R.Paul Consulting
R.Paul Consulting

2016 Blog Entries


If you're a business owner here in Georgia, now is the time to take advantage of these two massive tax breaks before the end of the calendar year.

First on the table is Section 179, allowing businesses to deduct the total purchase price (or lease) of certain equipment and/or software.  Total allowable deduction for 2016? $500,000!  More information can be found here on the Section 179 website.

Next are the slew of Georgia State tax-credits, specifically the Job Tax Credit.  This incentive fuels companies to expand, providing as much as $4,000 in annual tax savings per job.  More information on this credit, as well as the many more that Georgia offers can be found here on the Georgia.Org website.


Ordering Capital equipment, specifically Imaging, can be stressful, especially if you're working with a new vendor.  Over the last 15 years in my position as an Imaging Supervisor I've built a rapport with a number of major OEM's.  The thought of doing business with anyone else was very intimidating, not to mention ones credibility is on the line if anything goes awry.  With reimbursements nose-diving, staggering costs to maintain compliancy and accreditation via governing bodies, dramatic loss in productivity when dealing with insurance companies, and the growing cost to maintain billing staff - just to get paid - one has to deal with this culminated force by trimming overhead expenses. 

For those of you that don't keep a pulse on emerging trends, the refurbished medical equipment market here in the US is expected to reach 12 billion dollars by 2021, almost doubling this current years forecasts.  One can strongly assume that within the next five years if you haven't purchased a piece of refurbished medical equipment, odds are you will by 2021. 

The looming question remains - who can one trust?

Enter BC Technical.

Our practice just completed the installation of three major additions to our imaging portfolio; a 64 slice GE VCT, a dual-headed GE Ventri dedicated cardiac gamma camera, and an UltraSpect workstation.  The initial deal just involved the CT scanner, but because of how much they exceeded my expectations, they were invited to bid on other projects, which they were successful in procuring.  All in all, the entire process from the bidding, negotiating, financing options, and flexibility has quenched any previous reservations when doing business with a non-OEM entity.

Learn from my experience; don't be complacent.  Commit now and start saving!


Never underestimate the power of prone imaging, otherwise known as the 'poor man's attenuation correction.'  After its implementation, our false-positives were considerably lower.


Consistently meeting or exceeding my expectations, these companies have all made my 2016 recommended vendor list:

Inventory Distributors - Henry Schein, Lynn Medical
Pharmaceutical Distributor – Henry Schein
GPO – Intalere, Vizient
Radiopharmacy Services - Cardinal Health
Dosimetry Badges – Radiation Detection Company
Imaging Equipment Providers – GE Healthcare, BC Technical
Field Service Engineers – GE Healthcare
Power Backups - Powercom
Financing – GE Capital
Flood Source Provider – Lynn Medical
Physicist Services – Alliance Medical Physics
Radiation Monitoring Equipment Distributor – Medi-Nuclear
Scaler/GM Counter Calibration Services – Technical Services Group
Biowaste Management – MedPro
Patient Snacks/Beverages – Capital Office Products
EMR Client – eClinicalWorks
HR Services – ADP
Treadmill Stress Systems – Jaken Medical
Commercial Cleaners – Coverall
Radiopharmaceutical Management System – Syntrac
Hardware Based Resolution Recovery – UltraSPECT
Biomedical Services – Medical Maintenance Consultants
Nuclear Reporting Software – NRP by Syntermed
Nuclear Cardiology Processing – Emory Cardiac Toolbox by Syntermed
PACS – Genesis OmniVue
Linen Service – Southern Medical Linen Service
Georgia CON/LNR Legal Counseling – Ray & Sherman, LLC


That time I asked Bracco for two vials of CardioTec.

Back in 2009, I sent Bracco a letter requesting two vials of CardioTec (Teboroxime) to use in conjunction with UltraSPECT's iterative reconstructive algorithms.
Bracco CardioTec.pdf
Adobe Acrobat document [54.2 KB]




Ever wonder why so many Fortune 500 companies are moving to Georgia?  It's the tax exemptions and credits!


Here are the ones relevant to Healthcare:
(6) Sales to any Hospital Authority created by Article 4 of Chapter 7 of Title 31 of the Georgia Code. 


