Contact us at (801) 816-1149

27 Apr 2017

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

Physician Licensing No Comments

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

Physician Licensing No Comments

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

Physician Licensing No Comments

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

Physician Licensing No Comments

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.

10 Mar 2017

Virginia passes proactive legislation to protect telemedicine for eye care

Physician Licensing No Comments

Original by: Jonah Comstock

Reposted by: Physician Licensing Service
March 10, 2017

This article has been updated with comments from Opternative and the Virginia House of Delegates.



In stark contrast to the law that past last year in South Carolina, the state of Virginia has proactively passed a pro-telemedicine bill that protects the rights of optometrists and ophthalmologists to see patients and issue prescriptions via telemedicine.



The law, signed late last month, states that “for the purpose of a provider prescribing spectacles, eyeglasses, lenses, or contact lenses to a patient, a provider shall establish a bona fide provider-patient relationship by an examination (i) in person, (ii) through face-to-face interactive, two-way, real-time communication, or (iii) store-and-forward technologies.”



“Today, the Commonwealth struck a good balance,” Virginia State Delegate Peter Farrell, one of the sponsors of the legislation, said in a statement last month. “We have signaled to entrepreneurs that their ideas and innovations are welcome in our state. As we empower doctors to utilize these new telemedicine options that will increase access to healthcare and lower costs, we have also made sure that the health and safety of our residents comes first.”



The law was the result of lobbying by telemedicine eye care companies, who have undertaken lobbying in response to local optometry and ophalmology industry groups seeking legislation to oppose them. The most prominent example of this so far is in South Carolina, where Chicago-based Opternative is currently suing the state over a law forbidding online or app-based eye exams. Opternative considers the law anti-competitive and in violation of South Carolina’s constitution. The American Optometric Association, which lobbied for the legislation and opposes the suit, holds that technology like Opternative’s endangers patients.



Opternative was one part of a group of ocular telemedicine companies that worked for the legislation, which also included 1800Contacts and Simple Contacts, an NYC-based startup that raised $2 million in November. It was Simple Contacts that original made MobiHealthNews aware of the bill, but Opternative told MobiHealthNews in an email that not all parties contributed equally to that effort and that “Simple Contacts never showed up for the committee hearings or spent one day on the ground lobbying in Virginia”. Correction: A previous version of this story said EyeNetra was involved in lobbying for this bill. That was in error.



In a Medium post, Simple Contacts founder and CEO Joel Wishkovsky said that Virginia passed the law after being approached by industry groups about passing an anti-telemedicine law, but after meeting with telemedicine groups, ended up doing just the opposite.



“The Virginia State Legislature, when approached to pass a law that would ban our technology, decided to take a closer look,” he wrote. “They spoke to dozens of medical experts and determined that what Simple Contacts and many other telemedicine platforms do is not only safe, but is good for their constituents. Last week, they passed HB 1497, a law that explicitly recognizes the potential of ocular telemedicine and sets common sense guidelines on its use to ensure only high quality care is delivered.”



The law does provide a list of conditions in-person or remote eye doctors must meet. They must obtain an updated medical history, conform to the standard of care, and be licensed in Virginia, among other requirements. The law also says the prescription cannot be “determined solely by use of an online questionnaire”.



While the Virginia law was something of a happy accident, Wishkovsky is hopeful that other states will follow Virginia’s lead to protect telemedicine from the get-go.



“Virginia is the first state to pass these protections, and will serve as a blueprint for others that want to encourage telemedicine to flourish,” he wrote. “As product builders, we didn’t anticipate that helping patients would be controversial, but it is clear that some industry players are interested in preserving the old way at any cost. Unfortunately the patients are the ones who bear that cost. So we have no choice — we’ll be there, across the country, engaging with legislators, regulators and groups that want to advance healthcare to protect patient’s interests and fulfill our mission of making healthcare simpler and more convenient.”

