Physicians Office Resource Volume 7 Issue 10

Physicians ™ Volume 7 • Issue 10 Office Resource Take Advantage of Increased 2013 Tax Deductions for Capital Equipment Purchases Details on Page 29 www.PhysiciansO!ceResource.com 1 .PhysiciansO!ceResource.com Check out our brand new product directory at: www

Full Page Ad MOST COMPREHENSIVE M E N U AVA I L A B L E Increase Your Efficiency. Improve Their Experience. #8400 #8401 Improving the patient experience just got easier— ® with the i-STAT System and Piccolo Xpress , now available ® from Abbott Point of Care Lab Solutions. Faster turnaround of lab-quality results to accelerate your clinical decision-making. More ways to increase patient satisfaction. For in vitro diagnostic use only © Abbott Point of Care Inc. To learn more about how our technology, process, and service innovations can help your 400 College Road East, Princeton, NJ 08540 (609) 454-9000 (609) 419-9370 (fax) facility meet its goals, contact your Abbott Point of Care or Distribution Representative, or www.abbottpointofcare.com visit www.abbottpointofcare.com and www.piccoloxpress.com. i-STAT is a registered trademark of the Abbott group of companies in various jurisdictions. Lab Solutions End User Ad 031433 Rev. A 05/13 Piccolo Xpress ® is a registered trademark of Abaxis, Inc. Abaxis Part Number 888-3236 Rev. A Technology I Process I Services 2 Physicians O!ce Resource

Featured Product Digital Doppler with #8402 Great Performance & Customer Service 30-day no obligation trial! !e DigiDop uses digital signal processing similar to high-end audio equipment to reduce unwanted background noise and let the Doppler sounds through bright and clear. Also important is the customer service you can expect from Newman Medical. Full 2-year warranty on all parts and labor. Outside of warranty-standard Made in the USA! service fees of $149 for main units and $79 for probes-no bench or evaluation fees! TABLE OF CONTENTS Volume 7 - Issue 10 From the Publisher Page 5 Product Spotlight Page 6 Physician Productivity vs. Patient Satisfaction: Not Quite a Conundrum Page 9 by Dylan J. Chadwick (POR Sta! Writer) Ask the Expert Page 15 by Barry Craig, MLT (NCA), CLC Challenges & Forces: A Menu of Options for Improving Care Page 21 by Michael D. Paquin, FHIMSS Year-End Money Moves: How to Take Advantage of Increased Tax Deductions for 2013 Page 29 by Sean Hanlon, Director of Professional Communications (POR) Is Your Lab on the Cutting Edge of Diagnostic Testing? Should it Be? Page 33 by Maria Hardy, IMA (ASCP) www.PhysiciansO!ceResource.com 3

® not everyone is this Full Page Ad Offer valid on kits purchased August 1 , 2013 – January 31 , 2014 st st Three kits (Part #190) must be purchased on one invoice to qualify Go to www.osomflu.com for more info and redemption forms #8403 2 extra test sticks included for external QC testing Less than 1 minute hands on time, results in 10 minutes Room temperature storage Online, multi-lingual training at www.osomtraining.com To contact your Sekisui Diagnostics Territory Manager call 800-332-1042 © 2011 Sekisui Diagnostics, LLC. OSOM® the QC Inside and OSOM Training logos are registered trademarks of Sekisui Diagnostics, LLC. Please note that the value of the special offer(s) the Customer may receive from the manufacturer under this program is a “discount or other reduction in price” to Customer under Section 1128B(b)(3)(A) of the Social Security Act [42 U.S.C. 1320a-7b(b)(3)(a)]. Accordingly, Customer shall disclose this and any other discounts or other reductions in 4 Physicians O!ce Resource DIAGNOSTICS price received under this program under any state or federal program which provides cost or charge-based reimbursement to the Customer for the products and services purchased under this program.

