- With more and more telehealth networks operating across state lines, several professional groups are calling for an easier way for clinicians to obtain permission to practice in multiple states.
“Many providers on the phone with a patient don’t ask the question, ‘Where are you at?’” said Elliot Vice, director of governmental affairs for the National Council of State Boards of Nursing (NCBSN). “What we’re trying to do is put in a legal structure that facilitates” telehealth and makes that question unnecessary.
Vice, whose group is generally credited with being the first to seek a national framework for licensing, was part of a panel discussion at last week’s American Telemedicine Association Fall Forum in New Orleans. Along with the Federation of State Boards of Physical Therapy (FSBPT) and the Association of State and Provincial Psychology Boards (ASPPB), his organization is looking for a framework that would enable its members to practice in different states or countries without stepping on the toes of state or provincial regulatory agencies.
And that’s not an easy thing to negotiate.
“Education is an obstacle,” said Mark Lane, of the FSBPT, which has lobbied four states to sign onto a compact that would give PTs the privilege (rather than a license) to practice in member states. Most state boards are hesitant to give up any licensing authority, he says.
Other obstacles include funding and organization. Organizations representing speech pathologists and occupational therapists, whose members would greatly benefit from the ability to work in other states, don’t have the resources to lobby for a compact or set up an advisory board.
“We need greater involvement, frankly, from the telehealth community,” said Vice. “The wave is building, and you’ve got a chance to get on your surfboard and ride it.”
Vice – who off-handedly pointed out that the nation’s first interstate compact is the U.S. Constitution – said the NCSBN began the conversation for a mutual recognition model of licensure in the 1980s, which established that the nurse’s license in his or her home state is accepted in participating states. That led to a Nurse Licensure Compact that attracted some 25 states before interest waned. The board spent two years modifying the compact, in particular making it more telehealth friendly, and reintroduced it as an Enhanced NLC this past January.
Some 10 states have signed onto the enhanced compact, Vine said, including three states that did not favor the original compact, and another 20 states are interested. He’s hoping the compact has enough support to go live in 2018.
A similar effort for physicians, the Interstate Medical Licensure Compact developed and overseen by the Federation of State Medical Boards (FSMB), became official in 2015 and now has 17 member states, with two more considering joining.
That effort – like those highlighted at last week’s ATA conference – has drawn criticism from state medical officials who feel the compacts undermine states’ rights to regulate the industry, especially with regard to denying licenses or sanctioning those who don’t meet professional standards of conduct.
But Vice and others pointed out that the compacts would still give local boards control while making it less cumbersome for members to apply for and keep track of licenses. Janet P. Orwig, MBA, the ASPPB’s associate executive officer for member services, pointed out that one psychologist, who’s an expert on death penalty cases, spends $100,000 to $125,000 a year just to maintain 25 licenses. And Lane said he knows of a physical therapist who has 30 licenses.
Some have also called for the creation of one national license that would enable clinicians to work in any state or province. While not discussing that option, the panelists did note that state or regional medical boards are valuable in tracking clinicians, making sure they hold to the standards of their profession and dealing with violations.
But with telehealth becoming a standard of care for many professions, Vice, Lane and Orwig noted it’s becoming more difficult to clearly define where the doctor is practicing and where the patient is located.
“This is no longer just the bedside,” Vice said. “It’s telehealth. It’s nursing. It’s everything.”