Physician FAQ and Policies

During the course of a patient encounter, the physician may, at his or her discretion, submit a prescription for a patient (member). Drugs that our doctors typically prescribe include antihistamines and antibiotics. Our physicians can also prescribe maintenance medicines, such as those used to treat high cholesterol, diabetes and hypertension, if, for example, a member is in transition to a new insurance plan or doctor or the patient is traveling and has left a prescription medication behind.

Physicians are encouraged to only issue prescriptions if you are able to gather the appropriate information to accurately diagnose and treat a given condition. A prescription is never promised to a patient and physicians may refer members to their primary care physician, an urgent care center or other appropriate care if they are not able to adequately diagnose and prescribe over the phone.

If a physician does prescribe medication, he or she will normally limit the supply to no more than thirty days, as that is the supply usually covered by insurance. Patients with chronic illnesses will be encouraged to visit their primary care physicians or other specialists for extended care.

A small number of jurisdictions restrict prescriptions and video consults. These restrictions change from time to time.  Physicians should be aware of these state restrictions where they hold licenses.

We ask that First Stop Health physicians not prescribe the following via telemedicine:

• Medications that are listed on the DEA list of controlled substances, such as narcotics (e.g., oxycodone) or amphetamines (e.g., Adderall) and anti-anxiety drugs (e.g., belonging to the benzodiazepine class of drugs Klonopin, Lorazepam, Valium, and Xanax)
• Lifestyle medications (e.g., Viagra) or diet pills (e.g., phentermine). Also, we do not provide prescriptions for anxiety, depression (e.g., Abilify or Prozac)
• Tramadol or medical marijuana

Physicians CAN prescribe drugs containing pseudoephedrine (e.g. Sudafed or Claritin D) in those states that require a prescription.

First Stop Health physicians may prescribe the following types of medications at their discretion­­­­­­­. Although the following medications are not controlled substances and may be prescribed via telemedicine, please use caution and take a thorough medical history before prescribing medications such as:

• Gabapentin
• Flexeril
• Fluoroquinolones

First Stop Health physicians may provide refills of contraceptives.

As First Stop Health is not a replacement for a Primary Care Provider, please limit prescriptions to no more than a 30-day supply of medication at a time. We encourage you to take a medical history of the patient to determine whether a refill is appropriate. If you are completing your notes via the physician web portal, you may review the patient’s previous First Stop Health consultation notes in the Consultation History area in the lower righthand corner of the notes screen.

Procedural / Clinical Guidelines

1. Always introduce yourself to the member by first and last name, and say you are calling from First Stop Health.
2. Identify the patient by confirming their name and DOB.
3. Take an appropriate medical history prior to making a diagnosis. You will receive symptoms, allergy, and current medication information through our web-based physician portal or electronic dictation on the phone prior to a consultation, but you should be sure the patient didn’t leave anything out of their pre-consult survey.
4. Explain the diagnosis to the patient in easy-to-understand terms.
5. Explain the treatment plan to the patient. Take the time to offer the patient an explanation of why you are prescribing, or not prescribing, a medication. Our members call us when they are sick and often times expect a prescription will be given. If, in your judgment, a prescription medication is not indicated, we DO EXPECT that you will patiently explain to the member why a prescription is not indicated and offer over-the-counter remedies that may be more appropriate. It takes a little extra time, but patients really appreciate it and it is a great satisfaction builder. After all “doctor” comes from the Latin for “teacher,” and education is part of our mission. You can be confident that we will back you up in the event of patient complaints regarding antibiotic prescriptions.
6. Always give patients clear verbal instructions for treatment and follow up, including the caveat that they should see an in-person physician, visit an urgent care center, or even the ER if their condition warrants it or their symptoms worsen.

Please note that First Stop Health does not consider new diagnoses of Sexually Transmitted Infections to be an appropriate use case for telemedicine, and that patients reporting new symptoms of such conditions should be referred to in-person care for examination.

