Dr. Humayun Chaudhry, CEO of the Federation of State Medical Boards

Mark Masselli: This is Conversations on Healthcare I'm Mark Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Well Margaret more Americans will be seeing their medical provider
virtually big insurers are paving the way for patients to be seen by their provider online
for a variety of ailments they would ordinarily require a trip to their provider's office.

Margaret Flinter: With the expansion of telemedicine's getting a big boost from the
insurance industry. Aetna currently allows for some three million E - visits with clinicians
online and that number is expected to grow to eight million in the coming year and well
point. Another big insurer anticipates four million E - visits in the coming year.

Mark Masselli: It saves money and for patients faced with higher and higher
deductibles and co - pays it's more affordable for them as well. A trip to the emergency
room could cost thousands of dollars or more a typical teladoc consult is $50 not to
mention the convenience for the patient as w ell.

Margaret Flinter: Well there are some urging that we move into this realm with caution.
Some providers concerned about the high tech approach undermining the high touch
approach but I don’t think they have much evidence to support that view.

Mark Ma sselli: And then there are of course there are rules governing medical license
insurers that don’t allow for practicing across state lines. We're still in the early stage of
a telemedicine regulations that will address all of these issues.

Margaret Flint er: That something that our guest today knows quite a bit about Humayan
Chaudhry is President and CEO of the Federation of State Medical Boards which
oversees licensing and disciplining a physicians around the country, helping to set best
practice guideli nes.

Mark Masselli: There are proposed new draft regulations in inter - state compact that
would help alleviate the growing shortage of physicians and allow for more expensive
telemedicine enterprises should be an interesting conversation.

Margaret Flinter: We'll also have our weekly visit with Lori Robertson Managing Editor
of FactCheck.org no matter what the topic you can hear all of our shows by going to
chcradio.com.

Mark Masselli: And as always if you have comments email us at [email protected] or
find us on Facebook or Twitter we love hearing from you.

Margaret Flinter: We'll get to our interview with Humayan Chaudhry in just a moment.

Mark Masselli: But first here is our producer Marianne O'Hare with this we ek's headline
news.

(Music)

Marianne O'Hare: I'm Marianne O'Hare with this Healthcare Headlines. Two federal
appeals court penal issued conflicting rulings on whether the government could
subsidize health insurance premiums for people in three dozen stat es that use the
federal insurance exchange. The United States court of appeals for the fourth district
enrichment upheld subsidize saying that a rule issued by the internal revenue service
was a permissible exercise of the agencies discretion. The ruling came within hours of
a two to one ruling by the US court of appeals for the district of Columbia circuit which
said the government could not subsidize insurance for people in states that use the
federal exchange. That decision could potentially cut off f inancial assistance for more
than 4.5 million people who are found eligible for subsidized insurance on the federal
exchange or market place.

Meanwhile the numbers of those who gain coverage during the first open enrollment
period shows an estimated 20 mil lion Americans gained coverage the journal of the
American Medical Association calculated some 7.8 million young adults had gain
coverage under Obama Care by being allowed to stay on their parents plan until the
age of 26, eight million gain coverage throu gh the online insurance market places and
over four million gain coverage with the expansion of Medicaid. And handling all of that
online insurance business continues to present challenges the centers for Medicare and
Medicaid has kicked off a search for a company that will serve as their technology
vendor for healthcare.gov the federal insurance exchange. They're looking for a
contractor capable of "working under aggressive time constrains" official saying this
does not mean they're dissatisfied with the current contractor Accenture who replaced
the original contractor that bought the rollout.

A Florida jury is (inaudible 3:58 ) to decisive blow to one of the leading manufacturer of
cigarettes R. J. Reynolds a 23 billion dollar punitive damage ruling in th e case of a
woman who sued the company for her husband's untimely death due to smoking. The
case Cynthia Robinson versus R. J. Reynolds Tobacco Company sued on the grounds
of company knowingly sold the product to her husband a long time smoker by marketin g
a product they knew was addictive, deadly and fill with harsh chemicals that weren't
listed on the package. The jury also awarded 16 million dollars in compensatory
damages to the plaintiff sending a statement to the tobacco industry that it cannot
cont inue to lie to the American people and government about the addictiveness of their
product. I'm Marianne O'Hare with these Healthcare Headlines.

