- The latest state to consider telemedicine practice standards also happens to be one of the nation’s largest and least populated.
Montana Rep. Kirk Wagoner (R-Montana City) has introduced legislation to “put sideboards on the practice of telemedicine” in a state that ranks 4th in size but 44th in population and 48th in population density. He told the Great Falls Tribune guidelines are needed to help a state where population centers are few and far between and residents need help accessing healthcare.
Like a majority of states that have recently enacted telemedicine legislation, House Bill 389 allows a Montana physician to establish a doctor-patient relationship through “audio-visual interaction or store-and-forward technology,” as well as the traditional in-person visit. It also defines the originating site as the site where the patient is receiving telemedicine, enabling patients to connect with doctors from their home, business or other locations outside the clinic or hospital.
In addition, the bill would not allow telemedicine doctors to prescribe controlled substances without an in-person consult. It would allow for prescriptions via telemedicine after a physician-patient relationship has been established – but not by telephone, online questionnaires, e-mail or patient-generated medical history.
The bill comes as good news for Michael Vlases, a Bozeman physician who’s used telemedicine in the past to reach patients who couldn’t make it to his office because of poor road conditions.
“Telemedicine technologies are out there now, and they’re very good,” he told the Great Falls Tribune. “They give patients more resources for healthcare and more flexibility ... often in much more convenient ways.”
The proposed legislation would set guidelines for a service that’s well-used in the state. Some 14 clinics are part of the REACH (Realizing Education and Community Health) Montana telehealth network, and South Dakota-based Avera Health’s eCare telehealth network extends into the state as well. Several hospitals are also part of the Frontier Community Health Integration (FCHI) ECHO demonstration project funded through the Centers for Medicare & Medicaid Services.
It’s also an integral part of the Indian Health Service’s efforts to serve Native American populations throughout the West.
“Telemedicine is part of the future,” Jonathan Gilbert, MD, clinical director for the IHS office in Billings, , told the Billings Gazette in a feature on telemedicine services at the Lame Deer Health Center, the first IHS center in the country to use the technology in its emergency room. “It’s a fantastic way to bring board-certified specialists to a frontier community and to raise the bar.”
Montana was one of the first states to pass a telehealth parity law, which took effect at the beginning of 2014.
“I want our rural, agricultural communities to thrive, and this is one way to strengthen these smaller communities so they can remain viable,” Governor Steve Bullock said after signing the bill into law in April 2013. “We have some amazing new technology, and this bill encourages its use so that rural doctors have a way to provide their patients with services that may not be available for hundreds of miles.”
“We are a unique state because we are so rural,” added State Sen. Edward Buttrey (R-Great Falls), who introduced the bill. “People in the rural and remote corners of the state deserve to get quick, safe, adequate care and be reimbursed as if they were face-to-face with the physician.”
In 2015, Montana was one of the first states to join the Federation of State Medical Boards’ Interstate Medical Licensure Compact, establishing a streamlined process for licensure to practice telemedicine across state lines (in all, 18 states has signed the compact). Also that year, the state scrapped its requirements for a separate telemedicine license in favor of a full, unrestricted license requirement for physicians from other states.