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12 Dec 2017

Walgreens makes telemedicine deal with NewYork-Presbyterian for Duane Reade stores

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The telemedicine services will rely on software and kiosks from AmericanWell.


Walgreens has embarked on a deal with NewYork-Presbyterian health system to provide non-emergency telemedicine services at drugstore retailer Duane Reade stores around New York City, starting with a branch on Wall Street with plans to roll out to other branches in Manhattan, Brooklyn, and Queens. It marks the first time Walgreens has collaborated with a local healthcare provider to deliver its telehealth and digital strategy, a company news release noted.


NewYork-Presbyterian and Walgreens are providing the telemedicine services as part of the NYP OnDemand suite of digital health services. They will be delivered through in-store-kiosks at $99 per visit. The kiosks are provided by AmericanWell, a company with which NewYork-Presbyterian has an existing partnership, said NewYork-Presbyterian Chief Transformation Officer Dr. Peter Fleischut in a phone interview.


The kiosks are equipped with connected medical devices including a thermometer that measures temperature by swiping the forehead, a blood pressure cuff, and a pulse oximeter that measures the amount of oxygen in the body. A dermascope, which allows the provider to see a high-resolution view of skin conditions, is also available through a Walgreens partnership with Iagnosis, according to the news release. The teledermatology service is referred to as DermatologistOnCall.


The service will also be provided through the Walgreens website as NYP OnDemand Urgent Care. Customers can use it to have a video chat with board-certified emergency medicine doctors.


NewYork-Presbyterian has been piloting the use of telemedicine as a way of triaging walk-in patients at emergency departments through NYP On Demand Express Care. It has been rolled out to four of the hospitals in its network to date: Weil Cornell, Columbia Presbyterian, The Allen Hospital, and Lower Manhattan Hospital. Fleischut said the service has helped it whittle down the duration of emergency room visits from an average of two hours to 30 minutes. Patients who have used the service span 18 to 98 years old, noted Fleischut.


By increasing access points to NY-Presbyterian physicians, the deal with Walgreens allows the hospital to expand access points to the hospital, extending its brand and network reach, adding more patients to its system.  Fleischut also addressed the question of how to help patients who use the service but may have a more urgent condition that can be addressed in the setting of a Duane Reade.


“We find there is more and more need for immediate access to physicians and lot of low acuity needs. That is why we provide these services. If a condition is more severe…we can provide some services virtually and refer some situations onto a specialist or an emergency department,” said Fleischut.


In addition to the in-store kiosks, Walgreens customers in the New York area using the Walgreens website can access NYP OnDemand Urgent Care to video chat with board-certified emergency medicine doctors, the news release said.


Walgreens inked a collaboration deal with MDLive two years ago to offer telemedicine services in its stores around the country.


Asked about the deal, Greg Orr, Walgreens divisional vice president of digital health said in an email that the deal expands Walgreens’s strategy to provide healthcare access for its customers in a convenient way. He noted that it complements an existing collaboration with MDLive, which focuses on general health issues and mental health services.


Telemedicine delivered through kiosks failed for one healthcare startup, HealthSpot, which went out of business  last year. RiteAid purchased its assetsfor just over $1 million. Still, Walgreens and NewYork-Presbyterian have the scale that HealthSpot was never able to achieve, plus they are bringing to bear different telemedicine capabilities.


“We see the kiosks as only part of a larger collaboration between Walgreens and NYP,” Orr said in an email. “Similar to our approach in retail, we believe in the power of omni-channel to connect customers with our brand both inside our stores and digitally to meet them wherever they are.  By collaborating with a well-known health brand like NYP in the New York City market we believe we can maximize convenience for our customers both inside our stores through kiosks as well as online through our digital properties.”


The deal will make Walgreens more competitive with other companies seeking to add on to their healthcare services such as CVS Health, which has entered into a deal to acquire Aetna.