From the Publisher Physicians Dear Readers, ™ We at Physicians O\"ce Resource are #rm believers of the adage, “if you’re not moving Office Resource forward, you’re moving backwards.” Which may not be entirely true from a physics standpoint – but it’s o$en the case with people/organizations and Published by progression/regression. !at’s why the POR team is Medical Education Resources, LLC constantly striving to make our company the best that we can so that we may bring you the best tools President Andrew C. Nimmo and resources for your practice. In the spirit of acnimmo@physicianso!ceresource.com moving forward, we are pleased to announce Publisher another resource to help you in your search for Aaron R. Medaris products – \"e NEW POR Product Directory at amedaris@physicianso!ceresource.com www.PhysiciansO\"ceResource.com. It’s now easier Business Manager than ever before for you to #nd, research, and Marci J. Hills request information on the products you need. Here mhills@physicianso!ceresource.com are just a few of the new features this product Account Manager directory provides: Brandi L. Brower • Search by category Editorial Board • Search by company Michael Paquin, FHIMSS, • Easily compare and contrast products Barry Craig, MLT (NCA), CLC • View educational brochures and materials Contributing Editor • View product videos Robert Posner, MD • Request information on multiple products at once IT Director You can read more about it on page 11 or better yet, Robert Farrell go to http://www.physiciansofficeresource.com/ Sr. Director, Professional diagnostics/directory/product to experience it yourself. Communications !is new Product Directory is up just in time for Sean Hanlon you to consider year end capital equipment Graphics & Production Manager purchases. As part of the “#scal cli%” legislation Keith A. Katsikas Jr passed at the beginning of 2013, when a physician practice acquires new equipment – including lab equipment, analyzers, furniture, certain so$ware Copyright © 2013 and more – they may deduct up to $500,000 of the To continue your free subscription of value during the #rst year of ownership! To learn Physicians Office Resource complete the more about this take a moment to see Sean Hanlon’s Business Reply Card at the center of this article on page 29 of this issue. magazine and drop in any USPS mailbox. !anks again for your continued support. Please If you are a manufacturer of medical let us know if there is anything we can do to better products or provide services to medical serve you. Here’s to #nishing out the year strong and professionals and would like to making sure we are moving in the right direction advertise your products or services to over 100,000 of the nation’s top come 2014. physicians who do in-o!ce testing, please call (603)488-1235 or visit: Wishing you continued success, www.physicianso!ceresource.com for more information. Aaron R. Medaris Thank you! Publisher www.PhysiciansO!ceResource.com 5

Product Spotlight #8404 iFOBT Dual Test System !is immunological test detects human hemoglobin in feces and allows two samples to be tested – economically – on the same device. Since polyps bleed intermittently, testing multiple samples from di%erent bowel movements improves accuracy and is recommended by the American Cancer Society. !e product is CLIA-Waived, requires no dietary restrictions and provides results within 5 minutes. Collection materials are included. A single iFOBT test system is also available. Cost E!ective Hematology Analyzer !e Abacus 5 and Abacus 5 with Autoloader #8405 features a 20 parameter 5 part di%erential hematology analyzer features closed and open tube sampling, is easy to operate and maintain, has a small footprint, and makes calibration and quality control procedures simple. Welch Allyn® CP 200 ECG Reliable, easy-to-use, and cost-e%ective ECG for any o\"ce setting. Large color LCD screen allows you to easily preview critical information on screen. Save time by using dedicated function or “hot keys” to perform the most common functions without scrolling through menus. Store up to 50 ECGs and 50 spirometry tests for later review and editing of patient data and interpretation. Easily connect directly to Welch Allyn CardioPerfect™ Workstation So$ware #8406 through cable interface. Optional spirometry testing and optional MEANS interpretation so$ware. For more information about these products or to place an order, visit: www.PhysiciansO!ceResource.com 6 Physicians O!ce Resource

Connectivity solutions that work. Give your patients better, more effective care with truly connected diagnostic solutions that simplify your workfl ow, improve diagnosis and reduce errors. IQvitals ® IQspiro ® #8407 #8408 IQholter ® #8410 IQecg ® #8409 IQ Digital Diagnostic Products t -JHIUXFJHIU BOE QPSUBCMF t *OUVJUJWF VTFS JOUFSGBDF t $POOFDU TFBNMFTTMZ XJUI TFMFDU &)3 &.3 or use with IQmanager ® t %FTJHOFE UP XPSL JO NPTU *5 FOWJSPONFOUT Save up to $1,000 on Midmark IQ Digital Diagnostic Devices during the 2013 Midmark Barrier-Free and Diagnostics Promotion! ® For more information, call 1-888-746-4981 or visit midmark.com/POR. Midmark Corporation, Versailles OH USA www.PhysiciansO!ceResource.com 7