27 Feb 2017

Telemedicine backpack helps bring doctor’s care to low connectivity areas

Physician Licensing No Comments


By Jonah Comstock

February 14, 2017

Re-posted by: Physician Licensing Service

February 27, 2017




The promise of telemedicine is ‘care anywhere’, but what happens when ‘anywhere’ is an area with little to no connectivity or reception? Lexington, Massachussets-based SwyMed is looking to tackle that conundrum with its DOT Telemedicine Backpack, unveiled today in advance of the HIMSS Annual Conference in Orlando next month.


The lightweight backpack contains four high-gain antennae, two modems, a rugged tablet, a fifteen-hour battery, and various tools like stethoscopes and ultrasounds. The idea is for paramedics and home healthcare workers to increase the amount of care they can provide via telemedicine, diminishing the need for expensive emergency department visits.


“At the end of the day, the first responders, there’s only so many things you can train them on or that they should have to be responsible for. If they have to be an IT technician as well as a healthcare technician, you’ve vastly increased their workload,” Jeffrey Urdan, chief operating officer of SwyMed, told MobiHealthNews. “What do you today? You dial on the radio, call on the phone, you describe what you see, the doctor kind of makes the best guess at what you’re describing and it’s just a longer, more complicated interaction. With this technology, you walk into the house with a backpack, you fire up a video conference, and the doctor can interact with the patient directly. The doctor is in the kit.”


The backpack can potentially be used for a lot of use cases, not just for first responders but also for making preventative visits to people with known chronic conditions who might have a hard time getting to the hospital, or for nursing homes that want to cut down on unnecessary hospital visits.


“We’re actually working with Texas Tech on a program right now, and they’ve got these enormous travel distances,” Urdan said. “The current standard of care is to go to the closest hospital, stabilize a patient, [and] a lot of time that means they drive a long way, they get to the hospital, and then they get transferred to the University Medical Center and that’s another hour. The idea is to be able to do that triage in the field. So you send the patient where they need to go, once. For that kind of thing it’s a pretty cool application.”


In rural areas, Urdan added, the cost savings are pretty apparent. “If you save one helicopter flight, you’ve just paid for the whole system,” he said.


Evie Jennes, chief commercial officer at SwyMed, says that the final product of the backpack is the culmination of several different streams of R&D for SwyMed.

“I think you have to have all the pieces of the puzzle,” she said. “And it took us some time to put them all together. Our software is key, because the software needs to work very well on low bandwidth. … The second thing is the hardware configuration. That took months and months. And the third piece –  and a very important piece – is the relationship we have with Verizon. We’re part of their priority program. When you combine those three things together, you can deliver the DOT Telemedicine backpack that we released today.”



22 Feb 2017

Telemedicine-Friendly FAST Act Heads Back to Congress

Physician Licensing No Comments

Legislators have resubmitted a bill that would remove rural limits and expand Medicare coverage of telestroke services nationwide. Proponents say the bill could save the lives of millions of stroke victims.

Image source: ThinkStock

Original posted by: Eric Wicklund – Editor –

Reposted by: Physician Licensing Service.


– Congress is set to revisit a bill that would expand Medicare reimbursement nationwide for telestroke services.



The Furthering Access to Stroke Telemedicine (FAST) Act, originally introduced in 2015, would alter the Social Security Act to allow Medicare coverage of telestroke services no matter where the patient is located. Current legislation allows those services only in certain rural areas.



U.S. Reps. Morgan Griffith (R-Va.) and Joyce Beatty (D-Ohio), who co-sponsored the original legislation, made the announcement this week that they have reintroduced the bill, with the support of the American Heart Association and American Academy of Neurology.



Both said they want to apply telemedicine technology that has proven its value in combatting the nation’s fifth leading cause of death.



“The FAST Act, as the name implies, will help more stroke victims gain faster access to high-quality care through remote evaluation and treatment – commonly called telestroke,” Beatty said in a press release. “As a stroke survivor and co-chair of the Congressional Heart and Stroke Coalition, I know firsthand how minutes can literally mean the difference between life and death. That is why I proudly join Congressman Griffith in reintroducing the FAST Act to ensure telestroke is readily available to more people.”



