James R. Moulton, II, M.D., F.A.C.O.G.

2069: After Hours

Birth Center
Concierge Medicine
Continence Testing
Contrast Ultrasound

As a member of the International Society of Cosmeto-Gynecology, he brings tools to the table. Trained in the use of Botox and fillers for dermal sculpting, he worked as a contractor for Azure Med Spa. Skin resurfacing was performed with both chemical peels and laser. In addition, laser hair removal was part of his repertoire. His talent for pelvic reconstruction was further refined with the arts of labiaplasty and vaginoplasty. He added liposuction and abdominoplasty with training in New York and New Jersey.

In concert with a maternal fetal specialist, Dr. Moulton developed a plan and a financial modeling for an Atlanta based birthing center. This project later developed into a home based birthing model.

We looked at profit loss statement review and subanalysis of individual processes within the office to subdivide a population into a concierge and insurance paying model. The future plan was to take this to 100% concierge services. The recession limited the concierge process due to a lack of patient resources.

Incontinence was evaluated on a neurological and physiological basis in the office. We performed contractual work for other GYN offices that led to virtual reading of the testing. He planned for the RV based mobile continence testing for women across Georgia and the company created was Gwinnett Continence Center. Dr. Moulton specialized in pelvic reconstruction with an emphasis in incontinence repair. He took this to the next level with spinal neuromodulator implantation.

He researched into new materials that could help the current ultrasound machines better delineate the uterine contour. Dr. Moulton is working to create this material and perform testing which is still in process. The most comparable materials were found in cardiothoracic literature.

EMR Design
Hispanic Clinic

We used a known adjunct to surgery for post surgical prevention of thromboembolism. We then expanded its horizon to two weeks post operative . The time for clotting after surgery goes well beyond the immediate care in the hospital. In our need to get people out of the hospital sooner we addressed what is likely the #1 risk to a post operative patient. TLC for Women used its network of 60 insurance companies to ping for reimbursement. Hopefully, many patients' lives have been saved. DVTRx is a working company.

In 2002 Dr. Moulton purchased a practice bringing together Mckesson practice management for the financial side, and MedicaLogic Logician for the patient side. GE then purchased both sides creating a dual database EMR. The combination grew into GE Centricity. TLC for Women moved into Greenway, a single database solution. Dr. Moulton tailored all of the product and templates specifically for evidence based medicine within TLC for Women. This was customized so that the midwives, nurse practitioners, physician assistants, and new physicians could follow and be protected by the evidence based medico-legal medicine. Through the years we helped new EMR solutions mature.

In a county with a large multinational population, we addressed a pre-Obamacare solution with a Medicaid model. We performed 80% obstetric services and 20% gynecologic services. In 2 years we expanded 1100 %. We had no capital outlay and saw patients at 4 locations.

Dr. Moulton performed multiple incontinence surgeries. Testing to base the physiologic cause of that incontinence revealed that many patients had neurologic incontinence, refractory to surgical cure. Medtronic had a device to treat neurologic incontinence called Interstim. This neuromodulator targets the communication problem between the brain and the nerves that control the bladder at the lumbosacral level. Dr. Moulton was one of the very few gynecologists performing this neurosurgical implantation technique.

Dr. Moulton designed a building that fit the needs of TLC for Women in its growth plan. The building was designed emboldening the art of movement. How a practitioner moves in concert with his assistants is unique to each practice. To further subdivide that space for leasing, until growth has been realized, was another challenge. This building was 2069 Teron Trace. Some projects had no commonality with TLC for Women, whereas, some were more intimately involved. This included TLC Beautiful Babies, an elective 3D ultrasound business. Gwinnett Continence Center started its testing here. The boardroom was used for teaching surgeons interactively real time for 11 different companies. Massage.mbs.tlc was formed to add massage into the space in the boardroom, which addressed pregnancy and back pain. Pregnancy yoga was the next extension. The 2069 after-hours model made use of the same space in a shift like pattern to contiguously use the space. Other offices were leased to podiatric, gynecologic, and radiology practices.

Medicaid Review
Mobile TLC

He served as a professional reviewer of cases. His expertise in evidence based medicine made him a source for experiential review.

TLC for Women billing was expanded through virtual locations. He was able to read ultrasonographic and urogynecologic cases and bill accordingly. Bringing both sides to a mobile unit was incorporated to further expand the reach. On the RV model we incorporated a surgical bed where we could perform endometrial ablation, tubal ligation, and incontinence testing.

We explored the opportunity to address surgery from a microsurgical prospective. Endometrial destruction using nanorobots was first hypothesized then engineered with a multi-system process. We are still very early in the implementation and discovery of the eventual final processes. Dr. Moulton would love to continue with GA Tech and put the processes in place if we could learn much more about the tasking of the robots.

Several other projects in addition to the above are in early stages of development.

Patient Education Systems
Sleep Studies
St. Judes

The office at 2069 Teron Place was built and engineered with CAT-5E to every room to enable virtual learning while a practitioner is out of the room. This includes obstetric, gynecologic, surgical, and pre/post-operative teaching. A third party company came into being 8 years after the initial building with the above name. This teaching enabled patients to follow a decision tree to affect their treatment.

The third shift of 2069 After Hours was an opportunity to bring in sleep studies with a third party provider.

This was a purely philanthropic organization that was formed based upon Dr. Moulton's Catholic upbringing. We know and respect the larger company's name and reputation, and want to continue with the same dedication. We helped bring live theater to downtown Lawrenceville, GA. The theater now is involved in teaching children as well as running two live theaters.