Product Focus #8411 CLIA-Waived Fecal Immunochemical Test !e InSure® FIT™ Fecal Immunochemical Test and its unique water-based blue brush collection method make it easier to screen for colorectal cancer. Unlike other tests that require fecal handling and test card smears, InSure FIT requires a gentle brushing of the stool in water. Two tests on one card follows ACS recommendations for colorectal cancer screening. InSure FIT has high sensitivity, no dietary or medicinal restrictions and the patient-friendly collection method may improve patient compliance and satisfaction. #8412 HemoCue Hb 201+ Analyzer + 200 Cuvettes The HemoCue Hb 201+ System is a CLIA waived Hemoglobin analyzer for quick, simple and reliable quantitative Hemoglobin results. • Results in less than a minute • 3 easy steps • Lab quality accuracy • Safe and easy to use SCHILLER MS-2015 Touch Screen ECG 12 Lead ECG with A Touch of Class! #8413 !e future of cardiography is here now! !e MS-2015 unites precision, performance and a sophisticated but simpli#ed user interface. Simply touch the large (15 in) high-resolution color display and you’re in business; recording, selecting and printing the highest quality 12 lead ECG’s faster than you can imagine. Since MS-2015 exports ECG’s in XML, PDF and DICOM format, you can transmit recordings to any system that supports these industry standards. !e MS-2015 is a combination of intelligent design and long lasting incomparable value! For more information about these products or to place an order, visit: www.PhysiciansO!ceResource.com 8 Physicians O!ce Resource

Physician Productivity vs. Patient Satisfaction: Not Quite a Conundrum Dylan J. Chadwick Physicians O!ce Resource Sta\" Writer O verall, the “Triple Aim” approach to behavior and patient satisfaction, and found that the two the improvement of healthcare is end goals aren’t necessarily mutually exclusive. sound. In accordance with the Productivity Hold-Ups concept, physicians are to provide the highest level of care, patients are to In her TalkChart article 5 Biggest Barriers to have the best possible healthcare experience and the service itself is to be provided at the Physician Productivity (Surprise: They’re Not All lowest cost. While the last corner in the Triple Aim Electronic Medical Charting) Andrea Jacques outlines triangle is a continuing challenge for physicians (and some of the most frustrating physician “bottlenecks” politicians), this article will focus on the first two, that which put an efficient practice in a daily stranglehold. of physician productivity and of patient satisfaction. These obstacles range from so called “schedule busters” In a Permanente Journal article entitled Patient in which a steady stream of attention-needing walk-in Experience and Physician Productivity: Debunking the patients throw off a tightly planned schedule to that of Mythical Divide contributors describe a time-intensive patient encounters. For example, seeing preconception which many physicians hold when it elderly patients may take a physician much longer to comes to “Triple Aim” healthcare as a zero-sum game. visit with than a young adult, and if there’s a steady !at is to say that, for many physicians, the concepts stream of elderly patients, it can have a tremendous of “patient satisfaction” and “physician productivity” effect on a physician’s level of productivity. operate like disproportionately weighted participants Other factors, like the patient panel size, general on a see-saw. Any improvement in one area leads to workflow obstacles which can come up (such as a an overall dis-improvement in another area and vice new electronic medical records system) and the versa. Essentially, improvement in one area can only general disruption of time-consuming, yet come at the expense of another. important, established routines, can all chew into a A 2012 study conducted by HealthPartners Inc. (St physician’s overall productivity, and require much Paul, MN) took this popular physician apprehension to time and effort to handle. heart as they constructed a study which charted groups When it comes to a quick fix or an easy cure-all for of physicians in four specialty departments (podiatry/ productivity woes, Jacques simply says “there isn’t one.” foot and ankle surgery, gastroenterology, general surgery The fact is, there will always be changes and variables and vascular surgery) and sought to find correlative in the day to day workings of a practice, and there’s no behaviors between physicians with “strong” levels of sure-fire way to prevent anything from going awry. productivity and those with “strong” levels of patient Streamlined efficiency and productivity is often satisfaction. All of the studied physicians worked in a achieved only after time and a careful evaluation of end similar environment and under similar conditions, for goals and some on-the-job practice. However, this isn't example, all studied physicians in the field of to say that the end goal of upping both patient gastroenterology saw the same kinds of patients, had satisfaction and physician productivity is hopeless. similar workloads and had the same type of facility and support staff. Though admittedly small in scope relative Scatterplot to the entire healthcare landscape in the country, the study did find some key correlations between physician !is isn't to say that the end goal of upping two www.PhysiciansO!ceResource.com 9