“This critical bill would make a world of difference for stroke survivors facing barriers to telestroke services,” added AHA President Steven Houser, PhD, in the release. “Evidence indicates that telestroke improves patient outcomes and reduces disability. However, nearly 94 percent of the strokes that occur in America take place in areas where telestroke is not paid for by Medicare. We urge Congress to give more Medicare patients access to this proven form of treatment and support the FAST Act.”



There’s no shortage of studies and testimony indicating that telemedicine can save the lives of stroke patients by speeding up the time to clinical intervention – most often, the administration of the clot-busting drug Tissue Plasminogen Activator (tPA) within four hours of a stroke.



In late 2015 the Cleveland Clinic published a study reporting a door-to-CT rate of 13 minutes on average and a door-to-intravenous thrombolysis (IV-tPA administration) rate of 32 minutes on average through the use of a mobile stroke treatment unit. Under normal circumstances, where a patient exhibiting signs of a stroke is rushed to the nearest hospital, those rates average 18 minutes and 58 minutes, respectively.



Last August, Kaiser Permanente released a study showing a 75 percent increase in timely use of tPA following a telemedicine consult.



“These findings have important implications for future delivery of stroke care,” Kaiser Permanente researchers, writing in The Permanente Journal, reported. “Particularly in hospitals with limited local resources and/or limited access to neurologic expertise, telestroke is an important tool to aid in the evaluation and treatment of potential stroke. We specifically found that unwarranted hospital variability in stroke care could be eliminated through a standardized telestroke program. Additionally, telestroke may aid in triage and transfer decisions and in identifying patients potentially eligible for endovascular intervention or patients who might otherwise benefit from transfer to a stroke center.”



Shortly thereafter, the AHA joined with the American Stroke Association to release a scientific statement on quality measures and outcomes for the use of telemedicine in stroke cases, marking the first time that standards had been proposed for the platform.



“Telestroke has evolved over the last decade and is now used quite extensively to take care of acute stroke patients in the U.S. and the rest of the world,” Lawrence R. Wechsler, MD, chairman of the AHA/ASA writing committee, said. “Because of this we felt it was time to bring out this statement, which provides a structure against which hospitals can measure the quality of their telestroke programs so patients can be assured of getting the quality they deserve.”



Griffith and Beatty’s bill follows by days the resubmission of another piece of telemedicine legislation. Earlier this week, Michigan Sens. Debbie Stabenow and Gary Peters resubmitted the Hallways to Health Act, which aims to boost telehealth services in schools by connecting them with community health centers and create a demonstration project to expend access in underserved areas.



In resubmitting the FAST Act, Griffith recalled how fast action saved the life of Virginia Congressman Bob Bloxom when he suffered a stroke in 2001.



tPA and telestroke ought to be readily available to help improve the chances of recovering from a stroke,” Griffith said.



“Telemedicine has the potential to improve the lives of millions of individuals suffering from chronic conditions.,” added American Academy of Neurology President Terrence L. Cascino, MD, FAAN, in this week’s press release. “Stroke is a condition that needs to be treated immediately in order to minimize damage to the brain. This legislation focuses on expanding access to a proven method for treating strokes quickly.”



“Stroke patients with access to a neurologist have significantly better outcomes than those that do not. Reimbursing for telestroke consultations under Medicare will dramatically increase the number of beneficiaries who have timely access to a neurologist, ultimately producing steep reductions in disability that should save the federal government money.”

31 Jan 2017

When flu cases rise, physicians start making more (virtual) house calls

Physician Licensing No Comments
















Telemedicine is the new wave in patient-provider relationships. It has taken on a large share of the ongoing flu epidemic. Jupiterimages Thinkstock images



JANUARY 27, 2017 11:00 AM

Reposted by Physician Licensing Service


The ongoing influenza epidemic has strained emergency rooms, urgent care clinics and physician offices as patients seek relief.


One area that is providing relief on both sides of the stethoscope is telemedicine.


Telemedicine puts patients in touch with providers via telephone and webcam.


“It certainly is a way to relieve some of that pressure on doctors offices, urgent care and ER,” said Dr. Robert Bernstein, vice president of clinical affairs for Carena, a Seattle-based virtual urgent care clinic.


