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Licensing woes make inter-state telemedicine a headache

By Jennifer Bresnick

- Getting insurance coverage for telemedicine may be difficult, but it’s downright impossible to take advantage of the budding interest in internet medicine if you can’t obtain – or don’t know that you need to obtain – the proper medical licensing to chat with patients in other states.  With each state adhering to different regulations, and every one jealously guarding its right to determine the practice of medicine within its borders, providers need to carefully ensure that they aren’t stepping on any toes when they fire up the computer.

The majority of states, including California, Colorado, Florida, Indiana, and Iowa require a full, unrestricted medical license in order to consult, test, diagnose, or treat a patient who lives there, which means jumping through all the hoops to be certified in a target area.  North Dakota, for example, classifies remote consults as taking place where the patient lives, not where the doctor is located, meaning physicians need to be qualified to practice according to North Dakota rules.

There are often exceptions for radiologists who are offering a second opinion on images, with “teleradiology” making up a distinct category in the legislation.  Infrequent x-ray consults don’t require a full medical license in Puerto Rico, and in Rhode Island, you don’t need state license if the radiologist is simply helping out a fully state-licensed physician.  Oregon has separate requirements for teleradiology, telemonitoring, and telemedicine status: the differences are mostly in the paperwork.  There are also Boards of Medicine that offer special telehealth licenses or certificates, often available for a fee.

This patchwork of laws poses problems for physicians who want to reach out across state lines, and policy experts are taking notice as telemedicine becomes increasingly popular with insurers and patients.  In April, the Federation of State Medical Boards (FSMB) announced an initiative to explore the use of interstate compacts to simplify telehealth licensing.  Interstate compacts are used to foster state cooperation on a variety of issues, from rivers and fishing rights to transport and conservation.  This summer, FSMB will be bringing together representatives from around the country to discuss practical ways of streamlining telemedicine.

“One of the most important consensus points that we continue to hear in discussions of possible models for medical licensure is that they should be state-based,” said Humayun J. Chaudhry, DO, President and CEO of the FSMB. “Most policy experts agree state authority ensures the best assurance of patient protection in physician licensing – which remains our number one priority.  An interstate compact could address the need for efficiency and speed in licensing, while not compromising the inherent value of a state-based system, and most importantly, patient safety.”

“More than 75 percent of the physicians who are licensed in Wyoming are licensed in another state, yet only about 40 percent of our licensees live in Wyoming,” added Wyoming Board of Medicine Executive Director Kevin Bohnenblust, JD. “States like ours, with patients who live in small and sometimes remote communities, rely on physicians who do not reside here. We are excited with this development.”

As telemedicine expands, especially as private insurers start offering the service as a way to boost preventative medicine and cut hospital admissions and related costs, state authorities will need to figure out a way to open their borders to well-meaning, qualified physicians while maintaining their ability to govern healthcare interactions under their jurisdiction.


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