med monthly july 2011
DESCRIPTION
The July 2011 issue of Med Monthly magazineTRANSCRIPT
Med MonthlyJuly 2011
MAYO ONEDONEMayo Clinic’s flight team
Do you iPad?Why you should be using these
gadgets in your practice
Breast surgeryDr. Becker helps women feel
better about themselves
&
Transform Your Healthcare Facility with the Power of EMS™ Software
find out how you can lead your facility to a comprehensive scheduling solution:
800.440.3994 or www.dea.com/healthcare
Enhance workflow for all aspects of trainings, meetings, conferences, etc.
Maximize room and resource utilization with utilization reports and more
Improve event awareness with a powerful web-based calendar
needs.
contents44
18 CODING FOR THE REST OF USWhy everyone needs to know some coding
22 NEW “ACCESS REPORTS”New reporting rules for HIPAA
27 SHARING YOUR GIFTSDr. Kobs volunteers for international organization
30 MEDICAL SCHOOL TAKES A VACATIONMedical schools on the beach
36 MAYO ONE & DONE The men and women of Mayo One
20
research and technology10 DR. BECKER HELPS WOMEN LOOK THEIR BEST 13 BEATING TUMORS AT THEIR OWN GAME
careers14 THE NURSING SHORTAGE
your practice16 MAKE YOUR PRACTICE KID-FRIENDLY20 WHY YOU SHOULD USE IPADS
healthy living42 ASTHMA: THE HYGIENE HYPOTHESIS
the kitchen44 SUSTAINABLE GOURMET
features
in every issue6 editor’s letter24 book review
47 for sale54 top nine
Tangy blue cheese salad
Cover photo of Mayo One pilot Jeffrey Sterns courtesy Mayo Clinic.
iPads for your practice
editor’s letter
Managing Editor
Alice Osborn
6 | JULY 2011
We have an international theme this month at Med Monthly, which is perfect since July is an ideal time to embark on a long overseas vaca-tion, perhaps to a locale with sun, sand and
cool drinks. July is also halfway to Christmas, but I don’t want to think about that!
In this issue, you’ll find George Cox’s feature where he shares the benefits American students gain when they decide to attend a Caribbean medical school education. You’ll also learn about the fascinating and never-ending work of Dr. Jeff Kobs of Raleigh, N.C. who is the president of COAN Health, a nonprofit group of orthopedic doctors and health practitioners who travel regularly to Nicaragua to serve the local population. You’ll also meet Dr. Hilton Becker, a cosmetic and reconstructive breast surgeon based out of Boca Raton, Fla. who shares his innovative talents and skills in almost every continent. You’ll also find in our July issue Megan Cutter’s book review on “The Healing of America: A Quest for Better, Cheaper and Fairer Health Care” by T.R. Reid, Mary Pat Whaley’s informative article on medical coding and how the Mayo helicopter team fights against the clock on a daily basis. You’ll also know the best vacation deal overseas and what the price of drugs is in other countries after reading this issue.
I’m looking forward to my new position as managing editor of Med Monthly as we bring you more stories of the unsung heroes who save lives every day and generously give back and care about their communities. We’ll also share tips to make your practice successful on all levels, as well as cooking and healthy lifestyle strategies. Next month we’ll focus on pediatrics and learn about the human-centered approach to healing at the Duke Center for Integrative Medicine in Durham, N.C.
Our goal here at Med Monthly is to give you inspiring stories that you won’t find anywhere else. Send us a note at medmonthly.com to let us know how we are doing and give us feedback on what stories you want to see in this maga-zine. Also take a minute to visit our updated website at MedMonthly.com and “Like” on us on Facebook.
Enjoy our July issue!
Dr. Edward Loganis a general and cosmetic dentist prac-ticing in O’Fallon, Missouri. Dr. Logan graduated from the University of Wash-ington School of Dentistry. After years of learning the business side of dentistry, Dr. Logan decided to write a book. Den-tistry’s Business Secrets was published
late last year. You can read more articles by Dr. Logan at his website DentistrysBusinessSecrets.com.
Megan Cutteris a professional writer, editor and cre-ative journaling instructor. In addition to providing writing, editing, coaching for writers and public relations services, she facilitates creative writing work-shops, specifically in the areas of writ-ing for health and wellness. To find out
more about Megan, visit her at cuttersword.com.
Med Monthly
Publisher
Managing Editor
Creative Director
Contributors
Advertising Director
Philip Driver
Alice Osborn
Courtney Flaherty
George CoxDr. Edward Logan Cathy WarschawKimberly LicataMary Pat Whaley Megan CutterShauna Smith Duty
Bill Turner
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 medmontly.com/writersguidelines.
July 2011
Subscription InformationSubscriptions are $69 for one year or $89 for two years. Individual copies are $5.95 each. To subscribe call 919.747.9031 or
visit medmonthly.com
P.O. Box 99488Raleigh, NC 27624
Online 24/7 at medmonthly.com
contributors
Mary Pat Whaley, FACMPE is Board Certified in Healthcare Man-agement and a Fellow in the Ameri-can College of Medical Practice Executives. She has worked in health-care and healthcare management for 25 years. She can be contacted at [email protected].
George Coxmoved to Raleigh, NC in 1983 and obtained an MA from NC State in 1990. He has ghostwritten two novels and a collection of blogs and short articles. Currently, George is prepar-ing his own novel for publication, and enjoys the opportunity to write
freelance in his spare time. Besides writing, working, and raising two teenagers, George still finds time to fingerpick a few original compositions on his classical guitar.
Kimberly Licata is an attorney at Poyner Spruill, who practices health law and participates on the Firm’s Emerging Technologies and Privacy and Information Security teams. She may be reached at [email protected] or 919-783-2949.
MEDMONTHLY.COM |7
8 | JULY 2011
ManageMyPractice.comYour go-to resource for health-care practice management
Visit ManageMyPractice.com. Today!
About the expert
Mary Pat Whaley, FACMPE, is board certified in health-care management and a fellow in the American College
of Medical Practice Executives. She has worked in health care and health-care management for over 25 years. Mary
Pat is also a well-respected author and highly sought-out speaker
and consultant.
Manage My Practice is the go-to online source of technology, information and resources for practice management professionals, and it is visited by over 10,000 medical-practice managers and medical providers each month.
Careers
Customer Service
Day-to-Day Operations
Electronic Medical Records
Finance
Human Resources
Innovation
Leadership
Marketing
Medicare & Reimbursement
Social Media
A BETTER WAY TO ACCESS PATIENTINFORMATION
Long Island Patient Information eXchange
“Improving patient care through secure data accessibility”
The LIPIX platform offers clinicians real time secure access to their patients’ medical records via the internet from most Long Island hospitals.
Contact us at 877.MY.LIPIX (695.4749) or visit us on the web at www.lipix.org for a FREE LIPIX user account and gain authorized access to patient data faster.
ManageMyPractice.comYour go-to resource for health-care practice management
Visit ManageMyPractice.com. Today!
About the expert
Mary Pat Whaley, FACMPE, is board certified in health-care management and a fellow in the American College
of Medical Practice Executives. She has worked in health care and health-care management for over 25 years. Mary
Pat is also a well-respected author and highly sought-out speaker
and consultant.
Manage My Practice is the go-to online source of technology, information and resources for practice management professionals, and it is visited by over 10,000 medical-practice managers and medical providers each month.
Careers
Customer Service
Day-to-Day Operations
Electronic Medical Records
Finance
Human Resources
Innovation
Leadership
Marketing
Medicare & Reimbursement
Social Media
A BETTER WAY TO ACCESS PATIENTINFORMATION
Long Island Patient Information eXchange
“Improving patient care through secure data accessibility”
The LIPIX platform offers clinicians real time secure access to their patients’ medical records via the internet from most Long Island hospitals.
Contact us at 877.MY.LIPIX (695.4749) or visit us on the web at www.lipix.org for a FREE LIPIX user account and gain authorized access to patient data faster.
10 | JULY 2011
research & technology
D r. Hilton Becker uses his passion and skills at breast reconstructive and plastic surgery to help patients
when they are the most vulnerable: after mastectomies and after botched cosmetic operations. “Some of the most gratifying parts of my work are treating patients who have had complications with breast implants, multiple operations or previous breast problems where we can help them with our new advanced tech-niques and correct them in one operation.” Dr. Becker’s experience in reconstructive breast surgery greatly enhances his ability to per-form cosmetic surgery of the breasts. “I combine my knowledge of recon-struction and cosmetics to benefit both populations,” he states.
Originally from South Africa, and now practicing in Boca Ra-ton, Florida at the Hilton Becker Clinic of Plastic Surgery, Dr. Becker is recognized both nationally and internationally as an expert in breast reconstructive surgery with over 25 years of experience in the field. He has lectured and taught surgeons all over the world and is extensively published on the subject of breast
surgeries and reconstruction of the breast.
The Becker Adjustable Breast Implant
After experiencing the emotional and physical toll breast cancer took on his patients early in his career, Dr. Becker was determined to help these patients who underwent mastecto-mies maintain their femininity and self-esteem following the loss of their natural breasts. He soon invented the Becker Adjustable Breast Implant in 1984. The implant enables the woman to have a one-stage reconstruc-tion at the time of the mastectomy, which is also called primary recon-struction. How it works is that the double-lumen saline-gel implant is a combination tissue expander and a breast implant in one, so the im-plant can be stretched to stretch the breast tissue. The saline is in the inner chamber for tissue expansion and the gel is in the outer for a softer-feeling implant. Dr. Becker explains, “Once you’ve stretched and shaped the tissue sufficiently then the tissue expander is removed and the implant remains behind. The patient doesn’t need to go back for a second operation as you do
when a traditional tissue expander is used. Now that the surgeons are doing less invasive mastectomies and saving more and more skin, this implant is getting more use.”
The implant allows a woman to regain her confidence and figure im-mediately and achieve her desired results as the implant is shaped and sized when fluid is added through a port which is removed once healing has taken place. This one-stage recon-struction is suitable for a high per-centage of patients and not only does the adjustable implant reduce scar-ring and surgery complications, the size and shape of the breasts can be modified through the implants. This is especially important if one breast has had radiation or another trauma. Besides reconstructive surgery, the Becker adjustable implant is useful for women who want an augmenta-tion and a lift (here the volume can be fine-tuned and the breasts can be better shaped), for those who have asymmetrical breasts or who have had previous complications with implants.
The Scarless Breast LiftDr. Becker is the pioneer of the
sub-areolar (circum-areolar) or scar-
Dr. Becker helps women look and feel their bestBreast surgery inventor and innovator
By Alice Osborn
Be very careful about advertising because anyone can advertise that they’re the greatest authority on earth. They need to be board certified in their specialty.
Speak to other patients who have been treated by the surgeon you’re seeking. View the surgeon’s Before and After pictures. Research that the surgeon has treated complications. Do your due diligence and don’t rush into surgery. Don’t elect to get the cheapest surgery because it won’t come with warranties for the implants, or guarantees to help with problems after the first few months and you may not get the best type of sur-gery for your condition.
less breast lift which he performs with the adjustable implant. The lift is done around the outer edge of the areola where the scar can be camouflaged. The areolar tissue is elevated and all of the tension is placed under the areola instead of on the skin so the scar doesn’t stretch and is less noticeable than traditional techniques. The lift is enhanced with the use of the Internal Mesh Bra, which was first used in reconstructive surgeries.