(Music)

Mark Masselli: We're speaking today with Dr. Humayan Chaudhry a President and
Chief Executive Officer of the Federation of State Medical Boards a national nonprofit
organization that represents the 70 state medical boards of the United States and its
territories responsible for licensing and disciplining doctors. Dr. Chaudhry served as
their Commissioner of Health Services for Suffolk County, New York an internist in
osteopath Dr. Chaudhry served as the Chairmen of the Department of Medicine at a
college of osteopathic medicine at the New York Institute of Technology and he's author
of several books inclu ding medical licensing and disciplining America. He earned his
masters at Harvard School of Public Health his MD at the New York Institute of
Technology. Dr. Chaudhry welcome to Conversations on Healthcare.

Dr. Humayan Chaudhry: Thank you very much I'm delighted to be on your show.

Mark Masselli: That's great your organization, the Federation of State Medical Boards
monitors regulations for licensing and discipline of physicians across the country and
while you're a national organization licensing a phy sician is still really governed at the
state and territory level. Could you share with our listeners a little bit of history about
the actual scope and reach of the federation and why type of oversight and policy
directions are you responsible for the med ical field?

Dr. Humayan Chaudhry: Sure the practice in medicine in the United States has been
regulated by the state since really the founding of our nation. The Federation of State
Medical Boards my organization was founded more than a 100 years ago to respect
states rights while encouraging the sharing of information about doctors, encouraging
the creation of a common language and taxonomy related to physician discipline and
best practices in the area of licenser and discipline of physicians. So the FS MB does
not have any authority over the state boards as such but we do provide services for
them as well as for physicians and put together policies on their behalf that better
protect the public. Ultimately the mission of every state licensing board is t o protect the
public. Many of these policies of the federation creates overtime become state law,
whether they do and to what extent is entirely up to the states.

Margaret Flinter: Dr. Chaudhry one area that's beginning to get a lot of attention is
telemedicine which we think is poise to just explode in the coming years, combination of
both available technology and real need for increasing capacity. So your organization
the Federation of State Medical Boards has been getting some attention lately fo r a
proposal that would help expedite licenser across state lines. Maybe you could tell us
about this draft legislation that you've created the interstate medical licenser compact.

Dr. Humayan Chaudhry: About two decades ago the states recognize a need t o
support what's known as licenser portability in other words the ability of the physician
practice in more than one jurisdiction. So for instance back in 1996 the federation

created on behalf of the state a federation credentials verification service FCV S so that
physicians wouldn’t have to request a transcript from a medical school or verify their
identity. Every time they applied for an additional license or move to another state.
Last year the states wonder if they could do more or should do more for three primary
reasons. One, the worsening physician shortage. Second, the Affordable Care Act and
the greater need for access to care and really the third point that you mentioned
Margaret the advancement of telemedicine. And so all those three compell ing reasons
came together this began January of 2013 the states got together under our offices and
explored what might be other options by which they can support these efforts. And so
was born the notion of maybe an interstate medical licenser compact may be way to
address these issues in a way that make sense for the state regulatory boards for
physicians as well as the public.

Mark Masselli: So frame up for us what are some of the requirements that states are
thinking about and what are the criteria gove rning providers seeking expedited licensers
across state lines might face.

Dr. Humayan Chaudhry: It turns out that interstate compacts have been around in the
United States since the founding of the nation. There are actual ly more than 200
interstate com pacts. So the good news is that this isn't an entirely new concept, it is
perhaps for the state licensing boards as it relates to the doctors. It looks like the states
will be requiring that a physician who wishes to get multiple state licenses through t his
pathway should have unrestricted license to practice in one of the participating states
and we call that a Principle Licenser State so you have to identify as a physician if you
want to go through this pathway one state where you have obtain licenser i n the usual
way.