Photo: NewYork-Presbyterian

Re-posted by Physician Licensing Service – Dec 12, 2017

Original link:

08 Dec 2017

How to reduce Christmas stress

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“It’s the most wonderful time of the year,” but also a time when stress levels soar. We have put together some top tips to stop stress in its tracks and make the season of goodwill more enjoyable.
stressed woman wearing christmas hat

The holidays can be a time of high stress levels, but managing stress can help you to have a happy and healthy Christmas.


While Christmas is known as “the season to be jolly,” it can be a significant source of stress, pressure, and conflict for many of us. Some people can feel overwhelmed by the excess, expectations, and exchange and become depressed during the holidays.


A lack of time and money, credit card debt, and the pressure of gift giving can often contribute to stress during the holiday season.


Most of us are aware of the adverse effects that stress can have on our body. It can impact our thoughts, feelings, and behaviors, and it can lead to high blood pressureheart diseasediabetes, and obesity if left unchecked.


In fact, research has shown that there is an increase in the occurrence of heart attacks and heart-related deaths during the festive season, which may be due to stress, heavy alcohol consumption, a fatty diet, or all three. Therefore, it is of utmost importance that holiday stress is dealt with — pronto.


With all the cooking, decorating, visiting, and gift giving, the holidays can seem more like trying to meet a high-pressure deadline than a vacation. So, try these Christmas stress-busting strategies to ease the strain and help stress melt away.

1. Limit spending


Money issues are one of the leading causes of stress during the holiday season, according to a pollconducted by the American Psychological Association (APA) in 2004. Recent data collected in the APA’s annual Stress in America survey reflect this finding and report that 62 percent of us feel stressed about money.

woman wearing Christmas hat and shopping

Avoid overspending by setting a budget.


Holiday retail sales in November and December 2017 are expected to increase between 3.6 and 4 percent and total between $678.75 billion to $682 billion, according to the National Retail Federation. These figures are up from $655.8 billion last year.


Gift buying, entertainment, and travel can all fuel financial burden, even for the savviest shoppers. However, here are some steps that you can take to limit financial stress.

Set a budget. First of all, make sure that all your usual expenses are accounted for so that you do not fall short on bills such as rent. Plan for any other spending over the holidays, including any parties you may be hosting or traveling to visit friends or family.

Once these items have been subtracted from your budget, you can then work out how much you can spend on gifts. Being organized and realistic about your budget will help you to ensure that you do not overspend.


Make one financial decision at a time. Make sure that you space spending-related decisions out. Trying to make too many decisions at once can be overwhelming, which can lead to depletion of your willpower and an increased risk of overspending.


Avoid temptation. It is often impossible to steer clear of stores and shopping malls altogether over the festive season, but limiting the time that you spend in these places can also help you to curb your spending.


Manage impulsive spending by taking only the cash you can afford to spend on shopping trips and leaving all credit and debit cards at home.

Recognize how you deal with stress-related money problems. Sometimes, during tough economic moments, individuals turn to smoking, alcohol, gambling, or excessive eating to try to relieve stress. These behaviors can lead to arguments and conflicts between partners and families.


Be mindful and seek help from a healthcare professional if you find that these behaviors are causing you problems.


Keep in mind what is important. Overspending can overshadow the true sentiment of Christmas. If your expense list exceeds your monthly budget, keep in mind that your relationships with friends and family are more important than material objects.


2. Manage expectations

Everyone has an idea in their heads of the perfect holiday, but when reality falls short of the vision, stress can ensue. Try to manage expectations with these simple tips.

Be realistic

family sitting at the table with Christmas dinner

Having a late dinner will not ruin your day.


Despite your grand plans, no event ever runs seamlessly, and this also rings true for holiday celebrations. Rather than accumulating stress along the way from any mishaps that might occur, view these miniature calamities as an opportunity to exercise flexibility and resilience.


Dinner being 30 minutes late, spilling food on your festive outfit, or having a lop-sided tree is not going to ruin your day. Instead, they’ll create fond memories that you can reflect on in years to come.