Continuing his mission to help women have healthy breasts
Dr. Becker donates his time by lec-turing about his highly sought-after surgical skills for physicians in South Florida and around the world. Dr.
Becker continues his mission to help breast cancer patients by perform-ing free surgeries in Thailand, China, Brazil, Croatia, Mexico, Germany, and Panama as well as other countries. He has helped many patients who have had reconstructive surgery done overseas because it’s cheaper and have later developed problems at home. Dr. Becker says, “Many times you don’t stay overseas for three months and you can develop problems weeks or months after the surgery that you don’t anticipate. The areas where we see the complications are with patients going overseas or patients running to the cheapest possible surgeon.”
Visit beckerbreastimplants.com for more information about Dr. Becker and his practice.
DR. BECKER’S TIPS FOR CHOOSING A COSMETIC SURGEON:
Courtesy istockphoto.com
Want to know more?Call John Nowak at 1.704.681.1703, or e-mail [email protected]. Mention Priority Code ADMJN11A. You can also visit us online at www.bankofamerica.com/practicesolutions.
* All programs subject to credit approval and loan amounts are subject to creditworthiness. Some restrictions may apply.** Banc of America Practice Solutions may prohibit use of an account to pay off or pay down another Bank of America account. Bank of America and Banc of America Practice Solutions are trademarks of Bank of America Corporation. Banc of America
Practice Solutions is a subsidiary of Bank of America Corporation. © 2011 Bank of America Corporation
At Banc of America Practice Solutions,, you can rely on our industry leadership. Our financing professionals understand the challenges of managing and growing a practice. Let us help you succeed.
◆ New office start-ups — get started with up to 100% project financing,* including design, construction, equipment and working capital.
◆ Practice sales and purchases — our team of experts can provide the experience and industry knowledge you need for buying and selling.
◆ Business debt consolidation**— to improve your cash flow.
◆ Office improvement and expansion — remodel, refurbish, or expand.
◆ Commercial real estate — choose from a suite of comprehensive real estate loan options to buy, refinance,* or relocate, terms up to 25 years.
◆ Equipment financing*— choose from a variety of options and flexible terms tailored to meet your needs.
What kind of financing do you need?You’ll find it here – and much more.
Product Features:*
◆ Terms up to 15 years on:
– Practice sales and purchases
– Office improvement and expansion
◆ Loans up to $5 million
◆ Flexible repayment options
04.11_Nowak_AllProducts_Med_2.indd 1 4/13/11 9:54 AM
research & technology
MEDMONTHLY.COM | 13
Surgical oncologist Barish Edil is working with colleagues on a pancreatic cancer vaccine.
Tumors are tricky things, and pancreatic tumors especially so. With an ability to deceive and ulti-mately thwart the body’s immune sys-tem, pancreatic cancer has long held the upper hand against physicians and patients fighting the disease.
Even in those rare cases when sur-geons successfully remove the tumor, the cancer often returns in full force.
Consequently, a diagnosis of pan-creatic cancer is often tantamount to a death sentence, if not in the first go-round then the next, usually less than a decade after the initial diagnosis.
Now, though, a vaccine developed by Johns Hopkins researchers could
potentially weight the fight in the immune system’s favor.
During a clinical trial 10 years ago, a group of
Hopkins researchers led by oncologist
Elizabeth Jaffee distributed
an experi-
mental pancreatic cancer vaccine to 10 patients. As is often expected in pancreatic cancer diagnoses, several of those patients eventually suffered recurrences and died. But today, three remain alive and cancer-free, and all signs point toward the vaccine as the cause.
“With pancreatic cancer, that’s exceedingly rare,” says surgical oncolo-gist Barish Edil. “The five-year survival rate for this disease is only around 20 percent, and the 10-year rate, well, that is quite rare.”
Edil, joined by a group of oncology colleagues, has taken the helm of the clinical trial’s second phase, which is now in its second year. He’s also altered the approach.
In the trial’s first incarnation, the vaccine was distributed only after pa-tients had undergone a Whipple opera-tion and received chemotherapy. Now, however, patients receive one vaccine dose before surgery and right after, fol-lowed by four more vaccinations after chemotherapy.
The pre-surgery vaccinations offer several advantages in treating the dis-ease, Edil says. First and most obvious-ly, the body receives an immune boost
that could prove helpful as patients deal with the threefold challenge of
fighting the cancer, undergoing major surgery and coping with chemotherapy and radiation. And, of course, there’s the hope that the tough vaccine regimen will fight off can-cer recurrence. But there is a third benefit that’s
proving most exciting for Edil and his colleagues: the chance to reach out to patients before surgery allows physi-cians to observe the effects the vaccine has on the tumor postoperatively.
Since the trial opened, 22 patients have received the vaccine. Examina-tions of the patients’ tumors have shown that each has developed disease-fighting lymph nodes, a sure sign that the immune system is bat-tling harder and more effectively than has ever been possible before.
“We have the immune system work-ing to kill the cancer cells,” Edil says. “This is the first time we’ve ever seen that, plus we have long-term survivors now, which is especially unique. Our hope is that the body is revved up so that when the cancer comes back, which it does with pancreatic cancer quite often, the immune system will be able to kill those cells as well.”
Of course, there are still improve-ments to be made.
For instance, despite any immune-boosting effects the vaccine may have, chemotherapy and radiation treat-ments ultimately thwart the immune system all over again.
“We’ve shown that even after we give the vaccine, once we start giving patients chemo and radiation therapy, certain cells that attack cancer go down again,” Edil explains. “We have to figure out how to integrate the two treatments so that they work well together.”
Beating tumors at their own game
Reprinted from Cutting Edge, a publica-tion for the department of Surgery Johns Hopkins Hospital
Photo by Brian Hoskins
Want to know more?Call John Nowak at 1.704.681.1703, or e-mail [email protected]. Mention Priority Code ADMJN11A. You can also visit us online at www.bankofamerica.com/practicesolutions.
* All programs subject to credit approval and loan amounts are subject to creditworthiness. Some restrictions may apply.** Banc of America Practice Solutions may prohibit use of an account to pay off or pay down another Bank of America account. Bank of America and Banc of America Practice Solutions are trademarks of Bank of America Corporation. Banc of America
Practice Solutions is a subsidiary of Bank of America Corporation. © 2011 Bank of America Corporation
At Banc of America Practice Solutions,, you can rely on our industry leadership. Our financing professionals understand the challenges of managing and growing a practice. Let us help you succeed.
◆ New office start-ups — get started with up to 100% project financing,* including design, construction, equipment and working capital.
◆ Practice sales and purchases — our team of experts can provide the experience and industry knowledge you need for buying and selling.
◆ Business debt consolidation**— to improve your cash flow.
◆ Office improvement and expansion — remodel, refurbish, or expand.
◆ Commercial real estate — choose from a suite of comprehensive real estate loan options to buy, refinance,* or relocate, terms up to 25 years.
◆ Equipment financing*— choose from a variety of options and flexible terms tailored to meet your needs.
What kind of financing do you need?You’ll find it here – and much more.
Product Features:*
◆ Terms up to 15 years on:
– Practice sales and purchases
– Office improvement and expansion
◆ Loans up to $5 million
◆ Flexible repayment options
04.11_Nowak_AllProducts_Med_2.indd 1 4/13/11 9:54 AM
Surgical oncologist works to create pancreatic cancer vaccine
14 | JULY 2011
careers
Despite a slow economy, the health care industry contin-ues to thrive. This is partially due to growing demand from
the aging baby boomer population, who require additional health care services today and into the future. These same boomers are retiring, leaving many areas of the health care field open for new professionals look-ing to get involved in helping others.
Nurses, in particular, are in high
demand. Many areas of the country are experiencing major nursing short-ages. Those with a degree and certifi-cation are valuable to employers, and it’s not uncommon for experienced nurses to have a number of opportu-nities to choose from.
Jobs in health care are increasing de-spite losses in other major industries. Over the last 12 months, health care has added 283,000 jobs, or an average of 24,000 jobs per month. As the larg-
est health care occupation, registered nurses will likely fill many job open-ings in the future. With above average growth numbers projected through 2018 and a national median wage of $62,450, there is a unique opportunity for registered nurses.
The majority of nurses work in a hospital — approximately 60 percent — but nurses are also needed in other places. Some alternative workplaces include offices of physicians, home
Nursing shortage means opportunity for those interested in health care
Over the last 12 months, health care has added
283,000 jobs, or an average of 24,000
jobs per month.
health care services, government agen-cies and educational services. Because complicated procedures, once only performed in hospitals, are now being performed in physicians’ offices and in outpatient care centers, demand for qualified nurses with strong leadership skills at these locations is increasing.
Whether just starting down the nursing career path or looking to take on a leadership role and influence the delivery of care, education and train-ing are highly valued by employers in this field. Higher education helps practitioners become more skilled and knowledgeable nurses, thus allowing them to step forward as lead-ers, while helping improve health care delivery and patient outcomes.
How can you become a nurse? Getting the right education is key. Employers expect nurses to keep their skills current and be able to handle multiple tasks and an increasing num-
ber of patients. There are a variety of options for those considering a nursing degree. Typically nurses get a two-year associate degree or a four-year bachelor’s degree that includes coursework and clinical training. For those that wish to expand their skill-set and become leaders in this field, higher education programs prepare nurses for the increased responsi-bilities and challenges facing today’s health care practitioners.
Many nursing students today are considered non-traditional students. This means these working learners have full-time jobs, are parents, spous-es or active members of the military. If you fit into this category, you can still pursue a nursing degree through a flexible online school like University of Phoenix, which has one of the largest nursing schools in the United States with more than 30 years of experience.
For nurses who have a two-year
degree and want to advance to a four-year degree, the RN to BSN program (registered nurse to bachelor’s of science in nursing) provides students the opportunity to advance their credentials, knowledge and skills on their own schedule, allowing time for family and other work obligations.
Nurses help those in need both emotionally and physically. Some nurses choose to specialize in a type of patient, such as children or the elderly, or they specialize in a cer-tain area of treatment, such as in the emergency room or during surgery. No matter what your personal inter-est, the demand for nursing continues to grow and offers a once in a lifetime opportunity for those looking for job security, career growth and the ability to make a difference in other people’s lives.
Reprinted courtesy of ARA content
Courtesy istockphoto.com
If you offer medical or dental care to children,
you need to make the kids
adore you.
MEDMONTHLY.COM | 17
In 1979, McDonald’s rolled out an innovation that revolutionized marketing in the fast food industry: the Happy Meal. Since then, the
Happy Meal has become iconic across the globe, and some connoisseurs are serious Happy Meal toy collectors. There is no denying that the Happy Meal was one sensational idea.
Dentists and physicians can learn something from McDonald’s. Please the kids, and the parents will become loyal customers. We know that moth-ers usually choose the family health care providers. Logic tells us to target our marketing efforts towards moms. We also know that moms give their children’s doctor and dental care visits top priority, usually over the parents’ own care. That initial visit is your op-portunity to please the kids and thus please the parents.
What’s Your Happy Meal?Whether you’re a pediatrician,
pediatric dentist, or family health-care provider, if you offer medical or dental care to children, you need to make the kids adore you. Prove your dedication, concern, and genuine compassion to the children, and the parents will become loyal patients.
After a visit to your office, what do you think Mom asks her child? “Did
you like the doctor?” It’s the same type of question you would ask your child after a first day at school. “Did you like your teacher?”
