For a majority of states, telemedicine regulations require that the provider be licensed within the state that the patient is located at the time of the visit. For a local or regional hospital with physicians and other qualified health professionals who actively participate in telemedicine, having licensure in another state is not necessarily a problem. But, for telemedicine vendors who operate across state lines and employee or contract with their own providers, licensure must be obtained to truly be national. These licensure barriers impede implementation and assimilation of telemedicine into mainstream medical practice. There are few exceptions to licensure such as physician-to-physician consultations, educational encounters, residential training programs, public health services, emergency sessions, and encounters involving military personnel.
State and federal policy makers are getting involved, yet not always with the same goals. Certain policies restrict access to virtual visits with qualified providers, yet others are moving to lessen restrictions and remove barriers to accessing effective and convenient health care. As a national telemedicine vendor, CareClix believes that patient health outcomes will improve with easier access to providers.
Alaska provides a great example of a state in urgent need of a fully-functional and effective telemedicine program, as over 40 percent of the population lives in rural areas.1 Alaskan legislators drafted Senate Bill 74 with the intention of reforming Medicaid, from fraud reduction and payment reform strategies to the expansion of telehealth to underserved areas with limited access to healthcare. Regarding the latter, Bill 74 specifically wanted to increase access by allowing out-of-state physicians who are licensed in Alaska to provide care in Alaska, removing the requirement that only providers that live in the state can prescribe medication without a physical examination. The Federal Trade Commission reviewed the bill and provided positive feedback that supports aspects of the proposed law, commenting that the bill “would likely increase the supply of telehealth providers, enhance competition, and reduce health care costs, thereby benefiting Alaskans, especially underserved populations with limited access to health care.”2 Yet, they also urged lawmakers to refrain from additional regulations that would hold telehealth to a different standard than in-person consultations.
Several proposed pieces of federal legislation are looking to address the interstate licensure issue by redefining the "place of service" stipulation from the originating site (the site of the patient) to the distant site (site of the provider delivering care). By redefining "place of service", this could resolve the licensing barrier and increase access to patients in need of more convenient care. The Interstate Medical Licensure Compact, drafted by the Federation of State Medical Boards, could be a compromise in that it seeks to expedite medical licensure for physicians wanting to practice in multiple states.3 The Federation of State Medical Boards estimates that nearly 80 percent of physicians in the United States would be eligible for expedited licensure.4 Requirements for a physician to meet eligibility include completing a GME program, passing the USMLE, having no disciplinary actions on their license, having a specialty certification, and possessing a medical license in one of the licensure compact states.5
Telemedicine continues to grow as an alternative way to delivery care. Patients like it, providers are finding innovative ways to fit it into their schedules, technology is improving, and implementation costs are decreasing. CareClix welcomes thoughtful legislation that increases access for patients to receive evidence-based care that is appropriate for their conditions and helps them avoid unnecessary ER visits and hospital readmissions.
Thanks to Armand Heydarian and Jeremy Gottlich for their support in writing this blog post.