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16 Apr 2018

ATA18 – Visit our booth at the American Telemedicine Assoc. Conf. in Chicago

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The largest and most important gathering of telemedicine professionals in North America will take place in less than 2 weeks in Chicago, Illinois, April 29th through May 1st.

Physician Licensing Service will be there to answer questions and advise on multi-state acquisition of medical licensure and to share proven effective risk management techniques learned over 21 years of licensing medical professionals.

What is telemedicine?


How can I benefit from using technology to interface with my preferred health care professionals?


Why are so many people talking about telemedicine and will it really benefit my family?


What do I gain and what do I lose from using advanced telemed technology to service my family’s heath care needs?



These are questions that many of us have asked when viewing the dizzying array of new technology available for individuals and families to use when communicating with doctors and hospital staff. We have all seen how modern technology has revolutionized how we communicate with our friends, family and coworkers. The upcoming conferencing discussing these issues in Chicago will be a great place to find answers.


Come see our booth at ATA18 in Chicago this April 29th through May 1st and find out about our Physician Licensing Service special promotion for multi state acquisition. For details please email Tony at or call 888-551-2140.




05 Apr 2018

Intermountain Turns Telehealth, mHealth Into a Connected Care Platform

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By gathering 35 different telehealth and mHealth services into one connected care platform, Intermountain Healthcare aims to make care coordination and management and community effort.

Intermountain Healthcare has decided to bring all of its telehealth and telemedicine programs together under one virtual roof.


The 22-hospital, 180-clinic health system, based in Salt Lake City, recently announced the launch of Connect Care Pro, which is being billed as one of the nation’s largest virtual hospital services. Officials say the platform, in the planning stages for five years, seeks to gather together Intermountain’s 35 digital health programs.


“We decided that we needed to bring it all together under one entity,” says James Sheets, the health system’s Vice President of Outreach Services Development. “We all want to be singing from the same sheet of music from now on.”


The naming of the new service, Sheets says, is quite deliberate.


“Healthcare is focused so much on virtual or tele- programs, but this is more than just a video visit,” he says, running down a list that includes telestroke, telehealth programs for behavioral health and newborn critical care, telepharmacy services and digital health services that make use of connected health devices. “Connected kinda defines what we’re doing.”


It actually defines what many hospitals and health systems have been doing for the last few years: launching telehealth and mHealth programs and pilots here and there, defining specific goals or targeted populations, and building up a collection of services that don’t integrate easily. By moving to gather those services together, Intermountain is moving into what many believe to be next phase of telehealth.


“We’re gathering together what’s been a quite fragmented (collection of services), which will allow us to grow and scale up even more.”


Connect Care Pro, which will be coordinated out of a 20,000-square-foot facility in nearby Murray, will also bring into focus a particular goal of Intermountain and telehealth in general – to extend care coordination and management outside the health system and help small hospitals and medical groups keep their patients.


“We’re building relationships with communities,” Sheets says. “We can now export some of our expertise. Healing and health is connected to the support you have around you.”


That philosophy has already proven its value. Intermountain officials say their connected care program allowed a small hospital in the southern part of the state to connect via telemedicine for a consult on a sick baby. That critical care consult negated the need for a transfer to Intermountain’s newborn intensive care unit in Salt Lake City, a trip that would have cost more than $18,000 and caused even more stress for the family.


“Our goal is to keep care in the communities,” says Sheets, noting Intermountain’s telehealth programs not only encompass the health system’s own hospitals but nine others outside the system. And there are plans to push that envelope even further, with remote patient monitoring and chronic care management programs and services that extend to new sites, like schools, prisons and skilled nursing facilities.


One of those nine hospitals outside the Intermountain system is Kane County Hospital, an independent facility located in Kanab, near the Arizona border. In a press release provided by Intermountain, the hospital’s chief nursing officer, Charlene Kelly, RN, BSN, said her hospital has used a telemedicine platform for potentially life-saving mental health evaluations.


“Kanab has had one of the highest suicide rates in the state, not including patients that come to us from our border town in Arizona, and we don’t have a crisis worker here,” she said. “Trying to place a patient who has not had a crisis evaluation was next to impossible.  With crisis care from Intermountain Healthcare, patients receive that crisis evaluation in less than an hour, and if the crisis worker recommends inpatient treatment they assist in placing the patient.”


“Our providers just love having this service available,” she added.


Original article written by Eric Wicklund and posted on March 6, 2018.

Reposted by Physician Licensing Service.


26 Mar 2018

Senators Include Telemedicine in New Bill to Modernize the VA

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A proposal to enable VA doctors to treat veterans via telemedicine no matter where they live is included in a new VA modernization bill submitted by Sens. John McCain and Jerry Moran.

Photo supplied by Thinkstock


A new bill that seeks to modernize the oft-criticized Department of Veterans Affairs includes a provision allowing VA doctors to treat veterans via telemedicine no matter where they live.



The 125-page Veterans Community Care and Access Act of 2017, filed this week by Sens. John McCain (R-Ariz.) and Jerry Moran (R-Kansas), uses the same language as that featured in the Veterans E-Health & Telemedicine Support (VETS) Act of 2017 (H.R. 2123), which was passed by the House last month and now awaits a Senate vote.