So what do you want the child’s an-swer to be? Develop a marketing plan to make your goal a reality. With good, well thought out marketing, you can determine your future. Here are a few Happy Meal ideas to get you started:
Big Success Club Everyone appreciates recognition for a job well done.
Rewarding good grades in school is an obvious success to honor, but you might also recognize accomplish-ments in Boy Scouts, Girl Scouts, Awanas (a faith-based organization for children), and other clubs. Den-tists should have a cavity-free club, and doctors can recognize children for healthy habits, like exercising and eating right.
Create a promotion for kids and parents to share successes on your Facebook page and blog. In addition, tangible rewards may include: stick-ers, candy, gift certificates for frozen yogurt, movie tickets, or a Wall of Fame in your lobby.
Kid-Friendly Surroundings Stage your office so that parents don’t have to tell their children, “No! Stop!
Be quiet! Don’t touch!” Set up an area in your lobby with
contemporary toys and games. Modern kids are tech savvy, so equip your office with WiFi, as well. You might also incorporate television and video games into the children’s area. Your bathroom and treatment rooms should be kid-friendly, as well.
Don’t forget, Mom sometimes has to spend thirty minutes in a treatment room entertaining her children. Both kids and mother may feel apprehen-sive, anxious, or scared. A distraction would be wonderful. Make sure the kids have something fun to do in the treatment room so that Mom can relax during the wait.
A Team Who Loves Children From your receptionist to your nurses, everyone in the practice must not only tolerate but like children.
When interviewing perspective em-ployees, ask how they feel about chil-dren — even kids who have ADHD and don’t take medication. During team meetings, share tips and tactics for pleasing children and parents or handling difficult situations with children. Set the expectation that your team members will make children feel welcome and secure in your office so you’ll be that much closer in finding your practice’s Happy Meal.
Think of the childrenHow to make your practice more kid-friendly
By Shauna Smith Duty
your practice
18| JULY 2011
There is no one, and I do mean no one, in your medical practice who does not need to know the basics of coding. Here is why
this is important:
Providing services to patients is the business of health care.
Every person who relies on health care for their living should understand something about the business they are in. This should not outweigh the fact that we are privileged to care for patients, but as the saying goes, “No money, no mission.”
It takes a team to produce care
The silos of front desk, billing, nursing and scheduling must come together to share their knowledge and produce a high-quality, reimbursable patient visit. Here are the roles each member of the team plays:
The patient calls for an appointment and the scheduler matches the patient’s problem to an appropriate appoint-ment type. The scheduler finds out if the patient is new or established and why the patient wants to be seen. The patient arrives for the appoint-ment and the front desk assures that all current demographic and insurance information is collected. The nurse rooms the patient, tak-
ing vitals, reviewing medications and reviewing the reason for the visit – the chief complaint. The physician or mid-level provider cares for the patient, documenting the visit and choosing the appropriate service and diagnosis codes. The patient completes the visit by paying any deductibles or co-insurance due and making any future appoint-ments needed. The checkout staff enters the payments and/or charges if the service codes have not already been posted via the EMR. The biller “scrubs” the claim, check-ing for any errors and electronically submits the claim to the payer. The hope is that the claim is clean and will be accepted and paid immediately (within 30 days.)
When staff understands how impor-tant their contribution is to the finan-cial viability of the practice and how all the pieces fit together, they are more incentivized to perform.
“Coding” means two things: service codes and diagnosis codes. Service codes describe office visits, surgery, laboratory, radiology, pathology, anes-thesia and medical procedures that are provided by physicians, nurse practi-tioners, and physician assistants. Diag-nosis codes describe signs, symptoms, injuries, diseases, and conditions. The critical relationship between a service code and a diagnosis code is that the diagnosis supports the medical neces-
sity of the procedure. Service codes are called either CPT codes or HCPCS (pronounced “hick-picks) based on the payer/insurer who uses them. Most commercial insurers use CPT (Current Procedural Ter-minology) codes, but Medicare and Medicaid use HCPCS (Healthcare Common Procedure Coding System.) Codes are globally grouped into Level I and Level II:
Level I codes include the 5-digit numeric CPT (Current Procedural Terminology) codes. These were devel-oped by the American Medical As-sociation (AMA) in 1966 and remain proprietary to the AMA. The codes are updated in October and become effec-tive as of the next calendar year. They are available as a printed manual or as an electronic file. Level II codes are national codes developed by the Centers for Medi-care and Medicaid Services (CMS) to describe medical services and supplies not covered in the CPT. They consist of alphabetic characters (A through V) and four digits.
There are two ways that patient services are coded so they can be billed to insurance companies. The first is through the use of a preprinted coding sheet, which goes by many different names: superbill, encounter form, routing sheet, patient ticket, or bill-ing form. The physician or mid-level
Coding for the rest of usAnd why everyone in your practice needs a basic knowledge of coding
By Mary Pat Whaley, FACMPE
your practice
provider indicates which services were provided and maps specific diagnosis codes to the services.
The second is abstraction from the medical record. A coder reads the doc-umentation provided by the physician or mid-level provider, and matches codes to the services described in the record. Computerized coding abstrac-tion via an electronic medical record (EMR) is also an option.
Basic coding rules for every practice Always have the latest edition of CPT and HCPCS. Service codes change annually and it is important to use the correct code for the calendar year. Check new, revised and deleted codes annually and change your encounter form and codes in your billing system to match. Attend webinars or seminars annu-ally to stay up-to-date on large-scale coding changes for your specialty or for all specialties. For instance, tobacco
cessation counseling is reportable to and payable by Medicare for the first time in 2011 – see a handy guide here (http://www.aafp.org/online/en/home/clinical/publichealth/tobacco/reim-bursement.html) and every specialty can bill it. You may also want to sub-scribe to coding newsletters for your specialty or check your physician’s specialty society to see what they offer. Utilize the National Correct Coding Initiative (NCCI) to make sure which codes are to be submitted individually versus being bundled. Many practices do not know about or use the NCCI information for the simple reason that it is complex and confusing and changes regularly. Someone in the field who offers great (free) information on the NCCI edits is Frank Cohen at www.frankcohen.com. Have an in-house crosswalk for provider abbreviations to make sure that they have signed off on what their abbreviations mean. The best of all worlds is requiring the physician or mid-level provider to supply a code as
opposed to a description. Use scrubbing software tools to check service and diagnosis code mismatches, Local Coverage Deter-minations (LCDs) for Medicare, any services without appropriate diagnosis codes and any diagnoses without stan-dard accompanying services. Audit your documentation regu-larly to ensure it matches your level of service (“if you didn’t document it, you didn’t do it”) especially if you are not documenting electronically with deci-sion support tools. Audit yourself or hire a firm to audit for you and docu-ment lessons learned and any correc-tive action taken. This should be part of your practice compliance plan. Note that physician regulatory insurance is now available (Google it) for around $1500 per physician per year. It is always the physician or mid-level provider’s ultimate responsibility to choose the codes that best correlate with what s/he did. When in doubt, always defer to the provider of the service.
20 | JULY 2011
M y business manager recently purchased an iPad for her family’s use to replace a laptop and
provide a communication device for her son who has a communication disorder. It has been fascinating to see the role that this iPad technology is playing in the lives of people with Autism Spectrum Disorders and com-munication disorders. Her enthusi-asm over its usefulness has led her to look into the uses of an iPad within a dental office.
Patient Education ToolWith the iPad’s ability to quickly
display pictures it can serve as a pa-tient education tool, providing your patients with the opportunity to view photos of their smile in the palms of their hands. Yes, the display of these pictures can also be accomplished on a laptop, computer monitor or mounted TV so this usage alone cer-tainly doesn’t justify the purchase of an iPad. However, some dentists have noted that their patients seem to react better to the “cool factor” of holding an iPad while viewing their photos.
Useful Dental AppsThe main reason to purchase any of
Apple’s iProducts is to take advantage of the applications available for virtu-ally every area of life. Are there any iPad apps designed for dental practice management or patient education? A quick browse of the iTunes store displays several dental specific apps, but you can rest assured that many more apps are in the works. One app that is receiving great reviews is DDS GP which was created by a practic-ing dentist to be used for patient education. This app includes dem-onstrations of many common dental problems and their treatments. The demonstrations include drawings, but no video or sound, which allows the dentist to explain the patient’s specific case while showing possible treatments. The DDS GP app allows dentists to add their own photographs and design treatment plans which can be printed or e-mailed. Dentists who use this app for patient education are raving about its effectiveness.
Charting ToolMany doctors, and a large number
of dentists, have transitioned to using tablets for their medical and dental charting. With the release of the iPad in 2010, several dental practice man-agement software distributors have been working on an iPad based chart-
ing app. EdgeEHR, which offers den-tal practice management software for use with the Mac operating system, has launched a touch based chart-ing application that integrates with edgeDMS. The edgeDMS app allows for dentists to use the iPad to chart and check patient history. This app integrates with the edgeDMS software and can share information with other Mac computers running edgeDMS.
Potential PitfallsAs I consider whether this new
technology would be helpful to my office, I have a few concerns. The first concern is about durability of the iPad and the possibility that it could get bumped or dropped in a dental office. To decrease my worries, I believe I would want to purchase an Otterbox Defender series case before intro-ducing the iPad into my office. The Apple Warranty does not cover drops, bumps or spills, but other companies offer extended warranties that cover these occurrences. I’ve never been one for expensive extended warranties, but I might consider a warranty from a company like Square Trade to cover these possibilities.
For more information visit dentistrys-businesssecrets.com.
Why you should be using iPads in your dental practice
By Edward M. Logan, DDS
Consumer technology aids practices, patients
your practice
MEDMONTHLY.COM | 21Courtesy istockphoto.com
22 | JULY 2011
For months we’ve waited and wondered what the govern-ment was going to say about what many have called the least
used right under the Health Insur-ance Portability and Accountability Act (HIPAA), the right to an ac-counting of disclosures. Back in 2009, Congress passed the Health Informa-tion Technology for Economic and Clinical Health Act (HITECH), which significantly expanded the disclosures that need to be listed in an accounting of disclosures, which caused concern
among providers. You may be asking where are we now? On May 31, 2011, the Office of Civil Rights (OCR) of the federal Department of Health and Human Services (HHS), the agency that enforces HIPAA, issued a Notice of Proposed Rulemaking (NPRM) to modify HIPAA’s standard for the ac-counting of disclosures as required by HITECH.
Because of the concerns of the pro-vider community, many wrote OCR in advance of the NPRM about the ex-
panded right. Most commenters told the government that the accounting of disclosures would offer little to no value to a patient while costing pro-viders substantial time and expense to produce. The government not only failed to reduce the potential hardship of the HITECH changes, but further expanded this right into a new right: a patient’s right to an “Access Report.” You won’t find the definition of an “Access Report” in the HIPAA statute or the HITECH Act. An “Access Re-port” is something that is brand new
and was created by OCR. This report is OCR’s attempt to provide patients with what OCR thinks patients really want, namely, a list about who is look-ing at their information. An access re-port must include all disclosures and uses of protected health information in an electronic designated record set.
An access report must be un-derstandable to the individual and provide date and time of user’s access, user’s name, description of informa-tion accessed, and action taken by
user. This must be provided within 30 days of a patient’s request (subject to a single extension). Patients will get one free access report per twelve (12) month period. After that free report, providers may charge a patient for subsequent reports on a per cost basis. For many, the most alarming aspect of the NPRM is that OCR believes the HIPAA Security Rule requires that this detail about access to information be tracked, maintained, and monitored. Many experts in the field had not in-terpreted the Security Rule so broadly,
and currently, few providers and business associates keep this level of access information for three (3) years as proposed by the NPRM.
