Interstate Licensing Bill for Telemedicine Gathers Support

Ken Terry

August 18, 2015

Twenty-one organizations have signed onto the Telemedicine for Medicare (TELE-MED) Act of 2015, which was recently introduced in both the US House of Representatives and the US Senate. The bill, which was previously proposed in 2013, would enable physicians licensed in one state to care remotely for Medicare patients in other states without getting additional medical licenses in those states. It would not, however, affect the severe restrictions that Medicare now places on telemedicine coverage.

Among the organizations that expressed support for the measure in letters to its bipartisan House and Senate cosponsors are the American Telemedicine Association (ATA) and an assortment of employer groups, technology companies, patient support groups, and giant health insurer Anthem. In addition, the American Health Information Management Association, representing health Internet technology professionals, and the College of Health Information Management Executives, which consists mainly of chief information officers, support the legislation.

The American Medical Association (AMA) and the Federation of State Medical Boards (FSMB) oppose the bill. The AMA has been struggling lately with the issue of telehealth, according to the publication Modern Healthcare, and the FSMB has addressed the licensure issue with its Interstate Medical Licensure Compact.

Physicians in states that participate in the FSMB compact can apply for an expedited license in a compact state other than their own without having to fill out another formal application or having to provide another set of documents to the other state's board. If their own state board attests to their qualifications, the other board will license them in its state. However, they still must pay a license fee to that board.

So far, 11 states have joined the FSMB compact, four more than the minimum of seven necessary to set it in motion. Legislatures in eight other states are considering bills to participate in the compact, and nearly 30 state medical and osteopathic boards have expressed support for it, according to the FSMB.

"Medicine Is Where the Provider Is"

Gary Capistrant, chief policy officer of the ATA, admits that the growth of the compact is one of the barriers to the TELE-MED bill's passage. "Some people are looking to see whether the FSMB compact deals sufficiently with this issue," he told Medscape Medical News.

The ATA endorsed the TELE-MED Act, he says, because "we favor the kind of measures that are based on one state license and reciprocity [in other states], just like [the reciprocity for] driver's licenses."

Moreover, he pointed out, the ATA is not sure that the FSMB compact will reach all states. Even if it does, he said, the continuing requirement that physicians pay license fees in each state represents a major barrier. The ATA estimates that physicians now spend a total of $300 million to be licensed in multiple states.

Asked whether the ATA would support the compact if license fees were not an issue, Capistrant said that the FSMB solution would still not address differing telehealth requirements in various states. "Many states have separate telehealth regulations. They will sometimes hold telehealth to a different standard than what applies to in-person [encounters]. The requirements change over time, and it's hard for doctors to be aware of them."

What the ATA wants, he explained, is for the regulations of the state where the physician is located to govern his or her use of telehealth. "Medicine is where the provider is. Where the patient is is not where the practice of medicine occurs."

The TELE-MED Act does say that the state that licenses the physician will continue to have disciplinary authority over the physician. But it says nothing about the ability of other states to discipline the doctor for any harm he or she may cause a patient. Capistrant conceded that the measure would not override telehealth regulations in other states, but he argued that "it's a logical extension of the bill."

An Issue of Patient Safety

Humayun F. Chaudhry, MD, president and chief executive officer of the FSMB, said his organization opposes the bill because of concern about patient safety. "The compact is a way to preserve state-based regulation and the ability of state boards to protect patients and to follow up when there are issues that go wrong, while at the same time addressing access to care and supporting new technology," he told Medscape Medical News.

If a physician could be licensed in all states simply by being licensed in one state, he said, a patient who suffered an adverse outcome would have no recourse from the state medical board in his or her state, if that were different from the state where the doctor practiced. A California resident who was treated online by a New York doctor, for instance, could get no relief from the California medical board, and it would be difficult to get the New York board to act on a California case, Dr Chaudhry said.

Twenty-five states have reviewed the FSMB compact so far, he said, and he predicts that it will be adopted by more and more states. "We're confident that in the next year or two, this will be a way for physicians to engage not only in telemedicine but also in the practice of medicine [across states]. We feel this is the way to proceed. Patient safety is the bottom line."

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