You should have an unblemished disciplinary record completion of a residency training
program and not be the subject of any investigation by a licensing agency or law
enforcement. But the states felt that there were some common elements t o the
requirements that would assure them of patient safety ultimately while enabling the sort
of licenser portability to occur in a way that hasn’t been seen before in the United
States. When we presented the idea to our house of delegates last April in 2013 there
was actually unanimous support to aggressively explore this idea. We haven't seen
unanimous report like that in long time coming from across the United States. So there
is a lot of support for it and momentum. We're currently in a process of finalizing some
of the language this is indeed the fastest moving initiative in the history of our
organization.

Margaret Flinter: You're certainly not the only healthcare profession that's been looking
at this issue of the interstate compacts and we hear so much these days about inter -
professional collaboration practice and education. I'm curious as to whether you're

collaborating with other professional organizations, nursing, dentistry, pharmacy and
trying to move forward kind of a common agenda across the board. And then I guess
on just the specific level back to the safeguards issue if there is a problem with a
provider who requires professional discipline. How does the fact that they're licensed
under the compact make things different from what we will see today?

Dr. Humayan Chaudhry: We have been having very good communications and
meetings over the years with our friends as that National Council of State Boards of
Nursing as well as the National Association of Boards of Pharmacy those are our two
counterparts in the area of nursing and pharmacy. In fact the last time we got together
we remark that collectively we regulate several million doctors, nurses and pharmacist
so there is a nursing compact the nursing professional working under the off ices of the
NCSBN the nursing association for the boards. Several years ago put together a
compact and they've had some success 24 state have signed off on that. So when we
began discussions about a interstate compact for physicians we talk to our friend s at the
nursing boards to find out what work and what didn’t work. So for the physician side on
the state board side that help because the physician said that if the state boards are
going to sign off on this they need to know if a physician is practicin g medicine in their
jurisdiction.

And so one way to achieve that was through making sure that when a physician signals
that they wish to practice in a particular jurisdiction that jurisdiction would formally issue
a license just like they do today which al lows them to follow through should something
go wrong. And that was a critical step in getting much broader support than we might
have otherwise. In the current process when a board action is taken by a licensing
board through the federation's offices we have a board action data bank and as soon as
that information becomes available to us electronically we share that instantaneously
with all 70 of the state medical in osteopathic boards in the United States. And that's a
great mechanism of assuring that there's data sharing and information sharing.

With the compact there's actually greater flexibility because you can build in language to
assure even greater protection of the public and so one of the items in the compact is
states that any state that is pa rtner to this compact would agree that if one of the
physicians who's got the license through this compact is being investigated that
information of that physician's being investigated also be shared with the other states.
Right now many states statutes o nly allow sharing of information across state line when
an action is taken not before. So that adds an additional layer of public protection every
now and then things go wrong and there should be mechanisms in place to protect the
public. And so that is something that exist in this compact in a better way than perhaps
exist otherwise.

Mark Masselli: We're speaking today with Dr. Humayan Chaudhry President and Chief
Executive Officer of the Federation of State Medical Boards responsible for licensing
and discipline physicians. Dr. Chaudhry talk to me a little bit about the Affordable Care
Act and were there any elements of it that sort of stepped on the toes of states medical
licensing boards or issues that you're still trying to work out with HHS in term s of
policies or things that you've brought up legislatively were there any tension points?