Many providers have never had a patient request an accounting of disclosures since implementation of this HIPAA standard in 2003. This is despite providers having noti-fied patients of this right in their HIPAA-mandated Notice of Privacy Practices. Back in the old days (be-fore HITECH), the accounting had to
Health and Human Services modifies HIPAA’s accounting disclosures
By Kimberly Licata
The Office of Civil Rights of the federal Department of Health and Human Services issued a Notice of Proposed Rulemaking
to modify HIPAA’s standard for the accounting of disclosures as required by HITECH
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include all disclosures (but not uses), except for those that were specifically excluded from the list. Pre-HITECH, providers did not have to account for disclosures made to carry out treatment, payment and healthcare operations (so-called TPO uses or disclosures); to the individual himself or herself; incident to a permitted or required use or disclosure; pursuant to an authorization; for the facility director or individuals involved in the patient’s care; for national security or intelligence purposes; to law enforce-ment or correctional facilities; as part of a limited data set; or that occurred prior to the compliance date for the provider. This was a situation where the exceptions did swallow the rule. HITECH removed many of these exclusions. Of particular interest to many providers was HITECH’s re-moval of the exception for uses or dis-closures to carry out TPO. The NPRM details what HIPAA requires of the
accounting of disclosures from spe-cific facts about each use or disclosure to the three (3) year period covered. The accounting need not include dis-closures or uses of which the provider has already notified the individual (such as any breach notification).
There are a few positives about the NPRM. First, it only applies to electronic records. This is a change from the prior rule. Second, the government thinks electronic health records (EHRs) should be able to do this for you without significant effort. While this may not be true today, this will likely encourage EHR vendors to make this an easier process for Stage 2 Meaningful Use. Remember EHRs certified under Stage 1 did not have to provide an accounting feature, but this feature will be required for later Stages. Third, providers are up in arms about this expansive right(s) and some softening may occur although it is unlikely to be completely re-
moved. A lawsuit may be filed about the constitutionality of the right to an access report. Fourth, the proposed rule identifies explicitly the seven (7) categories of disclosures that must be listed in an accounting. Interestingly, these do not appear to include dis-closures for TPO. Finally, the govern-ment is soliciting your comments on or before August 1, 2011 about the NPRM. What you say about how this will impact you and your practice (positively or negatively) helps OCR make the final rule more palatable.
To review the notice of proposed rulemaking, go to OCR’s website: www.hhs.gov/ocr/privacy/index.html where you will find links to the May 31st NPRM and the related press release.
Editor’s note: These comments are not intended to establish an attorney-client relationship and are not intended to be legal advice.
24| JULY 2011
We all know that our health care system is
failing individuals and communities across the United States, but how can we begin to change it? Before stepping into the current politi-cal battlegrounds over health care, understand-ing global health care structures can provide an educational founda-tion to build upon in order to address our cur-rent health care crisis.
“The Healing of Amer-ica: A Quest for Bet-ter, Cheaper and Fairer Health Care” by T.R. Reid looks at other health care models around the world from France and Germa-ny to Japan and Canada.
T.R. Reid then dives right into the United States health care crisis with an example of a young woman who dies from a curable illness, but who was unable to work and therefore denied the health care she needed. Providing many statistics, Reid reports that over twenty thousand Americans die each year because they cannot afford health care costs.
nation’s health care crisis, the benefits and drawbacks of other health care models and questions we should all be putting forth, whether we are physicians, administrators, or individuals.
We learn that the United States has one of the high-est infant mortality rates in the world, and that as leader in the industrialized world, our health care systems time and time again rates as one of the worst. In fact, it was shocking to learn that “the average American can expect a shorter life than people in relatively poor countries like Jordan.”
This implores the question, are other health care models any better? T.R. Reid dissects four different models- The Bismark Model (Germany, Japan, Belgium, Switzerland
and Latin America), The Beveridge Model (Great Britain, Italy, Spain and Scandinavia), The National
Health Insurance Model (Canada) and The Out-of-
Pocket Model (Africa, Cambo-dia, India and Egypt) providing an
overview, historical references, benefits as well drawbacks and comparisons to the US healthcare system.
In looking at these four models,
Inter-weaving personal accounts of visiting doctors across the world, global statistics and historical details on four different health care models, the reader gathers a wealth of knowl-edge about the current state of the
The Healing of America: A Quest for Better, Cheaper and Fairer Health Care
your practice
Review by Megan M. Cutter
Photo by Courtney Flaherty
MEDMONTHLY.COM | 25
T.R. Reid evaluates quality, cost, choice and effectiveness, in addition to comparing them to the American health care system. T.R. Reid dispels many myths about other global heath care models including socialized heath care, rationed care, bureaucracy within systems or that these systems are just too foreign to be used within the US.
T.R. Reid also mentions the com-
bination of systems that we use in the United States citing veteran, military, and Native America as a British model; senior care as being similar to the Canadian model; working individuals who receive insurance through their employers as similar to Germany or Japan; and the millions of individuals who pay out of pocket because they
have no insurance coverage.“The Healing of America: A Quest
for Better, Cheaper and Fairer Health Care” breaks down what a unified health care system would look like and what universal coverage would mean. Though he only touches on the recent changes in health care reform from 2010, the reader will understand why it is so difficult to change.
Instead of finding the jumbled and
confused argument slanted toward a politician’s agenda, readers will come away with a clear and focused over-view to create their own perspective with questions to take beyond the pages of the book.
While T.R. Reid is unable to give concrete steps that physicians, health care administrators, organizations or
even individuals in the community can make in their everyday decisions, “The Healing of America: A Quest for Better, Cheaper and Fairer Health Care” provides concrete information that every health care organization should grasp in order to ask questions that can move the nation’s health care system in the right direction.
Health care providers and admin-istrators can see why individuals walk
into their offices frustrated or why individuals must wait until their illness becomes an acute crisis to seek help. Understanding the systemic problem gives recognition to the many facets of the health care system, so that whether you are a large health care facility or a private doctor’s office, you can provide the best care to your clients.
Reid reports that over twenty thousand Americans die each year because they cannot afford health care costs.
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A Mural, created by volunteers now decorates the children’s ward of the Nicaraguan facility.Photos courtesy Dr. Kobs.
feature
MEDMONTHLY.COM | 27
By Alice Osborn
28 | JULY 2011
them technology upgrades and start an anesthesia program, which goes down twice a year.”
At this teaching hospital there are residents and attending surgeons so when the COAN team performs surgery there’s always follow-up care. The U.S. doctors train Leon doctors and expect their skills to improve after each subsequent visit. Because of the regular visits, the hospital knows when the American team is coming back. “We’re getting the right patients to the right surgeons,” remarks Kobs. “I’ll see 20-30 patients during the clinic on Sunday, our first day, for broken bones, club foot, shoulders, and knees. I also perform a lot of tertiary orthopedics where patients had a fracture and it wasn’t treated right and I have put it back together.”
There are a few challengesChallenges to serving the residents
of Leon for orthopedic care include the language barrier, the lack of equip-ment, and education.
To overcome mis-communications, Christina Dees, of Carolina Beach, North Carolina, was the group’s liaison with the Nicaraguan gov-ernment and the team of doctors. Using her business background and fluen-cy in Spanish she served as the COAN team’s translator, bookkeeper, webmaster and fund-raising coordinator for many years. She also found a way others could contribute to the hospital’s needs by raising money to paint a mural in the pediatric ward, improving the nurse’s station and installing ceiling fans. Dees and her husband also started a grant program for participants so the cost of $1500 per trip would be lessened. Now on maternity leave, she says, “It was
my dream job,” and that Dr. Kobs was wonderful to work with.
Dees continues, “Working with COAN, its doctors, and volunteers, has given me unique life experiences I will forever remember as vividly as the day I saw them. I traveled the country of Nicaragua with doctors Bob Caudle and Ed Campion, seeking out new hospitals that needed our help. It didn’t matter to them that these places had no state-of-the-art operating rooms or fancy equipment; what mattered was that there were people who just needed treatment, some who needed life changing surgeries. Simple treatments and supplies weren’t affordable or available. Seeing the love and passion the COAN doctors have for helping others is truly addictive. It is a dedica-tion that changes people’s lives forever. That same contagious passion can be seen in the volunteers of COAN. Volunteers like nurses and lay people who selflessly give up their vacation time each year to go and change lives
no matter what the cost.”Dr. Kobs adds, “We’ve taken infrastructure mis-
sions, with three in Jan-uary where we took laypeople to paint, fix sinks and toilets; to help the hospital do what it won’t do for themselves, since this
is sometimes a last priority for the hospital.
It makes a big difference for the staff and doctors.”
“When something breaks, they don’t have any money to fix it. So they put in a governmental request and they don’t get to it that fast,” Kobs says. In order to stretch the COAN equip-ment budget, medical reps give COAN implants and sometimes COAN receives grants and supply donations from medical equipment companies. “When we first started going our drills came from Sears to use in the OR and were very hard to keep sterile, but now
It’s been said that serving others through your passion can lead to health, happiness and abundance. If this is true then Dr. Jeffrey K. Kobs, the president of COAN (Cooper-
ación Ortopédica Americano Nica-rgüense) is a very wealthy man indeed. Since 1993 Kobs has practiced at Raleigh Orthopedic Clinic, in Raleigh, North Carolina, his “day job” while volunteering for COAN, a not-for-profit organization committed to opti-mizing the orthopedic health care and well-being of the Nicaraguan people. “I get more out of it sometimes than they do. I have friends down there so going down and working with colleagues in a different country who really need the help is extremely rewarding,” says Kobs. “It’s its own reward. I see pa-tients who are so incredibly apprecia-tive and they know that if we weren’t there they may not get any care. We’re preventing poverty.”
Nicaragua is the second poorest country in the Western Hemisphere af-ter Haiti. COAN’s patient base is made up of low-income people, mainly fami-lies and children, who need emergency treatment and longer term orthopedic care. “We are trying to change the or-thopedics of Leon and then hopefully all of Nicaragua over time and we’re starting to make some headway,” says Kobs.
Founded in 2002, with the help of Robert Pontz, the vice president and managing partner of Progress USA, Inc., COAN is a group of orthopedic doctors comprising of all different practices that travel four times a year in January, April, July and October to the Heodora teaching hospital in León for one week at a time. The team leaves on a Saturday and returns on the fol-lowing Saturday.
However, in COAN’s first year the doctors only visited one week in a year. Kobs remarked that there wasn’t enough impact and COAN couldn’t keep the hospital supplied. “We wanted to do more educational support, give
MEDMONTHLY.COM | 29
we have battery-powered regular OR grade drills.”
COAN also brings English to the hospital. Two times a week COAN pays for an English teacher to give a lesson for the residents and attend-ings for an hour and a half. “All of the orthopedic literature that’s worth anything at all is in English,” Kobs states. “The same applies with papers in that the paper needs to be English and most of the published data is in English.” Monday through Friday the COAN team works in the OR and then in the morning they conduct lectures. One day of that week the residents are expected to give the COAN team lectures in English. At first there wasn’t any place for the orthopedic team to meet. “There was one room that was too hot so what we did we spent $2,000 to fix up a storage space on the roof that includes A/C and a library. That’s where we give our talks and lectures and the entire department can fit there. We have them set up with the Internet too,” Kobs adds.
