State licensure issues challenging telemedicine borders
As healthcare undergoes revolutions in technology, customer service and outcome-based payment reform, payers and providers alike have looked to the highly untapped potential of telemedicine as one solution to improve and lower the cost of service delivery.
However, as the National Law Review noted last week, “archaic” state licensure requirements restrict the use of telemedicine by requiring physicians be licensed in any state where they practice medicine, even digitally—even if the interaction is for routine services with an established patient.
This is a particular impediment to patients obtaining care across state lines and the clinicians serving them, as it complicates their ability to interact digitally for follow-up care.
“While some states allow out-of-state physicians to practice telemedicine without an in-state license so long as the standard of care is met, most require an out-of-state physician to traverse a difficult, uncertain and sometimes cost-prohibitive path to conduct even the most routine visits via telemedicine,” the National Law Review finds.
The issue also impacts physicians traveling out of state, with some states requiring they be licensed in that state in order to digitally interact with patients at their home practice, adds Latoya Thomas, director of the State Policy Resource Center for the American Telemedicine Association.
The issue applies even for patients and providers around state borders, where it’s common to cross state lines for work and other purposes. Thomas notes there is a formal agreement in the D.C. metropolitan area, in which D.C., Maryland, and Virginia have agreed upon reciprocity, but such arrangements aren’t seen broadly outside that region.
However, the impact of licensure goes far beyond the issue of travel, Thomas tells Healthcare Dive, affecting deeper healthcare issues from patient choice to care collaboration/coordination and workforce issues for hospitals.
“Our current state-by-state licensing structure presents some challenges for healthcare more broadly,” she says, though some state licensing boards and their national entities are working on solutions.
“What you’re seeing now is this trend for licensing boards—whether they be for physicians, nursing, physical therapy, psychology—to look at their policies and say, ‘How can we adapt them to accommodate these new clinical delivery models and not stand in the way of patient access to care?’”
However, it’s a piecemeal approach; even when a national group holds up a model to the state boards, it still requires state adoption.
Several boards are currently pursuing different licensing solutions, Thomas says.
One, the Federation of State Medical Boards, is expediting the process for clinicians getting additional state licenses. “So you still need a license in every state [where] you’re going to practice, but you’ll get your license at a much faster rate than you would before due to their compact,” Thomas says.
A nursing board is taking another approach based on mutual recognition, Thomas says. RNs and NPs that have a license in a state recognized by another state can practice across those lines based on that compact.
The Association of State and Provincial Psychology Boards has also created a licensing compact for intra-jurisdictional tele-psychology.
“These are some of the approaches that the national groups have created in the hopes that their state counterparts will adopt them,” Thomas says.
It’s not just individual practitioners in need of solutions. Telemedicine companies and multi-state healthcare systems are impacted as well, Thomas adds.
Collaboration takes a hit, particularly in cases where specialists may be rare in states or even across the U.S. “Current licensure laws may not allow the specialist to consult in that case unless the specialist is licensed there,” she says.
As hospitals look at ways to enhance access to care and ensure workforce capability, these licensure limitations become a burden operationally and financially, Thomas says, as organizations work to make sure their providers apply for licenses as needed and comply with confusing state-by-state regulatory language.
“It is something I think hospitals across the country are becoming familiar with if they haven’t already,” Thomas says, “and trying to figure out how they can comply with current standards but also prepare themselves for any new policies that might come down the pike in 2016.”