“We see all the urgent care issues from rashes to bladder infections,” Bernstein said. “A lot of coughs and colds.”


Carena contracts with clients around the country and several in the region including, Virginia Mason Medical CenterUniversity of Washington Medicine and CHI Franciscan in Tacoma.


Carena has 25 providers including family medicine physicians and nurse practitioners on staff.


Some clients such as CHI Franciscan add in their own physicians as part of its Franciscan Virtual Urgent Care. The service costs $35.


MultiCare Health System offers Doctor on Demand. That service provides patients immediate access to a board-certified physician for a range of medical issues. The cost of each video doctor visit is $49.


MultiCare also has eCare. That online service provides online diagnosis and treatment service for common health conditions. Patients are connected to clinicians via email or text for a $25 fee.


At CHI Franciscan, a patient begins the telemedicine process by calling in or registering through the internet.


Emergency departments can also refer patients. There’s even a mobile app.


CHI Franciscan’s website begins with a series of questions to screen anyone who should instead be calling 911.


“Welcome,” the website continues. “We’re sorry you’re not feeling well.”


Once a patient requests a visit, they will get a call back within 20 minutes, Bernstein said. Though times have lagged a bit during the epidemic, callbacks are still averaging 10 minutes.


Many patients contact the system looking for a medicine to treat their flu symptoms, Bernstein said.


First, “We really have to ask the question, ‘Is this flu or is it something else?’ ” he said.


Physicians look for red flags indicating a more serious condition.


If a patient seems dehydrated, has respiratory involvement, has a complication such as pneumonia or is in a high-risk category, then they will be referred to an in-person visit.


If it turns out the patient needs in-person care, they are not charged for the virtual visit, said Dr. Jessica Kennedy-Schlicher, CHI’s virtual urgent care director.


“It’s really a win-win for the patient and the physician, who wants to provide that access and that convenience but wants to see that patient in the most appropriate location,” Kennedy-Schlicher said.


When that patient is referred to an in-person visit, CHI Franciscan will alert the clinic or emergency department and provide them with appropriate patient records.


Bernstein said conversations between patient and provider can often be more engaged when conducted via telephone or webcam. Patients feel more comfortable at home and less intimidated by the medical surrounding.


“They often feel more connected to the provider than in person,” he said.


But, the physicians acknowledged, there are disadvantages.


Physicians can’t use stethoscopes, thermometers and other diagnostic equipment on a virtual patient.


A webcam might show skin color, but not as accurately as an in-person visit would.


Kennedy-Schlicher said doctors can work around those issues.


“Your intuition as a physician gets pretty good over the years,” she said. “If you feel like there’s a piece of information you need, you bring them in. You would err on the side of having more information.”


Telemedicine promises to get more efficient as more tools come online in the coming years.


Patients with chronic diseases, for instance, could have portable diagnostic equipment at home, which could be accessed by physicians.


Maybe those robots that now sterilize hospital rooms might one day make house calls.
Read more here:

19 Jan 2017

Puerto Rico fights back doctors’ exodus granting them huge tax incentive

Physician Licensing No Comments


Published January 10, 2017 –

Reposted by Physician Licensing Service

In an attempt to prevent more doctors from leaving, and perhaps even pull back the hundreds gone over the last couple years, the new governor of Puerto Rico has included in his first package of bills a measure that is basically a lifesaver for the medical profession on the island.

















An orthopedic technician attends to a patient at the Medical Center pediatric clinic in San Juan.  (AP)


The measure seeks to lower the fixed income tax rate on all practicing physicians, from the current 33 percent to 4 percent. It also proposes a tax exemption for the first $250,000 earned.


Puerto Rico’s governor Ricardo Rosello, a scientist with no political experience, was sworn in last week.


“Puerto Rico’s recovery begins today,” he said in his inauguration speech.


Over the last 12 years, Puerto Rico lost 2,422 doctors – about 347 doctors per year – according to local newspaper El Nuevo Dia, This has led to a dramatic shortage of health services in the island.


