State boards’ pol­icy for telemedicine may present road­blocks

Modern Healthcare - - NEWS - By An­dis Robeznieks

The 10 physi­cians who prac­tice tele­stroke medicine and te­leneu­rol­ogy in the Mayo Clinic’s Phoenix telemedicine hub ei­ther have med­i­cal li­censes or are work­ing to­ward ob­tain­ing them in four states be­sides Ari­zona. The law doesn’t re­quire it. But Mayo has de­cided that’s the best way to go for its pro­gram.

Many more doc­tors soon may have to ap­ply for med­i­cal li­censes in other states as their med­i­cal or­ga­ni­za­tions move into the rapidly grow­ing field of telemedicine. That may be­come some­what eas­ier be­cause the Fed­er­a­tion of State Med­i­cal Boards is work­ing on an in­ter­state com­pact to stream­line the process for ob­tain­ing mul­ti­ple state li­censes.

At its an­nual meet­ing in April, mem­ber state boards will vote on adopt­ing the fed­er­a­tion’s pro­posed telemedicine pol­icy cod­i­fy­ing stan­dards and prin­ci­ples for state boards and leg­is­la­tures in de­vel­op­ing their own poli­cies and reg­u­la­tions. The fed­er­a­tion pro­posal in­cludes two key prin­ci­ples.

One is that whether a physi­cian and pa­tient have a dig­i­tal or a face-to-face en­counter, there should be no dif­fer­ences in the stan­dards of care. The other is that “the prac­tice of medicine oc­curs where the pa­tient is lo­cated at the time telemedicine tech­nolo­gies are used,” the pro­posal states.

Re­quir­ing doc­tors to be li­censed in ev­ery state where their telemedicine pa­tients are lo­cated is not be­ing re­ceived well by some telemedicine play­ers. It would in­volve sig­nif­i­cant costs, said Jonathan Link­ous, CEO of the Amer­i­can Telemedicine As­so­ci­a­tion, which op­poses telemedicine-spe­cific in­ter­state li­cens­ing re­quire­ments. Be­tween 22% and 25% of U.S. doc­tors cur­rently hold mul­ti­ple state li­censes. The costs as­soci- ated with procur­ing mul­ti­ple li­censes may to­tal up to $300 mil­lion a year, and that will in­crease as more doc­tors be­gin to pro­vide telemedicine ser­vices in other states, he said.

Dr. Bart De­maer­schalk, di­rec­tor of tele­stroke and te­leneu­rol­ogy at the Mayo Clinic in Phoenix, ar­gued that the fed­er­a­tion pol­icy could ham­per rather than fa­cil­i­tate tele­health ex­pan­sion. While he said he ap­pre­ci­ated the fed­er­a­tion’s prin­ci­ples of putting pa­tient wel­fare first, ad­her­ing to the high­est stan­dards of care, pro­tect­ing pa­tients’ pri­vacy and se­curely stor­ing their in­for­ma­tion, he dis­agrees with the mul­ti­state li­cens­ing re­quire­ment. The need to ob­tain mul­ti­ple state li­censes has slowed the growth of Mayo’s pro­gram, he said. It cur­rently has physi­cians in Phoenix, Rochester, Minn., and Jack­sonville, Fla., pro­vid­ing 3,000 neu­rol­ogy con­sults a year for a net­work of 36 hos­pi­tals across 10 states.

Con­tin­ued reg­u­la­tory bar­ri­ers to telemedicine could lead to higher costs and poorer out­comes for pa­tients, De­maer­schalk cau­tioned. A re­cent Mayo Clinic study in the Amer­i­can Jour­nal of Man­aged Care found that com­pared with a pa­tient in a ru­ral com­mu­nity hospi­tal, pa­tients in a tele- stroke net­work in­curred costs that were $1,436 lower.

In ad­di­tion, a re­cent study, by RAND Corp. re­searchers pub­lished in Health Af­fairs ex­am­ined vir­tual vis­its pro­vided by Dal­las-based Te­ladoc. It con­cluded that us­ing Te­ladoc in­stead of the emer­gency depart­ment or a visit to the doc­tor’s of­fice “could gen­er­ate large sav­ings for health plans.” Te­ladoc matches pa­tients with physi­cians who are li­censed in their state.

The three big­gest ob­sta­cles to telemedicine are state li­cens­ing and hospi­tal cre­den­tial­ing, re­im­burse­ment is­sues, and the cost of tech­nol­ogy, De­maer­schalk said.

Re­im­burse­ment for tele­health ser­vices is an­other ma­jor con­cern. Ac­cord­ing to the Na­tional Con­fer­ence of State Leg­is­la­tures, 43 states and the District of Columbia pro­vide some form of Med­i­caid re­im­burse­ment for pri­mary-care tele­health ser­vices, while 19 states and the District of Columbia now re­quire pri­vate plans to re­im­burse providers for tele­health pri­mary-care ser­vices.

Te­ladoc CEO Ja­son Gore­vic said his com­pany has “gone from ob­scu­rity to main­stream” in five years. Con­sul­tants now in­clude telemedicine as “a core strat­egy” that they present to their em­ployer clients when de­vel­op­ing a cost-ef­fec­tive health ben­e­fits pack­age, he said.

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