Another challenge is that the hos-
pital doesn’t have enough of the right equipment or they use older methods that American orthopedists abandoned sixty years ago. “We’re working very hard at getting people out of traction,” states Kobs. He continues that he used to see a bunch of patients up on trac-tion in open, common wards with tibia and femur fractures. Of course their leg fractures could not heal properly. To solve this problem, Kobs involved the help of Dr. Lou Zirkle of Richland, Washington, who runs a program called SIGN (Surgical Implant Gen-eration Network) that provides rods (which are orthopedic implants that heal fractures) to underdeveloped na-tions. COAN bought $25,000 worth of rods and took them down on a mis-sion to teach the residents how to do the rodding. “We don’t see people in traction anymore because of the rods,” Kobs remarks. “They do substandard work by our standards because they don’t have the right equipment and the other part is that they don’t know the exact right way to treat patients. Learning is gained through repeti-
tion and they’re not learning proper methods because they’re not trained.” He says that American doctors learned in the last century to rod and clean the wound the same day and not put the patient up in traction. In contrast, Nicaraguan doctors have been trained that patients must remain in traction until the skin closes.
Sometimes the innovation that’s inexpensive can save lives. Take the case of healing open wounds with a wound V.A.C. (Vacuum Assisted Closure) costing $10,000. Rising to the challenge, the longtime fish owner made his own wound V.A.C. out of an aquarium aerator pump for $35 and dubbed it the “Turtle” or officially, the Negative Pressure Wound Therapy System. It helps extract the fluid from the wound using pressure and tubing so doctors can stitch the skin on both sides. “You can do this procedure at the bedside and not in the OR. It took a year for me to develop and I want to make it open source so it’s more read-ily available. In Leon we’ve used it on two patients so far and I want to make as many as I can for the next trip,” Kobs describes.
What’s next for COAN?Right now Dr. Kobs and his team are
busy working on fundraising, enroll-ing more members, building awareness and preparing for the next mission. Through his and COAN’s efforts, men are back at work providing for their families after a broken leg, a boy with club foot can walk again and Leon’s hospital’s residents practice what they learned in the far reaches of Nicaragua.
Kobs often tells his Nicaraguan colleagues, “You do have what you need and you should perform surger-ies in the more modern way. You have to believe in yourselves and do it the right way.” He adds, “We all want these techniques to migrate from Leon and spread to the rest of the country.” With his determination, generosity and lead-ership this wish will become a reality.
30 | JULY 2011
feature
Medical school takes a vacationThe Caribbean isn’t just for vacation anymore. From Ross University to the American University of the Caribbean, now you can find quality medical schools in paradise.
By George Cox
Medical school takes a vacation
Not a bad place to study. St. George’s, Grenada is home to St. George’s University.
Courtesy iStockphoto.com
32 | JULY 2011
Popular for its vacation hotspots, the Caribbean also offers excellent opportunities for medical students desiring an affordable alternative to
universities in the United States. Since St. George’s University, the first Carib-bean medical school, was founded in 1977, sixty more medical schools have been founded throughout the islands. Schools like the American University of the Caribbean in St. Maarten, Ross University in Dominica, West Indies, and others are dedicated to chal-lenging prospective students as they build a secure foundation in medical scholarship. Qualified students at-tending these schools will develop high standards of professionalism and proficiency in their medical specialty, paving the way to an invaluable career
in public health care.However, some medical profes-
sionals claim that Caribbean medical schools have too easy entrance require-ments and less than rigorous curricula to adequately prepare graduates to become quality physicians. Further-more, low tuition could suggest poor or inadequate facilities, substandard laboratories, and insufficient clinical research opportunities. Critics also argue that Caribbean graduates prac-ticing in U.S. hospitals may not be taken too seriously by their American-educated colleagues. Ultimately, these critics suggest that the medical schools of the Caribbean are nothing more than a secondary choice for students who failed the entrance requirements for U.S. medical schools.
While some of these naysayers may have legitimate points, prospective medical students considering a Carib-bean school should take a closer look at some of the more reputable ones be-fore making an informed choice. Many physicians from Caribbean schools are practicing medicine successfully in the
United States, making wonderful con-tributions to the healthcare industry.
American University of the Caribbean in St. Maarten
Located on the magnificent island of St. Maarten, American University of the Caribbean (AUC) was founded with one simple goal—to produce “vision-ary, skilled, compassionate doctors.” The AUC campus overlooks Simpson Bay Lagoon and allows students access to a variety of spectacular beaches and island activities like diving, sailing, golf, and shopping. First class restaurants and live entertainment enhance stu-dents’ living experience.
Academically, the school maintains state of the art facilities, ultra-modern classrooms and laboratories, a virtual
imaging anatomy lab, and a techno-logically advanced medical library. Students develop skills through challenging instruction and meticu-lous training from an experienced faculty pool of over 500 dedicated physicians, scientists, teachers, and scholars. Since its founding in 1978, AUC has graduated more than 4,000 fully licensed physicians who practice medicine in many different countries around the world.
Fully accredited by the Accreditation Commission on Colleges of Medicine (ACCM), AUC models its curriculum after U.S. medical schools, providing students with five semesters of medical science training at the St. Maarten cam-pus before clinical studies at hospitals in the U.S. and England. To be considered for enrollment, entering students must have a baccalaureate degree from an accredited university and have recently passed the MCAT. Tuition and fees range from $32,000 to $34,400 for the first year, with living expenses vary-ing from $10,000 to $14,000 per year.
Compared to the first-year tuition and living costs at some U.S. schools, such as Harvard Medical School ($66,000) and East Carolina Medical School ($31,889), AUC’s fees are definitely very competitive.
Spacious on-campus dormito-ries feature fully equipped kitchens, air conditioning, and cable TV and Internet availability. Of course, stu-dents and families may opt to enjoy these amenities in a more tranquil residence in one of the nearby towns, such as Beacon Hill, Pelican Key, and Simpson Bay.
Campus organizations at AUC include Alpha Omega Phi (Honor and Service Society), the American Medi-cal Student Association (AMSA), and the Student National Medical Associa-tion (SNMA). Other campus groups
include religious-oriented organiza-tions as well as a Student Government and a Diversity Council.
Modern learning facilities housed in a culturally diverse environment give AUC students an unsurpassed educational experience at an afford-able price.
Ross University in DominicaNestled on the mountainous volca-
nic island of Dominica, Ross Universi-ty offers students a solid foundation in medical training in a classical Carib-bean environment. The entire campus is wireless, with high-quality multime-dia technology in the classrooms and laboratories, a comprehensive modern library, and two Learning Resource Centers.
Enthusiastic students benefit from the advanced facilities and dedicated faculty, acquiring the quality foun-dation in medical science necessary for the required clinical rotations at affiliated U.S. teaching hospitals. In its thirty years of committed service,
When not in class, students have access to a campus fitness center and sport fields for soccer, football, tennis, and volleyball.
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For more information about these schools, visit their websites:
American University of the Caribbean aucmed.edu/
Ross University rossu.edu
St. George’s University sgu.edu/
St. James University at Bonaire bonaire.sjsm.org/
34| JULY 2011
Ross University has graduated over 7,700 students, with over 600 physicians successfully placed in U.S. residencies. Many Ross graduates have specialized in various areas of medicine, includ-ing invasive cardiology, endocrinology, geriatric medicine, plastic surgery, and oncology. Whether Ross graduates go into private practice or research, they are among the most diverse and successful medical professionals in the world.
A 2006 graduate of Ross, Dr. Challie Minton says the university gave him the “opportunity to get into school quickly, and get into a residency program” that allowed him to “become a highly respected physician in North Carolina.” A U.S. Navy Corpsman, Dr. Minton was a bit older than a typical medical student in the U.S., but at Ross he met other Corpsmen and Army medics who “were over thirty years old and had at least 5-10 years medical experi-ence.” Many of his colleagues have been accepted into top residencies programs and Fellowships across the country, including Sylvia Marcos M.D., a Ross graduate who was the Chief Resident at Kings County Hospital in Brooklyn, New York, one of the top Internal Medi-cine programs in the country.
Students must meet standard ac-ceptance requirements and be finan-cially prepared for entrance in to Ross. According to the school’s published tuition rate for the 2010-2011 academic year, each Basic Science semester costs $15,600, with the each semester of Clinical Sciences averag-ing $17,500. Financial assistance is available through governmental and private loans.
When not in class, students have access to a campus fitness center and sport fields for soccer, football, ten-nis, and volleyball. Brimming with a rich, diverse culture, Dominica offers a variety of outdoor activities for residents, including hiking, scuba diving, and snorkeling in the eastern Caribbean. To pay for these activities, students may have to exchange their currency for Eastern Caribbean (EC)
currency; however, most businesses accept the U.S. dollar.
Whether from the United States, Canada, or anywhere in the world, incoming medical students to Ross University will gain access to a superb teaching facility, highly accredited teachers and researchers, and an island paradise they will love to call home. Dr. Challie Minton credits Ross with his success as a physician, from the opportunity “to rotate at great hospitals across the country to finishing as a visiting student at Duke University and passing with honors.”
Final WordWhile the Caribbean hosts high
quality, affordable medical schools, a student must do adequate research before making an informed decision. While the school’s location may be exotic and tempting, its U.S. accredita-tion, rigorous course work, and acces-sibility to prestigious research clinics should be significant factors in a pro-spective student’s decision to attend.
If the goal is to practice at a particu-lar U.S. hospital, students would be wise to do a little homework first. Be-fore applying to the Caribbean school of their choice, students should find out if the school in question is accred-ited by the LCME (Liaison Committee
on Medical Education which accredits medical schools in the United States). They should be aware that in order for them to do rotations in hospitals in the U.S. that the individual school must first be reviewed and approved by some licensing boards, especially in California, Florida, New Jersey, and New York.
Students should know when was the school established, its percentage of students that are U.S. citizens, and the credentials of its faculty. Student’s premed advisors should provide good information about the advantages and disadvantages of attending a particu-lar Caribbean medical school. Finally, students must research the school’s accreditation, ultimately choosing the school with the most rigorous curriculum and access to the most prestigious clinics for rotations.
While medical schools in the Carib-bean present a viable alternative to the U.S based institutions, serious students should be able to narrow down the op-timum candidates. Performing a little research and asking the right questions will help them make the best choice to start their career in the medical field.
Other reputable medical schools in the Caribbean include St James in Bonaire and St. George’s University in Grenada.
READY TO ENROLL?
MEDMONTHLY.COM | 35
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MAYO ONE & DONE The Mayo Clinic’s Mayo One
helicopter has to beat the clock to save lives.
By Marie Zhuikov
Christoper Russi, D.O., is an emergency medicine specialist and chair of Mayo’s emergency medical services research committee.
All photos courtesy Mayo Clinic
feature
MEDMONTHLY.COM | 37
38 | JULY 2011
Medical helicopter trans-port has become much more. Thanks to research and rigorous training,
the Mayo One staff delivers state-of-the-art care as soon as they reach patients.
A tour bus veers out of control across an Interstate highway in south-ern Minnesota, rolling on its side, injuring and trapping passengers. Moments later a school bus collides with another vehicle, sliding off a state highway.
