AcuteCare Telemedicine Blog


Patching the Current System Will Not Advance the Great Promise of Telehealth

The deliberate march towards meeting the Federation of State Medical Boards’ (FSMB) goal of streamlining medical licensing of physicians continues. The FSMB promises that a new compact of seven states will trigger changes that will ultimately help reduce redundant licensing requirements by creating one place where physicians submit basic information such as their education and credentials. Last month Idaho and Utah were the latest states electing to join Montana and West Virginia as this compact attempts to speed up the process of licensing doctors across state boundaries. While some question why only seven states are required for implementation of this compact, just three more states are now needed to initiate the process that promises to remove a formidable barrier to telemedicine growth nationwide.

Despite being one of the most promising technologies to improve patient care and lower the rising costs of healthcare, telehealth is surviving in a regulatory environment that was established during an era devoid of modern telecommunication devices and technology. State physician licensing is currently controlled by 50 state medical licensing boards, each with their own requirements, policies and credentialing criteria. The current licensing process is a substantial impediment to the advancement of telehealth across state lines, sparking an intense debate over the need for a traditionally unpopular nationalized licensing system.

In an attempt to ward off yet another federal intrusion into states affairs, last year the FSMB proposed a voluntary national compact on joint licensing for the states. The goal is to secure the cooperation of enough states to quiet any calls to replace state-based physician licensing with a national program. The reason for the compact is that the FSMB previously approved a telemedicine policy that defines the location of the practice of medicine as the state where the patient is located, not the physician. The model legislation calls for at least seven states to participate in the compact in order to form a governing commission made up of representatives from the participating states.

From the outset industry leaders and telemedicine supporters saw the effort as a weak attempt to stem the growing tide to replace an outdated and inefficient system. The FSMB compact does little to address the cost associated with acquiring a license in each state and in fact increases the costs by adding fees associated with handling and processing the information.

Washington Board of Osteopathic Medicine and Surgery Executive Director Blake Maresh says, “For some, the interstate compact offers a tested Constitutional precept that could creatively forestall federal intervention that might otherwise supplant the longstanding authority of state medical boards, for others the possibility of other state boards licensing physicians who practice in their states, coupled with the establishment of new governmental organizations, leaves them uneasy at best.”

It is certain that the authors of state and federal constitutions could not have envisioned the advance of modern technology and the impact of those advances on preserving and improving the lives of their constituents. Delivering the benefits of increased access to the latest and best medical care, improved patient outcomes and lower costs must trump preserving outdated constitutional precepts. We must intensify our focus on implementing new processes designed to advance the great promises of telemedicine.



This Could be the Year the Predictions are Realized

Telemedicine has been around for nearly a generation but its universal adoption remains restrained and its best promises to revolutionize the delivery of healthcare unrealized. With each approaching year a prediction that “it’s time has come” echoes throughout the industry and each year the gap to full realization closes only incrementally.

For more than one generation now sweeping improvements in treatment and changes in how healthcare providers deliver their product and service has been a benchmark example of an industry experiencing continuous improvement. Even concerns over how telemedicine will handle the lack of a direct in-person physical examination, the management and maintenance of patients medical records and the assurance of follow-up patient care have been widely debated and in large part addressed by medical professionals with the implementation of standards, protocols and guidelines for the practice of telemedical care.

Private insurers are recognizing the potential benefits of telehealth to controlling rising costs and improving access to improved medical care. Federally funded Medicare and other state payers are deliberately moving to approve payments for telehealth services for many of their constituents and the Veterans Administration (VA) has shown leadership in advancing new communication technologies to improve access to specialized care for their veterans.

But the regulatory groups responsible for multi-state licensing continue to adversely influence the rate of expansion of telemedical care nationwide. Recent offers from state medical licensing boards to streamline the licensing process has left many to doubt the effectiveness these changes will have in removing the barrier to meaningful progress. Advocates of the traditional licensing procedures are quick to point out the importance of these procedures to patient safety and assurance of care quality. Opponents see their limited effort in changing the process as an attempt to preserve a regulatory function that is out of date with the reality of today’s global economic environment.

In an era where geographic lines and narrowly defined market distribution models have all but disappeared from nearly every other industry, the healthcare industry continues to struggle with outdated regulatory processes which impede the full implementation of the benefits of telemedicine.

If the shared goal of both proponents and opponents of change is to improve the quality and efficiency of medical care for all consumers, then why does a more dynamic solution to removing the licensing barrier appear to be so difficult?



Does The FSMB ‘Compact’ Go Far Enough?

A new bill was introduced to Congress earlier this month that is designed to remove what many are calling a significant barrier to the expansion of telemedical services throughout the US. The “Telemedicine for Medicare Act,” or HR 3077, was introduced Sept. 10, in the House by Reps. Devin Nunes, R-Calif., and Frank Pallone, D-N.J.

In introducing the bill, Rep. Nunes said, “By reducing bureaucratic and legal barriers between Medicare patients and their doctors, it expands medical access and choice for America’s seniors and the disabled.” For doctors who treat Medicare patients, the bill will remove the state-by-state licensing requirement which has existed since the very formation of the states. Presently, each state requires a physician to be licensed in the state where the medical care is being performed, making it difficult and unnecessarily expensive for doctors to practice telemedicine across state lines.

“Keeping medical licensure within the states’ domain maximizes surveillance of physician quality while fostering diversity by preventing potentially unreasonable control by Federal agencies,” says AcuteCare Telemedicine Chief Executive Officer Matthews Gwynn, M.D. “The efforts by regional state groups to streamline licensure is a good solution.”

Joel White, the Health IT Now coalition executive director says, “Congress has already had success in implementing a national telemedicine framework for members of the Department of Defense (DOD) and Veterans Administration (VA), this Nunes-Pallone bill does the same thing for Medicare beneficiaries.”

As if taking a cue from the bill sponsoring congressmen, the Federation of State Medical Boards (FSMB) has just released model legislation which would create a multistate “compact” system, where member states will experience a streamlined interstate licensing process. While the proposed compact promises to expedite the path to individual licensing requirements within those member states, it appears that it will not sufficiently address the costs associated with fees charged for each license or with the process as a whole in non-member states. The model legislation calls for at least seven states to participate in the compact.

Many industry leaders feel that if more states sign-on to the compact it will head-off the federalization of medical licensing. But at first read, the FSMB compact model would complement many of the same negative, bureaucratic, bells, whistles and hoops that would most likely come with a national licensing system, leading others to see the proposed FSMB legislation as a means to preserve the centuries-old influence of state medical boards’ authority over the authorizing of physicians’ practices.

With the Congress already demonstrating a respectable performance in providing a successful framework for telemedicine to flourish, through the DOD and the VA, the present actions and efforts by FSMB and their supporters to bring the entrenched state licensing process into the 21st century, and avoid federal intervention, may be an example of too little, too late.