Understand that your call IS BEING RECORDED and is available to us and to THE PATIENT, as part of their medical record. At the end of the call you will be asked to record your encounter notes, including Subjective/ Objective, Assessment/ Plan, Patient Instructions, and Prescription (if indicated) into the web-based doctor portal or to dictate your notes into the IVR on the telephonic system. We appreciate knowing as much of your thought process as appropriate, which could include a differential diagnosis and conditions you feel are “ruled out.”

Consultation Protocol

Pre-consultation Screening

A member who calls First Stop Health (FSH) to consult a doctor will be routed to a customer service representative. The member will have to accept HIPAA authorization to share medical information with providers and also allow providers to share medical information with FSH in order to speak to a doctor.

The representative will complete a pre-consult survey including:

• Patient identification and location
• Symptoms
• Drug allergies
• Current medications
• Preferred pharmacy

Alternatively, the patient may request a consultation online from a web-based patient portal, and the same data (see above) will be collected to create a consultation request.

Consultation Acceptance and Completion

When a new consult is available, our system will send a notification to the doctors who are licensed in the state where the patient is located.

If you are logged in to the doctor portal, the portal will make a notification sound and also a browser tab notification will flash to let you know a consult is available. If the consult is not immediately claimed on the portal, physicians who are not logged in to the portal will then receive text notifications. Text notifications may take several minutes to reach your phone due to carrier delays.

Simply click the green “Begin Consultation” button on your portal dashboard to start the consultation. You will be shown the patient’s name, state, gender, symptoms, current medications, and allergies, and our system will immediately call you to connect you to the patient via our platform.

Once connected to the member, click the “Patient Answered” button. You can speak to the patient and type notes in the Encounter Notes screen of the portal (you may use one of our templates for notes for the most common telemedicine diagnoses available in the dropdown menu in the upper left if you wish).

Use the radio buttons in the top right to indicate whether or not there is a prescription on this consultation. Navigate by using the tabs at the top of the page or the red “Next” button at the bottom of the page.

The following screen allows you to ePrescribe in a window within our doctor portal. Hit “Send,” then “Submit” to submit the medication. Proceed through steps 1-4 (see detailed prescription training below). Once you are on Step 4 of 4, you will see a “Result” success message across the screen reading either “new eRx successfully submitted” or “waiting for pharmacy response.” Both are success messages. Click the red “Next” button at the bottom of the eRx window to progress to the final screen.

Indicate whether you referred the patient to their PCP, an urgent care facility, or the ER, or whether the patient does not need to follow up if the issue resolves on its own. Finally, if needed, use the text field on this screen to communicate any questions or issues regarding this consultation to First Stop Health’s team. Hit “Submit” at the bottom of the screen to complete the consultation process. This is the trigger for payment for the consult.

You may also claim a consultation by text message, speak to the patient, and then complete consultation notes and ePrescribe on the portal. Claim the consult with the link to the patient as above, then, when finished speaking to the patient, press *7. *7 is the system trigger to hang up on the patient call and launch the post-consultation dictation system. Please press *7 if you initiated the consult by clicking the link in a text message, as the system will need the feedback that you completed the patient call to proceed appropriately.

You will hear the menu options “Press 1 if you left a voicemail. Press 2 if you’ve spoken to the patient, and you wish to complete your notes by telephone. Press 3 if you’ve spoken to the patient, and you wish to complete your notes on the web-based portal.”

Press 3 and log in to the web portal, and scroll down to the Consultation History list.

Hit the red “Edit” pencil to enter notes and ePrescribe for the consultation. If you have not logged in within 15 minutes, you will receive a reminder email that notes need to be completed for that consultation.

Alternatively, if you are not near a computer, you may use our fully telephonic system to complete the consult. You will receive a text consultation alert notification. This text will include the link to our system phone number and consultation ID that corresponds to the consult.

To accept the consultation, simply touch the phone number in your text message to call into our system. Our system will connect your to the patient. Once the consultation has been accepted by a doctor, the system will send a text to the other doctors letting them know that the consultation has been serviced.

If you accept the consultation by calling into our system, the system will dictate the patient’s symptoms and drug allergies to you. The system will prompt you to either repeat the information or connect to the member.

