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Docs Recommend Reforming Licensure Rules to Boost Telehealth Adoption

Noting that the current state-based medical licensure process hinders telehealth expansion, two doctors are recommending that the US adopt a 'mutual recognition' policy.

Source: ThinkStock

By Eric Wicklund

- Telehealth advocates have long argued that state licensure requirements pose an unnecessary burden to the adoption of connected health services. Now a pair of doctors are arguing that the US should adopt a “mutual recognition” policy that allows providers to practice in any state with just one medical license.

In an article published this week in The American Journal of Managed Care, Pooja Chandrashekar, AB, of Harvard Medical School and Sachin H. Jain, MD, MBA, of the Stanford University School of Medicine and the CareMore Health System argue that state-based medical licensing “poses a significant barrier to the widespread adoption of telemedicine services.” Allowing state medical boards to set the rules, they say, creates “a patchwork of inconsistent state licensure laws” that push providers away from practicing in multiple states.

“This antiquated system of state-based medical licensure, originally enacted in the 19th century to reduce medical malpractice and protect patient safety, has profound implications for the promise of telemedicine to increase access to care for vulnerable populations and mitigate the impacts of the national physician shortage,” they wrote.

Chandrashekar and Jain are following in the path of others who have long argued that the practice of medicine is – or should be – identical in each state, and that a medical license should be valid in all states, as is a driver’s license. Requiring providers to apply for a license in each state is expensive and time-consuming, and particularly difficult for clinicians in health systems whose telehealth platforms span multiple states and direct-to-consumer telehealth platforms that might even be available in all the states.

This, in turn, affects patients as well.

READ MORE: Eyeing Telehealth, AAFP Urges States to Adopt Interstate Licensure

“The impact of restricting telemedicine falls hardest on poor patients, the uninsured, and those who rely on state Medicaid programs, many of whom lack access to reliable transportation and cannot travel across state lines to see specialists,” they wrote.

As for maintaining the status quo, the two researchers note that proponents of the current licensure landscape say mutual recognition would compromise patient safety, reduce state revenues due to lost licensing fees, and complicate telehealth reimbursement.

There have been efforts to alleviate the program. The Federation of State Medical Boards, a non-profit representing some 70 state medical and osteopathic boards, launched the Interstate Medical Licensure Compact in 2017, giving providers in member states a streamlined path to multiple licensure. Similar licensure compacts are now up and running for nurses, psychologists and physical therapists, but the IMLC has only been accepted in about half the states and the other compacts are much smaller.

Chandrashekar and Jain call those compacts “a step in the right direction but far from the solution.” They say the programs don’t eliminate the challenges or costs of applying for multiple licenses.

Instead, they call on the US to adopt a mutual recognition program whereby each state honors a provider’s medical license no matter where it was issued. Such a program would have to be established by a federal mandate, with consistent standards for using telehealth and improved data-sharing among the state medical boards. In addition, state would have to kick in money to support the program, and all provider would be required to specify a home state, or SPL, to clarify any questions regarding attribution and reimbursement.

READ MORE: Telehealth Licensure Compact for Psychologists Is Ready to Go Live

Chandrashekar and Jain note that similar policies are now in effect in Australia and Europe, as well as the US military and Us Public Health Service. And this past year, the Veterans Health Administration was allowed to revise its national telehealth program to allow any VA-sanctioned care provider to treat veterans in any state, regardless of state licensing rules.

Some have suggested one license spanning the entire country, while advocates for state licensure argue that state medical boards provide local accountability and provide a better balance of provider and patient protections.

One prominent critic is Shirley Svorny, a professor of economics at California State University in Northridge and an expert in healthcare regulation. In a 2018 mHealthIntelligence interview in which she debated the merits and drawbacks of the IMLC, she argued against one nationwide license, saying it would require a costly federal agency to oversee the process.

Instead, Svorny said states should be able to set their own licensing rules, under one of two options:

  • Individual states pass legislation to allow out-of-state telemedicine providers to offer services in the state under their home-state license – a process now in place in a handful of states; or
  • Have Congress redefine the location of the interaction between patients and physicians from that of the patient to that of the physician.

“Digital patients would be treated like patients who travel across state lines or national borders for care,” Svorny said of the second option. “A physician would need only one license, and would be responsible for only one set of licensing laws governing the practice of medicine - that of his or her home state. When it comes to state board oversight, all complaints would go to the licensing board of the physician’s home state.”

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