“Perhaps without knowing it or having planned it, we are training professionals to go to other places,” said Jaime Plá, executive president of Puerto Rico’s Hospital Association.


“Puerto Rico is becoming the supplier of professionals, not only in the health area but also in engineering,” he said, as quoted by the paper.


Puerto Ricans have been hit with dozens of new taxes in the past four years and increases in utility bills as former Gov. Alejandro Garcia Padilla aimed to generate more revenue for a government he said was running out of money.


Despite those and other measures, the island’s government has defaulted on millions of dollars’ worth of bond payments and declared a state of emergency at several agencies.


Rossello said he also aims to boost public-private partnerships and use that revenue to save a retirement system that faces a $40 billion deficit and is expected to collapse in less than a year.


He pledged to work closely with a federal control board that U.S. Congress created last year to oversee Puerto Rico’s finances, and he has said he supports negotiations with creditors to help restructure a public debt of nearly $70 billion.


The federal control board has requested a revised fiscal plan that has to be approved by end of January, saying that the one Garcia Padilla submitted last year was in part unrealistic and relied too heavily on federal funds — he refused include austerity measures.


Rossello has said he would request an extension of that deadline as well as an extension of a moratorium that expires in February and currently protects Puerto Rico from lawsuits filed by angered creditors.


The AP contributed to this report.




16 Jan 2017

Telemedicine In Schools Helps Keep Kids In The Classroom

Physician Licensing No Comments

Many states are experimenting with telemedicine to address health disparities that can depress student achievement.


telemed lady


Veronica DeSimone, the school nurse at Ducketts Lane Elementary in Elkridge, Maryland, has conducted nearly 25 telemedicine visits with doctors this school year. Telemedicine is becoming more common in schools across the country.



Originally posted: 01/04/2017 10:14 am ET | Updated Jan 04, 2017

Reposted by Physician Licensing Service

By Michael Ollove



ELKRIDGE, Md. — In late November, on the first cold morning of the season, a second-grader at Ducketts Lane Elementary School had trouble breathing during recess.



When the school nurse, Veronica DeSimone, examined the girl, she heard wheezing in her chest and noted her low oxygen levels. DeSimone determined that the child was having an asthma attack.



The nurse would have administered relieving medication, but the girl’s parents hadn’t yet signed a permission form or delivered their daughter’s medicine to the school. The girl’s father, the only parent available, was at work at least an hour away. There was not time to wait for him to come get his daughter.



Not long ago, DeSimone would have had to call an ambulance to take the child to the emergency room, forcing her to miss the rest of her classes that day.



Instead, DeSimone set up an online video and audio link to an emergency room pediatrician at Howard County General Hospital. With earlier permission from the girl’s parents to participate in the school’s telemedicine program, DeSimone examined her with a digital stethoscope, which allowed the pediatrician to listen to the girl’s lungs remotely.



The doctor quickly confirmed DeSimone’s diagnosis and directed her to administer the necessary medicine. Within 10 minutes, the child was breathing normally and back in class.


map tele







Telemedicine, increasingly used in prisons, nursing homes and remote areas, is becoming more common in schools. According to the American Telemedicine Association, at least 18 states authorize Medicaid reimbursement for telemedicine services provided in schools and 28 states plus Washington, D.C., require private insurers to cover telemedicine appointments as they would face-to-face doctor visits.



Telemedicine, increasingly used in prisons, nursing homes and remote areas, is becoming more common in schools.



Telemedicine can’t always replace an in-person examination — a doctor often has to touch a patient, for example, to diagnose the cause of abdominal pain — but it does make it less likely that a child will have to miss class for a visit to the doctor’s office.



“The piece for me that is so exciting is how many more kids are able to stay in school,” said Heidi Balter, principal of Ducketts Lane, which was outfitted with telemedicine equipment a year ago.



Lawmakers and educators around the country echo that enthusiasm. “School telehealth will be a game changer in terms of children’s health, keeping them in school and improving educational outcomes,” said Democratic state Rep. Kip Kendrick, who helped pass a new Missouri law that allows Medicaid payments for telemedicine in the schools.



