Pennsylvania will enter 2017 as the 17th member state of the Interstate Medical Licensure Compact, an agreement enabling physicians in member states to obtain expedited licenses to treat by telemedicine patients located in other member states.
Telemedicine refers to situations in which medical professionals treat patients remotely and communicate electronically.
State laws require physicians to hold a license from the state in which a patient receives care, comply with state-specific regulations, and pay license fees in multiple states. These costly requirements discourage physician participation in interstate telemedicine, a problem the compact attempts to address.
Under the compact, physicians who want to treat patients in member states by telemedicine must apply to their own member state’s medical licensure board for a background check and a letter verifying their professional qualifications. A physician deemed eligible must then register for an expedited license with other member states’ medical boards.
Member-state medical boards may continue to charge registration fees for the licenses of out-of-state physicians, who remain bound by the medical practice laws of the states where their telemedicine patients reside. Physicians given disciplinary action by one member state’s board are automatically subject to equal or lesser sanctions by other member-state boards under the compact.
Pennsylvania’s membership in the compact is effective on December 26, 2016, which is 60 days after Gov. Tom Wolf (D) signed into law state Rep. Jesse Topper’s House Bill 1619, which passed the legislature without a single “no” vote on October 18.
Dr. Jeffrey English, a Georgia-based telemedicine practitioner and director of clinical research at the Multiple Sclerosis Center of Atlanta, says the compact facilitates interstate patient treatment without subjecting physicians to additional federal oversight.
“While we want to expand access to health care, a lot of physicians are concerned about nationalizing doctors’ offices and administering over state lines,” English said. “The compact is a happy medium because it is an efficient registration and payment process for doctors and thereby makes easier the application for multiple state licenses. However, we are not controlled by the federal government with nationalized licenses, which is important.”
Shirley Svorny—an economics professor at California State University-Northridge who teaches courses in health, labor, and urban economics—says the compact’s use of the word “interstate” is a false characterization.
“The Interstate Medical Licensure Compact promotional materials are misleading,” Svorny said. “The compact does not allow physicians to practice across states with one license. Under the compact, physicians must still have a license in each of the compact states and practice under the rules and regulations of that state.”
Svorny says the nonprofit group Federation of State Medical Boards secured funding from the U.S. Health Resources and Services Administration’s (HRSA) Licensure Portability Grant Program to promote the compact among the states.
Instead of making licenses portable, the compact continues to require duplicative licensing processes among the states, Svorny says.
“This is ironic because the [HRSA’s] literature specifically decries the existing duplicative licensing process as an ‘unnecessary licensure barrier to cross-State practice’ that fails to address ‘workforce needs and improve access to health care services,’” Svorny said. “Yet, the Interstate Medical Licensure Compact keeps the duplicative licensing process intact.”
Government Behind the Times
English says state laws have failed to keep pace with technology capable of expanding patient access to medical care.
“Telemedicine is any electronic media or platform that allows us to deliver patient care in general,” English said. “It is inexcusable that we can’t deliver care to anybody, anywhere in the country. Technology has progressed in the last five years to a point where patients can have secure, quick access to doctors who live hours away from them.”
By the year 2021, telemedicine will widely prove a cost-effective health care choice for patients, doctors, and lawmakers. English says.
“Within the next five years, you will see widespread adoption of this technique because it’s cheaper to just help [patients] over the internet,” English said. “When you keep people out of the hospital and keep them healthy, you save a lot of money.”
Increasing Rural, Inner-City Access
Svorny says the proliferation of telemedicine expands health care access in underserved rural and urban areas.
“Telemedicine is important because it offers expanded access to care, which can be lifesaving [in emergencies],” Svorny said. “This is especially important in rural areas, where lack of access to physician services has been a perennial problem. It is also of value in urban areas, where it is increasingly difficult to get physicians to agree to serve in an on-call capacity at night or on weekends.”
Patients and providers benefit from the time and money telemedicine saves, Svorny said.
“For day-to-day care, telemedicine offers a convenient substitute for a routine office visit,” Svorny said. “Telemedicine has been shown to be an efficient way to keep track of and advise patients with chronic conditions such as heart disease, diabetes, asthma, and progressive lung disease. Studies of the impact of the use of telemedicine to treat chronic conditions find lower mortality, reduced hospital admissions, lower costs, and increased patient satisfaction.”
Jordan Finney ([email protected]) writes from Boise, Idaho.
Michael Hamilton, “Dr. Jeffrey English: Bring Doctors to Patients with Telemedicine,” Health Care News Podcast, The Heartland Institute, November 7, 2016.
Latoya Thomas and Gary Capistrant, “State Telemedicine Gaps Analysis: Coverage and Reimbursement,” American Telemedicine Association, January 2016.
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