Both bills would allow VA-affiliated practitioners to treat veterans through telemedicine in any state, bypassing state licensure laws, as long as they follow established healthcare standards and have an active and unrestricted state license.



Both bills also call on VA Secretary David Shulkin to report back to Congress within a year “on the effectiveness of the use of telemedicine by the Department of Veterans Affairs.”



Shulkin has included the same telemedicine provision in his “Anywhere to Anywhere VA Health Care” program, unveiled in September and backed by the Justice Department.



While the VETS Act, co-sponsored by Reps. Julia Brownley (D-Calif.) and Rep. Glenn Thompson (R-Pa.), sailed through a unanimous House vote in early November, its companion bill in the Senate, submitted by Sens. Joni Ernst (R-Iowa) and Mazie Hirono (D-Hawaii), still awaits a vote – not a sure bet, given the Senate’s busy workload and a lack of progress on single-item bills.



With their bill, McCain and Moran are tacking the telemedicine provision onto a much larger effort to modernize the VA and repair its less-than-stellar image in serving veterans.



The bill would establish a Veterans Community Care Program that coordinates healthcare inside and outside VA health systems for the nation’s veterans, including establishing access and quality standards, safe prescribing standards and a walk-in care protocol. It also calls on VA facilities to coordinate care with non-VA providers by sharing medical records and determining reimbursement.



“In the wake of the scandal in care at VA hospitals in Phoenix and around the country, we vowed to guarantee our veterans timely access to quality treatment,” McCain said in a joint release issued by the two senators“The Veterans Choice Program was the first step in delivering on that promise, but much more needs to be done to provide all veterans a choice in when and where they receive care.”



“Our bill would strengthen and improve the core elements of Choice by consolidating and streamlining the VA’s community care program,” he continued. “Moreover, the bill would deliver long overdue, critical reforms to the VA, including commonsense reporting standards that ensure cost-efficient care to our nation’s veterans.”


“Demand has demonstrated that veterans want and need healthcare options in their communities, but there must be reform at the VA to create a system that works for them,” Moran added. “This joint effort to reform the VA will offer veterans an integrated healthcare system within their community that reduces red tape, enhances their quality of life and provides care that is worthy of their service and sacrifice.”



The VETS Act has received support from a broad range of organizations, including the American Telemedicine Association, American Medical Informatics AssociationFederal Trade Commission, Health IT Now, the American Academy of Family Physicians, the College of Healthcare Information Management Executives (CHIME), Teladoc, Oracle, the American Psychological Association, the Brain Injury Association of America, the National Association of Social Workers and the University of Pittsburgh Center for Military Medicine Research.



The AAFP’s support was guarded, however. The organization said it would support this specific bill to improve veterans’ access to much-needed healthcare services, though it “still strongly supports state-based licensure and regulation of physicians and other healthcare providers as well as the states’ ability to regulate the practice of telehealth in their state.”



Among those opposed to the provision is the Medical Board of California.



In an Oct. 30 letter to Shulkin, the board said the VA secretary’s proposed rule “would undermine California’s ability to protect healthcare consumers, as the board will have no ability to discipline VA providers that are licensed in another state and providing telehealth outside of a VA facility in California, as they do not hold a license to practice in California.”



“Although the board believes that telehealth is a useful tool that can be used to provide appropriate service to patients in California, the board believes that it is very important for physicians treating patients in California to be licensed in California,” the letter concluded.



Original posted by Eric Wicklund on 12/05/17

16 Mar 2018

PLS Announcement: Now licensing all mid-levels. Physician Assistants, Nurse Practitioners, etc.

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Physician Licensing Service is pleased to announce the creation of our mid level team, designed to service the medical licensure needs of Physician Assistants and Nurse Practitioners(APRN).

Over the last 20+ years, we have provided time management services for working medical professionals. Time is a resource that is very coveted in modernity and our business model has been designed to keep working medical professionals focused on what makes them successful. Tens of thousands of our clients have chosen to hire out the 20+ hours of mindless phone calls and paperwork necessary to acquire a medical license in any given state.



THIS NEW SERVICE for Physician Assistants and Nurse Practitioners is now available in all 50 states in the United States for a one time low cost fee. For details on timeframes and costs associated please contact our Business Director, Tony Hendricks, at 801-449-9196 or



Call or email us to find out what we can do to save you time and money through our new mid level service offering.

05 Mar 2018

Can Telemedicine Be Both Cost Efficient and High Quality?

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Health insurance companies are encouraging patients to turn to apps and virtual visits to save time and money, but some patients end up not getting the care they need.

Erica Jensen, with her 5-month-old daughter, Charlee Jaques, by her side, video conferenced with her doctor, Dr. Marie McDonnell, from her mother’s home in Wilmington, Mass., on March 15, 2016.(DINA RUDICK/THE BOSTON GLOBE VIA GETTY IMAGES)


LAST MONTH, JENNIFER McMurrain of Bartlesville, Oklahoma, didn’t go to the doctor – she requested one by app. “I had horrible sinus pressure in my head,” she said. “I knew immediately it was a sinus infection and to get over it I’d need a round of antibiotics and prednisone.” So McMurrain relied on Teladoc, a telemedicine provider that partners with Aetna, her insurance provider. She told the doctor she was asthmatic and that if she didn’t receive treatment, her medical history indicated the infection would settle in her chest.