Once connected to the member, you can complete the consultation. When the consultation is completed, you will press *7 to enter into the post-consultation notes dictation system. You will be prompted to dictate the diagnosis, treatment plan, Rx (if indicated), follow-up procedures and other notes. This is a critical point of the consultation and once completed, is the trigger for payment.

If the Patient Doesn’t Answer the Call

In the rare event that the patient misses the call, please leave the following message, “This is YOUR NAME calling for your First Stop Health consultation, we will call you back in 2 minutes to complete your consultation. Please be available to take the call.”

On the telephonic system, Press *7 and then press 1 to indicate you left a voicemail, according to the prompt.

If you initiated the consult on the portal, you can click “Left Voicemail” and our system will call you back to re-try the patient automatically in 5 minutes. You also have the option of releasing the consultation if you are no longer available to take it- Hit the “Release Consultation button and it will go back out to the pool of available doctors.

Our system will also notify the patient that the encounter was missed and that the system will call them again in 5 minutes. After 5 minutes, the system will call you back to restart the consultation.

If the patient misses both of your calls you will be compensated for the consultation at the agreed-upon rate (including if the consult was claimed with extra incentive).

Post-consult Protocol

If the consultation is completed via the web-based portal:

• Complete the notes via the portal workflow by typing the Subjective/Objective, Assessment/Plan, Patient Instructions, and ePrescribe (if indicated)
• Hit “Next” at the bottom of the screen to navigate to the next screen. Click “Submit” on the final screen to complete the consult (this triggers payment for the consult)

If the consultation is completed via the telephonic system:

• press *7 or wait until the patient is no longer on the line and dictation initiates

to dictate the following notes onto a recording

• Subjective/Objective
• Assessment/Plan
• Patient Instructions
• Prescription
• Referral

Hang up only when the system indicates that the dictation is complete and that “you may now hang up.”

Consultation Summaries (Work/School Excuse Notes)

Please specify a date range that the patient should limit contact in the Patient Instructions section of your notes. Please instruct the patient to call the 888 number back (the one they called to request a consult) and speak to member services to obtain their summary because we cannot email them due to HIPAA constraints.

Payments are conducted during the first week of each month, and deposited directly into your bank account at the end of the first week or beginning of the second week of the month. You will receive a consultation summary prior to the deposit being made to give you an opportunity to review the consultation totals.

If you would like to change the tax classification of your independent contractor relationship with FSH, please submit a request by email to fill out a new W-9 form.

You may change the bank account you are paid into by any time by requesting a new ACH form by email.

Please visit http://www.tokbox.com/tools/connectivity/ once and run the video connectivity test on the devices you plan to use to perform video consultations.

1. Receive a video-specific consultation alert from the video alert system phone number. Reply “Yes” to accept and receive the assignment.

The text of the alert will read: First Stop Health **VIDEO** consultation #12345 is available.  State: XY [if peds, age n]. Reply YES to accept.

The text of the alert will read: First Stop Health- You have been assigned video consult ID #12345. Please visit https://video.fshealth.com/1234567890 to complete the consultation.

2. Receive a link to join the video room by email and text. Your device/browser will prompt you for permission to use the camera and microphone. Please accept to proceed to the video call.
   • If on a desktop, click the link in the assignment email to open the video consultation in a different window and speak to the patient.
   • If on mobile, assure you have the First Stop Health app downloaded. As a doctor, you are not currently able to log in to the app, but you may use the app to open video consults when they are assigned to you. Click the link in the text message to join the video session via the app on your mobile device. Note: The mobile app has patient-facing messaging, but you are still able to use it as a doctor.

3. Video recording begins when the doctor enters the room. Log in to the physician portal, and you will be directed to the notes for the video consult immediately. You can relaunch the video consult room by clicking “Video Exam Room” button again or by clicking the link to join the video room from the text message. Complete notes and prescription (if applicable) on the web-based portal as with a phone consultation. Call Physician Services at (888)468-8219 if you need any assistance or have questions.