Kathy Berns storyIt was a busy evening for the crews
of Mayo One. The pilot, flight nurse and flight paramedic land in fields or roadways to get as close as they safely can to patients. It’s emergency trans-portation, yes, but Mayo One is also a modern medical care delivery system. This means treatment begins the mo-ment the team in the blue flight suits reaches patients.
“The situations you encounter in emergency services are exciting, but also gratifying,” says Kathy Berns, a certified Clinical Nurse Specialist and flight nurse with Mayo One. “You make a difference for people during the worst day of their life.”
Mayo flight crews also make a dif-ference because they are constantly improving, through training, and also through research in this specialty environment.
Shock in the SkyMayo Clinic conducts research to
ensure its patients are getting the best care anywhere and that includes at 2,500 feet in the air. Even in the ex-treme conditions Mayo One encoun-ters, flight crews are doing scientific research for the same reason.
Take shock, for instance.Medical shock is a life-threatening
emergency in itself, and one of the
most common causes of death for the critically ill because it may lead to a lack of oxygen in arterial blood or multi-system organ failure. Determin-ing what type of shock a patient is experiencing can save their life. Mayo One crews often see patients before the classic signs occur. “The ability to recognize shock can be elusive,” says Christopher Russi, D.O., emer-gency medicine specialist and chair of Mayo’s emergency medical services (EMS) research committee.
The National Institutes of Health is funding a Mayo study on flight crews’ ability to assess medical shock and its impact on patient care. As with many of the EMS and Mayo One research projects, this one studies patient care delivered by the crew. Other projects involve review of the medical record or hospital outcomes. Few of these research projects involve traditional clinical studies because it is challeng-ing to obtain patient consent at the time of transport, says Dr. Russi.
Through part of his role, Dr. Russi develops educational programs to help improve the diagnosis of shock by flight teams and to evaluate the program’s effectiveness. Dr. Russi describes the four types of shock as falling along a spectrum:
Hypovolemic shock is most often due to blood loss or dehydration.
Cardiogenic shock is caused by a heart attack or congestive heart failure.
Obstructive shock occurs when the ability of the heart to pump blood is restricted. This could be due to a heart attack or severely collapsed lung.
Distributive shock happens when there’s been a spinal cord injury or from overwhelming infection (sepsis). The blood vessels lose their tone and circulation stops.
A related project of Dr. Russi’s investigates the effectiveness of a non-invasive tissue oxygen monitor to detect the first stages of hypovole-
mic shock. The tissue oxygen moni-tor, called an InSpectra StO2 Tissue Oxygenation Monitor developed by Hutchinson Technology Inc. uses a sensor that fits in a patient’s hand. The sensor emits four beams of near infrared light to test the underlying muscle tissue for oxygen saturation. The InSpectra monitor detects low oxygen levels before the classic signs and symptoms of shock manifest. Dr. Russi is looking at the feasibility of using the monitor in a helicopter environment and hopes to develop treatments correlating to the StO2 values in future studies.
Dr. Russi finds research in the EMS field particularly satisfying. “There are a lot of questions left to ask and dogma to refute. I like to design a way to find answers. If you can gain better outcomes for patients, that’s number one.”
OTHER MAYO ONE RESEARCH Evaluating effectiveness of Airtraq optical device, which uses prisms and mirrors to help proper placement of breathing tubes
Study on ventilator masks significantly decreased necessary intubation rates, improved patient comfort, reduced complications and shortened hospital stays
Retrospective records study helped improve venti-lator settings by crew members
Mayo One crews obtained patient blood samples to help better identify those who may develop blood clots
Improving Patient Outcomes
Two other Mayo One studies have already improved emergency care for patients. They involve changing how helicopters are dispatched to a scene and what equipment they carry. Helicopters were previously dis-patched only after an ambulance crew or law enforcement had arrived and deemed it necessary. Now at Mayo, that decision is in the hands of the 911 dispatchers. That practice is called Autolaunch.
“When a call comes into a dis-patch center, the dispatcher sends the helicopter at the same time as the ambulance,” says Berns. “This can save 10 to 15 minutes, which is vital for a victim in an emergency.” The dis-patcher considers key medical criteria, the situation at the scene of injury and the likelihood of serious injuries. Examples include vehicle rollovers, head-on collisions, pedestrian-vehicle accidents, and other major sources of trauma.
Shortening the time it takes to get a helicopter launched means quicker medical response at the patient’s side and earlier arrival at the trauma cen-ter. Berns says their research demon-strates that Autolaunch saves lives and improves patient outcomes. The Mayo One findings were published in Air Medical Journal in 2002 and were later presented at the Aeromedical World Congress in Norway and Switzerland. The study has also been shared at sev-eral venues across the United States.
Few emergency helicopter services carry blood for en route transfusion, and even fewer carry both blood and plasma. Administering blood during transport can be critical to avoiding complications from shock. Mayo One conducted research on the feasibility of having blood on board and those findings were published as early as 1998 in the Air Medical Journal and
presented at several conferences in Austria and Germany in addition to the U.S. All Mayo One helicopters are equipped to carry blood, and the Mayo One aircraft in Rochester also carries plasma. Research on the ben-efits of carrying plasma is currently being conducted. The helicopters are also equipped with special warming compartments for saline solution and other fluids.
Seeing at NightFlight nurse Jeffrey Stearns is based
at Eau Claire, Wis., but his research efforts are impacting care and safety throughout Mayo One’s five-state flight area.
“Let’s say it’s a new moon night and you’re descending into a landing zone,” Stearns says. “What you see are flashes of red and blue, but even
with our landing lights on, around that scene it’s a black hole. Are there trees? Where are the tree lines? Are there telephone poles or power poles with lines? All those are potential obstacles.”
In 2006, Mayo became only the third civilian air medical service in the country to have all crew members use night vision goggles on all flights at night.
By wearing night vision goggles, crews can see objects nearly as though it were daylight, says Stearns. Stearns and Mayo Clinic’s transport division have also been involved in discussions with the Federal Aviation Administra-tion and the National Transportation Safety Board on how the entire air medical transport industry can pro-vide the highest amount of safety.
“From our viewpoint, it’s hard to
MEDMONTHLY.COM | 39
imagine working without night vi-sion goggles. They’re a critical piece of equipment for safety,” Stearns says. He’s awaiting word on a research grant designed to collect data on the safety benefits of night vision goggles. Stea-rns plans to work with Fort McCoy in Sparta, Wis., to use their multi-pur-pose flight operations area to create different landing zone situations.
“We’ll film them with one camera us-ing a night vision goggle and one cam-era without,” Stearns says. “We’ll test our crews on the landing zones and, us-ing simple geometry, calculate the time to obstacle avoidance on a standard rate of descent. We’ll be able to quantify the difference between aided and unaided night vision for the emergency medical
transport environment.”Jeff Stearns was recently named
International Medical Crew Member of the Year by the Association of Air Medical Services for his work to pro-mote the improvement of patient care in the emergency medical transport community.
Coordinating EMS Research
Dr. Russi oversees all these studies and assists anyone who wants to con-duct EMS research projects. Research coordinator, Luke Myers, a registered paramedic, is also a vital committee member. He assists with data entry and reports outcomes. Myers says the
group logged 17 publications last year involving research conducted through Mayo Clinic Medical Transport, which includes the four Mayo One helicop-ters, Mayo MedAir jet ambulance and Gold Cross ground ambulance.
“The field of EMS is relatively new,” says Myers. “It started in the 1960s. Most of the information available is hospital-based research, but we are developing our own knowledge base now for emergency transport.”
Stearns adds, “Mayo gives us the ability to conduct research and the tools needed to help a patient that are far beyond what other helicopter services can provide. Mayo does it right. Not everyone has Mayo Clinic’s standards for quality and value.”
Cancer took my dad Michael Landon’s life when I was only 8.
Today we know a lot about preventing this disease. If you
smoke, quit. Eat more vegetables, fruits, and vegetarian meals.
These steps are powerful - for you and your whole family.
- Jennifer Landon
To download a free PDF of The Cancer Survivor’s Guide: Foods that Help You Fight Back, a nutrition guide with more than a hundred cancer-fighting recipes, visit
www.CancerProject.org/Guide
Cancer robbed my family.Please protect yours.
A crew from Mayo One.
40 | JULY 2011
Cancer took my dad Michael Landon’s life when I was only 8.
Today we know a lot about preventing this disease. If you
smoke, quit. Eat more vegetables, fruits, and vegetarian meals.
These steps are powerful - for you and your whole family.
- Jennifer Landon
To download a free PDF of The Cancer Survivor’s Guide: Foods that Help You Fight Back, a nutrition guide with more than a hundred cancer-fighting recipes, visit
www.CancerProject.org/Guide
Cancer robbed my family.Please protect yours.
healthy living
42| JULY 2011
What do clean houses have in common with child-hood infections?
One of the many ex-planations for asthma being the most common chronic disease in the devel-oped world is the “hygiene hypoth-esis.” This hypothesis suggests that the critical post-natal period of immune response is derailed by the extremely clean household environments often found in the developed world. In other words, the young child’s envi-ronment can be “too clean” to pose an effective challenge to a maturing immune system.
According to the “hygiene hypoth-esis,” the problem with extremely clean environments is that they fail to provide the necessary exposure to germs required to “educate” the immune system so it can learn to launch its defense responses to infec-tious organisms. Instead, its defense responses end up being so inadequate that they actually contribute to the development of asthma.
Scientists based this hypothesis in part on the observation that, before birth, the fetal immune system’s “de-fault setting” is suppressed to prevent it from rejecting maternal tissue. Such a low default setting is neces-sary before birth—when the mother is providing the fetus with her own anti-bodies. But in the period immediately after birth the child’s own immune system must take over and learn how to fend for itself.
The “hygiene hypothesis” is sup-ported by epidemiologic studies dem-onstrating that allergic diseases and asthma are more likely to occur when the incidence and levels of endotoxin (bacterial lipopolysaccharide, or LPS) in the home are low. LPS is a bacterial molecule that stimulates and educates the immune system by triggering signals through a molecular “switch” called TLR4, which is found on cer-tain immune system cells.
The science behind the hygiene hypothesis
The Inflammatory Mechanisms Section of the Laboratory of Immu-
nobiochemistry is working to better understand the hygiene hypothesis, by looking at the relationship be-tween respiratory viruses and allergic diseases and asthma, and by studying the respiratory syncytial virus (RSV) in particular.
What does RSV have to do with the hygiene hypothesis?
RSV is often the first viral pathogen encountered by infants.
RSV pneumonia puts infants at higher risk for developing childhood asthma. (Although children may outgrow this type of asthma, it can account for clinic visits and missed school days.)
Are cleaner homes giving us asthma?
Asthma: The Hygiene Hypothesis
By Ronald Rabin, MD
Do clean enviroments provide enough exposure to germs?
RSV carries a molecule on its sur-face called the F protein, which flips the same immune system “switch” (TLR4) as do bacterial endotoxins.
It may seem obvious that, since both the RSV F protein and LPS sig-nal through the same TLR4 “switch,” they both would educate the infant’s immune system in the same beneficial way. But that may not be the case.
The large population of bacteria that normally lives inside humans educates the growing immune system to respond using the TLR4 switch. When this education is lacking or weak, the response to RSV by some critical cells in the immune system’s defense against infections—called “T-cells”—might inadvertently trig-ger asthma instead of protecting the infant and clearing the infection. How this happens is a mystery that we are trying to solve.
In order to determine RSV’s role in triggering asthma, our laboratory studied how RSV blocks T-cell prolif-eration.