The doctor refused to help; instead of a prescription, McMurrain got “a lecture on how people use antibiotics too much.” Then she got sicker. The sinus infection moved into her lungs, she missed four days of work, and her husband fell ill as well.


In 2017, Teladoc treated 24 million patients. Ninety-two percent, the company claims, were pleased. Some subscribe to the service directly, but others, like McMurrain, access Teledoc through their health insurance. For providers like Aetna, telemedicine offers cost savings and increased access to care. But some consumers wonder how their insurance companies make sure telemedicine partners provide quality care – and what, if any, accountability measures are in place when they don’t.


At Aetna, Head of Network Product and Telemedicine Strategies David Hildebrand says their Teladoc contract includes “performance guarantees” for hold times, call length, and member satisfaction. He mentions no guarantees regarding standard of care. When it comes to whether physicians have the credentials and experience Teladoc claims, Hildebrand says, “We trust them and contractually they’re obligated.”


This trust has propelled the partnership for seven years. When Aetna chose Teladoc in 2011, the telemedicine provider was one of two on the market. “We found them to be the largest and most experienced at that time,” Hildebrand explains, noting email security practices were also considered.


Today, the American Telemedicine Association says around 200 providers are in operation, but Aetna doesn’t plan to change partners any time soon. While Hildebrand says they “continually look at all available options,” changing providers is difficult for a company of Aetna’s size, especially when long-term vendors become partners.


“Over the years we’ve expanded the offering and the partnership to additional services,” he explains. “We’ve rolled out behavioral health with them. We’ve rolled out dermatology, as well as a caregiver program. And we have the opportunity to partner with them and look at building out new products and services. We look at the data together. We look at the communications to our members together, and try to understand them, and provide information at the right time to them, provide them resources to our customers.”


“We’re really trying to innovate… and look at figuring out where the next evolution of telemedicine will go,” he continues. “And it’s easier to do that when you have an incumbent that is as much invested in supporting your members as you are.”


“We’re happy with the partnership that we have; our customers are happy with it.” he adds. How does he know they’re happy? Teladoc surveys say so.


“We do a follow-up with everybody at 72 hours to see if they’ve gotten better or if they needed to go see another provider,” explains Teladoc CEO Jason Gorevic, specifying that everybody really does mean everybody. “Every consumer gets at least an electronic follow up after 72 hours.” That’s where the 92 percent pleased statistic comes from.


That’s what’s supposed to happen, but in reality, everyone doesn’t receive a survey. McMurrain didn’t. Neither did fellow Aetna customer Kim Guthrie of Olney, Texas, who called Teladoc last month with a urinary tract infection. “The doctor told me within three minutes that she couldn’t treat me,” Guthrie says. “She said I needed to go to my regular doctor.”


After refusing service, Teladoc next refused to issue a refund. “It’s just very frustrating,” Guthrie adds, explaining that, as a teacher, she has a fixed income. “Teladoc makes money either way,” she continues, adding that she thinks “they are screwing people over.”


“Obviously, I can’t respond to an individual case without looking into it, but I’m happy to,” Gorevic responded after being asked about Guthrie and others’ claims.


While patients like Guthrie and McMurrain end up having to pay for both a Teladoc consultation and a visit to their regular doctor, Gorevic says financial savings are one of telemedicine’s big draws. The exact amount charged varies by plan, but he says the typical Teladoc appointment costs insurance companies “about $45. That contrasts to about $120 to $125 for a typical office visit, somewhere in the neighborhood of $175 for an urgent care visit, and north of $1,000 for an emergency room visit.” Overall, Teladoc-funded studies show each call saves providers an average of $472.


While Teladoc does keep Aetna’s costs down, Hildebrand says customers aren’t required to see teledoctors before or instead of their primary care physicians: “We don’t have a benefit plan that says they need to use this service before they do something else. It is set up there [for] convenience, to provide access, and allow them to access the service when they feel it’s most important to them.” He does, however, note telemedicine services are priced “at a lower cost share to try to encourage utilization.”


This holds true industry-wide. Oscar Health customers can access the insurance provider’s Doctor on Call service, which directs to Teladoc and other vendors, for free. UnitedHealthcare works with Doctor on Demand and American Well. UnitedHealthcare Director of Communications Lynne High says, “The total cost of a visit is under $50, with the member’s portion of the cost determined by their benefit design.”


“Consumers throughout their entire lives are shifting to the on demand economy, whether it’s booking travel or shopping for groceries or buying shoes,” Teladoc’s Gorevic says, adding “healthcare fits right in with the rest of the economy. Consumers see this as a more-convenient, more-timely way to get care. It also happens to be a more cost-effective way to get care.”