Physician Productivity vs. Patient Satisfaction antes is hopeless in a practice though. Improving they put more of a personal energy into each visit. physician productivity may be a time-intensive Perhaps this seems problematic to many physicians practice, but it doesn’t have to come at the expense who hold true to apprehensions like “I can only of improving patient satisfaction. At least, that’s achieve strong productivity or strong patient what the Health Partners Inc. study shows. In a satisfaction - I can’t do both” or “If I had more time to nutshell, the organization plotted studied spend with my patients, I would have greater patient physicians into quadrants on a scattergram. Strong satisfaction.” Furthermore, it may seemingly violate performers in the quadrant of “productivity” were the idea that physician productivity and patient plotted into one area, while strong performers in satisfaction can't be achieved in tandem, that only by “patient satisfaction” were plotted into another, cutting into productivity (i.e. longer patient visits) can while those who carted weak in both areas were they see an upswing in patient satisfaction. plotted accordingly. However, the subtext of the study indicates that !e study found many physicians who excelled in when patients feel comfortable and that their needs both areas simultaneously and, through further are being addressed with care, they are more apt to investigation, found that di%erent levels of success on report high levels of satisfaction. When they their chart came as the result of di%erent in-o\"ce understand what is being said to them, and can see a characteristics. physician who is not rushing through a diagnosis and an explanation, but who is taking time to go through Strong Productivity and Strong and address concerns bit by bit, on an emotionally Patient Satisfaction Skills available level, they leave the o\"ce feeling empowered and willing to comply. When patients can see that, !e HealthPartners Inc. study found, among other amidst a busy schedule, a physician is able to address things, that those physicians who scored high in both them personably and with warmth, they feel at ease. areas had a general “personable” relationship with !ey speak more &uidly and more easily, they share their patients. !ese physicians were adept at their own medical histories more willingly, and conveying warmth from the beginning of a visit and ultimately, the process is made more streamlined, and could deliver cogent information clearly and in a ultimately? !ey're more willing to comply. controlled manner. !ese physicians also put a high Physician productivity isn’t strictly related to premium on “teaching” their patients, giving them the number of patients they see every day, but is adequate time to ask questions while ensuring that also a function of the thoroughness with which their own explanations were understood. !ey proved they provide healthcare. Perhaps breaking out of a able to recap a patient’s history and could generally be routine and implementing a few new measures in heard beginning statements with “I read your chart…” each visit will take some time, and may initially cut so as to establish common ground and understanding down on the number of patients they can see each with their patients. !ese physicians were described day. It goes without saying that there will always be as “con#dent, but not arrogant,” they #nished their days in which things don’t go according to plan. dictation and coding each day and had clinical sta% to However, by putting a little bit more into each enter orders and prepare an a$er-visit summary patient visit, just a few minutes more, what a where applicable. physician might lose in time, they’ll more than !ose who scored low in both areas were make up for in healthy patients, high satisfaction described with a lack of “being there” emotionally, no scores and a clear and honest physician/patient smiling, and acting abruptly. !ey didn’t greet relationship with more instances of healthy and patients with handshakes (when culturally complying patients. These all result in higher long appropriate), they made no attempt to match the term productivity yields in the big picture, as fewer patient’s energy during the visit, they kept patients patients will need to come back for non- waiting and wondering and while trying to get a compliance issues. Productivity and patient diagnosis, they created a sense of “interrogation.” satisfaction come together in this equation, as they provide the highest and most efficient level of Not Mutually Exclusive thorough and personalized healthcare coupled with the best patient experience possible. On the surface, what made high performing physicians chart well with patient satisfaction, is that 10 Physicians O!ce Resource

Check out our new and improved Product Directory: it’s easier, faster, more resourceful – It is simply the best way to !nd what you need, fast! Quickly filter results by Category... Submit Multiple Requests at Once! Full Page Ad View a wide range of materials useful in making informed decisions quickly! ...or by Company! www.physicianso!ceresource.com/diagnostics/directory/product www.PhysiciansO!ceResource.com 11