Dr. Humayan Chaudhry : To be honest we're about public protection, we're not about
the issue of cost per se having said that we have a database of physicians who ge t
discipline as well as physicians who are licensed. And we are having some very good
conversations with folks at CMS as well as HHS about making sure that they know that
they have access to this sort of information today that may not always have been
pos sible. So that type of conversation is occurring but really nothing directly in terms of
anything coming out of the administration that negatively impacts what the states are
trying to do. In fact quite the contrary earlier this year the federation receiv e a very nice
letter sign by 16 US senators bipartisan as a matter of fact thanking the state boards for
moving forward with this interstate compact idea. There's been broad support for what
we're trying to do which is move forward with supporting the acc ess to care needs of the
nation's population in a smart way in a way that preserves state base medical licenser
which has been around since the beginning of the nation and ultimately protects the
public.

Margaret Flinter: Mm - hmm, well Dr. Chaudhry I wonde r if you could share your
thoughts on other area that you've been engaged in that is really considering social
media in the healthcare field. I think your organization has taking a look at the
proliferation of social media use among healthcare professiona ls. And I'm curious what
are your seeing as some of the trends where social media and medicine intersect.

Dr. Humayan Chaudhry: So as a matter of fact while technology is a wonderful thing we
can engage in instantaneous sharing of information and communi cations unlike ever
before. There's a great potential there to support the healthcare needs especially
among underserved populations. And so over the years the federation has tried very
hard to work with the states to be proactive. So several years ago the federation came
up with a telemedicine policy that we recently updated as an example how we're trying
to keep up with all the advancements going on. Social media is the other area that was
not actually on our radar as an area of concern per se but we were approach by some
researchers a few years ago who wanted to study the issue and we said sure we're not
sure this is even a big issue among the state licensing boards. To make a long story
short we did a survey of our licensing boards and we were quite taken aback by the
results that 92% of the responding state medical boards said that they have had a
problem with having to discipline physicians for inappropriate use of social media.

One was inappropriate patient communication where perhaps the physicia n was too
forward with the patient or engaged in inappropriate communication that you would
never expect to occur in person but somehow with technology it was facilitated including
asking the patient on a date for instance. Another was misrepresentation o f credentials
where a physician using social media claim to have either especially certification or an
expertise in an area when they really didn’t. And a third was really a violation of patient
confidentiality which has always been a concern with technol ogy and the ubiquity of it
and how there may not necessarily be safeguards. And so two years ago the federation
partnered with the American College of Physicians and put together a joint policy
statement that goes into some of this background but essentia lly says to physicians feel
free to use technology but please pause before you send, use social media thoughtfully
and recognize that there are some inherent dangers in how you may use it
inappropriately.

Mark Masselli: You also had some of your own exper ience with social media you are
the health commissioner Suffolk County in New York talk to us a little bit about your own
personal experience there I think it was with the H1N1 flu epidemic and what were the
lessons learned for the public as well?

Dr. Huma yan Chaudhry: Well it was a good example Mark of how social media can be
a value not only in one to one physician to patient care but also in population of health
and public health. So Suffolk County for some of your listeners who may not know is a
fairl y large jurisdiction with a population of about a million and a half. And so as the
H1N1 flu epidemic began to hit we have to shut down schools, we have to work very
closely with state agencies devoted to public health as well as the CDC and some
federal agencies as well. And blackberry and Twitter were still relatively new and smart
phones are relatively new but many of us used it in public health and found that many of
the federal officials involve in managing that epidemic as well as the officials in N ew
York State were also using it. So it was a great way to not only get information
instantaneously about any new cases for instance or any follow - up investigation that
needed to be done. But also enabled me to stay in touch with the leadership of all
to wns and villages across the county. That really impressed me with the value of
technology in that particular area of public health.

Margaret Flinter: We've been speaking with Dr. Humayan Chaudhry, President and
Chief Executive Officer of the Federation o f State Medical Boards. You can learn more
about their work by going to FSMB.org or follow him on Twitter at (inaudible 19:42 ). Dr.
Chaudhry thank you so much for joining us today on Conversations on Healthcare.

Dr. Humayan Chaudhry: My pleasure thank you.