But no matter how cost-effective care gets, providing it – and addressing people’s health concerns – isn’t as simple as buying milk. Khan Shoieb, head of communications for Oscar Health, says when a customer experiences a problem due to quality of care, employees “direct the member to address their concerns specifically with Teladoc” as opposed to Oscar, stressing that Oscar and Teladoc “are two separate entities.” Hildebrand says Aetna’s contract with Teladoc outlines processes for escalation and issue resolution, but open communication is important, especially from people like McMurrain and Guthrie, who don’t make it into Teladoc’s surveys..


“If there’s a problem,” Hildebrand says, “we would want to know about it and address it right away.”


Original By Terena Bell, Contributor – – Feb. 27, 2018, at 3:41 p.m.

Reposted by Physician Licensing Service

23 Feb 2018

Taking the Telemedicine Leap

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In October 2012, Medicare began rewarding hospitals that provide high-quality care for their patients through the Hospital Value-Based Purchasing (VBP) Program. Under VBP, hospitals are paid for inpatient acute care services based on quality of care — not the volume of services they provide.  To this end, a hospital’s Total Performance Score (TPS) and unplanned readmissions are significantly and inversely related to readmission rates.



These new payment models have driven hospitals to evaluate the variables that might impact the readmissions of their patients. One of the most common discharge locations for hospitalized patients are Skilled Nursing Facilities (SNFs). In some communities, this increased scrutiny has revealed that facilities that are not providing services adequate to prevent readmissions, which results in those facilities no longer being a preferred referral source.




Beginning on October 1, 2018, the SNF VBP Program will begin to reward (or penalize) SNFs for 2017 performance by offering incentive payments for the quality of care they deliver to Medicare patients. In this new environment, SNFs across the nation are now – more than ever — seeking creative ways to utilize telemedicine to distinguish themselves with their hospital partners and deliver a higher level of care to their patients by treating them in place, thereby avoiding hospital transfers.



Telemedicine is growing at a rapid pace, and the number of patients using telehealth services will rise to seven million in 2018, up from less than 350,000 in 2013. Broadly defined, telemedicine is the monitoring, diagnosing and treating of patients from a distance using technology. Recent technological advances, particularly during the past 10 years, have enabled medical providers at many levels to be virtually at the bedside like never before.



Telemedicine has been proven to deliver results across a variety of settings with definitive measurables such as length of stay, readmissions, emergency room visits and improved access to caregivers.  However, to achieve positive results and reap the benefits, consideration should be given to several factors.



Key considerations


As SNFs assess the value of telemedicine at their individual facilities, here are areas they ought to consider before taking the leap:



  • How does this service fit into our overall strategy of patient care? A good telemedicine program can make patients and families more comfortable and confident in the care at the facility level. It is beneficial to take into consideration if this will be used to attract new patients. The program should retain patients at the facility, avoiding costly and uncomfortable ambulance trips and Emergency Department visits. Also, it’s best to determine if the results achieved will be used to maintain preferred provider status. The support given to the nursing staff can result in less stress and turnover. It’s important that the organization articulate the reason for adopting a new service and can support both its installation and usage.


  • How will this integrate with current workflow? As with any new program, an important factor to consider with any telemedicine implementation is how it fits within an existing workflow. Ideal telemedicine solutions should enhance and support the care already being delivered, not create one-off processes that required additional staff time.


  • What is the status of the facility’s wireless internet capability? Facilities will need to ensure that they have enough bandwidth to implement the types of telemedicine services they are considering. This can be as simple as adding some new access points or range extenders as well as if more complex solutions might be required. The wireless capability should be assessed in tandem with the telemedicine service provider.  The equipment proposed by the telemedicine provider can have an important impact on the necessary upgrades.


  • How much additional staff training will the service require? It is important to understand what the training costs are in terms of dollars as well as the time needed for educating staff and attending physicians on how the telemedicine solution will be used. Is the proposed equipment so complex that the nursing team might struggle with engaging the telemedicine physicians?


  • Is there reporting available to measure the results of the service? How can metrics be accessed and communicated to the facility leadership and in what format? Is there a customer service group that works to enable satisfaction and results after the initial launch of the service? Assuring that the telemedicine provider is prepared to measure and meet the SNF administrative needs are critical success factors.



Measuring the Impact



For SNFs moving forward with telemedicine services, they will find the best successes by understanding their baseline data and setting clear objectives for the program.  Important baseline elements to track before and after the service installation are:


  1. The typical length of stay for a patient


  1. Number of patients who return to the hospital each month



  1. The percent of those who leave and who never return


  1. The percent who return after a hospital stay



  1. The facility Resource Utilization Groups (RUG) Rates

Using this information, the facility can derive the impact on lost revenue.  By comparing the results quarterly to baseline data, the return on investment can be clearly demonstrated.




In a recent study by the TRECS Institute (a non-profit organization dedicated to improving care for seniors while decreasing healthcare cost), during which telemedicine physician services were used, both a dramatic improvement in the quality of patient care delivered as well as a significant financial benefit were reported: in many instances of hospital admissions/readmissions were averted. Additionally, results revealed positive increases in net revenue for the study facility, which significantly exceeded the cost of the telemedicine provider’s services, thereby improving both top- and bottom-line financial performance for the SNF.