Product Focus Leverage the Power of a Single, #8414 Integrated POC Testing Solution !e fully automated i-STAT System o%ers a broad menu of tests for diagnostic and treatment indicators related to disease state management and clinical practice guidelines. Using just 2 or 3 drops of blood, the system provides time-sensitive tests at the patient’s side in just minutes. Fast, E\"cient, Reimbursable ABI/Vascular System The Vista AVS by Summit Doppler Systems makes the ABI and other arterial exams faster and easier to conduct, interpret and document. This full-featured system has three modalities: PVR, bi-directional Doppler probe and arterial PPG. It includes automated cuff inflation/ deflation, built-in printer, graphic waveform display with step-by-step exam instructions, 9 cuffs, and software for full-page reporting, exam storage and PC download capability. The advanced diagnostic features #8415 of the Vista AVS enable the user to perform ABI exams in both the supine and seated position, toe brachial index (TBI) exams, segmental studies and stress ABI testing! #8416 Non-invasive Hemoglobin and SpO2 device Pronto-7 quickly and easily puts painless non-invasive spot-checking of hemoglobin (SpHb), SpO2, pulse rate and perfusion index into the palm of your hand. With accurate results in less than a minute, Pronto-7 eliminates needles and time-consuming laboratory analysis while reducing the risks and delays associated with traditional blood tests. Reimbursable and CLIA excluded. For more information about these products or to place an order, visit: www.PhysiciansO!ceResource.com 12 Physicians O!ce Resource

Pain Practice Laboratory ,Q 2IÀFH 'UXJ 7HVWLQJ—Made Easy #8417 Full Page Ad ‡ RESULTS IN ng/mL ‡ RESULTS EVERY 15 SECONDS ‡ FAST - OVER 400 TESTS PER HOUR ‡ TRAINING PROVIDED ‡ LAB CERTIFICATION ASSISTANCE ‡ VALIDATION ASSISTANCE #8418 CLC480 Benchtop or CLC720 Floor Model Chemistry Analyzer DRUGS OF ABUSE ADULTERANTS 6-AM cocaine oxycodone aldehyde acetaminophen creatinine phencyclidine BUN alcohol ecstasy propoxyphene chromate reagent amphetamine ethylglucuronide salicylate halogen barbiturate fentanyl* tapentadol* nitrite benzodiazepine meperidine* tricyclics oxidant buprenorphine methadone tramadol* pH reagent cannabinoids methadone metabolites zolpidem* specific gravity carisoprodol* opiates *for forensic use and more... Carolina Chemistries offers the complete laboratory package to include: a Chemistry Analyzer, reagents, assistance with validation laboratory certification and compliance. carolinachemistries.com 8BLF 'PSFTU #JPUFDI 1MBDF t / 1BUUFSTPO \"WFOVF t 8JOTUPO 4BMFN /$ t t t DPOUBDUTBMFT!DBSPMJOBDIFNJTUSJFT DPN www.PhysiciansO!ceResource.com 13

Product Focus #8419 EDAN iM50 Multi Parameter Patient Monitor !e EDAN iM50 patient monitor boasts an 8.4” color display and an optional Touch Screen. Due to its compact size and Li-Ion battery, this monitor is suitable for transport; Pre & Post-Op’s or even EMS. Perfect for monitoring patients that require any type of sedation, it can be used for Adults, Pediatrics or even Neonates. With the optional Respironics EtCo2, the EDAN iM50 is the most economical patient monitor available in the US. New Influenza Test Receives FDA CLIA Waiver The BD Veritor™ System for Rapid Detection of Flu A +B is the first rapid influenza test system that #8420 incorporates a digital read out of results to receive CLIA waiver. The system provides objective results on an easy to read digital display, unlike current CLIA-waived rapid influenza tests, which require a subjective visual test interpretation to determine a positive or a negative test result. SimpleABI Systems for ABI, TBI #8421 and Segmental Vascular Testing Use the power of the newest computers to produce the reimbursement reports you need quickly, easily, and accurately. !e diagnosis is made using the gold standard Doppler and simple pulse volume recording (PVR) waveforms. Working directly on the computer is simple, intuitive, e%ective, and minimizes the time needed to get the reports necessary for diagnosis and reimbursement purposes. !e system meets all the latest CPT® and Medicare requirements (speci#cally dual ankle pressures-unlike dubious competitors) for CPT code 93922, 93923 and 93924.  Made in the USA! For more information about these products or to place an order, visit: www.PhysiciansO!ceResource.com 14 Physicians O!ce Resource