Help children to be realistic


When children get older and start to become more aware of what they want and what their friends have, parents can feel pressurized to deliver, meet their expectations, and provide them with the perfect presents.

Help your child to create a wishlist that outlines any gifts they desire. Make sure they know that they will not receive everything on the list and highlight anything that is not acceptable or obtainable.

Remind your child that Christmas is about being together, not a list of presents to tick off a list. Planning fun activities that encourage everyone to come together and have fun can create excitement.

Take some time out

Carrying the world on your shoulders and trying to achieve everything alone during the holidays can take its toll on your mind and body.


Enlist some help in accomplishing some of the tasks on your list and take some time out. Destressing can benefit you and the rest of your family. Focus on doing something that you find relaxing to recharge your batteries, such as reading a book, watching a Christmas movie, listening to music, or going for a massage.

3. Avoid overindulging


‘Tis the season for indulgence, and whether it be a festive holiday party or a family dinner, we are surrounded by extravagant foods and alcoholic drinks.

person standing on the scales after eating Christmas food

Allow yourself some holiday treats, but quickly go back to eating healthful foods and doing exercise to avoid weight gain.


Although many of us only gain an extra pound during the holiday period, that extra pound may build up over the coming years and contributeto obesity later in life, according to the National Institutes of Health (NIH).

Excessive stress raises appetite and cravings for sugary and fatty foods, and chronic drinking can further exacerbate stress by raising levels of the stress hormone cortisol.


Dietitians from the University of Missouri in Columbia recommend that families should aim to maintain healthful dietary habits during the holidays in order to avoid weight gain and stress.

  • Eat a healthful diet during the day. Eat some high-protein snacks, such as yogurt or an apple with peanut butter, so that you are not too hungry by the time that dinner arrives.
  • Make simple food swaps. Eat whole-wheat bread instead of white, and brown rice instead of white, to help keep you feeling fuller for longer.
  • Be treat-wise. Enjoy seasonal treats, but try to control portion sizes.


If you do find yourself overindulging, maintain perspective. One day of indulgence will not lead to significant weight gain, as long as you plan to get back on track with healthful food choices and exercise the next day.


4. Go for a walk

The antidote for holiday stress could be just as simple as taking a walk around the block. Researchdemonstrates that physical activity reorganizes the brain in such a way that it reduces its response to stress.

Family walking in the woods

Go out for a walk with the family to decrease stress.


Regular exercise can help to decrease tension and boost and stabilize mood. Furthermore, exercising produces endorphins — natural painkilling chemicals that are released in the brain — that improve your ability to sleep and reduce stress.


Research also shows that if you convince the rest of the family to leave the couch and come along on the walk with you, your stress levels will be reduced even further.


Researchers found that working out in a group reduced stress levels by 26 percent and improved physical, mental, and emotional quality of life.

5. Have some fun

As you decorate the tree or bake festive cookies, forget all the items left on your to-do list and give yourself permission to have fun.

family playing Christmas games

Organize fun activities to boost laughter and reduce stress.


Laughter goes a long way in the fight against stress and could be just what the doctor ordered.


Laughter lightens your mood, stimulates your heart, lungs, and muscles, and also releases endorphins. Laughter also boosts circulation, helps muscles relax, and lessens the physical symptoms that are associated with stress.


Whether your laughter is powered by sidesplitting moments in your favorite movie, jokes at the dinner table, a holiday prank, or an afternoon of fun activities, be sure to include some holiday humor, giggles, and guffaws. Even looking forward to a funny event raises relaxation-inducing hormones and decreases stress hormones.


Finding positive, healthful ways to manage stress could reduce many of the related adverse health consequences. Finding stress-busting techniques that work best for you can enable you to have a stress-free Christmas.