(7) Sales of tangible personal property and services used specifically in the treatment function when the sales are to a nonprofit (i.e., a tax exempt organization under the Internal Revenue Code) nursing home, inpatient hospice, general hospital or mental hospital. Application process is through Form ST-NH1. 

(7.05) From July 1, 2015 through June 30, 2018, sales of tangible personal property to a nonprofit health center in this state which has been established under the authority of and is receiving funds pursuant to, the United States Public Health Service Act, 42 U. S. C. Section 254b if such health clinic obtains an exemption determination letter from the commissioner. Application process is through Form ST-NHC. Annual application required. Application must be filed electronically through the Georgia Tax Center. Qualifying sales are exempt from the 4% state sales tax. These sales are subject to all local sales taxes.

(7.3) From July 1, 2015 to June 30, 2018, sales of tangible property and services to a nonprofit volunteer health clinic primarily treating patients with incomes below 200% of the poverty level and which property and services are used exclusively in performing a general treatment function when such clinic is a tax exempt entity under the Internal Revenue Code and obtains an exemption determination letter from the Commissioner. Application is through Form ST-NVHC. Annual application required. Application must be filed electronically through the Georgia Tax Center. 


(47) Sales or use of drugs that are lawfully dispensable only by prescription for the treatment of natural persons; Insulin regardless of whether the insulin is dispensable only by prescription; prescription eyeglasses and contact lenses; drugs dispensable by prescription for the treatment of natural persons without charge to physicians, hospitals, etc. by pharmaceutical manufacturers or distributors; drugs and durable medical equipment dispensed or distributed without charge solely for the purposes of a clinical trial approved by the FDA or an institutional review board. Note: This exemption does not include over-the-counter drugs, drugs sold for animal use, or nonprescription eyeglasses. 


(50) Sales of insulin syringes and blood glucose level measuring strips dispensed without a prescription. 


(51) Sales of oxygen when prescribed by a licensed physician

(52) Sale or use of hearing aids. 

(54) Sale to or use by a patient of any prescribed durable medical equipment or prescribed prosthetic device. 


(72) The sale to or use by a patient of all mobility enhancing equipment prescribed by a physician.





One of the most frustrating, and equally confounding, challenges for Healthcare providers in Georgia (historically has been a red state, yet this law completely defies laissez faire), is the CON filing process through the Georgie Department of Community Health.  The supposed purpose behind the law is to 'ensure the availability of adequate health care services to meet the needs of all Georgians, while safeguarding against the unnecessary duplication of services that perpetuate the costs of health care services.'  Below are a list of all projects that require a CON:

  1. New hospitals, including general, acute-care and specialty hospitals
  2. New or expanding Nursing Homes and Home health agencies
  3. All multi-specialty and certain single-specialty Ambulatory Surgery Centers
  4. Providers of Radiation Therapy, Positron Emission Tomography, Open Heart Surgery, and Neonatal Services
  5. Major medical equipment purchases or leases (e.g. MRI, CT Scanners) that exceed the equipment threshold
  6. Major hospital renovations or other capital activities by any health care facility that exceed the capital expenditure threshold
  7. Before a health care facility can offer a health care service, which was not provided on a regular basis during the previous 12-month period, or add additional beds

Thresholds as of July 2016:
Capital Expenditures, O.C.G.A. § 31-6-40(a)(2) $ 2,903,530
Single-Specialty Physician-Owned Ambulatory Surgery Facilities, O.C.G.A. § 31-6-47(a)(18) $ 2,903,530
Joint Venture Ambulatory Surgery Centers, O.C.G.A. § 31-6-47(a)(19) $ 5,807,061
Equipment, O.C.G.A. § 31-6-40(a)(3) $ 1,246,165

During the filing process, what's commonly not mentioned is the legal counseling that specializes in CON/LNR law is highly recommended.  Most projects fail to take into account these costs which can easily breach five figures, even with the simplest of projects.

Recent reports have questioned this laws efficacy, 
now enforced in 35 states, with the latest stating it diminishes quality of care and in some cases even raises death rates.  The Fiscal Times has a great article shedding some light on this failed policy.




Highly recommend paying Becker's website a visit.  Very few have the pulse on Healthcare like they do.







Questioning your processing techniques?  Both Cedars and Ectoolbox do a great job of supporting their users by posting tutorials and operating manuals.

Here are Cedars Tutorials

Here is Ectoolbox's operating instructions




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