Mary Jo Gorman, Chief Executive Officer, TripleCare

Physician Licensing Service
February 23, 2018









Implementing a successful telemedicine solution is a smart and affordable way to stay in preferred provider networks, increase facility census, reduce hospital readmissions, make room for happier residents and their families and ensure more confident staff members are part of the team.


Go ahead and take the leap; it may just be what helps you stay afloat amid the changing healthcare waters.



Mary Jo Gorman, M.D, is chief executive officer of TripleCare, a leading high-acuity telemedicine services provider to skilled nursing facilities throughout the U.S. She can be reached at


30 Jan 2018

Enhanced Interstate Nurse Licensure Compact Implemented

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Published on Medscape by Troy Brown, RN – January 25, 2018

Republished by Physician Licensing Service


The National Council of State Boards of Nursing (NCSBN) has added new requirements to the Nurse Licensure Compact, an interstate agreement that allows nurses to practice in multiple states with one license.



The Enhanced Nurse Licensure Compact (eNLC) adds state and federal criminal background checks, restricts licensure for nurses with felony convictions, and standardizes licensure requirements among participating states. The implementation date for the eNLC was January 19, 2018.



“Although these nurses may skip the licensing process in the eNLC states, they still must follow the laws and nurse practice act of each state where a patient is located. The eNLC affects registered nurses and licensed practical or licensed vocational nurses; it does not apply to advanced practice nurses,” healthcare attorney Carolyn Buppert, MSN, JD, writes in an article for Medscape Medical News published November 1, 2017.



Maryland signed the original NLC into law in 2000. It enables registered nurses and licensed practical/vocational nurses licensed in one compact state to practice in other compact states without having to obtain an additional license. Advanced practice nurses are not included in the compact.



Proponents of the compact say it enables nurses to provide direct nursing care and telenursing services to patients located across the United States without having to obtain multiple licenses. The compact also facilitates the movement of nurses across state borders to provide care during disasters and reduces licensing burdens for nurses who live in areas that border two or more states.



The enhanced version adds the requirement of a criminal background check (state and federal) at the time of initial licensure and restricts nurses from obtaining a multistate license if they have ever been convicted of a felony. In addition, the eNLC requires compact states to adopt the NCSBN’s Uniform Licensure Requirements, which “establish consistent standards for initial, endorsement, renewal and reinstatement licensure needed,” according to the American Nurses Association.



“Nurses who had a multistate license as of July 20, 2017, will not need to meet these requirements and will be grandfathered in under whatever requirements they met at the time of their application. However, if they move to another state, they will be subject to the requirements of the eNLC,” Buppert explains.



To date, 29 states have enacted eNLC legislation: Idaho, Montana, North Dakota, South Dakota, Nebraska, Wyoming, Utah, Colorado, Arizona, New Mexico, Texas, Oklahoma, Missouri, Iowa, Arkansas, Wisconsin, Kentucky, Tennessee, Mississippi, Virginia, West Virginia, North Carolina, South Carolina, Georgia, Florida, Delaware, Maryland, New Hampshire, and Maine.



eNLC legislation is pending in Vermont, Massachusetts, Michigan, Indiana, Illinois, and New Jersey. That legislation must be signed by the states’ governors after advancing through the states’ legislatures.



Nurses in good standing whose declared primary state of residence is a compact state are eligible to practice nursing in any of the other compact states; however, they are only allowed to have one license. As with drivers’ licenses, nurses who change their state of residence must obtain a new license in the new state and surrender the former multistate license.



Nurses whose primary states of residence are noncompact states are not eligible for a compact license, according to the NCSBN.

24 Jan 2018

23 Tips for Starting and Running a Private Practice

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Original story by: Nathan Wei, MD – June 06, 2017 –

Reposted by Physician Licensing Service



During my 4 years of medical school, 4 years of residency, and 2 years of fellowship, not once did I receive any type of exposure to how to run a business.



I suppose it didn’t matter to those who were going to stay in academic medicine. However, for those of us who elected to go into private practice, it was an incomplete education.



In my 30-plus years of private practice, I’ve had ups and downs. I have had victories as well as ignominious defeats. So for those of us in the trenches, and on the basis of my experiences, I’d like to provide a few pointers on how to start—and run—a successful practice:



  1. Formulate a business plan. This should be heavily weighted on the numbers—meaning the economics of what it takes to operate a private practice.



  1. Create a USP, or “unique selling proposition.” This is a brief statement of why someone should see you as opposed to somebody else. You should not use such words as “quality” and “service.” I have yet to see somebody say, “We offer mediocre quality and poor service.” Here are some good examples from the past. When Domino’s first started, their USP was “fresh, hot, pizza delivered in 30 minutes or less or your money back. ” Federal Express’s USP when they first started out was, “When it absolutely, positively has to be there before 10 AM.” A USP is different from a tagline. Taglines often read as stupid; a good USP does not.



  1. Your entire practice needs to be run on systems, and each person in your office should be aware of how these systems work. This will prevent the “Sally knows how to do it, but nobody else does” syndrome.



  1. Be unique yourself, and be unique in how the public see you. People aren’t going to knock down your door just because you’re “he of good doctors.” People such as Dr Phil and Dr Oz may take this a bit too far, but assuming you’re competent at what you do, a public image can’t hurt.



