Atlanta, GA. Physician Recruitment Opportunities. P.O. Box 1441 Brentwood, TN Nobleanalytics.com Office:

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1 Atlanta, GA Physician Recruitment Opportunities P.O. Box 1441 Brentwood, TN Nobleanalytics.com Office:

2 Executive Summary Physician Recruitment Opportunities Intentions of Physician Recruitment Opportunities Report The Physician Recruitment Opportunities (PRO) is not intended in any way to be used as or substituted for a STARK compliant Community Needs Analysis. The intention of the PRO is to offer potential clients an opportunity to review and understand the opportunities to recruit based on the physician needs by specialties within its geographic service area (GSA). The PRO contains a list of ZIP codes forming the GSA and the list of specialties with a need of 1.0 or more within the study area. The Physician Recruitment reports only show the specialties that qualify based on the stated parameters with a for general needs analysis (all demographics included) or a * for Medicare needs analysis (only 65+ population included). Legal Opinion The product which includes a specific methodology is one which is used to assist providers in determining whether a need exists for additional physicians in a given area. Because the methodology is based on more detailed information that is specific to a geographic area than has previously been used to analyze the situation, it can provide backup documentation and support the decision if the recruiting ends up being challenged through the audit process or in court. Noble s Community Utilization Model The standard physician-to-population ratio commonly used to determine physician needs assumes all physicians are the same and every community has the same healthcare needs regardless of demographics. Noble Analytics believes this is inadequate for several reasons. The first is because physicians often have more than one office making it difficult to determine how often a particular physician is serving inside a community. Second, physicians will work more or less than the average physician for personal reasons not related to the healthcare needs of the community. Third, the simple physician-to-population ratio ignores that healthcare needs vary from community to community. Finally, it does not account for the fact that people can easily migrate into and out of a community when seeking care. Noble Analytics model addresses these shortcomings by focusing on the level of healthcare services people receive in the community, compared to the level of healthcare received by the average person in a given state based on the number of cases seen. The purpose of the Noble Community Utilization Model is to match the level of physician activity in a community to the needs of the people who live there. A sliding scale will communicate that the physician needs by each specialty are within a floating range. Based on the available data, Noble Analytics has determined that the physician needs lie within the sliding scale. All physicians and their activities used in the Noble Utilization models are based on patient volumes from a third party vendor and collected insurance claims information by a third party vendor. All other Medicare Provider Utilization and Payment Data (CY 2013) will originate from information received from CMS. Nurse practitioners ( NP ) and physician assistants ( PA ) cases will be matched to the specialty of the physician that oversees the practice; however, neither will be included in the overall physician supply. Noble s Community Utilization Model for Medicare Neither the Stark Law nor the AKS expressly require a community needs assessment associated with the Stark Law exception or AKS safe harbor for physicians recruited by hospital. However, for arrangements that fall outside the AKS safe harbor (i.e., 75% of the impacted patients do not reside in a health professional shortage area or medically

3 underserved area), the Office of Inspector General ( OIG ) will look to whether the recruiting hospital possess documentary evidence of an objective need for the recruited physician s services. The Noble Community Utilization Model for Medicare is similar to the standard Community Utilization Model but focuses on the specific needs of Medicare users. As reimbursement rates have dropped for Medicare relative to the rates of private insurance providers, the number of physicians serving the Medicare population has decreased. At times this decrease is severe enough to cause a considerable hardship on the Medicare population. NP and PA encounters will be matched to the specialty of the physician that oversees the practice and will be included in the total number of encounters. However, the number of NPs and PAs will not be included in the overall physician supply. In order to apply The Noble Community Utilization Model for Medicare, a physician must commit to serving a substantial number of Medicare patients.

4 Study Area Type: GSA PRO Sample - Atlanta, GA Map Hospitals 0 mi Copyright and (P) Microsoft Corporation and/or its suppliers. All rights reserved. Certain mapping and direction data 2012 NAVTEQ. All rights reserved. The Data for areas of Canada includes information taken with permission from Canadian authorities, including: Her Majesty the Queen in Right of Canada, Queen's Printer for Ontario. NAVTEQ and NAVTEQ ON BOARD are trademarks of NAVTEQ Tele Atlas North America, Inc. All rights reserved. Tele Atlas and Tele Atlas North America are trademarks of Tele Atlas, Inc by Applied Geographic Solutions. All rights reserved. Portions Copyright 2012 by Woodall Publications Corp. All rights reserved.

5 Geographic Service Area (GSA) ZIP code (*) Name County Avondale Estates DeKalb County Alpharetta Fulton County Alpharetta Fulton County Marietta Cobb County Alpharetta Fulton County Conyers Rockdale County Conyers Rockdale County Covington Newton County Grayson Gwinnett County Clarkston DeKalb County Alpharetta Fulton County Suwanee Gwinnett County Cumming Forsyth County Decatur DeKalb County Decatur DeKalb County Decatur DeKalb County Decatur DeKalb County Decatur DeKalb County

6 30038 Lithonia DeKalb County Snellville Gwinnett County Cumming Forsyth County Cumming Forsyth County Lawrenceville Gwinnett County Lawrenceville Gwinnett County Lawrenceville Gwinnett County Lawrenceville Gwinnett County Lilburn Gwinnett County Loganville Walton County Lithonia DeKalb County Marietta Cobb County Marietta Cobb County Marietta Cobb County Marietta Cobb County Marietta Cobb County Marietta Cobb County Marietta Cobb County Norcross Gwinnett County Roswell Fulton County Roswell Fulton County

7 30078 Snellville Gwinnett County Scottdale DeKalb County Smyrna Cobb County Smyrna Cobb County Stone Mountain DeKalb County Tucker DeKalb County Stone Mountain DeKalb County Stone Mountain DeKalb County Norcross Gwinnett County Norcross Gwinnett County Conyers Rockdale County Duluth Gwinnett County Duluth Fulton County Acworth Cobb County Acworth Cherokee County Austell Cobb County Canton Cherokee County Canton Cherokee County Cartersville Bartow County Lithia Springs Douglas County Mableton Cobb County

8 30127 Powder Springs Cobb County Douglasville Douglas County Douglasville Douglas County Hiram Paulding County Kennesaw Cobb County Kennesaw Cobb County Dallas Paulding County Austell Cobb County Woodstock Cherokee County Woodstock Cherokee County Fairburn Fulton County Fayetteville Fayette County Fayetteville Fayette County Griffin Spalding County Hampton Henry County Jackson Butts County Jenkinsburg Butts County Jonesboro Clayton County Jonesboro Clayton County Locust Grove Henry County McDonough Henry County

9 30253 McDonough Henry County Morrow Clayton County Newnan Coweta County Newnan Coweta County Palmetto Fulton County Peachtree City Fayette County Rex Clayton County Riverdale Clayton County Senoia Coweta County Sharpsburg Coweta County Stockbridge Henry County Conley Clayton County Tyrone Fayette County Union City Fulton County Ellenwood DeKalb County Riverdale Clayton County Forest Park Clayton County Atlanta Fulton County Atlanta Fulton County Atlanta Fulton County Atlanta DeKalb County

10 30308 Atlanta Fulton County Atlanta Fulton County Atlanta Fulton County Atlanta Fulton County Atlanta Fulton County Atlanta Fulton County Atlanta Fulton County Atlanta Fulton County Atlanta DeKalb County Atlanta DeKalb County Atlanta Fulton County Atlanta DeKalb County Atlanta DeKalb County Atlanta Fulton County Atlanta Fulton County Atlanta Fulton County Atlanta Fulton County Atlanta DeKalb County Atlanta Fulton County Atlanta Fulton County Atlanta Fulton County

11 30336 Atlanta Fulton County Atlanta Fulton County Atlanta DeKalb County Atlanta Cobb County Atlanta DeKalb County Atlanta DeKalb County Atlanta Fulton County Atlanta Fulton County Atlanta DeKalb County Atlanta DeKalb County Atlanta Fulton County Atlanta Fulton County Atlanta Fulton County Atlanta DeKalb County Atlanta Fulton County Buford Gwinnett County Buford Gwinnett County (*)The chosen geographic service area ( GSA ) is composed of randomly chosen set of contiguous ZIP codes from which a hospital can sample the physician needs in the area.

12 Physician Recruitment Opportunities Primary Care Specialty Family/General Practice Internal Medicine Pediatrics General Physician Recruitment Medicare Physician Recruitment Specialists Specialty Addiction Medicine Adolescent Medicine General Physician Recruitment Medicare Physician Recruitment Allergy/Immunology Anesthesiology Bariatric Medicine Cardiovascular Disease Child and Adolescent Psychiatry Critical Care Medicine Dermatology Emergency Medicine Endocrinology/Diabetes/Metabolism Gastroenterology Please note, those specialties that do not have a need of 1.0 or more have been omitted from this report. Shows the needs of 1.0 or more physicians within that specialty. * Shows the needs of 1.0 or more physicians within that specialty, with the understanding that a physician must commit to serving a substantial number of Medicare patients.

13 Specialty General Physician Recruitment Medicare Physician Recruitment Geriatrics Gynecological Oncology Hospice and Palliative Medicine Medical Genetics Neonatal-Perinatal Medicine Nephrology Neurological Surgery Neurology Neuromusculoskeletal Medicine, Sports Medicine * Nuclear Medicine * Obstetrics/Gynecology Oncology Ophthalmology Oral & Maxillofacial Surgery Orthopedic Surgery Orthopedics Osteopathic Manipulative Medicine Otolaryngology Pain Medicine * Palliative Medicine Please note, those specialties that do not have a need of 1.0 or more have been omitted from this report. Shows the needs of 1.0 or more physicians within that specialty. * Shows the needs of 1.0 or more physicians within that specialty, with the understanding that a physician must commit to serving a substantial number of Medicare patients.

14 Specialty Pathology Pediatric Cardiology Pediatric Critical Care Medicine Pediatric Emergency Medicine Pediatric Orthopedics Pediatric Otolaryngology Pediatric Pulmonology Pediatric Surgery Pediatric Surgery - Neurological Pediatric Urology Phlebology General Physician Recruitment Medicare Physician Recruitment Physical Medicine & Rehabilitation Plastic Surgery Preventive Medicine Psychiatry Pulmonary Critical Care Medicine Pulmonary Disease Radiology Rheumatology Sleep Medicine Please note, those specialties that do not have a need of 1.0 or more have been omitted from this report. Shows the needs of 1.0 or more physicians within that specialty. * Shows the needs of 1.0 or more physicians within that specialty, with the understanding that a physician must commit to serving a substantial number of Medicare patients.

15 Specialty General Physician Recruitment Medicare Physician Recruitment Sports Medicine Surgery Thoracic Surgery Trauma Surgery Urology Vascular Surgery Please note, those specialties that do not have a need of 1.0 or more have been omitted from this report. Shows the needs of 1.0 or more physicians within that specialty. * Shows the needs of 1.0 or more physicians within that specialty, with the understanding that a physician must commit to serving a substantial number of Medicare patients.