Telemedicine legislation would facilitate licensure across state lines


A bill being drafted by Sen. Tom Udall (D-Utah) would make it easier for physicians to practice telemedicine in many states instead of applying for a separate license for each state. Udall anticipates introduction of the bill this spring.

“Telemedicine is medicine, just practiced virtually,” said Fern Goodhart, Udall’s legislative assistant, at a Jan. 31 Capitol Hill briefing sponsored by the American Telemedicine Association (ATA), which advocates for use of remote medical technologies.

Legislation may be needed because the private-sector market has not generated medical license portability, even with the increasing adoption of health IT and networking capabilities, Goodhart said.

Physician licensure has been a barrier to those interested in developing telemedicine programs. Physicians seeking to expand their healthcare practice through such programs must obtain a medical license in each state in which patients receive care via telemedicine, said Jonathan Linkous, the ATA's CEO.

“It’s time we explore nationwide licensure reform that will help to increase consumer choice, improve safety and cut costs,” he said, adding that many states have the same basic licensure requirements.

Telemedicine is critical for access to quality care in rural areas, said Deanna Larson, vice president for quality and e-care initiatives for South Dakota-based Avera Health, which offers services across seven states in a primarily rural region of the country.

Larson pointed out that there is not a large enough population in Avera's coverage area to support specialists, who generally live in urban or heavily populated areas, and yet remote patients still need access to specialist services.

“These services are vital,” she said, adding that telehealth has enabled the health plan to avoid $4 million in unnecessary transfer charges and admissions to hospitals.

Larsen said she has assigned two employees just to do the lengthy paperwork for licensure. “I’d rather have them working with patients,” she said.

Federal agencies that provide healthcare, such as the Veterans Affairs and Defense Departments, offer license portability for their physicians. In addition, the Fiscal Year 2012 National Defense Authorization Act, which President Barack Obama signed into law, incorporated the Servicemembers’ Telemedicine and E-Health Portability (STEP) Act.

It overcomes some barriers to state licensure for telemedicine so that service members can better access private healthcare professionals in other states, such as those offering mental health services, said Darrell Owens, a legislative assistant for Rep. Glenn “GT” Thompson (R-Pa.), who introduced the legislation.

“We will be collecting data to show that this model works,” Thompson said.

Udall's bill would streamline licensure with a unified set of standardized data in a comprehensive and interoperable database of primary source verified credentials, Goodhart said. It could include claims history, hospital privileges and a criminal background check with a unified application. The information would only have to be entered once.

“You can think of it as a national practitioner database or unified provider database or a federation-based credential verification source on steroids with improvements,” Goodhart added. Ultimately, she noted, telemedicine could have nationwide or federal licensure, state reciprocity or mutual recognition and registration.

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