  1. Early on, expect to do grunt work. This means giving talks, meeting and greeting, and doing other things to help make sure people know who you are.



  1. Recurring newsletters and correspondence can be critical. The newsletters should contain news of interest to you and prospective patients. This does not mean the newsletter should be all about what you do. That’s boring. The newsletters should feature a patient and what makes them interesting (with their permission, of course). Perhaps they have an unusual hobby, etc. Maybe include recipes, jokes, or cartoons—anything to increase personal engagement.



  1. Financially speaking, don’t be afraid of going negative. By that, I mean you may need to forgo your initial consultation fee; however, you can make this up on the back end. This will involve your looking at the math.
  2. Make sure your cash flow is gaining. You’ll have to know how to analyze a profit and loss statement, as well as a balance sheet.



  1. Hire wisely. Make sure you have a system in place. Remember, when interviewing a perspective person, it is important to go over the traits that are important for your practice. Also, remember that people will behave the way they behave. In other words, a good question to ask is, “When X happened to you, what did you do about it?” You can predict future behavior by learning about past behavior.



  1. Hire slow, fire fast. This goes not only for employees, but also for patients. Doctors tend to hold onto both employees and patients for much too long. Life is too short to go through that stress.


Technology, Public Relations, and More

  1. Use technology to help make you more efficient. However, do not use technology for technology’s sake. The human touch will always supersede technology when it comes to taking care of patients.



  1. Learn empathy and persuasion strategies. Some may consider these to be manipulative. I certainly do not. You need to gain people’s trust, but not abuse it.



  1. Work very hard on building your reputation, and maintaining it. It only takes a moment for someone to destroy your reputation. This is unfortunate, because your reputation is the most important thing you have when it comes to a successful practice.



  1. Remember this: You are a marketer of what you do; you are not what you do. In other words, it is important to market yourself as the physician of choice. A prospective patient has a lot of different choices. As soon as you understand this important concept, the quicker things will begin to happen. People will seek you out for who you are more than for what you are.



  1. Learn public relations. Here are a few good ways to get good publicity: Do not believe in the old adage that any publicity is good publicity. Bad publicity will sink you very quickly.



  1. Write a book. When you write a book, you can become perceived as an authority—as an expert. It is not difficult to write a book. I have written a number of books over the years, and with all of the self-publishing options nowadays, you do not need Madison Avenue gurus to help you.



  1. Guard your wallet. There will be plenty of people after your bank account. Do not let them have access to it.



  1. Make sure you have a website that contains appealing information as well as an offer. That offer should be a lead-generation offer for more information that will allow you to build your patient database.



  1. Learn how to do video. This way, when people search Google or YouTube, they may find you.



  1. Continue to learn. Learn new techniques that will help your patients. Learn how to do procedures. The fact of the matter is that procedures still pay more than cognitive services. To this end, make yourself unique.



  1. If you must run an ad, that ad must justify its cost. Always have a clearly defined offer.



  1. Reactivate old clients. People’s lives are busy. Believe it or not, you are not at the top of their mind. It helps to remind former patients of who you are. The newsletter helps, but occasionally you may have to reactivate patients who have not returned. This reactivation campaign should be systematized.



  1. Finally, listen to the experts; don’t believe someone who has never run a business. People always have plenty of advice, even if they don’t have skin in the game.


19 Jan 2018

Study: Telemedicine Consults Help Save About $500 Per Patient

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An analysis of the eConsult service finds that doctors using the telemedicine platform for cardiology consults saved about $500 in Medicaid costs per patient over a six-month span.

Source: ThinkStock

By Eric Wicklund – January 17,2018

Reposted by – Physician Licensing Service 

January 17, 2018 – A telemedicine consult platform for cardiology cases saved almost $500 per patient in Medicaid costs over in-person treatments, according to a newly released study.


In what’s being billed as the first published randomized study of the eConsult platform, researchers at Community Health Center and the University of Connecticut Health Center found that the telemedicine platform, which facilitates virtual consults with a specialist, yielded lower mean adjusted total costs of $655 per patient, or lower mean costs of $466 when adjusted for non-normality, compared to those using face-to-face consults over a six-month span.


In addition, the eConsult group reported reduced costs of $81 per patient for outpatient cardiac procedures, as well as improving access to care for underserved patients and reducing the rate of no-shows for providers.


“The results of our analysis show for the first time that when [primary care providers] are given an option to use eConsults for Medicaid beneficiaries, the total costs and the cost of outpatient cardiac tests and procedures at 6 months are significantly lower, by $466 and $81, respectively, compared with the traditional [face-to-face] approach,” the study, highlighted in the January issue of the American Journal of Managed Care, reported.


The study was conducted by a team led by Daren Anderson, MD, CHC’s vice president and chief quality officer and director of the Weitzman Institute, CHC’s research and innovation arm, both based in Middletown, Conn.


“The important findings from this research are that a relatively simple intervention, the use of eConsults to communicate with cardiologists, can improve access to care and reduce the need for face to face consults, all while saving the system money – a win-win for patients and payers,” Anderson said in a press release announcing the study’s results. “The $466 saved per cardiology eConsult demonstrates the economic benefit, while patients who commonly endure long waits for specialists receive timely, high quality care.”