Studying the effect of RSV on T-cells in the laboratory, however, has been very difficult. That’s be-cause when RSV is put into the same culture as T-cells, it blocks them from multiplying as they would naturally do when they are stimulated. To get past this problem, most researchers kill RSV with ultraviolet light before adding the virus to T-cell cultures. However we did not have the option of killing the RSV because that would have prevented us from determining the virus’s role in triggering asthma.
Our first major discovery was that RSV causes the release from certain immune system cells of signaling molecules called Type I and Type III interferons that can suppress T-cell proliferation (Journal of Virology 80:5032-5040; 2006).
ConclusionThe hygiene hypothesis suggests
that a newborn baby’s immune system
must be educated so it will function properly during infancy and the rest of life. One of the key elements of this education is a switch on T cells called TLR4. The bacterial protein LPS nor-mally plays a key role by flipping that switch into the “on” position.
Prior research suggested that since RSV flips the TLR4 switch, RSV should “educate” the child’s immune system to defend against infections just like LPS does.
But it turns out that RSV does not flip the TLR switch in the same way as LPS. This difference in switching on TLR, combined with other char-acteristics of RSV, can prevent proper education of the immune system.
One difference in the way that RSV flips the TLR4 switch may be through the release of interferons, which suppresses the proliferation of T-cells. We still do not know whether these interferons are part of the rea-son the immune system is not prop-erly educated or simply an indicator of the problem. Therefore, we plan to continue our studies about how RSV can contribute to the development of asthma according to the hygiene hypothesis.
Further researchThis finding that Type I and Type
III interferons can mediate the sup-pression of T-cells caused by RSV generated two significant questions that our laboratory is now addressing:
Interferons are important mol-ecules that enhance inflammation, so why—in the context of RSV—do they suppress T-cells?
Interferons are clearly not the only way RSV suppresses T-cells. What are the other mechanisms that may depend upon T-cells coming in direct contact and communicating with other immune cells?
Finally! A prescription with side effects you want.
Blueberries and red beans are powerful remedies against cancer. Research shows that fruits, vegetables, and other low-fat vegetarian foods may help prevent cancer and improve survival rates. A plant-based diet can also lower cholesterol.
For a free nutrition booklet with cancer fighting recipes, call toll-free 1-866-906-WELL or visit www.CancerProject.org
Article reprinted courtesy of the US Food and Drug Administration
MEDMONTHLY.COM | 43
the kitchen
Summer is all about enjoying nature at its finest. On a sunny afternoon or a warm, starlit evening, a grilling get-together
is the perfect way to celebrate both the beauty of the season and the bounty of fresh foods that it brings.
Building a gourmet menu doesn’t mean that you’ll have to spend hours in the kitchen preparing before guests arrive. By keeping the menu simple and focused on the foods and flavors that are perfectly in season, you can showcase what makes summer special without sacrificing time spent with your guests.
When it comes to the ingredients you’ll use, take a sustainable approach by visiting local farmers markets or your own garden plot, if you have one. It’s important to remember that ingredients other than vegetables can still be sustainable and environmen-tally friendly. Blue cheese varieties from Salemville, for instance, are rBGH free, contain no preservatives or chemical additives, and are sustain-ably produced by an Amish commu-nity in Cambria, Wisc., where cows are hand-milked twice daily without the use of machines or electricity.
And since steak is the
perfect main dish for a grill-
ing get-together, look for steaks with labels with identifying information, letting you know that it is grass-fed or pasture-raised.
Plan on serving at least four dishes: a salad, a side, a main dish and a dessert. A green salad topped with rich blue cheese and herb dressing is a wonderful, fresh start to the meal. Follow it with a side dish of seasonal vegetables and cheese-topped steak. Depending on the vegetable you
choose, it’s possible to prepare both your side and main dishes on the grill, allowing you to spend more time out-side with your guests. Complete the meal with a sweet treat of ripe sum-mer fruits baked into a rustic French galette or tossed with fresh mint as a topping for a light sorbet.
Try these recipes for your salad and steak courses and you’ll be prepar-ing sustainable dishes that perfectly capture the essence of summer. For more recipes and grilling tips, visit salemville.com.
Gourmet, simple,
sustainableA meal perfect for
summer entertaining
44| JULY 2011
Article reprinted courtesy ARA content
Steak with Gorgonzola Thyme Crust
INGREDIENTS:
2 teaspoons Worcestershire sauce 2 beef tenderloin or small rib eye steaks (about 6 ounces each), cut 3/4-inch thick
Blue Cheese Salad with Blue Cheese Dressing
INGREDIENTS:
Dressing:1/2 cup plain nonfat yogurt1/4 cup skim milk1/2 cup green onions (including green tops), thinly sliced1/4 cup Salemville Amish Blue or Salemville Smokehaus Blue cheese, crumbled1/2 clove garlic, pressed1/4 teaspoon basil 1/4 teaspoon rosemary, crushedDash salt, to taste
Salad:1 large head iceberg lettuce 6 slices thick-cut bacon1 cup Salemville Amish Blue or Smokehaus Blue cheese, crumbledBlack pepper, to tasteChopped pears, walnuts, red onion and/or tomatoes, to taste
DIRECTIONS:
In small bowl, stir together yogurt and milk. Mix in onions, cheese, garlic, herbs and salt. Cover and chill 30 minutes or more to blend flavors.
Cook bacon until crisp and crum-ble into large pieces. Cut lettuce into four to six wedges. Pour blue cheese dressing over the top. Sprin-kle bacon over dressing. Add ad-ditional crumbled cheese, freshly ground black pepper, chopped pears, walnuts, red onion and/or tomatoes, if desired. Makes four servings.
1 large or 2 small cloves garlic, minced 1/4 teaspoon freshly ground black pepper2 teaspoons fresh thyme, chopped, or 1/2 teaspoon dried thyme 1/2 cup Salemville Amish Gorgon-zola cheese, crumbled
DIRECTIONS:
Preheat broiler. Spoon Worcester-shire sauce over both sides of the steaks and let stand five minutes. Sprinkle garlic and pepper over steaks.
Place steaks on rack or broiler pan. Broil 3 to 4 inches from heat source three to four minutes per side for medium rare steak.
Remove pan from broiler. Sprinkle thyme, then cheese over steaks. Return to oven and broil two min-utes, or until the cheese is golden brown.
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BENEFITS OF ROTHMAN INDEX
Rapid Response Surveillance
Improved Continuity of Care
Acuity Staffing
Physician Rounding
Earlier Alerts
Quality of Care
Readmission Risk Management
For Information Call (866) 362-0001
www.RothmanHealthcare.com
The Rothman Index utilizes existing EHR data to provide concise, timely and powerful insights into changes in a patient’s health. Vital signs, lab values and nursing assessments are
converted into a single score that reflects overall patient condition. The graphical interface provides at-a-glance oversight of multiple patients to aid clinical decision support and enable
early interventions.
Patient Graphs are Color-Coded based on Severity of Condition
Opportunities for
Earlier Intervention
MEDMONTHLY.COM |47
North Carolina
North Carolina (cont.)
the sales
Occupation Health Care Practice located in Greensboro, North Carolina has an immediate opening for a primary care physician. This is 40 hours per week opportunity with a base salary of $135,000 plus incentives, professional liability insurance provided and an excellent CME, vacation and sick leave package. Send copies of your CV, NC Medical License, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, E-mail: [email protected] Family Practice physician opportunity in Raleigh, North Carolina. This is a locum’s position with 3 to 4 shifts per week requirement that will last for several months. You must be BC/BE and comfort-able treating patients from 1 year of age to Geriatrics. You will be surrounded by an exceptional, experienced staff with beautiful offices and accommodations. No call or hospital rounds. Send copies of your CV, NC Medical License, DEA certificate and NPI certificate with number to Physician Solutions for immediate con-sideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, E-mail: [email protected]
Methadone Treatment Center located near Charlotte, North Carolina has an opening for an experienced physician. You must be comfortable in the evaluation and treatment within the guidelines of a highly regulated environment. Practice operating hours are 6:00 a.m. till 3:00 p.m. Monday through Friday. Send copies of your CV, NC Medical License, DEA certificate and NPI certificate with number to Physician Solu-tions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, E-mail: [email protected]
Family Practice physician is needed to cover several shifts per week in Rocky Mount, North Carolina. This high profile practice treats pediatrics, women’s health as well as primary care patients of all ages. If you are available for 30 plus hours per week for the remainder of the year, this could be the perfect opportunity. Send copies of your CV, NC Medi-cal License, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, E-mail: [email protected]
Cardiology practice located in High Point, North Carolina has an opening for a Board Certified Cardiovascular physi-cian. This established and beautiful facility offers the ideal setting for an enhanced life style. There is no hospital call or invasive procedures. Look into joining this 3 physician facility and live the good live in one of North Carolina’s most beauti-ful cities. Send copies of your CV, NC Medical License, DEA certificate and NPI certificate with number to Physician Solu-tions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, E-mail: [email protected]
Family Practice Physician needed for full time employment in established primary care practice in High Point, North Caro-lina. Salary with full benefits and production incentive for an energetic Board Certified FP. The ideal candidate can begin practicing as early as June 2011. Please send a copy of your current CV, North Carolina medical license, DEA certificate and NPI certificate with number along with your detailed work history and CME courses completed to; Physician Solutions, P.O. Box 98313, Raleigh, NC 27624. E-mail: [email protected] or phone with any questions, PH: (919) 845-0044.
Board Certified Internal Medicine Physician position is avail-able in the Greensboro, North Carolina area. This is an out-patient opportunity within a large established practice. The employment package contains salary plus incentives. Please send a copy of your current CV, North Carolina medi-cal license, DEA certificate and NPI certificate with number
Physicians needed
Physicians needed
To place a classified ad, call 919.747.9031
Classified
Pediatric UpdateJuly 11-14, 2011Kiawah Island, SC
Make plans to join us for our 34th Annual Pediatric Update Conference with topics including: Pediatric Gastroenterology, Lice and Bedbugs, Genetics for primary care, and a special presentation about how implementing patient-and family-centered care into your practice has been proven to improve the quality of care (MCG Health and the MCG Children’s Medical Center have been recognized as national leaders in Patient and Family Centered Care). Concurrent Breakout Ses-sions will return, with Dr Bill Lutin presenting his problem cases in pediatric cardiology, (with Dr Bill’s Rhythm Review) and Dr. Chris White’s always popular interactive “Rash Decisions”! We are also pleased to have Dr Jatinder Bhatia, Chair of the AAP Committee on Nutrition presenting “need-to-know” updates on nutrition. We will also continue to offer Breakfast Round-tables - small group discussions of problem cases, with each table led by one of our Faculty. Finally, we will have a whole morning dedicated to coding and reimbursement which will more than pay for itself in improving your practice’s bottom line. Visit our web site for additional conference information and on-line registration:http://www.georgiahealth.edu/ce/pedupdate2011.html
Seminars and CoursesSouth Carolina
BENEFITS OF ROTHMAN INDEX
Rapid Response Surveillance
Improved Continuity of Care
Acuity Staffing
Physician Rounding
Earlier Alerts
Quality of Care
Readmission Risk Management
For Information Call (866) 362-0001
www.RothmanHealthcare.com
The Rothman Index utilizes existing EHR data to provide concise, timely and powerful insights into changes in a patient’s health. Vital signs, lab values and nursing assessments are
converted into a single score that reflects overall patient condition. The graphical interface provides at-a-glance oversight of multiple patients to aid clinical decision support and enable
early interventions.