$27,000 in Equipment



Many states still limit Medicaid reimbursement for telemedicine, and, according to the American Telemedicine Association, 24 states specify settings, such as a doctor’s office, where a patient must be in order to participate in a telemedicine appointment.



In Texas, the state Medical Board is involved in a legal dispute over its insistence that “a doctor-patient relationship” be established before telemedicine can be used. The dispute, however, doesn’t apply to school telemedicine as long as a school nurse is present.



But as state policymakers become more accustomed to telemedicine and familiar with its benefits, “we’re seeing many of the restrictions falling to the wayside,” said Latoya Thomas, the director of state policy for the American Telemedicine Association.



The impetus for school telemedicine in Howard County, where Ducketts Lane is located, came from former County Executive Ken Ulman. Ulman believed that health disparities in lower-income areas of the county were depressing student achievement, and that telemedicine might help.



In 2015, the county chose Ducketts Lane and five other elementary schools to be the first to offer telemedicine services. All of the schools drew students from economically disadvantaged areas and all had full-time nurses.



The county found a willing partner in Howard County General, which was looking for ways to expand access to its services. The hospital agreed to pick up the costs of making its emergency room pediatricians available for telemedicine calls from the six schools during school hours.



The county picked up the tab for the $27,000 in telemedicine technology that each school required. The equipment included a video monitor, a camera, and digital stethoscopes and otoscopes, to check ears, noses and throats and transmit the images.



Two local pediatric practices also agreed to make their doctors available. Unlike Howard County General, which is forgoing reimbursement, the practices bill private insurers when the children they treat have that coverage. Maryland Medicaid only covers telemedicine when a doctor or nurse practitioner (not a registered nurse, like most school nurses) is present during the exam.



Quicker Diagnoses



Even when kids must miss school because they have contracted a contagious illness, such as strep throat or conjunctivitis, telemedicine allows remote doctors to make a quick diagnosis and prescribe medicine, hastening the child’s return to school, said Sharon Hobson, the head of telemedicine in Howard County schools.



Often telemedicine doctors are able to rule out a contagious condition, recognizing, for example, that reddened eyes are the result of allergy rather than conjunctivitis. “We used to have to send them home in the chance that it was pink eye,” said DeSimone. “Now we can keep them.”



Last year, the six Howard County schools conducted 150 telemedicine exams. Midway through this year, the total is 87.



Ninety-eight percent of the kids who are treated through telemedicine (not including those who are contagious or have conditions that can’t be treated through telemedicine) immediately return to their classes.



Other school systems have reported similar results. Studies have also shown that telemedicine in schools reduces trips to the emergency room.



“Not having to pull my child out of school & take him to the pediatrician is a huge benefit,” one parent wrote in a Howard County schools survey. “Saves time & money.”



Managing Chronic Illnesses



In the future, Hobson hopes that telemedicine in Howard County will be able to not only address acute health conditions — the sudden onset of symptoms — but also help students manage chronic conditions, such as asthma, attention deficit hyperactivity disorder and obesity. She also hopes to use telemedicine to provide mental health counseling.



Schools in the Bronx and in South Carolina already are using school telemedicine for mental health. It is being used for speech pathology in Michigan, and in New Mexico, an effort is underway to use school telemedicine in oral health.



The Medical University of South Carolina, in Charleston, provides telemedicine services to 47 schools. James McElligott, the medical director for telehealth at the hospital, said he is most gratified by the work the hospital does with Pace Academy, a school for children with multiple disabilities.



In the past, many of those children simply had to endure minor ailments, such as rashes and earaches, because it was just too difficult to transport them to a doctor or hospital. Now, using telemedicine, the Medical University can provide almost immediate relief.



Some doctors say they actually prefer telemedicine encounters to face-to-face exams with children. David Monroe, medical director of the Children’s Center at Howard County General, said the images provided by the telemedicine instruments are often better than what he can see using conventional equipment on a squirming child. “It’s easier because you get this high-definition picture, which I never get otherwise,” Monroe said.


Original article link: