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10 Nov 2017

NewYork-Presbyterian specialists use telemedicine to treat stranded Puerto Ricans

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The medical center jumped in after Hurricane Maria to deliver care services in what it calls a proof-of-concept for using telehealth tools in emergency response.

telemedicine in Puerto Rico

Original by Bill Siwicki – posted November 09, 2017 – 02:56 PM

Reposted by Physician Licensing Service


NewYork-Presbyterian Weill Cornell Medical Center sent an emergency team to work with patients on the ground in Puerto Rico and conduct visits with specialists using telemedicine tools in the wake of Hurricane Maria’s devastation.


The move comes amid a 2017 hurricane season during which other hospitals such as Nemours, and telemedicine companies including LiveHealth Online, Doctor On Demand and EpicMD, have been offering free virtual consultations to people in storm-ravaged areas in Florida, Texas and Puerto Rico.


Beginning on Oct. 27, NewYork-Presbyterian sent people to Puerto Rico to deploy the telemedicine equipment that enabled them to consult with specialists back in New York.


“On the first day, I received a call from physician assistant Nancy Pagan that she needed a consultation for a 2-year-old boy with diabetes who had elevated blood sugar for the past two weeks,” said Shari Platt, MD, chief of pediatric emergency medicine at the medical center. “Within one hour, we were using our telemedicine service to perform peer-to-peer consultation in a three-way communication.”


That live video conference included Pagan, Platt and and Zoltan Antal, MD, the chief of pediatric endocrinology at NewYork-Presbyterian Weill Cornell Medical Center.


The caregivers were able to virtually see the child, speak with the mother, and advise Pagan on how to adjust the insulin dose and diet to better manage his diabetes, which had become uncontrolled.


“Being able to see the child, and assess his behavior, his level of comfort and hydrated state, and his well appearance, was a priceless aspect of this evaluation, as a simple phone discussion could not have provided this critical information that helped to guide his care,” Platt said. “Further, for his mother to be able to speak with Dr. Antal, to see his face, and have an eye-to-eye contact, offered a powerful connection and an intangible sense of trust and faith in our care.”


Clinicians are using such telemedicine technologies in Puerto Rico Rico and elsewhere to deliver specialist and sub-specialist care in ways that emergency teams simply cannot without the tools.


“Many of the patients have had complex medical conditions that even in our own emergency department would be managed with the consultation of a sub-specialist,” Platt said. “And this level of specialization cannot be duplicated by emergency teams on the ground.”


Access to specialized medical care is frequently difficult, if not impossible, following disasters. And with people having grown accustomed to seeing and speaking with friends and family via video or Facetime, Platt said telemedicine enables patients to be cared for by a specialist when necessary.


That said, it’s still early to tell for certain what impact telemedicine will have on Puerto Rico overall as it continues to recover and what that might mean for other areas that face storms in the future.


Telemedicine bridges the gap and allows the medical center’s physicians to treat patients as if the medical center’s caregivers were there in person. So from that standpoint, the use of telemedicine in Puerto Rico is in essence a proof of concept that the digital health services can be of tremendous value in emergency and disaster response situations.


“What we can say is that as a result of our time providing aid in Puerto Rico, we know now that we can still provide access to general and sub-specialty care that can adequately address chronic conditions such as diabetes and dermatological care for certain skin reactions that occur during times like this and especially when the patients might not have access,” said Rahul Sharma, MD, emergency physician-in-chief at NewYork-Presbyterian/Weill Cornell Medical Center.



15 Sep 2017

Patients and families save time and money with telemedicine visits study finds

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Patients and families who use telemedicine for sports medicine appointments saved an average of $50 in travel costs and 51 minutes in waiting and visit time, according to a new study by Nemours Children’s Health System. Each telemedicine visit also saved the health system an average of $24 per patient, researchers reported at the American Academy of Pediatrics National Conference & Exhibition.


Original posted 9/15/17 by:

Reposted 9/15/17 by: Physician Licensing Service


“There’s a constant need to innovate care delivery to demonstrate value to patients and families,” said Alfred Atanda Jr., MD, an orthopedic surgeon at the Nemours/Alfred I. duPont Hospital for Children and author of the study. “Nemours’ tech-savvy care environment provides another way to get patients the care they need — where and when they need it. We were able to do so while saving families time and money.”


In a cohort study of 120 patients younger than 18 who had at least one telemedicine visit between September, 2015 and August, 2016, the Nemours researchers compared total time of clinical visit, percentage of time spent with attending surgeon, and wait time, to data from in-person visits in the department. Data were collected for postoperative evaluations, surgical/imaging discussions, and follow-up visits. Demographic data and diagnosis were recorded from the electronic medical record.


The findings support the use of telemedicine to reduce costs for both the patient and hospital system, while maintaining high levels of patient satisfaction, researchers said. After each visit, parents were asked to complete a five-item satisfaction survey. Ninety-one percent of parents found the application easy to download, 98 percent would be interested in future telemedicine visits, and 99 percent would recommend telemedicine to other families.


The study, which was conducted in a pediatric sports medicine practice, also found that the percentage of time spent with the provider was significantly greater for telemedicine than for in-person visits (88% vs. 15% of visit time). Families also saved significant travel time and expense, avoiding an average of 85 miles of driving, resulting in $50 of savings in transportation cost per telemedicine visit.


Researchers said the study demonstrates that telemedicine can successfully be used in pediatric subspecialties to maximize healthcare resources and stretch the availability and expertise of the limited number of pediatric subspecialty providers.


“We know that telemedicine is often looked to for common childhood ailments, like cold and flu, or skin rashes. But we wanted to look at how telemedicine could benefit patients within a particular specialty such as sports medicine,” said Atanda. “As the healthcare landscape continues to evolve and the emphasis on value and satisfaction continues to grow, telemedicine may be utilized by providers as a mechanism to keep costs and resource utilization low, and to comply with payor requirements.”


Nemours has implemented telemedicine throughout its health system with direct-to-consumer care for acute, chronic, and post-surgical appointments, as well as through its partner hospitals, schools, and even cruise ships. Nemours CareConnect is a 24/7 on-demand pediatric telehealth program which provides families access to Nemours pediatricians through a smartphone, tablet, or computer–whether they are at home, school, or even on the sports field. If necessary, the physician may order a prescription, using geo-location service on the smartphone or tablet, and send it to the nearest pharmacy.​​


Original found here:

28 Jul 2017

Both sides of aisle agree in Congress — telemedicine is the future!

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Last Thursday, in the midst of the intense debate about the future of ObamaCare, Congress held yet another hearing extoling the virtues of telehealth and remote patient monitoring, and lamenting the barriers in Medicare that are preventing seniors from accessing these new technologies in the same way as patients in the commercial market.




The hearing in the House Small Business Committee followed a typical pattern of hearings on telehealth. It began with witnesses outlining the litany of evidence of how telehealth and remote monitoring are supporting patients with chronic disease like diabetes, COPD and CHF, as well as patients who can’t access primary care or behavioral health services because of distance or workforce shortages.


Testimony always includes evidence of improved access, quality and reduced costs. At Thursday’s hearing, Michael Adcock, administrator of the Center for Telehealth at the University of Mississippi, testified about a remote patient monitoring pilot for patients with diabetes that resulted in a “marked decrease in blood glucose, early recognition of diabetes-related eye disease, reduced travel to see specialists and no diabetes-related hospitalizations or emergency room visits among our patients.”



The program demonstrated savings of over $300,000 in the first 100 patients over six months. The Mississippi Division of Medicaid extrapolated this data to show potential savings of over $180 million per year if 20 percent of the diabetics on Mississippi Medicaid participated in this program.



What more could we want? We are locked in a national debate about coverage, but the underlying issue is cost. Telehealth and remote patient monitoring have proven through the Veterans Administration, the commercial sector and health systems that these tools can save money, improve quality and access, and there are plenty of peer-reviewed studies that show it.



Last Thursday’s hearing also hosted Nicole Clowers, the managing director of the Health Care team at the General Accounting Office (GAO). She detailed a GAO report in which they determined that only 0.2 percent of Medicare Part B fee-for-service beneficiaries accessed services using telehealth in 2014. Not two percent — but 0.2 percent. That compares with more than 90 percent of large employers in the commercial market offering telehealth.



There is something that Congress can do to finally facilitate more telehealth and remote monitoring in Medicare. First, they can make telehealth and remote monitoring part of the basic benefit in Medicare Advantage (MA). MA plans are already trying to offer these tools to their beneficiaries, but the administrative burden of a supplemental benefit creates barriers. By simply allowing plans to offer them as part of the basic package, we would facilitate access for 18 million Medicare beneficiaries.



On the fee-for-service side of Medicare, Congress can grant the Secretary of Health and Human Services authority to waive telehealth restrictions if the Actuary of the Center for Medicare and Medicaid Services (CMS) determines that allowing particular codes in Medicare Part B to be offered through telehealth will decrease costs and maintain quality, or increase quality while maintaining costs.




This solution is far from simply lifting all telehealth restrictions, as stakeholders from the patient, doctor, hospital and health plan communities would like. It is instead, a painstaking process of code-by-code review of evidence related to cost savings that will ensure the Medicare budget is protected (for those who believe that telehealth would somehow cost Medicare money rather than save it). Rep. Bill Johnson (R-Ohio) and Rep. Doris Matsui (D-Calif.) introduced a bill Thursday that will do just that.



On remote monitoring, we already have codes that allow for the collection and interpretation of physiologic data, such as remote ECG, blood pressure and glucose monitoring, but it’s bundled with other codes, which means it can’t be billed separately. Congress or CMS could unbundle this code and open remote monitoring in the Medicare program.



This is an ideal time to take action on telehealth and remote monitoring in Medicare.


It is a bipartisan issue with support from members as diverse as Sens. Roger Wicker (R-Miss.), John Thune (R-S.D.) and Thad Cochran (R-Miss.) to Brian Schatz (D-Hawaii), Ben Cardin (D-M.D.), Mark Warner (D-Va.).


In the House, Reps. Diane Black (R-Tenn.), Greg Harper (R-Miss.), Peter Welch (D-Vt.), Bill Johnson (R-Ohio), Mike Thompson (D-Calif.) and Doris Matsui (D-Calif.) are all working together.


If Republicans from Mississippi and Tennessee and Democrats from Vermont and California can come together — surely we can get this done.






Krista Drobac is the executive director of the Alliance for Connected Care, an advocacy organization dedicated to achieving the promise of connected care in Medicare. 

20 Jul 2017

At a growing number of schools, sick kids can take a virtual trip to the doctor

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School nurses offer far more than just Band-Aids these days. As the prevalence of childhood conditions like asthma and diabetes have risen, nurses treat a wide range of problems. Still, only an estimated 40 percent of U.S. schools have a full-time nurse, according to the National Association of School Nurses.



But now telemedicine — virtual doctor visits over video — is increasingly helping nurses do their jobs. Telemedicine programs are making inroads in schools, where a student referred to the nurse can be plopped in front of a screen and connected with a physician. Special computer-connected otoscopes and stethoscopes allow doctors to check ears, noses, throats, and heartbeats from afar.



Proponents say telemedicine in schools can bring benefits such as the ability to treat more complex conditions and keeping chronically ill kids in school.




And a report on a school telemedicine program in Rochester, N.Y., found that it “redressed socioeconomic disparities in acute care access in the Rochester area, thus contributing to a more equitable community.”



But the programs are still relatively new and the ability of schools to fund them long-term isn’t guaranteed. Funding sources can change from year to year, school district to school district. A patchwork of private insurance, Medicaid, grants, and families paying out of pocket covers existing school telemedicine programs.



“The value of telemedicine depends on what your telemedicine model is,” said Dr. Kenneth McConnochie, professor of pediatrics at the University of Rochester Medical Center, where he helped develop the telemedicine program. “For that reason, some kids are gonna get lousy care.”



‘It’s convenient access’



In recent years, several school districts in Dallas, Texas, have started telemedicine programs in partnership with Children’s Health System in Dallas.



Starting with two preschools in 2013, the program eventually grew to reach 97 schools in Texas, and has conducted 4,000 virtual doctor visits at those schools since 2013.



At the schools, nurses use a rolling cart that holds a large, high-definition screen for videoconferencing and a variety of digitally connected medical scopes and tools. An encrypted, HIPAA-secure connection ensures privacy.



“I have the technology to listen to heart sounds, look in ears, at skin and in mouths,” said Dr. Stormee Williams, a pediatrician who sees students via video. “But I can’t check an abdomen, so no tummy aches. And that’s the number one complaint among school-age children. But one school nurse said that she can have them lie down for 10 or 15 minutes, and then they’re ready to go back to class.”



Parents have to fill out a consent form ahead of time allowing their kids to have telemedicine consults. The forms include private insurance information, for families that have it. For those without private insurance, the company can bill Medicaid.



And arrangements like these do more than just make sure kids get treatment — they make the whole process faster and get kids back to class with less interruption.



“It’s not just access, it’s convenient access,” said McConnochie. “Even when kids have access, they still end up sitting in the emergency room for six hours. Telemedicine can eliminate that.”

Who pays?



Generally, for telemedicine consults done at schools, the parents’ insurance is billed. For kids without private insurance, coverage may come from Medicaid, but not universally: Only 23 states and D.C. allow Medicaid reimbursement for school-based telemedicine, according to a 2017 report from the American Telemedicine Association.



In the states that don’t allow Medicaid to cover the visits, grants or local government funds can pay for telemedicine programs. Some school districts use local government funds earmarked for public health initiatives. Others rely heavily on education or health grants.



“It basically expands the reach of school nurses, it doesn’t replace them,” explained Dr. Steve North, a specialist in adolescent medicine and the medical director at the 10-year-old Health-e-Schools program, which currently serves 33 schools covering 12,000 students in western North Carolina. It conducted 874 visits in during the 2015-16 school year.