Patient Graphs are Color-Coded based on Severity of Condition
Opportunities for
Earlier Intervention
Research and technology articles
To place a classified ad, call 919.747.9031
Urgent Care opportunities throughout Virginia. We have con-tracts with numerous facilities and 8 to 14 hour shifts are avail-able. If you have experience treating patients from Pediatrics to Geriatrics, we welcome your inquires. Send copies of your CV, VA Medical License, DEA certificate and NPI certificate with number to Physician Solutions for immediate consider-ation. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, E-mail: [email protected] Pediatric Locums Physician needed in Harrisonburg, Danville and Lynchburg, Virginia. These locum positions require 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 immedi-ate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, E-mail: [email protected]
Virginia
Physicians needed Practice sales
IndianaPain Management Practice located in Indiana is now listed for sale. The main practice has been serving the community with two satellites located about 30 miles from the main practice. All three practices are being offered for $785,000 with the main practice building offered for $950,000. The two satellite practices being leased for a very reasonable monthly rent. If you are interested in a Pain Management practice that will generate impressive profits from month one, this could be your opportunity. Contact Medical Practice Listings at (919) 848-4202 for more information. View additional listings at; www.medi-calpracticelistings.com
North CarolinaImpressive Internal Medicine Practice in Durham, NC; The City of Medicine. Over 20 years serving the commu-nity, this practice is now listed for sale. There are 4 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 as-sist with a smooth transition. Contact Medical Practice Listings at (919) 848-4202 for more information. View ad-ditional listings at: www.medicalpracticelistings.com
Modern Vein Care Practice located in the mountains of North Carolina. Booking 7 to 10 procedures per day, you will find this impressive vein practice attractive in many ways. Housed in the same practice building with an Inter-nal 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 Prac-tice Listings at (919) 848-4202 for more information. View additional listings at: www.medicalpracticelistings.com
Family Practice located in Hickory, North Carolina. Well established and a solid 40 to 55 patients split between an MD and physician assistant. Experienced staff and outstanding medical equipment. Gross revenues aver-age $1,500,000 with strong profits. Monthly practice rent is only $3,000 and the utilities are very reasonable. The practice with all equipment, charts and good will are priced at $625,000. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or E-mail: [email protected]
Internal Medicine Practice located just outside Fayette-ville, North Carolina is now being offered. The owning physician is retiring and is willing to continue working
Classified
along with your detailed work history and CME courses com-pleted to; Physician Solutions, P.O. Box 98313, Raleigh, NC 27624. Email: [email protected] or phone with any questions, PH: (919) 845-0054.
Locum Tenens opportunity for Primary Care MD in the Triad Area, North Carolina. This is a 40 hour per week on-going assignment in a fast pace established practice. You must be comfortable treating pediatrics to geriatrics. We pay top wage, provide professional liability insurance, lodging when necessary, mileage and exceptional opportunities. Please send a copy of your current CV, North Carolina medical li-cense, DEA certificate and NPI certificate with number along with your detailed work history and CME courses completed to; Physician Solutions, P.O. Box 98313, Raleigh, NC 27624. E-mail: [email protected] or phone with any questions, PH: (919) 845-0054.
North Carolina (cont.)
the sales
MEDICAL PRACTICE LISTINGSView national practice listings or contact us for a
confidential discussion regarding your practice options.
[email protected] | medicalpracticelistings.com
MEDMONTHLY.COM |49
Primary Care practice specializing in Women’s careRaleigh, North Carolina
The owning female physician is willing to continue with the practice for a reasonable time to assist with smooth owner-ship transfer. The patient load is 35 to 40 patients per day, however that could double with a second provider. Excep-tional 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, tactful and well appointed 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 view our other listings at
www.medicalpracticelistings.com
North Carolina Family Practice located about 30 minutes from Lake Norman has everything going for it.
Gross revenues in 2010 were 1.5 million and there is even more upside. The retiring physician is willing to continue to practice for several months while the new owner gets established.
Excellent medical equipment, staff and hospital near-by, you will be hard pressed to find a family prac-tice turning out these numbers.
Listing price is $625,000.
Medical Practice Listings For more information call
(919) 848-4202. To view other practice listings visit medicalpracticelistings.com
EXCELLENT FAMILY PRACTICE FOR SALE
Established North Carolina Primary Care practice only 15 min-utes from Fayetteville, 30 minutes from Pine Hurst, 1 hour from Raleigh, 15 minutes from Lumberton, and about an hour from Wilmington. The population within 1 hour of this beautiful practice is over one million. The owning physician is retiring and the new owner will benefit from his exceptional health care, loyal patient following, professional decorating, beautiful and modern free standing medical building with experienced staff. The gross revenue for 2010 is $856,000 and the practice is very profitable. We have this practice listed for $415,000. Call today for more details and information regarding the medical building. Our Services:• Primary Health• Well Child Health Exams• Sport Physical• Adult Health Exams• Women’s Health Exams• Management of Contraception• DOT Health Exam• Treatment & Management of Medical Conditions• Counseling on Prevention of Preventable Diseases• Counseling on Mental Health• Minor surgical Procedures
Exceptional North Carolina Primary Care Practice for Sale
For more information call Medical Practice Listing at (919) 848-4202. To view our other listings, visit medicalpracticelistings.com.
“With PACSHealth™, I fi nally have an easy way to monitor our PACS system 24/7. I can rest assured that system data is clean and consistent across the board and errors, if any, are quickly repaired. I can do my job in a fraction of the time that it used to take with better results.”
– Scottsdale Medical Imaging Ltd
tel: [email protected]
www.pacshealth.com
Ensure Optimal Performance of your Global PACS System
• PACS Status Reporting • System Monitoring Dashboard
• Audit Log Management/ HIPAA Compliance Tool
50 | JULY 2011
the sales
Practice for sale
North Carolina (cont.)
South CarolinaLucrative E.N.T. practice with room for growth, located three miles from the beach. Physician’s assistant, audiol-ogist, esthetician, and well-trained staff. Electronic medi-cal records, Mirror imaging system, established patient and referral base, hearing aids and balance testing, es-thetic services and Candela laser. All aspects of Otolar-yngology, 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, Cosmet-ics, Laryngology & Trans-nasal Esophagoscopy. All the organization is done, walk into a ready-made practice as your own boss and make the changes you want, when you want. Physician will to stay on for smooth transition.
for the new owner for a month or two assisting with a smooth transaction. The practice treats patients 4 and ½ days per week with no call or hospital rounds. The schedule accommodates 35 patients per day. You will be hard pressed to find a more beautiful practice that is modern, tastefully decorated and well appointed with beautiful art work. The practice, patient charts, equip-ment and good will is being offered for $415,000 while the free standing building is being offered for $635,000. Contact Medical Practice Listings for additional informa-tion. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or E-mail: [email protected]
Primary Care practice specializing in women’s care. The owning female physician is willing to continue with the practice for a reasonable time to assist with smooth ownership transfer. The patient load is 35 to 40 patients per day, however that could double with a second provider. Exceptional cash flow and profitable prac-tice 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, tactful and well appointed throughout. New computers and medi-cal management software add to this modern front desk environment. This practice is being offered for $435,000. Contact Medical Practice Listings for additional informa-tion. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or E-mail: [email protected]
Hospital support is also an option for up to a year. The listing price is $395,000 for the practice, charts, equip-ment and good will. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or E-mail: [email protected]
Practice for sale
South Carolina (cont.)
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Classified
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 Permanent placement
When your physician can’t work tomorrow do you have a plan B?
With an extensive network of health-
care providers and over 20 years of
experience in physician staffing, Physi-
cian Solutions is a leader in the indus-
try. We specialize in primary care and
place doctors in facilities such as famil-
ly practices, urgent cares, pediatrics of-
fices and occupational health.
Short term or long term, Physician Solutions has your covered
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 fully equipped, plus digital X-Ray. Extensive corporate accounts as well as walk-in traffic. Lab equipment includes CBC. The owning MD is retiring, creating an excellent opportunity for a MD to take over an existing patient base and treat 25 plus patients per day from day one. The practice space is 2,375 sq. feet. This is an exceptionally opportunity. Leased equipment includes: X-Ray $835 per mo, copier $127 per mo, and CBC $200 per mo. 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
Plastic Surgery practice for sale with lucrative E.N.T. specialty
Myrtle Beach, South Carolina
Practice for sale with room for growth and located only three miles from the beach. Physician’s assistant, audiologist, esthetician, and well-trained staff. Electronic medical records, Mirror imaging system, established patient and referral base, hearing aids and balance test-ing, esthetic services and Candela laser. All aspects of Otolaryngol-ogy, busy skin cancer practice, established referral base for reconstruc-tive 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, Cosmet-ics, Laryngology & Trans-nasal Esophagoscopy. All the organization is done, walk into a ready made practice as your own boss and make the changes you want, when you want. Physician will to stay on for smooth transition. Hospital support also an option for up to a year. The listing price is $395,000.
For more information call Medical Practice Listing at (919) 848-4202. To view our other listings, visit medicalpracticelistings.com.
Practice at the beach
Large Louisiana Pediatric Practice This Louisiana Pediatric Practice treats an average of 30 plus patients per day and is open 4 ½ days per week. The owner/MD treats patients and she has a part time physician assistant that provides a second provider 2 to 4 days per week. Fully equipped and staffed, this practice is ready for the new owner to accept a full patient load. The MD that owns the practice will be moving to join her husband in California during the summer or as soon a proper transfer in ownership takes place. She is more than willing to continue with the practice for a few months to assist with a smooth transfer.
Practice For Sale
Asking price: $165,000
Call Medical Practice Listings today and we will be happy to provide more details regarding this
pediatric practice opportunity!
(919) 848-4202 | MedicalPracticeListings.com
MEDMONTHLY.COM |51
places for medical jobs
best
54 | JULY 2011
top
Pennsylvania 9
1
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California
Florida Another state with a high number of boomers is Florida. With an estimated 3 million residents over 65, Florida needs health care workers to care for the aging population.
IllinoisThe government gave home heath aids a raise in this state to encourage more people to enter the health care industry but other health care workers have also seen pay increases.
Massachusetts Massachusetts has some of the best hospitals to work for in the country, including Mass General and Brigham & Women’s open positions in the health care industry continue to increase.
Michigan
New Jersey Registered nurses are in high demand in New Jersey. While the need increased by 7,000 there is an 18% vacancy rate in the New Jersey nursing field.
North Carolina
Ohio This state created a health care shortage task force to address changes to be made in health care encourage more people to become health care professionals.
Source: allhealthcare.com Photos by Keith Syvinski, Danie Pratt and Sam LeVan.
Working in the health care industry is a surefire way to get and keep a job, but if your looking for a new job or just a career change, check out the top 9 best states for health care jobs.
The aging Baby Boomers are to blame for the need for more health care workers in California. According to allhealthcare.com there are roughly 4 million California residents over 65.
The state government has invested in health care train-ing programs and has spent millions to promote nursing programs in schools. They are also experiencing a short-age in specialty physicians.
Nursing shortage estimates for NC were at just over 8,000 in 2010 rank-ing NC 19th for nursing needs.
With over 17,000 health care related job opportunities, Pennsylvania created the Pennsylvania Center for Health Careers to help fill hospitals and health care facilities with the employees it needs.
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