Original Published
Reposted by Physician Licensing Service
06 Dec 2017


Physician Licensing No Comments

The Michigan House of Representatives passed a bill to join an interstate compact to synchronize its medical licensing regulations with those of 22 other states, allowing health care providers licensed in participating states to provide services.


OCTOBER 30, 2017
Original By Joshua Paladino
Re-posted By Physician Licensing Service








The Michigan House of Representatives passed a bill to join an interstate compact to synchronize its medical licensing regulations with those of 22 other states, allowing health care providers licensed in participating states to provide services in Michigan.


Legislators approved House Bill 4066 (HB 4066) on October 10. The bill now awaits action by the Michigan Senate Committee on Health Policy.


Increasing Health Care Access


HB 4066’s sponsor, state Rep. Jim Tedder (R-Clarkston), says the bill would help increase consumers’ access to quality health care.


“In an age when we see advances in telemedicine, we also hear recurring themes of lack of access to quality care in rural and underserved areas,” Tedder said. “The interstate medical licensure compact allows a means through which specialty practice physicians can maintain multistate licensure in an expedited process.”


The bill would synchronize Michigan’s health care licensing rules with other states’, Tedder says.


“In effect, through a compact, we’re really coordinating our statutory and regulatory rules in line with others,” Tedder said. “This brings a lot of states in line with what I consider to be very highly scrutinized rules here in Michigan.”


Staving Off Federal Overregulation


Interstate compacts can preempt federal regulatory overreach, Tedder says.


“In many cases, when you see an interstate compact established, it preempts any potential for federal licensure of physicians,” Tedder said. “With increasing health care costs and increasing encroachment from the federal government, this is a prudent preemption of any forthcoming licensing regulations at the federal level.”


Pros and Cons of Compact


Jarrett Skorup, strategic outreach manager with the Mackinac Center for Public Policy, says the proposed compact has advantages and disadvantages.


“There’s two sides to this, from a free-market standpoint,” Skorup said. “The one side is licensing restrictions are too high in all professions, so we want to work toward lessening that. To the extent that this allows people to move among states with one license, it’s a good thing. The problem with it is, you don’t want Michigan to lock itself into restrictive licensing agreements or into a compact that will vote to raise requirements.”


Skorup says reciprocity agreements, in which states agree to recognize other states’ occupational licenses, are a good idea.


“You pretty much have the same requirements in every state to be a medical doctor, so for those states with similar requirements, it makes sense for states to enter a reciprocity agreement,” Skorup said.

30 Nov 2017

State Medical Boards Slammed After New Year – Experts Suggest Applying NOW

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The contract rush is real around the turn of every new calendar year for physicians looking to relocate or extend their telemed reach into new markets. Expect the medical boards to be extra busy this holiday season with all of the movement in the medical industry to expand its operations.

20-year-anniversary-v2Because of the high demand for physicians in the United States, many experts in the medical licensing field have suggested that doctors get ahead of the new year’s rush by applying now for needed medical licenses. Medical boards prioritize licensure by the order of submission and getting in early before the January 1 rush ensures you will be licensed first.

Physician Licensing Service has spent the last 20 years mastering each state medical board in United States. The expertise gained in our 20 years of serving physicians have made us a valuable asset to 1,000’s of medical practices in North America.

Take advantage of our Preferred Pricing Structure for practicing physicians by emailing Tony Hendricks at or by calling at 801-449-9196.


You can also order new medical licensing services through a secure, 128bit encrypted, website by going to HERE.

22 Nov 2017

HAPPY THANKSGIVING to all of the friends and family of PLS

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PHYSICIAN LICENSING SERVICE would like to give a heartfelt thank you to all of our friends and family this holiday season and we wish the best for you and yours.





Consider our service to alleviate medical licensing pressure this season by contacting  Tony Hendricks at



Special custom pricing for multi-state license acquisition. Take advantage of our new Quantum licensing division specifically designed for inter-office coordination to augment the backlogged licensing divisions within.


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?

Physician Licensing No Comments

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.”