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Mark Masselli: At Conversations on Healthcare we want our audience to be truly in the
know when it comes to the facts about healthcare reform and policy. Lori Robertson is
an award - winning journalist and managing editor of FactCheck.org a no npartisan,
nonprofit consumer advocate for voters that aim to reduce the level of deception in US
politics. Lori what have you got for us this week?

Lori Robertson: Well in the run up to the November midterm elections we're seeing
republicans claiming th at their republican primary opponents support the Affordable
Care Act. But the claims use out of context quotes and exaggerations. In Georgia in a
contentious house raise republican Bob Johnson and Buddy Carter are both opposed to
the Affordable Care Act and have called for its repeal. But you wouldn’t know that from
their competing ads. Johnson's ad claims that Carter said Obama Care was "not so
bad" that's a cherry picks quote. Carter said that "some of the things that have
happened so far are not so bad" but he immediately added that "the worst part is yet to
come". Johnson's campaign websites further claims that Carter left the door open to
Obama Care's Medicaid expansion in Georgia and it highlights part of an up ad Cater
had written. But that to o was out of context, Cater was explaining the views of others
who favored the Medicaid expansion a Carter ad meanwhile says that Johnson has
"membership in and endorsement firm groups that support Obama Care" the ad doesn’t
say this but it's referring to Johnson's membership in the American medical association
which has generally been supportive of the Affordable Care Act. Johnson is a surgeon
but Johnson like Carter has called for repeal of the law. Some members of the AMA
support the healthcare law and some do not. The Carter campaign besides other
medical groups that support Johnson but those association don’t change the fact that
Johnson has been opposed to the healthcare law. And that's my fact check for this
week I am Lori Robertson Managing Edito r of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact, that you would l ike checked, email us at
www.chcradio.com. We will have FactCheck.org's Lori Robertson check it out for you
here on Conversations on Healthcare.

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Margaret Flinter: Each week conversations highlights a bright idea about how to make
wellness a part of our communities and to everyday lives. Food labeling could be going
one step further than simple calorie counts in the future. Pu blic health researchers at
the University of North Carolina have some pep in their step for another approach to
getting co nsumers attention when pondering those food and beverage choices. There's
growing interest in a new approach to displaying calorie counts next menu items instead
show the amounts of exercise that would be required to burn off those calories consume

from d rinking say a 20 ounce cola. They developed an icon symbolizing a person
walking and how far that person would have to walk to erase the calories they are just
about to consume.

Dr. Anthony Viera : And we showed them the full menu with all items and so on e group
was randomize to no information except the food items. Another one was a menu of
pretty much every item and it had the calories and then a third option had calories plus
minutes to walk with our little figure and it had, you know for example 91 mi nutes. And
then finally a fourth menu that show the same exact thing with the same exact figure
with miles to walk. So it might say 5.1 miles.

Margaret Flinter: Dr . Anthony Viera , Professor at the University of North Carolina,
Chapel Hill School of Publ ic Health. He said the study showed quite clearly that when
consumer saw the consuming of food or drink item would require them to walk five miles
to burn those calories off as oppose to just seeing the calories. It had a direct impact on
the choice.

Dr. Anthony Viera: So if you looked at total calories ordered when you are shown no
label the average calories ordered with 1020 when you are shown calories only which
is, you know, sort of the policy the current policy the average order was 927 calories.
A nd when shown calories plus miles the average was 826 calories so as you could see
there was a definite decrease in calories when you're shown calories plus miles.

Margaret Flinter: The results of the initial study were so conclusive they are now scaling
up their research to test it in restaurants. Restaurant food labeling showing a consumer
how much exercise will be required to burn off the calories consumed, helping them
comprehend the actual calorie value of the foods they chose and maybe that's positi vely
impacting their intention to consume fewer calories more wisely, now that's bright idea.

(Music)

Margaret Flinter: This is Conversations on Healthcare, I'm Margaret Flinter.

Mark Masselli: And I'm Mark Masselli, peace and health.

Conversations on He althcare, broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org and brought to you by the Community
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