Ask the Expert Barry Craig, MLT (NCA), CLC Lab Coordinator, CHS Member POCCA (Point of Care Coordinators Alabama) Member Helena Laboratories Focus Group Q What is best way to keep up with to perform competency assessments. !is means that personnel cannot perform competencies on each expiration dates for reagents, other unless they meet the CLIA standards. controls, and other materials? Ultimately, the LD is responsible to ensure that all A: I suggest making an Excel database for all items you currently testing personnel are competent and maintain their competency in order to perform and report accurate use. You can set it up to change colors when an item and reliable test results. listed reaches its expiration date. Another method you Evaluating and documenting competency of can use is a shelf system. Put newly received items on personnel responsible for testing is required at least a lower shelf and mark them with the received date. semiannually during the #rst year the individual tests Put items in use on a higher shelf and date them with patient specimens. !erea$er, competency assessment an opened date and open expiration date. What is an must be performed at least annually. Competency open expiration date, you ask? Glad you are so full of assessment can be done throughout the entire year by questions! !e open expiration date is the date that a coordinating it with pro#ciency testing events, product expires once opened. Most reagents, controls, training new employees, error log and problem log and calibrators are good until the date printed on the resolutions, etc. !ese things can be used as part of label as long they are not opened. Once opened, the competency assessment. expiration date is usually shortened to 30 or 60 days. Q: How am I supposed to test my PT samples? Any Q: Who is responsible for performing the di#erently than I test patient specimens? competency assessment? A: PT samples must be tested in the same manner you A: !e Technical Consultant (TC) for moderate test patient specimens. !is means testing the PT complexity testing is responsible for performing and samples the same number of times as patient documenting competency assessments. !e specimens, at the same time as patient specimens, by competency assessments may also be performed by the same personnel that routinely test the patient other personnel who meet the regulatory quali#cation specimens, and using the same test system that is requirements for TC for moderate complexity testing. routinely used for the patient specimens. PT samples The Technical Supervisor (TS) for high should be rotated among the testing personnel in complexity testing is responsible for performing your laboratory. Please note that some PT sample and documenting competency assessments. This preparation may be necessary before testing. In other responsibility can be delegated, in writing, to a words, a$er preparation, PT samples must be treated General Supervisor (GS) as long as the GS meets in the same manner as patient specimens. However, the regulatory qualifications as a GS for high NEVER send PT samples out of your laboratory for complexity testing. any reason, even if you routinely send out patient Testing personnel who do not meet the regulatory specimens for additional or con#rmatory testing. quali#cations of a TC, TS, or GS cannot be designated www.PhysiciansO!ceResource.com 15

Product Focus #8422 i-Lipo™ The Latest in Laser Lipolysis i-Lipo™ is the latest in laser lipolysis, o%ering you a way to achieve ultimate body contouring with no pain, no needles and no down time. i-Lipo™ incorporates 36 laser diodes into four treatment pads with the Ultra infrared vacuum massage for skin tightening and to target more stubborn fatty deposits, enhance lymphatic drainage and promote skin renewal. Results can be seen immediately a$er treatment. FDA cleared for sale in the US. i-Lipo is Awarded the Best Slimming Treatment Victoire de la Beaute, Paris. #8423 Burdick® 8500 ECG by Cardiac Science !e Burdick 8500 ECG includes a friendly user interface and multi- angle 7-inch widescreen, and color display makes reading waveform data easy. Protocol choices streamline your work&ow. With the Burdick 8500 ECG, you can: • Store up to 300 digital ECG records. • Reduce typing mistakes and save time by downloading patient information from your electronic medical record (EMR/HIS) system. • Enjoy an industry-leading, four-year warranty and service program for worry-free usage. #8424 Prodigy Bone Densitometer Your practice demands dependable dual-energy X-ray absorptiometry (DXA) assessment, and Prodigy delivers with excellent precision and low-dose radiation. With third-generation DXA-technology re#ned over 30 years, and nearly 11,000 units installed in 93 countries, you can be assured of Prodigy’s ability to help you care for your patients. Prodigy provides precise data on so$ tissue and bone composition, including bone-mineral density (BMD), lean- and fat-tissue mass, and percentage of fat. For more information about these products or to place an order, visit: www.PhysiciansO!ceResource.com 16 Physicians O!ce Resource