CHC and the Weitzman Institute launched one of the first eConsult pilots in 2015, working with Safety Net Connect, a California-based developer of online care coordination services. Working at first with cardiac care patients, the program routed all specialist referrals from CHC providers through an online system that allows the specialist to review the case online. This includes access to the patient’s medical record and any questions the primary care doctor may have about his/her diagnosis and treatment so far.


Based on that success, CHC and the Weitzman Institute created the Community eConsult Network, a non-profit to manage and run the program, which now includes eConsult services in several states across the country. In 2016, the Centers for Medicare & Medicaid Services approved the program for Medicaid reimbursement.


“With limited specialty providers available to treat Medicaid patients, appointment wait times can be as long as a year, leading to healthcare disparities, higher rates of disability and complications in chronic diseases,” CMS officials said in a 2016 press release. “SNC’s eConsult system has been proven to increase access to timely, cost-effective specialty services for underinsured and underserved patients, many of whom live in rural areas with limited access to specialty care.”


Now those savings are coming into focus.



For their study, Anderson and his colleagues drew data from 235 Medicaid patients receiving face-to-face cardiac care treatment and 134 involved in the eConsult program.


In the eConsult group, 59 were referred for face-to-face consults due to the urgency of their condition or an established relationship with a cardiologist. Of the rest, which

were referred to a reviewing cardiologist on the virtual care platform, 54, or 72 percent, didn’t require a specialty consult and were treated by the PCP, who received some guidance through the eConsult platform.


In the control group, 196 of the 235 patients, or 83 percent, had a face-to-face visit with a cardiologist; of the other 39 patients, 24 were no-shows.


Anderson and his colleagues said the eConsult platform proved itself by enabling PCPs to manage and coordinate care for more of their own patients rather than pass them off to a specialist, while also reducing referral waiting times for those in need of a consult. The primary source of savings, they said, was in a reduction in unnecessary and costly treatments.


Others savings, they said, included transportation and administrative costs incurred by safety-net health centers, some of which “invest significant resources not only in scheduling specialty visits for their patients, but also in providing extra support to help patients overcome financial, transportation, and other logistical barriers to reduce the likelihood of a no-show.”


Not included in the study was the impact on patients. Anderson and his colleagues noted one study undertaken in Canada that found significant costs savings in avoided transportation and lost productivity and wages from taking time off from work.


“These potential benefits associated with the eConsult represent unmeasured but potentially important cost savings that accrued to patients in this study,” they said.


While pointing out the value of the eConsult platform to healthcare providers and their patients, the study also noted that changes need to be made for the program to continue its success.


Anderson and his fellow researchers concluded that the eConsult platform can be valuable to state Medicaid agencies and health systems seeking ways to improve healthcare access for the underserved while reducing costs.


“Policy changes that support the use of eConsults as a new service modality could result in significant savings to the Medicaid program in a relatively short time frame,” they noted. “However, sustaining eConsult programs will require changes in reimbursement policies, either by authorizing payments for eConsults on a fee-for-service basis or by increasing the opportunities for primary care and specialty providers to share in the savings that accrue from more efficient and effective care.”


10 Jan 2018

Clinicians Brace for AI to Transform Medicine

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Artificial intelligence is coming … how will it affect medicine?




The doctor enters and pulls up the electronic medical record. The patient’s history is already there. So is the CT scan. The doctor drags and drops the image, presses the “analyze” button. An actionable diagnosis appears a moment later.


If artificial intelligence (AI) were to one day take over much of clinical practice, as some fear or anticipate — being potentially faster, more reliable, and generally better at certain tasks than humans — clinical decisions may no longer depend on tired eyes, imperfect risk scores, or lagging guidelines. Does that leave a role for physicians as decision-makers? Or will they become like Uber drivers in the age of GPS, just following directions issued from a device?


“GPS is not always precise,” offered Thomas Luscher, MD, a cardiologist at Switzerland’s University Hospital in Zurich, during a recent panel at the American Heart Association (AHA) meeting. “If you’re smart enough you can figure out how false it is.”


That’s the general idea of how things may also go in medicine once AI enters the mainstream. Clinicians today are cautiously optimistic that AI won’t exactly take their jobs. At risk, however, are those whose tasks involve a lot of repetitive tasks, such as looking at scans.


And that’s what automation is good for: processing information in rote, or nearly rote, fashion at high speed and with no issues of distraction or fatigue.


“I tell young people, ‘Don’t become a radiologist. You will be substituted by a machine,'” Luscher said.


Skeptics might point out that automation in medicine is hardly new in 2017. Automated ECG analysis began in the 1970s; computer vision is long established in liquid cytology for analyzing Pap smears; the MelaFind device for screening skin lesions is FDA approved.


Those systems, however, were narrowly focused and to a large extent still rely on human backup. ECG analysis software, for example, makes enough false diagnoses of atrial fibrillation and inappropriate cardiac catheterization laboratory activations that cardiologists generally know not to rely on it for clinical decisions.


