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Interstate Licensing Problematic for Telemedicine Market

With increased support for the compact, some critics report that the telemedicine legislation is expensive, time-consuming, and provides no value to patient care.

By Jacqueline Belliveau

- The Interstate Medical Licensure Compact may be a way for private organizations to use telemedicine as a financial gain rather than a method for providing quality patient care, according to a press release by the Association of American Physicians and Surgeons (AAPS).

Telemedicine legislation for physician licensure

The compact legislation is a voluntary pact between states and organizations for streamlining licensing for qualified healthcare providers who wish to provide care across multiple states. It aims to increase access to quality healthcare for patients in rural or underserved areas and foster the use of telemedicine technologies to connect medical experts with patients.

Alabama, Idaho, Illinois, Iowa, Minnesota, Montana, Nevada, South Dakota, Utah, West Virginia, Wisconsin and Wyoming have already enacted the compact, while 26 states have introduced the legislation.

The AAPS, a small advocacy group of about 5,000 members, argues that there is a conflict of interest with the Federation of State Medical Boards (FSMB), a private, tax-exempt organization and the legislation, because the FSMB sells products and services that state medical boards require for physicians to be certified.

“FSMB has now become part of a lucrative industry that imposes significant expense without value onto patients and practicing physicians,” Paul Martin Kempen, MD, PhD, director of the AAPS, wrote in the spring issue of the Journal of American Physicians and Surgeons.

“While non-physicians are being given the authority to practice medicine and prescribe without the physician oversight requirements of SMBs (state medical boards), physicians are being subjected to more expensive and onerous requirements, which bring in revenue for FSMB and other tax-exempt corporations, which lobby extensively and have achieved a high degree of regulatory capture.”

According to the AAPS, a major point of contention with the compact is how they evaluate physicians who are eligible to join the telemedicine network. The compact defines a qualified physician as one who holds a specialty certification or a time-unlimited specialty certification recognized by the American Board of Medical Specialties or the American Osteopathic Association. Under that definition, the AAPS says, one-quarter of practicing physicians in the United State would not qualify under the compact.

The AAPS also notes that the FSMB has been encouraging states to use its Maintenance of Certification (MOC) program, which sets industry standards for certifications for physicians.The MOC is an American Board of Internal Medicine (ABIM) program that grants participating physicians with a specialty certification for demonstrating lifelong learning as long as they regularly complete approved MOC activities.

“Except for the declining number of physicians with a lifetime certificate, MOC is required to maintain specialty board certification and thus required to be licensed through the compact. ... However, its own definition of ‘physician’ requires MOC for most physicians participating in the compact,” Jeremy Snavely wrote in the Journal.

According to the AAPS, the MOC is expensive and time-consuming, and creates little to no value for quality patient care. The compact is a “back door” way for states to approve its fee-based programs, the organization argues.

The compact would strengthen the FSMB’s influence on board certifications and maintain high costs for certification fees, especially in the rising telemedicine market, according to the AAPS.

A similar bill introduced to Congress, called the Tele-Med Act of 2015, allows licensed Medicare physicians to provide care to Medicare beneficiaries across state lines using telehealth technology.

The Tele-Med Act of 2015 has been praised for its attempt to provide a high quality of care at a reduce cost to patients in underserved populations using telemedicine. However, the care would only be provided to Medicare beneficiaries.

Compact supporters say its goal is to provide quality care using telehealth across state lines to underserved patients, like the Tele-Med Act of 2015, but critics argue that private organizations cannot make appropriate decisions when faced with conflicts of corporate gain and patient care.

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