“We see all patients, regardless of their ability to pay,” North said. “We have a very generous sliding scale for patients without insurance or who are underinsured. Students who are uninsured or have extremely high-deductible plans and have a household income less than 400 percent of the federal poverty level are seen at no cost to the family.”



North is quick to point out, however, that telemedicine, an innovation meant to supplement the limited number of school nurses, can also be hampered by that limitation. According to the National Association of School Nurses, 35 percent of schools employ only part-time nurses, while one-quarter of U.S. schools do not have a nurse at all.



“The school can only use it if the school nurse is available,” he said. “And schools often share nurses, so at a school with a part-time nurse, a child who gets sick when the nurse isn’t in wouldn’t have access.”



In those cases, North added, the student is simply sent home or picked up by a parent.



A former schoolteacher, North started Health-e-Schools in 2007 with money from a fellowship grant. Today, the group purchases the necessary equipment with government and foundation grants, and both North and a nurse practitioner see and treat schoolchildren. Still, telemedicine in schools is “a relatively new concept,” North said, and there isn’t an established or recommended way to go about creating a school-based telemedicine program. “There’s not an easy entry point.”



Many schools do it through partnerships with hospitals, local government, a nonprofit social service agency, or a for-profit company. The Sioux Falls School District in South Dakota set up a telemedicine program for its 31 schools with Catholic-based health care provider Avera Health. Some school districts provide telemedicine through city or county health departments. Others contract with companies like 24/7 Kid Doc.



But all this variation makes for a model that is unevenly applied and difficult to maintain for keeping kids healthy, said Williams. She pointed out that because Texas opted out of Medicaid expansion under the Affordable Care Act, the school telemedicine program needed a state waiver to get Medicaid funding.



“One thing we need is sustainability,” she said. “Waivers and grants aren’t going to last forever.”


Original article:

By LEAH SAMUEL @leah_samuel

JULY 19, 2017

Reposted by Physician Licensing Service on July 20, 2017

07 Jul 2017

Physicians: Can social media make or break your career?

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For doctors in the digital age, your social media fingerprint has the power to either advance or damage your career.

Studies show that many doctors are not following professional guidelines when it comes to using social media.









Whether you’re using social media to post pictures of your vacation in the Cayman Islands or to reach out to colleagues regarding a challenging patient, the line between personal and professional, as well as what’s appropriate, can sometimes become blurred.

Research has shown that many physicians using social media report minimal formal training in professional conduct online, as well as a lack of awareness regarding which guidelines to follow.


A number of recent studies have highlighted the level of unprofessional social media content posted by physicians.


These included profanity, references to (or appearing to be) intoxicated, and sexually suggestive photographs. They also included possible HIPAA violations, which have the potential to damage careers.


While this behavior has been observed across all career stages, including attending physicians, the levels were highest among residents and recently graduated physicians.


It’s easy to get caught out when talking about patients online, as an article in The Hospitalisthighlighted. Even supposedly innocuous identifying features can “turn a seemingly harmless post on social media into a patient privacy violation.”


“Any physician who uses social media has to be mindful and conscious about protecting private patient information even on personal accounts,” said Toni Brayer, M.D., chief executive officer of Sutter Pacific Medical Foundation in San Francisco, CA.

But your online presence and interactions can also be powerful tools, said ophthalmology resident Steven M. Christiansen, M.D., an avid blogger and Twitter user based at the University of Iowa in Iowa City.


How can you turn social media to your advantage? And what guidelines can you follow to make the most of professional social media?

Using social media for your reputation


Matt Dull, M.D. – who is due to start his critical care fellowship at the Spectrum Health Hospital in Grand Rapids, MI – became interested in using social media professionally when he heard a keynote speaker at a national medical conference discuss the fact that patients were looking for providers on social media.


“He said that being engaged with your patients on social media will be of increasing importance in the years to come,” Dr. Dull explained.


As a resident, he said, he doesn’t need to engage patients outside the hospital. But, he added, “In the future, I will be looking for ways to reach patients and potential patients through social media.”

Indeed, an increasing number of patients turn to doctor rating sites such as Rate MD, Yelp, and Vitals when choosing a physician.


“We know that [those sites] are increasingly important avenues for patients seeking more information about healthcare providers,” said Dr. Brayer. “We’ve learned that ‘stars’ matter and we celebrate good reviews internally and respond to any patient complaints directly for our physicians.”


As Dr. Christiansen noted, “We have worked too hard in our training to let a few poor ratings keep patients from coming to see us. Social media can help us create and establish an online presence we control.”

Connect with colleagues and learn


One of the greatest benefits of social media for physicians is the ability to connect with colleagues to improve diagnostic and other medical skills.

“I only recently started using social media for professional purposes,” said Dr. Dull. He started by joining the International Hernia Collaborative, a large Facebook group for surgeons to discuss complex hernia operations.


“From there, I found all of the other professional ways to leverage social media,” he said. “I now regularly find interesting journal articles, medical blog posts, and discussions of new therapies through Twitter.”


Indeed, a survey of 153 Dutch clinicians found that 76 percent of them used Twitter to extend their network of colleagues, while 71 percent used it to update their colleagues about their work.


Pathologists, for instance, use social media to share images with colleagues, students, patients, and even the general public, while professional medical organizations such as the American College for Chest Physicians use it to promote their specialty and provide education, which extends to patients.


“I use social media to promote health and wellness and as a way of letting people know what is happening in my organization and in the community,” said Dr. Brayer. “As a physician I have a strong voice and see myself as an expert with useful information.”


Twitter is also becoming a hugely effective tool for communicating content live from medical meetings.

Dr. Christensen and his colleagues published a study in Ophthalmology in August 2016, comparing Twitter activity during the American Academy of Ophthalmology’s 2014 and 2015 meetings. The “tweets” reached 23.7 million Twitter users in 2014, and 24.5 million in 2015.


Social media is also a powerful outlet for advocacy, says Dr. Christensen. A 1-minute YouTube video that highlighted his ophthalmology-related discussions with congressional representatives was viewed 1,700 times in the first week of its posting.


I can tell you that my involvement in social media has opened up countless opportunities to network with others both within ophthalmology and many other specialties.”

Steven M. Christiansen, M.D.


Whether you are going to use social media to connect with your colleagues, reach out to potential patients, or educate the general public, adhering to professional guidelines is key to protecting yourself and turning social media to your own advantages.

Practice safe social media


The American Medical Association (AMA), and most specialty medical societies, have developed ethics policies on the use of social media during the past few years.

These recommendations tend to revolve around the privacy of both you and your patients. Here is a summary:

  1. Do not post any patient-identifiable information anywhere, ever.
  2. Set privacy settings on media sites to protect your own information and content, but know that even if you restrict your posts to your own network, the information can leak out. A good rule of thumb is to never post anything that you wouldn’t want to see in a peer-reviewed journal.
  3. Maintain appropriate boundaries of the patient-physician relationship. Just because you are online doesn’t mean that the rules are relaxed.
  4. Separate your personal and professional content. Set up a separate Facebook page to promote your practice or talk about professional issues, and leave the personal one for family and friends – not patients.
  5. Say something if you see a colleague posting unprofessional content that may violate professional standards.
  6. Recognize the potential consequences of your online life, including negatively affecting your reputation among patients and colleagues.


Dr. Brayer has first-hand experience of putting these guidelines into practice. An emergency department physician who Dr. Brayer friended on Facebook frequently mentioned patients that she had treated.

“Even though no names were used, it bothered me to see those posts,” Dr. Brayer said. As the AMA policy suggests, Dr. Brayer told her friend that these posts could violate privacy rules.


“I would recommend health professionals should never post anything with stories about patients or conditions, even if they think they are shrouding identity. It’s too close of a line to walk and patient privacy is our oath and responsibility,” Dr. Brayer said.

Starting in social media



If you are new to the professional side of social media, here are five simple tips to follow:

  1. Start a professional Twitter feed and share things that you are already doing – for example, medical conferences that you attend, clinical research, and important clinical studies in your field.
  2. Keep the personal and the professional accounts separate. For instance, have two Twitter handles, two Facebook pages, and two Instagram accounts.
  3. Make it clear that you are speaking only on behalf of yourself and are not representing your employer.
  4. Don’t ever give medical advice in a public forum.
  5. Expect criticism from colleagues. Use that to educate them on the value of social media done right.


“With all of its problems, there is no doubt that social media is here to stay,” Dr. Brayer commented. “As healthcare professionals we should use this tool as much as possible to promote health, nutrition, medical-political points of view such as information on the Affordable Care Act, healthcare legislation, and changes in Medicare and Medicaid. I believe the public is hungry for accurate health news they can trust.”
30 Jun 2017

What is the Interstate Medical Licensure Compact? – What Doctors Need to Know

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The world of medical licensing in the United States has changed and the physician has come out on top. 


The IMLC is a great way for telemedicine, Locums Tenens and individual doctors looking to relocate to practice across state lines with a simplified and expedited process for obtaining medical licenses. This new licensing process can be very useful for select doctors who want to add a few more tracks of land to their practice boundaries.

Only select states have chosen to be a part of the Interstate Medical Licensure Compact and of the 18 states that are currently included only 8 of them have chosen to be an SPL (State of Principal Licensure). State of Principal Licensure is a designation for a ‘Home State’ for you to base your medical practice in. In order to capitalize on the benefits of the IMLC you must be based in one of the following states:


Alabama – Idaho – Iowa – Kansas – West Virginia – Wisconsin – Wyoming


A physician shall designate one of the member states as the state of principle license (SPL), as long as that state is

  1. The state of primary residence for the physician
  2. The state where at least 25% of the practice of medicine occurs
  3. The location of the physician’s employer
  4. If, 1, 2, and 3 don’t apply – the state designated as state of residence on federal income tax
    1. A physician my re-designate a member state as the Principle at any time


There are few more unique details and requirements to qualify and for a complete list please contact Tony Hendricks,


Once the SPL is established you are now able to obtain a completely expedited full medical license in the following states:

  1. Alabama
  2. Arizona
  3. Colorado
  4. Idaho
  5. Illinois
  6. Iowa
  7. Kansas
  8. Mississippi
  9. Montana
  10. Nebraska
  11. Nevada
  12. New Hampshire
  13. Pennsylvania
  14. South Dakota
  15. Utah
  16. West Virginia
  17. Wisconsin
  18. Wyoming




Physician Licensing Service is here to help you navigate the waters of this new legislation and to learn how it can benefit your medical practice. For a FREE custom consultation on your eligibility in the new IMLC please contact Tony Hendricks, Business Director at Physican Licensing Service –

27 Apr 2017

How much PGY(post graduate training) do I need?

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Post Graduate Training Requirements

This week, we continue discussion in our eligibility series. Previously, we talked about the 7 Year Rule and how this differs from the 10 Year Rule, both of which can quickly put up road blocks to a physician medical license.  Your next question should be, “Do I have enough post graduate training to qualify for this state’s license?”

Read more

05 Apr 2017

Medicare & Telemedicine: Your Top Reimbursement Questions, Answered

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When it comes to telemedicine, navigating the reimbursement process can be tricky. What rules do you need to follow to ensure you get paid? How do you know your patients are eligible for telemedicine? How does the billing process actually work?


We get these questions all the time at eVisit. While the answers vary a bit depending on which payer you’re talking about, it’s usually easiest to start with Medicare.
Medicare currently provides coverage for more than 55 million older Americans. Doing telemedicine with your Medicare patients is a huge opportunity to make a difference in their care experience, especially since Medicare patients are the most likely to have multiple chronic health issues and need frequent care.


So how does telemedicine reimbursement through Medicare work? The good news is, since Medicare is a national program, the guidelines for telemedicine are the same no matter what state you’re in. That makes things a little easier than navigating reimbursement through Medicaid or private payers.


Here are answers to the top questions we hear about Medicare and telemedicine reimbursement.


Does Medicare reimburse for telemedicine?

Yes! Medicare has covered telemedicine for many years now in order to increase care access to Medicare patients.


What types of telemedicine does Medicare cover?

There are several different kinds of telemedicine, including real-time, store-and-forward, and home monitoring. Currently, Medicare covers real-time, live video telemedicine in all 50 states. Store and forward telemedicine (which involves sharing patient medical data remotely for diagnosis and analysis, and does not require the patient to be present) is actually also covered by Medicare, but not billed as a telemedicine service. CMS advises physicians to bill these services the same way as medical services delivered onsite.


As of 2015, Medicare also now provides some coverage for home monitoring under the new chronic care management CPT code 99490.


Store-and-forward telemedicine services are only covered in Alaska and Hawaii, and home monitoring is not covered at all.


Which Medicare providers can bill for telemedicine?

Only certain healthcare providers can get paid for telemedicine under Medicare. These include Physicians, nurse practitioners, physician assistants, nurse-midwives, clinical nurse specialists, certified nurse anesthetists, clinical psychologists, clinical social workers, and registered dietitians or nutrition professionals.


Keep in mind that if you’re a provider not included on this list, you may still be able to practice telemedicine depending on your state medical board recommendations. But under Medicare, you would not be able to bill and get paid for that service.


What is an originating site? And what’s a distant site?

If you’ve been reading up on Medicare and telemedicine at all, you probably noticed the terms “originating site” and “distant site.” Understanding these is very important. The originating site means the location where the Medicare patient is at the time of the telemedicine service. The distant site means where the healthcare provider is at the time of the telemedicine service.


While many of us now think of telemedicine as a secure video conference between a patient at home and a healthcare provider at their office (or home), Medicare hasn’t yet caught up to this idea. Traditional Medicare does not yet recognize the patient’s home as an eligible originating site.


Traditionally, patients participating in telemedicine would come to a local health center to see their primary care doctor, and that doctor would use a telemedicine system to include a distant specialist in the appointment. Now that telemedicine has expanded well beyond this model, the Medicare rules need some updating.


So, what qualifies as an eligible originating site?

To qualify as an eligible originating site, the location has to meet two conditions:


It has to be located in a Health Professional Shortage Area (HPSA) or a county outside of a Metropolitan Statistical Area (MSA). Check whether an address is in a HPSA with this quick tool.

It has to be one of the following types of healthcare facilities:

Physician or practitioner office


Critical Access Hospitals (CAH)

Rural Health Clinics

Federally Qualified Health Centers

Hospital-based or CAH-based Renal Dialysis Centers (including satellites)

Skilled Nursing Facilities (SNF)

Community Mental Health Centers (CMHC)

Note: Independent Renal Dialysis Facilities are not eligible originating sites.



What health services can be delivered via telemedicine?

You can find a complete list of the covered CPT and HCPCS codes on this handout from Medicare. See pages 3 and 4.


How do I bill telemedicine?

As long as you’ve met all the other Medicare guidelines for telemedicine (eligible provider, distant site, originating site), billing is as easy as choosing the appropriate covered CPT code and adding the modifier “GT.” The GT modifier tells Medicare that the service was delivered via telemedicine.


How much will I get paid?

You’ll get paid the same amount for a telemedicine service as the corresponding in-person service. Just look-up the CPT code on the Medicare physician fee schedule to see the amount.


When will the restrictions on eligible originating site change?

While there’s nothing definite yet, legislators proposed the Medicare Telehealth Parity Act of 2015 this past July that would eliminate some of the restrictions on eligible originating sites. The bill would also expand the eligible healthcare providers and medical services. You can stay tuned on policy updates by following us (@eVisit) and the Southwest Telehealth Resource Center (@UA_ATP)!


Does telemedicine reimbursement work differently for traditional Medicare and Medicare Advantage plans?

Yes! All the restrictions and guidelines outlined here apply to traditional Medicare. In contrast, Medicare Advantage plans fall under private payers and have flexibility to cover telemedicine reimbursement as they wish.


In other words, if one of your patients has a Medicare Advantage plan, getting reimbursed for telemedicine will likely be much easier!


(Written by Teresa Iafolla at Southwest Telehealth Resource Center –


About Physician Licensing Service
Now in our 20th year of business, Physician Licensing Service has been changing the face of healthcare licensure. We have developed a proven system to remove the barriers common to state medical licenses and get doctors practicing in record time. Our business model focuses on simplifying the process for all involved parties. This includes the state medical boards themselves, because PLS takes great care to keep abreast of their updates in this ever changing field, and work within those guidelines. For a doctor seeking a medical license, PLS will take on the entire process, including eligibility research, paperwork, verifications, and follow up.

21 Mar 2017

When to Hire a Medical Licensing Company- Part One

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When to Hire a Medical Licensing Company- Part One

submitted by PLS, March 21, 2017

In a perfect world, medical licensing would not be as onerous or difficult as it is in reality and you would not have to decide whether to pursue licensing on your own or hire an independent medical licensing agency to assist you.

There are mitigating factors to consider when deciding to use a medical licensing company and I’d like to discuss some common circumstances. Of course, we here at Physician Licensing Service think that you should always use a licensing agent because of our superior quality, speed and professionalism, but we know that there may be instances in which you decide to pursue a license on your own.


Below are some scenarios that warrant professional assistance:

Speed, Convenience, Efficiency & Accuracy

The process of obtaining medical licenses is time consuming.  It will pull you away from more desirable pursuits.  The paperwork, the phone calls, the chasing of verifications, the follow-up may not be attractive to you.  Hiring an experienced licensing company is an efficient and cost-prudent alternative.

Disciplinary Background or Legal Issues

If you have experienced any disciplinary actions in your medical background (either during training or in practice) or if you  have ever had a run in with the law (other than minor traffic infractions- you should seek licensing advice before starting the licensing process- even if your legal issues are resolved.

Some states require more documentation than others when it comes to items in a profile that they consider “red flags”. Court documents need to be requested and narratives must be written explaining the situation in a manner that the medical board finds acceptable.  If you try to handle the legalese on your own, you will likely have to duplicate your efforts until the documents are arranged to the board’s satisfaction. These delays can cost you time and money if other documents expire at the board while you are busy re-doing work on a few items.

Revocation, Investigation or Suspension of Any Medical License

Similar to the above situation, you need to investigate whether you qualify for a new license if you have had issues with other licenses in the past. If you have a license revoked and you do not have another unrestricted license to practice in a different state, you will not likely be granted a license in another jurisdiction.  If you are luckily granted a license, it may be automatically restricted by the granting jurisdiction, thus creating additional issues for you in the future since you now have one revoked and one restricted license, instead of just a revoked license.