What sets AI apart is the growing sophistication enabled by increased computing power and, just as important, the emergence of “Big Data” for training the algorithms.


Earlier this year, an AI system reportedly beat clinicians at recognizing 12 out of 14 arrhythmias and with better sensitivity and specificity. And just a few weeks ago, a computer algorithm outperformed human pathologists in diagnosing cancer metastasis in sentinel lymph node specimens.


The reach of AI is expected to increase as databases grow with the influx of information from wearables, electronic health records, and personal genomics firms as well as conventional sources.


Turning Point


“AI is a critical transformative part of the history of medicine. Medicine is an information system, now firmly so than ever before,” commented Harlan Krumholz, MD, of Yale School of Medicine in New Haven, Connecticut, at the AHA panel, adding that his academic group started hiring mathematicians and people who can code in Python.


“It will find its way into decision support, providing guidance on diagnostic interpretations, assisting in assessing prognosis, enabling better assessments of risks and benefits of particular clinical strategies – and generally spreading expertise. It will be a foundation for precision medicine,” he later told MedPage Today.


“The biggest impact of AI in medicine in the short term will be in the area of pattern recognition and image interpretation. Currently we are limited by human cognitive capabilities, which lead to high miss rates on image interpretation and marked inter and intra-observer variability,” Krumholz said. “We will also be able to extract useful information that is hard to discern with our eyes. Other important areas will center on prediction, with improved means of estimating prognosis – and of complications and risk.”


In addition to its potential for delivering better care, AI will be a democratizer of healthcare wherever it is available, according to Rima Arnaout, MD, a cardiovascular imaging sub-specialist at University of California San Francisco.


“Right now, the big academic medical centers with experienced niche specialists often provide better diagnosis and care for patients with rare or complex conditions. But if models for patient diagnosis and management are trained on data from those experts and made widely available, patients at big academic centers and rural clinics alike will have better access to better care,” she said.


Arnaout and Krumholz are both in the trenches of making AI a reality in medicine, her taking part in the effort to develop image-recognition tools to diagnose disease with higher accuracy and precision than human beings, and him investigating ways that AI may improve patient care and outcomes by identifying high-risk patients — those who may, say, be more likely to be re-admitted to the hospital after a medical procedure.


But to call today’s technology in its infancy would be an understatement.


Joseph Hill, MD, chief of cardiology at UT Southwestern in Dallas, said that he doesn’t know anyone practicing medicine with AI today. “In my world, AI-facilitated interpretation of echocardiograms is on the horizon but likely 10 years from prime time,” he said, predicting that initial uses will likely be in analyzing x-ray images.


It comes down to the technology not being widely available at an affordable cost, said George Welch, MD, a cardiologist at New York’s Manhattan Cardiology. “The cost of that technology will have to come down significantly before any of us are using it on a larger scale.”


Available Now or Soon


One application Welch is following is IBM’s Watson, which is being trained by a coalition o CVf hospitals, ambulatory radiology providers, and imaging technology companies for use in health imaging. Other Watson-enabled projects include WatsonPaths and Watson EMR Assistant, two projects launched in collaboration with the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, the former seeking to make it easier to trace how AI determined the best option for each clinical scenario and the latter designed to highlight the most important information from patient medical records.


Yet another recent AI-based rollout comes from Hitachi and Boston-based Partners Connected Health, which purportedly can predict hospital readmissions within 30 days for patients with heart failure. It identifies patients who would benefit from a special readmission prevention program, saving the healthcare system a substantial number of dollars.


And it’s not just the big names that are putting real effort into this technology: Andreessen Horowitz just created a new $450-million fund to invest in startups developing AI and machine learning for healthcare.


After all is said and done, when AI has been fed enough data and cash, when it moves from infancy to its teenage years, and people are satisfied with its reliability and accessibility, the question remains: will doctors really lose their jobs to a computer?


“This type of capacity will reduce a lot of the roadwork that cardiologists do and will free up our time to spend with patients and create a better connection and bond with patients,” Welch suggested.


“There’s still a role for radiologists — all the machine is doing is giving you a prediction,” said former FDA Commissioner Robert Califf, MD, at the AHA panel. “What do you do with probabilities? There’s a tremendous role for radiologists. This is bringing humanism back to medicine, the interaction with people. The role of the doctor is going to get bigger and bigger.”


For his part, Califf is now employed at Verily, Google’s life sciences division, where he has a hand in Project Baseline. The study continues to recruit for a goal of 10,000 participants who will volunteer massive amounts of their daily health information via wearable technology, surveys, and clinic visits — perfect fodder for feeding to AI, ostensibly.


Yet “AI is not a cure-all for the problems in healthcare,” Arnaout emphasized, adding that “especially with respect to supervised learning, an AI tool is only as good as the data you train it with. The medical community needs to be very careful in curating training data for these models, providing high-quality data that represents all ages, genders, races, ethnicities, and patient conditions.”


“If we don’t do this, we can allow some dangerous biases about our patients and diseases to get baked right into our systems of care,” she warned


  • by Nicole Lou,Contributing Writer, MedPage Today – December 26, 2017
  • article reposted by Physician Licensing Service – January 10, 2018