30 pm. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: [email protected]
3-5 days per week in Durham, NC Geriatric physician needed immediately 3-5 days per week, on-going at nursing home in Durham. Nursing home focuses on therapy and nursing after patients are released from the hospital. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: [email protected] GP Needed Immediately On-Going 1-3 Days Per Week at Addictive Diease Clinics located in Charlotte, Hickory, Concord & Marion North CarolinaGeneral Practitioner with a knowledge or interest in ad-dictive disease. Needed in October on-going 1-3 times per week. This clinic requires training so respond to post before October 1st. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: [email protected]
Primary Care Physician in Northwest NC (multiple locations)Primary care physician needed immediately for ongo-ing coverage at one of the largest substance abuse treatment facilities in NC. Doctor will be responsible for new patient evaluations and supportive aftercare.Counseling and therapy are combined with physi-cian’s medical assessment and care for the treatment of adults, adolescents and families. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: [email protected]
Pediatrician or Family Medicine Doctor in Fayetteville Comfortable with seeing children. Need is immediate - Full time ongoing for maternity leave. 8 am - 5 pm. Outpatient only. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: [email protected]
Physicians needed
North Carolina (cont.)
Immediate need for full time GP/FP for urgent cares in eastern NCUrgent care centers from Raleigh to the eastern coast of NC seek immediate primary care physician. Full time opportunity with possibility for permanent place-ment. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: [email protected]
General Practitioner Needed in GreensboroOccupational health care clinic seeks general practi-tioner for disability physicals ongoing 1-3 days a week. Adults only. 8 am-5 pm. No call required. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, andPH: (919) 845-0054, email: [email protected]
Pediatrician or Family Physician Needed Immediately at clinic in Roanoke Rapids, NCPediatric clinic in Roanoke Rapids, NC seeks Peds phy-sician or FP comfortable with children for 2-3 months/on-going/full-time. The chosen physician will need to be credentialed through the hospital, please email your CV, medical license and DEA so we can fill thisposition immediately.
County Health Department in Fayetteville, NC seeks GP/IM/FP Full-Time, On-Going ShiftsGP/IM/FP Needed Immediately at County Health Department in Fayetteville, NC. Approximately 20 patients per day with hours from 8 am -5 pm. Call or email for more information. [email protected]
Occupational Clinic in Greensboro, NC seeks FP/GP for On-Going ShiftsLocum tenens position (4-5 days a week) available for an occupational, urgent care and walk in clinic. The practice is located in Greensboro NC. Hours are 8 am-5 pm. Approximately 20 patients/day. Excellent staff. Outpatient only.
continued on page 66
To place a classified ad, call 919.747.9031
classified listings
Classified
66| DECEMBER 2012
Pediatric Locums Physician needed in Harrisonburg, Danville and Lynchburg, VA. These locum positions re-quire 30 to 40 hours per week, on-going. If you are seek-ing 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: [email protected]
Urgent Care opportunities throughout Virginia. We have contracts with numerous facilities and eight to 14-hour shifts are available. If you have experience treating pa-tients from pediatrics to geriatrics, we welcome your in-quires. Send copies of your CV, VA medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solu-tions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, E-mail: [email protected]
South Carolina
Physicians needed
North Carolina (cont.)
Diabetic Clinic 1 hour from Charlotte seeks FP/GP/IM for On-Going ShiftsPrimary care physician needed immediately for out-patient diabetic clinic one hour outside Charlotte, NC On-going. Hours are 8 am -5 pm with no call. Approxi-mately 15-20 patients a day.
Addictive Disease Clinic in Charlotte, NC and sur-rounding cities seeks GP/FP/IM for on-going shiftsAn addictive disease clinic with locations with loca-tions in Charlotte, NC and surrounding cities seeks a GP with an interest in addictive medicine for on-going shifts. This clinic has 15-25 open shifts every month and we are looking to bring on a new doctor for consistent coverage. The average daily patient load is between 20 and 25 with shifts from 8 am - 5 pm and 6 am - 2 pm. If you are interested in this position please send us your CV and feel free to contact us via email or phone with questions or to learn about other positions.
Child Health Clinic in Statesville, NC seeks pediatri-cian or Family Physician comfortable with peds for on-going, full-time shifts. Physician will work M-F 8 am - 5 pm, ongoing. Qualified physician will know EMR or Allscripts software. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: [email protected]
Practice wanted
Pediatric Practice Wanted in Raleigh, NCMedical 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 re-ceives exceptional national, regional and local exposure. Contact us today at (919) 848-4202.
North Carolina
continued on page 69
continued from page 65
Physicians needed
Virginia
A family and urgent care in Little River, SC seeks an FP/EM physician for 1 to 2 days per week, on-going shifts. The practice is a one-physician facility and is looking for a physician to come in regularly. The prac-tice is small and does not have a large patient load. The qualified physician will have experience in Family or Emergency medicine. If you have any availability and a SC medical license contact us today and we will do our best to work around your schedule. Physi-cian Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: [email protected]
Primary care practice specializing in women’s careRaleigh, North Carolina
The owning physician is willing to continue with the practice for a reasonable time to assist with smooth ownership trans-fer. 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 prac-tice seeker. This is a remarkable opportunity to purchase a well-established woman’s practice. Spacious practice with several well-appointed exam rooms and beautifully decorat-ed throughout. New computers and medical management software add to this modern front desk environment.
List price: $435,000
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
Comfortable seeing children. Needed immediately.
Call 919- 845-0054 or email: [email protected]
PEDIATRICIAN
FAYETTEVILLE, NCor family medicine doctor needed in
66| DECEMBER 2012
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.
Primary Care Practice For Sale
Medical Practice Listings919.848.4202 | [email protected]
www.medicalpracticelistings.com
Adult & pediAtric integrAtive medicine prActice for sAle
This Adult and Pediatric Integrative Medicine practice, located in Cary, NC, incorporates the latest conventional and natural therapies for the treatment and prevention of health problems not requiring surgical intervention. It currently provides the following therapeutic modalities:
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
• 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
Call 919-848-4202 or email [email protected]
Practice for sale
Lucrative ENT Practice with room for growth, located three miles from the beach. Physician’s assistant, audiolo-gist, 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, laryngol-ogy and trans-nasal esophagoscopy. All the organiza-tion 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. Hos-pital 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, Ra-leigh, NC 27624. PH: (919) 848-4202 or email: [email protected]
Practice for sale
South Carolina
To place a classified ad, call 919.747.9031
North Carolina
Classified
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. Con-tact Medical Practice Listings for more details. email: [email protected] or (919) 848-4202.
Washington
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 informa-tion. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or email: [email protected]
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 list-ings 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 List-ings at (919) 848-4202 for more information. View addition-al 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 own-ership 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 well-appointed 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 [email protected]
Internal Medicine Practice located just outside Fayette-ville, 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 transac-tion. The practice treats patients four and a half days per week with no call or hospital rounds. The schedule accom-modates 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 be-ing 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 protected]
North Carolina (con't)
classified listings
continued from page 66
MEDMONTHLY.COM |69
THINKING ABOUT SELLING YOUR PRACTICE?
Medical Practice Listings can help you sell your practice online!
919.848.4202 | medicalpracticelistings.com
The Standard Listing offers you the opportunity to gain national exposure by posting your listing on our website which is viewed daily by our network of professionals. This option also includes a brief practice consultation to explain the benefits of marketing through the Medical Practice Listings website.
In addtion to the benefits in the standard listing our Professional Listing affords you access to services provided by our expert legal and marketing team and a Bizscore Practice Valuation. This valuation compares your practice with other practices in your area, provides projections and determines what your practice is worth.
Now offering two types of listings to better serve all practice specialties and budgets.
Standard Listing Professional Listing
Visit us today at www.medicalpracticelistings.com to learn more.
PHYSICIANS NEEDED: Mental health facility in Eastern North Carolina seeks:
PA/FT ongoing, start immediatelyPhysician 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 immediatelyThe Director of Medical Services is responsible for ensuring all patients receive quality medical care. The director supervises medical physicians and physi-cian 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,
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: [email protected]
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 immediatelyAn 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, documenta-tion of patient progress in medical record, education of patients/families, provision of educational groups for patients.
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 protected]
NC OPPORTUNITIES LOCUMS OR PERMANENT
For more information about Physician Solutions or to see all of our locums and permanent listings,
please visit physiciansolutions.com
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.
medmonthly.com | 919.747.9031
ADVERTISE YOUR PRACTICE BUILDING IN MED MONTHLY
MEDMONTHLY.COM |71
Ophthalmic and Neuro-Ophthalmic PracticeRaleigh North Carolina
This is a great opportunity to purchase an established ophthalmic practice in the heart of Raleigh. Locate on a major road with established clients and plenty of room for growth; you will appreciate the upside this practice offers. This practice performs comprehensive ophthalmic and neuro-ophthalmic exams with diagnosis and treatment of eye disease of all ages.
Surgical procedures include no stitch cataract surgery, la-ser 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
Comprehensive Neuro-Ophthalmic Practice
We have a established woman’s practice in the Raleigh North Carolina area that is available for purchase. Grossing a consis-tent $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 prac-tice is very visible and located in the heart of medical commu-nity. There are 7 well appointed exam rooms, recently upgraded computer (EMR), the carpet and paint have always been main-tained. The all brick building can be leased or purchased.
Contact Cara or Philip for detailsregarding this very successful practice.
Medical Practice Listings; 919-848-4202
Woman’s Practice in Raleigh, North Carolina.
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.
Hospice Practice Wanted
To find out more information call 919-848-4202 or e-mail [email protected]
www.medicalpracticelistings.com
American Council on Exercise®
4 8 5 1 P A R A M O U N T D R I V E , S A N D I E G O , C A 9 2 1 2 3 U S A
( 8 0 0 ) 8 2 5 - 3 6 3 6 X 6 5 3 | W W W . A C E F I T N E S S . O R G
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
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 STM
ACE Certified: The Mark of QualityLook for the ACE symbol of excellence
in fitness training and education.For more information, visit our website:
www.ACEfitness.org
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.
Unfortunately, its motor is inside playing video games.
OCCUPATIONAL HEALTH CARE PRACTICE FOR SALEGreensboro, 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 equip-ment includes CBC. The owning MD is retiring, creat-ing 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 in-cludes: 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.
PRACTICE FOR SALE
Asking price: $385,000
To view more listings visit us online at medicalpracticelistings.com
In mid December, a pediatrician or family medicine doctor comfortable with seeing children is needed full time in Roanoke Rapids (1 hour north of Raleigh, NC) until a permanent doctor can be found. Credentialing at the hospital is necessary.
Call 919- 845-0054 or email: [email protected]
PEDIATRICIANOR FAMILY MEDICINEDOCTOR NEEDED IN
ROANOKE RAPIDS, NC
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.
MODERN MED SPA AVAILABLELocated in beautiful coastal North Carolina
MedicalPracticeListings.com | [email protected] | 919.848.4202
Call 919-848-4202 or email [email protected]
Woman's Practice Available for SaleAvailable for purchase is a beautiful boutique women’s Internal Medicine and Primary Care prac-tice located in the Raleigh area of North Carolina.
The physician owner has truly found a niche special-izing 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 Medi-cine 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
Located in South Denver, Colorado, this practice features high patient volume and high visibility on the internet. Established referral sources, owner (psychologist) has excellent reputa-tion 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
Practice for Sale in South Denver
For more information contact Dr. Jack McInroy at 303-929-2598 or [email protected]
Neurofeedback and Psychological 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.
Wanted:Urgent Care Practice
Call 919-848-4202 or e-mail [email protected]
Medical Practice ListingsBuying and selling made easy
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
FAMILY PRACTICE FOR SALEA beautiful practice located in Seattle, Washington
MedicalPracticeListings.com | [email protected] | 919.848.4202
Medical Practice ListingsSelling and buying made easy
76| DECEMBER 2012
Pediatrics practice wanted in NCConsidering your options regarding your pediatric prac-tice? 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.
Pediatrics Practice Wanted
Medical Practice ListingsCall 919-848-4202 or e-mail [email protected]
www.medicalpracticelistings.com
Internal Medicine Practice for Sale
Call 919-848-4202 or email [email protected]
Located in the heart of the medical community in Cary, North Carolina, this Internal Medicine practice is accepting most private and government insurance payments.
The average patients per day is 20-25+, and the gross yearly income is $555,000.
Listing Price: $430,000
Primary Care Practice for SaleHickory, 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
Established primary care practice in the beautiful foothills of North Carolina
MEDMONTHLY.COM |77
Please direct all correspondence to [email protected] serious, qualified inquirers.
lOne of the oldest Locums companieslLarge client listlDozens of MDs under contractlExecutive office settinglModern computers and equipmentlRevenue over a million per yearlRetiring owner
MD STAFFING AGENCY FOR SALEIN NORTH CAROLINA
The perfect opportunity for anyone who wants to purchase an established business.
Med MonthlyMed 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!
919.747.9031
Also available online 24/7medmonthly.com
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.
NC MedSpa For Sale
For more information call Medical Practice Listings at919-848-4202 or e-mail [email protected]
www.medicalpracticelistings.com
78 | DECEMBER 2012
the top
5
Holiday HealthTips
2EAT YOUR VEGETABLES AND SALAD FIRSTIf you are at a party with a lot of tempting food, try to start with healthy vegetables and salads. These will fill you up and reduce the temptation to over-indulge on high-fat, high-calorie foods. Just a taste of your holiday
favorites should then satisfy your taste buds.
EXERCISE EVERY DAYGet out of the house for a walk to view the Christmas lights and decorations in the evening. Be sure to dress for the weather and take along a flashlight and/or reflective clothing to illuminate your path and make you visible to traffic. Be very careful in areas that
are prone to freezing to avoid falls.
COMBINE SHOPPING AND WALKINGIf the weather prevents you from walking outdoors, combine a holiday shopping trip with your exercise. Indoor malls are
great places to walk, and many have walking clubs. If you are planning on shopping in a particular store, park near an entrance on the opposite end of the mall -- even if time is short, you will still get some exercise.
DRINK MODERATELYDrinking too much may not just mean a terrible hangover. Around this time of year, doctors report seeing a spike in erratic heartbeats—dubbed “holiday heart syndrome.” It is more common among people who usually aren’t heavy drinkers but drink in excess for a short time. Keep it on the rocks because melting ice dilutes a cocktail and creates more liquid. So or-der your drink on the rocks to try to avoid a quick buzz and sip it longer before a refill.
13 REMEMBER TO TAKE
YOUR MEDICATIONSHolidays often disrupt routines and may cause you to forget your life-
saving medications. As you note social appointments, add a reminder to take your medications or order re-fills. If you are traveling, be sure to take enough medications with you in case of delays and have a copy of your prescriptions in case of loss.
In 1987, radio personality, Bob Rivers, recorded “The 12 Pains of Christmas” in which the litany of each “thing of Christmas that’s such a pain to me” includes finding a Christmas tree or a parking space, screaming children, facing the in-laws, rig-ging up the lights, and sending Christmas cards. It’s a popular song each holiday season and very funny, but also very true. We hope following some of our holiday health tips can relieve some of your seasonal stress so you can enjoy the holiday and its indulgences without sacrificing your health goals in closing of the year.
MEDMONTHLY.COM | 79
8
7
GET A GOOD NIGHT'S SLEEPHoliday celebrations can often disrupt regular sleep patterns. Try to get to sleep at the same time every night and avoid heavy foods and alcoholic beverages before bedtime. Take a nap if you feel the need during the day to help recharge your energy. AND DON’T TRY TO STAY AWAKE TO SEE SANTA!
PRACTICE ALLERGY-FREE DECORATINGIf you suffer from allergic rhinitis, the culprit may be your holiday decorations. Decorations stored away all year can build up a coating of dust that can trigger
allergies. You may also need to rethink Christmas tradition and substitute an artificial tree, as many people are allergic to real trees. The newer trees are very lifelike and safer (they don't dry out and become fire hazards).
KNOW YOUR FOOD INGREDIENTSIf you have food allergies, don't be afraid to ask about ingredients in dishes made by others. Be especially careful of home-baked
goods if you have an allergy to tree nuts or peanuts. Those ingredients may not be obvious at first sight but can be deadly if you are affected by these types of allergies.
6
MANAGE STRESSThe holidays don’t need to take a toll on your health. Keep a check on over-commitment and over-spending. Balance work, home, and play.
Get support from family and friends. Keep a relaxed and positive outlook. And make plans for January because if you have social events coming up with people you like, you’ll be upbeat about what’s to come, avoiding depression during the holidays.
Read more at:http://seniorhealth.about.com/od/prevention/tp/holiday_health.htmhttp://www.foxnews.com/health/2011/12/01/holiday-health-tips/
9
When someone in your practice can’t work tomorrow, make us your Plan B
With an extensive network of health care providers and over 20 years of experience in physician staffing, Physician Solutions is a leader in the industry. We specialize in primary care and place doctors, nurses and office staff, including front desk and billing, in family practices, urgent cares, internal medicine, pediatrics offices and occupational health facilities.
We’ve got you covered!
P.O. Box 98313, Raleigh, NC 27624
phone: 919.845.0054 fax: 919.845.1947e-mail: [email protected]
www.physiciansolutions.com
Physician Solutions MD STAFFING Locum tenens Nurses Front Desk and Offi ce Staff Permanent placement
Short-term or long-term, Physician Solutions has you covered
Scan this QR code with your smartphone to learn more.