#8426 #8425 Physicians O\"ce Resource Information Card 8400 Physicians O!ce Resource Information Card 6100/6200 8400 8409 8418 8427 8436 8445 8454 8463 8472 8481 8401 8410 8419 8428 8437 8446 8455 8464 8473 8482 8402 8411 8420 8429 8438 8447 8456 8465 8474 8483 8403 8412 8421 8430 8439 8448 8457 8466 8475 8484 8404 8413 8422 8431 8440 8449 8458 8467 8476 8485 8405 8414 8423 8432 8441 8450 8459 8468 8477 8486 8406 8415 8424 8433 8442 8451 8460 8469 8478 8487 8407 8416 8425 8434 8443 8452 8461 8470 8479 8488 8408 8417 8426 8435 8444 8453 8462 8471 8480 8489 Circle the product #’s that correspond with the items you would like more information on. First _______________________ MI ____ Last ___________________________ Su!x ______ Facility Name __________________________________________________________________ Street _________________________________________________________________________ City _______________________________________________ State ______ Zip ____________ Phone ___________________________ E-mail _______________________________________ Specialty ______________________________________________________________________ Are You Budgeted? Yes R No R Please continue my FREE subscription to (POR) Physicians O!ce Resource monthly medical digest. Buying Time Frame: Immediate Purchase R 2-3 Months R 4-6 Months R Over 6 Months R Comments ____________________________________________________________________ Signature ________________________________________________ Date ________________ www.PhysiciansO!ceResource.com 17

#8428 #8427 IMPORTANT: DO NOT ENLARGE, REDUCE OR MOVE the FIM and POSTNET barcodes. They are only valid as printed! Special care must be taken to ensure FIM and POSTNET barcode are actual size AND placed properly on the mail piece to meet both USPS regulations and automation compatibility standards. NO POSTAGE NECESSARY IF MAILED IN THE UNITED STATES BUSINESS REPLY MAIL FIRST-CLASS MAIL PERMIT NO. 104 MANCHESTER NH POSTAGE WILL BE PAID BY ADDRESSEE PHYSICIANS OFFICE RESOURCE 43 GOLDEN DR BEDFORD NH 03110-9941 18 Physicians O!ce Resource Artwork for User Defined (4.25\" x 5.5\") Produced by DAZzle Designer, Version 9.0.05 Layout: sample BRM card with IMB.lyt (c) 1993-2009, Endicia, www.Endicia.com February 28, 2011 U.S. Postal Service, Serial #

#8429 #8432 #8431 #8430 #8433 #8434 #8435 #8438 #8436 #8437 #8439 www.PhysiciansO!ceResource.com 19

Product Focus #8440 CryOmega Twin Pack Introduced in 2011, CryOmega® has become the preferred disposable cryosurgical device for many physicians.  CryOmega is equipped with an internal 16-gram nitrous oxide cartridge (-89°C/-127°F).  Producing a direct spray with pinpoint accuracy, treatment of dermal lesions in a variety of clinical settings is possible.  CryOmega is available as a single unit and as a Twin Pack.  !e Twin Pack contains 2 units, delivering added convenience and signi#cant cost savings. #8441 Making Hematology Easy and A!ordable !e 2013 QBC STAR Hematology Analyzer is a compact and easy to use complete blood count analyzer designed to bring CBC’s to the point of care. With a 9-parameter complete blood count at the push of a button, the STAR makes on-site hematology easy and a%ordable. #8442 Simple, Connectivity Solutions That Work IQecg® is an easy-to-use, digital 12-lead resting ECG solution that helps you quickly administer testing and access the patient information you need to make informed cardiac assessments. · Seamlessly integrates with top EHR/EMR solutions · Lightweight and portable · View and monitor live 12-lead ECG · Review and edit ECG results on-screen · Detects and warns possible arm lead reversal while in live ECG screen For more information about these products or to place an order, visit: www.PhysiciansO!ceResource.com 20 Physicians O!ce Resource