Suspensions and investigations are similar to the above situation in which you will need to gather documentation and write narratives for the situations in question- even if the suspension is complete or the investigation was closed. A good rule of thumb is to consider anything that has been reported to the NPDB or shows up on your medical licensing profile as a red flag in the eyes of the medical board. Seeking professional licensing assistance in these instances is in your best interest.

Graduated from Medical School Overseas, Graduated from Medical School More Than Twenty Years Ago or Graduated From a Medical School That Has Closed

Any of these situations will usually require additional footwork to verify through primary sources (required by the state medical boards) and will take a few extra hours of legwork.  Some of these issues can be alleviated if you already have an established FCVS profile (see our blog about FCVS), but if you do not have FCVS, then you will certainly need professional assistance to source the necessary documents to complete your medical license.

Thus concludes part one of our Professional Assistance Series.  If you have additional questions, or wish to find out more about hiring a professional medical licensing company to assist you with your state medical licensing or credentialing needs, please contact us directly at or call our toll free number at (801) 816-1149.

Check back next week to read our blog about claiming your licensing fees as tax deductions.

About Physician Licensing Service

Now in our 20th year of business, Physician Licensing Service has been changing the face of healthcare licensure.  We have developed a proven system to remove the barriers common to state medical licenses and get doctors practicing in record time.  Our business model focuses on
simplifying the process for all involved parties. This includes the state medical boards themselves, because PLS takes great care to keep abreast of their updates in this ever changing field, and work within those guidelines. For a doctor seeking a medical license, PLS will take on the entire process, including eligibility research, paperwork, verifications, and follow up.


16 Mar 2017

Physician License Eligibility: Exams & Certification

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The 10 Year Rule

It’s amazing how far one can get into a job search before even considering eligibility.  Unfortunately, many physicians will spend hours searching for jobs in a particular state only to find out later they’re not eligible for licensure with that state’s medical board.   Alternatives or waivers can be found in some instances but this is not always an option.

Additionally, with the unique nature of each state’s regulations, it can be very frustrating trying to sort it out.  To simplify this, our next few blogs will focus on licensing eligibility as we seek to educate our clients about the different requirements for each medical board. Below are some useful facts to know as you consider your next state license. Of course you can call us at any time for a free eligibility check: 888-551-2140.
This week, we focus on the 10 year rule. In short, this simply means that you must have taken a qualified exam within the last 10 years to be considered eligible to apply.  Accepted exams include USMLE, any ABMS board certification (or recertification), or the SPEX exam (offered through the FSMB).  This won’t be a problem for most physicians who finished training within the last 10 years, although we strongly urge you to keep up on your board certification.  Where this comes up most frequently is with experienced physicians who trained more than 10 years ago and, more specifically, who have a lifetime certification with their boards.  In those instances, the only possible options are:

  • Recertify with your boards: considering the alternatives, this may be the easiest move if you need that license
  • Take the SPEX: this is a 1 day, proctored exam, but it is “general knowledge” so there is quite a bit of preparation as well as cost
  • Choose a different state: it may sound dramatic, but unless that license is a “must-have,” many physicians don’t feel options 1 or 2 are worth the effort

Below are the states that currently enforce the Ten Year Rule (please note the states with waivers or exceptions):

  • Alabama
  • Arizona***
  • Louisiana
  • Minnesota
  • Mississippi
  • Montana
  • North Carolina*
  • Nevada
  • Oregon*
  • South Carolina*
  • Texas
  • Utah**
  • *These states have a waiver possible, if you’ve fulfilled 150 hours of category 1 CME within the last 3 years.  All CME hours must be completed before the application is submitted to the medical board
  • **Utah’s rule is actually 5 years, but a waiver is offered for board certified physicians
  • ***AZ will offer a waiver for current board certification

* This list is current as of 02/22/2017 and is subject to change. Please see State Requirements for the most updated information.
As always, please feel free to call us with any questions.  We’re always happy to review your situation and provide advice at no charge: 888-551-2140

About Physician Licensing Service

Now in our 20th year of business, Physician Licensing Service has been changing the face of healthcare licensure.  We have developed a proven system to remove the barriers common to state medical licenses and get doctors practicing in record time.  Our business model focuses on simplifying the process for all involved parties. This includes the state medical boards themselves, because PLS takes great care to keep abreast of their updates in this ever changing field, and work within those guidelines. For a doctor seeking a medical license, PLS will take on the entire process, including eligibility research, paperwork, verifications, and follow up.